<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">2010年4月—2011年8月云南省元江县发生一起甲型副伤寒暴发疫情,587例确诊甲型副伤寒。有关部门进行了病例环境调查、分布特征分析、接触者管理、疫区处置和疫情报告;同时开展了病例与环境标本病原学检测,利用病原菌分子分型与基因组学技术,追溯疫情来源。结果显示,疫情起源与输入病例有关联,病原菌随污水排入蔬菜田、污染蔬菜、病例生吃污染蔬菜而感染;形成病例–污水–蔬菜–人群传播循环。采取环境污染控制、病例诊断治疗、密切接触者监测、人群健康教育防治策略措施后,历时17个月疫情得到完全控制。提示,病原菌分子分型、基因组学技术在流行病学调查、病原菌识别信息的传染源溯源和疫情精准控制中具有十分重要的作用。</span>

目的 探讨基因组大数据管理架构,提升传染病控制中基因组大数据管理水平.方法 收集和参考传染病控制领域基因组大数据的重要科技文献以及政策性资料,采用Delphi法咨询相关专家总结归纳管理要素,建设信息化的管理平台.结果 初步构建数据管理方案、试剂耗材及相关服务采购管理信息平台和微生物基因组数据库等协同管理体系,采购管理平台由管理部门、业务部门和测序服务公司组成,并与基因组数据库关联,进行数据的审核、验收和分析,做到数据及时更新和共享,比传统的审核流程快8～9d.制定平台的基本框架和功能分区,改变其粗放式管理传统做法,提高了科研工作效率.结论 基因组大数据管理体系有利于加强平台管理的信息化、规范化及专业化建设,为课题的结题和审计提供统计数据,提升服务保障功能.

目的 分析2015-2016年伤寒、副伤寒法定报告病例数，了解全国及高发省份流行病学特点和变化趋势，为防控措施和策略的制定提供依据。 方法 采用描述性流行病学方法对网络直报系统中2015-2016年伤寒、副伤寒报告病例数进行分析。 结果 2015-2016年全国共报告伤寒、副伤寒病例22 536例，死亡2例，年平均发病率为0.83/10万，较2014年的伤寒、副伤寒发病率下降18.63%。监测点共对14 465份血样标本进行培养，分离出菌株289株，阳性分离率为2.00%，伤寒与副伤寒之比为1.21：1。病例均以农民和民工为主，其次为散居儿童和在校学生，伤寒、副伤寒发病率均以0~4岁组儿童最高（分别为1.70/10万和0.80/10万）。贵州、云南、广西、广东、浙江、湖南和新疆为疫情高发省份，非监测点病例数上升。 结论 2015-2016年全国伤寒、副伤寒发病水平处于相对较低的状态，

目的 分析2014年全国伤寒/副伤寒流行病学特征,探索西南5个省份疫情聚集区域.方法 采用描述性流行病学分析方法对大疫情报告系统的2014年伤寒/副伤寒疾病信息进行统计分析,使用ArcGis 10.5软件绘制病例地理分布特征图,采用SaTScan时空聚类方法扫描分析云南、贵州、湖南、广西和广东5个省(自治区)的伤寒/副伤寒疫情的时空聚集性.结果 2014年我国共报告伤寒/副伤寒病例13 768例,总发病率为1.02/10万,与2013年相比,总发病率下降1.92％,无死亡病例,其中伤寒10460例(75.97％),副伤寒3 308例(24.03％),发病数与2013年相比,伤寒降低了2.44％,副伤寒降低了3.10％;伤寒/副伤寒的发病高峰为6--9月,占全年病例数的46.23％;伤寒/副伤寒病例均以农民为主,其次为散居儿童和在校学生.西南5省(区)时空扫描分析显示,一类和二类聚集区主要分布在相邻省份的县(市、区).结论 我国伤寒/副伤寒发病率逐年降低,高发省份伤寒/副伤寒的防控不能放松,尤其是非监测点的疫情上升应引起重视,调查并探索危险因素,根据风险因素采取针对性的综合防控策略.高发省相邻省份之间病例聚集明显,可能存在跨地域传播.

Objective To establish a rapid and specific multiplex polymerase chain reaction assay for the detection of diffuse adherent Escherichia coli (DAEC) and understand the prevalence of DAEC infection in diarrhea patients in China.Methods The multiplex PCR assay was established based on four adhesion-associated genes,i.e.afaB,afaC,afaD,daaE and 16S rRNA gene was used as control.The assay was evaluated with other E.coli strains and enteric pathogens.A total of 389 stool samples from diarrhea patients were screened by the multiplex PCR assay.Results The multiplex PCR assay could amplify the related genes and the sensitivity was 3.20 x 101 CFU/reaction or 8.01 x 103 CFU/ml for pure culture.The detection rate of DAEC in diarrhea patients was 6.2％.Conclusion The established multiplex PCR assay is specific suitable for screening and detection of DAEC.

Objective To provide evidence for an efficient and productive acquirement of scientific research resources in disease control system,and to elucidate patterns in supply orders and disease control capability.Methods The laboratory consumable orders and regulation data were collected from China CDC from 2008 to 2015.Descriptive analysis and correlation analysis were used to discover the influence of laboratory reagent consumable materials on disease control ability.Results We found that during the eight years,domestic reagent supplies accounted for 21.90％ of all reagents supplies,while imported reagent supplies accounted for 78.10％.The ratio of domestic and imported reagent was 0.30,and domestic and imported supplies ratio was 0.23.There was a positive correlation between reagent consumables and research outputs such as scientific publications.The correlation coefficients were 0.764,0.712,P＜0.05.Conclusion Most the laboratory reagents used in the study period was imported.The peaks of consumption were in June and December.Rational purchase of reagent supplies could promote the construction of disease control system,and contribute positively to the disease control management.

Objective: To identify the source and to comment on control program regarding an outbreak of paratyphoid A fever in a county, through field studies. Methods: Descriptive epidemiological methods were adopted to describe the epidemiological characteristics of the outbreak, which occurred in Yuanjiang county, Yunan province between 2010-2011, China. Case-control study with environmental investigation was performed to identify related risk factors and pathogens while isolation and susceptibility on the suspected pathogens were conducted. Subsequently, intervention and preventive measures were taken for the control of the outbreak. Results: A total of 600 cases were diagnosed and reported as paratyphoid fever A which spread over the whole Yuanjiang county, including 10 townships with different incidence rates. The disease was spatially clustered and the prevalence rates in these townships decreased with increasing distances from the polluted fields. Data from the case-control study discovered that consumption of raw vegetables was the main risk factor associated with this outbreak of paratyphoid fever (OR=65.3, P<0.001). Management of patients did not meet the requirements while feces and urine of the outpatients polluted the wastewater system in the city. Salmonella paratyphi A isolates were identified from the improperly disinfected wastewaters in hospitals and city systems, respectively. After the measures as prohibiting the planting of vegetables in contaminated fields and disinfection of hospital wastewater were taken, the outbreak subsided. Conclusions: Urban and hospital wastewater used for vegetables irrigation together with the tradition of eating uncooked vegetables seemed responsible for the outbreak of this paratyphoid fever. Intervention programs carried by the local government played a key role in controlling this large outbreak.

目的 建立高通量半自动化的细菌传代体系.方法 使用自动液体处理器、可丢弃性机械手枪头以及带有二维码的顶旋冻存管建立高通量半自动化的细菌传代体系,比较不同参数下构建体系细菌的交叉污染率.结果 原始菌液与新鲜细菌储存液的混匀体积、活塞移动速度、可丢弃型机械手枪头及液面间的位置关系与菌种交叉污染相关;高通量半自动化的细菌传代体系效率高于手工方法.结论 高通量半自动化的细菌传代体系可提高细菌保存的工作效率,简化了菌种保藏实验室的工作流程,具有较好的应用前景.

BACKGROUND:Since the 1990s, paratyphoid fever caused by Salmonella Paratyphi A has emerged in Southeast Asia and China. In 2010, a large-scale outbreak involving 601 cases of paratyphoid fever occurred in the whole of Yuanjiang county in China. Epidemiological and laboratory investigations were conducted to determine the etiology, source and transmission factors of the outbreak.METHODOLOGY/PRINCIPAL FINDINGS:A case-control study was performed to identify the risk factors for this paratyphoid outbreak. Cases were identified as patients with blood culture-confirmed S. Paratyphi A infection. Controls were healthy persons without fever within the past month and matched to cases by age, gender and geography. Pulsed-field gel electrophoresis and whole-genome sequencing of the S. Paratyphi A strains isolated from patients and environmental sources were performed to facilitate transmission analysis and source tracking. We found that farmers and young adults were the populations mainly affected in this outbreak, and the consumption of raw vegetables was the main risk factor associated with paratyphoid fever. Molecular subtyping and genome sequencing of S. Paratyphi A isolates recovered from improperly disinfected hospital wastewater showed indistinguishable patterns matching most of the isolates from the cases. An investigation showed that hospital wastewater mixed with surface water was used for crop irrigation, promoting a cycle of contamination. After prohibition of the planting of vegetables in contaminated fields and the thorough disinfection of hospital wastewater, the outbreak subsided. Further analysis of the isolates indicated that the origin of the outbreak was most likely from patients outside Yuanjiang county.CONCLUSIONS:This outbreak is an example of the combined effect of social behaviors, prevailing ecological conditions and improper disinfection of hospital wastewater on facilitating a sustained epidemic of paratyphoid fever. This study underscores the critical need for strict treatment measures of hospital wastewater and the maintenance of independent agricultural irrigation systems in rural areas.

OBJECTIVE:To explore some effective management measures for rational use of pediatric medication in China.METHODS:1 298 literatures about pediatric medication in the hospitals were collected from 1999 to 2010. The main risk typesand risk factors of pediatric medication were analyzed from macroscopic and microcosmic perspective. RESULTS:4 objective factors and 2 subjective factors contributed to forming the risks of pediatric medication. The objective factors were made up of pediat-ric medication policies,medical technology,educational level for patient guardian,pediatric physical character;and the subjectivefactors included moral hazard and behavioral risk. There were 5 key risks of pediatric medication existed in the practice,including incorrect medicine combination;inappropriate usage,dosage and unsuitable selection of dosage form;the high rate of antibiotic suse;inadequate explanation of usage,and dosage safety information in pediatric drug package inserts;and wide clinical use of high risk drugs for children,such as Cephalosporin antibiotics,and TCM injection. CONCLUSIONS:It is necessary to set up thenational incentive policy of pediatric medicine R&D and monitoring mechanism of rational drug use. In the hospital,great importance should be attached to construct the special management system of pediatric medicine,and improve drug use monitoring andthe professional knowledge of patients guardian.

Typhoid and paratyphoid fevers are still a serious public health problem in some countries.People used to confuse the transmission routes of the diseases and their risk factors.This paper attempts to summarize the transmission risk factors of typhoid and paratyphoid fevers in order to provide reference for the prevention and control of typhoid and paratyphoid fevers outbreak and suggest the identification of transmission risk factors.

OBJECTIVE:To establish an early-warning indicator system on outbreak of hemorrhagic fever with renal syndrome by Delphi method seeking expert advices.METHODS:Firstly, the literature review and the experts meeting method were used to formulate the initiator frame work and indicators. A two-round consultation was used to filter indicators, discuss the boundary of indicators and determine the weighting coefficient among 25 experts from 14 provinces, municipalities and autonomous regions. The relative weightiless of indicators was determined by the weight coefficients method.RESULTS:The experts' average length of service in prevention and control of hemorrhagic fever with renal syndrome was (23.80 ± 11.70) years. The positivity coefficients of the two-round experts were 100% and 72%. Kendall's coefficients of the two-round consultation were 0.50 (χ(2)(R) = 148.95, P < 0.01) and 0.54 (χ(2)(R) = 212.63, P < 0.01) and opinions among experts became consistent and the consultation had achieved the need of forecast. Four first-class indicators (host animals, risk population, social environment and case-related indicators) and 14 second-class indicators were filtered to develop the indicators system. The weight coefficients of the first-class indicators were 0.28, 0.23, 0.23 and 0.26.CONCLUSION:The early-warning index system of hemorrhagic fever with renal syndrome has been established and it could provide a reference for the forest and warning of HFRS outbreak.

Objective To develop an early-warning indicator system of brucellosis outbreak. Methods The methods of literature review and expert discussion were used to formulate the initiatory framework and indicators, and then Delphi method was used to filter indicators, discuss the boundary of indicators and determine the weighting coefficient. Results The average length of service provided by experts who engaged in prevention and control of brucellosis was (25.10 ± 8.80) years and the positive coefficient of the consultant experts of the two-round results were 95% and 68%, respectively. Kendall coefficients were 0.35, 0.54 and X2R value were 81.31 and 285.27, respectively and P value was all less than 0.01. Five first-level indicators(the host animal, high-risk groups,social environment, index case and the level of previous disease) and 13 secondary indicators were selected to develop the early-warning indicator system of brucellosis outbreak. The weight coefficients of the five first-level indicators were 0.21, 0.22, 0.17, 0.21 and 0.19, respectively. Conclusions The early-waming indicator system of brucellosis outbreak is initially established. We propose to develop the early-warning programs according to local conditions and the indicator system.

Objective To develop an indicator-based early warning system for Lyme disease outbreaks. Methods The preliminary framework and indicators were formulated based on literature review and expert consensus. The early warning indicators and respective weights were determined using Delphi expert consultation, and the impacts of different indicators were measured by weighting coefficients. Results An indicator-based early warning system for Lyme disease was formed using six primary warning indicators, including the host and vector, high-risk population, meteorological factors, social environment, previous prevalence and index cases, as well as 14 secondary indicators. Conclusion The indicator-based early warning system for Lyme disease in China has been basically established. Local early-warning proposals should be based on the indicator system and tailored to the actual situations.

Objective To develop the indicator system for early warning of Japanese encephalitis.Methods The literature review and the experts meeting method were used to set the initial frame work and indicators first,then Delphi method was used to screen indicators and determine the weighting coefficient.Results Five first-class and 10 second-class indicators involved in immune status of population to Japanese encephalitis infection,transmission vector,reservoir host,social environment,and case-related indicators were set up for the early warning of Japanese encephalitis.Conclusion The indicator system for early warning of Japanese encephalitis was set up in China,but the reliability and validity need to be evaluated by using historical epidemic data of Japanese encephalitis.

In order to construct a theoretical framework about early-warning indicator system for zoonoses outbreak,the literature research and expert meetings were conducted to draw out the initial indexes.Delphi method was used to screen evaluation indexes and determine the weight of indexes to finish the zoonoses outbreak early-warning index system.A total of 55 experts were consulted by two-round questionnaire investigation.There are 7 first-class indicators were filtered in this study,including host animals,major media,pathogen,meteorology,population,social environment,patients and incidence level,which could be divided into 22 second-class indicators.Results showed that the system could provide a theoretical basis for early-warning forecast on zoonoses,but the reliability and validity are need to be furtherly evaluated by historical epidemic data of zoonoses.

To develop the index system for early-warning of epidemic or outbreak of leptospirosis,literature review and expert meeting were used to formulate the initiatory framework and indexes,and then Delphi method was used to filter indexes and determine the weighting coefficient.Seven first-class and twenty-seven second-class indexes were selected to develop two kinds of index systems,epidemic areas,and non-endemic areas with potential risk of epidemic or outbreaks.Also,the theoretic models consisted of different indexes combinations were built for conducting the alerts of leptospirosis outbreak or epidemic at three levels: alert before outbreak or epidemic,early warning,and warning announcement by local government.It's suggested that the early-warning index system of leptospirosis are established and it could provide a reference for the forecast and warning of leptospirosis outbreak.

Objective To study the criterion of the laboratory network for etiological surveillance of infectious diseases,provide the reference for the laboratory network to conduct etiological surveillance of infectious diseases in a highly effective and orderly way.MethodsAccording to the features of detection technologies and etiological surveillance of infectious diseases,the study of common factors and key factors of etiological surveillance and key elements of the criterion of laboratory network for etiological surveillance of infectious diseases were conducted.ResultsThe criterion of laboratory network for etiological surveillance of infectious diseases should include the management measures,standard operating procedure,personnel training,quality control,laboratory evaluation/inspection,laboratory safety and effective collaboration with network members.ConclusionIt is necessary to establish a laboratory network for etiological surveillance of infectiou diseases.The criterion of laboratory network for etiological surveillance of infectious diseases is essential for the success of etiological surveillance of infectious diseases.

目的 评价IS6110限制性片段长度多态性(IS6110-RFLP)、间隔区寡核苷酸分型(Spoligotyping)及多位点可变数量串联重复序列分析(MLVA)3种方法在结核分枝杆菌基因分型研究中的应用.方法 分别采用IS6110-RFLP、Spoligotyping及MLVA对40株结核分枝杆菌临床分离株进行基因分型研究,比较3种方法的分型效果.结果 使用IS6110-RFLP方法,40株结核分枝杆菌呈现出35种基因型,33株具有独特的基因型;使用Spoligotyping方法,40株结核分枝杆菌呈现出17种基因型,11株具有独特的基因型;使用MLVA方法时,40株结核分枝杆菌呈现出34种基因型,29株具有独特的基因型;当3种方法联合使用时,40株结核分枝杆菌呈现出39种基因型,38株具有独特的基因型.结论 MLVA和IS6110-RFLP方法的分辨率高于Spoligotyping,但是对于IS6110单拷贝或低拷贝的菌株,MLVA方法的分辨率要高于IS6110-RFLP.MLVA、IS6110-RFLP和Spoligotyping联合应用可有效地进行结核病的流行病学调查和病原学监测.

The monoclonal antibodies against the 38 kD antigen of Mycobacterium tuberculosis were prepared and these antibodies after purification and labeled with FITC were used to establish the direct immunofluorescent antibody assay for the detection of M. tuberculosis in sputum specimens of patients. Under this circumstance, monoclonal antibodies against M.tuberculosis H37Rv strain was prepared by routine procedure with positive hybridoma clones selected by ELISA and identified with immunoblotting. And these monoclonal antibodies were purified with ammonia sulfate precipitation and Sephadex G-50 chromatography. In this way, 4 hybridoma cell lines producing monoclonal antibodies had been selected, and the titer of antibodies ranged from 1∶6 400 to 1∶12 800 demonstrated by ELISA assay. As confirmed by Western blot assay, all these 4 antibodies could bind specifically with 38 kD protein of M.tuberculosis and appearance strong bands of immune reaction. The positive rate M.tuberculosis in 41 sputum specimens of patients with tuberculosis direct by immunofluorscent antibody assay was 90.24%, significantly higher than that of acid-fast staining method (P0.05). These results suggest that this method of testing should be valuable to the preliminary clinical diagnosis of tuberculosis.