一起学校诺如病毒腹泻暴发调查分析

目的对泉州市某封闭学校发生的一起腹泻暴发疫情进行调查和分析。方法采用现场流行病学调查方法了解病例发生情况及可疑传播因素;采用ELISA、RT-PCR等方法对人体和外环境标本进行检测。结果本次疫情从2007年3月29日开始至4月13日结束,共发生腹泻病例99例,罹患率13．9％。从6份病人粪便标本中均检测出诺如病毒核酸片段。疫情特点符合经食物和接触传播传染病特征。结论本次疫情为一起由诺如病毒引起的腹泻暴发,可疑传染源为被污染的早点,传播模式主要为接触传播。     

Re-assessing vulnerability to foodborne illness: pathways and practices

Foodborne illness is a major public health concern, often approached by focusing on socio-demographic groups who are considered most ‘vulnerable’ to foodborne disease such as elderly people or pregnant women. Based on a review of existing literature and original research with UK consumers, this paper proposes an alternative approach to analysing vulnerability to foodborne illness. Challenging conventional approaches that focus on the inherent vulnerability of particular socio-demographic groups, the paper emphasises the context-specific and situational nature of vulnerability and the practices and pathways through which people negotiate specific threats which may, in turn, affect their future vulnerabilities. The paper also addresses the gap between lay and expert knowledge that may increase exposure to particular food-related risks. Evidence is provided from research on the food safety and health implications of consumers’ everyday domestic practices including behaviours that do not comply with current ‘best practice’ advice. The evidence supports a turn from notions of inherent vulnerability, based on the membership of certain socio-demographic groups, towards a more nuanced understanding of situational vulnerability, based on the context and logic informing specific social practices.     

Interdisciplinary clinical assessment of patients with illness attributed to environmental factors

Patients with health problems attributed to environmental factors such as chemical pollutants and electromagnetic fields often do not present evidence of an environmental aetiology of their symptoms. It has been postulated, that their problems are due to disorders diagnosed by other medical disciplines, especially allergology and psychiatry. Our study was designed to subject these patients to a comprehensive diagnostic program involving several medical disciplines in order to achieve diagnoses appropriate to explain the patients' symptoms.Fifty patients consecutively referred to the department of environmental medicine in the university hospital of Aachen, Germany, were submitted to the following examinations: (i) environmental medicine (history, clinical examination, biological and/or ambient monitoring for environmental agents); (ii) allergological examination (history, clinical examination, skin tests); (iii) psychiatric examination (psychopathological examination, psychometric and neuropsychological testing). In addition, the patients were examined in other hospital departments according to the symptoms presented. The findings were discussed in case conferences attended by the physicians involved in order to achieve individual diagnoses.The numbers of patients to whom diagnoses were given by different medical disciplines are as follows: psychiatry (32 patients), dermatology (4), allergology (2), neurology (2), rheumatology (2), gynaecology (1), haematology (1). The most frequent mental disorders diagnosed by the psychiatrists were somatoform disorders (19), followed by schizophreniform and delusion disorders (7).In spite of extensive diagnostic efforts, patients with health problems attributed to the environment usually do not present sufficient evidence of an environmental aetiology of their symptoms. On the other hand the symptoms often meet the diagnostic criteria of other diseases, especially of mental disorders.     

Capacity of state and territorial health agencies to prevent foodborne illness

The capacity of state and territorial health departments to investigate foodborne diseases was assessed by the Council of State and Territorial Epidemiologists from 2001 to 2002 with a self-administered, Web-based survey. Forty-eight health departments responded (47 states and 1 territory). The primary reason for not conducting more active case surveillance of enteric disease is lack of staff, while the primary reasons for not investigating foodborne disease outbreaks are limited staff and delayed notification of the outbreak. Sixty-four percent of respondents have the capacity to conduct analytic epidemiologic investigations. States receiving Emerging Infections Program (EIP) funding from the Centers for Disease Control and Prevention more often reported having a dedicated foodborne disease epidemiologist and the capability to perform analytic studies than non-EIP states. We conclude that by addressing shortages in the number of dedicated personnel and reducing delays in reporting, the capacity of state health departments to respond to foodborne disease can be improved.     

Environmental health specialists' self-reported foodborne illness outbreak investigation practices

To collect qualitative data on the investigation practices of environmental health specialists with respect to foodborne illness outbreaks, the authors convened six focus groups of randomly selected specialists working in public health agencies in eight states. Participants discussed their investigation activities, methods used to identify contributing factors, success in identifying contributing factors, and the difficulties they faced when conducting investigations. Findings revealed substantial variability in the type of activities in which participants engaged during investigations, and the amount and nature of the collaboration between epidemiologists and environmental health specialists during investigations. Many participants indicated that during investigations they often did not identify contributing factors associated with an outbreak. Participants also identified several difficulties associated with outbreak investigations, including difficulties associated with restaurant employees, restaurant customers, and environmental health organizations.     

Perceived etiology of foodborne illness among public health personnel.

Few data exist about perceptions regarding the etiology of foodborne illness. Among public health staff throughout Tennessee, the three pathogens most commonly believed to cause foodborne illness in the United States actually account for only 12% of disease. Fewer than 3% of respondents correctly identified the leading cause of foodborne illness.     

Outbreak of norovirus illness associated with a swimming pool

On 3 February 2004, the Vermont Department of Health received reports of acute gastroenteritis in persons who had recently visited a swimming facility. A retrospective cohort study was conducted among persons attending the facility between 30 January and 2 February. Fifty-three of 189 (28%) persons interviewed developed vomiting or diarrhoea within 72 h after visiting the facility. Five specimens tested positive for norovirus and three specimen sequences were identical. Entering the smaller of the two pools at the facility was significantly associated with illness (RR 5.67, 95% CI 1.5-22.0, P=0.012). The investigation identified several maintenance system failures: chlorine equipment failure, poorly trained operators, inadequate maintenance checks, failure to alert management, and insufficient record keeping. This study demonstrates the vulnerability of recreational water to norovirus contamination, even in the absence of any obvious vomiting or faecal accident. Our findings also suggest that norovirus is not as resistant to chlorine as previously reported in experimental studies. Appropriate regulations and enforcement, with adequate staff training, are necessary to ensure recreational water safety.     

Outbreak of febrile illness due to dengue virus type 3 in Calcutta during 1983

An epidemic of dengue fever broke out in Calcutta between July and August 1983. Persons of all age groups were affected with a preponderance of young adults. Haemorrhagic manifestations and shock were not observed. Virus was isolated from 4 acute phase sera and identified as dengue type 3 (DEN-3), the first isolation of DEN-3 virus in Calcutta. Serotesting with 9 paired blood samples established dengue infection in 7 and a flavivirus group reaction in 2. Examination of 36 single sera revealed presumptive dengue infection in 15 and a flavivirus group reaction in 17, while the remaining 4 were negative to all flavivirus antigens.     

Outbreak of illness due to volatilized asphalt coming from a malfunctioning fluorescent lighting fixture

We investigated an outbreak of headache, eye irritation, sore throat, nasal congestion, and nausea in an office complex, ongoing for three months and regularly resolved upon leaving the building. Investigation suggested that the etiology of the illness was malfunctioning fluorescent light ballasts , which overheated and resulted in melting and volatilization of contained asphalt . Correction of the problem resulted in almost complete disappearance of symptoms within two weeks.     

Domestic and travel-related foodborne gastrointestinal illness in a population health survey

Routine surveillance data underestimate incidence of foodborne gastrointestinal (FGI) illness and provide little information on illness related to travel. We analysed data from the Welsh Health Survey to estimate population incidence, and to examine risk factors for FGI and factors associated with consulting a doctor. Reported frequency of any FGI in the 3 months before interview was 20.0% [95% confidence interval (CI) 19.5-20.4; equivalent to 0.8 episodes per person-year], and for travel-related FGI was 1.6% (95% CI 1.5-1.8). In the final model, sex, age group, marital status, self-reported health, long-term illness, smoking and alcohol consumption were all independent predictors of FGI. People who consulted a doctor were likely to be older, in poorer health, taking regular medication, or to report mental illness. FGI is common but risk factors for illness and consultation differ and impressions of the epidemiology of the disease based on surveillance data are therefore distorted.     

Food safety: emerging trends in foodborne illness surveillance and prevention

Between 250 and 350 million Americans are estimated to suffer acute gastroenteritis annually, with 25% to 30% thought to be caused by foodborne illnesses. Most vulnerable to foodborne diseases are elderly people, pregnant women, immune-compromised people, and children. While bacterial causes such as Salmonella are widely recognized and monitored as foodborne infections, other important bacterial causes such as Clostridium perfringens , Bacillus cereus , and Staphylococcus aureus are less well known. While the majority of cases of foodborne diseases are of unknown cause, bacteria and viruses are the most likely causative agents. Caliciviridae (Norwalk-like) virus cases are more difficult to identify, but represent the most common cause of known and probably unknown cases. Fresh produce has to be added to the traditional list of foods requiring careful selection and handling to prevent foodborne disease. To assess the disease burden in the United States, morbidity and mortality surveillance activities are done by several networks and systems with collaboration among federal agencies and health departments. Not all important causes are being equally monitored. Critical behaviors by food processors, food retailers, foodservice personnel, and consumers can reduce the risk of foodborne illness episodes. Dietetics professionals can more readily monitor new developments and update knowledge and practice through online resources.     

An outbreak of community-acquired foodborne illness caused by methicillin-resistant Staphylococcus aureus.

Infections with methicillin-resistant Staphylococcus aureus (MRSA) are increasingly community acquired. We investigated an outbreak in which a food handler, food specimen, and three ill patrons were culture positive for the same toxin-producing strain of MRSA. This is the first report of an outbreak of gastrointestinal illness caused by community-acquired MRSA.     

北京市食源性胃肠炎的疾病负担

目的 了解北京市食源性胃肠炎的疾病负担,为食源性疾病的防治提供依据。方法 采用多阶段分层随机抽样方法,选取北京市6个监测地区内9885人,进行入户面对面调查,了解其过去4周急性胃肠炎的发病、就诊情况以及因急性胃肠炎产生的各类费用,计算急性胃肠炎的疾病负担;根据文献报道的急性胃肠炎的食源性比例,推算食源性胃肠炎疾病负担。结果 急性胃肠炎的年发病率为0.15次/人年(95%CI 0.13～0.16),估算调查期间北京市食源性胃肠炎发病人数为911 975人次。每年约有290 190人次就诊,9120人住院。北京市食源性胃肠炎的总经济负担为1.47亿元,约占全市年生产总值的0.07‰;其中直接费用1.07亿元(医疗费用0.94亿元,非医疗费用0.12亿元),间接费用0.40亿元。结论 北京市人群食源性胃肠炎的疾病负担不容忽视,应进一步完善食源性疾病主动监测体系,更准确地评估食源性疾病对社会和健康造成的影响。     

Outbreaks of respiratory illness mistakenly attributed to pertussis--New Hampshire, Massachusetts, and Tennessee, 2004-2006

Pertussis, or whooping cough, is a highly infectious, nationally notifiable respiratory disease associated with prolonged cough illness and paroxysms of coughing, inspiratory "whoop," or posttussive vomiting. Reported pertussis cases have tripled in the United States since 2001, with 25,616 probable or confirmed cases reported in 2005. This increase has been attributed to increased circulation of Bordetella pertussis, waning vaccine-induced immunity among adults and adolescents, heightened awareness of pertussis among health-care providers, increased public health reporting, and increased use of polymerase chain reaction (PCR) testing for diagnosis. To minimize the spread of pertussis, control measures must be implemented early in the course of illness when the risk for transmission is highest. However, diagnosis of pertussis is complicated by nonspecific signs and symptoms, particularly in the early catarrhal stage of disease. In addition, the lack of rapid, sensitive, and specific laboratory tests makes early and accurate identification of pertussis challenging. This report describes two hospital outbreaks and one community outbreak of respiratory illness during 2004-2006 in New Hampshire, Massachusetts, and Tennessee that were attributed initially to pertussis. However, subsequent investigations revealed negative or equivocal laboratory results and epidemiologic and clinical features atypical of pertussis, suggesting that pertussis was not the cause of these outbreaks. The findings in this report underscore the need for thorough epidemiologic and laboratory investigation of suspected pertussis outbreaks when considering extensive control measures.     

甘肃省社区人群食源性疾病患病因素分析

目的 了解甘肃省社区人群食源性疾病患病流行情况,并探索其影响因素,为制定疾病干预措施和合理配置卫生资源提供科学依据.方法 采用分层随机抽样方法于2011年12月-2013年11月选取甘肃省3个调查点共4917户居民,完成4229份样本人群的调查,通过人户面对面访谈的形式,用调查问卷收集信息.结果 食源性疾病加权月患病率...     

一起O_(9,12)H_(g,m)肠炎沙门菌食物中毒的流行病学调查分析

目的掌握2015年江阴市某企业一起暴发食源性疾病事件的原因。方法按照《食品安全事故流行病学调查技术指南》,采用现场流行病学调查,参照GB4789-2012和WS/T13-1996方法进行病原菌的分离培养,对检出菌进行血清型鉴定。结果根据现场流行病学调查分析、病例主要症状、病例便样与剩余食品中均检出O9,12 Hg,m肠炎沙门菌。结论本次事件是因食用被O9,12 Hg,m肠炎沙门菌污染食品而引发的一起暴发食源性疾病。应加强食品安全监管,加强个人卫生,防止食品受到致病菌污染,避免该类事件再次发生。