流行病学调查与病原体分子分型综合分析在一起甲型副伤寒暴发溯源控制中作用
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摘要
2010年4月—2011年8月云南省元江县发生一起甲型副伤寒暴发疫情,587例确诊甲型副伤寒。有关部门进行了病例环境调查、分布特征分析、接触者管理、疫区处置和疫情报告;同时开展了病例与环境标本病原学检测,利用病原菌分子分型与基因组学技术,追溯疫情来源。结果显示,疫情起源与输入病例有关联,病原菌随污水排入蔬菜田、污染蔬菜、病例生吃污染蔬菜而感染;形成病例–污水–蔬菜–人群传播循环。采取环境污染控制、病例诊断治疗、密切接触者监测、人群健康教育防治策略措施后,历时17个月疫情得到完全控制。提示,病原菌分子分型、基因组学技术在流行病学调查、病原菌识别信息的传染源溯源和疫情精准控制中具有十分重要的作用。
An outbreak of paratyphoid fever epidemic occurred in Yuanjiang county of Yunnan province between April2010 and August 2011, with 587 cases diagnosed as paratyphoid fever A. Relevant institutions conducted a field study to analyze distribution characteristics of the cases, environment monitoring, management of contact persons, disposition of epidemic region, and the reporting of the epidemic. Specimens from the cases and environment of epidemic region were detected for isolation and identification of pathogens with molecular typing and genomics technique simultaneously to trace infectious source of the epidemic. The investigation findings demonstrated that the epidemic was related to some imported cases and that the pathogen-contaminated irrigation water polluted vegetables planted and the infection might caused by eating of uncooked vegetables by the cases; the findings also suggested a infectious source-sewage-contaminated vegetablepopulation transmission cycle. The epidemic subsided 17 months after the implementation of targeted measures including environment contamination control, diagnose and treatment of the cases, management of the contacts, and health education among the public. The results indicated that molecular typing and infectious tracing with genomics technique could play an important role in precision control of paratyphoid fever epidemic.
An outbreak of paratyphoid fever epidemic occurred in Yuanjiang county of Yunnan province between April2010 and August 2011, with 587 cases diagnosed as paratyphoid fever A. Relevant institutions conducted a field study to analyze distribution characteristics of the cases, environment monitoring, management of contact persons, disposition of epidemic region, and the reporting of the epidemic. Specimens from the cases and environment of epidemic region were detected for isolation and identification of pathogens with molecular typing and genomics technique simultaneously to trace infectious source of the epidemic. The investigation findings demonstrated that the epidemic was related to some imported cases and that the pathogen-contaminated irrigation water polluted vegetables planted and the infection might caused by eating of uncooked vegetables by the cases; the findings also suggested a infectious source-sewage-contaminated vegetablepopulation transmission cycle. The epidemic subsided 17 months after the implementation of targeted measures including environment contamination control, diagnose and treatment of the cases, management of the contacts, and health education among the public. The results indicated that molecular typing and infectious tracing with genomics technique could play an important role in precision control of paratyphoid fever epidemic.
引文
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[2]王树坤,王志刚,张晓和,等.2010-2011年云南省元江县一起甲型副伤寒暴发调查与处置[J].中华流行病学杂志,2017,38(2):200-201.
[3]Wang JF,Wang Y,Zhang J,et al.Spatiotemporal transmission and determinants of typhoid and paratyphoid fever in Hongta district,Yunnan province,China[J].PLoS Neg Trop Dis,2013,7(3):e2112.
[4]倪世友,王榆淞,王树坤,等.1999-2015年红塔区伤寒与副伤寒流行特征和气象变量的研究[J].中国微生态学杂志,2017,29(5):598-603.
[5]张红强,王树坤,王艳芳,等.玉溪市红塔区1998-2007年伤寒和甲型副伤寒流行趋势分析[J].中国自然医学杂志,2008,10(6):401-405.
[6]王树坤,姚云波,储从家,等.萘啶酸抗性甲型副伤寒病原菌的克隆扩散和遗传多样性[J].中华微生物学和免疫学杂志,2008,28(12):1109-1115.
[7]艾敏,王树坤.全球伤寒与副伤寒的流行情况、危险因素和预防策略[J].中国公共卫生,2018-09-06网络出版,DOI:10.11847/zgggws1120207.
[8]Mogasale V,Maskery B,Ochiai RL,et al.Burden of typhoid fever in low-income and middle-income countries:a systematic,literature-based update with risk-factor adjustment[J].The Lancet Global Health,2014,2(10):e570-e580.
[9]Vollaard AM,Ali S,van Asten HA,et al.Risk factors for typhoid and paratyphoid fever in Jakarta,Indonesia[J].JAMA,2004,291(21):2607-2615.
[10]孙军玲,张静,马会来,等.2012年全国和高发省份伤寒、副伤寒流行特征分析[J].中华流行病学杂志,2013,34(12):1183-1188.