非新生儿破伤风诊疗规范

破伤风分为新生儿破伤风和非新生儿破伤风。我国已于2012年消除了新生儿破伤风,但非新生儿破伤风仍是一个严重的公共卫生问题。非新生儿破伤风重症患者在无医疗干预的情况下,病死率接近100%,即使经过积极的综合治疗,全球范围病死率仍为30%~50%,是一种极为严重的潜在致命性疾病。为规范我国非新生儿破伤风诊疗行为,提高医疗质量,保障医疗安全,特制定本规范。本规范包括了非新生儿破伤风的病原学、流行病学、发病机制、临床表现及实验室检查、诊断、鉴别诊断、分级、治疗等方面内容。     

Lower immunity to poliomyelitis viruses in Australian young adults not eligible for inactivated polio vaccine

There are limited long-term data on seroprevalence of neutralising antibody (nAb) to the three poliovirus serotypes following the switch from oral polio vaccine (OPV) to inactivated polio vaccine (IPV). In Australia, combination vaccines containing IPV replaced OPV in late 2005. Using serum and plasma specimens collected during 2012 and 2013, we compared prevalence of nAb to poliovirus type 1 (PV1), type 2 (PV2) and type 3 (PV3) in birth cohorts with differing IPV and OPV eligibility from an Australian population-based sample. In the total sample of 1673 persons aged 12 months to 99 years, 85% had nAb against PV1, 83% PV2 and 67% PV3. In the cohort 12 to <18 years (eligible for 4 OPV doses, last dose 8–14 years prior), a significantly lower proportion had nAb than in the 7 to <12 year cohort (eligible for 3 OPV doses and an IPV booster, last dose 3–8 years prior) for all poliovirus types: [PV1: 87.1% vs. 95.9% (P = 0.01), PV2: 80.4% vs. 92.9% (P = 0.003) and PV3: 38.1% vs. 84.0% (P < 0.0001)]. These data suggest individual-level immunity may be better maintained when an OPV primary schedule is boosted by IPV, and support inclusion of an IPV booster in travel recommendations for young adults who previously received only OPV.     

Are refugees arriving in Denmark an under-immunised group for measles? A cross-sectional serology study

BackgroundIn 2018, Europe faced the highest number of Measles cases in a decade. In Denmark, the childhood vaccination programme has a coverage of approximately 90%. To eliminate the disease, vaccine coverage needs to be above the herd immunity threshold of 95%. This can be even more difficult to obtain, when vaccination programmes break down due to war, natural disasters etc. and concern has been raised, that unvaccinated refugees could facilitate spread of measles when migrating.MethodsIn order to address this concern, we tested 513 newly arrived refugees and family reunified refugees aged between 0 and 70 years for measles IgG antibodies. The participants were tested as part of a general health assessment between May 2016 and October 2018. In the cohort, 50% were males and the majority came from Syria (55%).ResultsWe found that 85% of the total group of refugees had immunity against measles. The 15% lacking antibodies were evenly distributed between the various countries of origin. Moreover, we found immunity to increase with age, leaving young children most vulnerable to infection, 79.9% (<19 years) vs 89.1% (≥19 years). Interview questions on previous vaccinations did not correlate to serology.ConclusionRefugees have measles immunity slightly lower than the host population.     

Pesticides contaminated dust exposure,risk diagnosis and exposure markers in occupational and residential settings of Lahore,Pakistan

There are few studies documenting the dust loaded with pesticides as a potential non-dietary exposure source for occupational worker and populations living near agricultural farms and pesticides formulation plants. In present study we have evaluated the pesticide concentration in dust from potential sites and relevant health risk from dust ingestion. Furthermore, the effect of currently used pesticides was investigated on blood and urine parameters of subjects: farmer, factory worker, urban resident and rural resident and controlled subjects with presumably different levels of exposure. The urinary metabolites (TCPY and IMPY) were quantified as biomarkers of exposure to chlorpyrifos and diazinon in relation with biomarkers of effect including BuChE, LH, FSH, testosterone and oxidative stress. Results showed that chlorpyrifos and diazinon were present in higher concentration in dust and posed a high health risk to exposed subjects. The mean SOD value was high among the farmer (3048 U/g Hb) followed by factory worker (1677.6U/g Hb). The urinary biomarkers – TCPY and IMPY- were found higher in exposed subjects as compared to control. Furthermore, testosterone was found in higher concentration in factory worker than control (12.63 ng/ml vs 4.61 ng/ml respectively). A decreased BuChE activity was noticed in occupational group and significant differences were observed in control verses exposed subjects. The PCA analysis evidenced the impact of pesticides on exposure biomarkers and male reproductive hormones. The study suggests that dust contaminated with pesticides engenders significant health risk particularly related to the nervous and endocrine system, not only for occupational workers exposed to direct ingestion but also for nearby residential community. Succinctly putting: Pesticides loaded dust in the city of Lahore, being a high priority concern for the government of Pakistan, demands to be addressed.     

浙江省艾滋病自愿咨询检测求询者的动态变化分析

目的对比2008年和2009年浙江省艾滋病自愿咨询检测(VCT)数据,探索今后VCT工作的方向。方法通过下载艾滋病综合防治数据信息管理系统中,检测咨询信息管理定时统计的数据、2008年和2009年不同类型的求询者的数量和艾滋病病毒(HIV)阳性者的数量,利用卡方检验进行统计学分析。结果 2008年共完成咨询检测73 918人次,2009年共完成咨询检测81 386人次。求询者中有非婚异性性行为史者有上升趋势,2008年占46.98%(34 730/73 918),2009年占49.12%(39 977/81 386),两年对比差异有统计学意义(P<0.05)。2008年和2009年分别经VCT发现HIV感染者255人和331人,感染者中以男男性行为者、非婚异性性行为者、配偶/固定性伴HIV阳性者为主,注射吸毒史(P<0.05)、有非婚异性性行为史者(P<0.05)和有男男性行为史者对比,差异有统计学意义(P<0.05)。结论要对大众进行宣传艾滋病VCT服务,特别是针对具有男男性行为、非婚异性性行为、配偶/固定性伴HIV阳性的人群要加强宣传。     

Description of liver disease in a cohort of HIV/HBV coinfected patients

BackgroundFactors associated with advanced liver disease have been incompletely explored in HIV/HBV coinfected patients.ObjectivesTo describe liver-related morbidity, mortality, and related risk factors, in HIV/HBV coinfected patients.Study designWe followed-up 107 consecutive HIV/HBV coinfected patients. Clinical, biological and virological data were collected every 3 months. Liver-related mortality and a composite score were used to define advanced liver disease.ResultsThe patients were mainly sub-Saharan Africans (61%) or Europeans (33%). Forty-four percent of patients had liver biopsy, 78% of patients received lamivudine. Advanced liver disease (ALD) was diagnosed in 19/107 patients during follow-up (mean 4.8 years): 10 extensive fibrosis, 5 cirrhosis, 3 hepatocellular carcinoma resulting from cirrhosis, and 1 fulminant hepatitis following lamivudine withdrawal. Eleven patients died, 4 from HBV-related liver disease. In univariate analysis, male gender, mean HIV and HBV viral loads, and raised AST/ALT transaminases were associated with increased risk of ALD. The strongest associations, in a multivariate model, were mean AST transaminase and cumulated time receiving lamivudine, with a favourable effect. 39% of patients with increased mean AST presented with ALD, versus 7% when normal mean AST (Relative Risk 5.5).ConclusionsDuring HIV/HBV coinfection, transaminase levels are strongly associated with ALD. Normal mean AST has a high negative predictive value, contrary to previously reported data in HIV/HCV patients.     

浙江省1990-2006年疫苗时代乙型病毒性肝炎流行病学特征分析

目的：分析乙型病毒性肝炎（乙肝）疫苗纳入计划免疫管理前后浙江省乙肝流行病学特征的变化,为调整防控措施提供依据。方法：收集疫情、流行病学调查相关资料,运用描述流行病学方法整理资料,使用SPSS13．0进行统计处理。结果：乙肝发病率自1990年缓慢波动上升,2006年全人群乙肝发病率较1990年上升65．83％,HBV感染率较1992年下降12．99％,其中儿童乙肝发病率、HBV感染率较免疫管理前平均分别下降了66．84％、89．44％,年龄发病高峰在管理前是5～9岁和20～34岁组,在管理后仅是20～34岁组,且高峰上升明显,HBV感染率随年龄增加而升高。乙肝发病无明显季节高峰。高发地区由舟山、杭州向温州、金华、丽水转移。各年龄组人群乙肝疫苗接种率与发病率和感染率的变化呈负相关（P〈O．001）。结论：乙肝疫苗纳入计划免疫管理后,儿童乙肝发病率及HBV感染率大幅下降。扩大乙肝疫苗接种人群,尤其是育龄期青壮年,能加快控制乙肝。     

Living in the Context of Poverty and Trajectories of Breast Cancer Worry,Knowledge, and Perceived Risk after a Breast Cancer Risk Education Session

ObjectivesThe purpose of this paper was to demonstrate how living in neighborhoods with high levels of poverty (while controlling for personal income) impacts personal characteristics, which in turn impacts retention of breast cancer risk knowledge and changes in worry and perceived risk.MethodsThe data from this project come from a larger, National Cancer Institute-funded study that included a pretest, a breast cancer risk education session, a posttest, the option of an individualized risk assessment via the Gail Model and three follow-up phone calls over the next 9 months.ResultsThe percent of individuals living below poverty in the community in which the participant resided was predictive of the personal characteristics assessed, and these characteristics were predictive of changes in breast cancer worry and knowledge across time.ConclusionDifferentiation of self and monitoring, two of the individual characteristics that seem to allow people to process and use information to make “rational” decisions about health care, seem to be impacted by the necessity for adaptation to a culture of poverty. Thus, as a health care community, we need to tailor our messages and our recommendations with an understanding of the complex intersection of poverty and health care decision making.     

Effects of home-based Voluntary Counselling and Testing on HIV-related stigma: Findings from a cluster-randomized trial in Zambia

HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n = 1500) and a follow-up survey (n = 1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (β = −0.22, p = 0.423). Being tested for HIV was associated with a reduction in stigma (β = −0.57, p = 0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (β = −0.78, p = 0.080 vs. β = −0.37, p = 0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma.