美国针对A类生物恐怖剂的医学防护技术研究进展

美国"炭疽事件"充分说明了生物恐怖威胁的现实性,同时也刺激了美国科技界对生物恐怖防护技术的研究.此文就美国针对A类生物恐怖剂预防和治疗相关技术的研究进展作了综述.     

美国CDC针对炭疽生物恐怖事件的应急处理措施

2001年10月,有人故意在美国散布炭疽杆菌,为应对这一政治事件并答复其他国家关于处理炭疽生物恐怖事件的咨询,美国疾病预防控制中心(CDC)成立了一支由内科医生、微生物学家、流行病学家和其他从事国际事务及传染病方面的公共卫生官员组成的国际援助队伍,并开展了工作。 2001年10月12日至2002年1月2日,该支队伍通过电话和Email提供全天24小时的咨询和技术支持。发布针对炭疽和生物恐怖应急准备情况的电子文件,并与世界卫生组织(WHO)及其区域办公室交流信息。求助的问题可分成4类:实验室问题;一般生物恐怖信息;环境和职业危害;生物恐怖应急情况处理。     

炭疽攻击对人类的威胁及防御策略

生物恐怖由来己久，最近美国炭疽事件引发的恐慌己波及世界。本文主要从生物攻击的角度分析了炭疽的生物学特性及其在生物武器中的地位对人类的威胁；简述了炭粗的感染类型及传播机制和防制措施，以及疫苗在抵御炭疽性生物恐怖活动中的作用和局限性，并宏观地指出遏制生物恐怖活动威胁的4个重要策略。     

炭疽生物袭击的防治措施及对策

最近,美国等许多国家相继发生通过邮件进行炭疽生物袭击事件。据不完全统计,自10月5日佛罗里达州美国媒体公司下属《太阳报》的一位编辑死于吸入性炭疽病后,到美国国会参议院多数党领袖马斯·达施勒于17日在国会主楼外告诉媒体,在他的办公室已有31人在呼吸道内检测出了炭疽杆菌为止,美国已经发现至少有45例炭疽感染者或携带者。美国卫生与公众服务部长汤普森于10月14日在华盛顿接受福克斯新闻台采访时称其为“生物恐怖”。这是人类遭受生物袭击后,首次公开承认面对的是“生物恐怖”。     

美国炭疽的流行现状及进展

炭疽是人畜共患的急性传染病,曾对人类健康造成极大的威胁和危害。由于动物疫苗接种和卫生条件改善,人类炭疽的发病率明显下降,但作为生物武器的潜在威胁仍然存在,并已在局部地区成为现实,应引起高度的重视。本文结合自然感染的炭疽流行病学历史,重点介绍美国炭疽的流行现状及生物恐怖相关炭疽的特点和防治措施。     

美国炭疽的流行现状及发展

炭疽是人畜共患的急性传染病,曾对人类健康造成极大的威胁和危害。由于动物疫苗接种和卫生条件改善,人类炭疽的发病率明显下降,但作为生物武器的潜在威胁仍然存在,并已在局部地区成为现实,应引起高度的重视。本文结合自然感染的炭疽流行病学历史,重点介绍美国炭疽的流行现状及生物恐怖相关炭疽的特点和防治措施。     

生物恐怖的威胁及其对策

20 0 1年 9月 1 1日美国遭遇恐怖袭击 ,一年多以来美国民众除一直沉浸在恐慌和哀伤之中外 ,还时时处于面临邮件炭疽袭击的危险中。生物恐怖袭击已经成为世界各国无法回避的问题。目前 ,有关生物性攻击的威胁以及可能造成的灾难和人类将面临何种生物威胁都成为国家安全与公共卫生关注的焦点。图 1　美国国防部网站展示的炭疽显微图1　什么是生物恐怖 ?生物恐怖是使用致病性微生物或毒素等作为恐怖袭击武器 ,通过一定的途径散布致病性细菌、病毒 ,造成烈性传染病的爆发、流行 ,导致人群失能和死亡 ,引发社会动荡。其使用方式包括散布细菌气溶…     

生物恐怖应对的健康教育研究进展

美国“9·11”事件及邮件炭疽袭击事件发生以来,生物恐怖活动受到人们的高度重视。各国政府正在加紧采取措施,防范生物恐怖事件的发生。 生物恐怖(bioterrorism)是使用致病性微生物或毒素等作为恐怖袭击武器,通过一定的途径散布致病性细菌、病毒,造成烈性传染病的暴发、流行,导致人群失能和死亡,引发社会动荡。由于生物恐怖技术含量低、隐蔽性强、威胁性大,一旦发生,后果极为严重[1]。     

流行病学理论与疾病控制实践相结合的教学模式

随着 2 1世纪疾病谱和死亡谱的变化 ,公共卫生领域正面临着巨大的挑战 ,其中主导学科——流行病学 ,在疾病的预防控制中担负着重要的角色。国内外绝大多数传染病、原因不明和突发性公共卫生事件的调查处理 ,都离不开流行病学工作者的参与。自“9.1 1”恐怖袭击事件以来 ,美国境内出现与生物恐怖有关的炭疽 ,并由此展开防范生物恐怖炭疽的现场流行病学研究工作[1 ] 。这些活动加速了流行病学这门应用学科日益渗透到疾病控制工作的各个领域 ,也向教育工作者提出如何向社会输送实用型人才的任务。联合国教科文组织指出 :教育既应提供一个复杂的…     

生物恐怖的出现与应对措施

进入新世纪的第一年 ,就发生了震惊世界的美国“9·11恐怖袭击事件”。当多数美国人还在惊魂未定之际 ,又自 10月 5日开始陆续发生了由于邮递白色粉末而引发的一系列所谓“炭疽事件”或“炭疽恐怖” ,而且波及佛罗里达、纽约及新泽西等地 ,从而使美国朝野上下再次陷入一场新的惊恐中 ,所谓“生物恐怖 (ｂｉｏ ｌｏｇｉｃａｌｔｅｒｒｏｒｉｓｍ)”一词也就应运而生。回顾历史 ,帝国主义者以包括炭疽杆菌在内的病原微生物作为战剂(即所谓生物战剂 ) ,在交战对方的军队、居民及牲畜中进行人工瘟疫的所谓“生物战 (ｂｉｏｌｏｇｉｃａｌｗａｒ…     

2018年四川省红原县1起炭疽暴发疫情调查分析

目的分析炭疽疫情调查和处置过程,为今后炭疽疫情处置提供经验和参考。方法对疫情数据、现场调查信息及处置措施进行流行病学分析和统计描述。结果此次疫情共报告7例炭疽病例,其中肠炭疽5例,皮肤炭疽2例,死亡2例。所有病例均为炭疽疫区常住居民,其中3例肠炭疽有病死牛(马)肉类食用史,2例肠炭疽感染途径不详,2例皮肤炭疽有病死牛(马)畜接触史。2例死亡病例在基层医疗机构未被及时正确诊断。经采取流行病学调查、疫点处置、病例治疗、健康教育等措施,疫情得到及时控制。结论牧民接触、食用病死牛(马)是感染炭疽的主要途径,牧区基层医疗机构对该类疾病的诊断意识较弱。建议加大牧民炭疽健康教育力度,提高牧民健康防病意识;加大基层医疗机构炭疽病例的诊断治疗技术的培训力度,提高基层医疗机构炭疽病例早期识别能力。     

Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults

The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis.     

2005-2011年甘肃省炭疽流行病学分析

目的 分析甘肃省近年炭疽流行病学特征,为制定防制策略提供科学依据.方法 对甘肃2005-2011年炭疽疫情报告情况及相关资料进行回顾性分析.结果 7年来甘肃省每年均有炭疽病例发生,累计报告发病306例,发病率在0.07/10万～0.25/10万之间波动,年平均发病率为0.17/10万;具有一定的地域性特征,主要发病在牧区,甘南州发病率最高(4.88/10万);发病季节多见于夏秋季的6-9月,占总发病数的54.58％;男性(67.65％)多于女性(32.35％),年龄以青壮年为主;以皮肤型炭疽最为多见,占98.37％.结论 甘肃省仍然是我国炭疽高发省份之一;认真做好炭疽防治知识的宣传教育工作,加强相关部门间合作,及时发现并处理疫情是防治本病的重要措施.     

Anthrax vaccination in the Millennium Cohort: validation and measures of health

BACKGROUND: In 1998, the United States Department of Defense initiated the Anthrax Vaccine Immunization Program. Concerns about vaccine-related adverse health effects followed, prompting several studies. Although some studies used self-reported vaccination data, the reliability of such data has not been established. The purpose of this study was to compare self-reported anthrax vaccination to electronic vaccine records among a large military cohort and to evaluate the relationship between vaccine history and health outcome data. METHODS: Between September 2005 and February 2006 self-reported anthrax vaccination was compared to electronic records for 67,018 participants enrolled in the Millennium Cohort Study between 2001 and 2003 using kappa statistics. Multivariable modeling investigated vaccination concordance as it pertains to subjective health (functional status) and objective health (hospitalization) metrics. RESULTS: Greater than substantial agreement (kappa=0.80) was found between self-report and electronic recording of anthrax vaccination. Of all participants with electronic documentation of anthrax vaccination, 98% self-reported being vaccinated; and of all participants with no electronic record of vaccination, 90% self-reported not receiving a vaccination. There were no differences between vaccinated and unvaccinated participants in overall measures of health. Only the subset of participants who self-reported anthrax vaccination, but had no electronic confirmation, differed from others in the cohort, with consistently lower measures of health as indicated by Medical Outcomes Study 36-Item Short Form Health Survey for Veterans (SF-36V) scores. CONCLUSIONS: These results indicate that military members accurately recall their anthrax vaccinations. Results also suggest that anthrax vaccination among Millennium Cohort participants is not associated with self-reported health problems or broad measures of health problems severe enough to require hospitalization. Service members who self-report vaccination with no electronic documentation of vaccination, however, report lower measures of physical and mental health and deserve further research.     

2009-2013年内蒙古炭疽流行病学特征分析

摘要:目的　分析2009-2013年内蒙古自治区炭疽流行病学特征,为预防和控制该病提供参考依据。方法　收集2009-2013年炭疽疫情资料,采用描述性流行病学方法,对其进行分析。结果　炭疽发病呈现老疫区反复不断,多以散发为主,偶有暴发。东部地区发病高于西部地区,有向西部地区蔓延趋势。男性多于女性,分别占80.73%和19.24%。农、牧民为主要发病群体。发病主要集中在30～59岁人群。结论　2009-2013年内蒙古炭疽发病呈现老疫区反复不断,主要集中在夏秋季节;年龄、性别、职业存在差异,主要分布在东部农牧区。畜牧部门和卫生部门应建立协作机制,加强防治工作,使危害降到最低水平,防止疫区的扩大。     

我国炭疽的流行动态及其相关影响因素研究

通过分析2005—2021年河北省承德市炭疽疫情流行特征,为制定该市炭疽防治对策、降低发病率提供参考依据。

收集以往承德市炭疽疫情资料,整理分析数据,对流行病学特征进行描述性分析。

2005—2021年承德市共报告炭疽病例11例,无死亡病例,平均发病率为0.08/10万,总体保持在低发水平。临床分型中皮肤炭疽10例、肺炭疽1例。病例主要集中在围场县,占报告病例总数的90.91%,其次在平泉市。发病时间集中在每年的7、8月,病例年龄以30~59岁为主,男女性别比为2.67∶1。

近年来承德市炭疽疫情呈上升趋势,夏季是高发季节,农村多发,以男性青壮年农民为高发人群。须强化疫情监测,加强健康教育,提升防病能力,及时发现疫情并积极应对处置。

     

Anthrax in eastern Turkey, 1992-2004

We investigated animal and human anthrax cases during a 13-year period in eastern Turkey. From 1992 to 2004, a total of 464 animal and 503 human anthrax cases were detected. Most cases occurred in summer. Anthrax remains a health problem in eastern Turkey, and preventive measures should be taken.     

1958-2010年阿坝州炭疽流行状况分析

目的分析阿坝州1958-2010年炭疽发病情况,找出发病规律和特点,探讨有效降低炭疽病发病的措施和方法。方法对53年来的炭疽疫情数据进行流行病学分析。结果 53年来累计报告炭疽病例1 349例,死亡21例,年均发病率3.47/10万、死亡率0.06/10万。全年均有病例报告,但集中在4～10月,3个牧区县的发病占报告总数的89.03%;职业以牧民为主,发病年龄集中在20～44岁。1958-2001年发病率在0.8/10万～2.52/10万之间,2002-2010年发病率在6.33/10万～12.66/10万之间。结论阿坝州1958-2001年炭疽发病较平稳,2002年起发病呈逐年上升趋势,且发病主要在牧区,应加强健康教育和畜牧业管理,做好疫点、外环境消毒和预防接种,有效控制牧区炭疽流行。     

Occupational health guidelines for remediation workers at Bacillus anthracis-contaminated sites--United States, 2001-2002

Despite the apparently low disease rate from exposure, protection for remediation workers at B. anthracis-contaminated sites is warranted because inhalational anthrax is rapidly progressive and highly fatal, PPE does not guarantee 100% protection, and the risk for developing disease cannot be characterized adequately. The guidelines described here go beyond HAZWOPER requirements and include recommendations for treating inhalation exposure to B. anthracis spores as a medical emergency, medical follow-up as long as the risk for anthrax persists or a worker is receiving antibiotic prophylaxis, accommodation of a mobile workforce, and assurance that workers understand the need for immediate medical attention should symptoms of anthrax occur. Completion of the 6-dose series of anthrax vaccine followed by annual booster doses will decrease the reliance on antibiotics for the prevention of anthrax. Measures to protect workers must include both medical measures (i.e., vaccination, antibiotic prophylaxis, or a combination of both) and measures to prevent exposure (e.g., PPE and environmental controls).     

The dissemination of anthrax from imported wool: Kidderminster 1900-14

Background: A century ago anthrax was a continuing health risk in the town of Kidderminster. The distribution of cases in people and in animals provides an indication of the routes by which spores were disseminated. The response to these cases provides an insight into attitudes to an occupational and environmental risk at the time and can be compared with responses in more recent times.

Aims: To assess the distribution of anthrax cases associated with the use of contaminated wool and to review the response to them.

Methods: The area studied was Kidderminster, Worcestershire, England, from 1900 to 1914. Data sources were national records of the Factory Inspectorate and local records from the infirmary, Medical Officer of Health and inquest reports, and county agricultural records, supplemented by contemporary and later review articles. Case reports and summary data were analysed, and discussions and actions taken to improve precautions reviewed.

Results: There were 36 cases of anthrax, with five deaths, one of which was the sole case of the internal form of the disease. Cases of cutaneous anthrax were most frequently found in those handling raw wool, but they also occurred in workers at later stages of the spinning process and in people with little or no recorded exposure to contaminated wool. Limited precautionary measures were in place at the start of the study period. Some improvements were made, especially in the treatment of infections, but wool with a high risk of anthrax contamination continued to be used and cases continued to arise. Major changes were made to the disposal of waste and to agricultural practice in contaminated areas to curtail outbreaks in farm animals.

Conclusions: The introduction of anthrax as a contaminant of imported wool led not only to cases in the highly exposed groups of workers but also to cases in other members of the population and in farm animals. The measures taken during the study period reduced fatalities from cutaneous anthrax but did not eliminate the disease. Public concern about the cases was muted.