目的 对杭州市间日疟病例感染的间日疟原虫(Plasmodium vivax)裂殖子表面蛋白1(MSP-1)和环子孢子蛋白(CSP)基因的多态性进行描述性分析. 方法 收集杭州市2008-2019年报告的间日疟病例的血样和流行病学资料.采用全血DNA抽提试剂盒提取疟原虫基因组DNA,巢式PCR分别扩增Pvmsp-1和Pvcsp基因的特异性片段,并进行双向测序.应用DNAStar、MEGA 6.0软件对氨基酸序列进行序列比对和遗传进化分析,并采用邻接法构建系统进化树.采用SPSS 17.0统计学软件对基因多态性及感染来源地进行描述性和归纳分析. 结果 共收集间日疟病例血样56份,巢式PCR扩增的Pvmsp-1和Pvcsp基因片段分别测序成功44份和54份血样.序列分析显示,44条Pvmsp-1序列可分为4种基因型,分别为Sal Ⅰ型18份、Belem型8份、R-Ⅲ型17份和R-Ⅳ型1份;54条Pvcsp序列分为两种基因型,分别为VK210型52份和VK247型2份.对Pvmsp-1基因的分型特征和感染来源地分析发现,Sal Ⅰ型分布广泛,在我国华东地区,东南亚地区,印度,埃塞俄比亚等多个国家或地区存在.我国华东地区的主要分布类型为R-Ⅲ型,此外,R-Ⅲ型在南亚、东南亚地区也有分布.Belem型主要分布在东南亚、南亚和埃塞俄比亚等国家或地区.对Pvcsp基因的多态性特征和感染来源地分析发现,共有4种多态性特征具有一定的地域特征. 结论 杭州市2008-2019年报告的间日疟病例的Pvmsp-1和Pvcsp基因存在较丰富的多态性特征,部分特征具有一定地域性.

[目的]了解父母因素对初中生校外闲暇时间体力活动的影响,为促进儿童青少年体力活动提供依据.[方法]用多层整群随机抽样的方法抽取6所中学的622名学生参与研究.问卷调查学生运动及父母影响因素,采用logistic回归分析影响因素.[结果]58.7％的家长会给子女购买运动装备,57.6％的家长在子女运动期间陪伴孩子一起运动.父母直观行为表率报告率为22.8％.获得父母后勤支持及父母直观行为表率的学生在双休日进行中、高强度身体活动(MVPA)情况较好,差异有统计学意义.logistic回归分析显示,有父母后勤支持的学生双休日出现MVPA达标是无父母后勤支持学生的1.51倍(95％CI:1.01～2.27).[结论]父母后勤支持及直观行为表率能促进初中生进行MVPA,立足家庭干预可以提升子女校外体力活动水平.

目的 基于生态学模型分析上海市金山区初中学生课余时间体力活动的影响因素,为促进青少年健康素质提供依据.方法 从金山区抽取6所公立初中学校,从每个年级随机抽取1个班级学生为研究对象,监测1周课余时间学生体力活动情况;根据社会生态学模型设计问卷调查影响学生体力活动的因素,并采用最优尺度回归模型进行分析.结果 发放问卷645份,回收有效问卷622份,问卷有效率为96.43％.622名初中学生周一至周五课余时间和双休日进行体力活动时间的中位数分别为29.00 min和45.00 min;个体层面、 人际层面和环境层面因素评分分别为(10.53±2.04)分、(5.10±1.51)分和(8.31±1.85)分.最优尺度回归分析结果显示,居住地(β=-0.117、-0.159)、 个体层面(β=0.244、0.277)、 人际层面(β=0.113、0.085)和环境层面(β=-0.140、-0.120)是学生周一至周五课余时间和双休日体力活动的影响因素.周一至周五个体层面影响最大,为62.2％;其次为人际层面20.8％和居住地16.8％.双休日个体层面的影响最大,为65.4％;其次为居住地23.6％和人际层面10.5％.结论 金山区初中学生课余时间体力活动水平受个体层面因素的影响最大,其次为人际层面和居住地;初中学生双休日体力活动不足,居住地的影响仅次于个体层面.

目的 了解2013-2017学年上海市金山区中小学生因呼吸系统症状/疾病缺课的流行特征,为减少因呼吸系统症状/疾病缺课制定干预措施提供依据.方法 收集2013-2017学年上海市金山区中小学生因呼吸系统症状/疾病缺课数据,描述中小学生缺课的流行特征,比较不同性别、学段、月份的缺课情况.结果 2013-2017学年上海市金山区中小学生因呼吸系统症状/疾病缺课率为0.0802％,全学年出现2个高峰,分别集中在3和12月.男生缺课率显著高于女生(P＜0.01);各学年不同学段缺课率差异均有统计学意义(均P＜0.01),小学缺课率最高.结论 小学生及男生是因呼吸系统疾病/症状缺课的重点关注人群.雾霾天气应避免或减少外出或户外体力活动;秋冬和冬春交替季节,应多关注天气,适当增减衣物;学校应加强对教室环境卫生的消毒,避免学校发生聚集性疫情,充分发挥学校呼吸系统症状监测的及时预警作用.

目的 探究上海市金山区中小学生呼吸系统病因缺课率的空间分布特征,为降低呼吸系统病因缺课率提供理论依据.方法 以街镇为单位,采用空间统计方法对金山区2013-2017学年41 089名因呼吸系统症状/疾病缺课中小学生的信息,结合地理信息进行空间格局分布及空间聚集性分析.结果 中小学生2013-2017学年因呼吸系统症状/疾病缺课率为0.80‰.5学年各街镇呼吸系统病因缺课率分布格局变化较小,局部空间自相关分析存在1个高-高聚集区域.时空扫描统计量分析发现存在1个主要聚集区域(LLR=2 382.9,RR=2.89,P＜0.01),分布在金山区东南方向街镇;2个次要聚集区域(LLR值分别为34.6,14.9,RR值分别为1.19,1.13,P值均＜0.01)分布在金山西北方向和南部街镇.结论 上海金山区中小学生呼吸系统病因缺课具有时空聚集性,应加强金山区东南方向呼吸系统病因防控工作.

Primary amebic encephalitis (PAM) is a devastating central nervous system infection caused by Naegleria fowleri, a free-living amoeba, which can survive in soil and warm fresh water. Here, a 43-year-old healthy male was exposed to warm freshwater 5 days before the symptom onset. He rapidly developed severe cerebral edema before the diagnosis of PAM and was treated with intravenous conventional amphotericin B while died of terminal cerebral hernia finally. Comparing the patients with PAM who has similar clinical symptoms to those with other common types of meningoencephalitis, this infection is probably curable if treated early and aggressively. PAM should be considered in the differential diagnosis of purulent meningoencephalitis, especially in patients with recent freshwater-related activities during the hot season.

目的 利用运动手环评估初中生1周每日不同时段步行数及相关因素,为提高学生身体活动水平提供参考.方法 在上海市金山区招募6所公办中学,抽取六至八年级学生(675名)按要求佩戴手环1周,并记录特定时段步行数及活动内容,上学日分路途(上学和放学)、在校(上午和下午)、居家;周末分上午、下午、晚上.结果 每日步数为8 332步,上学日每日步行数高于周末(9 065,6 392步)(t=22.9,P＜0.01).在校期间步行数最多,占61.3％;其次是路途(25.5％).上学日同时段男生步行数均高于女生,乡村学生均高于城镇,超重与肥胖学生均高于正常学生(P值均＜0.05);低活跃组学生在有体育课安排下步行数高于无体育课安排(t男=1.99,t女=2.45,P值均＜0.05).结论 该研究为在不同时段内增强学生身体活动水平提供依据,有助于实施有效可行的干预措施.

目的 比较2017年与2012年金山区中学生日常饮食行为、缺乏体力活动行为变化情况,为开展相关防控提供依据.方法 采用多阶段分层整群抽样方法,于2012年和2017年分别抽取上海市金山区8所中学2 010名学生和12所中学3 154名学生开展问卷调查.结果 与2012年相比,2017年过去7d男、女生健康饮食(经常吃新鲜水果、蔬菜、吃早餐、喝牛奶/酸奶)行为报告率均下降,男生分别由46.65％,71.57％,83.39％,51.54％降至39.47％,66.05％,76.18％,43.83％,女生分别由62.65％,79.37％,84.50％,50.23％降至49.11％,71.80％,79.15％,41.70％(P值均＜0.05);非健康饮食行为中,男生经常喝汽水饮料行为报告率由8.09％升至10.87％,男、女生经常吃甜点行为报告率均下降,男生由22.47％降至11.54％,女生由34.27％降至16.20％;女生吃油炸食物报告率由7.66％降至4.13％(P值均＜0.05).过去7d男生“中等强度体育运动＜3 d”及“参加课外体育锻炼＜3 d”报告率均增加,分别由31.74％,39.40％升至37.51％,71.03％,女生“参加课外体育锻炼＜3d”报告率由44.82％升至77.64％(P值均＜0.05).男生和女生每天“玩电子游戏≥4h”及“上网时间≥ 4 h”行为报告率均上升,男生分别由15.34％,14.48％升至24.49％,20.63％;女生分别由7.84％,9.80％升至11.80％,13.64％,不同年度间差异均有统计学意义(P值均＜0.01).结论 金山区青少年日常饮食行为及体力活动情况不容乐观,需针对青少年危险行为发生特点采取干预措施.

目的 了解上海市金山区孕妇和学龄儿童的碘营养状况.方法 2016-2018年,按人口比率概率抽样法,每年抽取5个街道(镇),每个街道(镇)中随机抽取1所小学,2016年从5所小学中随机抽取350名6～11岁学生,2017-2018年从5所小学中每年随机抽取200名8～10岁学生,检测尿碘含量及其家中食用盐碘含量,2017年增加甲状腺容积测量.2016-2018年分别在所抽取的5所街道(镇)中,共抽样检测301名孕妇的尿碘含量,并检测其家中食用盐碘含量.结果 2016-2018年6～11岁学龄儿童、孕妇的尿碘平均中位数分别为170.00 μg/L和128.16 μg/L,尿碘中位数逐年下降,2018年孕妇尿碘中位数下降明显,为98.00 μg/L.2016-2018年合格碘盐食用率6～11岁学龄儿童从77.43％下降至48.00％,孕妇从79.00％下降至56.44％,合格碘盐食用率逐年下降明显.碘含量平均中位数6～11岁学龄儿童和孕妇分别为23.60和23.40 mg/kg,碘含量中位数亦逐年下降.2017年8～10岁学龄儿童甲状腺肿大率为2.00％.结论 2016-2018年上海市金山区儿童甲状腺肿大率低于国家标准,儿童碘营养水平适宜,孕妇碘营养水平逐年下降,处于碘营养不足状态.应进一步加强孕妇碘营养的健康干预.

Objective To understand the demographic characteristics and clinical features of hookworm infectors in high infection area in South Mountain area of Zhejiang Province,and to find the risk factors of infection,so as to provide the evidence for formulating prevention and control measures.Methods In 2018,according to the soil-borne nematode monitoring results of the previous year in Zhejiang Province,three villages with relatively more hookworm infections were selected from Qingtian County in South Mountain area of Zhejiang Province,and more than 10 cases of hookworm infection were selected from each survey site.A face to face questionnaire survey was conducted by all investigators using a questionnaire designed by the Center for Infectious Disease Control and Prevention,Zhejiang Provincial Center for Disease Control and Prevention,and information on the general condition,past diagnosis history,clinical symptoms and risk factors of infection of infected persons were collected.The stool samples were collected and tested for infection by modified Kato-Katz method to evaluate the drug deworming effect in the previous year.Results A total of 33 cases of hookworm infection were investigated,including 18 males and 15 females;the age ranged from 33-85 years old,mainly concentrated in 60-79 years old,a total of 23 cases (69.7％).Ten cases (30.3％) had been diagnosed with hookworm disease;19 cases (57.6％) had similar symptoms of hooky dermatitis;and 12 cases (36.4％) had gastrointestinal symptoms in the past three years.There were 31 cases (93.9％) worked in the field for more than one month each year,18 cases (54.5％) used fresh manure directly at home,6 cases (18.2％) were used to working barefoot in the field,and 30 cases (90.9％) used to wearing slippers in the field.A total of 32 eligible stool samples were examined,and 4 case (12.5％) were still positive for hookworm eggs.Conclusions Among the infectors,fertilizing with fresh stool,working barefoot or wearing slippers in the field may serve as the risk factors.There is a certain failure proportion to eliminate the infection status when adopting only one round anthelminthic treatment.For prevention and control hookworm infections,comprehensive intervention measures including infection source management,harmless treatment of stools,individual behavior intervention and environment improvement are suggested.

收集患者门诊和住院病历,采用描述性流行病学方法对浙江省温州市1例儿童内脏利什曼病病例的基本情况、发病诊疗经过、密切接触人员、生活习惯和环境、愈后转归等进行调查.患者,丽水市青田县人,2018年1月17日出现发热、呕吐症状,期间体温反复升高.入院后查体,全身浅表淋巴结未及肿大,面色苍白,扁桃体二度肿大,黏膜发白,脾肋下2 cm.血常规检查白细胞、红细胞、血小板计数均降低,铁蛋白升高,自然杀伤(NK)细胞活性下降.血清学检测EB (epstein-barr)病毒抗体阳性.骨髓涂片检查可见巨噬细胞吞噬血细胞现象.诊断为“EB病毒感染相关性嗜血细胞综合征”,给予更昔洛韦抗病毒并加依托泊苷(VP16)、环孢素(CSA)治疗,病情好转,2月5日出院,门诊随访.2月19日为继续完成VP16、CSA化疗,再次入院.3月21日骨髓血涂片查到利什曼原虫无鞭毛体,确诊为内脏利什曼病.PCR检测扩增出120 bp的利什曼原虫动基体小环DNA特异性条带.葡萄糖酸锑钠(五价锑600 mg/d×6 d,静脉注射;停药2d,五价锑300 mg/d×12 d)治疗后,患者症状好转.流行病学调查结果显示,该病例为输入性内脏利什曼病病例,在其西班牙的住所附近公园内被白蛉叮咬而感染的可能性最大.

Naegleria fowleri is the only Naegleria spp. known to cause an acute, fulminant, and rapidly fatal central nervous system infection in humans called primary amebic meningoencephalitis (PAM). In 2016, a patient with suspected PAM was found in Zhejiang Province of China. The pathogen was identified by microscopic examination and PCR. The positive PCR products were sequenced and the sequences were aligned using the NCBI BLAST program. The homologous and phylogenetic analysis was conducted using MEGA 6 program. On microscopy of direct smears, motile cells with pseudopodia were observed, and the motion characteristics of the pseudopodia as well as the cell morphology suggested that the pathogens were amoeba trophozoites. Wright-Giemsa-stained smears showed amoeba trophozoites of various shapes, which measured 10-25μm in size; these were characterized by a prominent, centrally placed nucleolus and a vacuolated cytoplasm. PCR was negative for Entamoeba histolytica and Entamoeba dispar, but positive for Naegleria spp. and N. fowleri. The nucleotide sequences acquired in this study have been submitted to GenBank with accession numbers KX909928 and KX909927, respectively. The BLAST analysis revealed that the sequences of KX909928 and KX909927 had 100% similarity with the sequence of the N. fowleri gene (KT375442.1). Sequence alignment and the phylogenetic tree revealed that the N. fowleri collected in this study was classified as genotype 2 and was most closely related to Naegleria lovaniensis. This study confirmed N. fowleri as the agent responsible for the infection in this patient. PAM normally progresses rapidly and is generally universally fatal within a week. Unfortunately this patient died at 2 weeks after the onset of symptoms.

[目的]了解上海金山区居民对预包装食品营养标签使用情况及其影响因素,为制定适宜的营养干预措施提供依据.[方法]采用多阶段分层随机抽样方法,对辖区660名居民预包装食品营养标签认知与应用情况及其相关因素进行问卷调查.[结果]居民对预包装食品上营养标签的知晓率和认可率为62.0％和76.8％,年龄越低、文化程度越高,居民知晓和信任营养标签的比例越高;仅41.5％的居民能正确理解营养成分表的含义,选购食品时营养标签的应用率为35.0％;不用营养标签的主要原因为看不懂营养标签(35.9％)和品牌选择习惯(27.7％),其中低学历、高年龄、以及有慢性病史的调查对象以看不懂标签为主(分别为42.6％,42.5％和42.2％),而高学历、低年龄、无慢性病的调查对象则以习惯品牌而不关注标签为主(分别为41.3％,37.9％和32.7％).[结论]我区居民对营养标签的实际应用率低于认知率,不同人群不用营养标签的原因不同,应有针对性地加强宣教和指导,引导居民科学使用营养标签.

目的 分析2011-2015学年金山区中小学生因病缺课的流行特征和原因,为降低学生因病缺课率,制定干预措施提供依据.方法 收集2011-2015学年金山区中小学生因病缺课系统监测数据,描述中小学生因病缺课流行特征,并比较不同性别、不同学段学生因病缺课情况.结果 2011-2015学年金山区中小学生总因病缺课率为0.28％,缺课的首位原因为发热,占全部缺课病例的42.95％;其次为呼吸系统症状/疾病(22.24％)、消化系统症状/疾病(10.60％)以及传染病(6.45％);缺课病例集中于11-12月及3-5月,各种病因所致缺课分布高峰的时间不同;各学年男生缺课率均高于女生(P值均＜0.01);不同学段之间,小学缺课率最高,高中最低,各学年不同学段缺课率差异均有统计学意义(P值均＜0.01);传染病和伤害所致的平均缺课天数最多(6.7,5.2d).结论 小学生及男生是缺课的重点关注人群.应根据中小学生缺课的主要病因及其时间分布特点提前采取措施,降低学生缺课率.

[目的]了解上海市金山区中、小学生伤害的发生状况及流行病学特征,为政府和相关部门制订相关伤害干预策略和措施,降低学生伤害发生率提供依据.[方法]收集金山区2010-2016学年全部中、小学生伤害个案报告卡提供的数据,分析该人群伤害发生的原因、性质、临床特征等.[结果]2010-2016学年共监测学生伤害1387例,伤害发生率为0.386％;小学生、初中生和高中生伤害发生率分别为0.410％、0.437％和0.169％,差异有统计学意义(x2=70.186,P＜0.01);男生女生伤害发生率分别为0.522％及0.231％,差异有统计学意义(x2=196.987,P＜0.01);伤害原因主要为跌倒/落(69.36％),其次是碰撞挤压伤(9.22％)、交通事故(9.15％)、烧烫伤(4.04％);伤害发生时活动以消遣活动为主,占40.45％,其次是体育活动33.02％、日常起居活动13.91％;伤害原因分布表现出性别差异和学段差异.[结论]我区中、小学生伤害发生情况在不同性别和学段之间存在差异,需针对性开展干预措施.

本文报告了1例浙江省人体口腔寄生美丽筒线虫病病例.

目的 了解上海市金山区中小学生传染病发病状况,为学校传染病防控工作提供科学依据.方法 资料来源于“上海市学校因病缺课缺勤网络直报系统”,采用描述流行病学方法,对2011-2016年中小学传染病进行统计分析.结果 2011-2016年累计报告传染病1 783例,男、女性别比为1.32:1,差异具有统计学意义(X2=10.12,P=0.001);发病高峰在3-5月和11-12月;发病年龄以7～9岁为主,随着年龄的增长病例数呈现波动性下降趋势(x2趋势=9 118.79,P＜0.05);小学生发病率呈现逐年递增趋势,并且高于中学生,差异具有统计学意义(X2=181.58,P＜0.05);传播途径以呼吸道传播为主(73.98％),消化道次之(22.82％);发病率居前5位的依次是水痘(2.56‰)、手足口病(1.13‰)、流行性感冒(0.57‰)、猩红热(0.29‰)和流行性腮腺炎(0.26‰),其中手足口病、流行性感冒、猩红热、流行性腮腺炎4种传染病发病率小学生均高于中学生,差异具有统计学意义(X2值分别为301.79,37.76,117.18,62.60,P值均＜0.05).结论 金山区小学生传染病发病率处于上升趋势.应加强小学传染病的监测和防控工作,重点关注呼吸道传染病.

Objective To investigate physical activity and its determinants during leisure time among junior high school students in Jinshan District during the leisure time and to promote physical activity for children and adolescents. Methods Six primary schools were randomly cluster selected and then a class was selected from each grade, in which all students provided the informed consent record the content and time of static and dynamic physical activities on weekdays (from leaving school to arriving at school on the next morning) and on weekends (all day). Results The average of static activity time was 3.70 h and 7.85 h respectively during leisure time on weekdays and weekends; the students with higher grade spent more time on study-related activities and the students on the town also spent more time on static physical activity. The median of dynamic physical activities was 29.0 and 45.0 min respectively on weekdays and weekends, the median of MVPA (moderate and rigorous physical activity) was 14.0 and 17.5 min. About 36.0％ students took the initiative transportation way on the weekdays and 11.4％ students spent at least one hour on MVPA, the students of grade 7th, residence in town, academic performance above average preferred to MVPA. Conclusion Junior middle school students in Jinshan District have insufficient time for physical activity during the leisure time, and schools, families, and communities should make joint effort to promote physical activities.

To study the epidemiological distribution and the incident trends of imported malaria from 2012 to 2016 in Zhejiang Province, southeastern China, we collected data on malaria from the Information System for Parasitic Disease Control and Prevention. A total of 1,003 malaria cases were reported during 2012-2016, and all of these cases were imported. Plasmodium falciparum was the predominant species (76.3%) in Zhejiang Province. The percentage of Plasmodium vivax decreased from 33.6% to 8.1%, whereas the percentage of Plasmodium ovale and Plasmodium malariae increased. Most cases were male (89.8%), mostly in the age group of 21-50 years (82.6%). Businessmen (33.0%), workers (21.0%), farmers (18.8%), and overseas laborers (11.7%) were at high risk. The origin of the largest number of imported cases was Africa (89.5%), followed by Asia (10.0%) and Oceania (0.5%). The time interval from illness onset to confirmation was found to be significantly associated with the complications of patients. Out of 3,461 febrile individuals tested during reactive case detection, 10 malaria-positive individuals were identified. Effective surveillance and response system should be strengthened to prevent the reintroduction of malaria.

目的 对杭州市某实验小学学生鼻出血开展现场流行病学调查,分析原因.方法 根据鼻出血病例定义,在全校师生中开展现场流行病学调查,同时收集同期日平均气温、 日降水量和PM2.5资料以及校园环境检测结果,分析该校学生鼻出血发病的危险因素.结果 2017年4月1日—5月4日该校共发现鼻出血学生174例,罹患率为9.28％,无教职员工病例.鼻出血量为少量的有47例,占27.02％;一般的有54例,占31.03％;大量的有73例,占41.95％.病例发病时间集中在4月19日—5月4日,有153例,占87.93％.病例分布于所有年级和楼层,无明显集中趋势.学生鼻出血发病与日平均气温呈正相关(r=0.402,P=0.019).该校3幢教学楼的东面于4月19日、20日、21日和27日对脚手架实施喷漆作业,喷漆前(4月1—18日)和喷漆后(4月19日—5月4日)学生鼻出血罹患率分别为1.12％和8.16％;Logistic回归分析结果显示,喷漆后学生鼻出血发病风险是喷漆前的3.948倍(95％CI:2.789～5.587).结论 该校工地脚手架喷漆作业是引起学生鼻出血的主要危险因素.