西安市婴儿麻疹发病原因及防治策略的探讨

近年来,西安市未及接种麻疹疫苗（MV）的周岁内婴儿麻疹发病有增高趋势,为查明原因,在2000年春季对西安市儿童医院收治的436例≤7岁麻疹患儿进行了分析。结果＜8月龄未接种MV的病例占34.40％,发病最多的是6、7、8月龄,分别占周岁内病例数的18.18％、15.91％和21.82％。同时随机抽取51名5～8月龄未接种MV未患过麻疹的健康婴儿和63名育龄期妇女,用酶联免疫吸附试验（ELISA）间接法检测麻疹IgG抗体,结果7名5月龄儿童麻疹抗体阳性率为57.14％,GMT为1∶148.4,随月龄增长抗体阳性率逐渐下降,12名8月龄婴儿均为阴性。63名育龄期妇女抗体阴性占15.87％,抗体处于低水平占58.73％,中等水平19.05％,高水平只占6.35％。此结果表明,婴儿发生麻疹主要是母亲麻疹抗体水平低,导致婴儿母传抗体水平低、维持时间短,不能保护婴儿至8月龄MV初种时。因此建议对育龄期妇女进行婚前MV接种,并将MV初种月龄调整至6月龄。     

6月龄婴儿麻疹疫苗免疫效果及人体反应观察

疫苗时代育龄期妇女体内麻疹抗体多为麻疹疫苗所介导,所生婴儿母传抗体消失提前,未及初免月龄已成为易感者。针对北京市及其它一些大城市＜8月龄婴儿麻疹发病越来越突出的情况,为控制该人群发病,选取北京市户籍的6月龄婴儿119人进行麻疹减毒活疫苗（MV）免疫效果及人体反应观察。结果显示6月龄婴儿中有84％母传抗体已阴转,阳性者抗体水平也极低。接种MV后抗体阳性率达到86.6％,免疫成功率为80.7％,几何平均滴度（GMT）为1∶528.45;接种后的发热率、皮疹率分别为16.8％、2.52％。提示实施6月龄的MV初免程序是可行的。与本市8月龄婴儿初免监测数据相比,6月龄婴儿的MV免疫成功率和GMT偏低,提示婴儿母传抗体的存在对MV的免疫成功率有一定的干扰作用外,与年龄相关的因素如低月龄婴儿免疫系统的发育程度可能是影响免疫效果的更为主要的因素。建议对6月龄和8月龄婴儿MV初免的成本效果进行研究,如果采取6月龄初免,应考虑在满1岁时复种1剂MV;加快研制免疫原性好并适用于低月龄婴儿的新型MV;对与年龄有关的因素作更深入的探索。     

合肥市55例小于1岁麻疹病例分析

目的　为了解和掌握我市小于 1岁年龄组麻疹发病原因 ,制定防制策略 ,加速我市控制麻疹的步伐 ,对 5 5例小于 1岁的麻疹病例进行分析。方法　通过全市麻疹监测和疫情报告两个系统上报的疑似麻疹病例 ,采集静脉血测麻疹IgM抗体 ,择其抗体阳性的麻疹确诊病例 5 5例进行详细调查 ,填写统一设计好的调查表 ,最后对调查表内容进行分析。结果　 5 5例中 ,小于 8月龄 2 6例 (47.3%) ,大于 8月龄 2 9例 (5 2 .7%) ;大于 8月龄 (麻疹免初月龄 )有麻疹疫苗 (MV)接种史的仅占 2 7.6 %,其中城市病例中 ,接种MV者占5 0 %,农村病例占 11.1%。结论　未到MV初免月龄的婴儿发病比例较多 ;农村MV接种及时率低是造成小于 1岁儿童麻疹发病多的主要原因。     

天津市婴儿麻疹流行状况及相关因素分析

[目的]分析天津市婴儿麻疹流行状况及相关因素,为控制麻疹提出策略。[方法]对天津市历年法定传染病报告系统麻疹监测数据和流行病学调查资料进行分析,用酶联免疫吸附试验(ELISA)间接法检测麻疹IgG抗体。[结果]天津市麻疹发病显示明显的年龄分布特点,2005～2009年间均是1岁以下婴儿发病率最高,婴儿麻疹占麻疹病例的构成比呈增高趋势。73.97%的8月龄～1岁婴儿麻疹病例未进行过免疫接种。8月龄以下婴儿随月龄增长抗体阳性率逐渐下降,7月龄时抗体阳性率降至16.67%。医院就诊史与1岁以下婴儿麻疹有关,OR=15.4。[结论]天津市2005～2009年间麻疹发病均是1岁以下婴儿发病率最高,婴儿麻疹占麻疹病例的构成比呈增高趋势。未及时免疫、麻疹胎传抗体的滴度低以及医院就诊史等因素可能与婴儿麻疹发病有关。     

洛阳市婴儿麻疹流行病学特征分析

目的通过分析洛阳市婴儿麻疹流行特征,了解洛阳市婴儿麻疹发病的流行变化规律,为控制婴儿麻疹发病提供依据。方法对洛阳市2009—2014年383例婴儿麻疹病例流行特征及可能影响因素进行分析。结果婴儿麻疹病例占全市麻疹病例总数的构成比为39.12%。从6月龄发病明显增多,发病人群主要分布在7~9月龄,占发病总数的55.87%;全年均有病例发生,3~5月份为发病高峰。结论婴儿麻疹病例增多主要与麻疹母传抗体消失过早、医院内感染、接种MV不及时、接触传染源等因素有关。     

中国三城市麻疹母婴配对及小月龄母传抗体水平消长研究

目的 了解宁波市、哈尔滨市和济南市小月龄婴儿麻疹年龄构成变化及母传抗体衰减情况.方法 收集2004-2007年麻疹疫情资料并分析;同时采用血清流行病学方法进行麻疹母传抗体研究.结果 三城市麻疹病例主要发生在<1岁婴儿中,且<1岁组麻疹年龄发病率最高;三城市婴儿麻疹病例构成中均以5～8月龄为主.婴儿出生时麻疹抗体阳性率为89.3%,几何平均滴度倒数(GMRT)为738.93;6月龄和8月龄抗体阳性率分别只有6.9%和6.7%,GMRT分别为6.89和3.69;0～8月龄婴儿麻疹抗体阳性率随着月龄的增长呈趋势性下降;母亲的抗体阳性率为84.3%,GMRT为516.94,母亲麻疹抗体主要以低、中水平为主,分别占50.4%和30.3%;母婴麻疹抗体相关系数为0.840.结论 麻疹母传抗体下降,6月龄和8月龄婴儿抗体阳性率较低,几乎无保护作用.     

育龄妇女接种麻疹疫苗对婴儿麻疹发病影响的研究

目的研究育龄妇女接种麻疹疫苗（measles attenuated live vaccine,MV）对婴儿麻疹发病的影响,为降低婴儿麻疹发病提供参考。方法分析2006-2012年枣庄地区婴儿麻疹发病状况,采用酶联免疫吸附试验,检测育龄妇女接种MV后母婴麻疹抗体。用SPSS 11.5软件进行统计分析,分析方法运用χ2检验、t检验、F检验,以P〈0.05为差异有统计学意义。结果育龄妇女接种MV后（2010-2012年）婴儿年均麻疹发病率降至34.08/10万;病例以母亲孕前≥24个月接种MV者最高,占婴儿病例的50.00%（19/38）,其中〈8月龄占42.11%（16/38）;育龄妇女抗体阳性率、几何平均倒数滴度（GMRT）分别为95.72%和1 300.52,随时间推移到孕前24个月迅速下降至82.05%和521.35,接近免前水平（82.72%、419.78）。孕前3-6个月、8-12个月内接种,其婴儿（0-8月龄）麻疹抗体阳性率、GMRT明显高于相应对照（χ^2=27.92、24.41;t=10.23、9.78;均P〈0.01）,而其8月龄婴儿免疫成功率（76.19%-90.00%）、GMRT（672.24-712.56）差异均无统计学意义（χ^2=1.54,F=0.47,P〉0.05）。结论育龄妇女孕前3-12个月内接种MV,可显著提高母婴抗体水平,减少婴儿初免前暴露;同时不影响基础免疫成功率和GMRT水平,对降低婴儿麻疹发病,实现消除麻疹具有重要意义。     

广州市某区95例1岁以下疑似麻疹病例分析

目的了解〈1岁疑似麻疹病例不断增多的原因,为制定防制策略提供依据。方法用描述流行病学分析国家疾病监测信息报告管理系统中的广州市某区〈1岁疑似麻疹病例。结果95例病例中,失访9例;86例成功调查病例中,62例麻疹抗体阳性,24例抗体阴性。阳性病例中,〈8月龄29例（46．8％）,而≥8月龄（麻疹初免月龄）的33例病例中有麻疹疫苗（MV）接种史的占33．3％,其中本地病例接种率为72．7％,外地病例为13．6％。病例调查前确诊率（83．7％）高于调查后确诊率（67．4％）。结论诊断准确性较低、外地儿童增多且其MV及时接种率低、存在免疫失败、母传抗体低使未到MV初免月龄的婴儿发病增多等是导致该区〈1岁疑似麻疹病例不断增多的原因。     

芜湖市2005～2011年婴儿麻疹流行特征及影响因素分析

目的通过对芜湖市2005～2011年婴儿麻疹流行特征分析,了解芜湖市婴儿麻疹流行变化规律,探讨婴儿麻疹的预防控制策略。方法对芜湖市2005—2011年206例婴儿麻疹流行特征进行分析,并对婴儿麻疹可能的影响因素进行分析。结果2005—2011年芜湖市婴儿麻疹年均发病率为147．1／10万,处于全人群麻疹发病第一位。市区婴儿麻疹发病率高于农村地区。以5～8月龄为主,发病高峰为3～5月份。87．86％的婴儿麻疹病例无麻疹疫苗免疫史或免疫史不详,在有麻疹疫苗免疫病例中,52．00％的病例在麻疹疫苗接种后2W内发病,32．00％的病例在麻疹疫苗接种后4W以上发病。孕妇麻疹IgG抗体阳性率46．58％,有71．43％8月龄以上婴儿麻疹病例未及时接种或未接种麻疹疫苗,婴儿麻疹疫苗初免后平均麻疹IgG抗体阴性率为3．57％,麻疹流行强度、麻疹疫苗强化免疫、成人麻疹病例对婴儿麻疹病发病无明显影响。结论婴儿是麻疹高发人群,需进一步加强婴儿麻疹的预防控制工作。     

巢湖市2003～2007年麻疹流行病学特征和监测系统运行状况评价

目的了解麻疹流行病学特征和监测系统（NSS）运行状况,为控制和消除麻疹提供依据。方法对2003—2007年麻疹监测资料进行统计分析。结果2003—2007年共报告疑似麻疹628例,较法定传染病报告系统高19．62％。年均发病率为1．66／10万。麻疹发病高峰为3～6月份,发病以15岁以下儿童为主,占病例总数65．25％。331例I〉8月龄麻疹病例中,接种1剂次及以上的仅占19．34％。疑似麻疹病例及时报告、及时调查、标本采集、合格标本采集、及时送达、及时反馈率分别为95．86％、95．38％、75．48％、99．79％、88．40％、93．25％。排除病例与麻疹病例之比为0．67：1。结论MV接种率和接种质量低是麻疹发病的主要原因,≥15岁和〈8月龄人群麻疹发病逐渐增多。应提高2剂次MV接种率,加强成人MV接种,适时开展MV强化免疫,同时要进一步提高标本采集率和及时送达率,加强实验室检测。     

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.