从一起河鲀中毒调查探讨河鲀食用安全性的风险管理措施
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摘要
目的通过一起河鲀中毒事件的流行病学调查和人群关于河鲀安全性的知识、态度、行为(KAP)调查,探讨河鲀食用安全的风险管理措施。方法通过病例搜索,调查病例家庭成员进食史及发病情况,采用回顾性队列研究分析发病的高危因素,制作调查问卷调查了解当地村民有关河鲀中毒的知识、态度和行为。结果共搜索到14例病例,其中1例死亡。症状主要为头晕(100%)、四肢无力(79%)、四肢肌肉麻痹和行走困难(71%)、口舌肢端麻痹(71%)等。食用河鲀是发病的危险因素,加工过程保留鱼肝共同煮食可增加中毒的危险(RR=1.8,95%CI=1.1~3.1)。KAP调查发现70%(33/47)的村民近3年曾进食过河鲀,其中88%(29/33)来源于市场或流动摊贩;98%(46/47)的村民知道河鲀有毒,94%(44/47)的村民知道国家法律禁止食用河鲀鱼,但仍有94%(44/47)的人认为其味道鲜美值得品尝。结论食用混杂于无毒河鲀中的有毒河鲀是导致本次食物中毒的主要原因。居民对河鲀安全性知晓率高但依从性差。
Objective To discuss the safety risk management measures for puffer fish from the investigation on an outbreak of puffer fish intoxication and a knowledge-attitude-practice( KAP) survey on the puffer fish safety. Methods The cases were searched and all of their family members were investigated on food exposure history. A cohort study was conducted to identify risk factors. A self-designed questionnaire was used for KAP investigation. Results 14 puffer fish poisoning cases( one case died) were identified. Clinical symptoms included dizziness( 100%),weakness of limbs( 79%),muscular paralysis of the limbs or walking difficulty( 71%),orolingual numbness( 71%),and so on. Eating poisonous puffer fish was the risk factor,and fish meat and fish liver cooked together was significantly associated with poisoning( RR = 1. 8,95% CI = 1. 1-3. 1). The results of KAP showed that 70%( 33 /47) had puffer fish consumption in the last three years. 98%( 46 /47) knew the puffer fish was poisonous and 94%( 44 /47) knew the state law forbids eating puffer fish. Meanwhile 94%( 44 /47) of people considered the puffer a delicacy worth to eat. Conclusion This outbreak was caused by poisonous puffer fish consumption. Local residents had a high awareness of puffer safety,but a poor compliance to the prohibition of eating puffer fish.
Objective To discuss the safety risk management measures for puffer fish from the investigation on an outbreak of puffer fish intoxication and a knowledge-attitude-practice( KAP) survey on the puffer fish safety. Methods The cases were searched and all of their family members were investigated on food exposure history. A cohort study was conducted to identify risk factors. A self-designed questionnaire was used for KAP investigation. Results 14 puffer fish poisoning cases( one case died) were identified. Clinical symptoms included dizziness( 100%),weakness of limbs( 79%),muscular paralysis of the limbs or walking difficulty( 71%),orolingual numbness( 71%),and so on. Eating poisonous puffer fish was the risk factor,and fish meat and fish liver cooked together was significantly associated with poisoning( RR = 1. 8,95% CI = 1. 1-3. 1). The results of KAP showed that 70%( 33 /47) had puffer fish consumption in the last three years. 98%( 46 /47) knew the puffer fish was poisonous and 94%( 44 /47) knew the state law forbids eating puffer fish. Meanwhile 94%( 44 /47) of people considered the puffer a delicacy worth to eat. Conclusion This outbreak was caused by poisonous puffer fish consumption. Local residents had a high awareness of puffer safety,but a poor compliance to the prohibition of eating puffer fish.
引文
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[2]刘红梅.河豚鱼中毒[J].国外医学护理分册,1995,14(3):121-122.
[3]何家璋.安全食用河豚研究I.河豚毒素的研究[J].食品科学,1986,7(3):810.
[4]刘智禹.南海常见河豚鱼品种及其毒素含量的研究[J].福建水产,2011,33(1):40-44.
[5]月腹刺鲀[EB/OL].(2013-3-15)[2015-8-5].http://baike.baidu.com/view/8923460.htm.
[6]邢朝晖.河豚鱼中毒的预防[J].中国热带医学,2005,5(5):1112.
[7]张旭东.河豚鱼含毒状况研究进展(综述)[J].中国食品卫生杂志,1997,9(1):32-37.
[8]罗世杰,朱维杰.43例河豚鱼中毒原因分析[J].海军医学,1997,15(3):279.
[9]王奇欣.我国海捕河豚鱼的加工管理现状与思路[J].中国水产,2005(6):16-17.
[10]全国人民代表大会常务委员会.中华人民共和国农产品质量安全法[A].2006-04-29.
[11]全国人民代表大会常务委员会.中华人民共和国食品安全法[A].2015-04-24.
[12]国家食品药品监督管理局.关于餐饮服务提供者经营河豚鱼有关问题的通知(食药监办食函[2011]242号)[A].2011-06-09.
[13]褚发军,冉陆,马莉,等.2008—2010年全国突发公共卫生事件网络报告食物中毒流行病学分析[J].中国食品卫生杂志,2012,24(4):387-390.
[14]邓志科,宫庆礼,崔建洲,等.我国河豚鱼产业形势和发展战略[J].科学养鱼,2006(3):3-4.
[15]The Japanese ministry of health and welfare,statistics of communicable disease and food poisoning in Japan[R].Statistics and Information Department,Minister's Secretariat,Ministry of Health and Welfare,1967-1976.
[16]Tsunenari S,Uchimura Y,Kanda M.Puffer poisoning in Japan-a case report[J].J Forensic Sci,1980,25(1):240-245.
[17]陈永祥,陈锐,王永芳,等.日本河豚鱼管理概况[J].中国卫生监督杂志,2011,18(4):313-316.
[18]Food poisoning statistics 2009[EB/OL].(2011-01-24)[2015-08-05].http://www.mhlw.go.jp/english/topics/foodsafety/poisoning/dl/Food_Poisoning_Statistics_2009.pdf.
[19]张磊,邱从乾,陈俊,等.上海市鲜河豚鱼人群试食试验可行性研究[J].上海食品药品监管情报研究,2010(4):17-22.
[20]李直健.试食河豚安全性研究进展(综述)[J].中国公共卫生管理,2008,24(3):295-298.