北京市一起输入性皮肤炭疽疫情的快速调查与有效处置

Rapid investigation and effective management of an imported cutaneous anthrax outbreak in Beijing

  • 摘要: 目的 探讨非传染病医院应对输入性炭疽疫情的处置策略、暴露问题及改进方向,为提升类似疫情应对能力提供参考。方法 分析2024年北京市某非传染病医院处置2例输入性炭疽病例的诊疗、转诊、流行病学调查、密接管理及消毒等全流程。结果 疫情涉及2例内蒙古输入病例,1例为多型重症(肠炭疽、炭疽性脑膜炎、败血症炭疽及皮肤炭疽),于发病第8日死亡; 另1例为皮肤炭疽,经规范治疗后痊愈。通过快速响应,医院在发现患者皮肤特征性焦痂并追问流行病学史后立即启动应急响应,2 h内完成院内及辖区疾控中心上报,并申请专科会诊。共判定密切接触者31人,包括医务人员10人、同期就诊者21人,其中执行气管插管的2名医生被列为重点密接。所有密接均实施单间隔离医学观察14 d,医院环境终末规范消毒,本次疫情无续发病例及社区传播,未发生二代病例及医院感染。此次疫情暴露问题包括,早期识别困难、非专科医院诊断能力局限,医生依赖体征、忽视流调、专业知识储备不足。结论 本次疫情处置措施整体得当有效。非传染病医院需强化传染病早期识别能力、完善应急预案与演练、加强实验室建设与医防协同,以构建针对输入性、罕见传染病的"早发现、早报告、早诊断、早隔离、早治疗"防线。

     

    Abstract: OBJECTIVE To explore the disposal strategies, exposure issues and improvement directions for non-infectious disease hospitals in response to imported anthrax outbreaks, and to provide references for enhancing the ability to respond to similar outbreaks. METHODS A analysis was conducted on the entire process of diagnosis, treatment, referral, epidemiological investigation, close contact management and disinfection for two imported anthrax cases handled by a non-infectious disease hospital in Beijing in 2024. RESULTS The outbreak involved two imported cases from Inner Mongolia. One case was a multi-type severe case (intestinal anthrax, anthrax meningitis, septicemic anthrax and cutaneous anthrax), who died on the eighth day of onset. An other case was cutaneous anthrax, which was cured after standard treatment. Through rapid response, the hospital initiated an emergency response immediately after discovering the characteristic eschar on the patient's skin and inquiring about the epidemiological history. The hospital and the local disease control center reports were completed within 2 hours and specialist consultation was applied for. A total of 31 close contacts were identified, including 10 medical staff and 21 patients who visited the hospital during the same period. Among them, two doctors who performed tracheal intubation were listed as key close contacts. All close contacts were placed in single-room isolation for 14 days of medical observation, and the hospital environment was terminally disinfected according to standards. There were no subsequent cases or community transmission during this outbreak, and no secondary cases or hospital-associated infections occurred. The issues exposed in this outbreak included difficulties in early identification, limitations in diagnostic capabilities of non-specialized hospitals, doctors relying on physical signs, neglecting epidemiological investigations and insufficient professional knowledge reserves. CONCLUSIONS The disposal measures for this outbreak were overall appropriate and effective. Non-infectious disease hospitals need to strengthen early identification capabilities for infectious diseases, improve emergency response plans and drills, strengthen laboratory construction and medical-prevention coordination, and build a defense line for "early detection, early reporting, early diagnosis, early isolation and early treatment" against imported and rare infectious diseases.

     

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