A rubella outbreak investigation and BRD-II strain rubella vaccine effectiveness study,Harbin city,Heilongjiang province,China, 2010–2011

Background

In the 1990s, China introduced rubella vaccine into the private market using BRD-II virus strain, which is different than the globally used RA27/3 strain. In 2007, BRD-II rubella containing vaccine was introduced into the national immunization program and recommended for routine use. However, to our knowledge, there are no field vaccine effectiveness (VE) studies of BRD-II rubella vaccine. In April 2011, a rubella outbreak was detected in two daycare centers in Harbin city, China. We conducted an investigation to determine VE of BRD-II rubella vaccine.

Methods

Rubella cases were either laboratory-confirmed or epidemiologically linked to laboratory-confirmed cases. We collected demographic characteristics, migrant status, and history of rubella and measles vaccination from all children in the two daycare centers.

Results

The first case of rubella was on 22 November, 2010. Among the 143 children in the two daycare centers, 22 acquired rubella, for an overall attack rate (AR) of 15.4% (22/143). The AR in higher-grade classes (21.7%) was higher than in lower grade classes (3.9%). The AR among migrant children (47.8%) was higher than among local children (9.2%). Rubella vaccine coverage was 17% (24/143), while measles vaccine coverage was 100%. The AR among rubella-vaccinated children was 0% (0/24), and the AR among rubella-unvaccinated children was 18.5% (22/119), for a VE of 100% (P value = 0.025, 95% CI: 35–100%). Rubella vaccine coverage among children born before 2007 was 10.2% (10/98), and was lower than that for children born in 2007 or after (31.1% (14/45), RR = 0.33, 95%CI: 0.16–0.68). Emergency vaccination was conducted on 11 and 12 April 2011, and the outbreak stopped in one week later.

Conclusions

Domestic BRD-II strain rubella vaccine showed high vaccine effectiveness against rubella. Rubella vaccine coverage through routine immunization was insufficient. Consideration should be given for measuring rubella vaccine coverage to determine the need for catch-up vaccination in China.     

黑龙江省慢性病预防控制能力现状分析

目的了解黑龙江省慢性病预防控制能力现状,为加强该省慢性病防控能力建设、制定慢性病防控相关政策提供依据。方法对2011年黑龙江省1个省级、13个市(地)级和132个县(区)级疾病预防控制中心(疾控中心)慢病防控能力现状进行问卷调查,内容包括机构设置、人员和经费配置、继续教育情况,监测和干预工作开展情况以及科研能力等。采用SPSS 17.0统计软件进行数据分析。结果黑龙江省10个市(地)级和59个县(区)级疾控中心设有专职慢性病科(所)或以慢性病为主的科(所)。各级疾控中心从事慢性病防控人员327人,占所有在岗人员的4.57%(327/7 153),其中本科及以上学历者占42.81%(140/327)、医学类专业者占85.32%(279/327),从事慢性病工作不足5年者占60.25%(197/327)。84.62%(11/13)的市(地)级、87.88%(116/132)的县(区)级疾控中心参加慢病防控相关培训;92.31%(12/13)和65.91%(87/132)开展了死因监测工作;92.31%(12/13)和62.12%(82/132)开展了恶性肿瘤病例报告工作;53.85%(7/13)和68.18%(90/132)开展了高血压干预工作,38.46%(5/13)和67.42%(89/132)开展了糖尿病干预工作。市(地)级和县(区)级疾控中心配置慢性病防控专项经费的单位分别为15.39%(2/13)和14.39%(19/132),承担国内科研课题的单位分别为15.39%(2/13)和2.27%(3/132),发表过国内外期刊论文的单位分别为7.69%(1/13)和0.76%(1/132)。结论与2009年调查数据相比,黑龙江省各级疾控中心慢性病防控人员数量,县(区)级疾控中心设立专职慢性病科(所)或以慢性病为主的科所和配置慢性病专项经费的单位均有所增加,但仍存在机构和人员不足以及工作经费缺乏等问题。     

Risk Factors for Locoregional Failure in Patients With Inflammatory Breast Cancer Treated With Trimodality Therapy

PurposeTo compare patterns of local and regional failure between patients with inflammatory breast cancer (IBC) and non-IBC in patients treated with trimodality therapy.Materials and MethodsWe reviewed records of 463 patients with stage II/III breast cancer, including IBC, who completed trimodality therapy from January 1999 to December 2009.ResultsThe median follow-up was 46.3 months (range, 4-152 months). Clinical stage was 29.4% (n = 136) II, 56.4% (n = 261) non-IBC III, 14.2% (n = 66) IBC, 30.5% (n = 141) cN0/Nx, and 69.5% (n = 322) N1-N3c. All the patients received neoadjuvant therapy and mastectomy (98%, n = 456 with axillary dissection), and all had postmastectomy radiation therapy to the chest wall with or without supraclavicular nodes (82.5%, n = 382) with or without axilla (6%, n = 28). The median chest wall dose was 60.4 Gy. Patients with IBC presented with larger tumors (P < .001) and exhibited a poorer response to neoadjuvant therapy: after surgery, fewer patients with IBC were ypN0 (P = .003) and more had ≥ 4 positive nodes (P < .001). Four-year cumulative incidence of locoregional recurrence was 5.9%, with 25 locoregional events, 9 of which had a regional component. On multivariate analysis, triple-negative disease (hazard ratio [HR] 7.75, P < .0001) and residual pathologic nodes (HR 7.10, P < .001) were associated with an increased risk of locoregional recurrence, but IBC was not. However, on multivariate analysis, the 4-year cumulative incidence of regional recurrence specifically was significantly higher in IBC (HR 9.87, P = .005).ConclusionIn this cohort of patients who completed trimodality therapy, the patients with IBC were more likely to have residual disease in the axilla after neoadjuvant therapy and were at greater risk of regional recurrence. Future study should focus on optimizing regional nodal management in IBC.     

中国2013年度饮水型地方性氟中毒监测

目的 掌握目前中国饮水型地方性氟中毒病区病情现状及防治措施落实情况。方法 按照《饮水型地方性氟中毒监测方案》规定的方法和要求,在全国28个省(自治区、直辖市)和新疆生产建设兵团,抽取136个监测县,每个监测县随机抽取3个病区村作为固定监测点。根据《氟斑牙诊断》(WS/T 208-2011)对监测点所有8~12周岁儿童进行氟斑牙检查。调查改水村改水工程运行情况及水氟含量,以及未改水村饮水氟含量。水氟检测采用生活饮用水标准检验方法(GB/T 5750.5-2006)。结果 所有监测点8~12周岁儿童氟斑牙患病率平均为28.58%(7950/27817),氟斑牙指数为0.58。其中改水工程正常运转且水氟含量合格的监测村患病率为22.28%(3917/17583),氟斑牙指数为0.44;改水工程未正常运转或改水后水氟含量仍然超标的监测村患病率为38.74% (1926/4971),氟斑牙指数为0.84;未改水监测村患病率为40.03%(2107/5263),氟斑牙指数为0.81。三类病区儿童氟斑牙患病率的差异存在统计学意义。降氟改水工程的正常运转率为93.77%(286/305),改水工程水氟含量合格率为76.77%(228/297)。结论 全国饮水型地方性氟中毒病区儿童氟斑牙的病情整体上为边缘流行,有效改水可以显著降低病区儿童氟斑牙病情;病区降氟改水工程正常运转率接近95%,但水氟含量合格率低于80%。     

佳木斯市2004—2017年肾综合征出血热流行病学特征及疫苗效果

目的 了解佳木斯市2004—2017年肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)流行病学特征,评价HFRS疫苗防控效果,并为预防控制提供科学依据。方法 对佳木斯市2004—2017年HFRS网络直报资料进行描述性分析,率的比较采用卡方检验。结果 佳木斯市2004—2017年报告HFRS病例5 318例,年平均发病率为15.33/10万,不同年份的平均发病率差异有统计学意义(χ²=1 856.94,P<0.05)。HFRS发病具有明显的季节特征;病例主要以青壮年男性为主;职业以农民为主,占69.76%;男女性别比为3.64∶1,男性平均发病率高于女性,差异有统计学意义(χ²=1 617.99,P<0.05);HFRS疫苗接种后发病率逐年下降。结论 HFRS防控重点人群为农民,此外,工人、学生、离退休人员、家务等职业人群也应加强防护;疫苗接种对防控HFRS效果明显,建议提高45岁以上人群疫苗接种覆盖率。     

NMR spectroscopy based metabolomics confirms the aggravation of metabolic disorder in metabolic syndrome combined with hyperuricemia

Background and aimsHyperuricemia (HUA) were associated with Metabolic syndrome (MetS) and its components. However, the molecular mechanism of uric acid in the development of MetS was not well elucidated. The aim of this study was developing a systemic metabolic profile by using metabolomics approach to explore the molecular mechanism of uric acid in the development of MetS.Methods and resultsAnthropometric, clinical biochemical data, and serum samples were collected from patients with MetS, MetS combined with HUA (MetS & HUA) and healthy controls. ¹H nuclear magnetic resonance (NMR) spectroscopy was used to detect endogenous small molecule metabolites of serum samples, then multivariate statistical analysis was applied to distinguish samples of different groups. In addition, pathway analysis was performed to contribute to understanding the metabolic change. By serum metabolic profiling, a total of 20 identified metabolites including lipids, amino acids, and organic acids were significantly altered in MetS and MetS & HUA patients. MetS & HUA patients presented a more severe disorder in both identified metabolites and BMI and biochemical indexes. According to pathway analysis, there were 3 and 5 metabolic pathways remarkably perturbed in MetS and MetS & HUA group respectively.ConclusionTaken together, we identified disordered metabolites and related pathways for both MetS and MetS & HUA patients, and found a more severe metabolic disorder in MetS patients who has a higher serum uric acid. Our study provides biochemical insights into the metabolic alteration for the progress of MetS.     

基于中国双生子人群的冠心病遗传-BMI交互作用研究

目的 分析冠心病患病的遗传-BMI交互作用。方法 利用中国双生子登记系统募集的20 340对≥ 25岁的同性别双生子,构建单变量遗传-环境交互作用模型,通过评估BMI对冠心病遗传效应的修饰作用反映冠心病的遗传-BMI交互作用。结果 调整年龄后,在男性中发现BMI对冠心病患病受到的遗传效应有负向修饰作用,遗传效应修饰系数（β_a）及95% CI为-0.14（-0.22~-0.04）,说明log-BMI每增加1个标准差,冠心病的遗传通径系数减小0.14,从而导致冠心病的遗传效应减小。而且低BMI（<24.0 kg/m²）男性冠心病患病的遗传度为0.77（0.65~0.86）,而高BMI（≥ 24.0 kg/m²）组对应模型中的遗传度为0.56（0.33~0.74）。在女性中未观察到冠心病的遗传-BMI交互作用。结论 中国成年男性双生子人群中发现冠心病患病的遗传-BMI交互作用,且遗传因素在低BMI组冠心病患病中发挥更重要的作用。     

哈尔滨市农村居民乙肝疫苗接种率及影响因素分析

目的 了解哈尔滨市农村居民乙肝疫苗接种情况及影响因素,为提高农村人口乙肝疫苗接种率和制定防控策略提供依据。方法 综合乙肝发病率和地理位置,采用随机抽样的方法于2018年在哈尔滨市农村地区,针对18~59岁人群开展问卷调查;数据分析采用x2检验及二分类logistic回归模型。结果 各年龄组乙肝疫苗接种率分别为64.84%、49.44%、20.71%;学历由低到高各组乙肝疫苗接种率分别为29.09%、46.01%、47.83%、83.33%、100%,疾病知识掌握程度由低到高各组乙肝疫苗接种率分别为24.64%、39.25%、51.74%、疫苗知识掌握程度由低到高各组乙肝疫苗接种率分别为20.55%、32.12%、49.33%、各疾病防控行为积极性由低到高各组乙肝疫苗接种率分别为9.09%、21.52%、46.84%;农村人口乙肝疾病知识的“掌握”比例为32.50%。结论 年龄大、文化水平低、乙肝疾病知识认知水平低是影响农村人口乙肝疫苗接种的重要因素,哈尔滨市应针对该特点制定接种策略,提高农村人口接种率。