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Indolent systemic mastocytosis is a rare disease characterized by an increased number of mast cells in the bone marrow and other tissues, such as the liver, spleen, lymph nodes, and skin. Patients with indolent systemic mastocytosis and high serum tryptase levels are at risk for Hymenoptera venom-induced anaphylaxis. Hymenoptera venom immunotherapy in patients with specific IgE is safe and effective. While some patients can receive ultra-rush venom immunotherapy with minimal side effects, omalizumab effectively protects against anaphylaxis during the build-up phase.
A mastocitose sistêmica indolente é uma doença rara caracterizada por um número aumentado de mastócitos na medula óssea e em outros tecidos, como fígado, baço, linfonodos e pele. Pacientes com mastocitose sistêmica indolente e altos níveis séricos de triptase correm risco de anafilaxia induzida pelo veneno dos Hymenoptera. A imunoterapia com veneno de himenópteros em pacientes com IgE específica é segura e eficaz. Embora alguns pacientes possam receber imunoterapia com veneno ultrarrápido com efeitos colaterais mínimos, o omalizumabe protegeu efetivamente contra a anafilaxia durante a fase de acúmulo.
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Humans , Female , AdultABSTRACT
@#Abstract: Objective To analyze the recent cluster outbreaks of imported malaria and explore the risks, challenges and countermeasures for dealing with such events during malaria post-elimination era of malaria, and to provide reference for effectively addressing the risks and consolidating the achievements of malaria elimination. Methods The individual malaria case data from "The Information System for Infectious Disease Surveillance" and "The Information System For Parasitic Diseases Prevention And Control" were collected，and the diagnosis classification, infection source, time and space distribution of cases were analyzed. Results From January 1 to August 11, 2022, a total of 429 malaria cases were reported nationwide, an 18.9% decrease compared to the same period last year (529 cases), all of which were imported cases. The overall weekly trend of the outbreak remained stable, but since Week 31 (July 25-31), there has been a significant increase in the number of cases, with a peak on August 5. From July 25 to August 11, 2022, a total of 162 malaria cases were reported nationwide, up 315.4% from 39 cases in the same period last year, accounting for 37.8% of the total cases up to August 11, 2022. The main source of imported infections was Guinea (95 cases, 58.6%), with most cases reported in Longgang District, Shenzhen City, Guangdong Province (30 cases), Shilin County, Kunming City, Yunnan Province (21 cases), Chaoyang District, Beijing (11 cases), and Xiaoshan District, Hangzhou City, Zhejiang Province (7 cases). Conclusions Due to the concentration of returnees to China, several entry port cities simultaneously experienced cluster outbreaks of imported malaria, which brought immense pressure and challenges to local medical and health institutions. Health facilities at all levels need to maintain high vigilance and sensitivity, be well prepared, and avoid death and secondary transmission caused by imported cases.
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@#Abstract: Objective To collect and organize malaria case data in Hubei Province from 2017 to 2021, compare and analyze the malaria epidemic characteristics on the before and after malaria elimination, and provide scientific support for Hubei Province to further optimize the comprehensive strategies to prevent re-transmission after the elimination of malaria. Methods The study was conducted by collecting the data of reported malaria cases of Hubei during 2017-2021 from the Infectious Disease Surveillance Reporting and Management System, and conducting the epidemiological characteristics of malaria on pre-elimination (2017-2019) and post-elimination (2020-2021). Results A total of 429 cases of imported malaria were reported in Hubei Province from 2017 to 2021, and the malaria epidemic showed an obvious trend of rising first and then falling. On the pre-malaria elimination, 374 malaria cases were reported, including 262 cases of P.falciparum (70.05%); on the post-malaria elimination, 55 malaria cases were reported, including 25 cases of P.falciparum (45.45%). There was a statistically significant difference in the proportion of infections caused by the four types of malaria parasites before and after the elimination of malaria (χ2=14.248, P<0.05). On the pre-malaria elimination, the peak of disease onset mainly occurred in January, July, and November; on the post-malaria elimination, the peak of disease onset mainly occurred in January to February, and December. Both before and after malaria elimination, the reported cases were mainly concentrated in Wuhan, Yichang, Huangshi, Xiangyang, Shiyan and Huanggang, but the range of cases showed a clear trend of narrowing. Before and after malaria elimination, malaria cases in Hubei Province were mainly among young and middle-aged males aged 30-49. The proportions of workers and migrant workers increased from 37.70% and 9.09% before the elimination to 50.91% and 18.18% after the elimination, respectively, with a statistically significant difference (χ2=17.839, P<0.05). The percentage of interval from onset of illness to initial diagnosis ≥ 5d decreased from 21.66% before the elimination to 10.91% after the elimination (χ2=6.448, P<0.05). The percentage of definitive diagnosis of malaria at initial diagnosis in town clinic increased from 18.18% before the elimination to 50.00% after the elimination. The proportion of malaria cases diagnosed by county-level medical institutions increased from 22.73% before the elimination to 34.55% after elimination. There was no statistically significant difference in the proportion of malaria cases diagnosed by medical institutions at all levels before and after the elimination of malaria (χ2=5.630, P>0.05). The proportion of cases with the interval between initial diagnosis and diagnosis within 24h increased from 43.85% before the elimination to 70.91% after the elimination. There was a statistically significant difference in the proportion of cases with the interval between initial diagnosis and diagnosis before and after the elimination of malaria (χ2=14.006, P<0.05). Before and after malaria elimination, all reported cases were mainly imported from African countries. Conclusions There are imported malaria cases reported every year in Hubei Province before and after the elimination of malaria, which poses a great challenge to the prevention of re-transmission. Therefore, it is necessary to strengthen the surveillance system, detect and standardize the treatment of imported malaria cases in a timely manner, conduct targeted retransmission risk surveys and assessments, and consolidate the achievements of malaria elimination.
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@#Abstract: To explore the clinical characteristics, diagnosis and treatment of imported severe malaria and COVID-19 co-infection cases, and to provide scientific basis for epidemic prevention and control measures. The epidemiological characteristics, clinical manifestations, laboratory tests, treatment process and prognosis of 4 cases of severe malaria and COVID-19 co-infection with confirmed diagnosis were analyzed retrospectively. Four cases of severe malaria were African returnees of the same batch, male, aged 40-54 years old, with the same journey track. They all had African work and life history and acute onset. The main clinical manifestations were fever (4/4), chills (3/4), chills (3/4), nausea and vomiting (3/4), diarrhea (4/4), fatigue and anorexia (4/4). Two cases had headache and dizziness, confusion, muscle aches, two cases had cough, one cases had sputum, sore throat and runny urine. All 4 cases were confirmed by positive nucleic acid detection of the new coronavirus (2019-nCOV) in throat swabs. Plasmodium falciparum was found by microscopic examination of peripheral blood smears of all patients, and all of them were consistent with high altitude helminthiasis. All cases were accompanied by abnormal liver function and severe hypoproteinemia, two cases were hyperbilirubinemia, three cases were dyslipidemia, three cases were involved in abnormal tertiary hemogram with different degrees of elevation of procalcitonin, two cases were lactic acid poisoning, and one case was hypoglycemia. One case showed viral pneumonia on chest CT. All cases were treated individually according to the different conditions and were discharged after improvement, and were rechecked for 2019-nCOV nucleic acid and microscopic examination of blood smear negative for Plasmodium.During the global COVID-19 epidemic, the emergence of coinfection cases of con-infection of imported malaria parasites and severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2) makes the clinical diagnosis and treatment more complicated. It is important to establish the awareness of simultaneous prevention and diagnosis of COVID-19 and malaria for local prevention and control and early warning of severe cases, and timely and effective formulation of treatment plan to improve the comprehensive treatment efficiency.
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Objective To analyse the epidemiological characteristics of imported malaria cases after malaria elimination in Yixing City, Jiangsu Province, so as to provide reference for malaria prevention and control in grassroots healthcare institutions. Methods All data pertaining to malaria cases reported in Yixing City from 2016 to 2022 were retrieved from Chinese Disease Control and Prevention Information System, and the data pertaining to vector monitoring and human malaria parasite infections from 2016 to 2022 were collected for a descriptive statistical analysis. Results A total of 14 imported malaria cases were reported in Yixing City from 2016 to 2022, including 12 cases with Plasmodium falciparum malaria, one case with P. vivax malaria and one case with P. ovale malaria, and all cases acquired infections in Africa and then returned to Yixing City. Malaria cases were reported across 2016 to 2022 except in 2020 and 2021. Malaria cases were predominantly reported during the period between December and February of the next year, and workers were the predominant occupation. The institutions where malaria was initially diagnosed included county-level general hospitals, county-level disease prevention and control institutions and grassroots healthcare centers, and there were 10 cases with definitive diagnosis of malaria on the day of initial diagnosis, with a 64.29% (9/14) correct rate of initial diagnosis. There were 5 cases diagnosed with severe malaria, and the standardized response rate was 100.00% following the “1-3-7” surveillance and response strategy. Of all malaria vectors, only Anopheles sinensis was monitored in Yixing City from 2016 to 2022, and all humans were tested negative for blood smears exceptimportedmalariacases. Conclusions The correct rate of initial malaria diagnosis was not high in healthcare institutions in Yixing City from 2016 to 2022, and there are still multiple challenges for prevention of re-establishment of imported malaria.
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Objective To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province. Methods Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency. Results A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%). Conclusions Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.
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After achieving malaria elimination, preventing re-establishment from imported malaria and consolidating malaria elimination achievements are top priorities of the national malaria control program in China. Due to the long-term existence of overseas imported malaria cases and incomplete eradication of local epidemic conditions, there are multiple challenges for prevention of re-establishment from imported malaria in China. Hereby, we propose that regular assessment is an effective approach to maintaining the capability of prevention of re-establishment from imported malaria, and describe the purpose, significance, management and implementation of the capability assessment for prevention of re-establishment from imported malaria, so as to provide insights into the formulation and adjustment of malaria control strategies during the post-elimination phase.
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Objective To analyze the characteristics of imported malaria epidemic from overseas in Wuhan, to explore the management mechanism of on-site cases, and to accumulate experience for the treatment of imported malaria in large cities after malaria elimination. Methods The epidemiological data on imported malaria from abroad during the period of malaria elimination (2010-2019) in Wuhan were collected. The gender, age and severe illness-related factors of the cases were analyzed. Based on the characteristics of the epidemic and the current situation of prevention and control, the content and experience of the “Municipal-District 24-7” case mechanism were discussed. Results The medical resources in Wuhan were the best in the central region, resulting in a large number of imported malaria cases, with a total of 474 cases reported from 2010 to 2019 (40.79% of the total number of cases in Hubei Province), including 359 cases of falciparum malaria, 36 severe cases and one death (the death rate was 0.28%). The patients were mainly young and middle-aged men aged 20 to 49 years old (97.26%). There were many referral cases (40.30%), and there was no seasonal clustering of cases reported. The undiagnosed proportion at the first visit was 44.85%, and the time of attack-diagnosis was 4 days or more in 61.00% of cases. The occurrence of severe cases was related to unconfirmed diagnosis at the first visit (χ2=35.46, P<0.001) and attack-diagnosis time (Z=-6.49, P<0.001). Conclusion Imported malaria occurs frequently in Wuhan, mainly falciparum malaria. However, “Municipal-District 24-7” case mechanism has effectively curbed the occurrence of severe and death cases and provided valuable experience for case management in similar cities in China.
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Abstract@#On March 12, 2022, a case with Plasmodium vivax malaria was reported in the First Hospital of Jiaxing City. The case sought healthcare services due to persist, sharp distending pain of the brain and fever on February 25, 2022, and the symptoms showed no improvements following symptomatic treatment. Microscopy identified malaria parasites on March 12, and the case was definitively diagnosed as P. vivax malaria on March 13. The case was discharged from hospital on March 16 and relapsed on June 15. The case was a veteran from the China-Myanmar border, where malaria is highly prevalent, and had no history of travel after returning to Jiaxing City on October 2021. Based on epidemiological history and laboratory tests, the case was diagnosed as a cross-border mosquito-borne imported case of P. vivax malaria. The case was given treatment with mosquito vector isolation, and the case's family members, neighbors and colleagues were all tested negative for malaria parasites. There was no Anopheles sinensis detected in the case' residence; however, Anopheles was detected in the neighboring areas, indicating a risk of re-establishment. Returners from high-risk regions including borders and labor exporters are recommended to be included in malaria surveillance, and the sensitivity of malaria surveillance requires to be maintained and the diagnostic and treatment capability of malaria requires to be improved in medical institutions.
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OBJECTIVE To evaluate the clinical effectiveness and safety of domestic generic and imported original clopidogrel for antiplatelet therapy in patients with acute coronary syndrome （ACS）. METHODS The clinical data of ACS patients in Nanjing Drum Tower Hospital of China Pharmaceutical University from January 2020 to June 2021 were retrospectively collected by using electronic medical record system， and the patients were divided into original drug group （321 cases） and generic drug group （328 cases） according to the drug use. Both groups were given dual antiplatelet therapy with clopidogrel and aspirin. The effectiveness and safety outcomes of the two groups were followed up for 12 months and compared， the related influential factors were analyzed. RESULTS Major adverse cardiovascular events （MACE） occurred in 16 and 22 patients in original drug group and generic drug group respectively， including nonfatal myocardial infarction （4 and 5 cases）， stroke （2 and 4 cases）， revascularization （8 and 3 cases）， cardiovascular related death （2 and 4 cases）， and all-cause death （4 and 6 cases）. There were 12 and 7 patients with major bleeding events， 38 and 29 patients with minor bleeding events， and 33 and 21 patients with non-bleeding adverse events. There was no statistically significant difference in the cumulative incidence of related events （P values of Log-Rank tests were all greater than 0.05）. Cox regression analysis showed that the use of generic clopidogrel did not increase the risk of MACE and major bleeding events in ACS patients [hazard ratio of 1.305 and 0.416， 95% confidence interval of （0.678， 2.512） and （0.155， 1.117）， respectively， P＞0.05]， and the combination of proton pump inhibitors （PPI） could reduce the risk of major bleeding events [hazard ratio of 0.196， 95% confidence interval of （0.063， 0.611）， P＜0.05]. CONCLUSIONS Compared with imported original drug， domestic generic clopidogrel has similar clinical effectiveness and good safety. Combined use of PPI may be a beneficial factor to reduce the occurrence of major bleeding events in patients.
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Objective@#To investigate the epidemiological characteristics of overseas imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021, so as to provide insights into the prevention and control of overseas imported arthropod-borne infectious diseases.@*Methods@#The data pertaining to imported dengue fever and malaria cases in Yunnan Province from 2015 to 2021 were collected from the Chinese Disease Prevention and Control Information System, and the temporal distribution, regional distribution, population distribution, sources, diagnosis and treatment of imported dengue fever and malaria cases were descriptively analyzed.@*Results@#Totally 4 332 overseas imported dengue fever cases and 2 011 overseas imported malaria cases were reported in Yunnan Province form 2015 to 2021, which accounted for 30.09% of all reported dengue fever cases and 98.53% of all reported malaria cases. The number of overseas imported dengue fever and malaria cases peaked from August to November (83.13% of all imported dengue fever cases) and from April to July (59.08% of all imported malaria cases), and the cases were predominantly reported in Dehong Prefecture (50.99% and 58.88%), with farmers as the predominant occupation (40.21% and 67.93%). The dengue fever and malaria cases were mainly imported from Southeast Asia (99.04% and 88.21%), and the proportions of definitive diagnosis of dengue fever and malaria were 88.33% and 97.80% at township hospitals, respectively.@*Conclusions@#The number of overseas imported dengue fever and malaria cases peaked from August to November and from April to July in Yunnan Province from 2015 to 2021, and the cases were predominantly reported in Dehong Prefecture and imported from Southeast Asia, with farmers as the predominant occupation.
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ObjectiveTo characterize the prevalence and epidemic situation of imported malaria cases in Songjiang District of Shanghai from 2013 to 2022， and to provide evidence for malaria prevention and control. MethodsRelated data were collected and analyzed， including malaria cases， blood testing of febrile patients， and mosquito surveillance in Songjiang from 2013 to 2022. ResultsA total of 13 002 febrile patients in Songjiang were tested for plasmodium parasites from 2013 to 2022， among which 18 malaria cases were confirmed， including 17 cases of falciparum malaria and 1 case of ovale malaria. Moreover， a total of 36 malaria cases were notified in Songjiang through the National Notifiable Disease Reporting System from 2013 to 2022， including cases reported from Songjiang District and other districts or provinces with physical addresses in Songjiang. Of them， there were 31 cases of falciparum malaria， 2 cases of vivax malaria， 2 cases of ovale malaria and 1 case of quartan malaria. The gender ratio of male to female cases was 17∶1， and the majority was young and middle aged. In addition， 35 cases were imported from Africa and 1 case from southeast Asia； 34 cases were migrant workers， and 2 cases were travellers abroad； 17 cases were found and reported in Songjiang， 15 cases were reported from other districts of Shanghai， and 4 cases were reported from other provinces； 27 cases were treated in Shanghai， 3 cases were treated in other provinces and 6 cases were treated with self-provided antimalarial drugs. Mosquito surveillance in Songjiang showed that density of Anopheles sinensis was extremely low. ConclusionNo indigenous malaria case has been notified in Songjiang since 2008. Malaria surveillance on migrant workers remains the focus of malaria prevention and control. Furthermore， achievement of malaria elimination in Songjiang should be continually enhanced to avoid potential further transmission of imported malaria.
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A patient with fever, chills, and pancytopenia as major clinical manifestations was presented. To investigate the cause, the patient’s peripheral blood was collected for pathogen screening using metagenomic next - generation sequencing (mNGS). The DNA sequence of Leishmania donovani was detected, and Leishmania amastigotes were found in bone marrow smears using microscopy. The case was therefore definitively diagnosed as visceral leishmaniasis, and was cured and discharged from hospital following treatment with liposomal amphotericin B for 14 days. This is the first imported case of visceral leishmaniasis since the founding of Shenzhen City in 1979.
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This article presents a severe cerebral malaria patient in shock with a close contact of COVID-19 that was successfully cured in a negative pressure ward during the global pandemic of COVID-19. The patient experienced a sudden onset of high fever and coma in a designated isolation hotel after returning from Africa, and was transferred to a designated hospital. Following antimalarial therapy, blood pressure elevation, increase of blood volume, bedside hemodialysis, mechanical ventilation, plasma and platelet transfusions, the case gradual recovered.
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Objective To examine the impact of COVID-19 pandemic on the epidemic status of imported malaria and national malaria control program in China, so as to provide insights into post-elimination malaria surveillance. Methods All data pertaining to imported malaria cases were collected from Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 through December 31, 2021. The number of malaria cases, species of malaria parasites, country where malaria parasite were infected, diagnosis and treatment after returning to China, and response were compared before (from January 1, 2018 to January 22, 2020) and after the COVID-19 pandemic (from January 23, 2020 to December 31, 2021). Results A total of 2 054 imported malaria cases were reported in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 to December 31, 2021, and there were 1 722 cases and 332 cases reported before and after the COVID-19 pandemic, respectively. All cases were reported within one day after definitive diagnosis. The annual mean number of reported malaria cases reduced by 79.30% in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region after the COVID-19 pandemic (171 cases) than before the pandemic (826 cases), and the number of monthly reported malaria cases significantly reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region since February 2020. There was a significant difference in the constituent ratio of species of malaria parasites among the imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 146.70, P < 0.05), and P. falciparum malaria was predominant before the COVID-19 pandemic (72.30%), while P. ovale malaria (44.28%) was predominant after the COVID-19 pandemic, followed by P. falciparum malaria (37.65%). There was a significant difference in the constituent ratio of country where malaria parasites were infected among imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 13.83, P < 0.05), and the proportion of malaria cases that acquired Plasmodium infections in western Africa reduced after the COVID-19 pandemic that before the pandemic (44.13% vs. 37.95%; χ2 = 4.34, P < 0.05), while the proportion of malaria cases that acquired Plasmodium infections in eastern Africa increased after the COVID-19 pandemic that before the pandemic (9.58% vs. 15.36%; χ2 = 9.88, P = 0.02). The proportion of completing case investigation within 3 days was significantly lower after the COVID-19 pandemic than before the pandemic (96.69% vs. 98.32%; χ2= 3.87, P < 0.05), while the proportion of finishing foci investigation and response within 7 days was significantly higher after the COVID-19 pandemic than before the pandemic (100.00% vs. 98.43%; χ2 = 3.95, P < 0.05). Conclusions The number of imported malaria cases remarkably reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region of China during the COVID-19 pandemic, with a decreased proportion of completing case investigations within 3 days. The sensitivity of the malaria surveillance-response system requires to be improved to prevent the risk of secondary transmission of malaria due to the sharp increase in the number of imported malaria cases following the change of the COVID-19 containment policy.
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SUMMARY: During the Covid-19 pandemic that has marked the last years, while governments tried to control the spread of the virus, many-body donation programs were suspended due to difficulties that could potentially be encountered. Given the low body donation acceptance rates during this period, through this study we aimed to evaluate academics' knowledge, attitudes, and behaviors in cadaver acceptance and embalming practices during the pandemic. The research population of th estudy consisted of the faculty of 112 universities in Turkey who taught in under graduate and graduate programs in the Anatomy Department in 2020. An electronic questionnaire of 24 items, including demographic data, was distributed to the participants' official e-mail addresses. In addition, support was received from the Turkish Anatomy and Clinical Anatomy Society, whose members were also approached through their official group e-mail accounts. Answers were collected from 78 (39 %) out of 200 academics. The findings of the study were under 5 headings (ınformation about cadaver donation and ımported cadavers, attitude towards ımportation of cadavers and acceptance of body donations, precautions against contagion in ımportation of cadavers and acceptance of body donations and thoughts on their adequacy, considerations for adoption of cadavers for post-graduation education, advice on avoiding contagion in cadaver embalming) were collected and analyzed. The study high lights the importance of cadaver acceptance and embalming practices for medical education to minimally continue in the post-pandemic period. It can also serve as a reference for being cautious when faced with similar situations in the future.
RESUMEN: Durante la pandemia de COVID-19, que ha marcado los últimos años, mientras los gobiernos intentaban controlar la propagación del virus, muchos programas de donación de cuerpos fueron suspendidos por las dificultades que se podían encontrar. Dadas las bajas tasas de aceptación de la donación de cuerpos durante este período, a través de este estudio buscamos evaluar el conocimiento, las actitudes y los comportamientos de los académicos en la aceptación de cadáveres y las prácticas de embalsamamiento durante la pandemia. El estudio se realizó el año 2020 en los programas de pregrado y posgrado de los Departamentos de Anatomía de 112 universidades de Turquía. Se distribuyó un cuestionario electrónico de 24 ítems, incluidos datos demográficos, a los participantes por correo electrónico oficial. Además, se recibió el apoyo de la Sociedad Turca de Anatomía y Anatomía Clínica, cuyos miembros también fueron contactados a través de las cuentas de correo electrónico de su grupo oficial. Se recopilaron respuestas de 78 (39 %) de 200 académicos. Los hallazgos del estudio se ubicaron en 5 encabezados (información sobre donación de cadáveres y cadáveres importados, actitud hacia la importación de cadáveres y aceptación de donaciones de cuerpos, precauciones contra el contagio en la importación de cadáveres y aceptación de donaciones de cuerpos y opiniones sobre su idoneidad, consideraciones para la adopción de cadáveres para la educación de posgrado y consejos para evitar el contagio en el embalsamamiento de cadáveres). El estudio destaca la importancia de la aceptación de cadáveres y las prácticas de embalsamamiento para que la educación médica continúe mínimamente en el período posterior a la pandemia. También puede servir como referencia para tenerse presente ante situaciones similares en el futuro.
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Humans , Male , Female , Adult , Cadaver , Health Knowledge, Attitudes, Practice , Human Body , Faculty/psychology , COVID-19 , Anatomy/education , Turkey , Tissue and Organ Procurement , Surveys and Questionnaires , Embalming , Anatomists/psychology , PandemicsABSTRACT
Introducción: El virus SARS-CoV-2 se propaga, principalmente, entre personas que están en estrecho contacto, de ahí la importancia de la detección de contactos y conocer las formas de transmisión entre estos. Objetivo: Identificar las principales formas de transmisión directa entre contactos de casos importados y autóctonos. Métodos: Se realizó un estudio descriptivo transversal sobre dos poblaciones: los casos confirmados de COVID-19 en la provincia Santiago de Cuba en el último trimestre de 2020 y los contactos directos declarados por dichos casos. En busca de la mejor representatividad se empleó un diseño de muestreo estratificado en dos etapas. Para la recolección del dato primario se empleó la entrevista; para resumir la información, el número y el porcentaje; para detectar posibles diferencias, las pruebas de hipótesis de una proporción y de comparación de proporciones mediante el Minitab v. 19 y para elaborar los gráficos el Microsoft Excel 2016. Resultados: El promedio de contactos fue mayor entre los casos autóctonos, con predominio de compañeros de trabajo, vecinos e hijos. La relación contacto-caso en los importados fue amigo(a), chofer y suegro(a), mientras que en los autóctonos fue hijo(a). Hubo menor empleo de acciones preventivas y predominio de contactos extradomiciliarios en los importados. Los contactos de los importados fueron hospitalizados con mayor frecuencia y presentaron mayor proporción de asintomáticos que los de los autóctonos, pero no hubo diferencias significativas. Conclusiones: No se obtuvo un patrón diferenciado de transmisión, excepto que la transmisión característica de los autóctonos fue entre padre e hijo y en los importados fue entre amigos(AU)
Introduction: SARS-CoV-2 spreads, mainly, through close contact among people, hence the importance of detecting contacts of confirmed cases and identifying the mode of transmission between them. Objective: To identify the main modes of direct transmission among contacts of imported and autochthonous cases. Methods: A cross-sectional descriptive study was conducted in two populations: the confirmed cases of COVID-19 in Santiago de Cuba in the last quarter of 2020, and their declared direct contacts. In the search of the best representativeness, a two-stage stratified sampling method was used. The interview was used to collect the primary data; numbers and percentage, to summarize the information; the one-sample proportion hypothesis test and the compare proportions test using Minitab v.19, to identify possible differences across groups; and Microsoft Excel 2016, to produce the graphics. Results: The average number of contacts was higher among the autochthonous cases, prevailing the co-workers, neighbors and children. The contact-case relationship in imported cases was friend, driver, and mother or father-in-law; while in the autochthonous cases, it was son or daughter. Preventive actions were less used, and extra-domiciliary contacts of imported cases predominated. Contacts of imported cases were hospitalized more often, and had a higher proportion of asymptomatic than the autochthonous cases, but there was no significant differences. Conclusions: A differentiated pattern of transmission was not obtained; except that, transmission among autochthonous cases was between parent and child; while in imported cases, it was between friends(AU)
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Humans , SARS-CoV-2/pathogenicity , CubaABSTRACT
Shanghai is a super-large metropolis with a highly developed globalization. Since the 21st century， Shanghai has experienced several threats of emerging and imported infectious diseases. Infectious disease surveillance has been established and developed from single-disease surveillances to a comprehensive surveillance network. Integration of clinical and preventive medicine has been gradually extended， which facilitates the improvement in the monitoring and early warning system. In 2020， when the COVID-19 epidemic spread， Shanghai quickly established a prevention and control expert team and a clinical medical expert team to effectively and shortly control local COVID-19 epidemic. In order to improve Shanghai’s capacity to respond to major epidemics of infectious diseases and public health emergencies， the metropolis will build and improve a three-level diagnosis and treatment system for emerging， imported， rare， and unknown infectious diseases in the next five years. Based on the big data monitoring platform of medical institutions， Shanghai will achieve the intelligence-supported diagnosis and treatment of infectious diseases， and consolidate the cooperation to implement the integration of clinical and preventive medicine.
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@#Abstract: Objective China was certified by World Health Organization as a malaria-free country in 2021. Malaria has become a rare infectious disease, and preventing the re-transmission of imported malaria and reducing deaths are the main challenges facing China after elimination of malaria. To analyze and clarify the characteristics of imported malaria deaths, and to provide prevention and treatment recommendations for overseas workers and health care workers. Methods The data of 17 imported malaria deaths in the analysis of malaria deaths from 2016 to 2020 by the National Severe Malaria Treatment Expert Group were collected, and the relevant clinical epidemiological data and disease course records were analyzed. Results The 17 malaria deaths were all imported from Africa with Plasmodium falciparum infection (malarial cerebral type), with no obvious regularity in the month of onset. Among them, 16 were male patients, 5 cases with underlying diseases such as diabetes mellitus, and 10 patients were first diagnosed in a second-level or lower hospital. Excluding patients who died of respiratory cardiac arrest in ambulances, the mean time difference between first onset and malaria diagnosis in 16 patients was 6.8 days (median 5.5 days), and the mean time between first onset and antimalarial treatment was 7.4 days (median 6 days), the mean time difference from initial onset to death was 10.3 days (median 8.5 days). Excluding cases with onset abroad and unknown time of return, all 14 patients developed the disease within 30 days after returning to China. Conclusion All the fatal cases were infected with Plasmodium falciparum imported from Africa. The patients' awareness of actively seeking medical treatment is weak, and the delay in seeking medical treatment caused by the insufficient diagnosis and treatment capacity of health institutions at the township level and below is the main reason for the deaths. It is recommended to strengthen the self-protection awareness of staff in malaria-endemic areas overseas and raise their awareness of malaria. For returnees from areas with high malaria risk, primary medical institutions should pay attention to the patient's travel history in Africa, improve the awareness of malaria diagnosis, malaria diagnosis and treatment capabilities.
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Objective:To understand the epidemic characteristics of malaria in Nanchang, and provide a basis for timely adjustment of prevention and control strategies and measures after elimination of malaria in Nanchang.Methods:By retrospective analysis, the malaria case information and epidemiological case questionnaire reported in Nanchang from 2016 to 2020 were collected from the "China Disease Control and Prevention Information System Infectious Disease Report Information Management System" and "Parasitic DiseasePrevention and Control Information Special Report System". General situation of the cases, three distributions (time, region and population distributions) and the source of infection were described and statistically analyzed.Results:A total of 69 malaria cases were reported in Nanchang from 2016 to 2020, including 39 cases of falciparum malaria, 19 cases of vivax malaria, 9 cases of ovale malaria, 1 case of quartan malaria and 1 case of mixed infection. The onset time of 69 malaria cases was not seasonal, and cases were reported every month; they were distributed in 8 districts (counties) of Nanchang, with Jinxian County was most, accounting for 36.2% (25/69); the sex ratio of men and women was 22 ∶ 1 (66 ∶ 3), and the age of the cases was mainly 20 - < 60 years old, accounting for 97.1% (67 cases); the occupation distribution was dominated by workers, accounting for 26.1% (18/69). The 69 malaria cases were all imported cases from abroad, of which 67 cases were imported from Africa, accounting for 97.1%.Conclusions:There is no report of local malaria case in Nanchang from 2016 to 2020, all cases are imported from abroad. In the future, the control and prevention of imported personnel from abroad should be strengthened.