舟山市一起肠炎沙门菌污染三明治引起食物中毒事件调查

目的 对不同学校发生的一起食物中毒事件开展流行病学调查,分析致病因子和污染来源,指导临床救治并提出预防措施。方法 通过调查病例临床特征和流行病学分布,结合实验室脉冲场凝胶电泳(PFGE)技术,对不同来源的沙门菌进行同源性分析,同时利用微量肉汤稀释法进行药敏试验。结果 此次事件涉及不同区县的4所学校,共发现疑似病例37例,确诊19例,病例临床特征主要为腹泻(70.27%,26/37)、发热(54.05%,20/37)、腹痛(51.35%,19/37)、呕吐(37.84%,17/37)等。实验室共分离肠炎沙门菌24株,其中19株来自病例,5株来自可疑食品三明治及其原料肉松。经PFGE分型,24株肠炎沙门菌聚类结果为100.00%。经药敏显示,19株病例株对萘啶酸耐药率为100.00%,对头孢西丁和亚胺培南耐药率均为5.26%(1/19)。结论 结合临床表现、流行病学调查、实验室检测结果,证实三明治原料肉松被肠炎沙门菌污染是导致本次事件的主要原因,建议监管部门加强对学校配餐公司的监督管理,提高公司从业人员食品安全意识,防范此类事件的发生。

Investigation and analysis of a Salmonella Enteritis food poisoning caused by sandwiches in Zhoushan

Objective To investigate a food poisoning events occurred in multiple schools at the same time,and analyze pathogenic factor, contaminated food and source, in order to guide clinical treatment and preventive measures. Methods Based on the investigation of clinical characteristics and epidemiological distribution of patients, homology analysis of Salmonella from different sources was carried out with the combination of pulsed field gel electrophoresis(PFGE) in the laboratory. Results Totally 37 suspected cases were found from 4 school in different districts, 19 cases were diagnosed. The main clinical features of the patients were diarrhea (70.27%, 26/37), fever (54.05%,20/37), abdominal pain (51.35%,19/37) and vomiting (37.84%,17/37). A total of 24 strains of Salmonella Enteritidis were isolated in the laboratory, of which 19 strains were from cases and 5 strains were from sandwiches and their dried meat floss. According to PFGE, 24 strains of Salmonella Enteritidis were clustered to 100.00%. The drug resistance rate of 19 cases was 100.00% to nalidixic acid and 5.26%(1/19) to cefoxitin and imipenem. Conclusion Combined with the clinical feature, epidemiological investigation and laboratory test results, it was confirmed that the main cause of the incident was the raw material of the sandwich which was contaminated by Salmonella Enteritidis. It is suggested that the regulatory department should strengthen the supervision of the school catering company, improve the food safety awareness and prevent the foodborne disease.