流行性乙型脑炎灭活疫苗三针基础免疫效果及反应研究

采用ＢＨＫ－２１细胞蚀斑减少中和试验，检测扬中县６～１８月龄婴儿乙型脑炎灭活疫苗中和抗体，追踪调查接种反应和第２年加免前后抗体变化，探讨３针基础免疫效果。结果表明：乙脑基础免疫中和抗体阳转率３针组达８２．２６％，２针组５２．９４％．Ｐ＜０．００５；抗体ＧＭＴ３针组１３．９０，２针组７．５７．Ｐ＜０．００５。第２年抗体维持水平，阳性率３针组７５．００％，２针组５１．５％．Ｐ＜０．００５；抗体ＧＭＴ３针组１１．８７，２针组５．８６，Ｐ＜０．０２。加免后阳性率，３针组达１００％，２针组９７．０６５，Ｐ＞０．５；抗体ＧＭＴ３针组１８８．０９，２针组为５６．１９．Ｐ＜０．００１。接种反应追踪调查未见严重反应，有关指标无组间和注射针次间差异（Ｐ＞０．５）。提示：采用３针进行乙脑疫苗基础免疫是安全的．可供选择的免疫策略。     

辽宁省肾综合征出血热沙鼠肾细胞、地鼠肾细胞灭活疫苗免疫效果评价

选择ＨＦＲＳ姬鼠型疫区盘锦大洼县、家鼠型疫区葫芦岛市，每个疫区选一试区与对照区，于每一试区分别接种ＨＦＲＳ长爪沙鼠肾细胞（Ⅰ型）和地鼠肾细胞（Ⅱ型）灭活疫苗各５０００人份。经过一个流行周年观察，显示两种疫苗安全，近期效果明显。沙鼠苗的中强反应率为２．１３％（５１／３５６），荧光抗体阳转率免前为６．２％（隐性感染），３针基础免疫后为１００％，一年后为５４．７６％，加强针后为１００％；抗体ＧＭＴ滴度分别为：３１．７、７９８、１６、５５７；中和抗体４次阳转率分别为０，７０．３７％、０、７３．３３％，抗体ＧＭＴ滴度分别为０、１０．７、０、１４．６。地鼠苗的中强反应率为３．９７％（５１／１２８４），荧光抗体４次阳转率分别为９．８８％（隐性感染）、１００％、３６．３６％、１００％；抗体ＧＭＴ滴度分别为３３．６、２３２、２５、３８７；中和抗体４次阳转率分别为０、５０％、１７．６５％、１００％，抗体ＧＭＴ滴度分别为０、９．３、２０、１５。但疫苗免疫针次、抗体持续时间、疫苗的远期流行病学效果等，有待进一步研究。     

麻疹疫苗初免月龄及接种针次的探讨

１９９３年广西８４个麻疹暴发点的流行病学和血清学调查发现，暴露后１～３月龄、４－５月龄、６～７月龄、８－１１月龄的未接种麻疹疫苗（ＭＶ）儿童的发病率分别为２．５％．１３．０％．１６．３％、１９．７％。血凝抑制抗体阴性率分别为０％、７１．２％．７９．２％．８５．９％。而１一７岁未接种儿童ＭＶ暴露后的发病率为２４．４％。根据所得资料，作者建议ＭＶ免疫可采用两针法，第１针提前到４一６月龄，可降低婴幼儿麻疹发病率，第２针在１５－２３月龄，可弥补因第１针免疫不成功或漏种的易感儿。     

流行性乙型脑炎减毒活疫苗血清学效果观察

为进一步考核用ＳＡ１４－１４－２株生产的流行性乙型脑炎（乙脑）减毒活疫苗接种儿童后的血清学效果，在湖北省乙脑流行区，对某山区小学从未接种过乙脑疫苗的９７名７～１３岁健康小学生接种该疫苗。免疫前和免疫后１个月采血检测乙脑中和抗体，结果：免前中和抗体阳性者８６人（８８．６６％），中和指数ＧＭＴ为１：６９５．３２，免疫１针后１个月，抗体阳性率达到１００％，中和指数ＧＭＴ为１：２７７８．２７；免疫前抗体阴性的１１名儿童，免疫后１个月全部阳转；免疫前中和指数≥１１０００者５４人（占５５．６７％），免疫后１个月增至８１人（８３．５１％）；６０．８２％的儿童免疫后１个月中和抗体滴度较免疫前增长≥２倍。这证明该疫苗免疫效果良好     

浓缩狂犬病疫苗接种反应及血清学效果观察

本文报告了１５６例接种地鼠肾组织培养浓缩狂犬病疫苗的临床反应和血清学效果。全身弱反应（体温３７１～３７５℃）０６％，中反应（３７６～３８５℃）１９％，无强反应（≥３８６℃）；局部弱反应（红肿＜２５ｃｍ）１３％，中反应（２６～５０ｃｍ）５８％，强反应（≥５１ｃｍ）４５％。经用ＥＬＩＳＡ法检测，注射５针浓缩狂犬病疫苗后两周，抗体阳转率为９４９％。抗体未阳转者增加３针免疫，即全部阳转。     

A群流脑多糖体菌苗基免两针间隔时间研究

对Ａ群流脑多糖体菌苗（下称流脑苗）基础免疫（下称基免）１针增至２针以及２针不同间隔时间的免疫效果作了研究。结果为：基免２针间隔１月组免后１月的近期效果与基免１针组比无差异；基免２针不同间隔时间各组免后１年阳性率在５８．１２～７６．３９％的较高水平，基免１针组则降至５．４％的低水平。表明流脑苗基免２针组远期免疫效果优于１针组，而基免２针间隔１月组免后１月、间隔半月组免后半年的阳性率（０．５２％和５３．７１％）均又高于间隔２月组的阳性率（２５．４４％和３０．７０％），故认为２针间隔以半月或１月为宜。     

山东省肾综合征出血热地鼠肾细胞灭活疫苗免疫效果及免疫策略研究

本文报告肾综合征出血热Ⅱ型地鼠肾细胞灭活疫苗在山东省高发人群接种后的免疫效果。疫苗初免３针后２周、１２个月血清中和抗体阳转率分别为６８．９６％（２０／２９）、１８．５％（５／２７），１２个月复种１针后血清中和抗体阳转率达１００％（２７／２７）（ＭＣＰＥＮＴ法）；几何平均滴度（ＧＭＴ）为８．４、３．２、１７．０５。通过１９９５年春峰及秋冬峰本病高峰期观察，接种人群未发生病人，对照人群发病２５例，发病率２１０．９／１０万，疫苗保护率１００％，疫苗接种无明显不良反应，安全性较好，近期免疫、防病效果较理想。     

海南省琼中地区三农场斑点热血清流行病学研究

目的：了解海南省斑点热流行状况。方法：用补体结合试验，在琼中县大丰、阳江及新进３个农场的健康人群、家畜及啮齿动物中进行斑点热血清流行病学及啮齿动物种群和带蜱情况调查。结果：共检查牛血清１８份，羊血清５０份，猪血清６３份，人血清７２份，鼠血清１２０份，西伯利亚立克次体、康氏立克次体、小蛛立克次体抗体阳性率羊血清分别为４％（２／５０）、２％（１／５０）和２％（１／５０）。猪血清分别为３．１７％（２／６３）、０％（０／６３）和３．１７％（２／６３），人血清分别为１６．６７％（１２／７２）、１１．１１％（８／７２）和２．７８％（２／７２），鼠血清分别为３０．００％（３６／１２０）、１０．８３％（１３／１２０）和７．５０％（９／１２０），牛血清中未检测出上述抗体。该地区的优势鼠种为黄毛鼠、屋顶鼠、针毛鼠，带蜱率分别为１５．９１％（７／４４）、３０％（１５／５０）、３６．３６％（８／２２）。结论：海南省琼中县存在斑点热自然疫源地。     

国产酵母重组乙肝疫苗不同免疫程序免疫的效果观察

应用２批国产酵母重组乙肝疫苗，分别按０、１、２、和０、１、６免疫程序对３９３名小学生进行１年免疫效果观察。所有接种的小学生中未发现严重副反应者。结果表明，免疫程序对抗体阳转率影响较小，第１针免疫后３个月（Ｔ３）时，接种各疫苗组的抗体阳转率均达或接近９０％，第１针免疫后７个月（Ｔ７）时，接种各疫苗组的抗体阳转率均达高峰（９０．００％～９８．２８％），其后开始缓慢下降，而抗体ＧＭＴ与免疫程序有关，０、１、２免疫程序组抗体ＧＭＴ上升快，而０、１、６组抗体峰值高。     

中国肾综合征出血热疫苗免疫效果评价和免疫策略研究

１９９３～１９９４年对中国试生产的肾综合征出血热沙鼠肾细胞Ⅰ型灭活疫苗（上海生研所和天元公司），乳鼠脑纯化Ⅰ型灭活疫苗（兰州生研所）和地鼠肾细胞Ⅱ型灭活疫苗（长春生研所），在疫区现场进行了人群接种、安全性观察和血清学、流行病学近期效果考核。结果：３种疫苗安全性皆较好，上海沙鼠苗、天元沙鼠苗、鼠脑苗和地鼠苗中强反应率分别为０．５６％、０．０３％、３．２６％、１．５７％。３种疫苗３针全程免疫后１４天，中和抗体阳转率地鼠苗为７８．７８％，上海沙鼠苗为５８．６４％，天元沙鼠苗为７０．００％，鼠脑苗为５１．０９％；荧光抗体阳转率地鼠苗为８２．６４％，上海沙鼠苗为９３．６９％，天元沙鼠苗为８３．３３％，鼠脑苗为８４．２７％。３种疫苗近期流行病学防病效果均较好，保护率地鼠苗为９７．６３％，上海沙鼠苗为９４．０７％，天元沙鼠苗为１００．００％，鼠脑苗为９６．００％。     

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.     

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.     

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.     

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.     

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.     

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.