一例与果子狸相关的SARS病例调查研究

2003年冬至2004年春广东省新出现了4例社区获得SARS病例,其中有一病例与果子狸相关,这是全球报告的唯一与果子狸直接相关的病例,为SARS由果子狸等野生动物传给人提供了流行病学证据,使对SARS来源于果子狸更加引起关注。对该病例流行病学、实验室检测、临床特点进行分析,有利于进一步认识SARS的来源,为预防控制措施提供依据。     

北京部分SARS临床诊断病例流行病学接触史与IgG抗体水平关系分析

目的 通过对302名SARS临床确诊病人的血清抗体IgG检测结果进行分析，探讨流行病学接触史与血清抗体阳性率之间的相关性，以及接触史在临床诊断中的意义。方法 样品为北京市疾病预防控制中心在SARS流行期内采集的住院的和康复的SARS临床确诊病人的血清，按照流行病学接触史分组分析。采用ELISA抗体检测方法检测抗SARS病毒IgG。结果 有流行病学接触史组的血清抗体阳性率与无接触史组具有显著差异。结论 流行病学接触史对SARS病例的诊断具有重要意义。在SARS临床诊断过程中应综合流行病学资料、实验室IgG检测结果和临床症状进行诊断。     

新疆喀什地区百日咳流行特征分析及6岁以下儿童抗体水平调查

目的掌握2004—2015年新疆喀什地区百日咳病例分布情况,包括发病的主要人群、发病时间及地区分布特征,了解人群对百日咳的真实免疫水平及发病情况,为今后做好百日咳预防控制提供科学依据。方法收集中国疾病预防控制中心疾病监测管理系统2004—2015年新疆喀什地区百日咳发病资料,运用描述流行病学方法进行分析,应用Excel 2007录入数据并统计处理;在新疆喀什地区选择0~6岁健康儿童751人,收集流行病学信息并采集血清标本,使用ELISA检测百日咳IgG抗体。结果 2004—2015年新疆喀什地区累计报告百日咳病例2 249例,占全疆百日咳报告病例的40.63%,死亡5例,年平均报告发病率4.82/10万,年平均死亡率为0.043/10万;病例主要集中在小年龄组,以2岁以下儿童为主,共报告发病1 599例,占总报告发病数的71.10%,以散发人群为主;在751名0~6岁健康儿童中,百日咳抗体阳性143人,阳性率19.04%;百日咳抗体阳性率随年龄增加而增加,5岁及以上组儿童抗体阳性率最高,阳性率25.13%;4剂次"百白破"疫苗接种史的儿童中,全程接种儿童其抗体阳性率明显高于其他儿童。结论新疆喀什地区百日咳疫情仍较严峻,全地区0~6岁儿童百日咳IgG抗体阳性率较低,儿童处于百日咳发病高危状态,应加强该地区百日咳的监测,进一步提高疫苗接种水平,防止疫情的进一步扩大。     

严重急性呼吸综合征患者冠状病毒总抗体及N和S蛋白抗体的随访研究

目的了解SARS冠状病毒（SARS—CoV）感染者血清中特异性IgM、IgG抗体和两个结构蛋白抗体的持续时间及相互关系。方法对146例SARS临床确诊且血清抗-SARS—CoV阳性病例,随访采集发病当13至发病后660d期间的血液标本共362份。以ELISA法分别检测抗-SARS—CoVIgM和IgG抗体、SARS—CoVN蛋白和S蛋白IgG抗体。结果抗-SARS—CoV IgM阳性率在发病20d内为46．5％（20／43）,21—40d阳性率最高（80．6％,25／31）,尔后逐渐下降,至发病后500d左右仅为8．2％（6／73）。IgG总抗体在发病20d内阳性率（34．9％,15／43）低于IgM抗体,在发病21～40d迅速达到100％,至发病后600—660d,其阳性率仍高达98．6％（70／71）。N—IgG抗体在发病40d后阳性率（92．5％,37／40）高于S-IgG（67．5％,27／40）,在61～90d、450—510d和600—660d3个时间点检测阳性率均高于S-IgG抗体;但两种结构蛋白抗体阳性率随时间延长均逐渐下降,两者于不同时间点的阳性率均低于抗-SARS—CoV总IgG。结论临床与病原学确诊的SARS患者,SARS—CoV特异性抗体阳性率在21—40d达高峰,IgG抗体阳性率100％。IgM抗体91．8％在感染500d以内消失;感染后两年IgG总抗体阳性率仍高达98．6％,推测可持续阳性3—5年。N—IgG和S-IgG抗体持续时间可能较短。     

2004年广州市4例散发严重急性呼吸综合征特点分析

目的　探讨 2 0 0 4年广州市散发严重急性呼吸综合征 (SARS)的特点。方法　对 2 0 0 4年确诊的 4例SARS患者的流行病学和临床资料、实验室和肺部影像学检查、预后等进行前瞻性研究。结果　 4例均为散发病例 ,分别于 2 0 0 3年 12月 16日至 2 0 0 4年 1月 8日起病。 2例有动物直接接触史 ,但均无食野生动物史。共 2 5 7例接触者均无发病 ,潜伏期不明确。急性发热起病 ,热程 7～11d。均有轻微咳嗽 ,无明显胸闷、气促 ;恶心、呕吐 1例 ,腹泻 1例。 4例患者白细胞及淋巴细胞呈不同程度降低 ,2例外周血T淋巴细胞亚群计数轻微降低。 3例丙氨酸氨基转移酶和天冬氨酸氨基转移酶轻度升高。血氧饱和度均无降低。 1例咽拭子中检测出SARS CoVRNA ,4例血清SARS IgM /IgG较早由阴转阳且滴度在短期内呈 4倍以上升高 ,中和抗体实验阳性。胸片检查均呈多肺叶渗出、实变及毛玻璃样改变。经对症综合治疗预后良好 ,4例均未使用激素及呼吸机。病程为 2 1～ 2 3d。近期随访无并发症发生。结论　 2 0 0 4年广州市 4例SARS均为社区获得性散发病例 ,临床表现轻 ,病程短 ,抗体出现早 ,易于治疗并迅速康复 ,无并发症和后遗症 ,未见续发病例。     

广东省佛山市严重急性呼吸综合征首例报告

目的 探讨严重急性呼吸综合征(SARS)的流行病学特点、诊断和治疗方法。方法 分析广东省佛山市首例SARS的流行病学特点、诊断和治疗过程，以及使用SARS患康复期血清SARS抗体检查确定回顾性诊断。结果 该病例具有以下特征：(1)有接触和食用野生动物史；(2)有持续高热、咳嗽、痰少和呼吸困难等症状；(3)白细胞(WBC)不高；(4)双肺弥漫性浸润；(5)病情迅速发展至急性呼吸窘迫综合征(ARDS)；(6)传染至与其密切接触的4名亲属；(7)患康复期血清抗冠状病毒抗体(IgG)阳性，经过抗病毒、抗生素、糖皮质激素、有创机械通气和分子吸附再循环系统(MARS)治疗，44天后治愈出院。结论 佛山市首例完全具备SARS诊断标准的主要特点，有很强的传染性，经过机械通气和多脏器支持等治疗，愈后良好。     

2004年中国首例社区获得性散发严重急性呼吸综合征的临床分析

目的　了解 2 0 0 4年我国首例社区获得性散发严重急性呼吸综合征 (SARS)病例的流行病学、临床、病原学检查特点及预后转归。方法　对患者流行病学及临床资料进行回顾性分析 ,并采用酶联免疫吸附试验 (ELISA)及免疫荧光试验检测SARS IgM /IgG抗体 ,荧光聚合酶链反应 (PCR)测定SARS CoVRNA。结果　患者 2 0 0 3年 12月 16日以发热起病 ,持续 8d ,有咳嗽、气促等症状 ,白细胞及T淋巴细胞计数降低 ,影像学检查示双肺密度增高影。起病前无流行病学依据 ,81名接触者均未出现发热等异常情况。 12月 2 7日被诊断为SARS疑似病例 ,2 0 0 4年 1月 5日确诊为SARS。经对症支持等综合治疗痊愈出院。对多份血清进行平行检测 ,SARS IgM阴转阳 ,滴度呈 4倍以上升高 ,SARS IgG在起病一周内出现 ,抗体滴度很快呈现 4倍以上升高。在咽拭子中检测出SARS CoVRNA。中和试验结果阳性。结论　该患者为 2 0 0 4年我国首例社区获得性散发SARS确诊病例 ,其无流行病学依据 ,临床表现不重 ,抗体出现早 ,病情恢复快。     

传染病和寄生虫病

20050666 北京市 SARS患者密切接触者发病及其危险因素分析/庞星火…//中华流行病学杂志.-2004,25(8).-674～676 2003年3～7月北京SARS流行期间共发生确诊SARS病例2521例。在5个区县的SARS密切接触者2195例中,有138例转为确诊病例,罹患率6.3％。其中家中隔离1179例次,医疗机构隔离67例次,集中隔离874例次,无隔离观察38例次,缺失37例次,罹患率分别为8.48％、23.88     

果子狸咬伤致狂犬病死亡病例报告

目的 分析1例果子狸咬伤致狂犬病死亡病例,为今后狂犬病防控提供参考.方法 对该病例进行流行病学调查和分析.结果 该病例被果子狸咬伤后未进行正规的伤口处置和免疫注射,48 d后出现狂犬病的临床症状和体征,在县级、省级医院均被诊断为狂犬病,于发病第7天死亡.结果 该病例被果子狸咬伤后导致感染狂犬病病毒死亡,被野生动物咬伤抓伤可能会导致狂犬病毒感染,应及时正确处理伤口,接种人用狂犬病疫苗和狂犬病免疫球蛋白.     

2004-2013年河南省洛阳市麻疹流行特征分析

目的分析河南省洛阳市2004-2013年麻疹流行病学特征,探讨麻疹防控措施。方法采用描述性流行病学方法,研究探讨洛阳市2004-2013年麻疹流行规律。结果 2004-2013年麻疹年均发病率为5.62/10万,最高发病年份为2006年,发病1 086例,发病率为15.89/10万。2010年后维持较低发病水平。2011年麻疹发病率降至历史最低水平(0.12/10万)。病例呈散发,主要集中城市人口密集,人群流动频繁的区域。1岁组散居儿童居多(占51.12%)。发病高峰为每年的2-5月。结论流动人口病例增加,做好适龄儿童常规免疫,加强成人和流动人口的麻疹疫情监测和免疫预防同样具有重要意义。     

3例SARS患者的RT-PCR与ELISA确认

目的 为了对SARS疑似患者进行快速早期诊断和进行血清学确认。方法 从SARS疑似患者含漱液与细胞病毒分离上清液中提取病毒RNA，进行逆转录套式PCR反应，扩增SARS病毒特异性核酸片段，进行序列测定与序列比对。并对患者不同发病日期采集的血清标本进行SARS病毒ELISA抗体测定。结果 SARS患者含漱液标本和细胞病毒分离上清液中均能扩增出特异性核酸片段，经测序证实来自SARS冠状病毒。患者血清标本中SARS病毒抗体在发病后18d开始呈阳性。以后随发病日期增加而升高。结论 逆转录套式PCR是一种早期、敏感、特异、快速检测传染性非典型肺炎疑似患者临床样本中SARS冠状病毒的理想方法。浙江省3例SARS临床诊断病例的含漱液和血清标本经SARS病毒核酸和抗体检测。证实为SARS病例。     

Case fatality of SARS in mainland China and associated risk factors

Objective To analyse the case fatality ratio (CFR) and its risk factors for severe acute respiratory syndrome (SARS) in mainland China by using a comprehensive dataset of all probable cases.
Methods The data of all probable SARS cases were derived from the Infectious Disease Reporting System of the Center of Diseases Control and Hospital Information Systems, during the 2003 epidemic in mainland China. The definition of probable SARS case was consistent with the definition for clinically confirmed SARS issued by the Ministry of Health of the People's Republic of China. We performed univariate and multivariate logistic regression analysis to determine the association of CFR with age, sex, residence location, occupation, the period of the epidemic and the duration from symptom onset to admission into hospital.
Results The overall CFR was 6.4% among 5327 probable SARS cases in mainland China. Old age, being a patient during the early period of a local outbreak, and being from Tianjin led to a relatively higher CFR than young age, late stage of a local outbreak and cases from Beijing. Guangdong Province resulted in an even lower CFR compared with Beijing.
Conclusions Because of their deteriorated health status and apparent complications, SARS patients aged >60 years had a much higher risk of dying than younger patients. At the early stage of local outbreaks, lack of experience in patient care and perhaps treatment also led to a relatively higher CFR. The Tianjin SARS outbreak happened mainly within a hospital, leading to a high impact of co-morbidity. The relatively young age of the cases partly explains the low CFR in mainland China compared with other countries and areas affected by SARS.     

Characterization of severe acute respiratory syndrome coronavirus genomes in Taiwan: molecular epidemiology and genome evolution

Since early March 2003, the severe acute respiratory syndrome (SARS) coronavirus (CoV) infection has claimed 346 cases and 37 deaths in Taiwan. The epidemic occurred in two stages. The first stage caused limited familial or hospital infections and lasted from early March to mid-April. All cases had clear contact histories, primarily from Guangdong or Hong Kong. The second stage resulted in a large outbreak in a municipal hospital, and quickly spread to northern and southern Taiwan from late April to mid-June. During this stage, there were some sporadic cases with untraceable contact histories. To investigate the origin and transmission route of SARS-CoV in Taiwan's epidemic, we conducted a systematic viral lineage study by sequencing the entire viral genome from ten SARS patients. SARS-CoV viruses isolated from Taiwan were found closely related to those from Guangdong and Hong Kong. In addition, all cases from the second stage belonged to the same lineage after the municipal hospital outbreak, including the patients without an apparent contact history. Analyses of these full-length sequences showed a positive selection occurring during SARS-CoV virus evolution. The mismatch distribution indicated that SARS viral genomes did not reach equilibrium and suggested a recent introduction of the viruses into human populations. The estimated genome mutation rate was approximately 0.1 per genome, demonstrating possibly one of the lowest rates among known RNA viruses.     

Severe Acute Respiratory Syndrome

Severe acute respiratory syndrome (SARS) is a newly emerged infection that is caused by a previously unrecognized virus - a novel coronavirus designated as SARS-associated coronavirus (SARS-CoV). From November 2002 to July 2003 the cumulative number of worldwide cases was >8000, with a mortality rate of close to 10%. The mortality has been higher in older patients and those with co-morbidities. SARS has been defined using clinical and epidemiological criteria and cases are considered laboratory-confirmed if SARS coronavirus is isolated, if antibody to SARS coronavirus is detected, or a polymerase chain reaction test by appropriate criteria is positive. At the time of writing (24 May 2004), no specific therapy has been recommended. A variety of treatments have been attempted, but there are no controlled data. Most patients have been treated throughout the illness with broad-spectrum antimicrobials, supplemental oxygen, intravenous fluids, and other supportive measures. Transmission of SARS is facilitated by close contact with patients with symptomatic infection. The majority of cases have been reported among healthcare providers and family members of SARS patients. Since SARS-CoV is contagious, measures for prevention center on avoidance of exposure, and infection control strategies for suspected cases and contacts. This includes standard precautions (hand hygiene), contact precautions (gowns, goggles, gloves) and airborne precautions (negative pressure rooms and high efficiency masks). In light of reports of new cases identified during the winter of 2003-4 in China, it seems possible that SARS will be an important cause of pneumonia in the future, and the screening of outpatients at risk for SARS may become part of the pneumonia evaluation.     

Lupus pneumonitis or severe acute respiratory syndrome?

Severe acute respiratory syndrome (SARS) is a serious respiratory illness caused by a novel human coronavirus. The disease is highly infectious and carries significant mortality and morbidity. There was a major outbreak of SARS in Guangdong, Taiwan, Beijing, Hong Kong and Toronto between March and June 2003. Common presenting features of SARS are high fever, chills, rigor, malaise, nonproductive cough, lymphopenia and pulmonary infiltrates, followed by rapidly progressive respiratory failure in some cases. We describe two patients with systemic lupus erythematosus (SLE) who presented with fever, systemic upset and pulmonary infiltrates between April and June, 2003. One patient was confirmed to have coronavirus pneumonia while the other had active SLE with lung involvement. Our cases illustrate the difficult diagnostic dilemma in the evaluation of febrile SLE patients during the SARS epidemic.     

Suspected SARS patients hospitalised in French isolation units during the early SARS epidemic: the French experience

During the SARS epidemic, many patients were screened according to WHO criteria but never went on to develop SARS. In May 2003, early in the epidemic, we conducted a retrospective study to describe suspected SARS patients hospitalised in France and compared them with documented cases of patients with SARS to evaluate the screening strategy. A total of 117 patients were studied. Only 3.4% had been in close contact with a SARS patient but 73.5% came from an affected area. 67.5% had fever and respiratory symptoms on their admission to hospital. 49.6% had fever and non specific symptoms. Clinical symptoms that were significantly more common among patients with SARS were fever, myalgia, dyspnoea, and nausea or vomiting. Presumed viral fever and respiratory tract infection were the most common diagnosis. Symptoms cannot be distinguished from an early stage of SARS confirming the usefulness of the WHO case definitions in isolation decision to avoid further transmission.     

Characteristics of COVID-19 infection in Beijing

BackgroundSince the first case of a novel coronavirus (COVID-19) infection pneumonia was detected in Wuhan, China, a series of confirmed cases of the COVID-19 were found in Beijing. We analyzed the data of 262 confirmed cases to determine the clinical and epidemiological characteristics of COVID-19 in Beijing.MethodsWe collected patients who were transferred by Beijing Emergency Medical Service to the designated hospitals. The information on demographic, epidemiological, clinical, laboratory test for the COVID-19 virus, diagnostic classification, cluster case and outcome were obtained. Furthermore we compared the characteristics between severe and common confirmed cases which including mild cases, no-pneumonia cases and asymptomatic cases, and we also compared the features between COVID-19 and 2003 SARS.FindingsBy Feb 10, 2020, 262 patients were transferred from the hospitals across Beijing to the designated hospitals for special treatment of the COVID-19 infected by Beijing emergency medical service. Among of 262 patients, 46 (17.6%) were severe cases, 216 (82.4%) were common cases, which including 192 (73.3%) mild cases, 11(4.2%) non-pneumonia cases and 13 (5.0%) asymptomatic cases respectively. The median age of patients was 47.5 years old and 48.5% were male. 192 (73.3%) patients were residents of Beijing, 50 (26.0%) of which had been to Wuhan, 116 (60.4%) had close contact with confirmed cases, 21 (10.9%) had no contact history. The most common symptoms at the onset of illness were fever (82.1%), cough (45.8%), fatigue (26.3%), dyspnea (6.9%) and headache (6.5%). The median incubation period was 6.7 days, the interval time from between illness onset and seeing a doctor was 4.5 days. As of Feb 10, 17.2% patients have discharged and 81.7% patients remain in hospital in our study, the fatality of COVID-19 infection in Beijing was 0.9%.InterpretationOn the basis of this study, we provided the ratio of the COVID-19 infection on the severe cases to the mild, asymptomatic and non-pneumonia cases in Beijing. Population was generally susceptible, and with a relatively low fatality rate. The measures to prevent transmission was very successful at early stage, the next steps on the COVID-19 infection should be focused on early isolation of patients and quarantine for close contacts in families and communities in Beijing.FundingBeijing Municipal Science and Technology Commission and Ministry of Science and Technology.     

Duration of symptom onset to hospital admission and admission to discharge or death in SARS in mainland China: a descriptive study

Objective  To describe and analyse factors associated with the duration of disease onset to hospital admission, admission to discharge and admission to death for severe acute respiratory syndrome (SARS), using the recently developed comprehensive database covering all regions of mainland China, and compare the results within and outside China.
Methods  The database included all probable 5327 SARS cases, of whom 343 died. Linear regression (uni- and multivariate analysis) was performed for all three durations to test the impact of the following variables: sex, age, occupation, geographic location and period of the SARS epidemic (time since the first case, i.e. 16 November 2002).
Results  The average duration of onset of symptoms to hospital admission was 3.8 days, of admission to discharge for those who survived was 29.7 days, while admission to death for casualties was 17.4 days. Health care workers, patients from Tianjin and patients infected towards the end of the epidemic had the shortest duration of onset to admission. Regarding admission to discharge, particularly young patients and patients from Guangdong had the shortest duration. Older age was the sole factor associated with shorter duration of admission to death.
Conclusions  The average duration and pattern (with time of epidemic and age) of onset of symptoms to hospital admission of SARS patients in mainland China were comparable to other affected areas. The duration of hospital admission to discharge was shorter than elsewhere, possibly because of different hospitalisation policies. The duration of hospital admission to death in mainland China, however, appeared to be shorter than in other areas, which is in striking contrast to the much lower case fatality in mainland China.     

Severe acute respiratory syndrome

PURPOSE OF REVIEW: Severe acute respiratory syndrome (SARS) is an infectious disease first recognized in November 2002 in Guangdong Province, China. It spread to many countries all over the world during February to June 2003, with 8098 cases reported. Twenty-one percent of the affected people were health care workers. Because SARS is a new emerging disease, this review describes the current understanding about the etiology, clinical pictures, laboratory and radiological findings of SARS. RECENT FINDINGS: Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) was quickly found to be the etiological agent of SARS in April 2003. The transmission of SARS-CoV between human beings is mainly due to close contact. Using barrier precautions, the transmission of SARS-CoV can be prevented. The most common clinical presentations of patients with SARS include fever, cough, and dyspnea. The common laboratory findings include lymphopenia, thrombocytopenia, elevated serum alanine and aspartate aminotransferase, lactate dehydrogenase, creatine phosphokinase, and C-reactive protein. The most common radiological finding is pneumonic lesion(s) in the chest radiogram. Many patients experience exacerbation of clinical symptoms in the second week of disease course and some may progress to respiratory failure and need mechanical ventilatory support. The overall case fatality rate is 9.6%. The current method of treatment of SARS is still controversial. SUMMARY: SARS is an infectious disease with high contagiousness and a high mortality rate. Early case identification and infection control are two important factors to limit its spread.