Leptospirosis in Germany, 1962-2003

Epidemiologic trends of human leptospirosis in Germany were investigated by analyzing national surveillance data from 1962 to 2003 and by conducting a questionnaire-based survey from 1997 to 2000. After a steady decrease of leptospirosis incidence from 1962 to 1997, surveillance data indicate an increase in disease incidence to 0.06 per 100,000 (1998-2003). Of 102 laboratory-confirmed cases in humans from 1997 to 2000, 30% were related to occupational exposures. Recreational exposures were reported in 30% (including traveling abroad in 16%), whereas residential exposure accounted for 37% of the cases. Direct contact with animals, mostly rats and dogs, was observed in 31% of the cases. We conclude that recent changes in transmission patterns of leptospirosis, partially caused by an expanding rat population and the resurgence of canine leptospirosis, may facilitate the spread of the disease in temperate countries like Germany. Preventive measures should be adapted to the changing epidemiology of leptospirosis.     

2007-2016年平顶山市布鲁氏菌病流行特征分析

目的 分析平顶山市2007-2016年布鲁氏菌病流行特征,为制定防控策略提供依据。方法 对平顶山市2007-2016年疾病监测报告信息系统报告的布鲁氏菌病病例信息进行描述性流行病学分析。结果 2007-2016年平顶山市共报告布病病例4 911例,年均发病率为10.53/10万,发病率逐年增高,郊县发病水平高于市区。发病呈现春夏季高峰特点,高峰期为3-7月。男性发病率明显高于女性,发病年龄集中在40~69岁。病例职业以农、牧民为主。报告病例中,实验室确诊病例占90%以上,异地报告病例比例和异常信息病例比例呈整体降低趋势,发病到诊断时间间隔逐年缩短,发现水平极大提高。结论 平顶山市布病防控形势依然严峻,应继续实施以传染源控制为主的综合防控措施,并针对重点人群强化健康教育,有效降低发病水平。     

Epidemiology of Diphtheria in Yemen, 2017-2018: Surveillance Data Analysis

BackgroundAs a consequence of war and the collapse of the health system in Yemen, which prevented many people from accessing health facilities to obtain primary health care, vaccination coverage was affected, leading to a deadly diphtheria epidemic at the end of 2017.ObjectiveThis study aimed to describe the epidemiology of diphtheria in Yemen and determine its incidence and case fatality rate.MethodsData were obtained from the diphtheria surveillance program 2017-2018, using case definitions of the World Health Organization. A probable case was defined as a case involving a person having laryngitis, pharyngitis, or tonsillitis and an adherent membrane of the tonsils, pharynx, and/or nose. A confirmed case was defined as a probable case that was laboratory confirmed or linked epidemiologically to a laboratory-confirmed case. Data from the Central Statistical Organization was used to calculate the incidence per 100,000 population. A P value <.05 was considered significant.ResultsA total of 2243 cases were reported during the period between July 2017 and August 2018. About 49% (1090/2243, 48.6%) of the cases were males. About 44% (978/2243, 43.6%) of the cases involved children aged 5 to 15 years. Respiratory tract infection was the predominant symptom (2044/2243, 91.1%), followed by pseudomembrane (1822/2243, 81.2%). Based on the vaccination status, the percentages of partially vaccinated, vaccinated, unvaccinated, and unknown status patients were 6.6% (148/2243), 30.8% (690/2243), 48.6% (10902243), and 14.0% (315/2243), respectively. The overall incidence of diphtheria was 8 per 100,000 population. The highest incidence was among the age group <15 years (11 per 100,000 population), and the lowest incidence was among the age group ≥15 years (5 per 100,000 population). The overall case fatality rate among all age groups was 5%, and it was higher (10%) in the age group <5 years. Five governorates that were difficult to access (Raymah, Abyan, Sa''ada, Lahj, and Al Jawf) had a very high case fatality rate (22%).ConclusionsDiphtheria affected a large number of people in Yemen in 2017-2018. The majority of patients were partially or not vaccinated. Children aged ≤15 years were more affected, with higher fatality among children aged <5 years. Five governorates that were difficult to access had a case fatality rate twice that of the World Health Organization estimate (5%-10%). To control the diphtheria epidemic in Yemen, it is recommended to increase routine vaccination coverage and booster immunizations, increase public health awareness toward diphtheria, and strengthen the surveillance system for early detection and immediate response.     

2006-2015年重庆市流行性乙型脑炎流行特征分析

目的 分析2006-2015年重庆市流行性乙型脑炎的流行特征,为控制乙脑流行提供有针对性和科学性的防治措施。 方法 采用描述性流行病学方法,利用SAS软件进行统计分析。 结果 2006-2015年重庆市共报告乙脑病例1 611例,发病率由2006年的0.72/10万降低到2015年的0.12/10万,发病率年均降低17.67%,年均发病率为0.49/10万;死亡31例,年均死亡率为0.009/10万,年均病死率为1.62%。男性发病率(0.57/10万)显著高于女性(0.40/10万)(P<0.05)。39个区县均有病例报告,发病呈散发,主要分布在大足区(129例,8.00%)、丰都县(123例,7.64%)、开县(114例,7.08%)、垫江县(97例,6.02%)。发病呈明显季节性,发病病例和死亡病例主要集中在7-8月(1 530例,94.97%);发病年龄以1~7岁为主,占73.43%,死亡以1~3岁为主,死亡中位年龄为2岁;职业分布以散居儿童为主,占55.62%。临床诊断病例698例(43.33%),实验室确诊病例913例(56.67%);病例以发热(89.63%),嗜睡(72.32%)等症状为主。病例中有疫苗接种史占18.37%,无疫苗接种史占26.88%,免疫史不详的占54.75%。 结论 重庆市乙脑发病逐年降低,今后应加强流行季节病例监测,在持续常规免疫的基础上,免疫重点应针对发病率相对较高地区的1~5岁散居儿童,同时提高个案调查质量和实验室诊断比例。     

Incidence and occurrence of tick-borne encephalitis and neuroborreliosis in Germany

Given the nationwide distribution of the vector, Ixodes ricinus, both neuroborreliosis and tick-borne encephalitis (TBE) might be expected to occur throughout Germany. However, cases of neuroborreliosis and TBE have so far only been reported in certain German states and counties. The aim of this survey therefore was to investigate the possible occurrence of TBE in regions not designated as known risk areas and the spread and incidence of neuroborreliosis throughout Germany. Data were collected by means of a questionnaire which was sent to 305 neurological clinics in Germany. Only twenty-two of them (7.2%) participated in a prospective, and 52 (17%) in a retrospective survey, therefore the significance of the study is limited. Cases of TBE were detected in five counties (Barnim, Dessau-Roßlau, Western Pomerania-Ruegen, Saarbruecken, Uckermark) that were not known so far as areas of risk according to the definition of the German Robert-Koch-Institute (RKI). The median incidence of TBE in various counties was 1.24 cases with a range from 0.19 to 20 cases per 100,000 inhabitants/year. Illnesses from neuroborreliosis were reported from all 61 counties, where clinics participated in the study. The incidence here varied between 0.19 and 23.4 cases with a median of 3.0 cases per 100,000 inhabitants/year. In areas where both diseases occurred, their incidence differed greatly from each other. The survey shows the occurrence of TBE in several counties in eastern Germany that are not defined as risk areas by the RKI and an incidence of neuroborreliosis in Germany that is significantly higher than reported to the public health authorities.     

Malaria incidence and mortality in Germany 1993-1997

Worldwide incidence of malaria has increased. This may result in an increasing risk for tourists in different areas of the world. Malaria is an important travellers' disease in Germany. Most cases imported to Germany originated from Africa (77%). Plasmodium falciparum caused 67% of all malaria cases. 63% of all cases were Germans, 76% of whom travelled for holidays or study trips. From 1993 to 1996 89 people died from malaria in Germany. Most cases of fatal malaria were reported among German citizens. The case fatality rate increases with age. About 50% of all patients had not undergone sufficient prophylaxis against malaria. Only 22% of the patients who started prophylactic treatment took chemoprophylactics regularly while travelling abroad. Adequate prophylaxis against malaria is the only way to reduce the incidence of imported cases of malaria.     

Regional variation in incidence and case fatality of myocardial infarction among young women in England, Scotland and Wales

OBJECTIVES: To examine the regional variation in incidence and case fatality of myocardial infarction among young women. DESIGN: Cross sectional survey, using population based incidence data. SETTING: England, Scotland and Wales. SUBJECTS: Subjects were women aged 16-44 with a diagnosis of myocardial infarction between 1 October 1993 and 15 October 1995. OUTCOME MEASURES: Incidence of myocardial infarction per 100,000 women years, with case fatality as a percentage of total cases. RESULTS: Incidence of myocardial infarction rose steeply from age 33 upwards, (maximum = 20.2 cases per 100,000 women years at age 44). The adjusted incidence rate for myocardial infarction was 3.7 (95% CI 3.2, 4.2) times greater in Scotland than in southern England. In contrast, case fatality was significantly lower in Scotland: 18.5% (95% CI 13.1%, 25.0%), compared with 31.0% (95% CI 25.9%, 36.0%) in southern England. CONCLUSIONS: The incidence of myocardial infarction varied widely within the United Kingdom. Case fatality variation may reflect differences in ambulance response, or in diagnostic acumen, within the regions.     

Knowledge among German and Turkish women about specifically female bodily functions, contraception, preventative medical examinations and menopause

The legally binding consent of a patient to surgical operations of certain diagnostic measures during hospitalisation is actually guaranteed only in cases where the medical information is oriented to the individual level of understanding of the patient. The real extent of actual knowledge about health relevant aspects is not always known. Immigrant women constitute a large portion of the patients in big German cities. In most clinics the difficulties in communication caused by persistent language barriers are not presently being solved in a satisfactory manner. In light of this situation, it seemed necessary to ascertain the knowledge of German and Turkish women with respect to specifically female bodily functions, contraception, preventative medical examinations and menopause. The study included a total of 320 German and 262 Turkish patients of both gynaecological units at the Virchow Women's Clinic in Berlin during the 1 1/2-year inquiry period (1997/98). The questionnaire we used was laid out in multiple choice format, whereby each question was provided with a list of possible answers (level of significance p < 0.05). Only a small portion of the general female populace (approximately 13% of the study population, 22% of German patients) is well-to-very-well informed about 'specific female bodily functions, anatomy, preventative health care and contraception', and this proportion is even smaller among Turkish female patients (3% of Turkish women surveyed). While the understanding demonstrated by immigrants who possessed strong writing skills in German is nearly as great as that of the German group, the proportion of patients who demonstrated less sophisticated understanding was still twice as high with 32.5% as compared to that of the German group (15%). According to the opinion of approximately one-third of the Turkish immigrants (German women 8.2%) surveyed, there are no (increased) health risks associated with menopause.     

2013-2017年安徽省人间布鲁氏菌病流行病学及临床特征分析

目的　了解安徽省人间布鲁氏菌病的流行状况以及临床特征,为我省制定人间布病防控措施提供科学依据。方法　对2013-2017年安徽省布病病例的流行特征、临床特征及危险因素暴露情况进行描述性分析。结果　安徽省2013-2017年累计报告394例布病病例,无死亡病例,年发病率分别为0.0301/10万（18例）、0.1260/10万（76例）、0.1249/10万（76例）、0.1270/10万（78 例）、0.2357/10万（146例）。发病高峰期是3-8月,病例年龄分布以45-64岁为主,占总病例数的49.2%;职业以农民为主,占总病例数的66.2%。86.8%的病例曾经与动物密切接触,主要动物是羊;有接触史的病例未采取任何防护措施者占86.2%。临床特征以乏力（86.4%）、多汗（78.9%）、关节肌肉疼痛（78.1%）最为常见（%）,出现脾肿大（11.2%）、淋巴结肿大（10.3%）、肝肿大（7.0%）、睾丸肿大（5.0%）症状的病例较少（%）。结论　安徽省布病发病数逐年增加,波及范围逐年扩大,病例以青壮年农民为主。病例主要通过与羊密切接触而感染,感染方式呈现出多元化的特点。建议加强多部门联防联控,提高群众的自我防护意识。     

Epidemiology of dengue/dengue hemorrhagic fever in Malaysia--a retrospective epidemiological study 1973-1987. Part I: Dengue hemorrhagic fever (DHF).

Dengue hemorrhagic fever (DHF), though endemic in the sixties, emerged as a major public health problem in Malaysia from 1973 onwards. The incidence rate of DHF which was 10.1 per 100,000 in 1973 has fallen down to 1.9 per 100,000 in 1987 with a mean case fatality rate of 6.4 per 100 persons. The Chinese appear to be more prone to DHF with the highest mean morbidity rate of 5.5 per 100,000 and case fatality rate of 6.1%. The incidence of DHF is higher in the males with a higher case fatality rate in females. Male Chinese appear to be mainly affected. The overall age-specific incidence rate is highest in two age groups, viz. 5-9 years and 10-19 years of age with a mean morbidity rate of 4.9 cases per 100,000. The mean age-specific case fatality rate was highest in the 0-4 years age group. Dengue hemorrhagic fever is predominantly an urban disease in Malaysia with a mean incidence rate of 5.3 cases per 100,000 as opposed to 1.2 cases per 100,000 being reported from rural areas. The mean overall incidence of deaths in the urban area is 0.5 compared to 0.1 per 100,000 for rural areas. There is a marked seasonal correlation between DHF cases and rainfall, with a peak in August. While all four serotypes of dengue viruses are found in Malaysia, Den 2 appears to be isolated with greater frequency during all the epidemics.     

2008—2018年北海市手足口病流行病学特征分析

目的 分析2008—2018年北海市手足口病流行病学特征,为手足口病防控工作提供科学依据。 方法 选取中国疾病预防控制信息系统2008—2018年北海市手足口病病例,应用描述性流行病学方法对三间分布特征进行分析,同时对部分病例样本进行实验室检测。 结果 2008—2018年北海市共报告手足口病例75 211例,年均发病率431.09/10万;其中手足口重症185例(占0.25%),死亡14例,病死率18.61/10万; 2008—2018年,北海市手足口病实验室共检测手足口病样本2 846份,阳性2 222份(阳性率78.07%)。轻症病例病毒分型以其它肠道病毒通用型为主(占37.18%),而重症病例以肠道病毒71型为主(占90.32%)。发病高峰主要集中在4—6月,9—11月有一个次高峰;海城区报告发病率最高,病例主要集中在1~3岁年龄段的散居儿童。 结论 2008—2018年北海市手足口病的发病率占据该市法定报告传染病的主要位置,该病2-3年为一个流行周期的现象仍将长期存在。防控重点主要是在发病高峰来临前提前介入,加强5岁以下重点人群特别是散居儿童的宣教和防控工作。     

2011-2015年北京海淀区布鲁氏菌病流行病学特征分析

目的 了解北京市海淀区人间布鲁氏菌病(布病)发病情况和特征,分析感染因素,为更好的做好布病防控工作提供科学依据.方法 选取2011-2015年北京市海淀区布病病例25例,监测牛羊养殖等高危人群253人,进行描述流行病学和血清流行病学分析.结果 近几年布病发病有逐渐上升趋势,每年3～6月是发病高峰;全区一半以上的街道乡镇均有病例发生,以散发为主,流动人口聚集地区发病较高;发病集中在50～70岁年龄组,男性多于女性,病例职业以家务及待业、离退人员和干部职员为主;感染途径主要是羊饲养人员,其次为偶尔接触羊和食用羊肉人员.253名高危人群中,抗体阳性14人,阳性率为5.53％.结论 北京市海淀区人间布病感染来源主要是羊,以多且散的点状流行为主.动物疫情防控是关键,应加强动物免疫并及时发现病畜,遏制布病在畜间传播.     

南京市人群原发性心肌病的发病率调查

原发性心肌病(ICM)是一组原因未明的心肌疾病。本病在自然人口中的分布情况,迄今尚不清楚。本文就南京市区60岁以内全部人口于1985~1989年期间发病的ICM逐个进行登记,并参照1980年WHO专家委员会所拟定的ICM命名与分类核实诊断,符合标准者计有275例,5年平均年发病率为2.6/10万,标化率2.1/10万。其中扩张型(IDCM)134例,肥厚型(IHCM) 132例,年均发病率均为1.3/10万,标化率分别为1.1/10万和0.9/10万。各型ICM的发病率随年龄增长而明显增高,20岁以后尤为明显。ICM男性年发病率3.0/10万,女性为2.2/10万。标化率分别为2.3/10万和1.8/10万,男性明显高于女性,尤以IHCM较为显著。5年间ICM的总的发病率有逐年增加趋势,其中IHCM更显著。本文调查结果为国内首次提供了以大范围自然人口为基础的ICM发病率。     

2005-2018年甘肃省庆阳市流行性乙型脑炎流行特征分析

目的 分析庆阳市流行性乙型脑炎（乙脑）的流行特征,为制定乙脑防控策略提供依据。方法 对2005-2018年庆阳市报告的乙脑病例数据进行描述性流行病学分析。结果 2005-2018年庆阳市共报告乙脑病例119例,年均报告发病率0.37/10万（0~3.06/10万）;死亡11例,病死率11.46%。发病覆盖范围逐年扩大,南部县区发病率（5.53/10万）较北部县区（0.63/10万）高。病例集中在7-9月份,8月份最多（63.87%）;病例年龄中位数为59岁（4~84岁）,45岁以上年龄人群发病数最多,占74.79%;职业以农民为主,占88.24%;98.32%的病例无明确的疫苗免疫史。结论 庆阳市乙脑发病率南部县区高于北部县区,主要发病人群为农村居住的中老年人,绝大多数病例无免疫史。应及时调整防控策略,提高成人乙脑疫苗接种率,加强农村地区环境卫生整治和农村居民的健康宣教。     

2006 - 2017年内蒙古锡林郭勒盟人间布鲁氏菌病流行特征分析

目的 了解锡林郭勒盟布鲁氏菌病（简称布病）的流行特征及变化趋势,为布病防控工作提供科学依据。方法 利用2006－2017年“传染病报告信息管理系统”中锡林郭勒盟的布病疫情数据,进行描述流行病学分析。结果 2006 - 2017年锡林郭勒盟共报告布病25 287例,平均发病率为206.47/10万; 2006 - 2009年逐年上升,2009年为发病高峰,从2010年开始逐年下降,年均下降约24%;苏尼特左旗、锡林浩特市和阿巴嘎旗报告病例数较多,分别占14.59%、12.40%和11.07%;发病年龄主要集中在25～54岁年龄组（78.16%）,男女性别比为1.71∶1,牧民报告病例数最多,占70.26%,其次为农民,占15.45%;布病发病高峰期在4 - 8月（占61.18%）,11月 - 次年2月份病例所占比例有增加趋势。结论 锡林郭勒盟布病综合性防控措施取得成效,但防控形势依然严峻。各有关部门应继续加强布病防控,根据疫情特点,采取适宜的布病防控策略。     

2008 - 2017年南京市手足口病流行特征及病原学分析

目的 了解南京市2008 - 2017年手足口病的发病趋势和流行特征,为进一步制定手足口病预防策略和措施提供依据。方法 采用描述性流行病学方法分析手足口病病例和病原的分布特征。结果 2008 - 2017年南京市共报告手足口病157 698例,年均报告发病率为206.61/10万（94.06/10万～305.02/10万）,累计报告死亡病例2例。2008 - 2013年报告发病率呈现升高趋势（t = 3.481,P = 0.025）, 2014年开始,发病率呈现隔年高发的周期性。2008 - 2017年累计报告重症病例2 307例,重症率为1.46%。手足口病发病呈现双峰模式,全年发病有2个高峰:4 - 7月（春夏高峰）和11 - 12月（秋冬高峰）,男性发病率为258.78/10万,女性发病率为187.44/10万。实验室检测病例共计8 373例,病原学分型结果显示,普通病例病原构成中其他肠道病毒占比37.17%,CoxA16占比33.04%,EV71%占比29.78%。重症病例则以EV71病原为主,其次是其他肠道病毒,占比19.46%,CoxA16占比3.97%。结论 南京地区手足口病的流行具有明显的季节、地区、人群分布和病原构成特点,针对重点人群做好疾病防控将有利于手足口病的整体控制。     

Effekte der Masern-Mumps-Röteln (MMR)-Impfung auf die Epidemiologie von Mumps in Deutschland

Mumps is an acute viral infectious disease characterized by fever and swelling and tenderness of one or more salivary glands, usually the parotid gland. Since 1976, the German Standing Committee on Vaccination (STIKO) has recommended a mumps vaccination as part of the routine immunization schedule in former West Germany. In East Germany, the vaccination was only introduced in 1991 after reunification. In the preceding decades, no comprehensive surveillance system existed in Germany. However, for East Germany and the successional federal states of former East Germany, data on mumps incidence are available from different Eastern surveillance systems for the time period 1968–2012. According to these data, the incidence of mumps has dropped from >?200 cases/100,000 annually in the pre-vaccine era to currently <1/100,000. Recently, an age shift has been noted predominantly in the Western federal states. Based on data from school entry examinations and seroprevalence studies, the age shift is likely due to insufficient vaccination coverage and secondary vaccine failure (“waning immunity”). In view of the changes in mumps epidemiology and the increase of outbreaks among adolescents and young adults, the implementation of a nationwide mandatory notification was initiated and came into effect in March 2013. Mandatory notification enables the early detection of outbreaks and obtainment of comprehensive data for evaluation of the immunization program in place. Regarding the long-term prevention of mumps in Germany, it is hoped that—as part of the measles and rubella elimination effort—coverage rates for the second MMR dose among children will increase nationwide above 95% and existing vaccination gaps among adults will be closed.     

Pattern of poisoning in rural Sri Lanka

An epidemiology study of poisoning was done in a geographically defined area in rural Sri Lanka, a developing agricultural country. The incidence of poisoning was 75 per 100,000 population and the death rate was very high (22 per 100,000 population). Both were highest in the age group 15-34 and there were significant ethnic differences in the incidence of poisoning. Agrochemicals were responsible for 59% of all poisonings. Paraquat was the commonest poisoning agent with a high fatality rate of 68%. Use of highly toxic agents may have resulted in deaths where there was no intention to commit suicide. Strict legislation regarding the sale, distribution and storage of agrochemicals could result in the reduction of mortality and perhaps the incidence of poisoning, in developing agricultural countries.     

Legionnaires’ Disease Incidence and Risk Factors,New York,New York,USA, 2002–2011

Incidence of Legionnaires’ disease in the United States is increasing. We reviewed case records to determine the the epidemiology of and risk factors for the 1,449 cases reported to the New York City Department of Health and Mental Hygiene, New York, New York, USA, during 2002–2011. The highest incidence (2.74 cases/100,000 population) occurred in 2009; this incidence was higher than national incidence for that year (1.15 cases/100,000 population). Overall, incidence of Legionnaires’ disease in the city of New York increased 230% from 2002 to 2009 and followed a socioeconomic gradient, with highest incidence occurring in the highest poverty areas. Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires’ disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease.