目的 对深圳市一起学校水痘暴发疫情进行现场流行病学调查和分析,了解疫情暴发的传播因素和水痘疫苗接种情况,为水痘疫情防控提供参考依据.方法 采用现场流行病学、自行设计的问卷和电话访谈,对病例和病例关联的校内外学生、老师、家属和邻居等进行回顾性调查,通过描述性流行病学和回顾性队列研究分析疫情暴发的传播因素和水痘疫苗接种情况.结果 深圳市一起学校水痘暴发疫情共报告7例病例,均为A小学一(5)班学生,班级罹患率为14.58％(7/48),其中男、女生罹患率分别为17.24％(5/29)、10.53％(2/19),差异无统计学意义(Fisher's精确检验,P＞0.05);病例临床症状均为出疹,传染源来自家庭,在班级内接触导致第二代病例发病高峰;接种不同剂次水痘疫苗的病例罹患率随接种剂次增加呈下降趋势,差异有统计学意义(X2趋势=46.119,P＜0.05),其中接种1剂次罹患风险是接种2剂次的4.9倍(95％CI:1.6～14.9).结论 该事件为深圳市一起学校班级内接触传播的水痘暴发疫情,2剂次水痘疫苗接种能够降低水痘传播风险,减少学校水痘暴发疫情的病例数,从而避免公共卫生问题的产生.

目的 通过一起幼儿园诺如病毒感染性腹泻暴发疫情的调查处理，分析疫情暴发危险因素，提出幼儿园诺如病毒感染性腹泻防控建议。方法 对病例进行描述性流行病学分析，采用回顾性队列研究和病例对照研究等方法查明暴发疫情的相关危险因素，并采集可疑标本进行实验室检测。结果 本次暴发疫情共发病144例（罹患率35.91%），检测16份肛拭子样品，结果11份诺如病毒核酸阳性（未分型），阳性检出率68.75%（11/16）。可疑危险因素是污染的卫生间，早餐南瓜粥和菜心炒米粉（OR=6.476，95%CI：1.179~35.582），未规范处置的呕吐物。结论 该事件为一起诺如病毒感染性腹泻暴发疫情，疫情发生的可能是首发病例在男教师卫生间腹泻后未及时清洁消毒导致厨工感染后污染食物和餐具而造成园内多班级学生和教师感染，后续学生和教师在校活动期间呕吐和腹泻污染环境引起日常接触传播或气溶胶传播，并导致病例家庭成员感染。

目的 探讨宝安区6～36月龄散居儿童手足口病发病的危险因素,提出针对性防控措施.方法 采用1∶1匹配病例对照研究方法,病例为自2019年6月1日起上传到《传染病报告信息管理系统》中居住地址位于宝安区内、6～36月龄的手足口病新病例;在同一社区内随机寻找月龄±2个月、同性别、无手足口病/疱疹性咽峡炎/发热伴出疹症状的儿童作为对照.根据自制问卷采用电话访问的形式进行调查.结果 共调查病例组和对照组各192人.多因素logistic回归分析显示:和5岁以下儿童一起居住(OR=4.976,P=0.002),发病前10 d接触过手足口病人(OR= 2.762,P＜0.001),发病前10 d去过游乐场所(OR=5.670,P＜0.001),孩子饭前总是/经常吮吸手指(OR=4.879,P=0.010)是危险因素;而看护人喂养前用肥皂洗手频率[总是/经常(OR = 0.213,P = 0.006)]、孩子饭前总是/经常用肥皂洗手(OR = 0.117,P＜0.001)是保护因素.结论 在宝安区手足口病流行季节公共游乐场所对疾病传播有重要作用,提高看护人和儿童的手卫生、避免儿童接触手足口病患者能降低患病风险,和5岁以下儿童居住的散居儿童家长更应该重视采取预防措施.

BACKGROUND:Little is known about the association between genetic susceptibility and the severity of hand, foot, and mouth disease (HFMD) infected with coxsackievirus A6 (CV-A6).METHODS:Three hundred and sixty-four CV-A6 HFMD patients were enrolled, including 115 severe and 249 mild patients. A genome-wide association study (GWAS) was performed involving eight DNA pools of 115 severe and 115 mild CV-A6 HFMD patients pair-matched by age and gender. Differences in relative allele signal scores of SNPs in Illumina Human OmniZhongHua-8 BeadChips were compared between the two groups. The tag SNPS for potentially functional SNPs or their high linked SNPs were selected for individual genotyping in all 364 patients and assessed for their associations with severe CV-A6 HFMD using multivariable logistic regression analyses.RESULTS:The top 30 significant SNPs obtained from pooled DNA GWAS analysis were checked for biological functions and their high linkage disequilibrium (LD) SNPs. Four tag SNPs (rs1558206, rs6927647, rs9375728 and rs10879355) were selected for further individual genotyping in 364 CV-A6 patients. Only SNP rs10879355 was associated with severe CV-A6 HFMD, with CC genotype having a greater risk of severe illness than TT+TC genotypes (OR=2.48, 95%CI: 1.34, 4.56). SNP rs4290270 is in complete LD with rs10879355 in Chinese Han children.CONCLUSIONS:This is the first report that one potentially functional SNP rs4290270 in the TPH2 gene may be associated with the risk of severe CV-A6 HFMD.

Coxsackievirus 6 (CV-A6) has been emerging as another predominant serotype for severe hand, foot, and mouth disease (HFMD) in China, after the introduction of enterovirus 71 inactivated vaccine (EV71 vaccine) for 3 years. Data on the risk factors for severe HFMD infected with CV-A6 are limited. We interviewed the caregivers to collected data on HFMD patients who sought medical care in the People's Hospital of Baoan district, Shenzhen, from 2015 to 2017. Totally, 131 severe patients were frequency-matched by age and gender with 174 mild patients infected with CV-A6. Univariable and multivariable logistic regression analyses were conducted to analyze the risk factors for severe CV-A6 HFMD. The average age was 20.62 +/- 14.18 months and 20.52 +/- 12.76 months for severe and mild patients, respectively. Multivariate analyses indicated complications at birth (odds ratio [OR], 4.18; 95% confidence interval [CI]: 1.64-10.63), peak body temperature over 39 degrees C (OR, 4.04; 95% CI: 2.29-7.10) and first-born child (OR, 2.17; 95% CI: 1.27-3.70) increased the risk of severe HFMD infected with CV-A6. Breastfeeding (OR, 0.52; 95% CI: 0.32-0.87), and washing hands after playing frequently (OR, 0.58; 95% CI: 0.34-0.97) were negatively associated with severe illness. Compared with HFMD with infection of EV-A71, complications at birth and first-born child were newly found to be associated with severe illness in HFMD patients infected with CV-A6.

目的 查明某小学皮炎暴发事件的致病因子、感染途径及危险因素,为疫情防控提供依据.方法 根据疾病特点制定病例定义,在学校和附近的社区健康服务中心搜索可疑病例,利用自行设计的调查表,对病例开展个案调查,对学校内外环境实地调查,利用回顾性队列研究分析验证暴露危险因素,现场捕获毒蛾幼虫进行鉴定.结果 共发现28例病例,主要临床症状为皮肤瘙痒、斑丘疹.首发病例于4月5日发病,从5月开始,陆续有散在病例出现,5月25日出现21例病例,且均为5年级3班学生和辅导员,之后再无病例出现,流行曲线显示此次暴发为点源暴发的单峰模式.其中学生21人,辅导员6人,清洁工1人;五(3)班15例,罹患率25.42％,一(2)班4例,罹患率6.82％,一(1)班2例,罹患率3.35％,班级分布差异有统计学意义(χ2=16.09,P<0.01).回顾性队列研究结果显示搬塑料凳(RR=17.95,95％CI:4.50～70.00)以及树下逗留(RR=+∞,95％CI:3.80～∞)为感染危险因素.经鉴定本次捕获的毒蛾幼虫为榕透翅毒蛾幼虫.结论 本次皮炎爆发疫情为病人接触到凳子上及散落的毒蛾幼虫刚毛所致.

目的 调查一起学校不明原因皮疹聚集性疫情的规模、病原和疾病传播的危险因素,提出针对性的预防控制措施建议.方法 2018年4月4日,在广东省深圳市宝安区某学校开展不明原因皮疹聚集性疫情的调查处置工作.制定病例定义,搜索病例,采用统一的流行病学个案调查表进行现场调查,描述病例的分布特征,采用回顾性队列研究方法调查发病的危险因素,采集病例血液标本进行病原抗体检测.结果 共搜索到病例12例,罹息率为11.9％(12/101).采集病例血液标本4份,检测均为人类细小病毒B19型IgM和IgG抗体阳性.回顾性队列研究显示与病例邻桌[RR=4.3(1.2～14.9)]、曾与病例下棋[RR=5.7(1.3～24.7)]是导致本次疫情的危险因素.结论 本次事件为一起由人类细小病毒B19型感染导致的传染性红斑聚集性疫情,疾病传播的危险因素为密切接触.

目的 了解深圳市宝安区5岁以下婴幼儿看护人轮状病毒胃肠炎的知信行,评价轮状病毒胃肠炎的社区干预效果.方法 在深圳市宝安区辖区内选取轮状病毒发病率、人口特征、医疗水平和经济水平接近且地理位置不相邻的两个街道分别作为干预街道和对照街道.对干预组辖区内的医疗场所规范其消毒处理,在医疗场所和社区内进行轮状病毒胃肠炎的健康宣教.调查干预前后两街道的婴幼儿看护人轮状病毒胃肠炎的知信行,干预后两街道儿童的轮状病毒胃肠炎的发病率.结果 干预街道看护人干预前后轮状病毒胃肠炎知识知晓率(x2=14.897,P＜0.001)、看护人使用开水煮的方式对婴幼儿奶具消毒的比例(x2=7.978,P=0.046)、消毒餐具的频率(Z=2.358,P=0.018)、使用开水煮的方式消毒餐具的比例有提高(x2=20.608,P＜0.001).干预后,干预组疫苗接种的比例高于对照组(x2=4.334,P=0.037).流行季节过后,干预街道RVGE患病率较对照组低,差异有统计学意义(x2=4.927,P=0.026).结论 通过规范医疗场所的消毒处理;加大医疗场所和社区的健教宣传,提高了婴幼儿看护人对轮状病毒胃肠炎的知识水平、促进其形成健康的看护习惯,可降低婴幼儿轮状病毒胃肠炎的发病率,为轮状病毒胃肠炎的社区干预提供可行方法.

Objective To explore the risk factors of severe cases of hand-foot-mouth disease (HFMD) infected by EV-A71 comparing with mild disease cases.Methods A total of 36 severe HFMD cases and 38 mild cases infected by EV-A71 tested in laboratory were selected from Shenzhen Baoan People's Hospital during May,2015 to July,2017.Questionnaire survey and intestinal virus nucleic acid detection were carried out.Logistic regression and chi square test were used to make analysis.Results Single factor logistic regression analysis showed that children with fever of 39 ℃ or higher,often play in the community before the onset may be the risk factors of severe;The first diagnosis of HFMD and the first diagnosis of hospital type for district-level hospitals and above may be severe protective factors (P＜0.05).Mutiple factors logistic regression analysis showed that the highest fever temperature ≥ 39 ℃ and the risk of severe cases playing in the community before onset were 5.56 times and 7.16 times higher than those in the control group;The type of first-visit hospital was district hospitals and above were the protective factors of severe cases (P＜0.05).Conclusions The highest fever temperature ≥ 39 ℃ could be used as the early identification index of EV-A71 severe cases.The severe risk could be increased by playing in the community at the peak of HFMD epidemics,while the type of first-visit hospital was district hospitals and above,which could reduce the risk of severe cases.

目的 分析非肠道病毒A组71型(enterovirus groupA type 71,EV-A71)感染手足口病患者的重症危险因素,为尽早识别重症患者并及时治疗提供依据.方法 收集深圳市宝安人民医院2015年5月～2016年11月收治的手足口病病例,明确感染的肠道病毒血清分型后选取非EV-A71感染的轻症和重症患者各185例,采用多因素条件Logistic回归方法筛选出重症手足口病的影响因素.结果 经多因素条件Logistic回归分析,发现发热最高温≥39℃(OR =6.61,95％ CI:3.17～ 13.81)、出疹类型为丘疹(OR=2.82,95％ CI:1.40～5.69)、出疹部位为足部(OR =2.05,95％ CI:1.08～ 3.90)、就诊延迟1d内(OR =3.44,95％ CI:1.56～7.58)、出生时有并发症(OR=7.37,95％ CI:1.66～32.70)、非母乳喂养(OR=1.89,95％ CI:1.01～ 3.54)、发病前常在小区玩耍(OR =2.92,95％CI:1.44～5.92)、经常咬玩具(OR =2.27,95％ CI:1.13～4.53)为非EV-A71手足口病重症的危险因素(均有P＜0.05).结论 应密切关注患者临床、实验室和卫生习惯等多项指标,及时发现手足口病重症的危险因素并进行临床诊治和健康教育.

目的 探讨柯萨奇A6型病毒(CVA6)感染所致重症手足口病的危险因素.方法 采用1:1匹配的病例对照研究方法,收集深圳市宝安人民医院2015年5月-2016年11月实验室确诊的CVA6感染所致重症和轻症手足口病例各101例,采用向后逐步回归的多因素logistic回归方法筛选影响因素.结果 出现丘疹、患儿经常咬玩具、照看人文化程度高中以下和发热最高体温≥39℃为CVA6感染所致重症的危险因素,母乳喂养和发病诊断时间间隔较短为保护因素.结论 及早诊断和母乳喂养可降低CVA6所致重症手足口病风险,丘疹和高热可作为手足口病重症早期识别指征.

MiRNA levels in plasma have emerged as potential novel noninvasive biomarkers for some diseases. We aimed to identify a miRNA expression profile in plasma of patients with coronary heart disease. The levels of plasma miRNA from a cohort of 49 patients with coronary heart disease and 13 healthy controls were detected by small RNA deep sequencing, the differentially expressed miRNAs were validated using the reverse transcription real-time quantitative polymerase chain reaction from an additional cohort of 135 hospitalized patients and 140 controls. Five miRNAs were differentially expressed, miR-30c-2-3p and miR-5091 were upregulated and miR-125b-5p, miR501-3p, and miR-31-5p downregulated in plasma of patients with coronary heart disease than in controls. This study identified 5 plasma miRNAs that might play an important role in the pathogenesis of coronary heart disease. The level of miR-30c-2-3p was 132 folds upregulation (P=0.000), it suggests that miR-30c-2-3p may be a potential noninvasive biomarker for the diagnosis of coronary heart disease, however, with further research.

通过系统培训提升健康教育工作人员专业素质是保障健康教育工作顺利进行的根本手段，而建立一套能够客观反映培训问题、评测健康教育人员专业化培训效果的培训评估体系，是加强健康教育人才队伍建设的关键。本文借鉴柯氏四级评估模型和CIPP模型从培训前、培训中、培训后三个阶段构建科学、完善、综合的健康教育人员专业化培训效果评估模型，为公共卫生机构建立科学、有效的健康教育人员培训策略提供参考。

本文针对目前健康教育工作领域培训存在的问题，借鉴其他领域有益的培训策略和先进的培训模式，提出从纵向和横向结构上构建起立体式、多角度、联动式的培训组织体系，实现培训资源利用效率的最大化；厘清健康教育工作体系的4类培训对象，实现培训的全覆盖；根据区域或机构的公共卫生任务、不同学历层次、专业水平的培训对象的需求确定具体的培训内容，选择恰当的培训组织形式和教学方式以保证培训效果的最优。加强培训制度化建设，以建立起科学、系统、有效的健康教育人员培训模式。

目的 了解某工厂1起感染性腹泻暴发疫情的流行特点和危险因素,为制定防制策略提供依据.方法 按照病例定义开展病例搜索,采用描述性流行病学方法分析疾病的流行特征并提供病因线索,利用回顾性队列研究和病例对照研究分析危险因素;采集患者和厨师肛拭子以及食品和外环境样本,用实时荧光定量逆转录聚合酶链反应(RT-PCR)进行病毒核酸检测,对PCR扩增产物进行测序以确定病毒基因型别.结果 2013年1月17日至21日共搜索到病例76例,罹患率为18.12％(76/414),普通员工罹患率为26.28％(72/274),中层人员为2.96％ (4/135),高管人员未发现患者(0/5),差异有统计学意义(P＜0.01).回顾性队列研究显示,到普通员工处用餐的中层人员罹患率为11.43％ (4/35),不去普通员工处用餐的则没有发病(0/75),差异有统计学意义(P＜0.01).病例对照研究显示,病例组在1月15日中餐和晚餐食用第1批员工餐的青菜的比例分别为64.00％(32/50)和70.83％(34/48),对照组比例分别为41.67％ (35/84)和50.00％(40/80),病例组均高于对照组,OR分别为2.489(95％ CI:1.209 ～5.125)和2.429(95％ CI:1.134 ～5.199),提示该天中餐和晚餐第1批员工餐的青菜暴露可能是危险因素.采集患者肛拭子、呕吐物、粪便、厨师肛拭子、手拭子以及食物、调料、厨具、水样本共64份,其中致病菌检测56份,均为阴性;诺如病毒核酸检测51份,其中13份患者肛拭、2份厨师肛拭、2份患者粪便、1份患者呕吐物样本为阳性,全部为GⅡ4.Sydney 2012新型诺如病毒毒株.结论 该起疫情可能是1起食物污染引起的新型诺如病毒感染性腹泻暴发疫情,建议加强食品从业人员健康教育,继续做好感染性腹泻病原学监测工作.

目的 探索登革热发病数与气象因素间的联系,为日后对登革热疫情预警提供依据.方法 收集深圳市2014年7月至11月的本地登革热发病资料,以及同期深圳市各气象条件,使用趋势线拟合散点图回归分析方法,探索气象因素与登革热发病的关系,并根据趋势线决定系数R2的大小判断拟合的优劣.结果 当气象因素与登革热发病数各取1 1日移动平均,且登革热发病数滞后气象因素3日时,两者相关性最高.结论 登革热发病数主要受平均气温,日最高气温,日最低气温以及平均气压影响,当平均气温介于22℃～27℃、日最低气温介于20℃～24℃、日最高气温介于26℃～30℃、平均气压低于100.4 kpa时,登革热发病数与上述气象因素呈正相关关系;当平均气温大于27℃、日最低气温大于24℃、日最高气温大于30℃、平均气压大于100.4 kpa时,登革热发病数与上述气象因素呈负相关关系.在主成分分析中,当主成分F介于-25～-12时,登革热发病数与F呈正相关关系;当F大于-12时,登革热发病数与F呈负相关关系.

目的 了解登革热流行区中学生相关知识、态度、行为和干预需求情况,为开展有针对性的干预措施提供依据.方法 采用多阶段随机整群抽样方法,对深圳市宝安区2所中学共550名中学生进行匿名自填式问卷调查,调查内容包括登革热防治相关知识、态度、行为,以及中学生获得知识的途径等.结果 本次调查共发放问卷559份,回收有效问卷550份,有效问卷回收率为98.39％.中学生对登革热防治知识总知晓率为51.02％,初中生和高中生差异有统计学意义.超过60％的学生对登革热表示害怕和担心,学生健康行为总形成率为69.60％.中学生已经获得的登革热防治知识主要来源于电视(77.05％)、互联网(67.37％)、宣传折页/海报(50.32％),将来主要希望通过互联网(74.36％)、电视(54.55％)、手机媒体(33.82％)获取知识.超过80％的学生不知道当地疾病预防控制机构的官网、微博和咨询电话,但绝大多数表示愿意使用.结论 尽管中学生对登革热相关知识有一定的了解,且在一定程度上具备了防治登革热的健康行为,但对登革热患者的症状、伊蚊发育水体识别的知识有待提高,且需着力通过健康教育促使学生更频繁地使用健康行为.

目的 对某街道医院发生的一起新生儿口腔疱疹炎医院感染暴发进行调查,为预防与控制医院感染提供参考.方法 对疫情进行描述性分析,使用x2分析比较毗邻街道医院罹患率差异.采集产妇及患儿外周血和咽拭子进行HSV-1病毒抗体检测(ELISA)和核酸检测(PCR).结果 新生儿口腔疱疹炎罹患率为2.23％(8/359),剖宫产或顺产完整的新生儿不发病,顺产侧切或破裂的新生儿罹患率为9.64％(8/83),不同分娩方式罹患率差异有统计学意义(P＜0.05),而在性别和病房中差异无统计学意义(P＞0.05).母亲及新发病的患儿外周血采样5份,4份单纯疱疹病毒1型(HSV-1)的IgG阳性,1份IgM阳性;排除因医院消毒不当或医护人员操作失误引起.结论 这是一起由HSV-1引起的新生儿口腔疱疹炎医院感染暴发,传播途径为经产道分娩时接触产妇血液传播.

Objective To analyze environmental risk factors of early-onset coronary heart disease in Baoan District,Shenzhen City,so as to explore intervention measures to decrease its incidence. Methods Totally 339 patients with coronary heart disease from the Peopleu0027s Hospital of Baoan District,Shenzhen were included in the study and grouped into early-onset coronary heart disease group(172cases)and late-onset coronary heart disease group(167cases)according to age at onset recorded in their clinical data.Having hypertension,diabetes,smoking,alcohol abuse,high total cholesterol(TC),high triglycerides(TG),high low density lipoprotein cholesterol(LDL),low high density lipoprotein cholesterol(HDL),high C-reactive protein(CRP),high uric acid(UA),and high fibrinogen(Fib)as potential environmental risk factors,Chi-square test and logistic regression analysis were used to explore risk factors of early-onset coronary heart disease and late-onset coronary heart disease. Results The percentages of high TG and low HDL were significantly higher in the early-onset coronary heart disease group than those in the late-onset coronary heart disease group(χ2=12.011,P=0.001;χ2=11.208,P=0.001).So were the men proportion and smoking rate(χ2=4.849,P=0.028;χ2=5.728,P=0.017).However,the incidence of hypertension was significantly lower in the early-onset coronary heart disease group than that in the late-onset coronary heart disease group(χ2=7.654,P=0.006).Logistic regression analysis indicated that after collaborative factors were corrected,high TG and low HDL were the environmental risk factors for earlyonset coronary heart disease(χ2=6.607,P=0.010;χ2=5.450,P=0.020)and complication with hypertension was a risk factor for late-onset coronary heart disease(χ2=6.702,P=0.010). Conclusions In the prevention of early-onset coronary heart disease,the lipid lowering therapy with lowering low density lipoprotein cholesterol as its primary goal should include lowering triglyceride level.And risk from smoking can not be ignored.

目的 探讨使用糖皮质激素(以下简称激素)对手足口病患者病情的影响. 方法 采用回顾性队列研究方法,通过比较激素暴露组与非暴露组病情严重程度变化的差异,以揭示早期使用激素对手足口病患者病情的影响. 结果 暴露组病情加重比例22.73％高于非暴露组10.45％(U=20 096.5,P=0.00);早期暴露组病情加重比例28.24％高于非早期暴露组11.65％(U-6 669,P=0.00).暴露组轻型病例病情加重者比例16.05％高于非暴露组轻型病例7.80％(U=4 799.5,P=0.01);早期暴露组轻型病例的病情加重比例20.83％高于非早期暴露组轻型病例8.05％(U=3 367,P=0.00).暴露组重症病例病情加重比例62.59％高于非暴露组重症病例15.19％(U=4 612.5,P=0.01);早期暴露组重症病例的病情加重比例32.53％高于非早期暴露组重症病例16.30％(U=4 550.5,P=0.00).暴露组病情加重程度与激素的使用剂量呈正相关(rP=0.30,P=0.046),与使用天数正相关(rP =0.32,P=0.02). 结论 轻型及重型手足口病病例应用糖皮质激素治疗、尤其是早期使用糖皮质激素对病情进展存在一定的危险性,建议轻型病例勿使用糖皮质激素治疗,而重型病例应慎用糖皮质激素治疗.