Study of norovirus infection and influencing factors in food practitioners in schools in Guangdong
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摘要:
目的 了解广东省学校食品从业人员诺如病毒感染现况,为开展学校诺如感染暴发疫情防控工作提供依据。 方法 采用横断面调查方法,按照分阶段目的抽样和方便抽样混合的抽样方法,分别于2019年春季开学前1周内、春季开学后第5~6周、秋季开学前1周内和秋季开学后第5~6周,采集广州、珠海、中山、江门4地市9所学校食品工作人员肛拭子样本,采用实时荧光聚合酶链式反应进行诺如病毒核酸检测,并通过logistic回归分析其感染影响因素。 结果 共采集1 747份样本,监测地区学校食品从业人员诺如病毒总阳性率1.43%(n=25),急性胃肠炎总体罹患率1.26% (n=22);学校食品从业人员诺如病毒感染率在不同地区、不同学校类型、开学前后、不同工种间比较,差异均无统计学意义(P>0.05);25名感染者中,无症状感染者占比达84.00%;学校食品从业人员诺如病毒感染的危险因素主要是参与村宴聚餐[比值比(OR)=8.36,95% 置信区间(CI):2.27~30.89]和家中有既往感染者(OR=10.94,95% CI: 2.92~40.96),患急性胃肠炎的危险因素主要是曾在饭馆酒楼等就餐(OR=4.88,95% CI: 1.77~13.51)。 结论 学校食品从业人员诺如病毒感染率总体虽然较低,且多为隐性感染,但易通过污染食物和水等导致传播,引起学校诺如疫情暴发,因此应加强对此类人群诺如病毒感染监测,强化卫生管理和健康教育。 Abstract:Objective To investigate the infection status of norovirus in food practitioners in schools in Guangdong province, and provide evidence for the prevention and control of norovirus infection outbreaks in schools. Methods A cross-sectional survey with convenient sampling method was conducted to collect the anal swabs of food practitioners in 9 schools within 1 week before the school open and 5–6 weeks after school open in spring and within 1 week before school open and 5–6 weeks after the school open in autumn in Guangzhou, Zhuhai, Zhongshan and Jiangmen, The norovirus nucleic acid was detected by real-time PCR, and the influencing factors of norovirus infection in food practitioners were identified by logistic regression analysis. Results A total of 1747 samples were collected. The positive rate of norovirus was 1.43% (n=25), and the attack rate of acute gastroenteritis was 1.26% (n=24). There was no differences in norovirus infection rate in food practitioners in different areas, in different types of schools, before and after school open, and with different types of work (P>0.05). Most infected persons (84.00%) were asymptomatic. The risk factors of norovirus infection were attending village banquet (OR=8.36, 95% CI : 2.27–30.89) and norovirus infection in family (OR=10.94, 95% CI: 2.92–40.96). The main risk factor of acute gastroenteritis was eating in restaurant (OR=4.88, 95% CI: 1.77–13.51). Conclusion The incidence of norovirus infection in food practitioners of schools is generally low, and most infections are asymptomatic, but food and water might be contaminated in food processing, resulting norovirus infection epidemics in schools. It is necessary to strengthen the norovirus infection surveillance, health management and health education in food practitioners in schools. -
Key words:
- Food practitioner /
- Norovirus /
- Asymptomatic infection /
- Acute gastroenteritis
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表 1 广东省学校食品从业人员样本采集情况及检测结果
Table 1. Sampling and testing results in food practitioners in schools
特征 采样数 检测阳性者 胃肠炎症状者 诺如病毒分型 阳性数(例) 阳性率(%) χ2值 P值 发病数(例) 发病率(%) χ2值 P值 GⅠ分型 GⅡ分型 性别 0.84 0.151 0.07 7.063 男性 841 13 1.55 11 1.31 1 12 女性 906 12 1.32 11 1.21 4 8 工种 0.91 0.822 0.91 0.553 炒菜 240 4 1.67 3 1.25 1 3 熟食/凉菜 519 6 1.16 8 1.54 1 5 分餐 414 5 1.21 5 1.21 0 5 其他(后勤、清洁) 574 10 1.74 6 1.05 3 7 地市 0.05 7.912 0.66 1.609 广州 658 10 1.52 10 1.52 1 9 珠海 615 5 0.81 5 0.81 2 3 中山 247 8 3.24 4 1.62 2 6 江门 227 2 0.88 3 1.32 0 2 学校类型 2.12 0.173 0.63 0.247 高等院校 1 273 15 1.18 15 1.18 3 12 中学 474 10 2.11 7 1.48 2 8 采样轮次 13.28 0.004 0.07 7.063 第一轮 486 10 2.06 11 2.26 1 9 第二轮 583 14 2.40 4 0.69 4 10 第三轮 324 1 0.31 5 1.54 0 1 第四轮 354 0 0.00 2 0.56 0 0 合计 1 747 25 1.43 22 1.26 5 20 表 2 广东省学校食品从业人员诺如病毒无症状者感染者、胃肠炎症状非诺如病毒感染者情况
Table 2. Basic information of norovirus-infected food practitioners without symptoms and non-norovirus-infected food practitioners with gastroenteritis symptoms in schools in Guangdong
特征 诺如病毒无症状感染者 胃肠炎症状非诺如病毒感染者 例数(诺如病毒感染者例数) 构成比(%) χ2值 P值 例数(有胃肠炎症状例数) 构成比(%) χ2值 P值 性别 0.01 1.000 0.00 1.000 男性 11 (13) 84.62 9 (11) 81.82 女性 10 (12) 83.33 9 (11) 81.82 工种 0.57 0.903 0.66 0.883 炒菜 3 (4) 75.00 2 (3) 66.67 熟食/凉菜 5 (6) 83.33 7 (8) 87.50 分餐 4 (5) 80.00 4 (5) 80.00 其他(后勤、清洁) 9 (10) 90.00 5 (6) 83.33 地市 2.12 0.548 1.05 0.789 广州 9 (10) 90.00 9 (10) 90.00 珠海 4 (5) 80.00 4 (5) 80.00 中山 7 (8) 87.50 3 (4) 75.00 江门 1 (2) 50.00 2 (3) 66.67 学校类型 0.20 1.000 0.75 0.565 高等院校 13 (15) 86.67 13 (15) 86.67 中学 8 (10) 80.00 5 (7) 71.43 采样轮次 0.34 0.844 4.28 0.233 第一轮 8 (10) 80.00 9 (11) 81.82 第二轮 12 (14) 85.71 2 (4) 50.00 第三轮 1 (1) 100.00 5 (5) 100.00 第四轮 0 (0) — 2 (2) 100.00 合计 21 (25) 84.00 18 (22) 81.82 表 3 广东省学校食品从业人员诺如病毒感染的影响因素分析
Table 3. Analysis on factors influencing norovirus infection in school food practitioners in Guangdong
因素 阳性数(例) 阳性率(%) 单因素分析 多因素分析 OR值(95% CI) P值 OR值(95% CI) P值 性别 男性 13 0.52 1.00 − 女性 12 0.48 0.86 (0.34~1.88) 0.697 − 工种 炒菜 4 0.16 1.00 熟食/凉菜 6 0.24 1.45 (0.41~5.18) 0.568 − 分餐 5 0.20 1.04 (0.32~3.45) 0.942 − 其他 10 0.40 1.52 (0.55~4.20) 0.424 − 地市 广州 10 0.40 1.00 珠海 5 0.20 1.88 (0.64~5.54) 0.251 − 中山 8 0.32 1.08 (0.21~5.63) 0.923 − 江门 2 0.08 4.08 (1.32~12.61) 0.014 − 学校类型 中学 10 0.40 1.00 高等院校 15 0.60 0.55 (0.25~1.24) 0.151 − 家中聚餐 否 20 0.80 1.00 是 5 0.20 2.04 (0.76~5.50) 0.159 − 村宴聚餐 否 22 0.88 1.00 1.00 是 3 0.12 8.90 (2.51~31.58) < 0.001 8.36 (2.27~30.89) < 0.001 饭馆酒楼等聚餐 否 22 0.88 1.00 是 3 0.12 2.22 (0.65~7.52) 0.203 − 同住家人发病 否 22 0.88 1.00 1.00 是 3 0.12 11.61 (3.213~41.917) < 0.001 10.94 (2.92~40.96) < 0.001 表 4 广东省学校食品从业人员胃肠炎症状者影响因素分析
Table 4. Analysis on factors influencing school food practitioners with gastroenteritis symptoms in Guangdong
因素 发病数(例) 发病率(%) 单因素分析 OR值(95% CI) P值 性别 男性 11 50.00 1.00 女性 11 50.00 0.93 (0.40~2.15) 0.697 工种 炒菜 3 14.00 1.00 熟食/凉菜 8 36.00 0.81 (0.21~3.08) 0.755 分餐 5 23.00 0.78 (0.25~2.41) 0.666 其他 6 27.00 0.68 (0.23~1.96) 0.469 地市 广州 10 45.00 1.00 珠海 5 23.00 1.88 (0.64~5.54) 0.251 中山 4 18.00 1.63 (0.39~6.89) 0.504 江门 3 14.00 2.01 (0.54~7.54) 0.302 学校类型 中学 7 32.00 1.00 高等院校 15 68.00 0.80 (0.32~1.96) 0.620 家中聚餐 是 4 18.00 1.81 (0.61~5.39) 0.290 否 18 82.00 1.00 村宴聚餐 是 1 5.00 2.89 (0.36~22.21) 0.309 否 21 95.00 1.00 饭馆酒楼等聚餐 是 5 23.00 4.88 (1.77~13.51) 0.002 否 15 68.00 1.00 同住家人发病 是 1 5.00 3.67 (0.48~28.63) 0.212 否 21 95.00 1.00 -
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