外送餐引起产气荚膜梭菌食物中毒流行病学调查分析
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(1.张家港市疾病预防控制中心,江苏 张家港 215600;2.苏州市疾病预防控制中心, 江苏 苏州 215004;3.苏州市虎丘区卫生监督所,江苏 苏州 215011)

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于颖慧 女 副主任医师 研究方向为营养与食品安全 E-mail:ehcoy@126.com 滕臣刚 男 主任医师 研究方向为营养与食品安全 E-mail:804555724@qq.com

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江苏省卫生厅预防医学科研课题(Y2015020);苏州市科技支撑项目(SS201658);苏州市卫生科接项目(GWZX201706)


Epidemiological investigation and analysis of Clostridium perfringens food poisoning caused by food delivery
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(1.Zhangjiagang Center for Disease Control and Prevention, Jiangsu Zhangjiagang 215600, China;2.Suzhou Center for Disease Control and Prevention, Jiangsu Suzhou 215004, China;3.Huqiu District Public Health Inspection Institute, Jiangsu Suzhou 215011, China)

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    摘要:

    目的 查明发生在某工厂的食源性疾病暴发的可疑食品、致病因子及危险因素等,并对事件调查过程中暴露出的问题进行探讨,为今后类似事件的防控和调查提供参考依据。方法 病例定义为于2019年3月3日~3月4日期间在M工厂加班职工中发生腹痛、腹泻(≥3次/24 h)或呕吐症状之一者,运用描述性和分析性流行病学方法开展病例访谈和回顾性研究。收集病例的粪便标本、剩余食品和相关环境样品进行病原分离和采用聚合酶链式反应(PCR)检测阳性菌株的毒素基因。结果 检索到病例106名,罹患率为73.6%(106/144),临床症状以腹泻(78.3%,83/106)、腹痛(78.3%,83/106)为主,部分半腹部胀气、胀痛(9.4%,10/106),无发热;流行曲线为点源暴露模式,潜伏期为2~22 h,可疑餐次为2019年3月3日的午餐;单因素分析和Logistic回归分析结果显示,发病与红烧鱼块[相对危险度(RR)=1.55,95%置信区间(95%CI):1.29~1.85]、蒜苗肉丝(RR=1.26,95%CI:1.01~1.57)和雪菜烧鸭血(RR=1.47,95%CI: 1.16~1.87)有关;在3份肛拭子、3份环境样品中检出产气荚膜梭菌,菌株和2份剩余食品均检测出α毒素和产气荚膜梭菌肠毒素(CPE)基因。送餐的D企业在加工经营中存在着被细菌污染并繁殖的条件。送餐的D企业在加工经营中存在着被细菌污染并繁殖的条件。结论 本次事件是因食用某供餐企业提供的配送餐引起的产气荚膜梭菌食物中毒,外送餐做好后应迅速冷却、低温储存,不能立即进食的,在食前要充分加热。

    Abstract:

    Objective To find out the suspicious food, pathogenic factors and risk factors of a foodborne disease outbreak in a factory, and to discuss the problems exposed in the investigation of the incident, so as to provide reference for the prevention, control and investigation of similar incidents in the future. Methods A case was defined as the onset of abdominal pain or diarrhea(≥3 times/24 hours)or vomiting in a person who worked in M factory from March 3 to March 4 in 2019. Case interviews and retrospective research was carried out using descriptive and analytical epidemics pathological method. Stool specimens of the cases,leftover food and related environmental samples were gathered for pathogen isolation and toxin gene detection using polymerase chain reaction(PCR). Results 106 cases were identified with a attack rate of 73.6% (106/144). The symptoms were diarrhea (78.3%,83/106), abdominal cramps (78.3%,83/106), abdominal gas pains(9.4%,10/106),and no fever. The epidemic curve showed a point source exposure pattern. The median incubation time was 10 hours (range:2-22 h). Illness were associated with three food items of the lunch on March 3 in 2019 by univariate analysis and Logistic regression analysis:braised fish pieces [relative risk (RR)=1.55,95% confidence interval (95%CI):1.29-1.85], pork stir-fried with garlic sprouts (RR=1.26,95%CI:1.01-1.57) and duck blood stir-fried with pickles (RR=1.47,95%CI:1.16-1.87). Alpha toxin and enterotoxin CPE genes were positive and beta toxin genes was negative in the Clostridium perfringens strain isolated in anal swabs of three patients, three environmental samples and two leftover food samples. There were possible bacterial contamination and reproduction in the processing and preparation of enterprise D, which delivered food. Conclusion This incident was caused by the food poisoning of Clostridium perfringens caused by the consumption of a meal provided by a catering company. After the meal was delivered, it should be cooled quickly and stored at low temperature. If it cannot be eaten immediately, it should be heated sufficiently before eating.

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于颖慧,滕臣刚,刘丽华,夏威,施惠军,陆逊,王晓蕾,张梦寒,季建刚.外送餐引起产气荚膜梭菌食物中毒流行病学调查分析[J].中国食品卫生杂志,2020,32(5):570-575.

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  • 收稿日期:2020-06-01
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  • 在线发布日期: 2020-11-18
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