目的 调查2019年西安市X大学第一附属医院住院患者腹泻暴发疫情的致病因子或危险因素,提出针对性防控措施和建议.方法 开展病例搜索和现场流行病学、卫生学调查,采集病例及相关人员、医院水及环境表面等标本,并通过反转录-聚合酶链式反应(RT-PCR)进行病原学检测.结果 调查住院患者、家属陪护、医院职工169人,累计发病22例,总罹患率为13.02％.病例临床表现以腹泻、腹胀、呕吐等为主.病区住院患者罹患率明显高于家属陪护(x2=16.341,P＜0.01);与首发病例共用厕所的住院患者及其家属陪护罹患率明显高于不共用厕所者(x2 =3.907,P＜ 0.05).尚未发现水源性和食源性可疑危险因素.20份病例标本和1份病房拖把表面涂抹标本检测结果为诺如病毒GⅡ型核酸阳性.结论 该起急性胃肠炎暴发疫情属于医院感染事件,由诺如病毒GⅡ型引起.传染源为隐性感染者或病毒携带者,病毒通过病房污染拖把(共同介质)以人-环境-人的模式造成传播,采取针对性措施后疫情得以控制.

Objective:To describe the epidemiological and etiological characteristics of clustered cases of hand, foot, and mouth disease (HFMD) in Xi’an from 2013 to 2018, so as to provide scientific evidences for HFMD prevention and control.Methods:Descriptive epidemiological method was used to analyze the epidemiological characteristics of clustered cases of HFMD in Xi’an from 2013 to 2018.Results:From 2013 to 2018, 4 221 clusters of HFMD were reported, affecting 12 301 individuals. The annual incidence peaks of HFMD clusters occurred during April to July. The top-three districts of the accumulative number of clusters were Yanta, Chang'an and Weiyang. The clusters mainly occurred in child care facilities. The overall positive rate of enteroviruses was 55.37% (1 620/2 926) and coxsackievirus A16 was the predominant type. the time intervals between initial onset and reporting were positively correlated with the duration and case numbers of the clusters (the r values were 0.727 and 0.507, respectively; P<0.05) . Conclusions:The clustered HFMD cases in Xi’an mainly occurred in child care facilities during spring and summer. It is necessary to strengthen the epidemic surveillance, the reporting management, and the sample collection and testing of cases in the high incidence areas, so as to control effectively the clustered cases.

目的 调查与分析岳阳市平江县两所学校一起感染性腹泻暴发,并探讨病因和可能的危险因素,评价措施效果,为今后的防控提供参考.方法 按照病例定义开展病例搜索,采用描述性流行病学方法进行分析,采用病例对照研究和队列研究验证假设;对学校食堂和饮用水进行卫生学调查;采集病例的肛拭子等生物样品和水源水、出厂水、学校管网末梢水等环境样品开展相关微生物检测.结果 该起疫情共发病116例,A小学罹患率为10.98％(72/656),B中学罹患率为6.96％(33/474),另有学校附近居民病例11例;病例组直接饮用自来水的比例为78.9％,对照组直接饮用自来水的比例为36.0％(OR=6.68,95％CI=3.180～14.030);使用该乡自来水的乡镇街道居民罹患率为2.96％(11/371);周边不使用自来水的居民罹患率为0.33％(1/300),两者比较差异有统计学意义(x2=6.54,P=0.011);检测14例病例肛拭子标本有10例诺如病毒核酸阳性,学校无二次供水,学校管网末梢水卫生学指标超标,水源水和B中学管网末梢水诺如病毒核酸弱阳性.结论 此次疫情为一起诺如病毒引起的感染性腹泻暴发,发病原因为学生饮用被诺如病毒污染的自来水所致.