一起SARS超级传播者引起医院内传播的调查

目的 了解传染性非典型肺炎(SARS)超级传播的传染性及其造成SARS医院内传播的情况。方法 调查2003年3月22日至4月15日江门市某医院1例SARS病例及其导致院内传播的其他SARS病例。对SARS病例住院病历、流行病学现场调查资料和特异性实验室检查资料进行分析。结果 该医院首例SARS病例于3月22日入院，4月1日确诊为SARS，4月2日死亡。4月2～15日该医院除了首例SARS病例外共报告SARS病例22例。除最后1例患在首例患死亡后第七天才进入曾诊治过该患的肾内科外，其余21例SARS患均与首例患有明确接触史。对4月2～13日发病的21例患分析结果显示，发病高峰为4月3～7日，占病例总数的71．43％(15／21)；19例患均为诊治首例患的肾内科的医护人员，该科室罹患率为59．38％(19／32)，另2例分别为同时在肾内科住院的患及陪护；估算病例潜伏期中位数为6d；对其中的11例病例进行血清SARS抗体．测定和PCR检测，结果均为单项或两项检验结果阳性。结论 证实是一起医院内传播的SARS流行；引起传播的关键原因是首例病例表现“不典型性”，医护人员欠缺防护，SARS病毒传染性强以及病区的布局不合理等因素；采取病区改造、加强医护人员的防护等一系列预防控制措施，尤其加强医院感染控制可以阻断流行。

A Survey on a SARS nosocomial "super-spread" event (SSEs) in Jianmen

Objective To understand the infectivity of a case with severe acute respiratory syndrome(SARS) and the nosocomial infection of SARS he introduced. Methods The information including hospital based medical records, cases epidemiologic survey and specific laboratory results of the first SARS case and those who contracted SARS from 22 March to 15 April, 2003 after close contact were collected and analyzed. Results The first SARS patient was diagnosed as SARS on 1 April after his admission to the hospital on 22 March, and was dead on 2 April. There were 22 persons who contracted SARS from 2 to 15 April after the death of the first case. 21 of the cases had apparent close contact with the first case, whereas the last one who entered the urology department where the first case had been cared 7 days after the death of the first case. The incidence peak was 3 to 7 April, accounting for 71.43%(15/21)of the 21 cases occurred during 2 to 13 April.19 of them were the health care workers who had cared the first case, with the incidence being 59.38%(19/32)in the department. The other 2 were a hospitalized patient and a company. The estimated median of the incubation of the cases was 6 days. 11 sampled serums were positively reacted at least by one of both ELISA or PCR laboratory testing methods. Conclusions It was proved to be a nosocomial infection of SARS. Atypical symptoms of the patient and insufficient cautions of the health care workers, the highly infectivity of the SARS virus and the unreasonable layout of the wards were the main determinants of the spread. The nosocomial infection of SARS could be controlled through a serial of precautions such as reconstructing the wards and strengthening the self protection among the health care worker.