我国钩端螺旋体病地理分布的研究

１９５５年本病列入法定传染病。１９５５～１９９３年全国累计报告２４２４０５７例，平均发病率为７．０８３４／１０万，死亡２４６３７例，平均病死率为１．０２％。全国有２６个省（市）自治区（不包括台湾省）均有本病报道。９０年代初钩端螺旋体病疫情相对稳定，常有局部爆发流行，并存在潜在流行因素。我国疫区分布广泛，钩端螺旋体病主要分布在北纬２５°～３５°，东经１００°～１２０°之间，也是长江流域的一些省份。     

钩端螺旋体病赫氏反应预防探讨

青霉素是治疗钩端螺旋体病（钩体病）的有效药物之一，但其首剂治疗后的赫氏反应（ＪＨＲ）发生率颇高，可使病情加重，转型及影响预后。如何防止ＪＨＲ的发生，已成为钩体病治疗中的一个重要临床问题。目前普遍使用肾上腺皮质激素（激素）预防ＪＨＲ的发生，但因剂量及用...     

涪陵地区钩端螺旋体病地理流行病学研究

涪陵地区钩端螺旋体病地理流行病学研究四川省涪陵地区卫生防疫站（邮编：６４８０００）李优良，谢忠，王光地为研究本地区钩端螺旋体病（简称钩体病）的地理流行病学特点，于１９７４～１９８２年对９县１市进行了调查。兹报告如下：方法和材料一、研究方法：按海拔高度...     

公卫：钩端螺旋体病

钩端螺旋体病(简称钩体病)是由各种不同型别的致病性钩端螺旋体(简称钩体)引起的急性人兽传染病。鼠类和猪为主要的传染源。本病遍布世界各地,热带和亚热带地区流行较严重我国31个省(包括台湾)、市、自治区均发现本病。尤以西南和南方各省多见,     

江苏省钩端螺旋体病流行病学分析

自 196 4年至 1999年江苏省共报告钩端螺旋体 (简称钩体 )病人 12 330例。70年代发病较高 ,80年代后期维持于低发病率水平 ,近几年全省发病均低于 6例。为探索其发病特征 ,现对全省196 4年～ 1999年钩体疫情及监测资料进行综合分析。1　材料与方法1.1　资料来源　疫情报告由江苏省疾病预防控制中心疫情室提供 ;监测点资料由各监测点历年资料汇总。1.2　方法　对疫情资料作流行病学分析 ,人群及病原监测按监测方案进行。2　结果2 .1　流行强度(1)发病率 :在 196 4年～ 1999年的 36年中 ,累计发病 12 330例 ,平均发病率 0 .6 4/10万 ,最高年份…     

一起钩端螺旋体病流行调查报告

一起钩端螺旋体病流行调查报告张田周，王建方，任留才钩端螺旋体病（简称钩体病）在水网地区发生较多，在豫西极少见到流行的报告，作者在偃师市工作期间，曾参与了一起该病流行的调查，现整理报告如下：１疫区概况：该次流行区位于偃师南部丘陵地区，以寇店乡、李家村发...     

山东莒县钩端螺旋体病暴发的调查报告

钩端螺旋体病(简称钩体病)在我省80年代后流行基本得到了控制。1990年雨水较多,莒县境区内涝较重。雨后发生了钩体病暴发。现将调查情况报告如下。1 流行情况1.1 地区分布本次暴发主要发生在青峰岭水库周围4个乡的29个村,其中以位于水库中游东侧的棋山乡为最重(村民在水中抢收庄稼时间较长),西侧的安庄乡和上游的天宝乡次之(村民接触水时间较短),下游的洛河乡最轻。共发病888人,死亡4人(表1)。     

钩端螺旋体病的血清学诊断

钩端螺旋体病是一种世界范围的人畜共患病,血清学试验是其重要的诊断方法之一,聚合酶链反应的应用加速了其分子水平的研究。为适应广大发展中国家的国情,一些简便、快速、价廉的血清学诊断方法应运而生,或在原有基础上加以改进。本文就目前开展的钩端螺旋体病血清学诊断方法作了综述。     

钩端螺旋体病的奇特反应现象

钩端螺旋体病的奇特反应现象中国预防医学科学院流行病学微生物学研究所（北京１０２２０６）林涛，时曼华江西省上高县卫生防疫站龙健在钩体病人血清中测得的针对异型菌的抗体滴度高于同型菌抗体滴度的现象，叫奇特反应（１～３），国内对此已有报道（４）．在１９９２年...     

钩端螺旋体外膜菌苗免疫效果的研究

钩端螺旋体 (简称钩体 )病主要在我国长江流域的省市流行 ,从 2 0世纪 6 0年代发现钩体病以来 ,累计发病近 15万例 ,病死近 2 5 0 0例 ,发病率和病死率都较高 ,危害性极大〔1〕。现使用的钩体浓缩菌苗 ,接种后对控制钩体病流行起到了重要作用 ,但该菌苗副反应较大 ,免疫效果不够理想 ,国内外学者均致力于新钩体菌苗研究〔2 ,3〕。目前 ,上海生物制品研究所已研制出钩体外膜菌苗 ,为了证实钩体外膜菌苗血清学免疫效果 ,由湖北省卫生防疫站牵头组成协作组 ,选择湖北省荆州市荆州区接种钩体外膜菌苗 ,进行现场观察 ,结果报告如下。1　对象和方…     

DNA vaccines against leptospirosis: A literature review

Leptospirosis is an infectious disease caused by pathogenic Leptospira species. The vaccines that are currently available for leptospirosis are composed of whole-cell preparations and suffer from limitations such as low efficacy, multiple side-effects, poor immunological memory and lack of cross-protection against different serovars of Leptospira spp. In light of the global prevalence of this disease, the development of a more effective vaccine against leptospirosis is of paramount importance. Genetic immunization is a promising alternative to conventional vaccine development. In the last 25 years, several novel strategies have been developed for increasing the efficacy of DNA vaccines. Examples of such strategies include the introduction of novel plasmid vectors, adjuvants, alternate delivery routes, and prime-boost regimens. Herein we discuss the latest and most promising advances that have been made in developing DNA vaccines against leptospirosis. We also deliberate over the future directions that must be undertaken in order to improve results in this field.     

A twelve-year study of leptospirosis on Barbados

Between November 1979 and December 1991, 398 cases of severe leptospirosis were confirmed on Barbados (range for 1980–1991 23–56; mean 32.7; incidence 13.3/100,000/year). For the six-year periods 1980–1985 and 1986–1991 there was no significant change in incidence with time. Incidence is unlikely to change significantly in the next decade. Monthly average case numbers ranged from 1.4 (July) to 4.3 (November). The average (2.8) for June to December (the 7 wetter months) was not significantly higher than that (2.5) for January to May (the 5 drier months). The age range was 7–86. There were three times as many male cases (302) as female (96), and nearly 10 times as many in those <35. Although the highest number of cases (69) was in males aged 15–24, the highest incidence was in the older age groups, particularly the male 65–74 year-olds, and the female 55–64 year-olds. Leptospirosis was the proven cause of death in 55 (13.8%) hospital patients (annual range 0–13, mean 4.5). Some of a further 39 fatalities might have been cases. Death from leptospirosis was nearly twice as common among the women as among the men. Only one patient under 20 years of age died.Leptospira were isolated and identified from 117 (29.4%) of the 398 sick patients. The infecting organisms werebim (serogroup Autumnalis — 75),copenhageni (Icterohaemorrhagiae — 26),arborea (Ballum — 14) andbajan (Australis — 2). These infecting serovars could not be distinguished clinically, but infection was milder in children than in adults. Despite its predominance in surveyed children, serogroup Panama was virtually absent in this study. Rainfall is the major factor affecting the distribution of cases; not surprisingly, sanitation workers and agricultural workers appear to be the groups at highest risk. The general lack of clear-cut risk factors reflects the ubiquity of leptospires in the environment and the fact that the disease is not entirely occupational.     

钩端螺旋体病的研究进展

钩端螺旋体病(钩体病)是全世界范围内流行的人兽共患病,也是洪涝灾区重点监控的传染病之一.2007年6月,我国多个省市遭受暴雨洪灾,钩体病一旦爆发,将成为重大公共卫生问题.此文就钩体病的病原学、流行病学、发病机制、诊断及预防进行综述.     

36例钩端螺旋体病暴发调查

对金华市磐安县九和乡发生的一起因下水采集石菖蒲而引发钩端螺旋体(钩体)病暴发疫情进行调查.     

Prevalence of leptospirosis in man. Pilot survey

A survey on the prevalence of leptospirosis was performed on the population living in an area of central Italy. The size of the sample was calculated in order to provide significant results in the case of a prevalence of infection in not less than 1 % of the population.Results demonstrated an unexpectedly wide circulation of leptospirosis in the surveyed area, showing a prevalence rate of infection of 11.34% for people living in rural areas and 3:08% for people living in the main town. The highest prevalence of infection (17.44%) was found in people between 30 and 44 years of age, living in rural areas.Such a wide circulation of undiagnosed past leptospiral infections was attributed both to the prevalence of mild clinical cases of leptospirosis in humans and the lack of microbiological tests performed to differentiate current leptospirosis from other infectious illnesses. An unexpected persistence in sera of co-agglutinins towards non-pathogenic serovars of L. biflexa was also noticed in healthy people.Criteria were established for the extension of the survey on the prevalence of leptospirosis to cover larger areas by limiting sampling to the more exposed age groups and to areas representative of a larger land belt.Corresponding author.     

Recent trends in human leptospirosis in Italy

The recent epidemiological trends of human leptospirosis in Italy were investigated using data collected for the years 1981–1985. A total of 626 hospitalized patients with clinical diagnoses of suspected leptospirosis were reported by hospital centers from several Italian regions. Epidemiological, clinical and seroimmunological data were collected in 517 of these cases and examined by the National Center for Leptospirosis.Serological findings in 33.5% of these subjects met the criteria for confirmation of the disease. In 21.8% of the subjects, low titer antibodies were detected, which possibly reflected previous leptospiral infections. An early antibiotic treatment of the current infection may also have lowered the seroimmunological response in some of these patients.In 59.3% of the confirmed cases, modes of transmission were allotted equally between accidental events and recreational or occupational activities. Drinking water from an open air fountain emerged as an uncommon mode of transmission; it was responsible for an outbreak of 33 cases of leptospirosis. In another 37.07% of the subjects, it was impossible to establish the mode of transmission.Respiratory or influenza-like symptoms were the only clinical signs of illness in 21.2% of the patients with confirmed leptospirosis.In comparison to the sixties and seventies, the prevalence of infecting serovars showed increasing incidence of infections due to serovars of the Javanica (11.0%) and Australis (11.0%) serogroups and an important decrease in the Bataviae serogroup infections (from 58.8% in rice-field workers in the forties to 0.6% in the years 1981–1985). Sejroe serogroup infections accounted for 4.5 per cent of confirmed cases of leptospirosis.In 49.7% of subjects with confirmed leptospirosis, cross-agglutination at the same titre with two or more serovars of different sero-groups occurred, thus preventing the identification of the serogroup of the infecting strain.     

Recombinant BCG strains expressing chimeric proteins derived from Leptospira protect hamsters against leptospirosis

Leptospirosis is a zoonosis that is responsible for one million human cases per year. Fusing multiple immunogenic antigens represents a promising approach to delivering an effective vaccine against leptospirosis. Mycobacterium bovis bacillus Calmette-Guérin (BCG) is a potential vaccine vector due to its adjuvant properties and safety. Two chimeric genes based on genic sequences of ligANI, ligBrep, lipL32, and lemA, were individually cloned into five BioBrick vectors with different promoters (pAN, Hsp60, 18?kDa, Ag85B and Ag85B plus signal sequence) for antigen expression in BCG. Groups of ten hamsters were vaccinated with recombinant BCG (rBCG) strains in two doses of 10⁶ CFU and challenged with 5?×?LD₅₀ of L. interrogans serovar Copenhageni. All rBCG vaccines expressing chimera 1, based on antigens LipL32, LigANI, and LemA, under the control of any promoter, protected 80–100% of the hamsters from challenge (P?<?0.05) and four of them also protected from renal carrier status; for chimera 2, based on LigANI and LigBrep antigens, the only vaccine that afforded survival rates statistically different from the control was the vaccine that incorporated the pAN promoter (60% of survival). A single vaccine dose was sufficient to induce significant IgG levels by all vaccine compositions evaluated; however, humoral response was not related to protection. These findings suggest that the combination of potential vaccine candidates in chimeric antigens and the use of BCG as a live vector are promising strategies by which it is possible to obtain an effective and sterilizing vaccine against leptospirosis.     

四川省2004－2018年钩端螺旋体病流行特征分析

目的 了解2004-2018年四川省钩端螺旋体病（钩体病）流行病学特征,为防控策略提供依据。方法 钩体病数据来源于全国法定传染病疫情监测网络直报系统和11个监测点数据,采用描述性流行病学方法分析,采用ArcGIS 10.2软件进行地图绘制,采用SaTScan 9.1.1软件进行时空扫描分析,描述钩体病时空聚集性特征。结果 2004-2018年四川省报告钩体病发病2 834例,死亡41例,发病率0.23/10万,死亡率0.003/10万,发病趋势波动向下。发病有明显季节性,主要集中在8月下旬至9月底,较水稻收割时间晚1~2周。男性为主,男女性别比为2.05：1;发病率较高的为50~65岁组。职业以农民为主,占82.75%（2 345/2 834）;其次为学生,占12.74%（361/2 834）,但2011年后学生病例报告极少。高发地区在南部长江流域沿岸马边彝族自治县（马边县）、沐川县等和东部嘉陵江流域仪陇县之间不断交替。时空扫描聚集性分析发现2个高发聚集区域（P<0.001）。11个监测点2004-2018年平均鼠密度为5.44%（14 351/263 767）;主要野外鼠种有四川短尾鼩（占69.07%）、黑线姬鼠（占12.73%）等;其中黑线姬鼠密度介于4.60%~0.19%之间,呈持续下降趋势,2018年达最低水平。鼠肾标本培养钩体阳性率的各年度间也呈下降态势。2007-2018年健康人群血清钩体抗体阳性率平均为24.52%（3 271/13 339）,主要流行菌群为黄疸出血群,近年未出现菌群的更替。结论 2004-2018年四川省钩体病发病水平极低,季节特征符合稻田型流行特征,人群以老年农民为主;高发地区在长江和嘉陵江流域周边互相交替。黑线姬鼠密度和带菌率均较低;主要流行菌群持续以黄疸出血群为主,健康人群钩体抗体阳性率处于较低水平。     

三峡坝区钩端螺旋体病监测结果分析

目的调查长江三峡水库坝区钩端螺旋体病流行因素和疫情。方法选择调查点,收集1996~2006年钩端螺旋体病疫情资料,进行钩端螺旋体病病原分离和抗体检测。结果2003~2006年长江三峡水库坝区钩端螺旋体病发病率比蓄水前低,采13份散发钩端螺旋体病人双份血清,用交叉吸收实验检测出临海、致热、乳山3个新的钩端螺旋体血清型;水库坝区清底后,鼠密度2.09%。室内褐家鼠为优势鼠种,占57.1%;户外黑线姬鼠和褐家鼠为优势鼠种,占66.67%。分离钩端螺旋体菌36株,分属5个血清群7个血清型,其中黄疸出血群占47.22%,波摩那群占27.78%,鼠肾、猪肾和蛙肾带菌率分别为2.67%、0.81%和0.25%,健康人群黄胆出血群阳性率为31.12%。结论长江三峡水库坝区蓄水期间没有发生钩端螺旋体病暴发流行,采取水库坝区清底可以有效降低鼠密度。     

Adjuvanted leptospiral vaccines: Challenges and future development of new leptospirosis vaccines

Leptospirosis is a neglected infectious disease of global importance. Vaccination is the most viable strategy for the control of leptospirosis, but in spite of efforts for the development of an effective vaccine against the disease, few advances have been made, and to date, bacterin is the only option for prevention of leptospirosis. Bacterins are formulations based on inactivated leptospires that present a series of drawbacks, such as serovar-dependence and short-term immunity. Therefore, bacterins are not widely used in humans, and only Cuba, France and China have these vaccines licensed for at-risk populations. The development of recombinant DNA technology emerges as an alternative to solve the problem. Recombinant protein-based vaccines or DNA vaccines seem to be an attractive strategy, but the use of adjuvants is critical for achievement of a protective immune response. Adjuvants are capable of enhancing and/or modulating immune responses by exposing antigens to antigen-presenting cells. In the last years, several components have been tested as adjuvants, such as aluminum salts, oil based-emulsion adjuvants, bacteria-derived components and liposomes. This review highlights the use of adjuvants in the multiple vaccine approaches that have been used for leptospirosis and their most important immunological aspects. Immune response data generated by these strategies can contribute to the understanding of the immune mechanisms involved in protection against leptospirosis, and consequently, the development of effective vaccines against this disease. This is the first review on leptospiral vaccines focusing on adjuvant aspects.