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贵州省旱灾期间一起甲型病毒性肝炎爆发的流行病学调查
引用本文:宁桂军,程萱芹,陈园生,黄孟,庄妍,黄艳,王定明,施国庆,罗会明.贵州省旱灾期间一起甲型病毒性肝炎爆发的流行病学调查[J].中国计划免疫,2013(5):435-438.
作者姓名:宁桂军  程萱芹  陈园生  黄孟  庄妍  黄艳  王定明  施国庆  罗会明
作者单位:[1]中国疾病预防控制中心免疫规划中心,北京100050 [2]中国疾病预防控制中心现场流行病学培训项目,北京100050 [3]黔西县疾病预防控制中心,贵州黔西551500 [4]贵州省疾病预防控制中心,贵阳550004
摘    要:目的调查贵州省黔西县甲型病毒性肝炎(甲肝)爆发疫情,查找危险因素和传播途径,提出针对性预防控制措施。方法2010年1月1日~4月19日,疑似为甲肝病例的黔西县居民,同时具备以下2个条件者:①出现无其他原因可解释的发热、乏力、纳差、厌油、腹胀、肝区疼痛中的任何2项,或出现黄疸(巩膜、皮肤或尿液黄染);②丙氨酸氨基转移酶≥2倍升高。确诊甲肝病例为疑似甲肝病例、且抗甲肝病毒免疫球蛋白M阳性者。通过查阅医院门诊记录等方式搜索病例。开展病例对照研究,比较两组水源、饮水习惯、饮食、洗手等的差异。结果共搜索到254例甲肝病例,GT乡和CG镇病例数分别占62%和31%,病例集中在5~20岁人群。流行曲线呈现两个高峰,为点源暴露模式。饮用LT河自来水比值比(OddsRatio,OR)=2.8,95%可信区间(ConfidenceInterval,CI):1.2~6.7]和喝生水(OR=8.4,95%CI:3.4-21.2)是发病的危险因素。LT河自来水检测细菌总数〉190菌落形成单位/毫升(m1),总大肠菌群〉1600最大或然数/100ml。结论此次甲肝爆发系饮用被污染的LT河自来水所致,要加强自来水消毒和卫生监督。

关 键 词:甲型病毒性肝炎  爆发  旱灾

An Epidemiological Investigation of Hepatitis A Outbreak during the Period of Severe Drought in Guizhou Province
Institution:NING Gui-jun, CHENG Xuan-qin, CHEN Yuan-sheng, et al. (Department of National Immunization Program, Chinese Center for Disease Control arm Prevention,
Abstract:Objective A hepatitis A outbreak in Guizhou province was investigated to identify risk factors and mode of transmission, and to provide control and prevent measures. Methods A suspected case was defined as onset between January 1 and April 19, 2010 with 2-fold increase in alanine aminotransferase and 〉 2 of the followings: fever, malaise, anorexia, nausea, abdominal discomfort and jaundice in a resident of the Qianxi county. A confirmed case was a suspected case with antibody to hepatitis A virus immunoglobulin M positive. Cases were searched in the hospitals, villages and schools. In a case- control study, the exposures to sources of water, drinking habits, food and washing hands were compared. Results 254 hepatitis A cases were identified. 62% and 31% cases occurred respectively in GT and CG towns. Most cases were 5-20 years old. The two peaks of the outbreak showed in the epidemic curve were related to the exposure of the source of origin. 91% of the cases and 77% of controls drank LT river water Odds Ratio (OR)=2.8, 95 % Confidence Interval (CI) : 1.2 6.7 ]. 79 % of the cases and 32 % of controls drank unboiled water (OR=8.4, 95 % CI : 3.4 21.2). The total bacterial count was 〉 190 colony- forming units (cfu)/ml and the total coliform was 〉 1600 most probable number (MPN)/100 ml in the LT river water. Conclusion Drinking unboiled contaminated water was responsible for the outbreak. Local government should supply chlorinated water and strengthen supervision of quality of water.
Keywords:Hepatitis A  Outbreak  Drought
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