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目的 了解传染性非典型肺炎 (SARS)超级传播者的传染性及其造成SARS医院内传播的情况。方法 调查 2 0 0 3年 3月 2 2日至 4月 1 5日江门市某医院 1例SARS病例及其导致院内传播的其他SARS病例。对SARS病例住院病历、流行病学现场调查资料和特异性实验室检查资料进行分析。结果 该医院首例SARS病例于 3月 2 2日入院 ,4月 1日确诊为SARS ,4月 2日死亡。 4月 2～ 1 5日该医院除了首例SARS病例外共报告SARS病例 2 2例。除最后1例患者在首例患者死亡后第七天才进入曾诊治过该患者的肾内科外 ,其余 2 1例SARS患者均与首例患者有明确接触史。对 4月 2～ 1 3日发病的 2 1例患者分析结果显示 ,发病高峰为 4月 3～ 7日 ,占病例总数的 71 4 3% (1 5 / 2 1 ) ;1 9例患者均为诊治首例患者的肾内科的医护人员 ,该科室罹患率为 5 9 38% (1 9/ 32 ) ,另 2例分别为同时在肾内科住院的患者及陪护 ;估算病例潜伏期中位数为 6d ;对其中的 1 1例病例进行血清SARS抗体测定和PCR检测 ,结果均为单项或两项检验结果阳性。结论 证实是一起医院内传播的SARS流行 ;引起传播的关键原因是首例病例表现“不典型性” ,医护人员欠缺防护 ,SARS病毒传染性强以及病区的布局不合理等因素 ;采取病区改造、加强医护人员的防护等一系列预防?
Objectives To understand the contagious nature of the SARS super-communicator and its impact on SARS hospital transmission. METHODS: One case of SARS and one case of other SARS causing nosocomial transmission in a hospital in Jiangmen from March 22 to April 15, 2003, were investigated. Inpatient medical records of SARS cases, epidemiological field survey data and specific laboratory test data were analyzed. Results The hospital’s first case of SARS was admitted on March 22nd and was confirmed as SARS on April 1 and died on April 2. From April 2 to April 5, the hospital reported a total of 22 SARS cases in addition to the first case of SARS. Except for the last patient who entered the department of nephrology who had been diagnosed and treated on the seventh day after the death of the first patient, the remaining 21 patients with SARS had a clear history of exposure to the first patient. The analysis of 21 patients with onset from April 2 to January 3 showed that the peak incidence was from April 3 to April 7, accounting for 71.43% (15/21) of the total number of cases; all of the 19 patients were The first case was diagnosed as medical staff in the Department of Nephrology. The prevalence rate was 59.3% (19/32) in the department of nephrology. The other two cases were patients who were hospitalized in the department of nephrology at the same time. The median incubation period was 6 days Serological SARS antibodies and PCR were detected in 11 of them, and the results were single or both. The conclusion proved to be a epidemic of SARS transmitted within the hospital. The key reasons causing the transmission were the first case’s “atypical”, the lack of protection of medical staff, the strong infectious of SARS virus and the irrational distribution of the ward. Transformation, to strengthen the protection of health care workers and a series of prevention?