The study aimed to explore the risk factors of close contacts developing pulmonary tuberculosis (TB), identify active TB and describe the sociodemographic characteristics of active TB among close contacts in Putuo District, Shanghai. A cross-sectional study was conducted among the close contacts of pulmonary TB in Putuo District from 2017 to 2018. Symptom questionnaire, Chest X-ray (CXR) and interferon-gamma release assay (IGRA) were carried out to screen the consenting close contacts. Three sputum samples were collected for sputum smear tests, sputum culture tests, and molecular-based diagnostics from whose screening was positive to confirm the diagnosis and receive treatment. A total of 1036 individuals were included in this study, with an average of 47.3 ± 19.4 years old, including 427 males and 609 females. Four of the close contacts had presumptive TB based on symptom screening. Fourteen had presumptive TB based on abnormal CXR finding and 52 had positive IGRA results. Multivariate analysis showed that index cases with positive sputum smears, close contacts who had presumptive TB based on symptom screening and their interaction term were at significantly higher risk of developing TB. Studies have shown particular emphasis should be put on those with bacteria-positive index cases or those who had presumptive TB based on symptom screening during follow-up. Since the proportion of latent tuberculosis infection is high among close contacts undergoing IGRA examination, measures such as tuberculosis preventive treatment can be considered to reduce the incidence of TB.

ABSTRACTLong-term care facilities (LTCFs) for older people play an important and unique role in multidrug-resistant organism transmission. Herein, we investigated the genetic characteristics of mobile colistin resistance gene (mcr-1)-carrying Escherichia coli strains isolated from wastewater of LTCFs in Shanghai. Antimicrobial susceptibility test was carried out by agar dilution methods. Whole-genome sequencing and plasmid sequencing were conducted, and resistance genes and sequence types of colistin in E. coli isolates were analyzed. Core genome multilocus sequence typing (cgMLST) analysis was performed by the Ridom SeqSphere+ software. Phylogenetic tree through the maximum likelihood method was constructed by MEGA X. Out of 306 isolates, only 1 E. coli named ECSJ33 was found, and the plasmid pECSJ33 from ECSJ33 harbored the mcr-1 gene that was located with 59,080 bp belonging to IncI2 type. The plasmid pECSJ33 was capable of conjugation with an efficiency of 2.9 × 10−2. Bioinformatic analysis indicated pECSJ33 shared backbone with the previously reported mcr-1-harboring pHNGDF93 isolated from fish source. Moreover, the cgMLST analysis revealed that ECSJ33 belongs to different lineages from those reported from previous E. coli strains but shared high similarity to NCTC11129 in cluster 11. The phylogenetic tree revealed MCR-1 of ECSJ33 in this study was mostly of animal food origin and that they were closely related. Our study firstly reports detection of genome sequence of a multidrug-resistant mcr-1-harboring E. coli ST155 from wastewater of LTCF source in China. The data may prove that the plasmid pECSJ33 belongs to food origin and help to understand the antimicrobial resistance mechanisms and genomic features of colistin resistance under One Health approach.IMPORTANCEOne Escherichia coli named ECSJ33 was found from wastewater of a long-term care facility (LTCF) and the plasmid pECSJ33 from ECSJ33 harbored the mobile colistin resistance gene (mcr-1) that was located with 59,080 bp belonging to IncI2 type, which was capable of conjugation with an efficiency of 2.9 × 10-2. This paper firstly reports an mcr-1-carrying E. coli strain ST155 isolated from LTCF in China. Comparative genomics analysis indicated pECSJ33 shared backbone with the previously reported mcr-1-harboring pHNGDF93 isolated from fish source. The phylogenetic tree revealed MCR-1 protein of ECSJ33 in this study was mostly of animal food origin and that they were closely related. Therefore, the pECSJ33 could be considered as food-origin transmission mcr-1-harboring plasmid.

OBJECTIVES:The rapid dissemination of the mcr-1 gene via plasmid-mediated transfer has raised concerns regarding the efficacy of colistin as a last-resort treatment for multidrug-resistant Gram-negative bacterial infections. Current mcr-1 gene detection methods mainly focus on cultured bacteria, which is a complex and time-consuming process requiring skilled personnel, making it unsuitable for field analysis. METHODS:A rapid detection technique combining recombinase polymerase amplification with a lateral flow dipstick targeting uncultured clinical samples was developed. RESULTS:This new method targeting the mcr-1 gene region (23 232-23 642 bp, no. KP347127.1) achieved a low detection limit of 10 copies/μL. The whole process was carried out with high specificity and was completed within 20 min. The evaluation assay was conducted using 45 human faecal samples; 16 strains yielded a 98% accuracy, closely matching antimicrobial susceptibility outcomes. CONCLUSIONS:The novel method integrates nucleic acid extraction, isothermal amplification, and a test assay, suggesting the potential for timely colistin resistance surveillance in frontline disease control and healthcare settings, supporting future prevention and clinical standardization efforts.

BackgroundCo-existence of colistin, β-lactam and carbapenem in multidrug-resistant Enterobacteriaceae isolates poses a serious threat to public health. In this study, we investigated and characterized the co-occurrence of blaCTX-M-65, blaOXA-1, and mcr-1.1 strain isolated from a clinical extensively-drug-resistant Escherichia coli ST744 in Shanghai.MethodsAntimicrobial susceptibility test was carried out by agar dilution methods. Whole genome sequencing was conducted, and resistance genes, and sequence types of colistin in E. coli isolates were analyzed. Plasmid stability and amino acid mutations were assessed in E. coli isolates.ResultsA colistin resistant E. coli ST744, named ECPX221, was identified out of 145 fecal samples collected. The strain carries a 60,168 IncI2 plasmid with the mcr-1.1 gene. The strain also has blaCTX-M-65, blaOXA-1, dfrA14, qnrS1, cmlA5, arr2, ampC, aph(4)-Ia, sul1, and aadA5 resistance genes. The plasmid pECPX221 was capable of conjugation with an efficiency of 2.6 × 10−2. Notably, 45% of the transconjugants were determined as mcr-1.1-harboring in the colistin-free environment after 60 generation of passage. No mutations occurred in pmrB, mgrB, and phoPQ gene in the mcr-1.1-harboring transconjugants. Bioinformatic analysis indicated pECPX221 shared highly similar backbone with the previously reported mcr-1.1-harboring pAH62-1, pMFDS1339.1, pSCZE4, and p2018-10-2CC. Furthermore, sequencing and phylogenetic analyses revealed a similarity between other MCR-1-homolog proteins, indicating that ECPX221 was colistin resistant.ConclusionThe stable transferable mcr-1.1-harboring plasmid found in the E. coli ST744 strain indicated the high risk to disseminate the extensively-drug-resistance phenotype among Enterobacteriaceae.

ObjectiveTo describe the characteristics of treatment outcomes of multidrug-resistant tuberculosis （MDR-TB） patients enrolled in second-line treatment in Shanghai from 2017 to 2018， and to analyze the influencing factors of treatment outcomes.MethodsTotally 182 MDR-TB patients were analyzed by using data collected from the China tuberculosis management information system， the hospital's electronic medical record information system， whole genome sequencing results and a questionnaire survey， and logistic regression analysis was used to analyze the factors affecting the success of treatment.ResultsIn 182 MDR-TB patients， the success rate of treatment was 65.4%， the loss to follow-up rate was 8.2%， the mortality rate was 4.9%， the unassessable rate was 13.7%， and the drug withdrawal rate was 7.7%. The factors affecting the success of treatment in MDR-TB patients included age （35‒ years old， OR=5.28， 95%CI： 1.58‒17.59， P=0.007； 55‒ years old， OR=16.30， 95%CI： 4.36‒60.92， P<0.001） and compliance to medication （OR=0.55， 95%CI： 0.42‒0.72， P<0.001）.ConclusionThe treatment success rate of MDR-TB patients in Shanghai from 2017 to 2018 is significantly higher than the average level in China. Older patients and patients with less compliant are at higher risk of adverse treatment outcomes.

目的:分析上海市老年2型糖尿病患者结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)筛查情况及其影响因素.方法:顺序纳入2019年9-12月在上海市徐汇区和长宁区参加公共卫生服务项目体格检查且符合入组标准的60岁及以上老年2型糖尿病患者,共计885例(长宁区430例,徐汇区455例),采用γ-干扰素释放试验检测其LTBI状况.采用调查问卷收集研究对象社会人口学信息、行为生活方式、既往糖尿病和其他慢性病病史及肺结核患者接触史,以及体格检查情况等信息.采用非条件二分类logistic回归分析的方法分析老年糖尿病患者发生LTBI的影响因素.结果:885例研究对象检出LTBI阳性者130例,阳性率为14.7％;其中,长宁区研究对象LTBI阳性率(17.4％,75/430)高于徐汇区研究对象(12.1％,55/455),差异有统计学意义(x2=5.057,P=0.025);吸娴者LTBI阳性率(22.5％,20/89)明最高于不吸烟者(13.8％,110/796),差异有统计学意义(x2=4.783,P=0.039).logistic回归分析显示,吸烟是老年糖尿病患者发生LTBI的危险因素[OR(95％CI)=1.891(1.031～3.468)].结论:上海市老年2型糖尿病患者LTBI阳性率处于较低水平,可对检测阳性患者采取增加随访频次及加强健康教育等措施,并对有吸烟史的老年糖尿病患者丌展LTBI筛查.

目的:了解上海市结核病密切接触者中结核潜伏感染(latent tuberculosis infection, LTBI)者的结核病发病风险及其时间特征。方法:采用前瞻性观察性研究方法，以2009至2010年上海市7个区户籍人口中确诊肺结核患者的密切接触者为研究对象，采用结核感染T淋巴细胞斑点试验(T-cell spot test of tuberculosis infection，T-SPOT.TB)判断结核分枝杆菌感染情况以识别LTBI，同时采用问卷调查的方法收集研究对象的基本信息和结核病密切接触史。通过结核病登记报告系统识别LTBI者在检测后连续9年内的发病情况，计算其结核病发病率和发病密度。采用 χ2检验对不同性别和年龄分组的发病率进行分层分析。 结果:2009年至2010年，共纳入376例确诊肺结核患者的982名密切接触者，其中287名密切接触者经T-SPOT.TB检测为LTBI。接受基线调查时感染者中位年龄为54岁，36.6%(105/287)的LTBI者为男性。截至2019年12月287名LTBI者中共发现5例新发结核病患者，2年累积发病率为0.35%，5年累积发病率为1.05%，9年累积发病率为1.74%(95%可信区间0.57%～4.02%)，中位发病时间为3.67年；研究期间共观察了2 666.75人年，结核病发病密度为1.875/1 000人年。不同年龄( χ2＝0.600， P>0.05)和性别( χ2<0.001， P>0.05)的LTBI者的结核病9年累积发病率差异均无统计意义。 结论:结核病患者密切接触者中的LTBI者的结核病发病集中在接触后前5年左右。

目的 对上海市2020年1月20日—3月24日报告的所有新型冠状病毒肺炎(COVID-19)确诊病例进行疫情特征和防控情况分析,掌握本市疫情时空扩散特征、传播和变动的空间差异及与落实的防控措施之间的内在联系.方法 通过整理上海市卫生健康委员会官方网站疫情通告和COVID-19确诊病例流行病学调查资料,收集汇总病例的年龄、性别、确诊日期、感染来源等,运用描述性流行病学方法分析本市COVID-19确诊病例的疫情扩散特征和采取的各项防控措施.结果 上海市COVID-19确诊病例中,18～40岁青年人感染的比重较大,占39.03％(169/433);疫情共分为5个阶段,分别为第一次缓慢上升阶段、高速增长阶段、升速放缓阶段、维持"0"报告阶段和再次缓慢上升阶段;各阶段各类COVID-19确诊病例的报告和上海市采取的各项防控措施密不可分;本市疫情扩散比最高为0.502 2,各区在不同疫情发展阶段,疫情扩散比均表现为不同形态;总体而言,上海市COVID-19疫情防控措施是卓有成效的.结论 上海市疫情已进入新的防控阶段,应根据国外COVID-19疫情形势,采取针对性的防控措施,及时发现境外输入性病例.

提出抗疫组织力主要是指疾病预防控制(以下简称"疾控")机构党组织为完成其承担的抗疫任务、实现党组织的抗疫目标而组织、凝聚、动员、影响疾控系统内外力量的能力,其作用主要体现在宣传党的抗疫主张、贯彻党的抗疫决定、团结动员疾控专业人员、推动疾控改革发展,以及为基层抗疫治理献策.以结果链模型梳理上海市疾控机构党组织抗疫组织力的实践内容,包括上海市疾控机构党组织响应贯彻党的抗疫主张与决定、疾控体系软件和硬件资源投入,形成抗疫专班组建、抗疫人员培训和全方位保障,动员提供循证献策与综合协调、流行病学调查、密切接触者追踪与管理等疫情防控"全链条式"卫生服务,保障市委、市政府统筹推进疫情防控和经济社会发展等重大决策落地,以及在上海市疾控机构党组织的服务意识、城市治理的健康启示和新时期疾控体系现代化建设的定位等方面的积极作用.

[背景]诺如病毒(NoV)是影响食品卫生与安全的重要污染物.贝类可富集环境水体中的病毒,是重要的食源性病原体传播载体.[目的]了解NoV在上海市贝类水产品中的污染状况,并对阳性株进行鉴定分型,为预防食源性疾病的发生,制定防控措施提供参考依据.[方法]采用实时荧光逆转录聚合酶链式反应法对2017—2019年上海地区采集的580份贝类水产品中NoV进行检测,用逆转录巢式聚合酶链式反应法对部分阳性样本病毒衣壳蛋白(VP)1区扩增片段进行分型分析.[结果]580份贝类样品中NoV检出率为8.97％,其中NoV GI型检出率为2.24％(13/580),NoV GII型检出率为5.86％(34/580),NoV GI和GII混合型检出率为0.86％(5/580).四个季节的贝类水产品中NoV检出率的差异有统计学意义(χ2=8.132,P=0.043),冬春季较高;不同种类贝类水产品NoV检出率差异有统计学意义(χ2=14.152,P=0.049),以蚌科、牡蛎科为高.VP1区部分核酸序列分子系统进化分析显示,贝类水产品中可检测到NoV GII.2、3c、13、17共4个NoV GII型的基因亚型存在.1株GII.2型与参考株X81879同源性为88.8％;2株GII.3c型之间同源性为91.6％,与参考株AB385626同源性为87.1％～92.0％;1株GII.13型与参考株AY113106同源性为93.6％;1株GII.17型与参考株LC037415同源性为98.6％,与2014年发现的江苏南京株KU757049和上海株KT380915同源性分别为97.8％和97.4％.[结论]上海地区贝类水产品中存在NoV污染,且污染具有季节特点,以冬春季污染较严重;其基因型以GII型为主.

目的 分析2008-2019年上海市非户籍人口肺结核流行特征及发病趋势,为完善针对非户籍人口的防控策略提供依据.方法 依据《传染病报告信息管理系统》中2008-2019年上海市非户籍肺结核患者的报告发病数据和人口数据,利用Joinpoint回归模型分析时间趋势,并计算各年度报告发病率和年度百分比变化(APC)及平均年度百分比变化(AAPC).结果 2008-2019年上海市共报告非户籍肺结核患者36 748例,占全人口报告发病例数的44.79％(36 748/82 047);12年间非户籍人口报告发病率由2008年的43.66/10万(3273例)下降至2019年的26.70/10万(2563例)(APC=-3.42％,t=-9.838,P＜0.01),平均报告发病率为33.02/10万(36 748例);男性患者23 685例,女性患者13 063例,男性的平均报告发病率为39.28/10万(23 685例),高于女性的平均报告发病率(25.61/10万,13 063例),差异有统计学意义(x2 =68.742,P＜0.01),男性与女性报告发病率均呈下降趋势(APC=-3.27％,t= 7.444,P＜0.01;APC= 3.74％,t= 9.791,P＜0.01);不同年龄组中15～29岁年龄组患者占比最多,为52.69％(19 364/36 748),平均报告发病率最高的年龄组为75～104岁,为104.67/10万(365例),各年龄组间报告发病率差异有统计学意义(x2 =486.537,P＜0.01),60～74岁年龄组报告发病率在2010年后呈上升趋势(APC=3.94％,t=3.443,P＜0.01),由50.44/10万(104例)上升至69.24/10万(154例).首诊地区为中心城区肺结核报告发病率2010年前呈明显下降趋势(APC=-7.99％,t=-2.758,P＜0.01),2010年后下降趋势变缓(APC=-1.28％,t=-4.726,P＜0.01),非中心城区报告发病率呈下降趋势(APC=-6.04％,t=-12.173,P＜0.01).涂阳肺结核和涂阴肺结核报告发病率均呈下降趋势(APC =-7.26％,t=-28.533,P＜0.01;APC=-1.67％,t=-3.852,P＜0.01).结论 2008-2019年上海市非户籍肺结核报告发病率总体呈下降趋势,男性报告发病率高于女性,60～74岁患者在2010-2019年发病率呈上升趋势,应在综合管理的基础上进一步完善针对非户籍人口的防控策略以迅速降低发病率.

为了解上海市2015-2017年急性结膜炎患者中腺病毒感染的型别分布及流行病学特征,本研究收集上海市2015-2017年间各区监测点医院符合病例定义的患者眼结膜拭子所有的标本,使用荧光PCR方法筛查腺病毒核酸.所有腺病毒核酸阳性标本接种HEp-2细胞,获得毒株后使用测序引物扩增腺病毒hexon、fiber和penton base基因高变区片段,使用生物信息学软件对测序后序列信息进行腺病毒基因特征分析.结果 显示,2015-2017年共收集急性结膜炎患者的眼结膜拭子标本2 594例,其中腺病毒核酸阳性652例(阳性检出率为25.13％),占急性结膜炎监测总阳性检出率的95.18％(652/685).经细胞培养后获得腺病毒阳性毒株138株,分离率为79.90％,其基因型别主要为人腺病毒D37亚型、B3亚型,分别占52.17％、28.99％.本研究提示,人腺病毒是引起上海市2015-2017年急性结膜炎感染的主要病原体,其中D37亚型和B3亚型为优势基因型且进化高度保守,需要进一步加强监测.

[目的]通过监测2018—2019年度上海市优势流行株A/H1N1(pdm09)亚型流感病毒对神经氨酸酶抑制剂(NAIs)的耐药情况,为上海市流感临床用药提供参考.[方法]随机选取60株A/H1N1(pdm09)亚型流行株,采用神经氨酸酶抑制实验及神经氨酸酶(NA)基因测序的方法,开展流行株对奥司他韦及扎那米韦敏感性和耐药性的监测和分析.[结果]60株流行株均对奥司他韦和扎那米韦敏感,未发现敏感性降低或者显著降低的情况;基因序列分析也未发现NA在催化活性关键位点及辅助位点出现氨基酸变异,佐证了神经氨酸酶抑制实验的表型检测结果.[结论]上海市2018—2019年度流行的A/H1N1(pdm09)亚型流感病毒对神经氨酸酶抑制剂依然敏感,为临床用药提供了科学参考.随着药物的广泛使用,应持续加强流感病毒耐药性监测,以有效指导临床用药.

目的分析2018—2020年上海市分离的B/Victoria系流感毒株与疫苗株的匹配性及基因变异情况。方法利用血凝抑制实验,对142株B/Victoria系流感毒株进行了抗原性分析,并选取了63株开展了血凝素（HA）及神经氨酸酶（NA）基因序列分析。结果 2018—2020年上海市流行的B/Victoria系流感毒株主要属于V1A.3分支,少数属于V1A.1分支及未缺失的V1A分支;抗原性分析显示,26.76%的流行株是疫苗株B/Colorado/06/2017鸡胚株的低反应株,与疫苗株相比,V1A.3分支流行株在HA蛋白的120环、150环、160环及190螺旋等关键的抗原决定簇及受体结合关键部位发生了5个氨基酸位点改变。结论 2018—2020监测年度B/Victoria系流行株与世界卫生组织推荐的疫苗株组分B/Colorado/06/2017匹配性不佳,仍需密切监测流行株的谱系及变异情况,为疫苗株的筛选提供可靠的数据。

Objective: To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China. Methods: From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria. Results: A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46% (119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77% (51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32% (21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups. Conclusions: Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.

新中国成立70年来,我国的结核病防治工作取得了举世瞩目的成就.上海市积极响应国家政策,不断完善结核病防治保障政策,有效保证了各项防治措施的有效落实,上海的肺结核疫情由新中国成立初期的全国最高(患病率4 000/10万)降至全国最低(36/10万).上海市从21世纪初开始实行肺结核病政府减免治疗政策,逐步加大政府财政资金投入,切实减轻患者经济负担,有效保证了全市肺结核患者成功治疗率维持在90%以上的高水平,促进了肺结核疫情的显著下降.文章介绍了上海市肺结核病政府减免政策不断完善的过程以及取得的成效.

目的 追踪2018年上海市一起输入性麻疹暴发的来源,并分析其病毒分子流行病学特征.方法 直接从临床咽拭子标本中提取病毒核酸,采用一步法反转录-聚合酶链式反应,扩增麻疹病毒核蛋白基因COOH末端676个核苷酸,然后对扩增产物进行核苷酸序列测定,并分析其同源性,以确定病毒基因型及其可能的来源.结果 本次暴发病例来自于同一家庭,且2例成年人病例在发病前21 d内有共同的出境旅游史;导致此次暴发的麻疹病毒为D8基因型.结论 结合流行病学调查和实验室检测结果,推断此次疫情为一起D8基因型麻疹病毒引起的输入性麻疹暴发.

近十年,上海市有效应对了甲型H1N1流感和人感染H7N9禽流感2次新型流感疫情,建立起了一套较完善的预警和应对体系.文章系统性回顾了上海市应对新型流感疫情策略,并梳理了预防控制的关键措施,包括健全的城市公共卫生预防和应急处置体系,有效的部门间协调和社会动员机制,动态地开展疫情研判.同时,在流感应对计划、监测信息分析、公共卫生风险评估、风险沟通等方面提出建议,为新型流感疫情准备、预防控制和应对等工作提供参考.

[目的]分析上海市肺结核病例流行特征,为进一步提高上海市肺结核防控和管理水平提供科学依据.[方法]采用描述性流行病学方法,从概况、时间分布、地区分布、性别和职业分布等方面对2006-2017年上海市报告的肺结核病例资料进行分析.[结果]上海市2006-2017年共报告肺结核病例84 902例,年均报告发病率为32.7/10万,呈逐年下降趋势(x2=2 216.958,P＜0.001);全市16个区均有肺结核病例报告,杨浦区、徐汇区和松江区2006 2017年年均报告发病率居前三位;男女性别比为2.17:1;65岁及以上年龄组报告发病率最高,为49.51/10万;离退人员、家务及待业和工人占比最多,分别为18.89％、14.61％、12.87％.[结论]2006z-2017年上海市肺结核报告发病率总体呈逐年下降趋势,老年组发病率较高,应在综合管理的基础上重点加强老年肺结核的防控和管理工作.

本文回顾了上海市卫生应急体系的发展历程,总结分析了上海市卫生应急体系的运行模式和特点,列举了上海市在2003年SARS疫情以后参与的重大卫生应急行动,并结合当前面临的机遇和挑战,提出了未来发展的思路和对策.