中国公共卫生

2025年河南省一起肺炭疽疫情调查

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潘静静 , 李舒雯 , 陈琼丽 , 闫肃 , 李致远 , 李亚飞 , 张白帆 , 罗雪 , 王海峰 , 叶莹 , 黄学勇 , 郭万申 ^*^,^*

中国公共卫生 | 公共卫生案例 2026,42(4): 460-463

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中国公共卫生 |公共卫生案例 2026 , 42 (4) : 460 -463

2025年河南省一起肺炭疽疫情调查

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潘静静（1984—），副主任医师，硕士，研究方向：传染病控制

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潘静静（1984—），副主任医师，硕士，研究方向：传染病控制

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潘静静, 李舒雯, 陈琼丽, 闫肃, 李致远, 李亚飞, 张白帆, 罗雪, 王海峰, 叶莹, 黄学勇, 郭万申^*^,^*

作者信息

河南省疾病预防控制中心传染病预防控制所河南省传染病病原生物重点实验室，郑州 450000

通讯作者:

郭万申，E-mail：gwscdc@126.com

作者简介:

潘静静（1984—），副主任医师，硕士，研究方向：传染病控制

Epidemiological investigation of a pulmonary anthrax case in Henan province, 2025

Jingjing PAN, Shuwen LI, Qiongli CHEN, Su YAN, Zhiyuan LI, Yafei LI, Baifan ZHANG, Xue LUO, Haifeng WANG, Ying YE, Xueyong HUANG, Wanshen GUO

Affiliations

Institute of Infectious Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Pathogen Microbiology, Zhengzhou 450000, China

Corresponding Author:

GUO Wanshen, E-mail: gwscdc@126.com

出版时间: 2026-04-10 doi: 10.11847/zgggws1147582

文章导航

摘要

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目的

分析河南省一起肺炭疽疫情的感染来源和流行病学特征，为肺炭疽的防控提供科学依据。

方法

对河南省2025年1月报告的一起肺炭疽疫情进行现场流行病学调查及相关处置工作，同时采集病例及环境样本进行实验室检测。

结果

河南省此次疫情共报告肺炭疽病例1例，职业为农民，因参与宰杀羊只或在活羊交易市场活动中感染；早期症状为发热，后表现为突发气喘、呼吸困难、胸闷、头晕头痛和恶心等症状，肺组织和肺泡灌洗液经高通量基因测序均检出炭疽芽孢杆菌序列，炭疽杆菌核酸检测均为阳性，血清标本炭疽杆菌免疫球蛋白G（IgG）抗体阳性。病例经治疗后痊愈出院，密切接触者及风险人员均未出现相关临床症状，相关环境样本炭疽杆菌核酸检测结果均为阴性。

结论

河南省此次疫情为一起通过吸入感染的原发性肺炭疽偶发疫情，仅涉及1例病例，未发生续发病例；病例感染来源于羊，感染途径可能与宰杀或者在活羊交易市场活动有关。

关键词

肺炭疽 / 疫情 / 感染来源 / 炭疽杆菌 / 炭疽芽孢杆菌序列 / 炭疽毒素 / 河南省

Abstract

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Objective

To analyze the source of infection and epidemiological characteristics of a pulmonary anthrax case in Henan province, thus providing a scientific basis for the prevention and control of pulmonary anthrax.

Methods

A pulmonary anthrax case reported in Henan province in January 2025 was investigated on site, with standard control measures implemented. Samples were collected from the patient and the environment for laboratory testing.

Results

In this outbreak in Henan province, one case of pulmonary anthrax was reported. The patient, whose occupation was a farmer, was infected due to participating in sheep slaughtering or activities in a live sheep trading market. The early symptom was fever, followed by sudden asthma, difficulty in breathing, chest tightness, dizziness, headache, nausea and other symptoms. High-throughput gene sequencing of the lung tissue and alveolar lavage fluid both detected sequences of Bacillus anthracis, and the nucleic acid test for B. anthracis was positive. The serum sample tested positive for B. anthracis IgG antibody. The patient was cured and discharged after treatment. No relevant symptoms appeared in close contacts or at-risk personnel, and the nucleic acid test results for B. anthracis in relevant environmental samples were all negative.

Conclusions

This outbreak in Henan province is an incidental case of pulmonary anthrax caused by inhalation. The source of infection is sheep, with potential routes of infection involving slaughtering activities or exposure at the live sheep market.

Key words

pulmonary anthrax / outbreak / infection sources / Bacillus anthracis / Bacillus anthracis sequence / anthrax toxin / Henan province

引用本文

潘静静, 李舒雯, 陈琼丽, 闫肃, 李致远, 李亚飞, 张白帆, 罗雪, 王海峰, 叶莹, 黄学勇, 郭万申. 2025年河南省一起肺炭疽疫情调查. 中国公共卫生, 2026 , 42 (4) : 460 -463 . DOI: 10.11847/zgggws1147582

Jingjing PAN, Shuwen LI, Qiongli CHEN, Su YAN, Zhiyuan LI, Yafei LI, Baifan ZHANG, Xue LUO, Haifeng WANG, Ying YE, Xueyong HUANG, Wanshen GUO. Epidemiological investigation of a pulmonary anthrax case in Henan province, 2025[J]. Chinese Journal of Public Health, 2026 , 42 (4) : 460 -463 . DOI: 10.11847/zgggws1147582

正文

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炭疽是《中华人民共和国传染病防治法》^[1]中规定的乙类传染病，由炭疽芽孢杆菌感染引起，其病原体是一种能形成芽孢的革兰氏阳性菌，主要毒力因子为荚膜多肽和炭疽毒素，后者由保护性抗原（protective antigen, PA）、水肿因子（edema factor, EF）和致死因子（lethal factor, LF）组成^[2]。这些毒素共同作用导致宿主细胞内环磷酸腺苷（cyclic adenosine monophosphate, cAMP）水平升高，抑制免疫反应，并最终引起组织水肿和坏死等病变^[3]。炭疽杆菌在干燥环境中可以形成芽孢存活数年至上百年，持续污染地方土壤和植被，形成疫区^[4]。牛羊通过误食被感染的草或饮低洼处积水而发病，进而感染与病畜或其制品接触的人类^[5]。皮肤炭疽是最常见的临床类型，炭疽杆菌通过皮肤黏膜接触或破损皮肤侵入引起感染^[6–7]，若吸入含有病原体的气溶胶，有可能引起肺炭疽，肺炭疽虽然较为少见，但其病情危重，病死率高，初期表现为流感样症状，随后迅速发生急性呼吸窘迫综合征、低氧血症和发绀等症状，病情进展快，常在24 h内导致死亡^[8]。在中国，炭疽常发生在广大农牧区，自20世纪90年代以来发病率持续下降，近年来又有所上升，但总体水平较低且以散发为主^[9–11]。2025年1月，河南省郑州市航空港经济综合实验区报告一起肺炭疽疫情，为河南省自1956年开展炭疽监测以来的首起肺炭疽疫情，为查明疫情发生原因、掌握肺炭疽流行特点、控制疫情传播，省、市、区疾病预防控制中心、公安、农业等有关部门联合开展调查处置工作。现将追踪调查结果报告如下。

1　疫情回顾

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1.1　病例发现和报告

2025年1月8日，河南省人民医院以“肺占位：感染？肿瘤？”收治入院1例病例，该患者年龄52岁，女，汉族，农民，自述4年前被诊断患布鲁氏菌病，目前已痊愈；患高血压7年、甲状腺功能亢进5年。1月12日，河南省人民医院对该病例1月10日采集的肺组织和肺泡灌洗液进行高通量基因测序，发现炭疽芽孢杆菌序列，当日核酸检测结果阳性，1月12日23:03，河南省人民医院报告肺炭疽临床诊断病例；1月13日，郑州市航空港经济综合实验区疾病预防控制中心报告肺炭疽单病例突发公共卫生事件；1月15日，病例血清免疫球蛋白G（Immunoglobulin G, IgG）抗体检测阳性，1月15日8:14，河南省人民医院订正报告为肺炭疽确诊病例。

1.2　病例发病和诊疗经过

病例于2024年12月21日发病，表现为发热，体温38 ℃，自行前往A乡B村卫生室就诊，给予静脉注射头孢呋辛和退热药物后体温恢复正常；12月24日突发气喘、呼吸困难、胸闷、头晕头痛和恶心等症状，无皮肤病变，到开封市尉氏县中医院就诊，以“肺炎”诊断入院，胸部计算机断层扫描（computed tomography, CT）检查结果提示右肺可疑占位，考虑“肺恶性肿瘤”；12月27日转入河南省肿瘤医院，病理检查均未发现恶性肿瘤细胞，血常规提示白细胞升高（30.38×10⁹/L），考虑“肺部感染”，2024年12月27日—2025年1月8日，给予盐酸莫西沙星氯化钠注射液和头孢哌酮舒巴坦钠氯化钠注射液治疗；2025年1月8日转入河南省人民医院，给予哌拉西林他唑巴坦抗感染治疗；1月9日，血常规提示白细胞正常（5.88×10⁹/L）；1月12日，病例肺组织高通量基因测序检出炭疽芽孢杆菌序列，由120负压救护车转送至郑州市第六人民医院（传染病医院）呼吸/内科重症监护室负压病房，给予莫西沙星注射液、注射用美罗培南和利奈唑胺片抗感染治疗，病例病情不断好转，于1月22日治愈出院。

2　实验室检测

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2.1　样本采集及检测

为核实诊断，2025年1月10日，河南省人民医院采集病例肺组织和肺泡灌洗液；1月12日，由河南省人民医院医学遗传研究所对上述样本进行高通量基因测序和炭疽核酸检测；1月12日，河南省人民医院采集病例咽拭子和血清样本，由郑州市疾病预防控制中心进行炭疽核酸检测及抗体检测；1月13日，河南省人民医院采集病例全血样本，由郑州市疾病预防控制中心进行核酸检测，同时郑州市疾病预防控制中心对1月10日采集的肺泡灌洗液进行染色镜检；1月14日，河南省疾病预防控制中心对1月12日河南省人民医院采集的血清样本再次进行抗体检测；1月17日和20日，分别采集病例深痰液和血液进行炭疽杆菌培养和核酸检测。

2.2　实验室检测结果

2025年1月12日病例肺组织和肺泡灌洗液经高通量基因测序均检出炭疽芽孢杆菌序列，炭疽核酸检测均为阳性，荧光定量聚合酶链式反应循环阈值（cycle threshold value, Ct）均为32；1月14日，抗体检测IgG抗体阳性。其余检测结果均为阴性。

3　流行病学调查

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3.1　感染来源及暴露史调查

距病例家500 m处有某活羊交易市场，病例常带孙女在活羊市场逗留与羊玩耍。2024年12月11日，病例丈夫去另一乡多个村收购多只活羊，后在本村活羊市场贩卖，留其中1只30斤左右的小羊在自家院中宰杀，丈夫主刀，病例主要参与处理内脏，并用扫帚进行地面血水和垃圾清扫。宰羊前后皮肤均无开放性伤口，宰杀结束后未及时清洁双手，整个宰杀加工环节未佩戴口罩和手套。调查时该羊相关的标本已无法获得。

3.2　环境调查

病例居住村庄常住居民90余户，共500余人。该村及周边村庄大部分村民从事活羊交易生意，村内共有3个活羊交易市场，卫生条件较差，道路扬尘较多。病例家庭为一独院，三层楼房，有独立卫生间、厨房，家中未饲养任何动物，家中卫生状况良好，地面为硬质水泥地，血水不易渗透。近期该乡未发现牛、羊等动物异常死亡情况，既往该村及周边村未报告人间和畜间炭疽疫情。为排查受污环境，郑州市航空港经济综合实验区疾病预防控制中心、金水区疾病预防控制中心和开封市疾病预防控制中心对各自辖区内的涉疫环境进行采样并进行炭疽杆菌核酸检测。共采集环境样本94份，包括病例家31份、某活羊市场4份、郑州市六院5份、河南省人民医院2份、河南省肿瘤医院19份、尉氏县中医院23份、病例宰杀羊只可疑来源养殖户10份。

3.3　密切接触者调查

参照《WS 283—2020 炭疽诊断》^[12]，通过询问病例本人、家属、医务人员和查看相关记录等方式进行密切接触者调查；判断密切接触者包括病例家属、病例诊疗期间接触的医护人员、同病房患者及其陪护者。共排查密切接触者71人、风险人员42人，合计113人。涉及郑州、开封、周口、商丘和驻马店5个地市。53人与病例最近的接触时间已>14 d，不予采取措施；60人需进行管控，其中47名密切接触者进行居家或集中隔离、预防服药，13名风险人员进行健康监测。

3.4　溯源分析

病例经常经过的活羊交易市场仅交易活羊，无其他家畜交易。病例在潜伏期内仅参与羊只宰杀，未接触其他牲畜。宰杀过程中清扫血水和冲刷地面可能产生气溶胶，市场土质地面出现的扬尘也可能产生气溶胶，加之病例接触这些气溶胶时均无防护措施。由此判断，病例感染来源为羊，感染途径可能与宰杀或者在活羊交易市场活动有关。病例所宰杀羊只为从周边散养户收购，通过重走收购路线回忆可疑来源为航空港经济综合实验区另一乡2家养殖户，但此2家养殖户家中均无病死羊情况且相关人员无异常症状；病例家庭宰羊环境、参与宰杀和食用的家人、养殖户人员及环境样本检测结果均为阴性；活羊交易市场的羊来源广泛，既有本土羊只，也有外地贩运羊只，市场环境样本检测结果亦为阴性。因此，不能明确病例的感染来源和可疑羊只的来源。

3.5　防控措施

将病例转入传染病医院隔离病房进行单间隔离，集中优质医疗资源，加强病例救治；对病例及其家属进行深入个案流调和现场卫生学调查，详细了解流行病学史；对密切接触者和风险人员进行深入排查、搜索，对密切接触者实施集中或居家隔离、预防性服药，对风险人员进行健康监测，对涉及外地市的风险人员发送协查；省、市、县联合调查处置，启动联防联控机制，联合公安和农业相关部门共同进行溯源调查，排查全区牛羊病死情况；对病例家庭、下水道、活羊市场、医疗机构、相关车辆等环境进行消毒；对病例所在村居民开展健康教育，宣传炭疽防控知识，提高居民防病能力，对活羊交易从业人员进行健康教育，提示做好防护，出现异常及时就诊；启动应急监测和病例搜索，未发现其他炭疽疑似病例；关注舆情动态，对公众进行正面引导，避免恐慌，未发生舆情事件；对各个疫点的防控措施落实情况进行专项督导，及时查漏补缺，杜绝防控漏洞。

4　讨　论

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根据流行病学调查、临床表现和实验室检测结果，综合判断河南省该起疫情为一起通过吸入感染的肺炭疽偶发疫情，仅涉及1例病例。根据调查结果判断病例感染来源为羊，但由于病例发现距离发病时间较长，未能明确具体感染来源。在中国，炭疽主要发生于西北和西南地区^[11,13–15]，河南省虽不是炭疽的高发地区，但交通发达，拥有庞大的人口基数和相对发达的畜牧业，有大量职业人群，尤其在农村^[16]，居民接触家畜及相关副产品机会较大，增加了炭疽的感染风险。

肺炭疽病例早期症状不典型，类似于感冒等常见呼吸道疾病，一旦错过诊疗时机就会迅速发展，并累及患者生命^[17–18]。本例病例为河南省自1956年开展炭疽监测以来首例肺炭疽病例，医疗机构普遍缺乏对肺炭疽的鉴别与诊断经验，病例先后就诊于多个层级的医疗机构，影像学表现类似于肿瘤。因此，早期被误诊为一般呼吸道感染和肺部肿瘤，自发病到诊断历时23 d。疫情涉及密切接触者和风险人员较多，但未出现续发病例。分析原因：一方面是疾病预防控制中心迅速响应，第一时间组织专业人员赶赴各个涉疫现场，同步开展疫情调查和防控工作，进行有效干预和控制措施；组织密切接触者集中或居家隔离、预防性服药，对风险人员进行健康观察；另一方面是医疗机构在未明确病原时根据病例特征及时给予抗感染治疗，控制病程发展。此外，病例主要为下呼吸道症状，肺泡灌洗液和肺组织为血性，但几乎无咳嗽、咳痰症状，咽部未检出核酸阳性，降低了进一步传播的风险。

一般认为，肺炭疽易发生于与羊毛、骨粉等农畜牧产品接触较多的职业人群中^[8]。而在本起疫情中，病例由于参与单次羊只宰杀或在活羊交易市场活动而发病。病例所在村庄道路和活羊交易市场地面尘土堆积，极易产生扬尘，增加了产生炭疽芽孢杆菌气溶胶的可能。扬尘造成肺炭疽发病并非偶然，在Griffith J等^[19]研究中，一名61岁的美国佛罗里达州居民在自驾旅行中驾车穿过野牛和驴群，接触飞扬尘土，3 d后因肺炭疽发作入院治疗，但从患者车辆、物品和车库等环境中采集的65份样本检测结果均为阴性。在Azarkar Z等^[20]研究中，一位伊朗东南部农村地区的65岁盲人在未能发现特定感染源的情况下患肺炭疽死亡，推测是通过接触受污染的空气尘埃或未知的污染物品而感染。以上研究结果均提示，肺炭疽的传播更具有偶然性，感染方式更加多样且隐匿，这对肺炭疽的防控和诊断具有重要意义。

在此次疫情处置过程中，疾控相关部门严格按照甲类传染病要求及时响应并采取果断措施；对密切接触者和风险人员进行判定和防控，并深入开展流行病学调查溯源，严密排查风险点位；成功救治病例，未出现续发病例、未造成医院感染、未形成负面舆论。对本次肺炭疽疫情调查处置工作进行回顾和总结，有以下经验和启示：一是高通量基因测序对疫情发现起到重要作用；二是联动合作提高了疫情处置的效率，省内各级、各区域防控部门相互配合，多组、多地、多场所同时调查；疾控监督员在疫情处置和措施落实方面发挥作用，在医防融合方面取得明显效果。同时，也暴露出了亟待思考和解决的问题：一是农村地区居民和养殖户对炭疽病知识了解甚少，缺乏必要的健康防护知识和法律意识，牲畜市场管理不严格；二是医疗机构对肺炭疽的关注度、认识程度和诊断能力不足，病例经历多次转诊后才得以确诊，增加了调查处理的复杂性和难度；三是炭疽现行诊疗标准《WS 283—2020 炭疽诊断》^[12]和诊疗方案《炭疽诊疗方案（2023年版）》^[21]中关于诊断标准不统一，对密切接触者的管理要求也不一致，对检测试剂没有明确的品牌要求，市面上销售的抗体检测试剂灵敏度存在差异，这些均给病例诊断和疫情控制造成不便和影响；四是溯源不成功可能造成污染的环境未被发现和消毒，可能为后续疫情埋下隐患。

综上所述，为有效应对此类炭疽疫情，建议充分发挥政府的主导作用，加强多部门联防联控，加强源头管控，规范相关牛羊市场的管理；加强医防融合，提高医疗机构对罕见传染病的识别诊断能力。应注意肺炭疽与呼吸道常见感染及肺部肿瘤相鉴别；加大健康教育，增强公众尤其是农村地区职业相关人群对炭疽的知晓和防控水平；在国家层面制定统一的诊断标准和密切接触者管理标准，并促进抗体检测试剂的研发应用。

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2026年第42卷第4期

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doi: 10.11847/zgggws1147582

接收时间：2025-04-01
首发时间：2026-10-23
出版时间：2026-04-10

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收稿日期：2025-04-01
修回日期：2025-07-12
录用日期：2025-10-09

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河南省疾病预防控制中心传染病预防控制所河南省传染病病原生物重点实验室，郑州 450000

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郭万申，E-mail：gwscdc@126.com

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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