CAJ | 학술논문

目的探讨2009年6月2-8日四川省某旅行团甲型H1N1流感暴发的传染来源、传播模式和危险因素.方法采用患者咽拭子实时荧光(RT)-PCR方法进行实验室确诊,应用回顾性队列研究调查旅行团所有成员与首发病例的接触情况.结果首发病例为一名美籍华人,6月2日在香港至成都的航班上发病,3-5日参加九寨沟景区旅游某旅行团,5-6日30名与首发病例同团的旅友先后9人发病(罹患率为30%).陔9例患者均发生在与首发病例近距离交谈(距离＜2m,时间≥2min)的16名旅友中(罹患率为56%),另14名与首发病例无近距离交谈的旅友均未发病(RR=∞,95%CI:2.0～∞).交谈时间≥10min者的发病风险高于交谈时间2～9min者(RR=4.8,95%Cl:1.3～180).与首发病例同桌吃饭,接受其口香糖和共同乘车、乘飞机等因素均不是本次发病的危险因素.结论该起甲型H1N1流感暴发疫情是由一例输入性病例引起,因二代病例与首发病例近距离谈话,病毒通过飞沫实现传播.甲型H1N1流感大流行中,防止飞沫传播有重大意义.
목적 탐토2009년6월2-8일사천성모여행단갑형H1N1류감폭발적전염래원、전파모식화위험인소.방법 채용환자인식자실시형광(RT)-PCR방법진행실험실학진,응용회고성대렬연구조사여행단소유성원여수발병례적접촉정황.결과 수발병례위일명미적화인,6월2일재향항지성도적항반상발병,3-5일삼가구채구경구여유모여행단,5-6일30명여수발병례동단적려우선후9인발병(리환솔위30%).해9례환자균발생재여수발병례근거리교담(거리＜2m,시간≥2min)적16명려우중(리환솔위56%),령14명여수발병례무근거리교담적려우균미발병(RR=∞,95%CI:2.0～∞).교담시간≥10min자적발병풍험고우교담시간2～9min자(RR=4.8,95%Cl:1.3～180).여수발병례동탁흘반,접수기구향당화공동승차、승비궤등인소균불시본차발병적위험인소.결론 해기갑형H1N1류감폭발역정시유일례수입성병례인기,인이대병례여수발병례근거리담화,병독통과비말실현전파.갑형H1N1류감대류행중,방지비말전파유중대의의.
Objective During June 2-8, 2009, 11 cases of the novel influenza A (H1N1)occurred in Sichuan Province, China. We investigated this outbreak to identify the source of infection,mode of transmission and risk factors for infection. Methods The primary case, a U.S. citizen,developed disease on June 2. From June 3 to 5, she joined Tour Group A for a trip to Jiuzhaigou. We telephoned passengers of the three flights on which the primary case had traveled in China, and members of Tour Group A. We asked whether they had any influenza-like symptoms during May 27 to June 12. Health authorities placed passengers whose seats were within three rows of the primary case on flights and members of Tour Group A on medical observation, and isolated individuals if they developed symptoms. We used real-time RT-PCR to test the throat swabs from symptomatic persons for the novel influenza virus and defined a confirmed case as one with influenza-like symptoms and laboratory confirmation. A retrospective cohort investigation to identify the risk factors for infection was conducted. We interviewed all members of Tour Group A about their detailed contact history with the primary case. Results During June 5 to 6, 9 (30%) of the primary case' s 30 fellow tour group members developed disease, compared with none of her 87 fellow passengers to Jiuzhaigou and 1 of her 87 fellow passengers on the returning trip (when several of the members of Tour Group A were symptomatic). 56% of the tourists who had talked with the primary case in close range ( ＜2 m) for ≥2 minutes developed disease, whereas none of the 14 other tour group members developed disease (RR= ∞; exact 95%CI: 2.0- ∞ ). Having conversed with the primary case for ≥ 10 minutes (vs. 2-9 minutes) increased the risk by almost five fold (RR=4.8, exact 95%CI: 1.3-180). Conversely, other kinds of contact, such as dining at the same table, receiving chewing gum from the primary case and sharing bus rides or planes with the primary case played no roles during this outbreak. Conclusion This novel influenza A (H1N1) outbreak was caused by an imported case, and transmitted mainly via droplet transmission when the primary case was talking with her fellow tourists during a tour. These findings highlight the importance of preventing droplet transmission during a pandemic.