绍兴市某中学肺结核暴发现场流行病学调查

目的 了解绍兴市某中学肺结核病暴发疫情的发病情况,查明暴发流行的原因及其危险因素,采取相应措施控制,以减少类似暴发事件的发生.方法 按照现场流行病学调查的方法和步骤,采用统一的病例定义,通过访谈、标准精制结核菌素(PPD)试验筛查、影像学及痰结核菌检查及可疑症状筛查进行病例搜索,调查病例的可能暴露史及病例之间的流行病学关联,查找发病和感染的原因和危险因素.结果 从暴发年级194名学生中搜索到9例病例,其中八3班8例,八1班1例,年级罹患率为4.6％.八3班结核罹患率高于八年级其他班(RR =24,95％ CI =3.0 ～184);八3班结核感染率高于八年级其他班(RR=1.8,95％ CI=1.3 ～2.5);八3班住宿生的结核感染率高于走读生(RR =2.0,95％ CI=1.3 ～3.2);八3班与首发病例相隔≤4个位置的学生罹患率显著高于＞4个位置的学生(RR =6.2,95％ CI=1.4 ～27).结论 这是一起由于首发病例探亲后感染患病,未被及时发现和治疗引起的校内结核病暴发.与首发病例同班、同住宿、座位近(≤4个座位)是发病和感染的危险因素.     

江苏省一起人间布鲁氏菌病暴发的调查

目的：查明2014年江苏省某村一起布鲁氏菌病（布病）暴发原因和感染危险因素,以采取有效控制措施。方法对该村直接从事羊只屠宰、交易等从业人员进行流行病学调查和实验室检测。结果共调查从业人员129人,18例布病血清学阳性,其中7例为确诊病例,11例为隐性感染者,该村从业人员布鲁氏菌感染率为14%。该村约90%羊只来源于北方布病高发疫区。从业人员工作时89%从不戴口罩、84%从不穿工作服、70%不戴手套。危险因素分析显示,工作时不戴手套（RR＝7.4,95%CI：1.1～53.0）、手部有伤口（RR＝3.4,95%CI：1.1～11.0）增加感染布病的风险。结论因外地未经严格检疫的病羊大量输入,且当地从业人员在屠宰和交易过程中缺乏有效防护导致此次布病人间暴发。     

1起流行性腮腺炎暴发疫情的现场流行病学调查

目的调查某中学1起流行性腮腺炎暴发疫情的感染来源、传播途径和危险因素,提出预防控制措施。方法按照病例定义开展病例搜索,采用描述性流行病学方法和病例对照研究方法进行分析。结果2012年2月23日至3月25日,某中学共发生流行性腮腺炎病例24例,罹患率为0．91％（24／2624）;病例有班级聚集性,共有4个班出现病例,罹患率分别为1．9％～38．0％,班级罹患率差异有统计学意义（P〈0．01）;罹患率最高的班级腮腺炎疫苗接种率仅为3．8％（2／53）。病例对照研究结果显示,接触病例（OR=6．90,95％CI为1．97～24．20）、与病例共同进餐（OR=5．37,95％CI为1．60～18．01）和同宿舍（OR=5．80,95％CI为1．72～19．58）均是发病的危险因素,而用洗手液或香皂洗手（OR=0．28,95％CI为0．09～0．94）是发病的保护因素。结论这是1起由班内病例引发的学校流行性腮腺炎暴发疫情,暴发原因可能是与病例密切接触和疫苗接种率低,建议加强学校晨午检制度,培养学生良好的卫生习惯,同时提高疫苗接种覆盖率。     

四川省人感染猪链球菌病危险因素的匹配病例对照研究

目的探讨人感染猪链球菌病的危险因素。方法采取1：M匹配的病例对照研究。对疫情早期发病的29例人感染猪链球菌患者及其家属、邻居和一起处理过病（死）猪的个体共147名匹配对照进行问卷调查。调查的危险因素重点是与病（死）猪及其制品的接触方式。统计分析采用条件logistic回归方法。结果多因素分析结果显示，病前一周内曾屠宰过（OR=11978，95％CI：3．355～42．756）和洗切加工过（OR=3008，95％CI：1．022～8．849）病（死）猪是发病的主要危险因素。估计屠宰和洗切加工暴露的归因危险度百分比分别为91．65％和66．76％。在研究人群中，喂养、销售、埋葬和食用等暴露因素不是发病的危险因素。结论屠宰和洗切加工病（死）猪是人感染猪链球菌病的重要危险因素。     

一起中学风疹暴发的流行病学调查和危险因素研究

目的分析疫情的流行病学特征,探讨发病危险因素,提出预防控制风疹疫情的措施。方法2013年4月对病例进行个案调查,采用描述性流行病学方法对病例进行分析;对罹患率最高的两个班级学生进行问卷调查,采用回顾性队列研究方法进行危险因素分析。结果本次暴发罹患率为2．10％,临床症状以皮疹为主,平均年龄16岁,男女罹患率差异无统计学意义（P〉0．05）,发病班级之间罹患率差异有统计学意义（P〈0．01）;初三（4）班和初三（2）班未及时隔离,罹患率为68．75％和4／5,回顾性队列研究表明：接触风疹病人是危险因素（RR=3．24,95％CI—I．28～8．18）;学生不良的洗手习惯与发病有关。结论本次疫情为风疹暴发,接触风疹病人和不良洗手习惯是疫情的危险因素。提示加强学生良好卫生习惯的培养,是预防疫情暴发的重要措施,同时建议校方及时发现和隔离病例。     

河池市某县甲型副伤寒暴发队列研究

目的查明暴发疫情发生原因和感染来源。方法开展病例搜索和回顾性队列研究,分析危险因素与暴发之间的关联性;采集标本进行可疑致病菌的检测。结果暴露人群罹患率为0．36％（111／31245）,其中学生罹患率为0．80％（92／11526）。主要临床表现为持续不规则发热、畏寒、头痛、头晕和脾肿大。部分自来水标本细菌总数和总大肠菌群数超标,暴露于自来水与暴发存在很强的关联性（RR=28．00,95％CI：15．60-50．24,AR％=96．43,x^2=124．76,P〈0．01）。结论生活用水（自来水）受污染是本次甲型副伤寒暴发的主要原因,生活饮用水卫生安全需要得到进一步加强。     

南京市江宁区秣陵街道方山社区两起水痘突发公共卫生事件的流行病学调查

目的：通过对南京市江宁区秣陵街道方山社区两起水痘突发公共卫生事件的流行病学调查分析,及时了解流行特征,探讨发病危险因素,提出有效的防控措施。方法：采用描述性流行病学方法和病例对照研究方法对南京市江宁区秣陵街道方山社区2008年发生的两起水痘突发公共卫生事件资料进行流行病学分析。结果：两起水痘突发公卫事件累计报告病例112例,一起发生在学校,一起发生在幼儿园,罹患率分别为3．07％和8．10％,分别历时53天和47天。小学一、二年级（占小学总病例数72．31％）和幼儿园的中、大班（占幼儿园总病例数93．18％）发病比例较高,而且在小学里,随着年级的升高水痘发病率逐渐下降;112例病例中仅有8例有明确的水痘疫苗接种史,在疫情发生幼儿园中接种过水痘疫苗学生的罹患率为2．33％,未接种过水痘疫苗学生的罹患率为7．53％,差异有统计学意义（P〈0．05）。在疫情发生幼儿园中,搭乘校车上学的学生发生水痘的危险是不搭乘校车上学的3．298倍（RR=3．298,95％CI=1．228～8．862）,而饭前洗手是一种保护因素（RR=0．171,95％CI=0．073～0．399）。结论：高度重视学校和幼儿园水痘暴发疫情的苗头,搭乘校车上学是水痘暴发危险因素,勤洗手能预防水痘,建议将水痘疫苗列入国家的计划内免疫范畴,降低水痘疫情的发生。     

天津市畜牧养殖人员无形体感染危险因素研究

目的 了解天津畜牧养殖人群中无形体感染情况,探讨无形体感染的危险因素.方法 整群抽取天津4个涉农区县作为调查点,共调查166例畜牧养殖人群,55例非养殖人群,运用间接免疫荧光方法检测人粒细胞无形体IgG抗体,应用病例对照分析无形体感染的可能危险因素.结果 天津市畜牧养殖人群无形体血清抗体阳性率为66.27％,高于非养殖人群(27.27％);中部地区是无形体感染的高危地区(OR =2.196,95％ CI:1.050 ～4.593);喂养较其他接触方式更易感染无形体(OR =4.938,95％ CI:1.397～17.458);养羊较养殖其他牲畜更易感染无形体(OR=6.419,95％ CI:1.566 ～26.306);牲畜散养是无形体感染的高危养殖方式(OR=2.830,95％ CI:1.335～6.001).结论 天津市畜牧养殖人员无形体感染率较高,感染率高低与所在地区,养殖动物、养殖方式有关.     

1起幼儿园水痘暴发调查及疫苗保护效果分析

目的 分析无锡市某幼儿园水痘暴发疫情的流行特征,评价水痘疫苗的保护效果.方法 通过病例主动搜索和问卷调查,对水痘暴发疫情进行描述性流行病学分析.采用回顾性队列研究方法评价水痘疫苗的保护效果.结果 该起暴发疫情共发生水痘病例22例,罹患率为5.39％(22/408);暴发持续31 d,波及2个班级,其罹患率分别为56.76％、3.23％,差异有统计学意义(x2=22.085,P＜0.05);男、女性罹患率分别为7.89％、3.48％.全园水痘疫苗接种率为72.89％,水痘疫苗的总保护效果为69.01％(RR=0.31,95％ CI:0.14～0.70),接种1剂次、2剂次的保护效果分别为63.38％ (RR=0.37,95％CI:0.15～0.85)、80.80％(RR=0.19,95％ CI:0.05～0.88),接种水痘疫苗≤3年和＞3年的保护效果分别为72.96％ (RR=0.27,95％CI:0.08～0.93)、66.93％(RR=0.33,95％ CI:0.13～0.81).结论 及时发现并隔离传染源对控制水痘暴发至关重要.建议提高幼儿水痘疫苗覆盖率,尤其是适龄儿童的2剂次水痘疫苗.     

金山区幼托机构聚集性手足口病疫情感染危险因素研究

目的探讨金山区托幼机构手足口病流行的危险因素,为重点人群和重点场所防控提供参考依据。方法选取2012年金山区幼托机构聚集性手足口病疫情中所有病例作为病例组,选择同期该年龄段病例就读幼托机构所在区域内其他没有发生手足口病病例的幼托儿童作为对照组进行病例对照研究。采用单因素和多因素非条件Logistic回归分析探讨其危险因素。结果近一周内手足口病病例接触史（OR=25．589,95％CI：10．905—60．049）、近～周是否去过密接人群场所（OR=3．009,95％凹：1．657—5．464）为发病的危险因素,变量本地户籍（OR=0．504,95％口：0．261～0．974）、饭前便后洗手习惯（OR=0．676,95％CI：0．372～0．989）及看护人防治知识落实意识（OR=0．552,95％口：0．306～0．998）为保护因素。结论病例接触史为其发病主要危险因素,良好卫生习惯及看护人手足口病防治知识落实对于幼托机构手足口病防治意义重大。     

Contaminated drinking water in one town manifesting as an outbreak of cryptosporidiosis in another

In early 1992 we identified an outbreak of cryptosporidiosis in Oregon and sought to identify and control its source. We used a series of studies to identify risk factors for illness: (i) a case-control study among employees of a long-term-care facility (LTCF); (ii) a matched case-control study of the general community; (iii) a cohort study of wedding attendees; and (iv) a cross-sectional survey of the general community. Drinking Talent water was associated with illness in the LTCF (OR = 22.7, 95 % CI = 2.7-1009.0), and in the community (matched OR = 9.5, 95% CI 2.3-84.1). Drinking Talent water was associated with illness only among non-Talent residents who attended the wedding (P < 0.001) and in the community (RR = 6.5, 95 % CI 3.3-12.9). The outbreak was caused by contaminated municipal water from Talent in the absence of a discernible outbreak among Talent residents, suggesting persons exposed to contaminated water may develop immunity to cryptosporidiosis.     

Serum cholesterol--risk factor for coronary disease mortality in younger and older blacks and whites. The Charleston Heart Study, 1960-1988.

Serum total cholesterol (> or = 6.7 mmol/L) measured in 1960 in the Charleston Heart Study cohort was found to be a risk for mortality from coronary heart disease during the period of 1960 to 1988 in white men (relative risk [RR] 1.5; 95% confidence interval [CI]: 1.1, 2.2), white women (RR 1.7; 95% CI: 1.1, 2.7), and black women (RR 1.6; 95% CI: .9, 2.9) after age, systolic blood pressure, smoking status, education level, obesity, and diabetes were considered. For black men, the relative risk was .96 (95% CI, .39, 2.39). Only among white women was the relative risk (RR 2.4; 95% CI, 1.2, 4.5) increased among those in the older ages (55 to 74) in 1960. The evidence for cholesterol as a risk factor for coronary disease mortality in black men is inconclusive and requires further study.     

Hormone replacement therapy and hip fracture risk: effect modification by tobacco smoking, alcohol intake, physical activity, and body mass index

The authors prospectively studied the overall effect of hormone replacement therapy (HRT) on hip fracture risk and the effect modification by behavioral habits and body mass index. A total of 6,159 postmenopausal women from the Copenhagen Center for Prospective Population Studies, Copenhagen, Denmark, with initial examination in 1976-1978 were followed until 1993. During follow-up 363 hip fractures were identified. Women who reported current use of HRT had a lower risk of hip fracture as compared with women who were nonusers (relative risk (RR) = 0.71; 95 percent confidence interval (CI): 0.50, 1.01). Use of HRT was associated with a lower risk of hip fracture in former (RR = 0.55; 95 percent CI: 0.22, 1.37) and current (RR = 0.61; 95 percent CI: 0.38, 0.99) smokers but not in never smokers (RR = 1.10; 95 percent CI: 0.60, 2.03). HRT was also associated with lower risk of hip fracture among alcohol drinkers (RR = 0.36; 95 percent CI: 0.14, 0.90) and among sedentary women (RR = 0.42; 95 percent CI: 0.18, 0.98) but not among nondrinkers (RR = 0.99; 95 percent CI: 0.61, 1.61) and physically active women (RR = 0.92; 95 percent CI: 0.42, 2.04). There was no evidence of interaction between use of HRT and body mass index. In conclusion, the protective effect of HRT on hip fracture appears to be strongest in women who ever smoked, in women who drink alcohol, and in women who are sedentary. The results suggest that history of behavioral habits offers important information concerning the probable degree of protection against hip fracture afforded by HRT.     

相位角预测手术病人营养风险及住院时间

目的:探讨生物电阻抗相位角(phase angle,PA)与胸外手术病人营养风险、住院时间(hospital length of stay,LOS)的关系。方法:60例胸部手术病人,应用营养风险筛查2002(NRS2002)、主观全面评定(Subjective Global Assessment,SGA)、白蛋白、人体成分分析、PA评价其营养风险及LOS。结果 :与对照组比较,手术病人PA偏低,男(6.0±1.0)vs(3.85±1.0),女(5.4±0.9)vs(4.9±0.6),P0.01。与正常PA比较,低PA者营养风险相对危险度,用NRS2002。无风险(RR 2.8,95%CI=1.2~6.9),中度风险(RR 3.9,95%CI=1.8~8.6),重度风险(RR4.2,95%CI=2.0~8.7);用SGA。营养良好(RR 2.5,95%CI=0.9~6.9),中度营养不良(RR 4.4,95%CI=2.1~9.4),重度营养不良(RR 3.9,95%CI=1.9~8.0),与NRS2002相似;与正常PA比较,低PA者住院时间倾向于延长(LOS≥21 d,RR=4.4,95%CI=2.2~8.8)。结论 :低PA与手术病人营养风险、LOS延长密切关联。PA测量有助于快速明确病人的营养风险对于确定病人营养干预和判断疾病转归提供了客观依据。     

上海市闵行区35岁及以上人群H型高血压患病及影响因素分析

目的 了解上海市闵行区≥35岁人群H型高血压的患病情况及其影响因素。方法 采用多阶段随机抽样的方法选择≥35岁的常住居民进行问卷调查、身体测量和实验室检查,用多因素Logistic回归分析H型高血压患病的影响因素。结果 本研究获得有效数据3 059人。≥35岁人群的H型高血压患病率为47.04%,H型高血压占高血压患者的比例为87.95%。多因素分析结果显示,男性（OR=1.44,95% CI:1.21~1.73）、年龄≥45岁（OR=2.05,95% CI:1.46~2.88）、超重（OR=1.67,95% CI:1.40~2.00）和肥胖（OR=2.80,95% CI:2.13~3.70）、血压级别≥2级（OR=13.42,95% CI:8.97~20.06）、患有糖尿病（OR=1.66,95% CI:1.35~2.04）、血清肌酐升高（OR=2.84,95% CI:1.35~5.99）、血清叶酸偏低（OR=1.46,95% CI:1.23~1.73）、血清维生素B12偏低（OR=1.22,95% CI:1.03~1.45）是H型高血压的危险因素。结论 上海市闵行区35岁及以上人群的H型高血压患病率高,有必要针对主要危险因素采取社区H型高血压的防控措施。     

腰围和体质指数动态变化对高血压发病的影响

目的 探讨腰围(WC)和BMI在2年随访时间内的动态变化对队列人群高血压发病的影响.方法 采用前瞻性研究方法,于2002年1月,对江苏省多代谢异常和代谢综合征(MS)综合防治研究队列人群中随访时间满2年的5888名对象进行第1次随访,完成随访4582名,并于2006年3月对随访时间满5年及参与了第1次随访的对象进行了第2次随访,完成2次随访的对象共3847名,其中满足条件的共2778名基线血压正常对象被纳入分析.基线时WC或BMI正常者在第1次随访时变为非正常者以及基线WC或BMI不正常者在第1次随访时依旧不正常者定义为非控制组;基线WC或BMI非正常者在第1次随访时变为正常以及基线WC或BMI正常者在第1次随访时依旧保持正常者定义为控制组.以第2次随访时是否为高血压作为结局变量(高血压=1,正常血压=0).运用COX比例风险回归模型分析相互调整的WC和BMI差值与高血压发病的关系,以及按照WC和BMI控制与否分层的高血压发病风险,并计算相应的OR和RR值及95％ CI值.结果 2778名研究对象中,新发高血压660例.WC差值和BMI差值以连续型变量进入模型作相巨调整时,男女性中高血压发病与WC差值的关联仍具有统计学意义(男性:OR=1.04,95％ CI:1.01～1.05;女性:OR=1.04,95％CI:1.02 ～1.06),而与BMI差值的关联不再具有统计学意义(男性:OR=1.04,95％CI:0.97～1.11;女性:OR =0.98,95％ CI:0.93～1.03).不论基线WC正常与否,非控制组人群的高血压风险高于控制组人群(基线WC正常组:RR=1.41,95％ CI:1.01～2.39;基线WC非正常组:RR =4.41,95％ CI:1.66 ～9.80).而在基线BMI非正常组中,控制组与非控制组的高血压发病风险差异无统计学意义(RR=1.33,95％ CI:0.88 ～2.02).当WC得到控制,BM1控制与否对高血压发病风险无明显影响(男性:RR=1.03,95％ CI:0.36～2.96;女性:RR =1.02,95％ CI:0.70～5.85),WC未得到控制时,即使BMI得到控制,高血压发病风险仍会明显增加(男性:RR =4.03,95％ CI:1.61～10.09;女性:RR=1.55,95％ CI:1.13 ～3.60).结论 WC和BMI的控制均可降低高血压发病风险,而相比于控制BMI,控制WC对降低高血压风险的效果更好.     

Age at natural menopause and cause-specific mortality

Several studies have suggested that a young age at menopause may be associated with increased risk of all-cause mortality. Few studies have examined the influence of age at menopause on specific causes of death other than coronary heart disease. Data from a prospective cohort study of US adults were used to examine the relation between age at natural menopause and all-cause and cause-specific mortality among women who never used hormone replacement therapy, who never smoked, and who experienced natural menopause between the ages of 40 and 54 years. After 20 years of follow-up between 1982 and 2002, 23,067 deaths had occurred among 68,154 women. Results from Cox proportional hazards models showed that all-cause mortality rates were higher among women who reported that menopause occurred at age 40-44 years compared with women who reported that menopause occurred at age 50-54 years (rate ratio (RR) = 1.04, 95% confidence interval (CI): 1.00, 1.08). This increased risk was largely due to higher mortality rates from coronary heart disease (RR = 1.09, 95% CI: 1.00, 1.18), respiratory disease (RR = 1.19, 95% CI: 1.02, 1.39), genitourinary disease (RR = 1.39, 95% CI: 1.07, 1.82), and external causes (RR = 1.56, 95% CI: 1.21, 2.02). These findings suggest that mortality from other diseases, as well as coronary heart disease, may contribute to the increased mortality associated with a younger age at menopause.     

Outbreak of scabies at a home for the elderly in the province of Huesca

BACKGROUND: Individuals residing in institutionalized living facilities are currently a high-risk group as regards scabies outbreaks. This study is aimed at analyzing the characteristics of one of these outbreaks, which occurred at a senior citizen living facility located in the municipality of Barbastro (Huesca) through the Huesca Provincial Epidemiological Monitoring Division. METHODS: Following the initial notification of cases, a specific scabies prevention protocol was set out. An epidemiological investigation was conducted, proceeding to an active search for cases among all of the individuals residing or working at the facility in question. The information gathered on the cases and contacts by means of a validated survey was included in a database using Epiinfo 6.0. The attack rate and the relative risk of those residing in each area of the center were estimated, taking as a reference that having the lowest attack rate. RESULTS: A total of nineteen (18 and 1 respectively) cases of scabies were detected among the 104 residents and 20 workers employed at the facility. The source of the outbreak could not be specifically determined, although at least two of the first cases had begun to show some symptoms six months prior to their detection. The average delay in diagnosis was 53 days. This outbreak had a greater effect on the males in the assisted living quarters (TA = 77%; RR = 18.5, C195% = 2.7-128.7). The only employee affected was the person in charge of this area, who had not employed the universal personal protection measures during his caregiving tasks. CONCLUSIONS: This is a scabies outbreak at a senior citizen living facility, probably due to the delay in diagnosing the first cases and the failure on the part of one caregiver to have employed the personal protection measures. A specific scabies-prevention protocol having been implemented was fundamental for the control of this outbreak.     

福建省新型冠状病毒肺炎患者密切接触者的流行病学特征与感染危险因素

  目的   探讨新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)患者的密切接触者的流行病学特征和感染的危险因素。   方法   描述2020年福建省111名COVID-19患者的密切接触者特征, 以111名(102名确诊和9名无症状感染者)感染新型冠状病毒的密切接触者为病例组, 以未感染新型冠状病毒且资料完整的2 337名密切接触者为对照组, 采用Logistic回归分析模型探讨密切接触者感染的危险因素。   结果   111例中男性57名, 女性54名, 男女比为1.1:1, 年龄中位数为49.5岁, 密切接触者感染率为1.7%(111/6 718)。引起47起聚集性疫情, 占总起数88.7%(47/53), 占总病例数54.7%(162/296), 有7例潜伏期超过14 d, 最长达21 d, 1起聚集性疫情显示原代病例发病前2 d具有感染性。家庭续发率4.2%(73/1 739)、社区续发率为10.1%(24/237)、养老院续发率2.7%(7/256)、社交场所续发率为2.0%(4/199)、工作场所续发率3.0%(3/99), 续发率差异有统计学意义(χ2=20.76, P < 0.001)。确诊病例以轻型和普通型为主(88.2%), 临床严重程度与原代病例没有区别。最后接触到确定密切接触者时间中位数为2 d, 确定密切接触者到实施隔离时间为中位数1 d, 最后接触到发病时间中位数为7 d, 发病至就诊时间中位数为4.9 d, 就诊到确诊均在当天完成。多因素分析结果显示, 随着年龄的增大, 感染风险越大, 15~岁(OR=4.22, 95% CI:1.79~9. 96)和≥50岁(OR=6.61, 95% CI:2.77~15.78);接触频率时间越久, 受感染的机会越大, 一般接触(OR=3.58, 95% CI:1.70~7.54)和经常接触(OR=8.30, 95% CI:4.65~14.80);暴露于现症病例(OR=3.64, 95% CI:1.65~8.04)更易感染。   结论   新型冠状病毒续发率较高, 在2.0%以上; 感染新型冠状病毒的密切接触者临床严重程度与原代病例没有差别, 均以轻症为主, 年龄、接触频率和原代病例有无症状是其危险因素; 密切接触者协同追踪管理信息化程度不高, 成效不理想。