Understanding of acute hemorrhagic conjunctivitis (AHC) epidemics and outbreaks of Paederus spp keratoconjuctivitis, periorbital oedema ("Nairobi red eyes") and dermatitis

A recent epidemic of acute conjunctivitis in Dar es Salaam showed again the importance of developing a strong infectious diseases epidemiological surveillance network which is effective in minimising disease outbreaks. The current misunderstanding of diseases causation and management explains the repetitive nature of acute hemorrhagic conjunctivitis (AHC) in Dar es Salaam. This article aims at increasing public awareness by elaborating two diseases (Acute Hemorrhagic Conjunctivitis and Paederus spp keratoconjuctivitis, periorbital oedema-"Nairobi red eyes") confused by many as being associated with recurrent epidemics of conjunctivitis Dar es Salaam.     

宜昌市2005-2014年急性出血性结膜炎流行特征

目的掌握宜昌市急性出血性结膜炎的发病趋势,为进一步采取干预措施提供依据。方法采用描述性流行病学方法进行分析。结果 2005-2014年急性出血性结膜炎疫情呈波动性,郊区发病大多高于城区(χ2=498.81,P=0.000.05);发病有季节性,8~9月为发病高峰,构成比为73.40%;男女性别比为1.56∶1。男性高于女性(χ2=199.99,P=0.000.05);10~14岁、15~19岁年龄组发病较多;不同职业群体中发病较多的为学生、农民、工人。结论全市急性出血性结膜炎发病呈波动性,仍是传染病防控工作的重点。     

Acute hemorrhagic conjunctivitis: a mixed virus outbreak among Vietnamese refugees on Guam.

In May 1975 the authors investigated an outbreak of acute hemorrhagic conjunctivitis that affected an estimated 29,000 refugees from South Vietnam who stayed on Guam while en route to the United States. Illness usually lasted6-10 days and was characterized by conjunctival injection (100%), lid edema (84%), eye irritation (81%) and subconjunctival hemorrhages (45%). Conjunctival swabs and paired serum specimens on a limited number of patients implicated enterovirus 70 as a major etiologic agent and adenovirus 11 as a less frequent agent. Adenovirus 8 and herpes simplex virus caused concurrent, sporadic cases of keratoconjunctivitis. Forty-three per cent of the refugees in a sample of 604 refugees were affected, and the attack rate was highest on evacuation vessels where crowding and poor sanitation facilitated person-to-person spread of infection. Because the outbreak subsided on Guam, and because infection was transmitted there to only 13 of about 1300 Americans in frequent contact with affected refugees, the risk of secondary outbreaks inthe United States appeared small.     

中国急性出血性结膜炎时空分布和社会环境影响因素分析

目的  通过分析急性出血性结膜炎(acute hemorrhagic conjunctivitis, AHC)时空分布特征以及研究影响其发病的社会环境影响因素,为该疾病防控策略提供科学依据。方法  本研究以中国2011-2017年31个省(自治区、直辖市)的AHC发病数据为基础,运用空间自相关分析方法探求疾病时空分布特征,并且使用地理探测器分析各环境因子对疾病的影响。结果  2011-2017年AHC年发病率波动较小,发病主要集中在夏秋季;空间上集中于中南地区以及华东地区;AHC发病率存在空间正相关,湖南省从高高聚集到低高聚集,防控力度要继续保持,贵州省从低高聚集到高高聚集,要注意周围省份疾病传播;气象、社会发展、经济文化等因素均不同程度影响AHC的发病,且因子的两两交互作用增强了发病风险,其中年均气温与其他因子的相互作用增加效应较强。结论  AHC发病时空分布不均匀,并且受各种社会环境因素的影响,空间自相关分析以及地理探测器模型的运用能有效地探索其时空特征以及影响因素,为AHC进行有重点的、有针对性的预防与控制发挥了重要的作用。     

Serosurvey for "acute hemorrhagic conjunctivitis" virus (Enterovirus 70) antibodies in the Southeastern United States, with review of the literature and some epidemiologic implications.

Acute hemorrhagic conjunctivitis (AHC) has been epidemic throughout much of the Eastern Hemisphere since its emergence in central West Africa in 1969. The disease had a distinctive clinical picture and an unusual geographic epidemiology. Between 1969 and 1975 AHC has occurred almost exclusively in crowded coastal areas of tropical countries during hot, rainy seasons. Only a few documented outbreaks have occurred in inland cities and in subtropical or temperate climate zones. Of 1014 residents of the eastern or southeastern United States who were screende for neutralizing antibodies to three or four strains of AHC virus (enterovirus type 70), three (0.3%) had titers ranging from 1:10 to 1:40. However, no clinical evidence of prior experience with AHC disease could be ascertained for these persons, so that the antigenic specificity of the detected antibodies is unknown. We conclude that populations of coastal tropical areas of northern South America and all of Central America are vulnerable to AHC epidemics.     

急性病毒性肝炎756例血清学及流行病学调查

目的 对2002年l-12月份市传染病医院收治的756例急性病毒性肝炎病例进行血清学及流行病学调查。方法 采用RIA(放射免疫测定)法检测HBsAg、HBeAg、抗-HBc IgM；采用：EIA(酶免疫测定)法检测抗-HAV IgM、抗-HCV IgM、抗-HDV IgM、抗-HEV IgM。结果 756例急性病毒性肝炎病例中甲肝34．66％，乙肝37．04％，丙肝6．48％，丁肝2．25％，戊肝25．13％。各型肝炎感染形式可以单一型，也可以是混合型或重叠型。结论 通过调查揭示我市五型病毒性肝炎的流行特征及不同性别、年龄、职业、月份中分布规律．对制定病毒性肝炎的预防策略、落实防治措施提供依据。     

一起医院内急性出血性结膜炎暴发的现场流行病学调查

目的调查深圳市S医院疑似急性出血性结膜炎暴发的危险传播因素,为及时控制疫情提供科学依据。方法按照病例定义开展病例搜索,描述疾病三间分布,结合现场流行病学调查方法,形成假设,采用病例对照研究,比较病例组与对照组之间使用科室公用厕所、使用公用水龙头洗脸或洗手、揉眼习惯等可能危险因素差异。结果 2011年6月7—15日,S医院共发现急性出血性结膜炎病例11例,所有病例均发生在W科住院部,罹患率为6.01%(11/183)。主要临床表现为眼部结膜充血(100.00%)、刺痛(81.82%)、异物感(72.73%)等。病程中位数为6 d(范围:3～11 d),无并发症发生。住走廊床位的患者罹患率为13.24%(9/68),明显高于住病房内患者的罹患率2.70%(2/74),差异有统计学意义(χ2=5.50,P=0.02)。"使用公用厕所"(OR=12.21,95% CI:1.28～288.33)、"使用公用洗手池"(OR=12.21,95% CI:1.28～288.33)和"揉眼睛"(OR=6.22,95% CI:1.08～39.96)是危险因素;对揉眼睛习惯"经常或有时"、"偶尔"、"从不"进行分析,发现发病风险随揉眼睛频次的增加而升高(Liner trend χ2=5.54,P=0.02)。结论结合病例临床表现和相关流行病学资料提示,这是一起急性出血性结膜炎暴发疫情。在短时间内无法改善硬件设施的情况下,建议S医院加强对公共厕所、水龙头等公共场所物体表面的消毒工作,教育患者不用手直接揉眼睛;同时建议政府进一步加大对医疗卫生机构病床建设的投入。     

北京市2010年一起由CoxA24v引起的急性出血性结膜炎疫情的流行病学及病原学特征分析

目的 了解2010年北京市某职业学院急性出血性结膜炎(acute hemorrhagic conjunctivitis,AHC)病例的流行病学及病原学特征.方法 对AHC聚集性疫情开展流行病学调查,分析每例患者感染来源,采用描述性流行病学方法进行统计分析.荧光定量RT-PCR检测肠道病毒70型(enterovirus 70,EV70)和柯萨奇病毒A组24型变异株(coxsackvirus A24 variant,CoxA24v),并用Hep-2细胞进行病毒分离,对病毒分离株的VP1全长基因序列进行种系发生分析.结果 某职业学院AHC聚集性病例8天有15例患者发病,检测8例患者眼拭子样本,4例为CoxA24v阳性,共分离获得2株CoxA24v毒株.该2个毒株VP1全长基因序列组内核苷酸同源性为99.7％,与北京市2010年分离毒株亲缘关系最近,与印度2007年部分毒株亲缘关系次之.结论 本起疫情由一个CoxA24v病毒链引起,CoxA24v毒株VP1全长基因序列与2010年北京市株及2007年印度部分分离株有较高同源性.应加强AHC症状监测并密切关注引起该病的肠道病毒的变异,为防制AHC提供科学依据.     

1986年我国急性出血性结膜炎流行的病原学研究

An epidemic of Acute Hemorrhagic Conjunctivitis (AHC) broke out in Shanghai, Henan and Fujian provinces of China in 1986. Twenty four strains of etiologically suspected virus were then isolated but not correctly identified. In 1990 9 out of 24 strains from these three places were re-examined by us in our laboratory, and found feasible to be neutralized by CA 24V antiserum, but not by antiserum to EV 70 as once reported by Henan. It was also found that these viruses (one strain from each of these three places) produced pathogenic changes in suckling mice, showed definite immuno-fluorescence with Mcabs, and were neutralized by McAbs against CA 24V which was isolated from Beijing by our laboratory in 1988. It is evident that all the isolates isolated from Shanghai, Henan and Fujian provinces in 1986 were Coxsackie-virus A 24 variant (CA 24V).     

The investigation of a recurrence of an AHC virus epidemic at Lucknow: a serosurvey for AHC virus antibodies before and after the epidemic.

An epidemic of acute haemorrhagic conjunctivitis (AHC) recurred at Lucknow during July to September 1975, after a gap of 4 years. Out of the 35 cases investigated thoroughly, 20 Entero-70-like cytopathogenic agents were isolated from the conjunctiva which were neutralized by antisera against AHC virus J670/71 of Japan. Seroconversion was seen in 7 out of 11 paired sera from patients. Serological study was also done on 100 sera collected before the AHC epidemic of 1971, 100 sera after 1971 and 100 sera after 1975 epidemic. There were no neutralizing antibodies in the pre-epidemic period, while 18% of sera after the first epidemic and 32% after the second epidemic showed antibodies. The incidence of antibodies was highest (43%) in children aged below 10 years. Of the children born after the first epidemic, 44% had antibodies. Thus our findings show that the AHC virus appeared for the firt time at Lucknow in 1971 and the almost complete absence of disease in children, and its mildness during second epidemic, may be due to immunity.     

2004-2011年广西横县急性出血性结膜炎流行特征分析

目的 分析广西横县急性出血性结膜炎(AHC)的流行特征,为今后制定防治措施提供科学依据.方法 收集该县各乡镇2004-2011年AHC流行及暴发疫情资料进行描述流行病学分析.结果 2004-2011年期间AHC在各乡镇均存在低密度的流行,年均人群发病率为12.41/10万.分别在2007和2011年出现较多的病例,人群发病率分别为11.53/10万和75.72/10万.男女比例为1.41:1.AHC流行期间为8-10月份,9月达到发病高峰.0～19岁的病例数占44.72％;20 ～24岁年龄组病例较少,占4.98％;而25～34岁年龄组升高至9.61％;而后随年龄增大病例逐渐减少.患病人群以学生、农民和幼儿为主.结论 AHC在该县乡均有流行,在人群密度较大的地方每三四年中极易出现1次暴发流行.     

SIR模型在一起校园急性出血性结膜炎暴发疫情处理中的应用

应用易感者-感染者-移出者(SIR)模型模拟学校暴发的急性出血性结膜炎,为疫情处理提供参考.采用经典SIR模型构建数学模型,Malthusian指数递减模型估计采取干预措施后的传染率系数(β),通过疫情早期数据确定参数和设置初始值,使用Matlab 7.1软件进行疫情处理效果模拟.结果 显示在无干预措施下,疫情将经历3个阶段:(1)初期(≤5 d)疫情发展较慢,是采取防控措施的最佳时期;(2)快速发展期(6～15 d)采取防控措施效果不甚理想;(3)中后期(≥16 d)90%以上易感者已被感染,采取措施已无较大意义.在有干预措施的情况下,SIR模型模拟结果显示,新发病例数迅速减少,疫情能得到有效控制,该结果与实际疫情发展情况基本相符.SIR模型对模拟校园急性出血性结膜炎暴发疫情具有较好效果.

Abstract：

To simulate intervention measures in controlling an outbreak of acute hemorrhagic conjunctivitis on one school campus by using the Susceptible-Infected-Recovered (SIR) model, to provide evidence for preparedness and response to the epidemic. Classical SIR model was used to model the epidemic. Malthusian exponential decline method was employed to estimate the infective coefficient β for interventions. The initial value of parameters was determined based on empirical data. The modeling was implemented using Matlab 7.1 software. Without interventions, the outbreak was expected to experience three phrases: (1)early stage (the first 5 days) in which the epidemic developed slowly and could be intervened easily; (2) rapid growing stage (6-15 days) in which the number of infected cases increased quickly and the epidemic could not be well controlled;and (3) medium and late stage (16 days and later) in which more than 90% of the susceptible persons were infected but the intervention measures failed to prevent the epidemic. With the implementation of interventions, the epidemic was predicted to be controlled in the early stage, under the SIR model. The simulation based on the SIR model kept an acceptable consistency with the actual development of epidemic after the implementation of intervention measures. The SIR model seemed effective in modeling interventions to the epidemic of acute hemorrhagic conjunctivitis in the schools.     

2016―2020年深圳市龙华区急性出血性结膜炎流行特征

目的  了解2016―2020年深圳市龙华区急性出血性结膜炎(acute hemorrhagic conjunctivitis, AHC)的疫情特征,为完善AHC监测和制定预防控制措施提供科学依据。方法  通过中国疾病预防控制信息系统收集2016―2020年深圳市龙华区AHC疫情数据,采用描述性流行病学方法分析流行特征。结果  2016―2020年深圳市龙华区共报告AHC病例986例,年均发病率为6.73/10万,2019年达发病高峰,2020年则下降。男性年均发病率高于女性(χ²=19.203, P＜0.001),1~ < 10岁年龄组发病率最高,夏季高发,职业构成以工人最多(50.30%)。结论  2016―2019年深圳市龙华区AHC呈逐年上升趋势,2020年因COVID-19疫情防控措施,发病率下降,未来还需把握契机,积极持续开展AHC的监测工作。     

Serologic status for pandemic (H1N1) 2009 virus, Taiwan

We studied preexisting immunity to pandemic (H1N1) 2009 virus in persons in Taiwan. A total of 18 (36%) of 50 elderly adults in Taiwan born before 1935 had protective antibodies against currently circulating pandemic (H1N1) 2009 virus. Seasonal influenza vaccines induced antibodies that did not protect against pandemic (H1N1) 2009 virus.     

运用SIQR模型模拟学校急性出血性结膜炎暴发的隔离防控效果

采用动力学模型评估急性出血性结膜炎(AHC )暴发疫情中隔离效果。结合AHC和动力学模型的特点,建立学校AHC暴发的易感-染病-移出(SIR)模型,由此再加人隔离措施,建立控制学校AHC暴发的易感-染病-隔离-移出(SIQR)模型,并以2011年长沙市某校AHC暴发疫情为例,评估AHC暴发学校隔离的防控作用。在无干预情况下,学校AHC暴发疫情的基本繁殖数(入_o)为6.80,疫情传播速度非常快,若不采取干预措施,在23 d内,几乎所有学生和教职员工均发病,累计发病738例,催患率高达99.73%,疫情将在9月I1日达到发病高峰,当日的新发病例数将达到126例。不同时间采取不同力度的隔离措施,防控效果不同,越早采取隔离措施、隔离力度越大,发病高峰越低、累计催患率(TAR)越小,暴发疫情控制效果越好。在第6天采取E=0.9措施时,累计患病数已经降至132例,此时TAR=17.84%。在AHC暴发疫情处置中,隔离可作为一项主要的防控措施。     

Acute hemorrhagic conjunctivitis due to enterovirus 70 in American Samoa: serum-neutralizing antibodies and sex-specific protection.

Acute hemorrhagic conjunctivitis due to enterovirus 70 has caused extensive outbreaks in tropical areas since 1969. Between December 1, 1990, and March 4, 1991, an outbreak of acute hemorrhagic conjunctivitis due to enterovirus 70 occurred in American Samoa, where an outbreak due to the same agent had occurred in 1981. A survey of 5% of the households (134 households, 1,095 individuals) was conducted throughout the island of Tutuila. The outbreak affected 58% of the population, with age-specific attack rates greater than 50% for all age groups except children younger than 2 years. Attack rates were significantly higher for children 2-10 years old (65%) than in the remainder of the population. Women aged 21-40 years had higher rates than did men the same age (66 vs. 49%), possibly because of the close association of women and young children. At higher preepidemic titers, there was evidence of protection from clinical disease among males but not among females. Enterovirus 70 can cause large outbreaks even in a population already exposed in a previous large outbreak; protection due to previous infection is only partial.