Incidence of community-acquired pneumonia in urban China: A national population-based study

BackgroundCommunity-acquired pneumonia (CAP) is one of the major global health problems worldwide. However, the epidemiological information of CAP is limited in China. This study aimed to estimate the incidence rate of CAP and describe the epidemiologic characteristics among the Chinese population.MethodsWe conducted a retrospective analysis of CAP incidence using the Chinese Urban Basic Medical Insurance database of 23 provinces in 2016, which covered 427.52 million urban beneficiaries of all age groups in Mainland China. CAP episodes were identified using a diagnosis-term-derived algorithm, and multiple CAP records of one single person within 90 continuous days were considered as one single episode. The incidence rates were calculated and described by sex, age, region, and season.ResultsA total of 1.42 million patients were identified as having one or more CAP episodes, and finally a sum of 1.48 million CAP episodes were counted. The overall incidence of CAP was 7.13 (95% CI: 6.11–8.15) per 1000 person-years, in males 7.32 (95% CI: 6.28–8.35) and females 6.93 (95% CI: 5.92–7.94) per 1000 person-years, respectively. The incidence varied by age with a U-shaped curve peaking in children aged < 5 years old [65.80 (95% CI: 62.52–69.08)] and elderly population aged ≥ 80 years old [14.98 (95% CI: 13.63–16.34)]. The incidence varied markedly by regions. Furthermore, the rate showed a clear seasonal trend, which peaked in spring, decreased in summer and autumn, and re-ascended in winter.ConclusionThis study reveals a relatively high level of CAP incidence in China. These findings provide baseline data for establishing effective prevention strategies, targeted at susceptible populations, regions, and seasons in China.     

湖南省新型冠状病毒肺炎聚集性疫情流行特征分析

目的 分析湖南省195起新型冠状病毒肺炎聚集性疫情的流行病学特征,为新型冠状病毒肺炎聚集性疫情防控提供科学依据。方法 收集2020年1—2月湖南省195起新型冠状病毒肺炎疫情资料,采用描述流行病学方法进行分析。结果 195起新型冠状病毒肺炎聚集性疫情,发病696 例,无死亡病例;报告事件数位居前三的是长沙市(51起)、岳阳市(31起)、邵阳市(22起)。疫情起数、发病数在1月31日均达到高峰。男女性别比1.02∶1;平均年龄44.7岁,其中15岁以下儿童42例(6.3%);无症状感染者55例(8.28%);病例以轻型和普通型为主,占79.5%。仅发生一代病例的事件为28起(14.4%),二代病例的事件154起(79.0%),三代病例的事件10起(5.1%),四代病例的事件3起(1.5%)。一代病例与二代病例代际间隔平均为6.2 d(95%CI:5.1~7.3),中位数5.0 d。家庭暴露聚集性疫情续发率范围0.7%~100%,中位11.8%;医疗机构续发率范围0.9%~20.0%,中位6.9%。127起(65.1%)为湖北输入型疫情。696例聚集性病例中,268例(38.5%)为首代病例,387例(55.6%)为二代病例,32例(4.6%)为三代病例,9例(1.3%)为四代病例。事件暴露方式多种多样,184起有同住暴露,185起有同车暴露,118起有聚会暴露,149起有聚餐暴露,165起有交谈暴露,8起有会议培训暴露。结论 湖南省新型冠状病毒肺炎聚集性疫情主要发生在家庭,应关注重点地区、重点人群、重点场所,落实各项防控措施,有效处置新型冠状病毒肺炎聚集性疫情,防止疫情进一步扩散。     

The polio vaccination story of Pakistan

BackgroundTo describe in chronological detail Pakistan’s decades long battle against poliovirus and evaluate the multiple factors impacting it.Main bodyPakistan’s fight is documented through various published research articles and reports on Pakistan’s progress in eradication of polio published by international agencies involved in elimination of poliovirus worldwide. The socioeconomic, religious, and political factors, violent religious militancy, conspiracy theories resulting in vaccine refusals are documented in detail emphasizing the ups and downs in the fight at different times since 1994 to present. Pakistan and Afghanistan are the only two countries in the world reporting cases caused by wild polio virus type 1 (WPV1) since 2017 and the only two countries that have never stopped the transmission of WPV1 Pakistan needs to work on a war footing to eliminate the disease. The need to act urgently is now being increasingly recognized by the Pakistani Government.ConclusionMany difficulties still remain. Pakistan has reached a critical stage in the fight against polio. The world will not accept any further delay or complacency as there is apprehension around the world that Pakistan may “export” polio to other countries and undermine the worldwide success in eradicating polio.     

Guillain Barre syndrome associated with COVID-19 infection: A case report

Novel outbreak with coronavirus 2019 began since 31 December 2019. Coronaviruses can cause multiple systemic infections that respiratory complications are the most obvious symptoms. In this report, we describe the symptoms of Guillain Barre syndrome (GBS) in one infected patient with COVID-19, for the first time. We reported a 65-years- old male patient with complaints of acute progressive symmetric ascending quadriparesis. Two weeks prior to hospitalization, the patient suffered from cough, fever, and RT-PCR was reported positive for COVID-19 infection. The electrodiagnostic test showed that the patient is an AMSAN variant of GBS. COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it creates immune-mediated processes. GBS is an immune-mediated disorder and molecular mimicry as a mechanism of autoimmune disorder plays an important role in creating it. It is unclear whether COVID-19 induces the production of antibodies against specific gangliosides. Further investigations should be conducted about the mechanism of GBS in patients with COVID-19, in the future.     

COVID-19, SARS and MERS: A neurological perspective

Central to COVID-19 pathophysiology is an acute respiratory infection primarily manifesting as pneumonia. Two months into the COVID-19 outbreak, however, a retrospective study in China involving more than 200 participants revealed a neurological component to COVID-19 in a subset of patients. The observed symptoms, the cause of which remains unclear, included impaired consciousness, skeletal muscle injury and acute cerebrovascular disease, and appeared more frequently in severe disease. Since then, findings from several studies have hinted at various possible neurological outcomes in COVID-19 patients. Here, we review the historical association between neurological complications and highly pathological coronaviruses including SARS-CoV, MERS-CoV and SARS-CoV-2. We draw from evidence derived from past coronavirus outbreaks, noting the similarities and differences between SARS and MERS, and the current COVID-19 pandemic. We end by briefly discussing possible mechanisms by which the coronavirus impacts on the human nervous system, as well as neurology-specific considerations that arise from the repercussions of COVID-19.     

血管紧张素转换酶2对儿童2019冠状病毒病的作用研究进展

随着严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在全球的肆虐，儿童感染者人数也越来越多。血管紧张素转换酶2（ACE2）是SARS-CoV-2感染人体的结合位点之一，可以与病毒尖峰蛋白结合，使得跨膜丝氨酸蛋白酶（TMPRSS2）启动S蛋白触发感染，引起白细胞介素-1、干扰素-γ、肿瘤坏死因子等多种炎性因子的产生。与成人相比，儿童的ACE2及TMPRSS2的表达水平较低，推测儿童症状较成人轻，发病人数较成人少均与此有关。该综述对SARS-CoV-2感染过程中ACE2的作用研究进展进行总结，有助于了解SARS-CoV-2的致病机制，为更好地开发药物及疫苗，防治儿童2019冠状病毒病提供参考。     

新型冠状病毒肺炎防控形势下儿童青少年慢性心力衰竭的临床管理建议

2019年12月我国湖北省武汉市爆发新型冠状病毒(2019-nCoV)感染疫情,目前已蔓延至全国各地,流行病学显示人群对该病毒普遍易感,且患有基础疾病的患者是重症、危重症的高危人群,同时儿童青少年感染病例数正日益增多。慢性心力衰竭儿童因其基础条件差,感染2019-nCoV后将给此类患儿的诊治带来严峻的挑战。结合儿童2019-nCoV感染的临床特点及儿童慢性心力衰竭的诊治要点,在此提出慢性心力衰竭儿童2019-nCoV感染的临床管理建议,以供临床参考。