浙江省肾综合征出血热疫苗效果免疫(感染)增强和免疫策略研究

目的 :观察肾综合征出血热 (HFRS)乳鼠脑纯化Ⅰ型灭活疫苗在浙江省HFRS高发疫区大面积人群接种后的安全性 ,考核血清学及近期、中期流行病学效果。方法 :采用间接免疫荧光法 (IFAT)检测特异性IgG抗体 ,用微量细胞病变中和试验 (MCPENT)检测中和抗体滴度。结果 :共接种 10 4 6 0人 ,全程接种者占 97.30 % ,对照 16 159人。全程接种后两周进行血清学观察 ,荧光抗体阳转率为 10 0 .0 0 % (6 7/ 6 7) ,中和抗体阳转率为 4 4 .4 4 % ,几何平均滴度分别为 72 .12和 4 .6 2。1年后加强免前、免后两周和免后 1年 ,荧光抗体阳性率分别为 2 8.57%、83.33%、75.0 0 % ;中和抗体阳性率分别为 14.80 %、55.56 %、35.0 0 %。疫苗近期 (基础免疫后 1年 )和中期 (基础免疫后 2年 )流行病学防病效果良好 ,人群保护率达 10 0 %。目前未发现接种人群中有免疫 (感染 )增强问题。结论 :HFRS疫苗近期和中期流行病学防病效果明显 ,取得良好的经济和社会效益     

浙江省肾综合征出血热疫苗接种现场人群免疫后10年效果评估

目的 连续观察和评价肾综合征出血热疫苗免疫接种人群10年后的流行病学和血清学效果.方法 在浙江省龙游县以村为单位,16～60岁健康者按接种和对照各半的原则随机分组.采用间接免疫荧光法检测特异性IgG荧光抗体,用微量细胞病变中和试验测中和抗体,以抗体滴度评价血清学免疫效果和用疫苗保护率评价防病效果.结果 接种前血清抗体阴性者全程接种后2周荧光抗体阳转率为100%(67/67),95%CI:96.3%～100%,中和抗体阳转率为44.4%(8/18),95%CI:22.0%～69.0%,几何平均滴度分别为72.1和4.6.1年后进行加强免疫,加强免疫前、免疫后2周,加强免疫后1、1.5、2、3和5年,荧光抗体阳性率分别为28.6%、83.3%、75.0%、53.1%、22.6%、10.0%、55.0%;中和抗体阳性率分别为14.8%、55.6%、35.0%、31.3%、26.0%、10.0%、50.0%.基础免疫后10年,荧光抗体阳性率下降到7.1%.但是现场流行病学保护效果很好,人群保护率达100%.结论 肾综合征出血热疫苗长期免疫效果良好,流行病学防病效果明显,经济和社会效益显著.     

肾综合征出血热灭活疫苗免疫效果观察

目的　观察肾综合征出血热 (HFRS)灭活疫苗在黑线姬鼠型为主的混合型疫区使用的安全性、血清学及流行病学效果。方法　 1994年 7月至 2 0 0 0年 7月在HFRS高发区　浙江省建德市采用HFRS (Ⅰ型 )灭活疫苗免疫接种 ,逐年测定抗体和观察发病情况。结果　疫苗基础免疫后抗体阳转率为 5 0 % ,1年后抗体阳转率和平均滴度均明显下降 ;5年后未能检出中和抗体 ,荧光抗体阳性率为 10 %。免疫后 7年内未发现病例 ,与对照组比较 ,保护率为 82 49%。结论　HFRS (Ⅰ型 )灭活疫苗具有良好的免疫效果和现场流行病学保护作用。     

肾综合征出血热疫苗免疫后血清学监测

目的 监测肾综合征出血热(HFRS)疫苗免疫接种人群血清抗体水平变化并评价疫苗血清学效果。方法 以村为单位,16～60岁健康者(删除既往患HFRS者、外出>9个月及疫苗禁忌症者)为观察对象,按接种和对照各半的原则随机分组,接种组共10 460人,对照组16 159人。采用间接免疫荧光法测特异性IgG荧光抗体,用微量细胞病变中和试验测中和抗体。结果 接种前血清抗体阴性者全程接种后2周荧光抗体阳转率为100.0％(67/67,95％CI:96.3～100.0),中和抗体阳转率为44 4％(8/18,95％CI:22.0～69.0),几何平均滴度分别为72.1和4.6。1年后进行加强免疫,加强免疫前、免疫后2周,免疫后1年、1.5年、2年、3年和5年,荧光抗体阳性率分别为28.6％、83.3％、75.0％、53.1％、22.6％、10.0％、55.0％;中和抗体阳性率分别为14.8％、55.6％、35.0％、31.3％、26.0％、10.0％、50.0％。免疫(感染)增强反应需要进一步研究。结论 HFRS疫苗免疫效果良好,血清抗体持续时间较长。     

肾综合征出血热地鼠肾细胞Ⅱ型灭活疫苗的安全性、免疫性及其流行病学效果考核

目的：考核HFRS地鼠肾细胞Ⅱ型灭活疫苗的安全性、免疫法及其流行病学效果。方法：采用间接免疫荧光抗体试验（IFA）、微量细胞变性中和试验（MCPENT），检测接种者血中荧光抗体及中和抗体水平；调查接种组与对照组发病情况。结果：以怀宁、广德两县18个村为疫苗观察现场，接种组7499人，对照组7261人，中强反应率为224％（5／223）。3针全程免疫后中和抗体阳转率为63．33％（19／30），荧光抗体阳转率为38.58％（27／70）；接种后1年内接种组无发病，对照组发病3例。结论：该疫苗的安全性较好；有一定水平的免疫应答，但防病效果应进一步观察确证。     

肾综合征出血热疫苗免疫效果和免疫策略研究

目的 现场验证HFRS-I型鼠脑纯化疫苗的安全性、血清免疫学与防病效果。方法 按随机整群分接种组，全程接种9012人和对照组16203人。采用0、7、28d及免后1年加强一针的免疫程序；分别采集免前、全程接种后2周，加强前、加强后两周、加强后1、2、3、4、5年的部分接种全血和微量耳血，分别测定中和抗体和IFA抗体。结果经1995年8月-2000年12月的5年间现场验证表明：HFRS-1型鼠脑灭活纯化疫苗除了因疫苗中残留蔗糖导致较重，较普遍的局部反应外，未发现其他严重的副反应，证明该疫苗有较好安全性，从血清免疫效果看。86例全程接种后两周的免疫血清，IFA抗体阳转率达100%，中和抗体阳转率为44.44%，1年后，IFA抗体和中和抗体阳性率分别下降到28.57%和14.80%。但加强后两周的血清IFA抗体和中和抗体阳性率分别反弹至83.33%和55.56%，其抗体几何平均滴度（GMT）也随之回升，但不十分明显，此外，在加强后2年IFA和中和抗体阳性率再次下降到较低水平，分别为22.5%和26.0%，到加强后4年，其中和抗体几乎全部转阴，但IFA抗体仍保持较高的阳性率。在接种组人群中除1例因接种2针，1例虽接种3针，未按规定程序接种而发病外，至今未发生其他病例，而对照组人群中已发病26例，其5例平均保护率达94.01%。结论 现场观察结果证明该疫苗具有安全性好，血清免疫学效果维持时间较长，现场防病效果可靠，对疫苗接种人群至少可保护5年以上，该疫苗值得在广大疫区推广应用。     

肾综合征出血热疫苗血清流行病学研究

目的 观察肾综合征出血热乳鼠脑纯化Ⅰ型灭活疫苗在浙江省肾综合征出血热高发疫区大面积人群接种后的安全性,考核血清学和中期流行病学效果。方法 采用ＩＦＡＴ法测特异性ＩｇＧ抗体,用ＭＣＰＥＮＴ法测中和抗体滴度。结果 共接种１０４６０人,全程接种者占９７．３０％,对照１６１５９人。全程接种后２周进行血清学观察,荧光抗体阳率为１００．００％（６７／６７）,中和抗体阳转率为４４．４４％,几何平均滴度分别为７２     

西安市出血热高发乡镇双价HFRS灭活疫苗普种后防控效果评价

目的优化免疫针次,提高疫苗接种率,观察双价出血热肾病综合征(HFRS)沙鼠肾细胞灭活疫苗对姬鼠型疫区防病效果,为制定西安市出血热防治对策提供依据。方法选择流行性出血热(EHF)发病率大于15/10万以上乡镇高危人群进行普种,年龄16~60岁。在其他因素不变的情况下,观察接种率、疫苗干预前后EHF发病率。对疫苗接种率、抗体阳转率进行检测,观察接种反应。结果EHF高发乡镇疫苗接种率提高了38.92%,优化免疫针次前后疫苗接种率有明显差异。高发乡镇EHF发病率下降了58.60%,疫苗干预前后EHF发病率有明显差异。高发乡镇疫苗接种率为85.25%。加强后14 d疫苗抗体阳转率为83.10%,接种双价疫苗人群无一例发病,疫苗的安全性良好。结论双价HFRS沙鼠肾细胞灭活疫苗接种率有大幅度提高,防治EHF有明显效果,应在其他乡镇推广接种。     

流行性出血热双价灭活疫苗的安全性和免疫原性观察

目的　观察流行性出血热 (EHF)沙鼠肾细胞双价灭活疫苗的安全性和免疫原性。方法　以高发疫区现场青壮年为对象 ,基础免疫 3针 ,一年后加强 1针。采用间接免疫荧光试验、微量细胞病变中和试验检测接种后荧光抗体和中和抗体 ,重点观察部分接种者免疫后 72h内的全身体温反应和局部副反应。结果　基础免疫后 2周 ,荧光抗体阳转率及几何平均滴度 (GMT)分别为99 .0 4%、2 4.5 1± 2 .0 6 ;中和抗体阳转率及平均滴度对 76 118(Ⅰ型 )为 91.30 %、18.2 7± 2 .2 1,对UR(Ⅱ型 )为 88.41%、12 .47± 2 .16。基础免疫后 1年 ,荧光抗体阳转率下降为 37.34% ,中和抗体总阳转率近 80 %。加强后 2周 ,荧光抗体和中和抗体阳转率均为 10 0 % ,中和抗体滴度对Ⅰ型为 37.0 9±2 .2 4,对Ⅱ型为 32 .6 1± 2 .0 5。接种后全身体温反应发生率为 0 .46 % ,局部反应发生率为 1.98% ,未见严重副反应发生。结论　流行性出血热双价灭活疫苗近期免疫效果良好 ,接种副反应率低     

陕西省肾综合征出血热疫苗免疫效果及免疫策略研究

本研究报告了肾综合征出血热（Ⅰ型）鼠脑纯化灭活疫苗及沙鼠肾组织培养灭活疫苗在陕西省高发病乡、高发人群的免疫效果。鼠脑疫苗全程接种后２周，血清中和抗体阳转率７８．５７％，几何平均滴度９．３８，接种组发病１例，发病率８．１７／１０万；对照组发病２４例，发病率１６７．９７／１０万，保护率９５．１３％，效果指数２０．５６。沙鼠肾疫苗接种后血清中和抗体阳转率７３．０８％，几何平均滴度１３．３９，接种组发病１例，发病率为６．０２／１０万；对照组发病６６例，发病率３４０．７３／１０万，保护率９８．２３％，效果指数５６．６０。两种疫苗接种反应轻微或无反应，无异常反应，表明疫苗安全性好，近期免疫防病效果好。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

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.