Re-emergence of Chikungunya virus in Malaysia

An outbreak of Chikugunya (CHIK) fever occurred among the fishing community in Bagan Pancor, Perak. The outbreak was laboratory confirmed within 48 hours after the receipt of the specimens. Fifty-three patients' serum samples were submitted for laboratory investigation and 47 (88.7%) were confirmed to be positive for CHIK infection by RT-PCR, and/or virus isolation, and/or in-house immunoflourescent test. RT-PCR and virus isolation were the tests of choice for patients with illness of four days or less and detection of CHIK specific IgM for those with more than four days of fever. The nucleic acid sequence based on the 354- and 294-bp of the nsP1 and E1 genes of the CHIK virus detected from pools of adults Aedes aegypti mosquitoes were identical to those CHIKV virus isolated from humans in the same locality. Phylogenetic analysis of the CHIK virus based on the 257 nts partial E1 gene indicates that Bagan Panchor's strain was closely related to the first CHIK virus isolated during the outbreak in Klang in 1998.     

百日咳再现及其应对策略的研究进展

20世纪80年代国外将百日咳发病水平控制在低点后陆续出现百日咳发病反弹的报道,研究学者将该现象称为"百日咳再现"。"百日咳再现"对免疫规划时期百日咳的防控提出新的挑战。百日咳发病率上升的同时,其流行特征亦发生改变,原先的应对策略已无法满足"百日咳再现"的防控需求。该文将对国内外"百日咳再现"的流行病学特征、传播模式的改变、"百日咳再现"的原因及其应对策略进行综述,对我国面对"百日咳再现"的防控形势提出建议。     

育龄妇女接种麻疹疫苗对婴儿麻疹抗体及麻疹疫苗接种的影响

目的：研究育龄妇女接种麻疹疫苗后所生婴儿的胎传麻疹抗体的动态变化,并了解其对婴儿接种麻疹疫苗的影响。方法：选择2012年1月1日至2012年12月31日300位育龄妇女纳入本研究,检测麻疹IgG抗体后进行随机对照试验（RCT）,设立高抗体无疫苗接种组（I组,52例）、高抗体疫苗接种组（II组,53例）、低抗体无疫苗接种组（III组,98例）和低抗体疫苗接种组（IV组,97例）。I组和III组不接种疫苗,II组和IV组接种麻腮风联合减毒活疫苗,各组均于待产时检测麻疹IgG抗体。检测育龄妇女所生婴儿出生时、8月龄大时、接种麻疹疫苗后半个月和接种麻疹疫苗后3个月血麻疹IgG抗体,于接种麻疹疫苗后半个月同时检测麻疹IgM抗体。分析育龄妇女待产时麻疹IgG抗体水平与婴儿出生时IgG抗体水平的相关性,分析婴儿麻疹IgG抗体的动态变化及IgM抗体的情况。结果：对育龄妇女待产时麻疹IgG抗体水平与新生儿脐带血麻疹IgG抗体水平进行pearson相关分析,显示相关系数为0.85,P=0.00,提示存在相关性。重复测量方法分析结果显示,I组和II组、III组和IV组之间婴儿麻疹IgG抗体变化差均异有统计学意义（均P=0.00）,而I组和III组、II组和IV组之间差异无统计学意义（分别为P=0.11和P=0.45）。接种后3个月各组间比较,F=1.36,P= 0.26,提示各组间此时间点上差异无统计学意义。婴儿IgG抗体趋势图显示,婴儿的胎传麻疹抗体水平随时间逐步减少,在接种麻疹疫苗3个月时又明显升高。I～IV组婴儿麻疹IgM抗体样本/临床值比值（S/CO值）经单因素方差分析,F=0.95,P=0.42,提示各组间差异无统计学意义。结论：育龄妇女接种麻疹疫苗可提高所生婴儿胎传麻疹抗体水平,使婴儿在接种麻疹疫苗前获得足够的保护性抗体,也不会影响婴儿接种麻疹疫苗的效果。     

Effects of ribavirin on measles

To assess the beneficial effectof ribavirin on measles, a study was conducted among one group (group A) of measles patients who were randomly assigned and treated with ribavirin along with supportive management and anothergroup who were also randomly assigned and treated by supportive therapy only acted as controls (group B) between January 2006 and December 2009 at ID&BG Hospital, Kolkata. Both the groups included 50 patients each and all were confirmed by serum IgM antibody detection. The duration of fever along with constitutional symptoms like malaise, cough, coryza, conjunctivitis, lacrimation, rash, hospital staying and complications of both the groups were compared. The duration and severity of fever and constitutional symptoms like anorexia, malaise, conjunctivitis, cough, etc, and maculopapularrash were much less in group A than those of group B and there were no complications in group A whereas there were many complications in group B cases and the duration of hospital stay of patients in group B were much more than those of group A cases. These results suggest that the beneficial effect of ribavirin on measles is established and each and every measles patient should be treated by ribavirin along with standard symptomatic managemen irrespective of duration regarding illness.     

Neurological complications of measles.

OBJECTIVE: To study the clinical features and course of neurological complications of measles. DESIGN: Prospective study. SETTING: Neurology Unit, Teaching Hospital, Kandy. PATIENTS: 10 patients admitted with neurological complications of measles during an outbreak. MEASUREMENTS: Assessment of clinical features and the neurological investigations. RESULTS: 6 had CSF IgM antibodies confirming a recent measles infection. 7 patients had encephalitis and 3 had myelitis. Complications had appeared 5 to 14 days after appearance of the rash. All patients with encephalitis had depressed level of consciousness (Glasgow coma scale 2 to 11) with seizures, 3 patients had lateralising signs, and assisted ventilation was required in 4. Cranial CTs were either normal or showed mild cerebral oedema. CSF analysis showed either normal or mildly raised protein without a cellular reaction. EEG in all 7 revealed diffuse delta activity. During the follow up period of 1 to 12 weeks, all showed a gradual improvement, except one who succumbed to respiratory complications of assisted ventilation. All others were left with some residual disability when last seen. Three patients with myelitis had symmetrical paraparesis. CSF protein was 60 to 80 mg/ml without a cellular reaction. All three improved without residual disability. CONCLUSIONS: Measles encephalitis is a life threatening complication. All three myelitis patients recovered completely within 5 to 8 weeks.     

一起麻疹暴发的调查分析

2005年1月9日～2月12日，柳州市西鹅乡帽合村一个外来流动人口居住点发生一起重大的麻疹暴发疫情。为了解暴发状况及流行病学特点，我们进行了现场流行病学调查，现将情况报告分析如下。