Werber Dirk, Mason Brendan W, Evans Meirion R, Salmon Roland L
Communicable Disease Surveillance Centre, National Public Health Service for Wales, Temple of Peace and Health, Cathays Park, Cardiff, United Kingdom.
Clin Infect Dis. 2008 Apr 15;46(8):1189-96. doi: 10.1086/587670.
Preventing household transmission of Shiga toxin-producing Escherichia coli O157 (STEC O157) infection is important because of the ease of interpersonal transmission and the potential disease severity.
We conducted a retrospective cohort study of households associated with an outbreak of STEC O157 infection in South Wales, United Kingdom, in autumn 2005. We investigated whether characteristics of the primary case patient or the household were predictors for secondary household transmission of STEC O157 infection. Furthermore, we estimated the proportion of cases that might be prevented by isolation (e.g., hospitalization) of the primary case patient immediately after the microbiological diagnosis and the number of patients with STEC O157 who would need to be isolated to prevent 1 case of hemolytic uremic syndrome. Based on dates of symptom onset, case patients in households were classified as having primary, coprimary, or secondary infection. Secondary cases were considered to be preventable if the secondary case patient's symptoms started >1 incubation period (4 days) after the date of microbiological diagnosis of the primary case.
Eighty-nine (91%) of 98 eligible households were enrolled. Among 20 households (22%), 25 secondary cases were ascertained. Thirteen secondary cases (56%) occurred in siblings of the primary case patients; hemolytic uremic syndrome developed in 4 of these siblings. Presence of a sibling (risk ratio, 3.8; 95% confidence interval, 0.99-14.6) and young age (<5 years) of the primary case patient (risk ratio, 2.03; 95% confidence interval, 0.99-41.6) were independent predictors for households in which secondary cases occurred. Of the 15 secondary cases for which complete information was available, 7 (46%) might have been prevented. When restricting isolation to primary case patients who were aged <10 years and who had a sibling, we estimated the number of patients who would need to be isolated to prevent 1 case of hemolytic uremic syndrome to be 47 patients (95% confidence interval, 16-78 patients).
Promptly separating pediatric patients with STEC O157 infection from their young siblings should be considered.
由于志贺毒素产生大肠杆菌O157（STEC O157）感染易于人际传播且疾病潜在严重，预防家庭传播很重要。
我们对2005年秋季英国南威尔士一起STEC O157感染暴发相关的家庭进行了一项回顾性队列研究。我们调查了原发病例患者或家庭的特征是否为STEC O157感染家庭内传播的预测因素。此外，我们估计了在微生物学诊断后立即隔离（如住院）原发病例患者可预防的病例比例，以及为预防1例溶血尿毒综合征需要隔离的STEC O157患者数量。根据症状出现日期，家庭中的病例患者被分类为原发性、共同原发性或继发性感染。如果继发性病例患者的症状在原发病例微生物学诊断日期后开始超过1个潜伏期（4天），则继发性病例被认为是可预防的。
98个符合条件的家庭中有89个（91%）被纳入研究。在20个家庭（22%）中，确定了25例继发性病例。13例继发性病例（56%）发生在原发病例患者的兄弟姐妹中；其中4名兄弟姐妹发生了溶血尿毒综合征。原发病例患者有兄弟姐妹（风险比，3.8；95%置信区间，0.99 - 14.6）以及年龄较小（<5岁）（风险比，2.03；95%置信区间，0.99 - 41.6）是发生继发性病例家庭的独立预测因素。在可获得完整信息的15例继发性病例中，7例（46%）可能已被预防。当将隔离限制在年龄<10岁且有兄弟姐妹的原发病例患者时，我们估计为预防1例溶血尿毒综合征需要隔离的患者数量为47例（95%置信区间，16 - 78例）。
应考虑将感染STEC O157的儿科患者与其年幼的兄弟姐妹迅速分开。
Zotero 插件