行政院衛生署委託科技研究計畫執行注意事項

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奠衔顾
7 years ago
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6 Abstract The impact of the underlying diseases that were more commonly seen in adult population than children on disease severity of dengue infections was rarely reported for most of the dengue infected were younger than 15 years old in dengue epidemic areas. We conduct a prospectively observational, hospital-based study on 311 dengue fever (DF) and 94 dengue hemorrhagic fever (DHF) cases in a 2002 Taiwan dengue serotype 2 outbreak. Univariate analyses revealed the significant risk factors associated with DHF cases were patients with diabetes mellitus (DM), Chronic renal insufficiency (CRI), and histories of past dengue infection (p=0.037, 0.025, 0.003, respectively). Multivariate logistic regression analysis revealed past dengue infection was the only significant factor for DHF (P=0.008). Nine patients died from DHF. Patients with CRI, DM, or aged more than 65 years old were correlated with higher mortality rate in the results of the univariate analyses. Multivariate logistic regression analysis revealed CRI was the only significant factor for mortality. In summary, prior hetero-serotype dengue infection was the most significant factor of DHF during this outbreak when more than 90% cases were adults. Clinicians should notice dengue infected cases with underlying disease of DM or CRI might have higher possibility of DHF/DSS and that CRI was a significant risk factor for mortality. The comparison of viral load at day 4 and day 5 did not reveal significant difference, however, the number of DHF cases with continuous blood samples is small. Some patient had fever more than 7 6

7 days were tested to be PCR positive with quantitative PCR. The sequence of a 240-nucleotide-long region across the envelope/non-structural 1 protein (E/NS1) gene junction of the isolates were determined and analysed. Alignment and comparison of the nucleotide and deduced amino acid sequences of the isolates revealed that nucleotide changes occurred mostly at the third position of a particular codon. Two nucleotide changes resulted in amino acid substitutions. Pairwise comparisons of the nucleotide gave divergence values randing from 0.4 to 6.6%. Comparison of the nucleotide sequences of the dengue isolates with those of other world revealed that the isolates in 2002 were obvious different from other strains. Phylogenetic tree shows that the isolates in 2002 were belonged to an independent genotype. engue hemorrhagic fever, 7

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26 1Gubler DJ. :Dengue and dengue hemorrhagic fever : its history and resurgence as a global public health problem, p.1-22.in D.J.Gulber and G.Kuno(ed.)Dengue and dengue hemorrhagic fever. CAB International, New York, N.Y. J.CLIN.MICROBIOL. Vol:40 p , Rice CM, Lences EM, Eddy SR, Shin SJ, Sheets RL, and Strauss JH. : Nucleotide sequence of yellow fever virus : implications for flavivirus gene expression and evolution. Science 229 p , Hemchal EA, and Putnak JR : The dengue virus. Clin. Microbiol. Rev. 3 p , Wu YC :Epidemic dengue 2 in LiouChyou Shiang, Pingtung County, in Chin. J. Microbiol. Immunol. 19: J.CLIN.MICROBIOL. Vol:40 p , Wu YC :epidemic and control of Japanese encephalitis and dengue fever in Taiwan. WHO Dengue Bull. 20: J.CLIN.MICROBIOL. Vol:40 p , Hsieh WC, Chen MF, Lin KT, Hsu ST, Ma CI, and Wu SS : Outbreak of Dengue fever in 1981 in Liouchyou Shiang, Pingtung County. Taiwan Yi Xue Hui Za Zhi 81 : J.CLIN.MICROBIOL. Vol:40 p , Harn MR, Chiang YL, Tian MJ, Chang YH, and Ko YC : The 1991 dengue epidemic in Kaohsiung City. J. Formos. Med.Assoc.92(suppl.1):S39-S43. J.CLIN.MICROBIOL. Vol:40 26

27 p , Ko YC, Chen MJ, and Yeh SM :The predisposing and protective factors against dengue virus transmission by mosquiro vector. Am. J. Epidemiol. 136: J.CLIN.MICROBIOL. Vol:40 p , Halstead SB, Rojanasuphot S, and Sangkawibha N :Original antigenic sin in dengue. Am. J. Trop. Med. Hyg.32: J.CLIN.MICROBIOL. Vol:40 p , Russill PK, and Nisalak A : Dengue virus identification by the plaque reduction neutralization test. J. Immunol. 99 p , Clarke DH, amd Casals J : Techniques for hemagglutination and hemagglutination-inhibition with arthropodborne virus. Am. J. Trop. Med. Hyg. 7 p , Eur J Clin Microbiol Infect Dis 21 p , Acta Virol 45(5-6) p , Indian J Med Res ;115:p31-36, Marita k, tanaka M, Igarashi A:Rapid identification of dengue virus serotypes by using polymerase chain reaction. J Clin Microbiol 29 : p J Virol Methods ;102(1-2):p , J Virol Methods ;98(2) : p , J Microbiol Immunol Infect ; 33(4) : p , FEMS Immunol Med Microbiol ;3091- : p1-7, J Virol Methods ;95(1-2) : p 19-32, J Med Virol ; 63(1) : p29-34,

28 22Journal of clinical microbiology : p , Journal of clinical microbiology : p , Journal of clinical microbiology : p , Haritoglou C, Scholz F, Bialasiewicz A and Klauss V : Ocular manifestation in dengue fever. Ophthalmologe June, 97 (6) :433-6, Wen KH, Sheu MM, Chung CB, Wang HZ and Chen CW : The ocular fundus findings in dengue fever. Kaohsiung J Med Sci 5 (1) :24-30,

29 Table 1. Univariate analysis of underlying disease and past history as the risk factor for dengue hemorrhagic fever. Variable No. evaluated No. of variable/no. of DF No. of variable/no. of DHF OR(95% CI) P value male /311 44/ ( ) Pulmonary disease /298 4/ ( ) 1.0 Gardiac disease /286 8/ ( ) Chronic liver /279 12/ ( ) 1.0 disease Chronic renal 388 6/297 7/ ( ) insufficiency Diabetes mellitus /311 16/ ( ) hypertension /311 25/ ( ) malignancy /311 5/ ( ) Gout /311 4/ ( ) Past history dengue /311 29/ ( ) operation 399 4/307 2/ ( ) Recent medication steroid 405 3/311 0/ ( ) 1.0 NSAID 405 7/311 2/ ( ) 1.0 Age > /311 19/ ( ) Rheumatic diseases included 2 SLE and 1 RA cases. NSAID: non-steroid anti-inflammatory drugs. 29

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Microsoft Word - 29卷第3期中文.doc

Microsoft Word - 29卷第3期中文.doc 2013 年 2 月 5 日第 29 卷第 3 期原著文章臺灣日本腦炎與鄰近國家之流行概況陳昱汝徐鳳光許麗卿衛生署疾病管制局研究檢驗中心摘要日本腦炎病毒的感染是亞洲及西太平洋地區重要的公共衛生問題, 近年流行地區略有擴大的趨勢