‘Outbreak Gold Standard’Selection to Provide Optimized Threshold for Infectious Diseases Early-alert Based on China Infectious Disease Automated-alert and Response System

The China Infectious Disease Automated-alert and Response System（CIDARS） was successfully implemented and became operational nationwide in 2008. The CIDARS plays an important role in and has been integrated into the routine outbreak monitoring efforts of the Center for Disease Control（CDC） at all levels in China. In the CIDARS, thresholds are determined using the ？Mean＋2SD？ in the early stage which have limitations. This study compared the performance of optimized thresholds defined using the ？Mean ＋2SD？ method to the performance of 5 novel algorithms to select optimal ？Outbreak Gold Standard（OGS）？ and corresponding thresholds for outbreak detection. Data for infectious disease were organized by calendar week and year. The ？Mean＋2 SD？, C1, C2, moving average（MA）, seasonal model（SM）, and cumulative sum（CUSUM） algorithms were applied. Outbreak signals for the predicted value（Px） were calculated using a percentile-based moving window. When the outbreak signals generated by an algorithm were in line with a Px generated outbreak signal for each week, this Px was then defined as the optimized threshold for that algorithm. In this study, six infectious diseases were selected and classified into TYPE A（chickenpox and mumps）, TYPE B（influenza and rubella） and TYPE C [hand foot and mouth disease（HFMD） and scarlet fever]. Optimized thresholds for chickenpox（P_（55））, mumps（P_（50））, influenza（P_（40）, P_（55）, and P_（75））, rubella（P_（45） and P_（75））, HFMD（P_（65） and P_（70））, and scarlet fever（P_（75） and P_（80）） were identified. The C1, C2, CUSUM, SM, and MA algorithms were appropriate for TYPE A. All 6 algorithms were appropriate for TYPE B. C1 and CUSUM algorithms were appropriate for TYPE C. It is critical to incorporate more flexible algorithms as OGS into the CIDRAS and to identify the proper OGS and corresponding recommended optimized threshold by different infectious disease types.

Analysis of Monitoring,Early Warning and Emergency Response System for New Major Infectious Diseases in China and Overseas

In recent years,the impact of new major infectious diseases on people’s normal life is becoming more and more frequent,which has brought great impact on people’s life safety and social economy,especially the corona virus disease 2019,which has been sweeping the globe.Public health and disease prevention and control systems in different countries have different performances in response to the pandemic,but they all have exposed many shortcomings.Countries around the world urgently need to improve the monitoring,early warning and emergency response systems for new major infectious diseases.As the outpost and main part of medical rescue,the hospital urgently needs to establish a set of scientifically advanced emergency response mechanism that is suitable for the business process of the medical system and unified standards in order to improve the response efficiency and quality of emergency treatment.

Military-civilian cooperative emergency response to infectious disease prevention and control in China

In recent years, the incidence of severe infectious diseases has increased, and the number of emerging infectious diseases continues to increase. The Chinese government and military forces have paid a great deal of attention to infectious disease prevention and control, and using military-civilian cooperation, they have successfully prevented numerous severe epidemic situations, such as severe acute respiratory syndrome(SARS), influenza A(H1N1), avian influenza H5N1 and H7N9, and Ebola hemorrhagic fever, while actively maintained public health, economic development, and national construction. This paper focuses on the mechanisms of the military-cooperative emergency response to infectious diseases–the joint working mechanism, the information-sharing mechanism, the research collaboration mechanism, and the joint disposal mechanism–and presents a sorted summary of the practices and experiences of cooperative emergency responses to infectious diseases. In the future, the Chinese military and the civilian sector will further strengthen the cooperative joint command system and emergency rescue force and will reinforce their collaborative information-sharing platform and technical equipment system to further improve military-civilian collaborative emergency infectious diseases disposal, advance the level of infectious disease prevention and control, and maintain public health.

Hospitals’responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019(COVID-19)pandemic:implications for low-and middle-income countries

The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.

Effect of Chicken Akirin2 Gene on Immune Response Induced by VP2 DNA Vaccine of Infectious Bursal Dis-ease Virus

[ Abstracts ] In order to investigate the effect of chicken Akirin2 gene on the immune response induced by VP2 DNA vaccine of infectious bursal disease virus （IBDV）. [ Methods] The 14-day-old SPF chickens were immunized with recombinant plasmids expressing VP2 protein and Akirin2 protein, and strength- ened immunization was conducted at the 14＇~ day after the first immunization. Finally, test chickens were challenged with IBDVBC6-85 virulent strain. [ Resultss ] Test results showed that Akirin2 gene could enhance the specific immune response induced by VP2 DNA vaccine, improve the proliferation of peripheral blood lym- phocytes and ＇affect the expressing of cytokines TNF-a, IFN-Y, IL-1β, IL-2, IL-4, IL 6, IL-9, IL-10, IL-17 and IL-18. Effects of recombinant plasmids co-ex- pressing Akirin2 protein and VP2 protein on cytokine expression showed some differences with the recombinant plasmids expressing Akirir/2 protein or VP2 protein along. [ Conclusions] Chicken Akirin2 gene could significantly enhance the humoral immune response and cellular immune response induced by VP2 DNA vaccine of IBDV.

Immunogenicity of formaldehyde and binary ethylenimine inactivated infectious bursal disease virus in broiler chicks

Infectious bursal disease virus (IBDV) was inactivated by two different chemicals—formaldehyde and binary ethylenimine (BEI). Formaldehyde was used at 0.1% and 0.2%, while BEI was used at concentrations of 0.001 and 0.002 mol/L. These four vaccines were tested for their efficiency in generating humoral immune response in different groups of broiler chicks. Both BEI-inactivated vaccines gave relatively higher antibody titers and were almost twice as efficient as formaldehyde-inactivated ones.

Need of surveillance response systems to combat Ebola outbreaks and other emerging infectious diseases in African countries

There is growing concern in Sub-Saharan Africa about the spread of the Ebola virus disease(EVD),formerly known as Ebola haemorrhagic fever,and the public health burden that it ensues.Since 1976,there have been 885,343 suspected and laboratory confirmed cases of EVD and the disease has claimed 2,512 cases and 932 fatality in West Africa.There are certain requirements that must be met when responding to EVD outbreaks and this process could incur certain challenges.For the purposes of this paper,five have been identified:(i)the deficiency in the development and implementation of surveillance response systems against Ebola and others infectious disease outbreaks in Africa;(ii)the lack of education and knowledge resulting in an EVD outbreak triggering panic,anxiety,psychosocial trauma,isolation and dignity impounding,stigmatisation,community ostracism and resistance to associated socio-ecological and public health consequences;(iii)limited financial resources,human technical capacity and weak community and national health system operational plans for prevention and control responses,practices and management;(iv)inadequate leadership and coordination;and(v)the lack of development of new strategies,tools and approaches,such as improved diagnostics and novel therapies including vaccines which can assist in preventing,controlling and containing Ebola outbreaks as well as the spread of the disease.Hence,there is an urgent need to develop and implement an active early warning alert and surveillance response system for outbreak response and control of emerging infectious diseases.Understanding the unending risks of transmission dynamics and resurgence is essential in implementing rapid effective response interventions tailored to specific local settings and contexts.Therefore,the following actions are recommended:(i)national and regional inter-sectorial and trans-disciplinary surveillance response systems that include early warnings,as well as critical human resources development,must be quickly adopted by allied ministries and organisations in African countries in epidemic and pandemic responses;(ii)harnessing all stakeholders commitment and advocacy in sustained funding,collaboration,communication and networking including community participation to enhance a coordinated responses,as well as tracking and prompt case management to combat challenges;(iii)more research and development in new drug discovery and vaccines;and(iv)understanding the involvement of global health to promote the establishment of public health surveillance response systems with functions of early warning,as well as monitoring and evaluation in upholding research-action programmes and innovative interventions.

Surveillance and response systems for elimination of tropical diseases: summary of a thematic series in Infectious Diseases of Poverty

The peer-reviewed journal Infectious Diseases of Poverty provides a new platform to engage with,and disseminate in an open-access format,science outside traditional disciplinary boundaries.The current piece reviews a thematic series on surveillance-response systems for elimination of tropical diseases.Overall,22 contributions covering a broad array of diseases are featured–i.e.clonorchiasis,dengue,hepatitis,human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS),H7N9 avian influenza,lymphatic filariasis,malaria,Middle East respiratory syndrome(MERS),rabies,schistosomiasis and tuberculosis(TB).There are five scoping reviews,a commentary,a letter to the editor,an opinion piece and an editorial pertaining to the theme“Elimination of tropical disease through surveillance and response”.The remaining 13 articles are original contributions mainly covering(i)drug resistance;(ii)innovation and validation in the field of mathematical modelling;(iii)elimination of infectious diseases;and(iv)social media reports on disease outbreak notifications released by national health authorities.Analysis of the authors’affiliations reveals that scientists from the People’s Republic of China(P.R.China)are prominently represented.Possible explanations include the fact that the 2012 and 2014 international conferences pertaining to surveillance-response mechanisms were both hosted by the National Institute of Parasitic Diseases(NIPD)in Shanghai,coupled with P.R.China’s growing importance with regard to the control of infectious diseases.Within 4 to 22 months of publication,three of the 22 contributions were viewed more than 10000 times each.With sustained efforts focusing on relevant and strategic information towards control and elimination of infectious diseases,Infectious Diseases of Poverty has become a leading journal in the field of surveillance and response systems in infectious diseases and beyond.

Combating infectious diseases of poverty: a year on

The Infectious Diseases of Poverty journal,launched a year ago,is a platform to engage outside the traditional disciplinary boundaries,and disseminate high quality science towards the improvement of health.This paper reviews the milestone achievements during its first year of operation.The journal has filled an important niche,addressing some of the main priorities in the Global Report for Research on Infectious Diseases of Poverty.Highlights include the publication of three thematic issues on health systems,surveillance and response systems,as well as co-infection and syndemics.The thematic issues have foregrounded the importance and innovation that can be achieved through transdisciplinary research.The journal has been indexed by PubMed since April 2013,with the publication of a total of 38 articles.Finally,the journal is delivering to wider range readers both in developing and developed countries with sustained efforts with a focus on relevant and strategic information towards elimination of infectious diseases of poverty.

2012-2022年北京市石景山区传染病自动预警系统运行情况分析

目的 评价2012-2022年北京市石景山区传染病自动预警系统运行情况,为传染病智慧化预警多点触发机制的建立提供参考。方法 利用中国疾病预防控制信息系统中的传染病自动预警系统,收集石景山区2012-2022年传染病自动预警系统监测数据,并进行描述性分析。结果 2012-2022年北京市石景山区传染病自动预警系统发出涉及29种传染病的预警信号4 555条,响应4 555条,响应率100.00%;平均响应时间为3.23 h, 11年间预警信号数先呈波动性下降趋势,2022年急剧上升;固定阈值法、时间模型和时空模型及时响应率分别为99.75%、97.37%和95.90%;3种预警模式暴发事件阳性率不同,暴发事件涉及病种为麻疹、肺结核、流行性感冒和手足口病,表明传染病自动预警系统对麻疹、肺结核、流行性感冒和手足口病预测准确率较高。结论 北京市石景山区传染病自动预警系统运行较稳定,预警信号及时响应率高,但仍需进一步完善优化,切实提高传染病监测预警系统的敏感性和及时性。

儿科医务人员传染病突发事件应急能力评价指标体系构建

目的 构建儿科医务人员应对传染病突发事件的应急能力评价指标体系。方法 以PPRR(预防、准备、反应、恢复)风险管理模型为基础,采用文献研究法和半结构式访谈法初步构建儿科医务人员传染病突发事件应急能力评价体系;采用专家函询法、层次分析法,确定儿科医务人员传染病突发事件应急能力评价体系内容和各指标权重。结果 最终获得一级指标4个、二级指标13个、三级指标37个,并确定相应指标的权重系数。2轮专家函询的问卷回收率分别为100%和94.44%,专家判断系数(Ca)均为0.922,熟悉程度(Cs)均为0.811,权威系数(Cr)均为0.866 5。结论 基于PPRR风险管理模型构建的儿科医务人员传染病突发事件应急能力评价指标具有较高的科学性和实用性,后续仍需在实践中继续优化和完善。

急性呼吸道传染病应急响应下的应急物资分级库存模型研究

目的:构建适用于不确定环境下的应急物资分级库存模型,以为传染病暴发后的应急响应提供更准确和有效的决策支持。方法:首先,使用“之”字形不确定分布构建应急物资分级模型;其次,将经济订购量(economic order quantity,EOQ)模型与应急物资分级模型相结合构建应急物资分级库存模型;最后,以W市某次急性呼吸道传染病事件为例,验证提出的应急物资分级库存模型的实用性和有效性。结果:该模型在大部分情况下能够准确地对应急物资进行分级,且以该模型计算得到的库存量十分接近需求量。结论:建立的应急物资分级库存模型在急性呼吸道传染病的应急响应中具有实用性和有效性,可以帮助决策者更准确地预测应急物资的需求,提高应急响应的能力和效率。

医联体内护士传染病相关应急能力现状及影响因素调查

目的探讨医联体内护士传染病突发公共卫生事件应急能力的现状及影响因素。方法采用便利抽样的方法,选取2022年1月—2023年1月404名医联体内护士进行问卷调查分析。统计404名不同特征护士应急能力得分、应急能力得分较低和较高的条目、应急能力得分情况,采用logistic多元分层回归分析医联体内护士传染病突发公共卫生事件应急能力得分的影响因素。结果一级指标准备得分最高的项目为“救援能力”(126.67±10.89)分,得分最低的项目为“风险沟通能力”(3.02±0.77)分;二级指标得分最高项目为“预防能力评分”(13.67±1.07)分,得分最低的项目是“应急演练评分”(3.43±0.78)分。三级医院、男性、年龄>39岁、临床经验>14年、硕士、有救援工作经验、有突发事件应急救援经验、过去5年参加过新发传染病事件应急演练、过去5年参加过常见传染病或新发传染病培训的护士应急能力得分高于一二级医院、女性、年龄<31岁和31~39岁、临床经验<6年和6~14年、本科和专科、无救援工作经验、无突发事件应急救援经验、过去5年未参加过新发传染病事件应急演练、过去5年未参加过常见传染病或新发传染病培训的护士,差异有统计学意义(P<0.05)。性别、年龄、学历、医院级别、临床经验、突发事件应急救援经验、过去5年参加新发传染病事件应急演练、过去5年参加常见传染病或新发传染病培训均为应急能力的主要影响因素(P<0.05)。结论医联体内护士应急能力评分处于中等水平。护理管理人员应选择适当的方法对医联体内护士进行传染病突发事件应急能力的演练和培训,以提高其应急能力。

基于PPRR理论的精神专科医院传染病防控能力评价指标体系构建

目的构建精神专科医院传染病防控能力评价指标,为提升精神专科医院传染病防控能力建设提供参考依据。方法基于PPRR危机管理理论,综合运用文献法、半结构式访谈法、德尔菲法、层次分析法构建精神专科医院传染病防控能力评价指标体系。结果经过2轮专家函询,专家咨询积极系数均为100%,专家平均权威系数为0.88,协调系数较好,构建了一套包括4个一级指标,20个二级指标,85个三级指标的精神专科医院传染病防控能力评价指标体系,经层次法分析各级评价指标均符合一致性检验要求。结论该评价指标体系有一定的科学性和可靠性,为精神专科医院传染病防控提供了可行性标准。

美军应对重大传染病疫情实践与模式

目的分析美军应对重大传染病疫情实践与模式,以期为提高重大传染病处置能力提供参考。方法运用文献分析法,获取美军应对重大传染病的实践信息,总结其应对模式。结果美军基于疫情风险评估,针对各类人员出台并更新疫情处置指南。在疫情处置实践中采用了派遣医疗队、部署医院船、建造野战医院和扩大军工产能及军队医院服务范围4种形式。结论美军采用军地协同、地方主导的模式应对重大传染病疫情,对重大疫情防控具有一定的参考价值。

Toward innovative veterinary nanoparticle vaccines

Nanoparticles are significant for veterinary vaccine development because they are safer and more effective than conventional formulations.One promising area of research involves self-assembled protein nanoparticles(SAPNs),which have shown potential for enhancing antigen-presenting cell uptake,B-cell activation,and lymph node trafficking.Numerous nanovaccines have been utilized in veterinary medicine,including natural self-assembled protein nanoparticles,rationally designed self-assembled protein nanoparticles,animal virus-derived nanoparticles,bacteriophagederived nanoparticles,and plant-derived nanoparticles,which will be discussed in this review.SAPN vaccines can produce robust cellular and humoral immune responses and have been shown to protect against various animal infectious diseases.This article attempts to summarize these diverse nanovaccine types and their recent research progress in the field of veterinary medicine.Furthermore,this paper highlights their disadvantages and methods for improving their immunogenicity.

护理专业学生突发重大传染病事件应急能力分析与探讨

目的了解高校护理专业学生突发重大传染病事件应急能力现状及影响因素,提出相应对策。方法采用随机抽样的方法抽取392名学生,以在线填写问卷的方式调查其对突发重大传染病事件的应急能力。结果护理专业学生突发重大传染病事件应急能力调查问卷总分为(123.98±23.64)分,得分率为64.21%。其中,一级条目中预防能力条目得分率最高,为74.27%;准备能力条目得分率最低,为56.53%。结论护理专业学生突发重大传染病事件应急能力处于中等偏下水平,学历层次、年级、是否参加过相关培训、是否取得护士执业资格证是其主要影响因素。

广西传染病科护士突发公共卫生事件应急能力现况调查及影响因素分析

目的了解广西传染病科护士突发公共卫生事件应急能力现况,并分析影响因素,为护理管理者提高护理人员应急能力制定决策提供理论依据。方法采用便利抽样法,选取广西壮族自治区58家医院从事传染性疾病护理工作的687名护理人员为调查对象,使用一般情况调查表、护士突发公共卫生事件应急能力调查表对其进行调查。结果687名传染病科护士突发公共卫生事件应急能力得分为(4.19±0.63)分,处于较高水平。多重线性逐步回归分析显示,护士所在的医院等级、职称、是救援队成员、参与过应急救援及接受过培训演练是应急能力的主要影响因素(P<0.05)。结论广西从事传染病护理工作的护士应急能力已达到较高水平,但医院还需不断完善系统的应急管理体系。护理管理人员应制定合理的培训方案,系统、全面地提高护理人员的应急能力。

江苏省血液净化护理人员传染病突发事件应急能力及影响因素的多中心调查研究

目的调查江苏省14所各级医院血液净化护理人员传染病突发事件应对能力现状并分析影响因素。方法采用传染病突发事件应对能力问卷对江苏省14所各级医院从事血液净化的护理人员进行横断面调查。结果①331位血液净化护理人员传染病突发事件应对能力得分为(3.63±0.64)分。②单因素分析显示:有无救援经历(t=-3.396,P=0.001)、应急演练次数(F=8.509,P<0.001)、理论培训次数(F=8.905,P<0.001)、工作单位类型(F=3.278,P=0.021)、职称(F=2.748,P=0.043)、工作年限(F=6.205,P=0.002)与护理人员传染病突发事件应急能力存在差异。③多元线性回归分析显示救援经历(β=0.132,P=0.013)、应急演练(β=0.128,P=0.042)、理论培训(β=0.132,P=0.037)、工作单位类型(β=-0.119,P=0.022)、工作年限(β=0.131,P=0.017)是护理人员传染病突发事件应急能力的影响因素。结论血液净化中心护理人员传染病突发事件应急能力为中等水平,在应急处理方面仍有欠缺。今后的临床管理中需加强对血液净化护理人员传染病相关知识的培训,提高护理人员应对传染病突发事件的应急能力。

突发重大传染病事件背景下过负荷医院管理研究的范围综述

背景过负荷医院在突发重大传染病事件中发挥重要作用。与其他情况相比,过负荷医院在突发重大传染病事件背景下的管理与运营具有特异性,管理模式的漏洞会造成严重后果,目前尚无相关研究的梳理与总结。目的对突发重大传染病事件背景下过负荷医院管理的研究进行范围审查,以分析医院管理的要素及研究现状,为未来该领域的研究提供指导。方法以Arksey和O’Malley报告的框架和原则及相关学者提供的进一步建议构建方法学框架,检索Pubmed、Embase、Cochrane Library、中国生物医学文献数据库中相关研究,检索时限为建库至2022-06-17。对纳入文献进行汇总和分析。结果纳入25篇文献,均来自于新型冠状病毒感染疫情期间中国方舱医院与定点医院的研究,过负荷医院管理的要素涵盖应急准备、人员管理、运营管理和服务管理。结论对于过负荷医院管理的研究数量增加、研究领域广泛,但研究质量不佳、缺乏统一的评价指标与反馈工具。今后应提高与过负荷医院相关研究质量,制定标准化管理流程,完善评价指标的构建和落实,为临床护理实践提供更多指导。