Identification of geographic clusters for temporal heterogeneity with application to dengue surveillance

Identifying transmission of hot spots with temporal trends is important for reducing infectious disease propagation. Cluster analysis is a particularly useful tool to explore underlying stochastic processes between observations by grouping items into categories by their similarity. In a study of epidemic propagation, clustering geographic regions that have similar time series could help researchers track diffusion routes from a common source of an infectious disease. In this article, we propose a two-stage scan statistic to classify regions into various geographic clusters by their temporal heterogeneity. The proposed scan statistic is more flexible than traditional methods in that contiguous and nonproximate regions with similar temporal patterns can be identified simultaneously. A simulation study and data analysis for a dengue fever infection are also presented for illustration.     

2018—2020年徐州市食源性疾病监测分析

目的 分析徐州市2018—2020年食源性疾病哨点医院主动监测结果,了解该地区食源性疾病流行特征。方法 收集2018—2020年徐州市食源性疾病哨点医院监测的病例信息,并对部分病例的粪便样本进行病原学检测。结果 3年共监测食源性疾病病例7 548例,其中25～45岁年龄组占比最高(26.81%);6—9月为发病高峰;肉与肉制品(20.72%)为主要的可疑暴露食品;可疑食物进食场所主要为家庭(80.49%);农民(26.75%)和散居儿童(24.95%)病例构成比较高。共采集1 835份腹泻病例粪便样本,其中诺如病毒检出率最高为(4.69%)。结论 徐州市食源性疾病高发期为6—9月,具有明显的季节性,好发于家庭,肉与肉制品为主要暴露食品,感染患者集中在>25～45岁年龄组,诺如病毒感染率较高。     

1起ICU耐碳青霉烯类 鲍曼不动杆菌感染暴发的流行病学调查

[摘要]　目的?通过对我院ICU 9例耐碳青霉烯类鲍曼不动杆菌（carbapenem-resistant Acinetobacter baumannii, CRAB）感染者进行流行病学调查,探讨CRAB感染暴发的危险因素。方法?回顾分析2019年3月17日—4月12日我院ICU收治的9例CRAB感染者的临床资料及流行病学史,应用肠杆菌科基因间重复一致序列聚合酶链式反应技术（enterobacterial repetitive intergenic consensus-polymerase chain reaction, ERIC-PCR）分析其同源性,监测ICU环境卫生学情况。结果?我院ICU A4、A6、B3及C2床患者临床样本检出的CRAB为同一疑似克隆株;B5、C1床患者样本检出的CRAB为同一疑似克隆株;B2、B2加床患者临床样本检出的CRAB为同一疑似克隆株。通过环境卫生学监测,分别从病房的空气滤网、床栏、呼吸机按钮和护士手等部位分离出50株CRAB,其中23份样本检出与患者有相同耐药谱的CRAB。ERIC-PCR结果显示,9例临床分离菌株与25例环境菌株为克隆株。手术、气管插管和前期接受抗菌药物治疗是CRAB感染的危险因素。结论?ICU患者、工作人员感控管理不到位以及空气、环境和ICU医务人员手卫生的清洁消毒措施不严格可能是此次CRAB感染传播的原因,为了减少此类医院感染事件的发生,建议加强对ICU患者与工作人员管理、加强环境及物体表面的彻底消毒、提高手卫生依从性。     

中国人口老龄化对居民医疗卫生支出的影响研究

在人口老龄化的背景下,如何控制医疗费用、促进健康老龄化已经成为世界性难题。本文通过实证研究分析中国人口老龄化对医疗卫生支出的影响机制,为医疗和养老政策的制定提供参考。面板门槛效应模型的回归结果显示,中国人口老龄化对居民医疗卫生支出的影响与城镇化水平有关。城镇化水平存在双重门槛效应,当城镇化水平低于第二个门槛值,人口老龄化显著地减少了医疗卫生支出;当城镇化水平高于第二个门槛值,人口老龄化对医疗卫生支出的影响机制发生改变,显著地增加了医疗卫生支出。因此,如何在城镇化进程中增进老年人口的社会福祉是控制医疗费用、促进健康老龄化的关键。     

Hybrid Approach to Estimation of Underreporting of Tuberculosis Case Notification in High-Burden Settings With Weak Surveillance Infrastructure: Design and Implementation of an Inventory Study

BackgroundThe greatest risk of infectious disease undernotification occurs in settings with limited capacity to detect it reliably. World Health Organization guidance on the measurement of misreporting is paradoxical, requiring robust, independent systems to assess surveillance rigor. Methods are needed to estimate undernotification in settings with incomplete, flawed, or weak surveillance systems. This study attempted to design a tuberculosis (TB) inventory study that balanced rigor with feasibility for high-need settings.ObjectiveThis study aims to design a hybrid TB inventory study for contexts without World Health Organization preconditions. We estimated the proportion of TB cases that were not reported to the Ministry of Health in 2015. The study sought to describe TB surveillance coverage and quality at different levels of TB care provision. Finally, we aimed to identify structural-, facility-, and provider-level barriers to notification and reasons for underreporting, nonreporting, and overreporting.MethodsRetrospective partial digitalization of paper-based surveillance and facility records preceded deterministic and probabilistic record linkage; a hybrid of health facilities and laboratory census with a stratified sampling of HFs with no capacity to notify leveraged a priori knowledge. Distinct extrapolation methods were applied to the sampled health facilities to estimate bacteriologically confirmed versus clinical TB. In-depth interviews and focus groups were used to identify causal factors responsible for undernotification and test the acceptability of remedies.ResultsThe hybrid approach proved viable and instructive. High-specificity verification of paper-based records in the field was efficient and had minimal errors. Limiting extrapolation to clinical cases improved precision. Probabilistic record linkage is computationally intensive, and the choice of software influences estimates. Record absence, decay, and overestimation of the private sector TB treatment behavior threaten validity, meriting mitigation. Data management demands were underestimated. Treatment success was modest in all sectors (R=37.9%–72.0%) and did not align with treatment success reported by the state (6665/8770, 75.99%). One-fifth of TB providers (36/178, 20%) were doubtful that the low volume of patients with TB treated in their facility merited mastery of the extensive TB notification forms and procedures.ConclusionsSubnational inventory studies can be rigorous, relevant, and efficient in countries that need them even in the absence of World Health Organization preconditions, if precautions are taken. The use of triangulation techniques, with minimal recourse to sampling and extrapolation, and the privileging of practical information needs of local decision makers yield reasonable misreporting estimates and viable policy recommendations.     

Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications,Malawi

The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.     

Prevalence of Vision Loss and Associations With Age-Related Eye Diseases Among Nursing Home Residents Aged ≥65 Years

ObjectivesTo examine data from Delaware nursing homes to determine prevalence of age-related eye diseases (AREDs), vision impairment, and blindness and to compare the findings with the results of 11 US investigations of vision and eye health in nursing homes.DesignThis is a cross-sectional, retrospective study of nursing home patients.Setting and ParticipantsTwenty nursing homes in Delaware participated in the study, yielding comprehensive eye examination records for 2019 study participants.MethodsSummary statistics and regression analyses.ResultsThe overall prevalence of vision impairment or blindness was 63.8% and was above 60% for each age, sex, and race category. Prevalence of vision impairment or blindness was 68.4% among patients with cataracts, 69.4% among patients with macular degeneration, 70.5% among patients with glaucoma, and 68.4% among patients with diabetic retinopathy. Prevalence of blindness was 14.1%. Among patients with AREDs, prevalence of blindness ranged from 15.0% for patients with cataracts to 22.6% for patients with diabetic retinopathy. When compared with other investigations, we found wide variation in vision and eye factors reported and wide variation in the prevalence of those factors. Only 4 studies diagnosed both AREDs and visual function. Seven studies reported AREDs, and 7 reported vision impairment and/or blindness. Vision impairment or blindness ranged from 29% to 67%; cataract ranged from 32% to 83%; macular degeneration ranged from 4.6% to 70.7%. Glaucoma ranged from 5.3% to 41.4%; diabetic retinopathy ranged from 1.7% to 3.1%.Conclusions and ImplicationsComprehensive eye examinations showed that vision impairment and blindness affected 63.8% of nursing home residents. Compared with other studies, there was a wide range of vision factors reported and wide variation in the prevalence of vision impairment or blindness and AREDs. This investigation suggests the importance of eye care in nursing homes and the importance of reporting standard vision and eye health factors to inform policy and practice.     

2017-2019年某医院综合ICU医院感染目标监测分析

目的分析某医院综合重症医学科(ICU)医院感染目标性监测情况。方法对2017-2019年宁夏回族自治区人民医院ICU目标性监测数据,包括医院感染发病率、医院感染部位分布、三管使用及其相关感染、医院感染病原菌分布等进行回顾性分析。结果共监测ICU患者4953例,医院感染发病率为6.42%,医院感染例次发病率为8.46%;感染部位以呼吸系统为主占73.03%;泌尿道插管相关泌尿道感染(CAUTI)、血管导管相关血流感染(CRBSI)、呼吸机相关肺炎(VAP)感染发病率分别为1.50‰、2.46‰和13.66‰;检出病原菌356株,前三位依次为鲍氏不动杆菌、肺炎克雷伯菌和金黄色葡萄球菌。结论医院ICU医院感染发病率较高,感染部位以呼吸系统为主,分离病原菌以革兰阴性菌为主,总器械使用率高,提示临床应严格留置导管指征,对VAP等医院感染高危因素及时采取有效地预防措施,降低感染风险,保障患者安全。     

德尔菲法构建学生传染病症状监测质量控制和预警效果评价指标体系

目的 构建学生传染病症状监测质量控制和预警效果评价指标体系,为指导学生传染病症状监测预警工作提供科学依据。方法 在文献查阅基础上,通过两轮德尔菲法专家咨询筛选学生传染病症状监测质量控制和预警效果评价指标,并通过层次分析法和专家评分法确立指标权重,构建指标体系。结果 32位专家两轮咨询的专家积极系数分别为87.5%(28/32)和100.0%(28/28),专家平均权威系数(Cr)为0.792,第二轮咨询专家协调系数为0.245(χ²=459.416,P<0.001),经指标筛选,形成由6项一级指标、19项二级指标和43项三级指标构成的学生传染病症状监测质量控制和预警效果评价指标体系。6项一级指标权重从高到低依次为信息质量(0.2281)、学校管理(0.2123)、疾控管理(0.1927)、预警信息管理(0.1450)、系统维护(0.2)和预警效果评价(0.1108)。结论 本研究建立了学生传染病症状监测质量控制和预警效果评价指标体系,本体系专家积极程度和权威程度较高,意见趋于一致,可为国内学生传染病症状监测工作提供参考。     

High Case-Fatality Rate for Human Anthrax,Northern Ghana, 2005–2016

The human cutaneous anthrax case-fatality rate is ≈1% when treated, 5%–20% when untreated. We report high case-fatality rates (median 35.0%; 95% CI 21.1%–66.7%) during 2005–2016 linked to livestock handling in northern Ghana, where veterinary resources are limited. Livestock vaccination and access to human treatment should be evaluated.