CD4 T cell count as predictor of Pneumocystis carinii pneumonia in children born to mothers infected with HIV. European Collaborative Study Group.

OBJECTIVE--To assess the value of CD4 T cell count in predicting Pneumocystis carinii pneumonia in infants born to mothers infected with HIV, with reference to the guidelines from the Centers for Disease Control on prophylaxis against pneumocystis. DESIGN--Prospective birth cohort study. SETTING--Hospitals in 10 European cities participating in the European collaborative study. SUBJECTS--924 children born to mothers known to be infected with HIV at or before delivery. MAIN OUTCOME MEASURES--The incidence of P carinii pneumonia. CD4 T cell counts in children before diagnosis of the pneumonia. The proportions of children infected and uninfected with HIV who fulfilled the criteria for primary prophylaxis. RESULTS--Fourteen children were diagnosed with P carinii pneumonia. The cumulative incidence by the age of 6 years was 2% (95% confidence interval 0.9 to 3.0%). Of the 11 children with a CD4 T cell count predating diagnosis, only three fulfilled the criteria from the Centers for Disease Control for prophylaxis. Prophylaxis was indicated by 1 year of age for 62% of infected children who had not developed P carinii pneumonia and for at least 10% of uninfected children. CONCLUSIONS--Monitoring CD4 T cell count seems to be of limited value in deciding when to start prophylaxis against P carinii pneumonia in children born to mothers infected with HIV. The alternative approach of giving prophylaxis to all children born to infected mothers would be difficult to justify given the low incidence of the pneumonia.     

布鲁氏茵病防治基础研究现状与展望

布鲁氏菌病（简称布病）是由布鲁氏菌属细菌侵入机体引起的人畜共患传染病．近年来,布病疫情在世界范围内呈反弹趋势,我国尤甚．进入2000年以后,人间布病在我国成为报告发病数上升速度最快的传染病之一,令我国布病防治形势严峻．为了明确我国布病防治工作的现状和需求、最新研究现状和研究动态以及面临的挑战和机遇,深入研讨分析我国布病防治研究中的重大科学和关键技术问题,凝练和提出今后我国布病防治研究发展中亟需关注、解决的重要基础科学问题,在国家自然科学基金委员会资助下,由中国疾病预防控制中心地方病控制中心主办,哈尔滨医科大学、中国疾病预防控制中心传染病预防控制所和内蒙古地方病防治研究中心共同协办,于2013年6月21日召开了由来自全国布病防治与基础研究领域专家共同参加的“布鲁氏菌病防治基础研究发展战略研讨会”．会议在我国布病疫情最重的省份内蒙古自治区呼和浩特市召开,中国疾病预防控制中心传染病预防控制所、军事医学科学院疾病预防控制所、石河子大学、中国兽医药品监察所等19家从事布病防治与基础研究的科研院所、高等院校、疾病防治机构的40余位专家参加了此次会议．现结合文献资料以及本次会议的内容,对国内外布病流行现状、研究进展,以及影响我国布病防治的亟需解决的科学问题和建议作一综述．     

广州首起输入性基孔肯雅热的调查分析

广州网络报告的疑似"登革热"患者经广州市疾病预防控制中心流行病学调查、血清学检测、病原学分离培养等做出的诊断为首例输入性基孔肯雅热。又经中国疾病预防控制中心和广东省疾病预防控制中心对疑似基孔肯雅热患者作进一步基孔肯雅病毒抗体和核酸等检测,并对扩增出的基孔肯雅病毒特异性片段进行了序列测定和分析。核苷酸同源性比较显示,E2区(336nt)和NS1区(314nt)的核苷酸序列与意大利基孔肯雅病毒分离株ITA07-RA1及多株印度的基孔肯雅病毒分离株的序列高度同源(98%以上)。根据现场流行病学和实验流行病学的调查结果,可以确认这例疑似境外感染的输入性登革热实为基孔肯雅热病例,也是中国首例输入性基孔肯雅热病例。     

Botulism—Diagnosis,Management and Public Health Considerations

Botulism is an uncommon but often fatal disease associated with ingestion of a potent neurotoxin present in improperly preserved foods. Exposures to commercially preserved foods with an odd or peculiar taste almost never represent exposure to botulism toxin. Improperly prepared home-canned products which are tasted or consumed without heating are more likely to be associated with botulism.The management of suspect and confirmed cases of botulism is presented by medical epidemiologists in the State Department of Public Health, Bureau of Communicable Disease Control, to provide physicians in California with a practical approach to this problem.     

Epilogue. Establishment of the Center for Chronic Disease Prevention and Health Promotion

The establishment of the Center for Chronic Disease Prevention and Health Promotion (CCDPHP) at the Centers for Disease Control (CDC) following the Conferences on the State of the Art in Quality Control Measures for Diagnostic Cytology Laboratories is briefly discussed. The CCDPHP is expected to play a major role in the CDC's cancer control program, including participation in establishing effective screening programs and assuring the quality of such methodologies as the Papanicolaou test and mammography.     

An international collaborative study on foot and mouth disease virus assay methods. 1. Virus infectivity and neutralizing antibody assays

In a collaborative study sponsored by the European Commission for the Control of Foot and Mouth Disease, workers in 19 laboratories participated in the early phases (1, 2 and 4). All three phases were devoted to assessments of virus infectivity and the neutralizing activity of sera. Virus preparations and antisera distributed from one laboratory were tested either by 'in house' or suggested methods. Analyses of the results clearly showed that whilst 'within' laboratory variation in the results of replicate tests was low, there were significant differences in the results from various laboratories. By attempting to standardize test conditions with distributed materials, e.g. media and cells, etc., the 'between' laboratory variation was reduced.     

2013—2018年广州市荔湾区流行性感冒流行特征及病原学分析

目的 掌握广州市荔湾区2013—2018年流行性感冒(influenza,简称流感)病例及病原学的流行特征,为制定流感防控策略提供科学依据。方法 运用描述性流行病学方法对荔湾区2013—2018年流感数据进行分析。结果 2013— 2018年广州市荔湾区共报告流感7 585例,其中2018年最高为2 691例,发病率283.26/10万;2013年最低,仅有528例,发病率57.78/10万。流感流行趋势每年出现1~2次流行高峰,高峰季节为春季和冬季;男女性别比1.23∶1,差异无统计学意义( P >0.05)。年龄以0~<5岁和5~<15岁组为主;职业以散居儿童、学生和幼托儿童为主,年龄和职业差异有统计学意义( P <0.05)。共检测流感样病例(influenza-like cases, ILI)咽拭子标本总数 6 110 份,其中,流感病毒阳性标本总数564份,阳性率9.23%;每年可有1~2次检出高峰,高峰季节为春季和冬季。流感病毒型别呈现新甲H1型、季H3型和B型交替流行趋势。结论 广州市荔湾区流感防控重点人群是15岁以下的散居、托幼儿童和中小学生,防控重点季节为春季和冬季。据此预测,2019年则需重点防控新甲H1型(A型)流感病毒。     

Trends in incidence of AIDS associated with transfusion of blood and blood products in Europe and the United States, 1985-93.

OBJECTIVE--To quantify patterns and trends in incidence of AIDS associated with transfusion of blood and its products in 14 European countries and the United States. DESIGN--Data were derived from the World Health Organisation''s European non-aggregate AIDS dataset and, for the United States, from the Centers for Disease Control AIDS public information dataset. Rates were standardised by using the world standard populations and adjusted for reporting delays in each country. SUBJECTS--Cases of AIDS in patients with haemophilia and recipients of transfusions. RESULTS--Overall, between 1985 and 1993 almost 6000 cases of AIDS associated with transfusions were registered in the 14 European countries considered and over 8000 in the United States between 1985 and 1992. Most European countries had annual age adjusted rates lower than 0.5 per million children aged 12 or less and between 1 and 2 per million adults. The United States had rates around 1 per million children and 5 per million adults in the most recent period. For children, the highest rates were generally reached in 1985-7, whereas in adults the highest rates were in the late 1980s. France had the highest overall incidence of AIDS related to transfusion in Europe (3.3 per million). Romania had a major epidemic in children (over 30 cases per million children in 1988-90). Incidence rates of AIDS associated with transfusion were still increasing in some southern European countries in the early 1990s. CONCLUSIONS--Apart from in France and Romania it is clear that rates of bloodborne AIDS in European countries are lower than those registered in the United States.     

Report from a workshop on multianalyte microsphere assays

Multiplexed assays using fluorescent microspheres is an exciting technique that has been gaining popularity among researchers, particularly those in the public health field. Part of its popularity is due to its flexibility, as both immunoassays and oligonucleotide hybridization assays can be developed on this platform. This report summarizes a workshop held by the Centers for Disease Control and Prevention that discussed issues surrounding these assays and the Luminex 100 xMAP instrument. Topics included instrumentation, assay design, sample matrix and volume, quality control, and development of commercial applications.     

Amodiaquine and malaria prophylaxis

In 1985 the WHO and the United States Centers for Disease Control recommended that amodiaquine (400 mg weekly) could be used as a first-line malaria prophylactic in areas of the world with chloroquine resistance. Recently both the WHO and the CDC have withdrawn this recommendation. In this article, Tim Peto and Charles Gilks discuss the reasons behind the original recommendation and the events that led to the sudden change.     

Category of exposure to HIV and age in the progression to AIDS: longitudinal study of 1199 people with known dates of seroconversion. HIV Italian Seroconversion Study Group.

OBJECTIVES: To determine whether rate of development of AIDS is affected by category of exposure to HIV and whether the more rapid development found in older subjects persists for each exposure category. DESIGN: Longitudinal study of people with known date of seroconversion to HIV. SETTING: 16 HIV treatment centres throughout Italy. SUBJECTS: 1199 people infected with HIV through use of injected drugs, homosexual sex, or heterosexual sex. MAIN OUTCOME MEASURES: AIDS as defined by 1987 definition of Centers for Disease Control (including and excluding neoplasms) and by 1993 European definition. RESULTS: 225 subjects (18.8%) progressed to AIDS (Centers for Disease Control 1987 definition) during median follow up of 5.8 years. Univariate analyses showed more rapid progression to AIDS for older subjects compared with younger subjects and for homosexual men compared with other exposure categories. The age effect was of similar size in each exposure category and in men and women. In a bivariate model with age and exposure categories simultaneously included as covariates, differences by exposure category disappeared for use of injected drugs and heterosexual sex compared with homosexual sex (relative hazards 1.02 (95% confidence interval 0.71 to 1.45) and 1.07 (0.70 to 1.64) respectively), while the age effect remained (relative hazard 1.55 (1.32 to 1.83) for 10 year increase in age). Analyses using the other definitions for AIDS did not appreciably change these results. CONCLUSIONS: There was no evidence of differences in rate of development of AIDS by exposure category, while there was a strong tendency for more rapid development in older subjects for all three groups. This supports the view that external cofactors do not play major role in AIDS pathogenesis but that age is of fundamental importance.     

The Pathogen- and Incidence-Based DALY Approach: An Appropriated Methodology for Estimating the Burden of Infectious Diseases

In 2009, the European Centre for Disease Prevention and Control initiated the ‘Burden of Communicable Diseases in Europe (BCoDE)’ project to generate evidence-based and comparable burden-of-disease estimates of infectious diseases in Europe. The burden-of-disease metric used was the Disability-Adjusted Life Year (DALY), composed of years of life lost due to premature death (YLL) and due to disability (YLD). To better represent infectious diseases, a pathogen-based approach was used linking incident cases to sequelae through outcome trees. Health outcomes were included if an evidence-based causal relationship between infection and outcome was established. Life expectancy and disability weights were taken from the Global Burden of Disease Study and alternative studies. Disease progression parameters were based on literature. Country-specific incidence was based on surveillance data corrected for underestimation. Non-typhoidal Salmonella spp. and Campylobacter spp. were used for illustration. Using the incidence- and pathogen-based DALY approach the total burden for Salmonella spp. and Campylobacter spp. was estimated at 730 DALYs and at 1,780 DALYs per year in the Netherlands (average of 2005–2007). Sequelae accounted for 56% and 82% of the total burden of Salmonella spp. and Campylobacter spp., respectively. The incidence- and pathogen-based DALY methodology allows in the case of infectious diseases a more comprehensive calculation of the disease burden as subsequent sequelae are fully taken into account. Not considering subsequent sequelae would strongly underestimate the burden of infectious diseases. Estimates can be used to support prioritisation and comparison of infectious diseases and other health conditions, both within a country and between countries.     

How can we improve tracking of transplanted tissue in the United States?

Currently an estimated two million tissues are distributed for transplantation annually. With increasing use of recovered tissue, clusters of transplant-transmitted infection have shown the difficulty of tracking tissues from an infected donor to the recipient. The challenge of tissue tracking to multiple transplant recipients was illustrated in a recent investigation of transmission of hepatitis C virus infection from a donor of organs and tissues. When a tissue bank issued a recall of the donated tissue, the Centers for Disease Control and Prevention was notified to assist public health authorities; the mean time to locate and notify the physicians who had transplanted the tissue was 13 days, while the mean time to notify, inform, and test the patients was 29 days. Lack of common coding and nomenclature was one of the key challenges in tracking tissue to the recipient. Some changes that could improve timeliness in the event of a recall includes: (1) standardized tissue nomenclature and coding through unique donor identifiers; (2) tissue traceability requirements using systems similar to that used for blood products; (3) a surveillance system for adverse events that provides feedback at the provider level.     

American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm – 2023 Update

ObjectiveThis consensus statement provides (1) visual guidance in concise graphic algorithms to assist with clinical decision-making of health care professionals in the management of persons with type 2 diabetes mellitus to improve patient care and (2) a summary of details to support the visual guidance found in each algorithm.MethodsThe American Association of Clinical Endocrinology (AACE) selected a task force of medical experts who updated the 2020 AACE Comprehensive Type 2 Diabetes Management Algorithm based on the 2022 AACE Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan and consensus of task force authors.ResultsThis algorithm for management of persons with type 2 diabetes includes 11 distinct sections: (1) Principles for the Management of Type 2 Diabetes; (2) Complications-Centric Model for the Care of Persons with Overweight/Obesity; (3) Prediabetes Algorithm; (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Complications-Centric Algorithm for Glycemic Control; (7) Glucose-Centric Algorithm for Glycemic Control; (8) Algorithm for Adding/Intensifying Insulin; (9) Profiles of Antihyperglycemic Medications; (10) Profiles of Weight-Loss Medications (new); and (11) Vaccine Recommendations for Persons with Diabetes Mellitus (new), which summarizes recommendations from the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention.ConclusionsAligning with the 2022 AACE diabetes guideline update, this 2023 diabetes algorithm update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and diabetes mellitus and highlights the importance of appropriate management of atherosclerotic risk factors of dyslipidemia and hypertension. One notable new theme is an emphasis on a complication-centric approach, beyond glucose levels, to frame decisions regarding first-line pharmacologic choices for the treatment of persons with diabetes. The algorithm also includes access/cost of medications as factors related to health equity to consider in clinical decision-making.     

Use of national and international growth charts for studying height in European children: development of up-to-date European height-for-age charts

Background

Growth charts based on data collected in different populations and time periods are key tools to assess children’s linear growth. We analyzed the impact of geographic factors and the secular trend on height-for-age charts currently used in European populations, developed up-to-date European growth charts, and studied the effect of using different charts in a sample of growth retarded children.

Methods and Findings

In an international survey we obtained 18 unique national height-for-age charts from 28 European countries and compared them with charts from the World Health Organization (WHO), Euro-Growth reference, and Centers of Disease Control and Prevention (CDC). As an example, we obtained height data from 3,534 children with end-stage renal disease (ESRD) from 13 countries via the ESPN/ERA-EDTA registry, a patient group generally suffering from growth retardation. National growth charts showed a clear secular trend in height (mean height increased on average 0.6 cm/decade) and a North-South height gradient in Europe. For countries without a recent (>1990) national growth chart novel European growth charts were constructed from Northern and Southern European reference populations, reflecting geographic height differences in mean final height of 3.9 cm in boys and 3.8 cm in girls. Mean height SDS of 2- to 17-year-old ESRD patients calculated from recent national or derived European growth charts (−1.91, 95% CI: −1.97 to −1.85) was significantly lower than when using CDC or WHO growth charts (−1.55, 95% CI: −1.61 to −1.49) (P<0.0001).

Conclusion

Differences between height-for-age charts may reflect true population differences, but are also strongly affected by the secular trend in height. The choice of reference charts substantially affects the clinical decision whether a child is considered short-for-age. Therefore, we advocate using recent national or European height-for-age charts derived from recent national data when monitoring growth of healthy and diseased European children.     

N-estimation from retrospectively ascertained events with applications to AIDS.

It is a common sampling scheme in retrospective studies that the data set includes only individuals who satisfy a certain sampling criterion. In this paper we consider the situation when the sampling criterion is a specified event, and assume that an earlier event can be retrospectively identified given the occurrence of the specified event. A semiparametric method, which is a compromise between nonparametric and parametric methods, is employed for the estimation of the expected number of the specified events (namely, the N-estimation) occurring in arbitrarily given intervals. A number of statistical properties of the estimates are developed. Due to the limitation of semiparametric models, our estimates should be regarded as conservative estimates since in general they underestimate the actual number of the specified events. This type of limitation, however, cannot be avoided with nonparametric or semiparametric models. Applications to acquired immunodeficiency syndrome (AIDS) cases are considered. The blood transfusion AIDS cases reported to the Centers for Disease Control are analyzed in detail.     

土拉弗朗西斯菌检测研究进展

土拉弗朗西斯菌（Francisella tularensis）是土拉菌病（Tularemia）的致病菌,是最具传染性的致病菌之一,在自然界中已发现一百种以上的动物感染此菌。因其传播途径多样,易扩散、毒性强而被美国疾病控制预防中心列入A类生物恐怖制剂。土拉菌病是一种人畜共患病,致死率高,及时、准确的检测土拉菌对于土拉菌病患者及时治疗和防止扩散具有重要的意义。土拉菌检测方法很多,如菌培养,微凝集实验、酶联免疫吸附、快速检测试纸条、生物传感器、PCR、核酸杂交检测、质谱分析、基因芯片等。但到目前为止还没有一种成熟的用于土拉菌检测方法,其主要原因在于土拉菌致病性强,且不易分离培养。本文综述了土拉菌细菌学、免疫学、分子生物学方法检测的最新研究进展。     

中国土厉螨属一新种（蜱螨亚纲：厉螨科）

本文记述中国土厉螨属１新种,王氏土厉螨Ｏｌｏｌａｅｌｅｐｓｗａｎｇｉ,ｓｐ．ｎｏｖ,新种的模式标本保存在宁夏回族自治区地方病防治所。     

Does symptomatic primary HIV-1 infection accelerate progression to CDC stage IV disease,CD4 count below 200 x 10(6)/l,AIDS, and death from AIDS?

OBJECTIVE--To investigate the prognostic significance of symptomatic primary HIV-1 infection. DESIGN--Prospective study of homosexual men seroconverting to HIV in 1985 and 1986. Patients were followed up at least three times yearly with clinical examinations and T cell subset determinations for an average of 7.2 years. SETTING--Research project centred on attenders for treatment and screening for HIV at the Karolinska Institute, Stockholm. SUBJECTS--19 patients presenting with a glandular-fever-like illness associated with seroconversion to HIV and 29 asymptomatic seroconverters. MAIN OUTCOME MEASURES--Progression to Centers for Disease Control and Prevention stage IV disease, CD4 cell count below 200 x 10(6)/l, AIDS, and death from AIDS. RESULTS--Symptomatic seroconverters were significantly more likely to develop Centers for Disease Control and Prevention stage IV disease (95% v 66%), CD4 cell counts below 200 x 10(6)/l (84% v 55%), and AIDS (58% v 28%) and die of AIDS (53% v 7%). CONCLUSION--A glandular-fever-like illness associated with seroconversion to HIV-1 predicts accelerated progression to AIDS and other HIV related diseases.     

Acquired immune deficiency syndrome in Canada: the first 5 years of surveillance.

In the first 5 years of surveillance of reports of the acquired immune deficiency syndrome (AIDS) in Canada, from February 1982, the Laboratory Centre for Disease Control, Ottawa, was notified of 1133 cases reported through provincial ministries of health that met the case definition developed by the US Centers for Disease Control, Atlanta. Most cases (82.2%) were reported from the homosexual/bisexual risk group. Other risk groups were less frequently represented, in contrast to the experience in the United States, where a higher proportion of cases in drug abusers has been observed, and in Africa, where heterosexual spread is far more common. The presenting clinical picture and length of survival after diagnosis were similar to those reported for other countries. Differences between projected estimates of the number of AIDS cases obtained with polynomial and logistic growth models emphasize the need for solid epidemiologic data on the number of people infected with human immunodeficiency virus, the rates of transmission and the rates of progression to disease.