农村慢性阻塞性肺疾病患者疾病负担研究

目的了解铜山县农村慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的疾病负担。方法直接经济负担分析,采用自制调查表,入户调查,并查阅患者病历、乡、村门诊日志和住院记录等;间接经济负担采用潜在寿命损失年进行评估。结果铜山县农村人口COPD直接经济负担为1090元,男女以及各年龄组间差异无统计学意义(P>0.05)。中青年组的住院费高于老年组(P<0.05),老年组的门诊费高于其他年龄组(P<0.05);间接经济负担为4327050元,患者人均间接经济负担为20605元。结论 COPD给农村人口和社会造成了沉重的经济负担,应制定相应策略以降低其所引起的经济负担。     

济南市学校流感监测与学生疾病负担调查

目的 监测学校流感流行特征并分析学生疾病负担情况,为指导学校流感防控提供科学依据.方法 在济南市天桥、历下、高新3座城市建成区建立学校流感监测哨点,进行流感样病例(ILI)监测及暴发疫情监测,并进行学生流感疾病负担问卷调查.采用描述性流行病学对流感样病例监测结果和问卷调查资料进行分析.结果 2019年第42周—2020...     

流感通用疫苗研发技术平台与研究进展

接种疫苗是预防流感最有效措施。然而, 由于流感病毒存在抗原漂移和/或抗原转换, 常常使疫苗毒株与流行毒株不匹配, 以至于目前流感疫苗提供的保护非常有限。随着疫苗新技术的快速发展, 具有广泛保护性或通用的流感疫苗受到极大关注。能够有效诱导针对流感病毒保守表位的体液免疫和细胞免疫, 提供针对流感病毒各种型或亚型的良好保护, 安全有效, 且具备快速生产平台, 是新一代通用型流感疫苗研发的理想目标。本文就流感通用疫苗研发技术平台与最新研究进展进行综述。     

2010年中国营养缺乏性疾病负担及20年间的变化规律

目的 分析我国2010年年龄别的营养缺乏性死亡与伤残的疾病负担及20年的变化规律.方法 利用2010年全球疾病负担(global burden of disease,GBD)研究对中国的估计,描述了中国分年龄组人群营养不良的疾病负担现状和20年的变化规律.主要指标包括死亡率、早死导致的生命损失年(years of life lost,YLL)、伤残导致寿命年损失(years lived with disability,YLD)及伤残调整寿命年(disability-adjusted life years,DALY).结果 中国营养缺乏性疾病导致死亡率及DALY率在过去的20年中呈明显下降趋势,尤其是青壮年人群DALY率下降趋势明显.＜5岁儿童及≥70岁老年人的营养缺乏性疾病死亡率仍值得关注,＜5岁年龄组缺铁性贫血的YLD率有所上升;≥70岁老年人的各种营养缺乏性疾病DALY率下降并不明显,缺碘与其他营养不良的DALY率有不同程度上升.结论 按年龄分组的疾病负担更能准确地反映不同营养缺乏造成的影响,可有针对性地提出防治措施.     

伤残调整生命年衡量尘肺患者疾病负担的初步研究

目的探讨尘肺病预防的经济效益和社会效益。方法调查住院尘肺患者的经济损失和伤残状况，使用伤残调整生命年(DALY)全面衡量患者的尘肺疾病负担，分析影响伤残调整生命年的有关因素，定量说明预防尘肺发生可避免的经济损失和健康寿命损失。结果DALY的主要影响因素为年龄、尘肺分期、伤残等级、尘肺并发结核4项因素。136人DALY损失平均为8．37个健康年，年平均直接经济损失为16595元，年平均总经济损失为56855元。结论预防尘肺发病是减少其疾病负担的关键。     

辽宁省农村地区2013年脑卒中早死所致的疾病负担分析

目的 了解辽宁省农村地区2013年脑卒中早死所致的疾病负担情况,为脑卒中的防治提供科学依据。方法 收集辽宁省彰武和凤城两地2013年全死因死亡数据和人口学数据,计算早死所致健康寿命年损失（years of life lost,YLLs）、每千人YLL（YLL率）、标化YLL率、平均每人的健康寿命年损失（average years of life lost,AYLLs）、标化AYLLs、YLL率随年龄的变化情况。结果 脑卒中YLL率随年龄呈上升趋势。男性脑卒中年龄标化的YLL率和AYLLs分别为17.1‰和11.1年/人,大于女性（12.0‰和10.0年/人）。在74岁之前各年龄段脑卒中YLL率男性大于女性,到75~84岁女性超过男性。出血性脑卒中YLL率和标化YLL率分别为7.7‰和5.9‰,小于缺血性脑卒中（8.6‰和6.6‰）,AYLLs和标化AYLLs大于缺血性脑卒中。59岁之前脑卒中YLL率出血性大于缺血性,60岁之后缺血性大于出血性。结论 辽宁省农村地区脑卒中早死所致的疾病负担沉重,且与性别,亚型,年龄均有所联系。农村地区急需开展脑卒中相关健康教育,并采取有针对性的防治措施减轻脑卒中早死所致的疾病负担。     

2004-2005年中国西部农村地区居民慢性阻塞性肺部疾病的死亡负担

目的 分析2004-2005年我国西部农村地区居民慢性阻塞性肺部疾病(COPD)的死亡负担.方法 COPD死亡及人口资料均来自2004-2005年全国第3次死因回顾抽样调查.其中,西部农村地区有42个监测县(区),覆盖西部12个省,调查人年数为28 621 276.根据调查收集的人口资料和死亡个案数据计算西部农村地区居民COPD的死亡率、潜在寿命损失年数(YPLL)率、潜在工作损失年数(WYPLL)率、COPD造成的YPLL率/全死因造成的YPLL率,与其他农村地区比较.标化死亡率、标化潜在工作损失年数(SYPLL)率、标化潜在工作损失年数(SWYPLL)率的计算以2000年人口为标准人口,以2004-2005年全国期望寿命为标准期望寿命.结果 西部农村地区居民年龄越大,COPD的粗死亡率、YPLL率水平越高;不同性别居民COPD的粗死亡率、YPLL率水平不同,男性YPLL率为15.47‰,女性为15.73‰.西部农村地区居民COPD的粗死亡率、YPLL率、WYPLL率、COPD造成的YPLL率/全死因造成的YPLL率均较高,分别为:109.53/10万、15.76‰、2.82‰、11.23%.西部农村经济落后地区COPD的粗死亡率、YPLL率、WYPLL率、COPD造成的YPLL率/全死因造成的YPLL率均是最高,分别为:122.04/10万、27.47‰、4.26‰、13.44%.结论 2004-2005年我国西部农村地区COPD的死亡负担比其他农村地区严重,且经济落后地区死亡负担较高.

Abstract：

Objective To study the death burden of chronic obstructive pulmonary diseases (COPD) in west rural areas of China in 2004-2005. Methods The data from 2004-2005 the Third National Mortality Retrospective Sampling Survey were used in the study. A total of 28 621 276 person years were investigated in west rural areas, which covered 12 provinces, and consisted of 42 surveillance districts. Based on the data of death cause and population, mortality of COPD, years of potential life lost (YPLL) rate,working YPLL(WYPLL) rate, YPLL rate due to COPD/YPLL rate due to all deaths in west rural areas were calculated and compared with other rural areas. Standardized death rate,standardized YPLL (SYPLL) rate,standardized working YPLL(SWYPLL) rate were calculated from census data in 2000 as standard population and 2004-2005 national life expectance as standard life expectance. Results The elder has the higher crude death rate and YPLL rate of COPD in survey districts of west rural areas. And the crude death rate of COPD and YPLL rate were different in different genders. The YPLL rate was 15.47‰ in male and 15.73‰ in female. The crude death rate, YPLL rate, WYPLL rate, the ratio of YPLL rate due to COPD/YPLL rate due to all deaths in survey districts of west rural areas were: 109. 53/100 000,15. 76‰,2. 82‰, 11. 23% ,which were high. While crude death rate, YPLL rate, WYPLL rate,the ratio of YPLL rate due to COPD/YPLL rate due to all deaths in the poorest survey districts of west rural areas were:122. 04/100 000,27.47‰, 4. 26‰, 13.44%, which were higher than other stratifications of west rural areas. Conclusion The death burden of COPD in west rural areas in 2004-2005 was the heaviest one in China which experienced the feature that the poorer the rural regions,the heavier the death burden.     

基于供方、需方、管理方视角下基层医务人员流感疫苗接种现状SWOT分析

目的分析基层医务人员流感疫苗接种工作现状, 发现问题并探索促进基层医务人员流感疫苗接种的策略与措施。方法于2021年4-5月开展关键知情人访谈及文献研究, 基于流感疫苗的供方(流感疫苗生产企业)、需方(基层医疗卫生机构及基层医务人员)和管理方(各级政府、卫生行政部门和疾病预防控制部门)三方视角, 采用优势、劣势、机会和威胁(SWOT)分析技术对基层医务人员流感疫苗接种工作现状进行综合评价, 并建立SWOT分析矩阵。结果基层医务人员流感疫苗接种工作的存在的优势和机会包括基层医疗卫生机构流感疫苗接种可及性强、流感疫苗安全性较高、新型冠状病毒肺炎疫情(新冠疫情)提高了公众预防呼吸道传染病的意识和流感疫苗企业生产积极性、新型冠状病毒疫苗(新冠疫苗)的接种增强了我国疫苗流通系统的能力等;也存在流感疫苗价格偏高、总量供应不足、基层医务人员流感疫苗接种意识不强、缺乏流感疫苗需求评估机制、疫苗调配不畅、疫苗供应地区结构性失衡、疫苗浪费问题严重等劣势和威胁。建立了基层医务人员流感疫苗接种现状SWOT分析矩阵, 形成了优势机会(SO)策略、优势威胁(ST)策略、劣势机会(WO)策略、劣势威胁(WT)策略。...     

流感及流感疫苗与心血管疾病的关系

流感是威胁全人类健康的重大公共卫生问题,具有传播范围广、发病率高、传播速度快的特点。心血管疾病等慢性病的患者患流感后会引起症状持续时间延长、并发症的发生及原发病的加重。我国心血管疾病的患病率逐年上升,心血管疾病的预防工作任重道远。大量研究显示流感是心血管不良事件发生的危险因素,接种流感疫苗可以降低心血管不良事件发生的风险。由于流感病毒的变异性、流感的季节性特点等不可控因素,对于流感与心血管疾病发生的关系及接种流感疫苗是否能够降低心血管不良事件的风险,目前仍存在较大争议。本综述汇总了国内外相关研究,旨在为心血管疾病的二级预防提供新的方向。     

湖南农村中小学生伤害流行特征与疾病负担研究

目的 了解湖南省农村中小学生伤害特征和疾病负担,为降低中小学生伤害的发生率和疾病负担提供科学依据.方法 采取整群抽样的方法,自编问卷时湖南省益阳和怀化2个地区333名农村中小学生伤害发生情况和疾病负担进行调查.结果 333名学生中,近1 a内发生过伤害的有247名,占74.2％,伤害发生总人次为753人次.最常见的3种伤害分别是跌伤(58.3％)、锐器伤(33.0％)和烫烧伤(31.5％),发生地点主要是家里(53.8％)、学校(19.5％)和街道田埂(14.2％),受伤部位主要是上肢(42.4％)、下肢(36.5％)和头颈部(11.7％).遭受伤害后,61.4％的学生未处理或仅自己处理,23.5％的学生美观有影响、活动长期受限或致残;遭受伤害后平均休息(1.18±3.00)d,平均缺课(0.37±1.09)d;76.0％的学生遭受伤害后无任何资金花费.结论 应有针对性地开展早期安全教育,改变家长和学生对伤害的态度,加强伤害的防范措施,将农村中小学生伤害带来的损失降到最低水平.     

Randomized,single-blind,active-controlled phase I clinical trial to evaluate the immunogenicity and safety of GC3114 (high-dose,quadrivalent influenza vaccine) in healthy adults

Influenza is a major medically attended respiratory illness. The impact of influenza on morbidity and mortality is particularly high in the elderly. Immunosenescence attenuates the immune response of influenza vaccine in the elderly. High-dose influenza vaccine contains 60 μg of hemagglutinin per strain, four times more compared with standard-dose (SD) influenza vaccine. This study is a phase I clinical trial investigating the immunogenicity and safety of the GC3114, high-dose, quadrivalent inactivated influenza vaccine (HD-QIV) in healthy adults aged 19–64 years during the 2017–2018 season. Seroprotection rates of HD-QIV were 100.0% for A/H1N1, 96.67% for A/H3N2, 83.33% for B/Yamagata, and 96.67% for B/Victoria. Seroconversion rate for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria strains were 86.67%, 90.0%, 53.33%, and 53.33%, respectively, in the HD-QIV group. The post-/pre-vaccination geometric mean titer ratio (GMTR) was 15.28 for A/H1N1, 8.19 for A/H3N2, 3.56 for B/Yamagata, and 3.03 for B/Victoria in the HD-QIV group. Seroconversion rate and post-/pre-vaccination GMTR for A/H3N2 were significantly higher in the HD-QIV group than in the SD-QIV group (control). No serious adverse events were reported. In conclusion, GC3114 was safe, well-tolerated, and immunogenic in healthy adults. Clinical Trials Identifier: NCT03357263.     

Immunogenicity and tolerability of a virosome influenza vaccine compared to split influenza vaccine in patients with sickle cell anemia

The immunogenicity and tolerability of virosome and of split influenza vaccines in patients with sickle cell anemia (SS) were evaluated. Ninety SS patients from 8 to 34 years old were randomly assigned to receive either virosome (n = 43) or split vaccine (n = 47). Two blood samples were collected, one before and one 4–6 weeks after vaccination. Antibodies against viral strains (2006) A/New Caledonia (H1N1), A/California (H3N2), B/Malaysia were determined using the hemagglutinin inhibition test. Post-vaccine reactions were recorded over 7 days. Seroconversion rates for H1N1, H3N2 and B were 65.1%, 60.4% and 83.7% for virosome vaccine, and 68.0%, 61.7% and 68.0% for split vaccine. Seroprotection rates for H1N1, H3N2 e B were 100%, 97.6% and 69.7% for virosome, and 97.8%, 97.8% and 76.6% for split vaccine. No severe adverse reactions were recorded. Virosome and split vaccines in patients with sickle cell anemia were equally immunogenic, with high seroconversion and seroprotection rates. Both vaccines were well tolerated.     

Incidence of medically attended influenza infection and cases averted by vaccination, 2011/2012 and 2012/2013 influenza seasons

BackgroundWe estimated the burden of outpatient influenza and cases prevented by vaccination during the 2011/2012 and 2012/2013 influenza seasons using data from the United States Influenza Vaccine Effectiveness (US Flu VE) Network.MethodsWe defined source populations of persons who could seek care for acute respiratory illness (ARI) at each of the five US Flu VE Network sites. We identified all members of the source population who were tested for influenza during US Flu VE influenza surveillance. Each influenza-positive subject received a sampling weight based on the proportion of source population members who were tested for influenza, stratified by site, age, and other factors. We used the sampling weights to estimate the cumulative incidence of medically attended influenza in the source populations. We estimated cases averted by vaccination using estimates of cumulative incidence, vaccine coverage, and vaccine effectiveness.ResultsCumulative incidence of medically attended influenza ranged from 0.8% to 2.8% across sites during 2011/2012 and from 2.6% to 6.5% during the 2012/2013 season. Stratified by age, incidence ranged from 1.2% among adults 50 years of age and older in 2011/2012 to 10.9% among children 6 months to 8 years of age in 2012/2013. Cases averted by vaccination ranged from 4 to 41 per 1000 vaccinees, depending on the study site and year.ConclusionsThe incidence of medically attended influenza varies greatly by year and even by geographic region within the same year. The number of cases averted by vaccination varies greatly based on overall incidence and on vaccine coverage.     

陕西省汉中市2003年农村脑卒中患者疾病负担的研究

目的了解陕西省汉中市农村人口脑卒中的疾病负担.方法采用全球疾病负担研究中的潜在寿命损失年、潜在工作损失年和潜在价值损失年等标准计算方法,分析汉中市农村人口脑卒中的疾病负担.结果汉中市农村人口因患脑卒中产生的PYLL为220.0 a,其中男性为130.0 a,女性为90.0a;平均减寿年数为6.1年,减寿率为2.93‰;WPYLL为140.0 a,其中男性82.5 a,女性57.5 a;VPYLL为-471 a,其中男性-278 a,女性-193 a;PEYLL为651.92 a,其中男性358.49 a,女性293.43 a.结论脑卒中对该农村人口造成了一定程度的疾病负担、220 a的潜在寿命损失、140 a社会生产价值时间的损失,对男性造成的损失大于女性.     

云南省农村居民四种主要慢性病的疾病经济负担研究

目的 分析云南省农村居民高血压、糖尿病、冠心病和脑卒中的疾病经济负担。方法 采用分层随机抽样方法于2015年1月～9月对云南省农村抽取的4 979名≥35岁居民进行问卷调查和体格检查,采用人力资本法结合伤残调整生命年（disability adjusted life years,DALY）估算四种慢性病的疾病经济负担。结果 云南省农村居民高血压、糖尿病、冠心病和脑卒中的患病率分别为35.3%、9.9%、3.8%和1.7%;DALY值分别为2.4/千人年、5.2/千人年、23.5/千人年和21.1/千人年,其中以冠心病的每千人口DALY值最高。四种慢性病的人均疾病经济负担分别为6 667.4元、9 126.1元、9 270.0元和16 187.2元,其中男性分别为7 093.8元、9 510.4元、12 060.9元和19 262.4元,女性分别为6 250.7元、8 554.9元、4 849.4元和9 030.6元;男性四种慢性病的人均疾病经济负担均高于女性（均有P<0.05）。四种慢性病的总疾病经济负担分别为108 185.2百万元、41 529.5百万元、16 192.0百万元和12 649.0百万元。结论 高血压、糖尿病、冠心病和脑卒中对云南省农村居民造成了沉重的经济负担,应采取相应措施降低其导致的疾病经济负担。     

广州市越秀区托幼机构流感样病例暴发疫情经济负担评估和流感疫苗卫生经济学评价

目的 对广州市越秀区学龄前儿童的流感经济负担进行评估,并针对流感疫苗开展卫生经济学评价,为制定免疫规划策略提供依据。方法 以广州市越秀区托幼机构2019年1—6月发生的9起流感样病例暴发疫情的患病儿童为研究对象,采用问卷调查的方式开展经济负担评估,并以其中1起暴发疫情为基础建立SEIAR动力学模型,模拟不同接种策略下的疫情趋势,评价其经济学效益。结果 患病儿童总经济负担人均1 293.56（95% UI:1 096.23~1 592.84）元,其中直接医疗费用人均422.56（95% UI:320.71~555.29）元,直接非医疗费用人均125.95（95% UI:82.41~188.80）元,间接经济损失人均797.03（95% UI:661.50~938.76）元。在流行季前接种1剂次三价流感疫苗,每投入226.19元,可减少1例流感病例,每投入1元,可获得5.72元效益;接种2剂次三价流感疫苗,每投入178.77元,可减少1例流感病例,每投入1元,可获得7.24元效益;接种四价流感疫苗,每投入315.83元,可减少1例流感病例,每投入1元,可获得4.10元效益。结论 广州市越秀区托幼机构流感样病例暴发疫情经济负担较高,如在流行季前接种2剂次三价流感疫苗,可以获得正效益和最好的效益成本比。     

Efficacy and immunogenicity of high-dose influenza vaccine in older adults by age,comorbidities, and frailty

BackgroundA randomized trial demonstrated that a high-dose inactivated influenza vaccine (IIV-HD) was 24.2% more efficacious than a standard-dose vaccine (IIV-SD) against laboratory-confirmed influenza illness in adults ≥65 years. To evaluate the consistency of IIV-HD benefits, supplemental analyses explored efficacy and immunogenicity by baseline characteristics of special interest.MethodsDouble-blind, randomized, active-controlled, multicenter trial. Adults ≥65 years were randomized 1:1 to receive IIV-HD or IIV-SD and followed for 6–8 months postvaccination for the occurrence of influenza. One third of participants were randomly selected to provide sera for measurement of hemagglutination inhibition antibody (HAI) titers. Efficacy (IIV-HD vs. IIV-SD) against laboratory-confirmed, protocol-defined influenza-like illness (PD-ILI) and HAI geometric mean titer (GMT) ratios (IIV-HD/IIV-SD) were evaluated by age, and number of high-risk comorbid and frailty conditions.ResultsEfficacy (95% confidence intervals) of IIV-HD relative to IIV-SD against laboratory-confirmed PD-ILI was 19.7% (0.4%; 35.4%) for participants 65–74 years, 32.4% (8.1%; 50.6%) for those ≥75 years, 22.1% (3.9%; 37.0%) for participants with ≥1 high-risk comorbidity, 23.6% (−3.2%; 43.6%) for those with ≥2 high-risk comorbidities, 27.5% (0.4%; 47.4%) for persons with 1 frailty condition, 23.9% (−9.0%; 47.2%) for those with 2 frailty conditions, and 16.0% (−16.3%; 39.4%) for those with ≥3 frailty conditions. There was no evidence of vaccine efficacy heterogeneity within age, comorbidity, and frailty strata (P-values 0.351, 0.875, and 0.838, respectively). HAI GMT ratios were significantly higher among IIV-HD recipients for all strains and across all subgroups.ConclusionsEstimates of relative efficacy consistently favored IIV-HD over IIV-SD. There was no significant evidence that baseline age, comorbidity, or frailty modified the efficacy of IIV-HD relative to IIV-SD. IIV-HD significantly improved HAI responses for all strains and in all subgroups. IIV-HD is likely to provide benefits beyond IIV-SD for adults ≥65 years, irrespective of age and presence of comorbid or frailty conditions.     

流行性感冒裂解疫苗安尔来福在婴幼儿及儿童中应用的安全性观察

目的 进一步考察流感裂解疫苗安尔来福在6个月至3岁内婴幼儿及3～11岁儿童中应用的安全性,发现新药临床试验中可能未发现的不良反应.方法 本试验采用开放式临床试验设计,受试者为6个月至3岁以内婴幼儿和3～11岁儿童各100名,婴幼儿组使用剂量为0.25 ml/支,免疫程序为0、28 d.儿童组使用剂量为0.5 ml/支,免疫程序为1针.接种后进行30 min即时反应观察,以及进行24、48、72 h随访观察,接种后第7天如受试者未主动报告任何不良事件,将结束随访观察.结果 接种疫苗后总体不良反应发生率为6.0%(12/200),其中局部不良反应发生率为1.0%(2/200),全身不良反应发生率为5.5%(10/200),幼儿组和儿童组不良反应发生率分别为8.0%(8/100)和4.0%(4/100),均为轻度和中度反应,未见严重不良反应发生.结论 流感裂解疫苗安尔来福在6个月至3岁以内婴幼儿及3～11岁儿童中应用安全性良好.     

广州市诺如病毒感染性胃肠炎疾病负担评估

目的 对广州市诺如病毒感染性胃肠炎的疾病负担进行评估,为政府制定传染性胃肠炎和食源性疾病管理决策和控制措施提供科学依据。方法 分别评估广州市诺如病毒感染性胃肠炎散发和暴发部分的疾病负担,评估指标包括伤残调整生命年、发病率、住院率、罹患率等,数据主要来源于监测医院、历史文献资料以及“突发公共卫生事件管理信息系统”中的相关数据。结果 2014年广州市腹泻总病例数约为3 092 230人次,其中由诺如病毒感染所引起的腹泻病例数约为608 860人次。广州市2014年诺如病毒感染性胃肠炎年发病率为4 655/10万,住院率为0.03%,共发生暴发疫情6起,病例942例,平均罹患率为2.63%。综合散发与暴发数据,广州市2014年诺如病毒感染性胃肠炎的疾病负担为2 212 DALYs。结论 广州市诺如病毒感染性胃肠炎疾病负担较高,相关卫生部门应重视并加强对诺如病毒感染性胃肠炎的预防、控制管理以及教育宣传,开展针对性防控。