國立中山大學學位論文典藏.PDF

Size: px

Start display at page:

Download "國立中山大學學位論文典藏.PDF"

梅台堵
7 years ago
Views:

1 Detection and analysis of Anti-SARS-CoV Immunoglobulin G and associated risk factor among healthcare workers in Taiwan 1

2 2 Lab meeting

3 3

4 4

5 Abstract Severe acute respiratory syndrome (SARS) is an emerging infectious disease that first manifested in humans in China in November 2002 and has subsequently spread worldwide. According to the World Health Organization, 8098 cases occurred during the outbreak, and healthcare workers accounted for 1707 (21%) of the cases. To determine the prevalence of SARS infection of healthcare workers in Taiwan, we performed a serosurvey by the recombinant protein-based enzyme-linked immunosorbent assay (ELISA) to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1525 healthcare workers in 26 hospitals that admitted SARS patients in mid-may, Then, a case-control study was carried out to evaluate the risk factors of SARS infection among the healthcare workers. A total of 52 infected staffs and 78 hospital and age matched non-infected controls were recruited. The seroprevalence rate was 3.68% (58/1525) for healthcare workers. Univariate analysis showed that with the habit of drinking coffee or tea, taking care of fever patients more than 8 days, ever practice of CPR, suction of sputum, taking patient s temperature, use of P100 mask, use of N95 mask, use of face cover, use of goggles, use of gown, removing gloves after work, working in isolation area or fever screen station were significantly protective factors. In addition, eating jujube was a risk factor for SARS infection. Then, the multivariate analysis showed that use of P100 OR: 0.056, 95%CI: , p value: <0.001and working in isolation area OR: 0.153, 95%CI: , p value: 0.027or fever screen stationor: 0.103, 95%CI: , p value: 0.046were the most important protective factors for SARS infection. These findings suggest that nosocomial infection of SARS can be prevented effectively by use of P100 and the triage screening in emergency departments. Key wordssevere acute respiratory syndromecase-control study healthcare workerssars coronavirusseroprevalence 5

To determine the prevalence of SARS infection of healthcare workers in Taiwan, we performed a serosurvey by the recombinant protein-based enzyme-linked immunosorbent assay (ELISA) to test for

6 6

7 7

8 8

9 SARS-CoV 9

10 WHO Severe Acute Respiratory Syndrome (SARS) Ho and Su, 2004 Twu et al., 2003 ; Hui et al., 2004 SARS-CoV SARS-CoV VERO E6 Peiris et al., 2004SARS-CoV 10

11 Peiris et al., 2004; Peiris et al., 2003 Peiris et al., 2003 Ho and Su 2004; Hui et al., 2004; Leung et al., 2004; Lau et al., 2004 Leung et al., 2004; Xu et al., 2004 Poutanen et al., 2003 Anderson et al., 2004; Chen et al.,

12 Moira et al., 2004 high risk population McDonald et al.,

13 13

14 SARS SARS SARS World Health Organization, WHO SARS Peiris et al. 2004; Chen et al.,

15 15 (Severe Acute Respiratory Syndrome SARS) WHO 21 (emerging infectiousdisease) SARS

16 / SARS SARS Hui et al., 2004 E (diarrhea) SARS SARS 69 SARS Lau et al., 2004; Tomlinson and Cockram 2003; Lee et al., 2003) 16

17 17 SARS (Carlo Urbani) (57) SARS SARS SARS SARS SARS SARS SARS (McDonald et al., 2004

18 18 80 SARS Ho et al.,2004 SARS SARS SARS SARS Tambyah 2004 Chen et al., SARS

19 Chen et al., 2004 SARS Hsieh et al., 2005SARS Ho and Su 20 probable cases Esswein et al., 2004 WHO 19

20 SARS Ksiazek et al., 2003; Update MMWR 2003 Drosten et al., 2003 SARS Coronaviridae Marra et al.,2003 SARS Rota et al., 2003 SARS-CoV nm (1nm RNA RNA glycoprotein RNA Membrane protein, M Envelope protein, E Spike protein, S Haemagglutinin-esterase, HE 20

, 2003 SARS-CoV nm (1nm RNA RNA glycoprotein RNA Membrane

21 SARS-CoV RNA base pair, bp) SARS-CoV SARS-CoV Vero E6 SARS-CoV RNA SARS SARS MMWR 21 Mar,

22 SARS RT-PCR Real-time PCR ELISA IFA NT SARS Severe Acute Respiratory Syndrome Taiwan, MMWR SARS SARS Peiris et al., 2003 SARS 22

23 WHO SARS Suspect Case Probable Case Respiratory Distress Syndrome 23

24 24

25 25 McDonald et al., 2004 Personal protective equipment, PPE

26 SARS 26

27 SARS Chang et al., 2004 SARS World Health Organization 2003 Peiris et al., 2003; James et al., 2003 SARS McDonald et al., 2004 SARS nebulizer Lau et al., 2003; Lee et al., 2003; Tomlinason and Cockram 2003; Lau et al.,

28 and Sung 2004 et al., 2003 Yu Yen et al., 2006 Lau e al., 2004; Yu and Sung 2004 Shaw

29 SARS 29

30 30

31 31

32 32

33 33

34 34

35 Chang et al., 2004; Chen et al., 2005 SARS 35

36 36

37 37

38 38 Institutional Review BoardIRB

39 Enzyme-linked immunosorbent assayelisa Indirect Immunofluorescence assay Seroconversion Definitive criterion Serosurveillance Hsueh PR, Kao CL et al., 2004 ELISA Enzyme-linked immunosorbent assayelisa conjugate TMB AB Substrate A +Substrate B 39

40 100µl Stop solution2n H 2 SO 4 Immunofluorescence assayifa Indirect Immunofluorescence assayifa coated SARS-coronavirusSARS-CoV EUROIMMUN Co. reagent tray field SARS-CoV infected cells non-infected cells 2 BIOCHIP slideincubate BIOCHIP slide PBS-Tween Wash buffer fluorescein-labelled anti-human globulin conjugate BIOCHIP slide BIOCHIP slide PBS-Tween Wash buffer BIOCHIP slide glycerol/pbsbiochip slide 40

41 Logistic regression analysis Odd ratio, OR 41

42 Lin et al.,

43 ELISA IFA B8 B6 ICU 43

44 mean±sd mean±sd 44

45 45 SARS-CoV SARS-CoV SARS-CoV

46 OR: 2.40, 95%CI: , p : OR: 0.41, 95%CI: , p :

47 CPROR: 0.31, 95%CI: , p : OR: 0.48, 95%CI: , p : OR: 0.32, 95%CI: , p : P100OR: 0.06, 95%CI: , p : <0.001 N95OR: 0.35, 95%CI: , p : 0.006N95 OR: 0.38, 95%CI: , p : OR: 0.23, 95%CI: , p : 0.001OR: 0.26, 95%CI: , p : OR: 0.10, 95%CI: , p : <

48 SARS-CoV OR: 0.40, 95%CI: , p : X OR: 0.33, 95%CI: , p : OR: 0.05, 95%CI: , p : OR: 0.25, 95%CI: , p :

49 49

50 Chen et al., 2005) Fung asymptomatic infection Lee H.K.K, Tso E Y.K et al., 2003 IP M et al., 2004 Chen et al.,

51 ELISA OD IFA 1:8 Chang et al., 2004; Smith et al., 2005 OR: 0.22, 95%CI: , p : <0.001 OR: 0.29, 95%CI: , p : caffeine 51

52 Candurra and Damonte OR: 2.40, 95%CI: , p : OR:, 95%CI:, p : 52

53 SARS-CoV Loeb M P100OR: 0.05, 95%CI: , p : <0.05 OR: 0.597, 95%CI: , p : OR: 0.052, 95%CI: , p : <0.05 OR: 0.063, 95%CI: , p : <0.05 Lau et al., 2004; Teleman et al., 2004; Chia et al.,

54 Chen et al., 2004) 54

55 55

56 Duan SM Duan et al., 2003 recall bias Yu and Sung. 2004; Lau et al., 2004; Teleman et al.,

57 57

58 Anderson RM, Fraser C, Ghani AC, et al. Epidemiology, transmission dynamics and control of SARS: the epidemic. Philos trans R Soc Lond B Biol Sci 2004; 359(1447): Candurra NA, Damonte EB. Inhibition of Junin virus multiplication by caffeine. Rev Argent Microbiol Jul-Sep; 31(3) : Chang SC, Wang JT, Huang LM, et al. Longitudinal Analysis of Severe Acute Respirastory Syndrome(SARS) Coronavirus-Specific Antibody in SARS Patients.Clinical and Diagnostic Laboratory Immunology.2005;12: Chang WT, Kao CL, Chung MY, et al. SARS exposure and emergency deparement workers. Emerging Infectious Diseases. 2004; 10(6): Chen WK, Cheng YC, Chung YT, Lin CC. The impact of the SARS outbreak on an urban emergency department in Taiwan. Med Care 2005; 43(2): Chen YC, Chen PJ, Chang SC, et al. Infection control and SARS Transmission among Healthcare Workers, Taiwan. Emerging Infectious Diseases 2004; 10(5): Chen YC, Huang LM, Chan CC, et al. SARS in Hospital Emergency Room. Emerging Infectious Diseases. 2004; 10(5):

59 Cia S E, Koh D, Fones C, et al. Approproate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbresk in Singapore. Occup Environ Med 2005; 62: Drosten C, Gunther S, Preiser W, et al. Identification of a Novel Coronavires in Patients with Severe Acute Respiratory Syndrome. N Engl J Med 2003 May 15; 348(20): Duan SM, Zhao XS, Wen RF, et al. Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. Biomed Environ Sci. 2003; 16: Esswein EJ, Kiefer M, Wallingford K. et al. Environmental and Occukpational Health Response to SARS, Taiwan, Emerging Infectious Diseases 2004;10(7): Fung CP, Hsien TL, Tan KH. Et al. Rapid creation of a temporary isolation ward for patients with severe acute respiratory syndrome in Taiwan. Infection conteol and hospkital epidemiology. 2004;25(12) Ho KY, Singh KS, Habib AG, et al. Mild illness associated with severe acute respiratory syndrome coronavirus infection: lessons from a prospective seroepidemiologic study of health-care workers in a teaching hospital in Singapore. J Infect Dis 2004;189(4): Ho MS, Su IJ. Preparing to prevent severe acute respiratory syndrome and other respiratory infection. Lancet infect Dis 2004; 4(11):

60 Hsieh YH, King CC, Cathy W.S. et al. Quarantine for SARS, Taiwan. Emerging Infectious Diseases. 2005;11 2: Hsueh PR, Kao CL, Lee CN, et al. SARS Antibody Test for Serosurveillance. Emerging Infectious Diseases 2004;109: Hui DS,Chan MC, Wu AK, Ng PC.Severe acute respiratory syndrome SARS: epidemiology and clinical features, Postgrad Med J 2004; 80945: IP M, Chan PK, Lee N, et al. Seroprevalence of antibody to severe acute respiratory syndrome SARS-associated coronavirus among health care workers in SARS and non-sars medical wards. Clin Infect Dis. 2004; 38: JO LS, Galvani AP, Getz WM et al, Curtailing transmission of severe acute respiratory syndrome within a community and its hospital. Proc, R Soc. 2003;270(1528): Ksiazek TG, Erdman D, Goldsmith CS, et al. A Novel Coronavires Associated with Severe Acute Respiratory Syndrome. N Engl J Med 2003;34820: Lau JT, Fung KS, Wong TW, et al. SARS transmission among hospital workers in Hong Kong. Emerg Infect Dis 2004; 10(2): Lau JT, Yang X, Leung PC, et al. SARS in three categories of hospital workers, Hong Kong. Emerg Infect Dis 2004; 10(8):

61 Lee H K. K., Tso E Y.K. et al. Asymptomatic Severe Acute Respiratory Syndrome-associated Coronavirus Infection. Emerging Infectious Diseases. 2003; 9(11): Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003; 348(20): Leung GM, Hedley AJ, Ho LM, et al. The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients. Ann Intern Med 2004; 141(9): Lin YC, Dong SL, Yeh YH, et al. Emergency management and infection control in a radiology department during an outbreak of severe acute respiratory syndrome.the British Journal of Radiology 78(2005), Loeb M, McGeer A, Henry B, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis 2004; 10(2):251-5 Marra MA, Jones SJ, Astell CR, et al. The Genome Sequence of the SARS- Associated Coronavirus. Science 2003; : McDonald LC, Simor AE, Su IJ, et al. SARS in healthcare facilities, Toronto and Taiwan. Emerging Infectious Diseases 2004; 10(5): Moira CY, MB. Severe Acute Respiratory SyndromeSARSand Healthcare Workers. Int J Occup Environ Health 2004; 10:

62 Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study, Lancet 2003; 361(9371): Peiris JS, Guan Y, Yuen KY. Severe acute respiratory syndrome. Nat Med 2004; 10: S88-97 Peiris JS, Yuen KY, Osterhaus AD, Stohr K. The severe acute respiratory syndrome. N Engl J Med 2003 Dec 18; 349(25): Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, et al. Identification of severe acute respiratory syndrome in Canada. Nengl J Med 2003;348 20: Rota PA, Oberste MS.Monroe SS,et al.characterization of a novel coronavirus associated with Severe Acute Respiratory Syndrome.Science 2003, 300: Seto WH, Tsang D, Yung RW, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003 May 3; 361(9368): Severe Acute Respiratory Syndrome Taiwan, MMWR Morb Mortal Wkly Rep 2003, 52: Shaw K. The 2003 SARS outbreak and its impact on infection control practices. Public Health 2006 Jan; 120(1):

63 Smith A W, Teleman M D, et al. Asymptomatic SARS Coronavirus Infection among Healthcare Workers, Singapore. Emerging Infectious Diseases. 2005; 11(7): Tambyah PA. Severe acute respiratory syndrome from the trenches, at a Singapore university hospital. Lancet Infect Dis 2004; 4(11): Teleman MD, Boudville IC,Heng BH, et al. SARS transmission among hospital workers in Hong Kong. Emerging Infectious Diseases. 2004; 132(5) Tomlinason B, Cockram C. SARS: experience at Prince of Wales Hospital, Hong Kong. Lancet 2003;361(9368): Twu SJ, Chen TJ, Chen CJ, et al. Control Measures for Severe Acute Respiratory Syndrome SARSin Taiwan. Emerging Infectious Diseases. 2003;9: Update: outbresk of severe acute respiratory syndrome worldwide, 2003.MMWR Morb Mortal Wkly Rep 2003,52: World Health Organization. Consensus document on the epidemiology of severe acute respiratory symdromesars.2003 Oct Xu RH, He JF, Evans MR, et al. Epidemiologic clues to SARS origin in China. Emerg Infect Dis 2004;10(6): Yen MY, Lin YE, Su IJ, et al. Using an integrated infection control strategy during outbreak control to minimize nosocomial infection of severe acute respiratory syndrome among healthcare works. Journal of Hospital Infection 2006 Feb; 62(2):

64 Yu IT, Sung JJ. The epidemiology of the outbreak of severe acute respiratory syndrome (SARS) on Hong Kong what we do know and what we don t. Epidemiol Infect 2004;132(5):781-6 CDC -SARS 19(4):

65 65

66 66

67 67

68 68

69 69

70 70

71 71

72 72

73 73

74 74

75 Cumulative number of cases Areas Female Male Total Median age (range) Number of deaths a Case fatality ratio (%) Number of imported cases (%) Number of HCW affected (%) Date onset first probable case Date onset last probable case Australia Canada (1-45) 49 (1-98) (100) 0 (0) 26-Feb-03 1-Apr (2) 109 (43) 23-Feb Jun-03 China b Not available Not Applicable 1002 (19) 16-Nov-02 3-Jun-03 China, Hong Kong Special Administrative Region (0-100) Not Applicable 386 (22) 15-Feb May-03 China, Macao Special Administrative Region (100) 0 (0) 5-May-03 5-May-03 China, Taiwan c 42 (0-93) (6) 68 (20) 25-Feb Jun-03 France Germany India Indonesia Italy (26-61) 44 (4-73) 25 (25-30) 56 (47-65) 30.5 (25-54) (100) 2 (29) d 21-Mar-03 3-May (100) 1 (11) 9-Mar-03 6-May (100) 0 (0) 25-Apr-03 6-May (100) 0 (0) 6-Apr Apr (100) 0 (0) 12-Mar Apr-03 Kuwait (100) 0 (0) 9-Apr-03 9-Apr-03 Malaysia Mongolia (26-84) 32 (17-63) (100) 0 (0) 14-Mar Apr (89) 0 (0) 31-Mar-03 6-May-03 New Zealand (100) 0 (0) 20-Apr Apr-03 75

76 Philippines (29-73) (50) 4 (29) 25-Feb-03 5-May-03 Republic of Ireland (100) 0 (0) 27-Feb Feb-03 Republic of Korea (20-80) (100) 0 (0) 25-Apr May-03 Romania (100) 0 (0) 19-Mar Mar-03 Russian Federation Not Available 0 (0) 5-May-03 5-May-03 Singapore (1-90) (3) 97 (41) 25-Feb-03 5-May-03 South Africa (100) 0 (0) 3-Apr-03 3-Apr-03 Spain (100) 0 (0) 26-Mar Mar-03 Sweden (33-55) (100) 0 (0) 28-Mar Apr-03 Switzerland (100) 0 (0) 9-Mar-03 9-Mar-03 Thailand (2-79) (100) 1 (11) d 11-Mar May-03 United Kingdom (28-74) (100) 0 (0) 1-Mar-03 1-Apr-03 United States Viet Nam (0-83) 43 (20-76) (100) 0 (0) 24-Feb Jul-03 e (2) 36 (57) 23-Feb Apr-03 Total

77 SARS probable cases n = 664* Virus PCR or Ab (+) n = 346 (52.1%) survival n = 273 deceased (n = 73) CFR = 21.1% Both negative n = 317 (47.8%) survival n = 210 directly due to SARS n = 37 CFR = 10.7% SARS related n = 36 CFR = 10.4% Deceased (n = 107) CFR = 33.8% 77

78 78

79 79

80 80

81 81

82 82

83 83

84 84

85 85

90 90

91 91

92 92

93 93

SARS综述_临床版.doc

SARS综述_临床版.doc SARS ( ) 2002 11 Severe Acute Respiratory Syndrome SARS 2003 5 14 SARS 32 7548 573 ( 1) [1] SARS SARS 1 SARS May 14, 2003. available at http://www.who.int/csr/sars/map2003_05_14.gif 1 SARS 2002 11 2003