First documented case of imported tick‐borne encephalitis in Australia

We report a case of tick‐borne encephalitis that has not been described before in Australia. The patient was a returned traveller from Russia who had typical manifestations of this infection. Clinical diagnosis was elusive because of the peculiar biphasic nature of the illness and its rarity in Australia. Laboratory diagnosis was also challenging and required testing at a reference laboratory in the Czech Republic because of the unavailability of specific assays in Australia. This report aims to make physicians from non‐endemic regions aware that tick‐borne encephalitis can be imported and to familiarise them with its clinical course.     

Aristolochic acid-associated urothelial cancer in Taiwan

Aristolochic acid, a potent human carcinogen produced by Aristolochia plants, is associated with urothelial carcinoma of the upper urinary tract (UUC). Following metabolic activation, aristolochic acid reacts with DNA to form aristolactam (AL)-DNA adducts. These lesions concentrate in the renal cortex, where they serve as a sensitive and specific biomarker of exposure, and are found also in the urothelium, where they give rise to a unique mutational signature in the TP53 tumor-suppressor gene. Using AL-DNA adducts and TP53 mutation spectra as biomarkers, we conducted a molecular epidemiologic study of UUC in Taiwan, where the incidence of UUC is the highest reported anywhere in the world and where Aristolochia herbal remedies have been used extensively for many years. Our study involves 151 UUC patients, with 25 patients with renal cell carcinomas serving as a control group. The TP53 mutational signature in patients with UUC, dominated by otherwise rare A:T to T:A transversions, is identical to that observed in UUC associated with Balkan endemic nephropathy, an environmental disease. Prominent TP53 mutational hotspots include the adenine bases of (5')AG (acceptor) splice sites located almost exclusively on the nontranscribed strand. A:T to T:A mutations also were detected at activating positions in the FGFR3 and HRAS oncogenes. AL-DNA adducts were present in the renal cortex of 83% of patients with A:T to T:A mutations in TP53, FGFR3, or HRAS. We conclude that exposure to aristolochic acid contributes significantly to the incidence of UUC in Taiwan, a finding with significant implications for global public health.     

全国血吸虫病疫情资料回顾性调查 Ⅰ传播阻断县达标前后疫情变化分析

目的分析我国血吸虫病传播阻断地区在达到传播阻断标准（传阻）前后的疫情变化规律,为今后修订传阻标准以及更科学、规范地考核和评价防治工作效果提供依据。方法选择全国9个省17个血吸虫病传阻县,采取回顾性调查方法,收集、记录各县达到传播控制标准（传控）前10年和以后各年（截止2008年或2009年）疫情资料并建立数据库;分析、比较达标前后不同流行类型和地区的各疫情指标的变化规律。结果达传阻后,各类型疫区人群感染率均降至最低水平,少部分湖沼型和山丘型疫区分别在传阻后4年和9年有小幅上升,但均〈1%。湖沼型和水网型疫区活螺密度较高、变化较大,山丘型则较低并在传阻前后4年间降至最低;湖沼型疫区感染性钉螺时有发现,水网型和山丘型疫区则分别在达传阻后6年和10年发现有感染性钉螺复现。17个调查县从传控至传阻所历时间平均为17年。疫情非回升县达传阻前无感染性钉螺的平均持续时间为（2.71±1.10）年,其中湖沼型疫区为（3.80±1.43）年。结论达传阻后人群感染水平能维持在较低水平,而疫情回升主要表现在螺情回升。感染性钉螺可作为反映一个地区包括传染源控制等防治工作成效以及流行与传播危险程度的综合指标,持续而有效地控制感染性钉螺,是血吸虫病疫情达到传阻的基础。在我国目前社会经济发展水平和科学技术能力条件下,可将连续5年以上查不到感染性钉螺作为传阻标准之一。     

Density-dependent competitive suppression of sylvatic dengue virus by endemic dengue virus in cultured mosquito cells

Mosquito-borne dengue viruses are maintained in two discrete transmission cycles: a sylvatic cycle between nonhuman primates and sylvatic Aedes mosquitoes, and an endemic cycle between humans and peridomestic Aedes (primarily Ae. aegypti and Ae. albopictus). Most sylvatic strains are genetically distinct from endemic strains, and human infections with sylvatic strains have been detected only rarely. Interestingly, sylvatic strains replicate as well as endemic strains in Ae. aegypti and experimental models of replication in humans, suggesting that adaptive constraints may not explain the limited spillover of sylvatic strains into the endemic cycle. Within-host competition is another mechanism known to decrease emergence of strains into occupied niches. In the current study, we examined the magnitude of competitive suppression between sylvatic and endemic dengue strains of different serotypes in pair-wise mixed infections of cultured Ae. albopictus cells to test whether the ecotype or the initial ratio of the two strains influenced the outcome of competition. Strains isolated from nonhuman primates were competitively inferior to those isolated from humans. Moreover, competition was density-dependent; the magnitude of suppression increased as the starting density of a strain relative to its competitor decreased. These data suggest that competitive inferiority in endemic vectors coupled with a numerical disadvantage relative to resident endemic strains could restrict reemergence of sylvatic strains into the endemic cycle and contribute to the ecologically correlated genetic divergence between sylvatic and endemic strains.     

地方性砷中毒工作标准探讨

本文分析了我国地方性砷中毒各病使用的工作标准情况，探讨了地方性砷中毒工作标准问题，提出了有关确定病区，临床诊断，防治效果等方面制订标准原则，提出了包括病区确定与划分，临床诊断，治疗，预防等方面的工作标准，以病人临床皮肤病变表现为基础，将定性资料转化为定量资料，用以计算病员砷中毒积分或不同病区砷中毒指数，以便于进行病例间或病区间的横向比较。     

砷中毒指数在地方性砷中毒流行病学研究中的意义

应用一组改水干预前的地方性砷中毒资料 ,计算各发病单位的砷中毒指数。分析砷中毒指数与居民砷中毒检出率、掌跖角化率、水砷含量、尿砷水平、皮肤色素沉着、色素脱失等 ,均显示正相关关系。其中砷中毒指数 (y)与水砷 (x)相的曲线回归方程为 lg(y+0 .0 1) =3.0 16 x- 2 .16 ,两者相关系数为 r=0 .92 0 ;砷中毒指数 (x)与居民砷中毒检出率之间 r=0 .987,两者成直线回归关系 ,y=5 3.8x+1.5 1;砷中毒指数与足跖角化率之间亦呈良好线性关系 ,同样情况亦见于砷中毒指数与尿砷和异常尿砷检出率之间 ,相关系数分别为 0 .95 9和 0 .919。砷中毒指数与以上各指标的相关系数分析 ,P值均小于 0 .0 5 ,且都呈现良好的正相关关系。砷中毒指数以最简便方式概括了发病单位的砷中毒病例及病情程度 ,在比较不同单位病情时 ,比单纯的砷中毒检出率更能反映实际人群受砷危害情况 ,是流行病学研究中一较好的综合指标     

燃煤型慢性砷中毒病区不同人群发砷含量的比较

目的研究燃煤型砷中毒病区不同人群发砷含量与年龄、性别、病情的关系。方法发砷测定采用ＤＤＣ－Ａｇ法。结果病区砷中毒患者和病区正常对照组发砷含量均呈２０倍以上高于非病区正常对照组;患者发砷含量有随病情轻重程度而增高的倾向;正常人群中发砷含量男高于女的现象在燃煤型砷中毒患者和病区对照者中不再存在,且反有女性高于男性的倾向;患者发砷含量有随年龄增加而增高的趋势,主要是女性患者发砷含量随年龄增加而增高的因素造成的。结论发砷含量与环境煤砷污染有密切关系,发砷含量显著升高是燃煤型地方性砷中毒病区存在的主要特征之一;没有临床表现的病区砷毒接触者,可考虑称为亚临床砷中毒患者以引起对其防治的重视,而对此类患者存在的判断,发砷含量显得更为重要     

地方性砷中毒发病危险因素的病例对照研究

目的探讨地方性砷中毒（地砷病）的发病危险因素，评估p16甲基化在地砷病发病中的作用。方法采用两项1：1配对病例对照研究方法，40例病例选自病区确诊的地砷病患者，对照分别选自病区和非病区各40例健康人；采用标准化问卷进行调查，获取病例和对照组的有关暴露因素：采用甲基化特异性PCR（MS—PCR）技术，测定血样p16基因甲基化水平；并用条件logistic回归分析方法处理资料。结果病例与病区对照组分析结果表明，饮水含砷量（OR=4．2，P〈0．01）和饮水年限（OR=1．192．P〈0．05）对地砷病发病的影响有统计学意义。p16甲基化测定结果表明，病例组与非病区对照组比较，对地砷病发病的影响有非常显著的统计学意义（OR=10．0，P〈0．01）。结论饮水含砷量、饮水年限和p16基因甲基化可能都是地砷病发病的危险因素；但是，p16基因甲基化可能是地砷病发病的重要危险因素之一，这对阐明地砷病的病因和发病机制有着重要的理论意义。     

Coccidioidomycosis in Liver Transplant Recipients Relocating to an Endemic Area

Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States. This infection occurs at a rate of 1% to 8% in solid organ transplant recipients residing in the endemic area, and it has a high rate of disseminated infection and mortality. The risk of infection among transplant recipients from nonendemic areas visiting or moving to an endemic region is not known. We reviewed the clinical course of 41 liver transplant recipients who originally resided in and underwent liver transplantation in an area of low coccidioidal endemicity and who later relocated their follow-up care to our program, which is located in an endemic area. No patients received antifungal prophylaxis to prevent primary coccidioidomycosis. Among 37 patients with at least 1 year of follow-up care, the incidence of new coccidioidal infection was 2.7%. Coccidioidomycosis was identified in one patient and was manifested by fatigue, anemia, and pulmonary nodules. This patient survived with oral antifungal therapy. Coccidioidomycosis was not a frequent event in liver transplant recipients from areas of low endemicity who relocated to our highly endemic area.     

运用反距离加权插值法研究江苏省地方性氟中毒空间分布态势

目的 运用反距离加权插值法(IDW)研究江苏省地方性氟中毒在空间上的分布态势,探讨其在地方性氟中毒监测中的应用价值.方法 利用1982-1985年江苏省地方性氟中毒的调查数据,建立江苏省地方性氟中毒的地理信息数据库.以江苏省县界数字地图为背景,在Are View 3.3软件的支持下,利用地理信息系统(GIS)中的IDW,建立江苏省水氟和氟斑牙患病率的空间分布预测网,并与实际调查结果相比较.结果 利用IDW得到江苏省水氟和氟斑牙患病率的空间分布预测图.通过与实际调查结果的比较,表明运用IDW得到的空间分布预测图是真实、准确而详细的.结论 在地方性氟中毒监测中,利用IDW能够较好地通过抽样调查地区的氟中毒数据推断总体,估计江苏省地方性氟中毒的分布特征.     

燃煤污染型地方性氟中毒

氟中毒病是人体摄入氟素过多引起的中毒性疾病。通常将氟中毒分为工业性氟中毒及地方性氟中毒两大类,两者在氟素来源、分布区域及发病特点等方面均有明显差别。工业性氟中毒氟素来源于次生(污染)环境,即来自冶炼、化肥或火电厂等工业生产中矿石及煤炭在加工过程中释放的氟,分布范围多局限于污染源附近 有急性中毒也有慢性中毒;地方性氟中毒的氟素来源于原生(自然)环境,或来自干旱气候影响下,河流中下游或洼地中迁移富集的氟,或来自温泉或富氟矿石露头处释放的氟,分布较广,     

湖南省实施世界银行贷款血吸虫病控制项目9年效果分析

目的 分析1992-2000年湖南省实话世界银行贷款血吸虫病控制项目的防治成果。方法 疫区以行政村为单位，按居民感染率分为高、中、低三层，针对不同的层次，相应地采用吡喹酮人、畜化疗为主，辅以健康教育及环改灭螺防治策略；每年选择50个不同层次流行村为流动疾病监测点，进行疝情监测。结果 项目开始时全省35个流行县（市、区、农场）、471个流行乡，至2000年，先后有8个县（农场）达到了血吸虫病传播阻断标准；有25个县、300个乡（镇）达到传播控制标准；高度流行村由762个，减少到271个，中度流行村由1728个，减少到1053个，低度流行村由1447个，增加到2716个；居民感染率由11.59%下降至5.64%。结论 项目的实施使湖南省血吸虫病疫情有较大幅度降低，取得了预期的防治效果。     

Comparison of immune responses to a killed bivalent whole cell oral cholera vaccine between endemic and less endemic settings

Studies on safety, immunogenicity and efficacy of the killed, bivalent whole cell oral cholera vaccine (Shanchol) have been conducted in historically endemic settings of Asia. Recent cholera vaccination campaigns in Haiti and Guinea have also demonstrated favourable immunogenicity and effectiveness in nonendemic outbreak settings. We performed a secondary analysis, comparing immune responses of Shanchol from two randomised controlled trials performed in an endemic and a less endemic area (Addis Ababa) during a nonoutbreak setting. While Shanchol may offer some degree of immediate protection in primed populations living in cholera endemic areas, as well as being highly immunogenic in less endemic settings, understanding the characteristics of immune responses in each of these areas is vital in determining ideal dosing strategies that offer the greatest public health impact to populations from areas with varying degrees of cholera endemicity.     

Studies on hearing loss in a community with endemic cretinism in Central Java, Indonesia.

An audiometric study was carried out in a community of 642 subjects severly affected by endemic goitre and cretinism. Hearing loss was measured in 34 out of 41 subjects diagnosed as cretins, 92 normal subjects aged 5-20 years from the same community and 54 subjects (also of 5-20 years) living in a nearby control area without endemic goitre. The excess number of hearing defects in the endemic area seems to be entirely due to the process that leads to cretinism. There is no reason to describe deafness and deafmutism in an area with severe endemic goitre as a separate entity. The hearing defect showed a definite greater loss in the higher frequencies than in the lower frequencies and was found in 92% of the cretins. Deafmutism was present in 5, a loss of more than 60 db in 8, a loss of 40-60 db in 10 cretins. A loss of 20-30 db was found in 2.2% of normal subjects in the endemic area and 1.8% of those living in the control area. It is concluded that audiometry is a simple and significant test to establish the presence of the neurological form of endemic cretinism, which is the most prevalent form in most endemias. The differential diagnosis and pathogenesis of the described hearing defect are discussed.     

胶体染料试纸条试剂盒在血吸虫病大规模筛查中的应用

目的进一步验证血吸虫病胶体染料试纸条试剂盒在现场应用的效能。方法选择江西鄱阳湖沿岸湖沼地区的一个血吸虫病流行村15~70岁的自然人群404人,采用尼龙绢集卵孵化法、胶体染料试纸条法(DDIA)、酶联免疫吸附试验(ELISA)、环卵沉淀试验(COPT)等方法同时进行检测。另选一非血吸虫病流行区中未曾去过血吸虫病流行区的健康体检者418人,也同样应用DDIA、ELISA和COPT进行检测。结果DDIA、ELSIA和COPT的敏感性分别为96.59%、92.05%和85.23%,对流行区非血吸虫病人的特异性分别为96.32%、90.37%和95.59%。与非血吸虫病流行区健康者的阴性符合率分别为98.09%、97.37%和98.80%。结论DDIA试剂盒快速、简便,具有较高的敏感性和特异性,适用于血吸虫病流行区现场对目标人群的大规模筛查。     

Coccidioidomycosis in non-endemic areas: a case series

Coccidioidomycosis is a systemic infection caused by the soil fungus Coccidioides immitis, which is endemic to the south-western United States. Manifestations range from flu-like illness to pneumonia and septic shock. Diagnosis may be delayed or missed in non-endemic areas because of the low index of suspicion. We describe a series of 23 patients with coccidioidomycosis at one institution in a non-endemic area. Diagnosis was often delayed. In two patients, the route of exposure could not be determined, but 20 patients had a history of residence or travel to endemic areas, and the remaining patient had an occupational history of exposure to fomites from an endemic region. Five patients were immunosuppressed. Most patients responded well to medical therapy, surgery, or both. Although coccidioidomycosis is rare in non-endemic areas, physicians must keep it in mind when evaluating patients who have traveled to endemic areas or who are immunosuppressed.     

Coccidioidomycosis as a rare cause of pneumonia in non-endemic areas: A short exposure history should not be ignored

Coccidioidomycosis is endemic in the south-western USA. Two cases of infection in travellers returning to Hong Kong are described. A previously healthy patient who had travelled to an endemic area for a short time was successfully treated with fluconazole. A second patient with comorbidities and more prolonged exposure had disseminated and eventually fatal disease, despite prolonged administration of anti-fungal agents. Although coccidioidomycosis is a rare disease in Hong Kong, it should always be considered when there is a relevant travel history. Even a short period of travel to an endemic area should alert clinicians to this possibility when managing patients with severe pneumonia, especially those with multi-organ involvement. On the other hand, in patients with comorbidities, even aggressive and prolonged anti-fungal therapy may not guarantee a successful outcome.     

„Emerging Infectious Diseases“

Some emerging infectious diseases have recently become endemic in Germany. Others remain confined to specific regions in the world. Physicians notice them only when travelers after infection in endemic areas present themselves with symptoms. Several of these emerging infections will be explained. HIV is an example for an imported pathogen which has become endemic in Germany. SARS and avian influenza are zoonoses with the potential to spread from person to person. Avian influenza in humans provides a possibility for the reassortment of a potential new pandemic strain. Outbreaks of dengue fever in endemic areas are reflected in increased infections in travelers returning from these areas. Currently, West-Nile-virus infections are only imported into Germany. The timely implementation of diagnostic, therapeutic and infection control measures requires physicians to include these diseases in their differential diagnosis. To achieve this goal, good cooperation between physicians, laboratories and the public health service is essential.     

2000～2006年安徽省池州市贵池区血吸虫病疫情分析

目的分析池州市贵池区血吸虫病疫情变化,为更好地控制血吸虫病提供依据。方法收集贵池区2000～2006年的血吸虫病疫情监测资料,整理流行状况、人畜病情、螺情等相关材料,采用Cochran-Mantel-Haenszel χ^2检验和Spearman秩相关方法进行指标间关系的统计学分析。结果贵池区一、二类流行村数呈下降趋势,三、四类流行村数逐渐增加（χ^2=281.5,P〈0.01）;人群病情呈波动趋势（χ^2患病率=3705.6,P〈0.01;χ^2发病率=507.5,P〈0.01）;耕牛患病率呈整体下降趋势（χ^2患病率=118.5,P〈0.01）;螺情呈整体下降趋势,与其他指标间的相关性无统计学意义。结论贵池区7年间的血吸虫病疫情得到了一定控制,但仍需继续加强监测,以防止疫情突然反弹。     

Balkan nephropathy and malignant tumors

The question of whether the cancer death risk is higher in Balkan nephropathy (BN) foci has been approached by a comparison of 25 BN endemic municipalities with the same number of the group matched ones. It came out that the total cancer mortality was considerably higher, and mortality of nonurinary cancer slightly higher in BN endemic municipalities. The absence of a significant difference for the non-urinary cancer sites the authors explain by the fact that in municipalities designated as endemic only a part of the population lived in actual BN foci. They re-evaluated data published for Bulgarian BN endemic foci and concluded that, apart of a higher total cancer mortality, there was a significantly higher (although unrecognized) risk of nonurinary deaths in BN endemic settlements.