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上海甲型肝炎流行因素分析

Epidemiological Study on Epidemic of Hepatitis A in Shanghai

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【作者】 肖再平徐志一李永良苏竹君谈楚仪钱婉华

【Author】 Xiao Zaiping, et al., Department of Epidemiology, Shanghai Medical University (Shanghai 200032)

【机构】 上海生物制品研究所上海医科大学上海市徐汇区卫生防疫站上海市闵行区卫生防疫站上海市长宁区卫生防疫站 200052教授研究生导师

【摘要】 1988年,上海市区甲型肝炎流行。流行期间随机抽取1830份居民血清,用Abbott酶标试剂检测抗-HAV与抗-HAV IgM,并询问食毛蚶、发病情况。易感人群食毛蚶率达41.46%,食毛蚶者罹患率为32.35%,隐性感染率为5.51%。未食毛蚶人群依次为1.82%、3.13%。显性感染与隐性感染相对危险度分别为17.75和1.76。87.43%的病例与食蚶有关。食蚶量越大,发病率越高,呈剂量效应关系,20~49岁年龄组,食蚶率最高(46%~58%),罹患率亦最高(21%~29%),流行前、后人群易感率分别为35.85%和29.18%,1988年1~2月份出现的3次发病高峰,同3次毛蚶大量供应的日期分别相距30天左右。相当于一个平均潜伏期。1月4日禁止毛蚶出售,40天后发病高峰下降。本次血清流行病学研究表明,该次流行由生食毛蚶所致。

【Abstract】 An apidemic of hepatitis A occurred in Shai- ghai in 1988. During the epidemic period, 1830 serum specimens were randomly collected from Local residents and tested for anti--HAV and anti- HAV IgM. These residents were also inquired of whether they had eaten raw clam. The rate of eating raw clam in susceptibles reached 41. 46%. In clam-eating group, the attack rate was 32. 35% and the subclinical infection rate was 5. 51%. The rates in the individuals who hadn’t eaten raw clam were 1. 82% and 3. 31% respectively. 87. 43% cases were associated with eating clam. The dose-effect rela- tionship between clam consumption and the attack rate was demonstrated. Before and after the outb- reak the percentages of susceptibles to hepatitis A virus were 35. 85% and 29. 18% respectively. The sale of clam was forbidden by the Shanghai muni- cipal goverment on Jan. 4 because of the diarrhea caused by contaminated clam. Forty days later, the attack rate drastically declined. This sero-epidemio- logical study showed that the clam was the vehicle of the epidemic of the hepatitis A in Shanghai in 1988.

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