沈阳市人感染H7N9禽流感病例调查及外环境监测

目的了解沈阳市人感染H7N9禽流感流行病学特征及外环境病毒污染情况,为防控H7N9禽流感疫情提供科学依据。方法采用现场流行病学调查方法与描述性流行病学方法,分析2016～2017年沈阳市3例人感染H7N9禽流感确诊本地病例的流行病学相关资料;采集外环境样本313份,应用实时荧光定量PCR(Real-time PCR)方法检测样本中的H7N9禽流感病毒核酸。结果沈阳市发现的3例本地病例发病前均无外出史,为本地感染。从暴露史来看,病例发病前均有活禽接触史,并且在暴露的313份禽类外环境中检测到H5、H7、H9禽源性流感病毒核酸,其中检出H7流感病毒3份,阳性率为0.96%。3例病例入院前均有发热症状,无特异性临床表现,患者在确诊前院外治疗时间较长,最后发展为呼吸衰竭及急性呼吸窘迫综合征(ARDS)而死亡。采集密切接触者咽拭子160份标本,未检出H7N9禽流感。提示该病毒的人传人能力有限。由于防控措施及时有效,疫情未发生进一步扩散。结论暴露于活禽市场或接触活禽、在暴露的禽类外环境中检测到禽源性流感病毒核酸是人感染H7N9禽流感病毒的危险因素。     

2013年崇左市流行性感冒实验室检测结果分析

目的对崇左市2013年流行性感冒(流感)实验室控检测结果进行分析,了解2013年崇左市流感病原学特征,为实验室诊断流感提供参考。方法采集2013年崇左市人民医院及各地送检的流感样病例咽拭子标本912份,应用实时反转录聚合酶链反应(real time RT-PCR)技术检测样本中的AM、BNS、H1HA、H3HA、SWH1 HA、H5HA、H9HA、H7HA、N9NA基因。结果 912份标本中,检测到乙型流感病毒核酸阳性19份,季节性流感病毒H1亚型核酸阳性0份,季节性流感病毒H3亚型阳性4份,甲型H1N1病毒特异性基因片段阳性58份,季性性H3和甲型H1N1流感病毒核酸同时阳性1份,均未检测到人感染高致病性禽流感中的H5HA、H9HA、H7HA、N9NA基因。甲型H1N1的检出率较高为6.36%(58/912),阳性构成比为70.73%。乙型流感病毒核酸阳性率为2.08%(19/912),季节性H1流感病毒阳性率为0.00%(0/912),季节性H3流感病毒阳性率为0.44%(4/912),季性性H3和甲型H1N1流感病毒核酸同时阳性率为0.11%(1/912)。均未检测出人感染H5,H9,H7N9禽流感病毒。结论甲型H1N1仍是2013年崇左市流感的主要毒株类型,流行趋势以散发为主,较2009年大暴发流行有所下降。     

浙江省首例人感染H7N9禽流感病例的实验室检测与分析

目的 通过对杭州市萧山区1例疑似人感染禽流感病人咽拭子和鼻腔冲洗液样本进行检测和分析,加深对A型流感病毒抗原变异特性的认识,进一步提高实验室相应的检测能力.方法 以实时荧光定量PCR(real-time PCR)检测流感病毒核酸,对未能分型的HA、NA和M基因通过逆转录PCR(RT-PCR)扩增而后克隆测定;同时接种狗肾细胞(MDCK)进行病毒培养.结果 样本A型流感病毒核酸检测为阳性,但未能分型;HA、NA、M基因测序结果表明与禽源H7、N9、M基因相似性最高;同时A型流感病毒培养也呈阳性.结论 经过浙江省CDC与中国CDC证实,该患者感染H7N9禽流感病毒,为浙江省首个病例.     

赣州市首例人感染 H7N9 禽流感病例的检测报告

摘要:目的　监测赣州市的H7N9禽流感疫情,为该市流感疫情的判定及制定防控措施提供依据。方法　从国家级流感病毒哨点监测医院中采集疑似流感样病例监测标本,用荧光PCR方法检测流感病毒各型核酸片段。结果　在日常监测标本中检出一份H7N9禽流感病毒核酸片段阳性标本。结论　在日常流感病毒监测中检出赣州市首例H7N9禽流感病例。     

合肥市1例同病房密切接触者确诊人感染H7N9禽流感调查

目的分析安徽省合肥市1例同病房密切接触者人感染H7N9禽流感病例的流行病学特征,为制定人感染H7N9禽流感病毒相关防控措施提供参考依据。方法对安徽省合肥市1例同病房密切接触者进行流行病学调查,并采集呼吸道及血液标本应用逆转录聚合酶链反应(RT-PCR)方法检测H7N9病毒核酸。结果病例谷某于2016年12月22日确诊为人感染H7N9禽流感病例,无明显禽类接触史;12月18日该病例曾密切接触同病房闫某,后闫某确诊为H7N9禽流感病例且死亡;2人病毒核酸检测均为同种同源禽流感病毒核酸阳性;除闫某外,其他与谷某密切接触者均未出现人感染H7N9禽流感病毒症状。结论谷某可能为一起医院内感染疫情的续发病例,人传人的可能性大,但单传染力有限,非持续。     

思明区人感染H7N9禽流感流行特征及防控

目的分析厦门市思明区10例人感染H7N9禽流感的流行特征及防控效果,为制定防控措施提供依据。方法对2014年12月至2015年1月发生的10例人感染H7N9禽流感确诊病例进行描述流行病学分析。对活禽市场休市前后的外环境标本调查结果进行比较,评价防控效果。结果 10例感染病例(男9女1)中,9例有禽鸟类或活禽市场接触史,除1例密切接触者外,均为临床报告;9例重症(男8女1),50岁7例,BMI指数25的7例;治愈7例,死亡3例,病死率30.0%。采取休市措施前,患者周边活禽市场外环境样本H7N9禽流感病毒核酸阳性率12.5%,全区外环境标本阳性率14.5%;采取措施后,检测环境样本阳性率下降。结论思明区H7N9流感病毒主要通过禽-人传播,开展活禽市场休市措施可有效降低环境中病毒的阳性率,对预防人感染H7N9禽流感有重要意义。     

长春市首例人感染H7N9禽流感病例流行病学调查与防控对策

目的分析长春市首例人感染H7N9禽流感确诊病例流行病学特征,为防控提供科学依据。方法对确诊病例进行现场流行病学调查并进行实验室检测,描述病例的流行病学特征、实验室检测结果,追踪可能的感染来源。结果该病例发病前无活禽交易市场暴露史;密切接触者中无续发病例。病例自有养鸡场外环境标本中检出H7N9禽流感病毒,但病例曾购买禽类的本地销售商的饲养环境和运输工具均未检测出H7N9禽流感病毒。长春市报告病例标本的流感血凝素基因(H)和神经氨酸酶基因(N)与此前安徽省发现的H7N9流感病毒高度同源。结论接触感染H7N9禽流感病毒的禽类和暴露于出现H7N9禽流感病毒的外环境是人感染H7N9禽流感的危险因素。病毒传入途径尚不明确,该研究尚不能证实H7N9禽流感病毒可引起人与人之间传播。     

2012—2013年广州市职业暴露人群及环境禽流感监测分析

目的了解2012—2013年广州市职业暴露人群中禽流感病毒亚型隐性感染状况以及禽类市场环境中H7N9病毒污染状况。方法采集家禽职业暴露人群以及H7N9疫情专项调查人群血清样本和环境拭子样本,用红细胞凝集抑制试验(HI)检测H5N1、H7N9和H9N2亚型禽流感抗体,用实时荧光定量PCR方法对禽类环境样本进行禽流感病毒核酸检测。结果 2012年250份常规监测职业暴露人群血清样本中检出H5N1亚型抗体阳性2份,阳性率为0.80%。2013年394份常规监测职业暴露人群血清样本中检出H9N2亚型禽流感病毒抗体阳性29份,阳性率为7.36%。2013年259份专项监测血清样本中检出H9N2亚型禽流感病毒抗体阳性7份,阳性率为2.70%。2012年185份环境样本中共检出流感病毒阳性22份,阳性率为11.89%;其中H5亚型阳性13份、H9亚型阳性7份、A未分型阳性2份。2013年6 264份市场环境样本中共检出流感病毒阳性204份,阳性率为3.26%;其中H7N9亚型阳性5份、H5亚型阳性13份、H9亚型阳性80份、A未分型106份。结论广州市市场环境中存在H7N9病毒污染,暂未发现职业暴露人群感染H7N9禽流感病毒,但该人群H9N2隐性感染情况较为严重。     

九江市首例人感染H7N9禽流感的实验室检测分析

目的对九江市首例人感染H7N9禽流感患者进行实验室检测分析,为禽流感疫情的判定及制定防控措施提供依据。方法提取患者标本、活禽交易市场环境标本的病毒核酸,用荧光定量PCR方法检测甲型、乙型流感病毒核酸片段、季节性流感(包括H1N1、H3N2)、甲型H1N1、禽流感病毒H9、H7和H5核酸片段。结果乙型流感、季节性流感(包括H1N1、H3N2)、甲型H1N1流感、H9和H5高致病性禽流感扩增结果均为阴性;甲型流感通用引物和H7N9亚型流感病毒扩增结果均为阳性。活禽交易市场外环境标本中检出1份H7N9禽流感病毒核酸阳性。结论在日常流感样病例监测中要关注非常见流感病毒型别的监测,为研判我国流感的流行趋势提供依据。     

泰州市人感染H7N9禽流感疫情及相关因素分析

目的 了解2015—2018年近四年来泰州市人感染禽流感疫情的流行病学特征,为今后防控人感染禽流感提供参考。 方法 以近四年来泰州市人感染H7N9禽流感疫情及禽、环境监测数据为基础,分析禽流感疫情与禽、环境病毒分布的关系。 结果 研究期间泰州市共报告人感染H7N9禽流感18例,发病日期分布于2016年12月—2017年3月。禽、环境监测样本1 488份,发现阳性120份,其中H7N9病毒核酸阳性32份。疫情由南向北、呈现以人口密集区域为中心向周边扩散的趋势。 统计学分析病例数与禽、环境监测H7N9标本阳性率相关性未显示统计学意义(r=0.738,P>0.05)。病例咽拭子H7N9禽流感核酸检测阳性,在病例暴露的活禽交易场所环境样本中检出H7N9禽流感病毒核酸阳性,121名密切接触者核酸检测阴性。 结论 疫情冬春季节高发,禽、环境监测H7N9病毒核酸阳性的地区更易出现疫情,活禽交易可能是疫情传播与扩散的主要途径,疫情与禽、环境阳性监测结果趋势一致。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

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.