海上邮轮新型冠状病毒肺炎疫情暴发的风险探讨

通过多渠道收集信息，对2020年2月新型冠状病毒肺炎疫情流行期间漂浮海上的几艘邮轮上的疫情情况做了描述，从时空和人群方面对发病影响因素进行了分析，探索了邮轮人群感染风险及影响因素；并对疫情趋势进行了讨论，以期对认识此次疫情流行规律、处置措施影响及发展趋势有所启发。     

The HIV/AIDS epidemic in Ukraine: its potential social and economic impact

Present and immediately foreseeable medical knowledge suggest that HIV infection cannot be avoided by vaccination and that an affordable cure for the resulting syndrome, AIDS, is a long way off. There is a strong possibility that Ukraine is confronted by an HIV epidemic which will spread into the general population and that the most common mode of transmission will be through heterosexual intercourse. The epidemic in the Ukraine is currently concentrated among intravenous drug users. It is estimated that between 60,000 and 180,000 people may currently be infected. In present economic and social circumstances there are many features of Ukrainian society that may add to the probability of the epidemic becoming widespread in the general population. It is likely that this process may have already commenced. The result of this will be numerous additional deaths and illness over the short (5 year) (19,000-23,000 deaths), medium (10-15 year) (61,000-111,000), and longer terms (>20 year) (in excess of 40,000-160,000 deaths). The research reported here was undertaken in 1997-8 and describes the potential medium to long term social and economic impact of an HIV/AIDS epidemic in Ukraine. Using the concepts of risk environment, susceptibility and vulnerability, it reports the problems which might be expected to develop in relation to care of excess orphans, the elderly, vulnerable households and regions as well as among those working in the "third sector", a social sector upon which exponents of the importance of developing sound "civil society" in "transitional economies" place heavy emphasis.     

The potential for spread of HIV in the heterosexual population in Norway: a model study

A simulation model is used to investigate the potential for indigenous spread of human immunodeficiency virus (HIV) in the heterosexual population in Norway. The heterosexual population is grouped according to age, sex and whether paired or single. Estimates of various parameters of sexual behaviour are taken from a population-based questionnaire study. The questionnaire was sent to a random sample of 10,000 individuals, with a response rate of 63 per cent. The main simulation result is that with no inflow of infection from other risk groups, the heterosexual epidemic will decline if the average transmission probability per intercourse is 1 per cent or less. This result is insensitive to changes in the initial conditions. It is sensitive to changes in sexual behaviour, and to the shape of the transmission probability distribution. A review of empirical partner study data indicates an average transmission probability about 0.1 per cent per intercourse when no transmission modulating cofactors are present. It is concluded that with present sexual behaviour, the indigenous spread of HIV is not likely to sustain an epidemic in the Norwegian heterosexual population.     

Dengue fever epidemic potential as projected by general circulation models of global climate change.

Climate factors influence the transmission of dengue fever, the world's most widespread vector-borne virus. We examined the potential added risk posed by global climate change on dengue transmission using computer-based simulation analysis to link temperature output from three climate general circulation models (GCMs) to a dengue vectorial capacity equation. Our outcome measure, epidemic potential, is the reciprocal of the critical mosquito density threshold of the vectorial capacity equation. An increase in epidemic potential indicates that a smaller number of mosquitoes can maintain a state of endemicity of disease where dengue virus is introduced. Baseline climate data for comparison are from 1931 to 1980. Among the three GCMs, the average projected temperature elevation was 1.16 degrees C, expected by the year 2050. All three GCMs projected a temperature-related increase in potential seasonal transmission in five selected cities, as well as an increase in global epidemic potential, with the largest area change occurring in temperate regions. For regions already at risk, the aggregate epidemic potential across the three scenarios rose on average between 31 and 47% (range, 24-74%). If climate change occurs, as many climatologists believe, this will increase the epidemic potential of dengue-carrying mosquitoes, given viral introduction and susceptible human populations. Our risk assessment suggests that increased incidence may first occur in regions bordering endemic zones in latitude or altitude. Endemic locations may be at higher risk from hemorrhagic dengue if transmission intensity increases.     

基于SEIR-SEI模型长沙市输入性疟疾再传播风险预测

目的 模拟不同干预措施下长沙市输入性疟疾的疫情走向,评估不同干预措施的效果,为下一步防控提供科学依据。方法 建立输入性疫情和蚊媒数据库,根据疟疾的疾病自然史构建SEIR-SEI模型,通过改变参数来模拟不同干预措施的效果。结果 长沙市输入性疟疾疫情持续存在,以恶性疟最多［233例（58.0%）］,蚊媒以中华按蚊为主;发病人群主要为男性、年龄18～44岁者、农民工;病例最多的地区为浏阳市,输入国主要为非洲国家;单一干预下,叮咬率（θ）保持在0.01或蚊虫密度（k）保持在0.001以下时,疫情不发生再传播,缩短患者发病-确诊时间（1/γh）的效果优于只控制蚊虫叮咬率或蚊虫密度;实施综合干预的防控效果较单一干预明显提高,实施综合干预的防控效果较单一干预明显提高,当k≤1时,,θ≤0.3,1/γh≤7或者θ≤0.5,1/γh≤3时,疫情不会发生再传播风险;当k≤0.5时,θ≤0.5,1/γh≤7时,疫情也不会出现再传播风险。结论 长沙市时刻存在因输入性病例引发继发传播对潜在威胁,当出现输入性疟疾时,应采取灭蚊、防蚊、缩短发病-确诊时间等综合干预措施,将k控制0.5以下,θ控制在0.5以下,1/γh控制在7天以下最好。     

应用因子分析探讨影响流行性脑脊髓膜炎流行的因素

应用因子分析理论，结合随州市８年来的流脑监测资料，对影响流脑流行的１２个因素进行了研究。结果表明，影响流脑流行的前六位因素是：人群流脑菌Ｂ群、Ａ群带菌率、一月份相对湿度、一月份发病率、流行前期流脑接种率和人群抗体平均滴度。尽管当前流脑发病以散发为主，但影响流脑流行的因素并未完全消失，继续广泛使用流脑Ａ群多糖菌苗，加强对流动人口及重点地区人群的监测工作仍具有重要意义     

A hidden HIV epidemic among women in Vietnam

Background  

The HIV epidemic in Vietnam is still concentrated among high risk populations, including IDU and FSW. The response of the government has focused on the recognized high risk populations, mainly young male drug users. This concentration on one high risk population may leave other populations under-protected or unprepared for the risk and the consequences of HIV infection. In particular, attention to women's risks of exposure and needs for care may not receive sufficient attention as long as the perception persists that the epidemic is predominantly among young males. Without more knowledge of the epidemic among women, policy makers and planners cannot ensure that programs will also serve women's needs.     

Nutrition, Lipids, and Cardiovascular Disease

The evolving epidemic of cardiovascular disease in many newly industrialized societies will bankrupt their health care systems and reduce the available resources for other health priorities. Therefore, the prevention of this epidemic, or at least slowing the increase, is of the highest priority. The development of coronary heart disease (CHD) is an example of a common source epidemic due to increased consumption of saturated fat and cholesterol, low intakes of polyunsaturated fat, and increasing obesity. Hypertension, cigarette smoking, and diabetes mellitus contribute to risk of disease. The prevention of atherosclerosis beginning in young adults is of paramount importance. Careful monitoring of the evolving epidemic of CHD, including noninvasive evaluation of atherosclerosis, is important. A high-risk approach is very successful but expensive.     

湖北省重点人体寄生虫病流行现况与风险分析

回顾湖北省血吸虫病、疟疾、丝虫病、黑热病(内脏利什曼病)、土源性寄生虫病、食源性寄生虫病、棘球蚴病(包虫病)等七类重点人体寄生虫病的流行概况,掌握与分析其流行现状和态势.湖北省寄生虫病疫情已降至历史最低,但当前面临局部地区依然存在感染寄生虫的高风险因素;随着全球经济一体化程度的日益加深和"一带一路"战略的全面实施,与人...     

流行性喘憋性肺炎爆发性流行的调查研究

1986年1~3月份山西运城地K爆发流行性喘憋性肺炎,罹患率为13.77‰(校正罹忠率为17.50‰),病人多为婴幼儿,其中〇~岁组罹患率最高(89.06‰),1~岁组次之(55.7‰),随年龄增民,罹患率下降。性别间发病男性大于女性(χ²=101.09,P<0.00l),男女之比为1.4:1。病人临床表现一般较重,多数具有喘憋症状,病死率为1%。病人分布具苻家庭聚集性.其爆发与气温有关(rs=0.4799,P<0.05),日温差大,发病人数增多;与人均居室面积大小有关,随居室面积增大,罹患率下降(趋势χ²=5.58,P<0.05)。病原学和血清学研究证明,引起爆发的病原体为呼吸道合胞病毒(RSV)。     

The impact of regional climate change on malaria risk due to greenhouse forcing and land-use changes in tropical Africa

Background: Climate change will probably alter the spread and transmission intensity of malaria in Africa.Objectives: In this study, we assessed potential changes in the malaria transmission via an integrated weather–disease model.Methods: We simulated mosquito biting rates using the Liverpool Malaria Model (LMM). The input data for the LMM were bias-corrected temperature and precipitation data from the regional model (REMO) on a 0.5° latitude–longitude grid. A Plasmodium falciparum infection model expands the LMM simulations to incorporate information on the infection rate among children. Malaria projections were carried out with this integrated weather–disease model for 2001 to 2050 according to two climate scenarios that include the effect of anthropogenic land-use and land-cover changes on climate.Results: Model-based estimates for the present climate (1960 to 2000) are consistent with observed data for the spread of malaria in Africa. In the model domain, the regions where malaria is epidemic are located in the Sahel as well as in various highland territories. A decreased spread of malaria over most parts of tropical Africa is projected because of simulated increased surface temperatures and a significant reduction in annual rainfall. However, the likelihood of malaria epidemics is projected to increase in the southern part of the Sahel. In most of East Africa, the intensity of malaria transmission is expected to increase. Projections indicate that highland areas that were formerly unsuitable for malaria will become epidemic, whereas in the lower-altitude regions of the East African highlands, epidemic risk will decrease.Conclusions: We project that climate changes driven by greenhouse-gas and land-use changes will significantly affect the spread of malaria in tropical Africa well before 2050. The geographic distribution of areas where malaria is epidemic might have to be significantly altered in the coming decades.     

基于迁徙指数的复工时期中山市新冠肺炎疫情防控风险评估与应对

目的 分析中山市新型冠状病毒肺炎(简称新冠肺炎)疫情进展情况,评估中山市新冠肺炎的疫情输入风险。 方法 获取截至2020年2月29日24时全国新冠肺炎报告病例数(不含临床诊断病例;不含中国香港、澳门和台湾数据)和百度迁徙指数,对省外各市2月29日之前累计7 d报告病例数和中山市迁入指数进行相关分析,评估中山市返程复工期间新冠肺炎疫情输入风险。 结果 中山市累计报告确诊病例66例,输入性病例占比87.88%,其中湖北省49例,占74.24%。疫情输入风险排前4位的省份是广西、四川、湖南和江西,累计输入风险指数分别为1.0820、0.5494、0.2041和0.0656。近7 d中山市迁入人口排前11位主要城市中,有疫情输入风险的城市:永州市、重庆市。 结论 中山市的新冠肺炎疫情主要由湖北输入引起,目前疫情防控工作取得阶段性效果, 防止周边及疫情高发地区的病例输入风险仍是中山市今后疫情防控工作的重点。     

A space-time criterion for early detection of epidemics of influenza-like-illness

Objectives: To develop a method based on a space-time criterion for early detection of epidemics of influenza-like-illness in France. Methods: Since 1984, the French Communicable Diseases computer Network (FCDN) routinely detects epidemics of influenza-like-illness when the national incidence rate is, for 2 consecutive weeks, above a threshold computed by a periodic regression model. It appears that some areas reported early increases in incidence several weeks before the national epidemic. An optimised space-time criterion allows an early detection of the epidemic periods. Results: Applying this space-time criterion to the last 11 epidemics (from 1986), the sensitivity was 0.82 and the specificity was 0.99. Conclusion: This simple procedure can be used as an additional tool for early detection of an epidemic taking into account the distribution of new cases in space and time.     

绵阳市艾滋病高危人群规模估计及疫情预测

[目的]估计绵阳市各类艾滋病高危人群规模,推测艾滋病疫情,为防治工作提供依据。[方法]依据绵阳市艾滋病病例报告、哨点监测、综合监测等现有数据,参考有关资料,运用Work book估计法,估计绵阳市艾滋病高危人群基数,预测艾滋病疫情。[结果]估计绵阳市现有高危人群77730～191079人,现存成年(15～49岁)HIV感染者/艾滋病病人1533人。[结论]我市艾滋病疫情仍处于低流行状态,但高危人群规模较大,应有针对性地开展干预。     

洛阳市某小学诺如病毒感染引起聚集性疫情的调查分析

目的 调查分析某小学诺如病毒聚集性疫情流行特征、传播途径和危险因素,为疫情防控提供参考。方法 采用现场流行病学调查方法和PCR实验室检测方法查明原因,通过描述性流行病学方法和病例对照研究分析疫情危险因素。结果 本次疫情出现病例12例,其中实验室诊断病例2例,班级罹患率25.00%(12/48)。2份肛试子诺如病毒GⅡ型核酸检测阳性。首发病例可能为食源性感染,续发病例呈点源暴发特征,发病曲线有一明显单峰。主要危险因素为近距离(1 m内)暴露呕吐物(OR=15.00,P＜0.01))和参与呕吐物清理(OR=15.40,P＜0.05)。结论 该事件为一起诺如病毒GⅡ型感染引起的聚集性疫情,发生原因可能是首发病例发生食源性诺如病毒感染,其呕吐物污染教室环境,引起诺如病毒气溶胶或接触传播的点源暴发。     

Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood

Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of ‘tracking’ of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.     

The risk of yellow fever in a dengue-infested area

Yellow fever and dengue are viral infections that in urban centres are transmitted by the same arthropod vector, a mosquito of the genus Aedes. In order to estimate the risk of an epidemic of urban yellow fever in a dengue-infested area we calculated the threshold in the basic reproduction number, R0, of dengue, above which any single sylvatic yellow fever-infected individual will trigger an urban yellow fever epidemic. Specifically, we analysed the relationship between the extrinsic incubation period and the duration of viraemia, from which it is possible to define the R0 for dengue that would also suggest an outbreak potential for yellow fever. We also calculated the critical proportion of people to vaccinate against yellow fever in order to prevent an epidemic in a dengue-endemic area. The theory proposed is illustrated by the case of S?o Paulo State in southern Brazil, where dengue is endemic and the risk of urban yellow fever is already imminent.     

基于半定量风险评估和专家会商法的重点传染病疫情风险评估

目的 评估2019年广东省面临的重点传染病疫情风险,并分析风险相关关键要素。方法 收集整理相关信息,采用半定量风险评估和专家会商法对疫情风险进行研判。结果 2019年广东省面临的登革热病例境外输入风险将常年存在,本地疫情可能于5—6月开始出现。人禽流感疫情可能维持在较低水平。诺如病毒感染发病水平可能高于2017—2018冬春季。季节性流感可能存在冬春季和夏季流行高峰。手足口病发病强度可能高于2018年或持平,重症及死亡可能维持较低水平。麻疹疫情可能较2018年小幅增长。水痘和流行性腮腺炎疫情可能较2018年下降。基孔肯雅热和寨卡病毒病输入风险持续存在。不排除脊髓灰质炎、疟疾、中东呼吸综合征、埃博拉病毒病等病例输入以及输入引起本地传播的可能。结论 2019年广东省应特别关注登革热疫情,重点关注人禽流感、诺如病毒感染、季节性流感、手足口病等疫情,需要关注麻疹、水痘、流行性腮腺炎疫情,以及基孔肯雅热等输入性传染病相关疫情。     

The epidemiology of HIV infection, AIDS, and health care worker risk issues.

Acquired immunodeficiency syndrome (AIDS) has been a silent epidemic for 22 years. The 1st documented isolate of the human immunodeficiency virus (HIV) was detected retrospectively in a blood specimen from a young Central African man who had participated in a study in 1959. AIDS cases were 1st reported in 1981. 2 factors kept the AIDS epidemic silent: 1) the long incubation period between the initial infection and the onset of disease; and 2) the relatively recent intrusion of the virus into developed nations. Almost 100,000 people in the US now have AIDS. AIDS was found to be transmitted by blood; therefore, there is concern among health care workers (HCWs) about the risk of AIDS transmission. In the US, AIDS was 1st described in 1981 in 5 sexually active homosexual young men in Los Angeles. Soon, AIDS was describe in clusters of patients in other cities. It is defined as many unusual infections or cancers that suggest a poorly functioning immune system for which no other cause can be found. Statisticians with the US Public Health Service have used mathematical models to estimate the magnitude of HIV infection in the US. They currently estimate this to be 1-1.5 million infected persons. AIDS is not spread by casual transmission. The 3 established transmission routes--sex, contact with blood, and being born to an infected mother--are not equally efficient. It is estimated that all infected persons will sooner or later become seriously ill with HIV-related disease. To date, only 1 drug (Azidothymide or AZT) has been licensed as an effective antiviral drug. In April, 1988 the Centers for Disease Control (CDC) reported that HCWs developed AIDs with the same statistical frequency as the rest of the general population. The number of HCWs who have developed disease as a result of occupational exposure is so small that it is statistically undetectable. This does not mean there is no risk for occupational infection, but only that it is a relatively low risk for most HCWs. The major risk for transmission of HIV infection to HCWs is associated with handling sharp instruments. The major preventive effort should be directed at this problem. The CDC has suggested a system of infection precautions called "Universal Precautions" to protect HCWs from HIV infection. Another approach is "Body Substance Isolation." It is intended to be a complete isolation and precautions system. Reusable instruments should receive disinfection. Management of HCWs with potential exposure to HIV is discussed.     

感染性腹泻流行病学调查分析

目的：查明感染性腹泻病因，传播途径以及有关影响因素，完善有效控制该病流行的策略。方法：用样本估计总体发病水平推断流行强度。流行因素采用病例对照调查，并进行危险因素的单因素分析和多因素logistic回归分析；病原学检测使用普通培养基以及免疫磁株法与珂玛嘉、彩虹、头孢可肟三种特选培养基联合应用。结果：流行区感染性腹泻罹患率3．69％，并出现多例伴急性肾功能衰竭。优势菌为志贺氏菌属，占检出病原菌总数的65．67％(88／134)，大肠杆菌为流行过程的次优势菌株，检出34株，占25．37％，出血性大肠杆菌(EHEC)O157：H7是重症病例重要病原。吃剩饭菜、无防蝇设备和饭前洗手3项因素对腹泻病发生和流行有意义。结论：应通过卫生宣教、外环境灭蝇灭蛆及合理治疗腹泻病人控制疫情。