关闭活禽市场对防控人感染禽流感的成效与影响

活禽市场是城市人群感染禽流感的关键场所。关闭活禽市场,可以减少公众暴露风险,但无法从根本上杜绝人群暴露机会,禽流感真正的风险源是野鸟的高带毒率和分散、混乱的养殖,源头环节才是控制禽流感的关键。因此,关闭活禽市场并不能彻底改变鸟禽间的病毒感染谱和流行态势,对禽流感传播流行链影响有限,关闭活禽市场不仅剥夺了消费者的选择权,长远看也不利于家禽养殖业的健康发展和市场多元化需求,进而影响社会和经济的发展。     

Human Exposure to Live Poultry and Psychological and Behavioral Responses to Influenza A(H7N9), China

To investigate human exposure to live poultry and changes in risk perception and behavior after the April 2013 influenza A(H7N9) outbreak in China, we surveyed 2,504 urban residents in 5 cities and 1,227 rural residents in 4 provinces and found that perceived risk for influenza A(H7N9) was low. The highest rate of exposure to live poultry was reported in Guangzhou, where 47% of those surveyed reported visiting a live poultry market >1 times in the previous year. Most (77%) urban respondents reported that they visited live markets less often after influenza A(H7N9) cases were first identified in China in March 2013, but only 30% supported permanent closure of the markets to control the epidemic. In rural areas, 48% of respondents reported that they raised backyard poultry. Exposure to live commercial and private poultry is common in urban and rural China and remains a potential risk factor for human infection with novel influenza viruses.     

Highly Pathogenic Avian Influenza A(H5N1) Virus Infection among Workers at Live Bird Markets,Bangladesh, 2009–2010

The risk for influenza A(H5N1) virus infection is unclear among poultry workers in countries where the virus is endemic. To assess H5N1 seroprevalence and seroconversion among workers at live bird markets (LBMs) in Bangladesh, we followed a cohort of workers from 12 LBMs with existing avian influenza surveillance. Serum samples from workers were tested for H5N1 antibodies at the end of the study or when LBM samples first had H5N1 virus–positive test results. Of 404 workers, 9 (2%) were seropositive at baseline. Of 284 workers who completed the study and were seronegative at baseline, 6 (2%) seroconverted (7 cases/100 poultry worker–years). Workers who frequently fed poultry, cleaned feces from pens, cleaned food/water containers, and did not wash hands after touching sick poultry had a 7.6 times higher risk for infection compared with workers who infrequently performed these behaviors. Despite frequent exposure to H5N1 virus, LBM workers showed evidence of only sporadic infection.     

Home hygiene and environmental sanitation: a country situation analysis for India

Problems of the environment and of domestic hygiene are always related to poverty of population and the sanitation of settlements. Most cities and towns in developing countries, like India, are characterised by over-crowding, congestion, inadequate water supply and inadequate facilities of disposal of human excreta, waste water and solid wastes. Inadequacy of housing for most urban poor invariably leads to poor home hygiene. Personal and domestic hygiene practices cannot be improved without improving basic amenities, such as water supply, waste water disposal, solid waste management and the problems of human settlements. But even under the prevailing conditions, there is significant scope of improving hygiene practices at home to prevent infection and cross-infection. Unfortunately, in developing countries, public health concerns are usually raised on the institutional setting, such as municipal services, hospitals, environmental sanitation, etc. There is a reluctance to acknowledge the home as a setting of equal importance along with the public institutions in the chain of disease transmission in the community. Managers of home hygiene and community hygiene must act in unison to optimise return from efforts to promote public health. Current practices and perceptions of domestic and personal hygiene in Indian communities, the existing levels of environmental and peri-domestic sanitation and the 'health risk' these pose will be outlined, as well as the need for an integrated action for improving hygiene behaviour and access to safe water and sanitation.     

南昌市活禽市场禽流感病毒及从业人员特征分析

目的 了解南昌市活禽市场管理措施实施情况,活禽职业人群的流行病学特征和市场禽流感病毒污染现状。方法 采用概率比例规模抽样法（probability proportional to size sampling,PPS）抽取南昌市76家活禽市场及其职业人群作为调查对象。自制问卷收集活禽市场管理措施实施情况、活禽职业人群的人口统计学和职业暴露信息。实时荧光定量RT-PCR检测环境标本禽流感病毒核酸并分型。结果 76家市场中,55.26%（42/76）实施一日一清洗;76.32%（58/76）实行一周一消毒;97.37%（74/76）现场宰杀活禽;69.74%（53/76）活禽存栏过夜。390名从业人员的平均累计职业暴露时间为13.00年（6.12～20.00年）,主要暴露方式为宰杀（72.56%）和销售（55.90%）;11.79%近期接触过病死禽。474份环境标本中,75（15.82%）份A型流感病毒核酸阳性,其中H9阳性44份,H5阳性16份,H7阳性11份,H10阳性2份。结论 南昌市活禽市场禽流感防控措施未充分落实,市场禽流感病毒污染较为严重,提示需要进一步加强市场防控措施实施力度,降低活禽职业人群和市场顾客的感染风险。     

Hygiene promotion in Burkina Faso

Successful hygiene promotion programs in developing countries require identification of local risk practices and messages most likely to have a real impact on disease incidence. This process was applied in a diarrhea prevention program in Bobo-Dioulasso, Burkina Faso. Field workers observed and recorded events such as child defecation and met with mothers to develop feasible alternative practices. Key was prevention of feces from getting into the environment, either through better stool control or adequate hand washing after stool contact, preferably with soap. It was determined that the most effective means for stopping fecal material from getting into the child's environment is to ensure that feces are disposed of safely and to ensure that hands that have come into contact with feces are thoroughly washed. Prevention of fecal materials from entering the domestic environment substantially reduces the risk of secondary transmission through uncovered food, unwashed plates. Interventions that make water more accessible facilitate hand washing and other domestic hygiene measures. The need for costly fly control measures can be reduced by steps to abolish breeding sites in animal dung.     

2010-2012年南宁市职业暴露人群血清学和环境高致病性禽流感监测分析

目的了解南宁市职业暴露人群高致病性H5N1禽流感病毒的接触感染状况和南宁市及周边地区活禽市场、养殖厂等环境禽流感病毒H5、H7、H9亚型污染状况,为防治人禽流感提供科学依据。方法在2010-2012年采集从事家禽养殖、屠宰等人群血清标本用红细胞凝集抑制试验（HI）检测H5N1抗体;对在城乡活禽市场外环境采集的笼具涂抹、粪便和污水标本用荧光定量PCR法检测禽流感病毒FluA、HS、H7、H9核酸。结果共采集职业暴露人群80人份血清H5N1抗体均为阴性;环境标本175份禽流感病毒核酸监测阳性标本为47份,阳性率为26．86％。A型禽流感病毒核酸阳性标本分布于6个城区（县）的9个活禽农贸市场,各个季节采集的标本的阳性率有差异。3种类型的标本中,水的阳性率最高,其次是笼具涂抹标本,粪便的阳性率最低。结论禽流感H5亚型在南宁市职业暴露人群中未发现隐性感染;活禽市场环境普遍存在高致病性禽流感病毒的污染,H5和H9亚型是主要的病原体。     

2015年济南市环境中禽流感病毒监测与分析

目的 通过对济南市涉禽环境禽流感病毒监测,了解H5、H7和H9亚型禽流感病毒在外环境分布情况,为禽流感的防控提供科学依据。方法 2015年按季度采集济南市3类涉禽场所不同种类环境样本1 260份,采用实时荧光定量PCR法检测禽流感病毒核酸,使用Epi Info统计分析数据。结果 甲型流感病毒(Influenza A virus, FluA)在活禽农贸市场和大型家禽养殖场阳性率分别为29.67%和2.86%,集中散养户未检出FluA,3类场所检出率差异有统计学意义(χ2 = 55.77,P ＜ 0.001)。活禽农贸市场H9和H5亚型检出率分别为16.11%和6.67%,未检出H7亚型,3种亚型检出率差异有统计学意义 (χ2 = 18.18,P ＜ 0.001)。FluA在案板涂抹物、清洗禽类污水、禽类饮水、笼具涂抹物和禽粪检出率分别为50.00%、37.90%、20.66%、13.21%和13.11%,不同种类标本FluA的检出率差异有统计学意义(χ2 = 54.69,P ＜ 0.001)。采样季度对FluA检出率差异无统计学意义(χ2 = 0.53,P ＞ 0.05)。结论 济南市环境中存在H5和H9亚型禽流感病毒,以H9亚型为主;活禽农贸市场是感染禽流感的危险场所。应加大对活禽农贸市场的消毒力度,加强对禽流感病毒的持续监测。     

Critical issues for agrichemical safety in South Africa

A review is made of the potential for environmental and occupational exposure to agrichemicals in South Africa. Data from the farming industry in the Western and Southern Cape regions of South Africa confirm substantial use of a range of insecticides, fungicides, and other agrichemicals. The potential for worker exposure to hazardous agrichemicals is also substantial but, to date, such exposures have been poorly characterized. Further data identify important deficiencies in industrial hygiene measures with regard to safekeeping of chemicals on farms, disposal of empty containers, use of protective equipment, and levels of safety training among farm workers. Evidence is presented for widespread underreporting of agrichemical morbidity and mortality. Surveys investigating acute health effects among farm workers with occupational exposure to agrichemicals in South Africa have produced conflicting results. The possibility of chronic health sequelae from low-dose long-term exposure is an underresearched area that is only now being investigated. A number of important obstacles to agrichemical safety are identified: the multiplicity of laws relating to pesticides administered by different departments resulting in poor coordination; the failure of existing occupational health legislation to address the agricultural workplace adequately; the unavailability and incoordination of safety training; the absence of adequate surveillance data; and inadequacies in statutory requirements with regard to waste disposal on farms. Drawing on experiences of local initiatives, possible solutions are identified that address the public health context of the problem.     

济宁市禽流感职业暴露人群血清学和环境禽流感 监测分析

摘要:目的　了解济宁市职业暴露人群禽流感病毒的接触感染状况和环境禽流感病毒分布情况。方法　2010-2014年采集禽流感职业暴露人群的血清标本,采用马红细胞血凝抑制试验检测职业暴露人群H5N1血凝素抗体,采集环境标本采用Real-time PCR对标本进行A型及H5、H7、H9亚型禽流感病毒核酸检测。结果　本研究共采集677份家禽规模养殖场等禽流感职业暴露人群血清标本,进行H5N1抗体检测结果均为阴性;共采集城乡活禽市场等各类监测点的水、禽类（含候鸟）粪便及笼具表面等环境标本1754份,经核酸检测A型阳性28份（1.60%）,H9亚型阳性10份（35.71%）,H5亚型阳性1份（3.57%）,A未分型15份（53.57%）,2份样本H9、H5均为阳性,未检出H7亚型。仅从城乡活禽市场和规模养殖场检测到阳性标本,野生候鸟栖息地及其他场所未检测出阳性标本。粪便等不同类型标本中均检出阳性标本。结论　济宁市城乡活禽市场和规模养殖场中有H5、H9禽流感病毒存在,城乡活禽市场是禽流感病毒重要的存在场所,存在人感染禽流感风险,应加强禽流感监测并做好综合性防控措施。     

Risk for infection with highly pathogenic influenza A virus (H5N1) in chickens, Hong Kong, 2002

We used epidemiologic evaluation, molecular epidemiology, and a case-control study to identify possible risk factors for the spread of highly pathogenic avian influenza A virus (subtype H5N1) in chicken farms during the first quarter of 2002 in Hong Kong. Farm profiles, including stock sources, farm management, and biosecurity measures, were collected from 16 case and 46 control chicken farms by using a pretested questionnaire and personal interviews. The risk for influenza A (H5N1) infection was assessed by using adjusted odds ratios based on multivariate logistic regression analysis. Retail marketing of live poultry was implicated as the main source of exposure to infection on chicken farms in Hong Kong during this period. Infection control measures should be reviewed and upgraded as necessary to reduce the spread of influenza A (H5N1) related to live poultry markets, which are commonplace across Asia.     

北京市怀柔区禽养殖人员禽流感暴露情况

目的了解北京市怀柔区养禽人员禽流感暴露情况,为制定该人群禽流感防控措施提供依据。方法通过多阶段典型整群抽样方法抽取怀柔区800名从事禽类养殖人员（包括大型养禽场从业者,个体和家庭养禽者）进行暴露情况问卷调查。结果共调查794人,其中大型禽类养殖场人员84人（10．58％）,个体和家庭养禽人员710人（89．42％）。主要暴露方式是喂养（97．86％）、清扫禽舍（86．02％）;接触禽频率〉20d／月的人员所占的比例为82．62％,累计暴露时间〉4a的人员所占的比例为73．68％。相比个体和家庭,大型养禽场禽的疫苗接种率（95．24％）更高（x2=10．41,P〈0．01）,而人的流感疫苗接种率（31．27％）更低（x2=25．92,P〈0．01）。大型养禽场接触病死禽时防护采取率高于个体和家庭养殖者（P〈0．05）。结论怀柔区禽养殖人群存在禽流感疫苗接种率低、接触禽频率高,部分人员接触病死禽时尚未采取防护等问题。相关健康教育和管理措施的全面性、系统性、可及性、针对性都亟待增强。     

贵州省2014-2018年人感染H7N9禽流感病例流行病学调查分析

目的 了解贵州省Ｈ７Ｎ９禽流感病例的特征,为进一步防控提供参考。方法 收集贵州省2014-2018年人感染Ｈ７Ｎ９禽流感临床及流行病学疫情资料,用描述性流行病学方法分析其流行特征。结果 2014-2018年贵州省共确诊21例人感染H7N9人禽流感病例,死亡11例,病死率52.3%。以男性、中老年、农民为主,61.9%的病例发生在黔东南和黔南地区,2017年病例数占总病例数的80.9%,未发现聚集性疫情和二代病例。病例发现以不明原因肺炎监测发现为主,从暴露到发病、发病到首诊、发病到确诊、发病到抗病毒药物使用及发病到死亡的时间中位数分别为5天、3天、7天、7天和14天;有无基础性疾病的病死率差异无统计学意义（〖XC小五号.EPS;P〗=0.38,P=0.54）,后期病例病死率低于前期（〖XC小五号.EPS;P〗=4.24,P=0.04）。19例本地病例均有明确的活禽或活禽市场相关环境接触史,其中94.7%的活禽市场或活禽相关场所均检出H7核酸阳性,平均阳性率为32.3%(1.34%～82%),全面长期关闭活禽市场后疫情得到有效控制。 结论 接触活禽或活禽市场环境是感染的主要因素;加强活禽市场外环境监测,规范化管理及长期关闭活禽市场,可有效预警和控制疫情;加强基层医疗机构救治水平可有效降低病死率。     

Occupational exposure assessment using antibody levels: exposure to avian leukosis/sarcoma viruses in the poultry industry

Avian leukosis/sarcoma viruses (ALSV) infect and cause cancers in chickens. Poultry workers are exposed to ALSV and other infectious agents in the workplace. This study examines if industrial hygiene assessment of antibody levels in poultry workers can identify risky job tasks at the higher exposure risk to an infectious agent, i.e., ALSV. We compared ALSV antibody levels in poultry workers and control subjects. Occupational and demographical factors were examined for an association with the exposure risk in poultry workers. We found that the antibody levels were significantly higher in poultry workers than in control subjects. Job category and age together were significantly associated with the antibody levels in workers. Certain job tasks were identified with significantly higher antibody levels as compared to others, implying that recommendations should be made to protect workers at these jobs. The findings of this study indicate that the measurement of antibody levels in workers can be useful for industrial hygiene assessment of exposure to infectious agents.     

广州市禽类从业人群禽流感病毒感染特征分析

目的 应用血清流行病学调查广州市禽类从业人群感染禽流感病毒H5N1、H9N2、H7N7的状况,分析其感染特征.方法 采集广州市与禽类接触相关的职业人群血清,包括农贸市场活禽零售与非禽类零售人群、企业化家禽养殖与农村家禽散养人群、活禽批发市场人群、野生鸟驯养人群、生猪屠宰人群以及一般人群,用血凝抑制试验、中和抗体试验检测H5、H9、H7 IgG抗体;使用logistic回归分析、χ2检验分析感染率分布.结果 2881名调查对象中检测出4例H5抗体阳性(0.14%);146例H9抗体阳性(5.07%),其中以活禽零售人群H9感染率最高(14.96%),企业化家禽养殖人群为8.90%,活禽批发人群为6.69%,野生鸟驯养人群为3.75%,生猪养殖人群为2.40%,非禽类零售人群为2.21%,农村家禽散养人群为1.77%,一般人群为2.30%.而1926名禽类从业人群中H7抗体均为阴性.结论 人群中H5感染率较低,而H9感染率较高,未检测到H7感染;活禽零售、家禽批发、企业化家禽养殖等职业具有较高感染禽流感病毒的风险,其中以活禽零售感染风险最高,且接触家禽时间越长感染风险越高.     

Poultry movement networks in Cambodia: Implications for surveillance and control of highly pathogenic avian influenza (HPAI/H5N1)

Movement of poultry through markets is potentially important in the circulation and spread of highly pathogenic avian influenza. However little is understood about poultry market chains in Cambodia. We conducted a cross-sectional survey of 715 rural villagers, 123 rural, peri-urban and urban market sellers and 139 middlemen from six provinces and Phnom Penh, to evaluate live poultry movement and trading practices. Direct trade links with Thailand and Vietnam were identified via middlemen and market sellers. Most poultry movement occurs via middlemen into Phnom Penh making live bird wet markets in Phnom Penh a potential hub for the spread of H5N1 and ideal for surveillance and control.     

Superfund and contamination of workers' homes

Although originally conceived as a means to clean up abandoned hazardous waste sites, at least one state is now attempting to use the Superfund (CERCLA) legislation as a means to recover the costs of a home contamination incident. This case has not been litigated yet. If the state is successful, however, the Superfund program would be expanded not only to cover waste disposal practices but also industrial hygiene practices. Industries thus need to review the nature and disposition of their waste material and their industrial hygiene practices in order to assess their full potential exposure under Superfund. The small amounts of chemicals that may leave a factory on workers' clothing and shoes someday could develop into a costly home decontamination project. If a review of past and present industrial hygiene practices reveals that home contamination could have occurred, an industry should take an offensive (as opposed to defensive) role in correcting the problem. Not only can taking the initiative in remedying a problem help minimize damage to employee health, morale and public opinion, but clean-up costs can be reduced as well without sacrificing the quality of the remedial action.     

Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review

Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.     

Responses to Threat of Influenza A(H7N9) and Support for Live Poultry Markets,Hong Kong, 2013

We conducted a population survey in Hong Kong to gauge psychological and behavioral responses to the threat of influenza A(H7N9) and support for closure of live poultry markets. We found low anxiety and low levels of exposure to live poultry but mixed support for permanent closure of the markets.     

2008年某市医疗废物处理工作人员职业暴露状况调查

[目的]了解某市医疗废物处理工作人员职业暴露发生情况,为规范医疗废物处理工作人员职业安全和医疗废物管理提供依据。[方法]2009年．在某市抽取各级医院、社区门诊、环卫公司等23家单位对直接从事医疗废物处理的工作人员196名进行调查。[结果]调查196人．过去1年里101人发生过锐器伤或者破损的皮肤、黏膜污染．发生率为51．53％。暴露发生率的高低与性别无关,工龄长、文化程度高、防护意识强、接受过培训者暴露发生率较低．相反则较高;环卫公司最高,医院次之,社区门诊最低。医疗废物分类不规范是暴露发生的主要原因,收集打包是暴露发生的主要环节;暴露发生后。15．84％的工作人员能立即自行处理并上报,77．23％自行处理但未报告．6．93％未处理也未上报。[结论]某市医疗废物处理工作人员职业暴露情况较为严重。