邹城市部分儿童白喉免疫水平现况调查

邹城市自1977年发现最后1例白喉至今，已连续29年未出现白喉病例，基本达到预防控制的目的。在长期无白喉病例疫情出现的情况下，积极开展适龄儿童人群的白喉免疫水平调查，对了解当地儿童白喉免疫水平，预测白喉流行规律，科学合理制定计划免疫预防控制措施具有十分重要的意义。为此，邹城市采用锡克氏试验方法对邹城市部分儿童的白喉免疫水平进行了调查，现将结果报告如下。     

接种百日咳-白喉-破伤风联合疫苗偶合癫痫1例报告

目的通过分析1例接种百日咳-白喉-破伤风联合疫苗偶合癫痫症,探讨预防接种后偶合症与异常反应的调查与处理。方法采用面对面病例调查和现场调查,描述患者发病情况。结果经过对案例的调查和综合分析,患者出现癫痫现象与接种百日咳-白喉-破伤风联合疫苗没有不存在因果相关,属于预防接种偶合症。     

计划免疫后白喉流行规律的研究

本文分析百色地区21年来的白喉疫情资料和免疫监测资料,就计划免疫后的白喉流行规律问题进行研究。结果发现计划免疫后的白喉发病率、病死率有了大幅度的下降,周期性流行间隔延长,季节性高峰较低月亦后移。白喉发病有向大年龄组推移现象,白喉免疫水平显著提高,并指出了目前应加强疫情监视和人群免疫状况的监测,以采取相应对策。     

韶关市1956-2007年白喉流行病学及免疫学效果分析

目的了解韶关市白喉流行趋势,评估流行病学及免疫学效果,制定针对性措施防止白喉疫情的反复。方法采用描述流行病学方法,从流行病学、血清学等角度分析白喉流行病学及免疫学效果。结果随着疫苗接种率的提高,人群免疫水平达到并维持较高水平,白喉发病率自1959年的48.13/10万降至1989年的0.07/10万,1991年报告最后1例白喉病例,死亡率由6.19/10万降至1987年的0.02/10万,并经17年的流行病学、免疫学监测及法定传染病漏报调查证实,该市连续17年无白喉病例报告,成本效益比为1:12.53。结论韶关市在疫苗高接种率的干预下,实现了消除白喉的目标,社会及经济效益显著。但仍需继续做好免疫接种及监测工作,加强成人发病研究,严防白喉重新流行。     

一起人间狂犬病散发疫情的现场调查与处置

目的通过对河南省濮阳县某农村一起人间狂犬病散发疫情进行现场调查与处置,总结提出规范的调查与处置工作流程。方法对河南省濮阳县报告的一起人间狂犬病散发疫情进行现场调查与处置,分别进行流行病学调查、现场消杀、防控知识宣传、工作总结评估,同时开展肇事犬追踪和疑似病例搜索。最后提出人间狂犬病疫情综合防控措施,及对疫情处置效果进行评估。结果经现场核实,报告病例为临床诊断狂犬病病例。成立了疫情调查处置队伍,分流行病学调查2人,现场消杀1人,防控知识宣传1人,工作总结评估1人。列出疫情处置所需物品清单,对疫点及有关物品、用具进行消毒,无一犬伤多人情况,未搜索到疑似病例,采取发放宣传单、村内广播等形式进行了狂犬病防控知识宣传。经狂犬病常见潜伏期2~3个月后,无新发病例出现。结论狂犬病等人兽共患病疫情的规范处置应包括响应准备、现场处置、总结评估3个阶段。     

一起手足口病暴发疫情现场流行病学调查与控制

目的:掌握手足口病暴发疫情现场流行病学调查的方法,探究手足口病暴发疫情处置的措施。方法:应用现场流行病学调查的理论和方法,及时开展流行病学调查及样本采集,核实诊断,确定引发暴发疫情的原因,针对传染病流行3个环节采取预防控制措施。结果:平川区一起手足口病暴发疫情发生后,平川区疾控中心及时派出流行病学调查和实验室人员进入现场调查核实,收集流行病学资料和数据,综合分析判断疫情性质。根据发病患儿临床表现和流行病学调查及实验室检测结果,判定此次疫情为手足口病暴发,采取预防控制措施使疫情得到了有效控制。结论:手足口病是由多种肠道病毒引起的传染病,传播途径复杂,好发于学龄前儿童,在托幼机构中容易引起暴发流行;加强疫情监测与报告,学校及幼托机构落实晨午检制度,开展健康教育和行为干预,保持校舍开窗通风是预防手足口病等传播的有效手段;疫情发生后快速进入现场进行流行病学调查、核实诊断、分析确定引发疫情的原因是处置暴发疫情的关键;控制传染源、切断传播途径、保护易感人群是有效控制传染病流行的手段和措施。     

沧县一起学校结核病暴发疫情的调查报告

目的:分析肺结核爆发原因,总结经验和教训,为今后防治工作提供参考。方法:采用现场流行病学调查方法,描述性分析研究。结果:经过系统的现场流行病学调查和处置,疫情得到有效控制。结论:加强学校健康教育和传染病防控管理,早期发现疫情,专家参与及时处置疫情、适时心理疏导等措施可有效预防肺结核爆发。     

一起学校流行性腮腺炎爆发的调查及疫情处理

目的通过对一起流行性腮腺炎爆发流行的流行病学调查,分析病例爆发的原因和规律,总结疫情控制的有效经验.方法采取现场调查和医院就诊记录的方法调查病例,核实诊断,同时对疫情情况进行相应的流行病学调查,采取针对性的措施.结果有效控制了疫情的发展.     

同仁县年都乎乡夏卜浪村发生一起麻疹暴发疫情的调查报告

目的了解疫情发生的原因,采取预防控制措施,防止疫情蔓延,进行现场流行病学调查。方法对该乡及该村的卫生工作人员进行走访调查,了解基本情况;病例个案调查;采集疑似病例的血清标本,进行病毒的血清抗体鉴定。结果现场采取综合预防控制措施后,观察最后一例病例的一个最长潜伏期,无续发病例发生。结论根据调查确定此次疫情为一起麻疹暴发疫情     

一起幼儿园柯萨奇肠道病毒感染暴发的调查

目的 通过调查一起幼儿园柯萨奇肠道病毒感染暴发疫情,为肠道病毒感染的防治工作提供科学依据。方法采用现场流行病学方法对发病班级的儿童进行流行病学调查,收集病例肛拭子及咽拭子样本进行实验室检测。结果本次疫情共调查37名儿童,其中发病23名。病例以发热、呕吐、头痛、嗜睡等为主要症状。采集12名发病儿童和4名未发病儿童肛拭子及咽拭子标本进行实验室检测,柯萨奇肠道病毒阳性率93.75%。结论 综合流行病现场调查和实验室检测结果,确定为一起柯萨奇肠道病毒引起的暴发疫情。     

TWO UNUSUAL CASES OF CUTANEOUS DIPHTHERIA

Despite the high frequency in China of diphtheria infections of the upper respiratory tract, not a single case has yet been reported of cutaneous diphtheria. This fact may well be understood, if one considers the banality of clinical manifestations, which are caused by the bacilli. On the other hand, little importance has been stressed on the disease in the past, on account of its rare occurrence, and further- more, because one seldom observes the typicalfalse membrane-type disease on the skin. Moreover, it should be emphasized that the occurrence of a great many varieties makes it even more difficult to recognize at first glance the true nature of the disease. It is however of paramount importance, especially from an epidemiological point of view, to suspect cutaneousdiphtheria whenever a pustular, eczematous, ulcerative process does not yield to the ordinary treatment, and when these lesions show a preference to certain localization or to the com binations of predilections.     

深圳市宝安区健康人群百日咳、白喉、破伤风抗体水平监测

目的 了解宝安区健康人群破伤风、白喉、百日咳三种疫苗血清抗体水平,评价三种疫苗的免疫实施效果.方法 2011年随机抽取宝安区7个街道不同年龄段人群,采用试管凝集试验检测血清抗体水平.结果 破伤风、白喉、百日咳抗体保护率分别为98.33％,98.06％,98.33％,各年龄组人群均达到90％以上;几何平均滴度(GMT)分别为1∶80.63、1∶80.48、1∶1 409.35,均以21～32岁组最低;三种抗体保护率和GMT有随年龄增大而明显降低的趋势.结论 宝安区人群破伤风、白喉、百日咳免疫水平都较高,免疫屏障已经形成,短期内暴发流行百日咳、白喉、破伤风的可能性不大.     

无锡市垃圾无害化处理的卫生学评价

<正> 随着创建卫生城市的开展,垃圾处理日益受到重视,无锡市建立的垃圾处理厂,对垃圾处理采用二次发酵工艺,即“好氧堆肥发酵”、“自然堆肥贮存发酵”。现将发酵结果报道如下。1 材料与方法1.1 实验室条件下(温度26±1℃,相对湿度60％±5％)饲养家蝇1龄蛆500条,家蝇蛹500只。1.2 透气塑料筒20只(自制),编号1～20号1.3 垃圾处理厂的垃圾处理采用2次发酵,第1次机械通风好氧堆肥发酵10d,取出后入库,再第2次自然堆肥贮存发酵10d。     

15岁以下免疫儿童抗体水平调查

目的　了解 15岁以下儿童人群计划免疫针对疾病的抗体水平 ,为制定免疫策略和防治措施提供科学的依据。　方法　在城区和农村共调查 2 0 2人 ,采用卫生部 1998年颁布的《计划免疫技术管理规程》中的检测方法及判定标准进行监测。　结果　白喉抗体保护率为 73 80 % ,破伤风抗体保护率 63 2 4% ;百日咳、麻疹和乙肝表面抗体保护率分别为 91 3 3 %、87 70 %和 87 5 0 %。同时显示城区和农村儿童对以上 5种疾病抗体阳性差异皆无显著性 (P >0 0 5 )。　结论　鉴于白喉、破伤风抗体阳性率水平均低于《计划免疫技术管理规程》中的指标要求 ,建议采用白破联合疫苗开展加强免疫     

Respiratory diphtheria in three paediatric patients

From August till November 1998, the Paediatric and Anaesthetic Units of Hospital Kuala Terengganu managed three patients from Kuala Terengganu District who were ventilated for respiratory diphtheria. Their ages were 5, 4 and 7 years old and their immunisation for diphtheria were not complete. All three patients presented with respiratory distress and were ventilated for upper airway obstruction. Their treatment included intravenous penicillin and diphtheria antitoxin. One patient died of cardiogenic shock with secondary pneumonia. Pharyngeal and tonsillar swabs of all three patients grew toxigenic Corynebacterium diphtheriae biotype mitis. There were 765 throat cultures taken from contacts. The confirmed positive cultures grew 2 toxigenic and 3 non-toxigenic Corynebacterium diphtheriae biotype mitis and surprisingly, 10 non-toxigenic biotype gravis. A prevalence study is needed to document the endemicity of diphtheria in Kuala Terengganu and to determine the carrier rate of both biotypes. Steps have been taken to increase the immunisation coverage in children. The giving of regular booster doses of diphtheria toxoid to the adult population should be considered.     

广东省部分地区人群百、白、破IgG抗体水平监测

目的了解广东省健康人群血清中百日咳、白喉和破伤风（简称百、白、破）抗体水平，为百、白、破防控提供依据。方法采取分层整群抽样法抽出潮州市、汕尾市、深圳市等三个地区部分健康人群，采用间接ELISA法（定量）检测正常人血清中百、白、破Igc抗体水平。结果三个地区健康人群百日咳IgG抗体阳性率为54．1％，白喉IgG抗体保护率为76．4％，破伤风IgG抗体保护率为77．2％。结论广东省三个地区健康人群百日咳IgG抗体阳性率较低，部分地区白喉及破伤风抗体保护率比较低，白喉及破伤风抗体保护率有随着年龄的升高而降低的趋势，提示我们要加强百、白、破的接种率和接种质量。     

Immunisation of adults during an outbreak of diphtheria

In an outbreak of infection due to Corynebacterium diphtheriae in a hospital for mentally subnormal adults sera from 211 members of staff were screened for diphtheria antitoxin titres. Of these, 79 (37%) required immunisation, and a low dose preparation (1 LfU of diphtheria and 10 LfU tetanus toxoids) was offered. Of the 64 subjects who accepted a single immunisation and were subsequently retested, seroconversion to diphtheria toxoid occurred in 45 (70%), the rate being highest in younger adults. Seroconversion to tetanus toxoid occurred in 59% of subjects. Local reactions to the single dose were reported by 29 (43%) subjects, and nine (13%) experienced moderately severe local reactions and systemic symptoms. We conclude that adults should not be vaccinated without previous screening for susceptibility to diphtheria; that neither previous immunisation nor age is reliable in predicting the need for vaccination; and that though a single booster dose of diphtheria toxoid is probably effective in adults under 45, two doses should be given to those in the older age group.     

玉林市1950-2006年白喉流行病学和免疫效果分析

目的了解玉林市1950-2006年白喉的发病情况及免疫接种百白破混合制剂对白喉的免疫效果,探讨其发病原因及控制策略。方法采用回顾性研究的流行病学方法,分析1950-2006年白喉的流行病学特征及免疫接种百白破混合制剂对白喉的控制作用。结果使用百白破混合制剂免疫及全程免疫接种率提高至85%,锡克试验阴性率达90%以上,有效地控制我市白喉病例的发生和流行。结论有效的疫苗和高质量的免疫接种是控制白喉流行的关健措施。     

Diphtheria-tetanus overimmunization in children with no records: can it be prevented?

A pilot study was undertaken to assess the validity of two new tests for predicting the immune response of Toronto schoolchildren with no acceptable evidence of prior administration of diphtheria or tetanus toxoid to a routine booster injection of diphtheria and tetanus (DT) toxoid. The tests, an inexpensive enzyme-linked immunosorbent assay (ELISA) fingerprick test for tetanus antibodies and a modification of the Schick skin test for susceptibility to diphtheria, were administered before the booster injection. One week later the ELISA test was repeated and the result of the modified Schick test read. On both occasions a diphtheria microneutralization assay was done for "gold standard" evidence of prior exposure to diphtheria toxoid or toxin. The results were used to determine the sensitivity and specificity of a single prebooster tetanus ELISA test or a modified Schick test for predicting which children with no records could be safely protected with only one DT booster dose instead of the primary series of three or four doses usually given to such children. Only 6 of the 34 subjects (18%) were totally without prior exposure to tetanus toxoid. Two of the six (6% of 33 subjects) appeared to mount a primary immune response to diphtheria toxoid as well. An initial ELISA titre of 0.01 IU/ml or lower correctly identified all six children needing a full series of tetanus toxoid (sensitivity for a primary immune response 100%) and falsely identified only 3 of 28 immune children as needing the series (specificity for immunity 89.3%). The modified Schick test appeared to have even greater accuracy for identifying children needing a full series of diphtheria toxoid. However, its use, entailing the costs of an extra nurse visit, would have prevented only seven more children from receiving an unnecessary full series of diphtheria toxoid than use of the baseline tetanus ELISA test alone.