北京市学龄前儿童结核菌自然感染的研究

北京市从１９７８年成功实施现代结核病控制措施，结核病疫情明显好转，为掌握结核自然感染率及其在现代结核病控制措施下的下降趋势。在对新生儿及儿童采取一系列保护性预防措施的情况下，自１９８８年７月１５日于顺义县开始停止新生儿卡介苗接种。１９９５年对首批未接种卡介苗的６～７岁即１９８８～１９８９年出生的队列进入小学一年级的学生采用国际标准ＰＰＤ及国际标准结素试验技术进行结核菌素试验。１９９５年顺义县６～７岁儿童的结核感染率为１．３５％，估算年结核感染率为０．２１％，说明现代结核病控制措施对结核病感染的显著影响。顺义县１９８８～１９９５年０～４岁未接种卡介苗的儿童中结核性脑膜炎的发生继续减少。研究结果为评价现代结核病控制措施的效果及在不同结核病流行病学条件下修订卡介苗接种政策提供科学依据。     

哈尔滨市新生儿卡介苗接种质量控制的研究

本研究旨在提高新生儿卡介苗接种工作的质量。根据黑龙江省结核病控制法规，我们采取了一系列有效措施，如建立全市三级新生儿卡介苗接种网，培训接种人员。１９８６～１９９４年，新生儿卡介苗接种率、１２周结素阳转率及卡痕率，分别为９８％，９４％及９７％。结素反应硬结均径由７．１ｍｍ±３．０ｍｍ增至９．４ｍｍ±２．５ｍｍ，卡痕均径由２．５ｍｍ±０．８ｍｍ增至４．４ｍｍ±０．９８ｍｍ。０～１４岁结脑发病率由每１０万人口的１．３降至０．２。     

北京市丰台区外来儿童卡介苗接种状况的研究

目的掌握本地区外来儿童卡介苗接种状况。方法对小学二年级学生进行卡介苗接种史、卡痕、户口所在地、出生地情况调查，同时进行人型-PPD试验。结果外来儿童卡介苗接种率、卡痕率明显低于本地儿童。而未接种卡介苗儿童结素阳性率明显高于本地儿童。结论外来儿童的卡介苗接种工作应予加强。     

我国成人中糖尿病家族史与糖尿病发病某些特点的分析

目的分析我国成人中糖尿病家族史阳性率及其特点。方法对１９９４年我国２５岁以上２５万人群糖尿病调查中进行口服葡萄糖耐量试验（ＯＧＴＴ）（７５克）后诊断的糖尿病２７６７例和糖耐量正常的８６７４例进行比较。结果糖尿病人群中糖尿病家族史阳性率为１４．０％，正常人群有糖尿病家族史者为７．４％，两者有显著性差异（Ｐ＜０．００１）。糖尿病人群中父亲、母亲糖尿病家族史阳性率分别为３．４％、４．０％，两者无差异。有糖尿病家族史的糖尿病患者３３．６％发病年龄在２５～４４岁间，３３．１％在４５～５４岁段，另３３．３％的糖尿病患者发病年龄在５５岁以上。而无糖尿病家族史的糖尿病患者５０．２％在５５岁以后发病。家族史阳性组腰臀围比（ＷＨＲ）及收缩压均低于阴性组。结论有糖尿病家族史的糖尿病患者发病年龄早，而无糖尿病家族史的糖尿病患者发病年龄晚，且向心性肥胖，收缩压升高更明显。     

0～6岁儿童单纯性肥胖及相关因素调查

１９９７～１９９８年,我们对我区１４８１０例０～６岁儿童的生长发育情况进行了调查,共检出单纯性肥胖儿童４４８例,现对其相关因素进行分析。调查资料：本文男７４８８例,女７３２２例。分为０～１岁、１～３岁、３～５岁、５～６岁４个年龄组。调查项目及方法：①身高：用儿童身高坐高测量器测定,仪器误差不超过±０．２％,测量误差控制在±０．５ｃｍ。②体重：用杠杆式人体称测定,仪器误差不超过±０．１％,测量误差控制在０．１ｋｇ。③评价标准：以ＷＨＯ推荐的身高体重评价数值作为参照人数值,诊断界值点为大于相应身高…     

萧山市新生儿卡介苗接种工作监测与评价

为了解本省农村新生儿ＢＣＧ接种情况，特对萧山市农村１９９０～１９９２年ＢＣＧ接种监测。结果：接种率分别为９９．１％、９７．５％及９９．５％；出生３月内接种率占９１．８％；１２周阳转率为９０．６％，卡痕率为１００％，卡痕均径８．２４±３．３２ｍｍ。１９９２年０～４岁结脑及１５岁儿童结核发病均为０。近３年未发生接种事故。     

痰菌涂片阳性肺结核病人对家庭接触者的传染性调查(摘要)

本文选用1979年江西省结核病流行病学调查中的121例资料较完整的涂阳病人,对这些病例的家庭密切接触者的感染及患病情况进行调查并进行简要分析。一、感染率 133名15岁以下未接种过卡介苗的接触者,结素阳性率46.6％,强阳性率10.5％,与同期我省同年龄组儿童结素阳性率9.7％和强阳性率1.5％比较,有显著差异。二、患病率 15岁以下儿童(受检人数为253名),患病率     

卡介苗接种与肿瘤预防

全球应用卡介苗预防结核病已有半个多世纪,1970年Davigno等首次提出卡介苗接种可减少儿童白血病的发病率。他们在加拿大魁北克观察,发现≤15岁儿童接种卡介苗,其白血病的发病率是未接种儿童的1/2。英国医学研究委员会研究发现,接种卡介苗儿童的白血病死亡率为2.4/10万,而未接种对照组为4.1/10万,表明卡介苗对白血病的保护率约为40％。1972年Rosenthal报告,芝加哥1964～1969年有54414名新生儿接种卡介苗,仅1人死于白血病,而172986名未接种儿童中有21人死于白血病。后来Rosenthal又续报,以上人群20岁前所有类型的癌症     

北京市丰台区外来儿童卡介苗接种状况的研究

目的　掌握本地区外来儿童卡介苗接种状况。方法 对小学二年级学生进行卡介苗接种史、卡痕、户口所在地、出生地情况调查 ,同时进行人型-PPD试验。结果 外来儿童卡介苗接种率、卡痕率明显低于本地儿童。而未接种卡介苗儿童结素阳性率明显高于本地儿童。结论 外来儿童的卡介苗接种工作应予加强。     

徐州市1977—1993年疟疾IFA结果初析

本文报告了原间日疟流行区徐州市两个监测点居民和１５岁以下儿童用ＩＦＡ试验进行１７年疟疾抗体调查的结果。疟疾年带虫发病率与人群疟疾抗体阳性率呈正相关（ｒ＝０．７０，Ｐ＜０．０１），流动人口疟疾抗体阳性率和当地居民疟疾抗体阳性率有显著的差异（Ｕ＝１１．８７，Ｐ＜０．０１）。自１９８６年基本消灭疟疾后，每年流行季节末期人群抗体阳性率为０．０３％￣４．２６％，儿童抗体阳性率为０￣３．５％。显示疟疾传播已得     

Tuberculous meningitis in France in 1990: characteristics and impact of BCG vaccination

Setting: France, 1990.Objective: To measure the incidence and describe the characteristics of bacteriologically-confirmed tuberculous meningitis (TBM) and to estimate the protective efficacy of BCG vaccination in children aged less than 5 years.Design: An active surveillance of TBM cases confirmed by positive cerebrospinal fluid (CSF) culture was conducted through a network of microbiology laboratories serving 99.8% of regional and district general hospitals and other large private hospitals.Results: A total of 70 cases were reported: 61% were adults over 44 years, 64% were males and 77% were born in France. 7 patients were known to be infected with HIV. 6 cases were observed in children aged less than 5 years, 2 of whom had been vaccinated with BCG. 3 of the 6 children died (one had been BCGvaccinated). Given the 80% coverage of BCG in this age group, the protective efficacy of BCG vaccination was estimated to be 87.5% (95% CI: 30–98), which indicates that 14 TBM cases may have been prevented by BCG vaccination in 1990.Conclusion: Results are consistent with the number of TBM cases expected on the basis of a 0.04% annual risk of infection. Current BCG vaccination policy in France still has a measurable impact on the incidence of tuberculous meningitis in children under 5 years of age. Given the probable continuous decrease of the annual risk of infection in future years, alternative policies should be considered.     

Tuberculin survey in the Eastern Province of Saudi Arabia

We present the results of the Mantoux test (5 units tuberculin) survey in the Eastern Province of Saudi Arabia, which was conducted as part of a nationwide epidemiological survey of tuberculosis. A total of 1105 subjects were screened out of whom 630 gave a history of BCG vaccination in the past and 363 were BCG-negative. Among BCG-negative children aged 5-14 years, only 5% had a positive Mantoux, a rate lower than most Third World countries but higher than developed countries were under 2% of children are tuberculin reactors. This calls for continuation of free treatment of active cases and increased efforts towards screening of contacts. The results also vindicate the current policy of giving BCG vaccine at birth and probably indicates the need to revaccinate at school leaving age, in accordance with WHO recommendations. Tuberculin reactivity rose steeply with age (32% at age 15-24 and 72% at age 45-64 years) indicating the presence of a large pool of subjects at risk of breaking into active disease. Finally, 71% (201/283) of children aged 5-14 years who had received BCG vaccine at birth, reacted negatively to the Mantoux test. This supports the findings of previous studies that in the majority of subjects, BCG-induced tuberculin sensitivity fades a few years after vaccination.     

Can BCG-vaccinated children be included in tuberculin surveys to estimate the annual risk of tuberculous infection in India?

SETTING: Selected villages in three defined zones of India. OBJECTIVES: To compare the estimated prevalence of tuberculous infection among children with and without bacille Calmette-Guérin (BCG) scar. STUDY DESIGN: During a nationwide tuberculin survey, 1-9-year-old children were tuberculin tested using 1TU-PPD RT23 with Tween 80. RESULTS: In the 5-9 year age group, subgroups of tuberculous infected children could be seen as distinct humps among those with or without BCG scar, but not in those aged 1-4 years. In children aged 1-4 years, the estimated prevalence of infection was respectively 3.5%, 3.8% and 3.6% among children without BCG scar, and 4.8%, 4.7% and 4.5% among children with BCG scar in the western, northern and eastern zones. In those aged 5-9 years, the estimated prevalence was respectively 10.4%, 11.0% and 9.1% among children without BCG scar and 11%, 11.9% and 8.7% among children with BCG scar in the three zones. Thus, in children aged 1-4 years, the estimated prevalence among those with BCG scar was considerably higher than in those without BCG scar. This difference was small in those aged 5-9 years. CONCLUSION: Tuberculin surveys may be conducted irrespective of BCG scar status among children aged 5-9 years, when BCG vaccination is given using Danish 1331 strain during infancy under the Expanded Program of Immunization.     

Effect of BCG vaccination and non-tuberculous Mycobacterium infection on interferon gamma specific assay and a tuberculin skin test among children with a tuberculosis contact in Surabaya, Indonesia

The tuberculin skin test (TST) as a diagnostic tool for tuberculosis (TB) infection is used in many countries, including Indonesia, but lacks specificity. Interferon-gamma is a highly specific assay because it is not influenced by previous BCG vaccination or non-tuberculous mycobacteria (NTM) infections. We aimed to study the effect of BCG vaccination and NTM infection on the results of the interferon-gamma specific assay and TST among children with a TB contact. We carried out a cross-sectional study of children at an outpatient clinic in Surabaya, Indonesia. We studied 37 children aged 1-15 years having a household contact with an acid-fast bacilli positive adult index case. BCG vaccination was determined by the presence of a BCG scar. A PPD RT23 2 tuberculin test was used for the TST. ESAT-6, CFP-10, and TB 7.7(p4) antigens were used for the interferon-gamma assay by ELISA. Gastric aspirates were cultured in Lowenstein-Jensen media. A comparison of the two diagnostic tools among children aged 1-5 years without a BCG scar, revealed high agreement, while children with a BCG scar it revealed disagreement. Among children aged > 5 years with or without a BCG scar the comparisons revealed disagreement. Among children aged > 5-10 years, a comparison of the two diagnostic tools among NTM positive and negative children, there was a disagreement in results. Among children aged 1-5 years, the TST was influenced by a BCG scar. Infection with NTM had no influence on the results of the TST among children aged > 5-10 years, while in children aged 1-5 years and > 10 years the results could not be determined in this study.     

Tuberculosis screening results made at primary schools in Cizre

Tuberculosis (Tbc) gained importance as a public health problem in the recent years. The course of the disease is more severe in childhood. Tbc screening was made by The Tuberculosis Control 11th Group Presidency on the primary school students in Cizre, in November 2005. A total of 2242 children have been taken to this study. Of the children, 1130 (50.4%) were boys and 1112 (49.6%) were girls. The mean age of the children was 6.9+/-0.8 (range, 4-14) years. Concerning Bacillus Calmette-Guerin (BCG) vaccine scar, 1676 (74.7%) children had no scar, 536 children (23.9%) had single scar, and 32 children (1.4%) had double scar. The mean diameter of the tuberculin skin test (TST) was 2.1+/-2.7 mm. Regarding sexuality and TST mean diameter, statistically significant relation was not detected between girls and boys (p=0.3). The mean diameter of TST were 1.5+/-1.4 mm, 3.5+/-4.0 mm and 11.2+/-3.3 mm in the children with no BCG scar, in those with single BCG scar, and in those with double BCG scar, respectively. Of the TST results of all children, 2065 (92.1%) were negative, 101 (4.5%) were attributed to BCG, and 76 (3.4%) were positive, respectively. The rate of positiveness of TST was 1.2% in the children with no BCG scar, 8.9% in the children with single BCG scar, and 50% in the children with double BCG scar, respectively. A statistically significant correlation between the increase in the BCG scar number and the increase in the TST mean diameter was detected (p<0.05). Of the children who were likely to have Tbc, 139 (6.2%) were advised to apply at the dispensary. Single BCG vaccination was inadequate in the children. We suggest encouraging the families about postpartal single BCG vaccination. Furthermore, school screenings should be paid greater attention.     

Study on BCG vaccination and incidence of children's tuberculous meningitis in Liaoning province

The purpose of this study was to assess the effect of BCG vaccination on the incidence of tuberculous meningitis in children. A retrospective review was undertaken to find out vaccination rate of BCG and positive conversion mantoux rate in newborn infants. The results obtained were as follow: in 1980, vaccination rate was 51.61%, and the positive conversion Mantoux rate was 87.86%; in 1988 vaccination rate was 96.06%, and the positive conversion Mantoux rate was 94.92%. With the increase vaccination rate of BCG the incidence of tuberculous meningitis in children have decreased: in 1980 it was 3.27/100000; in 1988 it was 0.95/100000. The annual average incidence rate decreased by 14.28%.     

铜陵市婴幼儿卡介菌纯蛋白衍生物试验结果分析

目的了解卡介苗（BCG）预防接种质量,分析存在的问题及其影响因素,提出改进措施,促进预防接种规范、安全、有效地开展。方法用卡介菌纯蛋白衍生物（BCG-PPD）试验方法,随机调查300名儿童接种卡介苗3个月后的阳转率。结果卡介菌纯蛋白衍生物试验总阳性率86.33%,城市儿童卡介菌纯蛋白衍生物试验阳性率高于农村儿童。卡痕大小与卡介菌纯蛋白衍生物试验阳性率呈正相关;县级及以上医院产科接种卡介苗的儿童卡介菌纯蛋白衍生物试验阳性率高于乡镇级医院产科和预防接种门诊接种卡介苗的儿童。结论加强对卡介苗接种人员,尤其要加强农村乡镇卫生院和接种门诊的接种人员的技术培训,提高接种质量。     

Oral polio vaccines have not yet covered West Africa: survey of immunization coverage conducted in Niger

Following the re-emergence of polio in West Africa, an investigation was conducted on the occasion when transients gather for the festival in Niger, where the oral polio vaccine (OPV) and BCG coverage among children under the age of 5 years can be evaluated. A total of 259 children were investigated, including 186 from settled families and 73 from unsettled families. OPV coverage was found to be as low as 32.4%, and 61.8% of all participants in the study had not received both OPV and BCG. There were more children who had not received the OPV in unsettled families than in settled families. As there are still unvaccinated children in Niger, polio continues to occur among them. Moreover, outbreaks can transfer to more densely-populated areas, causing much larger outbreaks. To stop the chain of transmission, it is essential to reconsider the strategy of mass vaccination in order to cover all children thoroughly, including transients.     

The current situation and treatment of childhood tuberculosis]

We performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997. The diagnosis criteria for establishing TB were history of direct contact with TB patients, tuberculin skin test reactivity, positive bacteriology and radiographic findings compatible with TB. There were 192 males and 202 females (age range 1 month to 18 years of age, mean 6.3 years of age). Fifty-four percent of the cases were under 5 years of age. Primary pulmonary TB was presented in 200, post primary pulmonary TB in 97, pleural effusion in 53, endbronchial TB in 4, TB meningitis (TBM) in 28, miliary TB in 28 and other extra-pulmonary TB in 31. A history of contact with the patients was obtained in 72.8% of cases. Two hundred and thirty (58.4%) had received BCG, 134 (34%) no BCG, 30 (7.6%) were unclear. Especially, under 5 years of age, only 29 (13.6%) had received BCG. TBM is not disappeared in Japan and there were 28 cases with TBM. Fifteen patients out of them recovered completely, 8 patients recovered with severe neurological sequelae which included mental retardation, motor weakness, seizures and hydrocephalus and 5 patients died. Twenty-six had no BCG. Particularly in 1990s, we had experienced 4 dead TBM cases, 1 multi-drug resistant (MDR) TBM case and 1 TBM case due to nosocomial infection. Children with TBM should received 12-month regimen using initial daily treatment with isoniazid, rifampin, pyrazinamide, and streptmycin, followed by isoniazid and rifampin administered daily. Pulmonary TB in children is successfully treated with 6-month standard chemotherapy using isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily for 4 months. In order to promote TB control and eliminate childhood TB, especially in infants, the following is necessary; 1) early detection and treatment of adult TB patients, source of infection, 2) prompt and appropriate contact examination and chemoprophylaxis, 3) BCG vaccination during early infancy, 4) protection from MDR TB are most important in Japan.