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目的调查北京市某敬老院出现多名急性胃肠炎病例的感染来源、传播途径和致病因素。方法应用流行病学描述性分析、队列研究、现场卫生学调查以及实验室检验对暴发原因进行综合分析,判断可能的致病因素。结果该敬老院住院老人和职工均有发病,罹患率为15.2%(77/506),各职业罹患率无显著差异。不同楼层收住老人的自理能力有所不同,自理能力强、能自主摄入凉拌菜的老人比自理能力弱、不能自主摄入凉拌菜的老人罹患率高,差异有统计学意义(P<0.05)。调查8月21日早餐凉拌菜的暴露情况,暴露组罹患率为28.1%(76/270),非暴露组为0.4%(1/236),RR=66.4(95%CI:9.31~474.02)。在某些剩余食品、病例粪便、餐具涂抹及外环境涂抹中均检出嗜水气单胞菌。结论该次暴发疫情是由于摄入了被嗜水气单胞菌污染的凉拌菜引起的,建议敬老院对食堂外环境、加工工具进行彻底消毒,注意凉菜加工工具和储藏环境生熟分开。
Objective To investigate the origin, route of transmission and pathogenic factors of multiple acute gastroenteritis cases in a nursing home in Beijing. Methods The epidemiological descriptive analysis, cohort studies, field health surveys and laboratory tests were used to analyze the causes of the outbreak and to determine possible causative agents. Results The nursing home and elderly workers were both hospitalized, the attack rate was 15.2% (77/506), the occupancy rate was no significant difference. The ability to take care of the elderly on different floors is different. Self-care ability is strong. Elderly people who are able to take salad independently are weaker than those who can take care of themselves. The difference is statistically significant (P <0.05 ). To investigate the exposure of cold salad on August 21, the attack rate was 28.1% (76/270) in the exposed group and 0.4% (1/236) in the non-exposed group, RR = 66.4 (95% CI: 9.31-474.02). Aeromonas hydrophila was detected in some of the remaining foodstuffs, case excrements, tableware applications and external environment applications. Conclusion The outbreak was caused by ingestion of cold dishes contaminated with Aeromonas hydrophila. It is recommended that nursing homes should thoroughly disinfect the external environment and processing tools in the canteen, and pay attention to the separation of raw and processed food processing tools from the storage environment.