淮安市艾滋病异性性传播方式及分子流行病学研究

目的了解淮安市经异性性传播感染的HIV/AIDS人群的性传播构成方式以及病毒亚型分布情况。方法对艾滋病病例报告系统中,现住址为淮安市的经异性性传播病例进行面对面问卷调查,内容包括社会人口学特征和高危行为史。从经异性性传播感染的HIV/AIDS病例血液中提取DNA或RNA,用巢式PCR或RT-PCR方法扩增gag、env基因区片段,测定序列并分析。结果共调查HIV/AIDS病例166例,经商业异性性传播者占38.0%,经婚内或者固定性伴侣性传播者占40.4%,经非婚非商业异性性传播者占21.7%。结合gag和env 2个基因片段,最终确定了103分样本的基因亚型,发现有6种HIV-1亚型和重组型,其中,CRF01_AE占52.4%、CRF07_BC占20.4%、CRF08_BC占11.7%、B'(泰国B)占9.7%、B(欧美B)占3.9%、CRF55_01B占1.9%。结论淮安市HIV经异性性传播方式以经婚内或固定性伴传播为主;感染HIV-1流行株较为复杂,存在6种亚型和重组型,其中CRF01_AE重组型是主要流行株。     

Measles outbreak associated with an imported case in an infant--Alabama, 2002

Local transmission of measles is rare in the United States. Since 1997, the majority of measles outbreaks have been caused by imported cases. During October 19-November 15, 2002, an outbreak of 13 confirmed cases of measles occurred, with exposure in Alabama; 11 cases were among day care attendees who had not yet been vaccinated for measles. This was the largest outbreak of measles in the United States since 1999. In response to this outbreak, the Alabama Department of Public Health (ADPH) and CDC conducted an epidemiologic investigation that determined the outbreak was initiated by an imported case in an infant aged 9 months who had returned recently from the Philippines. Health-care providers should continue to include measles in differential diagnoses for febrile rash illnesses in infants, particularly those with recent travel to areas where measles is endemic.     

A multi-state outbreak of Salmonella Saintpaul in Australia associated with cantaloupe consumption

A multi-state outbreak of Salmonella enterica serovar Saintpaul infection occurred in Australia during October 2006. A case-control study conducted in three affected jurisdictions, New South Wales, Victoria and Australian Capital Territory, included 36 cases with the outbreak-specific strain of S. Saintpaul identified by multiple locus variable-number tandem repeat analysis (MLVA) in a faecal specimen and 106 controls. Consumption of cantaloupe (rockmelon) was strongly associated with illness (adjusted OR 23.9 95%, 95% CI 5.1-112.4). S. Saintpaul, with the outbreak MLVA profile, was detected on the skin of two cantaloupes obtained from an implicated retailer. Trace-back investigations did not identify the specific source of the outbreak strain of S. Saintpaul, but multiple Salmonella spp. were detected in environmental samples from farms and packing plants investigated during the trace-back operation. Cantaloupe production and processing practices pose a potential public health threat requiring regulatory and community educational interventions.     

Legionnaires' disease outbreak associated with a cruise liner, August 2003: epidemiological and microbiological findings

Eight cases of Legionnaires' disease were identified among the 215 German passengers after a cruise to the Nordic Sea in August 2003. An unmatched case-control study was conducted to identify risk factors and the source of infection. In total, eight passengers fulfilled the case definition, one of these died. Forty-two passengers served as controls. The attack rate was 4%. The mean age was 60 years for cases and 62 years for controls. Prolonged exposure to the spa pool seemed to be a risk factor of infection (OR 4.85, P=0.09). Legionella pneumophila serogroup 1, monoclonal antibody (mAb) subgroup 'Knoxville' was isolated from clinical and environmental samples. DNA sequence-based typing revealed that these isolates were indistinguishable from each other. The investigation showed the importance of an interdisciplinary approach of microbiology and epidemiology as not all sites on the ship that tested positive for L. pneumophila actually posed a relevant risk for the passengers.     

Housing conditions associated with recurrent gastrointestinal infection in urban Aboriginal children in NSW,Australia: findings from SEARCH

Objective : To examine the associations between housing and gastrointestinal infection in Aboriginal children in urban New South Wales. Methods: A total of 1,398 Aboriginal children were recruited through four Aboriginal Community Controlled Health Services. Multilevel regression modelling of survey data estimated associations between housing conditions and recurrent gastrointestinal infection, adjusting for sociodemographic and health factors. Results: Of the sample, 157 children (11%) had recurrent gastrointestinal infection ever and 37 (2.7%) required treatment for recurrent gastrointestinal infection in the past month. Children in homes with 3+ housing problems were 2.51 (95% CrI 1.10, 2.49) times as likely to have recurrent gastrointestinal infection ever and 6.79 (95% CrI 2.11, 30.17) times as likely to have received recent treatment for it (versus 0–2 problems). For every additional housing problem, the prevalence of recurrent gastrointestinal infection ever increased by a factor of 1.28 (95% CrI 1.14, 1.47) and the prevalence of receiving treatment for gastrointestinal infection in the past month increased by a factor of 1.64 (95% CrI 1.20, 2.48). Conclusions: Housing problems were independently associated with recurrent gastrointestinal infection in a dose‐dependent manner. Implications for public health: The role of housing as a potential determinant of health in urban Aboriginal children merits further attention in research and policy settings.     

云南中缅边境一起输入性登革热暴发的分子流行病学研究

目的调查云南中缅边境一起输入性登革热流行状况及其流行病毒株的分子流行病学特点。方法采集医院就诊和口岸入境人员中登革热、疑似登革热和不明原因发热患者血清标本并进行流行病学调查,采用ELISA检测登革病毒IgM抗体,RT-PCR检测登革病毒核酸,核酸阳性标本进行登革病毒PrM．C和NS,区的基因核苷酸序列测定和分析。结果2008年7—11月在云南省瑞丽市共采集急性期患者血清标本103份,经登革病毒IgM抗体和核酸检测,49例确诊为登革热。其中除1例为当地感染病例,其余48例均为输入性病例,其中18例来自缅甸木姐市居民,30例为中国居民到缅甸经商或务工返回后发病者。从缅甸输入病例血清中获得2株病毒(RLB61和RLC31)的PrM．C和NS,区基因核苷酸序列,同源性和系统进化分析表明,RLB61株为登革l型病毒,RLC31株为登革3型病毒,与东南亚登革病毒流行株具有较近的亲缘关系。结论经血清学和分子流行病学证实瑞丽市边境地区发生输入性登革热暴发,并间接证实缅甸木姐市2008年存在登革l和3型病毒流行。     

Clinical and epidemiological observations on an outbreak of plague in Nepal

In the autumn of 1967, plague broke out among hill people in western Nepal, a country that had not previously reported human plague. Two persons were infected from an active sylvatic focus at a grazing area 5 km from Nawra, the village where the epidemic occurred. The second patient introduced plague into the village where the rest of the cases occurred. Clinical and epidemiological evidence suggests that plague was spread both by the airborne route, resulting in 6 cases of tonsillar plague and 1 case of primary pneumonic plague, as well as by infected fleas, resulting in 17 cases of bubonic plague. Since no evidence of a rodent epizootic was uncovered in the village itself, and because of the distinct clustering of the bubonic cases, human-to-human spread of plague by infected ectoparasite vectors, presumably Pulex irritans, is thought to have occurred.     

Incidence and molecular analysis of Vibrio cholerae associated with cholera outbreak subsequent to the super cyclone in Orissa,India

An epidemiological study was carried out to find out the aetiological agent for diarrhoeal disorders in the cyclone and flood affected areas of Orissa, India. Rectal swabs collected from 107 hospitalized diarrhoea patients were bacteriologically analysed to isolate and identify the various enteropathogens. Detection of toxic genes among E. coli and V. cholerae was carried out by polymerase chain reaction (PCR) assay. Of the 107 rectal swabs analysed, 72.3% were positive for V. cholerae O1 Ogawa, 7.2% for V. cholerae O139, 1.2% for E. coli (EAggEC) and 1.2% for Shigella flexneri type 6. Using multiplex PCR assay it was found that all V. cholerae isolates were ctxA positive and El Tor biotype. Strains of V. cholerae O1 were observed to be resistant to nalidixic acid, furazolidone, streptomycin, co-trimoxazole and ampicillin. Except for nalidixic acid, the resistance pattern for O139 was identical to that of O1 strains. Representative strains of V. cholerae were further characterized by randomly amplified polymorphic DNA (RAPD) analysis and ribotyping. Both O1 and O139 V. cholerae strains exhibited the R3 pattern of ribotype and belonged to a similar pattern of RAPD compared with that of Calcutta strains. Early bacteriological and epidemiological investigations have revealed the dominance of V. cholerae O1 among the hospitalized patients in cyclone affected areas of Orissa. Drinking water scarcity and poor sanitation were thought to be responsible for these diarrhoeal outbreaks. Timely reporting and implementation of appropriate control measures could contain a vital epidemic in this area.     

Aftermath of stroke: an epidemiological study in Melbourne, Australia.

A population-based study of the incidence of stroke was carried out in an urban area of Melbourne, Australia. The 508 cases were followed up and the survivors interviewed briefly at three months and in more depth six months after the onset of stroke. Fifty-eight per cent of all subjects had survived to six months, and the strongest prognostic indicator was level of consciousness at time of maximum impairment. By six months, 25% of all cases were independent in self-care and mobile outside the home; of those patients aged under 75 years, suffering a first stroke and retaining full consciousness at the time of maximum impairment, the proportion was 50%. A very imperfect correlation was present between residual physical impairment and return to the full range of prestroke activities.     

A Salmonella Typhimurium 197 outbreak linked to the consumption of lambs' liver in Sydney, NSW

We identified an increase in the number of cases of Salmonella Typhimurium phage type 197 in New South Wales in February 2005. Cases were predominantly of Lebanese descent. To identify risk factors for illness, we conducted an unmatched case-control study including 12 cases and 21 controls. Eight of 12 cases (67%) and no controls reported eating lambs' liver (OR incalculable, P<0.05), and seven of nine cases (78%) and one of 21 controls (5%) reported eating fresh fish (OR 70.0, P<0.05). Among participants who did not eat liver, there was a strong association between eating fish and illness (OR 60.0, P<0.05). The fish was from divergent sources. Five cases had bought the liver from two different butcher's shops, which obtained the lambs' liver from a single abattoir. Consumption of liver is a risk for salmonellosis. Traditional dishes may place some ethnic groups at increased risk of foodborne disease.     

萍乡市一起咽结膜热暴发疫情调查报告

目的分析萍乡市一起咽结膜热暴发的流行特征和病因,为今后此类传染病防控提供参考。方法制定病例定义进行病例搜索,对所有病例进行个案调查,对游泳馆进行现场卫生学调查,对患者咽拭子标本和游泳池水进行实验室检测。结果本起疫情累计病例84例,发病高峰在8月1～5日;年龄以5～13岁最多,占总病例数的77.38%。患者发病前均有游泳史,临床表现主要为发热伴咽痛、扁桃体红肿、眼结膜充血等。8份现症病人咽拭子标本经Real-time PCR方法检测,确定为腺病毒感染。结论本起咽结膜热暴发疫情的病原体为腺病毒,暴发可能是通过被污染的游泳池水造成传播。     

Clinical and epidemiological aspects of an enterovirus outbreak in a neonatal unit

An outbreak of enterovirus infection occurred among neonates in a maternity hospital between July 7 and 22, 1999. Twenty neonates became ill (18 confirmed and two probable), an attack rate of 33%. The incubation period ranged from three to six days (mean, 4.2). The male:female ratio was 11:9 and the mean age at the onset of illness was 5.5 days. All the babies had fever, eight, a maculopapular rash, and six had symptoms of gastroenteritis, 11 developed meningitis. Nineteen neonates required hospitalization for three to seven days, but all were discharged home without sequelae. Enteroviral RNA was detected in all of 18 urines, and 14 cerebrospinal fluid specimens tested. A case-control study was conducted to determine risk factors associated with the outbreak. Rooming in the nursery ward was a significant risk factor (odds ratio=33.35; 95% confidence interval, 3.79-800; P=0.00002). No association was found between illness and other possible risk factors. Appropriate control measures resulted in resolution of the outbreak. Our findings demonstrate the potential for enteroviruses to cause widespread illness among newborns, and emphasize the usefulness of polymerase chain reaction in the early diagnosis of infection, and underline the role of effective control measures in interrupting viral transmission.     

Trace Metal Concentrations in Sediments and Oysters of Botany Bay,NSW, Australia

Surfical sediment (< 63 µm) trace metal concentrations (Zn, Cu, Pd, Cd, As) were analyzed from seven sites in Botany Bay, NSW, Australia, to assess the extent of contamination from the surrounding urban areas. The northwest shoreline of Botany Bay contained high surfical sediment trace metal concentrations relative to the southern shoreline. Surfical sediment Pb concentrations (10–120 µg/g) were above the current ANZECC/ARMCANZ interim sediment guideline value (50 µg/g) for the protection of benthic ecosystems at the northwest sites. Cooks River was identified as a major source of trace metals. Oysters grown in Botany Bay have greater Zn, Cu, and Cd concentrations than two relatively pristine reference locations, Jervis Bay and Batemans Bay, indicating that the Botany Bay region has elevated biologically available metal concentrations. Oyster tissue trace metal concentrations were below the Australian and New Zealand Food Authority standards. Translocation of oysters to sites around the bay identified Pb and Cd as the only trace metals to be accumulated over 3 months. Copper concentrations in transplanted oysters declined at most sites, indicating that the sites investigated in this study have less bioavailable copper than Woolooware Bay, the source of the oysters. The shallow waters along the southern shoreline are protected from the tidal flow that carry contaminated sediments and the biologically available trace metals appear to be low.Received: 31 May 2002/Accepted: 13 December 2002     

Giardiasis in NSW: Identification of Giardia duodenalis assemblages contributing to human and cattle cases,and an epidemiological assessment of sporadic human giardiasis

Two genetic assemblages (A and B) of the protozoan parasite species, Giardia duodenalis, infect humans, domestic animals and wildlife. In New South Wales, Australia, over 2000 sporadic human giardiasis cases are reported annually, but parasite sources and links between sporadic cases are unknown. This study describes G. duodenalis assemblages contributing to human and cattle cases in NSW, and examines demographic, spatial, and temporal distributions of NSW human infections and G. duodenalis assemblages. Genotyping by PCR-restriction fragment length polymorphism of the glutamate dehydrogenase (gdh) gene identified G. duodenalis assemblage B as the most common (86%) cause of infection among human cases (n = 165). Approximately 37% of cattle DNA samples were PCR positive (18S rRNA, gdh), and G. duodenalis assemblages E (69%) or B (31%) were identified from these samples. Human assemblage A was more common among older age groups, and seasonality in the geographic dispersal of human assemblage A was observed. The results of this study indicate G. duodenalis assemblage B is highly prevalent among humans in NSW, and the potential for cross-species transmission exists between humans and cattle in this region. Spatio-temporal and demographic distributions of human assemblage A and B are highlighted, and risk factors associated with these dispersal patterns warrants further research.     

Using machine learning tools to investigate factors associated with trends in ‘no-shows’ in outpatient appointments

Missed appointments are estimated to cost the UK National Health Service (NHS) approximately £1 billion annually. Research that leads to a fuller understanding of the types of factors influencing spatial and temporal patterns of these so-called “Did-Not-Attends” (DNAs) is therefore timely. This research articulates the results of a study that uses machine learning approaches to investigate whether these factors are consistent across a range of medical specialities. A predictive model was used to determine the risk-increasing and risk-mitigating factors associated with missing appointments, which were then used to assign a risk score to patients on an appointment-by-appointment basis for each speciality. Results show that the best predictors of DNAs include the patient's age, appointment history, and the deprivation rank of their area of residence. Findings have been analysed at both a geographical and medical speciality level, and the factors associated with DNAs have been shown to differ in terms of both importance and association. This research has demonstrated how machine learning techniques have real value in informing future intervention policies related to DNAs that can help reduce the burden on the NHS and improve patient care and well-being.     

A community outbreak of tuberculosis in Southern Austria: lessons learned for a targeted use of molecular epidemiological methods and tuberculin skin testing

A cluster of 10 cases of tuberculosis disease (one of them extrapulmonary) occurred from July 2001 until November 2003 in a health district in Southern Austria. Eight patients were culture confirmed and shared an identical strain. One of these eight cases was identified as outbreak-related by molecular strain typing only. Due to public pressure, a further 600 persons received chest X-ray and clinical examinations. Apart from one case which could be excluded from the outbreak because of a different strain pattern, no outbreak-related case of active tuberculosis was detected by this non-targeted procedure. Tuberculin skin testing, not part of the Austrian routine protocol of contact investigation in adults, was initiated after diagnosis of case 8. Forty-nine latently infected contacts were detected. Population-based genotyping of all isolates, prioritization of contact investigations and early use of targeted tuberculin skin testing are critical for effective tuberculosis control in low-incidence countries.     

Clinical and epidemiological features of an outbreak of influenza in Ulan Bator in 1971

In October and November 1971 an outbreak of influenza (type A virus) occurred in the town of Ulan Bator. A clinical and epidemiological investigation showed that some 30% of the population presented typical signs of influenza of medium severity. The etiology of the outbreak was confirmed by virological, serological, and fluorescent-antibody techniques. A detailed study of the antigenic structure of the virus isolated in the Mongolian People''s Republic, A/Mongolia/013/71, showed that it belonged to a new antigenic variety of the Hong Kong strain, A/Hong Kong/107/71 (H3N2).