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1.
Background
An outbreak of pandemic Influenza H1N1 occurred from 13 Feb to 20 Feb 2010 in a residential school at Belgaum, India.Methods
On report of sudden increase in number of students reporting sick with symptoms suggestive of flu like illness, an investigation was launched to detect the source of infection and to control the spread of infection amongst those not affected. Six random samples of throat from the initial cluster were collected and RT-PCR was done to confirm the diagnosis. The outbreak in this institution was effectively controlled by standard preventive & control measures in the absence of vaccine.Result
In a school of 335 children, 96 cases of Influenza like illness possibly resulting from pH1N1 (2009) were reported with an attack rate of 28.6%. Out of a total of 96 cases reported, 73 (76%) were hospitalized and 23 treated as outdoor patients. Serogroup A of Influenza H1N1 pandemic was identified to be the agent responsible for this outbreak as 06 random samples drawn from initial cluster tested positive on RT-PCR. A visit to an exhibition in the city was possibly the source of exposure amongst the children.Conclusion
An outbreak of Influenza H1N1 infection amongst students in a residential public School was found to be linked to a visit to an exhibition following which the secondary transmission led to further occurrence of cases. 相似文献2.
Background
In April 2009, Mexican health authorities announced an outbreak of a novel H1N1 influenza virus, which subsequently caused a pandemic. The world is now moving into the post-pandemic period. The experience gained in handling this pandemic at various levels under different settings has provided us many lessons for the future.Objective
To study the profile of various activities undertaken at flu screening centre as a response to pandemic influenza in a tertiary care hospital.Methods
Record-based study conducted in a tertiary care hospital of Pune. Required data was collected from records of flu OPD, ward and local health authority and interviewing related staff. Study included data from October 2009 to October 2010.Results
A total of 8020 people presenting with influenza like illness (ILI) were screened in the flu OPD under study. Out of these, only 388 (4.84%) met clinical criteria where throat samples were collected, out of which only 81 were found to be positive (20.88%). Total three fatalities (3.7%) occurred out of 81 who had tested positive. Most cases of flu were managed at home (76.54%) while only 19 (23.4%) lab confirmed cases of H1N1 required hospitalisation.Conclusion
Majority of cases of H1N1 (2009) were managed at home. Early diagnosis, quick initiation of treatment, infection control measures, and good care at the hospital can effectively reduce morbidity and mortality in H1N1 pandemic. 相似文献3.
Huey-Ling You Chao-Chun Huang Chung-Jen Chen Cheng-Chin Chang Pei-Lin Liao Sheng-Teng Huang 《Journal of the Chinese Medical Association》2018,81(5):458-468
Background
The pandemic influenza A (H1N1) virus has spread worldwide and infected a large proportion of the human population. Discovery of new and effective drugs for the treatment of influenza is a crucial issue for the global medical community. According to our previous study, TSL-1, a fraction of the aqueous extract from the tender leaf of Toonasinensis, has demonstrated antiviral activities against pandemic influenza A (H1N1) through the down-regulation of adhesion molecules and chemokine to prevent viral attachment.Methods
The aim of the present study was to identify the active compounds in TSL-1 which exert anti-influenza A (H1N1) virus effects. XTT assay was used to detect the cell viability. Meanwhile, the inhibitory effect on the pandemic influenza A (H1N1) virus was analyzed by observing plaque formation, qRT-PCR, neuraminidase activity, and immunofluorescence staining of influenza A-specific glycoprotein.Results
Both catechin and gallic acid were found to be potent inhibitors in terms of influenza virus mRNA replication and MDCK plaque formation. Additionally, both compounds inhibited neuraminidase activities and viral glycoprotein. The 50% effective inhibition concentration (EC50) of catechin and gallic acid for the influenza A (H1N1) virus were 18.4 μg/mL and 2.6 μg/mL, respectively; whereas the 50% cytotoxic concentrations (CC50) of catechin and gallic acid were >100 μg/mL and 22.1 μg/mL, respectively. Thus, the selectivity indexes (SI) of catechin and gallic acid were >5.6 and 22.1, respectively.Conclusion
The present study demonstrates that catechin might be a safe reagent for long-term use to prevent influenza A (H1N1) virus infection; whereas gallic acid might be a sensitive reagent to inhibit influenza virus infection. We conclude that these two phyto-chemicals in TSL-1 are responsible for exerting anti-pandemic influenza A (H1N1) virus effects. 相似文献4.
Use of immunization as strategy for outbreak control of varicella zoster in an institutional setting
V.K. Bhatti Lee Budhathoki Mahadevan Kumar Gurpreet Singh Amol Nath Maj Gen Velu Nair 《Medical Journal Armed Forces India》2014
Background
Outbreaks of varicella gets reported often in India. However, outbreak in health care providers living in closed institutional setting and role of vaccination as post exposure prophylaxis for control of outbreak has not been studied extensively. This paper presents epidemiological investigation and control strategy undertaken in such scenario.Methods
This is an epidemiological investigation of chickenpox in nursing students which highlights role of early identification and appropriate control strategy to prevent explosive outbreak in high risk vulnerable population. Vaccination of all susceptible in addition to isolation of cases, quarantine of suspects and proper screening for new cases was the major control strategy adopted.Results
The index case was imported and all eight cases occurred within the incubation period of the case. Two cases occurred in students previously vaccinated for chickenpox. No second or third wave of infection occurred showing vaccination as effective tool in outbreak control strategy.Conclusion
Early identification of cases and vaccination of all susceptible contributed to effective control of the outbreak. 相似文献5.
Background
Rotavirus is a common cause of diarrhea in children. There is a need for data on prevalence of rotavirus diarrhea especially in our setting. This study was carried out to determine the prevalence of rotavirus infection in children upto two years presenting with diarrhea and to ascertain factors associated with rotavirus infection in them.Methods
A cross sectional observational study was carried out to determine the prevalence of rotavirus infection amongst children less than 2 years presenting with diarrhea. The clinical profile of the children was analyzed along with detection of rotavirus antigen in stool.Results
A total of 250 children with diarrhea were included in the study. The Male: Female ratio was 0.97:1. We found 24% children presenting with diarrhea to be positive for rotavirus antigen. 78.3% of children with rotaviral diarrhea were in the age group of 6–15 months. There was a significant association between type of feeding and rotavirus diarrhea with reduced prevalence while on exclusive breast-feeding. Though only 10.4% of children with rotavirus diarrhea had severe dehydration, 61.5% of children with severe dehydration were positive for rotavirus.Conclusion
Rotavirus diarrhea caused substantial morbidity in our study population. The rotavirus positivity in these children was 24% and there was a significant association of rotavirus infection with type of feeding and severity of dehydration. 相似文献6.
Sourav Sen Shakti Prasad Panda K Shanmuganandan RM Gupta AK Praharaj 《Medical Journal Armed Forces India》2012
Background
The diagnosis of hepatitis B is routinely based on the detection of hepatitis B surface antigen (HBsAg) only. However, occult hepatitis B virus (HBV) infection (OBI), which is defined as infection with positive hepatitis B core antibody (anti-HBc) antibodies, positive DNA (deoxyribonucleic acid) PCR (polymerase chain reaction), and undetectable HBsAg, as well as anti-HBs antibodies in serum or plasma of HBV infected individuals, will remain undetected using this screening diagnostic approach of detecting HBsAg. The current study aims in studying the prevalence of the OBI amongst human immunodeficiency virus type 1 (HIV-1) infected individuals who have not been exposed to anti-retroviral therapy.Method
Estimation of HBsAg, anti-HBs, and anti-HBc total antibody status amongst 100 HIV-1 infected study participants was carried out using enzyme-linked immunosorbent assay (ELISA) kits. Detection of HBV-DNA was carried out by in-house qualitative PCR. CD4 + T lymphocyte counts were analysed using Becton Dickinson's (BD) FACSCount™ system.Results
The median age of the HIV-1 infected study population was 35 years (range: 22–67), with the gender distribution being 53 males and 47 females. The mean CD4 T lymphocyte count of the study participants was 210/mm3. Overall, serological evidence of HBV infection was observed in 28% of the HIV-1 infected study participants. There was 5% seropositivity for HBsAg, of which 2% were additionally positive for HBV-DNA-PCR. “Anti-HBc alone” status was seen in 18% of study participants, this being statistically higher in those with CD4 T lymphocyte counts < 200/mm3. While there was a single specimen with co-positivity for anti-HBc total antibodies and HBV-DNA, 5% of the in the study population exhibited anti-HBs antibodies positivity, with one sample exhibiting dual positivity for HBsAg and anti-HBs antibodies.Conclusion
Occult HBV infections may contribute to chronic liver damage, and associ-ated reactivation amongst immunocompromised individuals, HIV-1 in-fected being a subset of them. “Anti-HBc” testing followed by HBV-DNA detection by PCR can be utilised for such populations to detect OBIs. Early detection of hepatitis B viraemia will be important for deciding the antiviral therapeutic protocol so as to avoid evolution of antiviral resistance in the circulating HBV strains in HIV-1 infected individuals harbouring OBIs. 相似文献7.
K.R. Rathi M.M. Arora K. Sahai S. Tripathi S.P. Singh D.K. Raman K.B. Anand 《Medical Journal Armed Forces India》2013
Background
During recent outbreak of dengue fever in Delhi, there has been a significant increase in dengue-associated admission in hospitals. To better understand the pathology of dengue haemorrhagic fever, we conducted autopsies of dengue infections deaths within our hospital.Method
This was an autopsy study of dengue-associated deaths at a large tertiary care hospital.Results
From Sep 2009 to Dec 2010, a total of 1032 patients with serological evidence of dengue infection were admitted to our hospital. There were twelve deaths and autopsies were conducted in six. Adult respiratory distress syndrome, bleeding diathesis, hypotension, hepatic failure and acute renal failure were the common causes of death despite early hospitalization, intravenous fluid, and blood-product support.Conclusion
Dengue is associated with severe disease, and deaths do occur despite current supportive management. Early predictors of disease severity and better clinical interventions are needed. 相似文献8.
INTRODUCTION
The pandemic caused by the H1N1 influenza virus in 2009 resulted in extensive morbidity and mortality worldwide. As the virus was a novel virus, there was limited data available on the clinical effects of the virus on children in Malaysia. We herein describe the clinical characteristics of children hospitalised with H1N1 influenza at a tertiary care centre. We also attempted to identify the risk factors associated with disease severity.METHODS
In this retrospective study, we compared the characteristics of the children who were admitted to the University of Malaya Medical Centre, Malaysia, for H1N1 influenza during the pandemic with those who were admitted for seasonal influenza in 2002–2007.RESULTS
Among the 77 children (aged ≤ 12 years) admitted to the centre due to H1N1 influenza from 1 July 2009–30 June 2010, nearly 60.0% were aged < 6 years and 40.3% had an underlying medical condition. The top three underlying medical conditions were bronchial asthma (14.3%), cardiac disease (10.4%) and neurological disorders (11.7%). The risk factors for severe disease were age ≤ 2 years, underlying bronchial asthma and chronic lung disease. Two of the three patients who died had an underlying medical condition. The underlying causes of the deaths were acute respiratory distress syndrome and brain stem encephalitis.CONCLUSION
The clinical presentation of the children infected with pandemic (H1N1) 2009 influenza virus did not differ significantly from that of children with seasonal influenza. However, there were more complaints of fever, cough and vomiting in the former group. 相似文献9.
10.
James W Keck John T Redd James E Cheek Larry J Layne Amy V Groom Sassa Kitka Michael G Bruce Anil Suryaprasad Nancy L Amerson Theresa Cullen Ralph T Bryan Thomas W Hennessy 《J Am Med Inform Assoc》2014,21(1):132-138
Objective
Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed.Materials and methods
The system defines ILI as a patient visit containing either an influenza-specific International Classification of Disease, V.9 (ICD-9) code or one or more of 24 ILI-related ICD-9 codes plus a documented temperature ≥100°F. EHR-based data are uploaded nightly. To validate results, ILI visits identified by the new system were compared to ILI visits found by medical record review, and the new system''s results were compared with those of the traditional US ILI Surveillance Network.Results
The system monitored ILI activity at an average of 60% of the 269 IHS electronic health databases. EHR-based surveillance detected ILI visits with a sensitivity of 96.4% and a specificity of 97.8% based on chart review (N=2375) of visits at two facilities in September 2009. At the peak of the pandemic (week 41, October 17, 2009), the median time from an ILI visit to data transmission was 6 days, with a mode of 1 day.Discussion
EHR-based ILI surveillance was accurate, timely, occurred at the majority of IHS facilities nationwide, and provided useful information for decision makers. EHRs thus offer the opportunity to transform public health surveillance. 相似文献11.
Background
Road traffic accidents are a leading cause of mortality and morbidity globally. In India, more than a million are injured annually and about a lakh are killed in road traffic accidents.1 It causes the country to lose around 55,000 crores annually which is 2–3% of Gross Domestic Production (GDP).2 This cross sectional study was conducted to elucidate the role of various factors involved in road traffic accidents.Methods
Road traffic accident cases admitted to a tertiary care hospital between 01 Oct 2009 and 28 Feb 2011 were included in the study. A total of 182 patients were studied. Information was collected through questionnaire, hospital records and on-site visit. OPD cases, comatose patients and deaths were excluded.Results
Two-wheelers were the commonest vehicle involved in vehicular accidents. Most accidents happened at a speed of 40–60 km/h (37.9%). Most of the patients were aged between 20 and 30 years. Majority had a driving experience of less than 5 years. Monsoons witnessed 46.7% cases. Most cases occurred between 6 and 10 pm. Among severe injuries, the commonest was lower limb fractures (19.8%).Conclusion
There are multiple factors associated with road traffic accidents which due to the lack of road safety measures in the country are playing their role. It is the need of the hour to address this issue and formulate comprehensive, scientific and practical rules and regulations as well as evaluate its enforcement. 相似文献12.
Afreen Ayub Ashish Goyal Anupam Kotwal Aniket Kulkarni Atul Kotwal SM Air Cmde Ajoy Mahen 《Medical Journal Armed Forces India》2013
Background
Compliance and implementation of infection control guidelines have been recognized as efficient means to prevent and control hospital acquired infections.Objectives
To evaluate knowledge and practices about infection control guidelines amongst medical students and to explore their education needs as perceived by them and faculty.Methods
A total of 160 final year students and 100 faculty members of one of the top medical colleges in India were selected by simple random sampling in each group as per sample size of 143 students (alpha 0.05, error 7%, prevalence 60%) and 99 (error 7.5%) faculty. Data collected by pilot-tested, unlinked, anonymous questionnaire.Results
Amongst students, knowledge (77.50%; 95% CI, 70.24–83.72) was mixed with misconceptions. Only 31.25% always followed hand hygiene procedure; 50% recapped needles; disposal of hazardous material into designated containers always was low (sharps 20%, contaminated items 25%). Despite experiencing needle stick injury (6.25%) and splashes (40%), less than 30% reported these as 44% were unaware of reporting procedure. The discord between the perceptions of faculty regarding students and students' own perceptions was clearly evident (all Kappa values less than 0.50). Students and faculty agreed on workshops (58.13% and 58%) and reinforcement by colleagues (51% and 54%) but not on on-job training (51% and 34%) and part of curriculum (48% and 40%) for teaching–learning infection control.Conclusion
Tackling disconnect between students and faculty perceptions and empowering students with knowledge and skills in infection control is important. Approach needs to be researched and formulated as current methods seem to be inadequate. 相似文献13.
Infectious diseases have caused great catastrophes in human history, as in the example of the plague, which wiped out half of the population in Europe in the 14th century. Ebola virus and H7N9 avian influenza virus are 2 lethal pathogens that we have encountered in the second decade of the 21st century. Ebola infection is currently being seen in West Africa, and H7N9 avian flu appears to have settled in Southeast Asia. This article focuses on the current situation and the future prospects of these potential infectious threats to mankind.Outbreak is an epidemiological definition to describe an unexpected occurrence of an infection at a certain time and place. It may affect a small and a localized group, or impact on millions of people across continents. Two cases of a linked rare infection can be defined as an outbreak. A revisit through the history discloses that outbreaks were vast, deadly, and basically changed the course of human history.1 As an example, the plague reshaped the landscape of Europe and the world between 1347 and 1351. During this period, the global population was estimated to be 450 million, and 75 million at a minimum are believed to have perished. Consequently, half of Europe died in a period of 4 years.2 In the pre-antibiotic era, bacterial outbreaks caused much more mass destruction compared with other outbreaks with different infectious agents.1 But, this trend changed with the advent of antibiotics and viral outbreaks emerged. We believed that Ebola virus and H7N9 avian influenza virus are the most potential pathogens to cause mass destruction in the world. Thus, in this paper, we will focus on the current outbreaks of these 2 viral infections with the potential to cause mass destruction, and to greatly impact the international travelers.
Ebola hemorrhagic fever
The Filoviridae (Ebola, and Marburg viruses are the commonly known 2 members of Filoviridae) were originally documented in 1967 when the apes from Uganda led to outbreaks of hemorrhagic fevers among vaccine plant workers in Germany and Yugoslavia. These workers had direct contact with the animals by killing the apes, removing their kidneys, or preparing cell cultures for polio vaccine production.3 The Ebola hemorrhagic fever (EHF) is known to be the world’s deadliest infection, and many people lost their lives this year due to this filoviral pathogen.Viral characteristics
Ebola virus is a non-segmented, negative-sense, single-stranded RNA virus from the Filoviridae family. The genus of Ebola virus is classified into 5 different species (Zaire, Sudan, Bundibugyo, Tai Forest, and Reston agents) with differing virulence.4 The Zaire subtype has caused multiple outbreaks with case numbers up to several hundreds since 1976. The mortality reached 90% in these epidemics.5-8 The Sudan virus has been associated with fatality in half of the cases in Sudan and Uganda outbreaks.9,10 Interestingly, the Tai Forest virus has only been identified in one ethologist who performed a necropsy on a chimpanzee found dead in the Tai Forest. At the end, the patient survived.11 The fourth species, Reston virus, differs markedly from the others, was identified only in an animal reservoir in the Philippines.12 Finally, the Bundibugyo virus appeared in Uganda in 2007 causing an outbreak with 30% mortality.13 In 2014, the first outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa involved the major urban as well as rural areas.14 Molecular analysis indicated that the current virus was closely linked (97% identical) to variants of Ebola virus identified in the Democratic Republic of the Congo and Gabon.7Modes of transmission
It is likely that Ebola virus is maintained in small animals serving as a source of infection for both humans and wild primates. Bats have long been at the top of the list of potential reservoirs since Marburg virus, filoviral hemorrhagic fever agent, was recovered from the fruit bats captured at a cave in Uganda.13 Ebola virus has been known to be disseminating in nonhuman primates, seemingly as a result of their contact with unidentified reservoirs. This has contributed to a striking drop in chimpanzee and gorilla populations, and facilitated human outbreaks probably owing to the consumption of sick apes as food sources.15-17 According to the Animal Mortality Monitoring Network found in Gabon and Congo, the carcass of duiker was tested positive along with primates in 2005.18 Once introduced into the community, human to human transmission via contact with infected persons or their body fluids or secretions are considered the primary mode of transmission.19Impact of the current outbreak
In March 2014, the Ministry of Health of Guinea reported a disease outbreak characterized by fever, severe diarrhea, vomiting, and a high case-fatality rate. The first cases occurred in Guéckédou and Macenta districts. In May 2014, the epidemic jumped to neighboring districts of Kenema and Kailahun in Sierra Leone, and in June it expanded to Lofa district in Liberia.19 In September 2014, 5 countries from West Africa (Guinea, Liberia, Nigeria, Senegal, and Sierra Leone) documented EHF patients.20 The disease had a deep impact in Guinea, Liberia, and Sierra Leone.19 Moreover, the disease jumped to the United States of America (USA) and Spain with travel-associated cases and localized transmission.21 There have been 22,495 EHF cases, with 8,891 recorded deaths by February 1, 2015.22 Thus, the average case fatality rate was approximately 40%.According to the World Health Organization (WHO) Ebola Response Roadmap Situation Report, released on 26 October 2014, a total of 521 cases, including 272 deaths, had been reported among health care workers while caring for sick people.23Clinical presentation
The pathogen is classified as a hemorrhagic fever virus based on its clinical manifestations comprising coagulation defects, a capillary leak syndrome, and shock. The Ebola virus has been known to be the most virulent human pathogen along with Marburg virus causing severe hemorrhagic fever, fulminant septic shock, and finally, death.24 The course of infection, including signs and symptoms, incubation period (~11 days), and serial interval (~15 days), which is defined as the interval between disease onset in an index case patient and disease onset in a person infected by that index case patient were similar to that reported in previous outbreaks of EHF.19 The most common symptoms were fever (87%), fatigue (76%), loss of appetite (65%), vomiting (68%), diarrhea (66%), headache (53%), and abdominal pain (44%).19Treatment and immunization
Severely ill EHF patients require intensive supportive care, which is the mainstay of therapy.19 In October 1, 2014, 2 candidates for EHF vaccines had clinical-grade vials available for phase-1 clinical trials. One of these formulations was cAd3-ZEBOV (GlaxoSmithKline, Raleigh, SC, USA) and recombinant vesicular stomatitis virus - Zaire ebolavirus (rVSV-ZEBOV) (Public Health Agency in Winnipeg, Canada). A series of coordinated phase-1 trials will be initiated in more than 10 sites in Africa, Europe, and North America.25 Although no approved specific therapy is currently available in the treatment of EHF, several drugs such as brincidofovir, favipiravir, and ZMapp are under investigation for EHF. In the current outbreak, convalescent blood and plasma therapies have been used in a few patients. The numbers are too small to draw any conclusions on their efficacy.26Future prospects
When an outbreak comes to an end, it is a matter of great concern. According to the WHO, an EHF outbreak in a country is reported to be over when 42 days have passed, and new cases have not been observed. The maximum incubation period for EHF was 21 days. The 42-day period was set by the WHO (twice the maximum incubation period) to provide a strong margin of security.27 Currently, the USA, Spain, Mali, Senagal, and Nigeria are categorized as affected countries.21 Currently, EHF epidemic appears to be ending after the slowing of transmission.22Avian influenza A (H7N9) virus
Influenza, usually known as “flu”, was defined by Hippocrates approximately 2,400 years ago.28 The first considerable influenza-like illness pandemic recorded was of an outbreak in 1580, started in Russia and disseminated to Europe via Africa. During the outbreak, more than 8,000 people died in Rome.29,30 The major historical flu pandemics and their deep impacts on mankind are presented in Open in a separate windowThree (H7N9, H6N1, and H10N8) avian influenza viruses broke the animal-human barrier in Asia in 2013.31 One avian influenza case was detected in Taiwan due to H6N1 subtype, whereas 2 of 3 H10N8 human infections observed in China were lethal.31 However, human infections due to H7N9 have been progressively increasing since its first identification in 2013, and approximately one-third of the H7N9-infected patients died.31-33 Avian flu had the potential to spread “silently” among poultry and H7N9 infections did not cause severe disease in poultry, accordingly.34Viral characteristics
Influenza is an infection of birds and mammals caused by RNA viruses from the family of Orthomyxoviridae. There are 2 main types of influenza virus, type A and type B. Type A viruses are the most virulent human pathogens among the other influenza types and cause the most severe disease. Influenza A viruses are divided into subtypes based on the hemagglutinin (H) and the neuraminidase (N) localized on the virus surface. So far, 18 hemagglutinin and 11 neuraminidase subtypes were documented.35 Influenza B almost exclusively infects humans and is less common than influenza A.36Modes of transmission
All identified influenza A subtypes other than H17N10 and H18N11 viruses have been found among birds and these 2 particular influenza subtypes were recorded in bats. Wild birds have been the primary reservoir for all influenza A viruses and have been believed to be the source of the diseases in all other animals.37 In human influenza infections large amounts of influenza virus are often present in respiratory secretions of infected persons. Thus, the infection can be transmitted through sneezing and coughing, and is primarily acquired by large droplets (>5 microns).35,38 This mode of transmission facilitated the dissemination of influenza in the history and resulted in major outbreaks. Further, animal flu viruses transmitted to humans are usually dead-end infections, and the virus does not have the capacity to be acquired between humans easily. This limitation is an important barrier to global dissemination. Accordingly, for human H7N9 infections, which are the focus of this review, the available information strongly indicated that they originated from infected poultry with either direct contact or indirect exposures such as visiting wet markets and contact with environments where infected poultry have been stored or slaughtered. Currently, there is no evidence of sustained, ongoing person-to-person spread of H7N9.39 Since the influenza virus can be inactivated by soap, disinfectants, and detergents, frequent hand washing, and other sanitary measures reduce the risk of influenza transmission.40,41Impact of the current outbreak
In late March 2013, novel human infections due to avian influenza A H7N9 virus were reported from China.32 This particular influenza A virus had not previously been seen in either animals or people. The preliminary 133 cases were seen between February and May 2013. In this first wave, 44 patients died constituting a mortality of 33%, which was exceedingly high compared with other major historical pandemics.42 Most of these patients were considered to upsurge from exposure to infected poultry or contaminated environments. The number of new cases was highest in April 2013 and subsequently the patient flow dropped.43 The probable reasons for this reduction were the implementation of control strategies, such as closing live bird markets, summer weather conditions, and increased public awareness. Studies indicated that avian flu viruses, like seasonal influenza, have a seasonal pattern and they circulate better in cold weather and less in warm weather.44 Thus, a rise in the number of cases occurred in late 2013 and early 2014, coinciding with influenza season. More than 200 new cases have been confirmed during the second wave.45 Until May 2013, H7N9 cases were reported from 9 Chinese provinces at the Pacific region. After this, H7N9 infections were reported from 12 provinces, indicating the rapid dissemination of the outbreak.46In February 2014, the Malaysian Ministry of Health reported a human infection with avian influenza A (H7N9) in a traveler from China. This was the first imported case of H7N9 detected outside of China.47 There have been other H7N9 cases detected until April 2014. In April 2014, Taipei Centers for Disease Control in Taiwan informed 2 laboratory reported patients, as the last reported cases as per the 27 June 2014 WHO report.48Clinical presentation
The most common signs of influenza are fever, chills, sore throat, runny nose, severe headache, muscle pains, coughing, and fatigue.28 Although it is often confused with other influenza-like illnesses, the common cold in particular, influenza is a more severe disease.49 Complications of H7N9 virus infection include respiratory failure, acute respiratory distress syndrome, refractory hypoxemia, septic shock, acute renal dysfunction, multiple organ dysfunction, rhabdomyolysis, encephalopathy, bacterial and fungal infections like ventilator associated pneumonia, and blood stream infection with multidrug resistant bacteria.50 Approximately, two-thirds of hospitalized patients are admitted to the intensive care units, indicating the severity of the illness.51Treatment and immunization
The WHO Vaccine Composition Meeting for the 2014-2015 season held in February 2014 in Geneva approved that A/California/7/2009 (H1N1)pdm09-like virus, A/Texas/50/2012 (H3N2)-like virus, and B/Massachusetts/2/2012-like virus should be included in the trivalent vaccine formulation in the Northern Hemisphere.52 Consequently, the aforementioned novel avian strains are out of scope of the current vaccine formulation indicating the severity of the situation if the H7N9 influenza has global dissemination.Laboratory testing in preliminary cases showed that neuraminidase inhibitors (oseltamivir, zanamivir) were effective against H7N9 infections, but the adamantanes were not. In addition, early treatment with neuraminidase inhibitors have been reported to restrict the severity of illness.34,53Future prospects
Although it is likely that sporadic cases of H7N9 associated with poultry exposure will continue to occur in China, the virus has a pandemic potential, and it is possible that the virus can gain the ability to spread easily.49 The future prospects of H7N9 infections are still unclear. However, there is no scientific evidence implying it will trigger a current global outbreak. Thus, international surveillance for H7N9 and other influenza viruses with pandemic potential is of paramount importance. 相似文献14.
Background
An outbreak of food poisoning was reported from a Military establishment on 29 May 2011 when 43 cases of food poisoning reported sick in a span of few hours.Methods
A retrospective-prospective study was conducted. Data regarding the onset of symptoms, presenting features and history of food items consumed was collected. A detailed inspection of the mess for hygiene and sanitary status, cooking and storage procedure, and rodent nuisance was also carried out.Results
A total of 53 cases of food poisoning occurred between 29 and 31 May 2011. All cases had symptoms of diarrohea followed by fever (96.2%), headache (84.9%), abdominal pain (50.1%), nausea and vomiting (49.1%) and bodyache (39.6%) respectively. Based on the Attributable Risk (AR = 46.67%) and Relative Risk (RR = 4.5, 95% CI = 1.22–16.54) Potato-bitter gourd vegetable served during dinner on 28 May 2011 was incriminated as the food item responsible for outbreak.Conclusion
Symptomatology, incubation period and presence of rodent nuisance suggested contamination of Potato–bitter gourd vegetable with non-typhoidal Salmonella spp. 相似文献15.
Diva Reddy A.S. Kushwaha Atul Kotwal SM D.R. Basannar Ajoy Mahen 《Medical Journal Armed Forces India》2012
Background
High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra.Aim & objectives
This cross sectional study was carried out to determine the prevalence of hypertension in children 6–15 years and to study the association between selected variables and blood pressure.Material & methods
This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests.Results
The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males.Conclusion
In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study. 相似文献16.
目的分析广州市荔湾区首起职业学校甲型H1N1流感暴发疫情的流行病学特征,评估防控措施,为控制学校甲型H1N1流感暴发疫情提供科学依据。方法按照《甲型H1N1流感监测方案(第一版)》附录的甲型H1N1流感病例个案调查表,对每1病例进行现场流行病学调查;对发病3d内的现症患者采集咽拭子标本,送广州市疾病预防控制中心进行甲型H1N1流感病毒核酸检测;对密切接触者进行7d的医学观察。结果疫情持续7d,共确诊36例病例,罹患率为1.68%;男女性别比0.5∶1;住宿生走读生比3.5∶1。结论此次疫情为广州市荔湾区首起职业学校甲型H1N1流感暴发疫情,感染来源为社区。及时隔离病例以及规范对密切接触者的管理是控制甲型H1N1流感疫情的有效措施。 相似文献
17.
Background
Meningococcal infection may lead to life threatening meningitis and fulminant meningococcal sepsis. Sporadic cases of meningococcal infection have been reported in soldiers but no outbreak in soldiers has been reported earlier from India. This outbreak in soldiers serving in counter insurgency role under field setting was effectively controlled without compromising their operational commitment.Methods
This is an epidemiological investigation and control of an outbreak of meningococcal infection, bringing out the predisposing factors and highlighting the role of early diagnosis and management of cases. Mass chemoprophylaxis in contacts was used as an effective control measure in the absence of vaccine in this institution based outbreak.Result
Out of a total of 17 cases reported, 14 presented as meningitis and three as meningococcemia. Two cases of meningococcemia ended fatally. Serogroup A of Neisseria meningitidis was responsible for this outbreak. Gross over- crowding was the predisposing factor.Conclusion
An outbreak of meningococcal infection in soldiers deployed in counter- insurgency role was effectively contained using mass chemoprophylaxis in the absence of meningococcal vaccine.Key Words: Meningitis, Meningococcal infection, Outbreak, Soldier 相似文献18.
Background
Prevention of parent to child transmission (PPTCT) program was initiated in Armed Forces to reduce the vertical transmission of HIV by instituting single dose Nevirapine (sdNVP) in untreated HIV positive mothers in labour. The aim of this study was to evaluate the role of sdNVP to decrease viral load of HIV infected mother during labour and its efficacy in prevention of mother to child transmission of HIV.Methods
Thirty antenatal women tested positive for HIV at our PPTCT centre and delivered between Jan 2006 and May 2008 were evaluated. During labour these women were given sdNVP. Newborns were given syrup Nevirapine. The babies were tested for HIV infection at 48 h and six weeks after delivery.Results
Thirty HIV positive women delivered at our centre and four newborns were found positive for HIV infection at 48 h. After six weeks interval three neonates were detected for HIV infection as one infant at six weeks was found to be negative for HIV infection.Conclusion
The protection rate of Nevirapine in untreated HIV positive women is not ideal. It is recommended that all HIV positive women should be offered Highly Active Antiretroviral therapy as primary mode for PPTCT. 相似文献19.
Background
Tobacco use is increasing among women and girls across the globe as well as in all parts of India. In India, 8 to 10 lakh people die due to tobacco related diseases every year. This tobacco epidemic among women needs to be prevented.Objectives
Study was conducted to find the prevalence and pattern of tobacco consumption and it's association with education among females (15–49 years) in a rural village of Pune, Maharashtra, India.Material and Methods
A cross-sectional study was carried out among 313 females (15–49 years) in a rural field practice area of a Medical College in Pune during Feb 11 to May 11. Pre-tested questionnaire was used for collecting data by interview after obtaining informed consent. Statistical analysis was performed (Epinfo software version 3.5.3.).Results
Out of 313 female studied, 14.05% (44) and 0.96% (03) were found to be current and former tobacco user respectively while 84.98% (266) never used any form of tobacco in their lifetime. Mishri consumption (45%) was commonest form of smokeless tobacco use followed by quid use (36%). Majority of the tobacco users (54.55%) were illiterate. There was significant association between tobacco consumption and education level (p = 0.0295). Tobacco consumption was more with increasing age.Conclusion
Tobacco consumption was found to be prevalent in 14.05% of women. Almost all of them used smokeless tobacco, mainly mishri. Tobacco consumption was directly associated with age and inversely with educational level. Therefore increasing women's literacy may bring down tobacco use among women. 相似文献20.
Atul Kotwal SM Maj Harpreet Singh A.K. Verma R.M. Gupta Shishir Jain S. Sinha R.K. Joshi Prabhakar Teli Vijay Khunga Anuj Bhatnagar Richa Ranjan 《Medical Journal Armed Forces India》2014