Epidemiology of maternal morbidity and mortality

Maternal morbidity and mortality remains a significant health care concern in the United States, as the rates continue to rise despite efforts to improve maternal health. In 2013, the United States ranked 60th in maternal mortality worldwide. We review the definitions, rates, trends, and top causes of severe maternal morbidity and mortality, as well as risk factors for adverse maternal outcomes. We describe current local and national initiatives in place to reduce maternal morbidity and mortality and offer suggestions for future research.     

Prevalence of meningococcal meningitis in China from 2005 to 2010

BackgroundWe aimed to estimate the prevalence and epidemiologic characteristics of meningococcal meningitis (MM) in mainland China (excluding Taiwan, Hong Kong, and Macau) and to provide reference data for controlling the outbreak and prevalence of MM.MethodsData from the National Notifiable Diseases Registry System and the MM case information reporting system from 2005 to 2010 as well as data from the MM Surveillance System were used.ResultsThe morbidity of MM for the whole country was, on average, 0.09 cases per 100,000 (range 0.02 [2010]–0.18 [2005] cases per 100,000) from 2005 to 2010, the incidence rate was highest in the Xinjiang autonomous region (average 0.56 cases per 100,000), and the majority of cases came from Anhui province (average 0.32 cases per 100,000). Morbidity was highest in children under 1 year old (average 0.60 cases per 100,000). The proportion of laboratory-confirmed cases of serogroups A, B, and C were 37.2, 11.5 and 42.7, respectively, from 2005 to 2010.ConclusionsThe incidence level declined year-to-year in mainland China. Children and students are the most at risk groups. The proportion of serogroup C cases has increased year-to-year, and new cases of serogroup W135 have been found. Controlling the epidemic of serogroup C and preventing outbreaks of serogroup B and W135 represent major future challenges.     

A measles outbreak in a middle school with high vaccination coverage and evidence of prior immunity among cases,Beijing, P.R. China

BackgroundAge-appropriate receipt of ≥2 measles-containing vaccine (MCV) doses has been considered evidence of immunity against measles. Transmission of measles is rarely reported among such persons.MethodsWe report a measles outbreak in a middle school in Beijing that has high coverage with≥2 documented MCV doses. History of previous measles and documentation of MCV receipt were collected for all individuals. Cases were identified by active surveillance and confirmed by laboratory tests. Measles immunoglobulin G (IgG) titers and clinical presentations were obtained for each case.ResultsOf 1331 individuals without a prior history of measles, 1172 (88.1% [95%CI:86.4–91.5%]) and 1078 (81.0% [95%CI:78.9–83.1%]) had age-appropriate receipt of ≥2 MCV doses by domestic and U.S. CDC/ACIP criteria, respectively. Thirteen measles cases occurred in the outbreak. The index case and 3 secondary cases were students. The 9 tertiary cases included 2 teachers and 7 students. All 11 student cases received ≥2 age-appropriate MCV doses by Chinese domestic criteria; 8 were age-appropriately vaccinated by U.S. CDC/ACIP criteria. Measles IgG was detected during the acute phase of measles for all but 2 cases -the first case and 1 tertiary case. Among students with age-appropriate receipt of ≥2 MCV doses, the length of time since the last MCV was significantly associated with risk of measles: for the 1172 students, the risk was 4.6 [OR5.6;95%CI:1.4–22.9] and 5.5 [OR6.5;95%CI:1.4–29.8] times higher when the last MCV dose was 5–9 years and ≥10 years prior, respectively, compared with <5 years prior; for the 1078 students, the risk was 4.1 [OR5.1;95%CI:1.3–20.7] times higher when the last MCV dose was 5–9 years prior compared with <5 years prior.ConclusionsThis is the first report from China showing measles transmission among persons with prior evidence of immunity. Secondary vaccine failure may have played an important role in measles transmission. Further laboratory surveillance is needed to assess the persistence of vaccine-induced immunity of domestically-produced MCV in China.     

A hospital-associated measles outbreak among individuals not targeted for vaccination in eastern China, 2014

BackgroundAn outbreak of measles occurred in early 2014 among individuals not targeted for vaccination—adults, and infants too young to vaccinate, in Xiangshan County, Zhejiang Province, in eastern China.ObjectiveWe conducted an investigation to identify risk factors responsible for this outbreak and to provide evidence-based recommendations for measles elimination strategies in China.MethodsMeasles was diagnosed using national standard case definitions. In a case-control study, 20 randomly selected measles patients were matched with controls selected from the same village or community as each case in a 1:2 case-to-control ratio. Controls were matched on age, within 5 years, and gender. We compared exposure histories during the 7–21 days before rash onset of the case and the same time period for the matched controls. We also conducted a measles antibody seroprevalence survey of a convenient sample of residual serum obtained from healthy patients during routine care in a hospital.ResultsThe outbreak consisted of 45 measles cases, with an attack rate of 8.9/100,000 total population. Among cases, 91.1% (41/45) were adults (ranged 23–51 years) who had unknown vaccination histories; the other cases were infants younger than 8 months of age. The case-control study showed major risk factors to be a visit to Hospital X (OR_MH = 7.3, 95% CI: 1.8–30.7) and treatment in an IV room in Hospital X (OR_MH = 11.0, 95% CI: 1.3–96.1). The seroprevalence survey showed that 88.8% of adults had measles IgG antibodies, and that 100% of children 2–19 years of age were seropositive.ConclusionsThe outbreak was primarily among age groups not targeted for vaccination—primarily adults, but with some children too young to vaccinate. Visiting a hospital was the major risk factor for measles transmission. We conclude that in addition to maintaining high 2-dose coverage with measles vaccine, working with hospital infection control programs to implement evidence-based strategies to prevent or limit hospital transmission is an important action for eliminating measles in eastern China.     

一起流行性腮腺炎暴发中的疫苗效率评估

流行性腮腺炎(流腮)暴发疫情中对疫苗效率(VE)的评估,国外已有较多的研究报道^[1],而我国类似报道相对较少.2012年3-6月四川省阆中市某幼儿园发生一起流腮暴发疫情,发病儿童绝大多数属免疫覆盖人群,为此本研究通过此次疫情评估腮腺炎疫苗效率. 1.对象与方法:本文病例定义为2012年1月1日至6月22日该幼儿园儿童与老师出现单侧或双侧腮腺和(或)其他唾液腺肿胀、疼痛持续>2d且排除其他原因者.     

2021年11月中国大陆需关注的突发公共卫生事件风险评估

  目的  评估2021年11月在我国大陆地区发生或者可能由境外输入的突发公共卫生事件风险。  方法   根据国内外突发公共卫生事件报告及重点传染病监测等各种资料和部门通报信息,采用专家会商法,并通过视频会议形式邀请省（自治区、直辖市）疾病预防控制中心专家参与评估。  结果   预计11月突发公共卫生事件报告数将较10月上升。 我国境内发生新冠病毒境外输入及续发本地传播风险持续存在,但在可控范围内。 11月进入冬季采暖季节,非职业性一氧化碳中毒事件将进入高发时期。  结论   需要对新型冠状病毒肺炎予以特别关注,对非职业性一氧化碳中毒予以一般关注。     

The role of traditional treatment on health care seeking by caregivers for sick children in Sierra Leone: Results of a baseline survey

In Sierra Leone, traditional treatment is at times used in lieu of seeking allopathic healthcare for major illnesses causing child death. This paper describes the nature of traditional treatment for diarrhea and fever (presumed malaria). Weighted analysis and multi-logistic regression was applied to a household cluster survey (n = 5951) conducted in 4 districts in June 2010. Using structured questionnaires, heads of households, and caregivers of children under five years of age were interviewed about child morbidity and care seeking. A thematic analysis of qualitative data based on focus group discussions and in-depth interviews with family members from twelve villages in these same four districts, was also done. Illness-specific herbal remedies were described by respondents. Among 1511 children with diarrhea, 31% used traditional treatment. Among 3851 children with fever, 22% used traditional treatment. Traditional treatment for diarrhea was associated with being from a tribe other than the Mende, using government recommended salt sugar solution, not having a vaccine card, having more than two illnesses, and not seeking any allopathic medical treatment for diarrhea. For fever, traditional treatment was associated with being a tribe other than the Mende, having more than two illnesses, not having a vaccine card, Muslim religion, and not seeking any allopathic medical treatment for fever. Qualitatively, respondents describe herbalists as trusted with remedies that are seen to be appropriate due to the perceived cause of illness and due to barriers to seeking care from government providers.The social determinants of traditional treatment use and the prominent role of herbalists in providing them need to be addressed to improve child survival in Sierra Leone.     

北京市西城区广场集体健身运动参与者的运动现况调查

目的 了解广场集体健身运动参与者的运动习惯、需求及其对健康的自我评价,有针对性地提出深入推进广场集体健身运动的政策建议。方法 在北京市西城区随机抽取2个公园和4个社区,于2015年4月对遇到的广场集体健身运动参与者开展调查。结果 共调查222人,男性比例很少（约占17.6%）。参与运动后明显感觉到精力充沛者占82.9%,其次是心情变好（76.6%）、睡眠变好（65.3%）、朋友变多（52.7%）以及去医院次数减少（50.5%）。体质指数（body mass index,BMI）均值从参与前的24.6 kg/m²降到23.8 kg/m²（t=7.6,P<0.001）。超重比例由参与前的39.6%降到33.3%（χ²=1.9,P=0.168）,肥胖比例由参与前的13.5%降到7.7%（χ²=4.0,P=0.045）。64.9%的参与者在雾霾天仍然坚持运动,另外还有饭后1 h内运动（29.3%）、空腹运动（20.7%）、穿高跟鞋（13.5%）以及穿紧身裤（14.4%）等不良运动习惯。21.2%的公园参与者和53.0%的社区参与者认为场地缺乏。结论 广场集体健身运动对居民身心健康具有积极的影响,建议政府部门开展宣传,促进更多的男性参与广场集体健身运动,并组织专家进行指导以减少在雾霾天运动、空腹运动和穿高跟鞋运动等不良运动习惯。     

Trends in maternal mortality in the United States

Maternal mortality is a major global concern. Although a notable decline in maternal mortality in the United States occurred during the mid-20th century, this progress stalled during the late 20th century. Furthermore, maternal mortality rates have increased during the early 21st century. Around the year 2000 the maternal mortality rate began to rise and has since nearly doubled. Given that at least half of maternal deaths in the U.S. are preventable, the rise in maternal deaths in the U.S. is historic and worrisome. This overview will try to provide a context for understanding the problem of this rise in maternal mortality in the U.S. by briefly discussing how maternal mortality rates are reported from National Vital Statistics data and from a National Surveillance system. Trends and causes of maternal deaths and the difficulty with interpreting these trends will be discussed.