摘要
目的调查2011年7月石家庄市游泳馆暑假游泳培训班儿童游泳后出现以高热、咽痛、扁桃体肿大为特征的暴发疫情的病原和危险因素。方法制定病例临床诊断标准,采用统一的流行病学个案调查表对病例进行现场调查;采集患者咽拭子进行呼吸道病毒多重PCR检测与腺病毒分型PCR检测进行病原学调查;采用回顾性队列研究分析暴发的流行因素,其中暴露组为游泳馆暑假游泳培训班儿童,分别以该游泳馆服务半径3 km内无该馆游泳史的非游泳培训班儿童、市区内其他室内游泳馆暑期游泳培训班儿童、同馆的体校运动员为非暴露组,分析游泳行为、该馆游泳史、该馆2～5号泳池暴露史、不同时段游泳史与发病的关联强度。结果 2011年7月,石家庄市游泳馆暑假游泳培训班儿童（2～5号池）中,发现咽结膜热病例131例,罹患率为58.22%,发病高峰为7月18日。腺病毒7型阳性30例,hexon基因和fiber基因的核酸序列无变异。队列研究显示该游泳馆暑期培训班儿童发病是无该馆游泳史的非游泳培训班儿童的26.58倍（RR=26.58,AR=56.03%,AR%=96.24%）,是市区内其他室内游泳馆暑期游泳培训班儿童的12.55倍（RR=12.55,AR=53.58%,AR%=92.03%）,是同馆体校运动员（1号池）的21.81倍（RR=21.81,AR=55.55%,AR%=95.41%）;患病危险性随着游泳时段的后移而增加,呈时间效应关系（趋势性χ2=29.43,P=0.000）。结论石家庄市游泳馆暑期游泳培训班儿童游泳后发病是由该馆2～5号池水质受到腺病毒7型污染而引起的咽结膜热。应加强暑期培训班的传染病报告管理,严格泳池池水消毒,合理安排培训人次,防止疫情发生。
Objective To identify the pathogeny and risk factors for the children suffered from clustering high fever,sore throat and swollen tonsil,who had participated in a swimming training class during summer vacation in Shi Jiazhuang natatorium on July,2011. Methods Setting up a standardized definition to select cases and an uniformed epidemiological questionnaire to investigate and describe the epidemic characteristics. Pharyngeal swab samples were tested by PCR for etiological study. The risk factors,including swimming behavior,the history of swimming in pools No. 2 ～ 5 at this natatorium,and the relation of swimming at different time phase with the incidence,were analyzed by a retrospective cohort study. The children in this swimming training class were defined as the exposure group,and the children from dancing,English learning,drawing classes,swimming in other indoor pools,and swimmers who were trained at pool NO. 1 of this natatorium were defined as non-exposure groups. Results There were 131 cases suffered from pharyngoconjunctival fever in 225 middle and primary school children who participated in the swimming training class. The attack rate was 58. 22%. The peak of the incidence was on July 18.The incidence rate in the exposure group with a history of swimming at pools No. 2 ～ 5 of this natatorium was 26. 58 times higher than those in other training classes（ RR = 26. 58,AR = 56. 03%,AR% = 96. 24%）,12. 55 times higher than those swimming at other indoor pools（ RR = 12. 55,AR = 53. 58%,AR% = 92. 03%）,and 21. 81 times higher than swimmers who were trained at pool NO. 1（ RR = 21. 81,AR = 55. 55%,AR% = 95. 41%）.There was a time-response relationship between the incidence and swimming time phase（ χ2trend= 29. 43,P =0. 000）. The infection of type 7 adenovirus tested by PCR was revealed in 30 cases. Conclusions The outbreak of pharyngoconjunctival fever in this swimming training class was caused by the pollution of type 7 adenovirus.Strengthening reporting infectious diseases,strictly disinfecting swimming pools,and reasonably arranging the number of trainees in each class to prevent the outbreak of infectious diseases.
出处
《环境卫生学杂志》
2015年第4期369-372,376,共5页
JOURNAL OF ENVIRONMENTAL HYGIENE
关键词
腺病毒
咽结膜热
暴发
游泳池水
回顾性队列研究
adenovirus pharyngoconjunctival fever outbreak swimming pool water retrospective cohort study
