Tang Xue-feng, Liu Lun-guang, Ma Hui-lai, Zhu Bao-ping, Hao Cai-xia, Wu Xiao-yan, Fei Ning, Zhu Xiao-ping, Zhang Li-jie
Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2010 Sep;31(9):1050-2.
Vibrio cholera was extremely rare in Sichuan province(no cases in 2008). Any outbreak could indicate contamination through the food supply system. In July 2009, a hospital reported a cluster of 7 diarrhea patients;all attended the same banquet. One patient was confirmed to have Vibrio cholera (O139). We conducted this investigation to identify the source of this possible cholera outbreak.
We defined a suspect case as any banquet attendee with diarrhea (≥ 3 times/day). A confirmed case was a suspect case with a positive Vibrio cholera culture. We took stool samples or rectal swabs from all attendees for cholera culture and interviewed 272 banquet attendees about foods they ate at the banquet and kitchen workers about food preparation.
7.1% (24/337) of attendees developed cases within an average of 65 hours after eating. Three meals were served. All patients had the lunch whereas no patients only ate breakfast and/or dinner. Of 180 attendees who ate turtle meat 12% were case-patients, compared to 3.3% of 92 attendees who did not (RR = 3.6, 95%CI: 1.1 - 12). Of the 150 attendees who ate peanuts 13% were cases compared to 4.1% of 122 attendees who did not eat peanuts (RR = 3.1, 95%CI: 1.2 - 8.0). During preparation, the same utensil was used for fresh turtle meat and peanuts without washing in-between the process. Turtle meat and peanuts were stored for > 16 hours at room temperature after cooking before consumption. All 33 turtles originated from commercial production in another province.
This outbreak was likely caused by poor food handling of commercially produced turtles. We proposed that to improve microbiologic monitoring of aquatic food animals, and raise the awareness of good handling practices at mass gathering in rural China.
霍乱弧菌在四川省极为罕见（2008年无病例）。任何疫情爆发都可能表明通过食品供应系统受到污染。2009年7月，一家医院报告了7例腹泻患者聚集性病例；所有患者都参加了同一场宴会。其中1例患者被确诊感染霍乱弧菌（O139）。我们开展此次调查以确定此次可能的霍乱疫情爆发的源头。
我们将任何出现腹泻（≥3次/天）的宴会参与者定义为疑似病例。确诊病例为霍乱弧菌培养呈阳性的疑似病例。我们采集了所有参与者的粪便样本或直肠拭子进行霍乱培养，并就他们在宴会上所吃的食物对272名宴会参与者进行了访谈，还就食物制备情况对厨房工作人员进行了访谈。
7.1%（24/337）的参与者在进食后平均65小时内发病。宴会提供了三餐。所有患者都吃了午餐，而没有患者只吃了早餐和/或晚餐。在180名食用了龟肉的参与者中，12%为病例患者，相比之下，在92名未食用龟肉的参与者中，病例患者占3.3%（相对危险度=3.6，95%置信区间：1.1 - 12）。在150名食用了花生的参与者中，13%为病例，相比之下，在122名未食用花生的参与者中，病例占4.1%（相对危险度=3.1，95%置信区间：1.2 - 8.0）。在食物制备过程中，新鲜龟肉和花生使用了同一器具，且中间未进行清洗。龟肉和花生在烹饪后于室温下储存超过16小时才食用。所有33只龟均来自另一省份的商业养殖。
此次疫情爆发可能是由于对商业养殖龟的食品处理不当所致。我们建议加强对水产食用动物的微生物监测，并提高中国农村地区大规模聚餐时良好操作规范的意识。
