广东省一起因游泳引起的咽结膜热暴发调查

目的 查明广东省从化市一起咽结膜热暴发的病因和流行因素。 方法 制订病例定义，采用统一的流行病学个案调查表对病例进行调查，描述流行特征；采用病例对照研究分析流行因素。 采集咽拭子和眼拭子开展聚合酶链式反应（PCR）。 结果 2013年8月，从化市发生咽结膜热病例89例，以街口镇为主（58例），主要为6 ~ 10岁青少年，罹患率为5.82‰，发病时间集中在8月10 — 17日。 病例的临床特征为发热伴咽痛、扁桃体肿大或眼结膜红肿。预后良好，无死亡病例。 病例86.52%（77/89）有游泳史。病例对照研究结果显示，呛水（饮水）增加发病风险（ OR＝3.49，95%CI:2.07 ~ 11.49）。 41份标本中腺病毒核酸阳性17份，阳性检出率为41.46%。 对PCR阳性产物进行序列测定分析，确定为腺病毒4型，具有高度同源性。 结论 暴发疫情为4型腺病毒引起的咽结膜炎，因游泳池消毒不合格导致。

An outbreak of pharyngoconjunctival fever caused by swimming

Objective To investigate the pathogenic and epidemiologic factors of an outbreak of pharyngoconjunctival fever occurred in adolescents in Conghua, Guangdong province, in August 2013. Methods The established standardized case definition and unified epidemiologic questionnaires were used to investigate the cases and describe the epidemiologic characteristics. A case control study was conducted, PCR was performed to detect the pharyngeal and eye swabs collected from the cases. Results A total of 89 cases of pharyngoconjunctival fever were reported in Conghua, and 58 cases (65.17%)occurred in Jiekou town. The attack rate was 5.82‰. Up to 66.29% of the cases (59/89) were aged 6–10 years . Most cases (94.38%, 84/89) occurred from 10 August to 17 August. The clinical characteristics were fever accompanied by pharyngalgia, tonsillitis or conjunctivitis. The prognosis was good and no death was reported. Up to 86.52% (77/89) of the patients had the history of swimming. The case control study showed that the risk factors included choking water in swimming pool (OR＝3.49, 95% CI: 2.07–11.49)．Among 41 clinical samples, 17 were positive for adenovirus nucleic acid, the positive rate was 41.46%. The sequencing results of PCR products indicated that the pathogen was adenovirus type 4. Conclusion It was confirmed that the pathogen causing the pharyngoconjunctival fever outbreak in Conghua was adenovirus, and swimming in unqualified natatorium was the main route of transmission．