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北九州市の幼稚園の運動会に関連して発生したシゲラ症
A shigellosis outbreak associated with a sports festival at a kindergarten in Kitakyushu City, Japan.
PMID: 32624341 DOI: 10.1016/j.jiac.2020.06.005.
抄録
序論:
近年，日本ではシゲラ症の患者数は徐々に減少しているが，保育施設では土着のシゲラ症が発生することがある．全国のサーベイランスデータから幼稚園を対象としたシゲラ症の発生を確認した．
INTRODUCTION: Shigellosis cases have decreased gradually in Japan in recent years, but indigenous shigellosis outbreaks sometimes occur in childcare facilities. From national surveillance data, we identified a shigellosis outbreak involving a kindergarten.
方法:
北九州市でShigella sonneiを検出した後、幼稚園Zでは便検体採取や聞き取り調査など積極的な症例発見と疫学調査を行った。便検体を培養し，分離された菌株をパルスフィールドゲル電気泳動法（PFGE）および多座可変数タンデムリピート法（MLVA）で解析した．
METHODS: After detecting Shigella sonnei in Kitakyushu City, we conducted active case finding and epidemiological investigation in Kindergarten Z, including stool specimen collection and interviews. The stool specimens were cultured, and isolated strains were subjected to pulsed-field gel electrophoresis (PFGE) and multiple-locus variable-number tandem-repeat analysis (MLVA).
結果:
2014年9月1日から12月31日までの間に19例を確認した。確定14例、疑われる2例、無症状3例であった。19例のうち、疫学的には16例が幼稚園Zに関連していた（園児10名、家族5名、先生1名）。10月19日、幼稚園の運動会に胃腸疾患を持つ園児が参加し、園児は赤組と白組に分かれて赤組に所属していたが、この園児は白組に所属していた。発症率は赤組が8％（7/82），白組が0％（0/108）であった（相対リスクは10.5，95％信頼区間は1.3-82.1）．PFGEパターンは17例すべての分離株で同一または類似であった；7株は同一であり，その他の分離株はMLVAで1つの遺伝子座の違いを有していた．
RESULTS: Between September 1 and December 31, 2014, we identified 19 cases: 14 confirmed, 2 suspected, and 3 asymptomatic. Of the 19 cases, 16 were epidemiologically associated with Kindergarten Z (10 pupils, 5 family members, and 1 teacher). On October 19, a pupil with gastrointestinal illness participated in the kindergarten's sports festival, in which the pupils were split into "red" and "white" teams; the pupil in question belonged to the red team. Attack rates of the red and white teams were 8% (7/82) and 0% (0/108), respectively (relative risk, 10.5; 95% confidence interval, 1.3-82.1). PFGE patterns were identical or similar for the isolates in all 17 cases; 7 isolates were identical, and the others had one locus difference on MLVA.
結論:
感染源は特定できなかったが、運動会中の接触が幼稚園での感染拡大の原因となった可能性があると結論づけた。症状のある園児は運動会などの活動に参加しないようにすることが重要である。
CONCLUSIONS: We concluded that contact during the sports festival could have been responsible for spread of the shigellosis outbreak at the kindergarten, although the infection source was not determined. It is vital to inform guardians immediately after detection of shigellosis cases that symptomatic pupils should not participate in activities such as sports festivals.
Copyright © 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.