一起医疗机构环境新型冠状病毒核酸阳性事件溯源调查分析

岳勇; 陈恒; 冯静; 吕天萍; 田汶佳; 赵辰路; 廖骏; 胡敏; 李君钒; 程悦; 刘辉; 刘竹

doi:10.16462/j.cnki.zhjbkz.2022.02.020

一起医疗机构环境新型冠状病毒核酸阳性事件溯源调查分析

doi: 10.16462/j.cnki.zhjbkz.2022.02.020

岳勇^{1, 2},
陈恒^{1, 2},
冯静^{1, 2},
吕天萍³,
田汶佳²,
赵辰路^{1, 2},
廖骏²,
胡敏^{1, 2},
李君钒²,
程悦^{1, 2},
刘辉²,
刘竹^{1, 2, ,}

1.
610000 成都，中国医学科学院成都新发突发传染病防治工作站
2.
610000 成都，成都市疾病预防控制中心
3.
610000 成都，成都市双流区疾病预防控制中心

基金项目:

中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助 2020-PT330-005

成都市科技局重点研发支撑计划技术创新研发项目 2020-YF05-00133-SN

详细信息

通讯作者:
刘竹, E-mail: 137949813@qq.com

中图分类号: R184.1
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- 文章访问数: 536
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-04
- 修回日期: 2021-07-22
- 网络出版日期: 2022-02-10
- 刊出日期: 2022-02-10

Source-tracing investigation and analysis of a case of nucleic acid detection of 2019 Novel Corona Virus positive environmental samples in a medical institution

YUE Yong^{1, 2},
CHEN Heng^{1, 2},
FENG Jing^{1, 2},
LYU Tian-ping³,
TIAN Wen-jia²,
ZHAO Chen-lu^{1, 2},
LIAO Jun²,
HU Min^{1, 2},
LI Jun-fan²,
CHENG Yue^{1, 2},
LIU Hui²,
LIU Zhu^{1, 2
, ,}

1.
Chengdu Workstation for Emerging Infectious Disease Control and Prevention, Chinese Academy of Medical Sciences, Chengdu 610000, China
2.
Chengdu Center for Disease Control and Prevention, Chengdu 610000, China
3.
Shuangliu District for Disease Control and Prevention, Chengdu 610000, China

Funds:

Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences 2020-PT330-005

Chengdu Municipal Science and Technology Bureau Key R & D Support Program Technology Innovation R & D Project 2020-YF05-00133-SN

More Information

Corresponding author: Liu Zhu, E-mail: 137949813@qq.com

摘要

摘要: 目的针对成都市一起医疗机构环境SARS-CoV-2核酸检测阳性事件，开展溯源调查并分析发生原因，探讨医疗机构环境SARS-CoV-2核酸监测模式及异常处置方案。方法成都市和双流区疾病预防控制中心联合开展针对A医疗机构的调查，通过对A医疗机构相关影响因素进行流行病学调查，并采用SARS-CoV-2核酸检测试剂盒进行检测、开展二代测序检测溯源。结果 2021年1月18日―2021年1月20日A医疗机构采集环境标本62份，检出SARS-CoV-2核酸阳性标本30份(48.39%，30/62)。30份阳性标本根据采样地点分为公卫楼(9份)和综合楼(21份)，公卫楼标本的ORF1ab基因Ct值低于综合楼，差异有统计学意义(t=2.452, P=0.036)；根据标本性质分为外环境涂抹样(24份)和清洁工具涂抹样(6份)，外环境涂抹样的N基因Ct值低于清洁工具涂抹样，差异有统计学意义(Z=-2.204, P=0.028)。经基因测序分析，本次检出的SARS-CoV-2核酸阳性环境标本序列与SARS-CoV-2疫苗高度同源(＞99.9%)。结论本次A医疗机构的SARS-CoV-2核酸环境阳性是由于SARS-CoV-2疫苗接种过程中疫苗安瓿瓶破损，导致公卫楼接种室被污染，再经由清洁工人通过清洁工具扩散至发热门诊及综合楼等院内环境。随着SARS-CoV-2疫苗接种工作推进，医疗机构接种区域疫苗液环境污染发生概率大，因此需细化具体实施方案，科学有序开展疫苗接种，减少社会影响。
- 新型冠状病毒 /
- 环境核酸阳性 /
- 疫苗 /
- 溯源调查
Abstract: Objective This study is conducted against a case of positive nucleic acid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of environmental samples in a medical institution in Chengdu. Epidemiological investigation methods and laboratory tests are used to investigate the source and analyze the cause of the case, to explore the nucleic acid monitoring mode and the disposal scheme of abnormal conditions of SARS-CoV-2 in the medical institution environment. Methods Chengdu and Shuangliu district CDC jointly investigate A Medical Institution (A refers to a specific anonymous medical institute). Epidemiological surveys were conducted though related influencing factors of the medical institution. SARS-CoV-2 nucleic acid detection kits were used for detection. Sequencing was carried out on a second-generation sequencing platform. Results From Jan.18th 2021 to Jan.20th 2021, a total of 62 smear samples of environment and articles were collected, among which 30 samples were positive for SARS-CoV-2 nucleic acid. 30 positive samples were divided into Gongwei building (9) and Zhonghe building (21) according to the sampling location. The samples' Ct values of ORF1ab gene in Gongwei building were lower than that in Zhonghe building, and the difference was statistically significant (t=2.452, P=0.036). According to the nature of the specimens, they were divided into external environment smear samples (24 samples) and cleaning tool smear samples (6 samples). The N gene Ct values of external environment smear samples were lower than that of cleaning tools, and the difference was statistically significant (Z=-2.204, P=0.028). Through gene sequencing analysis, the sequence of SARS-CoV-2 nucleic acid positive environmental samples detected this time is highly homologous with SARS-CoV-2 vaccine (> 99.9%). Conclusions The positive environmental samples of SARS-CoV-2 nucleic acid in the medical institution are caused by the damage and leakage of COVID-19 vaccine ampoules in the process of vaccination, which led to the contamination of the vaccination room of public health building, and then transmit to the hospital environment of fever clinic and complex building through cleaning tools by cleaning workers. With the progress of COVID-19 vaccine vaccination, there is a high probability of environmental pollution of vaccine liquid in the vaccination area of medical institutions. Therefore, it is necessary in combination with the current normalization monitoring requirements of domestic COVID-19 epidemic situation to refine the specific implementation plan, conduct vaccination in a scientific and orderly manner, and reduce the social impact.
- SARS-CoV-2 /
- Environment nucleic acid positive /
- Vaccine /
- Traceability survey

HTML全文

图 1 A医疗机构环境SARS-CoV-2核酸阳性采样点分布示意图

Figure 1. A Medical Institution's environment COVID-19 nucleic acid positive sampling sites distribution schematic diagram

下载: 全尺寸图片幻灯片

图 2 A医疗机构SARS-CoV-2核酸阳性标本ORF1ab/N基因Ct值比较

Figure 2. Comparison of ORF1ab/N gene Ct values of SARS-CoV-2 nucleic acid-positive positive specimens in A Medical Institution

下载: 全尺寸图片幻灯片

图 3 A医疗机构环境样本与武汉市、成都市本地及近期境外毒株进化树对比

Figure 3. Comparison phylogenetic trees of A Medical Institutions' environmental samples, local and recent foreign viral strains of Wuhan and Chengdu

下载: 全尺寸图片幻灯片

表 1 A医疗机构不同SARS-CoV-2核酸阳性标本ORF1ab/N基因Ct值比较

Table 1. Comparison of ORF1ab/N gene Ct values of SARS-CoV-2 nucleic acid-positive positive specimens in A Medical Institution

分组		N	ORF1ab基因Ct值	t/Z值	P值	N基因Ct值	t/Z值	P值
阳性地点^#				2.452	0.036	1.965	0.08
	非公卫楼	21	39.17±1.97			36.96±1.99
	公卫楼	9	35.17±4.73			33.78±4.68
样本性质^*	外环境	24	38.71(36.17, 39.59)	-1.867	0.062	36.46(34.22, 37.93)	-2.204	0.028
M(IQR)	清洁工具	6	40.51(38.06, 41.54)			37.84(37.1, 38.57)
注：^#表示数据符合正态分布，^*表示数据符合偏态分布。

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