Re: China - Dengue 2014
machine translation
Guangdong Dengue: surprise new topic
At 01:35 on October 18, 2014 Economic Observer newspaper
The last two days of the National Day, the State Health Planning Commission deputy director Wang Guoqiang rate research group came to Guangzhou, went to Guangzhou Baiyun District, Panyu District, community and university campuses understand the mosquito disinfection situation, then went to the Eighth People's Hospital of Guangzhou Jiahe School District to visit patients. "Guangdong dengue epidemic situation is still grim, prevention and control work is still there blind, not paralysis slack." It said in a briefing on dengue prevention and control work.
Began in June this year, dengue fever, after a stable period three months later, the number of cases of infection appeared in "explosive" growth.
Up at 0:00 on October 15, Guangdong province a total of 20 prefecture-level cities reported a total of 33,793 cases of dengue fever cases, more than 2,894 cases last year more than 10 times, a total of six cases of reported deaths.
In the dengue outbreak in Guangdong, Guangzhou Youyi 28,477 cases of confirmed cases, five cases of dengue deaths in Guangdong hardest hit. In most cases, the Guangzhou Baiyun District, the number of confirmed cases to 8,599 cases, while the district grew by more than 7000 cases of diagnosed patients in the end of September to mid-October just two weeks of, cases of three deaths.
Dengue had not only a serious illness, their severe and mortality even lower than the flu, in the end is what causes it, and Guangzhou in Guangdong, a large area of the outbreak? Outbreak of dengue fever epidemic, which also provided the experience and lessons for primary health epidemic?
Epidemic
Admitted to the hospital of traditional infectious disease - Guangzhou Eighth People's Hospital (hereinafter referred to as "the city of eight Academy") was originally a seventh floor inpatient ward area of liver disease, dengue is now a patient isolation ward.
Huang Dawei (a pseudonym) is a patient diagnosed with dengue working in Baiyun District, the Economic Observer newspaper reporter saw him, he was just losers, sitting on the bed, the spirit looks pretty good. Huang Dawei said he did not think how he would dengue fever.
The notification according to the Guangdong Provincial Health dengue epidemic and Family Planning Commission official website showed Huang Dawei, Baiyun District, where only one day in September 25 has increased by 205 cases of confirmed cases, become the most confirmed cases Guangzhou area. In many days after the National Day, the Baiyun District, the number of new cases as many as four or five hundred cases a day, as of October 15, the cumulative confirmed cases up to 8599 cases of Baiyun District, Guangzhou, accounting for the number of all diagnosed cases of three.
Why the growth of the epidemic, Baiyun District, more than 7000 cases in the end of September to mid-October just two weeks? Director of the Guangdong Provincial Disease Prevention and Control Center to the Economic Observer newspaper reporter Zhang Yonghui said, according to the characteristics of dengue fever, the patient may exist hidden. At first many other areas the number diagnosed in Guangzhou, Baiyun District, but would probably have a number of hidden latent patients, until the mosquitoes in this region accumulated to a certain extent it will explode. In addition, the Baiyun District complex environment, population density, slow to mobilize personnel and easier to provide breeding ground for mosquito-borne soil. In addition to urban environmental problems, the Economic Observer reported CDC also learned from the Guangdong Province, Guangdong this year, dengue fever, "ferocious" roughly following reasons: Dengue epidemic cyclical characteristics, every three to five years, a large outbreak once, This year happens to be the peak of the dengue epidemic; Southeast Asian and South American countries this year, continued high incidence of dengue fever, and Guangdong foreign trade with these areas closely, resulting in imported cases increased significantly; addition Guangdong rain did not increase compared to the same period last year, while the central Guangzhou and Zhuhai Triangle area of the rain amount to more than last year, while the temperature rise over last year 0.4-0.6 degrees, mosquito-borne highly sensitive to temperature, the temperature rise will result in subtle intense mosquito breeding. In the role of a number of factors, one had severe and mortality is lower than the flu-like illness, even the formation of a large-scale outbreak.
Hospital treatment capacity in case of challenge
September 24, Huang Dawei began a high fever, and quickly went to 39 degrees, body aches, he thought it was the beginning of a cold, went to community hospitals Baiyun District fluids, burn or not to retire. Then he went to a hospital, where pumping blood, the doctor told him platelets is low, there may be dengue, but it does not completely confirmed. 6 days since, Huang Dawei high fever, until October 1 came to the city eight hospital.
Here, there are many like 黄大伟 this patient was removed several hospitals. In 黄大伟 the next bed, a 25-year-old young man, after a high fever to a secondary hospital, doctors diagnosed as viral fever and did not require hospitalization; another ward, one in Guangzhou Baiyun District employees youth by the end of September has been coughing and fever, has in a number of hospitals and private clinics, doctors diagnosed his bronchitis; A middle-aged men initially in the First Affiliated Hospital of Guangzhou University of Chinese Medicine clinic, and later because of illness Dr. Yan Chong suggested that he transferred.
They are to the city eight hospital after being diagnosed with dengue fever, and some have even organ bleeding. "The primary hospital laboratory testing methods, there are still some difficulties in the diagnosis of dengue fever." Baiyun district Hospital Medical Services, a section chief told the Economic Observer newspaper reporter.
It is understood that the current detection methods for screening dengue cases Guangzhou mainly nucleic acids, antibodies and antigen detection of three, in which the nucleic acid of the most accurate, and the effect is better than antigen detection of antibodies, but because each hospital laboratory conditions vary, hospitals are generally already have a sound means of detection, nucleic acid can be used in many hospitals do testing, but dengue laboratory reagents secondary level hospitals during the National Day only basic equipment in place. "Guangzhou more than a decade for the first time such a large-scale outbreak of the epidemic, laboratory diagnosis can not keep a lot of grass-roots hospitals." The Chief of Medical Services said. According to the Economic Observer newspaper reporter, in previous years, dimethyl hospital suspected dengue cases, blood samples are sent to CDC or city eight hospital for testing. After the epidemic this year, although some hospitals started doing antibody test, but accuracy is not high; during the National Day after the epidemic broke out, that she bought a reagent antigen started dengue virus antigen detection; but because of the price charged nucleic acid detection than the high, there is no carry. Even the antigen reagent, is also already begun shortage, in order to prevent the reagent is not enough, the government opened up the relevant green channel, designated agent to use, then let the hospital supplementary approval procedures.
Confirmed cases of dengue surge capacity for hospital admissions is no small challenge. June to September, the city hospital has treated more than 500 eighth dengue patients, the number of outpatient investigation is from the previous daily average 300 passengers surged to 460 people or more. In addition to the designated hospital, the other three hospitals are also overcrowded. Large hospital beds is limited, not so much treated patients, and let the patient dengue diaspora, they may be cross-infection, prevention and control of the seriousness of the situation has been before us.
In order to enhance the ability to treat dengue patients, some hospitals have set up a temporary isolation ward. A doctor Third Affiliated Hospital of Guangdong College of Pharmacy to the Economic Observer said, "in the absence of the formation of the isolation ward, we are definitely not admitted dengue patients if the patient receives other departments, and other types of patients live together, will lead to cross-infection, even in patients with suspected dengue fever this risk also exists, which is illegal. "At present, the hospital has treated about 100 patients with suspected or confirmed, accounting for a quarter of all hospital beds.
September 5, the Guangzhou Municipal Health Bureau issued the "Circular on Further Improving clinical treatment of dengue notice", the document, in addition to determining the four hospitals for treatment of severe cases of dengue fever again, it also explicitly states that "more than two infection Guangzhou Branch general hospital as dengue cases admitted to hospitals designated "while provisions are found qualified patients admitted to hospital in the presence of prevarication phenomenon can call 12320 health hotline to report.
Long-term mechanism to be established
For this outbreak, some of the medical staff, "said Guangzhou should've mosquito, March can be off, especially in poor areas like this environment, Baiyun District, such as the epidemic spread and then take measures to no time." According to the Guangzhou City Director of Health Management Division of city management committee early introduction of any patriotic Kivu, in the absence of the epidemic situation, early treatment with mosquito breeding sites, but later there will be a month of anti-mosquito operations.
March of this year, Guangzhou had 129 mosquito breeding sites do street survey, the survey showed Breteau index is relatively low, with an average of 4 or less (epidemic prevention and control required level: Breteau index <5); between April to June, Guangzhou monthly integrated organization of "four pests" action; enter in July, an increase of mosquitoes, mosquito frequency also increased, one week will be an anti-mosquito operations. In addition, the district, the streets will carry out disinfection work in accordance with the actual situation.
But the situation is unfavorable weather this year, Guangzhou long time hot flashes, but also large-scale outbreaks in Southeast Asia, and has been found in early foreign imported dengue cases. Zhang Yonghui believes that the key is not to fight dengue mosquito disinfection times, but rather whether to carry out a thorough disinfection, especially in the media has not been a lot of mosquito breeding, when it killed off in time. For the eradication of dengue epidemic, the ultimate solution is to clean up the water and environmental management, which requires positive action of all citizens.
But the lack of active residents clean up pots, trays, balcony, rooftop soda bottles, water containers consciousness; staff to the residents in the neighborhood courtyard home with no time to clean water, and some of the staff shut out, Some even throw a brick to the staff.
Ren Ng also beginning to emphasize the importance of the Economic Observer reported mobilize the masses. When he visited found some streets dirty and messy issues outstanding, as if the whole garbage dump in general. But the staff does not expect the streets to mobilize the masses to the streets to clean up and then spraying it directly into the "garbage dump" to spray, mosquito effects are greatly reduced.
Faced with the sudden outbreak of the epidemic, the parties seemed a little "surprise." "This large-scale outbreak of the epidemic is indeed a profound lesson." Zhang Yonghui, frankly, around the city, Guangdong, at all levels in reflection, Guangdong so many years to focus mainly concentrated in high mortality, sudden strong contingency of illness on, and for this severe dengue and mortality even lower than the flu-like illness, how to establish long-term mechanism to prevent and control, including the establishment of an early warning model technology sector, the health sector early diagnosis and treatment, environmental management, effective mobilize social forces so raised new issues.
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