An analysis on the reasons for the delay in discovering dengue fever outbreak in Zhejiang Province / 预防医学

Objective To learn the timeliness and reasons for the delay in discovering outbreaks via a dengue fever outbreak in Zhejiang Province,and try to improve our disease monitoring system.Methods Epidemic and clinic data were collected by searching cases and epidemiological investigation,and clinic behavior of cases in dengue fever outbreak were described,then the risk factors involved in the delay in discovering outbreak were analyzed.Results Totally 46 cases were found in this outbreak,among which 36 (78.28％) cases were infected before.The onset date of the first case we found was on July 15 th,57 day before the outbreak confirmation.According to the results,95.65％ of cases see a doctor after their sickness,and the rate of three day hospital visiting was 93.36％ (42/46),among which the rate of three day hospital visiting before pathogen confirmation was 91.67％ (33/36),and there was no statistic significance in diagnostic rate before and after pathogen confirmation(P =1.00).Conclusion Cases in this dengue outbreak presented high and timely outpatient rate.Thus,the delay confirmation of dengue fever outbreak was caused by the low sensitivity of doctors in all levels of hospital.More training on dengue fever diagnosis for doctors should be carried out in the future to control and prevent dengue fever more efficiently.

An analysis on leptospirosis surveillance of ten years in Zhejiang Province / 预防医学

Objective To analyze surveillance and survey data in Zhejiang Province,and to learn the distribution of the leptospirosis of the host animals and the crowd,in order to provide the basis for prevention and control.Methods Descriptive epidemiology and statistical analysis were conducted.The kidneys of mouse,frog,pig,and duck were collected for pathogen isolation.The serum samples of the clinic diagnosed patients and the host animals were tested by microscopic agglutination test or antibody.Results There were 1 31 cases of leptospirosis in Zhejiang Province from 2005 to 201 4, including 3 cases died.The incidence rate,mortality rate and fatality rate were 0. 025 2/1 00 000,0. 000 6/1 00 000,and 2. 29%,respectively. The cases were reported in all the areas except Zhoushan and Huzhou. The main endemic distributions were mountain areas of southern and central Zhejiang Province.The positive rate in blood of duck was highest and the main flora was icteroheamorrhagiae.The floras in patients'serum antibody were icteroheamorrhagiae and leptospira hebdomadis.The flora in patients was incongruous with the host animals.Conclusion The incidence of leptospirosis remains at low level in recent years in Zhejiang Province.The bacterial flora distribution was stable,but the outbreak of leptospirosis due to strain changing should be prevented.

Investigation report on an imported Zika virus case / 预防医学

Objective ToinvestigateanimportedcaseofZikavirusdiseaseinWenzhouCity,toexplorethesourceof infection,to analyse the problems during surveillance and diagnosis,and to provide evidence for prevention and control of Zikavirusdisease.Methods Byfieldinvestigation,medicalrecordsofthepatientwerecollectedandaface-to-face interview was conducted;blood,urine and saliva samples within 48 h were collected for RNA detection;assess the risk of diseasespreadingbymosquitosurveillanceandtakecontrolmeasures.Results Theonsetofthediseasewasonthepatient's way home from aboard on February 21st,2016.Before then,She lived in Paramaribo,the capital of Suriname in South America,which is an epidemic area of Zika virus.The patient had exposure history,with red,diffuse rash on her head,face, neck and limbs,and once was diagnosed as allergic eruption because of no fever.The two blood samples were both tested negative yet We detected urine and saliva samples showed positive.With the evidence above,the patient was finally diagnosed as an imported Zika virus case.The spreading risk of this case was low due to the low temperature.Conclusion there may be cases without fever or with blood sample tested RNA negative.As the weather gets warmer,missed diagnosis should be aware of,or the risk of spreading through mosquitos would increase.Therefore,in order to further improvement should lie in mosquito control and disease surveillance.

An enlightenment from disaster medical rescue of Philippines typhoon / 预防医学

Objective To summarize the medical rescue work of China emergency medical team in Philippines disaster area by typhoon Haiyan.Methods The rescue experience was summarized by retrospective study.Results A total of 1 831 patients visited the outpatient and emergency departments during those 10 days.According to the rapid risk assessment,the insect borne diseases,acute gastroenteritis infection and hospital infection were the major problems.The medical team took measures such as disinfection,vector control,cleaning up the environment,hospital infection control and providing the safe water to prevent the infectious diseases.Conclusion A sound organization and management system,high -quality members of the medical team,preparing the reasonable rescue plan and epidemic prevention measures,adequate supplies and effective communication were responsible for the success of the medical rescue.It is necessary to establish several international medical rescue teams at the national level.

Clinical and epidemiological characteristics of the 6 confirmed human cases with novel influenza A (H7N9) virus infection in Zhejiang / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the clinical spectrum, geographic location of human H7N9 avian influenza as well as the characteristics of population at high risk of infection, in order to develop strategies for the prevention and control of the infection. Clinical and epidemiological characteristics on the 6 confirmed human cases in Zhejiang were also analyzed.</p><p><b>METHODS</b>Real-time fluorescent quantitative PCR was used to test the nucleic acid of human H7N9 avian influenza infection, from pharyngeal swabs of the patients and their close contacts. Face to face interview and descriptive method were used to collect related clinical and epidemiological data. Statistical analysis was performed by SPSS 17.0.</p><p><b>RESULTS</b>Six confirmed cases were distributed in Hangzhou and Huzhou cities. The 6 confirmed human cases, including 5 males and 1 female were all confirmed with novel influenza A (H7N9) virus infection, with an average age as 60.83 years (with median as 64.50 years). Cough was the most common initial symptom to be noticed. The clinical manifestations would include fever, dizziness, pain of muscles, coughing, expectoration and short of breath. All the X-ray chest films showed severe pneumonia, and 5 of them having had other chronic diseases. None of the cases admitted to have had a history of exposure to ill/death avians. However, all of the cases had been frequently exposed to the agricultural-byproduct-trading-markets where the positive rate of novel influenza A (H7N9) virus in environmental specimens was up to 43.21%. 32 of the 375 close contacts (8.53%) to the 6 cases appeared abnormal symptoms, but no positive result related to novel influenza A (H7N9) virus nucleic acid was detected from their throat swabs.</p><p><b>CONCLUSION</b>Acute infection on the respiratory system seemed the main clinical manifestation. Elderly men, especially those with chronic diseases were under high risk of human infection with H7N9 avian influenza. The source of infection might be associated with the exposure to poultry. There was still lack of evidence to confirm the route of person to person transmission on H7N9 avian influenza.</p>

Study on comprehensive monitoring of mouse and effect of hemorrhagic fever with renal syndrome vaccine in high prevalence areas of natural focus infectious disease of Zhejiang province in 1994--2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the comprehensive monitoring mechanism of mouse and the effect of hemorrhagic fever with renal syndrome (HFRS) vaccine in the high prevalence areas of natural focus infectious disease of Zhejiang province in 1994 - 2010.</p><p><b>METHODS</b>The night trapping method was used to monitor the population proportion, density and the rate of hantavirus (HV) carriers in mice in Xikou township Longyou county in August and September from 1994 to 2010. The healthy residents in Xikou township aged 16 to 60 years were recruited. The subjects were randomly selected as vaccination group and control group according to age, sex, occupational distribution (10 178 in intervention group and 16 159 in control group). Intervention group was given purified and inactivated vaccine from suckling mouse brain, while the control group received no intervention. The prevention effect was evaluated by protective rate of vaccine.</p><p><b>RESULTS</b>The mouse population was stable in the sixteen years and the apodemus agrarius was the main type (76.5% (564/737)). The average density of mouse was 4.73% (1170/24 727). The average rate of virus carrier of mouse was 3.87% (41/1033). In 1994 - 1995, the density of mouse was 22.82% (186/815) and the rate of virus carrier was 7.0% (10/143). In 2009 - 2010, the density of mouse decreased to 2.75% (119/4330) and the rate of virus carrier was 5.5% (13/237). The average antibody positive rate of mouse from 2005 to 2010 was 4.8% (35/728) and the rate was 4.4% (6/138), 0.0% (0/113), 11.8% (16/136), 1.0% (1/104), 3.7% (4/109) and 6.3% (8/128) in each year (P < 0.01). The protective rate of HFRS vaccine was 96.2% (1 case in intervention group and 41 cases in control group).</p><p><b>CONCLUSION</b>The density of mouse decreased significantly in Zhejiang province. The rate of virus carrier of mouse is stable. The vaccine is effective.</p>

Study on the integrated monitoring program regarding mouse and main mouse-borne disease in Zhejiang province / 中华流行病学杂志

Objective To study the integrated monitoring program regarding mouse and plague, hemorrhagic fever of renal syndrome(HFRS)and leptospirosis. Methods Integrated monitoring plan was used. A designated office coordinated 5 departments' actions within the Zhejiang Provincial Center for Disease Control and Prevention(CDC). Cage-trapping method was conducted to monitor the density of mice from June to October, respectively. Results Lishui municipal CDC had finished the integrated monitoring program on mouse and mouse-borne disease while the Longyou CDC had finished the field investigation, using the integrated monitoring program.Specimens were sent to provincial CDC. The integrated monitoring program needed more number of personnel and better coordination. Lishui reported 3 leptospirosis cases and 58 HFRS cases in 2009,with the incidence rates as 0.13 and 2.44 per 100 000, respectively. Longyou reported 2 leptospirosis case and 1 HFRS cases in 2009, with the incidence rates as 0.49 and 0.25 per 100 000, respectively.Lishui and Longyou had no plague case. Lishui caught 91 mice in 2009 and the density was 4.17%.Longyou caught 37 mice in 2009, with the density as 1.18 percent. Most mice caught from Lishui were Apodemus agrarius and the next was Mus musculus. In Longyou the Rattus tanezumi ranked the first, followed by Apodemus agrarius. The positive rate of HFRS antigen in Lishui and Longyou were 10.42% and 4.59% respectively. The positive rate of HFRS antibody in Longyou was 3.70%. The culture positive rate of leptospirosis in mouse renal of Lishui and Longyou were 0 and 0.98%respectively. The culture positive rate of leptospirosis in pig renal, duck renal, frog renal and cattle urine of Longyou was 0. The culture positive rate of leptospirosis in duck blood of Longyou was 80%.Conclusion The integrated monitoring program on mouse and mouse-borne disease seemed to be feasible and could promote the integrated surveillance and control program on mouse and mouse-borne diseases in China.

A case-control study on the effect of immunoprophylaxis for rabies in Zhejiang province / 中华预防医学杂志

<p><b>OBJECTIVE</b>This research was to evaluate the effect of pre- and post-exposure prophylaxis for rabies and to analyze the reasons of invalidation.</p><p><b>METHODS</b>A case-control study was conducted in 132 rabies patients and 73 subjects exposed to homologous rabies in Zhejiang province. All the subjects were investigated face to face by using the same questionnaires at home. Non-conditional logistic regression was used to analyze the effect of measures and the reasons of invalidation.</p><p><b>RESULTS</b>14.4% (19/132) of cases and 93.2% (68/73) of controls had post-exposure, which resulted in an OR (95%CI) of 0.012 (0.004 - 0.035). However, 72.2% (13/18) of cases and 7.7% (5/65) of controls had not finished their post-exposure, and thus had an OR (95%CI) of 15.60 (3.85 - 63.26). Stratified analysis stated that post-exposure prophylaxis was a protective factor, with an OR (95%CI) of 0.01 (0.002 - 0.047). Poor financial condition and poor knowledge of rabies were the causes of non vaccination.</p><p><b>CONCLUSION</b>Post-exposure prophylaxis could protect the people exposed to rabies well and unfinished post-exposure prophylaxis was the main reason for its invalidation.</p>

Reproduction of a rat model of burn with infection / 中华烧伤杂志

<p><b>OBJECTIVE</b>To reproduce a reliable rat model of burn with infection for the study of prevention and treatment of infected wound.</p><p><b>METHODS</b>(1) Electrical burn producing apparatus equipped with constant temperature (80°C) and pressure (0.5 kg) was used to reproduce burn injury (with area of 4.5 cm(2)) on both sides of the back in 50 SD rats for different duration (4, 6, 8, 10, 12 s), with 10 rats for each burn duration. On post burn day (PBD) 1, gross condition of wounds was observed with naked eyes. Wounds on the left side were used to observe healing time. The wounds on the right side were used for histological observation to determine the depth of injury, and they were classified into superficial and deep partial-thickness injury. (2) Another 36 SD rats were divided into A (inflicted with superficial partial-thickness burn, n = 18) and B (inflicted with deep partial-thickness burn, n = 18) groups according to the random number table. Rats in both groups were treated in accordance with method of preliminary experiment. Immediately after burn, 0.1 mL of liquid containing 1 × 10(9), 1 × 10(7), 1 × 10(5) CFU Pseudomonas aeruginosa (PA) ATCC 27853 was respectively inoculated to the wounds on one side (with 6 rats for each amount), while the wounds on the other side were treated with the same volume of normal saline as control. Inflammatory reaction of wounds was examined with HE staining on post inoculation day (PID) 1. On PID 1, 2, 3, 5, 7, and 14, the number of subeschar bacteria was respectively counted and the bacteria were identified with Gram stain and biochemical reaction. Wound healing time was recorded. Data were processed with t test.</p><p><b>RESULTS</b>(1) Burn for 6, 8 s was respectively identified as injury time resulting in superficial or deep partial-thickness injury according to histological observation and wound healing time. (2) Obvious inflammatory cell infiltration was observed in the wounds in B group which were inoculated with 1 × 10(7), 1 × 10(9) CFU PA, and the infiltration was less marked in A group with inoculation of 1 × 10(9) CFU PA. (3) The bacteria isolated from wounds of A and B groups was identified as PA. The subeschar bacteria count within PID 14 in A group, in which different amount of PA was inoculated, was mostly less than 1 × 10(5) CFU/g of tissue, while that in B group in which 1 × 10(9) CFU PA was inoculated was more than 1 × 10(5) CFU/g of tissue. (4) There was no obvious difference in wound healing time between wounds inoculated with different amount of PA and wounds treated with normal saline in A group (with t value respectively 1.26, 0.29, 1.07, P values all above 0.05). Wound healing time of wounds in B group, in which 1 × 10(9) CFU PA was inoculated, was longer as compared with that treated with normal saline [(22.5 ± 1.0) d vs. (19.4 ± 1.6) d, t = 2.73, P < 0.05].</p><p><b>CONCLUSIONS</b>In rat, deep partial-thickness burn wound inoculated with 1 × 10(9) CFU PA ATCC 27853 is a reliable model with high reproducibility for the study of infection of burn wound.</p>

The preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy.</p><p><b>METHODS</b>fourteen burn patients with inhalation injury admitted to our hospital from January 2001 to December 2004 were enrolled as control (C) group, and they were treated with conventional systemic therapy and management of airway. Twenty-seven burn patients with inhalation injury admitted to our hospital from January 2005 to October 2009 were enrolled as advanced (A) group, and they were treated with conventional systemic therapy and advanced airway management, including bedside isolation of airway, fixation of both oxygen supply tube and humidifying tube, humidification in specific body position, thinning of sputum, lavement of airway and procedural sputum elimination, steam inhalation combined with medicine, and suction of sputum with interrupted negative pressure. Result of bacterial culture of sputum (the 7th day after tracheotomy) and chest X-ray (at admission and the 7th day after tracheotomy), pulmonary infection, change in blood gas analysis index and oxygen saturation (SO(2)), (within 7 days after tracheotomy), and the number of patients curd in 2 groups were observed and compared.</p><p><b>RESULTS</b>(1) Positive result of bacterial culture of sputum was observed in 11 (78.6%) patients in C group and 12 (44.4%) patients in A group. The difference between them was statistically significant (chi(2) = 4.36, P < 0.05). The main bacterium detected was Pseudomonas aeruginosa. (2) Pneumonia was suspected in 7 patients (25.9%) in A group by chest X-ray, which was obviously fewer than that in C group (8 Cases, 57.1%, chi(2) = 3.87, P < 0.05). The result was in accordance with the diagnosis of pulmonary infection. (3) No CO(2) retention, SO(2) and PaCO(2) abnormality caused by asphyxia was observed in 2 groups, PaCO(2) value in A group was close to that in C group (t = 0.89, P > 0.05). (4) In C group, 9 (64.3%) patients were cured, 5 patients died of pneumonia, wound sepsis, and MODS. In A group, 25 (92.6%) patients were cured, 2 patients died of MODS. Number of cure was obviously larger in A group than in C group (chi(2)= 5.22, P < 0.05).</p><p><b>CONCLUSIONS</b>The advanced airway management has better effects on isolation and humidification of airway, and thinning, drainage, and elimination of sputum. And it can decrease the probability of blind suction and injury to airway, and it prevents pulmonary infection following tracheotomy.</p>

Study on a 10-year protective effects of vaccination against hemorrhagic fever with renal syndrome / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the epidemiological and serological efficacy after 10 years of vaccination against hemorrhagic fever with renal syndrome (HFRS) vaccines in Zhejiang province.</p><p><b>METHODS</b>One county was randomly chosen as the research unit with all the healthy people between 16 and 60 years old were equally divided into study and control groups. The study group was vaccinated. Immunofluorescent antibody assay was used to test specific IgG antibody and Mcro-CPE method was used to test the titer of neutralizing antibody.</p><p><b>RESULTS</b>Two weeks after the full-course immunization, the seroconversion rate became 100% (67/67, with 95% CI as 96.3%-100%) by immunofluorescent antibody test (IgG) and 44.4% (8/18 with 95% CI as 22.0%-69.0%) by neutralization test with GMT titers as 72.1 and 4.6 respectively. Booster immunization was provided one year later. Time span as two weeks prior to, one year, one and half years, two years, three years and five years after booster immunization, the rates of seroconversion on immunofluorescent antibody using IFAT method, were 28.6%, 83.3%, 75.0%, 53.1%, 22.6%, 10.0% and 55.0% respectively, and rates of seroconversion of neutralizing antibody by Mcro-CPE method were 14.8%, 55.6%, 35.0%, 31.3%, 26.0%, 10.0% and 50.0% respectively. Nine years after the reinforcement, the rates of seroconversion of immunofluorescent antibody by IFAT method was only 7.1%. The vaccinated group had no patient seen but the control group appeared 34 patients including 3 deaths. According to the ten-year observation, the vaccine seemed effective with the protection rate in population reached 100%.</p><p><b>CONCLUSION</b>HFRS vaccine was effective on epidemiological, social and economical efficacy.</p>

A field epidemiological study on the risk factors of injury caused by typhoon / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the risk factors involved in the typhoon episodes and to put forward and evaluate the intervention measures.</p><p><b>METHODS</b>We defined a confirmed injury case as: 'a person with fall,scalpel and stab, collision, drowning, injuries and trauma due to flying debris and building collapse, asphyxiation due to entrapment in collapsed buildings by typhoon from 0 am,August 12 to 6 pm, August 14 2004' and a death case as: 'a person with fall, scalpel and stab, collision, drowning, injuries and trauma due to flying debris and building collapse, asphyxiation due to entrapment in collapsed buildings by typhoon from 0 am, August 12 to 12 am, August 18 2004'. We investigated all hospitalized injured cases in ten hospitals and telephoned to those who were not hospitalized and the cases of death. We did case-control study with 1 pair versus 2 cases. 74 cases were selected in ten hospitals. The controls were neighbors of the controls matched by occupation, sex, village, and within 5 years of age without injury in this typhoon. We asked the cases and the controls on their alertness regarding typhoon and what actions taken when typhoon arrived.</p><p><b>RESULTS</b>There were 392 injury cases in all ten hospitals and 50 death cases. The attack rate of injury was 27.3 per 100 000. The fatal rate was 11.3% with the death rate 3.1 per 100 000. We investigated 209 injury cases and 31 death cases. The number of cases who were injured from 1 to 6 hours before typhoon landing accounted for 64.6% (155) of all cases. The peak of epidemic curve was 4 hours before the landing of typhoon. Data on the analysis of 74 cases and 148 controls revealed that 42% (31) of the cases were outside their homes before and during typhoon compared to 15% (22) of the controls (OR = 3.9, 95% CI: 1.9-7.7). Compared with 20% (30) control persons (OR = 17,95% CI: 4.2-68). 28% (21) cases did not receive the alert of typhoon before it arrived compared with 18% (27) control persons (OR = 3.3, 95% CI:1.3-8.6). 53% (39) of the cases did not pay attention to the alert of typhoon before typhoon arrived.</p><p><b>CONCLUSION</b>Staying outdoor, not receiving or did not take seriously about the alert of typhoon seemed to be the risk factors of injury by the typhoon episode, suggesting that the government should increase the emergency preparedness and to raise the awareness on risks associated with typhoon.</p>

Serological surveillance on vaccine against hemorrhagic fever with renal syndrome / 中华流行病学杂志

<p><b>OBJECTIVE</b>To observe the serological and epidemiological efficacy of hemorrhagic fever renal syndrome (HFRS) vaccine in Zhejiang province.</p><p><b>METHODS</b>Immunofluorescent antibody assay and Mcro-CPE method were used to test specific IgG antibody and the titer of neutralizing antibody.</p><p><b>RESULTS</b>Two weeks after the injection of the third dose, the sero-conversion rates by both immunofluorescent antibody test (IgG) and neutralization test were 100.0% (67/67) (95% CI: 96.3 - 100.0) and 44.4% (8/18)(95% CI: 22.0 - 69.0) with geometric mean titers (GMTs) 72.1 and 4.6 respectively. The rates of seroconversion of immunofluorescent antibody by immunofluorescence antibody assay (IFA) were 28.6%, 83.3%, 75.0%, 53.1%, 22.6%, 10.0% and 55.0% before reinforcement, two weeks, one year, one year and a half years, two years, three years and five years after reinforcement. The rates of neutralizing antibody seroconversion by the Mcro-CPE method were found as 14.8%, 55.6%, 35.0%, 31.3%, 26.0%, 10.0% and 50.0% respectively. We found some antibody dependent immunization enhancement phenomenon among the inoculated population, but further observation was needed.</p><p><b>CONCLUSION</b>HFRS vaccine was immunologically effective and the duration of serous antibody last long.</p>

Reconstruction correction to Reconstrction of mandibular bone defects by using the techniques correction to teachniques of the reverse engineering and rapid prototyping / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility of designing and fabricating customized titanium bone substitutes to restore mandibular bone defects using reverse engineering (RE) and rapid prototyping (RP) techniques.</p><p><b>METHODS</b>Titanium tray for mandibular defects were designed and fabricated through multi-step procedures of reverse engineering and rapid prototyping, then in operation it was filled with cancellous bone and fixed.</p><p><b>RESULTS</b>The bone substitutes fabricated by this method had been successfully put into clinical use for maxillofacial surgery in 2 patients and got a satisfactory result.</p><p><b>CONCLUSIONS</b>Reverse engineering combining with rapid prototyping could accomplish the design and manufacture of implant for the restoration of mandibular bone defects.</p>

Effect of recombinant human basic fibroblast growth factor on angiogenesis during mandible fracture healing in rabbits / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effect of recombinant human basic fibroblast growth factor (rhbFGF) on angiogenesis during mandible fracture healing in rabbit.</p><p><b>METHODS</b>Fifty adult white rabbits were used for animal model and randomly divided into a control group (25 rabbits) and an experimental group (25 rabbits). The membranous complex of rhbFGF and bovine type I collagen was prepared and implanted into the rabbit mandible fracture site under periosteum. The animals were sacrificed on 7, 14, 28, 56 and 84 days respectively after operation and the whole mandibles were harvested. The expression of factor VIII related antigen (F8-RA) in callus was examined with immunohistochemical staining.</p><p><b>RESULTS</b>The amounts of microvascular formation in calluses in the rhbFGF-treating group on days 7, 14, 28 and 56 were more than those of the control group (P<0.01).</p><p><b>CONCLUSIONS</b>The results indicated that rhbFGF could stimulate microvascular formation during mandible fracture healing in rabbits.</p>