现流_第二次课件.pptVIP

* * 基于上述描述，我们形成了假设。对于伤寒这个疾病，文献显示最常见的传播途径是水源和食物源，人传人的情况非常非常非常罕见，而且本次现场调查的证据也显示不支持人传人。” * 学校基本情况； * 不支持食堂供餐 无桶装水的班级风险高于有桶装水的班级，二组发病高峰时间相同，提示水源传播的可能性较大； * * 流行病学曲线显示疫情从2月18日开始，22日达高峰，23-26日一直维持在一个较高的平台，之后发病数快速下降。 首发病例杜××，男，92岁，全护老人，日常生活不能自理。该病例2月17日晚上17时左右与家人在老人院附近的大嘴渔港用餐，食物为茄子煲和酸甜排骨，20时左右回老人院，18日凌晨5:30左右开始呕吐和腹泻，至当天下午15:30，共呕吐1次，腹泻6次，家属遂带病人到老人院对面的港湾医院就诊，予肠胃炎对症治疗（具体用药不详），18日晚20时左右送回老人院，之后未再呕吐和腹泻。与病例同餐的二名家人（儿子和妻子）均无任何不适症状。 * 全院老人总罹患率为31%，护工总罹患率为17%，二组无统计学差异（χ2=3.3，p=0.0700.05）。 * 1-5楼老人均有发病，4楼和3楼老人的罹患率最高（分别为57%和45%），各楼层罹患率存在统计学差异（χ2=35，p0.01）；1-2楼老人由同一批护工照看，3-5楼老人分别由各层专门的护工照看，而护工仅有4楼和3楼的发病，3楼护工的罹患率（45%）高于4楼护工的罹患率（18%），但无统计学差异（χ2=1.8，p=0.180.05）；全院老人总罹患率为31%，护工总罹患率为17%，二组无统计学差异（χ2=3.3，p=0.0700.05）。 * * Reviews help identify organisms, risk factors, and sources of exposures that have been observed in the past. * In other words, by being familiar with the disease, you can, at the very least, “round up the usual suspects.” * * * This is a typical propagated pattern – we see: Distinct peaks every 3 to 4 weeks. Each consecutive peak gets larger and larger. After the final peak the cases fall rapidly. Note that for most propagated outbreaks you expect a single source case. We do not see one – could this outbreak have started from a visitor – or did the investigators not do complete case finding for 2 incubation periods before the outbreak. Seeing this strong pattern is solid support for a hypothesis of propagated transmission. * * 病例分布在空间上无聚集性，提示存在存在广泛的环境源传播的可能，如食物、水或其他产品，或同一区域的病例被分散到各处 * The attack rate for all persons associated with the nursing home was 21%. When divided by residents, disabled residents, workers, and visitors we found no difference in risk. * The attack rate for students, workers, and teachers combined was 38%, but varied by subgroup. Although the attack rate for students (40%) and kitchen workers (60%) was not significantly different, the rate among teachers (1%) was much lower. Grade one students also had a significantly higher rate of PTF th