我国境外输入性疟疾防控策略对当前新型冠状病毒肺炎防控工作的启示

目前,我国新型冠状病毒肺炎本地传播已得到有效控制,但境外新型冠状病毒肺炎疫情形势日趋严峻。因此,我国新型冠状病毒肺炎防控工作面临境外输入的新挑战。疟疾曾在我国广泛流行,自2010年启动消除疟疾行动计划后,我国不仅阻断了疟疾本地传播,对每年3000例左右境外输入性疟疾病例的防控也卓有成效。本文通过对当前我国新型冠状病毒肺炎和疟疾疫情形势及流行特征的比较分析,结合我国境外输入性疟疾防控的成功经验,探讨当前新型冠状病毒肺炎疫情防控的策略和措施,为有效应对境外输入、巩固防控成果提供借鉴。     

新型冠状病毒肺炎防控期间规范疟疾诊疗流程的建议

2019年底新型冠状病毒肺炎的暴发流行,给疟疾等其他疾病的诊治工作带来了新的挑战。如果疟疾(尤其恶性疟)患者被漏诊误诊,有可能引发重症甚至危及生命。而如果防护和处置不当,不仅疟疾患者在就诊的过程中有可能感染新型冠状病毒,医务人员同样也面临很大的风险。因此,本文围绕当前疫情形势下如何做好疟疾诊治工作,对规范开展疟疾患者的诊疗流程提出建议,供医务工作者参考。     

凉山州一起新型冠状病毒肺炎聚集性疫情分析

目的通过对2例新型冠状病毒肺炎患者的流行病学调查分析,探讨新型冠状病毒肺炎的传播规律和防控措施。方法运用描述性流行病学方法对凉山州甘洛县2例新型冠状病毒肺炎进行流行病学调查分析。结果首例病例A为输入性病例,本地病例B为密切接触A导致发病,属于一起聚集性疫情。因两名患者互相隐瞒接触史导致本地病例B在本应被隔离而未被隔离期间产生了21名密切接触者,加大了疫情传播风险。结论在新型冠状病毒肺炎疫情防控工作中,现场流行病学调查要注重传统流行病学调查技巧与大数据技术的结合应用,排查患者可能接触的所有人员,避免漏掉密切接触者,同时加强对相关单位的培训及对公众的知识宣传。     

新型冠状病毒肺炎防疫期间急性胆道感染诊治体会

2020年1月20日,世界卫生组织将新型冠状病毒肺炎疫情列为国际关注的突发公共卫生事件,疫情被全世界关注。在此期间如何在有效控制传染源、切断传播途径、保护易感人群的同时,减少急腹症患者病情诊治的延误,保证临床工作的正常开展,显得尤为关键。参照相关现行的诊疗方案和指南,结合保定市第二医院实际情况,归纳总结了急性胆道感染患者的门诊分诊、治疗流程、操作分级和防控以及病区管理经验。经过分析,表明制订新型冠状病毒肺炎疫情期间急性胆道感染患者应急预案,可使得该类患者与新型冠状病毒肺炎患者进行鉴别,且在尽早接受急性胆道感染的规范诊治过程中避免新型冠状病毒的传播和交叉感染。     

氯喹药理特点及用于新型冠状病毒肺炎治疗的建议

2019年底,我国湖北省武汉市出现了新型冠状病毒肺炎疫情,随后在全国扩散并成为全球大流行。由于尚无针对新型冠状病毒的特效治疗药物和疫苗,我国新型冠状病毒感染救治临床专家团队在救治新型冠状病毒感染患者的同时,积极研究和筛选有效抗病毒治疗药物,发现一种古老的抗疟药--氯喹有一定抗新型冠状病毒效果,随后纳入我国新型冠状病毒肺炎诊疗方案。目前,临床应用的是氯喹衍生物磷酸氯喹和硫酸羟氯喹,这两种药物虽药理机制相近,但其治疗对象、疗效和不良反应均存在一定差异。本文拟通过对氯喹类药物已有研究和在疟疾临床治疗中的经验总结,为我国临床专家更科学合理地使用氯喹类药物进行新型冠状病毒肺炎治疗提供参考。     

某养老机构新型冠状病毒肺炎聚集性疫情流行病学特征分析

目的对某养老机构发生一起新型冠状病毒肺炎(COVID-19)聚集性疫情进行回顾性流行病学调查和分析。方法采用"新型冠状病毒肺炎防控方案(第三版)"推荐的个案调查表和依照"新型冠状病毒肺炎聚集性疫情流行病学调查指南(试行第一版)"进行。结果某养老机构有8名护理人员和住院老人感染新冠肺炎,年龄中位为59岁,男、女比例1∶7。于末次暴露后4~15 d确诊。排查出225名密切接触者,无三代院内续发传播;不排除无症状感染存在传染的可能性;病亡1例。结论本次聚集性疫情的感染来源于新冠肺炎确诊病例。建议防控策略应关注养老机构、监管场所等重点部门、重点人群的管控与监测。     

新疆巴州一起新型冠状病毒肺炎聚集性疫情分析

目的分析2020年2月新疆巴音郭楞蒙古自治州(巴州)一起新型冠状病毒肺炎(简称新冠肺炎)聚集性疫情流行病学特征、调查疫情传播链、查找可能的感染来源及危险因素,为今后有效防控新冠肺炎积累经验。方法应用现场流行病学方法的个案流行病学调查分析,开展疑似病例及密切接触人员临床检查及实验室检测、所有病例密切接触人员开展流行病学调查和集中医学隔离观察并采集咽试子;采用实时荧光定量RT-PCR法检测采集的呼吸道标本中新型冠状病毒核酸。结果 2例病例具有河南省周口市太康县有确诊病例地区旅行史和居住史,1例病例无外出史、在家中与外出归来的父母共同生活、期间无其他暴露史;3例病例临床症状符合发热和有肺部影像学特征,实验室检测阳性,确诊为新冠肺炎,为一起输入性导致本地感染的家庭聚集性疫情。结论随着全国疫情控制,各地逐步复工,进入巴州复工人群较多,存在输入性疫情发生的风险;因此需继续做好新冠肺炎疫情防控工作,全面落实综合防制措施,确保人群身体健康。     

新型冠状病毒肺炎相关肝损伤研究进展

新型冠状病毒肺炎的大流行对全球的公共卫生安全造成了巨大威胁及挑战,并改变了医疗配置的优先性。在新型冠状病毒肺炎的临床诊治中,可以观察到相当比例的患者发生肝损伤,尤其是重症或危重症患者。本文总结新型冠状病毒肺炎致肝损伤的流行病学、机制、临床特征及治疗,希望可对临床医生的决策和优化治疗提供帮助。     

新型冠状病毒肺炎疫情防控期间疟疾患者血样检测的思考和建议

目前全球新型冠状病毒肺炎(COVID-19)疫情不断蔓延,自境外疟疾流行区入境人员存在疟原虫及新型冠状病毒(SARS-CoV-2)双重感染风险,为及时、准确、安全地开展疟疾检测,保障输入性疟疾的早发现、早诊断和早治疗,笔者提出在COVID-19疫情防控期间,疟疾患者血样检测工作中需提高生物安全防护级别、优先采用快速诊断检测(RDT)和核酸检测方法、至少两种检测方法结果一致作为虫种确认依据、实施血片特殊制备的方法等建议,供各临床和疾控实验室参考。     

中国防止疟疾输入再传播面临的挑战和应对策略

疟疾曾是我国流行最严重的传染病之一。在几代人不懈努力下,我国疟疾防控成效显著。自2010年我国启动《中国消除疟疾行动计划（2010—2020年）》后,迅速阻断了本地疟疾传播,2017年首次在全国范围内实现了本地病例零报告,即将迎接WHO消除疟疾认证。但目前全球疟疾流行依然非常严重,我国每年仍有2 000多例境外输入性疟疾病例,防止输入再传播将成为下阶段我国疟疾防控工作的主要任务。本文分析了我国防止疟疾输入再传播工作中面临的主要挑战,并提出相应的应对策略,从而为巩固消除疟疾成果提供参考。     

新型冠状病毒肺炎疫情期间糖尿病基层管理专家建议

自2019年12月以来,我国发生新型冠状病毒肺炎(COVID-19)疫情。糖尿病患者COVID-19感染风险增高,且预后差。COVID-19疫情期间,基层医疗在糖尿病预防和血糖控制管理方面面临严峻挑战。中国糖尿病专家、基层医疗服务提供者和公共卫生管理者提出专家建议,旨在提高全国基层医疗卫生机构在COVID-19疫情期间的临床诊治能力并提供标准化的基本公共卫生和医疗服务。本建议的主要内容包括管理的基本要求、健康管理的工作流程、转诊、治疗和长期随访。     

Pediatric TB detection in the era of COVID-19

The effect of COVID-19 and measures in response to it on human lives, including healthcare, was enormous. The necessary healthcare services including communicable diseases, such as Tuberculosis (TB) were badly affected. Here an attempt has been made to trace the number of notified Pediatric TB cases during and after COVID-19 lockdown and unlock period, and then compared with the same period of previous year. The epidemic data on notified pediatric TB cases for 2019 and 2020 were extracted from the Health Management Information System (HMIS) database. The absolute numbers of monthly pediatric TB notifications from January to September for the year 2020 were compared to 2019, and the percentage decrease was estimated. The HMIS data shows that there is a significant decrease in pediatric TB notifications during COVID-19 epidemic in India. Especially, when the lockdown and related restrictions in response to COVID-19 was imposed, notifications were significantly decreased compared to the same period during the previous year. Even, the reduction numbers of pediatric TB notifications during post-lockdown are still more worrying. Though, little improvements were observed suddenly after lockdown was removed, but then-after again consisted decrease was reported; and these numbers again substantially lower than the numbers of previous year. Adequate measures to diagnose, control, and prevent TB focusing young children, should be implemented simultaneously with response to COVID-19 pandemic. Further, effective steps should be taken to remove the fear arising due COVID-19 pandemic among masses, so that the healthcare seeking may be improved.     

新型冠状病毒肺炎实验室诊断方法进展

在应对新型冠状病毒肺炎(COVID-19)全球大流行疫情过程中,实验室诊断发挥了至关重要的作用。本文对现有COVID-19实验室诊断方法,包括常用的核酸检测和血清学抗体检测进行分析总结,以便医务人员及时了解该领域进展,选择合适的检测试剂和筛查策略,共同抗击这场大流行疫情。     

新型冠状病毒肺炎疫情期间全国儿科消化内镜开展情况调查

目的总结新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）疫情期间全国儿科消化内镜开展诊疗经验,为下一步临床诊疗工作提供防控指导。方法中华医学会消化内镜学分会儿科协作组对全国47所儿科消化内镜中心2020年1月24日—3月1日内镜诊治开展情况以问卷调查表的形式进行了调查。结果疫情期间,儿科消化内镜中心采用了停止常规内镜诊疗、严格术前流行病学排查、增加特殊术前检查、术前内镜医师会诊制度、候诊区管理、精简工作人员、不同岗位不同防护级别、特殊麻醉管理、重视诊疗区域消毒、加强内镜清洗消毒及医疗废物管理等防控措施。47所医院在2020年1月24日—3月1日38 d内共完成536例儿科消化内镜诊疗,其中治疗210例（39.2%）,诊断326例（60.8%）,未发生一例院内感染。结论COVID-19疫情期间,全国儿科消化内镜中心根据国家疫情防控政策及相关指南要求,结合儿科特点及医院实际情况,在严格把握内镜诊疗指征、严密防护的前提下,安全开展了儿科消化内镜诊疗。     

新型冠状病毒肺炎诊治要点浅析

当前新型冠状病毒肺炎(简称"新冠肺炎")在中国引起严重疫情,而且对世界公共卫生造成巨大压力。截至发稿之日,全国确诊人数已逾8万例,全球超过10万例。为更好地增强临床医师对新冠肺炎的认识,我们结合新冠肺炎临床一线的救治体会、相关发表的研究文献和最近的诊疗方案,给大家简要概述新冠肺炎的诊治要点。期望能给临床医生提供一定的参考作用。     

A retrospective view of pediatric cases infected with SARS-CoV-2 of a middle-sized city in mainland China

The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 had resulted in a global pandemic. A comprehensive analysis of pediatric COVID-19 cases is essential to decipher the natural features of children under the risk of this disease.In the epidemic period, all the children infected with SARS-CoV-2 in Wuxi, a city with a stable medical system during the COVID-19 outbreak in China, were enrolled for comprehensive data documenting their clinical, prognosis, follow-up, treatment and various tests results. Combing their family cluster characteristics, the epidemiological, hospitalization, and transmission features of children with SARS-CoV-2 were analyzed and discussed.A total of 7 children were enrolled, including 4 mild cases, 1 moderate case, and 2 asymptomatic cases. The common symptoms were fever and dry cough. The length of viral nucleic acid duration in nasopharynx varied and was irrelevant to the severity of the symptom, whether symptomatic or asymptomatic. Two cases showed viral nucleic acid positive recurrence after discharge from the hospital. A child with type 1 diabetes was also focused, for the elevated blood sugar during hospitalization. All these children had close contacts with their family members, some of those were confirmed COVID-19 cases.We provided a holistic and detailed portrayal of the pediatric COVID-19 cases in a typical city of timely response to the epidemic. While the family cluster exhibits the major transmission mode, attention should be paid for the potential risk since the expanded social space of children in future.     

COVID-19 compared to other epidemic coronavirus diseases and the flu

Coronaviruses are among the largest group of known positive - sense RNA viruses with a wide range of animal hosts as reservoir. In the last two decades, newly evolved coronaviruses such as the severe acute respiratory syndrome coronavirus (SARS-CoV) which caused the infamous 2002 outbreak, the Middle East respiratory syndrome coronavirus (MERS-CoV) which caused an outbreak in 2012, and now the SARS-CoV-2 [responsible for the current coronavirus disease 2019 (COVID-19)] have all posed notable threats to global public health. But, how does the current COVID-19 outbreak compare with previous coronaviruses diseases? In this review, we look at the key differences between SARS-CoV, MERS-CoV, and SARS-CoV-2, and examine challenges in determining accurate estimates of the severity of COVID-19. We discuss coronavirus outbreaks in light of key outbreak severity indicators including, disease fatality, pathogen novelty, ease of transmission, geographical range, and outbreak preparedness. Finally, we review clinical trials of emerging treatment modalities and provide recommendations on the control of COVID-19 based on the mode of transmission of the coronaviruses. We also recommend the development and use of a standardized predictive epidemic severity models to inform future epidemic response.     

新型冠状病毒肺炎疫情时期急性胰腺炎诊疗经验及体会

目前新型冠状病毒肺炎(COVID-19)疫情正在世界范围内肆虐。医院作为疫情重灾区,医护人员和住院患者的健康安全受到严重威胁。急性胰腺炎(acute pancreatitis,AP)是消化内科常见的急重症,在COVID-19疫情时期,AP诊疗风险增加,消化内科医师应依据指南和诊疗常规,在有效防控疫情的基础上,做好AP的诊疗工作。本文结合中国人民解放军东部战区总医院消化内科的实际工作,分析了自2020年1月24日江苏省启动公共卫生事件一级响应至2020年2月22日收治的25例AP患者,总结COVID-19疫情时期我科诊疗AP的经验及体会,希望能为消化科医师提供帮助。