重症监护病房内一起疑似疥疮暴发的调查与防治

目的 分析重症监护病房内一起疑似疥疮的流行规律、临床特征,为采取有效预防与控制措施提供科学依据. 方法 采取病例查阅和现场流行病学调查的方式,对疑似疥疮暴发的时间分布、空间分布及人群分布等特征进行分析. 结果 本次调查发现,2011年8月底至10月中旬在同一重症监护病房内发生3名患者和2名医务人员疑似感染了疥疮,5名医患人员皮疹部位及瘙痒特征相似,发病时间和地点集中,存在交叉感染的可能性.5名医患人员使用硫磺软膏全身涂搽2个疗程后,症状逐渐缓解或消失,治疗效果明显,并给予了疥疮相关知识的教育指导,使用药物治疗和采取消毒隔离等措施后暴发得到控制,再无新发病例. 结论 未能及时考虑感染疥疮的可能性是发生本次医院感染暴发的主要原因.医务人员要掌握疥疮发病的临床特点,早期识别并采取有效的消毒隔离措施,以防止医院感染暴发再次发生.     

Organisation of health care during an outbreak of Marburg haemorrhagic fever in the Democratic Republic of Congo, 1999

Organising health care was one of the tasks of the International Scientific and Technical Committee during the 1998-1999 outbreak in Durba/Watsa, in the north-eastern province (Province Orientale), Democratic Republic of Congo. With the logistical support of Médecins sans Frontières (MSF), two isolation units were created: one at the Durba Reference Health Centre and the other at the Okimo Hospital in Watsa. Between May 6th, the day the isolation unit was installed and May 19th, 15 patients were admitted to the Durba Health Centre. In only four of them were the diagnosis of Marburg haemorrhagic fever (MHF) confirmed by laboratory examination. Protective equipment was distributed to health care workers and family members caring for patients. Information about MHF, modes of transmission and the use of barrier nursing techniques was provided to health care workers and sterilisation procedures were reviewed. In contrast to Ebola outbreaks, there was little panic among health care workers and the general public in Durba and all health services remained operational.     

Seroprevalence of antibodies to pandemic (H1N1) 2009 influenza virus among health care workers in two general hospitals after first outbreak in Kobe, Japan

Objective

To assess the prevalence including asymptomatic infection, infection risk of exposure to patients, and effectiveness of personal protective equipment (PPE) among health care workers (HCWs) during the first pandemic (H1N1) 2009 (pH1N1) outbreak in Kobe, Japan in May 2009.

Methods

A cross-sectional seroepidemiological study was conducted on 268 HCWs in the two hospitals in Kobe to which all pH1N1 inpatients were directed. Participating HCWs completed a self-administrated questionnaire and provided a single serum sample which was analyzed using a hemagglutination-inhibition (HI) antibody test.

Results

Of 268 subjects, 14 (5.2%) were found to have positive antibodies to the pH1N1 by HI assay; only 1 reported a febrile episode. Among the 14 seropositive cases, 8 received chemoprophylaxis. 162 HCWs (60.4%) had been exposed to patients. The seropositive rate (SPR) for pH1N1 of the exposed group was higher than that of the unexposed group, however not statistically significant (6.8% vs. 3.1%, p = 0.197). There were no statistically significant differences in SPR for any PPE.

Conclusion

The SPR for pH1N1 in the exposed group was higher than that of the unexposed group in HCWs; however, most of these individuals were asymptomatic. There was no statistically significant association between PPE implementation and pH1N1 seropositivity.     

Impact of the coronavirus disease 2019 outbreak on the transportation of patients requiring emergency care

The first confirmed community transmission of coronavirus disease 2019 in Daegu Metropolitan City, South Korea, occurred on February 18, 2020. In the following 70-day period, approximately 6000 new cases occurred, severely impacting the medical service system. This study investigated the crisis-impact on the local emergency transport system.Emergency medical service activity reports were retrospectively reviewed to determine patient demographics and initial vital signs. Delay in reaching the patient, transporting the patient to the hospital, and returning to the fire station were assessed and categorized based on patients’ initial vital signs. The study period was divided into 4 groups (1/1–2/18, 2/19–3/3, 3/4–3/31, and 4/1–04/30) and intergroup differences were analyzed.When compared to Period 1, the time-difference between the request to attend a scene and arrival at the scene was delayed in Periods 2, 3, and 4 by 4 minute 58 s, 3  minute 24 seconds, and 2 minute 20 seconds, respectively; that between arriving at the scene and at the hospital was delayed by 7  minute 43 seconds, 6 minutes 59 seconds, and 4 minutes 30 seconds, respectively; and that between arriving at the hospital and returning to the fire station was delayed by 29  minute 3 second, 25  minute 55 second, and 18  minute 44 second, respectively. In Period 2, for patients with symptoms of severe illness when compared to patients lacking such symptoms, the time-difference between the request to attend the scene and arrival at a hospital and between arrival at the hospital and returning to the fire station were 6 to 23 minute and 12 to 48 minute longer, respectively. Most of the delays impacted patients with a fever. In terms of condition, the statistical effect size for delay in transport time was from large to small: fever, hypoxia, abnormal respiratory rate, respiratory symptom, and hypotension.Outbreaks of infectious disease cause a paradoxical state in emergency medical transport systems, inducing delays in the transport of severely ill patients. Therefore, maintenance and improvement of the medical service system for both patients with infectious disease and those with other severe illnesses is required.     

The use of oseltamivir during an influenza B outbreak in a chronic care hospital

Background Residents of nursing homes and long‐term care facilities are at a higher risk of outbreaks of influenza and of serious complications of influenza than those in the community. In late July 2005, a 90‐bed chronic care psycho‐geriatric hospital in Sydney, Australia, reported cases of influenza‐like illness (ILI) occurring amongst its residents. Methods An investigation to confirm the outbreak, and its cause, was undertaken. Influenza vaccination levels amongst residents, and the effects of antiviral drugs used for prevention and treatment, were assessed. Oseltamivir was only given to the residents, in the form of both treatment and prophylaxis. Results A total of 22 out of 89 residents met the clinical case definition of ILI with onset on or after 27 July 2005. This represents an attack rate of 25%. Oseltamivir was commenced on day 9 of the outbreak. Influenza B was identified in six residents as the causative agent of the outbreak. No deaths or acute hospitalization were recorded for this outbreak and there were no further reported cases after the introduction of oseltamivir. Vaccine effectiveness was 75% and the strain of influenza B isolated was well matched to that year’s vaccine. Conclusions There are few data on the use of oseltamivir in influenza B outbreaks. Early antiviral intervention appeared to curtail this outbreak of influenza B in a chronic care facility. We found high vaccine effectiveness in this frail, institutionalized population, highlighting the importance of influenza vaccination for residents of chronic care facilities.     

云南省一起群体旋毛虫感染调查报告

2008年4月云南省西双版纳州突发了一起群体性旋毛虫感染事件,共有26人患旋毛虫病,ELISA查旋毛虫抗体,24人阳性,患者均有进食生野猪肉史。患者口服阿苯哒唑驱虫,20～30mg/（kg·d）,7d后病例均痊愈。加强对农户的卫生宣教和自宰生猪的管理,提倡健康饮食习惯是杜绝此类公共卫生事件发生的重要措施。     

An outbreak of scalp white piedra in a Brazilian children day care

White piedra is a superficial mycosis caused by Trichosporon spp. that affects the hair shaft of any part of the body. It is presented an outbreak of scalp white piedra seen in 5.8% of the children frequenting a day care in Northeastern of S?o Paulo State, Brazil. Mycological exam and culture identified T. cutaneum in all five cases, and scanning electron microscopy of nodules around hair shaft infected by Trichosporon spp. is demonstrated comparing them with those of black piedra and with nits of Pediculous capitis.     

一起冬季内源性恶性疟家庭暴发的调查

本文报道了一起内源性恶性疟冬季家庭暴发疫情,夫妻二人同时发病,经镜检确诊为恶性疟,经静滴蒿甲醚和甘露醇,口服伯氨喹以及对症处理后,患者痊愈,镜检复查未见疟原虫。     

Conversational behavior in two health care institutions for the elderly

This article develops a perspective for studying conversational behavior in geriatric institutions. The discussion first considers why conversation is a theoretically significant focus for communications researchers concerned with the aged, and then the article presents data from ethnographic studies of two nursing facilities. Symbolic interactionism underlies the analyses discussed here, for it is suggested that conversations are a means by which interactants communicate about (and so, "construct") their social reality, their relative social statuses, etc. The importance of conversational (more broadly, communicational) behavior for staff-patient relationships in nursing homes is especially highlighted by the data, which were collected over a fifteen-month period.     

An outbreak of leptospirosis in Orissa, India: the importance of surveillance

OBJECTIVE: To demonstrate the importance of surveillance systems in detecting emerging diseases and highlighting the strengths and weaknesses of an existing one. METHODS: The Orissa multi-disease surveillance system (OMDSS) was introduced in November 1999. Reporting units from the periphery send data to the district on a weekly basis. These reports are analysed regularly. A district task force (DTF) was available to intervene in the event of an outbreak. The OMDSS detected an increasing number of cases with fever and jaundice in June 2002. The DTF investigated this outbreak using clinical, epidemiological and laboratory tools to identify its cause. RESULTS: This outbreak, in a remote corner of India, was detected within 4 days by an existing surveillance system. Action was initiated within 24 h, but it took approximately two more weeks for the causative agent to be diagnosed. A total of 143 people were suspected to have leptospirosis between 23 June 2002 and 31 July 2002. The attack rate was 5.95% and the case fatality ratio (CFR) was 7.69%, both lower than outbreaks reported elsewhere in India. While males were infected more often than females, the CFR was higher among females and among the 6-15 year age groups. Exposure to infected water in a canal was the probable cause of the outbreak. IgM antibodies were positive in 33 of the patients and six patients tested positive for PCR and culture. Leptospirosis interrogans serovar canicola, Leptospirosis interrogans serovar pomona and Leptospirosis interrogans serovar hebdomadis were isolated. CONCLUSIONS: Leptospirosis is a new disease in this region of India. This outbreak was detected and diagnosed because of the surveillance system. The prompt response helped in containing the outbreak early enough. However, the morbidity and mortality could have been further mitigated if the delays in transmitting information had been minimized. An adequate laboratory support would have also helped considerably. We conclude stressing the importance of surveillance as a public health tool.     

A hepatitis C outbreak preceded the HIV outbreak among persons who inject drugs in Athens,Greece: Insights from a mathematical modelling study

People who inject drugs (PWID) comprise one of the major transmission risk groups for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In 2011, Athens experienced a large HIV outbreak among PWID. Significant public health interventions were implemented in response to the HIV outbreak. The aims of this study were to estimate the indirect effects of the HIV interventions on HCV infection and to evaluate the concept of the association between HCV and HIV infections in the case of Athens. A dynamic, stochastic, individual‐based model was developed to simulate HCV transmission among PWID. We calibrated the model to reproduce the observed HCV prevalence among PWID in Greece. Two years prior to the HIV outbreak, an undetected HCV outbreak has occurred. In 2009, the incidence of HCV infection increased from 640 (495, 842) cases in 2008 to 1260 (1060, 1500). The mean time from initiation of injecting drug use to HCV acquisition decreased from 29 months in 2008 to 13 months in 2009. After HIV interventions, HCV incidence declined by 64.8% in 2012, compared to 2009. The averted HCV incidence cases attributed to the HIV‐implemented interventions were 2200 (1950, 2480), during 2012‐2015. The cumulative number incident HCV cases in Athens during 2002‐2015 was about 9900 (7800, 12 100). Our results highlight that before the 2011 HIV outbreak in Athens, an HCV outbreak occurred in 2009. Prevention measures for HIV that took place in the Athens metropolitan area in 2012 reduced significantly the incidence of HCV.     

内蒙古兴安盟发生在2011年的一起炭疽爆发疫情分析

目的 分析内蒙古兴安盟2011年一起炭疽爆发案例流行病学特征及感染原因,为预防炭疽疫情的发生提出有效的防控措施.方法 疫情资料来源于兴安盟爆发疫情个案调查和疾病监测信息报告管理系统.分析2011年8-9月兴安盟全部炭疽病例的发病情况、时间分布、地区分布、人群分布、病原学检查结果.炭疽诊断按《炭疽诊断标准》(WS 283-2008)进行.结果 疫情分布在兴安盟的4个旗(县)、11个乡(镇、苏木)、20个村(屯、嘎查).共报告炭疽病例55例,其中疑似皮肤炭疽43例,临床诊断7例,确诊7例,诊断与确诊病例不完全一致;死亡3例,治愈52例.在时间分布上,主要集中于8月28日至9月8日,占总报告病例数的72.73％(40/55).在性别分布上,男性发病居多(47例),男女比为5.88∶1.00.在年龄分布上,30～＜55岁病例居多,占总报告数的70.91％(39/55).在职业分布上,农民居多,占总报告数的85.45％(47/55).55例发病者均有屠宰病死家畜或接触病死畜肉及其制品史.病原学检查结果显示,55份血液样本炭疽杆菌分离培养全部为阴性;55份皮肤样本涂片染色炭疽杆菌阳性7份,从皮肤样本中分离出7株炭疽杆菌.结论 炭疽爆发主要以青壮年及农民为主,屠宰病死家畜或接触病死畜肉是感染的主要原因.有效防控措施是不宰杀、不食用病畜及不贩卖病死牲畜.     

西藏自治区墨脱县一起疟疾暴发疫情的调查分析

目的 对西藏自治区墨脱县达木乡珠村发生的一起内源性疟疾暴发疫情进行描述和分析,以明确此次疟疾暴发的病例分型、分布特征、流行程度和流行规律,为防治和消除疟疾提供科学依据.方法 通过回顾性调查收集病例及相关数据,采用描述性统计学分析方法,阐明此次疟疾疫情的三间分布特征,并对疫情定性;通过镜检确定病例分型,为及时规范治疗提供...     

An outbreak of peste des petits ruminants (PPR) in camels in the Sudan

In mid-August 2004, an outbreak of a previously unknown fatal disease of camels was reported to Kassala State veterinary authorities. Several areas in the state were visited during August-October 2004 to collect epidemiological data and specimens for diagnosis. Clinically the disease was characterized by sudden death of apparently healthy animals and yellowish and later bloody diarrhea and abortion. The disease outbreaks coincided with the seasonal movement of animals towards autumn green pasture. Death was always sudden and proceeded with colic and difficulty in respiration. Mortality rate ranged between 0% and 50% and vary in accordance with the area with a mean of 7.4%. More than 80% of deaths were in pregnant and recently-delivered she-camels. All age, sex and breed groups were affected but more than 50% of deaths were reported in adult animals in comparison to calves and young camels. The main post-mortem findings include lung congestion and consolidation, paleness and fragility of liver, enlarged lymph nodes and congestion and hemorrhage of small intestine and stomach. Agar gel diffusion test (AGDT), RT-PCR and virus isolation in cell culture gave positive results for peste des petits ruminants virus (PPRV), a virus belonging to the Morbillivirus, Genus, member of the family Paramyxoviridae. The effect of this new devastating disease on camel production in the affected area was discussed as well as proposals for future research.