目的 分析2020-2021年北京市昌平区诺如病毒急性胃肠炎聚集性疫情流行特征,为科学制定诺如病毒急性胃肠炎疫情防控措施提供依据.方法 收集2020-2021年北京市昌平区诺如病毒急性胃肠炎聚集性疫情流调和临床资料,用实时荧光PCR方法检测诺如病毒;采用描述性的流行病学方法,分析疫情三间分布等流行病学特征.结果 2020-2021年北京市昌平区共报告51起诺如病毒急性胃肠炎聚集性疫情,疫情样本中诺如病毒检出率为20.08％(303/1 509);诺如病毒疫情冬季高发,发生在冬季的疫情占52.94％(27/51),其中12月占50.98％(26/51);城乡结合部的2个镇发生疫情起数最多,占47.06％(24/51),不同地区罹患率差异有统计学意义(x2=653.553,P＜0.05);托幼机构发生疫情起数最多,占58.82％(30/51),不同人群罹患率差异有统计学意义(x2 =797.526,P＜0.05);病例最常见的症状是呕吐,占78.61％(305/388),呕吐、腹泻和发热症状在不同人群间差异有统计学意义(P均＜0.05).结论 城乡结合部和托幼机构更易发生诺如病毒疫情;一年四季均有诺如病毒疫情发生,冬季高发,12月为流行高峰;病例以呕吐为主要临床表现.

Objective:To analyze the epidemiological characteristics of clustered epidemics of hand, foot, and mouth disease (HFMD) in Changping district of Beijing from 2018 to 2021.Methods:The epidemiological and etiological data of HFMD cluster epidemics in Changping district of Beijing from 2018 to 2021 were collected, and the descriptive epidemiological methods were used to analyze the distributions and pathogen constituents.Results:A total of 271 epidemics (including 266 clusters and 5 outbreaks) were reported from 2018 to 2021 and the average incidence rate was 11.04%. The median values of were both 2 d. The number of patients were positively correlated to the interval between epidemic on-set and reporting and to the duration of epidemics, with the correlation coefficients of 0.682 and 0.145, respectively (all P<0.05). The cases were mainly in the age group ≤ 5 years old, accounting for 77.67% (619/797). The epidemic mainly occurred in kindergartens, accounting for 78.97% (214/271). The top three number of epidemics occurred in Beiqijia town (51 epidemics), Huilongguan region (43 epidemics) and Dongxiaokou town (37 epidemics). The trend of epidemics reported was consistent with that of sporadic cases with the peak from May to July, and the second peak in September and November in some years. The main pathogens were coxsackievirus A 16 (CV-A16) and CV-A6. Conclusions:Clustered epidemic was the dominant type of epidemics in Changping District. Children under 5 years, kindergartens, the urban and rural fringe with dense population and large floating population are the key populations, places and areas for HFMD epidemic prevention and control. respectively. Early detection and reporting of the epidemic are the keys for prevention and control.

目的 探讨武汉市硚口区各级医疗机构消毒效果状况,为加强医疗机构消毒管理提供科学依据.方法 通过现场采样和实验室检测,对2016年-2021年该区各级医疗机构的环境空气、物体表面、医护人员手、使用中消毒液、压力蒸汽灭菌器、医院污水进行监测.结果 6年共采样6 815份,合格6 173份,总合格率为90.58％,各年度合格率分别为82.32％、87.88％、90.68％、93.28％、94.44％、96.83％,呈逐年上升趋势(x2=193.545,P＜0.05).结论 武汉市硚 口区各级医疗机构消毒效果总体合格率较好,呈逐年上升趋势,不同检测对象中,医务人员手合格率偏低,医院污水处理有待加强.需要加强卫生监督管理,加强医务人员的手卫生培训,落实消毒,加强医院污水消毒工作的落实.

目的 分析基层医院消毒灭菌效果的监测结果.方法 选取2019年与2020年该中心检验科收集的辖区内基层医院消毒灭菌检测标本各3000份作为研究对象.在2020年针对消毒灭菌工作的不足采取有效的改进措施.比较2019年、2020年基层医院的物体表面、高压灭菌器、紫外线灯、空气、医务人员手、使用中的消毒剂检测标本的合格率,并比较民营医院与社区卫生服务中心消毒灭菌检测标本的合格率.结果 2020年基层医院消毒灭菌检测标本总合格率(99.60％)明显高于2019年(97.67％),差异有统计学意义(P<0.05).2020年物体表面、高压灭菌器、紫外线灯、空气、医务人员手、使用中的消毒剂检测标本的合格率均明显高于2019年,差异有统计学意义(P<0.05).2019年民营医院的消毒灭菌检测标本总合格率及各类检测标本合格率均明显高于社区卫生服务中心,差异有统计学意义(P<0.05);2020年民营医院的消毒灭菌检测标本总合格率,物体表面、高压灭菌器、空气、医务人员手检测标本的合格率高于社区卫生服务中心,差异有统计学意义(P<0.05).结论 在采取改进措施后,基层医院各消毒灭菌检测项目的合格率整体提高,民营医院的消毒灭菌效果优于社区卫生服务中心,但依然存在部分项目消毒灭菌不合格的情况,基层医院应加强消毒灭菌管理.

目的 分析北京市昌平区诺如病毒感染性腹泻的流行病学特征,为进一步制定有效的防控措施提供依据.方法 用现场流行病学调查方法和描述分析方法,对2017-2020年北京市昌平区诺如病毒腹泻疫情报告和个案资料进行回顾性分析.结果 2017年1月-2020年12月,共报告疫情168起,累计病例1 876例,其中实验室诊断病例575例(30.65％),临床诊断病例1 799例(95.90％),无死亡病例.疫情以中小学(51.79％)为主要场所,其次是幼儿园(38.69％);时间上呈双峰分布;病例以3～17岁儿童为主(95.74％).不同年度发病人数构成比在疫情发生场所(x2=18.770,P=0.005)、年龄组(x2=22.215,P＜0.001)、性别(x2=7.864,P=0.049)和职业(x2=204.93,P＜0.001)间比较,差异有统计学意义.结论 诺如病毒感染引起的急性胃肠炎疫情发生场所以中小学校和幼儿园为主,发生时间段集中在学生开学期间,进入假期后大幅减少,学校应加强晨午检工作,及时停班并规范处置疫情,加强学校在传染病疫情处置方面的培训,做好疫情监测、健康教育宣传指导,降低传染病发病率.

目的 了解2006-2019年北京市昌平区布鲁氏菌病发病特征,为制定布鲁氏菌病预防和控制措施提供依据.方法 收集整理2006-2019年昌平区布鲁氏菌流行病学个案调查信息和重点行业人群血清学监测信息,采用描述流行病学方法分析数据.结果 2006-2019年昌平区共报告布鲁氏菌病患者90例,年发病率波动在0～ 1.3/10万;2-6月和12月为布鲁氏菌病发病高峰;男女性别比为3.3:1,40～ 59岁组发病居多、占报告病例的62.3％,以农民和家务及待业人员为主、占报告病例的65.6％;感染动物以羊为主、占87.8％,在养殖过程中感染占47.8％;共采集重点行业人员静脉血样2 505份,阳性64份、阳性率2.6％,年阳性率呈先升后降趋势,2015年阳性率最高为10.5％.结论 昌平区人间布鲁氏菌病疫情处于散发状态,感染与牛羊养殖密切相关;应继续做好疫情监测,加强养殖人员健康教育,改变不利于健康的传统生产、生活方式,自觉采取有效措施,预防并减少布鲁氏菌病的危害.

目的 了解北京市昌平区8～10岁儿童碘营养状况,为儿童碘缺乏病防治提供科学依据.方法 2017-2019年每年从本区随机抽取5所小学,每所小学随机抽取40名8～10岁儿童,收集其尿样和家中食用盐样测定尿碘水平和盐碘含量,并对儿童甲状腺进行B超检查.结果 采集600名儿童尿样,尿碘中位数为164.5μg/L;不同年份儿童尿碘水平差异有统计学意义(H=40.484,P＜0.01),呈逐年下降趋势(x2=-37.715,P＜0.01);尿碘水平男性儿童高于女性儿童(Z=-2.289,P＜0.05),农村高于城市(Z=.-4.281,P＜0.01).2017-2019年共检测食用盐样600份,盐碘中位数为20.4 mg/kg,碘盐覆盖率和合格碘盐食用率分别为87.5％和84.3％,各年份间盐碘水平差异有统计学意义(H=206.624,P＜0.01);不同年份碘盐覆盖率和合格碘盐食用率比较,差异均有统计学意义(x2=8.320、6.232,均P＜0.05),且均为上升趋势(x2=-6.595、6.120,均P＜0.05).B超检查600名儿童甲状腺容积,甲状腺肿大率为5.3％,不同年份、性别和年龄的儿童甲状腺肿大率比较差异无统计学意义(P＞0.05),农村儿童甲状腺肿大率高于城市儿童(x2=-6.376,P＜0.05).结论 2017-2019年北京市昌平区8～10岁儿童碘营养状况整体比较适宜,甲状腺肿大率高于国家标准,合格碘盐食用率低于国家消除碘缺乏病标准,建议对城市和农村采取因地制宜的措施以提高合格碘盐食用率,并定期评估儿童碘营养状况.

目的 了解1998-2020年北京市昌平区肾综合征出血热(HFRS)的流行特征,为做好防控工作提供依据.方法 收集1998-2020年北京市昌平区的HFRS疫情信息和宿主动物监测资料,采用SPSS 21.0软件进行描述性分析.结果 1998-2020年北京市昌平区累计报告HFRS病例145例,死亡1例,年平均发病率1.34/10万、病死率0.69％,95.17％的病例为原发性病例;报告病例主要分布在2007年之前,冬春季为发病高峰;青壮年发病居多,男女性别比为3.68∶1,以农民工、农民及工人为主;81.34％的病例有明确鼠接触史或居住/办公场所有鼠类活动痕迹;宿主动物监测显示优势鼠种为褐家鼠,平均鼠带毒率为1.04％.结论 北京市昌平区HFRS以直接或间接接触史者发病多见,应继续落实HFRS监测、防鼠灭鼠、临床诊治及健康教育等综合性防制措施.

目的 评估北京市昌平区第三次碘盐标准调整前后,儿童和孕妇碘营养水平变化,发现可能存在的碘缺乏风险,以便采取更加适宜的补碘策略.方法 按照《北京市碘盐监测实施方案》和《北京市碘缺乏病监测方案》开展监测,收集昌平区2009-2019年碘缺乏病监测数据,分碘盐标准调整前后和过渡期3个阶段对盐碘及尿碘数据进行分析.结果 2009-2019年共监测居民户食用盐3 252份,8～10岁儿童尿碘2 712份,孕妇尿碘2730份.碘盐标准调整前、过渡期和调整后盐碘中位数分别为31.2 mg/kg、25.4 mg/kg和22.3 mg/kg,3个阶段盐碘水平差异有统计学意义(H=1 362.155,P＜0.01),呈显著下降趋势;碘盐标准调整前、过渡期和调整后儿童尿碘中位数分别为266.7 μg/L、162.1μg/L和175.3 μg/L,3个阶段儿童尿碘水平差异有统计学意义(H=325.791,P＜0.01),由WHO推荐碘营养超过适宜量降至碘适宜量;碘盐标准调整前、过渡期和调整后孕妇尿碘中位数分别为181.1 μg/L、150.3 μg/L和139.8 μ.g/L,3个阶段孕妇尿碘水平差异有统计学意义(H=101.111,P＜0.01),由WHO推荐的碘营养适宜量下降到不足量.结论 碘盐标准调整后我区学龄儿童碘营养状况更趋于适宜、合理;但孕妇碘营养不足,应通过加强健康教育使孕妇有意识增加含碘丰富的食物摄入,以改善碘不足的现状.

目的 了解2018年北京市昌平区手足口病的流行特征及经济负担状况,为科学防控提供依据.方法 采用描述流行病学方法分析手足口病流行特征,采用SPSS 22.0统计分析手足口病经济负担.结果 北京市昌平区为手足口病高流行区,人群以散居及托幼儿童为主,季节特性呈夏季单峰流行,人群密集、外来人口聚集的地区,尤其是城乡接合部是手足口病的高发地区,重症病例和聚集性疫情的时间分布与流行高峰吻合.病原学以肠道病毒柯萨奇A组6型(CoxA6)和其他肠道病毒为主,重症病例以CoxA6为主.调查的158例手足口病患者总经济负担为426 645.18元,人均2 700.29元,轻症病例总经济负担358 846.04元,人均2 315.14元,重症病例总经济负担67 799.14元,人均22 599.71元.结论 北京市昌平区手足口病具有明显的人群、地区及时间分布特征,手足口病经济负担较重.CoxA6成为手足口病的主要病原体且在重症病例间发生.开展CoxA6病原学监测及经济负担的影响因素研究、加强托幼机构卫生监管,宣传手足口病的防控知识,落实消毒隔离等于预措施,以减少手足口病的传播和流行,从而降低手足口病的经济负担.

目的 了解2018年北京市昌平区诺如病毒感染疫情的流行病学特征,查找传染病防控漏洞和薄弱环节,为更好地预防和控制传染病的发生和传播提供依据.方法 采用现场流行病学调查方法,对每一起聚集性呕吐/腹泻疫情开展调查,收集疫情相关信息,采集病例、密切接触者以及相关人员的生物样品进行肠道病毒检测,并对数据进行统计分析.结果 68起疫情中聚集性疫情64起、暴发疫情4起;68起疫情中检出诺如病毒GⅠ型10起、诺如病毒GⅡ型44起、诺如病毒GⅠ型和GⅡ型混合感染12起、札如病毒2起;共采集标本376件,检出阳性标本198件,阳性率为52.66％;疫情报告病例数581例,波及5 748人,罹患率范围为4.21％～73.15％,平均罹患率为10.11％;≤12、13～18和≥19岁3个年龄组的呕吐、腹泻发病率比较,差异有统计学意义(x2=55.78、295.72,均P＜0.01).结论 中小学校和托幼机构是诺如病毒感染引起的急性胃肠炎疫情高发场所,应加强晨午检工作,对病例早发现、早隔离,及时停班并开展规范的消毒处置工作,对校医及班主任在传染病疫情处置方面加强培训,对学生和家长关于传染病防控方面加大宣传,多方联手做好传染病防控工作.

Objective: To systematically review the mortality burden study of influenza in mainland China. Method: "influenza", "flu", "H1N1", "pandemic", "mortality", "death", "fatality", "burden", "China" and "Chinese" were used as keywords, and a systematic literature search was conducted to identify articles in three English databases (PubMed, Web of Science and Embase) and three Chinese database (CNKI, WanFang and VIP) during 1990-2018 (excluding Hong Kong, Macao and Taiwan). The language of literature was restricted to Chinese and English. The inclusion criteria were human-oriented researches with method based on population, and research indexes included mortality and excess mortality. The exclusion criteria were non-primary research materials, predictive research and research on the burden of avian influenza related deaths. A total of 17 literatures were included, and the basic information to descriptive characteristics, methodology of modeling and the corresponding results were extracted. Results: All the 17 studies adopted indirect statistical models, with 14 of which adopted the regression model, and all the research index was excess mortality. All causes (16 studies), respiratory and circulatory diseases (14 studies) and pneumonia and influenza (10 studies) were the main causes of death associated with influenza. Influenza associated mortality burden in the elderly was higher, with the lowest excess mortality rates of all causes, respiratory and circulatory diseases, pneumonia and influenza being 49.57, 30.80 and 0.69 per 100 000 people, and the highest rates being 228.16, 170.20 and 30.35 per 100 000 people, respectively. In the non-elderly, the corresponding lowest rates were -0.27, -0.08 and 0.04 per 100 000 people respectively, and the highest rates were 3.63, 2.6 and 0.91 per 100 000 people, respectively. The influenza-related excess mortality was higher in the north, with a minimum of 7.8 per 100 000 and a maximum of 18.0 per 100 000, and slightly lower in the south, with a minimum of 6.11 per 100 000 and a maximum of 18.7 per 100 000. There were also differences in deaths caused by different influenza virus subtypes, with influenza A(H3N2) and influenza B virus possibly posing a heavier mortality burden. Conclusions: Studies on influenza mortality burden is mainly based on indirect model and urban level in China. The mortality burden of influenza in the elderly, the northern and subtype A(H3N2) and B were more severe.

目的 调查昌平区恙虫病的感染现状及危险因素,为制定全区恙虫病的防控策略提供依据.方法 2017年10-12月,在昌平区8个镇随机抽取常住人口开展恙虫病血清流行病学调查并进行危险因素分析.分别采用独立x2检验、分层x2检验及趋势性x2检验进行组间感染率分析.结果 本次调查共检测480份血清样本,其中55份恙虫病IgG抗体阳性,阳性率为11.45％;不同年龄(x2=57.712,P＜0.001)、教育程度(x2=35.257,P＜0.001)、职业(x2=17.222,P＜0.001)和地区(x2=69.469,P＜0.001)人群阳性率的差异有统计学意义.田间劳作(OR=3.03,95％CI:1.31～6.98)和草地行走(坐卧)(OR=3.18,95％CI:1.07～9.46)分别是农民和在职人员感染的危险因素.涂抹防虫剂(OR=0.45,95％CI:0.21～0.98)和外出后洗澡换衣(OR=0.48,95％CI:0.25～0.93)是保护因素.结论 北京市昌平区存在恙虫病隐性感染病例且具有显著的人群和地区差异,提示应加强监测与防控并开展进一步的调查研究.

Objective To estimate the excess numbers of influenza-like illness (ILI) cases associated with influenza from 2012 to 2017 in Changping district. Methods The surveillance data of ILI cases from secondary medical institutions and above in Changping district was collected to estimate influenza-associated excess numbers of ILI cases in different age groups using Serfling regression model and the adjusted Serfling regression model, respectively. Results The epidemic weeks of influenza were 52nd-2ndin 2012-2013, 52nd-6thin 2013-2014, 46th-3rdin 2014-2015, 52nd-14thin 2015-2016 and 47th-6thweeks in 2016-2017. The average number of annual influenza epidemic weeks was 10 (range: 4-15). The corresponding excess numbers of ILI cases attributed to influenza were 598 (95%CI: 207-719), 1 517 (95%CI: 1 070-1 964), 2 883 (95%CI: 2 243-3 522), 5 027 (95% CI: 4 067-5 986) and 3 126 (95%CI: 2 291-3 961) respectively. The average annual excess numbers of ILI cases were 2 630 (95%CI: 1 976-3 230) by the adjusted Serfling regression model, accounting for 57.6% of total ILI cases surveyed over the same period. Serfling regression model showed that the estimated results in age groups of less than 5 years old, 5-59 years old as well as in the whole population were consistent with the adjusted Serfling regression model. Conclusions The adjusted Serfling regression model was more accurate than the traditional Serfling regression model. The annual epidemic of influenza resulted in thousands of and tens of thousands of excess ILI cases and outpatient visits in Changping distirct.

本文对北京市昌平区农村居民人体重点寄生虫病防治知识知晓率及卫生行为形成情况进行抽样调查,为制定全区寄生虫病的防控策略提供有针对性的建议.本研究采用分层随机抽样法,随机选取的4个调查点,采用全国统一设计的结构式问卷,随机调查240人.结果显示,昌平区农村居民对人体重点寄生虫病防治知识的知晓率为22.7％,其在性别、年龄、文化程度和经济水平方面的差异均有统计学意义;卫生行为形成率为91.6％,并与地区经济水平呈正相关.结果表明,昌平区农村居民对人体重点寄生虫病防治知识的知晓率较低,特别是对华支睾吸虫病,但卫生行为形成率较高.应采取有针对性的健康教育工作,加强重点人群和重点地区的健康教育力度.

Objective To estimate excess mortality associated with influenza from 1991 to 2008 in Dalian city and to compare the results made by two different regression methods.Methods We collected mortality data of five municipal districts in Dalian city as well as the influenza surveillance data of northern China during 2003-2008 to estimate influenza-associated excess mortality of different age groups by using Serfling regression model and the negative binomial regression model,respectively.Results During 1991-2008,an average annual mortality rate was 605.2 deaths per 100 000 (538.1/105-658.6/105) while the respiratory and circulatory diseases accounted for 47.2％.From 1991-1992 through 2002-2003,an average annual influenza associated excess mortality rate due to respiratory and circulatory diseases was 8.5/105(4.2/105-12.8/105).From 2002-2003 through 2007-2008,an annual average influenza associated excess mortality rates was 5.7/105(2.3/105-9.0/105) by Serfling regression model,and 5.6/105(1.7/105-27.7/105) by negative binomial regression model.Conclusions The consistently of results from two models showed their reliability.Although an average of influenza associated excess mortality in Dalian city was low,proportion of excess deaths of 65 or higher remained above 90％,indicating that the elderly was the priority of influenza prevention and vaccination.

2003年8月10日下午18至19时,武汉市某大型酒店先后接待3家大型包席,共512人进餐,餐后陆续有28人出现腹痛、腹泻、恶心、呕吐等消化道症状.硚区疾病预防控制中心进行了流行病学调查、临床观察及病原学检验,现将调查结果报告如下.