广东省某寄宿制中学一起急性出血性结膜炎暴发疫情调查

罗丽贤; 曾彪; 易瑶; 翁嘉喜; 万力玮; 叶争; 谭春荣; 康敏; 张应涛

doi:10.16835/j.cnki.1000-9817.2025158

广东省某寄宿制中学一起急性出血性结膜炎暴发疫情调查

doi: 10.16835/j.cnki.1000-9817.2025158

罗丽贤^{1, 2},
曾彪³,
易瑶³,
翁嘉喜^{1, 4},
万力玮⁵,
叶争^{1, 6},
谭春荣⁶,
康敏³,
张应涛^3, ,

1.
广东省现场流行病学培训项目，广州 510000
2.
汕头市潮南区疾病预防控制中心疾病控制股
3.
广东省疾病预防控制中心传染病预防控制所
4.
惠州市惠东县疾病预防控制中心环境和学校卫生科
5.
广东省疾病预防控制中心慢性非传染性疾病预防控制所
6.
韶关市始兴县疾病预防控制中心流行病与寄生虫防控科

基金项目:

广东省重点领域研发计划项目 2022B1111020006

中国疾病预防控制中心标准化前期研究项目 BZ2024-Q049

详细信息

作者简介:
罗丽贤(1990-)，女，广东汕头人，大学本科，主管药师，主要从事传染病预防控制工作

通讯作者:
张应涛，E-mail: zhangyt9@mail2.sysu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 RR181.3⁺² R777.31
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出版历程
- 收稿日期: 2025-01-20
- 修回日期: 2025-03-10
- 网络出版日期: 2025-07-04
- 刊出日期: 2025-06-25

Investigation on an outbreak of acute hemorrhagic conjunctivitis at a boarding middle school in Guangdong Province

LUO Lixian^{1, 2},
ZENG Biao³,
YI Yao³,
WENG Jiaxi^{1, 4},
WAN Liwei⁵,
YE Zheng^{1, 6},
TAN Chunrong⁶,
KANG Min³,
ZHANG Yingtao^{3
, ,}

1.
Guangdong Provincial Field Epidemiology Training Program, Guangzhou (510000), Guangdong Province, China

摘要

摘要: 目的了解广东省某寄宿制中学一起急性出血性结膜炎(AHC)暴发疫情的特征及危险因素，为有效预防控制校园AHC疫情提供科学依据。方法 2023年9月1—28日，根据病例定义对该校559名在校学生和60名教职工进行病例搜索，对该起疫情的三间分布进行描述性分析；设计调查问卷开展病例对照研究，对疫情传播的危险因素进行分析，采用倾向得分匹配方法(PSM)控制基线资料差异。结果该中学共出现AHC病例269例，罹患率为43.46%；引起感染的病原体为柯萨奇病毒A24型(CA24v)。其中学生264例，罹患率为47.23%；教职员工5例，罹患率为8.33%。PSM共匹配成功153对，病例组和对照组性别、年级、班级构成差异均无统计学意义(χ²值分别为0.12，5.41，11.24，P值均>0.05)。多因素Logistic回归分析结果显示，毛巾与他人的有接触(OR=1.81)、近期接触过AHC病例(OR=4.89)的中学生AHC发病风险较大；平时戴眼镜(OR=0.43)、经常使用洗手液(OR=0.37)的中学生AHC发病风险较低(P值均 < 0.05)。结论该起疫情为一起由CA24v引起的学校AHC暴发疫情，具有明显的扩散传播速度快、影响范围大的特点。
- 结膜炎，急性出血性 /
- 疾病暴发流行 /
- 流行病学研究 /
- 发病率 /
- 学生
Abstract: Objective To investigate the characteristics and risk factors of an outbreak of acute hemorrhagic conjunctivitis (AHC) in a boarding middle school in Guangdong Province, in order to provide a scientific evidence for effective prevention and control of campus AHC outbreaks. Methods From September 1st to 28th 2023, case identification was conducted among 559 students and 60 faculty members using standardized definition. Descriptive analysis was conducted on the three distrubution patterns of the outbreak. Questionnaires were designed, and a case-control study was adopted to analyze the possible risk factors of the disease transmission. The propensity score matching (PSM) method was used to control the difference of baseline data. Results A total of 269 cases of AHC were identified, with an attack rate of 43.46%. The pathogen was confirmed as Coxsackie virus A24 variant (CA24v). Among these, 264 cases were students (attack rate of 47.23%) and 5 were staff (attack rate of 8.33%). A total of 153 pairs of PSM were successfully matched. After PSM matching, there were no statistically significant differences in gender, grade and class between the case group and the control group (χ²=0.12, 5.41, 11.24, P>0.05). The results of multivariate Logistic regression analysis showed that middle school students whose towels contacted with others (OR=1.81), and direct contact with other AHC cases recently (OR=4.89) were more likely to have AHC; while wearing glasses (OR=0.43) and frequent use of hand sanitizer (OR=0.37) were less likely to have AHC (P < 0.05). Conclusion The outbreak of AHC is caused by CA24v, demonstrating rapid spread and extensive impact within the school setting.
- Conjunctivitis, acute hemorrhagic /
- Disease outbreaks /
- Epidemiologic studies /
- Incidence /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 某中学不同特征人群AHC罹患率比较

Table 1. Comparison of AHC incidence rates of populations with different characteristics in a middle school

特征	选项	人数	罹患人数	χ²值	P值
人群类别	学生	559	264(47.23)	33.36	< 0.01
	教职工	60	5(8.33)
性别	男	347	163(46.97)	3.98	0.03
	女	272	106(38.97)
学生是否住宿	是	542	261(48.15)	6.16	< 0.01
	否	17	3(17.65)
学生年龄	12~ < 13	128	69(53.91)	4.89	0.18
	13~ < 14	168	83(49.40)
	14~ < 15	167	71(42.51)
	15	96	41(42.71)
教学楼层(年级)	一楼(七)	192	99(51.56)	9.25	< 0.01
	二楼(八)	172	90(52.33)
	三楼(九)	195	75(38.46)
班级	七(1)班	49	27(55.10)	22.47	0.02
	七(2)班	47	22(46.81)
	七(3)班	48	23(47.92)
	七(4)班	48	27(56.25)
	八(1)班	43	26(60.47)
	八(2)班	44	21(47.73)
	八(3)班	42	17(40.48)
	八(4)班	43	26(60.47)
	九(1)班	49	22(44.90)
	九(2)班	46	10(21.74)
	九(3)班	50	21(42.00)
	九(4)班	50	22(44.00)
宿舍楼层	二楼	133	72(54.14)	6.61	0.09
	三楼	142	65(45.77)
	四楼	133	70(52.63)
	五楼	134	54(40.30)
注： ()内数字为罹患率/%。

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表 2 PSM匹配前后病例组和对照组人口学特征比较

Table 2. Comparison of demographic characteristics between case group and control group before and after PSM

人口学指标	选项	PSM匹配前				PSM匹配后
人口学指标	选项	病例组 (n=187)	对照组 (n=243)	χ²值	P值	病例组 (n=153)	对照组 (n=153)	χ²值	P值
性别	男	118(63.10)	113(46.50)	11.71	< 0.01	89(58.17)	92(60.13)	0.12	0.41
	女	69(36.90)	130(53.50)			64(41.83)	61(39.87)
年级	七	78(41.71)	78(32.10)	17.79	< 0.01	50(32.68)	58(37.91)	5.41	0.07
	八	66(35.29)	62(25.51)			60(39.22)	41(26.80)
	九	43(23.00)	103(42.39)			43(28.10)	54(35.29)
班级	七(1)班	24(12.83)	18(7.41)	30.66	< 0.01	14(9.15)	14(9.15)	11.24	0.42
	七(2)班	14(7.49)	23(9.47)			14(9.15)	14(9.15)
	七(3)班	22(11.76)	19(7.82)			11(7.19)	19(12.42)
	七(4)班	18(9.63)	18(7.41)			11(7.19)	11(7.19)
	八(1)班	19(10.16)	15(6.17)			19(12.42)	11(7.19)
	八(2)班	14(7.49)	21(8.64)			14(9.15)	14(9.15)
	八(3)班	14(7.49)	14(5.76)			10(6.54)	7(4.58)
	八(4)班	19(10.16)	12(4.94)			17(11.11)	9(5.88)
	九(1)班	9(4.81)	26(10.70)			9(5.88)	12(7.84)
	九(2)班	5(2.67)	30(12.35)			5(3.27)	13(8.50)
	九(3)班	14(7.49)	26(10.70)			14(9.15)	14(9.15)
	九(4)班	15(8.02)	21(8.64)			15(9.80)	15(9.80)
注： ()内数字为构成比/%。

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表 3 某中学AHC暴发疫情危险因素Logistic回归分析(n=306)

Table 3. Logistic regression analysis on risk factors for AHC outbreak in a middle school(n=306)

自变量	选项	单因素		多因素
自变量	选项	OR值(95%CI)	P值	OR值(95%CI)	P值
平时戴眼镜	是	0.59(0.36~0.97)	0.02	0.43(0.25~0.76)	< 0.01
	否	1.00		1.00
用过同学的生活	是	1.51(0.94~2.44)	0.06
学习用品	否	1.00		1.00
毛巾与他人的有接触	是	2.15(1.34~3.44)	< 0.01	1.81(1.05~3.12)	0.03
	否	1.00		1.00
近期接触过	是	5.58(3.21~9.69)	< 0.01	4.89(2.71~8.80)	< 0.01
AHC病例	否	1.00		1.00
平时和其他班	是	2.23(1.38~3.59)	< 0.01	1.67(0.97~2.88)	0.06
同学玩耍	否	1.00		1.00
平时晾晒被子床单的频次^*	从不	1.00	0.18
平时晾晒被子床单的频次^*	每月< 1次	1.73(0.95~3.14)
	每月≥1次	1.43(0.84~2.43)
每天洗手频次^*	0~2	1.00	0.47
	3~5	0.60(0.25~1.41)
	≥6	0.60(0.26~1.41)
是否使用洗手液^*	基本不用	1.00	0.04	1.00
	偶尔使用	0.48(0.21~1.10)		0.50(0.19~1.29)	0.15
	经常使用	0.32(0.13~0.78)		0.37(0.14~1.00)	0.05
平时有揉眼睛	从不	1.00	0.01	1.00
行为^*	偶尔	2.15(0.97~4.78)		1.29(0.53~3.15)	0.57
	经常	3.45(1.48~8.06)		1.58(0.61~4.14)	0.35
注： ^*为有序变量。

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