广州市传染性非典型肺炎流行病学及预防控制效果的初步研究

目的 分析广州市2003年传染性非典型肺炎(SARS)流行的基本特征，探讨流行因素，评价防制措施。方法 对2003年广州市SARS患者进行流行病学调查，描述和分析流行病学、病原学和控制措施等相关资料。结果 2003年1月至4月17日，累计报告发病966例(男429例，女性537例)。首例广州市居民病例于1月2日发病；2月开始全市疫情呈上升趋势，2月上旬达到最高峰，此后疫情呈下降趋势，4月份后，平均每日新发病例降至10例以下；年龄分布以20—50岁发病数较多，低年龄组的发病数较少313个区(县级市)均有病例发生，但病例主要集中于7个中心城区，占总病例数的95％；职业以医务人员多发(占28．67％)；死亡36例，死者年龄在5—89岁之间，60岁以上占50％，死亡病例中原合并有其他疾患，如高血压、糖尿病、心脏病、肺气肿等占38.9％。发病有聚集性，42个家庭发生2例以上病例；28家医疗单位有277名医务人员发病；公共场所仅发生1起聚集性病例；学校未发生聚集性病例。流行病学特点：主要经呼吸道传播，可以气溶胶和飞沫的方式传播；接触性传播可能也是传播方式之一；传染力强，尤其是在密闭的空间内近距离接触病例获得感染的机会比较大；潜伏期1一11天，多数为3—8天，平均为5天；发病有明显的聚集性。主要控制措施及效果：病人隔离治疗，疑似病人隔离观察；加强病房通风换气；进行空气、物体表面消毒；医务人员加强个人防护。采取控制措施后，医务人员发病率显著下降。结论 根据广州市疫情控制的经验，SARS是可以预防和控制的。聚集性病例的控制应该作为重点，而控制医院内感染的发生，是非常关键的措施。

Study on the epidemiology and measures for control on severe acute respiratory syndrome in Guangzhou city

Objective To analyze the epidemiological characteristics,related risk factors,measures for its control of severe acute respiratory syndrome (SARS). Methods Data on epidemiological features,pathogens and measures for control were collected and analyzed. Results Since Jan 2003,infectious atypical pneumonia (AP) has become epidemic in Guangzhou city. The first autochthonous case was identified on Jan 2nd. Number of cased started to increase since February and reached peak in the early 10 days of February. Hereafter the epidemic tended to decline in March and since early April,the average number of new cases began to decrease,less than 10 per day. Epidemiological studies revealed that the number of cases aged between 20 and 50 was higher than that below the age of 20. Of the total 966 cases,429 were males versus 537 females. Geographically,the epidemics covered all 13 districts of Guangzhou,but 95% of the cases concentrated in 7 urban districts. As for professional distribution,health care workers accounted for 28.67 % of the total cases. There were 36 deaths,aged from 5 to 89,with half of them older than 60. Out of the victims, 38.9 % of them had complications as hypertension,diabetes,heart diseases and COPD etc. Data regarding the clustering features of cases showed that there were 42 families having 2 or more cases in one family,while 277 health workers suffered from SARS were concentrated in 28 hospitals. Only one outbreak took place in a public setting but no outbreak was reported in schools. Relevant research also indicated that SARS could be classified as an air-borne infectious disease,transmitted through aerosol and droplets,but close contact also played an important role in the mode of transmission. The disease was highly infectious,suggesting that people who had close contact with patients in the place with poor ventilation was in greater risk of getting infection. The incubation period ranged from 1 to 11 days (mainly from 3 to 8 days),with an average of 5 days. According to our observation,the following measures might be effective such as: early diagnosis,isolation and treatment provided to the patients,and suspected cases under medical observation should also be put in separate places. Improving ventilation and regular disinfection over air and stuff in hospital wards were also recommended. In order to prevent iatrogenic infection,sense on self-protection among health care workers must be strengthened. Patients were not allowed to be visited by any one other than hospital staff. Conclusion SARS is a preventable disease and can be under control. It is of great importance to prevent clustered SARS cases and the prevention of iatrogenic infection is essential.