【摘要】 目的 查明某企业食源性疾病暴发的致病因子、可疑食品和风险来源，提供类似事件调查处置和预防的参考依据。方法 通过描述性流行病学方法分析病例的临床特征、流行病学特征及相关危险因素，开展回顾性队列和病例对照研究，确定可疑餐次及食品，采集病例和厨工肛拭子、留样食品、餐饮具外表面及环境样本进行病原学检测，采用脉冲场凝胶电泳（pulsed field gel electrophoresis, PFGE）对沙门菌阳性株开展同源性分析。结果 共发现53例病例，罹患率为13.02%（53/407）,主要临床表现为腹泻（100.00%）、发热（90.57%）、腹痛（66.04%）等，部分伴有头晕、头痛、乏力、恶心、呕吐等症状。流行曲线为单次暴露后点源单峰分布模式。回顾性队列研究结果显示，7月30日午餐就餐者的发病差异有统计学意义（RR=8.87,95%CI:1.25～62.90）,病例对照研究结果显示，7月30日午餐的“原味烤鸭”为可疑食物（OR=435.00,95%CI:37.38～5 061.97）,剂量-反应关系提示原味烤鸭进食越多，发病风险越高(χ²_趋势=38.25,P<0.05)。共采集51份样本，有33份样本分离培养出沙门菌，经PFGE图谱分析为3种带型，以伦敦沙门菌菌株为优势血清型，另外存在印第安纳沙门菌和贝尔维尤沙门菌菌株。结论 本次事件为一起由多种血清型沙门菌引起的食源性疾病暴发，应进一步加强沙门菌监测、分型和聚类分析，掌握优势血清型动态。更多还原

【Abstract】 Objective To identify the causative factors,suspicious foods and risk sources of a foodborne disease outbreak in an enterprise,and to provide a basis for investigation,disposal and prevention of similar incidents. Methods Descriptive epidemiological methods were used to analyze the clinical characteristics,epidemiological characteristics and related risk factors of the cases. We performed retrospective cohort and case-control studies to identify suspicious meals and foods,collect cases’ and kitchen workers’ anal swabs,and reserve food samples. The outer peripheral surface of tableware and environmental samples were tested for etiology,and pulsed field gel electrophoresis( PFGE) was employed for homology analysis of Salmonella-positive strains.Results A total of 53 cases were found,with an attack rate of 13.02%( 53/407). The main clinical manifestations were diarrhea( 100.00%),fever( 90.57%),abdominal pain( 66.04%),etc. Some cases were accompanied by dizziness,headache,fatigue,nausea,vomiting and other symptoms. The epidemic curve showed that the outbreak was a unimodal distribution pattern of point source outbreak after a single exposure. The results of a retrospective cohort study displayed that there was a statistically significant difference in the incidence among those who ate lunch on July 30( RR = 8.87,95%CI: 1.25-62.90). The results of a case-control study revealed that the original recipe roast duck for lunch on July 30 was suspicious food( OR = 435. 00,95% CI: 37.38-5,061.97). The dose-response relationship indicated that the more the original recipe roast duck was eaten,the higher the risk of the disease( χ~2trend= 38. 25,P < 0. 05). A total of 51 samples were collected,of which Salmonella strains were isolated from 33samples. PFGE analysis demonstrated that there were 3 types of bands. Salmonella London strain was the dominant serotype,and there were Salmonella Indiana and Salmonella Bellevue strains. Conclusion This incident was a foodborne disease outbreak caused by multi-serotype Salmonella. Salmonella monitoring,typing and cluster analysis should be further strengthened to grasp the dynamics of dominant serotypes.更多还原