来自MMWR的重要讯息:新鲜菠菜受大肠杆菌污染以及其它疫情


  September 29, 2006 -- 美国CDC在9月29日的「每周发病率和死亡率报告」中,提到因为受污染的菠菜引起之大肠杆菌O157:H7型传染事件;高校学生的高运动伤害率强调了预防性介入之需要;50岁以上妇女并用荷尔蒙治疗的处方率降低。
  
  出现在26州的大肠杆菌O157:H7型感染和受污染的新鲜菠菜有关
  CDC报告了和目前受污染的新鲜菠菜有关的大肠杆菌O157:H7型感染情况之调查发现,这些案例已经在美国的26州出现。
  
  9月13日,CDC在华盛顿和奥勒冈州的流行病学家提出正式警告,指出在这些州出现的大肠杆菌O157-E7型传染源是新鲜菠菜;当日,这些流行病学家也接获来自新墨西哥州的消息指出有类似的群聚感染;CDC之后以脉冲式电泳法(pulsed-field gel electrophoresis,PFGE)确认这些细菌和其它州的病患所分离出来的是同一种细菌型。
  
  9月14日,FDA发布新闻和召开记者会建议消费者避免食用新鲜菠菜,且在两日后将警告扩及其它含菠菜的产品;9月21日,消费者被告知仅有在加州的三个郡所生产的菠菜和此波疫情有关。
  
  到了9月26日,FDA总共在26州接到183件此菌之病例报告,85%的报告出现在2006年8月19日和9月5日之间;据CDC表示,从开始出现疫情到确定是E. coli O157:H7感染历时15天;病患通常需要将近2到 3周的医疗照顾,以及细菌培养和PGFE检测,并将这些资料通报到CDC的资料库 。
  
  后续的调查发现52%的感染病患住院,16%有溶血性尿毒症候群,有一位病患死亡;另两例死亡是否和此波疫情有关则尚在调查中。
  
  经追踪发现感染源和新鲜菠菜有关 — 95%的病患在发病前10 天有食用未经煮食的新鲜菠菜,而以PGFE检测发现新墨西哥、犹他州和宾州等三地的三种包装菠菜有同一型的 E coli O157:H7。
  
  CDC指出,2003年以来,E coli O157:H7的零星感染案例曾在CDC的PulseNet 中报导(2003-2005年间平均一年21例),过去并未被视为爆发流行。
  
  同时进行的实验室和流行病学调查是监定菠菜是爆发流行的感染源的重要依据;包括由州公共卫生实验室进行的即时PFGE检测,由各州向CDC PulseNet提出的PFGE类型归类,以及在CDC PulseNet国家资料库进行的PFGE 类型分析,都对此次疫情以及未来的研究有所助益。
  
  有关此波疫情和其它医疗信息可在http://www.cdc.gov/foodborne/ecolispinach获得,亦可利用CDC的公共询问专线(1-800-CDC-INFO)和http://www.fda.gov/oc/opacom/hottopics/spinach.html获得对消费者的建议和食物安全规范。
  
  校园高运动伤害率强调了预防性介入之需要
  根据100所美国高校的2005-2006学年伤害监控系统之资料,在2004-2005学年,估计有420万高中学生曾发生运动伤害,其中的80%以上是初次发生,每1000件运动的相关伤害率是2.44 (例如训练或竞赛)。
  
  此调查包括九种运动:棒球、橄榄球、摔角(男孩)、垒球和排球(女孩)、篮球和足球(男孩和女孩);伤害的定义是指在高中参加这些运动的训练或竞赛时所发生,因而需要合格的运动训练员或医师的医疗照顾,在受伤后被限制参加运动一天以上者。
  
  橄榄球的伤害率(1000件训练或竞赛的相关伤害率是4.36)是其它运动的两倍之多,依序是摔角(2.50);足球(男生是 2.43,女生是2.36);女子篮球(2.01);男子篮球、女子排球、男生棒球和女生垒球的1000件训练或竞赛的相关伤害率都小于2。
  
  尽管伤害类型因训练或竞赛而异,将近80%的各种运动伤害是初次发生,且通常在训练时比在竞赛时更容易发生;约 50%的伤害导致需停止参与运动达七天以上;这些常见于橄榄球,女子篮球和摔角。
  
  CDC指出,虽然运动对健康有利,但运动伤害的风险和有效的预防策略仍不够清楚,为了降低伤害的风险,需确保适量的饮水和使用合适的防护器具,特定运动建议(例如封阻和擒抱摔倒时头部朝上以降低橄榄球有关的颈部伤害风险)可在国家运动伤害防护学会,网址http://www.nata.org/publications/brochures/minimizingtherisks.htm中获得。
  
  此外,可在http://www.cdc.gov/ncipc/tbi/coaches_tool_kit.htm.免费获得运动有关之脑震荡的预防和处置辅导信息。
  
  并用荷尔蒙治疗者急速减少
  一篇CDC的研究显示,在2001到2003 年间,50岁以上停经妇女使用estrogen-progestin荷尔蒙治疗的处方率减少44%。
  
  并用荷尔蒙治疗之减少,可能与治疗相关的健康风险大于治疗利益有关。

Highlights From MMWR: Update o

By Yael Waknine
Medscape Medical News

September 29, 2006 — The US Centers for Disease Control and Prevention (CDC) reported in the September 29 issue of the Morbidity and Mortality Weekly Report on outbreaks of Escherichia coli serotype O157:H7 infections related to the consumption of contaminated spinach; the high rate of new sports-related injuries among high school students that underscores the need for preventive interventions; and the decreasing prescribing rate for combination hormone therapy in women aged 50 years and older.


Escherichia coli O157:H7 Infections in 26 States Linked to Consumption of Fresh Spinach

The CDC has reported on findings from an ongoing investigation into Escherichia coli serotype O157:H7 infections related to consumption of fresh spinach. The cases have been reported in 26 US states.

On September 13, 2006, CDC officials were alerted by epidemiologists in Wisconsin and Oregon that fresh spinach was the source of E coli serotype O157-E7 outbreaks in those states; on that day, the epidemiologists were contacted by their New Mexico counterparts regarding a similar cluster of infections. The CDC then confirmed that the strains had the same pulsed-field gel electrophoresis (PFGE) patterns and matched them to patient isolates in other states.

On September 14, the FDA advised consumers via news release and press conference against the consumption of fresh spinach, and the warning was expanded 2 days later to include fresh spinach-containing products. On September 21, consumers were informed that only spinach grown in 3 California counties was implicated in the outbreak.

As of September 26, the agency had received reports of 183 patients infected with the outbreak strain in 26 states, 85% of which reported illness onset between August 19 and September 5, 2006. According to the CDC, the time from illness onset to confirmation of a case of E. coli O157:H7 was 15 days; approximately 2 to 3 weeks are usually required for the patient to seek medical care, for cultures and PGFE test results to be obtained, and for the data entered into the CDC database.

The ensuing investigation revealed that 52% of infected patients were hospitalized, 16% had hemolytic uremic syndrome, and 1 patient died; 2 other deaths potentially associated with the outbreak remain under investigation.

The source of infection was traced to fresh spinach — 95% of patients reported consuming uncooked fresh spinach during the 10 days before illness onset, and E coli O157:H7 with a PFGE pattern matching the outbreak strain was isolated from 3 open packages of fresh spinach consumed by patients in New Mexico, Utah, and Pennsylvania, respectively.

The CDC notes that although infections of this strain of E coli O157:H7 have been reported sporadically to CDC PulseNet since 2003 (mean, 21 cases/year for 2003-2005), it has not been associated with a recognized outbreak in the past.

Parallel laboratory and epidemiologic investigations were crucial for identifying spinach as the outbreak source; continued timely PFGE testing by state public health laboratories, PFGE pattern submission by states to CDC PulseNet, and analysis of PFGE patterns in the CDC PulseNet national database will be needed to aid in this and future investigations.

Updates regarding the outbreak and other clinician resources are available online at http://www.cdc.gov/foodborne/ecolispinach. Consumer advice and food-safety guidelines are available by telephone at the CDC's public inquiry line (1-800-CDC-INFO) and online at
http://www.fda.gov/oc/opacom/hottopics/spinach.html.


High Rate of New Sports Injury Underscores Need for Preventive Interventions in Schools

During the 2004-2005 school year, an estimated 4.2 million high school students experienced sports-related injuries, more than 80% of which were new, according to data from a 2005-2006 school-year injury surveillance system involving 100 US high schools. The corresponding overall injury rate was 2.44 per 1000 athletic exposures (eg, practices or competitions),

Nine sports were included in the survey: baseball, football, and wrestling (for boys); softball and volleyball (for girls); and basketball and soccer (for boys and girls). Injuries were defined as those obtained during participation in an organized high school athletic practice or competition; required medical attention from a certified athletic trainer or physician; and restricted participation in the sport for 1 day or longer after the injury.

Football had an injury rate that was almost double that of any other sport (4.36 injuries per 1000 practices or competitions), followed by wrestling (2.50); soccer (boys', 2.43, and girls', 2.36, respectively); and girls' basketball (2.01). Boys' basketball, girls' volleyball, boys' baseball, and girls' softball all had injury rates of less than 2 per 1000 exposures.

Although the types of injuries varied by practice and competition, approximately 80% of injuries in each sport were new and occurred more frequently during practice than competition. About 50% of injuries led to a loss of 7 or more days of play; these were more common in football, girls' basketball, and wrestling.

The CDC notes that although the health benefits of an active lifestyle are well known, the risks for sports-related injuries and effective prevention strategies remain less clear. To reduce the risk for injury, adequate hydration must be ensured and appropriate protective equipment used. Sport-specific recommendations (eg, block and tackle with the head up to decrease the risk for football-related neck injuries) are available from the National Athletic Trainers' Association online at http://www.nata.org/publications/brochures/minimizingtherisks.htm.

In addition, information regarding the prevention and management of sports-related concussion is available with a free tool kit for coaches at http://www.cdc.gov/ncipc/tbi/coaches_tool_kit.htm.


Use of Combination Hormone Replacement Therapy Undergoes Sharp Decline

A CDC study shows that the prescribing rate for estrogen-progestin hormone therapy decreased by 44% during 2001 to 2003, with the greatest decline observed among menopausal women aged 50 years and older.

The reduction in use of combined hormone therapy may be linked to a determination that health risks associated with the treatment outweigh potential benefits.

MMWR. 2006;55(38):1037-1060.

    
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