Effects of Humidity Variation on the Hantavirus Infection and Hemorrhagic Fever with Renal Syndrome Occurrence in Subtropical China

Infection rates of rodents have a significant influence on the transmission of hemorrhagic fever with renal syndrome (HFRS). In this study, four cities and two counties with high HFRS incidence in eastern Hunan Province in China were studied, and surveillance data of rodents, as well as HFRS cases and related environmental variables from 2007 to 2010, were collected. Results indicate that the distribution and infection rates of rodents are closely associated with environmental conditions. Hantavirus infections in rodents were positively correlated with temperature vegetation dryness index and negatively correlated with elevation. The predictive risk maps based on multivariate regression model revealed that the annual variation of infection risks is small, whereas monthly variation is large and corresponded well to the seasonal variation of human HFRS incidence. The identification of risk factors and risk prediction provides decision support for rodent surveillance and the prevention and control of HFRS.     

云南省2001～2002年肾综合征出血热监测研究

目的为掌握云南省肾综合征出血热流行病学特点,提供防治参考,对人间和鼠间疫情进行了监测.方法收集全省本病疫情资料,并在监测县采集人血清以及鼠肺脏和鼠血清作汉坦病毒抗原和抗体检查.结果 2001～2002年全省共报告本病102例,死亡3例,年发病率为0.12/10万,病死率为2.94%.主要发病地区为红河州、昆明市、楚雄州.疫区人群隐性感染率为4.19%.2002年在泸西、寻甸和永胜监测点捕获鼠类9种891只,居民区以褐家鼠和黄胸鼠为优势鼠种,野外以高山姬鼠为优势种;鼠间汉坦病毒带毒率为3.65%,带病毒鼠种为褐家鼠、黄胸鼠、小家鼠和高山姬鼠.2001年在大理市野外捕鼠12种140只,大绒鼠为优势种,带毒鼠为大绒鼠、大足鼠、黄胸鼠、社鼠和短尾鼠句.结论监测区内存在有以褐家鼠和黄胸鼠为主要宿主动物的家鼠型疫源地,也存在着以高山姬鼠和大绒鼠为主的野鼠型疫源地.发病率上升与较高的鼠密度和鼠间感染率有关.应采取以灭家鼠和接种家鼠型或两型混合疫苗为主的防治措施.     

2017-2020年湖北省荆州市肾综合征出血热宿主动物监测分析北大核心CSCD

目的总结荆州市2017-2020年肾综合征出血热(HFRS)宿主动物监测结果,为该市HFRS科学防控提供依据。方法在全市8个县(市、区)开展HFRS宿主动物监测。在春季(4-5月)和秋季(9—10月)采用夹夜法分别于室内、野外布放鼠夹。室内及野外选取荆州市常见生境。对捕获鼠进行鉴定,无菌取鉴定鼠肺,利用实时荧光定量PCR(RT-PCR)检测鼠肺汉坦病毒并分型。结果 2017-2020年荆州市平均鼠密度4.83%(1 106/22 910),鼠汉坦病毒阳性率9.83%(58/590)。鼠密度居前3位的地区分别为江陵县(9.61%)、沙市区(6.44%)和石首市(4.92%)。鼠汉坦病毒阳性率由高到低依次为沙市区(17.31%,27/156)、江陵县(8.51%,16/188)、监利县(8.42%,8/95)和洪湖市(7.29%,7/96),其它地区捕获鼠未检出汉坦病毒。春季鼠密度为5.47%(578/10 566)。其中室内生境鼠密度6.15%(146/2 374),鼠汉坦病毒阳性率1.89%(1/53),阳性鼠为厨房捕获小家鼠;野外生境鼠密度5.27%(432/8 192),鼠汉坦病毒阳性率11.76%(16/136),阳性鼠以小麦田和虾稻田捕获黑线姬鼠、褐家鼠为主。秋季鼠密度为4.28%(528/12 344)。其中室内生境鼠密度6.06%(198/3 269),鼠汉坦病毒阳性率0.78%(1/129),阳性鼠为杂物间捕获黄胸鼠;野外生境鼠密度3.64%(330/9 075),鼠汉坦病毒阳性率14.71%(40/272),阳性鼠以蔬菜田、虾田、虾稻田、稻田捕获黑线姬鼠和褐家鼠为主。捕获黑线姬鼠均携带HNTV型汉坦病毒;褐家鼠、小家鼠、黄胸鼠携带SEOV型汉坦病毒。结论荆州市HFRS宿主动物以野外捕获黑线姬鼠、褐家鼠为主,分别携带HNTV型、SEOV型汉坦病毒。江陵县、沙市区鼠密度及鼠汉坦病毒阳性率均较高。     

肾综合征出血热流行过程及其影响因素研究进展

肾综合征出血热（hemorrhagic fever with renal syndrome, HFRS）是由汉坦病毒（hantavirus）感染引起的一种乙类传染病,可引发急性肾损伤,病死率较高。汉坦病毒型别与选择性宿主转换和地区适应密切相关,并由此不断以基因重组等方式进化,不同型别汉坦病毒所致疾病严重程度不同。全球环境变化及宿主动物习性改变加速了汉坦病毒基因组变异;同时,我国大规模土地改造、基础设施建设也使人群与病毒宿主和疾病传播媒介的接触机会增加,一定程度上增大了人群患病风险。本文综述了肾综合征出血热流行过程的主要特征及其相关影响因素,为有效防控该疾病的发生和流行提供参考依据。     

携带汉坦病毒宿主动物分布特征研究

目的 研究西安地区携带汉坦病毒(HV)宿主种类及分布特点。方法 夹夜法捕获宿主动物后鉴定种类,利用荧光定量逆转录聚合酶链反应(RT-PCR)技术检测宿主动物肺脏中HV核酸。结果 2011-2013年在监测地域共捕获动物2 577只,鼠密度为3.28%,在9月份达到5.6%;其中黑线姬鼠(Aa)占63.4%,小家鼠(Mm)和褐家鼠(Rn)分别占18.98％和12.88％;312份动物标本中检出HV核酸,其中Aa占88.78%,Rn占5.12%,Mm占4.49%,在黄胸鼠(Rf)和北小社鼩(Cs)也检出HV核酸,在8月和9月捕获的阳性宿主占到了全部阳性的56.73%, 野外的阳性宿主占到了总阳性的87.82%。结论 西安地区鼠密度在9月达到高峰,鼠种主要为Aa,Mm和Rn,携带HV的动物有Aa,Rn,Mm,Rf和Cs等,形成了在野外以Aa为主,居民区以Rn 和Mm为主,阳性宿主动物主要出现在野外8月9月,这对本地区防控肾综合征出血热(HFRS)中宿主控制方面具有指导意义。     

2006-2015年福建省漳州市肾综合征出血热流行病学分析

目的 分析福建省漳州市肾综合征出血热(HFRS)流行特征和发病风险,为疾病防控提供科学依据.方法 整理和分析2006-2015年漳州市HFRS病例个案资料及宿主动物监测资料.结果 10年间,漳州市共报告HFRS 171例,死亡1例.年均发病率为0.352/10万,疫情呈上升趋势(x…d 2=58.60,P＜0.01).累计波及全市11县区70乡镇(56.00％),高发乡镇为华安县仙都镇、华丰镇,南靖县靖城镇,诏安县深桥镇、南诏镇.农村地区报告142例,职业以农民为主(79.58％),其中生猪养殖人员占该职业病例23.01％.病例报告单位集中在市级医院(86.55％),常见临床表现为发热、恶心、呕吐、腰疼、头疼、全身痛、少尿或无尿、眼睑浮肿等,血小板减少占72.67％,蛋白尿阳性83.09％.对比前后5年,病家屋内有鼠比例(80.49％,45.83％)明显下降,工作场所有鼠或鼠排泄物比例(60.98％,73.33％)-直较高.家栖鼠平均鼠密度为6.40％,鼠总带毒率7.42％,主要带病毒鼠种为褐家鼠,携带Ⅱ型汉城病毒.结论 漳州市是HFRS家鼠型疫源地,近年整体上处于高度散发,部分县区呈现逐年上升的趋势,建议加大高发地区监测和防治力度,开展全市基层医疗机构HFRS诊疗培训.     

Emerging Zoonoses: Hantavirus-Infektionen

Among the emerging viruses, hantaviruses are being focused on more and more due to their increasing number and worldwide distribution. Transmission occurs via inhalation of aerosolized infected rodent excreta. The symptoms and course of disease vary with the infecting hantavirus species. The distribution of the different hantavirus species correlates with the geographical distribution of the virus-type-specific rodent host. Hantaviruses in Europe and Asia cause hemorrhagic fever with renal syndrome (HFRS). Infection with Puumala, the prevalent virus type in Germany, results in a more moderate form of HFRS, nephropathia epidemica. Infections with virus species on the American continents lead to a clinical picture with predominantly pulmonary pathology (hantaviral pulmonary syndrome). No specific antiviral therapy or approved vaccines are available for any hantavirus species. Controlling the rodent populations and avoiding contact with rodent excrement are the only measures that can be undertaken to contain and prevent infection.     

Relation of Frailty to Outcomes in Percutaneous Coronary Intervention

There is growing awareness that frailty may be an important marker of adverse outcomes in PCI but there is no literature from national cohorts. This study examines a national cohort of patients who underwent percutaneous coronary intervention (PCI) regarding the prevalence of frailty, changes over time, and associated outcomes. The National Inpatients Sample was used to identify adults who underwent PCI procedures between 2004 and 2014. Frailty risk was measured using a validated Hospital Frailty Risk Score (HFRS) using the cutoffs <5, 5–15 and >15 for low, intermediate and high HFRS. From 7,306,007 admissions, a total of 94.58% of admissions were for patients who had a low HFRS(<5), 5.39% had an intermediate HFRS(5–15) and 0.03% had a high HFRS(>15). The prevalence of intermediate or high frailty risk patients has increased over time from 1.9% in 2004 to 11.7% in 2014. The incidence of in-hospital death increased from 1.0% with low HFRS to 13.9% with high HFRS. Mean length of stay also increased from 2.9 days to 17.1 days from low to high HFRS. High frailty risk was independently associated with an OR 9.91 95%CI 7.17–13.71 for in-hospital death, OR 4.99 95%CI 3.82–6.51 for bleeding and OR 3.96 95%CI 3.00–5.23 for vascular injury as compared to patients with low risk of HFRS. While rare in frequency overall, frailty is increasing in prevalence in recent years and intermediate and high HFRS associated with increased odds of mortality compared to low risk of frailty.     

2011-2020年河北省肾综合征出血热流行特征及宿主动物监测分析

目的 分析2011-2020年河北省肾综合征出血热(HFRS)流行特征及宿主动物监测数据,为防控工作提供依据。方法 应用描述性流行病学方法分析2011-2020年河北省HFRS病例及宿主动物监测资料。结果 2011-2020年河北省共报告HFRS病例6 357例,年平均发病率为0.88/10万;死亡17例,病死率为0.27%。河北省HFRS病例主要集中在秦皇岛、唐山、承德市,占病例报告总数的88.91%。病例呈现出“双峰型”分布,3-5月为发病大高峰,11-12月为小高峰;男女比例为2.36∶1,60～70岁年龄组发病率最高;HFRS病例以农民居多;居民区鼠密度及鼠带毒率均高于野外,2011-2020年鼠密度较平稳,鼠带毒率整体呈下降趋势。不同地区鼠带毒率与人群发病率呈正相关(r=0.972,P<0.01)。结论 河北省HFRS疫情在2013年达近10年发病高峰,整体呈现下降态势并趋于平稳,地理分布广泛又相对集中,应加强重点地区病例及宿主动物监测,落实防鼠灭鼠及免疫接种工作。     

Analysis of an Outbreak of Hemorrhagic Fever with Renal Syndrome in College Students in Xi’an,China

The aim of the present study was to analyze an outbreak of hemorrhagic fever with renal syndrome (HFRS), caused by a Hantavirus, in college students in the northern urban area of Xi’an in 2012. The outbreak affected six students and included two deaths. The epidemiological survey revealed that both of the deceased cases were misdiagnosed initially, and treatment was delayed. Furthermore, a higher rodent population density and lower HFRS vaccine coverage were observed in the affected area, which indicates a possible role in the outbreak. Rattus norvegicus (Rn) and Mus musculus (Mm) were the predominant host populations in the area. Genotyping revealed that all HVs from patients and rodents were Hantaan virus (HTNV). Sequence analysis of the S segments revealed that the HTNVs reported in this study had high similarity with strains reported in 2011 and 1985, but these viruses diverged from a strain isolated in 1984 and the HTNV prototype strain 76-118. Detection of anti-HV IgG and amplification of the S segment of HTNV from a non-natural HTNV reservoir indicates that further investigations by increased rodent trapping are necessary.     

2012-2018年陕西省渭南市肾综合征出血热流行特征及时空分布

目的 分析近几年渭南市肾综合征出血热(HFRS)的流行病学及时空分布特征,为HFRS的防治提供科学依据。方法 收集渭南市HFRS疫情和180个乡镇人口信息资料,采用描述性流行病学方法和空间流行病学方法结合SaTScan9.4和ArGis10.2等软件,对渭南市HFRS流行特征及时空分布进行分析。结果 2012-2018年渭南市共报告HFRS病例2 211例,年均发病率为6.37/10万,死亡率为0.02/10万,病死率为0.32%;2012年以后HFRS发病率明显下降,但2013年至2018年发病率呈现隔年上升波浪性发病趋势。HFRS病例以40-69岁组的男性为主,职业以农民为主。HFRS发病呈明显季节性,每年的11月至次年的1月为发病大高峰,5-7月为小高峰,其余月份有散在病例发生。HFRS病例主要分布于在渭南西南部的临渭区、华州区、华阴市。HFRS一类聚集区,均以临渭区为聚集中心,2012年至2015年覆盖临渭区与华州区,2016年覆盖临渭区、华州区与华阴市,2017年-2018年覆盖临渭区、华州区、华阴市和蒲城县。结论 渭南市HFRS发病有一定的季节性及人群聚集性,病例聚集于渭河流域和秦岭山脉附近,近年来渭南市HFRS聚集区域逐渐扩大,应采取“监测、健教、灭鼠、免疫”结合的综合防制措施。     

肾综合征出血热患者血清铁蛋白水平变化研究

目的 观察不同分型及不同分期肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者血清铁蛋白(ferritin,FRT)水平变化,探讨其在重症HFRS早期预警及预后(死亡)评估中的作用.方法 以空军军医大学第二附属医院传染科2011年10月—2013年12月收治的符合...     

Epidemiological investigations following an outbreak of hemorrhagic fever with renal syndrome in Greece

Epidemiological investigations were conducted following an outbreak of hemorrhagic fever with renal syndrome (HFRS) which occurred in the state of Epirus, northwestern Greece, in July and August 1983. A total of 8 patients were hospitalized during the outbreak; 3 were severely ill and 1 died. A serosurvey made in May 1984 sampled 184 of the approximately 400 residents of the village of Tsepelovo, where 4 patients resided, and found 12 (6.5%) persons, including convalescent sera from 4 patients, with antihantaviral antibody by immunofluorescent antibody (IFA) tests. Small mammal collections found house rats common in the village, but none exhibited anti-hantaviral antibody. Collections in nearby fields and mountains found Apodemus flavicollis rodents common, and 2 (6%) of 33 captured had high IFA anti-hantavirus antibody. Virus isolation attempts from rodent tissues were unsuccessful. Testing of convalescent patients' sera by IFA and plaque reduction neutralization tests indicated that the etiological agent was neither Puumala virus nor Seoul virus, but appears to be a strain of Hantaan virus or perhaps a new virus. The rodent host of this virus may be A. flavicollis, and the distribution of this species corresponds with previously reported cases of severe HFRS described elsewhere in central Europe.     

皖南地区HLA-Brs34933313基因多态性与肾综合征出血热的相关性分析

目的 探讨皖南地区汉族人群HLA-B基因单核苷酸多态性(Single Nucleotide Polymorphisms,SNP)rs34933313与肾综合征出血热(Hemorrhagic fever with renal syndrome,HFRS)的相关性。方法 采集HFRS患者14例(病例组)和健康组50例(对照组)新鲜血样,提取基因组DNA,通过等位基因特异引物-聚合酶链反应(ASP-PCR)对HLA-B基因位点分型,应用SPSS22.0统计分析其等位基因及基因型两组间的差异。结果 HLA-B基因rs34933313位点受试人群分布符合哈迪-温伯格(Hardy-Weinberg,H-W)遗传平衡,两组等位基因G、C(χ²=4.38,OR=2.45,P=0.04)和基因型GG、GC、CC(χ²=6.47,P=0.04)频率分布差异均有统计学意义;病例组中C等位基因的分布频率高于G等位基因,且携带C等位基因罹患HFRS的概率是G等位基因的2.45倍;亚组分析发现 HLA-B基因rs34933313位点在显性遗传模型下(χ²=6.45,P=0.01,OR=10.21,95%CI=1.24~84.18)与HFRS发病风险具有相关。结论 皖南地区汉族人群HLA-B基因rs34933313位点与HFRS发病风险存在相关性,且携带C等位基因者会提高HFRS的发生风险。     

Comment on Jameson et al.: Prevalence of Antibodies against Hantaviruses in Serum and Saliva of Adults Living or Working on Farms in Yorkshire,United Kingdom

This British hantavirus IgG prevalence study, aimed at 119 asymptomatic farmers in England, and using indirect immunofluorescence assay (IFA) as screening technique, concluded that rat-transmitted Seoul virus (SEOV) might be the main suspect as hantaviral pathogen in the UK. Exactly the same conclusion, using the same IFA screening technique, resulted from a 1994 serosurvey in the same country, and in 627 clinical cases plus 100 healthy controls. SEOV-positive study subjects were also mainly farmers with heavy rat-exposure, but residing in Northern-Ireland, a region where all other known rodent reservoirs for pathogenic hantaviruses are known to be absent, except the wild rat. A rodent capture action in and around the farms of eight seropositives confirmed SEOV seropositivity in 21.6% of 51 rats. All SEOV seropositives were patients, hospitalized with an acute feverish condition, a majority of which having the clinical picture of hantavirus-induced nephropathy, known as hemorrhagic fever with renal syndrome (HFRS). Leptospirosis, often mimicking perfectly HFRS, was serologically excluded. Thus, SEOV was established as a human hantaviral pathogen in the UK and in Europe 20 years ago.     

Frailty Assessment and Perioperative Major Adverse Cardiovascular Events After Noncardiac Surgery

ObjectiveFrailty is an emerging risk factor for adverse outcomes. However, perioperative frailty assessments derived from electronic health records have not been studied on a large scale. We aim to estimate the prevalence of frailty and the associated incidence of major adverse cardiovascular events (MACE) among adults hospitalized for noncardiac surgery.MethodsAdults aged ≥45 years hospitalized for noncardiac surgery from 2004-2014 were identified from the National Inpatient Sample. The validated Hospital Frailty Risk Score (HFRS) derived from International Classification of Diseases codes was used to classify patients as low (HFRS <5), medium (5-10), or high (>10) frailty risk. The primary outcome was MACE, defined as myocardial infarction, cardiac arrest, and in-hospital mortality. Multivariable logistic regression was used to estimate the adjusted odds of MACE stratified by age and HFRS.ResultsA total of 55,349,978 hospitalizations were identified, of which 81.0%, 14.4%, and 4.6% had low, medium, and high HFRS, respectively. Patients with higher HFRS had more cardiovascular risk factors and comorbidities. MACE occurred during 2.5% of surgical hospitalizations and was common among patients with high frailty scores (high HFRS: 9.1%, medium: 6.9%, low: 1.3%, P < .001). Medium (adjusted odds ratio [aOR] 2.05; 95% confidence interval [CI], 2.02-2.08) and high (aOR 2.75; 95% CI, 2.70-2.79) HFRS were associated with greater odds of MACE vs low HFRS, with the greatest odds of MACE observed in younger individuals 45-64 years (interaction P value < .001).ConclusionsThe HFRS may identify frail surgical inpatients at risk for adverse perioperative cardiovascular outcomes.     

Water vole (Arvicola terrestris scherman) density as risk factor for human alveolar echinococcosis.

Concern is growing in Europe about alveolar echinococcosis (AE) with the increase in grassland rodent and red fox populations, intermediate and definitive hosts for Echinococcus multilocularis, respectively. The objective of this study was to assess the influence of rodent densities on human AE distribution. Spatial Poisson regression analyses were performed with geomorphologic features, landscape composition, climatic characteristics, and water vole density as independent variables. The outcome consisted of AE cases diagnosed over the period 1980-1992. High vole density yielded a 10-fold risk (relative risk [RR] = 10.34, 95% confidence interval [CI] = 2.78-38.39), and the first plateau (400-700 m altitude) compared with the plain (200-400 m) was associated with a large increase in risk (RR = 7.10, 95% CI = 1.30-38.63). These results confirm that human AE is strongly influenced by the densities of arvicolid species. Foxes feeding almost exclusively on grassland rodents when the latter expand could mediate this relation.     

云南省2005-2012年肾综合征出血热流行现状

目的 为了科学的预防和控制云南省肾综合征出血热,对云南省2005-2012年肾综合征出血热流行现状进行综合分析。方法 用描述性的流行病学和统计学方法对收集自云南省疾病报告系统的肾综合征出血热资料进行统计分析。结果 共有260个肾综合征出血热病例报道,其中包括45个临床诊断病例,170个实验室诊断病例和45个疑似病例。根据病例数,将云南省肾综合征出血热病例分布分成4个区:1类区为高发地区,是大理州;2类区为次发地区,是昆明市、楚雄州和红河州;3类区为低发地区,是丽江市、怒江州、曲靖市、玉溪市,昭通市和保山市;4类区为不发地区,是迪庆州、德宏州,临沧市、普洱市、西双版纳州和文山州。云南省肾综合征出血热病无明显的季节性;40~50岁的农民发病数较多,且男性多于女性;结论 大理州及周边地区是肾综合征出血热预防控制的关键地区,特别是40岁以上的男性农民为防控的重点人群。为了搞好肾综合征出血热预防控制,应该开展爱国卫生运动,减少鼠密度和汉坦病毒双价疫苗的接种。在云南省的部分地区,仍有可能存在肾综合征出血热的暴发流行。     

2008-2012年河北省肾综合征出血热监测及流行特征研究

目的 通过分析2008 2012年的监测资料,描述河北省肾综合征出血热（HFRS）流行特征和变化趋势,为疾病的防控提供依据.方法 对河北省2008 2012年HFRS病例资料及宿主动物监测资料,采用描述性流行病学方法进行统计分析.结果2008 2012年,河北省共报告HFRS病例1 853例,死亡6例,平均发病率为0.524 2/10万,病死率0.32％;2008 2010年发病维持在低发态势,2011年以后发病逐渐上升,但病死率较低.发病主要集中在东北部的秦皇岛市、唐山市和中部的石家庄市,三市占总报告病例数的77.60％;全年各月均有病例报告,但呈现出“双峰型”分布,3～6月为全年发病最高峰;男女性别比为2.60∶1,发病以青壮年为主,其中40～50岁年龄组病例最多.≥60岁的病例上升明显,大年龄组发病有增加的趋势;职业分布以农民居多;鼠密度变化趋势不明显,波动不大;2008 2010年鼠带毒率呈逐年下降趋势,2011年和2012年鼠带毒率较前3年明显升高;PCR分型结果均为汉城型（Ⅱ型）,序列同以往的测序株比较,同源性较高;鼠带病毒指数与人群发病率呈正相关（r＝0.969,P＝0.006）.结论 河北省HFRS疫情呈上升趋势,尤其对于高发地区需加强监测,并强化疫苗接种意识和落实防鼠灭鼠工作;≥60岁的病例上升明显,应及时关注大年龄组人群.