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Evaluation of an HIV-Related Mortuary Surveillance System - Nairobi, Kenya, Two Sites, 2015. 与艾滋病毒有关的停尸房监测系统评估 - 肯尼亚内罗毕，两个地点，2015 年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-12-21 DOI: 10.15585/mmwr.ss6714a1.
Hammad Ali, Catherine Kiama, Lilly Muthoni, Anthony Waruru, Peter W Young, Emily Zielinski-Gutierrez, Wanjiru Waruiru, Richelle Harklerode, Andrea A Kim, Mahesh Swaminathan, Kevin M De Cock, Joyce Wamicwe
<p><strong>Problem/condition: </strong>Use of human immunodeficiency virus (HIV)-mortality surveillance data can help public health officials monitor, evaluate, and improve HIV treatment programs. Many high-income countries have high-coverage civil registration and vital statistics (CRVS) systems linked to case-based HIV surveillance on which to base HIV mortality estimates. However, in the absence of comprehensive CRVS systems in low- and medium-income countries, such as Kenya, mortuary surveillance can be used to understand the occurrence of HIV infection among cadavers. In 2015, a pilot HIV-related mortuary surveillance system was implemented in the two largest mortuaries in Nairobi, Kenya. CDC conducted an evaluation to assess performance attributes and identify strengths and weaknesses of the surveillance system pilot.</p><p><strong>Period covered: </strong>Data collection: January 29-March 3, 2015; evaluation: November 2015.</p><p><strong>Description of the system: </strong>The surveillance system objectives were to determine HIV positivity among cadavers at two mortuary sites in Nairobi, Kenya, and to determine annual cause-specific and HIV-specific mortality rates among the cadavers. Cadavers of persons aged ≥15 years at death admitted to either mortuary during a 33-day period were included. Demographic information and place and time of death were entered into a surveillance register. Cardiac blood was collected using transthoracic aspiration, and blood specimens were tested for HIV in a central laboratory. Causes of death were abstracted from mortuary and hospital records. Of the 807 cadavers brought to the mortuaries, 610 (75.6%) had an HIV test result available. The overall unadjusted HIV-positivity rate was 19.5% (119/610), which differed significantly by sex (14.6% among men versus 29.5% among women).</p><p><strong>Evaluation: </strong>The evaluation was conducted using CDC guidelines for evaluating public health surveillance systems. The attributes of simplicity, flexibility, data quality (completeness and validity), acceptability, sensitivity, predictive value positive, representativeness, timeliness, and stability were examined. The evaluation steps included review of the surveillance system documents, in-depth interviews with 20 key informants (surveillance system staff, including mortuary and laboratory staff, and stakeholders involved in funding or implementation), and review of the surveillance database.</p><p><strong>Results and interpretation: </strong>Implementation of the pilot mortuary surveillance system was complex because of extensive paperwork and the need to collect and process specimens outside of business hours. However, the flexibility of the system accommodated multiple changes during implementation, including changes in specimen collection techniques and data collection tools. Acceptability was initially low among the mortuary staff but increased after concerns regarding workload were resolved. Timeliness of spe
问题/条件：使用人体免疫缺陷病毒（HIV）死亡率监测数据可以帮助公共卫生官员监测、评估和改进 HIV 治疗计划。许多高收入国家都拥有高覆盖率的民事登记和生命统计系统（CRVS），该系统与以病例为基础的 HIV 监测相连接，可作为 HIV 死亡率估算的依据。然而，在肯尼亚等中低收入国家，由于缺乏全面的民事登记和生命统计系统，可以利用停尸房监测来了解尸体感染 HIV 的情况。2015 年，肯尼亚内罗毕两个最大的停尸房试点实施了与 HIV 相关的停尸房监测系统。疾病预防控制中心进行了一项评估，以评估监测系统试点的性能属性并确定其优缺点：数据收集：数据收集：2015 年 1 月 29 日至 3 月 3 日；评估：2015 年 11 月：系统描述：该监测系统的目标是确定肯尼亚内罗毕两个停尸点尸体中的 HIV 阳性率，并确定尸体中每年的特定病因死亡率和特定 HIV 死亡率。在 33 天的时间里，两个停尸房中任何一个停尸房接收的死亡时年龄≥15 岁的尸体都包括在内。人口统计学信息、死亡地点和时间被输入监控登记册。采用经胸抽吸法采集心血，并在中心实验室对血液标本进行艾滋病病毒检测。死亡原因摘自停尸房和医院记录。在送往停尸房的 807 具尸体中，有 610 具（75.6%）有 HIV 检测结果。未经调整的总体 HIV 阳性率为 19.5%（119/610），性别差异很大（男性为 14.6%，女性为 29.5%）：评估采用美国疾病预防控制中心的公共卫生监测系统评估指南进行。对简易性、灵活性、数据质量（完整性和有效性）、可接受性、灵敏度、阳性预测值、代表性、及时性和稳定性等属性进行了检查。评估步骤包括审查监测系统文件、对 20 名关键信息提供者（监测系统工作人员，包括停尸房和实验室工作人员，以及参与资助或实施的利益相关者）进行深入访谈，以及审查监测数据库：试点停尸房监控系统的实施非常复杂，因为需要大量的文书工作，而且需要在非工作时间收集和处理标本。然而，该系统的灵活性使其在实施过程中能够适应多种变化，包括标本采集技术和数据收集工具的变化。停尸房工作人员最初对该系统的接受度不高，但在解决了工作量方面的顾虑后，接受度有所提高。由于很少记录死亡时间，因此无法衡量标本采集的及时性。除死因（46.5%）外，系统提供数据的完整性普遍较高。虽然内罗毕最大的两家停尸房被包括在内，但监测系统可能并不代表内罗毕的人口。其中一个停尸房隶属于国家转诊医院，包括入院病人的尸体，一些死亡可能发生在内罗毕以外的地方，而且数据只收集了一个月：公共卫生行动：停尸房监测可提供尸体中艾滋病毒阳性和与艾滋病毒相关的死亡率数据，而在大多数撒哈拉以南非洲国家，这些数据无法从其他来源获得。提供这些死亡率数据有助于说明一个国家在实现流行病控制和联合国艾滋病毒/艾滋病联合规划署 95-95-95 目标方面的进展情况。为了解高发地区的艾滋病毒死亡率，正在肯尼亚西部推广停尸房监测系统。虽然这是一个低成本系统，但其可持续性取决于外部供资，因为停尸房监测尚未纳入肯尼亚国家艾滋病战略框架。
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引用次数: 0
Abortion Surveillance - United States, 2015. 堕胎监测-美国，2015年。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-11-23 DOI: 10.15585/mmwr.ss6713a1
Tara C Jatlaoui, Maegan E Boutot, Michele G Mandel, Maura K Whiteman, Angeline Ti, Emily Petersen, Karen Pazol

Problem/condition: Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States.

Period covered: 2015.

Description of system: Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2015, data were received from 49 reporting areas. Abortion data provided by these 49 reporting areas for each year during 2006-2015 were used in trend analyses. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births), respectively.

Results: A total of 638,169 abortions for 2015 were reported to CDC from 49 reporting areas. Among these 49 reporting areas, the abortion rate for 2015 was 11.8 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 188 abortions per 1,000 live births. From 2014 to 2015, the total number of reported abortions decreased 2% (from 652,639), the abortion rate decreased 2% (from 12.1 abortions per 1,000 women aged 15-44 years), and the abortion ratio decreased 2% (from 192 abortions per 1,000 live births). From 2006 to 2015, the total number of reported abortions decreased 24% (from 842,855), the abortion rate decreased 26% (from 15.9 abortions per 1,000 women aged 15-44 years), and the abortion ratio decreased 19% (from 233 abortions per 1,000 live births). In 2015, all three measures reached their lowest level for the entire period of analysis (2006-2015). In 2015 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women aged ≥30 years accounted for a smaller percentage of abortions and had lower abortion rates. In 2015, women aged 20-24 and 25-29 years accounted for 31.1% and 27.6% of all reported abortions, respectively, and had abortion rates of 19.9 and 17.9 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 17.7%, 10.0%, and 3.5% of all reported abortions, respectively, and had abortion rates of 11.6, 7.0, and 2.5 abortions per 1,000 women aged 30-34, 35-39, and ≥40 years, respectively. From 2006 to 2015, the abortion rate decreased among women in all age groups. In 2015, adolescents aged <15 and 15-19 years accounted for 0.3% and 9.8% of all reported abortions, respectively, and had abortion rates of 0.5 and 6.7 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2006 to 2015, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 41%, and their abortion rate decreased 54%. This decrease in abortion rate was greater than the decreases for women in any

问题/状况：自1969年以来，美国疾病控制与预防中心一直在进行堕胎监测，以记录美国合法人工流产妇女的数量和特征。涵盖时间：2015年。系统描述：每年，美国疾病预防与预防中心都会向52个报告地区（50个州、哥伦比亚特区和纽约市）的中央卫生机构索取堕胎数据。报告地区自愿提供这些信息。2015年，收到了49个报告地区的数据。2006-2015年期间，这49个报告地区每年提供的堕胎数据被用于趋势分析。人口普查和出生率数据分别用于计算堕胎率（每1000名15-44岁妇女堕胎次数）和比率（每1000例活产堕胎次数）。结果：2015年，美国疾病控制与预防中心共收到49个报告地区638169例堕胎报告。在这49个报告地区中，2015年的堕胎率为每1000名15-44岁妇女11.8次堕胎，堕胎比率为每1000例活产188次堕胎。从2014年到2015年，报告的堕胎总数下降了2%（从652639例），堕胎率下降了2%，从每1000名15-44岁妇女中有12.1例堕胎下降到2%，堕胎率从每1000例活产中有192例下降到2%。从2006年到2015年，报告的堕胎总数下降了24%（从842855例），堕胎率下降了26%（从每1000名15-44岁妇女15.9例堕胎），堕胎比率下降了19%（从每1 000名活产233例堕胎）。2015年，所有三项指标都达到了整个分析期间（2006-2015年）的最低水平。2015年和整个分析期间，20多岁的女性堕胎占大多数，堕胎率最高；年龄≥30岁的妇女堕胎的比例较小，堕胎率较低。2015年，20-24岁和25-29岁的妇女分别占所有报告堕胎的31.1%和27.6%，每1000名20-24岁或25-29岁妇女的堕胎率分别为19.9和17.9。相反，30-34岁、35-39岁和≥40岁的妇女分别占所有报告堕胎的17.7%、10.0%和3.5%，每1000名30-34岁和35-39岁及≥40岁妇女的堕胎率分别为11.6、7.0和2.5。从2006年到2015年，所有年龄组的妇女堕胎率都有所下降。2015年，怀孕13周的青少年一直保持在较低水平（≤9.0%）。在怀孕≤13周时进行的堕胎中，发生了向孕早期的转变，在怀孕≤6周时进行堕胎的比例增加了11%。2015年，24.6%的堕胎是通过早期药物流产（妊娠≤8周时的非手术流产）进行的，64.3%是在妊娠≤13周时通过手术流产进行的，8.8%是在妊娠>13周时通过外科流产进行的；所有其他方法都不常见（≤2.2%）。在那些有资格根据胎龄进行早期药物流产（即在妊娠≤8周时进行）的人中，35.8%的人通过这种方法完成了流产。2015年，有过一次或多次活产的妇女占堕胎总数的59.3%，没有过活产的女性占40.7%。有过一次或多次人工流产的妇女占流产总数的43.6%，没有过堕胎的妇女占56.3%，有三次或三次以上堕胎经历的妇女占堕胎总数的8.2%。作为美国疾病控制与预防中心妊娠死亡率监测系统的一部分，正在评估2015年与堕胎并发症相关的女性死亡人数。2014年是有数据可查的最近一年，有6名妇女被确认死于合法人工流产并发症。解释：在2006-2015年期间每年报告数据的49个地区中，报告的堕胎总数、比率和比率的下降导致了所有三项堕胎指标分析期间的历史新低。公共卫生行动：本报告中的数据可以帮助项目规划者和政策制定者确定堕胎率最高的女性群体。意外怀孕是人工流产的主要原因。在美国，增加获得和使用有效避孕药具的机会可以减少意外怀孕，并进一步减少堕胎次数。
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引用次数: 48
Abortion Surveillance - United States, 2014. 堕胎监测-美国，2014年。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-11-23 DOI: 10.15585/mmwr.ss6625a1
Tara C Jatlaoui, Jill Shah, Michele G Mandel, Jamie W Krashin, Danielle B Suchdev, Denise J Jamieson, Karen Pazol
<p><strong>Problem/condition: </strong>Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States.</p><p><strong>Period covered: </strong>2014.</p><p><strong>Description of system: </strong>Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2014, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 48 areas that reported data every year during 2005-2014. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births).</p><p><strong>Results: </strong>A total of 652,639 abortions were reported to CDC for 2014. Of these abortions, 98.4% were from the 48 reporting areas that provided data every year during 2005-2014. Among these 48 reporting areas, the abortion rate for 2014 was 12.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 193 abortions per 1,000 live births. From 2013 to 2014, the total number and rate of reported abortions decreased 2%, and the ratio decreased 3%. From 2005 to 2014, the total number, rate, and ratio of reported abortions decreased 21%, 22%, and 18%, respectively. In 2014, all three measures reached their lowest level for the entire period of analysis (2005-2014). In 2014 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2014, women aged 20-24 and 25-29 years accounted for 32.2% and 26.7% of all reported abortions, respectively, and had abortion rates of 21.3 and 18.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 17.1%, 9.7%, and 3.6% of all reported abortions, respectively, and had abortion rates of 11.9, 7.2, and 2.6 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. From 2005 to 2014, the abortion rate decreased among women aged 20-24, 25-29, 30-34, and 35-39 years by 27%, 16%, 12%, and 5%, respectively, but increased 4% among women aged ≥40 years. In 2014, adolescents aged <15 and 15-19 years accounted for 0.3% and 10.4% of all reported abortions, respectively, and had abortion rates of 0.5 and 7.5 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2005 to 2014, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 38%, and their abortion rate decreased 49%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abo
问题/状况:自1969年以来，美国疾病控制与预防中心进行了堕胎监测，记录了美国合法堕胎妇女的数量和特征。涵盖时间:2014年。系统描述:每年，疾病预防控制中心要求52个报告地区(50个州、哥伦比亚特区和纽约市)的中央卫生机构提供堕胎数据。报告地区自愿提供这些信息。2014年，从49个报告地区收到了数据。为进行趋势分析，对2005-2014年每年报告数据的48个地区的堕胎数据进行了评估。分别使用人口普查和出生数据来计算堕胎率(每1,000名15-44岁妇女的堕胎次数)和比率(每1,000名活产的堕胎次数)。结果:2014年共向疾病预防控制中心报告652,639例堕胎。在这些堕胎中，98.4%来自2005-2014年间每年提供数据的48个报告地区。在这48个报告地区中，2014年堕胎率为每1000名15-44岁妇女12.1例堕胎，堕胎率为每1000例活产193例堕胎。从2013年到2014年，报告的堕胎总数和比率下降了2%，比例下降了3%。从2005年到2014年，报告的堕胎总数、比率和比例分别下降了21%、22%和18%。2014年，所有三项指标都达到了整个分析期间(2005-2014年)的最低水平。在2014年和整个分析期间，20多岁的女性占堕胎的大多数，堕胎率最高;30多岁及以上的女性所占的堕胎比例要小得多，堕胎率也较低。2014年，20-24岁和25-29岁的女性分别占所有报告堕胎的32.2%和26.7%，20-24岁和25-29岁女性的堕胎率分别为21.3例和18.4例。相比之下，30-34岁、35-39岁和≥40岁的女性分别占所有报告流产的17.1%、9.7%和3.6%，每1000名30-34岁、35-39岁和≥40岁女性的流产率分别为11.9、7.2和2.6。2005 - 2014年，20-24岁、25-29岁、30-34岁和35-39岁女性的流产率分别下降27%、16%、12%和5%，而≥40岁女性的流产率上升4%。2014年，怀孕13周的青少年;(解释:在2005-2014年每年报告数据的48个地区中，2010-2013年报告的堕胎总数、比率和比例在2013年至2014年持续下降，导致所有三种堕胎措施都处于历史低点。公共卫生行动:本报告中的数据可以帮助方案规划者和决策者确定堕胎率最高的妇女群体。意外怀孕是人工流产的主要原因。增加有效避孕措施的获取和使用可以减少意外怀孕，并进一步减少美国的堕胎数量。
{"title":"Abortion Surveillance - United States, 2014.","authors":"Tara C Jatlaoui,&nbsp;Jill Shah,&nbsp;Michele G Mandel,&nbsp;Jamie W Krashin,&nbsp;Danielle B Suchdev,&nbsp;Denise J Jamieson,&nbsp;Karen Pazol","doi":"10.15585/mmwr.ss6625a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6625a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2014.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2014, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 48 areas that reported data every year during 2005-2014. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 652,639 abortions were reported to CDC for 2014. Of these abortions, 98.4% were from the 48 reporting areas that provided data every year during 2005-2014. Among these 48 reporting areas, the abortion rate for 2014 was 12.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 193 abortions per 1,000 live births. From 2013 to 2014, the total number and rate of reported abortions decreased 2%, and the ratio decreased 3%. From 2005 to 2014, the total number, rate, and ratio of reported abortions decreased 21%, 22%, and 18%, respectively. In 2014, all three measures reached their lowest level for the entire period of analysis (2005-2014). In 2014 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2014, women aged 20-24 and 25-29 years accounted for 32.2% and 26.7% of all reported abortions, respectively, and had abortion rates of 21.3 and 18.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 17.1%, 9.7%, and 3.6% of all reported abortions, respectively, and had abortion rates of 11.9, 7.2, and 2.6 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. From 2005 to 2014, the abortion rate decreased among women aged 20-24, 25-29, 30-34, and 35-39 years by 27%, 16%, 12%, and 5%, respectively, but increased 4% among women aged ≥40 years. In 2014, adolescents aged &lt;15 and 15-19 years accounted for 0.3% and 10.4% of all reported abortions, respectively, and had abortion rates of 0.5 and 7.5 abortions per 1,000 adolescents aged &lt;15 and 15-19 years, respectively. From 2005 to 2014, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 38%, and their abortion rate decreased 49%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abo","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"66 25","pages":"1-44"},"PeriodicalIF":24.9,"publicationDate":"2018-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15585/mmwr.ss6625a1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36694260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. 8岁儿童自闭症谱系障碍的流行与特征——自闭症与发育障碍监测网络，美国，2012。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-11-16 DOI: 10.15585/mmwr.ss6513a1
Deborah L Christensen, Kim Van Naarden Braun, Jon Baio, Deborah Bilder, Jane Charles, John N Constantino, Julie Daniels, Maureen S Durkin, Robert T Fitzgerald, Margaret Kurzius-Spencer, Li-Ching Lee, Sydney Pettygrove, Cordelia Robinson, Eldon Schulz, Chris Wells, Martha S Wingate, Walter Zahorodny, Marshalyn Yeargin-Allsopp
<p><strong>Problem/condition: </strong>Autism spectrum disorder (ASD).</p><p><strong>Period covered: </strong>2012.</p><p><strong>Description of system: </strong>The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence and characteristics of ASD among children aged 8 years whose parents or guardians reside in 11 ADDM Network sites in the United States (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin). Surveillance to determine ASD case status is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional service providers in the community. Data sources identified for record review are categorized as either 1) education source type, including developmental evaluations to determine eligibility for special education services or 2) health care source type, including diagnostic and developmental evaluations. The second phase involves the review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if one or more comprehensive evaluations of that child completed by a qualified professional describes behaviors that are consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides ASD prevalence estimates for children aged 8 years living in catchment areas of the ADDM Network sites in 2012, overall and stratified by sex, race/ethnicity, and the type of source records (education and health records versus health records only). In addition, this report describes the proportion of children with ASD with a score consistent with intellectual disability on a standardized intellectual ability test, the age at which the earliest known comprehensive evaluation was performed, the proportion of children with a previous ASD diagnosis, the specific type of ASD diagnosis, and any special education eligibility classification.</p><p><strong>Results: </strong>For 2012, the combined estimated prevalence of ASD among the 11 ADDM Network sites was 14.5 per 1,000 (one in 69) children aged 8 years. Estimated prevalence was significantly higher among boys aged 8 years (23.4 per 1,000) than among girls aged 8 years (5.2 per 1,000). Estimated ASD prevalence was significantly higher among non-Hispanic white children aged 8 years (15.3 per 1,000) compared with non-Hispanic black children (13.1 per 1,000), and Hispanic (10.2 per 1,000) children aged 8 years. Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only h
问题/状况:自闭症谱系障碍(ASD)。涵盖期间:2012年。系统描述:自闭症和发育障碍监测(ADDM)网络是一个主动监测系统，提供父母或监护人居住在美国11个ADDM网络站点(阿肯色州，亚利桑那州，科罗拉多州，佐治亚州，马里兰州，密苏里州，新泽西州，北卡罗来纳州，南卡罗来纳州，犹他州和威斯康星州)的8岁儿童中ASD患病率和特征的估计。确定ASD病例状态的监测分两个阶段进行。第一阶段包括筛选和提取由社区专业服务提供者进行的综合评估。确定用于记录审查的数据源分为以下两类:1)教育来源类型，包括用于确定特殊教育服务资格的发展评价;2)保健来源类型，包括诊断和发展评价。第二阶段包括审查所有由训练有素的临床医生进行的抽象评估，以确定ASD监测病例的状态。如果由合格的专业人员完成的对该儿童的一项或多项综合评估描述的行为符合精神疾病诊断与统计手册第四版文本修订版的诊断标准，则该儿童符合ASD的监测病例定义:自闭症障碍，广泛性发育障碍-未另有说明(包括非典型自闭症)或阿斯伯格障碍。本报告提供了2012年生活在ADDM网络站点集水区的8岁儿童的ASD患病率估计，按性别、种族/民族和来源记录类型(教育和健康记录与仅健康记录)进行了总体和分层。此外，该报告还描述了在标准化智力能力测试中得分与智力残疾相符的自闭症儿童的比例，已知最早进行综合评估的年龄，以前诊断过自闭症儿童的比例，自闭症诊断的具体类型，以及任何特殊教育资格分类。结果:2012年，在11个ADDM网络站点中，ASD的综合估计患病率为每1000名8岁儿童中有14.5名(69人中有1名)。8岁男孩(每千人23.4人)的估计患病率明显高于8岁女孩(每千人5.2人)。8岁非西班牙裔白人儿童的ASD患病率(15.3 / 1000)明显高于非西班牙裔黑人儿童(13.1 / 1000)和8岁西班牙裔儿童(10.2 / 1000)。在11个ADDM网络站点中，估计的患病率差异很大，从每1,000名8岁儿童中有8.2人(在马里兰州站点，只审查了医疗记录)到每1,000名8岁儿童中有24.6人(在新泽西州，既审查了教育记录，也审查了医疗记录)。与仅审查健康记录的监测点相比，审查教育记录和健康记录的监测点的估计患病率更高(分别为17.1 / 1,000和10.4 / 1,000);解释:在2012年ADDM网络站点中，总体估计ASD患病率为每1000名8岁儿童中有14.5人。在审查了教育和健康记录的网站中，估计的患病率较高，这表明特殊教育系统在为发育障碍儿童提供全面评估和服务方面的作用。估计ASD患病率的种族/民族差异，特别是西班牙裔儿童，以及最早进行全面评估的年龄差异和先前ASD诊断或分类的存在，表明一些儿童可能缺乏或延迟获得治疗和服务。公共卫生行动:ADDM网络将继续监测生活在美国选定地点的8岁儿童中自闭症谱系障碍的患病率和特征。来自ADDM网络的建议包括加强以下策略:1)降低社区提供者首次评估ASD的年龄，以符合健康人2020目标，即ASD儿童在36个月大时进行评估，并在48个月大时开始接受社区支持和服务;2)减少种族/民族在已确诊的ASD患病率、首次综合评估的年龄、既往ASD诊断或分类存在方面的差异;3)评估《精神障碍诊断与统计手册》第五版修订后的ASD诊断标准对ASD患病率的影响。
{"title":"Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012.","authors":"Deborah L Christensen,&nbsp;Kim Van Naarden Braun,&nbsp;Jon Baio,&nbsp;Deborah Bilder,&nbsp;Jane Charles,&nbsp;John N Constantino,&nbsp;Julie Daniels,&nbsp;Maureen S Durkin,&nbsp;Robert T Fitzgerald,&nbsp;Margaret Kurzius-Spencer,&nbsp;Li-Ching Lee,&nbsp;Sydney Pettygrove,&nbsp;Cordelia Robinson,&nbsp;Eldon Schulz,&nbsp;Chris Wells,&nbsp;Martha S Wingate,&nbsp;Walter Zahorodny,&nbsp;Marshalyn Yeargin-Allsopp","doi":"10.15585/mmwr.ss6513a1","DOIUrl":"https://doi.org/10.15585/mmwr.ss6513a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Autism spectrum disorder (ASD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2012.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence and characteristics of ASD among children aged 8 years whose parents or guardians reside in 11 ADDM Network sites in the United States (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin). Surveillance to determine ASD case status is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional service providers in the community. Data sources identified for record review are categorized as either 1) education source type, including developmental evaluations to determine eligibility for special education services or 2) health care source type, including diagnostic and developmental evaluations. The second phase involves the review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if one or more comprehensive evaluations of that child completed by a qualified professional describes behaviors that are consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides ASD prevalence estimates for children aged 8 years living in catchment areas of the ADDM Network sites in 2012, overall and stratified by sex, race/ethnicity, and the type of source records (education and health records versus health records only). In addition, this report describes the proportion of children with ASD with a score consistent with intellectual disability on a standardized intellectual ability test, the age at which the earliest known comprehensive evaluation was performed, the proportion of children with a previous ASD diagnosis, the specific type of ASD diagnosis, and any special education eligibility classification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For 2012, the combined estimated prevalence of ASD among the 11 ADDM Network sites was 14.5 per 1,000 (one in 69) children aged 8 years. Estimated prevalence was significantly higher among boys aged 8 years (23.4 per 1,000) than among girls aged 8 years (5.2 per 1,000). Estimated ASD prevalence was significantly higher among non-Hispanic white children aged 8 years (15.3 per 1,000) compared with non-Hispanic black children (13.1 per 1,000), and Hispanic (10.2 per 1,000) children aged 8 years. Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only h","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"65 13","pages":"1-23"},"PeriodicalIF":24.9,"publicationDate":"2018-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36729639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1665
Surveillance for Cancers Associated with Tobacco Use - United States, 2010-2014. 与吸烟有关的癌症监测——美国，2010-2014年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-11-02 DOI: 10.15585/mmwr.ss6712a1
M Shayne Gallaway, S Jane Henley, C Brooke Steele, Behnoosh Momin, Cheryll C Thomas, Ahmed Jamal, Katrina F Trivers, Simple D Singh, Sherri L Stewart
<p><strong>Problem/condition: </strong>Tobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures.</p><p><strong>Period covered: </strong>2010-2014.</p><p><strong>Description of system: </strong>Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2010-2014 and trends in annual age-adjusted incidence rates for 2010-2014. These cancer incidence data cover approximately 99% of the U.S.</p><p><strong>Population: </strong>This report provides age-adjusted cancer incidence rates for each of the 12 cancer types known to be causally associated with tobacco use, including liver and colorectal cancer, which were deemed to be causally associated with tobacco use by the U.S. Surgeon General in 2014. Findings are reported by demographic and geographic characteristics, percentage distributions for tumor characteristics, and trends in cancer incidence by sex.</p><p><strong>Results: </strong>During 2010-2014, approximately 3.3 million new tobacco-associated cancer cases were reported in the United States, approximately 667,000 per year. Age-adjusted incidence rates ranged from 4.2 AML cases per 100,000 persons to 61.3 lung cancer cases per 100,000 persons. By cancer type, incidence rates were higher among men than women (excluding cervical cancer), higher among non-Hispanics than Hispanics (for all cancers except stomach, liver, kidney, and cervical), higher among persons in nonmetropolitan counties than those in metropolitan counties (for all cancers except stomach, liver, pancreatic, and AML), and lower in the West than in other U.S. census regions (all except stomach, liver, bladder, and AML). Compared with other racial/ethnic groups, certain cancer rates were highest among whites (oral cavity and pharyngeal, esophageal, bladder, and AML), blacks (colon and rectal, pancreatic, laryngeal, lung and bronchial, cervical, and kidney), and Asians/Pacific Islanders (stomach and liver). During 2010-2014, the rate of all tobacco-associated cancers combined decreased 1.2% per year, influenced largely by decreases in cancers of the larynx (3.0%), lung (2.2%), colon and rectum (2.1%), and bladder (1.3%).</p><p><strong>Interpretation: </strong>Although tobacco-associated cancer incidence decre
问题/状况：吸烟是癌症的主要可预防原因，导致至少12种癌症，包括急性髓细胞白血病（AML）和口腔癌和咽部癌；食管胃结肠和直肠；肝脏胰喉肺、支气管和气管；肾脏和肾盂；膀胱；和子宫颈。本报告根据性别、年龄、种族/民族、大都市县分类、肿瘤特征、美国人口普查地区和州，对每种癌症类型的近期烟草相关癌症发病率进行了全面评估。这些数据对于烟草预防和控制措施的启动、监测和评估非常重要。涵盖的时间段：2010-2014系统描述：美国疾病控制与预防中心癌症登记处国家计划和国家癌症研究所监测、流行病学和最终结果计划的癌症发病率数据用于计算2010-2014年经年龄调整的平均年发病率和2010-2014年经过年龄调整的年发病率趋势。这些癌症发病率数据覆盖了约99%的美国人口：该报告提供了已知与吸烟有因果关系的12种癌症类型中每种类型的年龄调整后的癌症发病率，包括2014年美国卫生部长认为与吸烟有亲缘关系的肝脏和结直肠癌癌症。研究结果按人口统计学和地理特征、肿瘤特征的百分比分布以及按性别划分的癌症发病率趋势进行报告。结果：2010-2014年期间，美国报告了约330万例新的烟草相关癌症病例，每年约667000例。年龄调整后的发病率从每100000人4.2例AML病例到每100000人61.3例癌症病例不等。按癌症类型划分，男性的发病率高于女性（不包括癌症），非西班牙裔的发病率低于西班牙族（除胃癌、肝癌、肾癌和宫颈癌外的所有癌症），非大都市县的人发病率高于大都市县（除胃癌，肝癌，胰腺癌和AML外的所有肿瘤），西部低于美国其他人口普查地区（除胃、肝、膀胱和AML外）。与其他种族/民族相比，某些癌症发病率在白人（口腔和咽部、食道、膀胱和AML）、黑人（结肠和直肠、胰腺、喉部、肺和支气管、宫颈和肾脏）以及亚洲人/太平洋岛民（胃和肝）中最高。2010-2014年期间，所有烟草相关癌症的发病率每年下降1.2%，主要受喉癌（3.0%）、肺癌（2.2%）、结直肠癌（2.1%）和膀胱癌（1.3%）下降的影响，白人、黑人、非西班牙裔和非大都市县的人。这些与烟草相关的癌症发病率过高，反映了美国癌症发病率的总体人口统计模式，也反映了烟草使用模式。公共卫生行动：可以通过预防和控制烟草使用以及全面的癌症控制工作来减少与烟草相关的癌症发病率，这些工作的重点是降低癌症风险，及早发现癌症，并更好地帮助受癌症影响特别严重的社区。监测癌症发病率的持续监测可以确定烟草相关癌症发病率高的人群，并评估烟草控制计划和政策的有效性。可以开展实施研究，以更广泛地采用现有的循证癌症预防和筛查方案以及烟草控制措施，特别是针对癌症发病率差异最大的群体。
{"title":"Surveillance for Cancers Associated with Tobacco Use - United States, 2010-2014.","authors":"M Shayne Gallaway, S Jane Henley, C Brooke Steele, Behnoosh Momin, Cheryll C Thomas, Ahmed Jamal, Katrina F Trivers, Simple D Singh, Sherri L Stewart","doi":"10.15585/mmwr.ss6712a1","DOIUrl":"10.15585/mmwr.ss6712a1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Problem/condition: &lt;/strong&gt;Tobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Period covered: &lt;/strong&gt;2010-2014.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description of system: &lt;/strong&gt;Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2010-2014 and trends in annual age-adjusted incidence rates for 2010-2014. These cancer incidence data cover approximately 99% of the U.S.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Population: &lt;/strong&gt;This report provides age-adjusted cancer incidence rates for each of the 12 cancer types known to be causally associated with tobacco use, including liver and colorectal cancer, which were deemed to be causally associated with tobacco use by the U.S. Surgeon General in 2014. Findings are reported by demographic and geographic characteristics, percentage distributions for tumor characteristics, and trends in cancer incidence by sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During 2010-2014, approximately 3.3 million new tobacco-associated cancer cases were reported in the United States, approximately 667,000 per year. Age-adjusted incidence rates ranged from 4.2 AML cases per 100,000 persons to 61.3 lung cancer cases per 100,000 persons. By cancer type, incidence rates were higher among men than women (excluding cervical cancer), higher among non-Hispanics than Hispanics (for all cancers except stomach, liver, kidney, and cervical), higher among persons in nonmetropolitan counties than those in metropolitan counties (for all cancers except stomach, liver, pancreatic, and AML), and lower in the West than in other U.S. census regions (all except stomach, liver, bladder, and AML). Compared with other racial/ethnic groups, certain cancer rates were highest among whites (oral cavity and pharyngeal, esophageal, bladder, and AML), blacks (colon and rectal, pancreatic, laryngeal, lung and bronchial, cervical, and kidney), and Asians/Pacific Islanders (stomach and liver). During 2010-2014, the rate of all tobacco-associated cancers combined decreased 1.2% per year, influenced largely by decreases in cancers of the larynx (3.0%), lung (2.2%), colon and rectum (2.1%), and bladder (1.3%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Although tobacco-associated cancer incidence decre","PeriodicalId":48549,"journal":{"name":"Mmwr Surveillance Summaries","volume":"67 12","pages":"1-42"},"PeriodicalIF":37.3,"publicationDate":"2018-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36683223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surveillance for Violent Deaths - National Violent Death Reporting System, 27 States, 2015. 暴力死亡监测--全国暴力死亡报告系统，27个州，2015年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-09-28 DOI: 10.15585/mmwr.ss6711a1
Shane P D Jack, Emiko Petrosky, Bridget H Lyons, Janet M Blair, Allison M Ertl, Kameron J Sheats, Carter J Betz
<p><strong>Problem/condition: </strong>In 2015, approximately 62,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 27 U.S. states for 2015. Results are reported by sex, age group, race/ethnicity, location of injury, method of injury, circumstances of injury, and other selected characteristics.</p><p><strong>Reporting period: </strong>2015.</p><p><strong>Description of system: </strong>NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 27 states that collected statewide data for 2015 (Alaska, Arizona, Colorado, Connecticut, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident.</p><p><strong>Results: </strong>For 2015, NVDRS captured 30,628 fatal incidents involving 31,415 deaths in the 27 states included in this report. The majority (65.1%) of deaths were suicides, followed by homicides (23.5%), deaths of undetermined intent (9.5%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns varied by manner of death. Suicide rates were highest among males, non-Hispanic American Indian/Alaska Natives, non-Hispanic whites, adults aged 45-54 years, and men aged ≥75 years. The most common method of injury was a firearm. Suicides often were preceded by a mental health, intimate partner, substance abuse, or physical health problem, or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged <1 year and 20-34 years. Among males, non-Hispanic blacks accounted for the majority of homicides and had the highest rate of any racial/ethnic group. Homicides primarily involved a firearm, were precipitated by arguments and interpersonal conflicts, were related to intimate partner violence (particularly for females), or occurred in conjunction with another crime. When the relationship between a homicide victim and a suspected perpetrator was k
问题/条件：2015 年，美国约有 62,000 人死于与暴力有关的伤害。本报告汇总了美国疾病预防控制中心国家暴力死亡报告系统（NVDRS）提供的 2015 年美国 27 个州的暴力死亡数据。报告结果按性别、年龄组、种族/民族、受伤地点、受伤方式、受伤情况和其他选定特征进行了报告：NVDRS收集的暴力死亡数据来自死亡证明、验尸官/法医报告、执法报告和二手来源（如儿童死亡审查小组数据、凶杀案补充报告、医院数据和犯罪实验室数据）。本报告包括收集了 2015 年全州数据的 27 个州（阿拉斯加州、亚利桑那州、科罗拉多州、康涅狄格州、佐治亚州、夏威夷州、堪萨斯州、肯塔基州、缅因州、马里兰州、马萨诸塞州、密歇根州、明尼苏达州、新罕布什尔州、新泽西州、新墨西哥州、纽约州、北卡罗来纳州、俄亥俄州、俄克拉荷马州、俄勒冈州、罗得岛州、南卡罗来纳州、犹他州、佛蒙特州、弗吉尼亚州和威斯康星州）的数据。NVDRS 整理每例死亡的文件，并将相关的死亡（如多起凶杀、一起凶杀后自杀或多起自杀）联系到一起事件中：2015 年，NVDRS 共记录了 30628 起死亡事件，涉及本报告中 27 个州的 31415 例死亡。大多数死亡（65.1%）是自杀，其次是他杀（23.5%）、意图不明的死亡（9.5%）、合法干预死亡（1.3%）（即由执法人员和其他有合法权力使用致命武力的人员造成的死亡，不包括合法处决），以及非故意的枪支死亡（解释：本报告提供了 2015 年 NVDRS 数据的详细摘要。结果表明，自残或人际暴力导致的死亡最常影响男性、特定年龄组和少数群体。心理健康问题、亲密伴侣问题、人际冲突和一般生活压力是多种类型暴力死亡的主要诱发因素，包括现役或退役军人的自杀：NVDRS 数据用于监测与暴力有关的致命伤害的发生情况，并协助公共卫生部门制定、实施和评估旨在减少和预防暴力死亡的计划和政策。例如，弗吉尼亚州 VDRS 数据被用于帮助识别现役军人中的自杀风险因素，俄勒冈州 VDRS 自杀数据被用于协调支持退伍军人和现役军人的社区机构的信息和活动，亚利桑那州 VDRS 数据被用于为退伍军人提供护理的初级保健提供者制定建议。继续开发 NVDRS 并将其扩展到美国 50 个州、领地和哥伦比亚特区，对于减少暴力致死的公共卫生工作至关重要。
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引用次数: 0
Surveillance for Foodborne Disease Outbreaks - United States, 2009-2015. 食源性疾病暴发监测-美国，2009-2015。
IF 24.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-07-27 DOI: 10.15585/mmwr.ss6710a1
Daniel Dewey-Mattia, Karunya Manikonda, Aron J Hall, Matthew E Wise, Samuel J Crowe
<p><strong>Problem/condition: </strong>Known foodborne disease agents are estimated to cause approximately 9.4 million illnesses each year in the United States. Although only a small subset of illnesses are associated with recognized outbreaks, data from outbreak investigations provide insight into the foods and pathogens that cause illnesses and the settings and conditions in which they occur.</p><p><strong>Reporting period: </strong>2009-2015 DESCRIPTION OF SYSTEM: The Foodborne Disease Outbreak Surveillance System (FDOSS) collects data on foodborne disease outbreaks, which are defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Since the early 1960s, foodborne outbreaks have been reported voluntarily to CDC by state, local, and territorial health departments using a standard form. Beginning in 2009, FDOSS reporting was made through the National Outbreak Reporting System, a web-based platform launched that year.</p><p><strong>Results: </strong>During 2009-2015, FDOSS received reports of 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths. All 50 states, the District of Columbia, Puerto Rico, and CDC reported outbreaks. Among 2,953 outbreaks with a single confirmed etiology, norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]), followed by Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%). Outbreaks caused by Listeria, Salmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported. Among 1,281 outbreaks in which the food reported could be classified into a single food category, fish were the most commonly implicated category (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.</p><p><strong>Interpretation: </strong>Foodborne disease outbreaks provide information about the pathogens and foods responsible for illness. Norovirus remains the leading cause of foodborne disease outbreaks, highlighting the continued need for food safety improvements targeting worker health and hygiene in food service settings. Outbreaks caused by Listeria, Salmonella, and STEC are important targets for public health intervention efforts, and improving the safety of chicken, pork, and seeded vegetables should be a priority.</p><p><strong>Public health action: </strong>The causes of foodborne illness should continue to be tracked and analyzed to inform disease prevention policies and initiatives. Strengthening the capacity of state and local health departments to investigat
问题/状况:据估计，在美国，已知的食源性疾病病原体每年导致大约940万人患病。虽然只有一小部分疾病与公认的疫情有关，但疫情调查的数据提供了对导致疾病的食物和病原体以及发生疾病的环境和条件的深入了解。系统描述:食源性疾病暴发监测系统(FDOSS)收集食源性疾病暴发的数据，食源性疾病暴发的定义是由于摄入一种常见食物而导致的两例或两例以上类似疾病的发生。自20世纪60年代初以来，州、地方和地区卫生部门使用标准表格自愿向疾病预防控制中心报告食源性疾病暴发。从2009年开始，FDOSS通过国家疫情报告系统进行报告，该系统是当年启动的一个基于网络的平台。结果:2009-2015年期间，FDOSS收到了5,760起疫情报告，导致100,939人患病，5,699人住院，145人死亡。所有50个州、哥伦比亚特区、波多黎各和疾病预防控制中心都报告了疫情。在有单一病原学确认的2,953次暴发中，诺如病毒是暴发(1,130次暴发[38%])和暴发相关疾病(27,623次疾病[41%])的最常见原因，其次是沙门氏菌，有896次暴发(30%)和23,662次疾病(35%)。由李斯特菌、沙门氏菌和产志贺毒素大肠杆菌(STEC)引起的暴发导致82%的住院病例和82%的死亡病例。在报告的可将食物分类为单一食物类别的1,281次暴发中，鱼类是最常见的受影响类别(222次暴发[17%])，其次是乳制品(136次[11%])和鸡肉(123次[10%])。导致疫情相关疾病最多的食物类别是鸡肉(3114种疾病[12%])、猪肉(2670种[10%])和有籽蔬菜(2572种[10%])。多州暴发仅占报告的所有暴发的3%，但占11%的疾病，34%的住院治疗和54%的死亡。解释:食源性疾病暴发提供了有关致病病原体和食物的信息。诺如病毒仍然是食源性疾病暴发的主要原因，这突出表明继续需要针对食品服务机构工人的健康和卫生改善食品安全。李斯特菌、沙门氏菌和产志贺毒素大肠杆菌引起的疫情是公共卫生干预工作的重要目标，提高鸡肉、猪肉和有籽蔬菜的安全性应是优先考虑的问题。公共卫生行动:应继续跟踪和分析食源性疾病的原因，以便为疾病预防政策和行动提供信息。加强州和地方卫生部门调查和报告疫情的能力，将有助于查明与这些疫情有关的食物、病因和环境。
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引用次数: 685
Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2015. 各州和选定地方的某些健康行为和状况监测——行为风险因素监测系统，美国，2015年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-06-29 DOI: 10.15585/mmwr.ss6709a1
Cassandra M Pickens, Carol Pierannunzi, William Garvin, Machell Town
<p><strong>Problem: </strong>Chronic conditions and disorders (e.g., diabetes, cardiovascular diseases, arthritis, and depression) are leading causes of morbidity and mortality in the United States. Healthy behaviors (e.g., physical activity, avoiding cigarette use, and refraining from binge drinking) and preventive practices (e.g., visiting a doctor for a routine check-up, tracking blood pressure, and monitoring blood cholesterol) might help prevent or successfully manage these chronic conditions. Monitoring chronic diseases, health-risk behaviors, and access to and use of health care are fundamental to the development of effective public health programs and policies at the state and local levels.</p><p><strong>Reporting period: </strong>January-December 2015.</p><p><strong>Description of the system: </strong>The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to and use of health care, and use of preventive health services related to the leading causes of death and disability. This report presents results for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico (Puerto Rico), and Guam and for 130 metropolitan and micropolitan statistical areas (MMSAs) (N = 441,456 respondents) for 2015.</p><p><strong>Results: </strong>The age-adjusted prevalence estimates of health-risk behaviors, self-reported chronic health conditions, access to and use of health care, and use of preventive health services varied substantially by state, territory, and MMSA in 2015. Results are summarized for selected BRFSS measures. Each set of proportions refers to the median (range) of age-adjusted prevalence estimates for health-risk behaviors, self-reported chronic diseases or conditions, or use of preventive health care services by geographic jurisdiction, as reported by survey respondents. Adults with good or better health: 84.6% (65.9%-88.8%) for states and territories and 85.2% (66.9%-91.3%) for MMSAs. Adults with ≥14 days of poor physical health in the past 30 days: 10.9% (8.2%-17.2%) for states and territories and 10.9% (6.6%-19.1%) for MMSAs. Adults with ≥14 days of poor mental health in the past 30 days: 11.3% (7.3%-15.8%) for states and territories and 11.4% (5.6%-20.5%) for MMSAs. Adults aged 18-64 years with health care coverage: 86.8% (72.0%-93.8%) for states and territories and 86.8% (63.2%-95.7%) for MMSAs. Adults who received a routine physical checkup during the preceding 12 months: 69.0% (58.1%-79.8%) for states and territories and 69.4% (57.1%-81.1%) for MMSAs. Adults who ever had their blood cholesterol checked: 79.1% (73.3%-86.7%) for states and territories and 79.5% (65.1%-87.3%) for MMSAs. Current cigarette smoking among adults: 17.7% (9.0%-27.2%) for states and territories and 17.
问题：慢性疾病（如糖尿病、心血管疾病、关节炎和抑郁症）是美国发病率和死亡率的主要原因。健康行为（如体育活动、避免吸烟和避免酗酒）和预防措施（如去医生那里做常规检查、跟踪血压和监测血液胆固醇）可能有助于预防或成功控制这些慢性疾病。监测慢性病、健康风险行为以及获得和使用医疗保健是在州和地方各级制定有效的公共卫生计划和政策的基础。报告期：2015年1月至12月。系统描述：行为风险因素监测系统（BRFSS）是一项正在进行的、基于州的、随机数字拨号的固定电话和手机调查，对象是居住在美国的年龄≥18岁的非住院成年人。BRFSS收集与主要死亡和残疾原因相关的健康风险行为、慢性疾病和状况、获得和使用医疗保健以及使用预防性医疗服务的数据。本报告提供了2015年所有50个州、哥伦比亚特区、波多黎各联邦（波多黎各）和关岛以及130个大都市和微型城市统计区（MMSA）（N=441456名受访者）的结果，2015年，各州、地区和MMSA对预防性卫生服务的使用情况差异很大。对所选BRFSS措施的结果进行了总结。每组比例指的是调查受访者报告的健康风险行为、自我报告的慢性疾病或状况或按地理管辖区使用预防性医疗服务的年龄调整后患病率估计的中位数（范围）。健康状况良好或更好的成年人：各州和地区为84.6%（65.9%-88.8%），MMSA为85.2%（66.9%-91.3%）。在过去30天内身体健康状况不佳≥14天的成年人：各州和地区为10.9%（8.2%-17.2%），MMSA为10.9%。在过去30天内心理健康状况不佳≥14天的成年人：各州和地区为11.3%（7.3%-15.8%），MMSA为11.4%（5.6%-20.5%）。18-64岁有医疗保健覆盖率的成年人：各州和地区的覆盖率为86.8%（72.0%-93.8%），MMSA的覆盖率是86.8%（63.2%-95.7%）。在过去12个月内接受常规体检的成年人：州和地区为69.0%（58.1%-79.8%），MMSA为69.4%（57.1%-8.1%）。曾检查过血液胆固醇的成年人：79.1%（73.3%-86.7%）的州和地区和79.5%（65.1%-87.3%）的MMSA。目前成年人吸烟率：各州和地区为17.7%（9.0%-27.2%），MMSA为17.3%（4.5%-29.5%）。在过去的30天里，成年人酗酒：各州和地区为17.2%（11.2%-26.0%），MMSA为17.4%（5.5%-24.5%）。报告上个月没有休闲时间体育活动的成年人：各州和地区为25.5%（17.6%-47.1%），MMSA为24.5%（16.1%-47.3%）。报告在前一个月每天食用水果少于一次的成年人：各州和地区为40.5%（33.3%-55.5%），MMSA为40.3%（30.1%-57.3%）。报告在前一个月每天食用蔬菜少于一次的成年人：州和地区为22.4%（16.6%-31.3%），MMSA为22.3%（13.6%-32.0%）。肥胖成年人：各州和地区为29.5%（19.9%-36.0%），MMSA为28.5%（17.8%-41.6%）。诊断为糖尿病的年龄≥45岁的成年人：各州和地区为15.9%（11.2%-26.8%），MMSA为15.7%（10.5%-27.6%）。年龄≥18岁的成年人有一种关节炎：各州和地区为22.7%（17.2%-33.6%），MMSA为23.2%（12.3%-33.9%）。患有抑郁症的成年人：各州和地区为19.0%（9.6%-27.0%），MMSA为19.2%（9.9%-27.2%）。患有高血压的成年人：各州和地区为29.1%（24.2%-39.9%），MMSA为29.0%（19.7%-41.0%）。患有高血胆固醇的成年人：各州和地区为31.8%（27.1%-37.3%），MMSA为31.4%（23.2%-42.0%）。年龄≥45岁且患有冠心病的成年人：各州和地区为10.3%（7.2%-16.8%），MMSA为10.1%（4.7%-17.8%）。年龄≥45岁的中风成年人：各州和地区为4.9%（2.5%-7.5%），MMSA为4.7%（2.1%-8.4%）。解释：获得和使用医疗保健、健康风险行为和慢性健康状况的患病率因州、地区和MMSA而异。本报告中的数据强调了继续监测慢性病、健康风险行为以及获得和使用医疗保健的重要性，以协助规划和评估州、地区和MMSA级别的公共卫生计划和政策。 公共卫生行动：州和地方卫生部门和机构以及其他对卫生和医疗保健感兴趣的人可以继续使用BRFSS数据来识别患有慢性病、不健康行为和有限的医疗保健机会和使用的高危人群。BRFSS数据还可用于帮助设计、实施、监控和评估与健康相关的计划和政策。
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引用次数: 0
Youth Risk Behavior Surveillance - United States, 2017. 青少年风险行为监测-美国，2017年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-06-15 DOI: 10.15585/mmwr.ss6708a1
Laura Kann, Tim McManus, William A Harris, Shari L Shanklin, Katherine H Flint, Barbara Queen, Richard Lowry, David Chyen, Lisa Whittle, Jemekia Thornton, Connie Lim, Denise Bradford, Yoshimi Yamakawa, Michelle Leon, Nancy Brener, Kathleen A Ethier

Problem: Health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults in the United States. In addition, significant health disparities exist among demographic subgroups of youth defined by sex, race/ethnicity, and grade in school and between sexual minority and nonsexual minority youth. Population-based data on the most important health-related behaviors at the national, state, and local levels can be used to help monitor the effectiveness of public health interventions designed to protect and promote the health of youth at the national, state, and local levels.

Reporting period covered: September 2016-December 2017.

Description of the system: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of other health-related behaviors, obesity, and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. Starting with the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts were added to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their questionnaires. This report summarizes results from the 2017 national YRBS for 121 health-related behaviors and for obesity, overweight, and asthma by demographic subgroups defined by sex, race/ethnicity, and grade in school and by sexual minority status; updates the numbers of sexual minority students nationwide; and describes overall trends in health-related behaviors during 1991-2017. This reports also summarizes results from 39 state and 21 large urban school district surveys with weighted data for the 2017 YRBSS cycle by sex and sexual minority status (where available).

Results: Results from the 2017 national YRBS indicated that many high school students are engaged in health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving, 29.8% reported current alcohol use, and 19.8% reported current marijuana use. In addition, 14.0% of students had taken prescription

问题：健康风险行为是美国青年和成年人发病率和死亡率的主要原因。此外，按性别、种族/民族和在校年级划分的青年人口亚组之间，以及性少数群体和非性少数群体青年之间，存在着显著的健康差异。国家、州和地方各级最重要的健康相关行为的基于人口的数据可用于帮助监测公共卫生干预措施的有效性，这些干预措施旨在保护和促进国家、州、地方各级青年的健康。报告期涵盖：2016年9月至2017年12月。系统描述：青少年风险行为监测系统（YRBSS）监测青少年和年轻人中六类与健康相关的优先行为：1）导致意外伤害和暴力的行为；2） 烟草使用；3） 酒精和其他药物使用；4） 与意外怀孕和性传播感染有关的性行为，包括人类免疫缺陷病毒感染；5） 不健康饮食行为；以及6）身体不活动。此外，YRBSS监测其他健康相关行为、肥胖和哮喘的患病率。YRBSS包括由美国疾病控制与预防中心进行的全国学校青少年风险行为调查（YRBS），以及由州和地方教育和卫生机构进行的州和大型城市学区学校YRBS。从2015年YRBSS周期开始，在国家YRBS问卷和各州和大型城市学区使用的标准YRBS调查表中添加了一个确定性身份的问题和一个确定性别接触的问题，作为其问卷的起点。本报告总结了2017年全国YRBS对121种与健康相关的行为以及肥胖、超重和哮喘的结果，按性别、种族/民族、学校年级和性少数群体状况定义的人口亚组；更新全国性少数群体学生人数；并描述了1991-2017年间与健康相关的行为的总体趋势。本报告还总结了39个州和21个大型城市学区的调查结果，以及2017年YRBSS周期按性别和性少数群体状况（如有）划分的加权数据美国在调查前的30天内，全国39.2%的高中生（在调查前30天内驾驶汽车或其他车辆的62.8%中）在开车时发过短信或电子邮件，29.8%的人报告目前饮酒，19.8%的人表示目前吸食大麻。此外，14.0%的学生在没有医生处方的情况下服用了处方止痛药，或者与医生告诉他们在一生中使用一次或多次不同。在调查前的12个月里，19.0%的人曾在学校受到欺凌，7.4%的人试图自杀。许多高中生从事与意外怀孕和性传播感染（包括艾滋病毒感染）有关的性风险行为。在全国范围内，39.5%的学生曾发生过性行为，9.7%的学生一生中与四人或四人以上发生过性关系。在目前性活跃的学生中，53.8%的学生报告说，他们或他们的伴侣在最后一次性交时使用过避孕套。2017年全国YRBS的结果还表明，许多高中生从事与慢性疾病相关的行为，如心血管疾病、癌症和糖尿病。在调查前的30天里，全国范围内，8.8%的高中生吸烟，13.2%的高中学生至少有1天使用过电子蒸汽产品。43%的人在平均上学日玩视频或电脑游戏，或使用电脑3个小时或以上，从事非学校作业，15.4%的人在调查前7天内至少有1天没有进行过至少60分钟的体育活动。此外，14.8%的人患有肥胖症，15.6%的人超重。大多数与健康相关的行为的流行率因性别、种族/民族而异，尤其是性身份和性接触的性别。具体而言，性少数群体学生中许多健康风险行为的发生率明显高于非性少数群体。尽管如此，对长期时间趋势的分析表明，大多数健康风险行为的总体流行率已经朝着预期的方向发展。解读：大多数高中生成功地应对了从童年到青春期到成年的过渡，并成为健康高效的成年人。 然而，这份报告记录了一些由性别、种族/民族、在校年级，特别是少数性群体身份定义的学生亚组，其许多健康风险行为的发生率更高，这可能会使他们面临不必要或过早死亡、发病、，以及社会问题（例如，学业失败、贫困和犯罪）。公共卫生行动：YRBSS数据被广泛用于比较学生亚群体中健康相关行为的流行率；评估一段时间内健康相关行为的趋势；监测实现21个国家卫生目标的进展情况；提供可比的州和大城市学区数据；采取公共卫生行动，减少青年的健康风险行为，改善青年的健康状况。使用基于科学可靠数据的这份报告和其他报告，对于提高决策者、公众以及与青年合作的各种机构和组织对9-12年级学生，特别是性少数群体学生健康相关行为流行率的认识非常重要。这些机构和组织，包括学校和对青年友好的医疗保健提供者，可以帮助促进获得至关重要的教育、医疗保健和高影响力的循证干预措施。
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引用次数: 0
Malaria Surveillance - United States, 2015. 疟疾监测 - 美国，2015 年。
IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mmwr Surveillance Summaries
Pub Date : 2018-05-04 DOI: 10.15585/mmwr.ss6707a1
Kimberly E Mace, Paul M Arguin, Kathrine R Tan

Problem/condition: Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles species mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to provide information on its occurrence (e.g., temporal, geographic, and demographic), guide prevention and treatment recommendations for travelers and patients, and facilitate transmission control measures if locally acquired cases are identified.

Period covered: This report summarizes confirmed malaria cases in persons with onset of illness in 2015 and summarizes trends in previous years.

Description of system: Malaria cases diagnosed by blood film microscopy, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff members. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS), the National Notifiable Diseases Surveillance System (NNDSS), or direct CDC consultations. CDC reference laboratories provide diagnostic assistance and conduct antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. This report summarizes data from the integration of all NMSS and NNDSS cases, CDC reference laboratory reports, and CDC clinical consultations.

Results: CDC received reports of 1,517 confirmed malaria cases, including one congenital case, with an onset of symptoms in 2015 among persons who received their diagnoses in the United States. Although the number of malaria cases diagnosed in the United States has been increasing since the mid-1970s, the number of cases decreased by 208 from 2014 to 2015. Among the regions of acquisition (Africa, West Africa, Asia, Central America, the Caribbean, South America, Oceania, and the Middle East), the only region with significantly fewer imported cases in 2015 compared with 2014 was West Africa (781 versus 969). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 67.4%, 11.7%, 4.1%, and 3.1% of cases, respectively. Less than 1% of patients were infected by two species. The infecting species was unreported or undetermined in 12.9% of cases. CDC provided diagnostic assistance for 13.1% of patients with confirmed cases and tested 15.0% of P. falciparum specimens for antimalarial resistance markers. Of the U.S. resident patients who re

问题/条件：人类疟疾是由疟原虫属红细胞内原生动物引起的。这些寄生虫通过有传染性的雌性按蚊叮咬传播。在美国，大多数疟疾感染者都曾到过疟疾传播地区。不过，偶尔也会有未出国旅行的人因接触受感染的血液制品、先天性传播、实验室接触或当地蚊媒传播而感染疟疾。在美国开展疟疾监测是为了提供有关疟疾发生的信息（如时间、地理和人口），指导旅行者和患者的预防和治疗建议，并在发现本地感染病例时促进传播控制措施：本报告概述了 2015 年发病者中的疟疾确诊病例，并总结了往年的趋势：通过血片显微镜检查、聚合酶链反应或快速诊断检测确诊的疟疾病例由医疗服务提供者或实验室工作人员向地方和州卫生部门报告。病例调查由地方和州卫生部门进行，报告通过国家疟疾监测系统（NMSS）、国家应报告疾病监测系统（NNDSS）或直接向疾病预防控制中心咨询的方式传送给疾病预防控制中心。疾病预防控制中心参考实验室提供诊断协助，并对医疗服务提供者或地方或州卫生部门提交的血液样本进行抗疟药物耐药性标记检测。本报告总结了整合所有 NMSS 和 NNDSS 病例、疾病预防控制中心参考实验室报告以及疾病预防控制中心临床会诊的数据：2015 年，美国疾病预防控制中心收到了 1517 例疟疾确诊病例的报告，其中包括 1 例先天性病例，这些病例的发病者均在美国接受诊断。尽管自20世纪70年代中期以来，美国确诊的疟疾病例数量一直在增加，但从2014年到2015年，病例数量减少了208例。在获取病例的地区（非洲、西非、亚洲、中美洲、加勒比海地区、南美洲、大洋洲和中东）中，与2014年相比，2015年输入病例明显减少的唯一地区是西非（781例对969例）。在67.4%、11.7%、4.1%和3.1%的病例中分别发现了恶性疟原虫、间日疟原虫、卵形疟原虫和疟疾疟原虫。只有不到 1%的患者感染了两种病原体。12.9%的病例未报告或未确定感染物种。疾病预防控制中心为 13.1% 的确诊病例患者提供了诊断协助，并对 15.0% 的恶性疟原虫标本进行了抗疟药物耐药性标记检测。在报告旅行目的的美国居民患者中，68.4%是探亲访友。与2014年（32.5%）相比，2015年报告服用任何化学预防药物的美国居民比例较低（26.5%），且该群体的依从性较差。在已知化学预防药物使用情况和旅行地区信息的美国居民中，95.3%的疟疾患者没有坚持或没有采取疾控中心推荐的化学预防方案。在感染疟疾的妇女中，有 32 名孕妇，她们都没有坚持进行化学预防。2015 年，美国军事人员中共出现 23 例疟疾病例。3例疟疾病例是从部署到埃博拉疫区国家的约3000名军事人员中输入的；其中2例不是恶性疟原虫，1例病种不明。在 2015 年报告的所有病例中，17.1% 被归类为重症，11 人死亡，而 2000-2014 年期间平均每年死亡 6.1 人。2015年，疾病预防控制中心收到了153份恶性疟原虫阳性样本，用于监测抗疟药物耐药性标记（尽管某些样本的某些位点无法检测）；在132份样本（86.3%）、112份样本（73.7%）、48份样本（31.4%）、6份样本（4.3%）和1份样本（1.3%）中发现了与嘧啶耐药性相关的基因多态性，对磺胺多辛、氯喹、甲氟喹和青蒿素也有耐药性：2014年至2015年疟疾病例的减少与西非输入病例的减少有关。这一发现可能与前往该地区受埃博拉影响国家的旅行有所改变或减少有关。尽管全球在减少疟疾方面取得了进展，但该疾病在许多地区仍然流行，旅行者使用适当的预防措施仍然不足：预防疟疾的最佳方法是在前往疟疾流行的国家旅行时服用化学预防药物。正如美国
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