驻疆某部近5年暴发疫情特点及处置对策

目的 总结过去5年驻疆某部传染病暴发疫情发生情况,探讨疫情特点和规律,为今后疫情防控及处置提供依据.方法 汇总某部2006-2010年处置的十余起疫情,分析疫情发生的特点规律,并提出处置对策.结果 该部暴发疫情呈现4个特点:(1)呼吸道传染病疫情频发,与传染病疫情信息提示相一致;(2)群体性不明原因疫情时有发生、不易诊...     

大理州狂犬病疫情及其防控

目的了解掌握大理州狂犬病疫情动态,防止疫情蔓延扩大;对暴露后犬伤病人进行规范处置,防止人间狂犬病疫情发生、蔓延。方法按相关规范文件对大理州狂犬病疫情进行调查处置并对其效果进行评估。结果 2011年7~9月,大理州宾川、祥云、弥渡3个县5个乡镇5个行政村犬和家畜(骡、驴)间,经实验室检测证实发生动物间狂犬病疫情,并造成多起犬(驴)伤人事件,由于及时采取有效的防控措施没有波及人间;2013年10~11月,祥云县云南驿镇小桥村发生犬病狂犬病疫情,由于病犬伤人后没有及时按《狂犬病暴露后处置工作规范(试行)》处置,造成1例狂犬病病例死亡。结论动物间狂犬病疫情发生时只要采取有效防控措施,可有效控制动物间狂犬病疫情;针对犬(家畜)伤病人只要及时按《狂犬病暴露后处置工作规范(试行)》处置,可有效防止人间狂犬病发生。     

基于环比增长率和空间约束聚类算法分析中国COVID-19疫情的风险现状

  目的   分析中国31个省、自治区、直辖市和新疆生产建设兵团(以下简称“31个省(区、市、兵团)”)新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)疫情的近期防控态势, 基于各省份的疫情防控现状提出分区管理的设计建议。   方法   基于2020年1月25—2月8日中国31个省(区、市、兵团)COVID-19累计确诊病例数, 计算累计和新增确诊病例数的环比增长率, 并拟合随时间的线性函数得到环比增长率的线性趋势。进一步结合环比增长率的中位数(median, M)、标准差(standarddeviation, S)和累计确诊病例数进行AZP-SA(auto zone procedure with stimulate annealing, AZP-SA)的空间约束聚类, 对各省份疫情现状进行合理分区。   结果   中国31个省(区、市、兵团)累计确诊病例数的环比增长率在近期均呈现下降趋势。新增确诊病例数的环比增长率则没有呈现出明显的趋势方向。选择AZP-SA方法将中国31个省(区、市、兵团)分成8个区, 其中湖北及湖北周边省份属于疫情下降相对较慢的地区, 西北和北方省份疫情控制良好, 东部和东南省份的疫情控制效果处于两者之间。   结论   累计确诊病例数的环比增长率是衡量疫情短期趋势的良好指标, 基于累计确诊病例数及其环比增长率应用空间约束聚类可以对中国各省份的疫情现状进行划分, 为下一步的复工复产提供建议。     

广州市海珠区托幼机构手足口病疫情危险因素分析

探讨托幼机构手足口病疫情的危险因素,为完善托幼机构手足口病防控措施提供参考依据.方法 选取广州市海珠区2013年4-7月发生手足口病疫情的30个托幼机构,在每个托幼机构选取发生聚集性病例疫情、散发病例疫情和无病例3种情况的班级各1个共90个班级,用病例对照研究方法研究相关因素与手足口病疫情的关系.结果 单因素分析显示,聚集性病例疫情、散发病例疫情和无病例3种情况的班级间教室温度、教室通风面积、教室窗地比、玩具表面细菌菌落数、老师手足口病知识得分、规范洗手率和午检率差异均有统计学意义(F值分别为3.72,3.87,4.02,8.55,4.08,4.20,7.42,P值均<0.05);线性回归结果显示,教室通风面积(B=-0.319)和午检率(B=-0.233)为手足口病疫情发生的保护因素,而玩具表面细菌菌落数较多(B=-0.319,P<0.05)为手足口病疫情发生的危险因素(P值均<0.05).结论 加强教室通风、提高教师防控能力和做好玩具消毒对预防手足口病疫情发生有积极作用.     

一起学校水痘暴发疫情的流行因素及疫苗保护效果调查

目的调查一起学校水痘暴发疫情的流行病学特征,明确本起疫情发生及扩散的原因,评价水痘疫苗的保护效果。方法采用描述流行病学方法分析疫情流行病学特征,采用回顾性队列研究方法探讨疫情流行因素和水痘疫苗保护效果。结果该疫情总罹患率为5.03%(110/2 188);波及27个班4个年级,三年级和四年级罹患率较高,分别为6.48%(43/664)、5.61%(31/553);疫情历时4个月,共有7个发病高峰;在午托班午休的学生罹患率(7.01%,69/984)高于在家午休学生罹患率(4.18%,41/981),差异有统计学意义(χ~2=7.46,P=0.0063;RR=1.68,95%CI:1.16~2.44)。本次疫情中,91.82%的病例(101/110)为水痘突破病例。学生水痘疫苗总体接种率为83.09%(1 818/2 188),223名学生曾在本次疫情前罹患水痘;本次疫情发生前,水痘疫苗保护效果为75.51%(RR=0.25,95%CI:0.19~0.32),而本次疫情中,疫苗保护效果为33.50%(RR=0.67,95%CI:0.35~1.29)。结论应规范校内外午托班管理,防止疫情跨班级传播;一针次水痘疫苗在暴发疫情中保护效果较差,应进行水痘疫苗应急接种。     

两种风险评估方法在COVID-19疫情研判中的应用

目的 比较基于绝对数据进行风险评估的方法(简称绝对法)和基于相对指标进行风险评估的方法(简称相对法)两种方法在新型冠状病毒肺炎(简称新冠肺炎,COVID-19)疫情研判中的应用效果。 方法 绝对法以累计确诊病例数、本地感染病例占比、近1周聚集性疫情起数、近1周新增确诊病例4个指标计算风险;相对法以本地散发感染确诊病例占比、近1周确诊病例占比、近1周聚集性疫情起数和近1周新增确诊病例4个指标计算风险。以湖北省荆州市的COVID-19疫情数据为例,利用两种方法比较流行前期时间节点(2月1日)、流行中期时间节点(2月15日)和流行末期时间节点(2月27日)的风险评价结果。 结果 两种方法的评估结果中,33.3%(8/24)完全一致、50.0%(12/24)相差1个级别、16.7%(4/24)相差2个级别及以上。流行前期时间节点,相对法研判荆州区、公安县、洪湖市、松滋市为较高风险及以上,绝对法研判4个地区为中风险及以下。流行中期时间节点、流行末期时间节点,两种方法研判结果相同或相差1个级别。 结论 两种方法评估结果类似,均可以用于COVID-19疫情研判,在疫情流行早期,相对法更适于COVID-19疫情走势研判。     

新冠疫情前后学龄前儿童视屏时间变化及与行为问题关联

目的分析新冠疫情前后学龄前儿童视屏时间变化情况及与行为问题的关联。方法采用分层整群抽样方法,于2020年5月选取安徽省合肥市4个主城区、3个开发区、3个县和1个县级市8 844名学龄前儿童,调查学龄前儿童新冠疫情前后每日视屏时间,采用Conners父母用行为量表评价儿童行为问题,建立多因素logistic回归模型分析新冠疫情前后视屏时间变化与儿童行为问题的关联。结果新冠疫情前每日视屏时间(以下简称疫情前)≤1 h新冠疫情控制期每日视屏时间(以下简称控制期)≤1 h组共4 848人,占54.82%;疫情前≤1 h控制期 1 h组共1 888人,占21.35%;疫情前 1 h控制期≤1 h组共147人,占1.66%;疫情前 1 h控制期 1 h组共1 961人,占22.17%。与疫情前≤1 h控制期≤1 h组相比,疫情前≤1 h控制期 1 h组(OR=1.63,95%CI=1.42～1.88)、疫情前 1 h控制期≤1 h组(OR=1.57,95%CI=1.03～2.38)和疫情前 1 h控制期 1 h组(OR=1.78,95%CI=1.55～2.04)总行为问题的风险增高(均P 0.05)。与疫情前≤1 h控制期≤1 h组相比,疫情前≤1 h控制期1 h组和疫情前 1 h/控制期 1 h组学龄前儿童品行问题、学习问题、冲动–多动、焦虑、多动的风险均较高(P 0.05)。结论疫情可能增加学龄前儿童视屏时间,高视屏时间与高水平儿童行为问题相关联。     

温州市麻疹疫情风险评估指标及应用

目的 通过建立麻疹疫情风险评估指标体系,确定温州市2015年各县(市、区)的风险等级,为当地制定相应防控措施提供依据.方法 采用指标赋值法,对“基础免疫水平”“麻疹病例监测”和“疫情易发生扩散”3个一级指标开展评估,每个指标包括5个二级指标.二级指标得分相加得到一级指标得分.总评分设为100.00分,得分超过50.00分确定为高风险地区.结果 温州市基础免疫薄弱的是瓯海区(25.50分)和乐清市(23.50分);麻疹病例监测质量不高的是经开区(19.00分)和乐清市(17.00分);疫情易于扩散的是经开区(33.00分)和龙湾区(30.00分).总体麻疹疫情发生风险较高的是经开区(69.50分),其次是龙湾区(63.50分)、鹿城区(56.50分)、瓯海区.(56.50分)和乐清市(52.50分).结论 麻疹疫情风险评估指标能基本反映温州市麻疹疫情风险,疫情总体可控,但部分县(市、区)仍存在薄弱环节.经开区、鹿城区等监测质量不高的县,应加强监管,规范疫情处置并扩大应急接种对象和范围.龙湾区、乐清市等基础免疫水平薄弱的县,应提高麻疹疫苗的接种率和及时率.     

河南省新型冠状病毒肺炎聚集性疫情流行病学特征分析

目的对河南省报告的新型冠状病毒肺炎聚集性疫情流行病学特征进行描述与分析。方法选取截至2020年2月25日,河南省突发公共卫生事件管理信息系统报告的新型冠状病毒肺炎聚集性疫情,结合传染病报告卡、个案调查和调查报告,分析其流行病学特征。结果河南18个市的103个县(区)共报告新型冠状病毒肺炎聚集性疫情256起,占全省总县(区)的59.88%,涉及病例790例,其中708例为确诊病例(89.62%),82例无症状感染者(10.38%);输入病例269例(34.05%),本地病例521例(65.95%)。2月3—4日报告起数达到顶峰,报告聚集性疫情较多的地市为信阳、郑州、南阳、驻马店和商丘。聚集性疫情规模分别为2～4例222起(86. 72%)、5～9例27起(10.5%)、≥10例7起(2.73%)。聚集性疫情以家庭聚集为主(202起,占78.90%),不同类型聚集性疫情均以本地病例为主;中位潜伏期为7 d。结论新型冠状病毒传播力较强,容易造成较大范围的聚集性疫情,早期采取联防联控,各部门多措并举,严格落实有效的防控措施是聚集性疫情防控的关键。     

新疆2013年人间布鲁氏菌病监测结果及疫情分析

目的分析新疆维吾尔自治区(新疆)2013年人间布鲁氏菌病(布病)疫情形势,为及时采取有效防治措施提供科学依据。方法按《新疆人间布鲁氏菌病监测实施方案》,对4个监测县(市、区)进行疫情监测,同时对12个县(市、区)的高危人群进行筛查,以及对2013年新疆累计报告发病数进行描述性分析。结果 2013年新疆16个布病监测县(市、区)流行病学调查共15 809人,血清学检测10 553份,血检阳性数1258份,血检阳性率为11.92%,患病数1185例,患病率为7.50%,新发病例数1136例,发病率为5.16/10万。结论 2013年新疆人间布病血检阳性率、患病率和发病率均高于2012年,2013年全疆累计报告发病数3930例,与2012年(2251例)比较上升了74.59%,疫情形势仍比较严峻,今后应加强新疆人间布病疫情监测,密切关注疫情动态。     

Effectiveness and Timing of Vaccination during School Measles Outbreak

Despite high vaccination coverage in most European countries, large community outbreaks of measles do occur, normally clustered around schools and resulting from suboptimal vaccination coverage. To determine whether or when it is worth implementing outbreak-response vaccination campaigns in schools, we used stochastic outbreak models to reproduce a public school outbreak in Germany, where no vaccination campaign was implemented. We assumed 2 scenarios covering the baseline vaccination ratio range (91.3%-94.3%) estimated for that school and computed outbreaks assuming various vaccination delays. In one scenario, reacting (i.e., implementing outbreak-response vaccination campaigns) within 12-24 days avoided large outbreaks and reacting within 50 days reduced outbreak size. In the other scenario, reacting within 6-14 days avoided large outbreaks and reacting within 40 days reduced the outbreak size. These are realistic time frames for implementing school outbreak response vaccination campaigns. High baseline vaccination ratios extended the time needed for effective response.     

Changing epidemiology of Q fever in Germany, 1947-1999.

The epidemiology of Q fever in Germany was examined by reviewing relevant studies since 1947 and by analyzing available surveillance data since 1962. The average annual Q fever incidence nationwide from 1979 to 1989 was 0.8 per million and from 1990 to 1999, 1.4 per million. The mean annual incidence from 1979 to 1999 ranged from a minimum of 0.1 per million in several northern states to 3.1 per million in Baden-Württemberg, in the South. We identified 40 documented outbreaks since 1947; in 24 of these sheep were implicated as the source of transmission. The seasonality of community outbreaks has shifted from predominantly winter- spring to spring-summer, possibly because of changes in sheep husbandry. The location of recent outbreaks suggests that urbanization of rural areas may be contributing to the increase in Q fever. Prevention efforts should focus on reducing sheep-related exposures, particularly near urban areas.     

Automatic outbreak detection algorithm versus electronic reporting system

To determine efficacy of automatic outbreak detection algorithms (AODAs), we analyzed 3,582 AODA signals and 4,427 reports of outbreaks caused by Campylobacter spp. or norovirus during 2005-2006 in Germany. Local health departments reported local outbreaks with higher sensitivity and positive predictive value than did AODAs.     

Ongoing High Incidence and Case-Fatality Rates for Invasive Listeriosis,Germany, 2010–2019

We used 10 years of surveillance data to describe listeriosis frequency in Germany. Altogether, 5,576 cases were reported, 91% not pregnancy associated; case counts increased over time. Case-fatality rate was 13% in non–pregnancy-associated cases, most in adults ≥65 years of age. Detecting, investigating, and ending outbreaks might have the greatest effect on incidence     

Interdisziplin?res Management eines l?nder��bergreifenden Legionellenausbruchs

Between December 2009 and the end of January 2010, the largest hitherto known outbreak of Legionella in Germany took place in the cities of Ulm and Neu-Ulm. Of a total of 64 patients involved, 60 patients had to be hospitalized, and 5 patients died from the infection. This event was caused by a wet cooling tower of a large air conditioning system in the city center of Ulm. The search for the source of the Legionella emission was extremely difficult, since these plants are neither notifiable nor subject to authorization in Germany. We report about the search for the source and the measures to control the outbreak. We also discuss communication and coordination during these investigations. Regulatory measures as proposed by the World Health Organization (WHO) and the European Network for Legionellosis (EWGLI) and already implemented in numerous other European countries would be desirable to prevent such outbreaks in the future.     

SurvNet electronic surveillance system for infectious disease outbreaks, Germany

In 2001, the Robert Koch Institute (RKI) implemented a new electronic surveillance system (SurvNet) for infectious disease outbreaks in Germany. SurvNet has captured 30,578 outbreak reports in 2001-2005. The size of the outbreaks ranged from 2 to 527 cases. For outbreaks reported in 2002-2005, the median duration from notification of the first case to the local health department until receipt of the outbreak report at RKI was 7 days. Median outbreak duration ranged from 1 day (caused by Campylobacter) up to 73 days (caused by Mycobacterium tuberculosis). The most common settings among the 10,008 entries for 9,946 outbreaks in 2004 and 2005 were households (5,262; 53%), nursing homes (1,218; 12%), and hospitals (1,248; 12%). SurvNet may be a useful tool for other outbreak surveillance systems because it minimizes the workload of local health departments and captures outbreaks even when causative pathogens have not yet been identified.     

Multiple synchronous outbreaks of puumala virus, Germany, 2010

To investigate 2,017 cases of hantavirus disease in Germany, we compared 38 new patient-derived Puumala virus RNA sequences identified in 2010 with bank vole-derived small segment RNA sequences. The epidemic process was driven by outbreaks of 6 Puumala virus clades comprising strains of human and vole origin. Each clade corresponded to a different outbreak region.     

Die Auswirkungen des Klimawandels

Increasing temperatures, but also other climatic factors, will have an impact on human health. Apart from the direct consequences of extreme weather conditions (e.g., heat-related fatalities), indirect health consequences in the long-term are also of great importance. In addition to a likely increase in allergic diseases and additional complications in the course of cardiovascular and respiratory diseases, infectious diseases are of particular interest. In Germany, endemic pathogens, such as hantavirus (with its reservoir in small rodents), tick-borne pathogens (Borrelia burgdorferi, tick-borne encephalitis virus), and certain food- and water-borne pathogens, are of concern. Mild winters favor rodent populations and may result in hantavirus epidemics in the subsequent summer period. Statistical analyses show a significant association between temperature and campylobacter incidence in Germany. An outbreak of rodent-borne leptospirosis among strawberry harvesters enhanced by heavy rainfalls illustrates how weather conditions may influence disease occurrence. Pathogens that are non-endemic in Germany but are imported by humans, vectors, and reservoir animals pose an additional risk to the population. Increasing temperatures improve the conditions for establishment of new vectors and for autochthonous transmission of some pathogens (e.g., chikungunya, dengue, West Nile virus, malaria, or leishmaniasis). Climatic and ecologic conditions in Germany currently do not favor autochthonous outbreaks for most of these pathogens. However, if temperatures increase, as expected, such outbreaks will become more likely. Germany should enhance its research in public health activities in the field of climate change and infectious diseases.     

Effekte der Masern-Mumps-Röteln (MMR)-Impfung auf die Epidemiologie von Mumps in Deutschland

Mumps is an acute viral infectious disease characterized by fever and swelling and tenderness of one or more salivary glands, usually the parotid gland. Since 1976, the German Standing Committee on Vaccination (STIKO) has recommended a mumps vaccination as part of the routine immunization schedule in former West Germany. In East Germany, the vaccination was only introduced in 1991 after reunification. In the preceding decades, no comprehensive surveillance system existed in Germany. However, for East Germany and the successional federal states of former East Germany, data on mumps incidence are available from different Eastern surveillance systems for the time period 1968–2012. According to these data, the incidence of mumps has dropped from >?200 cases/100,000 annually in the pre-vaccine era to currently <1/100,000. Recently, an age shift has been noted predominantly in the Western federal states. Based on data from school entry examinations and seroprevalence studies, the age shift is likely due to insufficient vaccination coverage and secondary vaccine failure (“waning immunity”). In view of the changes in mumps epidemiology and the increase of outbreaks among adolescents and young adults, the implementation of a nationwide mandatory notification was initiated and came into effect in March 2013. Mandatory notification enables the early detection of outbreaks and obtainment of comprehensive data for evaluation of the immunization program in place. Regarding the long-term prevention of mumps in Germany, it is hoped that—as part of the measles and rubella elimination effort—coverage rates for the second MMR dose among children will increase nationwide above 95% and existing vaccination gaps among adults will be closed.     

Methods of outbreak investigation in the "era of bacteriology" 1880-1920

The advent of bacteriological methods in the later 19th century has been seen, on the examples of America and Germany, to have been followed by a new laboratory-based, contact-tracing method of investigating outbreaks of epidemic disease. In Britain, however, this new approach never took firm root, and practising epidemiologists continued to follow an observational and deductive tradition in field investigations, rejecting any primary dependence on bacteriological methods. Alongside this persistent observational practice, there emerged a new statistical approach, based in Pearsonian biometrics, which allied itself with experimental laboratory techniques to develop a more systematic, theoretical trajectory for explaining disease outbreaks in the years after World War I.