一起医院住院病人诺如病毒急性胃肠炎暴发疫情的调查

摘要:目的　调查某医院住院病人腹泻暴发疫情的致病因子，找出传染源和危险因素，提出针对性的预防控制建议，有效控制疫情。方法　采用统一的调查表对病例进行流行病学调查；开展现场卫生学调查并采集便标本，采用RT-PCR对便标本进行诺如病毒核酸检测。结果　调查该病区暴露的住院患者和医务人员135名，发现22名病例，罹患率为16.30%；患者临床表现以腹泻、恶心、呕吐为主，部分患者出现发热症状；不同楼层住院老人罹患率差异无统计学意义（χ2＝0.82，P＞0.05）；住院老人罹患率高于护工（χ2＝5.35，P＜0.05），不同性别住院老人发病风险相同（χ2＝0.18，P＞0.05）；采集的14份便标本中，8份检测结果为诺如病毒核酸阳性。结论　该次急性胃肠炎暴发疫情是由诺如病毒引起，传染源可能为隐形感染者或病原携带者，病毒通过某种共用媒介传播后再以人-人传播模式进一步扩散，高危人群为住院老人；采取针对性措施后，疫情得以有效控制。

An outbreak of norovirus gastroenteritis in a hospital ward

Abstract: Objective The aim of this study was to identify pathogen, the reservoir of infection and the risk factors of an outbreak of gastroenteritis in a ward, and to provide effective and scientific control measures. Methods The data of every patient was collected using unified questionnaire. Stool samples were collected and RT-PCR was employed to determine the gene fragment of calicivirus. Results A total of 22 cases were found, involving 21 cases of inpatients and one care worker. The attack rate was 16.30%. Diarrhea, nausea and vomiting were the most common symptoms among the patients. The attack rates of inpatients between different floors and gender had no statistically significant difference. And the attack rate of inpatients was higher than that of care workers. Fourteen cases of stool sample were collected, and gene fragment of calicivirus were detected in eight cases of stool sample. Conclusion The pathogen of the outbreak was novovirus, and the reservoir of infection was cover infected person or carrier. Norovirus was found to spread rapidly by some medium for public use. And contact transmission acted as the main route of transmission in the late stage of the outbreak. The high-risk group was elderly inpatients. The outbreak was under control after taking corresponding measures.