吕维维, 毛云霞, 周浩, 张钧, 查日胜, 高永军, 陆步来, 张俊骥, 杨海兵. 一起因二次供水污染导致的医院内诺如病毒胃肠炎暴发调查[J]. 疾病监测, 2016, 31(1): 49-53. DOI: 10.3784/j.issn.1003-9961.2016.01.012
引用本文: 吕维维, 毛云霞, 周浩, 张钧, 查日胜, 高永军, 陆步来, 张俊骥, 杨海兵. 一起因二次供水污染导致的医院内诺如病毒胃肠炎暴发调查[J]. 疾病监测, 2016, 31(1): 49-53. DOI: 10.3784/j.issn.1003-9961.2016.01.012
LYU Wei-wei, MAO Yun-xia, ZHOU Hao, ZHANG Jun, ZHA Ri-sheng, GAO Yong-jun, LU Bu-lai, ZHANG Jun-ji, YANG Hai-bing. An outbreak of norovirus infection associated with contamination ofsecondary water supply in a hospital[J]. Disease Surveillance, 2016, 31(1): 49-53. DOI: 10.3784/j.issn.1003-9961.2016.01.012
Citation: LYU Wei-wei, MAO Yun-xia, ZHOU Hao, ZHANG Jun, ZHA Ri-sheng, GAO Yong-jun, LU Bu-lai, ZHANG Jun-ji, YANG Hai-bing. An outbreak of norovirus infection associated with contamination ofsecondary water supply in a hospital[J]. Disease Surveillance, 2016, 31(1): 49-53. DOI: 10.3784/j.issn.1003-9961.2016.01.012

一起因二次供水污染导致的医院内诺如病毒胃肠炎暴发调查

An outbreak of norovirus infection associated with contamination ofsecondary water supply in a hospital

  • 摘要: 目的 调查江苏省苏州市某医院急性胃肠炎病例的感染来源、传播途径和危险因素。方法 制定病例定义搜索病例, 描述疫情三间分布特征, 开展病例对照研究验证暴发的可能原因, 运用反转录-聚合酶链反应(RT-PCR)检测诺如病毒核酸, 同时对饮用水进行理化和微生物检测。结果 暴发共持续7 d, 共有病例406例, 医院各类职业人群均有发病。二次供水区域的工作人员罹患率(14%~21%)高于市政自来水供水区域(0~5.3%)和桶装水(1.4%)供水区域。病例对照研究显示90%的病例和47%的对照有饮用二次供水史(OR=10, 95%CI:2.30~62.00)。10份病例粪便标本中有9份为I型诺如病毒核酸阳性,9份不同区域的二次供水样本中2份I型诺如病毒核酸阳性,二次供水样本菌落总数和总大肠菌群以及大肠埃希菌严重超标, 测量电开水器实际温度为78~81 ℃。结论 本次暴发疫情是由I型诺如病毒引起的急性胃肠炎暴发, 原因为医院二次供水的蓄水池受到周围环境的污染。建议该医院更换电开水炉, 并逐步将二次供水改建为市政自来水。

     

    Abstract: Objective To identify the infection source, transmission route and risk factors of an acute gastroenteritis outbreak in a hospital in Suzhou, Jiangsu province. Methods The cases were searched according to case definitions. A case-control study was conducted to test the hypothesis for this outbreak. Ten stool samples and 1 vomit sample were collected for the detection of norovirus using RT-PCR. Nine drinking water samples were collected for physiochemical and microbiological detections. Results The outbreak lasted for 7 days, and 406 cases were identified. The attack rate (AR) in nurses was highest (18%) and lowest in office staff (1.4%). The ARs in people in secondary water supply, tap-water and bottled water areas were 14%-21%, 0-5.3% and 1.4%, respectively. 90% of the cases and 47% of the controls had drunk water from secondary water supply system (OR=10, 95%CI:2.30-62.00). Up to 90% of stool samples (9/10)were norovirus positive and 22.2% of water samples from secondary water supply system (2/9)were norovirus positive. Total microbial counts, coliforms and the detection rate of Escherichia coli were highly exceed the standard in the water samples from secondary water supply system. The temperature of water from electric water heater was 78-81℃. Conclusion This outbreak was caused by the contamination of norovirus genotype I in the water tank of secondary water supply system.

     

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