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題名 | 諾羅病毒(Norovirus)引發某中學學生腸胃炎群聚事件調查=Investigation of Norovirus-Induced Gastroenteritis Outbreak among Students in a High School |
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作者 | 江大雄; 李品慧; 吳芳姿; 李淑妃; 高昆裕; Jiang, Donald Dah-shyong; Lee, Pin-hui; Wu, Fang-tzy; Lee, Shu-fei; Kao, Kun-yue; |
期刊 | 疫情報導 |
出版日期 | 20081000 |
卷期 | 24:10 2008.10[民97.10] |
頁次 | 頁753-762+左718-730 |
分類號 | 415.13 |
語文 | chi、eng |
關鍵詞 | 諾羅病毒; 腸胃炎; 流行病學; 食品中毒; Norovirus; Gastroenteritis; Epidemiology; Food posioning; |
中文摘要 | 諾羅病毒(norovirus)引起的腸胃炎群聚事件迭有所聞。西元2008年3月16日,雲林縣斗六市某中學學生集體發生腸胃炎群聚事件。為瞭解該事件之疫情規模、傳染途徑、致病原、可能發生原因及評估防治措施成效,乃進行相關的流行病學調查。本調查採用半結構式問卷詢問某中學高三學生發病症狀和發病時間,以便於採檢和探討傳染途徑。另進行病例-對照研究法來探討發生食品中毒的可能性。 380份高三學生問卷中,符合病例定義138人,侵襲率為36.3%。2件學生病例之糞便檢體都驗出諾羅病毒。諾羅病毒可以確定為本群聚事件之致病原,我們因此判定某中學發生諾羅病毒引起的腸胃炎群聚事件。又流行曲線圖判定傳染途徑為共同感染。3件廚工之糞便檢體也驗出與學生同型同群(G2/4)的諾羅病毒。分析3月15日學校供應中餐之各個菜色的結果顯示鮪魚通心麵(OR=7.445,95%CL= 2.571~21.554)與本次嘔吐、腹瀉群聚事件有統計學上的顯著相關。因此高度懷疑事件發生原因可能是鮪魚通心麵引起的食品中毒,但無食餘物檢體可供佐證。經採取學校廚房與餐廳等環境的消毒、學校廚房停業一週、要求3位檢驗出諾羅病毒的廚工停止上班和加強學生的洗手教育等防治措施後,於3月20日起學校就不再出現嘔吐、腹瀉的病例。我們懷疑諾羅病毒引起的腸胃炎群聚事件可能是由食品所引起,因此建議相關主管機關除要落實學校午餐留置48小時之規定外,對食餘物檢體的檢驗宜增列病毒的檢驗項目(如諾羅病毒)。 |
英文摘要 | Outbreaks of norovirus-induced gastroenteritis have occurred on and off in Taiwan. On March 16, 2008, a norovirus-induced gastroenteritis outbreak occurred in A High School in Douliou City, Yunlin County. This investigation was conducted in order to understand the outbreak scale, transmission route, infection origin, possible causes of the outbreak, and to assess the effectiveness of the control and preventive measures. The investigation uses semi-structure questionnaires to collect information from the 12th grade students about disease symptoms and onset dates for the purpose of taking relevant specimens and determining the possible transmission route. In addition, a case-control study was conducted to explore the possibility of occurrence of food poisoning. Among the 380 questionnaires distributed to the 12th grade students, a total of 138 cases fit the case definition showing an attack rate of 36.3%. Two fecal specimens from student cases were tested positive for norovirus. Due to the fact that norovirus can be confirmed as the source of the infection, this episode can be determined as a norovirus-induced gastroenteritis outbreak. By examining the epidemic curve, we can also determine the transmission route to be of one-point common source infection. Three of the fecal specimens collected from the culinary staff were also tested positive for the same type and strain of norovirus (G2/4) as those of the infected students. After analysis of the lunch prepared by the school on March 15, it is evident that the tuna macaroni (OR=7.445, 95%CL = 2.571~21.554) is statistically linked to this norovirus-induced gastroenteritis outbreak. Therefore, the tuna macaroni is highly suspected to be the cause of this incident of food poisoning. Unfortunately, no food specimens were available to confirm this. After the disinfection of the school’s kitchens, cafeteria, and surrounding environment, the school’s kitchen service was halted for a week. In addition, with the absence of the 3 infected culinary staff members, the enhancing of hand washing among the students, and other preventive measures taken, no new cases of vomiting and/or diarrhea occurred as of March 20. We suspected that this norovirus-induced gastroenteritis outbreak was induced by contaminated food. Therefore, it is recommended that corresponding health departments not only needs to carry out the regulation of retaining school lunches for 48 hours, but also to add new testing categories (e.g. norovirus) for the leftover food. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。