1起可能经空气传播引起的疱疹性咽峡炎暴发疫情的调查与分析

目的 对一起幼儿园疱疹性咽峡炎暴发疫情的调查分析,探讨疱疹性咽峡炎的空气传播方式,为防控策略提供参考。 方法 依据疱疹性咽峡炎病例定义,开展病例搜索与流行病学调查,采用RT-PCR方法检测肠道病毒核酸并进行基因分型,运用Excel 2010和SPSS 17.0整理数据与统计分析。 结果 此次疱疹性咽峡炎暴发疫情的罹患率为6.0%(25/419), 班级间的罹患率差异有统计学差异(χ2=30.64,P<0.05),中(3)班和小(3)班有明显聚集性;采集19份病例咽拭子和27份外环境棉拭子标本,其中15例病例咽拭子和1份中(3)班空调通风口涂抹样品人肠道病毒(通用)核酸阳性,分型确认均为柯萨奇病毒A组4型(Cox A4)。 结论 在疱疹性咽峡炎疫情期间,应做好教室开窗通风和空调系统消毒,以有效控制疫情的进一步扩散和蔓延。     

基于临床症状和病原学特征的手足口病与疱疹性咽峡炎流行病学分析*

目的了解上海市浦东新区儿童手足口病和疱疹性咽峡炎临床症状和病原学特征,比较两者的流行病学特征,为有效防控手足口病和疱疹性咽峡炎的发生提供依据。方法对2016年6月—2017年5月上海市浦东新区手足口病和疱疹性咽峡炎病例进行问卷调查,同时采集病例的咽拭子样本进行肠道病毒检测。结果疱疹性咽峡炎在一些临床症状上和手足口病表现相似,但发热、咽痛、呕吐及头痛的发生率均高于手足口病病例,差异有统计学意义(P0.05)。手足口病与疱疹性咽峡炎的病原学结果不同,手足口病以柯萨奇A6型(Cox A6)、肠道病毒71型(EV71)和柯萨奇A16型(Cox A16)为主,疱疹性咽峡炎以其他肠道病毒和Cox A6为主。结论疱疹性咽峡炎应该得到重视,并和手足口病一样进行监测管理,有助于进一步加强有针对性的防控措施。     

引起深圳市一起疱疹性咽峡炎暴发的柯萨奇A4病毒的鉴定及其VP1区序列分析

目的鉴定引起2012年深圳市罗湖区一起疱疹性咽峡炎暴发的病原体,并对鉴定的柯萨奇A4病毒(coxsackie virus A4,CVA4)的VP1基因进行全长的序列测定和遗传进化特征分析。方法采集罗湖区某幼儿园疱疹性咽峡炎暴发期间患儿的4份咽拭子样本和1份粪便标本,采用荧光RT-PCR法鉴定CVA4病毒,对阳性样本采用RT-PCR方法扩增CVA4病毒VP1区全长序列,并进行核苷酸序列测定和系统进化分析。结果病原学检测结果显示,引起此次疱疹性咽峡炎暴发的病原体为CVA4病毒。同源性分析显示,引起深圳疱疹性咽峡炎的CVA4病毒SZ-SK12030005、SZ-SK12030007与山东省2010株(KF150144)进化关系最近,核苷酸和氨基酸同源性分别为96.4%和99.5%;与2006年吉林株(JQ715708)的同源性最低,核苷酸和氨基酸同源性分别为87.9%和96.6%。VP1区亲缘进化树显示CVA4-SZ-SK12030005和CVA4-SZ-SK12030007属于GⅠB亚型。结论 GⅠB型CVA4病毒是引起此次深圳市疱疹性咽峡炎疫情的病原体。     

一起疱疹性咽峡炎疫情病原学分析

目的 了解2020年合肥地区一起幼儿园疱疹性咽峡炎(HA)聚集性疫情病原体型别及基因进化情况。方法采用实时荧光定量RT-PCR方法对11份咽拭子标本进行肠道病毒(EV)病原检测,柯萨奇病毒A6型(CVA6)核酸阳性的标本经传统RT-PCR扩增VP1基因,进行序列测定,用MEGA 6.0软件构建基因进化树。结果 11份咽拭子标本中6份CVA6核酸阳性,6条基因序列均为CVA6 D3亚型。结论 CVA6 D3型是引起本次幼儿园HA疫情的病原体,应加强对肠道病毒的监测,重视在幼托机构暴发的此类疫情。     

济南市柯萨奇病毒A组6型手足口病流行病学特征分析

摘要:目的　分析济南市柯萨奇病毒A组6型手足口病（HFMD）的流行病学特征,为该病的诊治与防控提供科学依据。方法　选取2013年济南市临床诊断为HFMD的病例为对象,采集患者发病1周内的粪便、咽拭子等标本,实时荧光定量聚合酶链反应（RT-PCR）方法进行病原学鉴定;对判定为柯萨奇病毒A组6型（CVA6）的手足口病确诊病例,采用描述流行病学方法进行流行病学特征分析。结果　2013年接受病原学检测的HFMD患儿共计848例（包括19例重症病例）,670例检测到肠道病毒（79.01%）。CVA6阳性141例（包括2例重症）,占阳性病例的21.04%（141/670）,在HFMD确诊病例的病原构成中居第3位;其中包括2起暴发、7起聚集性手足口病疫情。141例感染CVA6的HFMD患儿中,男女比例为1.71∶1（89/52）;病例年龄主要集中于3岁以下儿童（73.76%）,尤其是1岁以下患儿（26.95%）,两例重症病例均不到1岁;全市各县（市、区）全年均有发病,流行高峰期集中于7-11月（69.59%）。结论　CVA6是手足口病的重要病原体之一,可引起重症、暴发及聚集性疫情,应加强监测与研究。     

2018年成都市疱疹性咽峡炎聚集性和暴发疫情分析

目的了解成都市疱疹性咽峡炎聚集性和暴发疫情流行特征,为制定科学防控处置方案提供依据。方法收集2018年成都市报告处置的疱疹性咽峡炎聚集性和暴发疫情信息,采用描述性流行病学方法分析疫情三间分布特征。结果 2018年成都市共报告疱疹性咽峡炎聚集性和暴发疫情30起,其中暴发疫情1起,疫情主要发生在托幼机构(96.67%,29/30),累计报告病例148例,临床症状以咽部疱疹(38.01%)、发热(33.03%)为主。病例标本肠道病毒阳性检出率为53.13%,其中其他肠道病毒(EV-A71、CV-A16除外)检出率68.75%,CV-A16检出率31.25%,EV-A71检出率6.25%。结论成都市托幼机构疱疹性咽峡炎聚集性疫情呈高发态势,应制定针对性的科学防控策略,加强托幼机构传染病督导管理,有效防控疫情蔓延。     

2019年北京市某幼儿园1起聚集性发热疫情的病原分子生物学特征分析

目的了解2019年北京市某幼儿园聚集性发热疫情的病原分子生物学特征。方法采集北京市某幼儿园聚集性呼吸道发热疫情的病例咽拭子标本,利用实时荧光定量PCR方法对呼吸道病毒、肠道病毒和呼吸道细菌进行核酸筛检。对肠道病毒筛查阳性的标本利用肠道病毒VP1区特异性引物进行VP1片段扩增和测序,并对测序序列进行BLAST比对和进化关系分析。结果在收集的5例病例标本中,共检测到4例肠道病毒阳性标本,其他呼吸道病毒和呼吸道细菌检测均为阴性。VP1序列BLAST结果显示,4例肠道病毒均为柯萨奇病毒A6型(CVA6)。进化关系分析显示,该病毒与中国云南2018年的1株引起手足口病的CVA6毒株高度同源。结论北京市该起呼吸道聚集性发热疫情是由肠道病毒CVA6型引起。     

某中学1起甲3型流行性感冒暴发疫情调查

摘要:目的　分析某起流感暴发疫情的流行病学特征,探讨暴发原因,为提出防控措施提供科学依据。方法　采用现场流行病学调查方法,采集咽拭子标本开展病毒核酸检测,确定疫情的流行强度和暴发原因。结果　该次疫情持续约20 d,累计发病53例,罹患率为3.84（53/1380）,12例患者咽拭子标本结果为6份甲3型阳性和6份阴性。首发病例及续发病例带病上课、教室无定期通风、同一寝室多班级学生混住和流感疫苗免疫空白是引起本次疫情暴发的主要原因。结论　严格执行晨检和因病缺勤追因制度,及时隔离治疗病人,教室和宿舍定期开窗通风,保持室内空气新鲜,加强对学生洗手宣传,养成良好个人卫生习惯,积极推广流感疫苗的预防接种工作,以上综合措施是学校流感疫情防控的有效对策。     

一起学校甲型流感暴发疫情调查分析

目的分析顺昌县某中学一起甲型流感暴发疫情的流行病学特征,为学校甲型流感暴发防控提供参考。方法依据《流感样病例暴发疫情处置指南》(2018年版),采用其中的"流感样病例调查一览表"和"流感重症和死亡病例个案调查表"对流感样病例开展个案调查,并进行流行病学分析。结果 2019年1月4—17日,某中学共发病40人,罹患率为7.05%;男女比例为1.35∶1;采集的10例病例咽拭子标本,7份标本甲型H3N2流感病毒核酸阳性,2份标本甲型H1N1流感病毒核酸阳性。结论甲型流感传播速度快,尤其在人口密集场所。学校是流感暴发防控的重点场所,疫情报告的及时性对控制疫情的强度起关键作用,今后要加强学校和基层医务人员对流感等呼吸道传染病防控知识的培训。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.