探讨我国疟疾消除后,输入性疟疾防控策略的应用及保有实验室检测能力的重要性.在接诊国外输入疫情实战中,评价经典的显微镜检与荧光定量PCR检测疟原虫感染效能.2022 年 7 月 28 日几内亚务工归国人员在北京新冠肺炎隔离点集中隔离,8 月 1 日检出首例病例,收集同航班人员抗凝血样,采用流行病学研究方法的筛查一致性检验,对所有人员同时进行显微镜检和荧光定量PCR检测.结果显示,126 名归国人员中,17 例显微镜检发现疟原虫,感染率 13.5%.10 例荧光定量PCR阳性,感染率 7.9%,χ2= 2.03,P>0.05,两种检测方法无统计学差异.粗一致率为 94.4%,Kappa值 0.70,属于中度一致.原虫密度低的感染者荧光定量PCR检测容易漏检.结果表明,我国疟疾消除后,带虫回国人员具有再传播风险.保持显微镜检能力可以做到早发现、早治疗,是控制疟疾输入再传播的有效手段.

对北京市 1 例内脏利什曼病病例开展流行病学调查,确定感染来源,制定防控措施.收集病例就诊资料,在其感染地使用诱蛉灯开展白蛉监测、调查病犬信息,对病例和病犬骨髓液样本进行涂片、PCR检测、基因测序;对捕捉到的中华白蛉进行PCR检测.结果显示,病例以间断性发热、乏力就诊,医院以骨髓液涂片可见利什曼原虫无鞭毛体确诊为内脏利什曼病.感染地为门头沟王平镇,在该地区共捕获中华白蛉 4520 只,PCR结果阴性.病例、2 只病犬骨髓液利什曼原虫PCR阳性,且基因序列与婴儿利什曼原虫序列同源性分别为 94.44%、95.6%、93.23%,病犬骨髓液涂片查见利什曼原虫.结果表明,确定门头沟王平镇存在婴儿利什曼原虫感染传播链.需进一步开展白蛉、病犬分布范围调查,开展病例监测,多部门联合采取防控措施,防止内脏利什曼病疫情继续扩散.

目的 了解我国棘球蚴病疫情分布状况及流行病学特点,为优化防治策略提供依据.方法 收集2004-2020年国家传染病报告信息管理系统中全国棘球蚴病报告病例的数据,采用Microsoft Office 2016软件对报告病例的时间分布、地区分布、人群分布进行描述性统计分析.结果 2004-2020年全国31个省(直辖市、自治区)共报告棘球蚴病病例66 040例,其中9个流行省份[新疆(包括新疆生产建设兵团)、四川、青海、甘肃、宁夏、西藏、内蒙古、陕西和云南]报告65 340例,占全国总报告病例数的98.9％,22个非流行省份报告700例,占全国报告病例的1.1％.男性31 494例,女性34 546例.全国报告棘球蚴病例数从2004年的991例上升至2020年的3 650例,呈逐年增多的趋势(z=2.27,P＜0.05).非流行省份报告棘球蚴病例数从2004年的.17例上升至2020年的56例,亦呈逐年增多趋势(z=4.1675,P＜0.05).报告病例年龄分布主要以≥20岁年龄组为主,占91.3％(60 271/66 040),年龄不足1岁11例,≥85岁200例;职业分布中牧民和农民占全国报告病例数的 72.8％(48 074/66 040),其他主要为家务及待业者(5.5％,3 606/66 040),学生(4.6％,3 034/66 040).2020年非流行区共报告56例,河南报告最多(16例);其中输入性病例38例,由新疆输入24例;10个省份存在疑似本地感染病例.结论 我国西部9个省份的棘球蚴病流行仍然十分严重,报告病例数呈增多趋势.牧民和农民、青中年为高发人群.

分析2011—2021年北京市利什曼病流行情况,为制定北京市利什曼病的防控措施提供依据.对来源于中国疾病预防控制信息系统传染病报告信息管理系统中北京市报告的利什曼病例进行整理,采用Excel 2010和SPSS 20.0建立数据库并进行统计分析.结果显示,2011—2021年,北京市共报告124例利什曼病例,包括1例本地病例,123例输入性病例,其中,输入性病例中83例为内脏利什曼病,40例为皮肤利什曼病.输入性内脏利什曼病例中男女比例为2.32:1,主要集中在5岁以下儿童及40～49岁2个年龄段,病例职业以散居儿童、农民和家务及待业为主;均为境内外省输入病例,主要来源地为山西和甘肃;内脏利什曼病例的发病时间无明显季节性,从发病到确诊的时间中位数为62 d,出现发热的占比最大(74/83,89.2％),其次是肝脾肿大(28/83,33.7％)、乏力(17/83,20.5％)和贫血(16/83,19.3％).输入性皮肤利什曼病例中男女比例为19:1,主要集中在30～49岁,病例职业以干部职员、工人和商业服务为主,均为境外输入病例,主要来源国家为伊拉克;皮肤利什曼病例的发病时间亦无明显季节性,从发病到确诊的时间中位数为91.5 d,主要症状为皮肤溃疡和皮疹.结果表明,北京市利什曼病主要以境内外省输入和境外输入为主,2021年首次出现本地病例,应加强对利什曼病例的监测工作.

What is already known about this topic?:Echinococcosis is a serious zoonotic parasitic disease that predominantly infects humans; domestic animals like cattle or sheep; as well as wild animals such as small rodents. To date, there is a lack of comprehensive information about all potential environmental transmission routes for Echinococcus.What is added by this report?:This study assesses the importance of under-researched environmental factors for the transmission of Echinococcus. It concludes that hand hygiene is an important factor in the robust environmental transmission of Echinococcus granulosus.What are the implications for public health practice?:This study suggests that residents are at risk of catching echinococcosis through hand-oral transmission routes. Health education given to local residents is thus a key intervention, as well as avoiding close contact with dogs and ensuring proper hand-washing practices are followed.

分析北京市输入性疟疾死亡病例特征及危险因素,为减少病例死亡提供依据.2010-2020年北京市报告15例疟疾死亡病例,均为非洲感染的恶性疟病例.病例均为男性,平均年龄44.80±15.19岁,职业主要是工人和干部职员.死亡病例发病到初次就诊的时间中位数为1d,初次就诊到确诊的时间中位数为3d,病例初次就诊时诊断为疟疾的有7例.选择14名死亡病例,按照1∶4配对选择56名对照,单因素Logistic回归分析结果显示,病例组和对照组在3个变量之间的差异具有统计学意义,分别是并发症、初次诊断疾病、初次就诊—确诊时间间隔;多因素条件Logistic回归分析结果显示并发症为疟疾死亡的危险因素.结果 表明,北京市输入性疟疾死亡病例主要是由于延迟诊断导致,应继续开展健康教育增强病例就诊意识,强化培训提高医生诊断能力.

了解2016-2020年北京市土源性线虫病和华支睾吸虫病人群感染状况,为制定防控措施提供科学依据.2016-2020年,北京市每年设立3个监测点,包括土源性线虫病固定监测点和流动监测点各1个,华支睾吸虫病流动监测点1个,开展人群土源性线虫和华支睾吸虫感染状况监测,各监测点按照地理方位划分为东、西、南、北、中5个片区,每片区抽取1个乡(镇)的1个行政村,每个行政村整群抽取3周岁以上常住居民200人,采用改良加藤厚涂片法(一粪两检)检测虫卵,土源性线虫病监测点对3～9岁儿童加做透明胶纸肛拭法检测蛲虫卵.计算感染率,感染率间差异采用卡方检验.从传染病监测报告系统和流行病学调查资料收集华支睾吸虫病病例信息,对感染地和感染来源进行回顾性调查分析.2016-2020年,共调查15 200人,发现感染者10人,总感染率为0.07％(10/15 200),蛔虫和蛲虫感染率分别为0.06％(9/15 200)和0.01％(2/15 200),未检出华支睾吸虫感染者.山区感染率为0.13％(6/4 697),平原、丘陵和盆地等的感染率为0.04％(4/10 503),两者差异无统计学意义(P＞0.05).男性感染率为0.04％(3/7 148),女性感染率为0.09％(7/8 052),差异无统计学意义(P＞0.05).感染者年龄在33～65岁,感染者职业主要为农民(6人),其次为家务及待业人员(2人).2016-2020年,北京市共报告华支睾吸虫病16例,14例有食用生鱼片史,2例有食用未熟透的鱼肉史.北京市土源性线虫病感染率已较低,近郊和远郊少数农村是防控重点地区;华支睾吸虫病例时有报告,应加强监测和健康教育.

了解2013—2019年北京市境外输入性疟疾病例特征,为进一步做好疟疾防控工作提供科学依据.2013—2019年北京市共报告境外输入性疟疾病例614例,死亡10例,非洲输入的病例占95.11％(584/614).所有病例为实验室确诊病例,包括恶性疟504例(82.08％,504/614)、间日疟46例(7.49％,46/614)、卵形疟34(5.54％,34/614)、三日疟20例(3.26％,20/614)、混合感染10例(1.63％,10/614).病例报告无明显季节分布,男女性别比为13.62:1,80.65％的病例集中在20～49岁年龄段,排名前两位的职业是干部职员(35.12％,216/614)和务工人员(25.41％,156/614).614名病例中包括中国籍534例,外籍80例,现居住地分布广,其中现住址在北京的病例占57.00％(350/614),分布于全市15个区.病例的发病—确诊时间间隔中位数是3 d,3 d内确诊比例57.98％(356/614),其中恶性疟3 d内确诊比例为61.71％(311/504).结果表明,北京市输入性疟疾病例较多,且近两年三日疟、卵形疟、混合感染病例有所增加,须继续加强疟疾健康教育宣传和提升实验室检测能力.

分析北京市新型冠状病毒疫情形势下2例输入性疟疾病例的筛查与确诊,探求疟疾的快速诊断路径.新冠疫情期间,病例1于2020年2月返京,因新型冠状病毒Ig G、Ig M阳性,致疟疾确诊延迟;病例2于10月返京,因认识不足,未充分考虑疟疾致确诊延迟.两病例均由非洲返回,样本送本实验室进行显微镜检测和荧光定量PCR检测,送检当日明确诊断为疟疾,确诊时限均为9d.在重大公共卫生事件暴发时,需采取科学防控措施,仔细甄别疟疾等输入性传染病,防止出现严重后果.有效提高对疟疾的认识,加强宣传教育,保有检测能力,才能更好的应对复杂的传染病疫情.

Introduction Transmission of COVID-19 within families and close contacts accounts for the majority of epidemic growth. Community mask wearing, hand washing and social distancing are thought to be effective but there is little evidence to inform or support community members on COVID-19 risk reduction within families. Methods A retrospective cohort study of 335 people in 124 families and with at least one laboratory confirmed COVID-19 case was conducted from 28 February to 27 March 2020, in Beijing, China. The outcome of interest was secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the family. Characteristics and practices of primary cases, of well family contacts and household hygiene practices were analysed as predictors of secondary transmission. Results The secondary attack rate in families was 23.0% (77/335). Face mask use by the primary case and family contacts before the primary case developed symptoms was 79% effective in reducing transmission (OR=0.21, 95% CI 0.06 to 0.79). Daily use of chlorine or ethanol based disinfectant in households was 77% effective (OR=0.23, 95% CI 0.07 to 0.84). Wearing a mask after illness onset of the primary case was not significantly protective. The risk of household transmission was 18 times higher with frequent daily close contact with the primary case (OR=18.26, 95% CI 3.93 to 84.79), and four times higher if the primary case had diarrhoea (OR=4.10, 95% CI 1.08 to 15.60). Household crowding was not significant. Conclusion The study confirms the highest risk of transmission prior to symptom onset, and provides the first evidence of the effectiveness of mask use, disinfection and social distancing in preventing COVID-19. We also found evidence of faecal transmission. This can inform guidelines for community prevention in settings of intense COVID-19 epidemics.

2015年北京市根据《全国人体重点寄生虫病现状调查方案》和实施细则要求,采用分层整群随机抽样方法,选择13个区的52个调查点开展土源性线虫感染情况调查,7个调查点开展华支睾吸虫感染情况调查.每个调查点收集不少于250份常驻居民的粪样,采用改良加藤厚涂片法(一粪二检)检测土源性线虫及其他肠道蠕虫卵,3～6岁儿童加做透明胶纸肛拭法检测蛲虫卵.随机抽取部分人群开展寄生虫病防治知识问卷调查,了解相关知识认知情况.采用SPSS 20.0统计学软件进行统计分析.结果 显示,52个土源性线虫调查点共调查13 401人,蛔虫感染12例,其中4例混合感染鞭虫,总感染率为0.09％ (12/13 401).622名3～6岁儿童进行蛲虫检测,未发现感染者.7个华支睾吸虫调查点共调查1 782人,未发现感染者.12例土源性线虫感染者均来自燕山-太行山山地生态区,包括1名小学生和11名农民;燕山-太行山山地生态区土源性线虫感染率为0.18％ (12/6 673),京津唐城镇与城郊生态区感染率为0,两个生态区之间差异有统计学意义(P＜ 0.01).不同性别、年龄组、职业之间的感染率差异无统计学意义(P＞0.05).共收集调查问卷1 876份,城郊地区对寄生虫病知晓率最高,其中蛔虫病知晓率为83.72％ (607/725),华支睾吸虫病知晓率为56.83％ (412/725).北京市土源性线虫感染率下降明显,偏远农村地区40岁以上人群是防控重点.

Objective:To analyze epidemiological characteristics of coronavirus disease 2019 (COVID-19) at different stages in Beijing, so as to provide references for the prevention and control of COVID-19 and other emerging infectious diseases in the future.Methods:The information of confirmed COVID-19 cases from the "China Information System for Disease Control and Prevention" and epidemiological investigation reports. The demographic information, case source, onset time, hospital visit time and diagnosis time were analyzed for the characteristics of epidemics at different stages.Results:From January 19, 2020 to July 10, 2020, 935 of COVID-19 confirmed cases were reported. The epidemics can be divided into three stages, including the prevention and control stage of domestic imported cases mainly from Wuhan (from January 19 to February 28, 2020), the prevention and control stage of importing cases from abroad (from February 29 to June 10, 2020) and the prevention and control stage of local cluster cases mainly from Xinfadi market (from June 11 to July 10, 2020). In the first stage, cases were mainly local cases (51.46%) and domestic imported cases (48.54%). In the second stage, cases were mainly imorted cases from abroad and cases related to such cases (97.80%). In the third stage, cases were mainly local (99.12%). The difference in the proportion distribution of the sources in the three stages was statistically significant ( x2=1170.680, P<0.01). The median time interval from onset to hospital visit was 2.00 days (P 25 - P 75: 0-5.00) and the median time interval from hospital visit to confirmed diagnosis was 1.00 day (P 25 - P 75: 1.00-2.00). The median time interval from onset to confirmed diagnosis was 4.00 days (P 25 - P 75: 2.00-7.00). The diffenrence in the proportion distribution of the median time intervals at the three stages was statistically significant ( H=76.833, P<0.01; H=204.484, P<0.01). Conclusions:The demographic characteristics, sources of case and clinical features at the three stages in Beijing were all different. Differential prevention and control measures should be taken for precise prevention and control.

目的 分析北京市输入性疟疾流行病学特征,为制定疟疾防控措施提供参考依据.方法 收集2012～2017年北京市输入性疟疾病例信息和个案流行病学调查资料,采用SPSS 20.0统计学软件对疟疾病例流行病学特征和就诊情况进行统计分析.结果 2012～2017年北京市共报告输入性疟疾病例505例,全部为境外输入,其中474例(93.86％)来自非洲国家,20例(3.96％)来自亚洲国家,11例(2.18％)来自大洋洲国家.对全部病例的发病时间进行统一分析,发病高峰在6～8月份.所有病例为实验室确诊病例,恶性疟432例(85.55％),间日疟44例(8.71％),卵形疟18例(3.56％),三日疟10例(1.98％),混合感染1例(0.20％).发病后超过7天就诊的病例有20例(3.96％),就诊后超过7天才确诊的病例有49例(9.70％).402例首次就诊地在北京的病例中,有83例(20.65％)诊断为其他疾病.北京市医疗机构误诊比例呈下降趋势(Z=5.806,P=0.016).结论 北京市境外输入性疟疾防控形势依然严峻,应继续加强多部门合作,保持高效的疟疾监测体系.