1起伤寒副伤寒暴发的调查分析

目的　调查忠县伤寒副伤寒暴发的因素 ,为制定防制措施提供科学依据。方法　对患者进行统一个案调查并采样检测。结果　发现患者 961例 ,罹患率 3 68% ,其中血清学诊断 68例 (肥达反应阳性 ) ,病原学诊断 17例 ,其余病例根据临床表现 ,结合胶乳试验和流行病学史诊断 ;病例主要集中在场镇的 3所中小学 ,占 90 5 3% ;暴露因子分析显示 ,供应开水和未供应开水的学校罹患率分别为 0 2 1%、 2 6 2 8% ,两者发病差别有显著性 (P <0 0 0 5 ) ;常饮生水和不饮生水者罹患率分别为4 4 88%、 12 79% ,前者显著高于后者 (P <0 0 0 5 ) ;走读生和住校生罹患率分别为 17 5 6%、2 8 2 7% ,住校学生发病显著高于走读生 (P <0 0 0 5 ) ;饮用水中检出伤寒沙门菌。结论　饮水污染是本次伤寒副伤寒发生和流行的主要原因 ,生活密切接触传播也起着重要作用     

Postoperative complications after surgery for typhoid perforation in children in Ghana

One of the most severe complications of typhoid fever is perforation of the ileum (TPI); it is also a cause of high morbidity and mortality in endemic areas. After surgery for TPI, other complications may set in postoperatively, compounding the problem. A prospective study of 121 children who were operated upon for TPI to identify the postoperative complications showed that the most common was wound infection. The most serious were: mechanical intestinal obstruction, abdominal dehiscence, and enterocutaneous fistulae. Physicians caring for such children should be aware of these complications and their mode of presentation so as to quickly and decisively manage them to prevent more deaths. Accepted: 8 April 1998     

The malaria and typhoid fever burden in the slums of Kolkata, India: data from a prospective community-based study

Recent research has indicated that the malaria burden in Asia may have been vastly underestimated. We conducted a prospective community-based study in an impoverished urban site in Kolkata, India, to estimate the burden of malaria and typhoid fever and to identify risk factors for these diseases. In a population of 60452 people, 3605 fever episodes were detected over a 12-month period. The blood films of 93 febrile patients contained Plasmodium (90 P. vivax, 2 P. falciparum and 1 P. malariae). Blood cultures from 95 patients grew Salmonella enterica serotype Typhi. Malaria patients were found to be significantly older (mean age 29 years) compared with patients with typhoid fever (15 years; P<0.001) but had similar clinical features on presentation. Having a household member with malaria, illiteracy, low household income and living in a structure not built of bricks were associated with an increased risk for malaria. Having a household member with typhoid fever and poor hygiene were associated with typhoid fever. A geographic analysis of the spatial distribution of malaria and typhoid fever cases detected high-risk neighbourhoods for each disease. Focal interventions to minimise human-vector contact and improved personal hygiene and targeted vaccination campaigns could help to prevent malaria and typhoid fever in this site.     

Introducing Vi polysaccharide typhoid fever vaccine to primary school children in North Jakarta, Indonesia, via an existent school-based vaccination platform

OBJECTIVES: To report results on coverage, safety and logistics of a large-scale, school-based Vi polysaccharide immunization campaign in North Jakarta. METHODS: Of 443 primary schools in North Jakarta, Indonesia, 18 public schools were randomly selected for this study. Exclusion criteria were fever 37.5 degrees C or higher at the time of vaccination or a known history of hypersensitivity to any vaccine. Adverse events were monitored and recorded for 1 month after immunization. Because this was a pilot programme, resource use was tracked in detail. RESULTS: During the February 2004 vaccination campaign, 4828 students were immunized (91% of the target population); another 394 students (7%) were vaccinated during mop-up programmes. Informed consent was obtained for 98% of the target population. In all, 34 adverse events were reported, corresponding to seven events per 1000 doses injected; none was serious. The manufacturer recommended cold chain was maintained throughout the programme. CONCLUSIONS: This demonstration project in two sub-districts of North Jakarta shows that a large-scale, school-based typhoid fever Vi polysaccharide vaccination campaign is logistically feasible, safe and minimally disruptive to regular school activities, when used in the context of an existing successful immunization platform. The project had high parental acceptance. Nonetheless, policy-relevant questions still need to be answered before implementing a widespread Vi polysaccharide vaccine programme in Indonesia.     

2008～2010年开阳县伤寒、副伤寒监测结果分析

目的掌握开阳县伤寒、副伤寒疾病的流行情况,探寻危险因素,为提出有针对性的综合性防制措施提供依据。方法在开阳县选择既往发病较多的6个乡镇建立以全人群的伤寒、副伤寒病原菌监测系统,对就诊发热病例进行登记、采血作病原学检测,监测时间2008年5月～2010年8月。结果登记发热病例112 503例,采集血液标本8 529份,检出阳性病例92例,其中伤寒1例,副伤寒91例。病例以10～40岁人群为主,农民占确诊病例数的69.57%;体温在37.5～38.0℃的占52.17%,症状多以上感症状为主。结论开阳县流行的菌株主要为甲型副伤寒;加强对发热人群伤寒、副伤寒监测,早期发现、及时治疗病人是伤寒、副伤寒防控的重要措施。     

云南省2008—2010年伤寒副伤寒发病情况

目的掌握近年来云南省伤寒副伤寒的流行病学特征,为制定有效的预防控制措施提供科学依据。方法应用描述流行病学方法对云南省各州（市）2008—2010年的伤寒副伤寒疫情年报数据进行分析。结果云南省2008—2010年共报告伤寒副伤寒病例14 675例,死亡3例;年平均发病率为10.77/10万,年平均死亡率为0.002/10万。西双版纳州、玉溪市、德宏州、红河州、昆明市及保山市6个州（市）为云南省的高发地区,5—10月为高发月份（64.66%）,发病年龄以20~39岁组居多,农民和学生为高发人群（64.65%）。结论云南省伤寒副伤寒发病率处于较高水平,应采取综合性的预防控制措施。     

2001～2010年泗阳县伤寒流行情况分析

[目的]了解泗阳县伤寒流行情况,掌握流行趋势和流行特征,为制定防制对策提供依据。[方法]对泗阳县2001~2010年伤寒疫情资料进行分析。[结果]2001~2010年泗阳县累计伤寒发病40例,无死亡病例。年均发病率为0.38/10万。年发病率,2007年最高,为0.62/10万。年均发病率,来安社区最高,为0.80/10万;男性为0.40/10万,女性为0.36/10万;0~14岁为0.37/10万,15~34岁为0.46/10万,35~59岁为0.27/10万,≥60岁为0.53/10万。40例病人中,8~11月发病的占70.00%;农民占70.00%,散居儿童占12.50%,学生占12.50%;临床诊断的33例,病原学诊断的7例(伤寒6例,甲型副伤寒1例)。[结论]2001~2010年泗阳县伤寒疫情处于较低水平,病原学诊断率有待提高。     

伤寒、副伤寒疾病负担研究现状

国内外关于伤寒、副伤寒的疾病负担研究,大多从疾病流行病学负担方面进行评价,仅有少量有关伤寒疫苗的研究从成本效果方面进行深入的分析,认为在伤寒中高流行地区开展普遍的疫苗接种有较好的成本效果,在这些地区把伤寒疫苗纳入免疫规划具有重要意义.本文通过对国内外研究现状进行综合描述,以期为我国伤寒、副伤寒疾病的负担评价提供参考.     

Effectiveness of typhoid conjugate vaccine against culture-confirmed typhoid in a peri-urban setting in Karachi: A case-control study

BackgroundEnteric fever, caused by Salmonella Typhi and S. Paratyphi, is a cause of high morbidity and mortality among children in South Asia. Rising antimicrobial resistance presents an additional challenge. Typhoid Conjugate Vaccines (TCV) are recommended by the World Health Organization for use among people 6 months to 45 years old living in endemic settings. This study aimed to assess the effectiveness of TCV against culture-confirmed S. Typhi in Lyari Town, Karachi, Pakistan. This peri-urban town was one of the worst affected by the outbreak of extensively drug resistant (XDR) typhoid that started in November 2016.MethodsA matched case-control study was conducted following a mass immunization campaign with TCV at three key hospitals in Lyari Town Karachi, Pakistan. Children aged 6 months to 15 years presenting with culture-confirmed S. Typhi were enrolled as cases. For each case, at least 1 age-matched hospital control and two age-matched community controls were enrolled. Adjusted odds ratios with 95% confidence intervals (CIs) were calculated using conditional logistic regression.ResultsOf 82 typhoid fever patients enrolled from August 2019 through December 2019, 8 (9·8%) had received vaccine for typhoid. Of the 164 community controls and 82 hospital controls enrolled, 38 (23·2%) community controls and 27 (32·9%) hospital controls were vaccinated for typhoid. The age and sex-adjusted vaccine effectiveness was found to be 72% (95% CI: 34% − 88%). The consumption of meals prepared outside home more than once per month (adjusted odds ratio: 3·72, 95% CI: 1·55- 8·94; p-value: 0·003) was associated with the development of culture-confirmed typhoid.ConclusionA single dose of TCV is effective against culture confirmed typhoid among children aged 6 months to 15 years old in an XDR typhoid outbreak setting of a peri-urban community in Karachi, Pakistan.     

何廉臣《感症宝筏》手校稿本述考

《感症宝筏》原名《伤寒指掌》,为清代医家吴贞所著,何廉臣重订,体现了清代中后期寒温思想的融合。该稿本为何廉臣出版该书时手校之底本,由其子抄录,内有多处校对、抄录笔迹及校改痕迹。从该稿本的抄写和体例、稿本与通行本之对比、该稿本中的修改符号等几个方面进行论述,探讨其学术与文物价值。