目的 实现中国疾病预防控制信息系统中传染病监测数据常规分析和疫情资料汇编自动生成.方法 利用大数据、数据仓库、C++开发工具等实现传染病疫情数据挖掘技术,实现监测数据采集、存储、汇总和分析的自动化.结果 系统可在5分钟内完成10 000多份传染病电子报告卡的采集和存储工作,1分钟内导出聚集性病例或连续多年病例的三间分布情况;1分钟内自动实现监测数据常规分析;可完成1953年以来玉溪市数十万条传染病监测数据的采集,并在30分钟内自动生成1 000页疫情资料汇编.结论 该系统具有操作简单、通用性强、及时、准确、自动、高效的特点.传染病疫情数据挖掘技术可成为疫情管理、疾病控制人员监测与处置传染病疫情的关键技术.

Some serovars of Salmonella are not or rare found to cause salmonellosis in human. In our clinic-based surveillance, three rare Salmonella 4,5,12:a:- strains were recovered from three patients with diarrhea. To explore their genetic and epidemiological characteristics and pathogenesis, we conducted whole-genome sequencing, in vitro invasion assays in mammalian cells, and in vivo virulence assays in an animal model. The three isolates had indistinguishable molecular patterns and similar genome sequences, and clustered together with an isolate from edible fish traded among countries. The isolates had biochemical reactions identical with those of Salmonella subspecies enterica but belonged to subspecies salamae according to genome phylogeny, revealing a new serovar, S. enterica subsp. II serovar 4,5,12:a:-. The strains contained multiple virulence genes, elicited temporary bacteremia and enteritidis and caused cell damage in the mouse liver and cecum. This study provides evidence that this new Salmonella salamae serovar can infect humans and cause clusters of cases, and whole-genome sequencing detection and surveillance of Salmonella can help to accurately define Salmonella classification and clonality, improve diagnosis, facilitate outbreak detection and aid in the source tracing of salmonellosis epidemics.

Typhoid and paratyphoid fevers, one of major infectious diseases with global transmission potentiality and high incidence, still imposes pressing disease burden and major global-health concern in low- and middle-income countries. In endemic areas, the disease is characterized by high incidence, limited effect of prevention and control, and more cases caused by water contamination, food contamination and close contact. In addition, the remarkable characteristics of the disease in developed countries and regions are the low incidence rate and the relatively large proportion of tourism-related cases, and there are still difficulties in the sustainable reduction of the incidence rate. Detection and surveillance on typhoid and paratyphoid fevers in a timely and accurate manner is an important scientific and technological problem to prevent the outbreak and reduce the hazard. In the study, we summarized researches on risk factors, early detection and effective surveillance of typhoid and paratyphoid fevers, and paid attention to multispace-time node triggering and multi-disciplinary channel monitoring and etiological results in the process of outbreak and epidemic for providing a basis to the construction of an innovative technical system with sensitive specificity, staging measurement of typhoid and paratyphoid fevers.

目的 了解2010-2020年云南省伤寒与副伤寒流行特征,为制定有效防控措施提供科学依据.方法 对云南省11年的伤寒副伤寒疫情资料进行描述性分析.结果 2010-2020年全省共报告伤寒副伤寒病例35217例,死亡6例,年均发病率6.79/10万,总病死率0.017％;2010-2020年报告病例数、发病率总体呈现下降趋势.云南省伤寒副伤寒全年均有病例报告,主要发病于5-10月,占总病例数的60.75％;发病地区分布广泛,其中西双版纳州年平均发病率为全省最高(20.04/10万);以10岁为等组距,20～岁年龄组累计发病数最多,占总病例数的18.14％;男女性发病数之比为1∶1;发病人数最多的职业是农民(47.04％),其次为学生和学龄前儿童.结论 云南省11年来伤寒副伤寒发病总体呈下降趋势,应针对重点区域、重点人群和高发季节采取有效防控措施.

Infectious diseases are still one of the leading causes of morbidity and death globally, affecting public health and life, social and economic development, and even national security. Early detection focuses on detecting the abnormal information of infectious disease outbreaks or epidemics in a timely and sensitive way to conduct field investigation and verification. It is also a precursor to effective surveillance and early warning system. The effective surveillance and early warning system can fully and accurately understand the real conditions, driving forces, and transmission chain of the occurrence of a specific infectious disease outbreak and epidemic and put forward scientific and effective prevention and control strategies and measures. Due to the measurement of the resources support and the particular data collection value, it is not easy to obtain epidemiological, etiological, and other data information in a timely, complete and accurate manner. This paper summarized the theory and technology on early detection, effective surveillance, and early warning information on infectious diseases. It also integrated and utilized the multi-source data, including effective infectious disease surveillance and the country's early warning system, to better understand the outbreak epidemic, causes, risks, processes, and driving forces. Thus, it is possible to set up a sensitive, specific staging measurement innovative technical system to monitor, early warning, and timely respond to acute infectious diseases through multidisciplinary cooperation in China. It provides the basis for strengthening the surveillance and early warning of new emerging and major infectious diseases and public health emergencies, avoiding the spread of inadequate response to infectious disease, and preventing the resources waste of over-response.

<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 了解1999—2015年玉溪市红塔区伤寒与副伤寒(typhoid and paratyphoid fever,TPF)疫情变化情况,为TPF监测、 调查和控制提供科学依据.方法 TPF数据来源于1999—2015年玉溪市红塔区TPF临床诊断和实验室确诊病例,人口资料来源于红塔区统计年鉴.采用流行病学、 统计学和数学模型方法,描述分析TPF病例年月分布特征与规律,建立相应Gompertz模型并计算其参数.结果 6—10月为发病高峰,报告病例数占总病例数57.76％(4851/8398).2001、2004、2006、2007、2009年合计病例数5361例,呈现5个高发年和3个流行周期,周期范围19～40个月;其余12个低发年合计病例数3037例.总高发年6—10月平均发病率130.59/10万,高发年2001年6—10月病例数占当年总病例数63.89％(862/1349);总低发年6—10月平均发病率65.36/10万,低发年1999年6—10月病例数占当年总病例数43.48％(10/23).Gompertz模型分析结果显示,总流行时段、 总高发年、 总低发年模型病例数饱和值K分别为146、160、27,拐点坐标(t0,y0)分别为(3.61,72.94)、(3.60,80.08)、(3.56,13.55);高发年2001、2007年K值分别为502、125,(t0,y0)分别为(9.92,251)、(5.05,62.70);低发年2003、2005、2010、2011、2013年K值分别为42、64、111、37、24,(t0,y0)分别为(5.16,20.93)、(5.16,31.83)、(9.26,55.87)、(5.13,18.69)、(4.38,12.10).结论 1999—2015年红塔区TPF具有病例多、 发病率高、 季节性升降、 周期性波动、 长期趋势的流行特征;三个总模型t0有趋同性,高发年各参数值较大,低发年各参数值随年度发病率降低有减小趋势;TPF年、 月流行特征和模型参数可联合用作分析评价TPF疫情变化时间与空间节点、 数据化预警、 风险评估、 精准控制与防控效果.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">伤寒与副伤寒继续成为全球性主要发病与死亡原因之一,是发展中国家一个严重公共卫生问题。该病流行趋势、疾病型、病原型、危险因素的阶段性与区域性变化规律尚不清楚;地方病区显著特点是发病率高、防控效果局限、水源性与食源性和密切接触传播病例均多;发达国家等低发病率区域旅游相关病例构成比较大,可持续减少发病也有困难。本文检索分析1950—2015年全球主要伤寒与副伤寒文献,认识伤寒与副伤寒流行与发病、疾病型与病原型、卫生设施与危险因素的变化特征、趋势与规律,依据风险度评价决定因素与相关指标提出差异化防控策略,为进行疫情数据化预警、确定疫情变化时空节点和可持续控制与消除伤寒与副伤寒提供科学依据。</span>

目的 了解云南省玉溪市5岁以下急性腹泻病例的致病菌病原谱及其季节变化规律,为完善腹泻病防制策略提供依据.方法 在云南省玉溪市开展了为期1年的腹泻病监测,综合运用分离培养和核酸检测方法对腹泻病例粪便标本进行肠道致病菌多病原检测.结果 共对382名急性腹泻患儿进行了调查和采样,共分离到常见肠道致病菌51株(致泻性大肠杆菌26株,志贺菌9株,沙门菌8株,气单胞菌8株),致病菌总检出率为13.4％.夏季(5—7月)肠道致病菌检出率为38.9％,高于冬季(11月—次年1月)的7.3％,农村病例的检出率(17.6％)高于城区病例(7.7％).2岁以上儿童的检出率(31.8％)高于2岁以内儿童(10.9％).粪便标本的阳性率(23.1％)高于肛门拭子(6.0％).结论 致泻性大肠杆菌、 志贺菌、 沙门菌和气单胞菌是玉溪市5岁以下腹泻儿童的主要病原菌.

Objective To understand and analyze the epidemiological and clinical characteristics of brucellosis in Yuxi,and provide evidence to effective prevention and control strategies.Methods The totals of 101 patients were investigated from 2008 to 2015,which were used EpiInfo 7.0 and SPSS 17.0 software to analyze epidemiological and clinical characteristics.Results The brucellosis were increased year by year,and mainly attacked concentrated from April to August,Peak in May.The prevalence population was occurring among young and middle-aged men.The primary Occupation was poultry feeders (70.30％),and the 93.07％ of patients have contact with sheep.There were 76.24％ of the patients could get treatment in acute stage.Clinical manifestations mainly were fever (mostly irregular fever),fatigue,sweaty,muscle pain and joint pain,even concurrented damages of joint,liver,myocardium,uropoiesis and reproduction.The misdiagnosed rate was 100％.Conclusion The brucellosis was very serious in Yuxi.It should strengthen the health education and behavior intervention,and let people know more knowledge on brucella personal protection.Due to brucella complex and varied clinical manifestations,complications and misdiagnosis,the physician should strengthen the understanding of the disease and then improve the diagnosis and treatment level.

OBJECTIVES:To conduct a one-year pathogen surveillance of acute diarrheal disease based on outpatient clinics in township hospitals in rural Hongta District of Yunnan Province, China.METHODS:Fecal specimens of acute diarrhea cases and relevant epidemiological information were collected. Salmonella, Shigella, Vibrio, Aeromonas, Plesiomonas shigelloides and diarrheogenic Escherichia coli (DEC) were examined.RESULTS:Among the 797 stool specimens sampled, 198 samples (24.8%) were positive in pathogen isolation, and 223 strains were isolated. The order of isolation rates from high to low were DEC, Aeromonas, P. shigelloides, Salmonella, Shigella and Vibrio. The overall positive rate in middle school students and preschool children was relatively high; while the overall positive rate of less than 1-year-old infants and above 55 years olds was relatively low. The isolates were analyzed by pulsed-field gel electrophoresis (PFGE). Some cases had the same or very close onset time, and the isolates had similar PFGE patterns, suggesting a possible outbreak once occurred but was not detected by the current infectious disease reporting system.CONCLUSIONS:Pathogen infection and transmission in rapidly urbanized rural areas is a serious issue. There is a great need for a more sensitive and accurate mode of monitoring, reporting and outbreak identification of diarrheal disease.

[Objective] To analyze the epidemiological characteristic and trend of class A and B notifiable infectious diseases in Yuxi City from 1996-2015,provide scientific basis for the prevention and control work in the future.[Methods] The descriptive epidemiological method was used to analyze the epidemic data of class A and B notifiable infectious diseases which were reported by Yuxi Disease Surveillance Information Reporting and Management System between 1996 and 2015.[Results] Totally 23 kinds of class A and B notifiable infectious diseases were reported from 1996-2015,including 2 cases of plague reported in 1996 and 20 cases of cholera reported in 2009,and there were 17 kinds of class B infectious disease,including 93 273 cases and 237 deaths.The incidence rates fluctuated between 155.7/lakh and 320.7/lakh,and the mortality rates fluctuated between 0.05/lakh and 1.31/lakh,which were mainly affected by AIDS.The incidence rates of malaria,dysentery,typhoid and paratyphoid fevers decreased from 100/lakh (constitute ratio more than 33％) to 10/lakh (constitute ratio about 10％).The incidence rate of pulmonary tuberculosis increased from 33.8/lakh in 1997 to 59.2/lakh in 2004,and then gradually decreased,which reached 28.7/lakh in 2015.The epidemic situation from 1996-2007 was affected by intestinal infectious disease and showed a seasonal characteristic with the peak season of April to October.The cases of students,farmers and scattered children accounted for more than 65％ of the total cases.The age distribution showed that the cases concentrated in 0-9 year-old age group before 2006 and 20-49 year-old age group after 2006,which accounted for more than 20％ and 45％ of the total cases,respectively.[Conclusion] The prevention and treatment strategy which focus on priority diseases,key township and high-risk population is an effective means to control the infectious diseases.The implementation of the prevention and control mechanisms which lead by the government,cooperated by the health,education,agriculture,animal husbandry and other departments will be effectual.The threat of infectious diseases to human beings will exist for a long time,an effective response to the epidemic situation of infectious diseases depends on continuing to strengthen monitoring means,take comprehensive prevention and control method,improve the mechanism and strategy of prevention and control,implement the measures and solutions.

Objective To analyze the associations between the epidemiological features of typhoid/paratyphoid fever (TPF) and meteorological variables in Hongta area from 1999 to 2015, and provide scientific basis for TPF monitoring and control, as well as risk factor evaluation.Methods Descriptive epidemiology method and independently developed computer software were used to establish the database of distribution and epidemic features of TPF cases in Hongta District.The impacts of rainfall, temperature and relative humidity on incidence of TPF were analyzed with Pearson's correlation analysis and multiple stepwise regression analysis.Results 8,398 cases of TPF were reported from 1999 to 2015, including 23 and 44 cases in 1999 and 2015 respectively.The annual growth period, peak period and decline period of TPF cases were during March-May (average monthly growth rate of 63.8％), June-October (average monthly reduction rate of 2.0％), and November-February (average monthly reduction rate of 25.7％), respectively.The annual number of cases showed a seasonal increase from March to October, and a seasonal decline from November to February.Five high-intensity epidemic peaks appeared during 2000-2002, 2004-2005, 2005 2007,2007-2008 and 2008-2010 respectively;the peak periods ranged from 12 to 24 months, and the cyclic fluctuation periods ranged from 11 to 40 months.Pearson's correlation analysis showed that the monthly average incidence of TPF was positively correlated with the monthly average rainfall (r=0.825, P＜0.01),monthly average temperature (r=0.797, P＜0.01) and monthly average relative humidity (r 0.706, P＜0.05).The fitted model equation of monthly average incidence (Y) and monthly average rainfall (X) of TPF was Y 4.563+0.051X, established by multiple stepwise regression analysis.Conclusion The incidence of TPF in Hongta area featured seasonal increase/reduction, periodic prevalence and long term trend;the incidence of TPF is closely related to rainfall, temperature and relative humidity.The accumulation of in fectious sources, the formation of heavy pollution sources and the increase of exposed population contribute to the relationships between the epidemiological features of TPF and meteorological variables.

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 分析该次农村婚宴集体食源性疾病暴发事故的原因.方法 运用《食物安全事故流行病学调查技术指南》开展流行病学调查、卫生学调查和实验室检验,运用EipInfo12.0和SPSS18.0进行统计分析.结果 本次事件参加宴会735人,发病人数80人,发病率10.88％,临床表现以腹泻、呕吐、发热为主,平均潜伏期15h,危险暴露因素为猪头肉,在猪头肉和病人粪便中检验出韦太夫雷登沙门菌.结论 确认此次事件是一起因食用受韦太夫雷登沙门菌污染的猪头肉引起的聚集性食源性疾病.

目的 了解玉溪市伤寒副伤寒高发地区医院报告病例诊断的准确性,为伤寒副伤寒诊断及报告质量的提高提供参考.方法 采用回顾性调查方法对全市2012-2014年报告的伤寒、副伤寒病例的诊断结果进行调查.结果 本次收集病例510例,诊断符合率80.98％;伤寒诊断符合率55.00％,副伤寒诊断符合率66.06％;临床诊断病例符合率48.66％,实验室确诊病例符合率96.69％;临床病例中伤寒与副伤寒的构成为6∶1,确诊病例中伤寒与副伤寒的构成为1∶15;诊断符合率为100％的是玉溪市人民医院和中医院、新平县、元江县、峨山县,最低的是通海县(33.90％);各级医院的伤寒副伤寒临床诊断病例符合率为市级明显高于县乡两级,确诊病例符合率市、县和乡三级比较接近.结论 玉溪市伤寒副伤寒诊断符合率偏低,影响了网络报告的真实性,影响了预防控制策略和措施的实施.

目的 了解玉溪市2009-2014年流感流行特征和流感流行优势毒株的变化规律,为制定预防和控制策略提供依据.方法 采用MDCK细胞进行流感样病例标本的病毒分离培养,最后采用流感分型试剂进行病毒型别鉴定.结果 2009-2014年玉溪市流感实验室共监测流感样病例3 248例,阳性标本489份,阳性率为15.06％,新甲型H1N1、H3N2、B型流感分别占43.97％、28.22％和25.36％,学生和离退人员阳性病例分别占52.15％和14.11％;哨点医院流感样病例标本阳性检出率低于暴发疫情,差异有统计学意义(x2 =301.14,P＜0.01);每年10月到次年3月出现流行高峰,2009年10月至2011年3月以新甲型H1N1流感为主,2011年4月至2012年3月以B型流感为主,2012年4月至2013年3月以A (H3N2)型流感为主;2013年4月至2014年3月以B型流感为主.结论 玉溪市流感病毒优势毒株是甲型H1N1、H3N2、B型流感,优势毒株在2009-2014年发生了四次转变,其进一步变异的可能性仍然存在,加强流感样病例病原学与重点人群疫情监测有重要意义.

伤寒和副伤寒流行强度与区域人口数、发病率、病死率、高危人群、污水系统及卫生设施、地表水系及环境污染、健康教育与人群习惯的关系密切.美国疾病预防控制中心提出、世界卫生组织报道、国际学者引用的流行区域划分法是根据伤寒和副伤寒每年发病率的高、中、低水平来划分的,该划分法不能真实反映＜100万、100～1 000万、＞1 000万人口数的伤寒和副伤寒高、中、低流行强度和相应区域.本研究对全球伤寒和副伤寒流行强度区域文献作一综述,分析伤寒和副伤寒流行强度、流行强度区域及其指标体系,为查明相应流行强度区域危险因素、进行风险评估和制定防控策略提供科学依据.

目的 了解玉溪市伤寒、副伤寒报告病例的诊断与治疗现况,为伤寒、副伤寒诊断和治疗提供参考.方法 对玉溪市2012-2014年报告的伤寒、副伤寒病例的诊断与治疗进行回顾性调查分析.结果 本次收集病例510例,临床病例中伤寒与副伤寒的构成为6:1,确诊病例中伤寒与副伤寒的构成为1:15;确诊病例的相应临床症状和体征所占比例较临床病例高(P＜0.05),较接近诊断标准.伤寒、副伤寒确诊病例的嗜酸性粒细胞降低或消失,且比例高于临床病例(P＜0.05);确诊病例的培养率为100.00％,临床病例的培养率为44.92％;24.12％调查病例的疗程小于10天,临床病例的疗程较确诊病例短,有50.80％临床病例疗程小于10天;按出院标准进行便培养的仅占7.25％.结论 玉溪市伤寒、副伤寒临床病例的临床症状、体征、检验结果和治疗与确诊病例有差异,部分病例的诊断和治疗未按诊断标准和防治手册执行,尤其是临床病例更为突出,影响了预防控制策略和措施的实施.