北京市首例基孔肯雅热病例流行病学调查

目的 调查北京市首例基孔肯雅热( Chikungunya fever,CHIKV)病例的感染来源.方法 通过对患者及其密切接触人员访谈,分析患者的感染来源.结合北京市病媒生物监测数据,分析北京市出现CHIKV流行的风险.结果 北京市首例CHIKV病例为印度境内感染的境外输入性病例.病媒生物监测数据显示,该病例在京期间北京市伊蚊密度较低,北京市不会出现由此病例引发的CHIKV暴发.结论 2008 - 2010年,北京亚优势蚊种—白纹伊蚊的构成比和蚊媒密度逐年增加,北京市应继续做好病媒生物监测,并加强CHIKV防控工作,降低CHIKV暴发的风险.     

基孔肯雅热的流行现况及其防治对策

基孔肯雅热（Chikungunya fever，CHIK）是由基孔肯雅病毒（Chikungunya virus，CHIKV）引起的一种急性传染病。本文针对基孔肯雅热的病原学、流行现况、诊断方法、防治对策等方面做一综述。     

不同年龄组基孔肯雅热患者的临床表现比较

目的分析不同年龄组基孔肯雅热患者的临床表现。方法 130例基孔肯雅热患者,按年龄分为三组：〈30岁、30～岁、≥60岁组,分析其临床症状的差异。结果三组患者均出现发热,皮疹的发生率分别为86.8%、91.4%、90.9%,关节痛的比例分别为86.8%、91.4%、95.5%,关节痛持续时间超过14d的比例分别为2.6%、30.0%、36.4%;与〈30岁组比较,30～岁和≥60岁组患者出现关节痛持续时间超过14d以及累及3个或以上关节的比例高,差异均有统计学意义（χ2=13.026,P=0.001;χ2=6.792,P=0.034）。结论基孔肯雅热主要表现为发热、皮疹、关节痛,中、老年组患者出现关节疼痛持续时间较长,累及的关节多。     

基孔肯雅病毒深圳分离株的全序列分析

目的了解基孔肯雅病毒SZ_20101028株的全基因组分子遗传特征。方法通过C6／36细胞从患者血清中分离得到CHIKV,针对病毒的基因组设计了6条特异性引物,对病毒的全基因组进行扩增,测序并通过生物信息学软件分析该病毒株的全基因组分子遗传特征。结果病毒SZ_20101028株的全基因组核苷酸序列长度为12377nt,含两个开放阅读框。编码3722个氨基酸,两个编码区之间含有68nt非编码连接区;发现该毒株与2010年引起东莞基孔肯雅热疫情暴发的病原体核苷酸的同源性达到了99％,进化树分析结果表明,SZ_20101028株与2010年引起东莞疫情暴发的病原体的亲缘性最高,并且和2004年引起印度洋地区疫情暴发流行的病原体同属于印度洋亚型。结论深圳市首例输人性基孔肯雅病毒属于印度洋亚型,与2010年引起东莞疫情暴发的病原体的亲缘性最高。     

一起诺如病毒感染性腹泻暴发疫情流行病学调查

目的了解一起诺如病毒感染性腹泻暴发的特点和流行原因，探讨暴发疫情调查处理的经验，为制定防治对策提供科学依据。方法对开平市月山镇一起诺如病毒暴发疫情用流行病学方法进行分析。结果该镇水井片11月25日至12月5日共发生感染性腹泻238例，罹患率4．18％；患者各年龄组均有发病，青壮年居多；患者大多呈腹泻、呕吐等胃肠炎症状，病情较轻；对搜索到的575户2347人进行发病聚集性分析，发现有明显的家庭聚集性；不同村委会发病差异有统计学意义。部分病人粪便标本经检测诺如病毒阳性。疫情经加强饮用水消毒、病人隔离治疗、开展爱国卫生运动和健康教育等综合措施后得到控制。结论本起暴发疫情由诺如病毒感染引起，供水系统受到一过性污染是引起水源性暴发的主要原因。加强饮用水的消毒与管理，开展健康教育是控制疫情的关键。     

湖南省首起输入性基孔肯雅热疫情的发现与病原学诊断

目的 确认湖南省首起输入性基孔肯雅热(Chikungunya fever, CHIK)疫情。方法 采集病例和同行人员的血清标本,采用实时荧光定量PCR方法进行登革病毒(Dengue virus, DENV)、黄热病毒(Yellow fever virus, YFV)、基孔肯雅病毒(Chikungunya virus, CHIKV)核酸检测,对核酸检测阳性病毒标本进行基因序列测定,对测序结果进行生物信息学分析,构建系统进化树。结果 病例血清标本CHIKV核酸阳性,5名同行人员中有1人血清标本CHIKV核酸阳性。基因序列Blast比对显示与CHIKV序列同源性>99%。系统进化树显示感染CHIKV属于ECSA基因型。结论 通过流行病学调查和病原学检测,确定了湖南省首起输入性CHIK疫情。     

深圳市某小学一起水痘暴发疫情的现场流行病学调查

目的调查深圳市某小学一起水痘疫情的流行特征,探讨其危险因素。方法按照病例定义搜索病例,描述疾病的三间分布并开展危险因素现场调查分析。结果 2012年11月30日至2013年1月9日共搜索到符合病例定义的病例22例,首例病例发病时间为11月15日,未隔离;疫情报告日期和发病高峰为11月30日;对新发病例严格执行隔离措施,末例病例为12月19日。17例病例为一年级（6）班学生,该班罹患率为33.3%（17/51）,另有4例其它班级病例与该班首发病例在同一午托室休息。一年级（6）班未接种组的罹患率为100%（4/4）,接种组为33.3%（13/39）,水痘疫苗的4年保护率为66.7%。结论未尽早隔离首发病例、及时报告是此次疫情的主要危险因素,及时发现新发病例、严格执行隔离措施可有效控制疫情。疫苗保护效果还需深入开展评价。     

一起学校水痘暴发的现场流行病学调查

目的核实疫情,确定J学校水痘暴发的存在并描述疫情三间分布特征和流行强度,探讨发病危险因素。方法按照病例定义,开展病例搜索,描述其三间分布后,结合现场流行病学调查情况,形成假设,再采用回顾性队列研究方法验证假设。结果 2009年3月1日至4月28日搜索到符合病例定义的病例共45例。首例病例于4月2日发病,全校分别于4月8日、16日、21～27日出现3个发病高峰。二（4）班和二（5）班罹患率最高,分别为33.3%和27.1%。45例病例均为学生,男生罹患率为7.2%,女生罹患率为4.8%。7～10岁组38人,占84.44%。在全校学生中乘坐校车者发生水痘的危险是不乘坐校车者的2.3倍（RR=2.36,95%CI=1.29～4.32）。按不同年级进行的Mantel-Haenszel分层分析表明：乘车与不乘车2个队列之间罹患率差异有统计学意义（χ2=4.32,P〈0.05）。结论根据病例临床表现、三间分布特征,确定J学校存在水痘暴发;年级不是混杂因素,乘坐校车会增加水痘发病的危险性。     

一起疑为杯状病毒腹泻暴发的流行病学调查

目的　调查四川省广安市感染性腹泻暴发的流行情况 ,分析发病原因。方法　采用随机抽样的方法对广安市经济技术开发区、广安区机关单位、居委会和农村进行感染性腹泻的流行病学调查。所采粪便标本进行常规检测和肠道致病菌培养 ,用PAGE、ELISA和RT PCR方法进行腹泻病毒病原检测。结果　在调查的 4 5 6 7人中 ,发病 94 2例 ,罹患率为 2 0 .6 3% ,无死亡病例。发病率农村高于城区 (χ2 =2 2 .2 9,P <0 .0 0 5 ) ,5月 10～ 2 5日为发病高峰。 2 6份标本中 ,ELISA方法检出 4份杯状病毒阳性 ,RT PCR方法确认 1例。结论　本次感染性腹泻暴发流行的病原可能为杯状病毒     

广州市白云区一起登革热局部爆发流行的新特点

目的分析白云区2010年一起登革热爆发的流行病学新特点,为制定登革热预防控制措施提供科学依据。方法对各医院报告的病例进行流行病学调查,采集病例血清以ELISA法进行登革热IgM/IgG抗体检测,使用布雷图指数（BI）进行蚊媒密度调查,在疫点周围开展病例搜索。结果本次疫情流行历时69d,从8月22日至10月29日。共发病19例,其中男8例,女11例;发病年龄最小16岁,最大82岁,以青壮年为主,20～39岁占42.11%。职业分布以家务待业、离退休人员、干部职工发病较高。19例病例主要分布在方圆500m范围内,实验室确诊12例,检测结果显示,单份IgM阳性的6例,单份IgG抗体阳性的1例,IgM/IgG抗体双阳的有12例。9-10月以来BI持续超5,最高达到41,BI平均数为13.8。结论本次登革热爆发疫情呈现流行时间长、范围大、连续散发的新特点,应引起重视。     

HLA class II allele polymorphism in an outbreak of chikungunya fever in Middle Andaman,India

A sudden upsurge of fever cases with joint pain was observed in the outpatient department, Community Health Centre, Rangat during July–August 2010 in Rangat Middle Andaman, India. The aetiological agent responsible for the outbreak was identified as chikungunya virus (CHIKV), by using RT‐PCR and IgM ELISA. The study investigated the association of polymorphisms in the human leucocyte antigen class II genes with susceptibility or protection against CHIKV. One hundred and one patients with clinical features suggestive of CHIKV infection and 104 healthy subjects were included in the study. DNA was extracted and typed for HLA‐DRB1 and DQB1 alleles. Based on the amino acid sequences of HLA‐DQB1 retrieved from the IMGT/HLA database, critical amino acid differences in the specific peptide‐binding pockets of HLA‐DQB1 molecules were investigated. The frequencies of HLA‐DRB1 alleles were not significantly different, whereas lower frequency of HLA‐DQB1*03:03 was observed in CHIKV patients compared with the control population [P = 0·001, corrected P = 0·024; odds ratio (OR)  = 0, 95% confidence interval (95% CI) 0·0–0·331; Peto's OR = 0·1317, 95% CI 0·0428–0·405). Significantly lower frequency of glutamic acid at position 86 of peptide‐binding pocket 1 coding HLA‐DQB1 genotypes was observed in CHIKV patients compared with healthy controls (P = 0·004, OR = 0·307, 95% CI 0·125–0·707). Computational binding predictions of CD4 epitopes of CHIKV by NetMHCII revealed that HLA‐DQ molecules are known to bind more CHIKV peptides than HLA‐DRB1 molecules. The results suggest that HLA‐DQB1 alleles and critical amino acid differences in the peptide‐binding pockets of HLA‐DQB1 alleles might have role in influencing infection and pathogenesis of CHIKV.     

The relationship between chikungunya virus and the kidneys: A scoping review

Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality. Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.     

An outbreak of hepatitis A in an institution for the mentally retarded

From December 1977 until April 1978 a hepatitis A outbreak occurred in an institution for the mentally retarded. The institution housed 311 residents and had a staff of 308. The outbreak was studied by enzyme-linked immunosorbent assays for hepatitis A antigen and antibodies, and by liver function tests in serum. When the investigations started, 13 residents and one staff member were ill and already seropositive; 34 of the 182 residents that were seronegative at that time and 12 of the 223 seronegative staff members subsequently developed disease. Out of the 60 cases 32 were asymptomatic; 19 cases with jaundice were seen. Normal human immunoglobulin was administered to a large part of the seronegative group, but the effect is difficult to interpret as the immunoglobulin was often given after the presumed time of infection and failed to protect. Elevated liver enzyme levels were demonstrated in 38 of 60 patients.     

Sandfly fever virus outbreak in Cyprus

A major outbreak of febrile syndrome occurred during 2002 among the Greek Army forces in Cyprus. Serological and molecular investigations revealed that the causative agent was a Sicilian-like phlebovirus. A virus strain was isolated from a blood sample taken on the first day of the disease. Phylogenetic analysis of partial L RNA segment sequences revealed that the strain from Cyprus differed from sandfly Sicilian virus by 6.7% at the nucleotide level.     

Epidemiological and molecular assessment of a rubella outbreak in North‐Eastern Italy

From January to June 2008, a rubella outbreak involving 111 laboratory confirmed cases occurred in the Friuli Venezia Giulia (FVG) region of North‐Eastern Italy. The outbreak occurred initially in two residential homes for young adults disabled mentally and physically. Subsequently, the epidemic spread to the general population. Young adult cohorts were mostly affected and the mean age of the patients was 26.8 years; the majority of cases were male (73.8%), with a mean age of 26.6 years in males and 27.4 in females. Three pregnant women had a primary infection and two had their pregnancies terminated. Genotyping of 16 isolates showed the circulation of RUBV 2B, a genotype originating from Asia and South Africa and now present in Europe. In addition, molecular analysis revealed a well defined space‐temporal spread of two viruses showing distinct sequences. A seroepidemiological survey carried out in a city within the same geographical area showed that the proportion of women of childbearing age still susceptible to rubella virus was 5.5%, fairly close to the figure (<5%) expected by 2010. J. Med. Virol. 82:1976–1982, 2010. © 2010 Wiley‐Liss, Inc.