新型冠状病毒肺炎疫情防控期间内镜诊疗相关感染防控建议

针对2019年底出现在我国的新型冠状病毒肺炎疫情,全国上下拼尽全力积极抗疫。目前全国疫情在得到良好控制的同时,各大医疗机构为防控疫情纷纷暂停的各项高风险诊疗项目也陆续开诊。由此根据国家卫生健康委员会最新发布的《新型冠状病毒肺炎诊疗方案(试行第八版)》及《新型冠状病毒肺炎防控方案(第七版)》等文件,结合相关国家规范对新型冠状病毒肺炎疫情防控期间消化内镜、支气管镜及喉镜(软镜)诊疗的感染防控措施进行梳理和总结,提出相关建议以供临床医务工作者参考。     

青岛地区COVID19流行病学特征分析

目的分析青岛地区新型冠状病毒肺炎(COVID-19)的流行病学特征。方法纳入青岛市自2020年1月21日至3月3日所有COVID-19确诊病例(n=60),收集患者基本信息和流行病学资料,分析易感人群、传播模式、基本繁殖数、疫情进展及其与防控措施的相关性。结果 60例确诊患者包括27例输入性病例和33例本地感染病例。本地感染者以女性为主,占69.7%,显著高于输入性病例(37.0%)(χ~2=6.400,P=0.011)。本地共发生三代传播,发病例数逐代减少。青岛地区总病例R0值为1.49。本地一代、二代和三代的R0值分别为1.38、1.53、1.56。传播模式由家庭聚集性向密切接触转换。结论青岛地区本地传播病例女性易感,日新增病例总体呈波浪式下降趋势,目前疫情已基本得到控制,应进一步做好分区分级精准防控,加强对外来人员的隔离观察,防止出现疫情反弹。     

输入病毒导致的十起本土疫情首例病例新冠病毒基因特征分析

2020年4月中国阻断湖北省武汉市新冠肺炎疫情传播后,中国国内报道了多起由境外输入导致的本土聚集性新冠肺炎疫情。为分析引起聚集性疫情的输入性新型冠状病毒(SARS-CoV-2)的基因组特征,本研究对2020年4-11月份十起输入相关本土疫情首例病例的SARS-CoV-2全基因组基因特征进行分析,系统阐述了相关SARS-CoV-2的全基因组和氨基酸变异特征。结果显示,与武汉参考株相比,十起本土聚集性疫情首例病例的SARS-CoV-2核苷酸突变中位数为10个(8个-26个),氨基酸突变的中位数为6个(4个-16个),且刺突(spike,S)蛋白只有D614G一个氨基酸发生突变。除分支位点外,10条SARS-CoV-2全基因组序列的65个核苷酸突变位点以及35个氨基酸突变仅出现1-2次,呈现随机性。全基因组分析表明,这十起本土疫情的首例病例基因组按照中国分型法可划分为4个型,按照Pangolin分型法可划分为7个型,与我国2020年1-3月份武汉流行的毒株属于不同基因型,不是本土SARS-CoV-2的持续传播。与2020年9-12月英国和南非变异株属于不同基因型,无相关性。本文系统分析了2020年由输入病毒导致的十起本土疫情首例病例的SARS-CoV-2核苷酸与氨基酸变异特征,为我国新冠防控策略的制定以及后续新冠疫情的溯源提供了参考依据。     

《关于暂停2020全国中西医结合皮肤性病学术年会》的通知

正根据《中西医结合学会关于停止或取消学术会议等聚集性活动的紧急通知》精神,根据全国新型冠状病毒感染的肺炎疫情防控工作的严峻形势。依照《中华人民共和国传染病防治法》、《中华人民共和国突发事件应对法》等有关规定,中国中西医结合学会皮肤性病专业委员会决定,暂停原定于2020年4月23日     

新型冠状病毒疫苗接种与疫情进展

新型冠状病毒肺炎(简称新冠)疫情仍在发展,新型冠状病毒变异株的出现致使其传染性和致病性增强,部分国家的政府和民众防控措施松懈导致某些地区疫情加剧。新型冠状病毒疫苗广泛使用后,接种情况会影响疫情发展。本文主要阐述新冠疫情与疫苗接种、病毒变异的关联性,接种疫苗存在的问题及其应对措施,并建议在加快疫苗接种的同时应做好各项新冠防控工作。     

新型冠状病毒实验室检测方法研究进展

世界范围内流行的SARS-CoV-2已造成大批新型冠状病毒肺炎(COVID-19)患者,严重威胁着全人类生命健康.新型冠状病毒肺炎尚没有特效药,也没有疫苗,实验室确诊新型冠状病毒肺炎,隔离传染源,尽早治愈患者对整个疫情防控起着非常重要的作用.目前实验室检测方法有病毒分离培养、实时荧光定量PCR、环介导等温扩增技术、CRISPR/Cas技术、测序技术、基因芯片和抗原抗体检测.本文就上述几种方法做一综述,为确诊COVID-19提供参考.     

抗新型冠状病毒中和抗体药物临床研究进展北大核心CSCD

自1998年预防呼吸合胞病毒的帕利珠单抗药物上市以来,多种靶向病毒的治疗性抗体药物已成功用于感染性疾病的临床治疗。新型冠状病毒肺炎疫情暴发后,多种中和抗体药物快速进入临床研究阶段,展现出积极的治疗及预防效果,并以紧急使用授权的方式用于疫情防控。本文对抗新型冠状病毒中和抗体药物的临床进展和主要临床试验结果进行总结,以期为包括新型冠状病毒肺炎在内的新发、突发传染病中和抗体药物研发提供参考。     

一起流行性脑脊髓膜炎疫情的调查及控制

目的对流行性脑脊髓膜炎疫情进行流行病学分析,以了解流行性脑脊髓膜炎(流脑)发生的特点,评价防控措施的效果。方法采用现场流行病学、血清学调查的方法对发生的流行性脑脊髓膜炎疫情进行调查分析。结果此疫情鉴定为一起C群脑膜炎奈瑟菌引起的聚集性病例,3例病人均已接种过A群流脑多糖疫苗3～4次,而未接种过A群C群流脑多糖疫苗,对C群脑膜炎奈瑟菌无免疫力;采取相应措施后疫情得到控制,没有引起流脑流行。结论对C群脑膜炎奈瑟菌所致疫情,采取以预防性服药、应急接种为主的综合控制措施能得到有效控制。     

群体免疫理论与COVID-19的管控

2019年12月底,不明原因的肺炎病例在全球爆发,经检测是新型冠状病毒感染所致.感染该病毒引起的肺炎被命名为"COVID-19".从早期的"不明肺炎",到如今疫情在全球持续传播,急剧增长的肺炎病例确诊数字背后,各个国家(如中国,英国)对于新型冠状病毒的认知和防范都有着哪些不同的应对策略?热搜中的英国的"群体免疫"策略是...     

2017-2020年河南省漯河市呼吸道合胞病毒流行特征研究

呼吸道合胞病毒(Respiratory syncytial virus,RSV)是引起严重急性呼吸道感染(Severe acute respiratory infection,SARI)的一个重要病原,尤其以5岁以下儿童为主.为了解河南省漯河市SARI住院患者中RSV感染的流行病学和临床特征,为RSV预防控制及临床诊疗提供科学数据,本研究采集2017年10月至2020年8月河南省漯河市SARI住院病例的咽拭子,并收集流行病学和临床信息.采用荧光定量PCR方法鉴定RSV A/B阳性病例,分析其流行病学和临床特征.结果显示,本研究共入组1335例SARI病例,其中220例(16.48％)为RSV阳性,A和B亚型分别占64.55％和30.45％.RSV感染以5岁以下儿童为主(占91.36％),2岁以下婴幼儿占RSV感染病例的一半以上(占55.37％).RSV流行高峰出现在11月-次年1月,不同年份流行季可前后相差一个月.A﹑B亚型在不同月份可单独流行也可共流行.受新型冠状病毒肺炎疫情影响,2020年2-8月SARI病例数较往年同期减少60％以上,RSV阳性率在2020年2-8月降低为0.与非RSV感染组相比,RSV更易感染2岁以下儿童,下呼吸道感染占比更高(以支气管肺炎为主).本研究通过近3年SARI病例监测,揭示河南省漯河市RSV感染以冬春季常见,以下呼吸道感染为主,主要感染5岁以下儿童,其中2岁以下婴幼儿是防控重点人群.新型冠状病毒肺炎流行期间,由于限制性防控措施的干预,RSV感染大大降低.本研究将为RSV疫苗和单克隆抗体等预防性干预手段的使用策略提供基础数据.     

Scientific research progress of COVID‐19/SARS‐CoV‐2 in the first five months

A cluster of pneumonia (COVID‐19) cases have been found in Wuhan China in late December, 2019, and subsequently, a novel coronavirus with a positive stranded RNA was identified to be the aetiological virus (severe acute respiratory syndrome coronavirus 2, SARS‐CoV‐2), which has a phylogenetic similarity to severe acute respiratory syndrome coronavirus (SARS‐CoV). SARS‐CoV‐2 transmits mainly through droplets and close contact and the elder or people with chronic diseases are high‐risk population. People affected by SARS‐CoV‐2 can be asymptomatic, which brings about more difficulties to control the transmission. COVID‐19 has become pandemic rapidly after onset, and so far the infected people have been above 2 000 000 and more than 130 000 died worldwide according to COVID‐19 situation dashboard of World Health Organization ( https://covid19.who.int ). Here, we summarized the current known knowledge regarding epidemiological, pathogenesis, pathology, clinical features, comorbidities and treatment of COVID‐19/ SARS‐CoV‐2 as reference for the prevention and control COVID‐19.     

Prevention and treatment of COVID-19 using Traditional Chinese Medicine: A review

BackgroundA novel coronavirus (SARS-CoV2) outbreak in more than 200 countries recently caused viral pneumonia that was extremely infectious and pathogenic. The Chinese government proposes that both Traditional Chinese medicine (TCM) and Western medicine can be used in combination to treat pneumonia caused by SARS-CoV2, and TCM effectively provides continuous prevention and treatment.MethodsThe present review analyzes and summarizes the prevention and treatment of the novel coronavirus disease (COVID-19) with TCM. A classified analysis of the efficacy and advantages of TCM for the prevention and treatment of COVID-19 was performed, and the mechanisms of TCM in treating COVID-19 are summarized.ResultsTCM is effective in preventing COVID-19, and medical staff can prevent an iatrogenic infection by taking a decoction made based on the principles of TCM. As of March 13, 2020, new cases of COVID-19 in China have decreased in number to single digits. TCM's curative effect was outstanding, with a national participation rate of over 90%. More than 70,000 people were cured of COVID-19 and discharged from the hospital. Only approximately 10,000 patients are currently being treated, and the total treatment time is approximately 2 months.ConclusionsTCM is currently the best choice for the treatment and prevention of COVID-19, and it is expected that it will be promoted by countries around the world.     

33例普通型新型冠状病毒肺炎的临床特征分析

摘要 目的：总结33例普通型新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者的临床特征,为临床治疗提供指导。方法：回顾性分析我院收治的33例COVID-19患者的临床资料,对其特征进行分析。结果：31例患者有流行病学接触史,其中16例有家庭聚集情况。最常见的临床症状为发热、咳嗽等上呼吸道感染症状,少见可出现腹泻、上腹部不适,罕见头痛、视神经脊髓炎。患者治疗后实验室大部分指标均改善明显,但淋巴细胞以及心肌损伤标记物高敏心肌肌钙蛋白T(high sensitive cardiac troponin,hs-cTnT)改善稍晚。97.0 %的患者胸部CT中以磨玻璃影为主,但这与普通病毒性肺炎无明显区别,老年患者可合并胸腔积液。结论：在西安地区收治的COVID-19患者多数有明确的流行病学史,临床表现主要为发热咳嗽,但也可累及消化系统及神经系统出现症状。患者经治疗后实验室指标大部分改善明显,肺部影像学以磨玻璃样改变居多,也可出现胸腔积液。普通型患者经治疗后预后良好。     

Transmission and containment of the SARS-CoV-2 Delta variant of concern in Guangzhou,China: A population-based study

BackgroundThe first community transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant of concern (VOC) in Guangzhou, China occurred between May and June 2021. Herein, we describe the epidemiological characteristics of this outbreak and evaluate the implemented containment measures against this outbreak.Methodology/Principal findingsGuangzhou Center for Disease Control and Prevention provided the data on SARS-CoV-2 infections reported between 21 May and 24 June 2021. We estimated the incubation period distribution by fitting a gamma distribution to the data, while the serial interval distribution was estimated by fitting a normal distribution. The instantaneous effective reproductive number (R_t) was estimated to reflect the transmissibility of SARS-CoV-2. Clinical severity was compared for cases with different vaccination statuses using an ordinal regression model after controlling for age. Of the reported local cases, 7/153 (4.6%) were asymptomatic. The median incubation period was 6.02 (95% confidence interval [CI]: 5.42–6.71) days and the means of serial intervals decreased from 5.19 (95% CI: 4.29–6.11) to 3.78 (95% CI: 2.74–4.81) days. The incubation period increased with age (P<0.001). A hierarchical prevention and control strategy against COVID-19 was implemented in Guangzhou, with R_t decreasing from 6.83 (95% credible interval [CrI]: 3.98–10.44) for the 7-day time window ending on 27 May 2021 to below 1 for the time window ending on 8 June and thereafter. Individuals with partial or full vaccination schedules with BBIBP-CorV or CoronaVac accounted for 15.3% of the COVID-19 cases. Clinical symptoms were milder in partially or fully vaccinated cases than in unvaccinated cases (odds ratio [OR] = 0.26 [95% CI: 0.07–0.94]).Conclusions/SignificanceThe hierarchical prevention and control strategy against COVID-19 in Guangzhou was timely and effective. Authorised inactivated vaccines are likely to contribute to reducing the probability of developing severe disease. Our findings have important implications for the containment of COVID-19.     

Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone

IntroductionThe scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas.MethodsInternal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods—June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected.ResultsThere were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased from 1.0 to 8.8 per confirmed EVD case, EMC capacity increased from 32 to 100 beds, the number of burial teams doubled, and health promotion activities increased in coverage. These improvements in response were associated with the following changes between the same periods: the proportion of confirmed/probable cases admitted to the EMC increased from 35% to 83% (χ² p-value<0·001), the proportion of confirmed patients admitted to the EMC <3 days of symptom onset increased from 19% to 37% (χ² p-value <0·001), and reported funeral contact in those admitted decreased from 33% to 16% (χ² p-value <0·001). Mathematical modelling confirmed the importance of both patient management capacity and surveillance and contact tracing for EVD control.DiscussionOur findings demonstrate that control of EVD can be achieved using established interventions based on identification and appropriate management of those who are at risk of and develop EVD, including in the context of ongoing transmission in surrounding regions. Key attributes in achieving control were sufficient patient care capacity (including admission to specialist facilities of suspect and probable cases for assessment), integrated with adequate staffing and resourcing of community-based case detection and prevention activities. The response structure and coverage targets we present are of value in informing effective control in current and future EVD outbreaks.     

Epidemiological and clinical features in patients with coronavirus disease 2019 outside of Wuhan,China: Special focus in asymptomatic patients

ObjectivesIn December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan City and rapidly spread across the world. The clinical characteristics of affected patients in different regions and populations may differ. Thus, this study aimed to identify the characteristics of the disease to provide an insight about the prevention and treatment of COVID-19.MethodsData on the demographic characteristics and clinical findings of the patients admitted at the First Hospital of Changsha from January 1, 2020 to February 10, 2020 were assessed.ResultsIn this study, there were 8 (3.8%) asymptomatic, 21 (10.0%) mild upper respiratory tract infection (URTI), and 180 (86.1%) pneumonia cases. In total, 47 (22.5%) patients resided in Wuhan, and 45 (21.5%) had recently traveled to Wuhan before disease onset. Moreover, 19 (9.1%) had contact with people from Wuhan, and 69 (33.0%) were family cluster cases. The median incubation period was approximately 6.3 (range: 1.0–20.0) days. Fever and cough were the most common initial symptoms: 99 (49.3%) patients presented with fever, without cough; 59 (29.4%) with cough, without fever; and 33 (16.4%) with both fever and cough.ConclusionThe symptoms of patients with COVID-19 were relatively mild outside Wuhan, and family cluster was a remarkable epidemic characteristic. Special attention should be paid to asymptomatic patients.     

Whole Genome Sequencing versus Traditional Genotyping for Investigation of a Mycobacterium tuberculosis Outbreak: A Longitudinal Molecular Epidemiological Study

Background

Understanding Mycobacterium tuberculosis (Mtb) transmission is essential to guide efficient tuberculosis control strategies. Traditional strain typing lacks sufficient discriminatory power to resolve large outbreaks. Here, we tested the potential of using next generation genome sequencing for identification of outbreak-related transmission chains.

Methods and Findings

During long-term (1997 to 2010) prospective population-based molecular epidemiological surveillance comprising a total of 2,301 patients, we identified a large outbreak caused by an Mtb strain of the Haarlem lineage. The main performance outcome measure of whole genome sequencing (WGS) analyses was the degree of correlation of the WGS analyses with contact tracing data and the spatio-temporal distribution of the outbreak cases. WGS analyses of the 86 isolates revealed 85 single nucleotide polymorphisms (SNPs), subdividing the outbreak into seven genome clusters (two to 24 isolates each), plus 36 unique SNP profiles. WGS results showed that the first outbreak isolates detected in 1997 were falsely clustered by classical genotyping. In 1998, one clone (termed “Hamburg clone”) started expanding, apparently independently from differences in the social environment of early cases. Genome-based clustering patterns were in better accordance with contact tracing data and the geographical distribution of the cases than clustering patterns based on classical genotyping. A maximum of three SNPs were identified in eight confirmed human-to-human transmission chains, involving 31 patients. We estimated the Mtb genome evolutionary rate at 0.4 mutations per genome per year. This rate suggests that Mtb grows in its natural host with a doubling time of approximately 22 h (400 generations per year). Based on the genome variation discovered, emergence of the Hamburg clone was dated back to a period between 1993 and 1997, hence shortly before the discovery of the outbreak through epidemiological surveillance.

Conclusions

Our findings suggest that WGS is superior to conventional genotyping for Mtb pathogen tracing and investigating micro-epidemics. WGS provides a measure of Mtb genome evolution over time in its natural host context. Please see later in the article for the Editors'' Summary     

Temporal estimates of case-fatality rate for COVID-19 outbreaks in Canada and the United States

BACKGROUND:Estimates of the case-fatality rate (CFR) associated with coronavirus disease 2019 (COVID-19) vary widely in different population settings. We sought to estimate and compare the COVID-19 CFR in Canada and the United States while adjusting for 2 potential biases in crude CFR.METHODS:We used the daily incidence of confirmed COVID-19 cases and deaths in Canada and the US from Jan. 31 to Apr. 22, 2020. We applied a statistical method to minimize bias in the crude CFR by accounting for the survival interval as the lag time between disease onset and death, while considering reporting rates of COVID-19 cases less than 50% (95% confidence interval 10%–50%).RESULTS:Using data for confirmed cases in Canada, we estimated the crude CFR to be 4.9% on Apr. 22, 2020, and the adjusted CFR to be 5.5% (credible interval [CrI] 4.9%–6.4%). After we accounted for various reporting rates less than 50%, the adjusted CFR was estimated at 1.6% (CrI 0.7%–3.1%). The US crude CFR was estimated to be 5.4% on Apr. 20, 2020, with an adjusted CFR of 6.1% (CrI 5.4%–6.9%). With reporting rates of less than 50%, the adjusted CFR for the US was 1.78 (CrI 0.8%–3.6%).INTERPRETATION:Our estimates suggest that, if the reporting rate is less than 50%, the adjusted CFR of COVID-19 in Canada is likely to be less than 2%. The CFR estimates for the US were higher than those for Canada, but the adjusted CFR still remained below 2%. Quantification of case reporting can provide a more accurate measure of the virulence and disease burden of severe acute respiratory syndrome coronavirus 2.

The risk of death associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is fundamental to the disease burden imposed by the coronavirus disease 2019 (COVID-19) pandemic. Quantification of this risk can provide critical information on the health and socioeconomic impact of the pandemic and identify population subgroups at highest risk for severe outcomes. The risk of death from a diagnosed infection, often referred to as the case-fatality rate (CFR), is the proportion of people who die from a disease among all those diagnosed with the disease over a certain period.Estimates of the COVID-19 CFR vary in different populations and at different stages of the outbreak, ranging from 0.4% in China¹ to 31.4% in the northwest region of Italy.² From individual-level data for patients in Hubei Province, Mainland China,³ an adjusted CFR of 3.6% (95% confidence interval [CI] 3.6%–3.8%) was estimated. For the outbreak on the Diamond Princess cruise ship, the age-adjusted CFR was estimated at 2.6% (95% CI 0.9%–6.7%) in all age groups but was substantially higher (13.0%, 95% CI 5.2%–26.0%) among those aged 70 years or older.⁴For ongoing outbreaks and especially during the exponential growth phase, the delay between onset of disease and knowledge of the final outcome may result in biased estimates of the CFR.⁵ Furthermore, underestimation of the number of COVID-19 cases will inflate the CFR. Limited ability to test or recognize mildly or moderately symptomatic people in both the United States and Canada has likely led to substantial underestimation of the rate of infection in affected communities.^6,7Given the importance of the CFR in public health planning, we sought to estimate the CFR for ongoing COVID-19 outbreaks in the US and Canada while accounting for preferential ascertainment of severe cases (leading to underestimation) and the lag time between disease onset and death.     

新冠肺炎疫情防控常态化背景下医院信息化建设的实践与探索

摘要：近年来随着信息化技术的深入发展,其在人们的生产生活中的作用日益突出,对提高工作效率方面作用显著。2020年新年伊始,湖北省武汉市爆发新冠肺炎（COVID-19）疫情并迅速蔓延全国,国家高度重视,医务人员迅速行动,积极投入到这场与病毒作战的没有硝烟的战争中。经过全国上下艰苦努力,我国新冠肺炎疫情防控向好态势进一步巩固,防控工作已从应急状态转为常态化防控状态。医院信息化建设是医院现代化建设和新冠疫情防控的客观要求,在新冠肺炎疫情防控常态化背景下有重要意义。本文从新冠肺炎疫情背景下医院信息化建设概述,医院信息化建设存在的问题,医院信息化建设实践和医院信息化建设探索四个方面进行阐述,致力于探索出疫情防控背景下医院信息化建设的整体思路。