反向病原学

微生物来到地球的时间比人类早得多,不可能是为了“致病”人类而存在的。 微生物为了生存而具有多种功能,其中一些可危害人类,引起疾病。但还有大量的微生物没有被发现。 未来重大新发传染病的挑战,是应对新的病原体。 因此,我们提出反向病原学。 主要内容包括:（1）发现、分离、命名新的微生物;（2）评估新发现微生物的潜在致病性或者公共卫生意义;（3）提出未来可能引起新发突发传染病的新微生物目录; （4）研究检测、诊断、治疗、预防控制的技术、方法、措施、策略等;（5）预防发生严重急性呼吸综合征（SARS）样的重大新发突发传染病。     

临床常态与新发感染病原微生物研究进展

临床常态感染病原微生物、新发传染病(EID)微生物、再现传染病微生物、对医患造成严重危害,近年来逐渐成为研究热点,给社会经济带来极大损失,本文就临床常态微生物、EID微生物种类及临床特征做一综述,以期提高临床感控认识。     

2020－2021年度新型冠状病毒肺炎疫情发展趋势分析与应对

新型冠状病毒（新冠病毒）具有自然疫源性和流感病毒的流行特性,病毒复制快、细胞嗜性广、存活能力强,而且其无症状感染者普遍、传播隐蔽,病毒已经在人群适应,控制难度大。在新冠病毒疫苗发挥广泛保护效应之前,2020 — 2021年度全球疫情可能进一步恶化,我国仍然面临境外多渠道持续输入和局部暴发或疫情重现风险。 因此,应进一步开展我国疫情高发区人群携带新冠病毒状况和相应环境中新冠病毒的监测;建立国家超级可移动新冠病毒检测网络实验室,能够执行超大规模检测任务;实施差异化疫苗接种策略并密切跟踪监测疫苗接种的效果和效率;应继续强化戴口罩、勤洗手、保距离、常开窗、少聚会等行之有效的公共卫生措施。 新冠病毒疫情再一次警告大家,野生动物源性未知病原体所导致的新发传染病病原不断地出现已经成为“新常态”,必须前瞻性系统开展未知微生物发现和反向病原学研究,主动防卫和应对未来新发传染病疫情。     

国家重点研发计划“生物安全关键技术研发”重点专项启动

正中国疾病预防控制中心传染病预防控制所牵头承担日前,2016年国家重点研发计划"生物安全关键技术"重点专项"野生动物源性未来新发突发传染病病原体调查"(No.016YFC1201900)在北京举行项目启动会。由中国疾病预防控制中心传染病预防控制所张永振课题组牵头的10家来自科研院所、高校和医院的团队共同承担了该项目。人类的传染病主要来源于动物,70%以上新发传染病也由野生动物携带的病毒引起。近年来,随着社会因素所致     

新发传染病

新发传染病（emerging infectious diseases）是指新近30年来人们新认识到的或新发现的那些能造成地域性或国际公共卫生问题的新识别的和以往未知的传染病。     

IL28B基因多态性与丙型肝炎相关性的研究进展

丙型肝炎是世界上流行最广泛的严重威胁人类生命的传染病之一,目前世界上约有1.7亿人感染丙型肝炎病毒（hepatitis Cvirus,HCV）[1],中国约有3 700万-4 000万。每年的新发病例约300-400万,其主要通过血源性途径进行传播,包括输血、性接触传播、纹身和吸毒等,     

2004-2011年云南省西双版纳傣族自治州法定报告传染病疫情分析

目的 分析云南省西双版纳傣族自治州(西双版纳州)近8年法定传染病的流行特征,为制定防控措施提供依据。 方法 采用描述性流行病学方法对2004-2011年《疾病监测信息报告管理系统》报告的法定传染病疫情资料进行分析。 结果 2004-2011年全州无甲类传染病报告,报告乙类传染病18种共30 511例,死亡324例,年均发病率为365.62/10万,年均死亡率为3.81/10万。居乙类传染病前5位的病种依次为病毒性肝炎、肺结核、伤寒和副伤寒、疟疾和痢疾,占传染病报告总数的83.57%。2005年发生输入性登革热病例,2008年发生首例狂犬病病例,2010年发生本地感染登革热病例。 结论 8年间西双版纳州传染病发病率总体呈下降趋势,病毒性肝炎、肺结核、伤寒和副伤寒、性传播疾病、新发传染病和境外输入传染病应作为今后重点防制的主要传染病。     

新发非病毒性非细菌性传染病的诊治

近年来，一些新发传染病和已控制的传染病死灰复燃，对人类健康构成了严重的威胁。关于新发病毒性和细菌性传染病已作介绍，本文仅论述新发非病毒性、非细菌性传染病的诊治。 1猫抓病 1．1流行病学猫抓病为巴尔通体感染引起的一种急性自限性传染病，病死率小于1％。带菌的幼猫为传染源，狗、猴也会引起传染，但尚无人传人的报告，猫蚤叮咬传播不肯定。     

湖南省3个县乡村医务人员对新发传染病认知水平调查

目的了解湖南省3个县乡村医生对新发传染病认知水平,为农村新发传染病防治提供科学依据。方法应用自行设计的调查表,采用多级抽样的方法,抽取湖南省3个县(长沙县、平江县、邵东县)9个乡卫生院的乡村医生共209名作为调查对象,了解乡村医生基本情况、对新发传染病相关知识的知晓情况、对几种常见和不常见新发传染病知识知晓情况、对新发传染病政策相关知识知晓情况、新发传染病知识知晓主要途径等。结果本组调查对象对严重急性呼吸综合征(severe acute respiratory syndromes,SARS)、甲型H1N1流感等常见新发传染病的相关知识有一定程度的了解,尤其是SARS和甲型H1N1流感的传播途径知晓率达80.9%;对不常见的新发传染病,如埃博拉出血热病毒、莱姆病的相关知识知晓率偏低;对于新发传染病政策相关知识正确率较低,最低的是"甲类传染病未实行网络直报报告时间"一项,知晓率仅为4.3%。对新发传染病知识知晓途径通过培训获得的仅占5.3%。结论应加大乡村医生新发传染病防治相关知识、政策及操作技能的培训力度,扩大培训方式,提高其新发传染病防治能力。     

急诊护士新发传染病认知行为调查分析

目的:调查急诊护士新发传染病知识的储备情况及防护行为的现状并提出相应对策。方法:采用自行设计的调查问卷进行调查,内容包括:一般情况、知识来源、培训需求、新发传染病的相关知识、主要新发传染病的报告情况、标准性预防原则、个人防护情况、护士的心理状况、对今后学习相关知识的建议等。结果:护士主动学习的意识不足,只有22.2%的护士通过互联网自学;100%的护士都有培训需求;整体情况知识匮乏,但不同职称护理人员在传染病知识方面存在显著性差异,其中主管护师得分最高(35.4±6.0)分,显著高于护师(28.9±5.0)分和护士(25.1±3.8)分,护师得分显著高于护士;传染病的报告意识淡薄;标准性预防执行情况不到位;护士表示恐惧的心理普遍存在。结论:急诊护士平时应加强相关知识学习,加强标准性预防,以提升应对突发性新发传染病威胁的能力。     

Cryptosporidia and microsporidia--waterborne diseases in the immunocompromised host.

Cryptosporidia and microsporidia are emerging parasitic pathogens in immunocompetent and immunocompromised individuals. Cryptosporidium infects several wild and domestic animals that excrete oocysts into the environment and contaminated water represents the major source of infection for humans. Waterborne transmission of Cryptosporidium is a major risk for humans and appropriate measures have to be taken to protect immunocompetent and immunocompromised individuals to become infected. For microsporidia, the sources and ways of transmission are not well documented. Although several animal hosts have been identified recently, the relevant reservoirs of human microsporidia are still unknown. Also, the routes of spreading are unknown. Is microsporidiosis a zoonotic disease that will be transmitted through close contact with infected animals or is contaminated surface water responsible for transmission and represents a relevant reservoir? This review is designed to give information on these two emerging intestinal parasites in a format that will be useful to clinical microbiologists, physicians interested in infectious diseases, and public health personnel.     

用系统方法和同一个健康理念研究种间传染病

世界卫生组织估计,全球每年5700万例死亡中有25%是由微生物引起。研究报道有1415种传染性生物可使人类致病。种间传染病占所有已知传染性疾病的61%,但人类作为初始病原者仅占3%。在175个被认为是新的传染性生物中,有75%可致人畜共染。尽管不同物种间病因和治疗方法相似,但种间传染病及其对人类和动物健康的影响并未以整合的方式监测、预防和治疗。种间传染病中,一个药物的有效性和耐药在同一种系的不同物种间彼此相似。因此,在同一自然环境下包含多个物种的随机对照试验有效、可靠,并可减少所需志愿者的人数。"同一个健康"基于系统方法和多学科的共同努力,地方、国家和全球协作,以达到人、动物和环境的最佳健康状态。系统评价和Meta分析迄今一直是独立和学科导向的。必须搜集种间传染病的诊断准确性和(药物)治疗有效性的(研究)结果,因为临床前实验结果来自于实验动物。Cochrane协作网是建立种间传染病系统评价小组平台的选择之一,通过无偏倚的诊断实验和药物效能(结果)的Meta分析以支撑系统方法与同一个健康(理念)。     

Emerging infectious diseases: vulnerabilities,contributing factors and approaches

We live in an ever more connected global village linked through international travel, politics, economics, culture and human–human and human–animal interactions. The realization that the concept of globalization includes global exposure to disease-causing agents that were formerly confined to small, remote areas and that infectious disease outbreaks can have political, economic and social roots and effects is becoming more apparent. Novel infectious disease microbes continue to be discovered because they are new or newly recognized, have expanded their geographic range, have been shown to cause a new disease spectrum, have jumped the species barrier from animals to humans, have become resistant to antimicrobial agents, have increased in incidence or have become more virulent. These emerging infectious disease microbes may have the potential for use as agents of bioterrorism. Factors involved in the emergence of infectious diseases are complex and interrelated and involve all classifications of organisms transmitted in a variety of ways. In 2003, outbreaks of interest included severe acute respiratory syndrome, monkeypox and avian influenza. Information from the human genome project applied to microbial organisms and their hosts will provide new opportunities for detection, diagnosis, treatment, prevention, control and prognosis. New technology related not only to genetics but also to satellite and monitoring systems will play a role in weather, climate and the approach to environmental manipulations that influence factors contributing to infectious disease emergence and control. Approaches to combating emerging infectious diseases include many disciplines, such as animal studies, epidemiology, immunology, ecology, environmental studies, microbiology, pharmacology, other sciences, health, medicine, public health, nursing, cultural, political and social studies, all of which must work together. Appropriate financial support of the public health infrastructure including surveillance, prevention, communication, adherence techniques and the like will be needed to support efforts to address emerging infectious disease threats.     

大数据在传染病监测预警中的主要研究与应用进展

开展传染病监测预警是有效防控传染病的重要途径。 然而,我国从2004年建立法定传染病网络直报系统和2008年正式启用传染病自动预警系统至今,发现其存在数据来源单一、内容简单、预警时间关口相对滞后等问题,难以满足新突发传染病及不明原因疾病等的早期预警需求。 近年来,随着信息技术的不断发展与应用,传染病诊疗和监测技术手段不断提升,与大数据有关的传染病早期预警研究与实践已逐渐成为热点。 本文简要介绍了大数据的定义及特征,系统梳理了传染病相关大数据中各类数据源在传染病监测预警中的发展、应用实践、优势与局限性,概述了大数据的主要分析技术方法,以期为我国建立基于大数据的传染病监测预警机制和平台提供参考,进一步提升传染病监测预警的能力。     

Emerging infectious diseases: vulnerabilities, contributing factors and approaches

We live in an ever more connected global village linked through international travel, politics, economics, culture and human-human and human-animal interactions. The realization that the concept of globalization includes global exposure to disease-causing agents that were formerly confined to small, remote areas and that infectious disease outbreaks can have political, economic and social roots and effects is becoming more apparent. Novel infectious disease microbes continue to be discovered because they are new or newly recognized, have expanded their geographic range, have been shown to cause a new disease spectrum, have jumped the species barrier from animals to humans, have become resistant to antimicrobial agents, have increased in incidence or have become more virulent. These emerging infectious disease microbes may have the potential for use as agents of bioterrorism. Factors involved in the emergence of infectious diseases are complex and interrelated and involve all classifications of organisms transmitted in a variety of ways. In 2003, outbreaks of interest included severe acute respiratory syndrome, monkeypox and avian influenza. Information from the human genome project applied to microbial organisms and their hosts will provide new opportunities for detection, diagnosis, treatment, prevention, control and prognosis. New technology related not only to genetics but also to satellite and monitoring systems will play a role in weather, climate and the approach to environmental manipulations that influence factors contributing to infectious disease emergence and control. Approaches to combating emerging infectious diseases include many disciplines, such as animal studies, epidemiology, immunology, ecology, environmental studies, microbiology, pharmacology, other sciences, health, medicine, public health, nursing, cultural, political and social studies, all of which must work together. Appropriate financial support of the public health infrastructure including surveillance, prevention, communication, adherence techniques and the like will be needed to support efforts to address emerging infectious disease threats.     

Experimental Evidence for Reduced Rodent Diversity Causing Increased Hantavirus Prevalence

Emerging and re-emerging infectious diseases have become a major global environmental problem with important public health, economic, and political consequences. The etiologic agents of most emerging infectious diseases are zoonotic, and anthropogenic environmental changes that affect wildlife communities are increasingly implicated in disease emergence and spread. Although increased disease incidence has been correlated with biodiversity loss for several zoonoses, experimental tests in these systems are lacking. We manipulated small-mammal biodiversity by removing non-reservoir species in replicated field plots in Panama, where zoonotic hantaviruses are endemic. Both infection prevalence of hantaviruses in wild reservoir (rodent) populations and reservoir population density increased where small-mammal species diversity was reduced. Regardless of other variables that affect the prevalence of directly transmitted infections in natural communities, high biodiversity is important in reducing transmission of zoonotic pathogens among wildlife hosts. Our results have wide applications in both conservation biology and infectious disease management.     

Emerging infections in animals--potential new zoonoses?

It is well recognized that most emerging diseases of humans are zoonotic, and that the forces working to create emerging diseases in humans are also operating in animal populations. However, what is often overlooked is that emerging human diseases are usually preceded by the emergence of the same pathogen in an animal population. In fact, the developing disease in animals acts as a link allowing the disease to take hold and wreck havoc in public health. Numerous examples--Rift Valley fever, monkeypox, Nipah, and Ebola--serve to underscore this linkage and to highlight the increasing interconnectedness of animal and human health.     

近年来中国人兽共患病的流行趋势及防控态势

近年来,全球公共卫生安全事件频发,其中人兽共患病是个重要方面,频发的人兽共患病卫生安全事件,不仅对野生动物自身健康和生存,产生了极大的挑战,而且还严重地威胁人类的健康,破坏生态环境,危害社会稳定,影响国民经济持续快速发展,已成为世界性重大公共卫生问题。目前,人类对人兽共患病的了解还不够充分,必须加强野生动物疫源疫病系统化监测和基础研究工作。野生动物疫源疫病系统化监测工作,是预防和控制人兽共患病的源头。同时,人兽共患病的预防和控制,涉及人类、动物和生态三个主体,因此,对人兽共患病的预防和控制,必须采取多个部门的共同协调的策略。     

2021年我国夏季重点传染病疫情形势分析

  目的  评估2021年全国夏季重点传染病疫情形势,为进一步做好夏季重点传染病监测与防控提供参考和指导。  方法  根据我国传染病疫情报告信息管理系统、流感专病监测信息管理系统的监测数据,在对2021年1—5月全国法定传染病监测数据以及2017 — 2020年同期疫情形势进行分析基础上,采用专家会商法,研判我国2021年夏季重点传染病的疫情形势。  结果  2021年截至5月23日,全国共报告法定传染病247万例,较2020年同期（260万例）下降5%;排除新型冠状病毒肺炎（COVID-19）后,报告发病数较2019年同期（426万例）下降42%,较2017 — 2019年同期平均水平（324万例）下降24%;死亡7162例,较2020年同期（11671例）下降39%,较2017 — 2019年同期平均（7639例）下降6%。布鲁氏菌病报告病例数（2.7万）较2020年同期上升73%,较2017 — 2019年同期平均上升70%,内蒙古布鲁氏菌病发病率自2017年开始迅猛上升,宁夏回族自治区、甘肃省自2018年呈上升趋势。 手足口病报告病例数（43万例）和重症数（433例）较2020年同期分别上升985%和1070%。 全国共报告登革热病例15例,较2020年同期（110例）下降86%。 报告炭疽病例59例,较2020年同期（47例）略有增加。 流行性感冒报告病例数（10.7万例）较2020年同期下降90%。 2021年我国内地共报告11例人感染禽流感病例,较往年略有增加,均为散发。  结论  2021年1 — 5月全国法定传染病疫情总体低于往年同期平均水平,夏季仍将继续维持总体平稳态势。 预计夏季布鲁氏菌病、手足口病、登革热、炭疽的发病水平将呈现上升趋势,应加强对这些夏季重点传染病的监测预警。