广东省2013－2017年3种基因型诺如病毒感染暴发疫情的流行特征

目的 分析2013－2017年广东省115起由GⅡ.2、GⅡ.17和GⅡ.4/Sydney 3种基因型引起的诺如病毒感染暴发的流行特征,为诺如病毒感染疫情的防控提供科学依据。方法 通过“突发公共卫生事件报告管理信息系统”收集2013年1月1日至2017年11月30日广东省报告的诺如病毒感染暴发疫情,采用RT-PCR方法对每起疫情的病例标本进行诺如病毒核酸检测,经基因测序后确定病毒基因型,对GⅡ.2、GⅡ.17和GⅡ.4/Sydney 3种基因型暴发疫情特点进行分析,采用直接标准化法计算病例呕吐和腹泻的比例。结果 广东省2013年1月1日至2017年11月30日共报告诺如病毒感染暴发疫情167起,GⅡ.2、GⅡ.17和GⅡ.4/Sydney 3种基因型引起115起。暴发场所中,GⅡ.2型为小学占39.68%（25/63）、托幼机构占28.57%（18/63）、中学占25.40%（16/63）、大学占6.35%（4/63）;GⅡ.17型为中学占41.03%（16/39）、其他社会单位占20.51%（8/39）、小学占15.38%（6/39）、大学占12.82%（5/39）、社区和托幼机构各占5.13%（2/39）;GⅡ.4/Sydney型为大学占53.85%（7/13）、托幼机构和其他社会单位各占15.38%（2/13）、小学和中学各占7.69%（1/13）。传播途径中,GⅡ.2型为接触传播占77.78%（49/63）、食源性传播占17.46%（11/63）;GⅡ.17型为食源性传播占53.85%（21/39）、接触传播占15.38%（6/39）、水源性传播占12.82%（5/39）;GⅡ.4/Sydney型为食源性传播占53.85%（7/13）、接触传播占38.46%（5/13）。临床表现中,GⅡ.2型的标准化呕吐比例为73.76%、腹泻比例为42.85%;GⅡ.17型的标准化呕吐比例为76.37%、腹泻比例为51.40%;GⅡ.4/Sydney型的标准化呕吐比例为54.10%、腹泻比例为55.95%。结论 GⅡ.2型主要涉及小学、托幼机构和中学,以接触传播为主;GⅡ.17型主要涉及中学和其他社会单位,以食源性传播为主;GⅡ.4/Sydney型主要涉及大学,食源性传播比例最高,接触传播也有较高比例。     

广州市2017年某高校诺如病毒GⅡ.4 Sydney 2012变异株感染暴发调查

目的 分析2017年广州市GⅡ.4 Sydney 2012变异株引起的诺如病毒感染暴发疫情的流行特征和分子生物学特征,为诺如病毒感染疫情的防控提供依据。方法 设计调查表收集病例发病资料和疫情数据,采集现症病例和厨工的肛拭子以及环境标本进行病原学检测,阳性标本进行基因测序和同源性分析。采用病例对照研究方法分析疫情的相关危险因素。结果 2017年9月17-21日,广州市大学城某高校累计发生诺如病毒感染病例226例,包括223例在校学生和3例厨工,学生罹患率为0.73%（223/30 711）;宿舍A区学生罹患率最高（1.73%,164/9 459）,无院系和班级聚集性;主要危险因素为18-20日在A区食堂就餐（OR=10.75,95% CI：5.56~20.79）,发病风险最高的是18日晚餐,另一危险因素是同宿舍有病例（OR=3.65,95% CI：1.92~6.94）;诺如病毒核酸阳性的厨工全部来自A区食堂,阳性率为26.67%（12/45）,病毒基因测序结果为GⅡ.4 Sydney 2012变异株,与学生病例的病毒基因序列相似度为100%。结论 本次疫情是继2013年之后诺如病毒GⅡ.4 Sydney 2012变异株再次在学生人群引起的较大规模暴发疫情,由食源性传播的可能性较大,同时不排除接触传播。     

2012-2014年广东省哨点医院诺如病毒GII.4 Sydney变异株流行状况及暴发疫情特征分析

目的：分析2012年1月至2014年6月广东省哨点医院诺如病毒GII.4 Sydney变异株流行状况,以及由诺如病毒GII.4 Sydney变异株感染引起的暴发疫情特征。方法2012年1月至2014年6月在广东省选取22家医院的门诊科室为监测哨点,将采集的腹泻病例粪便样本（共10750份）送至市级CDC,进行病毒核酸提取及诺如病毒核酸检测,所有阳性样本递送至广东省CDC,并按照随机数字法抽取了855份进行诺如病毒基因分型,共成功测序样本690份。采用χ2检验比较不同年龄组、不同时期内腹泻病例诺如病毒感染情况。通过广东省突发公共卫生事件管理信息系统,收集2012年1月至2014年6月广东省13起由诺如病毒GII.4 Sydney变异株感染引起的社区暴发疫情数据,进行社区流行病学分析。结果2012年8月首次检出诺如病毒GII.4 Sydney变异株,2012年11月检出比例为13/15。2012年11月至2013年1月（T1时期）,各月份中腹泻病例诺如病毒感染阳性率分别为23.8%（100/421）、15.9%（61/383）、19.2%（95/495）,2013年11月至2014年1月（T2时期）,各月份中腹泻病例诺如病毒感染阳性率分别为17.0%（90/529）、8.7%（37/426）、11.2%（46/409）,均低于T1时期（χ2值分别为6.65、9.93、10.74,P值分别为0.010、0.002、0.001）。T1时期内≥15、<15岁组腹泻病例诺如病毒感染阳性率分别为26.3%（143/543）、14.9%（113/756）（χ2=25.90,P<0.001）;T2时期≥15、<15岁组阳性率分别为10.1%（52/516）、14.3%（121/848）（χ2=5.09,P=0.024）。13起暴发疫情中,食源性传播占10/13。结论广东省2012年8月首次检出诺如病毒GII.4 Sydney变异株,2012年11月起呈现社区流行,流行1年后,强度降低;由诺如病毒GII.4 Sydney变异株引起的暴发疫情主要以食源性传播为主。     

北京市2014－2018年诺如病毒急性胃肠炎暴发的影响因素分析

目的 分析2014－2018年北京市诺如病毒急性胃肠炎暴发的影响因素。方法 收集2014年4月至2018年3月北京市诺如病毒急性胃肠炎聚集性事件及暴发资料,应用非条件logistic回归模型分析诺如病毒急性胃肠炎暴发的影响因素。结果 北京市共报告由诺如病毒感染引起的急性胃肠炎事件765起,85.88%（657/765）为聚集性事件,14.12%（108/765）为暴发。在暴发中,70.37%（76/108）发生在2017年;84.26%（91/108）发生在冬、春季节;88.89%（96/108）发生在托幼机构及中小学;主要传播途径为人传人（81.48%,88/108）;93.52%（101/108）为GⅡ组诺如病毒感染引起。多因素logistic回归分析结果显示,在近郊区及远郊区发生的事件,出现暴发的风险分别是城区的1.84倍（95% CI：1.13～3.02）及3.78倍（95% CI：1.62～8.82）;在小学、中学及其他机构发生的事件,出现暴发的风险分别是幼儿园的6.26倍（95% CI：3.53～11.10）、14.98倍（95% CI：6.23～36.01）及8.71倍（95% CI：3.07～24.71）;就诊率低于全部事件就诊率中位数的,发生暴发的风险是就诊率高的2.29倍（95% CI：1.42～3.68）;传播途径为食源性的事件,发生暴发的风险为人传人传播的14.55倍（95% CI：3.15～67.07）。结论 加强郊区、中小学及其他机构诺如病毒暴发疫情的防控力度,急性胃肠炎患者积极就医,做好食源性疫情的防控及厨工的健康管理,有助于减少诺如病毒急性胃肠炎的暴发。     

杭州地区2014-2015年急性胃肠炎患者感染诺如病毒的流行病学特征分析

目的 了解2014-2015年杭州地区急性胃肠炎患者中诺如病毒的流行病学特征。方法 收集1 109份急性胃肠炎患者的临床流行病学资料和粪便样本,采用一步法双重荧光RT-PCR对样本中诺如病毒(GⅠ、GⅡ型)进行初筛,然后随机选择诺如病毒阳性的样本核酸进行多重RT-PCR扩增,对产物进行测序分析。结果 1 109份的粪便样本中,诺如病毒检出率为26.87%(298/1 109),以GⅡ亚型为主,占25.52%(283/1 109),GⅠ亚型占1.35%(15/1 109);不同性别人群诺如病毒检出率差异无统计学意义(P>0.05);不同年龄组人群中诺如病毒检出率分别为16.94%(<5岁)、19.45%(5~18岁)和32.26%(≥18岁);全年均可检出诺如病毒感染,高发季节为12月至次年3月,阳性率为29.67%~37.08%。序列分析显示,GⅡ基因亚型中以GⅡ-4/Sydney株为主(46.43%,13/28),其次为GⅡ-4/2006b株;GⅠ基因亚型中以GⅠ-1亚型为主(55.56%,5/9)。结论 诺如病毒是导致2014-2015年杭州地区急性胃肠炎的主要病原之一,GⅡ基因亚型特别是GⅡ-4/Sydney变异株和GⅡ-4/2006b变异株是该地区流行的优势毒株。     

江苏省近期急性胃肠炎暴发中诺如病毒分子特征分析

目的 了解江苏省胃肠炎暴发疫情中诺如病毒(NoV)感染状况,并对其病原分子流行病学特征进行初步研究.方法 收集江苏省2012年10月至2013年3月7起胃肠炎暴发疫情患者肛拭子标本共67份,采用实时荧光RT-PCR定性检测,NoV阳性标本用RT-PCR扩增其聚合酶区及VP1区基因片段进-步测序分型.结果 7起疫情均为NoV感染引起的暴发,检测阳性率为67.2％(45/67).全部45株阳性毒株序列分析表明7起疫情中除-起是由GⅡ.3型感染引起外,其余6起均由新GⅡ.4感染引起,其中38株毒株与2012年澳大利亚参考株GⅡ.4/Sydney株同源性均在99％以上.进-步对6株新型Sydney变异株的衣壳蛋白VP1区扩增测序,并与9株近年流行株的VP1区氨基酸序列比对,发现该6株毒株的VP1区部分氨基酸已出现突变,而氨基酸位点的突变是与病毒抗原性密切相关.结论 江苏省7起疫情暴发聚集且感染毒株型别单-,说明已出现新NoV变异株,其原型株GⅡ.4/Sydney已在国外多地引起暴发和流行,提示该毒株将是今后防控监测的重点.     

上海市2013-2018年成年人诺如病毒引发感染性腹泻的流行特征研究

目的 了解上海市成年人感染性腹泻患者中诺如病毒的流行特征,为上海市诺如病毒感染性腹泻防控策略的制定提供科学依据。方法 在上海市22家监测点医院的肠道门诊中开展腹泻症状监测,收集患者人口学信息、流行病学资料和主要症状,同时采集患者粪便标本,送至医院所在区CDC检测诺如病毒,分析2013-2018年不同人群和季节的诺如病毒检出率,利用logistic回归分析探讨人群感染诺如病毒的影响因素。结果 在12 083例感染性腹泻患者中,诺如病毒阳性检出率为19.28%（2 330/12 083）,主要型别为GⅡ群（83.63%）。其中男性检出率（20.78%）高于女性（17.73%）,30~44岁组人群诺如病毒检出率最高（21.51%）,2015年检出率最高（23.60%）,以上差异均有统计学意义（P<0.05）。诺如病毒感染以10月至次年4月为高发季节。诺如病毒阳性患者以水样便居多（75.94%）,35.84%患者伴有呕吐症状。多因素logistic回归分析显示,男性、30~44岁组、干部职员、冬季及外出史是感染诺如病毒的危险因素。结论 上海市成年人腹泻患者诺如病毒感染率高,引起的感染性腹泻全年均可发生,冬、春季高发,在诺如病毒引发的感染性腹泻的防控工作中应针对不同年龄、性别、季节采取特异性防控措施。     

2015—2020年湖南省感染性腹泻病原学及分子流行病学特征分析

目的 了解湖南省感染性腹泻的病原谱,追踪其分子流行病学演变趋势,为感染性腹泻的综合防治提供科学依据。 方法 通过哨点监测结合暴发疫情监测的方法,收集2015—2020年湖南省感染性腹泻标本,对细菌病原采用细菌培养、生化鉴定进行检测;对病毒病原采用分子生物学方法进行分型鉴定,并对部分PCR阳性标本进行序列测定。 结果 哨点医院主动监测的总阳性率为35.61%,病毒检出率20.26%高于细菌检出率11.26%,混合病原感染检出率为4.09%。细菌病原谱以沙门菌O∶4群鼠伤寒型为主,病毒病原谱以轮状病毒A组G9P[8]型和诺如病毒GⅡ.4Sydney[P31]型感染为主。不同监测、不同年份的病原谱构成及其基因型变迁规律各不相同:哨点医院监测细菌阳性率低而病毒阳性率高时,诺如暴发疫情随之增加;暴发疫情中诺如病毒感染为86.78%,其中69.43%为GⅡ型感染,12.42%为GⅠ型感染,混合感染占3.03%。诺如病毒暴发疫情具有明显季节性,优势基因型为GⅡ.2[P16]占42.97%。 结论 2015—2020年湖南省感染性腹泻病毒类病原体高于细菌类,鼠伤寒沙门菌、A组轮状病毒G9P[8]和诺如病毒GⅡ.4 Sydney [P31]是最主要的病原体和优势血清/基因型;GⅡ.2 [P16]是诺如病毒暴发流行的优势基因型;通过连续哨点监测的数据支持,提前为暴发疫情做好了防控,促成了湖南省感染性腹泻发病率的平稳下降。     

江苏省一起胃肠炎暴发疫情中分离的诺如病毒基因特征分析

目的 分析江苏省一起胃肠炎暴发疫情中分离的诺如病毒基因特征。方法 对2016年12月16－27日江苏省一起急性胃肠炎暴发疫情中病例的肛拭子标本进行核酸提取,利用诺如病毒特异性引物对部分RNA依赖的RNA聚合酶序列及完整衣壳蛋白序列（VP1）进行RT-PCR扩增,扩增产物测序后进行基因特征分析。结果 序列比对结果显示,PCR产物在诺如病毒RNA依赖的RNA聚合酶区与GⅡ.g型别的西班牙株及芬兰株处于同一分支,同源性为98.7%,在VP1区与GⅡ.1型别的美国株同源性更高（99.4%）,初步推断为重组病毒。进一步通过重组分析软件Simplot分析,其可能重组位点在VP1的5 106位点,定位在ORF1/2交叠区。VP1氨基酸变异位点分析显示,其假定的抗原表位及受体结合表位均未出现变异,仅在132位氨基酸位点由N突变为S。结论 江苏省胃肠炎暴发疫情中分离的诺如病毒为GⅡ.g-GⅡ.1重组变异株。     

中山市诺如病毒感染暴发疫情特征分析

目的 分析2016-2019年广东省中山市诺如病毒感染暴发疫情流行特征,为防控诺如病毒提供参考.方法 通过国家突发公共卫生事件管理信息系统收集2016-2019年中山市诺如病毒感染暴发疫情现场调查资料,描述性分析诺如病毒感染暴发疫情的时间、地点和人群分布等流行特征.结果 2016-2019年中山市共报告诺如病毒感染暴发...     

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.     

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.     

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.     

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.     

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.