长江重大沉船事件援救中的血吸虫病防控应急处置及效果评价

目的评价长江监利段"东方之星"重大沉船事件发生后血吸虫病防治工作措施和成效,为今后突发事件救援中的血防应急处置工作提供经验。方法根据监利县沉船事发地点与搜救地点涉及乡镇的历史血吸虫病疫情资料及现场调查情况,对应急现场处置各项措施进行评价,并结合事件后处置情况,对评价区域的螺情、重点人群化疗、人畜病情监测、重点水体监测情况进行调查,综合评估灾后血吸虫病防治效果。结果沉船事故及救援现场均未发现感染性钉螺;监利县5个乡镇活螺平均密度为0.064只/0.1 m~2,未发现感染性钉螺。对2 090名外来人员进行血清学检测,阳性率为0.29%,未发现粪检阳性病人。发热门诊哨点监测未发现血吸虫感染病例,未发现粪检阳性耕牛。在沉船事故发生点及其上下游的4个村开展哨鼠监测,未发现血吸虫感染哨鼠。结论 "东方之星"沉船事件发生后所采取的血吸虫病防治措施行之有效,实现了突发事件后无血吸虫病传播的目标。     

风险评估模型在血吸虫病传播风险研究中的应用

随着血吸虫病研究的深入,风险评估模型被广泛应用到血吸虫病防治研究领域.本文对常见的血吸虫病风险评估模型和贝叶斯模型的理论基础和实际应用作一综述,以期为我国消除血吸虫病工作提供参考.     

安徽马鞍山市辖区实现血吸虫病传播阻断目标风险评估

目的 析安徽马鞍山市辖区近年来血吸虫病疫情变化趋势,评估到2015年实现血吸虫病传播阻断目标风险。方法 009～2013年期间,通过免疫学和病原学相结合的方法开展人畜病情监测;采用系统抽样结合环境抽查法开展螺情监测;同时,通过人畜化疗和钉螺控制措施开展血吸虫病防控工作。结果2009～2013年,人群治疗及扩大化疗2 060人次,采用IHA法共筛查20 622人次,血检阳性率平均为3.75%,处于徘徊稳定状态;kato法粪检查病1 526人次,均未查出阳性。5年间家畜扩大化疗279头次,家畜查病231头次,均未查出阳性。2009～2013年,开展药物灭螺611.3 hm2,环境改造灭螺10.7 hm2,开展螺情监测3 152 hm2,均未查获感染性钉螺;活螺密度从2009年0.205只/0.11m2下降到2013年的0.007 5只/0.11m2,呈现逐年下降趋势,有螺面积比2009年下降44.1%。结论2009年以来,马鞍山市辖区血吸虫病疫情呈现稳中有降的趋势,5年间均未查出病人、病畜和感染性钉螺,活螺密度和有螺面积逐年下降,距离血吸虫病传播阻断目标差距逐渐缩小。目前主要障碍仍然是辖区尚有较大面积的钉螺分布环境。     

基于德尔菲法的湖北省血吸虫病传播阻断后风险评估指标体系构建

目的 构建湖北省血吸虫病传播阻断后风险评估指标体系(下文简称"风险评估指标体系"),为血吸虫病精准防控提供依据.方法 通过资料收集、文献检索和专家访谈,初步构建风险评估指标体系.选择专家开展两轮咨询,根据指标重要性、可操作性、敏感性及综合评分对指标体系进行筛选,计算各指标权重,通过计算专家积极系数、权威程度和协调系数对...     

无锡市血吸虫病传播阻断后风险评估指标体系研究

目的建立无锡市血吸虫病传播阻断后风险评估指标体系,为制定防控政策提供参考。方法采用文献法初步构建无锡市血吸虫病传播阻断后风险评估指标体系框架,通过2轮德尔菲法对备选指标进行评分和筛选,最终建立风险评估指标体系并计算各指标的归一化权重和组合权重。结果经过两轮专家咨询,建立了包括3个一级指标和15个二级指标的风险评估指标体系。自然环境、重点人群和社会环境等3个一级指标的归一化权重分别为0.370 6、0.292 9和0.336 5。二级指标中流动人口的组合权重最高,为0.125 2,散养家畜的组合权重最低,为0.037 1。一级指标的专家权威度系数范围为0.91~0.93,二级指标的专家权威度系数范围为0.79~0.92。结论本研究建立的无锡市血吸虫病传播阻断后风险评估指标体系具有一定的科学性和权威性,为血吸虫病传播风险评估提供了依据。     

2014年云南省血吸虫病重点环境哨鼠监测与风险分析

目的 目的 建立和完善云南省血吸虫病监测预警机制, 及时发现可疑高危环境, 预防人畜感染。方法 方法 选择云南省 大理州巍山县、 洱源县和大理市3个疫情较重县 （市） 的8个村庄作为监测点, 开展重点水域哨鼠预警监测。对回收饲养 后成活的哨鼠进行解剖观察, 并用ELISA方法检测哨鼠血清抗体。同时记录分析监测点水域周围居民和家畜接触疫水 情况, 并综合近3年疫情资料进行风险评估。结果 结果 共投放哨鼠300只, 哨鼠总回收率为94.67%, 总死亡率为8.80%。未 发现血清抗体阳性和解剖阳性哨鼠。接触疫水人员主要为村民、 学生、 儿童和渔民, 接触方式主要为洗手洗脚、 收种作 物、 捕鱼、 洗菜和游泳等。监测点近3年钉螺面积、 人群感染率和耕牛感染率均呈下降趋势, 但仍存在一定的传播风险。 结论 结论 3个监测县 （市） 血吸虫病传播得到有效控制, 但仍需加强以传染源控制为主的综合防治措施。     

合溪水库工程对血吸虫病传播的影响及预防控制对策研究

目的 观察合溪水库建设工程对血吸虫病传播的影响,提出预防控制血吸虫病流行的对策。 方法 根据《血吸虫病防治条例》的相关规定,开展合溪水库建设工程血吸虫病卫生学评价工作。收集工程设计报告和血防历史资料,现场勘测工程涉及区域有关情况,开展螺情和病情现况调查,综合分析工程建设项目对血吸虫病流行和传播的影响,提出预防控制血吸虫病流行的措施。结果 合溪水库建设工程对血吸虫病传播具有利弊两重性,如不采取措施则会弊大于利。一方面可在局部区域内消灭钉螺以及阻止钉螺扩散;但另一方面也存在着钉螺孳生、繁殖、扩散以及传染源输入的风险,可能造成区域内血吸虫病重新传播流行。针对影响风险,在工程建设期和运行期需要趋利避害,采取应对措施,防止因工程建设导致钉螺扩散和血吸虫病重新传播流行,提高建设项目的综合效益。结论 合溪水库建设工程存在血吸虫病重新传播流行的潜在危险,应采取有效的控制措施以降低风险。     

四川芦山地震灾区血吸虫病传播风险初步分析与评估

目的 评估 “4 ⋅ 20” 四川芦山地震灾区灾后血吸虫病传播风险, 为科学制定灾后血吸虫病防控措施提供依据。方法 通过回顾性调查雅安市血吸虫病历史疫情资料和芦山县血吸虫病监测点疫情数据, 并选择芦山县芦阳镇火炬村和天全县新华乡落改村为现场, 进行血吸虫病传播风险快速评估, 综合分析、 评估灾后血吸虫病传播风险。结果 芦山县和天全县历史血吸虫病疫情较重。火炬村和落改村2个评估点的活螺平均密度分别为0.02只/0.1 m2 和和0.03只/0.1 m2 , 未发现感染性钉螺。落改村评估点发现犬粪密度为0.009份/100 m2 。地震灾后灾区沟渠等环境受损严重, 易造成钉螺扩散。居民安置点厕所等卫生设施遭到严重破坏, 容易出现粪便污染环境; 外来救援人员的进入和人群流动性增加, 容易导致外来传染源输入。结论 地震灾后芦山县和天全县已具备血吸虫病传播的高风险条件, 极易出现血吸虫病暴发流行。应合理设置灾民安置点, 加强粪便管理, 开展高危环境灭螺, 加强健康教育宣传, 强化监测, 防止出现灾后血吸虫病暴发流行。     

南水北调中线引江济汉工程对血吸虫病传播风险评估及干预措施

目的评价南水北调中线引江济汉水利工程可能对血吸虫病传播造成的风险,提出工程建设中控制血吸虫病传播的干预措施。方法搜集工程建设相关资料,调查工程区3个县(市、区)近年血吸虫病疫情,并在工程取水口现场开展漂浮物观测实验与船只携带钉螺现场调查。结果在引江济汉水利工程区存在引水、输水、供水及航运等引起钉螺扩散的4大风险因素。针对这些风险因素,提出了渠道硬化、增设沉螺池和拦漂网或筛孔墙、规范有螺区的取土处理、以及加强工程区监测等减少血吸虫病传播风险的防治对策和措施。结论虽然引江济汉工程建设存在可能引起或增加血吸虫病传播的风险因素,但只要在工程建设中采取相应的干预措施,可将风险降到最低限度。     

Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with different types of infectious agents, includ-ing CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature(via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manu-facturer and User Facility Device Experience database, or "MAUDE"; and the Internet(via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the sub-urbs of Chicago(IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Con-trol and Prevention(CDC), which published a report about this outbreak in Morbidity and Mortality WeeklyReport(MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's in-fection control practices following this CRE outbreak, were also reviewed. While this article focuses primar-ily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infec-tious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently as-sociated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospi-tal X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including broncho-scopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endos-copy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind andnear the forceps elevator located at the distal end othe ERCP endoscope, are recommended. If the ERCPendoscope features a narrow and exposed channel thathouses a wire connecting the GI endoscope's controhead to this forceps elevator, then this channel's com-plete reprocessing, including its flushing with a deter-gent using a procedure validated for effectiveness, is also emphasized.