人α干扰素预防儿童急性呼吸道感染效果的研究

儿童急性呼吸道感染,特别是上呼吸道感染,在儿童发病率中占首位,严重地危害小儿健康。我们采用人α干扰素对284名健康儿童进行急性呼吸道感染的预防,取得了较好效果。现将结果报告如下。     

医务人员呼吸道感染影响因素的巢式病例对照研究

目的 探索医务人员在院内感染呼吸道传染病的影响因素,针对性的提出院感防范重点及感染控制改进建议.方法 本研究采用巢式病例对照研究的方法.选取北京市东城区和西城区的9家二级以上医院,将符合条件的医务人员作为一个队列,对其医疗行为进行为期一个月的观察.依据咽拭子病原学检测结果判定研究对象的呼吸道感染状况,并将他们分为病例组...     

参芪煎剂预防小儿反复呼吸道感染的效果与机理研究

目的观察参芪煎剂预防小儿反复呼吸道感染的效果以及对小儿唾液SIgA水平的影响.方法利用放射免疫法对反复呼吸道感染患儿及健康儿童进行唾液SIgA测定,并对反复呼吸道感染患儿随机分为两组,其中观察组40例,给予口服参芪煎剂.对照组36例,不给予特殊预防性措施,于疗程结束10～15天内复查唾液SIgA.并对所有患儿随访1年,以明确再发呼吸道感染的次数.结果反复呼吸道感染患儿与正常健康儿童唾液SIgA水平均数间有显著性差异,前者明显低于后者,观察组患儿服用参芪煎剂2疗程后,其唾液SIgA水平有不同程度的提高.差别有统计意义,且在随访1年内,再发呼吸道感染的次数明显减少.结论唾液SIgA水平较低是导致小儿反复呼吸道感染的原因之一,参芪煎剂对唾液SIgA有明显提升作用,对预防小儿反复呼吸道感染有显著效果.     

呼吸道传染病的特点及预防控制探讨

目的探讨呼吸道传染病的特点及预防控制效果。方法对2012~2013年度我院内呼吸道传染病进行了回顾性临床资料分析,对比加强医院感染管理前后医院感染的数据。结果通过对两年我科医院感染情况进行统计发现,2013年度呼吸科感染发生率14.67%,低于2012年的25.33%(P<0.05)。此外,医护人员相关工作质量评价及患者对护理工作的满意程度亦明显较2011年有了提升P<0.05)。结论在强化医院感染管理后,可以明显降低院内感染的发生,保护患者以及医护人员的健康。     

乌鲁木齐地区冬春季小儿呼吸道感染者中呼吸道合胞病毒感染的研究

目的 了解乌鲁木齐地区冬春季节呼吸道感染患儿中呼吸道合胞病毒(RSV)的感染状况以及分子流行病学的基本情况.方法 研究对象为2006年11月-2007年4月于新疆维吾尔自治区人民医院儿科住院以及部分于门诊就诊,明确诊断为急性呼吸道感染的患儿,采集咽拭子280份,呼吸道分泌物112份.对全部标本采用反转录聚合酶链反应(RT-PCR)方法进行RSV及其亚型检测.随机取5份阳性标本测序,进行序列比较及同源性分析.结果 392份样本中共检出RSV阳性68份,阳性率17.3%(68/392),其中A基因型64份,占93.3%(64/68),B基因型4份,占6.7%(4/68).5株测序结果提示当地RSV与其他国家及地区代表株之间的同源性为63.1%～99.4%.进化树进一步显示存在A、B两个亚型.结论 RSV是引起2006-2007年冬春季该医院儿童急性呼吸道感染的重要病原体,以A亚型为主要流行株.

Abstract：

Objective To research the infections of respiratory syneytial virus(RSV)in children with respiratory tract inflammation and define its molecular epidemic features in Urumchi.Methods SamDles were collected from November 2006 to April 2007 in the People's General Hospital of Xinjiang Uygur Autonomous Region,including 112 respiratory secretions and 280 nasopharyngeal swabs. RSV and its subgroups were detected by nested PCR.The five positive amplicons selected randomly from all positive samples were sequenced and compared with other RSV in GenBank by BLAST and DNAStar.Results of all 392specimens.68 RSV G gene segments were tested.Among them,RSV lineage A occupied 93.3%,while B occuDied 6.7%.The identities between them were 63.1%-99.4%.Phylogenetic analysis defined that they belonged to two different clusters.Conclusion RSV was one of the important viruses leading to children's respiratory tract infections in the People's General Hospital of Xinjiang Uygur Autonomous Region during winter and spring from 2006 to 2007.RSV subtype A was the prevalent genotype in the hospital dunng this epidemics.     

深入分析小儿下呼吸道肺炎支原体感染治疗的临床效果

目的：观察研究小儿下呼吸道肺炎支原体感染的治疗方法,为临床治疗提供更多的参考依据。方法选取110例检出肺炎支原体感染的儿童患者,诊断方法是临床血清检测,利用大环内酯类药物治疗,最后对其治疗的临床效果进行深入分析。结果诊断显示,患病早期,患者的主要临床表现症状是发热,在持续性发热的同时伴有剧烈的咳嗽现象;在治疗肺炎支原体感染中使用大环内酯类抗生素具有良好的效果。结论临床上必须采用血清学检测的手段对小儿下呼吸道肺炎支原体感染进行检测。治疗多采用阿奇霉素等大环内酯类药物。在临床诊断中会出现多种不典型病例,因此要加强诊断的力度。     

昏迷患者气管切开后预防呼吸道感染的护理

目的：探讨昏迷患者在气管切开术后预防呼吸道感染的护理方法。方法对我科收治的32例昏迷后气管切开的患者,给予保持呼吸道湿化、定期翻身拍背、吸痰等护理方案。结果在32例昏迷后气管切开的患者中,有24例患者痊愈,4例患者好转出院,发生肺部感染的患者有1例,3例患者因其它原因死亡。结论通过给予昏迷后气管切开的患者保持呼吸道湿化、定期翻身拍背、吸痰等护理方案,降低了术后患者出现呼吸道感染,提高了患者生命和生活质量,为昏迷后气管切开的患者的护理方案提供了新的思路。     

春季注意预防呼吸道感染

随着春天的到来,呼吸道疾病尤其是呼吸道感染性疾病也开始增多.春季很容易发生感冒、流感、急性上呼吸道感染、支气管炎和肺炎等疾病,老人和小儿更易患急性呼吸道感染性疾病,特别是流行性感冒.因此,采取预防措施是相当重要的.本文为了预防这些呼吸道疾病应该注意的问题展开了陈述.     

急性呼吸道感染患儿巨细胞病毒感染的研究

巨细胞病毒 (ＨＣＭＶ)在人群中感染非常普遍 ,但大多数呈亚临床不显性感染或潜伏感染 ,在宿主特殊的状态下 ,这种潜伏感染可被激活为其重要的生物学特征[1,2 ] 。为研究小儿急性呼吸道ＨＣＭＶ感染 ,根据 1994年全国小儿巨细胞病毒感染学术会议上拟定的诊断标准[3 ,4 ] ,选用ＨＣＭＶ ＩｇＭ为ＨＣＭＶ活动感染指标 ,对 2 5 0例冬春季急性呼吸道感染 (ＡＲＩ)患儿和 5 0名同期健康儿童进行了ＨＣＭＶ ＩｇＭ、呼吸道合胞病毒ＩｇＭ(ＲＳＶ ＩｇＭ) ,腺病毒ＩｇＭ(ＡｄＶ ＩｇＭ)特异抗体同步检测和部分临床资料分析。1　材料和方法1.1　病…     

呼吸道合胞病毒（RSV）感染预防的研究进展

人类呼吸道合胞病毒是严重威胁婴幼儿健康的重要因素这一。该病毒主要引起下呼吸道的感染，导致婴幼儿中气管炎和支气管炎的流行。本文就其近年来国内外对该病毒感染预防研究进展作一综述。     

Immunogenicity and reactogenicity of high- vs. standard-dose trivalent inactivated influenza vaccine in healthcare workers: a pilot randomized controlled trial

Objectives

To compare immunogenicity, reactogenicity and acceptability of high- and standard-dose trivalent inactivated influenza vaccine (HDTIV, SDTIV) in 18- to 64-year-olds.

A randomized trial of vitamin D supplementation to prevent seasonal influenza and enterovirus infection in children

PurposeThis study aimed to evaluate whether vitamin D supplementation can reduce the incidence of influenza and enterovirus infection in Taiwanese children.MethodsThis randomized, double-blind, controlled trial included children aged two to five years between April 2018 and October 2019 from daycare centers. All the participants were randomly assigned to a vitamin D supplementation group (2000 IU/day) or placebo group for one month. The primary outcome was the incidence of influenza and enterovirus infection in the following six months, and the secondary outcome was the incidence of influenza and enterovirus infection in the children's household members.ResultsTwo hundred and forty-eight children participated. The vitamin D group showed a relative risk reduction of 84% against influenza compared to the placebo group but did not reach statistical significance. Kaplan–Meier curves revealed that the placebo group had a higher probability of influenza infection than the vitamin D group (log-rank test, p = 0.055), but the incidence of enterovirus infection was similar between the two groups (p = 0.946) among children. Among children's household members, the incidence of influenza (p = 0.586) and enterovirus infection (p = 0.528) were both similar between the two groups. All children who were tested for serum 25(OH)D levels after vitamin D intervention had 25(OH)D levels above 30 ng/mlConclusionVitamin D supplementation may have a small preventative effect against influenza infection but does not affect enterovirus infection among preschool children. A high-dose short-term vitamin D intervention might be a way to elevate children's serum vitamin D levels in the first month of starting kindergarten.     

Extremely low prevalence of asymptomatic COVID-19 among healthcare workers caring for COVID-19 patients in Israeli hospitals: a cross-sectional study

ObjectivesWe aimed to compare the prevalence of asymptomatic coronavirus disease 19 (COVID-19) among clinical staff in designated COVID-19 units versus that among staff in similar units with no known or suspected COVID-19 patients.MethodsWe conducted a cross-sectional survey of healthcare workers (HCWs) in eight Israeli general hospitals. The survey involved a questionnaire and a PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We surveyed HCWs in COVID-19 units and comparison units (internal medicine and cardiology) between 30th April and 7th May 2020.ResultsThere were 522 participants: 291 from COVID-19 units and 231 from comparison units. Only one participant (0.2%, 95%CI: 0.005–1.1%)—an asymptomatic nurse on a COVID-19 unit—tested positive for SARS-CoV-2. In participating COVID-19 units there were two symptomatic HCWs with confirmed COVID-19 in the 2 weeks before the survey; both were infected by contact with a co-worker outside of the COVID-19 unit.ConclusionsThe low prevalence of asymptomatic COVID-19 among HCWs, coupled with an absence of symptomatic COVID-19 acquired during patient care, suggest that Israel's national guidelines for personal protective equipment, which are consistent with those of the World Health Organization, adequately protect HCWs.     

Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre,randomized clinical trial in primary care

ObjectivesTo determine the benefits and harms of discontinuing unnecessary antibiotic therapy for uncomplicated respiratory tract infections (RTI) when antibiotics are considered no longer necessary.MethodsMulticentre, open-label, randomized controlled clinical trial in primary care centres from 2017 to 2020 (ClinicalTrials.gov, NCT02900820). Adults with RTIs—acute rhinosinusitis, sore throat, influenza or acute bronchitis—who had previously taken any dose of antibiotic for less than 3 days, which physicians no longer deemed necessary were recruited. The patients were randomly assigned in a 1:1 ratio to discontinuing antibiotic therapy or the usual strategy of continuing antibiotic treatment. The primary outcome was the duration of severe symptoms (number of days scoring 5 or 6 on a six-item Likert scale). Secondary outcomes included days with symptoms, moderate symptoms (scores of 3 or 4), antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months.ResultsA total of 467 patients were randomized, out of which 409 were considered valid for the analysis. The mean (SD) duration of severe symptoms was 3.0 (1.5) days for the patients assigned to discontinuation and 2.8 (1.3) days for those allocated to the control group (mean difference 0.2 days; 95% CI –0.1 to 0.4 days). Patients randomized to the discontinuation group used fewer antibiotics after the baseline visit (52/207 (25.1%) versus 182/202 (90.1%); p 0.001). Patients assigned to antibiotic continuation presented a relative risk of adverse events of 1.47 (95% CI 0.80–2.71), but the need for further health-care contact in the following 3 months was slightly lower (RR 0.61; 95% CI 0.28–1.37).ConclusionsDiscontinuing antibiotic treatment for uncomplicated RTIs when clinicians consider it unnecessary is safe and notably reduces antibiotic consumption.     

A cluster randomized trial comparing two interventions to improve treatment of major depression in primary care

BACKGROUND: Many patients with major depression are non-adherent to antidepressant medication and do not receive care according to current guidelines. There is increasing evidence that treatment of depression in primary care can be improved. Comparison between effective interventions may help to establish the active ingredients of such interventions. METHOD: In a randomized trial two interventions to improve treatment of major depression in primary care were compared (1) a depression care programme, targeting general practitioners (GPs), patients, and systematic follow-up, and (2) a systematic follow-up programme. Thirty GPs were randomized and 211 primary-care patients with current major depression were included. All patients were prescribed a selective serotonin reuptake inhibitor. Outcome measures included adherence to antidepressant medication, and depression outcome. RESULTS: No significant differences in adherence rates and treatment outcome measures were demonstrated between interventions at week 10 or week 26. Adherence rates were high and treatment outcome was favourable. CONCLUSIONS: The depression care programme was not superior to the systematic follow-up programme. Systematic follow-up in depression treatment in primary care seems to be an intervention per se, having the potential to improve adherence and treatment outcome.     

2009甲型H1N1流感流行期间北京急性呼吸道感染儿童常见呼吸道病毒的研究

目的了解2009至2010年甲型H1N1流感大流行期间北京地区急性呼吸道感染患儿中,除流感病毒外的其他几种常见呼吸道病毒感染的流行情况。方法设计并建立检测包括呼吸道合胞病毒（RSV）A/B亚型,副流感病毒（PIV）1、2、3型,腺病毒（ADV）和人博卡病毒（HBoV）在内的多重实时荧光PCR方法,并应用该方法对2009年6月至2010年2月甲型H1N1流感大流行期间,对首都儿科研究所附属儿童医院就诊的急性呼吸道感染患儿中甲型H1N1流感病毒检测阴性的咽拭子标本进行上述呼吸道病毒的核酸检测。结果新建立的多重RT-PCR方法最低可检测的目标基因含量为10～300拷贝数,未见与其他非目标病毒的交叉反应。本研究共检测标本849份,病毒检测总阳性率为39.0%（331份）,5岁以下占87.6%（290/331份）。各病毒的检测阳性率分别为RSV-A亚型1.4%（12份）,RSV-B亚型8.4%（71份）,PIV-1型8.2%（70份）,PIV-2型0.5%（4份）,PIV-3型3.9%（33份）,ADV13.9%（118份）,HBoV2.7%（23份）。RSV检出以B亚型为主（85.5%）,流行高峰在2009年11月至2010年2月。PIV检出以PIV-1型及PIV-3型为主,PIV-1型的流行高峰在2009年7月至2009年10月,PIV-2型及PIV-3型的流行高峰在2009年6～9月。ADV病毒在研究期间均有较高检出率（平均为13.9%）,HBoV的流行高峰在2009年9～12月。结论除流感病毒外,ADV、RSV-B及PIV可能也是2009甲型H1N1流感流行期间引起儿童急性呼吸道感染的重要病原。比较以往的资料可见各病原在2009甲型H1N1流感流行期间的流行季节性及检出率基本未受到新型流感病毒的影响。     

Investigation of an outbreak of symptomatic SARS-CoV-2 VOC 202012/01-lineage B.1.1.7 infection in healthcare workers,Italy

ObjectivesIn December 2020, Italy began a national immunization campaign using the BNT162b2 coronavirus disease 2019 (COVID-19) mRNA vaccine, prioritizing healthcare workers (HCWs). Immune serum from vaccinated subjects seems (largely) to retain titres of neutralizing antibodies, even against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) VOC 202012/01-lineage B.1.1.7. Here, we describe an outbreak of SARS-CoV-2 lineage B.1.1.7 infection in three HCWs in a hospital setting; two of the HCWs were fully vaccinated (i.e. had received two doses).MethodsTwo physicians and one nurse working on the same shift on 20th February 2021 were involved in the outbreak. Real-time PCR, antigen tests, and serological tests for the IgG anti-spike protein of SARS-CoV-2 were performed, along with whole-genome sequencing (WGS).ResultsSARS-CoV-2 infection was confirmed in all three HCWs; all presented with mild symptoms of COVID-19. The two physicians were fully vaccinated with BNT162b2 vaccine, with the second dose administered 1 month before symptom onset. Both had high titres of IgG anti-spike antibodies at the time of diagnosis. WGS confirmed that all virus strains were VOC 202012/01-lineage B.1.1.7, suggesting a common source of exposure. Epidemiological investigation revealed that the suspected source was a SARS-CoV-2-positive patient who required endotracheal intubation due to severe COVID-19. All procedures were carried out using a full suite of personal protective equipment (PPE).ConclusionsThis mini-outbreak highlights some important issues about the efficacy of vaccines against transmission of SARS-CoV-2 variants, the high risk of exposure among HCWs, and the need for optimized implementation of PPE in hospitals. The wide circulation of VOC 202012/01 in Europe and Italy highlights the need to improve surveillance and genetic sequencing.