Objective:To analyze the epidemiological characteristics of clustered outbreaks in the early stage of the coronavirus disease 2019 (COVID-19) epidemic in Haidian district, Beijing, so as to provide reference for future epidemic prevention and control.Methods:The data of patients in the COVID-19 clustered outbreaks in Haidian district from January 20 to February 28, 2020 were collected, and the characteristics of the epidemic were analyzed by descriptive epidemiological methods.Results:In the early stage of the epidemic, a total of 13 clustered outbreaks occurred in Haidian District, involving 45 infected patients, including 5 deaths. The outbreaks were mainly family clusters (11/13) and imported cases from other provinces (9/13). Four outbreaks caused by transmission during the incubation period were observed. The incubation period, M ( P25, P75) was 5 (3.5, 7.5) d and the serial intervals, M ( P25, P75) was 5 (3.5, 11.5) d. For patients proactively seeking medical attention, 50% (13/26) had multiple visits at hospitals. The nucleic acid of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 84.1% (37/44) of the cases between 2 days before and 7 days after disease onset. The overall secondary attack rate was 11.6% (29/249) while the rate in family was 32.1% (27/84). Conclusions:In the early stage of the COVID-19 epidemic in Haidian district, the outbreaks were mainly family clusters. Improving the ability in early identification of the cases, quarantine of close contacts and timely sample collection will assist controlling the epidemic from expanding.

目的 分析北京市海淀区学龄前儿童手足口病流行病学及病原学特征,为海淀区手足口病防控工作提供理论依据.方法 对中国疾病预防控制信息系统中2009-2019年住址为北京市海淀区的手足口病临床诊断病例和实验室确诊病例的流行病学资料、病原学检测情况以及肠道病毒71型灭活疫苗(EV-71疫苗)接种情况进行流行病学分析.结果 2009-2019年海淀区累计报告学龄前儿童手足口病病例37 069例,年均发病率为2621.36/10万,死亡2例,死亡率0.14/10万.其中重症222例,重症比例0.60％.报告发病率居前3位的是2011年(4 419.63/10万)、2010年(4 112.35/10万)和2012年(3 905.62/10万),各年发病率差异(x2=6 845.793,P＜0.05)和重症比例差异(x2=98.67,P＜0.05)均有统计学意义.2016年开始接种EV-71疫苗后发病率和重症比例均有明显下降,2016-2019年EV-71疫苗接种率由1.58％提高到26.20％,差异有统计学意义(x2=6 2163.318,P＜0.05).通过哨点医院监测,2009-2019年海淀区学龄前儿童手足口病病例肠道病毒阳性率为69.51％.结论 手足口病防控需要多措并举,加强多价疫苗研发能进一步降低手足口病发病率.

Objective: To investigate the clusters of COVID-19 associated with a market (market Y) in Haidian District, Beijing, and analyze the chain of transmission and provide reference for effective prevention and control of COVID-19. Methods: The investigation of field epidemiology and cluster epidemic was used to describe the distributions of all COVID-19 cases. The time sequence diagram of the cases, disease onset was drawn and transmission chains were analyzed. Real-time RT-PCR assay was conducted for SARS-CoV-2 nucleic acid test by using the respiratory samples of the cases. Results: The COVID-19 epidemic, originated from a wholesale farm produce market (market X) in Fengtai District, Beijing, was introduced by a marketer in the market Y who had exposed to market X, causing 8 clusters of 20 confirmed cases of COVID-19 and one asymptomatic case, including 8 men and 13 women, in market Y, surrounding communities, food plaza, companies,families and other places. The incidence peaked during June 10-14, 2020; the median age of the cases was 45 years, ranging from 5 years to 87 years. The initial symptoms of the cases included fever (10/20) and pharynx discomfort (7/20). The median of incubation period was 5 days (IQR:3-8). The median of serial interval between primary case and secondary cases was 5 days with a secondary attack rate of 3.7%(20/538), and the secondary attack rate in household close-contacts was 14.0% (7/50). Conclusions: The clusters of COVID-19 associated with market Y were caused by several modes of transmission, including human-to-human, contaminated material-to-human, etc. The combined public-health response measures were effective to control the COVID-19 epidemic in Haidian district of Beijing.

Objective:To analyze the epidemiological characteristics and spatial and temporal clustering of incidence of influenza from 2015 to 2019 at the street/township level in Haidian district, Beijing.Methods:The incidence data of influenza in Haidian district was collected from the Infectious Disease Reporting Management System, and descriptive epidemiological method, spatial autocorrelation analysis and retrospective spatiotemporal scanning analysis were used to analyze the characteristics of reported influenza cases.Results:The average incidence rate of influenza in Haidian district was 356.94/100 000 during 2015-2019. The peak period of incidence was the 49th week to the 17th week of next year. The incidence rates of influenza among students, children in childcare, children under 10 years old and people 80 years old or above were high. The hot spots showed dynamic changes from south to north. The most likely cluster were in the midwest of Haidian district, and the time was the 1st week to the 4th week of 2019.Conclusions:Incidence rates of influenza in Haidian district varied among different groups of people, and showed temporal and spatial clustering during 2015-2019. Different prevention measures should be applied to different groups of populations, time and areas.

目的 了解北京市海淀区医疗机构传染病报告填写质量,为进一步提高传染病信息报告工作质量提供科学依据.方法 按照分层抽样原则,从北京市海淀区64家医疗机构中共抽查1150张纸质(电子)传染病报告进行填写质量调查,调查内容包括完整性、准确性、一致性和正确性.结果 报告填写的完整率、准确率、一致率和正确卡率分别为92.44％,88.52％,83.04％和70.87％;不同类型医疗机构完整率差别有统计学意义(P<0.05),不同级别、类型医疗机构准确率、一致率和正确率差别有统计学意义(P<0.05).结论 应加强培训与监管,建立健全医疗机构自查工作等管理机制,完善传染病信息报告信息化建设,进一步提高传染病报卡填写质量.

目的 构建医疗机构传染病信息报告的质量评价各指标的组合权重,并对北京市海淀区医疗机构传染病信息报告质量进行综合评价.方法 采用熵权法和主成分因子分析法构建单一评价模型,利用最优方案构建组合评价模型并形成各评价指标的组合权重;利用组合权重,对不同类型医疗机构的传染病信息报告质量进行评价.结果 熵权法和主成分分析法模型评价结果差别具有一致性(w=0.956,P<0.01);组合模型赋予漏报率、迟报率、不完整比率、不准确比率、不一致比率和工作量6个指标的权重分别为0.319、0.328、0.115、0.098、0.109和0.032;各单一评价模型与组合权重模型对不同类型医疗机构的排序结果一致,即:地方二、三级医疗机构>高校医疗机构>社区卫生服务中心/站>部队医疗机构.结论 各单一评价模型对各医疗机构评价结果不尽相同,但总体趋势一致;组合权重模型对不同类型医疗机构传染病信息报告的质量评价结果与实际情况相符;不同类型医疗机构传染病信息报告质量存在差异.

Objective Analysis the pathogenesis,diagnosis and the source of infection of human infection with avian influenza A(H7N9) of a mild case in Haidian district of Beijing,propose measures to control plague.Methods To investigate patients and their families face to face by using case questionnaire of human infection with Avian Influenza A(H7N9).A face to face interviews was carried to get the information.Results The case showed upper respiratory symptoms which were the first symptom.The child healed after outpatient treatment receiving treatment of anti-inflammatory and anti-viral.Source of infection was unknown.The case healed without lung infection,not taking Tamiflu.Conclusions Human infection with avian influenza A(H7N9) is an emerging infectious diseases,unspecified infection and epidemiological characteristics.It is important to strengthen Influenza-like illness (ILI) surveillance,flu pathogen surveillance,pneumonia of unknown causes surveillance and other infectious disease surveillance,to detect the patients timely,and propose prevention and control measures as soon as possible.

目的 调查某医院住院病人腹泻暴发疫情的致病因子,找出传染源和危险因素,提出针对性的预防控制建议,有效控制疫情.方法 采用统一的调查表对病例进行流行病学调查;开展现场卫生学调查并采集便标本,采用RT-PCR对便标本进行诺如病毒核酸检测.结果 调查该病区暴露的住院患者和医务人员135名,发现22名病例,罹患率为16.30％;患者临床表现以腹泻、恶心、呕吐为主,部分患者出现发热症状;不同楼层住院老人罹患率差异无统计学意义(x2=0.82,P＞0.05);住院老人罹患率高于护工(x2=5.35,P＜0.05),不同性别住院老人发病风险相同(x2=0.18,P＞0.05);采集的14份便标本中,8份检测结果为诺如病毒核酸阳性.结论 该次急性胃肠炎暴发疫情是由诺如病毒引起,传染源可能为隐形感染者或病原携带者,病毒通过某种共用媒介传播后再以人-人传播模式进一步扩散,高危人群为住院老人;采取针对性措施后,疫情得以有效控制.

目的 分析北京市海淀区一起腺病毒53型引起的结膜炎暴发疫情流行病学特征.方法 对某中学发生的结膜炎病例进行流行病学调查,采集咽拭子和眼拭子标本进行病毒分离和鉴定.结果 病例主要集中在初一、初二和初三年级,患病率分别为11.5％、14.9％和9.8％,流行曲线为单峰分布,疫情持续59 d,由学生通过密切接触传播.平均年龄14.4岁.患者以眼部不适症状为主,无发热症状,其中单眼不适61例,占85.9％;双眼不适10例,占14.1％.其中结膜充血41例,占57.7％;畏光1例,占1.4％;眼部疼痛5例,占7.0％;眼痒7例,占9.9％;眼分泌物增多3例,占4.2％.推测最长潜伏期为35 d.经过Hep-2细胞培养分离毒株4株,采用中和试验鉴定为腺病毒53型,与PCR检测结果一致.结论 该起疫情是由腺病毒53型引起的结膜炎暴发,应加强对高危人群防控知识的宣传教育.

Objective To build various single models and combination model based on Exponentially Weighted Moving Average(EWMA for forecasting weekly-incident of Hand-foot-mouth disease(HFMD), and to verify and evaluate the goodness of fit of the models. Methods A ARIMA- Generalized Autoregressive Conditional Heteroskedasticity(GARCH) model, Vactor Autoregressive(VAR) model and Holt-Winters- Multiplicative model were built using meteorological factors and the incidence of HFMD during May 2, 2008 to May 5, 2013. The reciprocal EWMAs of the absolute percentage error(APE) of single models at different times were adopted as combined weights of single models to build combination model based on EWMA. Incidence of HFMD forecasting during May 6, 2013 to June 30, 2013 was performed by various models. Results The value of mean absolute percentage error(MAPE), root mean square error(RMSE) and Theil inequality coefficient(TIC) of single models were higher as compared to combination model.The optimal model was got when the combination model weighting factor was 0.1. Conclusion Combination model based on EWMA is superior to every single model.

Objective To understand the epidemiological characteristics of viral diarrhea among adults in Haidian district, Beijing.Methods Stool samples were collected from 282 adults in Haidian district of Beijing from June 2012 to May 2013 to detect five kinds of common diarrhea virus with fluorescent PCR. Results 119 samples were detected among 282(42.20%, 119/282), the detection rate was 9.22% for rotavirus, 26.60% for norovirus, 5.32% for astrovirus, 2.84% for sapovirus and 0.00% for adenovirus.Co-infection was detected in 5 cases. The most common type was co-infection of sapovirus and norovirus, accounting for 60.00%(3/5). Adults of 20-40 years old were the major patients, the incidence peaks of viral diarrhea among adults occurred in autumn and winter. Conclusion Norovirus is the most prevalent pathogen of adults viral diarrhea in Haidian district of Beijing in 2012-2013,followed by rotavirus. Co-infection is detected too, to which close attention should be paid in future epidemiological and etiological researches.

第五章打架风波是小鹿出生的季节了。乔戴透过树丛看到了小小尖尖的蹄子所画出的窗花格般的娇嫩脚印。每到一个地方,他总是一面走,一面留神地看着地面,看看有没有它们来去的足印。每当乔戴发现一对孪生小鹿的足迹,他就几乎不能自制。他总是想":我可以给它妈咪留下一只,我自己要一只。"一天晚上,他提出养一只小宠物的请求,可是遭到了妈妈无情的拒绝。彭尼为了让儿子高兴起来,决定第二天带乔戴去猎公鹿,然后去沃卢夏换些日用品,再去看望赫托奶奶。第二天上午,男人、小孩和猎狗向东出发了。他们如愿地猎到了一只肥壮的公

钓鲈鱼春天的下午,天气暖融融的。彭尼干完农活,决定带刚刚病愈的乔戴去钓鱼。乔戴心里想,从某种角度讲,钓鱼比打猎好。钓鱼既没有打猎那么紧张、刺激,也没有打猎那么恐怖、可怕。钓鱼时的心跳是正常的,有时间四处浏览。他们来到锯齿草池塘。一只"蓝彼得"（美洲骨顶鸡）从他们前面跑了过去,那

第三章小狗换猎枪彭尼决定用小狗珀克跟福雷斯特家做交易,换一支新枪。吃过早饭,乔戴劈了很大一堆木柴,装满妈妈的木柴箱,等彭尼挑水一回来,就可以开始他们的远征了。两英里的路程炎热而又寂静。当"福雷斯特岛屿"界标性的高大树木在前方赫然耸立时,彭尼跳下马,抱起小狗,又上了马。他将狗狗抱在自己怀里。乔戴说":你干吗抱它?""没你的事儿。"他们一走出那片凉快

第七章"草翅膀"死了小鹿花去了乔戴许多时间。不论他到哪里,它总是如影随形地跟着他。最初几个星期跟他在一起时那种睁大眼睛的惊异表情,变成了一种机灵的、领悟的神情。它的样子看上去已经像老朱莉娅一样聪明了。

随着我国规范化住院医师培训工作的完善和体系的建立,急需建立公共卫生医师规范化培训工作,更新原有的培养模式,改革人才培养体系,逐步建立起一套完整的公共卫生医师规范化预防人才培养体系。经过多年努力,北京市于2011年出台《北京市公共卫生医师规范化培训细则》,并开始进行规范化培训,海淀区疾病预防控制中心(CDC)作为规范化的传染病基地,通过第一批学员的学习,对培训规范、对象、时间、教材、课程、考试结果进行介绍和分析,对培训中存在的不足提出设想,使基地学员在专业基础知识、基本技能、沟通技巧、外语水平、职业道德等方面进行规范化的培训,加速培养出有一定水平的高质量的疾控人才。

小鹿来了6月中旬的一天,为了报复,福雷斯特兄弟们设陷阱把乔戴家的猪捕走了。彭尼决定带乔戴去要回。晚饭后,他们向西进发。太阳还挂在树梢上。已经有好几天没有下雨了,可是现在北方和西方,雨积云堆得低低的。一片铁灰色正从东方和南方悄悄地向西方耀眼明丽的天空蔓延。没有一丝风,空气像是一条厚厚的羽绒被

Objective To study the epidemiological characters of an influenza A/H1N1 outbreak in a middle school in Haidian district,and to provide effective and scientific measures of respiratory diseases prevention and control in schools.Methods The data of every patient and basic information of school were collected,and epidemiological descriptive analysis was conducted in the study.Results The duration of the influenza A/H1N1 outbreak was seventeen days.One hundred and nine patients were diagnosed and the attack rate of students was 5.08%(104/2 048),the attack rate of teachers was 2.23%(5/224) and the proportion of recessive infected patients was 7.34%(8/109).The incidence rate of influenza likely patient of 2009 was higher than that of 2008.In the early period,most patients were grade two of junior high school,while in the middle period and the later period,most patients were grade three of junior high school.There was no obvious sexual variation in the attack rate of A/H1N1 influenza;The clinical symptoms of patients were typical.The proportions of influenza A/H1N1 patient was 30.95%(104/336) in influenza likely patients.Conclusion The first patient in this A/H1N1 influenza outbreak is infected in community.Carrying out strict morning-noon health check-up and epidemic situation reporting system,timely isolation of patients and people around patients,implementation of health propaganda and inoculation are successfully utilized in control of epidemic influenza.

[Objective] To discuss the pathogenetic features,types of pathogenic bacteria and drug resistance of bacillary dysentery by laboratory confirmation and clinical diagnosis in Haidian District,and then provide evidence for rational drug using in clinical diagnosis.[Methods] Determinated pathogenic bacteria by feces culture,and identify the species,grouped and serotyped by biochemistry and serology.Investigated the clinical symptoms and analyzed its clinical manifestation and drug resistance.[Results] The major clinical manifestations of the confirmed bacillary dysentery were atypical.Among the confirmed bacillary dysentery patients,more women were infected than men,which was great different from the clinical gender ratio.Only one patient had the mucopurulent bloody feces,which was one typical manifestation in bacillary dysentery.Most of the patients had watery feces,paste feces and loose feces.46.15% of the patients had the symptom of tenesmus.One patient endured abdominal pain.The main manifestations were dull pain and colic.The mild cases of patients might have normal temperature.88.89% of the patients' total leukocyte increased.The detecting rate of Shigella was 6.28% ;while the detecting rate of other pathogenic bacteria was 9.18%.Shigellas were resistant to ampicillin,rifampicin,nalidixic acid and tetracycline.[Conclusion] The major clinical manifestations of the confirmed bacillary dysentery are atypical,which are difficult to distinguish from other pathogenic bacteria infection.At least there are 9.18% of the clinical confirmed bacillary dysentery misdiagnosed.We should make comprehensive diagnosis by the symptoms,manifestation,temperature and laboratory test.Shigellas have various drug resistances towards different antibiotics,and thus we should strengthen monitoring.

[Objective]To understand the morbidity,epidemic character,bacterial spectrum and drug resistance of bacillary dysentery in Haidian district in 2007,provide the basic data for scientific control and prevention of bacillary dysentery in the Beijing 2008 Olympic Games. [Methods]According to the information from Disease Directly Reporting Network in Haidian District in 2007,the current incidence of bacillary dysentery was analyzed descriptively. The Shigella samples in enteric clinics were tested in subtypes and drug resistance. [Results] In 2007,there are 5286 cases of bacillary dysentery reported in Haidian District,and the incidence rate was 213.98/lakh with the second place among 38 kinds of legal notifiable infectious disease. The epidemic peak occured through June to September,and the August had the highest incidence rate of bacillary dysentery with 1288 cases reported,which accounted for 24.37% of the cases during the year. The cases focused on 0~4 years old group,20 years old group,5 years old group and 70+ years old group. The majority of patients were students,scattered children,government functionaries and retirees,with the constituent ratio at 70.17%.The food was the main inducing factor of bacillary dysentery. The distribution of subtypes showed that Shigella Sonnei and Shigella Flexneri accounted for 80.00% and 20.00% respectively. The drug resistances of Shigella for various antibiotics were different. [Conclusion] Bacillary dysentery still was one of the important public health problems which harm to the health of Haidian people,and the incidence rate was higher than the national average level. The prevalence showed significant season peak. The society should pay more attention to prevention and control among the key populations,including 0~4 years old group,school students,government functionaries and clerks. Shigella Sonnei was the dominant subtype in Haidian District. Therefore,the prevention and control of Bacillary dysentery in all departments should be strengthened,especially in the administration of food health.