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Objectives: To analyze the causes of a foodborne outbreak in rural areas of Xinjiang between April 2 and April 5 in 2016. Methods: Cases and the relevant background information were obtained by consulting outpatient records of local health centers and regional people's hospitals and interviewing doctors and residents. All samples were collected by the laboratory test through epidemiological and food hygiene investigations. The χ2 test (Fisher's exact probability method) was used to compare differences in incidence rates. Molecular typing, virulence genes and single nucleotide polymorphisms (SNPS) were analyzed by using Pulsed Field Gel Electrophoresis (PFGE) and Whole Genome Sequencing (WGS). Results: A total of 142 cases were found in this study, with incidence rate at 5.7‰ (142/24 979). Among all cases, the main symptoms were nausea (94%), vomiting (92%) and abdominal pain (67%), and the incubation period was about 2 h (1-7.5 h). There were 16 Staphylococcus aureus isolates identified and all of them could produce A+C+E mixed enterotoxin. PFGE showed 100% homology. WGS further revealed that there were 9 and 1 strains contained by Sequence Type 1 (ST1) and ST5405, respectively. All ST1 strains were in the same clade on the genome tree. Among these, 7 strains shared close proximity (74 SNPs) and 2 strains shared close relationships as well (127 SNPs). The S. aureus isolates that caused the outbreak were introduced by a mutant isolate from the milk supply station. Conclusions: This foodborne outbreak was mainly caused by Staphylococcus aureus contamination.
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Humans , Disease Outbreaks , Electrophoresis, Gel, Pulsed-Field , Foodborne Diseases/epidemiology , Staphylococcus aureus/geneticsABSTRACT
Objective To understand the unhealthy related behaviors of echinococcosis patients in Tibetan region in Sich-uan Province,so as to provide the references for the health education of echinococcosis.Methods The echinococcosis patients who were registered in the Tibetan region in Sichuan Province were selected as target population. The basic situation and un-healthy related behaviors of them were surveyed by individual interviews.Results Totally 368 echinococcosis patients were in-vestigated.The proportion of patients who lived with dogs was 53.3%,who did not wash hands before meals was 23.4%,who ate raw food was 15.5%,who fed dogs with diseased livestock visceral organs was 9.8%,who drank unboiled water was 8.7%,and who played with dogs was 5.4%.The proportion of nomads'unhygienic behaviors was higher than that of sedentary residents'un-hygienic behaviors.The proportion of playing with dogs and feeding dogs with diseased livestock visceral organsin students was higher than that in nomads.Conclusion There are some unhealthy related behaviors in echinococcosis patients in Garzê Prefec-ture,and the different health education modes for echinococcosis patients with different characteristics should be applied.
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<p><b>OBJECTIVE</b>To determine the prevalence of urolithiasis in young children fed infant formula (IF) contaminated with melamine, and the association between IF consumption and urolithiasis.</p><p><b>DESIGN</b>A total of 2 733 children < or = 3 years of age on September 1, 2008 in two townships of Gansu Province, China were studied. Cases of urolithiasis were diagnosed by ultrasonography. Milk product consumption was determined by their caregivers. Remaining IF samples were tested for melamine and cyanuric acid.</p><p><b>RESULTS</b>Of 2 733 eligible children in the two townships, 2 186 (80%) were enrolled in our study. Overall, 16.6% (362) of 2 186 children had urolithiasis. The prevalence was 24.6% in children exclusively fed Sanlu brand IF, 9.7% in those fed other IF, and 8.5% in those fed exclusively on other milk products. For children exclusively breast-fed, no urolithiasis was found (P < 0.05). The prevalence of urolithiasis was 11.4% in children fed 400 g of Sanlu IF, rising to 37.5% in children fed over 25 600 g. Of 48 Sanlu IF samples, 91.7% contained melamine (median = 1 800 ppm; range = 45-4 700) and 66.7% contained cyanuric acid (median = 1.2 ppm; range = 0.4-6.3). Melamine was also detected in 22.2% of 36 other brand IF (median = 27.5 ppm, range = 4-50).</p><p><b>CONCLUSIONS</b>Urolithiasis was associated with melamine-contaminated IF. Although one product caused most morbidity, other milk products may have also contributed to the outbreak.</p>
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Child, Preschool , Humans , Data Collection , Food Contamination , Infant Food , Triazines , Toxicity , UrolithiasisABSTRACT
Objective To identify the source of infection and risk factors and to provide control measures regarding an outbreak of gastroenteritis involving 30 villagers.Who attended the same wedding party held on March 5th,2012,a survey was carried out.Methods Case was defined as having onset of vomiting,nausea,stomachache or diarrhea among the attendees of a wedding party.We randomly selected and interviewed 140 from 470 attendees on their symptoms and food exposures at the wedding.We compared food-specific attack rates (AR) for gastroenteritis in a retrospective cohort study.The leftover foods were tested for Salmonella,Shigella,and Staphylococcus aureus.The leftover Boletus mushrooms were examined and species determined by the Kunming Institute of Botany,Chinese Academy of Sciences.Results Of the 140 attendees 61％ (85) developed gastroenteritis.Case-attendees had vomiting (94％),nausea (89％),stomachache (53 ％),and diarrhea (51％).The AR among attendees who ate Boletus mushroom was 69％ (81/118),compared to 18％ (4/22) of those who did not (RR＝3.8,95％ CI:1.5-9.2).When comparing the ARs between the attendees on consumption of other foods,data did not show statistically significant differences.Among the 7 species of Boletus identified from the leftover mushrooms,3 (B.venenatus,B.sinicus and B.magnificus) were toxic.Store keepers bought dried or fresh mushrooms from local villagers who had picked up them from the mountains.Salmonella,Shigella,and Staphylococcus aureus tests on those leftover food showed negative results.Conclusion Poisonous Boletus mushroom contributed to this outbreak.We recommended that education should be targeted on mushroom-pickers regarding how to recognize the poisonous mushrooms.Regulations and laws should also be developed to facilitate the necessary process.
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Objective To describe the epidemiologic characteristics and clinical manifestations of 59 persons recruited via an intemet chat group who complained of AIDS-like symptoms, so as to formulate effective intervention strategies and measures. Methods Case was defined as onset of any three of the following self-reported AIDS-like symptoms in a member of relevant "intemet chat groups": persistent low grade fever, rash, swollen lymph node, fatigue, diarrhea, weight loss and low CD4+T count. We administered an internet-based questionnaire, and invited 59 of the 88 casepersons for voluntary physical examination and laboratory testing. Results The 59 case-persons came from 22 provinces; 54 (91.5 %)were men; the median age was 34 (range: 22-53)years; 84.7% of them had high-risk sexual behaviors before the onset of self-reported symptoms. The median time interval from exposure to onset was 15 d (range: 1-365 d). Blood specimens for all the 59 case-persons were tested negative for HIV and syphilis antibodies. There was also no evidence of Xenotropic murine leukemia virus-related virus infection. One case-person was tested positive for hepatitis C virus antibody. The average CD4'T lymphocyte count was 707/μl. Of the 59 case-persons,57 (96.6%) sought medical care from multiple providers; 40 were diagnosed to have no physical disorders. Conclusion None of the 59 case-persons had any evidence of infection with HIV or any other infectious agents that could explain their self-reported symptoms.
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Objective To provide evidence-based recommendations to the government on strategies for reducing the impact of the imminent influenza pandemic, we conducted a survey on the personal protective and healthcare seeking behaviors of Beijing residents in the wake of the worldwide epidemic of the novel 2009 H1N1 influenza virus, and potential changes in these behaviors during a full-blown pandemic. Methods We used a two-stage Mitofsky-Waksberg telephone survey to collect information for Beijing residents ≥ 18 years of age and weighted the sample by the census estimate of Beijing population for 2008. A structured questionnaire was used to collect information about the respondents' knowledge regarding the novel influenza virus, current personal protective and healthcare seeking behaviors during a full-blown influenza pandemic. Results 286 Beijing urban residents were interviewed during May 15 to 18 (response rate: 62%). 77%(95%CI: 71%-82%) of the residents that they would cover their sneezes at home, and 93%(95%CI: 89%-96%) would do so in a public place. Of the residents would cover their sneezes at home, 66% (95%CI: 57%-74%) would covered their sneezes by hand, 33% (95%CI:25%-42%) by facial tissue, and only 0.4% (95%CI: 0.1%-2.9%) by sleeves. Similarly, of the residents would cover their sneezes at a public place, 64% (95%CI: 56%-71%) would cover their sneezes by hand, 33%(95%CI: 26%-41%) by facial tissue and 0% by sleeves. 46% (95% CI: 32%-59%) of the residents would wash their hands after covering their sneezes with hand in public places, and 77% (95%CI: 64%-89%) would do so at home. Higher percentages of residents would wear a mask (63%, 95% CI: 56%-70%) and get vaccinated (43%, 95% CI: 37%-50%) during a pandemic than under currently situation (3.5%, 95% CI: 1.7%-7.0% for wearing a mask; 13%, 95% CI: 9.8%-18% for getting vaccinated). 86% (95% CI: 81%-89%) of the residents would visit a doctor for an influenza-like illness during a pandemic, similar to the percentage currently seen (76%, 95%CI: 70%-81%). 71%(95%CI: 63%-78%) of the residents would visit a doctor for influenza-like illness and would choose a tertiary medical center; with percentage (74% , 95% CI: 66%-80%) similar to the one during a pandemic. Conclusion Beijing residents need to be aware of the proper ways to cover their noses when sneezing (especially using their sleeves more), and to wash their hands. An effective plan to triage patients should be immediately established to efficiently utilize the limited healthcare resources, which would likely be further strained during a pandemic.
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<p><b>INTRODUCTION</b>Based on the estimate results of the capacity and preparedness of Beijing hospitals to respond to pandemic influenza, using flu surge model to evaluate its applicable hypothesis and to provide government with sentient strategy in planning pandemic influenza. Through collection of medical resources information, we calculated the possible impaction on hospitals by Flu Surge model and explored the applicable hypothesis in model operation through a questionnaire, direct observation and group discussion in 3 hospitals in Beijing. Based on flu surge model estimation during a 6-week epidemic from a pandemic virus with 35% attack rate, Beijing would have had an estimation of 5 383 000 influenza illnesses, 2 691 500 influenza outpatients, 76 450 influenza hospitalizations and 14 508 excess deaths. For a 6-week period with 35% attack rate, there would be a peak demand for 8% of beds, 210% of ICU beds, and 128% of ventilators estimated. Outpatients in different level hospital were quite disproportionated with 1742/ hospital/day, 650/hospital/day, and 139/hospital/day respectively. The sampled health workers had a mastery of 63.4% of the total knowledge and skills of diagnosing and treating of influenza, 73.5% of them washed their hands and 63.5% used PPE correctly. The total beds capacity, medical beds capacity and respiratory medical beds capacity would increase 8%, 35% and 128% respectively.</p><p><b>CONCLUSION</b>The estimation results could be referenced when planning the pandemic strategy, but the results should be treated objectively when considering the hypothesis and practical situation in this model being used.</p>
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Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Disease Outbreaks , Hospital Bed Capacity , Hospital Planning , Hospitalization , Influenza, Human , Epidemiology , Models, Statistical , Surge CapacityABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical features of unexpected sudden death (SUD) clustered in families in Yunnan province.</p><p><b>METHODS</b>This retrospective study analyzed the clinical features of SUD occurred between July to September 2005 in 7 families in Yunnan province.</p><p><b>RESULTS</b>All 16 SUD patients shared common clinical features such as fatigue and repeated syncope and one group of SUD patients (n = 8 from 4 families) presented with the gastric intestinal tract manifestations including nausea, vomiting, abdominal pain and diarrhea with suspected dietary history and abnormal laboratory enzyme findings (GOT/GPT, CK/CKMB, LDH/LDH1 etc.). In SUD patients without gastric intestinal tract manifestations (n = 8 from 3 families), there were no clear symptoms before death and repeated ventricular tachycardia and ventricular fibrillation were recorded in one survivor. There was no clear evidence for the involvements of hereditary and infectious factors for observed SUD.</p><p><b>CONCLUSION</b>The reason for the unexpected sudden death clustered in 7 families in Yunnan remains unclear. Repeated syncope and fatigue served as the common clinical features in the presence or absence of gastric intestinal tract manifestations in all SUD cases. Further studies are needed to clarify the pathology and detailed clinical manifestations of SUD occurred in this area.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Bias , Cause of Death , China , Epidemiology , Death, Sudden , Epidemiology , Family , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To understand the epidemiologic and clinical characteristics of the "Yunnan unknown-cause sudden cardiac death (YUSCD)".</p><p><b>METHODS</b>Cases of YUSCD occurred in 2002-2004 were investigated with cross-sectional study. Clinical manifestation was observed and analyzed.</p><p><b>RESULTS</b>The YUSCD areas were mountainous and most of the YUSCD cases appeared between June and August. Most of the YUSCD cases were young farmers and showed family/village clustering nature. Most of the patients died quickly with only few recovered. The overall incidence of YUSCD was 1.83% with mortality as 1.51%. The fatality rate of YUSCD appeared to be 78.1%.</p><p><b>CONCLUSION</b>The YUSCD cases had a clustering feature along with time and area. The clinical manifestation of YUSCD could not be specifically identified, making the clinical diagnosis and treatment difficult when practicing in the fields that called for further studies on epidemiology, clinical work and etiology.</p>
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Humans , China , Epidemiology , Cross-Sectional Studies , Death, Sudden, Cardiac , Epidemiology , SeasonsABSTRACT
<p><b>OBJECTIVES</b>To study the pathologic feature of sudden cardiac death in Yunnan province and to investigate the role of myocarditis.</p><p><b>METHODS</b>During the period from 1991 to 2006, there were 29 cases of sudden cardiac death with autopsy performed. Fourteen of these cases were diagnosed to have myocarditis based on Dallas criteria and World Heart Federation's consensus. The clinical and pathologic findings were reviewed. The cardiac conduction system was examined in details by serial sectioning in 3 cases.</p><p><b>RESULTS</b>Fourteen cases suffered with myocarditis, which accounted for 48% of all cases of sudden cardiac death studied. The age of the deceased ranged from 8 to 68 years (mean = 30 years), with male-to-female ratio equaled to 9:5. Lymphocytic myocarditis and neutrophil myocarditis were the two major types, affecting 11 and 3 cases, respectively. The inflammatory infiltrates were often patchy rather than diffuse. The inflammatory foci were detected only in 8% to 42% (average = 20%) of the paraffin sections of the heart tissue. These lesions were usually located in the lateral wall of left ventricle and occasionally in interventricular septum and right ventricular wall. Myocardial injury was mild in most cases while patchy myocytolysis or coagulation necrosis was observed only in a few cases. Most of the lesions were relatively new and histologic evidence of myocardial repairing sometimes coexisted. Pericarditis and subacute endocarditis were also identified in 4 and 1 cases, respectively. Atrioventricular node was involved by myocarditis in 1 of the 3 cases examined for cardiac conduction system. Two cases showed gross evidence of cardiac dilatation (either left ventricle or biventricular). Respiratory tract and pulmonary infection was present in 5 cases.</p><p><b>CONCLUSIONS</b>Myocarditis represents one of the major pathologic changes of sudden cardiac death occurring in Yunnan province. The inflammation is usually focal. Further studies are required for delineation of possible etiologies which may include virus, bacteria or exogenous toxin.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Atrioventricular Node , Pathology , China , Epidemiology , Death, Sudden, Cardiac , Epidemiology , Pathology , Dilatation, Pathologic , Pathology , Endocarditis , Pathology , Inflammation , Pathology , Lymphocytes , Pathology , Myocarditis , Diagnosis , Epidemiology , Mortality , Pathology , Myocardium , Pathology , Pericarditis , PathologyABSTRACT
<p><b>OBJECTIVE</b>To identify the epidemiological and clinical features of unexpected sudden cardiac deaths (SUD) in Yunnan.</p><p><b>METHODS</b>Choosing the old SUD cases from Xiangyun, Heqing, Nanjian and Dayao counties and using the standardized verbal autopsy Form, we interviewed the family members of the cases, witnesses and doctors as well as reviewing their medical files to get relative information.</p><p><b>RESULTS</b>We identified 116 SUDs in 21 villages from 1984 to 2004. The village-specific annually standardized incidence rates were ranged from 0.2/1000 to 8.9/1000 (median = 0.8/1000). 66% and 29% of the SUDs occurred in July and August respectively. The incidence rates of SUD were higher (1.6/1000, chi(2) = 16, P < 0.01) in 10 - 39 year-olds, and higher in females than in males (RR = 1.6, 95% CI: 1.1 - 2.3). Seventy percent of SUD occurred in families having clustering nature and 60% of the additional cases in the family were occurred within 24 hours (median = 20 hours) after the first SUD identified in the family. SUD occurred in 23 families followed the first affected family in a village during the same season. In these 23 families, 61% of the first SUD occurred within 8 days after the first SUD in the first affected family. 68% and 66% of the SUDs did not have any complaints or signs during the last 3 weeks or from 3 weeks to 2 days prior to the onset of the disease. 63% of the SUDs had cardiac symptoms within the last 2 days prior to the onset with major symptoms as dizziness, nausea, faintness, unconsciousness, weakness and palpitation. The median duration from acute onset to death was 2 hours.</p><p><b>CONCLUSIONS</b>The extreme time-space clustering of SUD in families and in villages suggested that the risk factors occurred in specific time and location. Familial clustered SUD cases had common exposure pattern. Sudden onset of acute cardiac symptoms often followed by sudden death. Epidemiological study on new cases was necessary to identify risk factors and to develop hypothesis for causation. In July 2005, we instituted a special SUD surveillance system for all the affected counties together with 10 counties which had no reported cases.</p>