甘孜州318国道鼠疫疫源地施工人员感染风险调查分析
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摘要
目的了解四川省境内318国道沿线疫源地施工人员对鼠疫防控知识的知晓情况,及施工工人居住环境中的鼠群密度以及带菌水平。方法对理塘、巴塘、雅江3个现鼠疫疫源县境内的318国道沿线疫源地施工队按照行政村分段,并进行系统抽样,再对抽取施工队进行单纯随机抽样,对抽取对象进行面对面调查。结果对所获动物材料443份进行细菌学检验,分离到鼠疫菌46株,自毙喜马拉雅旱獭体内检出鼠疫菌32株,占全部分菌数的70%;采集到牧犬、藏系绵羊、旱獭等动物血清523份,其中阳性血清38份,最低滴度为1:640,最高滴度为1:40 960;采用不同生境路线法调查旱獭密度,平均旱獭密度0.90只/ha; 5 m夹线法共捕鼠56只,总捕获率7.33%;对捕获的197只旱獭进行体蚤梳捡,染蚤率88%,蚤指数4.72,获蚤930只,主要以谢氏山蚤、斧形盖蚤和指形盖蚤为主。调查施工人员335人,平均年龄38 y(最小18 y,最大68 y),以男性(83%)、汉族(78%)为主,文化程度主要为初中(142人,42%)和小学(98人,29%)。外来务工人员数占全部调查对象的95%,务工时间主要以4个月以上(占全部对象34%)和一个月以内(占全部对象26%)为主;90%调查对象无正规建筑公司推荐或组织,长期以小工程队形式存在,人员配备15～20人。335名调查对象中,知晓鼠疫传播基础知识知的有81人(占全部对象24%);81人中对鼠疫"三报、三不"知晓仅22人,且正确回答率为占全部对象5%;58%调查对象居住方式以帐篷为主,其中地铺占63%,简易床占29%; 90%调查对象施工环境主要为高山草甸和高山灌丛。各施工队均未配备医务人员,也无相应伤口消毒、处置医疗用品。81%调查对象午休期间在草场睡觉;71%调查对象在工作结束后洗手;61%调查对象表示在施工期间未从事捕猎行为,并愿意去听相关鼠疫知识的讲解;34%调查对象愿意在发现病死动物后上报,但其中94%的人不知道疫情正确上报单位;88%调查对象在工友出现类似鼠疫症状时选择上报施工管理人员。施工负责人在工人出现疑似鼠疫症状时,10人中有3人选择报告疾控中心,余表示让工人自行前往卫生院进行医治。结论甘孜州318国道沿线施工人员鼠疫知晓率低,工作环境危险度大,人员个人防护不到位,且人员流动性大,发生人间鼠疫感染风险大,远距离传播风险高。建议相关部门加大施工人员鼠疫防护知识宣传及监测,防治人间鼠疫发生。
Objective To understand the knowledge of plague prevention and control along national highway 318 in Sichuan province,and the rat density and the level of bacteria in the living environment of construction workers. Methods The construction teams of the epidemic areas along the national highway 318 in Litang,Batang and Yajiang where are plague foci at this stage were divided according to administrative villages,and systematic sampled,and conducted simple random sampling to extract the construction team,finally,a face to face survey was conducted. Results A bacteriological examination of 443 samples of animal materials was carried out,and 46 strains of pestis were isolated. 32 strains of pestis were detected in the dead Himalayan marmot,accounting for 70% of the total number of bacteria. A total of 523 serum samples were collected from dogs,Tibetan sheep and marmots,among which 38 were positive,the lowest titer was 1 to 640,and the highest titer was 1 to 40960. Different habitats were used to investigate the density of marmots,and the average density of marmots was 0.90/ha. The total capture rate was 7.33%.To pick up fleas in 197 marmots which were collected,the fleas rate was 88%,the flea index was 4.72,a total of 930 fleas were captured,it was mainly composed of Shaishan mountain fleas,hatchet cover fleas and finger-shaped cover fleas. A total of 335 construction workers were investigated,average age was 38( youngest 18,oldest 68),mainly were male( 83%) and the Han nationality( 78%); degree of education as follows,junior middle school culture degree( 142,42%) and primary school( 98,29%). The number of migrant workers accounted for 95%,and the majority of the work time was more than 4 months( 34%) and within one month( 26%). 90% of the survey respondents were not recommended or organized by formal construction companies,and have long been in the form of small engineering teams with 15 to 20 persons. There were 81 in 335( 24%) persons got the knowledge of the plague spread,only 22 in 81 persons got the knowledge about Three report and Three no,and the correct answer rate was only 5%; 58% of respondents lived in tents,of which 63% were bunk beds and 29% were beds; 90% survey objects' construction environment of is mainly alpine meadow and alpine shrub. All the construction teams were not equipped with medical personnel,and there was no corresponding disinfection and treatment of medical supplies. 81% of the respondents slept in the pasture during their lunch break,71% wash their hands after work,61% were not engaged in hunting during the construction period and were willing to listen to the knowledge of the plague. 34% were willing to report after they were found dead animals,but94% of them did not know the correct report units. 88% choose to report to the construction manager when they developed symptoms similar to the plague. When the construction manager discovered symptoms of the plague,3 of the 10 people chose to report the CDC,and the rest let the workers to go to the health care center for medical treatment on their own. Conclusion Along the national highway 318,the construction personnel plague awareness was low,the work environments were dangerous,the staff personal protection did not enough,plus and personnel fluidity was so big,thus the human plague infection risk was high,and longdistance transmission risk is high too. It was suggested that the relevant departments should intensify the publicity and monitoring of the protection knowledge of construction personnel to prevent the human plague occurrence.
Objective To understand the knowledge of plague prevention and control along national highway 318 in Sichuan province,and the rat density and the level of bacteria in the living environment of construction workers. Methods The construction teams of the epidemic areas along the national highway 318 in Litang,Batang and Yajiang where are plague foci at this stage were divided according to administrative villages,and systematic sampled,and conducted simple random sampling to extract the construction team,finally,a face to face survey was conducted. Results A bacteriological examination of 443 samples of animal materials was carried out,and 46 strains of pestis were isolated. 32 strains of pestis were detected in the dead Himalayan marmot,accounting for 70% of the total number of bacteria. A total of 523 serum samples were collected from dogs,Tibetan sheep and marmots,among which 38 were positive,the lowest titer was 1 to 640,and the highest titer was 1 to 40960. Different habitats were used to investigate the density of marmots,and the average density of marmots was 0.90/ha. The total capture rate was 7.33%.To pick up fleas in 197 marmots which were collected,the fleas rate was 88%,the flea index was 4.72,a total of 930 fleas were captured,it was mainly composed of Shaishan mountain fleas,hatchet cover fleas and finger-shaped cover fleas. A total of 335 construction workers were investigated,average age was 38( youngest 18,oldest 68),mainly were male( 83%) and the Han nationality( 78%); degree of education as follows,junior middle school culture degree( 142,42%) and primary school( 98,29%). The number of migrant workers accounted for 95%,and the majority of the work time was more than 4 months( 34%) and within one month( 26%). 90% of the survey respondents were not recommended or organized by formal construction companies,and have long been in the form of small engineering teams with 15 to 20 persons. There were 81 in 335( 24%) persons got the knowledge of the plague spread,only 22 in 81 persons got the knowledge about Three report and Three no,and the correct answer rate was only 5%; 58% of respondents lived in tents,of which 63% were bunk beds and 29% were beds; 90% survey objects' construction environment of is mainly alpine meadow and alpine shrub. All the construction teams were not equipped with medical personnel,and there was no corresponding disinfection and treatment of medical supplies. 81% of the respondents slept in the pasture during their lunch break,71% wash their hands after work,61% were not engaged in hunting during the construction period and were willing to listen to the knowledge of the plague. 34% were willing to report after they were found dead animals,but94% of them did not know the correct report units. 88% choose to report to the construction manager when they developed symptoms similar to the plague. When the construction manager discovered symptoms of the plague,3 of the 10 people chose to report the CDC,and the rest let the workers to go to the health care center for medical treatment on their own. Conclusion Along the national highway 318,the construction personnel plague awareness was low,the work environments were dangerous,the staff personal protection did not enough,plus and personnel fluidity was so big,thus the human plague infection risk was high,and longdistance transmission risk is high too. It was suggested that the relevant departments should intensify the publicity and monitoring of the protection knowledge of construction personnel to prevent the human plague occurrence.
引文
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[3]马英.青海省近20年人间鼠疫流行动态分析.中国人兽共患病学报[J].2010,26(12):1178-1179.
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[5]李超.五种蚤实验室感染鼠疫的观察.地方病通报[J].1997,12(3)5-8.
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[9]汪立茂.四川省又一旱獭鼠疫疫源县的发现[J].预防医学情报杂志,2012,28(11):856-867.
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