Cryptococcus gattii infections in China: extent of the problem?

Approximately 70 species are accepted in the genus Cryptococcus;1 however,only two species,Cryptococcus neoformans (C.neoformans,serotypes A,AD and D) and C.gattii (serotypes B and C) are responsible for almost all human cryptococcal infections,2,3 and resulted in over 1 million new cases of cryptococcosis in the world each year with over 600 000casualties.4 It is generally assumed that cryptococcal infections are acquired by inhalation of fungal spores,desiccated cells,or poorly encapsulated yeasts from environmental niches,such as decayed wood debris of certain tree species or bird droppings.5 Epidemiological surveys have shown that C neoformans caused about 80％ of cryptococcosis cases globally each year,particularly in immunocompromised persons,such as human immunodeficiency virus (HIV)-infected people and acquired immunodeficiency syndrome (AIDS) patients,2,3 while C.gattii primarily infects apparently immunocompetent hosts,and is mainly responsible for the remaining cases of cryptococcosis.6,7     

HIV and syphilis infections among street-based female sex workers in China, 2010–2012

Background Female sex workers （FSW） were high-risk population for HIV and other sexually transmitted diseases （STD） earlier,and now are an important driver of the HIV/AIDS epidemic in China.Sentinel surveillance for FSW was set up to monitor the trend of HIV prevalence and risk behavior-related HIV infection.This study collected the data on street-based FSW from HIV sentinel surveillance system to understand HIV and syphilis infections,risk behaviors,and intervention in China from 2010 to 2012.Methods The study population was the street-based FSW who were recruited for the national HIV integrated biological and behavioral surveillance between 2010 and 2012.Demographic information,HIV-related risk behaviors,and HIV and syphilis testing results were described and trend analysis was performed.Results Between 2010 and 2012,the number of street-based FSW surveyed was 3725,3425,and 3335,respectively.HIV knowledge awareness rate significantly increased from 74.6% in 2010 to 76.8% in 2011 and 82.2% in 2012 （P 〈0.01）.More FSW consistently used condom in the last month （49.0% in 2010; 51.0% in 2011; and 59.0% in 2012） and in the last commercial sex （72.0% in 2010; 78.5% in 2011; and 80.0% in 2012） over time.The proportions of individuals who received HIV testing in the last year were 31.2% （2010）,37.0% （2011）,and 36.9% （2012） （P-trend 〈0.01）.HIV prevalence rate changed from 1.5% in 2010 to 1.4% in 2011 and 2.3% in 2012 （P-trend=0.01）.Syphilis prevalence rate was 6.9%,7.2%,and 7.1% in the same period.The top three provinces with the highest average HIV prevalence rates over the 3 years were Guangxi （5.9%）,Yunnan （4.2%）,and Sichuan （1.2%）.Conclusions Street-based FSW are at high risk of HIV and syphilis infections.Intervention efforts need to target streetbased FSW who are of old age and minority,who use illicit drugs and have syphilis infection.     

Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005–2006

Background Men who have sex with men （MSM） have become one of the most risky populations for HIV infection in China. Though several cross-sectional sero-prevalence studies have been conducted, the annual HIV incidence remains unknown in this population.
Methods We applied IgG-capture BED-enzyme immunoassay （BED-CEIA） to define the recent HIV-1 infections among MSM in Beijing in the years 2005 and 2006 and the annual HIV incidence was estimated.
Results Overall, 1067 MSM samples were collected, including 526 samples in the year 2005 and 541 in 2006. In 2005, of 17 HIV seropositive samples, 7 were identified as recent HIV-1 infections and the estimated HIV infection incidence was 2.9% per year （95% CI, 0.8%-5.0%）. In 2006, of 26 HIV seropositive samples, 9 were identified as recent HIV-1 infections and the estimated annual incidence was 3.6% （95% CI, 1.3%-5.9%）, which was 0.7% higher than that in 2005. Individuals engaging in male group sexual intercourse （5.17% vs 0.87%, P=0.019） and having receptive anal sexual intercourse more than five times （2.79% vs 0.33%, P=0.047） in the past 6 months significantly increase the risk of being infected by HIV-1.
Conclusions A high level of annual HIV-1 infection incidence was observed among MSM in Beijing for the consecutive years 2005 and 2006 with a continuous increasing trend. The rising incidence and related high risk behavior among MSM alarmed the health authorities and calls for more effective intervention strategies among this population.     

Trends in the major causes of death in China, 1982–2010

Since the introduction of a series of reform and open policies in its economic system in 1976,China has been in a boom period of social and economic fields.Rapid development in economy and the consequent improvement in living conditions,nutrition,and health care help to decrease infant mortality and deaths from infectious diseases,and notably effected the patterns of mortality.For example,respiratory diseases,acute infectious diseases,and tuberculosis were the leading causes of death in 1957,while diseases of heart,cerebrovascular disease,and malignant neoplasm were the fifth,sixth,and seventh leading causes of death.1 Up to 1975,cerebrovascular diseases,diseases of heart,and malignant neoplasm were the top three death causes,followed by respiratory diseases,digestive diseases,and pulmonary tuberculosis.1 A prospective cohort study involving a representative sample of the adult Chinese population was conducted in 2005,which revealed that the five leading causes of death were malignant neoplasm,diseases of heart,cerebrovascular disease,accidents,and infectious diseases among men and diseases of heart,cerebrovascular disease,malignant neoplasm,pneumonia and influenza,and infectious diseases among women.     

Time-series analysis of the relationship between air quality, temperature, and sudden unexplained death in Beijing during 2005–2008

Background  There is a yearly increase in the rate of sudden unexplained death (SUD), even through extensive physical examination and the testing of a large number of biomarkers, the cause of sudden death in patients previously in good health cannot be fully determined. During clinical practice, a spatial aggregation phenomenon has been observed in the incidence of sudden unexplained death. Previous research has shown that environmental factors, such as air pollution, weather conditions, etc., have a significant impact on human health. In the wake of the continuous environmental damage, the relationship between environmental factors and sudden unexplained death still needs to be studied. To study the relationship between sudden unexplained death and air quality and temperature, commonly used markers such as particulate matter of aerodynamic diameter <10 μm (PM₁₀), daily average concentration of the gaseous pollutants sulfur dioxide (SO₂) and nitrogen dioxide (NO₂), and the daily average temperature were investigated.

Methods  The methods include collecting the data of sudden unexplained death; air quality monitoring; meteorological monitoring from January 1, 2005 to December 31, 2008; utilizing generalized additive models (GAM); controlling the influential factors such as secular trend, seasonal trend, and Sunday dummy variable; and analyzing the correlation between daily inhalable particle concentration, daily average temperature, and the number of daily SUD.

Results  There was no statistical significance between the daily inhalable particle and daily incidence of sudden unexplained death. Incidence rate of sudden unexplained death had nonlinear positive correlation with daily temperature. When the temperature was 5°C above the daily average temperature, the daily incidence of sudden unexplained death went up with the rising temperature.

Conclusion  Temperature may be one of the key risk factor or precipitating factor of SUD.

     

Prehospital road traffic injuries among the elderly in Beijing, China: data from the Beijing Emergency Medical Center, 2004–2010

Background Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing’s geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.

Methods In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using χ2 tests and Logistic regression analysis.

Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 (P <0.001). The mean age was (72.92±5.67) years, and 911 (53.40%) of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%). Our statistical analysis found three factors for injury severity: abdominal injuries (P <0.001), number of injury sites (P=0.027), and head injuries (P=0.034). The decline in traffic injuries is due to a decrease in victims aged 65–74 years and pedestrians; the severity of RTIs also decreased.

Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

     

湖北省2005年急性血吸虫病发病因素分析与控制对策探讨

目的通过分析湖北省2005年急性血吸虫病发病因素和规律,为遏制湖沼型血吸虫病流行区急感发生,提供有效的防治对策。方法建立急感发病数据库,对数据库和急感突发疫情疫点的流行病学调查资料进行统计分析。结果全省急性血吸虫病发病呈抛物线曲线趋势,全省累计发生153例,性别男女比为3.31∶;感染人群主要为36～55岁年龄段的农民,其次为7～15岁学生;结合突发疫情疫点落实防治工作评分结果,耕牛防治工作最差,人群查治病工作也未能落实。结论发生感染地区县、乡镇范围与以往基本一致,特别显示这类地区要加大防治工作力度;分析感染病人的年龄、职业、接触方式等指标,表明要重点针对农民和中小学生加强健康教育;有效地遏制或减少急感发生,要解决防治工作中存在的困难和问题,重点做好人畜同步防治工作,认真扎实地落实每年的防治工作任务。     

湖北省2008年血吸虫病疫情控制考核评估

目的考核评估湖北省预防控制血吸虫病中长期规划防治目标和效果。方法分析湖北省2007、2008年血吸虫病疫情控制资料;查阅和审核15个县(市、区)(以下简称县)2004-2008年血吸虫病防治资料;每县随机抽取3个流行村,现场调查人、畜血吸虫病感染情况,资料整理和归档情况,考核和评估血吸虫病疫情现状。结果防治资料表明全省5408个流行村人群、家畜感染率均降至5%以下。15个县、45个抽样村2004-2007年资料均为合格;2008年资料整理系统、规范,得分均>70分,建立了以村为单位的反映疫情变化的档案资料。现场考核的15个县3279个流行村的人畜感染率均降至5%以下,其中人群感染率≥1%的村2544个(占77.58%),<1%的村578个(占17.63%),为0的157个(占4.79%),人群平均感染率最高的是公安县(3.72%),家畜(耕牛)感染率最高的是沙市区(3.51%)。现场调查45个流行村,人畜感染率均在5%以下,其中人群感染率最高的3个村分别为公安县积玉村(2.98%)、嘉鱼县复阳村(2.50%)、潜江市进步村(2.46%)。耕牛感染率最高的3个村分别为江陵县花彭村(3.51%)、监利县烟灯村(2...     

湖北省2005年急性血吸虫病突发疫情应急处理与分析

目的描述和分析湖北省2005年血吸虫病突发疫情的特点、处理情况和暴发原因。方法按照卫生部血吸虫病突发疫情标准,对2005年全省范围内发生的血吸虫病突发疫情进行核实调查,并收集有关疫情资料进行分析。结果湖北省2005年共发生血吸虫病突发疫情6起,全部在疫情发生地启动预案。全部急感病例都得到及时、有效地治疗。疫点现场都进行了查灭螺、高危人群排查、健康教育和耕牛查治病工作,疫点得到及时处理,疫情得到有效控制。结论血吸虫病突发疫情应急处理预案的实施对疫情的有效控制和处理起到了积极的促进作用,但暴露出的实际工作中的问题还有待及时地解决。     

广州市2001-2005年血吸虫病监测结果分析

目的了解广州市辖区内的增城、花都原血吸虫病区在阻断流行后的疫情动态。方法设假螺点进行查螺;水下诱螺;对7～14岁的低年龄组人群及外来流动人员进行酶联免疫吸附试验(ELISA)监测;捕杀野鼠解剖,制作压片镜检。结果螺情监测未能查到钉螺,低年龄组人群检测1021人,结果为阴性,检查外来人员356人,阳性者17人(4.7%),阳性者经粪检复查没有发现血吸虫病人。结论广州市血吸虫防治成果是巩固的,但随着经济的发展,人口、货物流动大,而邻近几省血防形势仍较严重,而且随着人们生活的不断好转,外出旅游人员增多,接触疫区疫水机会亦不断增大,随时会威胁广州市。因而提示,阻断后的监测不但不能放松,而且要继续加大监测力度,特别是输入性外来人员的监测。     

上海南汇区2001-2005年流动人口血吸虫、疟疾、丝虫病检疫情况分析

目的分析上海南汇地区外来流动人员血吸虫病、疟疾、丝虫病(简称“三病”)检疫的状况,为制定预防控制措施提供依据。方法采用三联抗原片免疫酶染试验或间接荧光抗体试验,对外省市来沪人员、居留3个月以上者进行“三病”检测。结果2001-2005年共检测外来流动人员39993名,“三病”抗体总阳性247人,阳性率0.62%,其中,血吸虫抗体阳性率0.39%,疟疾阳性率0.18%,丝虫阳性率0.05%。结论外来流动人口必须加强“三病”检疫及管理,这样才能有效控制外源性血吸虫、疟疾、丝虫病在本地流行。     

湖北省2004年4起急性血吸虫病暴发疫情分析

目的探讨急性血吸虫感染(下称急感)暴发流行的原因及防治对策。方法对湖北省2004年4 起急感暴发疫情进行现场调查分析。结果共55例(确诊病例48例,临床病例7例),其中,男性31例,女性 24例;年龄最大57岁,最小5岁;职业分类以农民(27例)和学生(25例)为主;接触疫水方式以戏水游泳(26 例)和生产、生活(21例)为主。结论控制急感暴发流行,应以提高春查春灭质量和加强中小学生及农民健康教育水平为主。     

广东省血吸虫病巩固监测情况分析及防治对策探讨

目的了解广东省血吸虫病传播阻断后的疫情动态,探讨新形势下的防治措施。方法建立血吸虫病监测系统,在原疫区对钉螺和传染源进行同步监测。结果1996-2006年共查螺7120.29万平方米,未发现活的钉螺。复查历史病人14893人,复治2747人,复治率为18.44%(2747/14893);外来人口调查:皮试检查2353人,阳性率为2.42%(57/2353),血清学检查7749人,阳性率为0.70%(54/7749);低年龄组人群调查:皮试检查9073人,阳性率为3.84%(348/9073),血清学检查11498人,阳性率为5.00%(575/11498),阳性者经粪检复查未发现血吸虫感染者。解剖野鼠1753只,检查耕牛18266头,均未发现血吸虫虫卵阳性。通过被动监测,2004年,2005和2006年分别报告输入性病例46例、8例和36例,以珠江三角洲地区报告病例数最多,占94.44%(82/90);年龄以15～55岁人群为主,占78.89%(71/90);职业以工人为主,占30.00%(27/90);其中急性感染病例2004年和2005年分别有1例和3例。结论目前广东省血吸虫病防治成果巩固,但必须加强监测,重点是输入性传染源及钉螺的监测。     

暴发性急性胰腺炎早期感染特点分析

目的 探讨暴发性急性胰腺炎（FAP）患者早期感染的临床和细菌学特点.方法 回顾性分析82例外科重症监护病房收治的FAP患者的病史资料,比较发病14 d内继发感染患者（早期感染组,n=51）与非感染患者（非感染组,n=31）感染相关因素和28 d病死率,分析早期感染组患者的感染与细菌学特点.结果 早期感染组机械通气比例和早期手术比例显著高于非感染组（P＜0.05）,两组其他感染相关因素和28 d病死率差异无统计学意义（P〉0.05）.早期感染组共检出68株病原菌,分别为革兰阳性菌22株（32.4%）,革兰阴性菌29株（42.6%）,真菌17株（25.0%）;早期感染组胆道感染11例（21.6%）,肺部感染24例（47.1%）,胰腺与胰周感染8例（15.7%）,血流性感染3例（5.9%）,创面感染7例（13.7%）,尿路感染4例（7.8%）.结论 FAP患者早期感染发生率较高,机械通气和早期手术可能与早期感染的发生相关;革兰阴性菌为主要病原菌,革兰阳性菌和真菌也占据一定比例.     

暴发性急性胰腺炎早期感染特点分析

目的 探讨暴发性急性胰腺炎（FAP）患者早期感染的临床和细菌学特点。方法 回顾性分析82例外科重症监护病房收治的FAP患者的病史资料,比较发病14 d内继发感染患者（早期感染组,n=51）与非感染患者（非感染组,n=31）感染相关因素和28 d病死率,分析早期感染组患者的感染与细菌学特点。结果 早期感染组机械通气比例和早期手术比例显著高于非感染组（P＜0.05）,两组其他感染相关因素和28 d病死率差异无统计学意义（P>0.05）。早期感染组共检出68株病原菌,分别为革兰阳性菌22株（32.4%）,革兰阴性菌29株(42.6%),真菌17株(25.0%);早期感染组胆道感染11例（21.6%）,肺部感染24例（47.1%）,胰腺与胰周感染8例（15.7%）,血流性感染3例（5.9%）,创面感染7例（13.7%）,尿路感染4例（7.8%）。结论 FAP患者早期感染发生率较高,机械通气和早期手术可能与早期感染的发生相关;革兰阴性菌为主要病原菌,革兰阳性菌和真菌也占据一定比例。     

淮安市儿童急性呼吸道感染病原学分析

目的探讨急性呼吸道感染（ARI）患儿呼吸道病原体的感染情况及季节流行特点,为临床实施行之有效地预防和诊治提供依据。方法应用间接免疫荧光法（IFA）检测该院2015 年1 月-2015 年12 月3 461 例0～12 岁ARI患儿血清中呼吸道合胞病毒（RSV）、腺病毒（ADV）、甲型流感病毒（FluA）、乙型流感病毒（FluB）、副流感病毒（PIV）、肺炎支原体（MP）、肺炎衣原体（CP）、嗜肺军团菌（LP）IgM抗体。结果3 461 份血清中呼吸道感染病原体IgM 抗体阳性检出率为69.17%,最常检测到的病原体是FluB（51.1%）、FluA（36.38%）、MP（25.14%）和RSV（9.04%）。FluA、FluB和MP 感染无明显季节性,检出率整年均较高;RSV 呈现流行高峰在冬、春季;ADV和CP 为春、夏季多发;PIV和LP发病率终年较低。随年龄增长RSV发病率下降,而其他病原体则相反。病原体混合感染检出1 627 例,占47.01%;混合感染最常见病原体为FluA+FluB和FluA+FluB+MP。结论淮安地区2015 年8 种呼吸道病原体阳性率达69.17%,以FluB检出率最高;呼吸道病原体感染的流行季节各有不同;伴随年龄的增长RSV 阳性率降低,而其他病原体阳性率则逐步增长;以FluA 和FluB 的混合感染为最多见;早期检测呼吸道病原体,将有助于儿科医生诊治和控制呼吸道感染。