Study on human case of avian influenza in Guangzhou 2006 without causing human-to-human transmission among close contacts / 中华流行病学杂志

<p><b>UNLABELLED</b>Study on human case of avian influenza in Guangzhou 2006 without causing human-to-human transmission</p><p><b>OBJECTIVE</b>To explore the possibility of transmission from a human case of avian influenza to his close contacts.</p><p><b>METHODS</b>Close contacts of the human case of avian influenza in Guangzhou 2006 were found out according to the definition and methods publicized by the Ministry of Health, People's Republic of China. Epidemiological investigation and medical observation were carried out. Serum antibodies were tested in some of the close contacts.</p><p><b>RESULTS</b>The avian influenza patient had never left Guangzhou in the month prior to disease onset. No contact history with dead or diseased poultry was found. A total of 56 close contacts, including his girl friend, relatives, friends and medical staff who had taken care of him, were brought under medical observation for 7 days but none of them showed signs of infection.</p><p><b>CONCLUSION</b>Unlike SARS, direct contact with patient contracted with avian influenza at the end of incubation period and in the stage of illness through flying droplets, saliva, mucous membrane and skin injuries will not lead to human-to-human transmission, indicating the virus' ability to pass from human to human is limited.</p>

The effects of 4 laboratory test kits in early detecting of severe acute respiratory syndrome coronavirus / 中华流行病学杂志

<p><b>OBJECTIVE</b>To compare the 4 test kits on severe acute respiratory syndrome coronavirus (SARS-CoV) gene, antigen and antibody for early diagnose of SARS patients.</p><p><b>METHODS</b>Three enzyme linked immunosorbent assay (ELISA) kits were used to detect SARS-CoV IgG, IgM and N protein and fluorescent polymerase chain reaction (F-PCR) kit was used to detect SARS-CoV RNA.</p><p><b>RESULTS</b>In 162 serum samples, 90.2% (55/61) became N protein positive in 1 - 5 days and 92.8% (13/14) became positive IgM and IgG in 15 - 18 days after the onset of disease, respectively. On 82 gorgling samples, the positive rates of F-PCR were 56.3% (14/24) in 1 - 5 days and 71.4% (10/14) in 6 - 9 days after the onset.</p><p><b>CONCLUSION</b>Other than F-PCR, N protein had good effect in the early detection on dubious patients which could lead to effective prevention and control of the epidemic.</p>

An investigation on nosocomial infection with severe acute respiratory syndrome in health-care workers at 13 key hospitals in Guangdong Province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analysis the risk factors influencing nosocomial infection of severe acute respiratory syndrome (SARS) in health-care workers and to evaluate effectiveness of its control and preventive measures in 13 key hospitals caring for SARS patients.</p><p><b>METHODS</b>Number of SARS patients, clinical conditions of them, its attack rate in health-care workers, and characteristics of hospitals, including their environment, isolating measures, etc. were investigated at the 13 hospital in Guangzhou to analyze the risk factors influencing nosocomial infection of SARS and its attack rates in health-care workers before and after implementation of preventive measures and to evaluate their effectiveness.</p><p><b>RESULTS</b>Totally, 841 patients with SARS were treated at the 13 hospitals in Guangzhou and 285 health-care workers caring for them infected nosocomially. Attack rate in health-care workers was higher at general hospitals, hospital accepting more cases in critical conditions and hospitals with poor precautious measures, and lower in hospitals with isolated wards or areas, or department of infection, specially caring for SARS patients, and those with effective intervention measures to prevent secondary infection.</p><p><b>CONCLUSION</b>Nosocomial infection of SARS in health-care workers was affected by clinical condition of SARS patients, characteristics and environment of hospitals and their personal protective measures adopted.</p>

Effectiveness of personal protective measures in prevention of nosocomial transmission of severe acute respiratory syndrome / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of personal protective measures of health care workers (HCWs) against severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>A case-control study from ten hospitals in Guangdong, with 180 non-infected and 77 infected staff members that accessed the isolation unit every day, and participated in direct first aid for severe SARS patients. All participants were surveyed about how they were using personal protective equipment (PPE), protective drugs and hygiene habits when caring for patients with SARS. Statistical analysis was done with either chi(2) or Fisher's exact test for univariate analysis, whereas we used forward stepwise selection (Waldesian) for logistic regression.</p><p><b>RESULTS</b>Univariate analysis showed that mask, gown, gloves, goggles, footwear, "hand-washing and disinfecting", gargle, "membrane protection", "taking shower and changing clothing after work", "avoid from eating and drinking in ward", oseltamivir phospha tall had protective effects (P < 0.05), but stepwise logistic regression showed significant differences for mask (OR = 0.78, 95% CI: 0.60 - 0.99), goggles (OR = 0.20, 95% CI: 0.10 - 0.41) and footwear (OR = 0.58, 95% CI: 0.39 - 0.86). Analysis for linear trend in proportions showed that dose response relationship existed in mask, gown, gloves, goggles, footwear, gargle, "membrane protection" and "taking shower and changing dree after work" (P < 0.01). The attack rate of HCWs who were rescuing severe SARS patients without any PPE was 61.5% (16/26). It seemed that the more the protective measures were used, the higher the protective effect was (P < 0.001), and could reach 100% if mask, gown, gloves, goggles, footwear, "hand-washing and disinfecting" were all used at the same time.</p><p><b>CONCLUSIONS</b>Nosocomial infection of SARS can be prevented effectively by precautions against droplets and personal contact. HCWs must take strict protection according to the guidance of WHO or Chinese MOH and pay attention to personal hygiene.</p>

Analysis on the characteristics of blood serum Ab-IgG detective result of severe acute respiratory syndrome patients in Guangzhou, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To probe blood serum Ab-IgG characteristics of severe acute respiratory syndrome (SARS) patients in Guangzhou and investigate the related factors.</p><p><b>METHODS</b>The serum of such population diagnosed as SARS convalescent patients, non-SARS patients, family consanguineous contraction persons, wild animal and vegetable salesman and community common people was collected. The lab detective method of ELISA was adopted for these serum samples. And the epidemic investigations for the SARS patients were also carried out.</p><p><b>RESULTS</b>Of these populations, the detective rate of Ab-IgG for the clinic diagnosed SARS patients, which was 53.7%; That for the wild animal salesman and community common people were 16.7% and 0.9%, respectively. Among the clinic diagnosed SARS patients, the positive antibody detective rate was 90.4% for those which had specific contact history or infectivity, which was higher than that for other population. Among the specific contact history or infectivity cases, the antibody positive rate for the young and the old was lower than that for the adult. Meanwhile the difference did not exist among other cases. The antibody positive rate was identical between the male and the female. And the antibody detective rate was decreased by the month.</p><p><b>CONCLUSION</b>As a whole SARS-CoV Ab-IgG detective rate for the clinic diagnosed SARS patients was 53.7% only. The reasons for that mainly lie in the wrong clinic diagnosis besides these factors such as age, hormone use and reagent and so on. The combination of lab detection results and epidemic investigation was propitious to the diagnosis veracity. It was impossible for the sub-clinic infection of SARS-CoV virus. The importance in the virus transmitting course need to be further studied.</p>

Study on the epidemiology and measures for control on severe acute respiratory syndrome in Guangzhou city / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the epidemiological characteristics, related risk factors, measures for its control of severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>Data on epidemiological features, pathogens and measures for control were collected and analyzed.</p><p><b>RESULTS</b>Since Jan 2003, infectious atypical pneumonia (AP) has become epidemic in Guangzhou city. The first autochthonous case was identified on Jan 2nd. Number of cases started to increase since February and reached peak in the early 10 days of February. Hereafter the epidemic tended to decline in March and since early April, the average number of new cases began to decrease, less than 10 per day. Epidemiological studies revealed that the number of cases aged between 20 and 50 was higher than that below the age of 20. Of the total 966 cases, 429 were males versus 537 females. Geographically, the epidemics covered all 13 districts of Guangzhou, but 95% of the cases concentrated in 7 urban districts. As for professional distribution, health care workers accounted for 28.67% of the total cases. There were 36 deaths, aged from 5 to 89, with half of them older than 60. Out of the victims, 38.9% of them had complications as hypertension, diabetes, heart diseases and COPD etc. Data regarding the clustering features of cases showed that there were 42 families having 2 or more cases in one family, while 277 health workers suffered from SARS were concentrated in 28 hospitals. Only one outbreak took place in a public setting but no outbreak was reported in schools. Relevant research also indicated that SARS could be classified as an air-borne infectious disease, transmitted through aerosol and droplets, but close contact also played an important role in the mode of transmission. The disease was highly infectious, suggesting that people who had close contact with patients in the place with poor ventilation was in greater risk of getting infection. The incubation period ranged from 1 to 11 days (mainly from 3 to 8 days), with an average of 5 days. According to our observation, the following measures might be effective such as: early diagnosis, isolation and treatment provided to the patients, and suspected cases under medical observation should also be put in separate places. Improving ventilation and regular disinfection over air and stuff in hospital wards were also recommended. In order to prevent iatrogenic infection, sense on self-protection among health care workers must be strengthened. Patients were not allowed to be visited by any one other than hospital staff.</p><p><b>CONCLUSION</b>SARS is a preventable disease and can be under control. It is of great importance to prevent clustered SARS cases and the prevention of iatrogenic infection is essential.</p>

Epidemiological study on severe acute respiratory syndrome in Guangdong province / 中华流行病学杂志

<p><b>OBJECTIVES</b>To understand the epidemiological characteristics of severe acute respiratory syndrome (SARS) outbreaks in some areas of Guangdong province and to provide scientific basis for prevention and control measures against it.</p><p><b>METHODS</b>Standardized questionnaire was used on individual cases. Data on the epidemiological characteristics as time, place, persons and aggregation status of SARS cases, development of the epidemics, were analyzed with software EPI 6.0.</p><p><b>RESULTS</b>The incidence of SARS in Guangdong province was 1.72/100,000 with case fatality rate as 3.64%. Most cases of SARS occurred between the last ten days of January and the first ten days of February with the peak (61.88% of the patients) occurred in the first ten days of February. As to the distribution of place, Pearl river delta region-economically developed with great number of mobile population-was heavily affected areas (account for 96.66% of the total patients). The majority of patients were young adults and medical staff seemed to be the most affected subgroup (account for 24.9% of the patients in total). Family and hospital aggregation of patients comprised the another two important characteristics of SARS (account for 37.1% of the total patients).</p><p><b>CONCLUSION</b>Current knowledge on SARS suggested that it was an air-borne infectious disease with human beings served as the source of infection. The incubation period of the disease was from 1 to 12 days with a median of 4 days. Respiratory secretions and close contact contributed to person-to-person transmission. Most cases were distributed in Pearl river delta region, an area famous for its economic development and heavy flow of mobile population.</p>