AN EPIDEMIC OF PNEUMOCOCCAL DISEASE IN AN OVERCROWDED, INADEQUATELY VENTILATED JAIL
AN EPIDEMIC OF PNEUMOCOCCAL DISEASE IN AN OVERCROWDED, INADEQUATELY VENTILATED JAIL
复制标题
DOI：
10.1056/nejm199409083311004
复制
发表时间：
1994-09-08
影响因子：
158.5
通讯作者：
BREIMAN, RF
中科院分区：
文献类型：
--
作者：
HOGE, CW;REICHLER, MR;BREIMAN, RF
背景。在美国，许多惩教设施目前的运营人数远远超过其容量，其生活条件可能会导致呼吸道感染的爆发。我们调查了在休斯敦一所过度拥挤的监狱中发生的一次疫情，当时有两名囚犯在同一天死于肺炎球菌败血症。在抗生素时代，肺炎球菌疾病的爆发是罕见的。
方法。我们在病例对照研究和队列研究中评估了肺炎球菌疾病的风险因素。通过测量二氧化碳水平和流向监狱生活区的气流来评估通风情况。通过对随机抽取的囚犯的咽拭子标本进行培养来确定无症状感染的程度。用酶免疫测定法确定血清型特异性免疫。
结果。在四周的时间里，46名囚犯患有急性肺炎或由肺炎链球菌12F血清型引起的侵袭性肺炎球菌疾病。该监狱的容量设定为3500名囚犯，但在疫情爆发时容纳了6700人；囚犯的人均居住面积中位数仅为34平方英尺（3.2平方米）（四分位间距为28至56平方英尺[2.6至5.2平方米]）。人均居住面积为80平方英尺（7.4平方米）或更大的囚犯中，患病病例明显更少（P = 0.030）。二氧化碳水平在1100至2500 ppm之间（可接受的水平为……（此处英文原文似乎不完整））
Background. In the United States many correctional facilities now operate at far over capacity, with the potential for living conditions that permit outbreaks of respiratory infections. We investigated an outbreak that was identified in an overcrowded Houston jail after two inmates died of pneumococcal sepsis on the same day. Outbreaks of pneumococcal disease have been rare in the era of antibiotics.Methods. We assessed risk factors for pneumococcal disease in both a case-control and a cohort study. Ventilation was evaluated by measuring carbon dioxide levels and air flow to the living areas of the jail. The extent of asymptomatic infection was determined by culturing pharyngeal specimens from a random sample of inmates. Type-specific immunity was determined with an enzyme immunoassay.Results. Over a four-week period, 46 inmates had either acute pneumonia or invasive pneumococcal disease due to Streptococcus pneumoniae serotype 12F. The jail's capacity had been set at 3500 inmates, but it housed 6700 at the time of the outbreak; the inmates had a median living area of only 34 ft(2) (3.2 m(2)) (interquartile range, 28 to 56 ft(2) [2.6 to 5.2 m(2)]) per person. There were significantly fewer cases of disease among inmates with 80 ft(2) (7.4 m(2)) per person or more (P = 0.030). Carbon dioxide levels ranged from 1100 to 2500 ppm (acceptable,