Disease Surveillance

Multi respiratory pathogens detected in COVID-19 patients and their family members in Haidian district, Beijing

Liu Fangyao, Zhang Heng, Jiao Lijie, Liu Feng

, DOI: 10.3784/jbjc.202009230329

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Objective To analyze the infection status of common respiratory pathogens in coronavirus disease 2019 (COVID-19) patients and their family members in Haidian district of Beijing and compare the disease severity between the COVID-19 patients with co-infections and the COVID-19 patients only infected with SARS-CoV-2. Methods Multiplex PCR was used to detect the pathogen spectrum by using the respiratory tract samples of COVID-19 patients and their family members collected by the Haidian Center for Disease Control and Prevention during January-June, 2020. The differences in age and gender distributions and the severity of illness between the co-infection group and the non-co-infection group were compared. Results Parainfluenza virus, human metapneumovirus, NL63 coronavirus and Mycoplasma pneumoniae were detected in some samples of the COVID-19 patients, and respiratory syncytial virus, human metapneumovirus and NL63 coronavirus were detected in samples of some family members. There was no statistical differences between the co-infection group and the non-co-infection group in gender, age distributions and the severity of illness Conclusion Co-infections of SARS-CoV-2 and other respiratory pathogens were observed in the COVID-19 patients in Haidian district. There was a difference in pathogen spectrum detected in samples between the COVID-19 patients and their family members. No increased morbidity or mortality were observed in the COVID-19 patients co-infected with other respiratory pathogens. Application of multiplex PCR can provide more accurate evidence for the development of medical strategies.

Research progress of reclassification and virulence factors of Clostridioides difficile

Lin Shan, Song Xiaojun, Qu Pinghua, Jin Dazhi

, DOI: 10.3784/jbjc.202012250440

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Based on the research of phenotypic characteristics, chemical taxonomy and phylogeny, Clostridium difficile has been classified into the genus Clostridioides and renamed as Clostridioides difficile (C. difficile). In recent years, multi-drug resistant C. difficile infection has caused a significant increase in the number of antibiotic treatment failures and recurrent cases. At present, some European and American countries have established a complete surveillance systems and corresponding clinical diagnosis and treatment guidelines for C. difficile infection, but related works started late in our country. What's more, a large number of non-standardized antibiotic use, even abuse, still exist in clinical treatment in China, resulting in great challenges for the prevention, control, diagnosis and treatment of C. difficile infection. This study aimed to summarize the reclassification of C. difficile and the research progress of its virulence factors in order to provide reference to revise and standardize the name of Clostridioides difficile, promote domestic research of C. difficile and its pathogenic mechanism.

Epidemiological characteristics and research progress of Clostridioides difficile in China

Wu Yuan, Li Wenge, Jia Xiaoxi, Wang Yuanyuan, Zhang Wenzhu

, DOI: 10.3784/jbjc.202012210425

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Clostridioides difficile is recognized as the predominant pathogen for antimicrobial associated diarrhea and health care facility-associated infectious diarrhea, and is also listed as one of the urgent threat associated with antibiotics by Centers for Disease Control and Prevention of USA. In recent decades, studies on C. difficile and the rate of C. difficile infection increased dramatically. The aim of this study was to analyze the epidemiological characteristics of C. difficile infection and summarize research progress of C. difficile in China, which might help the further studies of C. difficile in China.

Detection of pathogens in clinically diagnosed cases of bacillary dysentery in Shunyi, Beijing

Yang Jie, Lyu Ziwei, Tan Dunfang, Ji Guoqiang, Li Ying, Zhang Maojun

, DOI: 10.3784/jbjc.202008310305

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Objective To analyze the composition and characteristics of pathogens of clinically diagnosed cases of bacillary dysentery in Shunyi, Beijing, and provide evidence for the effective prevention and control of bacillary dysentery. Methods A total of 44 clinical samples were collected from clinically diagnosed bacillary dysentery cases for the detections of Shigella, Campylobacter, Salmonella, Vibrio parahaemolyticus, Vibrio cholerae, Diarrhea Escherichia coli and Yersinia enterocolitica. Serotyping, molecular subtyping and virulence gene detection were performed for the pathogenic isolates. Result No Shigella and Yersinia enterocolitica were detected, and the positive rate was 30.00% (9/30) for Campylobacter, 18.18% (8/44) for Salmonella, 15.91% (7/44) for V. parahaemolyticus, 4.55% (2/44) for Diarrhea E. coli and 3.13% (1/32) for V. cholerae. Nine Campylobacter jejuni strains belonged to 9 STs; 8 Salmonella strains belonged to 4 serotypes and 7 PFGE patterns; 8 V. parahaemolyticus strains belonged to 4 serotypes and the virulence genes were tdh+/trh- and 1 V. cholerae strain belonged to non O1/O139 serotype and the virulence genes were ctx-/t3ss+. Conclusion The misdiagnosis rate of bacillary dysentery was high in Shunyi, to which close attention should be paid. The detection rate of pathogenic bacteria was high in clinically diagnosed cases of bacillary dysentery and the predominant pathogens were Campylobacter and Salmonella. The rapid differential diagnosis method between Shigella and other diarrhea pathogenic bacteria should be established and applied as soon as possible.

Optimization of isolation and culture method of Shigella spp. from stool samples

Wang Qifa, He Ziqiang, Li Yinmei, Hu Yongfeng, Jin Dong

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Objective To optimize the isolation method of Shigella spp. from stool samples. Methods A total of 129 stool samples were cultured with EC broth and Shigella enrichment broth. The ipaH gene was detected by PCR. Different selective media, including XLD medium, MAC medium, and SS medium, were used for the isolation of Shigella spp. The reference strains of Shigella spp. were used for simulated enrichment culture. Real-time PCR was used as detection method. Results The positive rate of EC broth enrichment samples with anaerobic condition was 38.76% and 34 ipaH gene positive strains were isolated (26.36%). The positive rate of Shigella enrichment broth samples with anaerobic condition was 55.81%, which was significantly higher than that of EC broth (P < 0.01), and 48 ipaH gene positive strains were isolated (37.21%). The isolation rate of Shigella spp. could be improved with other selective media such as MAC medium and SS medium except XLD medium. Anaerobic condition could increase the content of Shigella flexneri (Ct value decreased), but it had no obvious influence on Shigella sonnei. Conclusion Enrichment with 2-3 different selective culture media in combination with molecular biological method might be an effective way to improve the isolation rate of Shigella spp. in stool samples.

Molecular epidemiological characteristics and antibiotic resistance of multi-drug resistant Salmonella 14,[5]12:i:- in Guangdong

Huang Jingmin, Ke Bixia, Li Bosheng, He Dongmei, Liu Zhe, Li Zhencui, Deng Xiaoling

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Objective To study the characteristics of multi-drug resistance of Salmonella 1,4,[5],12:i:- and its genetic background in Guangdong province, and provide strong support for the drug resistance surveillance of this serotype and the early warning, prevention and control of foodborne disease outbreaks in Guangdong. Methods A total of 92 strains of Salmonella 1,4,[5],12:i:- collected from the sentinel hospitals for diarrhea pathogen surveillance in Guangdong province were included in the study. Minimal broth dilution method was used to detect the minimum inhibitory concentration of strains to 27 antibacterial agents. Whole-genome sequencing was applied to study the molecular characteristics associated with antibiotic resistance. Multilocus sequence typing (MLST) and whole-genome single nucleotide polymorphisms (wgSNPs) were conducted to analyze population structure of the isolates and evolutionary relationship between the isolates and global circulating strains. Results The multidrug resistance of Salmonella 1,4,[5],12:i:- was serious, with high resistance to tetracycline, ampicillin and sulfisoxazole, moderate resistance to aminoglycosides, cephalosporins, and high sensitivity to quinolones simultaneously. Resistance genes carried by the isolates were various. The drug resistance genes were consistent with overall drug-resistant phenotypes. The transmission of drug resistance genes mediated by mobile genetic elements such as IncHI2/IncHI2A, IncQ-type plasmids and insert sequences was the main mechanism of multidrug resistance of Salmonella 1,4,[5],12:i:-. MLST analysis showed that ST34 was the predominant clone of Salmonella 1,4,[5],12:i:- in Guangdong. Phylogenetic analysis found that the serotype population belonged to the same evolution branch with global circulating strain, which indicated a close genetic evolutionary relationship with international circulating clone. Conclusion The multidrug resistance patterns of Salmonella 1,4,[5],12:i:- varied in Guangdong, the drug resistance mechanism was complex, and acquired drug resistance was predominant. The multidrug resistant Salmonella 1,4,[5],12:i:- isolates in Guangdong showed a specific phylogenetic lineage. ST34 with a extensive antibiotic resistance pattern was predominant, which was consistent with the global trend.

Whole genome analysis on rotavirus isolated in outbreak in Ninghe district of Tianjin, 2020

Lei Yue, Zhuang Zhichao, Tian Hong, Dong Xinghua, Li Xiaoyan

, DOI: 10.3784/jbjc.202012020407

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Objectives To understand the whole genome characteristics of rotavirus A strains isolated from acute gastroenteritis cases in an outbreak in Ninghe district of Tianjin in 2020. Methods The viral nucleic acids of rotavirus isolated from positive stool samples collected in Ninghai were extracted for real-time PCR confirmation, the sequencing library were constructed following the instructions, the gene sequencing was conducted by the second generation sequencing method, and the sequencing data were analyzed by phylogenetic software, and 11 gene fragments full-genome sequences were analyzed by homology and phylogenetic analyses. Results Complete gene sequences of 4 strains of rotavirus were obtained successfully by the second generation sequencing method. All the strains shared >99% homology and showed the Wa-like constellation G9-P［8］-I1-R1-C1-M1-A1-N1-T1-E1-H1. Furthermore, phylogenetic analysis revealed that the VP7 genes belonged to lineage G9-VI and the VP4 sequences belonged to lineage P［8］-3. Amino acid substitutions were observed in the antigenic regions of the VP7 and VP4 gene. The nonstructural protein 4 (NSP4) genes contained multiple substitutions in antigenic sites I and II. The other NSP genes were conserved. Conclusion The study revealed that rotavirus G9-VI and P［8］-3 were the pathogens of this outbreak. The variations of the 4 strains were minor compared with the circulating strain. The continuous surveillance and analysis of the whole genomic constellation of circulating rotavirus strains needs to be strengthened to provide evidence for the prevention and control of rotavirus infection.

Analysis on HIV-1 infection, behavior and influencing factors in MSM in sentinel surveillance, Shanghai, 2012–2019

Wu Jian, Zhang Jiayu, Wang Xuting, Shu Weiping, Xu Yuan, Qin Xiaoyun, Ning Zhen

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Objective To investigate the infection status of human immunodeficiency virus-1 (HIV-1) and related behaviors in men who have sex with men (MSM) in Shanghai, identify the influencing factors, and provide evidence for HIV prevention and control. Methods Consecutive sentinel surveillance in MSM were conducted from 2012 to 2019. Blood samples were collected from the MSM and tested for HIV, syphilis and hepatitis C virus (HCV) antibodies. Logistics regression analysis was used to identify the influencing factors. Results A total of 3207 MSM were investigated from 2012 to 2019, they were mainly aged 25–34 years, unmarried and non-local population, and lived in Shanghai for more than 2 years. Most of them had education level college or above. The median of coverage rate of AIDS prevention service was 86.3%, and the median of awareness rate of AIDS related knowledge was 94.6%. The median of HIV antibody positive rate was 6.5%, which showed an overall upward trend (P<0.001). Up to 85.2% of MSM reported that they had anal homosexual behaviors in the past six months, among these MSM, 79.3% used condom at each anal sex. In the past six months, the proportions of condom use in homosexual, commercial homosexual and heterosexual behaviors all increased (P<0.05). Multivariate logistic regression analysis showed, education level of senior high school or lower (OR=1.506, 95% CI: 1.067–2.126, P=0.020), non-consistent condom use in anal sex (OR=1.379, 95% CI: 1.005–1.891, P=0.047), drug use (OR=3.688, 95% CI: 1.412–9.634, P=0.008) and syphilis status (OR=5.872, 95% CI: 3.784–9.111, P<0.001) were risk factors for HIV infection. Conclusion The positive rate of HIV antibody in MSM in Shanghai is still high, and HIV related risk behaviors are still common. It is necessary to further explore a comprehensive prevention and control intervention model to reduce the HIV infection in MSM.

Epidemiological and etiological characteristics of norovirus infection in children aged ≤5 years in Hubei, 2018–2019

Li Jing, Zhang Ting, Zou Wenjing, Cai Kun, Xu Junqiang

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Objective To understand the epidemiological and molecular characteristics of norovirus associated with acute diarrhea in infants and young children in Hubei province from 2018 to 2019. Methods A total of 922 stool samples from children aged ≤5 years with diarrhea were collected from viral diarrhea surveillance sentinel hospitals in Hubei Province from 2018 to 2019. The nucleic acids of norovirus GⅠ and GⅡ were detected by reverse transcription polymerase chain reactions. RT-PCR was used to amplify RNA polymerase and capsid region of the strain from norovirus positive samples and the PCR products were sequenced and genotyped. Results Among the 922 stool samples collected, 122 were norovirus positive (13.23%), in which 119 were norovirus GⅡ positive (97.54%) and 3 were norovirus GⅠ positive (2.46%). The difference in the infection rate between boys and girls was significant ( χ²=8.805, P=0.003). Children aged ≤5 years, especially the infants aged6 - 12 months, were the population with high incidence. Norovirus infection mainly occurred in winter and spring, there were two incidence peaks, and the higher one occurred during October-December. Norovirus GⅡ was predominant and recombination genotypes were mainly GⅡ.4 Sydney ［P31］(27.71%), GⅡ.2［P16］(26.51%), GⅡ.3［P12］(26.51%) and GⅡ.4 Sydney ［P16］(16.87%). Conclusion Multi genotypes and different recombination subtypes of norovirus were detected in children aged≤5 years with diarrhea in Hubei from 2018 to 2019. It is necessary to strengthen the surveillance for norovirus genotype and protect key population for the prevention and control of norovirus infection.

Investigation of Neisseria meningitidis in healthy population in Kashgar, Xinjiang, 2019

Chen Ziman, Xie Na, Xu Li, Wang Tongmin, He Lijuan, Zhu Bingqing, Gao Yuan, Shao Zhujun

, DOI: 10.3784/jbjc.202011250397

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Objective To investigate the carriage of Neisseria meningitides in the healthy population of Kashgar, Xinjiang. Methods In four counties in Kashgar prefecture, a total of 703 throat swabs were collected from healthy people in different age group selected by cluster random sampling. N. meningitides was isolated and identified by culture and real-time PCR. The serogroup of N. meningitides strain was determined by slide agglutination and real-time PCR. The laboratory results and epidemiological survey data were analyzed. Results In this study, a total of 91 N. meningitides strains were isolated with a carriage rate of 12.94%. The proportion of serogroup B, C, W, Y, E and non-groupable (NG) strains were 32.97% (30/91), 13.18% (12/91), 16.48% (15/91), 12.09% (11/91), 1.10% (1/91) and 24.17%(22/91), respectively. The N. meningitides carriage rate in healthy population were 27.27% (27/99) in age group 15–19 years, 15.00% (21/140) in age group ≥20 years, 14.20% (23/162) in age group 7–14 years, 9.18% (9/98) in age group 5–6 years, 4.90% (5/102) in age 3–4 years and 5.88% (6/102) in age group 0–2 years, respectively, the differences were significant ( χ²=45.725, P<0.05). A total of 185 throat swabs were positive in real-time PCR, and the difference in detection rates between culture and real-time PCR was significant ( χ²=153.589, P<0.05). Conclusion The N. meningitides carriage rate in healthy population in Kashgar was relatively high with age group 15–19 years having the highest carriage rate. The serogroups of N. meningitides strains isolated from the healthy population were complex. The application of real-time PCR in the carriage survey of N. meningitides in healthy population can increase the positive rate of the detection.

Functional Study on gene AL536_RS29525 of Vibrio fluvialis

Zhang Anran, Liu Xiaoshu, Huang Yuanming, Han Yu, Liu Ping, Li Jie, Kan Biao, Liang Weili

, DOI: 10.3784/jbjc.202101250043

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Objective To investigate the sequence characteristics of gene AL536_RS29525 located upstream of VflT6SS2 major cluster and downstream of paar gene of Vibrio fluvialis, its influence on VflT6SS2 secretion function and bactericidal activity as well as possible regulatory mechanism. Methods Muscle and GeneDoc softwares were used to compare and analyze AL536_RS29525 and homologs. Deletion mutant of AL536_RS29525 was constructed using suicide?plasmid based on the homologous recombination technology . Trans-complementation plasmid was constructed by cloning the coding sequence of AL536_RS29525 into plasmid pSRKTc, which was mobilized into the deletion mutant by conjugation. The expression and secretion of Hcp effector were analyzed by Western Blot. Standard bactericidal assay with E. coli as prey was used to measure the bactericidal ability of derivative strains. Luminescence activity of Lux based promoter fusion was used to test the promoter activities of VflT6SS2 major cluster and hcp orphan cluster in ΔAL536_RS29525 mutant strains and wild strains. Quantitative reverse transcription PCR (qRT-PCR) was used to detect the hcp (tssD2) and vipA (tssB2) mRNA level. Results The genomic structure and sequence of AL536_RS29525 homologs were conserved in Vibrio species. The deletion of AL536_RS29525 greatly decreased the expression and secretion of Hcp, and also significantly reduced the bactericidal ability. These defects can be restored by introducing the trans-complementation plasmid pSR-29525 into ΔAL536_RS29525 mutant. The mRNA expression levels of hcp (tssD2) and vipA (tssB2) of ∆AL536_RS29525 were lower than those of wild strains. However, the promoter activities of VflT6SS2 major cluster and hcp orphan were not significantly different between the mutant strains and wild strains. Conclusion AL536_RS29525 is an important component required for the expression and secretion of VflT6SS2 with a critical role in bactericidal activity of V. fluvialis.

Epidemiologic characteristics of measles and influencing factors in Baiyun district, Guangzhou, 2009–2019

Zhao Lixuan, Pang Zhiming, Lin Daner, Wang Zhiyun, Meng Yan, Lu Ruijun, Zhou Yong, Lu Jiahai

, DOI: 10.3784/jbjc.202012090413

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Objective To analyze the epidemiologic characteristics of measles and related influencing factors in Baiyun district of Guangzhou from 2009 to 2019 and provide evidence for measles prevention and control. Methods The measles surveillance system was used to carry out descriptive analysis on confirmed measles cases in Baiyun district from 2009 to 2019 and discuss the influencing factors. Results From 2009 to 2019, a total of 1430 confirmed measles cases were reported in Baiyun district, with an average annual incidence of 6.74/100,000, the cases mainly occurred during April – July, but the seasonality has been less obvious in recent years. The cases were mainly children aged < 2 years and adults aged 20–29 years. The cases were mainly distributed in population from other cities or provinces. The cases with 0 dose, 1 dose, ≥2 doses, and unknown immunization history of measles-containing vaccines (MCV) accounted for 61.73%, 7.26%, 17.46%, and 29.12%, respectively. The risk factors for measles in <18 years old group included being in floating population and medical treatment seeking history 7–21 days before onset (P < 0.05), and being on local population and history of MCV vaccination were the protective factors. Being in floating population was a risk factor for measles in people aged ≥18 years (P < 0.05). Conclusion Measles mainly occurred sporadically in Baiyun district, the incidence showed a single peak pattern and decline trend. Children aged <2 years and adults aged >20 years in floating population were the key populations in measles prevention and control. It is necessary to strengthen the active case finding in floating population, vaccination certificate check for the entrancement of private schools, active measles surveillance in medical institutions and encourage young migrant workers with unknown measles vaccination history to receive MCV, conduct accurate supplementary vaccination and take multiple measures to prevent periodic measles epidemic.

Spatiotemporal analysis on influenza in Hangzhou, Zhejiang, 2019–2020

Liu Muwen, Yang Xuhui, Wang Jing, Song Shujuan, Sun Zhou, Kao Qingjun

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Objective To analyze the temporal and spatial distribution of influenza epidemics in Hangzhou, and provide evidence for influenza prevention and control. Methods The influenza incidence data in Hangzhou during 2019–2020 were collected from “China Disease Prevention and Control Information System”, and the influenza outbreak data in Hangzhou during this period were derived from the epidemic response reports of Centers for Disease Control and Prevention in Hangzhou. Software ArcGIS 10.2 was used for global/local spatial autocorrelation analysis, and software SaTScan was used for spatiotemporal epidemiological analysis. Results A total of 264 410 influenza cases were reported in Hangzhou from January 1, 2019 to September 30, 2020, with an incidence rate of 269.98 per 10 000. The incidence peak was during December 2019 – January 2020 with cases accounting for 66.54% of the total. GSA Moran’s I value from the first quarter of 2019 to the first quarter of 2020 was positive and statistically significant (P<0.001). A total of 71 areas with high-high clustering were detected by local spatial association analysis, mainly located in the urban area and surrounding areas of Hangzhou. The spatiotemporal analysis showed that the class Ⅰ clustering areas were mainly located in the urban area and the surrounding areas of Hangzhou during December 15 2019 – January 25 2020, and the relative risk (RR) was 20.86, the log likelihood ratio (LLR) was 142 431.21 (P<0.001). The clustering areas detected by local spatial autocorrelation analysis and spatiotemporal analysis were similar to the actual outbreak distribution. Conclusion Temporal and spatial clustering of influenza incidence existed in Hangzhou during 2019–2020. Influenza prevention and control in the main urban areas and surrounding areas should be strengthened from November to January of the following year.

Estimation of excess number of diarrhea cases in intestinal disease outpatients in Beijing with adjusted Serfling regression model, 2012−2019

Liu Baiwei, Wang Yu, Tian Yi, Wang Xiaoli, Yan Hanqiu, Li Weihong, Shen Lingyu, Gao Zhiyong, Jia Lei, Wang Quanyi

, DOI: 10.3784/jbjc.202010220361

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Objective To estimate the excess number of diarrhea cases in intestinal disease outpatients in Beijing and analyze the characteristics of the excess cases. Methods The number of diarrhea cases diagnosed for the first time in 16 intestinal outpatient departments providing service all the year around in Beijing from 2012 to 2019 were collected to estimate the excess number of diarrhea cases with adjusted Serfling regression model. Results From 2012 to 2019, a total of 216 930 diarrhea cases were diagnosed for the first time in the 16 intestinal outpatient departments in Beijing, the age of the cases was mainly above 18 years. With adjusted Serfling regression model, 10 excess diarrhea epidemic periods were found, in which 28 135 excess cases occurred (95% CI: 13 423–42 847), accounting for 50.10% of the baseline level (95% CI: 23.90%–76.29%). The excess number of diarrhea cases diagnosed in the intestinal outpatient departments in spring, summer, autumn and winter were 2 673 (95% CI: 985–4 361), 11 564 (95% CI: 6 296–16 833), 2 570 (95% CI: 1 112–4 028) and 11 328 (95% CI: 5 030–17 626), respectively. The excess number of diarrhea cases in summer showed a decrease trend from 2012 to 2019 in Beijing ( χ²=5949.180, P<0.001), while the excess number of diarrhea cases in winter has been in increase since 2016. Conclusion Summer is the peak season of diarrhea diagnosis in Beijing, but in recent years, excess number of diarrhea cases increased obviously in winter. It is necessary to strengthen the surveillance for viral diarrhea in winter and adjust the corresponding prevention and control strategies.

Investigation of brucellosis epidemics in human and animals in Baoshan, Yunnan

Li Yanping, Ma Qiang, Huang Dongsheng, Zhao Ming, Ma Yunliang, Tang Xianyan

, DOI: 10.3784/jbjc.212101070013

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Objective To understand the characteristics of the brucellosis epidemics in human and animals in Baoshan prefecture of Yunnan province and provide scientific references for the prevention and control of brucellosis. Methods Descriptive epidemiological methods were used to analyze the investigation and response data of the two public health emergencies caused by brucellosis in Baoshan. Results Since 2017, two epidemics of brucellosis have been reported in Baoshan. In the first epidemic, a worker in a sika deer breeding farm showed fever with unknown reason and limb weakness, Brucella serological testing result was positive, and the antibody titer was 1∶400+. Brucella melitensis was detected by blood culture. Ten blood samples of sika deer were collected and tested by rose bengal plate agglutination test, the results showed that 2 samples were positive. The second epidemic was caused by infected beef cattle. In the response of the epidemic, 10 cattle attendants and 6 veterinarians were investigated. The blood samples of two persons were positive. Conclusion Two epidemics of brucellosis in Baoshan were effectively controlled through timely epidemiological investigation and managements. It is suggested to implement strict quarantine before the introduction of economic animals and strengthen the surveillance for brucellosis in staff and economic animals in breeding farms.

Comparison of the typing ability of the 6-site MLVA scheme and core genomic SNP scheme for Vibrio parahaemolyticus isolated in China

Zhang Jingshan, Zhao Wenxuan, Chen Meiling, Du Xiaoli, Zhao Lin, Wang Zijian, Xiao Wenjing, Zhang Weiwei, Zhao Hongqun, Li Jie, Diao Baowei, Kan Biao, Pang Bo

, DOI: 10.3784/jbjc.202111050373

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Objective To compare the ability of the whole-genome sequencing (WGS) SNP typing scheme with the multilocus tandem repeat analysis (MLVA) typing scheme for molecular typing of Vibrio parahaemolyticus isolated in China, and analyze the advantages and disadvantages of the two methods. Methods The MLVA scheme with six VNTR loci and the SNP scheme based on the whole genome sequence were used to analyze the molecular typing of 56 strains of Vibrio parahaemolyticus isolated in China, and evaluate the effects of these two methods with the isolates in China with quantitative indicators. Results Thirty-one MLVA types were obtained from 56 strains of V. parahaemolyticus by MLVA and the D value was 0.949. Thirty-three core genome SNP types were obtained in the same collection of strains by core genome SNP typing and the D value was 0.967. The discriminatory ability of the two typing methods is very close, and the typing results are highly consistent. Conclusion The 6-site MLVA typing scheme has similar typing capabilities to the typing scheme based on core genome SNP.

Epidemiological characteristics of measles outbreaks in international schools in Minhang district, Shanghai 2019

Chen Honghong, Zhang Liping, Su Hualin, Jin Baofang, Wang Ye

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Objective To analyze the epidemiological characteristics of a measles outbreak in international schools in Minhang district of Shanghai during May - June in 2019.. Method An epidemiological investigation was conducted in all the suspected measles cases detected in the outbreak. Blood samples and throat swabs were collected from the cases to detect measles antibody and viral nucleic acid. Clinical and epidemiological characteristics of measles cases were discussed and described. Risk factors of measles transmission were assessed. Results A total of 18 suspected measles cases were reported in the outbreak, in which 12 were laboratory confirmed (66.67%). Three cases studied at Shanghai American School, 9 cases studied at the British International School Shanghai. In the 12 confirmed measles cases. 11 were with foreign nationality（91.67%）. The peak time of measles outbreak was from May 28 to June 6, during which 9 cases were confirmed (75%). The age of the 12 cases ranged from 4 years to 15 years. Among them 1 had 3-dose measles-containing vaccine (MCV) immunization history (8.33%), 7 had 2-dose MCV immunization history (58.33%), 4 cases had 1-dose MCV immunization history (33.33%). Conclusion The investigation results suggested that the cause of the outbreak might be the common exposure to the index case during school sports meeting and Shanghai tennis club activity, indicating some students are susceptible to contracting measles infection in international schools. It is essential to strengthen joint prevention and control of infectious diseases in international schools according to local management requirement. It is strongly suggest that Shanghai education commission as well as Shanghai health department to formulate regulations and laws on vaccination certificate admission and supplementary vaccination in foreign students. Increasing the coverage rate of 2-doseMCV shots is an effective measure to prevent and control measles outbreak in schools.

Global yellow fever update, 2019

Gong Zhenyu, Gong Xunliang

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2019年全球霍乱流行概况

Gong Zhenyu

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Chinese reference list of core health indicators

, DOI: 10.3784/jbjc.202011300402

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Epidemiological characteristics of diarrhea pathogens and drug resistance of diarrhea-related bacteria in diarrheal patients in Miyun district, Beijing

Zhang Weiwei, Feng Baoli, Wang Jinlong, Han Yajun, He Guangxue

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Objective To understand the infection status of pathogenic bacteria and drug resistance characteristics in diarrhea patients in Miyun district, Beijing, and provide evidence for the prevention and treatment of infectious diarrhea. Methods The stool samples were collected from two sentinel hospitals in Miyun (Miyun District Hospital and Miyun Traditional Chinese Medicine Hospital) from 2014 to 2019. Pathogenic bacteria were identified by culture and isolation and drug resistances were analyzed. Diarrhea related viruses were also detected by real-time PCR. Results From 2014 to 2019, a total of 1 870 stool samples were collected. And 267 strains of bacteria (84 Salmonella strains, 52 Vibrio strains, 111 Escherichia coli strains, 10 Aeromonas strains, 8 Campylobacter strains, 2 Shigella strains) were isolated. And 314 samples were positive with viruses (204 with norovirus GII, 28 with norovirus GI, 61 with rotavirus, 17 with adenovirus, 4 with zaravirus). The highest positive rate was in age group <14 years (43.95%). The highest annual detection rate of diarrhea pathogens was in the third quarter, with an average positive rate of 40.26% in six years. The annual detection rate of diarrhea related viruses were higher in the first and fourth quarters, with an average positive rate of 18.86% and 23.63% respectively in six years. The drug resistance rates of Salmonella and diarrheagenic E. coli were 84.52% and 87.39% respectively. 36.90% of Salmonella strains and 36.94% of diarrheagenic E. coli strains were multidrug resistant. Conclusion In Miyun district, the composition of pathogens causing diarrhea tends to be diversified. Multidrug resistance of bacteria is serious. It is necessary to strengthen the pathogen surveillance, promote collaborations of multidisciplinary to response together, strengthen the management and rational use of drugs, and take effective measures to prevent and control the occurrence of drug resistance.

Clinical characteristics and drug resistance profile of 276 non-tuberculosis mycobacterium pulmonary disease patients

Niu Haijun, Li Yuanchun, Zhao Yanlin, Li Minghu

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Objective To investigate and analyze the clinical characteristics, pathogen species composition and drug sensitivity to first-line anti tuberculosis drugs of patients with non-tuberculosis mycobacterium (NTM) pulmonary disease from Nanyang, Henan province, and provide evidence to improve the diagnosis and treatment of NTM pulmonary disease. Methods A total of 276 patients with NTM pulmonary disease (all living in Nanyang) who visited the Sixth People's Hospital of Nanyang City from January 2015 to December 2019 were enrolled retrospectively. The baseline data, clinical symptoms, imaging manifestations and other information of the patients were collected, PCR reverse dot blot hybridization was used to identify NTM strains, and absolute concentration method was used for drug sensitivity test. SPSS18.0 was used for statistical analysis. Results From 2015 to 2019, the identification rates of NTM patients in suspected tuberculosis (TB) patients were 1.05%, 1.11%, 1.23%, 1.54% and 1.70%, respectively. Among the 276 NTM patients, men accounted for 61.59% (170/276), and the average age of the patients at onset was（51.21 ± 8.33）years. The main clinical manifestations were cough, expectoration, chest tightness, shortness of breath or anhelation. The most common imaging manifestations were pleural thickening (53.62%, 148/276), bronchiectasis (42.39%, 117/276) and cavity (40.58%, 112/276). Eight NTM strains were identified, and the top four strains were Mycobacterium intracellular (32.61%, 90 / 276), Mycobacterium Kansaii (23.91%, 66/276), Mycobacterium abscessus (21.38%, 59/276) and Mycobacterium avium (14.49%, 40/276). The drug resistance rates of the four major NTM to isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin were 92.55% (236/255), 83.53% (213/255), 54.51% (139/255), 89.02% (227/255), 78.82% (201/255) and 64.31% (164/255), respectively. In NTM subspecies, M. aeruginosa was more likely to cause symptoms such as fever, chest tightness, shortness of breath or anhelation and imaging findings such as bronchiectasis and cavity compared with M. avium. Conclusion The identification rate of NTM pulmonary disease in Nanyang increased year by year. The clinical characteristics were similar to those of patients with pulmonary TB. Close attention should be paid to the patients with risk factors and complications in clinical practice, and the imaging manifestations and bacteriological characteristic should be differentiated. The common NTM strains had high resistance to the first-line anti TB drugs, so the treatment plan should be standardized.

Analysis on spread trend of anti-tuberculosis drug resistance, Liuzhou, Guangxi

Tan Shounan, Zheng Zhigang, Huang Baoyang, Qin Zhenhua, Tan Jinxue, Wei Wudi, Liang Bingyu, Liao Yanyan, Pan Peijiang, Jiang Junjun, Ye Li, Liang Hao

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Objective To understand the spread trend of drug resistant tuberculosis (DR TB) over time in Liuzhou City, Guangxi Zhuang Autonomous Region, and provide evidences to contain the spread and transmission of DR-TB. Methods Data from the DR TB surveillance network in Liuzhou were analyzed. The percentage of DR-TB cases among the newly registered TB cases and the average annual percentage change (APC) were calculated. The regression model was constructed with linear and binomial regression. The hypothesis testing of the average APC was conducted by using line/curve fitting approach. Results A total of 571 DR-TB cases were detected through the DR surveillance network in Liuzhou from 2014 to 2019, accounting for 2.14% (571/26691) of new registered TB cases. The number of DR-TB cases increased from 50 in 2014 to 189 in 2019, an increase of 2.60 times. Of those with drug resistant TB, 30.30% (173/571) were isoniazid resistant, 19.26% (110/571) were rifampin resistant, 29.25% (167/571) were multi-drug resistant (MDR), and 7.01% (40/571) were extensive drug resistant (XDR). In MDR TB cases, XDR TB cases accounted for 23.95%. From 2014 to 2019, the proportion of XDR-TB cases among newly registered TB cases increased from 0.15% to 0.17%. After 2016, the result of APC testing indicated that the total number of DR TB, isoniazid resistant TB cases and rifampin resistant TB were significant increased among new tuberculosis cases (P=0.031, P=0.018, P=0.043). Although the increasing trends of MDR TB and XDR TB cases were observed among new tuberculosis cases, the differences were not significant (P_{MDR TB}=0.098, P_{XDR TB}=0.484). Conclusion The average APCs of DR TB, isoniazid resistant TB and rifampin resistant TB cases significantly increased in Liuzhou overtime, but the difference in case increase over time between MDR TB and XDR TB had no significance. It is necessary to conduct consecutive surveillance to facilitate the development of evidence based prevention and control measures for DR TB and improve the prevention and control of TB and the spread of DR TB.

Epidemiology and awareness of brucellosis in populations at high risk in Hulunbuir, Inner Mongolia Autonomous Region, 2010-2019

Liu Dongyan, Wang Yong, Zhang Wenyang

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Objective To analyze the surveillance results of brucellosis in high-risk population in Hulunbuir, Inner Mongolia Autonomous Region from 2010 to 2019 and provide evidence for adjusting the brucellosis prevention and control strategy. Methods The stratified sampling surveillance in populations with direct exposures to livestock and its products was conducted in counties of Hulunbuir. Blood samples were taken from the individuals in these counties for preliminary screening by using rose bengal plate agglutination test (RBPT) and for confirmation by using serum agglutination test (SAT).The survey of brucellosis related knowledge awareness was carried out in the above-mentioned populations. The questionnaire included three parts: basic knowledge about brucellosis, risk factors and brucellosis prevention knowledge. Descriptive statistics were used to analyze the infection, incidence and knowledge of brucellosis among high-risk populations. The rate and composition ratio were compared with χ² test, and P<0.05 was considered to indicate significance. Results From 2010 to 2019, a total of 162 539 blood samples were tested in Hulunbuir, in which 8 556 were positive (5.26%). Over time, the positive rate of blood test showed a downward trend. The difference was significant (χ²=448.824, P<0.05). The positive rate of blood test was 6.19% in pastoral areas, 6.10% in semi-agricultural and semi-pastoral areas, 5.68% in forest areas and 1.95% in cities. The differences among different areas were significant (χ²=792.139, P<0.05). As for age distribution, the positive persons were mainly young adults between 30 and 59 years old. The infected persons were engaged in breading industry (82.36%), other occupations (including workers, students, unemployed and others) (15.94%), and meat food processing, production, sales and transportation (1.69%). From 2010 to 2019, a total of 170 327 people were surveyed in Hulunbuir, in which 1 525 brucellosis cases were detected. The incidence rate was 0.90%. The incidence showed a fluctuating decreasing trend among different years with statistical significance (χ²=1 089.662, P<0.05). The awareness rate of brucellosis during 2014-2019 was continuously investigated with a total of 47,187 people being covered and 46,614 valid questionnaires being collected. The total awareness rate was 90.48%, and the total awareness rate showed an upward trend. The differences among years were significant (χ²=632.442, P<0.05). The awareness rate was 92.95% in cities, 90.48% in forest areas, 89.96% in pastoral areas and 88.47% in semi-agricultural and semi-pastoral areas. The differences were significant (χ²=122.780, P<0.05). Conclusion The prevention and control strategy for human brucellosis in Hulunbuir has achieved certain progress, but the situation is still serious. Therefore, it is necessary to carry out continuous surveillance for human brucellosis and conduct health education in populations at high risk.

Hot issues after marketing of COVID-19 vaccine

Ye Pengling, Wang Ming

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The pandemic of COVID-19 continues to spread worldwide, suggesting that the epidemic would continue in natural state. Although some progress has been achieved in the treatment of COVID-19, it is far from containing the spread of the epidemic. Therefore, human beings have pinned their hopes of controlling the COVID-19 epidemic on the development of vaccines. Currently, several COVID-19 vaccine products have been applied to immunize the population after completion of phase Ⅲ clinical trials. The safety, immunogenicity, efficacy, immunization procedures and response to virus mutations of different COVID-19 vaccines are the great concern of the public. The public and experts in the field are confused about the efficacy of vaccines due to the different evaluation indicators used by research and development institutions in publishing vaccine development and application information and the interpretation by media from different perspectives and calibers. This paper summarizes the published research data and discusses the hot issues in development and post-marketing application of COVID-19 vaccine.

Mental health status of staff and influencing factors in disease prevention and control system in Shanghai in the context of routine COVID-19 prevention and control

Xie Yanxin, Qi Hui, Pan Jie, Lu XiangHua, Hao Lipeng, Zhu Weiping

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Objective To investigate the mental status of staff in Shanghai's disease control and prevention centers (CDCs) and analyze the relevant factors in the context of routine prevention and control of COVID-19. Methods Stratified cluster sampling was used, a questionnaire survey of 538 staff members in 4 CDCs in Shanghai was conducted. Results The medium scores of depression, anxiety, interpersonal loneliness were 10, 7 and 4, respectively. Statistical difference in depression score was found among the staff with different education backgrounds, marital status, occupations, underlying diseases, units, work shifts. Statistical differences in anxiety and feeling loneliness scores were found among the staff with different education backgrounds, occupations, underlying diseases, units, work shifts. Multi-factor analysis showed that units, underlying disease, work shift, education background and long working time in the past 2 weeks were the main influencing factors for depression; units, underlying diseases, work shifts and long working time in the last 2 weeks were the main influencing factors for anxiety; units, work shifts were the main influencing factors for feeling loneliness. Conclusion The scores and influencing factors of depression, anxiety and feeling loneliness in the staff in CDCs in Shanghai were different. It is suggested that targeted measures should be taken to improve mental health status of the staff based on the investigation results.

An investigation of a botulism poisoning event in Urumqi, Xinjiang

Gulina Tuerdi , Gao Pengya, Sun Hui, Sun Xihe, Li Xinyue, Lu Xuancheng, Liu Yang, Xu Xuefang

, DOI: 10.3784/jbjc.202009170320

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Objective To investigate the pathogenic factors and causes of a botulism poisoning event and provide evidence for the prevention and control of the similar events in the future. Methods Field epidemiological survey was conducted through consulting medical records, interviewing relevant doctors and household survey, Laboratory test was done after collecting case stool samples and residual food samples for the detection of Clostridium botulinum. Results Two poisoning cases were confirmed and admitted to hospital. After botulinum antitoxin A and B treatment, the symptoms were significantly alleviated. C. botulinum was isolated, which was identified as type A C. botulinum after detection of type A toxin gene by real time quantitative PCR. Type A botulinum toxin was detected in mouse experiments. Conclusion This poisoning event was caused by homemade tempeh contaminated by C. botulinum type A. It is recommended to strengthen health education about the prevention of contamination in food production and storage. Medical institutions should prepare emergency medicines for food poisoning. Antitoxin serum should be used for the treatment of botulism poisoning.

The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine — United States, December 2020

Gong Zhenyu, Gong Xunliang

, DOI: 10.3784/jbjc.202012270443

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2021年1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 Diseases in January 2021

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《疾病监测》杂志稿约

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