2009年云南不明原因猝死流行病学和临床特点分析

目的 描述2009年云南不明原因猝死(YSUD)的流行病学和临床特点.方法 采用统一调查表,调查猝死病例的家庭成员、见证人和诊治医生,查阅诊治记录,收集猝死病例流行病学和临床信息.结果 2009年云南省5个县的5个自然村报告7起YSUD事件,共22人受罹,其中猝死16例(72.73%),同发病例6例(27.27%).16例猝死病例分布于7个家庭,家庭聚集性猝死病例14例,占87.50%(14/16).15例(93.75%)发生于既往无YSUD事件报告的村庄.猝死病例分布于7月5例(31.25%),8月11例(68.75%);男性8例,女性8例;中位年龄31岁(10～67岁),其中20～39岁年龄组10例,占62.50%.猝死者死亡中位时间为5 min(3～115 min).5例猝死者死前无任何临床表现,其中倒地而亡3例和睡眠时死亡2例;10例死亡前表现为口唇发绀、胸痛、头晕、心悸、面色苍白、头痛、抽搐、晕厥等,均无发热症状.结论 2009年YSUD事件中,除1例外均发生在过去无猝死报告的村庄,发生季节、聚集性及临床特点与以往YSUD事件情况基本一致.     

云南省116例不明原因猝死回顾性研究

目的了解云南省不明原因猝死流行病学和临床特征.方法选择祥云、鹤庆、南涧和大姚4个县既往不明原因猝死病例作为调查对象.采用统一调查表,调查猝死者家庭成员、见证人和诊治医生,查阅诊治记录,收集病例信息.结果1984-2004年,21个自然村发生116例不明原因猝死;7月和8月病例分别占66%和29%,10～39岁年龄组发生率（1.6/1000）高于其他年龄组（x^2=16,P〈0.01）,女性高于男性（RR=1.6,95%CI：1.1～2.3）;70%为家庭聚集性病例,61%家庭续发猝死发生在首例猝死后的24小时内（中位数20小时）;63%病例死亡前主诉头晕、头昏、恶心、昏迷、晕厥、乏力、心悸等症状,急性发病至死亡时间中位数2小时.结论云南省不明原因猝死有明显的空间和时间聚集性,表明危险因素在特定条件下存在;家庭猝死集中,提示同源暴露;急性发病表现为心源性疾病症状,死亡突然.     

2005年云南不明原因猝死的家庭和村庄聚集性研究

目的 探讨云南不明原因猝死的家庭和村庄聚集性.方法 选择2005年该病的52例监测病例作为研究对象,并采用Poisson分布和β-二项分布拟合病例在家庭中的分布,用Poisson分布和负二项分布拟合病例在村庄中的分布.结果 病例在家庭中的分布服从β-二项分布(x2=0.25,P=0.62),尤其是在人口数较少的家庭,但不服从Poisson分布(x2=46.01,P＜0.001);在村庄中的分布服从负二项分布(X2=0.05,P=0.58),但不服从Poisson分布(X2=110.57,P＜0.001).结论 云南不明原因猝死具有家庭和村庄聚集性.     

济南市2012年托幼机构手足口病聚集性疫情流行病学分析

了解济南市2012年托幼机构手足口病聚集性疫情的流行特征,为有效防控托幼机构手足口病聚集性疫情提供依据.方法 应用描述性流行病学方法,对2012年济南市托幼机构手足口病聚集性病例流行特征、病原分布等资料进行分析.结果 2012年济南市共报告手足口病聚集疫情342起,其中托幼机构疫情214起(包括1起暴发疫情),累计病例734例.市区托幼机构聚集性病例发病率(15.61/10万)显著高于郊县(7.73/10万)(x2=92.823,P<0.01).4月托幼机构聚集病例开始上升,5-6月报告起数达到高峰.病例以3~4岁为主,占托幼机构聚集性疫情病例总数的81.20%.聚集性疫情主要以CoxA16病毒感染为主(56.77%).结论 托幼机构是手足口病聚集性疫情防控的重点场所,5-7月是防控工作的关键时期.     

云南省2002—2004年不明原因心源性猝死事件流行病学和临床特征分析

目的分析2002-2004年云南不明原因心源性猝死事件流行病学和临床特征。方法对2002-2004年所有云南不明原因心源性猝死报告病例进行现场调查,利用描述流行病学方法,总结流行病学、临床调查和实验室检查结果,分析其特点。结果2002-2004年共报告64例死亡病例和18例同发病例,事件分布在12个县的23个自然村。以自然村为单位发病率为1.83%,死亡率为1.51%,病死率为78.1%。91.3%的病区村位于山区和半山区,7-8月的病例数占总病例数的93.94%,15～50岁组的发病者为59.8%,64.63%的病例具有家庭聚集性,89.02%的病例具有村庄聚集性。大多数病例的病程很短,病程在24h内的患者主要症状有恶心、呕吐、头昏、晕厥、乏力、胸痛和气促等。结论病例分布具有高度的时间和空间聚集性;死亡病例主要表现为心源性猝死。     

一起感染性腹泻事件的流行病学调查

目的 了解居民楼腹泻病例增多的原因、传播途径、流行因素,为应对疫情发生提供科学的依据.方法 收集2006年9月16日至29日发生的21例感染性腹泻病例进行流行病学分析.结果 该居民楼感染性腹泻病例家庭聚集性明显,8户家庭有21例腹泻病人,罹患率为61.76%(21/34).其中6个家庭有学龄前儿童,5个家庭的孩子在1～2岁之间,彼此间有一定的接触史.结论 经流行病学调查,居民楼感染性腹泻被初步判定是接触性传播.通过有效的预防控制措施,疫情得到控制.     

1975-2004年云南不明原因心源性猝死回顾性调查

目的 探索云南不明原因心源性猝死的流行病学规律和发病特点.方法 选择曾上报云南不明原因心源性猝死病例的23个县进行云南不明原因心源性猝死病例回顾性调查及病例搜索,以1975-2004年21年中的猝死病例为调查对象,逐级培训调查员,统一调查方法,统一制定及下发调查表格,死者家属、见证人、救治医生、村干部为询问对象. 结果 299例被定为"云南不明原因心源性猝死",其中死亡病例286例(95.65%),同发病例13例(4.35%).死亡病例中有36例(12.04%)为该次回顾性调查中搜索到.该病发病具有明显的家庭和村庄聚集性、明显的季节分布、青壮年多发等流行病学特点及突然发病、突然死亡的发病特点;病区自然村主要分布在2 1002 300 m高海拔地带.结论 云南不明原因心源性猝死是一种新的、尚未被完全认知的一类疾病;可能是由多种病因共存,遭受某种致病因子打击而表现出以"猝死"为主要发病特点的疾病.     

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。     

2009～2018年高密市报告手足口病病例分析

目的了解高密市手足口病的流行病学特征及发病趋势,为制订手足口病的防治策略提供科学依据。方法使用描述流行病学方法对高密市2009～2018年中国疾病预防控制信息系统报告的手足口病病例进行分析。结果 2009～2018年高密市报告手足口病病例7 297例,其中重症病例252例,死亡1例,年均发病率为83.25/10万。发病高峰集中在5～8月(81.60%);报告病例主要发生在人口密集的城区(密水街道、醴泉街道、朝阳街道),占全部病例的52.26%;发病人群主要为5岁及以下儿童(96.21%),男性发病率(103.18/10万)高于女性(63.28/10万)(P0.01)。实验室诊断阳性病例中,EV71型229例(43.61%),Cox A16型158例(30.09%),其他肠道病毒138例(26.29%)。结论高密市手足口病存在发病年龄低、季节性明显、流行毒株不断变化等特征。     

2014年许昌市手足口病流行特征分析

目的分析2014年许昌市手足口病流行病学特征,为制定科学有效的防控措施提供依据。方法运用描述性流行病学方法对2014年手足口病流行病学特征进行分析。结果共报告手足口病病例8 420例,发病率为196.54/10万,为全市法定报告传染病首位,其中重症病例444例,死亡6例;各县(市、区)均有病例报告,3~6月份为发病高峰期,5岁以下散居儿童为主要发病人群,其中1岁年龄组发病率最高,死亡病例均为2岁以下散居儿童;病原学监测结果显示普通病例EV71型占38.25%,CoxA16型占16.73%、其它肠道病毒占45.02%;重症病例EV71型占79.72%,CoxA16型占3.56%,其它肠道病毒占16.73%;聚集性疫情多集中在村庄散居儿童,高发季节局部地区或集体单位尤其是幼托机构存在暴发的可能。结论 2014年许昌市手足口病处于高度流行态势,普通病例以其它肠道病毒感染为主,而重症病例仍以EV71感染为主,应进一步加强防控力度,采取加强监测、健康教育、聚集性疫情应急处置等综合性防控措施。     

Sudden and unexplained deaths in sleep (Laitai) of young men in rural northeastern Thailand.

Sudden and unexplained death in sleep (SUDS) is a significant cause of death of young adults in several Asian populations, but its distribution and incidence are not well known. We conducted a survey by mail of SUDS (known as 'laitai' in the local dialect) that occurred in adults during 1988-1989 in 3867 villages in northeastern Thailand with a total population of 5.42 million. Headmen of 2651 villages (68.6%) returned the questionnaire and sudden deaths of adults 20-49 years old were reported in 396 of these villages. The validity of reports was assessed by interviewing next of kin and witnesses in a sample of 92 villages reporting sudden deaths; 60 of 127 reports of SUDS from these villages were verified (47.2%). Officials and villagers in seven villages that did not respond to the questionnaire were also interviewed and no cases of sudden death were found. The verified SUDS victims were all men wth a mean age of 35.9 years (SD 7.8). A family history of SUDS was reported in 40.3% of index cases and 18.3% had brothers who had died similarly; no such deaths were reported among sisters. The estimated annual rate of death from SUDS among men 20-49 years was 25.9 per 100,000 person years (95% confidence interval (CI): 21.0-30.7). The sudden deaths were seasonal with 38% occurring during March-May and 10% during September-October (chi 2 = 9.45, P = 0.02). Sudden death in sleep is a leading cause of death of young men in rural northeastern Thailand and the characteristics of Thai victims are similar to those of other Asian victims of this unexplained syndrome.     

云南省35个村不明原因猝死发病特征分析

目的 通过调查云南省不明原因猝死发病的主要特征,为探明35个村不明原因猝死的危险因素提供依据.方法 采用1:3配比病例对照研究方法,选择35个发病自然村和105个对照村,调查人口、水源、矿场、周围环境等因素.结果 70.0%的病例自然村年人均收入处于相对贫困线以下,36.7%处于绝对贫困线以下;病例自然村和对照村与乡医院的平均距离为13.6和11.7 km;自然村周围有矿场(OR=4.18,95%CI=1.05～16.64)和与乡医院距离远(OR=1.25,95%CI=1.05～1.49)的地区发生不明原因猝死的危险增加.结论 远离城镇、交通不便、居民生活水平低下、卫生条件差等可能是不明原因猝死发生的背景因素,而与自然村周围的地质环境的关系可能更为密切.     

云南省丽江市历年不明原因心源性猝死病流行因素探讨

目的探讨1998年以来，丽江4个县1个区，10个乡镇，13个自然村，连续发生不明原因的心源性猝死（累计猝死42例）的流行因素。方法通过现场处置，从猝死家庭的亲戚发病中进行心电图检查，并采集所有可疑标本进行化学元素、细菌、病毒、毒物、心肌酶谱的检验。结果该病发病集中发生在6～8月，发病者多发于农民，发病突然，死亡快，临床症状不典型，多发生于青壮年，且女性多于男性，病区多分布在卫生条件差的山区、半山区，生活中粮食较单一，甚至为缺粮户，平时爱饮生水，水源为暴露性沟水，发病村厕所为简易性厕所或无厕户，家养牲畜为牛、猪、狗、鸡、马，居住环境界线不太分明，人畜共用盆、瓢、桶等餐饮工具，有明显的家庭聚集现象和亲源现象。结论经心肌形态学及病原学等方面的研究结果表明，发生在丽江的不明原因猝死病例，是由肠道病毒引起的急性病毒性心肌炎点状爆发流行，同时认为该病大多数病区与克山病病区相重叠，病区处于单一性食物环境，可能是缺乏维生素、硒、锌等化学元素，也可能是接触放射性物质引起的疾病。     

A descriptive epidemiology on sudden death among workers]

A survey on sudden unexpected death, that is, death within 24 hours from acute onset, among Japanese workers was carried out. Questionnaires were sent to full-time occupational health physicians who were active members of the Japan Association of Industrial Health at the time of the survey. Though 241 doctors answered (response rate: 61.5%), only 53 of them who had had both sudden death cases and the desire to join in this research co-operated in this survey. During the 5 years of observation (from Jan. 1, 1986 to Dec. 31, 1990), 143 cases of sudden death, 141 males and 2 females, were reported. The mean age was 46.5 (S. D. 10.5) for males. The ages of the 2 females were 31 and 44. Onset took place most frequently at home (55%) and most often during sleep (26%). This may be due to the higher rate not only of onset but of death resulting from acute onset at home and during sleep. Similar to the previous findings, a small peak of incidence was found early in the morning (4:00 AM--9:00 AM), although this was not statistically significant. However, the weekly and seasonal variations were a little different from previous reports. In this study, sudden death tended to occur more on Monday, Thursday, Friday, and Saturday (not statistically significant), and as for the seasonal variation, more cases occurred in April, November, and December which were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)     

云南不明原因猝死时空分布特征研究

目的掌握云南不明原因猝死时空分布特征,为病因研究提供线索。方法使用1975—2008年回顾性调查和监测报告的375例云南不明原因猝死病例,描述其时间分布特征;制作猝死自然村空间分布图、采用一阶邻近系数等空间分析方法和技术来分析病例的空间分布特征;用K-均值聚类方法将发生猝死的自然村聚成几类发病区域,分析不同区域的时间分布特征。结果云南不明原因猝死病例分布在97个自然村;猝死自然村分布在云南省中部和西北部,在空间分布上呈现聚集性特征（一阶最邻近系数为0．489,P〈0．001）;97．0％的猝死发生于6～9月,猝死日期中位数为7月22日,在7月和8月各出现一个高峰;按空间位置可将猝死自然村聚为4类病区,用A、B、C、D表示,以鹤庆和宁蒗为代表的B类病区发病日期中位数为7月30日,比其他病区发病日期中位数7月19日迟11天。结论云南不明原因猝死具有时间特异性和空间特异性,主要在6～9月份集中发生在云南省中部和西北部区域的山区和半山区,不同区域发病时间不完全一致。     

Changing patterns of infant death over the last 100 years: autopsy experience from a specialist children's hospital

Objectives

Infant mortality has undergone a dramatic reduction in the UK over the past century because of improvements in public health policy and medical advances. Postmortem examinations have been performed at Great Ormond Street Hospital for over 100 years, and analysis of cases across this period has been performed to assess changing patterns of infant deaths undergoing autopsy.

Design

Autopsy reports from 1909 and 2009 were examined. Age, major pathology and cause of death was reviewed from these cases and entered into an anonymized database. A subsequent comparative analysis was performed.

Setting

All postmortems performed and reported at Great Ormond Street Hospital in 1909 and 2009.

Participants

Infant deaths, aged 0–365 days, were identified and subsequently analysed for the two years.

Main outcome measures

Comparative proportional analysis of postmortem findings from the two time periods.

Results

Three-hundred and fifty-seven and 347 autopsy reports were identified from 1909 and 2009 including 178 and 128 infant deaths, respectively. The commonest cause of death in 1909 was infection (74%) compared to 20% of deaths in 2009. The most frequent final ‘diagnosis’ in 2009 was ‘unexplained sudden unexpected infant death (SUDI)’, despite a full postmortem including ancillary investigations. In contrast, there were no such cases recorded in 1909, but there were frequent deaths due to gastroenteritis and malnutrition together accounting for 16% of cases, compared to one case of gastroenteritis in 2009. Fifteen percent of 1909 cases had infections which are almost never fatal with appropriate treatment in 2009, including tuberculosis, diphtheria and syphilis. Congenital anomalies were detected with similar frequencies at both time points, (21% and 19% in 1909 and 2009, respectively).

Conclusion

In the UK, significant changes in patterns of pathology have occurred in paediatric autopsy cases performed at a single specialist centre. Fatal infections and malnutrition (both poverty-related) have reduced yet the incidence of congenital anomalies has remained similar.