2024年新疆生产建设兵团某幼儿园诺如病毒暴发调查

An investigation on the Norovirus Outbreak in a kindergarten of a Certain regiment of Xinjiang Production and Construction Corps in 2024

  • 摘要:目的】调查分析新疆生产建设兵团某幼儿园一起诺如病毒暴发疫情的感染来源,为制定针对性疫情防控措施提供参考。【方法】通过面对面访谈,电话回访,查阅幼儿园考勤登记本、医疗机构门诊日志及出入院登记等方式搜索病例,采集病例的粪便、呕吐物、肛拭子,以及食物留样、剩余食材、食堂和教室环境样本,全部样本均同时进行诺如病毒实时荧光逆转录聚合酶链反应(RT-PCR)检测和沙门菌、致泻埃希菌、金黄色葡萄球菌等肠道致病菌的实时荧光定量聚合酶链反应(PCR)筛查。采用描述性流行病学方法分析疫情特征及感染来源。【结果】 2024年5月7日—10日,全园共有114名儿童(男64名,女50名) ,其中小班26名。本次疫情共发现15例聚集性病例,均为小班儿童,总罹患率为13.16%(15/114)。临床主要表现为呕吐(93.33%),腹泻(80.00%),发热(20.00%),腹痛(6.67%)。15例病例中,男童9例,女童6例,男女性别比为1.5:1。病例主要集中在4岁儿童,占总病例的73.33%(11/15)。疫情持续63 h 40 min。共采集42份标本,包括病例样本13份(呕吐物5份、粪便7份和肛拭子1份)、48 h食物留样和剩余食材4份、食堂环境样本5份,以及小班教室环境样本20份(储物箱3份、被褥2份、乐高墙4份、水彩笔3份、玩具柜4份、水杯涂抹样本3份、直饮水机出水口水样标本1份)。RT-PCR结果显示,13份病例标本中检出阳性7份,阳性检出率为53.85%(7/13),其中5例为诺如病毒GⅡ型;呕吐物和粪便样本的阳性检出率分别为40.00%(2/5)和71.43%(5/7)。5份小班教室环境样本检出诺如病毒GⅡ型,阳性检出率为25.00%(5/20)。【结论】本次事件是一起发生在幼儿园的由诺如病毒GⅡ型感染引起的暴发性聚集性疫情,应强化健康宣教,提高教职工、学生及家长防病意识,养成良好的卫生习惯,早发现、早处置。

     

    Abstract: Objective To investigate and analyze the source of infection in an outbreak of gastroenteritis in a kindergarten of Xinjiang Production and Construction Corps, and to provide a reference for formulating epidemic prevention and control strategies.Methods Cases were identified through face-to-face interviews, telephone follow-ups, and by reviewing kindergarten attendance records, medical institution outpatient logs, and admission/discharge registers. Fecal samples, vomitus, anal swabs, food samples, leftover ingredients, and environmental samples from kitchens and classrooms were collected. These samples were simultaneously screened for norovirus using real-time fluorescent reverse transcription polymerase chain reaction (RT-PCR) and for enteric pathogens such as Salmonella, diarrheagenic Escherichia coli, and Staphylococcus aureus using real-time fluorescent quantitative PCR.Results From May 7 to 10, 2024, a total of 114 children (64 boys and 50 girls) were enrolled in the kindergarten, including 26 children in the younger class. A total of 15 norovirus cases were identified, all from the younger class, resulting in an overall attack rate of 13.16% (15/114). The main clinical symptoms included vomiting (93.33%), diarrhea (80.00%), fever (20.00%), and abdominal pain (6.67%). The male-to-female case ratio was 1.5:1 (9:6), with most cases occurring among 4-year-olds, accounting for 73.33% (11/15) of all cases. The outbreak lasted 63 h 40 min. A total of 42 samples were collected, including 13 clinical specimens (5 vomit samples, 7 fecal samples, and 1 anal swab), 4 food samples and leftover ingredients from the 48-hour food retention period, 5 environmental samples from the cafeteria, and 20 environmental samples from the small class classroom (3 storage boxes, 2 bedding sets, 4 LEGO walls, 3 watercolor pens, 4 toy cabinets, 3 cup wipe samples, and 1 tap water sample from the direct drinking water dispenser). RT-PCR results showed a positivity rate of 53.85% (7/13) among patient specimens, with 5 patients testing positive for norovirus GII genotype. The positivity rates for vomitus and fecal samples were 40.00% (2/5) and 71.43% (5/7), respectively. Norovirus GII genotype was detected in 5 out of 20 environmental samples from the younger class classroom, yielding a positivity rate of 25.00% (5/20).Conclusion This incident is an outbreak and cluster of infections caused by norovirus type GⅡ in a kindergarten. It is necessary to strengthen health education, enhance the disease prevention awareness of teachers, students and parents, develop good hygiene habits, and detect and handle the disease as early as possible.

     

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