Disease Surveillance

Molecular characteristics of Clostridium difficile infection in diarrhea inpatients in Fuyang district of Hangzhou, Zhejiang

Youping Huang, Xuhua Jin, Julian Ye, Yun Luo, Jun Li, Xiaojun Song, Chen Huang, Dazhi Jin

Accepted Manuscript , DOI: 10.3784/j.issn.1003-9961.2019.01.000

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Abstract:
Objective To investigate current infection status of Clostridium difficile in hospitalized patients with diarrhea in Fuyang district of Hangzhou, Zhejiang province. Molecular characteristics of C. difficile isolates and risk factors of the patients were analyzed. Methods A total of 228 stool samples were collected the diarrhea patients in our hospital from May 2017 to February 2018. C. difficile strains isolation and identification were performed by using anaerobic culture. The isolates were typed by multilocus sequence typing. The antibiotic resistance test was performed by using agar dilution assay. The clinical data were statistically analyzed. Results Forty one strains of toxigenic C. difficile were isolated from 228 stool samples, in which 31 strains of C. difficile were from patients with hospital acquired diarrhea. The average age of the patients was 67.8 years, the patients were mainly from departments of gastroenterology (34.1%) and nephrology (19.5%). ST2, ST3 and ST54 were the major sequence types. All the isolates were sensitive to metronidazole, vancomycin, tetracycline, and piperacillin. The results of clinical data analysis showed that more diarrhea patients who were aged ＞60 years, had underlying diseases and used antibiotics within 8 weeks were infected with C. difficile（χ²＝4.229, 9.022, 5.767, P＝0.023, 0.001, 0.009）. Conclusion C. difficile infection mainly occurred in hospitalized diarrhea patients in Fuyang. Old age, underlying disease and antibiotic use within 8 weeks were the risk factors for C. difficile infection. This study indicated that C. difficile surveillance needs to be further strengthened in the prevention and control of nosocomial infection.

Analysis on prevalence of hepatitis B and establishment of prediction model in Xianyang, Shaanxi, 2005–2017

Fengying Li, Ting Ma, Wenrui Luo, Meining Liu, Bo Ma, Rongqiang Zhang

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Objective To analyze the prevalence of hepatitis B in Xianyang of Shaanxi province from 2005 to 2017, and establish a suitable prediction model for hepatitis B in Xianyang in 2018. Methods The data of reported cases of hepatitis B in Xianyang from 2005 to 2017 were collected. Descriptive epidemiological method was used to analyze the prevalence of hepatitis B and the time series prediction system of SAS 9.2 software was used to establish the best prediction model of hepatitis B incidence in Xianyang. The model was verified by using the incidence data of hepatitis B in Xianyang in 2018. Results A total of 48 184 cases of hepatitis B were reported in Xianyang from 2005 to 2017, including 9 325 clinically diagnosed cases (19.35%) and 38 859 laboratory confirmed cases (80.65%), among these cases, 23 716 occurred in males and 24 468 occurred in females, with a sex ratio of approximately 1∶1. The cases were distributed in people aged 20–60 years. Most cases were farmers, and there was no obvious seasonality. The SAS 9.2 software time series forecasting system was used to establish the monthly incidence prediction system of hepatitis B in Xianyang. The best prediction model established for the monthly incidence of hepatitis B in Xianyang from 2005 to 2017 was Log Winters Method-Addictive model. Conclusion The result of the prediction indicated that he reported cases of hepatitis B would decline in Xianyang in 2018. However, it is still necessary to strengthen the hepatitis B vaccination in populations at high risk is still needed to reduce the incidence of hepatitis B.

Analysis on diagnosis quality of selected notifiable communicable diseases in Yunnan, 2016−2017

Yan Lin, Ran Lu, Zhenhui Li, Yanbo Qi, Hui Guo

Accepted Manuscript

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Objective To evaluate the diagnosis accordance rates of selected notifiable communicable diseases in Yunnan. Methods The survey was conducted in 36 medical institutions of 15 counties in 5 prefectures in Yunnan according to the latest national standards of diagnosis of communicable diseases. Results A total 871 patients affecting by 13 communicable diseases were surveyed. The disease specific diagnosis accordance rate was 91.60%, the disease classification accordance rate was 83.50% and the overall diagnosis accordance rate was 76.12%. The diagnosis accordance rates of hepatitis A, hepatitis B, bacillary dysentery and typhoid/paratyphoid fever were lower than other diseases, which were 46.15%, 57.93%, 59.68% and 60.61% respectively. As the descending of the level of medical institutions, the diagnosis accordance rate declined. The diagnosis accordance rates in medical institutions at provincial, prefectural, county and township level were 86.67%, 85.84%, 73.72% and 52.38% respectively. Conclusion Compared with other provinces, the diagnosis accordance rates of notifiable communicable diseases were low in Yunnan. It is necessary to strengthen the medical staff training on communicable disease diagnosis and reporting in grass root medical institutions in Yunnan.

2018年12月中国甲乙丙类传染病疫情动态简介National Data of Class A, B and C Communicable Disease in December 2018

Accepted Manuscript , DOI: 10.3784/j.issn.1003-9961.2019.01.001

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Abstract:
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2018年12月中国甲乙丙类传染病疫情概要

Accepted Manuscript , DOI: 10.3784/j.issn.1003-9961.2019.01.002

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Risk assessment of public health emergencies concerned in the mainland of China, January 2019

Zhiheng Hong, Chao Li, Jing Yang, Miao Jin, Jinghuan Ren, Dan Li, Wenxiao Tu, Ling Meng, Guoqing Shi, Nijuan Xiang

Accepted Manuscript , DOI: 10.3784/j.issn.1003-9961.2019.01.003

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Abstract:
Objective To assess the risks of public health emergencies, both the indigenous ones and imported ones, which might occur in the mainland of China in January 2019. Methods An internet based expert counsel was conducted to analyze the surveillance data of public health emergencies and priority communicable diseases in China reported through different channels, and the experts in all the provincial centers for disease control and prevention attended this video conference. Results The incidence of public health emergencies reported in January would lower than that in December 2018, which might mainly be the epidemics of chickenpox, seasonal influenza, mumps and other infectious diarrheal diseases. Sporadic cases of human infection with avian influenza virus might still occur. The activity level of seasonal influenza would continue to rise. The incidence of norovirus caused infectious diarrhea declined but still remained at high level, and the outbreaks could still be witnessed in schools. The epidemic of Ebola virus disease in the Democratic Republic of Congo is still serious, the possibility of imported cases to China still exists, but the risk of widespread in China caused by imported cases is very low. The incidence of non-occupational carbon monoxide poisoning would keep at high level in January. Conclusion Close attention should be paid to seasonal influenza, human infection with avian influenza virus and non-occupational carbon monoxide poisoning, and general attention should be paid to norovirus caused infectious diarrhea and Ebola virus disease in the Democratic Republic of Congo.

Investigation of a serogroup B meningococcal meningitis case in Shenzhen

Xianghui Shi, Suyun Fan, Chunqing Zhu, Jianming Zhong, Yuyuan Zeng, Hongwei Shen

Accepted Manuscript

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Objective To investigate the cause of a serogroup B meningococcal meningitis case in Shenzhen. Methods The epidemiological investigation was conducted for the case and close contacts. The cerebrospinal fluid and blood samples from the case and the throat swabs from the contacts were collected for the pathogen isolation/culture and PCR detection. The isolates were sequenced with next generation sequencing method. Results Two strains of serogroup B Neisseria meningitidis were isolated from the blood sample of the case and throat swab of case’s mother respectively. The two isolates shared the same MLST type of ST-3200/CC4821, same 16S rRNA sequence, and same alleles of genes related to antibiotic susceptibility and coding peptides. Conclusion The meningococcal disease case was caused by the transmission of serogroup B N. meningitidis from case’ mother who was a healthy carrier.

Joinpoint regression model analysis on epidemiological trends of hand, foot and mouth disease in Guangdong, 2008–2017

Siqing Zeng, Limei Sun, Haojie Zhong, Xiaohua Tan, Fen Yang, Yifang Long

Accepted Manuscript

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Objective To analyze the change in the epidemiological trends of hand, foot and mouth disease (HFMD)in Guangdong province. Methods The incidence data of HFMD in Guangdong during 2008–2017 were collected from National Notifiable Infectious Disease Reporting Information System, and population data in Guangdong during this period were collected from Guangdong Statistical Yearbook. The epidemiological trends of HFMD were analyzed by using Joinpoint regression model. Results The incidence trend of HFMD began to change in 2012. From 2008 to 2012, the incidence rate of HFMD increased sharply (β₁＝72.552, P＝0.001), and from 2012 to 2017, the incidence increased with slight fluctuation, the difference had no significance (β₂＝6.647, P＝0.588). The incidence change trend was not parallel between males and females, the change extent in males exceeded that in females. The incidence increase sharply from January to May and peaked in May, then it began to decline, the monthly annual percent change (APC) was 138.33%(P＝0.002). From May to December, the incidence of HFMD declined slightly, the monthly APC was –19.19% (P＝0.002). Two joinpoints were detected among the trend change of the monthly incidence rate of HFMD in 2008、2013 and 2017 years respectively and only one joinpoint was found in the other years. The age specific incidence was characterized by high level in age group from 0– to 2– years (Age group APC＝17.32%,P＝0.001), decrease rapidly from age group 2– years to 15–19 years (APC＝−44.81%,P＝0.000), and keeping at low level from age group 15–19 years to ≥85 years (APC＝−2.66%,P＝0.148). Conclusion The annual incidence of HFMD in Guangdong first showed a rapid increase and then slight increase with fluctuation during 2008–2017. The trend change of annual incidence rate was significantly different between male and female. Two models were found in the trend change of monthly incidence rate and there were significant seasonal variations. Very most of the HFMD case were among young children, so they were the key object for prevention and control. Prevention and control measures should be more targeted.

Study on epidemiological characteristics of viral diarrhea in children under five years old in Lulong county of Hebei, 2013–2017

Wenna Zhao, Yingying Liu, Qiuli Yu, Tong Su, Yun Xie, Shunxiang Qi

Accepted Manuscript

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Objective To analyze the epidemiological and etiological characteristics of viral diarrhea in children under five years old in Lulong county, a surveillance area of viral diarrhea, of Hebei province from 2013 to 2017 and provide evidence for the prevention and control of viral diarrhea. Methods A total of 1 451 stool samples were collected from diarrheal children aged ＜5 years in sentinel hospitals in Hebei province between 2013 and 2017. Rotavirus antigen was detected by using enzyme-linked immunosorbent assay (ELISA) and RV identification and genotyping were conducted with nested RT-PCR. Human caliciviruses (HuCV) and human astrovirus (HAstV) were detected by RT-PCR. Adenovirus was detected by PCR. The data was analyzed by using software SPSS 20.0. Results Among 1 451 stool samples, 968 (66.71%) were positive for at least one virus and 148 (15.29%) were positive for more than one virus. The positive rates of RV, HuCV, AV and HAstV were 46.59%, 18.88%, 8.06% and 4.14% respectively. The highest detection rates of diarrhea viruses (76.60%) and RV (56.11%) were recorded in age group 12– 17 months, followed by those in age group 18–23 months. There were significant differences in the positive rates of diarrhea viruses and RV among different age groups (

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＝52.142, P＜0.05;

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＝46.218, P＜0.05). The detection peaks of both diarrhea viruses and RV occurred during November–March. Among the RV strains, G9 was the most common G serotype (79.29%), P［8］ was the most common P genotype (85.50%), and most strains belonged to G9P［8］ (75.30%). HuCV positive samples were mainly norovirus positive. Conclusion RV and HuCV were the main pathogens causing infant diarrhea in Hebei during 2013–2017. Autumn and winter were the high incidence seasons.

Analysis on surveillance for key occupational diseases in Taiyuan, 2017

Zhiwei Yan, Yunjun Deng, Fengqin Li

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Objective To understand the distribution of key occupational hazards and the characteristics of occupational diseases in Taiyuan, Shanxi province, and provide scientific evidence for the prevention and control of occupational diseases. Methods The occupational hazards information, occupational health surveillance data and incidence data of 10 key occupational diseases in Taiyaun from January 1 to December 31, 2017 were collected for a descriptive epidemiological analysis. Results A total of 51 815 workers exposed to occupational hazards were discovered in 612 large state-owned enterprises of mining and manufacturing in Taiyuan. Coal dust and noise exposures were the most common occupational hazards, affecting 26 401 and 16 887 workers, respectively. A occupational health surveillance for 42 458 persons/times was conducted in 2017, and the surveillance rate was 72.07%. A total of 30 suspected occupational disease cases and 64 occupational contradiction cases were reported. In 2017, there were 100 new occupational disease cases reported, including 83 coal worker pneumoconiosis cases, 9 noise deafness cases, 7 silicosis cases and 1 welder pneumoconiosis case. Conclusion A comparably high proportion of workers were exposed to coal dust and noise, and coal worker pneumoconiosis was the most common occupational disease in Taiyuan. So, the control of occupational hazards and occupational health management for exposed population should be strengthened in related enterprises.

Analysis on measles antibody level in healthy population in Dali Bai autonomous prefecture, Yunnan, 2012–2018

Yanjun Liu, Zuo He, Ran Xu, Fang Guan

Accepted Manuscript

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Objective To understand the measles antibody level in healthy population in Dali Bai autonomous prefecture of Yunnan province during 2012−2018 and provide scientific evidence for the elimination of measles. Methods Blood samples were collected annually from healthy populations in 8 age groups selected through stratified random sampling, a total of 28 459 blood samples were collected. Serum measles IgG was detected by using enzyme linked immunosorbent assay (ELISA). Results The differences in annual positive rate of measles IgG in healthy population were significant. The positive rate was lowest in 2016 (89.6%) and highest in 2013 (97.3%). The positive rate was ＞90% in other years. The differences in the positive rate were significant among different age groups (P＜0.05). The positive rate was lower in age groups 8−17 months and 25−34 years. There were significant differences in the positive rate and antibody geometric mean concentration (GMC) among people receiving different doses of measles containing vaccine (P＜0.05). The GMC was highest in people receiving 3 doses of measles vaccination (1 921.1 mIU/ml). Conclusion The immunity barrier has been basically formed in Dali, the possibility of measles outbreak is low, but close attention should be paid to the potential risk of measles in adults. It is necessary to conduct supplementary immunization activity in order to increase population antibody level and reduce the incidence of measles.

Analysis on injury-related deaths in Haidian district of Beijing, 2010–2015

Xiao YU

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Objective To understand level, causes and distribution of injury-related deaths in Haidian district of Beijing. Methods This statistical analysis was based on death surveillance data in Haidian from 2010 to 2015. The death causes were classified according to ICD-10, and the data were analyzed with software Excel 2016 and SPSS 19.0. Results A total of 1 608 injury-related deaths were reported in Haidian during 2010–2015, the average annual mortality rate was 11.67/100 000, ranking 6^th in all death causes. The injury related mortality rate in males was 13.14/100 000, significant higher than that in females (10.18/100 000) (χ²＝25.305, P＜0.05). The first three leading injury related death causes were accidental fall (43.16%), traffic accident of motor vehicle (20.90%) and suicide (3.98%). Accidental fall occurred mainly in the elderly aged ≥65 years, accounting for 86.46%. The mortality rate of accident fall increased with age in both males and females, the differences were significant indicated by trend χ² test (χ²＝1466.648, P＜0.05, χ²＝1 506.781, P＜0.05). Conclusion Injury is one of the major death causes in residents in Haidian. The injury mortality rate is higher in males than in females, it is necessary to strengthen the intervention and prevention in males. Fall mainly occurs in the elderly, the prevention and control of fall in older adults need to be strengthened.

Isolation, culture and identification of Clostridium in infant and young child food, biological samples and environmental samples

Yinju Du, Kexin Xu, Lihong Cheng, Haiyan Guo, Haijian Zhou, Yu Liu, Xuefeng Miao, Xuguang Xie, Furong Zhang, Jinxing Zhao

Accepted Manuscript

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Objectives To understand the Clostridium carriage levels of infant and young child food, biological samples and environment in Liaocheng, identify the collected samples with different methods and provide evidence for food hygiene supervision departments to take effective measures to reduce Clostridium contamination. Methods A total of 257 samples were used for anaerobic and micro aerobic cultures. Then the characteristics of growth, gram staining and morphological features of the isolates under ordinary microscope were analyzed. At last the isolates were identified by 16S rRNA gene cloning method. Results A total of 97 strains of Clostridium were detected in 257 samples, the detection rate was 37.74%, including 38 strains of Clostridium bifermentans, 14 strains of Clostridium tertium, 12 strains of Clostridium sporogenes, 11 strains of Clostridium butyricum, 9 strains of Clostridium sordellii. The sources of 97 Clostridium strains were as follows: stool samples (50 strains), soil samples (28 strains), milk powder samples (6 strains), swabs of surface of table (6 strains), nipple (3 strains), water used for milk powder (2 strains), swabs of hands of milkmen (2 strains). Conclusion The carriage rate of Clostridium in infant and young child food, biological samples and environment was very high in Laiocheng. The detection rate of C. bifermentans was highest, followed by C. tertium, C. sporogenes and C. butyricum.

Assessment of disability level and weight of sporadic Creutzfeldt-Jakob disease cases in China

Lina Zhang, Yuan Wang, Wulayin Xiemusiye, Kang Xiao, Jing Wang, Wei Zhou, Qi Shi, Chen Gao

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Objective To evaluate the disability level and weight of the sporadic Creutzfeldt-Jakob disease (sCJD) cases in China. Methods Two ways were used to obtain disability weight of the sCJD cases in China. One was Delphi method, another one was the expert assessment of visual analogue scale (VAS). Results The mean disability weight of the 180 sCJD patients was 0.920, which was calculated based on the standard disability level obtained by Delphi method. The median disability weight of the sCJD cases from expert assessment of VAS was 0.850. Conclusion The results indicated that the sCJD patients were in poor health with high disability weight. It is necessary to paid special attention to them and strengthen the research in the field of prion diseases to facilitate the prevention and treatment of the disease.

Plague epidemiology in natural plague foci in Yulong, Yunnan, 2005–2017

Zhengxiang Liu, Wenfeng Cai, Zongti Shao, Xingde Duan, Zihou Gao

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Objective To understand of plague epidemic trend in Yulong natural plague foci in Lijiang prefecture of Yunnan province during 2005 — 2017 and provide evidence for the prevention and control of plague in Yulong plague foci. Methods By using descriptive epidemiological methods, we analyzed the time, population and area distributions and epidemic trend of animal and human plague in Yulong county and Gucheng district during this period. Results During 2005 — 2017, plague epidemic was very active in Yulong plague foci distributed in the Luzi village of Nanxi village committee of Huangshan township in Yulong county, and Mushu village of Houshan village committee of Qihe township in Gucheng district. The epidemic and incidence peak mainly occurred during April-May. In the past 13 years, 13 epidemic foci in 8 plague epidemics were found, and in a human plague epidemic occurred in 2015, five pneumonic plague cases were diagnosed, including 2 deaths. Conclusion Since the confirmation of Yulong plague foci, the plague epidemic in animals has been active and continuous. It is necessary to strengthen the surveillance for plague and make timely response to the animal epidemic to prevent the plague spread from animals to human.

Epidemiological characteristics of acute hepatitis B in Gansu, 2005–2016

Pinggui Wang, Lijie Zhang, Guomin Zhang, Jian He, Xiaoshu Zhang, Jin An

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Objective To understand the epidemiological characteristics and changing trend of acute hepatitis B in Gansu province from 2005 to 2016, and provide evidence for the development of prevention and control measures in the future. Methods The incidence data of acute hepatitis B cases from 2005 to 2016 in Gansu Province were obtained from the national disease prevention and control information system of China. Results From 2005 to 2016, the reported incidence rate of acute hepatitis B in Gansu Province showed a downward trend, which dropped from 17.7/100 000 in 2005 to 5.2/100 000 in 2016, a decline of 70.6%. In recent years, the reported incidence rates of acute hepatitis B in Gannan and Linxia prefectures (15/100, 000 and 14/100 000 respectively) were significantly higher than those in other areas. Since 2005, the reported incidence rates of acute hepatitis B in all age groups had decreased. The incidence rate decreased by 88.8% in age group 5–14 years, by 80.4% in age group 15–29 years and by 66.0% in age group 30–59 years. The incidence peak occurred in older age groups. A total of 29 709 cases of acute hepatitis B were reported in Gansu from 2005 to 2016, in which 73.4% (21 825) were adults aged 15 — 49 years, only 7.3% (2156) were children under 15 years old. The cases in framers and students accounted for 53.1% and 15.8% respectively. The proportion of the cases in farmer increased year by year, reaching 76.8% in 2016. The reported incidence rate of acute hepatitis B in men was higher than that in women during this period. Conclusion The reported incidence rate of acute hepatitis B in Gansu has decreased significantly, and the decline was more obvious in age group 5 — 29 years. Adults in rural areas are the key population in immunization program. It is suggested to conduct the evaluation of acute hepatitis B reporting accuracy in Gannan and Linxia prefectures.

Spatial-temporal distribution characteristics of hand，foot and mouth disease in Jingzhou, Hubei, 2008–2017

Menglei Yao, Tian Liu, Li Wang, Shuqiong Huang, Jing Cai, Wenwen Yang, Ran Wu

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Objective To analyze the spatial-temporal distribution characteristics of hand foot and mouth disease (HFMD) in Jingzhou, Hubei province, from 2008 to 2017, and provide evidence for the prevention and control of HFMD. Methods The global and local autocorrelation analyses on the spatiotemporal clustering of the incidence data of HFMD at street/township scale in Jinzhou during this period were performed by using software ArcGIS 10, and the spatiotemporal clustering analysis on the incidence data of HFMD was performed by using software SaTScan 9.4. Results A total of 53 159 cases were reported in Jingzhou from 2008 to 2017, with an average annual incidence rate of 91.59/100 000. Spatial autocorrelation analysis showed that the incidence rate of HFMD had positive spatial correlation. The incidence rate of HFMD had obvious spatiotemporal clustering characteristics, the main clustering area was found in the central urban area of Jingzhou and adjacent counties and townships. Conclusion Understanding the spatial and temporal distribution and spatial clustering characteristics of the incidence data of HFMD at street/township scale in Jingzhou has important public health significance for the allocation of public health resources, effective prevention and control of HFMD.

Epidemiological characteristics, spatial and temporal distribution and incidence trend of hemorrhagic fever with renal syndrome in Hubei, 2010－2017

Honghui Liu, Tian Liu, Xuesen Xing

Accepted Manuscript , DOI: 10.3784/j.issn.1003-9961.2018.12.000

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Objective To analyze the surveillance data of hemorrhagic fever with renal syndrome (HFRS) in Hubei province from 2010 to 2017, describe the population, spatial and temporal distribution of HFRS, and make prediction of its incidence in 2018. Methods Traditional epidemiology, space epidemiology, time series analysis and other methods were used in combination with software Satscan, Arcgis and SPSS to explore the spatiotemporal distribution of HFRS in Hubei from 2010 to 2017 and predict its incidence trend. Results The overall incidence of HFRS was highly sporadic from 2010 to 2017. The overall incidence was higher in 2017 than in other years. The disease occurred all the year round with two incidence peaks in May and December. The change trend of reported case number was basically consistent with rat density. From 2010 to 2015, the average rat density generally showed an upward trend. It increased year by year to 5.31% in 2015. There was some spatiotemporal clustering of HFRS in 2017, which was in central Hubei. The ARIMA (1,0,0) (0,1,1) model had the best fitting effect and the residual was white, The noise test can provide suggestions for the early monitoring and early warning of HFRS in Hubei. It is estimated that the case number of HFRS in Hubei from January to June of 2018 would be about 192, indicating a high incidence year. Conclusion The incidence of HFRS in Hubei was in increase in recent two years, and the incidence of HFRS had a positive correlation with rat density. The prediction of HFRS epidemic should be made in combination with the use of ARIMA (1,0,0) (0,1,1) model in central Hubei, and it is suggested to continue the comprehensive HFRS prevention and control, such as surveillance, health education, deratization and immunization, according to the rat density and virus carriage rate surveillance results.

Changes in disease surveillance reporting model based on health big data: Inspirations from the construction of big data analysis center of health management in Yichang

Zhouzhi Wu, Chengzhong Xu, Yong Xu, Pei Zhang

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Objective To discuss the change trend and development of the disease surveillance reporting model in China. Methods Trough analysis on the development of the current disease surveillance system in China, along with the construction of big data for health management and its application in the field of disease surveillance reporting in Yichang, some inspirations of future changes in disease surveillance reporting model were obtained. Results Disease surveillance information system in China has achieved a rapid development. However, there are still problems such as insufficient data sharing, underreporting and misreporting. Some progress has been achieved in the management of disease surveillance information based on hospital information system, but data sharing and comprehensive application are still difficult. Based on the big data analysis center for health management, an intelligence disease surveillance system construction and application has been conducted in Yiuchang, and improvement have been made. Conclusion Under the background of health big data, a series of changes and developments in the disease surveillance reporting model and management would emerge, such as the establishment of information system at grassroots level, active intelligence surveillance, risk factor surveillance and early warning.

Global epidemiology and risk factors of nipah virus infection in human, 1998–2018

Hualei Xin, Aili Xue, Jiwei Liang, Bo Qiu, Liyan Dong, Bei Pan, Jing Jia, Yalin Han, Xiaowen Hu, Jingfei Zhang, Zhongjie Li, Fachun Jiang

Accepted Manuscript

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Objective To understand the epidemiology characteristics and risk factors of nipah virus infection in the world. Methods According to the WHO case definition of nipah virus infection in 2004, we describe the spatial, temporal and population distributions of nipah virus infection in the world and analyze the risk factors by using the data from website of WHO and PubMed. Results From September 1998 to June 2018, a total of 662 nipah virus infection cases, including 369 deaths, were reported in 5 countries, the case fatality rate was 55.7%. Before 2000, only Malaysia (283 cases) and Singapore (11 cases) reported nipah virus infection cases. During 2001–2010, 155 and 71 cases were reported by Bangladesh and India respectively. Since 2011, nipah virus infection cases have been reported by Bangladesh (106 cases), India (19 cases) and Philippines (17 cases). The case fatality rate increased from 38.5% in Malaysia and 9.1% in Singapore before 2000 to 62.6% in Bangladesh and 70.4% in India during 2001–2010 and to 81.1% in Bangladesh, 89.5% in India and 52.9% in Philippines after 2011. Among the reported cases, 623 (97.4%) occurred during January–May. The risk factors for nipah virus infection included close contact with sick pig in Malaysia and Singapore and human to human transmission and drinking of date palm sap contaminated by fruit bat in Bangladesh and India. Conclusion Nipah virus infection had spread from Western Pacific Region to Southeast Asia and a rising trend was noted for the case fatality rate. Also, the cases were mainly reported in the harvested season of date palm sap in Western Pacific Region and Southeast Asia.

Selection of specific target genes of Kingella kingae and investigation of carrier rate in healthy people

Yang Song, Na Xie, Zhujun Shao, Siyu Zhou, Yuan Gao

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Objective To analyze the specificity of target genes used in specific PCR detection of Kingella kingae and select suitable assay for the K. kingae carriage investigation in healthy population in China. Methods By comparing the relationship of 16S rDNA, groEL and rtxA genes with other closely related gene sequences published in National Center for Biotechnology Information (NCBI) database, the conservation of three target genes in K. kingae was analyzed. The specificity, sensitivity and stability of the selected real-time PCR were verified. By using the established assay, 513 pharyngeal swabs were detected. Results Phylogenetic tree based on rtxA gene showed high homology among different strains of K. kingae, and the similarity of rtxA gene with Moraxella bovis was 72%. rtxA gene was more conservative and specific than 16S rDNA and groEL genes, which is more suitable for the detection of K. kingae. The real-time quantitative PCR assay for K. kingae was proved to be rapid, specific, sensitive and reproducible, the detection sensitivity was 1copies/μl．For 513 pharynx swabs, 107 were detected positive (20.86%). Conclusion rtxA gene is highly conserved in K. kingae and can be used as a target gene for nucleic acid detection. Real-time PCR based on rtxA showed that K. kingae had a high carriage rate in healthy population with certain age distribution characteritics in China.

Spatiotemporal clustering of anthrax in Gannan Tibetan autonomous prefecture of Gansu, 2011–2017

Weimin Lyu, Kongfu Wei, Dongpeng Liu, Weizhong Zhou, Weirong Wang, Qingrong Chen

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Abstract:
Objective To analyze the spatial distribution and spatial clustering of anthrax in Gannan Tibetan autonomous prefecture of Gansu province from 2011 to 2017. Methods The incidence rate of anthrax in Gannan from 2011 to 2017 was used to calculate the global Moran’s I and local G statistics and analyze its spatiotemporal distribution characteristics at township level. Results The spatial correlation in the incidence rate of anthrax was found in Gannan from 2011 to 2017, and the hot spot areas were mainly in some townships of Maqu, Luqu, Xiahe and Zhuoni counties. Spatiotemporal analysis showed that high incidence of anthrax clustered most likely in 25 townships of Maqu, Luqu and Xiahe ciunties during 2015−2017 (log likelihood ratio,LLR＝260.09, RR＝12.91, P＜0.001). Conclusion Results from this study indicated that the spatiotemporal clustering of anthrax incidence was obvious during 2011−2017 and Maqu, Luqu and Xiahe are the key areas in anthrax prevention and control in Gannan of Gansu.

Spatial analysis and mathematical modeling of human infection with avian influenza A (H7N9) virus in Zhejiang, 2013−2016

Renjie Zhang, Na Li, Xiaoxiao Wang, Biyao Liu, Fudong Li, Shuangfeng Zhang, Xuehai Zhang, Zhen Wang

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Abstract:
Objective To investigate the spatial distribution of the cases of human infection with influenza A (H7N9) virus in Zhejiang province during 2013−2016, establish mathematic models to identify the environmental and social factors associated with disease distribution and provide methodological support for the prevention and control of the disease. Methods Based on the incidence data of human infection with H7N9 virus, virus surveillance data of environmental samples as well as population and socioeconomic data in Zhejiang during this period, a spatial database was established. Global Moran’s I and Getis-Ord Gi* were applied to explore the spatial distribution of H7N9 virus infection epidemic. Geographically Weighted Regression (GWR) model was constructed to analyze the spatial correlation between the epidemic and population density, poultry density and virus distribution in environment. The results were compared with those of Ordinary Least Squares (OLS) model. Results From 2013 to 2016, a total of 252 human cases of H7N9 virus infection were reported and the viruses were detected in 846 surveillance sites distributed in 77 counties and districts of 11 prefecture-level cities, . At provincial level, the epidemic spread from central-northern part of Zhejiang to surrounding areas; at city level, the epidemic spread from downtown area with high population density to surrounding counties or districts. Spatial regression analysis suggested that the number of human infection cases was correlated with population density and number of H7N9 virus positive surveillance sites (t＝4.127 and 2.697 respectively, P＝0.000 and 0.009 respectively). GWR model (R²＝0.504) showed better fitness compared with OLS model (R²＝0.257). Conclusion The H7N9 virus infection epidemic in Zhejiang originated in Huzhou and gradually spread to the surrounding areas of Hangjiahu plain. The virus is distributed wildly in the province now. Live poultry marketing might be the main route for the spread of the infection. The spatiotemporal clustering of human infection with H7N9 virus was very obvious, the epidemic was more likely to occur in area with high population and poultry densities and more virus positive surveillance sites. GWR model is suitable for practical application due to its good predicting effect for the distribution of human infections with H7N9 virus.

Analysis and identification on Bacillus anthracis virulence in the event of the anthrax vaccine suspected virulence recovery

Enmin Zhang, Zhifei Zhan, Qiang Wei, Xixing Zhang, Yanhong Hu, Xin Xia, Kanglin Wan, Jianchun Wei, Lidong Gao

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Objective To investigate the virulence and the environmental contamination of Bacillus anthracis used in a teaching experiment in the event of a anthrax vaccine suspected virulence recovery, and provide scientific basis for disposing the event. Methods Weinvestigated the event and collected the experimental culture, frozen strain and the environmental samples concerning the teaching experiments; The culture was identified by phage lysis and penicillin sensitivity test; The rpoB gene on chromosome, pagA gene on plasmids pXO1 and capC gene on plasmids pXO2 of the culture, frozen strain and the related environmental samples were detected by TaqMan real-time PCR assay. Results The results showed that there were obvious phage plaque and clear zone around penicillin slip on the culture. The detection of rpoB and pagA genes was positive, but the capC gene was negative in the culture and the frozen strain. The detection of rpoB, pagA and capC genes of Bacillus anthracis was all negative in the environment samples from the teaching sites. Conclusion The culture and the frozen strain were Bacillus anthracis without capC gene, and the virulence recovery of anthrax vaccine was not found in the event. There was no contamination of Bacillus anthracis in the teaching sites.

Epidemiological characteristics of hand, foot and mouth disease in Jinhua, Zhejiang, 2011–2017

Zhifeng Pang, Zhuping Jin, Guangming Zhang, Meng′an Chen

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Objective To analyze epidemiological characteristics of hand, foot and mouth disease (HFMD) in Jinhua, Zhejiang province, during 2011–2017 and provide evidence for the prevention and control of HFMD in Jinhua. Methods The descriptive epidemiological analysis was conducted on the incidence data and the etiological detection results of HFMD. Results A total of 88 157 HFMD cases, including 34 severe cases and 14 deaths, were reported in Jinhua during 2011 –2017, with an annual average incidence of 232.09/100 000. The epidemic of HFMD was characterized by high incidence every other year and annual double incidence peaks during April-July and during October-December. The difference in area distribution of HFMD cases was obvious, the incidence rate in urban area was 1.66–2.12 times higher than that in rural area. Most cases were children aged ≤5 years (96.10%), the high incidence age was observed in age group 1–3 years. Up to 97.06% of the severe cases and all the deaths occurred in children aged ≤3 years. More cases occurred in males than in females with a ratio of 1.47∶1. Most cases were children outside (69.60%) or in child care settings (28.14%). Etiological test of 3 789 mild cases samples showed that 2 126 were enterovirus positive (56.11%), of which the cases caused by enterovirus 71(EV71), coxsackie virus A16 (Cox A16) and other enteroviruses accounted for 24.60%, 18.77% and 56.63%, respectively. EV71 caused the majority of severe cases and deaths. Conclusion HFMD had a wide distribution in Jinhua with obvious seasonality and population distribution difference. The prevention and control of HFMD in populations at high risk, high incidence seasons and key areas should be strengthened, and the vaccination in children aged ≤3 years should be further promoted. Furthermore, it is necessary to improve the surveillance schemes to increase the number of samples, sampling frequency and pathogenic detection items.

Immunization coverage of national immunization program in Taizhou, Zhejiang, 2017

Yiwen Xu, Yiping Chen, Lianhua Wang, Xiang Zheng, Chunhua Qiu

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Objective To understand the coverage of national immunization program (NIP) in children in Taizhou, Zhejiang province. Methods The coverage of NIP was investigated in 18 townships selected through stratified cluster sampling in 9 counties of Taizhou through Zhejiang Immunization Information System. Results A total of 34 265 children, including 23 316 local children and 10 949 migrant children, were investgated. The routine vaccination rates in children aged 2 years remained at high levels and the coverage rates in all counties were above 95%. The vaccination rates of 2^nd dose Japanese encephalitis vaccine (JEV), 4^th dose polio myelitis attenuated live vaccine（PV）and 1^st dose meningococcal polysaccharide vaccine-type A and C (MPV-AC) were all above 98% in children aged 7 years. The vaccination rates of diphtheria-tetanus vaccine (DT) in all counties were above 95%, except Xianju. Compared with other vaccines, the coverage rate of 2^nd MPV-AC was lowest, and it was above 90% only in a few counties, i.e. Huangyan, Linhai, Yuhuan, Tiantai and Sanmen. The coverage rates in local children were higher than those in migrant children. The differences in coverage rates of Bacillus Calmette-Guérin (BCG), 4^th dose PV, 1^st dose diphtheria tetanus and pertussis vaccine (DTP), 4^th dose DTP, 2 doses meningococcal polysaccharide vaccine-type A (MPV-A), 2 doses MPV-AC, 2^nd dose JEV, hepatitis A vaccine (HepA) and DT were significant between local children and migrant children. Conclusion The Immunization coverage of NIP remained at a high level in both local children and migrant children. However, the coverage rates in migrant children were lower than those in local children. Also, migrant children got vaccination later than local children did. Therefore, we should strengthen the management of migrant children.

Analysis on hepatitis B vaccine immunization cost trend in community health service institution in Beijing, 1992–2013

Dan Wang, Yiwei Guo, Shiwen Shi, Jiang Wu, Xuefeng Shi, Min Lyu, Xi Wang, Qian Bai

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Abstract:
Objective To calculate and analyze hepatitis B vaccine (HBV) immunization cost and its change pattern in community health service institution, and provide data support for policy-making and input-output evaluation of HBV immunization. Methods First, field investigation, and questionnaire survey were conducted to collect related information, and a database was established in ACCESS, the data was entered twice. Next, the data was analyzed in Excel 2016 software. Results From 1992 to 2013, the overall cost of HBV immunization increased from171.42 ten thousand yuan to 556.21 ten thousand yuan with an annual growth rate of 5.76%; and the unit cost increased from 12.47 yuan to 21.29 yuan with an annual growth rate of 2.58%. In community health centers, the cost of HBV immunization mainly originated from labor cost. Therefore, to some extent, the growth of total cost in community health centers can attributed to that of labor cost. Conclusion For HBV immunization in communities in Beijing, both the overall cost and unit cost showed obvious increasing trends. The growth rate of unit cost was lower than that of total cost, and the growth of the overall cost in HBV immunization in communities was mainly resulted from the increase of labor cost.

Analysis on spatial and temporal clustering of dengue fever epidemic in Zhejiang, 2004－2016

Liyun Ai, Enfu Chen, Jimin Sun, Jiangping Ren

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Objective To investigate the spatial and temporal distribution of dengue fever in Zhejiang province from 2004 to 2016 and provide scientific evidence for dengue fever prevention and control. Methods The information of dengue fever cases of Zhejiang province from 2004 to 2016 was collected from Chinese Center for Disease Control and Prevention. Software SaTScan was used to analyze the spatial and temporal clustering of dengue fever cases, and software ArcGIS was used for the result visualization. Results Spatial and temporal scan statistics detected 2 clusters (P＜0.05) of dengue cases in Zhejiang during 2004–2016. The class Ⅰ cluster was in Yiwu (1 August 2009-30 September 2009) and the class Ⅱ cluster was in Cixi (1 September 2004–31 October 2004). Sporadic outbreaks had one class I cluster in Yiwu and Pujiang (1 August 2012–31 December 2016), and two class Ⅱ clusters in the urban areas of Ningbo (1 July 2013–31 October 2016) and Hangzhou (1 July 2013–30 November 2016). Conclusion The distribution pattern of dengue fever in Zhejiang from 2004 to 2016 showed clustering trend. Yiwu and the urban areas of Ningbo and Hangzhou were at high risk for dengue fever importation. It is necessary to develop effective dengue fever prevention and control strategy in Zhejiang

Comparison of three methods for identification of clinical isolates of Aeromonas

Yanyan Zhou, Zheng Nan, Donghui Yan, Jianrong Su

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Objective To compare the identification effects of clinical isolates ofAeromonas by using multi locus phylogenetic analysis (MLPA), mass spectrometer (VITEK MS system) and biochemical analyzer (VITEK Ⅱ system) and provide evidence for the research of species identification and classification of Aeromonas. Methods The Aeromonas strains isolated from clinical specimens of hospitalized patients and outpatients suffered from diarrhea in our hospital between December 2014 and October 2017 were collected for the identification with VITEK MS system, VITEK Ⅱ system and MLPA, respectively. Results The isolated Aeromonas strains were divided into 10 species by MLPA, i.e. A. veronii, A. caviae, A. hydrophila, A. dhakensis, A. enteropelogenes, A. media, A. sanarellii, A. taiwanensis, A. bivalvium, and A. allosaccharophila. The identification rate of Aeromonas was 100.0% at genus level and 16.2% at species level by VITEK MS system, in addition, the identification rate was 83.3% (5/6) for A. enteropelogenes and 50.0% (1/2) for A. media. The identification rate of Aeromonaswas 89.2% at genus level and 0.0% (unspecified and false) at species level by VITEK Ⅱ system. Conclusion MLPA was an accurate tool for the delineation of Aeromonas species. VITEK MS system was more accurate than VITEK Ⅱ system to identify Aeromonasat both the genus and species level. VITEK MS system had a certain ability to identify rare species of A. enteropelogenesand A. media.

Distribution of serotypes and drug resistance of ESBLs-producing Salmonella in Wenzhou, Zhejiang

Sucai Chen, Lizhen Shen

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Objective To study the serotype distribution and drug resistance characteristics of ESBLs-producing Salmonella in Wenzhou, Zhejiang province, from 2013 to 2017 and provide evidence for the disease prevention, diagnosis and treatment in clinical practice. Methods From January 2013 to December 2017, a total of 294 Salmonella strains were collected from our hospital and all the district centers for disease control and prevention in Wenzhou, and the serotypes of ESBLs-producing Salmonella strains were confirmed by E-test quantitative analysis. The drug sensitivity and epidemiological characteristics of the strains were analyzed. Results The screening of 294 strains of Salmonellafound 68 (23.13%) ESBLs-producing strains, involving three serotypes and including 41(60.29%, 41/68) Salmonella typhimurium strains , 19(27.94%, 19/68) Salmonellaenteritis strains and 8(11.76%, 8/68) Salmonella derby strains . The cases were mainly children aged 3–5 years (61.76%, 42/68) and infants aged 0–2 years (17.65%, 12/68). The clinical samples were mainly intestinal samples, accounting for 69.12% (47/68), followed by blood samples, accounting for 30.88% (21/68). The resistant rate of ESBLs producingSalmonella was 41.18% to cefepime, 52.94% to compound sulfamethoxazole and 47.06% to tetracycline. No strains which were resistant to imipenem, ciprofloxacin and levofloxacin were found. Conclusion The transmission of ESBLs-producing Salmonella was serious in Wenzhou, the major serotype was Salmonella typhimurium, which were mainly detected in infants. ESBLs-producing Salmonella has different resistance to antibiotics, especially the poor sensitivities to cefepime, compound sulfamethoxazole, tetracycline, etc. Multidrug resistance monitoring should be strengthened in clinical practice.

Analysis on major death causes and disease burden in residents in Tibet, 2015

Zhuoma Pingcuo, Jinlei Qi, Cangjue Gama, Yajie Li

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Objective To understand the mortality and death cause distribution in residents of Tibet and provide evidence for disease prevention and control. Methods Based on data from the global burden of disease study (GBD2015) of China and the Nation Mortality Surveillance System, the analyses on mortality, constituent ratio, disability adjusted of life years (DALY) were conducted. Results The crude mortality was 672.53/100 000 and the age-standardized mortality was 1 146.81/100 000. The mortality rate was higher in males than in females. Three major diseases were chronic disease (76.27%), infectious disease and maternal nutritional deficiency disease (14.64%) and injury (9.13%). The top five causes of death were cerebrovascular disease, respiratory disease, heart disease, digestive system disease and malignant tumor. The highest mortality was in age group ≥70 years（8 676.14/100 000）and the lowest mortality was in age group 5–14 years (83.94/100 000). The highest level diagnostic unit where most death cases sought medical care was class Ⅲ hospitals and deaths mainly occurred at home. Conclusion Chronic disease was the major cause of death in Tibet, the gender and age specific mortality level and death cause rank varied, so it is necessary to conduct targeted disease prevention and control in residents in Tibet.

Investigation of noruvirus infection status in diarrhea cases in sentinel hospitals in Tianjin, 2015–2016

Wenlong Zheng, Shuai Zhao, Jie Ma, Sha Luo, Yan Ji, Guohong Jiang

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Objective To understand the epidemiologic characteristics of norovirus infection in sporadic diarrhea cases in Tianjin during 2015–2016. Methods The epidemiological information of sporadic diarrhea cases were collected from five sentinel hospitals in Tianjin from January 2015 to December 2016. The stool samples were collected for norovirus nucleic acids detection by using real-time reverse transcription-PCR (real-time RT-PCR), and genotyping was performed for the detected strains. Results A total of 1 249 stool samples were collected from the diarrhea cases, the positive rate of norovirus was 14.41% (180/1 249); The highest detection rate was found in young children aged ＜1 year, with a detection rate of 26.07% (85/326); The differences in detection rate among different age groups had significance, (P＜0.01). The detection rate of noroviruses was significantly higher in the first and fourth quarters than in the second and third quarters. The detection rates in Binhai new district, urban area and rural area were 30%, 16.62% and 11.89%, respectively. GⅡ was the predominant genotype of norovirus detected in the diarrhea cases. The infections with norovirus GⅡ accounted for 86.05%, the infection with norovirus GⅠ accounted for 11.05%, and co-infection with noroviruses GⅠ and GⅡ accounted for 2.91%. The infection rate of norovirus GⅠwas highest in age group 6–45 years (33.33%). The infections with norovirus CⅠ mainly occurred during April-September. Conclusion The infection rate of norovirus in diarrhea cases in Tianjin sentinel hospital was high. The incidence in winter and spring was high. Binhai new district was an area with high incidence, infants and young children were group with high incidence. GⅡ was the predominant genotype. The incidence of infection with norovirus GⅠ was relatively high in young and middle-aged groups. It is necessary to conduct the prevention and control of norovirus infection according to the epidemic characteristics, and active surveillance should be conducted in populations at high risk.

Characteristics of Klebsiella pneumoniae detected in patients with hepatic abscess in Wenzhou

Sucai Chen, Lizhen Shen

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Objective To investigate the microbiological characteristics, capsule type, virulence gene and drug resistance of Klebsiella pneumoniae detected in patients with hepatic abscess. The differences of K. pneumoniae with different virulence characteristics detected in patients with hepatic abscess were compared. Methods The clinical data of 165 hepatic abscess patients with K. pneumoniae infection in our hospital from 2015 to 2017 were retrospectively analyzed, and 102 strains of K. pneumoniae with high virulence were confirmed by using wire drawing test. The strains were divided into high virulence group and common group. The classification and virulence gene rmpA of serum capsule were detected by using PCR amplification. VITEK 2 Compact automatic microbiological assay instrument was used for drug susceptibility test and the results were statistically analyzed. Results Among patients with hepatic abscess, the community acquired infection rate of K. pneumoniae was higher. Up to 83.33% of the infected patients had no underlying disease and 81.60% of hepatic abscess cases were caused by highly virulent K. pneumoniae strain with high mucous phenotype, and the capsule type were mainly serum K-1 and K-2, which carried rmpA gene. Common K. pneumoniae was mainly mucous free, and the capsule type was non-serum K-1 or K-2 type, a few of them carried rmpA gene. The resistance of K. pneumoniae with high virulence to 10 common used antibiotics was low, and 3 strains of K. pneumoniae with high virulence producing Extended Spectyum β Lactamases (ESBLs) were detected. No K. pneumoniae strain resistant to carbapenem was detected. Conclusion The main pathogen of hepatic abscess was K. pneumoniae with high virulence and high level mucous, and mainly with serum type K-1 and K-2, Severe community-acquired infection of highly virulent K. pneumoniae causing liver abscess occurred in patients with normal immunity. The resistance of to common used antibiotics was low. Three strains of K. pneumoniae with high virulence producing ESBLs were detected, and they showed upward trend in drug resistance, to which more attention should be paid in clinical practice.

Analysis on incidence of injury death in residents in Dali, Yunnan, 2015−2017

Zhannan Cao, Sheji He, Zhaoyun Shi, Ling Chen, Binghua Duan

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Objective To analyze the injury death level and injury causes in local residents in Dali prefecture of Yunnan province from 2015 to 2017. Methods We collected the surveillance data about causes of injury death from 2015 to 2017 in Dali and code death causes of injury cases according to the international classification of diseases (ICD-10). The data about the cause of injury death were statistically analyzed by using Excel 2007 and SPSS 17.0, and the data standardization was based on national population census data in 2010. The indicators used in the analysis included crude mortality rate, standardized mortality rate and constituent ratio. Results The average crude mortality rate was 598.99/100 000 and the standardized mortality rate was 601.29/100 000 in Dali prefecture from 2015 to 2017. The injury mortality rate was 59.93/100 000, and the standardized injury mortality rate was 60.45/100 000. Injury death was the fifth leading cause of death, ranking after respiratory disease, cerebrovascular disease, heart disease and cancer. The first five leading injury death causes were traffic accident, accidental fall, suicide, accidental poisoning and drowning, and the related deaths accounted for 86.94% of the total injury deaths. Accidental asphyxia was the main cause of injury death in infants aged ＜1 year, accounting for 48.72%. Among children aged 1−14 years, the most common injury death cause was drowning, accounting for 41.38%, and among people aged 15−59 years, the major injury death cause was traffic accident; and accidental fall was the major cause of death in people aged ≥60 years. Conclusion Injury was one of the main causes of death in Dali prefecture. It is necessary to conduct targeted injury prevention and to explore measures by which intervention of injury prevention can be improved to reduce the incidence of injury.

2018年美国可能与先天性寨卡病毒感染有关的出生缺陷和神经发育异常数据分析

Zhenyu Gong, Xunliang Gong

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Abstract:
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美国对可能接触寨卡病毒男性咨询服务和预防寨卡病毒通过性传播的最新指南（2018年8月）

Fuzhe Gong, Zhenyu Gong

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Abstract:
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Incidence trend and characteristics of cerebral infarction in residents in Tianjin, 2010－2016

Xiaodan Xue, Dezheng Wang, Ying Zhang, Wei Li, Chengfeng Shen, Shuo Pang, Guohong Jiang

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Abstract:
Objective To investigate the incidence trend and characteristics of cerebral infarction in residents in between 2010 and 2016, analyze the incidence differences in population with different characteristics, and provide evidence for the prevention and control of cerebral infarction. Methods The data of new cerebral infarction cases between 2010 and 2016 were collected from Tianjin Cerebral Infarction Surveillance System. The incidence of cerebral infarction and its distribution in different age groups, gender groups and urban or rural areas was analyzed. The population data based on the Sixth National Population Census in 2010 were used for standardized rate estimation. Difference among different groups was compared with χ² test. The χ_trend² test was used to analyze the incidence trend with years and in different age groups. The change the incidence during this period and prediction of the incidence during 2017–2020 were analyzed by using Joinpoint software. Results The average age of initial cerebral infarction was 65.50 years, the smoking rate was 32.18%, and the recurrent rate was 34.01%. The incidence rate of cerebral infarction in Tianjin increased gradually from 2010 to 2016 with the crude incidence rate ranging from 379.70/100 000 to 583.64/100 000, and with the standardized incidence rate ranged from 212.40/100 000 to 291.52/100 000 (P＜0.000 1). The increase in rural area was more obvious. The incidence rate was consistently higher in male residents (the crude incidence: 450.17/100 000–698.82/100 000, the standardized incidence rate: 249.20/100 000–350.34/100 000) than in female residents (the crude incidence rate: 308.44/100 000–467.87/100 000, the standardized incidence rate: 174.48/100 000–232.85/100 000, allP＜0.001). And in all age groups, the incidences in men were higher than in women (P＜0.001). According to the prediction, the incidence of cerebral infarction in Tianjin will reach 808.58/100 000, and the standardized incidence of the disease will be 371.03/100 000 by 2020. Conclusions The incidence of cerebral infarction increased during the past 7 years. There was no turning point for decrease, and the increasing trend was more obvious in rural areas and in men. Attention should be paid to the disease and targeted interventions should be taken to reduce the incidence of cerebral infarction.

Awareness of brucellosis related knowledge and prevalence of risk behaviors in farmers and herdsmen in Zuoyun, Shanxi

Mengjie Geng, Liping Wang, Lijie Zhang, Lingjia Zeng, Xiang Ren, Cuihong Zhang, Zhongjie Li

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Objective To understand the awareness of brucellosis related knowledge and the prevalence of risk behaviors in farmers and herdsmen in Zuoyun county of Shanxi province, and provide reference for public health education about brucellosis prevention and control. Methods Farmers and herdsmen were selected in Zuoyun through stratified two-staged sampling, A self-designed questionnaire was used to collect the information about their awareness of brucellosis related knowledge, prevalence of risk behavior and self-protection. The differences in the knowledge awareness and risk behavior prevalence between farmers or herdsmen who had suffered from brucellosis and those who had never suffered from brucellosis were analyzed with χ² test. Results Among the 491 subjects surveyed, 70.47% knew that brucellosis will lead to muscle pain, 41.96% knew the fever symptom of brucellosis, 12.63% had no knowledge about the common symptoms of brucellosis. 82.06% believed the delivery of livestock might lead to the infection with brucella, 56.08% thought slaughtering livestock might lead to the infection, 41.65% believed eating undercooked beef and mutton might lead to the infection. When delivering the lambs, 77.17% of the subjects surveyed never wore masks, 64.84% never wore protective gloves; when dealing with livestock apoblema, 81.99% never wore masks, 72.04% never wore protective gloves. Although the local health department have conducted the health education of brucellosis knowledge, but 41.55% of the subjects surveyed answered receiving no health education about brucellosis. The differences in the correct answer rate among farmers and herdsmen with different education background were significant (χ²＝16.360, P＜0.05); the rate of drinking raw milk was 56.25% in those who had suffered from brucellosis and 43.75% in those who had never suffered from brucellosis, the difference were significant (χ²＝7.914, P＜0.05). Conclusion This survey indicated the local farmers and herdsmen had low awareness of brucellosis related knowledge, which was much lower than the expected, they usually took no protection measures in contacting livestock. It is necessary to strengthen the health education about brucellosis prevention and control in local farmers and herdsmen to improve their self-protection and reduce the prevalence of brucellosis.

Genetic characteristic analysis on 33 strains of rubella virus isolated in Chaoyang district of Beijing, 2012–2016

Yan Gao, Yang Jiao, Yusong Zhang, Shiyao Zhang, Lin Gu, Jianhong Zhao, Fang Wang, Lingli Sun

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Objective To identify the genotype and the genetic characteristics of rubella virus isolated from throat swabs of suspected rubella cases in Chaoyang district of Beijing during 2012–2016. Methods Vero /SLAM cells were used to isolate rubella viruses from throat swabs collected from rubella cases in rubella outbreak and sporadic cases in Chaoyang during this period. The fragments of E1 genes of the isolates were amplified by RT-PCR and then the PCR products were directly sequenced and analyzed. The phylogenetic tree based on the 739 nucleotide sequences of E1 genes were conducted using the rubella virus strains isolated in Chaoyang and 32 WHO reference strain sequences representing 13 genotypes, another phylogenetic tree was also conducted with the 33 rubella virus strains isolated in Chaoyang and 16 rubella virus strains isolated in other provinces in China for the multiple sequence comparison. Results A total of 33 strains of rubella virus strains were isolated, which belonged to two different genotypes, i.e. 1E (8 strains) and 2B (25 strains). The genotype 1E strains were detected during 2012–2013, and the genotype 2B strains were detected during 2012–2016. The intra and inter genetic distance of genotype 2B strains were less than those of genotype 1E strains. Conclusion Two genotypes of rubella virus (1E and 2B) were detected in Chaoyang during 2012–2016. The nucleotide sequence of genotype 2B strain was more stable and genotype 2B strain has gradually become predominant.

Cost estimation of hepatitis B vaccine immunization in obstetrics departments of hospitals in Beijing, 1992–2013

Pei Gao, Dan Wang, Shiwen Shi, Min Lyu, Xuefeng Shi, Jiang Wu, Yiwei Guo, Xi Wang

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Abstract:
Objective To estimate the cost of hepatitis B vaccine (HBV) immunization and its change pattern in the obstetrics departments of hospitals in Beijing, and provide data support for policy-making and evaluation of HBV immunization efficiency. Methods Data collection was conducted through field investigation and questionnaire survey. Database was established with ACCESS, and data were entered twice. Data analysis was performed with software SAS 9.4 and Excel 2016. Results From 1992 to 2013, the overall cost HBV immunization in obstetrics departments of hospitals in Beijing increased from 410 011.52 yuan to 4 344 244.00 yuan, with an annual growth rate of 11.90%; and the unit cost increased by 7 times, from 5.38 yuan to 37.25 yuan, with an annual growth rate of 9.65%. The cost of HBV immunization mainly originates from labor cost. Therefore, to some extent, the growth of overall cost of HBV immunization in hospitals is due to the increase of labor cost. Conclusion In the obstetrics departments of hospitals in Beijing, both the overall cost and the unit cost of HBV immunization showed an obvious increasing trend. The growth rate of unit cost was lower than that of total cost, and the growth of total cost mainly attributed to the increase of labor cost.