作　　者： (邢彦）; (江初）; (华伟玉）; (刘锋）; (赵振）; (王磊）; (李婕）;

机构地区： 北京市海淀区疾病预防控制中心消毒科,100094

出　　处： 《中华流行病学杂志》 2017年第9期1174-1178,共5页

摘　　要： 目的了解北京市海淀区某学校诺如病毒感染暴发的流行特征，为学校诺如病毒感染疫情防控策略提供科学依据。方法收集疫情发生学校基本情况及患者发病基本资料，并对其进行描述性分析，采集患者和厨师的粪便及肛拭子标本及环境标本进行实验室检查。结果海淀区某学校7日内累计发现患者119例，临床症状以呕吐（94．1％，112／119）、腹痛（46．2％，55／119）为主，无住院病例，无重症和死亡病例。学生病例平均年龄6．38岁，最小年龄5岁，最大年龄11岁。患者分布在22个班级，主要分布在一年级某班，共35人（占30．17％）。共采集粪便及肛拭子标本134份，检出病例诺如病毒阳性7份，病例札如病毒阳性1份，餐饮从业人员札如病毒阳性5份。剩余食品、桶装水、饮水机入水及出水口涂抹标本未检出沙门菌、志贺菌、致泻性大肠埃希菌及副溶血性弧菌，病例集中的班级及宿舍水卫生学指标异常；住宿、教室位于阴面、水卫生学指标异常与发病有关（P〈0．05）。结论该起疫情是由诺如病毒引起的以呕吐、腹痛为主要临床症状的、胃肠炎暴发疫情，并达到突发公共卫生事件（Ⅳ级）报告标准；首发病例发现和隔离不及时，呕吐物消毒不规范是导致传染源出现由点及面的接触传播、病例集中出现的主要原因，但不排除水传播的可能；应加强托幼机构、学校等重点场所疫情监测和学生吐泻物的消毒处理，防止类似疫情的发生。 Objective To study the epidemiological characteristics of an outbreak caused by norovirus infection in a school in Haidian district, Beijing. Methods Basic information of the school and data related to patients in the fields survey were collected and analyzed descriptively. Laboratory tests were performed to test the stool and anal swab specimens of both patients and cooks as well as the environmental specimens. Risk factors related to the incidence were analyzed through a case-control study. Results A total number of 119 patients were identified in the school. Clinical symptoms were mild, mainly involving vomiting （94.1%, 112/119）, abdominal pain （46.2%, 55/119）, but no need of hospitalization. The average age of the student patients was 6.38, with minimum and maximum between 5 and 11. Patients were found in 22 classes, but mainly in grade 1 and class 7 where 35 patients were found （30.17%）. A total of 134 specimens of rectal swabs and stool were collected, with 7 positive for norovirus and 6 for sappovirus. Salmonella, Shigella, lapactic Escherichia coli and Vibrio parahaemolyticus were not found in on dinner sets, residual foods, bottled water or in drinking fountains. Index on water hygiene was unsatisfactory in classrooms or dormitories where more cases were found. Accommodation, north-facing-classrooms, abnormal water hygiene indexes were found related to the oecurance of the disease （P〈0.05）. Conclusions The outbreak was identified a gastroenteritis infection, caused by norovirus with symptoms as vomiting and abdominalpain. This event reached the reporting standards of public health emergencies-level IV. Discovery and isolation of the first case was not timely while transmission of the disease might be water-bome. Surveillance programs on symptoms, disinfection of vomit and stool in places like nurseries and schools should be strengthened to prevent the norovirus outbreak.

关 键 词： 学校 诺如病毒 暴发 突发公共卫生事件