中国某小学百日咳暴发：大环内酯类耐药伯氏百日咳杆菌的感染和传播。
Pertussis Outbreak in a Primary School in China: Infection and Transmission of the Macrolide-resistant Bordetella pertussis.
机构信息
From the Department of Infectious Diseases, Xi'an Children Hospital, Xi'an, China.
Department of Vaccine Preventable Diseases, Xi'an Center for Disease Control and Prevention, Xi'an, China.
出版信息
Pediatr Infect Dis J. 2018 Jun;37(6):e145-e148. doi: 10.1097/INF.0000000000001814.
BACKGROUND
A pertussis outbreak was studied in a primary school in Xi'an, China, in March 2016. The school consisted of 536 pupils 6-12 years of age who were divided into 12 classes of 6 grades (2 classes for each grade). The identified index case was an 11-year-old girl at class 2 of grade 5.
METHODS
Interview was conducted and nasopharyngeal swabs were taken from all pupils (N = 94) in the 2 classes of grade 5. Nasopharyngeal swabs were tested by both culture and polymerase chain reaction (PCR).
RESULTS
Four culture- and 17 PCR-positive cases were identified in 94 pupils. Infection rate was significantly higher in class 2 compared with that in class 1 [37.0% (17/46) vs. 14.6% (7/48), χ(2) = 4.26, P < 0.05]. All Bordetella pertussis isolates were macrolide-resistant, harbored prn1/ptxP1/fim3-1 as previously reported and belonged to multilocus variable tandem repeat analysis type MLVA 195. Of the 17 DNAs positive for diagnostic PCR, 12 were also positive for 23S ribosomal RNA PCR. All the 12 DNAs had the A2047G mutation of 23S rRNA gene of B. pertussis.
CONCLUSIONS
This study described a pertussis outbreak caused by macrolide-resistant B. pertussis in a primary school and indicated that close contact of index case causes the bacterial transmission.
背景
2016 年 3 月，中国西安市的一所小学发生百日咳疫情。该校共有 536 名 6-12 岁的学生，分为 12 个班，每个年级 6 个班。确定的索引病例是五年级 2 班的 11 岁女孩。
方法
对五年级的 2 个班的所有学生（N=94）进行访谈并采集鼻咽拭子。鼻咽拭子均进行培养和聚合酶链反应（PCR）检测。
结果
在 94 名学生中，发现 4 例培养阳性和 17 例 PCR 阳性病例。2 班的感染率明显高于 1 班[37.0%（17/46）比 14.6%（7/48），χ²=4.26，P<0.05]。所有百日咳博德特氏菌分离株均对大环内酯类药物耐药，携带先前报道的 prn1/ptxP1/fim3-1，并属于多位点可变串联重复分析型 MLVA 195。17 例诊断性 PCR 阳性 DNA 中有 12 例也对 23S 核糖体 RNA PCR 阳性。12 个 DNA 均具有 23S rRNA 基因的 B. pertussis A2047G 突变。
结论
本研究描述了一起发生在小学的大环内酯类耐药的百日咳博德特氏菌引起的百日咳疫情，表明指数病例的密切接触导致了细菌传播。
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