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目的为了查明2014年浙江省慈溪市发生的一起伤寒暴发原因、传播方式、波及范围,提出针对性的预防措施开展本次调查。方法对病例进行流行病学个案调查,并对其中76例进行1∶1病例对照研究,比较病例组和对照组危险因素暴露情况。对现场调查资料应用描述性流行病学和卫生统计学方法进行分析。结果本起疫情共发生伤寒91例,病例以成年人为主,本地户籍病例占90%以上,发病率为6.20/10万,流行曲线呈现双峰状,病例分布由中心城区逐渐向周边乡镇/街道扩散。病例对照研究显示,生食蚶子(OR=5.00,95%CI:1.57~21.62)是可疑危险因素,但卫生学调查提示蚶子来源环节污染可能性小。分层分析后发现使用被粪便污染的井水冲洗贝壳类海产品和经口使用被粪便污染的井水(OR=22.89,95%CI:2.73~503.40)是导致本次伤寒暴发的原因。采集井水样本检测结果显示受到粪便污染。结论本次伤寒暴发为使用了受污染的井水所导致,建议所有菜市场禁用井水,卫生部门加强饮用水的卫生监督和管理,继续推动农村改水改厕。
Objective To find out the causes, modes of transmission and spread of an outbreak of typhus in Cixi City, Zhejiang Province in 2014 and put forward targeted preventive measures to carry out this survey. Methods A case-by-case survey was conducted in epidemiological cases. A case-control study of 76 patients in 1: 1 group was conducted. The exposure of risk factors in case group and control group was compared. Descriptive epidemiological and hypostatic statistical methods were used to analyze field survey data. Results A total of 91 cases of typhoid fever were reported in this outbreak. The cases were mainly adults. More than 90% of the household registrations occurred. The incidence rate was 6.20 / 100,000. The epidemic curve showed a bimodal pattern. The distribution of cases gradually shifted from the central urban area to surrounding towns / diffusion. Case-control studies have shown that raw food prickly heat (OR = 5.00,95% CI: 1.57 ~ 21.62) is a suspicious risk factor, but hygiene studies suggest that prickly heat source is unlikely. Stratified analysis revealed that the use of well-contaminated well water to flush shellfish and oral use of well-contaminated well water (OR = 22.89, 95% CI: 2.73 to 503.40) was the cause of the outbreak. Collection well water sample test results show contaminated by faeces. Conclusion The outbreak of typhoid fever was caused by the use of contaminated well water. It is recommended that all markets prohibit well water. The health department should strengthen hygiene supervision and management of drinking water and continue to promote water and sanitation in rural areas.