浙江省湖州市某小学一起乙型流感病毒和人鼻病毒混合感染暴发疫情调查

刘彬辉; 彭财伟; 彭二磊

doi:10.3784/jbjc.202212190545

浙江省湖州市某小学一起乙型流感病毒和人鼻病毒混合感染暴发疫情调查

Investigation of an outbreak of co-infection of influenza B virus and human rhinovirus in a primary school in Huzhou, Zhejiang

摘要

摘要:
目的了解浙江省湖州市某小学一起乙型流感病毒和人鼻病毒混合感染引起的呼吸道感染暴发疫情的流行病学特征。
方法根据《流感样病例暴发疫情处置指南》（2018年）等开展调查。采集病例咽拭子样本开展甲乙型流感病毒、腺病毒、人偏肺病毒、博卡病毒、呼吸道合胞病毒和人鼻病毒核酸检测。
结果共发现99例相关病例，临床表现以咳嗽、咽痛、发热为主，部分病例有乏力、头晕、头痛等症状。首发病例为2022年2月18日，暴发病例集中在2月21—28日，末例病例为3月25日，历时36 d疫情结束。病例均为1～3年级学生，发病班级总罹患率为36.80%（99/269），其中103班为43.04%（19/45），105班为13.64%（6/44），201班为65.91%（29/44），202班为15.56%（7/45），203班为72.73%（32/44），308班为13.04%（6/46），其他班级未检出病例，班级间罹患率总体差异有统计学意义（χ²=71.570，P<0.05）。男生罹患率为40.88%（56/137），女生罹患率为32.58%（43/132），性别差异无统计学意义（χ²=0.480，P＞0.05）。共采集53例现状病例咽拭子样本，7例咽拭子乙型Victoria亚型流感病毒核酸阳性，18例人鼻病毒核酸阳性，6例为混合感染；乙型Victoria亚型流感阳性率为24.53%，人鼻病毒阳性率为45.28%。
结论该小学暴发疫情初期的病例临床症状以发热为主，为典型的流行性感冒暴发疫情，随着时间的推移，发热病例占比逐渐减少，疫情后期病例以普通感冒症状为主，通过实验室检测证实该暴发疫情初期的病例为感染乙型流感，中期的病例出现乙型流感和人鼻病毒混合感染，后期的病例为感染人鼻病毒。因此，一起暴发疫情在不同阶段的新增病例的临床症状与体征发生变化时，可考虑2种及以上病原体混合感染。

Abstract:
Objective To understand the epidemiological characteristics of an outbreak of respiratory tract infection caused by co-infection of influenza B and human rhinovirus in a primary school in Huzhou, Zhejiang province, and provide scientific reference for the prevention and control of school outbreaks caused by co-infection of influenza B and human rhinovirus in the future.
Methods The investigation was carried out according to the Guidelines for Response to Influenza Like Illness Outbreaks (2018 edition).The throat swabs of the cases were collected for the nucleic acid detectios of influenza A and B virus, adenovirus, human metapneumo virus, Boca virus, respiratory syncytial virus and human rhinovirus.
Results A total of 99 respiratory tract infection cases were found. The clinical manifestations of the cases were mainly cough, sore throat and fever. Some cases had fatigue, dizziness, headache and other symptoms. The first case occurred on February 18, 2022, and the cases mainly occurred from February 21 to February 28 and the last case occurred on March 25. The outbreak lasted for 36 days. The cases were all students in grades 1-3. The overall attack rate was 36.80% (99/269), the attack rate was 43.04% in class 103(19/45), 13.64% in class 105 (6/44), 65.91% in class 201 (29/44), 15.56% in class 202 (7/45), 72.73% in class 203 (32/44), and 13.04% in class 308 (6/46). No cases were found in other classes. The difference in attack rate among classes were significant (χ²=71.570, P＜0.05). The attack rate was 40.88% in boy students (56/137) and 32.58% in girl students (43/132), the difference was not significant (χ²=0.480, P＞0.05). A total of 53 throat swabs were collected from the cases, in which 7 were positive for nucleic acid of influenza B virus Victoria lineage, 18 were positive for nucleic acid of human rhinovirus, and 6 were positive for multiple viruses; The positive rate of influenza B virus Victoria lineage was 24.53%, and the positive rate of human rhinovirus was 45.28%.
Conclusion The clinical symptom of the cases at the initial stage of the outbreak was mainly fever, indicating a typical influenza outbreak, but the proportion of fever cases gradually decreased over time. The cases at the later stage of the outbreak mainly had common cold symptom. Laboratory tests confirmed that the cases at the initial stage of the outbreak were infected with influenza B virus, the cases at the middle stage were infected with influenza B virus and human rhinovirus, and the cases at the later stage were infected with human rhinovirus. Therefore, when the clinical symptoms and signs of new cases change at different stages of an outbreak, co-infection of two or more pathogens can be considered.

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