世界卫生组织(WHO,The World Health Organization) 感染科 2007-01-01
Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholerae present in faecally contaminated water or food. Primarily linked to insufficient access to safe water and proper sanitation, its impact can be even more dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed. Countries facing complex emergencies are particularly vulnerable to cholera outbreaks. Massive displacement of IDPs or refugees to overcrowded settings, where the provision of potable water and sanitation is challenging, constitutes also a risk factor. In consequence, it is of paramount importance to be able to rely on accurate surveillance data to monitor the evolution of the outbreak and to put in place adequate intervention measures Coordination of the different sectors involved is essential, and WHO calls for the cooperation of all to limit the effect of cholera on populations.
世界卫生组织(WHO,The World Health Organization) 感染科 2004-01-01
Two recent advances in managing diarrhoeal disease – newly formulated oral rehydrationsalts (ORS) containing lower concentrations of glucose and salt, and success in using zincsup plementation – can drastically reduce the number of child deaths. The new methods,used in addition to prevention and treatment of dehydration with appropriate fluids, breastfeeding, continued feeding and selective use of antibiotics, will reduce the duration and severity of diarrhoeal episodes and lower their incidence. Families and communities are key to achieving the goals set for managing the disease by making the new recommendations routine practice in the home and health facility.
美国疾病控制与预防中心(CDC,Centers for Disease Control and Prevention) 感染科 1999-01-01
Cholera and dysentery have afflicted humankind for centuries. The epidemics they cause have affected the outcome of wars and the fates of countries. In much of the world, epidemic cholera and dysentery are uncommon, but during the past decade these two diseases have re-emerged as causes of significant morbidity and mortality in many developing countries.
美国疾病控制与预防中心(CDC,Centers for Disease Control and Prevention) 感染科 1992-03-01
UNTIL recently, cholera has been rare in the Americas. However, epidemic cholera appeared in Peru in January 1991 and spread rapidly through Latin America. In the first year of this epidemic, 17 cases of cholera that were associated with travel to Latin America were reported in the United States. More cases are likely to be seen. Although no spread from these imported cases has occurred, it is possible that some areas of the United States with poor sanitary conditions may be at risk for limited continued transmission of cholera. This article reviews the methods for recognitiondiagnosis, and treatment of cholera.
美国疾病控制与预防中心(CDC,Centers for Disease Control and Prevention) 感染科 2002-12-11
Rabies is a fatal disease in humans, and, to date, the only survivors of the disease have received rabies vaccine before the onset of illness. The approach to management of the rabies normally should be palliative. In unusual circumstances, a decision may be made to use an aggressive approach to therapy for patients who present at an early stage of clinical disease. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon-alpha, and ketamine. Corticosteroids should not be used. As research advances, new agents may become available in the future for the treatment of human rabies.
美国疾病控制与预防中心(CDC,Centers for Disease Control and Prevention) 感染科 2009-01-01
During 2009, 49 states and Puerto Rico reported 6,690 rabid animals and 4 human rabies cases to the CDC, representing a 2.2% decrease from the 6,841 rabid animals and 2 human cases reported in 2008. Approximately 92% of reported rabid animals were wildlife. Relative contributions by the major animal groups were as follows: 2,327 (34.8%) raccoons, 1,625 (24.3%) bats, 1,603 (24.0%) skunks, 504 (7.5%) foxes, 300 (4.5%) cats, 81 (1.2%) dogs, and 74 (1.1%) cattle. Compared with 2008, numbers of rabid raccoons and bats that were reported decreased, whereas numbers of rabid skunks, foxes, cats, cattle, dogs, and horses that were reported increased. Fewer rabid raccoons, compared with 2008, were reported by 12 of the 20 eastern states where raccoon rabies is enzootic, and number of rabid raccoons decreased by 2.6% overall nationally. Despite a 10% decrease in the number of rabid bats that were reported and a decrease in the total number of bats submitted for testing, bats were the second most commonly submitted animal, behind cats, during 2009. The number of rabid skunks that were reported increased by 0.9% overall. The proportion of rabid skunks in which infection was attributed to the raccoon rabies virus variant decreased from 47.3% in 2008 to 40.9% in 2009, resulting in a 12.7% increase in the number ofrabid skunks infected with a skunk rabies virus variant. The number of rabid foxes increased 11.0% overall from the previous year. Four cases of rabies involving humans were reported from Texas, Indiana, Virginia, and Michigan. The Texas case represented the first presumptive abortive human rabies case, with the patient recovering after the onset of symptoms without intensive care. The Indiana and Michigan cases were associated with bat rabies virus variants. The humanrabies case in Virginia was associated with a canine rabies virus variant acquired during the patient’s travel to India.
美国疾病控制与预防中心(CDC,Centers for Disease Control and Prevention) 感染科 2008-01-01
These recommendations of the Advisory Committee on Immunization Practices (ACIP) update the previous recommendations on human rabies prevention (CDC. Human rabies prevention—United States, 1999: recommendations of the Advisory Committee on Immunization Practices. MMWR 1999;48 [No. RR-1]) and reflect the status of rabies and antirabies biologics in the United States. This statement 1) provides updated information on human and animal rabies epidemiology; 2) summarizes the evidence regarding the effectiveness/efficacy, immunogenicity, and safety of rabies biologics; 3) presents new information on the cost-effectiveness of rabies postexposure prophylaxis; 4) presents recommendations for rabies postexposure and pre-exposure prophylaxis; and 5) presents information regarding treatment considerations for human rabies patients. These recommendations involve no substantial changes to the recommended approach for rabies postexposure or pre-exposure prophylaxis. ACIP recommends that prophylaxis for the prevention of rabies in humans exposed to rabies virus should include prompt and thorough wound cleansing followed by passive rabies immunization with human rabies immune globulin (HRIG) and vaccination with a cell culture rabies vaccine. For persons who have never been vaccinated against rabies, postexposure antirabies vaccination should always include administration of both passive antibody (HRIG) and vaccine (human diploid cell vaccine [HDCV] or purified chick embryo cell vaccine [PCECV]). Persons who have ever previously received complete vaccination regimens (pre-exposure or postexposure) with a cell culture vaccine or persons who have been vaccinated with other types of vaccines and have previously had a documented rabies virus neutralizing antibody titer should receive only 2 doses of vaccine: one on day 0 (as soon as the exposure is recognized and administration of vaccine can be arranged) and the second on day 3. HRIG is administered only once (i.e., at the beginning of antirabies prophylaxis) to previously unvaccinated persons to provide immediate, passive, rabies virus neutralizing antibody coverage until the patient responds to HDCV or PCECV by actively producing antibodies. A regimen of 5 1-mL doses of HDCV or PCECV should be administered intramuscularly to previously unvaccinated persons. The first dose of the 5-dose course should be administered as soon as possible after exposure (day 0). Additional doses should then be administered on days 3, 7, 14, and 28 after the first vaccination. Rabies pre-exposure vaccination should include three 1.0-mL injections of HDCV or PCECV administered intramuscularly (one injection per day on days0, 7, and 21 or 28). Modifications were made to the language of the guidelines to clarify the recommendations and better specify the situations in which rabies post- and pre-exposure prophylaxis should be administered. No new rabies biologics are presented, and no changes were made to the vaccination schedules. However, rabies vaccine adsorbed (RVA, Bioport Corporation) is no longer available for rabies postexposure or pre-exposure prophylaxis, and intradermal pre-exposure prophylaxis is no longer recommended because it is not available in the United States.