上海市宝山区居民散发诺如病毒感染性腹泻影响因素的病例对照研究

摘要

Objective To investigate the risk factors for sporadic norovirus infection in residents in Baoshan,Shanghai.Methods A 1∶2 matched case-control study was conducted in 80 norovirus infection cases selected as case group from hospitals in Baoshan from March 1,2015 to April 30,2016,all the cases were laboratory confirmed,and the control group were the people who had no diarrhea or vomiting during the previous two weeks.A self-designed questionnaire was used in the survey.Conditional logistic regression model was used for univariate and multivariate analysis.Results Among the 80 norovirus infection cases,66 were infected with G Ⅱ virus (82.50％),14 were infected with G Ⅰ virus (17.50％).The results of univariate analysis showed that the risk for norovirus infection in mild manual workers was 2.446 times higher than that in strong manual workers (OR =2.446,95％ CI:1.228-4.872).Contact with vomiting and diarrhea patients 3 days before onset (OR =8.267,95％ CI:2.359-28.975),dining out 3 days before onset (OR =2.822,95％ CI:1.467-5.429) and consumption of seafood 3 days before onset (OR =3.000,95％ CI:1.841-4.888) were the risk factors for norovirus infection.Multivariate analysis indicated that contact with vomiting and diarrhea patients 3 days before onset (OR =6.959,95％ CI:1.896-25.537) and consumption of seafood 3 days before onset (OR =2.283,95％ CI:1.336-3.899) were the risk factors for norovirus infection.Washing hands before meals (OR =0.609,95％ CI:0.408-0.909) was a protective factor.Conclusion Norovirus G Ⅱ was the main pathogen causing intestinal infection in Baoshan.Contact with vomiting/diarrhea patients and consumption of seafood were the possible risk factors for norovirus infection.It is necessary to strengthen the health education and improve seafood safety surveillance.%目的 探索居民散发诺如病毒感染的潜在危险因素.方法 采用1∶2配比病例对照研究方法,选取2015年3月1日至2016年4月30日在上海市宝山区各级医疗机构肠道门诊就诊、实验室确诊为诺如病毒感染的80例患者为病例组,选择2周内无腹泻、呕吐症状的人群作为对照组.利用自行设计的调查表进行问卷调查,应用条件logistic回归进行单因素与多因素分析.结果 80例诺如病毒感染病例,实验室分型GⅡ型66例,占82.50％,GI型14例,占17.50％.单因素分析显示从事低体力劳动的人群感染诺如病毒的风险是从事高强体力劳动的人群的2.446倍(OR=2.446,95％CI:1.228 ～4.872);发病前3d接触呕吐、腹泻患者(OR=8.267,95％CI:2.359 ～ 28.975)、发病前3d有外出就餐史(OR =2.822,95％ CI:1.467 ～5.429)和发病前3d食用海鲜(OR =3.000,95％ CI:1.841～4.888)是诺如病毒感染的危险因素.多因素分析显示:发病前3d接触呕吐、腹泻患者(OR=6.959,95％CI:1.896 ～ 25.537)和发病前3d食用海鲜(OR =2.283,95％ CI:1.336 ～3.899)为诺如病毒感染的危险因素,饭前洗手(OR=0.609,95％CI:0.408～0.909)为保护性因素.结论 上海市宝山区诺如病毒感染以GⅡ型为主.接触患者和食用海鲜是诺如病毒感染的可能危险因素.应加强健康宣传,做好海水产品卫生监测工作.