CAJ | 학술논문

目的调查广州市某高校急性胃肠炎病例的感染来源、传播途径和危险因素.方法按照病例定义开展病例搜索,采用描述性流行病学和病例对照研究进行分析；样本采用RT-PCR检测诺如病毒核酸,阳性标本分析基因核苷酸序列并进行同源性分析.结果 2013年1月8-21日该校共发生诺如病毒感染性腹泻141例,罹患率为8.5‰(141/16 600)；8-9日为发病高峰；病例无班级和宿舍聚集性；病例对照调查显示A餐厅为早期病例的感染场所(OR=3.46,95％CI:1.07～11.1 6),1月7日的午餐是可疑餐次(OR=4.34,95％CI:1.18～17.37),可疑食物是手撕鸡套餐(OR=17.82,95％CI:4.46～78.17)；采集病例和厨工肛拭子、剩余食物及环境涂抹样等266份,诺如病毒RT-PCR检测阳性21份(17例),病例阳性率为42.8％(9/21),A餐厅厨工阳性率为29.6％ (8/27),经基因测序为GⅡ.4/Sydney_2012变异株,学生、教职工病例与厨工同源性为100％.结论该次疫情为诺如病毒GⅡ.4/Sydney_2012变异株感染引起的急性胃肠炎暴发,其原因是携带病毒厨工污染食物所致,以食源性传播途径为主.
목적 조사엄주시모고교급성위장염병례적감염래원、전파도경화위험인소.방법 안조병례정의개전병례수색,채용묘술성류행병학화병례대조연구진행분석；양본채용RT-PCR검측낙여병독핵산,양성표본분석기인핵감산서렬병진행동원성분석.결과 2013년1월8-21일해교공발생낙여병독감염성복사141례,리환솔위8.5‰(141/16 600)；8-9일위발병고봉；병례무반급화숙사취집성；병례대조조사현시A찬청위조기병례적감염장소(OR=3.46,95％CI:1.07～11.1 6),1월7일적오찬시가의찬차(OR=4.34,95％CI:1.18～17.37),가의식물시수시계투찬(OR=17.82,95％CI:4.46～78.17)；채집병례화주공항식자、잉여식물급배경도말양등266빈,낙여병독RT-PCR검측양성21빈(17례),병례양성솔위42.8％(9/21),A찬청주공양성솔위29.6％ (8/27),경기인측서위GⅡ.4/Sydney_2012변이주,학생、교직공병례여주공동원성위100％.결론 해차역정위낙여병독GⅡ.4/Sydney_2012변이주감염인기적급성위장염폭발,기원인시휴대병독주공오염식물소치,이식원성전파도경위주.
Objective To identify the source of infection,route of transmission and risk factors related to a cluster of acute gastroenteritis cases in a university of Guangzhou.Methods Cases were identified according to the definition.Descriptive epidemiological approaches and casecontrol study designs were employed in the analysis.All the samples were tested for norovirus by RT-PCR.Positive samples were subjected to both nucleotide sequence and homology analysis.Results A total of 141 cases related to norovirus gastroenteritis were identified in January 8 to 21,2013,with the attack rate as 8.5‰ (141/16 600).The peak in morbidity was seen on January 8 to 9.No clustering was found in different classes or dormitories.Results from the case-control study revealed that early cases were infected in Restaurant A (OR=3.46,95％CI:1.07-11.16) and the cold shredded chicken set meal (OR=17.82,95％ CI:4.46-78.17) served at lunch (OR=4.34,95％ CI:1.18-17.37) on January 7 was under suspicion.A total of 266 samples,including rectal swabs from the patients and kitchen wokers,leftover food and environmental swabs,were collected.Twenty-one samples (collected from 17 persons) were positive for norovirus by RT-PCR.About 29.6％ (8/27) of the kitchen workers in the Restaurant A were tested positive for the virus.The pathogen was identified as the new norovirus genotype Ⅱ.4 variant,termed Sydney 2012.The virus strains isolated from the patients among student and staff and the kitchen workers were 100％ identical in their nucleotide sequence.Conclusion This was the first reported acute gastroenteritis outbreak caused by the new norovirus genotype Ⅱ.4 variant,Sydney 2012,which showed that the food was contaminated by the asymptomatic kitchen workers who carried the virus.