新型冠状病毒肺炎流行现状及应对策略进展

随着北半球秋冬季节来临,以呼吸道飞沫和密切接触传播为主要途径的新型冠状病毒肺炎（新冠肺炎,2019冠状病毒病）给各国防控带来了新的挑战。本文从新冠病毒变异、全球流行形势、群体免疫问题、无症状感染对我国疫情防控的影响、疫苗的进展和治疗等方面对新冠肺炎流行及应对现状进行综述,以期为新形势下我国疫情防控策略的规划和调整提供借...     

如何“围堵”新发传染病流行

当前,我国正处于新冠肺炎疫情防控的关键时期。从2019年年底武汉发现肺炎病例至今,在国家联防联控机制的带动下,中国采取了基于围堵策略的防控措施,在全国范围内广泛开展体温检测、佩戴口罩与洗手消毒等,同时进行积极主动监测,迅速发现并立即诊断、隔离病例,严格追踪并隔离密切接触者等相关措施。通过所采取坚定有力的综合性非药物性干预措施,有效降低了新冠肺炎病毒的传播,为全球应对新冠肺炎疫情提供了重要的经验并赢得了宝责的“时间窗”。     

新型冠状病毒肺炎无症状感染者在疫情传播中的作用与防控策略

新型冠状病毒肺炎（新冠肺炎）无症状感染者成为我国防控疫情反弹的热点问题。本文介绍新冠肺炎无症状感染者现象、定义、发现过程与疫情报告和统计规则，阐述初诊为无症状感染者在跟踪观察一个最长潜伏期后，病情自然发展变化将其化分为隐性感染无症状感染者和潜伏期无症状感染者两大类，利用现有数据分析无症状感染者的传染性及其对疫情传播扩散的作用，探讨我国防止无症状感染者可能造成疫情反弹所面临的挑战，并提出防控及研究相关建议。     

GIS在传染病方面的实时预警溯源系统

新型冠状病毒肺炎(以下简称“新冠肺炎”)疫情暴发以来,GIS技术等空间信息技术在可视化呈现新冠肺炎疫情分布、传播和早期预测预警等方面提供了大量的技术手段和应用实例,这些技术手段和应用实例为新冠肺炎疫情的科学防控和精准施策奠定了基础。本文针对新冠肺炎疫情,使用GIS方法设计出传染病实时预警溯源系统,并在此基础上介绍了该系统在新冠肺炎疫情防控中的应用,为进一步提升新冠肺炎疫情防控水平提供参考。     

一起由进口冷链海产品引起的新型冠状病毒肺炎家庭聚集性疫情调查

目的 调查一起由进口冷链海产品引起的新型冠状病毒肺炎家庭聚集性疫情的流行病学特征，为冷链产品引发的新冠肺炎疫情防控提供依据。方法 应用现场流行病学方法调查阳性货物、无症状感染者、密切接触者及相关人群，采用实时荧光定量RT - PCR对呼吸道及环境标本进行病毒核酸检测，采用化学发光法进行血清学抗体检测，分析疫情传播链，开展溯源调查工作。结果 此次疫情是一起因工人作业中未进行有效防护而暴露于被病毒污染的进口冷链海产品造成感染，进而引发家庭聚集性疫情。结论 进口冷链海产品污染可传播新冠肺炎病毒，若防控不当可感染并引发聚集性疫情。要坚持“人物同防”，并将进口冷链产品作为疫情防控的重中之重。     

健康促进视角下的我国新冠肺炎疫情应对

新冠肺炎疫情是新中国成立以来传播速度最快、感染范围最广、防控难度最大的一次重大突发公共卫生事件。疫情发生以后,党和政府采取了强有力的防控救治措施,疫情防控阻击战取得重大战略成果。我国疫情防控工作得到世界卫生组织和许多国家的认同,本文尝试从健康促进视角分析我国新冠肺炎应对经验,提出工作建议。     

新冠疫情常态化防控期间医院感染的特点及其应对措施

目的 分析传染病特别是新冠肺炎的流行病学特点,探讨新冠疫情常态化形势下医院感染防控的策略和措施。方法 分析医院感染的流行病学特点,结合贵州省人民医院在新冠疫情期间医院感染防控措施经验,提出传染病流行背景下的医院感染管理策略。结果 建立科学的防控体系,预检分诊、做好重点科室(部门)、医务人员防护、患者就诊、环境清洁与消毒、医疗废弃物、医院感染监测的管理控制,医务人员和患者及其家属培训与宣教是医院感染防控的重要组成部分。结论 新冠肺炎影响范围大,危害严重,疫情防控常态化形势下,不断分析总结医院感染管理和防控实践经验,及时完善医院感染应对策略和措施,是保障医疗质量和安全的重要举措,对于防止传染病疫情通过医院蔓延扩散有重大作用,是一项长期的任务。     

新型冠状病毒肺炎暴发疫情流行病学调查经验初探

目的探索流行病学调查在新型冠状病毒肺炎(新冠肺炎,Corona virus disease 2019,COVID-19)防控中的作用,进一步做好攻坚阶段的流行病学调查处置工作。方法总结新冠肺炎暴发疫情防控策略措施及实践经验,分析存在的问题,提出合理的应对措施。结果从暴发疫情流行病学调查角度探讨并提出新冠肺炎防控策略与措施,包括:如何认识流行病学调查,如何进行暴发疫情的流行病学调查,何时开展暴发疫情控制工作,如何开展暴发疫情控制工作,关于传染性、暴发与流行的分析,疫情信息如何报告与管理,如何认识关于传染病可防可控问题。结论流行病学调查是新冠肺炎防控中重要的策略与措施,新冠肺炎是可防可控的。     

新冠肺炎疫情下军队干休所门诊部面临的防控难题及经验对策

正当前新冠肺炎在北京、河北和东北等地局部区域再度集中频发,截至2021年1月27日24时,据国家卫健委公布的统计数据,全国31省(自治区、直辖市)和新疆生产建设兵团累计报告确诊病例89 326例,累计死亡病例4 636例。从整个患者群体来说,平均年龄51岁,中老年人群高发。老年人免疫功能弱,是传染病的易感人群和高危易发人群。国家、军队各级疫情防控工作领导小组对老年人这一特殊群体予以高度重视,国家卫健委老龄健康司于2020年1月28日发布《关于做好老年人新型冠状病毒感染肺炎疫情防控工作的通知》,与通知一并下发的《养老机构疫情防控措施》,对暂未发现病例的养老机构提出了建立新冠肺炎疫情防控工作机制、     

基于SWOT分析法的深圳市新冠肺炎疫情常态化阶段防控影响因素及应对策略研究

目的 总结深圳市新冠肺炎疫情常态化阶段的防控经验,科学制定下一阶段的疫情防控与技术发展策略。方法 采用SWOT分析法,列举深圳市新冠肺炎疫情常态化防控阶段的优势、劣势、机会和威胁因素,根据SWOT分析矩阵产生优势—机会、劣势—机会、优势—威胁和劣势—威胁策略。结果 新冠肺炎疫情防控常态化阶段,深圳市共制定疫情防控策略15条,其中优势—机会策略4条、劣势—机会策略4条、优势—威策略4条、劣势—威胁策略3条。结论 通过SWOT分析法制定的疫情防控策略符合实际需求,具有良好的指导作用。     

Modelling of COVID-19 vaccination strategies and herd immunity,in scenarios of limited and full vaccine supply in NSW,Australia

Several vaccines for SARS-CoV-2 are expected to be available in Australia in 2021. Initial supply is limited and will require a judicious vaccination strategy until supply is unrestricted. If vaccines have efficacy as post-exposure prophylaxis (PEP) in contacts, this provides more policy options. We used a deterministic mathematical model of epidemic response with limited supply (age-targeted or ring vaccination) and mass vaccination for the State of New South Wales (NSW) in Australia. For targeted vaccination, the effectiveness of vaccinating health workers, young people and older adults was compared. For mass vaccination, we tested varying vaccine efficacy (VE) and distribution capacities. With a limited vaccine stockpile enough for 1 million people in NSW, if there is efficacy as PEP, the most efficient way to control COVID-19 will be ring vaccination, however at least 90% of contacts per case needs to be traced and vaccinated. Health worker vaccination is required for health system resilience. Age based strategies with restricted doses make minimal impact on the epidemic, but vaccinating older people prevents more deaths. Herd immunity can only be achieved with mass vaccination. With 90% VE against all infection, herd immunity can be achieved by vaccinating 66% of the population. A vaccine with less than 70% VE cannot achieve herd immunity and will result in ongoing risk of outbreaks. For mass vaccination, distributing at least 60,000 doses per day is required to achieve control. Slower rates of vaccination will result in the population living with COVID-19 longer, and higher cases and deaths.     

The resurgence risk of COVID-19 in China in the presence of immunity waning and ADE: A mathematical modelling study

The mass vaccination program has been actively promoted since the end of 2020. However, waning immunity, antibody-dependent enhancement (ADE), and increased transmissibility of variants make the herd immunity untenable and the implementation of dynamic zero-COVID policy challenging in China. To explore how long the vaccination program can prevent China at low resurgence risk, and how these factors affect the long-term trajectory of the COVID-19 epidemics, we developed a dynamic transmission model of COVID-19 incorporating vaccination and waning immunity, calibrated using the data of accumulative vaccine doses administered and the COVID-19 epidemic in 2020 in mainland China. The prediction suggests that the vaccination coverage with at least one dose reach 95.87%, and two doses reach 77.92% on 31 August 2021. However, despite the mass vaccination, randomly introducing infected cases in the post-vaccination period causes large outbreaks quickly with waning immunity, particularly for SARS-CoV-2 variants with higher transmissibility. The results showed that with the current vaccination program and 50% of the population wearing masks, mainland China can be protected at low resurgence risk until 8 January 2023. However, ADE and higher transmissibility for variants would significantly shorten the low-risk period by over 1 year. Furthermore, intermittent outbreaks can occur while the peak values of the subsequent outbreaks decrease, indicating that subsequent outbreaks boosted immunity in the population level, further indicating that follow-up vaccination programs can help mitigate or avoid the possible outbreaks. The findings revealed that the integrated effects of multiple factors: waning immunity, ADE, relaxed interventions, and higher variant transmissibility, make controlling COVID-19 challenging. We should prepare for a long struggle with COVID-19, and not entirely rely on the COVID-19 vaccine.     

新型冠状病毒肺炎防控对学校卫生工作的挑战

自新型冠状病毒病疫情暴发至今,我国采取积极有效的应对策略,已取得防控疫情阶段性的胜利;目前我国多个地区的中小学、大学已经分批复学。鉴于儿童、青少年感染新型冠状病毒临床特征和生长发育的特殊性,我国学校卫生防控面临了极大的挑战。本文基于近期国内外有关2019新型冠状病毒的研究进展,综述儿童、青少年感染2019新型冠状病毒的临床和流行病学特点,提出目前学校复学存在的防控挑战,并初步探讨可能的应对策略。     

Increasing acceptance of a vaccination program for coronavirus disease 2019 in France: A challenge for one of the world’s most vaccine-hesitant countries

France is one of the most vaccine-hesitant countries in the world, including for coronavirus disease 2019 (COVID-19). After 10 months of restrictive measures and media coverage of the dangers of COVID-19, French attitudes towards a vaccine continue to deteriorate. The communication strategies of the government have not helped; in fact, they have made the situation worse.Empirical studies on the national strategy for management of the COVID-19 pandemic in France have shed light on the reasons for vaccine hesitancy. These studies have identified four pillars for the vaccination strategy: i) Communication regarding the importance of herd immunity, ii) making healthcare workers the focus of the vaccination campaign, iii) citizen mobilization and guaranteed consultations, and iv) access to free vaccines without delay. This paper discusses the evidence supporting this strategy.     

Vaccination willingness,vaccine hesitancy,and estimated coverage at the first round of COVID-19 vaccination in China: A national cross-sectional study

BackgroundVaccination against coronavirus disease 2019 (COVID-19) has become an important public health solution. To date, there has been a lack of data on COVID-19 vaccination willingness, vaccine hesitancy, and vaccination coverage in China since the vaccine has become available.MethodsWe designed and implemented a cross-sectional, population-based online survey to evaluate the willingness, hesitancy, and coverage of the COVID-19 vaccine among the Chinese population. 8742 valid samples were recruited and classified as the vaccine-priority group (n = 3902; 44.6%) and the non-priority group (n = 4840; 55.4%).ResultsThe proportion of people’s trust in the vaccine, delivery system, and government were 69.0%, 78.0% and 81.3%, respectively. 67.1% of the participants were reportedly willing to accept the COVID-19 vaccination, while 9.0% refused it. 834 (35.5%) reported vaccine hesitancy, including acceptors with doubts (48.8%), refusers (39.4%), and delayers (11.8%). The current coverage was 34.4%, far from reaching the requirements of herd immunity. The predicted rate of COVID-19 vaccination was 64.9%, 68.9% and 81.1% based on the rates of vaccine hesitancy, willingness, and refusal, respectively.ConclusionsThe COVID-19 vaccine rate is far from reaching the requirements of herd immunity, which will require more flexible and comprehensive efforts to improve the population’s confidence and willingness to vaccinate. It should be highlighted that vaccination alone is insufficient to stop the pandemic; further efforts are needed not only to increase vaccination coverage but also to maintain non-specific prevention strategies.     

The effect of health literacy on COVID-19 vaccine hesitancy among community population in China: The moderating role of stress

BackgroundThe public’s hesitant attitude is a major subjective barrier in promoting vaccination against COVID-19 to build herd immunity. The current study aimed to address how individual factors such as health literacy and perceived stress affect people’s vaccine hesitancy of COVID-19 vaccine, and to provide insights for tailoring vaccine-promotion strategies.MethodsWith structured questionnaires, an online survey was conducted to address the relationship between the health literacy, perceived stress, and COVID-19 vaccine hesitancy among community population in mainland, China. Moderated analysis was conducted to test the effect of health literacy on vaccine hesitancy among people with different levels of perceived stress.Results560 responses were collected in total. 39.8% of the participants reported vaccine hesitancy, and this rate was higher among younger people and female. Moreover, people with higher level of health literacy showed reduced vaccine hesitancy, while this effect was only significant among those with low or moderate level of stress. For people with high level of stress, no significant effect of health literacy was found.ConclusionsThe findings suggest that increasing people’s health literacy could lead to reduced vaccine hesitancy in community sample. However, this effect disappeared when the stress level was high, suggesting other promotion services may need to be developed to increase the acceptance of COVID-19 vaccine. In conclusion, vaccine promotion strategies should be tailored for different populations, with taking account of individual’s health literacy and perceived stress.     

新冠肺炎疫情医院内流行病学调查及思考

 新冠肺炎疫情暴发以来,已经蔓延至160多个国家,造成了世界范围的大流行,给全球医疗系统带来了巨大冲击,造成了巨大的经济损失。新型冠状病毒基因组不断发生变异,其免疫逃逸能力更高、传染性更强,感染者趋向于轻症的特点,给疫情防控带来了更大的挑战。中国疫情防控经历了4个阶段,取得了举世瞩目的成绩,证明了中国疫情防控模式的先进性、科学性。快速、强大的病原体检测能力和快速精准的流行病学调查能力是此次新冠疫情能在中国被有效控制的法宝。在医疗机构特别是新冠肺炎定点医院,出现新冠肺炎疫情时及时、高效、规范的流行病学调查是医院内疫情防控的关键。精准的流行病学调查,是医院内对涉疫人群和涉疫区域实施分级管控的前提和基础,是防止疫情在医院内扩散和防止医务人员非战斗减员的保障。医院内新冠疫情的流行病学调查与社会面的流行病学调查相比有其特殊性,需要在小范围内进行更为精准的流行病学调查,既要防止疫情的扩散,又要尽可能的保障普通患者的就医需求。如何开展医院内（重点区域内）疫情流行病学调查将成为疫情防控的新课题。在新冠疫情的医院防控中,中南大学湘雅医院始终坚持在疾病预防控制中心指导下以自身力量为主导完成医院内新冠肺炎疫情流行病学调查,形成了医院流调的湘雅模式。本文结合医院内流行病学调查之湘雅经验,介绍新冠肺炎疫情医院内流行病学调查的意义、方法、主体,以及新形势下医院感染面临的挑战及展望。