北京部分SARS临床诊断病例流行病学接触史与IgG抗体水平关系分析

目的 通过对302名SARS临床确诊病人的血清抗体IgG检测结果进行分析，探讨流行病学接触史与血清抗体阳性率之间的相关性，以及接触史在临床诊断中的意义。方法 样品为北京市疾病预防控制中心在SARS流行期内采集的住院的和康复的SARS临床确诊病人的血清，按照流行病学接触史分组分析。采用ELISA抗体检测方法检测抗SARS病毒IgG。结果 有流行病学接触史组的血清抗体阳性率与无接触史组具有显著差异。结论 流行病学接触史对SARS病例的诊断具有重要意义。在SARS临床诊断过程中应综合流行病学资料、实验室IgG检测结果和临床症状进行诊断。     

10例香港儿童SARS患者的临床特点

WHO有关SARS监测定义为高热(>38℃);一种或以上呼吸道症状,包括咳嗽、呼吸短促和呼吸困难;症状出现前10d内,有到SARS流行地区的旅行史或/和有与SARS感染者密切接触史。SARS除通过医院内密切接触传播外,家庭内接触SARS患者也是重要的传播途径,因而儿童是高危感染者,但是到目前为止主要是有关成人患者的报道。最新出版的Lancet中,香港Hon KLE等报道了10例儿童感染者的临床治疗经验。2003年3月13日～28日,香港威尔士亲王医院收治了10例年龄在1.5～16.4岁的儿童SARS疑似患者,均有与SARS患者密切接触史,均有持续高热、咳嗽和进行性肺部放射学异常变化和淋巴细胞减少,作者总结了这些     

凉山州一起新型冠状病毒肺炎聚集性疫情分析

目的通过对2例新型冠状病毒肺炎患者的流行病学调查分析,探讨新型冠状病毒肺炎的传播规律和防控措施。方法运用描述性流行病学方法对凉山州甘洛县2例新型冠状病毒肺炎进行流行病学调查分析。结果首例病例A为输入性病例,本地病例B为密切接触A导致发病,属于一起聚集性疫情。因两名患者互相隐瞒接触史导致本地病例B在本应被隔离而未被隔离期间产生了21名密切接触者,加大了疫情传播风险。结论在新型冠状病毒肺炎疫情防控工作中,现场流行病学调查要注重传统流行病学调查技巧与大数据技术的结合应用,排查患者可能接触的所有人员,避免漏掉密切接触者,同时加强对相关单位的培训及对公众的知识宣传。     

糖尿病病友春季五注意

春季是疾病的好发季节，对于糖尿病病友来说，也要多加注意：预防感冒 糖尿病患者对于感冒不能掉以轻心，必须严加预防。平时要保持居室空气流通，在感冒流行期间，少去人多拥挤的公共场所，外出时要戴口罩，并注意随气温变化及时增减衣服。     

湖北地区医务人群严重急性呼吸道综合征冠状病毒血清学调查分析

目的 确定医务人群中是否存在严重急性呼吸道综合征(SARS)冠状病毒(SARS-CoV)隐性或亚临床感染及健康带毒者。方法 以问卷调查方式抽样调查湖北地区有可能接触SARS—CoV的高危医务人群的流行病学状况；以酶联免疫吸附法测定血清SARS-CoV IgM、IgG；以一步法双重RT—PCR检测受试者喉漱液是否存在SARS-CoV。结果 接受调查的102名医务人员中，均曾在抗SARS一线工作过，9名曾到过SARS流行疫区，84名(82．3％)在2003年SARS流行期间，否认曾与确诊SARS患者有过接触；18名报告与确诊SARS患者有过接触，其中1名曾无防护接触过数天，但无任何不适，其他17名均为有防护接触，其中3名在接触后20天内曾有过感冒样不适。全部102名受调查者的血清SARS—CoV IgM、IgG以及喉漱液SARS-CoV检测均为阴性。结论 本次抽样调查未发现湖北地区医务人群中曾经有过SARS-CoV隐性或亚临床感染，也未发现有上呼吸道SARS—CoV健康带毒的情况。     

80例SARS病例的流行病学调查

对80例SARS患者进行流行病学凋查分析。结果:72例患者(90％)有明确的SARS患者接触史,接触时间最短仅20min,潜伏期2-20天,平均为(7.6±4.3)天。80例患者中医务人员占66.3％(53/80),非医务人员为33.7％(27/80);两组中有接触史的例数分别为49例(92.5％)和23例(85.2％),两者     

儿童严重急性呼吸综合征的临床表现和转归

作者前瞻性地随访了香港严重急性呼吸综合征(SARS)流行早期头10例儿童SARS患者。 所有10例均符合WHO所定的SARS定义并均有与受感染成年SARS患者密切接触史。发热是10例的共同症状,中位数热程为6(3～11)日。利巴韦林治疗期间患者血红蛋白水平无明显下降。8例患者发热无消退时加用了皮质类固醇激素疗法。1例幼童和4例青少年应     

陕西省首例人感染H7N9禽流感病例及聚集性疫情调查分析

目的 通过对陕西省首例人感染H7N9禽流感病例及聚集性疫情的流行病学的调查,了解病例感染的来源和危险因素,为今后类似疫情的防控工作提供依据。方法 对两例病例、家属、医护人员等进行流行病学调查,对两例病例的咽拭子进行核酸检测,对活禽市场等采集鸡笼、饮水环境等进行核酸检测,结合检测结果,分析此次疫情的流行病学特征和防控措施。结果 病例A发病前7 d有活禽暴露史,发病后未能及时确诊,病例死亡;病例B发病前无明确的活禽或活禽市场暴露史,4月22日出现低热症状,24日探望了病例A,5月2日病重后及时报告接触史,实验室确诊后,经积极救治,5月26日痊愈。结论 病例A的感染来源可能是活禽或活禽市场环境暴露,病例B感染来源可能是与病例A近距离接触,病例A与B传播方式为人传人的可能性较大。     

北京市血液透析单位重症急性呼吸综合征发病及预防情况的调查

目的 了解2003年3～6月北京市血液透析中心重症急性呼吸综合征(SARS)发病及预防情况。方法 采用统一的调查表对北京市83家透析中心(军队医院透析中心除外)SARS发病及其预防措施进行调查。结果 (1)即时返回调查表的有81家(三级医院36家,二级医院37家,一级医院8家),共有透析患者2885例,工作人员673名。临床诊断SARS7例(7／2885,0．24％),痊愈3例,死亡4例,所有工作人员无SARS或疑似病例,无透析中心内部传播者。(2)所有透析中心均采取了额外的消毒措施。98．8％(80／81)的透析中心使用一次性透析器。98．8％(80／81)的透析中心对患者开展了SARS预防知识教育。90％以上的透析中心的患者透析前测体温、更换拖鞋和病号服。所有透析中心的医务人员在透析治疗过程中戴口罩、戴帽子,93．7％(74／79)的透析中心医务人员戴手套,22．8％(18／79)的透析中心医务人员戴护目镜。结论 参加本次调查的各透析中心均无SARS内部传播。加强环境消毒、医务人员的自身防护、对患者卫生习惯的教育,有助于预防SARS在透析中心内的传播。     

HIV／AIDS临床防治体会

本文重点讨论HIV/AIDS临床防治方面的问题。 1 AIDS合并卡氏肺孢子虫肺炎(PCP)应注意与SARS相鉴别 2002年11月广州开始流行SARS,很多医务人员被感染,个别还献出了生命。由于预防不到位,SARS传播至国内外。2003年3月北京开始有SARS的流行。基于当时对病因不明,卫生部制定了确诊和拟诊SARS的诊断标准:具有流行病史,接触感染或传播他人;临床有发热、干咳、气短;血白细胞正常或偏低,淋巴细胞明显降低;胸片肺部有阴影;抗生素治疗无效。北京各大医院收治了很多患者,从年初疾病控制中心统计看,全部诊为SARS,而未见其他肺炎的报道,也就是说有些支原体肺炎可能也误诊为SARS。在排除     

Risk factors for SARS infection among hospital healthcare workers in Beijing: a case control study

Objective  To evaluate possible severe acute respiratory syndrome (SARS) infection associated risk factors in a SARS affected hospital in Beijing by means of a case control study.
Methods  Fifty-one infected and 426 uninfected staff members were asked about risk behaviours and protective measures when attending to SARS patients. Univariate and multivariate logistic regression analyses were performed to identify the major risk and protective factors.
Results  Multivariate analysis confirmed the strong role of performing chest compression (or intubation, which is highly correlated), contact with respiratory secretion, and emergency care experience as risk factors to acquire SARS infection. For the studied protective measures, wearing 16-layer cotton surgical mask, wearing 12-layer cotton surgical mask, wearing multiple layers of mask, taking prophylactic medicine, taking training and nose washing turned out to be protective against infection.
Conclusions  This study highlighted activities associated with increased and decreased risk for SARS infection during close contact with SARS patients. These findings may help to guide recommendations for the protection of high-risk occupational groups.     

Survey and enlightenment on the wearing of protective equipment of nurses working on the front line against COVID-19

At present, coronavirus disease 2019 (COVID-19) remains a significant challenge for health workers around the world. This survey aims to highlight the status of the implementation of occupational protection measures for nurses working on the front line against COVID-19, and to analyze the problems in the process of wearing protective equipment.This cross-sectional study was conducted among 165 nurses who worked in COVID-19-stricken areas in China in March 2020. The questionnaire covered 3 aspects, namely: general information, the current condition of protective equipment wearing, and the wearing experience of protective equipment.A total of 160 (96.97%) valid questionnaires were collected. The average time of wearing protective equipment for the nurses surveyed was 6.38 ± 3.30 hours per working day. For first-line nurses with low risk of infection, repeated wear of protective equipment was as follows: medical protective mask 30.77%, double latex gloves 8.46%, goggles/protective mask 15.38%, protective suit 15.38%; less wear of protective equipment were as follows: work cap 7.69%, surgical mask 7.69%, single layer latex gloves 30.77%, goggles/protective mask 30.77%, and isolation gown 46.15%. For nurses who were at moderate risk of infection, repeated wear of protective equipment was as follows: surgical mask 62.22%, goggles/protective mask 68.89%, and isolation gown 65.56%; less wear: work cap 3.33%, medical protective mask 15.56%, latex gloves 15.56%, goggles/protective mask 5.56%, and protective suit 16.67%. For front-line nurses with high risk of infection, repeated wear of protective equipment was as follows: surgical mask 64.91%, more than double latex gloves 8.77%, goggles/protective mask 75.44%, isolation gown 75.44%; less wear: work cap 1.75%, medical protective mask 1.75%, latex gloves 26.32%, goggles/ protective mask 1.75%, protective suit 1.75%. The main discomforts of wearing protective equipment were poor vision due to fogging (81.88%), stuffiness (79.38%), poor mobility (74.38%), sweating (72.5%), and skin damage (61.25%).More detailed personal protection standards should be developed, and the work load of nurses should be reduced. Actions should be taken to ensure the scientific implementation of personal protective measures. To solve practical clinical problems, future protective equipment may focus on the research and development of protective equipment applicable for different risk levels, as well as the research on integrated design, fabric innovation, and reusability.     

Risk factors for SARS infection within hospitals in Hanoi, Vietnam

We investigated a nosocomial infection of severe acute respiratory syndrome (SARS) in Vietnam in 2003 and attempted to identify risk factors for SARS infection. Of the 146 subjects who came into contact with SARS patients at Hospital A, 43 (29.5%) developed SARS, and an additional 16 (11%) were asymptomatic but SARS-coronavirus (CoV) seropositive. The asymptomatic infection rate accounted for 15.5% of the total number of infected patients at Hospital A, which was higher than that of 6.5% observed at Hospital B, to where all patients from Hospital A were eventually transported (P<0.05). At Hospital A, the risk for developing SARS was 12.6 times higher in individuals not using a mask than in those using a mask. The SARS epidemic in Vietnam resulted in numerous secondary infections due to its unknown etiology and delayed recognition at the beginning of the epidemic. The consistent and proper use of a mask was shown to be crucial for constant protection against infection with SARS.     

SARS: hospital infection control and admission strategies

Nosocomial clustering with transmission to health care workers, patients and visitors is a prominent feature of severe acute respiratory syndrome (SARS). Hospital outbreaks of SARS typically occurred within the first week after admission of the very first SARS cases when the disease was not recognized and before isolation measures were implemented. In the majority of nosocomial infections, there was a history of close contact with a SARS patient, and transmission occurred via large droplets, direct contact with infectious material or by contact with fomites contaminated by infectious material. In a few instances, potential airborne transmission was reported in association with endotracheal intubation, nebulised medications and non-invasive positive pressure ventilation of SARS patients. In all SARS-affected countries, nosocomial transmission of the disease was effectively halted by enforcement of routine standard, contact and droplet precautions in all clinical areas and additional airborne precautions in the high-risk areas. In Hong Kong, where there are few private rooms for patient isolation, some hospitals have obtained good outcome by having designated SARS teams and separate wards for patient triage, confirmed SARS cases and step-down of patients in whom SARS had been ruled out. In conclusion, SARS represents one of the new challenges for those who are involved in hospital infection control. As SARS might re-emerge, all hospitals should take advantage of the current SARS-free interval to review their infection control programmes, alert mechanisms, response capability and to repair any identified inadequacies.     

Wearing masks as a protective measure for children against traffic-related air pollution: A comparison of perceptions between school children and their caregivers in Ho Chi Minh City,Vietnam

Background

Traffic-related air pollution (TRAP) problems are unlikely to be solved in the short term, making it imperative to educate children on protective measures to mitigate the negative impact on their health. Children and their caregivers may hold differing views on wearing a face mask as a safeguard against air pollution. While many studies have focused on predicting children's health-protective behaviours against air pollution, few have explored the differences in perceptions between children and their caregivers.

Objectives

To examine this, we conducted a study that compared the health beliefs of two generations and evaluated the factors that influence the use of masks by children to reduce air pollution exposure.

Methods

The study was conducted in 24 secondary schools and involved 8420 children aged 13–14 and their caregivers. We used a Health Belief Model (HBM)-based instrument containing 17-item self-administered health beliefs questionnaires to gather data. The results were analysed using hierarchical logistic regression to determine the probability of children frequently wearing masks to protect against TRAP.

Results

Our study showed both children and caregivers recognised that several factors could influence mask-wearing among children: discomfort or difficulty breathing while wearing a mask and forgetting to bring a mask when going outside; perceived threats of the poor quality of air and children's respiratory health problems; and cues to mask use (i.e., seeing most of their friends wearing facemasks and ease of finding masks in local stores). However, only children were significantly concerned with public perception of their appearance while wearing a mask. Females were more likely to wear masks, and caregivers with higher levels of education were more likely to encourage their children to wear masks. Children who commuted to schools by walking, biking, or motorbiking were also more accepting of mask-wearing than those who travelled by car or bus.

Conclusions

Children and their caregivers hold different perceptions of wearing masks to protect against air pollution. Children are more susceptible to social judgements regarding their appearance when wearing a mask.     

Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS)

We did a case-control study in five Hong Kong hospitals, with 241 non-infected and 13 infected staff with documented exposures to 11 index patients with severe acute respiratory syndrome (SARS) during patient care. All participants were surveyed about use of mask, gloves, gowns, and hand-washing, as recommended under droplets and contact precautions when caring for index patients with SARS. 69 staff who reported use of all four measures were not infected, whereas all infected staff had omitted at least one measure (p=0.0224). Fewer staff who wore masks (p=0.0001), gowns (p=0.006), and washed their hands (p=0.047) became infected compared with those who didn't, but stepwise logistic regression was significant only for masks (p=0.011). Practice of droplets precaution and contact precaution is adequate in significantly reducing the risk of infection after exposures to patients with SARS. The protective role of the mask suggests that in hospitals, infection is transmitted by droplets.     

广东省佛山市严重急性呼吸综合征首例报告

目的 探讨严重急性呼吸综合征(SARS)的流行病学特点、诊断和治疗方法。方法 分析广东省佛山市首例SARS的流行病学特点、诊断和治疗过程，以及使用SARS患康复期血清SARS抗体检查确定回顾性诊断。结果 该病例具有以下特征：(1)有接触和食用野生动物史；(2)有持续高热、咳嗽、痰少和呼吸困难等症状；(3)白细胞(WBC)不高；(4)双肺弥漫性浸润；(5)病情迅速发展至急性呼吸窘迫综合征(ARDS)；(6)传染至与其密切接触的4名亲属；(7)患康复期血清抗冠状病毒抗体(IgG)阳性，经过抗病毒、抗生素、糖皮质激素、有创机械通气和分子吸附再循环系统(MARS)治疗，44天后治愈出院。结论 佛山市首例完全具备SARS诊断标准的主要特点，有很强的传染性，经过机械通气和多脏器支持等治疗，愈后良好。     

Suspected SARS patients hospitalised in French isolation units during the early SARS epidemic: the French experience

During the SARS epidemic, many patients were screened according to WHO criteria but never went on to develop SARS. In May 2003, early in the epidemic, we conducted a retrospective study to describe suspected SARS patients hospitalised in France and compared them with documented cases of patients with SARS to evaluate the screening strategy. A total of 117 patients were studied. Only 3.4% had been in close contact with a SARS patient but 73.5% came from an affected area. 67.5% had fever and respiratory symptoms on their admission to hospital. 49.6% had fever and non specific symptoms. Clinical symptoms that were significantly more common among patients with SARS were fever, myalgia, dyspnoea, and nausea or vomiting. Presumed viral fever and respiratory tract infection were the most common diagnosis. Symptoms cannot be distinguished from an early stage of SARS confirming the usefulness of the WHO case definitions in isolation decision to avoid further transmission.