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Epidemiological characteristics and typing of diarrheagenic Escherichia coli from adults in Haidian district of Beijing, 2013–2020
Bai Jing, Shi Lifei, Han Xirong
, DOI: 10.3784/jbjc.202102260340
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  Objective  To understand the epidemiological characteristics and pulsed-field gel electrophoresis (PFGE) typing of diarrheagenic Escherichia coli (DEC) isolated from adults in Haidian district of Beijing from 2013 to 2020.   Methods  Stool samples or anal swabs were collected from 1961 adults with diarrhea in 3 sentinel hospitals for DEC detection. Meanwhile, the 66 strains isolated were used for analyzed for genetic typing by PFGE.   Results  A total of 187 DEC strains we're detected from 1 961 cases (9.54%). Enterotoxigenic E. coli (ETEC) and enteroaggregative E. coli (EAEC) had higher detection rates of 4.18% (82/1 961) and 3.93% (77/1 961), respectively. The proportion of astA/pic in EAEC and estIa/estIb in ETEC were highest, accounting for 79.22% (61/77) and 84.15% (69/82), respectively. The gender, age and occupation specific differences in DEC detection rate showed no significance. The proportions of patients with fever, vomiting and abdominal pain were 28.65% (53/185), 34.59% (64/185) and 78.92% (146/185) respectively. The predominant types of DEC varied in different years, the detection rate of DEC was high during June–September. No same PFGE patterns or pattern clustering were found for EAEC and Enteropathogenic E. coli (EPEC). A total of 19 PFGE patterns were detected in 23 ETEC strains indicated by cluster analysis. The similarity between these patterns was 4.84%–100.0%.   Conclusion  The detection rate of DEC increased in recent years, and ETEC and EAEC were predominant. It is necessary to collect and analyze the information about the epidemiological characteristics of diarrhea patients and establish the local database of DEC PFGE pattern to provide reliable data supporting for the prevention and control of DEC infection in the future.
Genetic and evolutionary characteristics of an avian influenza A (H5N8) virus isolate from migratory bird
Huang Xin′er, Zhou Xue, Hou Sai, Hou Yinxu, Yu Junling, Chen Qingqing, Zhu Qian, He Lan, Gong Lei, Wu Jiabing, He Jun
, DOI: 10.3784/jbjc.202106030319
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  Objective  To analyze the genetic and evolutionary characteristics of an avian influenza A (H5N8)virus strain isolated from a dead swan at a migratory bird monitoring station in Feidong county of Anhui province.   Methods  Virus RNA extraction was conducted by using the samples collected from the dead swan, and real-time fluorescence quantitative RT-PCR was used the subtyping of influenza virus. HA and NA gene sequencing after amplification of the positive samples were conducted by first-generation sequencing method. Bioinformatics software was used to construct phylogenetic evolutionary tree and analyze its molecular characteristics.   Results  The nasal swab, beak swab and cloacal swab from the dead swan in Feidong, which were received on December 1, 2020, were all positive for H5 subtype by PCR. Sequencing results showed that the strains from three samples shared the same sequence of avian influenza A (H5N8) virus. Phylogenetic analysis showed that the virus belonged to 2.3.4.4 lineage and had high similarity with the isolates from Egypt and Russia. The HA and NA genes were in Eurasian lineage and had been adapted to different hosts. The HA cleavage site of the virus showed highly pathogenic molecular characteristics, carried 6 glycosylation sites and contained the amino acid mutations of S133L, S137A, T160A, D187N, K193N, Q196K and S227R. There were K389R and V589T mutations in PB2 protein, N409S mutations in PA protein, N30D and T215A mutations in M1 protein, S31N mutations in M2 protein, and P42S mutations in NS1 protein.   Conclusion  The receptor binding site of avian influenza A (H5N8) virus isolated in this study was still avian origin receptor, but it had the molecular characteristics of human origin receptor. Mutations in other amino acid sites suggested the risk of increased virulence of avian influenza virus, and further surveillance is needed.
Analysis on epidemiological characteristics of rabies in China, 2020
Liu Min, Liu Zhengran, Tao Xiaoyan, Zhu Wuyang
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  Objective   To analyze the epidemiological characteristics of rabies in China in 2020 and provide scientific evidence for the development of prevention and control policies in the next stage.   Methods   The incidence data of rabies from National Notifiable Disease Reporting System (NNDRS) in 2020 and the national surveillance data were collected for a descriptive analysis.   Results   A total of 202 cases of rabies cases were reported in 21 provinces (municipalities and autonomous regions) in 2020, and the incidence rate decreased by 30.34% compared with 2019. The rabies cases were mainly distributed in the central and southern China, the cases reported in 4 provinces with high case number, i.e. Hunan (59 cases), Henan (27 cases), Sichuan (20 cases) and Jiangsu (17 cases), accounted for 60.89% of the total cases in China. The incidence was highest in August, and lowest in April. The majority of rabies cases were farmers, and the male-to-female ratio of cases was 1.93:1, and the majority of the cases were middle-aged and elderly. The data of 85 cases were collected for case analysis. The results showed that dogs were the main animals attacking human (97%), nearly 60% of the dogs were domestic dogs, including the self-raised and neighbor-raised, and most of them caused human injuries through active attack and bite. Up to 65% of the cases had grade III exposure, the upper limbs was the main exposure site, and 66% of the wounds were untreated; Eight patients with grade III exposure were vaccinated (5 of them were injected with passive immune agents), but they died before completing the whole course of vaccination; The incubation period of most cases was less than one year.   Conclusion   The incidence of rabies continued to decrease significantly in 2020 based on the consecutive decline for 13 years, but the incidences in Hunan, Henan and other provinces were still higher, to which close attention needs to be paid. It is necessary to strengthen the management and immunization of dogs, especially rural dogs, and conduct the management of cats to maintain the achievements in the prevention and control of rabies.
Modelling analyses on transmissibility of COVID-19 epidemic and control effect in Ruili, Yunnan
Xiong Huan, Li Zhibo, Ran Lingyun, Cao Zufeng, Wei Tao, Liu Wei, Zhang Xusheng
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  Objective  The prevention and control of the importation of COVID-19 in Ruili, Yunnan, China, is challengeable due to the long border with Myanmar. By estimating the transmissibility of COVID-19 and the effect of the enhanced control measures for the COVID-19 epidemic in Ruili through a renewal equation model, this study aimed to provide scientific evidence for the prevention and control of COVID-19 epidemic in border areas.   Methods  The COVID-19 epidemic data in Ruili from March 30 to April 16, 2021 were collected from the official website of Ruili. The epidemiological analysis was carried out by using Excel 2019. To describe the transmission dynamics of the COVID-19 epidemic in Ruili, a renewal equation model was established using R language 4.0.5 under an assumption of index cases entering Ruili on 27 March 2021, three days earlier before the first reporting of the epidemic on 30 March 2021. In the context of strict prevention and control measures implemented from 30 March, it is further assumed that the transmission of COVID-19 would stop to increase at some time point. Markov Chain Monte Carlo algorithm (MCMC) was used to calculate the medians of model parameters and their 95% confidence interval.   Results  From March 30 to April 16 2021, a total 133 COVID-19 cases, including 90 confirmed cases and 43 asymptomatic infection cases, were reported in Ruili. The median age of the confirmed cases was 32 years and the median age of the asymptomatic infection cases was 28 years. Nineteen asymptomatic infection cases were further diagnosed as confirmed ones. The median of serial interval was about 5.00 days, and the median of its standard deviation was about 24.67 days. The reproduction number (R) was about 1.5 in the early stage of the epidemic, and decreased to <1.0 (about 0.6 ) within one week after the prevention and control measures were strengthened. According to the model, the daily number of new infections would decrease to <1 after April 17.   Conclusion  Under the reasonable assumptions about index cases, the renewal equation model fitted the epidemic data well, which predicted that the COVID-19 epidemic in Ruili would be under control within a short period of time. The experience in the response of COVID epidemic in Ruili can be used as useful reference for COVID-19 epidemic prevention and control in border areas with similar conditions.
Development and application of loop-mediated isothermal amplification combined with nanoparticle-based lateral flow biosensor for rapid detection of Leptospira interrogans serogroup icterohaemorrhagiae
Wang Yi, Yang Xinggui, Liu Ying, Huang Junfei, Wang Ming, Ying Xia, Tan Qinqin, Hu Yong, Li Shijun
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  Objective  To develop and evaluate a rapid detection assay for Leptospira interrogans serogroup icterohaemorrhagiae based on loop-mediated isothermal amplification (LAMP) combined with nanoparticle-based lateral flow biosensor (LFB).   Methods  The LAMP primers targeting the glycotransferase gene (gtf) in the O-antigen gene cluster of L.serogoup icterohaemorrhagiae were designed. After specific label of primers (FIP-FAM and LF-Biotin) and condition optimization, we evaluated the sensitivity, specificity and feasibility of gtf-LAMP-LFB assay. A total of 53 strains of Leptospira were identified by using LAMP-LFB assay, PCR and microscopic agglutination test (MAT), and the results were analyzed to evaluate the practicality of LAMP-LFB assay.   Results  Our data showed that the detection limit of the assay was 100 fg/μL for genomic DNA of reference strain of L. icterohaemorrhagiae (56601), and the specificity was 100% because there were no cross reactions with nucleic acids of other Leptospira serogroups and non-Leptospira strains. For the application examination, LAMP-LFB and MAT identification results were completely consistent, while the sensitivity of LAMP-LFB assay was higher than PCR. In addition, the color of CL and TL bands could be observed directly to determine the results by using LFB to detect LAMP amplicons.   Conclusion  The LAMP-LFB assay developed based on LAMP technique has high repeatability, sensitivity and specificity, which can be used for the rapid and accurate identification of the strains of L.interrogans serogroup icterohaemorrhagiae, and can be used as a potential screening and diagnosis tool for L.interrogans serogroup icterohaemorrhagiae.
Whole genome sequencing of Clostridium butyricum that caused the first infant botulism in China
Dong Yinping, Wang Wei, Jiang Tao, Xu Jin, Li Fengqin
, DOI: 10.3784/jbjc.202108040431
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  Objective  To analyze the data obtained from a whole genomesequence of type E botulinum neurotoxin producing Clostridium butyricum TJ-S,which was isolated from stool sample of an infant botulismcase for the first time in China.  Methods  Genomic DNA was extracted from TJ-Sisolate, the whole genome sequencing was carried out using Pacific Biosciences RS Ⅱ platform and analyzed.   Results  One independent closed circle chromosome and one plasmid were found in TJ-Sisolate. The lengths of the chromosome and plasmid were 3 949 987 bp and 747 151 bp, GC contents was 28.2% for chromosome and 28.2% for plasmid, respectively. The bont/e gene wasfound in the typical orfX cluster that located on chromosome, and there were three transposase encoding genes on upstream of the cluster. The phylogenetic analysis showed that TJ-S strain and two type Eproducing C. butyricumstains which were isolated from infant botulism cases in the United Kingdom were in the same clade.  Conclusion  The bont/e gene was located in the stable classic orfX cluster of C. butyricum, and it was the main pathogenic gene causing botulism in human. This is the first report of genomic data mining and analysis of type E botulinum neurotoxin producing C. butyricum in China.
Investigation of a cluster of COVID-19 cases imported through inbound air flight
Wang Hui, Zhang Zhizhong, Li Yongguang, Li Wanping, Long Jiali, Chen Zongqiu, Xie Chaojun, Luo Lei, Zhang Zhoubin
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  Objective  To understand the epidemiological characteristics and explore source of infection of coronavirus disease 2019 (COVID-19) cases imported through an inbound air flight from Kenya to Guangzhou, China.   Methods  Using a standardized questionnaire, we collected information of the travelers’ demographic characteristics and illness before, during, and after the flight. We also collected data about the factors potentially associated with COVID-19 transmission during the flight by retrospective cohort study.   Results  There were 211 passengers and 14 crew members on the flight. A total of 31 COVID-19 patients were diagnosed among all passengers, in which 11 (35.48%) were symptomatic and 20 (64.52%) were asymptomatic. The attack rate was 14.69% (31/211). The cases were mainly the employees of GC Company. Retrospective cohort study suggested that high frequency of contact with foreigners or sharing rooms with COVID-19 cases in the Republic of Congo were risk factors for SARS-CoV-2 infection. The risk ratios were 6.250 for the passengers high frequency of contact with foreigners (95% CI: 1.095~35.682) and 11.500 for the passengers sharing rooms with COVID-19 cases (95% CI: 1.835~72.069) and.   Conclusion  The cases detected in this flight might be infected outside China, and the possibility of being infected due to the exposure in the flight was low. But it is still necessary to take effective personal protection in airplanes.
Epidemiological characteristics of rifampicin-resistant and multidrug-resistant tuberculosis in Qinghai
Jiang Mingxia, Wang Zhaofen, Ma Binzhong, Chao Xiuzhen, Wang Rong, Ma Yongcheng, Li Bin, Wang Chaocai, Li Erchen, Wei Yujia, Li Yongxue
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  Objective  To understand the detection of rifampicin-resistant tuberculosis (RR-TB) and the distribution of multidrug-resistant tuberculosis (MDR-TB) in Qinghai province and provide theoretical evidence for the prevention and control of RR-TB.   Methods  The tuberculosis reference laboratory of Qinghai Provincial Center for Disease Control and Prevention used the proportional method to test the drug susceptibility of 1182 Mycobacterium tuberculosis strains collected from 8 cities in Qinghai from 2016 to 2019 to four commonly used first-line and two second-line anti-TB drugs (isoniazid, rifampicin, ethambutol, streptomycin, kanamycin, ofloxacin). The results of rifampicin-resistance detection and MDR-TB prevalence were analyzed.   Results  The overall rifampicin-resistant rate of 1182 M. tuberculosis strains was 11.42%, and the overall multidrug-resistant rate was 8.80%. The MDR-TB cases accounted for 77.04% of RR-TB cases. The differences in rifampicin-resistant rate and multidrug-resistant rate in different years were significant (χ2=373.672, 225.453, P<0.05). The rifampicin-resistant rate and multidrug-resistant rate were higher in retreated cases than in initial treated cases, and the difference was significant (χ2=130.865, 99.943, P<0.05). There were statistically significant differences in rifampicin-resistant and multidrug-resistant rate between men and women (χ2=130.779, 99.888, P<0.05), among different age groups (χ2=342.791, 163.139, P<0.05), ethnic groups (χ2=130.993, 100.003, P<0.05) and occupation groups (χ2=253.844, 186.207, P<0.05).   Conclusion  The rifampicin-resistant rate in TB cases in Qinghai was high, and multi-drug resistance was also common. Therefore, the surveillance and treatment of drug–resistant TB should be strengthened, especially in men, young and middle-aged people, ethnic minorities, farmers and herdsmen and other key groups.
Application of protein amplification in vitro in the diagnosis of neurodegenerative diseases
Chen Dongdong, Shi Qi, Dong Xiaoping
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Patients with neurodegenerative diseases are usually in the end stage when they are diagnosed. The diagnosis of these diseases mainly depends on the differentiation of clinical symptoms, which causes certain difficulties in diagnosis. In the past few years, some new diagnostic approaches have been developed for the early diagnosis of neurodegenerative diseases. Protein misfolding cyclic amplification (PMCA) and real-time quaking-induced conversion (RT-QuIC) are ultra-sensitive protein amplification assays for the detection of misfolded protein aggregates. With the improvement of these technologies, it has been gradually applied to detect the misfolded proteins in prion disease, synuclein disease, Alzheimer's disease and Pick's disease. PMCA and RT-QuIC have also shown high sensitivity and specificity in the pre-clinical stages, and can be used for differential diagnosis. As laboratory auxiliary diagnostic methods, PMCA and RT-QuIC have great application prospects.
Analysis of prion protein molecular characteristics in laryngeal squamous cell carcinoma
Wei Wei, Wu Yuezhang, Chen Dongdong, Song Yuntao, Xu Guohui, Shi Qi
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  Objective  To observe the molecular characteristics of prion protein in laryngeal squamous cell carcinoma tissues.   Methods  Molecular characteristics of prion protein in laryngeal squamous cell carcinoma tissues were analyzed with the help of western blot. Distribution characteristics of prion protein and PRNP genetic features in laryngeal squamous cell carcinoma tissue were analyzed by the methods of immunohistochemical and gene sequencing assay, respectively.   Results  Western blots showed that three types of glycosylation forms of prion proteins were presented in laryngeal squamous cell carcinoma tissues. Immunohistochemical assay showed positive expression of prion protein and mainly distributed in cell membrane and cytoplasm, with the increasing of the malignancy in tumor, the level of prion protein increases. Gene sequencing illustrated no mutation in PRNP gene. All codon 129 of PRNP gene were homozygous for methionine and that of 219 were homozygous for glutamate.   Conclusion  Characteristics of prion protein in laryngeal squamous cell carcinoma tissues are different from center nerve system like brain tissue. Its expression levels were associated with the malignant degree of tumor, which is possible to be a molecular marker for early diagnosis of laryngeal squamous cell carcinoma.
Detections of major respiratory pathogens in pneumonia patients in early phase of COVID-19 epidemic in Tongzhou, Beijing
Zhang Guofeng, Fang Chuangsen, Wang Yanchun, Gao Xiang, Zhang Chong, Zhen Bojun, Zhang Ping, Zhao Fengling, Gao Jie, Zhou Jinglin, Luo Yuxin, Wang Jianguo, Li Ying, Zou lin
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  Objective  To understand the infection status of major respiratory pathogens in pneumonia patients in the early phase of coronavirus disease 2019 (COVID-19) epidemic (January-March, 2020) in Tongzhou district of Beijing.   Methods  A total of 252 pneumonia patients were enrolled in this study. Real-time PCR tests was conducted for the detections of 32 pathogens by using the samples from all the patients. Both sputum samples and throat swabs were collected from 144 patients.   Results  The positive rates of viruses, bacteria, and pneumocystis were 13.10% (33/252), 50.00% (126/252), and 1.59% (4/252), respectively. Co-infections were detected in 43 patients (17.06%, 43/252), in whom 13 had co-infections with viruses and bacteria or viruses and pneumocystis, and 30 had co-infections with two or more bacterial species or bacteria and pneumocystis. There were significant differences in the positive rates of Haemophilus influenzae (χ2=9.557, P=0.002) and Mycoplasma pneumoniae (χ2=7.831, P=0.005) between patients with or without underlying diseases. The differences in positive rates of viruses (χ2=16.112, P=0.003) and M. pneumoniae (χ2=10.741, P=0.030) were significant among five age groups. No significant difference was found in the positive rate of viruses between sputum samples and throat swabs of 144 patients (χ2=1.003, P=0.316). However, the positive rate of Streptococcus pneumoniae was significantly higher in sputum samples than in throat swabs (χ2=5.533, P=0.019).   Conclusion  In the early phase of COVID-19 epidemic in Tongzhou, co-infections of respiratory pathogens were detected in some pneumonia patients. The detection rate of bacteria was higher in sputum samples than in throat swabs.
导 读
Xu Xuefang
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Epidemiology of human brucellosis in Taiyuan, Shanxi, 2011–2020
Liu Jing, Wang Wanjin, Zhang Xiaojia, Zhao Yanhong
, DOI: 10.3784/jbjc.202104010173
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  Objective  To analyze the prevalence of human brucellosis in Taiyuan, Shanxi province, from 2011 to 2020, and provide evidence for the effective prevention and control of human brucellosis.  Methods  Descriptive statistical analysis was conducted for the local brucellosis cases in Taiyuan from 2011 to 2020 by using the data from “China Disease Prevention and Control Information System”.  Results  The average annual incidence of brucellosis in Taiyuan from 2011 to 2020 was 2.60/100 000 (1.24–4.51/100 000), with the highest incidence in 2014 (4.51/100 000); the annual peak of the incidence was during March - July; all the counties (cities, districts) reported cases, but the incidence rate in suburban counties (8.80/100 000) was higher than that in urban area (1.21/100 000) ( χ2=1 432.21, P<0.001), but the proportion of the cases in urban areas was in increase, which was significantly higher during 2016–2020 (41.44%) than that during 2011–2015 (35.56%). The difference was significant ( χ2=3.899, P=0.048). The male-to-female ratio of cases was 4.1∶1. The cases occurred in all the age groups (0–85 years), but the cases aged 20–60 years accounted for 69.22%, and the proportion of the cases aged ≥60 years increased during 2016–2020 (28.70%) compared with that during 2011–2015 (22.35%), the difference was significant ( χ2=5.745, P=0.017). Most cases were farmers (69.13%), but the proportion showed a downward trend from 74.17% during 2011–2015 to 61.11% during 2016–2020, the difference was significant ( χ2=21.205, P<0.001).  Conclusion  The incidence of human brucellosis in Taiyuan from 2011 to 2020 showed a fluctuation trend, and the cases mainly occurred in rural area, but the cases in urban area increased, and the proportion of the cases aged ≥60 years also increased, suggesting that it is necessary to conduct health education and take behavior intervention in urban population and in elder population.
TOPSIS and RSR method based comprehensive evaluation of quality of influenza-like illness surveillance in China, 2013–2019
Gao Yige, Yang Lei, Chen Tao, Yang Jing, Shu Yuelong
, DOI: 10.3784/jbjc.202104290239
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  Objectives  Technique for order preference by similarity to ideal solution (TOPSIS) and rank-sum ratio (RSR) were used to evaluate the quality of surveillance of influenza-like illness in sentinel hospitals and network laboratories in China. In addition, the applicability of TOPSIS and RSR in evaluating the quality of influenza surveillance was also discussed.  Methods  Indicators were selected according to the national influenza surveillance program for a comprehensive evaluation of the performance of sentinel hospitals (5 indicators) and network laboratories (6 indicators) in China from 2013 to 2019 by using TOPSIS and RSR.  Results  TOPSIS results showed that the first, median, and third quartiles of C values in sentinel hospitals and laboratories increased from 2013 to 2019. RSR results showed that the grading boundaries of sentinel hospitals and laboratories showed an overall increasing trend. Compared with 2013, the RSR grade increased in 188 sentinel hospitals, decreased in 99 sentinel hospitals and remained in 224 sentinel hospitals in 2019, and the RSR grade increased 113 laboratories, decreased in 76 laboratories and remained in 128 laboratories in 2019.  Conclusion  The overall surveillance quality of sentinel hospitals and network laboratories in China has been improved. The results of TOPSIS and RSR were objective and reliable, which could be applied in the quality evaluation of influenza-like illness surveillance.
Serological surveillance for avian influenza virus in environment and population with occupational exposure in Gansu, 2019–2020
Li Baodi, Li Hongyu, Xu Congshan, Zhang Hui, Wang Xueying, Zhao Zhe, Wang Peng, Yu Deshan
, DOI: 10.3784/jbjc.2021
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  Objective  To understand the infection status of avian influenza virus in population with occupational exposure s in Gansu province from 2019 to 2020 and the contamination of avian influenza viruses in the environment of live poultry markets, and provide evidence for the prevention and control of human infection with avian influenza virus.  Methods  Environmental samples such as surface swabs of poultry cages and feces of poultry, were collected from live poultry markets in Gansu. Real-time fluorescent RT-PCR was used to detect nucleic acid of influenza A virus in the samples. The positive samples were then tested for nucleic acid of H5, H7 and H9 subtypes of avian influenza virus. At the same time, serum samples from population with occupational exposure to avian influenza virus were collected, and the hemagglutination inhibition (HI) method was used to detect the antibodies to avian influenza A (H5N6), (H7N9), and (H9N2) viruses.   Results  A total of 5, 225 environmental samples were collected from 2019 to 2020, in which 1, 069 were positive (20.46%); the predominant strains belong to subtype H9, and there were 14 mixed infections of subtype H7 and H9 viruses; the positive rate in Dingxi was highest (40.79%), followed by Tianshui (40.00%), Longnan (37.63%), Baiyin (31.05%) and Jiayuguan (26.35%). The positive rate of avian influenza virus was highest (46.16%) in poultry chopping board swabs (46.26%) and lowest in poultry drinking water samples (15.71%). The difference was significant (χ2=21.038, P<0.05). Seven serum H9 antibody positive samples were detected in 437 persons with occupational exposures.   Conclusion  Avian influenza virus contamination in the environment of live poultry markets in Gansu was mainly caused by subtype H9 virus, subtype H7 I was sporadically detected, and no subtype H5 virus was detected, and there was less latent H9N2 virus infection in the population with occupational exposures. Active surveillance should be strengthened to prevent the outbreak of human infection with avian influenza virus.
Avian influenza virus in external environment in Akesu, Xinjiang, 2017–2020
Rong Xiaosu, Li Hu, Ma Ruijie, Jiang Wei, Jiang Qingli, Zhou Hongliang
, DOI: 10.3784/jbjc.202104070172
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  Objective  To understand the distribution of avian influenza virus in external environment in Akesu of Xinjiang and provide evidence for the prevention and control of human infection with avian Influenza virus in Akesu.   Methods  Real time fluorescent quantitative RT-PCR was used to test the external environment samples in Akesu for the detection of avian influenza, and influenza A virus positive samples were further detected for H5, H7 and H9 subtypes. Software Excel and SPSS 25.0 were used to analyze the differences in distribution of avian influenza virus in different years, seasons, samples and surveillance sites.  Results  A total of 580 samples were collected in Akesu from 2017 to 2020, and the positive rate of influenza A virus was 34.14%, the positive rate of H9 subtype was 94.95%, H5 subtype was 1.51%, and H5 + H9 mixed subtype was 3.54%, but H7 subtype was not detected. The annual positive rate of avian influenza virus in the external environment reached peak in October (62.50%). Among the six types of samples, the positive rate of poultry drinking water was highest (48.28%), and the positive rate of sewage in poultry markets was lowest (22.08%). The environment of the live poultry markets was contaminated by H9 and H5 subtypes of avian influenza virus.   Conclusion  The surveillance results showed that the positive rate of avian influenza virus in the external environment of Akesu was high, mainly H9 subtype virus, and less H5 subtype virus. It is necessary to strengthen the surveillance for avian influenza virus in the external environment to understand the distribution of the virus in time and discover new subtypes of viruses for the early warning, prevention and control of human infection with avian influenza virus in Akesu.
Analysis on spatiotemporal distribution of tuberculosis in Ningxia, 2004–2019
Wang Ruonan, Yang Zhenggui, Ma Ning, Liu Weichen, Zhao Yu
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  Objective   To understand the spatiotemporal distribution of tuberculosis (TB) in different areas in Ningxia and provide evidence for the precise prevention and control of TB and the optimization the of medical resource allocation.   Methods   Based on the standardized incidence ratio (SMR) of TB in 22 counties (districts) in Ningxia from 2004 to 2019, spatial correlation exploration was used to explore the spatiotemporal distribution of TB in Ningxia.   Results   The reported incidence of TB in Ningxia showed a decreasing trend from 66.08/100 000 in 2004 to 27.08/100 000 in 2020. TB-SMR showed area clustering in 2007, 2009, 2010, 2015 and 2016, respectively. The global Moran's I values were 0.37, 0.29, 0.31, 0.28 and 0.28, respectively. The spatial clustering analysis showed that the high-high clustering area was distributed in southern Ningxia, while the low-low clustering area shifted from central to northern Ningxia. Discussion The spatiotemporal distribution of TB in Ningxia showed a significant spatial clustering pattern, which might be associated with the social and economic development level, the medical and health resources allocation and population floating. Therefore, it is important to strengthen the TB surveillance in southern and northern Ningxia, carry out targeted TB prevention and control in floating population and reasonably allocate medical resources to improve the prevention and control of TB in Ningxia.
Application of CRISPR-Cas12a system in detection of Vibrio parahaemolyticus and tdh gene
Lu Pan, Li Zhe, Li Zhenpeng, Zhao Wenxuan, Xiao Wenjing, Zhang Tianzi, Zhang Jialiang, Kan Biao, Pang Bo
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  Objectives  To establish a rapid detection and typing assay for the detection of Vibrio parahaemolyticus by combining recombinase aided amplification(RAA)with clustered regularly interspaced short palindromic repeats(CRISPR)system.   Methods  By purifying CRISPR associated protein Cas12a, RAA primers, crRNA and single-stranded DNA reporter were designed and synthesized, and fluorescence and lateral flow dipstick methods were established to detect V. parahaemolyticus. The bacterial nucleic acid was extracted by boiling method, and the product amplified by RAA was added to the CRISPR-Cas12a detection system to test the sensitivity and specificity of the assay.   Results  In this study, 110 strains of V. parahaemolyticus and 121 strains of other intestinal diarrheagenic bacteria were detected, and the coincidence rate was 99.1%. The minimum detection limit of bacteria was 103 CFU/ mL, and the minimum detection limit of nucleic acid concentration of CRISPR-Cas12a was 77.5 pM. The sensitivity of CRISPR-Cas12a was higher than that of agarose gel electrophoresis. For 50 strains of V. parahaemolyticus with tdh and 12 strains of V. parahaemolyticus without tdh, one strain of V. parahaemolyticus with tdh was not identified, the successful identification rate was 98.4%.   Conclusion  CRISPR-RAA can be used for the rapid detection of V. parahaemolyticus and tdh gene with high specificity and sensitivity.
Incidence trend and epidemiological characteristics of pulmonary tuberculosis in students in Inner Mongolia, 2015–2020
Xu Lijuan, Wu Xiaofeng, Lang Shengli, Zhang Xin
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  Objective  To analyze the incidence trend and epidemiological characteristics of pulmonary tuberculosis (TB) in students in Inner Mongolia Autonomous Region and provide a reference for the effective prevention and control of pulmonary TB in students.  Methods  The pulmonary TB reporting data in students in Inner Mongolia from 2015 to 2020 were collected from the subsystems of “Infectious Disease Surveillance” and “Tuberculosis Information Management” in Infectious Disease Surveillance and Management System and the population data were collected form Inner Mongolia Statistical Yearbook for the analyses on the spatial, temporal and population distributions of reported pulmonary TB cases in students and the treatment delay of the cases.  Results  A total of 405 pulmonary TB cases in students were reported in Inner Mongolia in 2020 with the reported incidence of 13.76/100 000 (405/3 087 700), a decrease of 13.20% compared with 2015 (15.86/100 000, 493/3 109 100). The annual reported incidence peak of pulmonary TB in students was during March–April. The reported incidence during the two months was lower in central area (4.54/100 000) than in eastern area (24.87/100 000) and western area (9.82/100 000). In terms of the constituent ratio of the pulmonary TB cases in all age groups in 2020, the proportion was highest (39.05%, 157/402) in age group 16–18 years (senior high school students), followed by that (32.84%, 132/402) in age group 19–22 years (college students). The delayed treatment rate of the pulmonary TB cases was 56.22% (226/402).  Conclusion  The reported incidence of pulmonary TB in students in Inner Mongolia fluctuated irregularly. The cases mainly occurred in age group 16–18 years, and the incidence was slightly higher in eastern area. Therefore, it is necessary to further strengthen the health education and active TB surveillance in schools to prevent the spread of pulmonary TB.
Risk factors of bloodstream infection of carbapenem-resistant Klebsiella pneumoniae
Zhou Junchen, Li Juan, Dong Aiying, Zhou Haijian, Xue Jiaqi, Duan Like, Shi Qiyuan, Liu Zeliang, Gao Pengfang, Han Xiao
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  Objective  To identify the multi-risk factors od bloodstream infection of carbapenem-resistant Klebsiella pneumoniae (CRKP), and provide evidence for the clinical diagnosis, treatment and prevention of infection disease.   Methods   The retrospective analysis was carried out by using the clinical data of the bloodstream CRKP infection cases with completed medical records diagnosed in the affiliated hospital of North China University of Science and Technology from January 2013 to December 2020, the patients infected with carbapenem-sensitive Klebsiella pneumoniae (CSKP) during the same period were included as control group . Software SPSS 23.0 was used for univariate and multivariate analyses to identify the risk factors for bloodstream infection of CRKP.   Results  The case fatality rate in bloodstream CRKP infection group was significantly higher than that in bloodstream CSKP infection group (χ2=31.396, P<0.001). The 56 patients with bloodstream CRKP infection were mainly distributed in intensive care unit (ICU) (80.36%). Univariate analysis indicated that the differences in prevalence of hypoproteinemia, uses of β-lactams (except carbapenems), carbapenem antibiotics, quinolone antibiotics and hormone before infection and the uses of indwelling invasive instruments, indwelling central catheter, indwelling stomach tube, indwelling catheter, ventilator assistance of mechanical ventilation and ICU stay before infection were significant between the two groups, (P<0.05). The binary logistic regression analysis showed that the use of carbapenem antibiotics (OR=26.310, P<0.001) and the use of indwelling central venous catheter (OR=9.534, P=0.035) before infection were the independent risk factors of bloodstream CRKP infection.   Conclusion  The cases fatality of bloodstream CRKP infection was high. Using carbapenem antibiotics before infection and using indwelling central venous catheters often indicate poor prognosis. It is suggested to have a rational use of antibiotics and improve the prevention and control of nosocomial infection.
Epidemiological characteristics and trend of public health emergencies in Jiangxi, 2004–2019
Fang Ji, Fu Weijie, Hu Lingling, Wang Xiaowen, Xiong Xiaoqing
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  Objective  To explore the epidemiological characteristics of public health emergencies in Jiangxi province, analyze its future trend and provide evidence for risk assessment and response of public health emergencies in Jiangxi.   Methods  The incidence data of public health emergencies in Jiangxi from 2004 to 2019 were collected from the public health emergency information management sub-system of national disease prevention and control information system with Excel, and software SPSS 19.0 was used for statistical analysis.   Results  From 2004 to 2019, a total of 574 public health emergencies were reported in Jiangxi, of which 329 (57.32%) belonged to grade Ⅳ or above. The main types of public health were infectious diseases epidemics (346, 60.28%), food poisoning (119, 20.73%) and air pollution (71, 12.37%). The incidence peaks of infectious disease epidemics were during April–June and during September–December. The incidence peak of food poisoning was during June-September, The events caused by environmental factors mainly occurred during January–February and in December. Schools and families were key places where public health emergency is prone to occur; Food poisoning was the main cause of death, resulting in 84 deaths (58.74%).   Conclusion  The public health emergencies occurred in Jiangxi were mainly infectious diseases epidemics and food poisoning, and schools and families were the main places. Food poisoning was the main cause of death. It is necessary to pay close attention to the emerging infectious diseases and imported infectious diseases.
Detection of Brucella DNA in blood samples of Marmota himalayana in Qinghai-Tibet Plateau by real-time fluorescence quantitative PCR
Li Jiquan, Ma Li, Xue Hongmei, Xu Liqing, Zhang Aiping, Yu Shouhong, Ren Lingling, Yang Xuxin
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  Objective   To detect Brucella DNA in blood samples of Marmota himalayana in Qinghai-Tibet Plateau by real-time fluorescence quantitative PCR (real-time PCR).   Methods   The whole blood samples of Marmota himalayana in Qinghai-Tibet Plateau were collected for serological tests of Brucella, including tiger red plate agglutination test (RBT), tube agglutination test (SAT) and colloidal gold immune test (GICA). The positive samples of serological tests were detected by real-time PCR. The SAT results was chosen as a diagnostic criteria to analyze the sensitivity and specificity of the improved degree of tube real-time PCR and evaluate the accuracy of the micro real-time PCR results.   Results   We collected 1 466 whole blood samples of Marmota himalayana, in which 64 were positive in RBT, 28 were positive in GICA, and 18 were positive in SAT. Sixty four RBT positive samples were detected by real-time PCR, in which 56 samples and positive control strains had specific amplification fluorescence curve, 8 samples and negative control strains had no specific amplification curve. Real time PCR had a sensitivity of 100% compared with SAT and GICA and a specificity of 99.93% compared with RBT, the Kappa value was 0.81, which were highly consistent.   Conclusion   Compared with traditional methods, real-time PCR is rapid and highly specific, which is suitable for the detection of Marmota himalayana samples.
dapb1 gene used for taxonomic classification and species identification of Nocardia
Xu Shuai, Che Yanlin, Li Zhenpeng, Huang Yuangming, Han Lichao, Li Dan, Li Zhenjun
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  Objective  To evaluate the ability of the dapb1 gene in taxonomic classification and species identification of Nocardia.   Methods  The genome sequences of 230 strains (198 Nocardia strains and 32 non-Nocardia strains) were downloaded from public database NCBI and GSA, and the dapb1 genes were extracted from the genomes of 198 Nocardia strains, including 90 type strains, 31 reference strains and 77 clinical strains. Multi sequence alignment was conducted with clustalo, and the phylogenetic trees were constructed by using iqtree. The average nucleotide identity (ANI) was calculated, and the 16S rRNA sequence was amplified by PCR, and the amplified fragment was purified and sequenced and compared with the identification result of the dapb1 gene.   Results  Based on the dapb1 gene, a phylogenetic tree of type strains of Nocardia was constructed, 90 type strains were divided into five clades. The sequence similarity of the dapb1 gene among species was 73.80%–97.74%, and the average similarity was 82.40%. This method was applied for 31 reference strains and 77 clinical strains of Nocardia. The result showed that the concordance rate between 16S rRNA gene and ANI was 77.7%, while the concordance rate between the dapb1 gene and ANI was 100%. Using dapb1 gene has higher resolution ratio and accuracy than using 16S rRNA gene to accurately identify Nocardia species. The sequence similarity of 97.75%–98.07% can be used as a cut-off value for the identification of novel species of Nocardia.   Conclusion  Using dapb1 gene has a good interspecies resolution ratio to quickly and accurately identify Nocardia species and truly reflect the phylogenetic relationship among Nocardia species, which can be widely applied in the analysis on genetic structure of Nocardia, outbreak tracing, and surveillance for circulating strains.
Progress in research of molecular typing of Leptospira in China
Li Zhe, Xu Yinghua, Xin Xiaofang
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With the development of molecular biology, genomics and bioinformatics, the molecular epidemiology of Leptospira has been further studied. New molecular typing methods and the sequencing of a large number of Leptospira genomes have enabled researchers to gain a new understanding of Leptospira. Based on the molecular classification methods of Leptospira applied at home and abroad in recent years, this paper summarizes the 16s rRNA genotyping, pulsed field gel electrophoresis, site sequence classification, site variable number tandem repeat sequence classification and whole genome sequencing to help the finding of new type strains of Leptospira, and revealing the host and regional transmission relationship among different strains, This review can provide reference for the application of molecular typing methods and the prevention and control of leptospirosis in the future.
Bile tolerance characteristics of different Aeromonas species
Nan Zheng, Yu Li, Ma Liyan, Su Jianrong, Zhou Yanyan,
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  Objective  To understand the bile tolerance of different Aeromonas species and explore the reasons for the different infection sites of Aeromonas hydrophila and other Aeromonas.   Methods  A total of 20 Aeromonas strains from 8 species were selected, and the bile minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) to these strains were tested, and the growth curves of common Aeromonas species under different bile concentrations, anaerobic or aerobic environments were described.   Results  Different strains of Aeromonas had different tolerance to bile. A. veronii and A. enteropelogenes were more resistant to bile, with MIC of 9%–11% and MBC of 11%–12%; A. hydrophila, A. caviae, A. media and A. bivalvium were less resistant to bile, with MIC of 4% and MBC of 6%–10%. There were different bile tolerance among different strains of A. dhakensis. The MIC and MBC to A. dhakensis isolated from the gallbladder were all 11%, while the MIC and MBC to A. dhakensis isolated from feces were only 5% and 8%.   Conclusion  When the initial amount of Aeromonas was larger, the tolerance to bile would be also higher; after increasing the initial amount of bacteria, A. hydrophila had the best tolerance to bile. The anaerobic environment was helpful for the early adaptation of Aeromonas to bile.
Analysis on mortality and trend of breast cancer in women in Beijing, 2010–2020
Ma Jiaxin, Wei Zaihua, Su Jianting, Wang Ping, Du Jing, Wang Jing, Liu Qingping, Zhang Yiming, Wu Zhixin
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  Objective   To analyze the mortality and trend of breast cancer in women with registered permanent residence in Beijing from 2010 to 2020, and provide scientific evidence for the prevention and control of breast cancer.   Methods   Based on the surveillance data of breast cancer deaths in women in Beijing from 2010 to 2020, the mortality rate, standardized mortality rate and years of premature death per 100,000 people (YLL rate) and other indicators were calculated, and the change in interval between onset and death of the patients and the proportion of the patients with secondary metastasis from 2010 to 2020 were analyzed. Software Joinpoint was used to analyze the trend of changes in the mortality rate and age-specific rate of breast cancer in the women in Beijing from 2010 to 2020.   Results   From 2010 to 2020, a total of 9,108 deaths of breast cancer occurred in the women with registered permanent residence in Beijing, and the crude death rate in 2020 was 14.43/100,000, an increase of 33.12% (AAPC=3.10%, P<0.001) compared with 2010 (10.84/100,000), the age standardized mortality rate slowed a slighter increase (AAPC=1.10%, P<0.012). From 2010 to 2020, the median of age and the survival time from onset to death of the women who died of breast cancer in Beijing all showed an upward trends.   Conclusion   From 2010 to 2020, breast cancer was still the main cause of deaths from malignant tumors in women in Beijing, ranking fifth in malignant tumors. In recent years, the morbidity and mortality of breast cancer increased with year, but the survival time of women with breast cancer showed some increase, indicating that the prevention and treatment of breast cancer was effective in Beijing.
Spatiotemporal distribution during 2014–2019 and prediction of maternal and child mortality in Guangdong
Lin Xiaodan, Xu Bixia, Yao Weiguang
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  Objective   To understand the spatiotemporal distribution of maternal and child mortality during 2014–2019 and predict the future trends during the 14th Five-Year Plan period in Guangdong province.   Methods   The indicators related to maternal mortality and child mortality in Guangdong from 2014–2019 were collected, and software Arc GIS was used for spatial analysis and GM (1, 1) model was used for prediction analysis.   Results   The overall mortality rate under 5 years old (U5MR), infant mortality rate (IMR), and neonatal mortality rate (NMR) in Guangdong from 2014 to 2019 showed decreasing trends, but the maternal mortality rate (MMR) fluctuated. The 2019 data showed the differences in the indicators were significant among areas. The predicted MMR, U5MR, IMR and NMR in Guangdong by 2025 would be 9.92/100 000, 1.54‰, 1.32‰ and 0.85‰, respectively.   Conclusion   Maternal and child health care in Guangdong has made some achievement. In the future, it is necessary to further reduce maternal mortality, promote the optimization and integration of medical and health resources and provide life-cycle maternal and child health services.
Detection and analysis of common respiratory pathogens in hospitalized children with respiratory tract infection in Shunyi district of Beijing from 2019 to 2020
Kang Xvli, Zhang Mingying, Liu Hao, Zheng Xin
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  Objective   To understand the change characteristics of respiratory pathogens in hospitalized children with respiratory tract infection in Shunyi district of Beijing from 2019 to 2020, and to provide basis for the prevention and treatment of respiratory tract diseases in children.   Methods   The case information of hospitalized children with respiratory infection in Shunyi district hospital from 2019 to 2020 was collected. The age, gender and IgM antibody test results of respiratory pathogens (rickettsia, mycoplasma pneumoniae, respiratory syncytial virus, chlamydia pneumoniae, influenza A virus, influenza B virus, parainfluenza virus, legionella pneumophila and adenovirus) were entered by Excel 2007. SPSS 22.0 was used for statistical analysis. Chi square test was used to compare the detection rate of respiratory pathogens in different years, seasons and age groups.   Results   There were 1 791 hospitalized children with respiratory infection in Shunyi district hospital from 2019 to 2020, including 1 061 cases in 2019 and 730 cases in 2020. The IgM antibody of single pathogen was positive in 937 cases (52.76%, 937/1 791), mainly mycoplasma pneumoniae (22.97%, 414/1 791), influenza B virus (12.44%, 224/1 791) and parainfluenza virus (11.77%, 223/1 791). Compared with 2019, the detection rates of respiratory syncytial virus and adenovirus increased in 2020, while the detection rates of the other six pathogens decreased. The detection characteristics of different pathogens varied with seasons. In different age groups, the detection rate of pathogens in <1 year (12.50%), 1–3 year (42.63%), 3-7 year (59.90%) and ≥ 7 year (65.06%) groups increased in turn.   Conclusion   The ≥3 year children, mycoplasma pneumoniae and virus infection are the focus of children's respiratory infection prevention and control; the children's respiratory infection prevention and control should be paid attention in different seasons.
Risk assessment of public health emergencies concerned in the mainland of China, December 2021
Wei Yinong, Li Chao, Wang Dayan, Ren Jinghuan, Meng Ling, Tu Wenxiao, Xiang Nijuan, Shi Guoqing
, DOI: 10.3784/jbjc.202112190650
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  Objective  To assess the risk of public health emergencies, both the indigenous ones and the imported ones, which might occur in the mainland of China in December 2021.   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 provincial centers for disease control and prevention attended this video conference.   Results   It is expected the public health emergencies in December 2021 will increase compared with that in November 2021.There is still risk, which is under control, of both coronavirus disease 2019 (COVID-19) imported cases and subsequent local transmission of imported COVID-19 cases in China. Sporadic human infections of avian influenza might occur continuously, while seasonal flu cases will increase with more outbreaks. It is expected that non-occupational carbon monoxide poisoning will increase significantly in December compared with that in November, as a consequence of decreasing temperature during winter and growing demand for heating among people.   Conclusion  Special attention should be paid to COVID-19. General attentions should be paid to human infections of avian influenza, seasonal flu and non-occupation carbon monoxide poisoning.
A survey of visual acuity and color vision of primary school pupils in Yangzhou, Jiangsu
Liao Yuexia, Sun Xinxin, Hang Lin, Chen Yuying, Yang Yong
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  Objective   To investigate and analyze the current status of visual acuity and color vision of primary school pupils in Yangzhou, Jiangsu province, and provide evidence for policymaking and interventions for children vision health.   Methods   A total of 7 471 pupils from grade 1 to grade 6 were selected by stratified cluster sampling in 7 primary schools in Yangzhou for visual acuity and color vision tests to understand the prevalence of poor eyesight, color amblyopia and achromatopsia by ophthalmologists.   Results   Among the primary school pupils, 44.77% had poor eyesight and 13.08% wore glasses. The rates of poor eyesight and glass wearing increased with the grade rising in higher grade pupils. The rates of poor eyesight and glass wearing were significantly higher in urban pupils than in rural pupils. More girls had poor eyesight compared with boys. The incidence rate of color vision deficiency was 1.98% in the primary school pupils, and it was 3.36% in boys and was 0.50% in girls.   Conclusion   In the primary schools in Yangzhou, the prevalence of poor eyesight increased with grade rising in high grade pupils, and it was higher in girls and in urban area. Color vision deficiency existed in pupils, but the prevalence was significantly higher in boys. It is necessary to suggest parents and teachers to pay attention to the vision health of children and conduct early vision health intervention to reduce the risk for poor eyesight in pupils.
Changes of chemokine CXCL1 in prion-infected cell model
Chen Jia, Shi Qi, Chen Cao, Dong Xiaoping
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  Objectives  To explore the change characteristics of chemokine CXCL1 in prion-infected cell model SMB-S15, and compare the effect of change of prion contents on CXCL1 level in prion-infected cells.   Methods  The transcription and translation levels of CXCL1 in SMB-PS, SMB-RES and SMB-S15 cells were analyzed by fluorescence quantitative PCR, western blot and enzyme-linked immunosorbent assay (ELISA). The protein levels of CXCL1 in SMB-S15 cells without prion and with little prion treated with resveratrol and 3, 4-dihydroxyphenylene methylene acetone respectively were analyzed by ELISA.   Results  In prion-infected SMB-S15 cells, the transcription level of CXCL1 was significantly higher than that in SMB-PS and SMB-RES cells, showing statistical difference. The expression level of CXCL1 in SMB-S15 cells was higher than that in SMB-PS and SMB-RES cells in both cell lysate and corresponding medium. The protein level of CXCL1 in SMB-S15 cells treated with resveratrol at different times and treated with 3, 4-dihydroxyphenylene methylene acetone at different concentrations all showed decreasing trendsPin a time and dose dependent manner.   Conclusion  The level of CXCL1 significantly increased in prion-infected cells, and was positively correlated with the level of intracellular prions.
Investigation of an epidemic of sapovirus infection in an university
Li Dongliang, Zeng Zhen, Zhang Wenyan, Zhang Lei, Lu Lin, He Lifang
, DOI: 10.3784/jbjc.202108060438
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  Objective  To investigate the cause of an infectious diarrhea epidemic in an university, evaluate the effectiveness of the response measures and provide scientific evidence for the prevention and control of infectious diarrhea.   Methods  Descriptive research, case-control study and retrospective questionnaire survey were used to investigate the epidemic. The results were entered into Excel database and analyzed by software SPSS.   Results  A total of 66 cases were reported with an attack rate of 3.08% (66/2144). A total of 32 samples were collected, including anal swabs, drinking water, and surface swabs of food and living environment. Five anal swabs of the cases' were positive for sapovirus.   Conclusion  The epidemic of infectious diarrhea was caused by sapovirus. Public toilet using might be the risk factor for the transmission.
Probability of premature deaths of 4 major chronic diseases and its change trend in Tai’an, Shandong, 2014–2019
Du Weiping, Zhou Yuan, Li Xinwei, Zhang Zhijun, Gao Rongtao
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  Objective   To understand mortality rate, probability of premature deaths caused by four chronic diseases, i.e. cardiovascular and cerebrovascular diseases, malignant tumor, chronic respiratory disease, and diabetes, in Taian of Shandong province, and provide scientific evidence for the development of chronic disease prevention and control strategies.   Methods   Using the death surveillance data in Taian residents during 2014—2019, The crude mortality rates, age-specific standardized mortality rates, constituent ratios, probabilities of premature deaths of four chronic diseases, the average annual growth rate and annual percentage change(APC)were calculated. The trend change was evaluated by curve estimated exponential distribution regression model with software SPSS20.0.   Results   From 2014 to 2019, the deaths caused by four chronic diseases accounted for 88.67% of the total. the overall probability of premature death decreased from 17.08% to 16.46%, the APC was −0.80%, the difference in change trend was significant(P=0.003). The APC of probability of premature death in men was −0.20%, the difference in change trend was not significant(P=0.467). The APC of probability of premature death in women was −1.78%, the difference in change trend was significant(P=0.032). The average probability of premature death caused four chronic diseases in men(22.58%)were higher than that in women(10.81%). Tthe probabilities of premature deaths of cardiovascular and cerebrovascular diseases, malignant tumor, chronic respiratory disease, and diabetes in men were 2.02 times, 2.38 times, 2.37 times, 1.06 times higher than those in women.   Conclusion   The probabilities of premature deaths caused by major chronic diseases showed decline trends in Tai’an, however, the decline trends have not fully met the requirements of "Healthy China 2030" initiative. The concept of "health" should be fully considered in the process of public policy development and implementation, and it is necessary to strengthen the integration of medical treatment and prevention, especially in male population, to accelerate the reduction of premature deaths caused by chronic diseases.
Investigation of selenium levels in internal and external environments in population in Keshan disease endemic area in Zhangjiakou, Hebei, 2018
Gu Haijun, Hao Liping, Li Li, Zhang Haixia, Han Guyi
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  Objective  To understand the selenium levels in the internal and external environments in endemic and non-endemic areas of Keshan disease in Zhangjiakou, Hebei province, and provide the basis for the identification of the prevention and control priorities and development of sustainable prevention and control measures to eliminate Keshan disease.   Methods  According to the National Survey Program on Selenium Levels and Related Factors in Internal and External Environments in endemic and non-endemic areas of Keshan Disease, the Keshan Disease Selenium Survey was carried out in September 2018 in 3 counties (district) where Keshan disease has been controlled and 4 counties (district) where Keshan disease has been eliminated and 2 counties (district) without Keshan disease in Zhangjiakou. Ten families, including 3, 4 and 3 families with poor, moderate and good living conditions, in one village of one township of these areas were surveyed. A total of 270 hair samples were collected from children, childbearing aged women and adult males and a total of 270 samples of 3 kinds of staple foods were collected. Meanwhile, a total of 90 soil samples were collected from the survey sites. The selenium content was detected by hydride atomic fluorescence spectrometry, and the t-test and variance analysis were performed by using software Epi Data 3.5.1 and SPSS 22. 0.   Results  The soil selenium content in Keshan disease endemic area was higher than that in non-endemic area, but the difference was not significant(P>0.05). The average hair selenium content in residents in 9 counties of Zhangjiakou was 0.3507±0.1014 mg/kg, and the overall nutrient level of selenium was moderate. The selenium content in children in the disease endemic area was lower than that in those in non-disease endemic area, and there was no significant difference(P>0.05), and the difference in hair selenium content between the adults in the disease endemic area and those in the non-disease endemic area had no significance. The food selenium content in the disease endemic area was lower than that in the non-disease endemic area, and there was no significant difference.(P>0.05). The differences in food selenium content among the different stable foods, including wheat flour, rice and broomcorn millet flour, in the families with different living conditions were not significant.   Conclusion  The selenium level in the external environment in Keshan disease endemic area in Zhangjiakou were basically stable, while the selenium content in the internal environment in the Keshan disease endemic area significantly increased, which might be related to the improvement of living standard and the change of dietary structure, so continuous surveillance should be carried out to consolidate the achievement in the elimination of Keshan disease.
Analysis on surveillance date of brucellosis in Shanxi, 2005–2019
Bai Yongfei, Zheng Yuhua, Tie Ping, Yan Changfu, Wang Ting, Wang Jingying, Li Xueming, Yang Hongxia, Cui Buyun
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  Objective   To understands the prevalence of brucellosis in Shanxi province from 2005 to 2019, and provide evidence for the prevention and control of brucellosis.   Method   The epidemiological surveillance data of brucellosis from both state level and province level surveillance areas in Shanxi from 2005 to 2019 were used for a descriptive epidemiological analysis . Results According to the routine surveillance data, a total of 70 736 brucellosis cases were reported in Shanxi during this period. The lowest incidence rate was 6.96/100 000 in 2005, and the highest was 23.53/100 000 in 2014, the average incidence rate was 13.28/100 000. Up to 36 639 cases of brucellosis were reported in Datong, Shuozhou, Jinzhong, Xinzhou, accounting for 51.80% of the province total .The brucellosis cases mainly occurred during March–July, accounting for 60.24%(42 613/70 736),The brucellosis cases were mainly young adults (30–69 years old), men, farmers and herdsman. A total of 83 brucellosis outbreaks were reported, including 1 reported as a public health emergency. In the 16 surveillance areas of brucellosis, 144 634 persons were surveyed, in which 33 150 received serological test with 2 436 being positive for Brucella (7.35%). Brucella was isolated from 161 blood samples of 1 034 patients in acute phase (15.57%, 161/1 034), including 160 strains of Brucella melitensis biovar 3 and 1 strain of mutant.   Conclusion   The prevalence of brucellosis in Shanxi is still serious with high intensity and wide geographic distribution, posing challenge to its prevention and control. It is necessary to further strengthen the brucellosis surveillance, prevention and control should in Shanxi.
Summary of global surveillance data of infectious diseases in November 2021
Han Hui, Wu Bo, Jia Jiaojiao, Song Yueqian
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In November 2021, a total of 65 infectious diseases were reported globally, affecting 226 countries and regions. Except for influenza, the top five infectious diseases affecting greatest number of countries and regions were Corona virus disease 2019 (COVID-19,226), dengue fever (31), measles (21), poliomyelitis (11) and cholera (10). The top five infectious diseases with highest case fatality rates were Ebola virus disease (81.8%), Lassa fever (18.6%), yellow fever (15.3%), meningitis (7.9%) and plague (7.6%). The top five infectious diseases with greatest number of deaths were COVID-19, malaria, cholera, dengue fever and yellow fever. The prevalent infectious diseases in Asia were COVID-19 and dengue fever, the prevalent infectious diseases in Africa were COVID-19, Ebola virus disease, cholera, yellow fever, Lassa fever, poliomyelitis, malaria and measles, the prevalent infectious diseases in America were COVID-19, dengue fever, chikungunya fever and Zika virus disease, the prevalent infectious disease in Europe were COVID-19 and West Nile fever.
2021年11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 November 2021
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2021年11月中国甲乙丙类传染病疫情动态概要
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Epidemiological characteristics of associated epidemics in Tongzhou district, Beijing, 2015-2020
Yang Lili, Yang Yanna, Xi Lu, Cui Yan, Zheng Ranran, Li Hua, Zhen Bojun, Li Hongjun
, DOI: 10.3784/jbjc.202104080189
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  Objective  To analyze the characteristics of the associated epidemics in Tongzhou district of Beijing from 2015 to 2020, identify the risk factors and provide scientific basis for the early warning, prevention and control of infectious disease epidemics.  Methods  The surveillance data and investigation reports of associated epidemics in Beijing from January 1, 2015 to December 31, 2020 were collected from Beijing Infectious Disease Surveillance and Epidemiological Investigation System for a descriptive analysis on the epidemiological and etiological characteristics of associated epidemics in Tongzhou. The data were processed with Excel 2013.  Results  From 2015 to 2020, a total of 237 cases in associated epidemics were reported in Tongzhou, including 96 cases of fever, 102 cases of diarrhea, 37 cases of rash, 2 cases of conjunctival redness and 0 cases of jaundice. Among the 37 cases of rash, 27 hand-foot-mouth disease or herpetic angina cases were diagnosed, and 5 varicella cases were diagnosed. The incidence peak of the 237 cases was during June–August, and the secondary peak was in November. The incidence peak of the 102 cases of diarrhea was during June–September. The incidence peaks of fever were in June, December and January. The incidence peaks of rash were during May–June and during October–November, and two conjunctiva redness cases occurred in November and December. The top 5 townships with high case numbers were Liyuan (53 cases), Yongshun (29 cases), Songzhuang (19 cases), Lucheng (18 cases) and Zhangjiawan (16 cases). The associated epidemics mainly occurred in urban area and rural-urban continuum. The associated epidemics occurred in middle and primary schools (child care settings) in Tongzhou accounted for the highest proportion of the total, followed by that in family, company or collective dormitories, restaurants or the tourist groups to Beijing, vocational college or professional training institution, construction site. In 2020, the proportion of associated epidemics in primary school (child care settings) dropped sharply, and the proportions in other settings considerably increased. The pathogens of 18 associated epidemics were identified in 2020.  Conclusion  The types of associated epidemics in Tongzhou varied with month, showing high consistency with other surveillance data. It is necessary to strengthen epidemic prevention and control in key areas, such as urban area and urban-rural continuum, vocational college or professional training institution, family, construction site and other specific places, and conduct pathogen detection through the Infectious Disease Surveillance and Epidemiological Investigation System of Beijing.
Drug resistance and molecular typing of Vibrio parahaemolyticus from diarrhea patients in Songjiang district, Shanghai, 2016–2020
Yu Jiali, Qiao Xuefei, Sheng Fengsong, Qian Yiqing, Wu Jianhao, Wu Jiajin, Li Xin
, DOI: 10.3784/jbjc.202103190135
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  Objective  To understand the virulence genes, antibiotics resistance and molecular typing of Vibrio parahaemolyticus isolated from diarrhea patients in Songjiang district, Shanghai, and provide scientific basis for the better prevention of foodborne diseases.   Methods  V. parahaemolyticus detection was conducted according to WS271-2007, and the isolated strains were used for antimicrobial susceptibility testing by broth microdilution method, virulence genes detection by PCR and molecular typing by pulsed-field gel electrophoresis (PFGE).   Results  From 2016 to 2020, a total of 2 053 anal swabs from patients with diarrhea were collected, and 155 strains of V. parahaemolyticus were isolated. The average detection rate was 7.55%. The detection rate was statistically higher in summer and autumn (11.80%) than in winter and spring (0.13%) (χ2=92.725, P<0.01). The detection rate in 2019 was higher (10.55%) than those in other years, and there was a significant difference compared with 2016 and 2020 (χ2=8.890, P<0.05), but there were no significant differences in detection rate among five years (χ2=4.602, P>0.05). All the 155 V. parahaemolyticus strains carried virulence gene tlh, 87.74% carried tdh, 2.58% carried trh, and 8.39% carried no tdh and trh. The differences were significant (χ2=317.890, P<0.01). V. parahaemolyticus was sensitive to various antibiotics, and the resistance rate to cefazolin was highest (56.25%). Some strains were resistant to ampicillin and ciprofloxacin, and 3 strains were multi-drug resistant. PFGE molecular typing results showed that there were 7 clusters of V. parahaemolyticus, with 80 PFGE types. Some strains isolated from 2016 to 2020 shared 100% homology, and they were predominant strains.   Conclusion  The detection rate of V. parahaemolyticus was high in patients with diarrhea in Songjiang district of Shanghai. Most strains detected carried virulence gene tdh, and they were highly resistant to cefazolin. The predominant strains clustered within five years, to which attention must be paid.
Impact of COVID-19 epidemic on incidences of notifiable communicable diseases in Guangzhou, 2020
Zhou Qin, Li Hailin, Liu Yuan, Hu Wensui, Dong Zhiqiang, Liu Wei, Hou Jianrong, Yang Zhicong.
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  Objective  To analyze the impact of COVID-19 epidemic on the incidences of notifiable communicable diseases in Guangzhou in 2020.   Methods  The data from National Communicable Disease Reporting Information System were used for a descriptive analysis on the incidences of reported notifiable communicable diseases in Guangzhou at four periods of COVID-19 epidemic in 2020 (pre-response period: January 1–January 22; the first level response period: January 23–February 23; the second level response period: February 24–May 8; the third level response period: May 9–Dec 31). The result was compared with the average levels during the same periods of 2015–2019. Software R3.5.0 was used for statistical analysis.   Results  The reported incidence rates of notifiable communicable diseases in the four periods in Guangzhou in 2020 were 272.38/100 000, 51.16/100 000, 130.34/100 000 and 664.25/100 000, respectively. The incidence rate increased by 187.76% and decreased by 30.37%, 57.64% and 41.85%, respectively, compared with the average levels during the same periods of 2015–2019, especially the incidence rate of class C communicable diseases. The incidences of all kinds of communicable diseases in class A and B with different transmission routes decreased significantly after the start of the first level response, and decreased slowly in the second and third level response periods except natural focal diseases and vector-borne diseases, but the incidences of blood borne and sexual transmitted disease showed increases during the second and third response periods. The incidence rate of acute communicable diseases, such as influenza, decreased significantly after the start of the first level response and further decreased after the start of the second level response. However, the incidences of chronic communicable diseases, such as HIV/AIDS, syphilis and hepatitis B, showed decrease after the implementation of first level response, but showed less decrease during the second and third level response periods.   Conclusion  During the COVID-19 epidemic in Guangzhou in 2020, the incidences of reported notifiable communicable diseases decreased significantly, especially the incidences of acute communicable diseases, such as influenza, and such decreases could be found even in the late stage of the epidemic. The declines of the incidences of chronic communicable diseases were obvious in the early stage of the epidemic, but the incidences showed less decreases, became stable and increased slightly in the late stage of the epidemic.
Investigation of risk for infectious diseases in 298 overseas workers of China
Huang Xiaoxia, Li Jiguang, Yang Fenyou, Li Chuan, Wang Qin, Li Dexin, Li Jiandong
, DOI: 10.3784/jbjc.202105080247
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  Objective  To preliminarily understand the health related problems of overseas workers of China, and provide basic data for the establishment and improvement of the health service system.   Methods  The information about the general characteristics and health-related problems of the overseas workers were collected by questionnaire survey, and software SPSS 19.0 was used for statistical analysis.   Results  From 2019 to 2020, a total of 298 overseas workers aged 25–57 years (median 37 years old) were included, most of them were men (99.7%), and the majority were aged 30–39 years (58.4%). The oversea working places were distributed in 26 countries in Asia (79.5%) and Africa (20.5%). The median daily sleeping time of the workers was 7 hours, and 34.9% (104/298) of the workers thought that sleep quality got worse. Mosquito bite was common problem, which was much more serious in Southeast Asia (93.8%) and Africa (80.3%). The threat posed by endemic vector-borne diseases was serious, and malaria (2 cases), dengue fever (1 case) had occurred. More workers had paid attention to the vaccination against frontier quarantine diseases, and 96.7% (58/60) of the workers working in Africa had been vaccinated against yellow fever. However, some workers still missed the vaccination, which might lead to infectious disease infection. While working abroad, 42.3% (126/298) of the workers had one or more of following symptoms, diarrhea (28.5%), cough, lung discomfort, rash, fever, abdominal pain and bleeding spot. The disease incidence rate was higher in Africa than in Asia, and 26.5% (79/298) of the workers had been sick while working abroad, and the sick rate was higher in Africa than that in Asia. Three workers had been infected with typhoid. The awareness of health protection in the overseas workers had been improved, and access to medical and health services had been increased, which was reflected in the stockpiling of commonly used drugs, the prevention and control of key infectious diseases, and the attention to physical and mental health.   Conclusion  The health protection and promotion of overseas staff of China has been strengthened and gradually improved, a feasible, efficient and standardized health care service system for overseas workers targeting digestive tract disease, vector-borne diseases and vaccine preventable diseases and combining with comprehensive non-specific indicators, such as diet intake and sleep quality, can be established to prevent the cross border transmission of infectious diseases.
Species diversity and antimicrobial resistance of Salmonella detected in pork and chicken in Yuyao, Zhejiang
Huang Shaojun, Yuan Shanshan, Zhu Jiahui
, DOI: 10.3784/jbjc.202105070243
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  Objective  To understand the distribution and pollution of Salmonella in pork and chicken in Yuyao, Zhejiang.   Methods  A total of 206 fresh pork and chicken samples were collected from major shopping malls and farm produce markets in Yuyao between June 2019 and October 2020, and then the enrichment, isolation, biochemical identification, serotyping and drug sensitivity test were conducted.   Results  In 61 chicken samples and 145 pork samples, 25 and 68 were positive for Salmonella, respectively. The positive rates were 40.98% and 46.90% . A total of 117 strains of Salmonella belonging to 17 serotypes were isolated from 93 meat samples, including 89 strains from pork samples and 28 strains from chicken samples. S. derby (30/89, 33.71%), S. London (15/89, 16.85%), S. rissen (14/89, 15.73%) and S. typhimurium (13/89, 14.61%) were the predominant serotypes in pork samples. However, S. enteritidis (9/28, 32.14%), S. Kentucky (6/28, 21.43%), and S. typhimurium (4/28, 14.29%) were most commonly detected in chicken samples. Severe antibiotic resistance to penicillins, tetracyclines and folate pathway antagonists were detected. The resistance rates to ampicillin, piperacillin and tetracycline and compound sulfamethoxazole were 79.49%, 52.14%, 74.36% and 56.41%, respectively. A total of 71 multidrug-resistance (MDR) strains were detected, and 41 strains, including 29 strains from pork samples and 12 strains from chicken samples, showed multi resistance to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole and tetracycline (ACSSuT). There were 11 extended-spectrum β-lactamases (ESBLs) producing strains, accounting for 9.40%, including 5 strains from pork samples (5.62%, 5/89) and 6 strains from chicken samples (21.43, 6/28).   Conclusion  This study indicated that the detection rate of Salmonella was high in chicken and pork samples in Yuyao. The isolates belonged to multi serotypes and showed high multidrug-resistance rate and complicated resistance mechanism. Therefore, it is necessary to strengthen the daily meat monitoring and analysis to provide evidence for the timely intervention to reduce transmission of Salmonella to humans through food chain.
Laboratory identification of tuberculosis outbreak in a middle school in Beijing
Yu Qin, Liu Haican, Zhao Ailan, Li Machao, Yu Nan, Zhang Aijie, Xu Wei, Wan Kanglin, Wei Yunfang
, DOI: 10.3784/jbjc.202104160206
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  Objective   To analyze the characteristics of the Mycobacterium tuberculosis isolates from a tuberculosis (TB) outbreak in a middle school in Beijing, from October 2018 to January 2019 with Laboratory detection techniques and provide evidence for the tracing, prevention and control of the TB epidemic.   Methods   A laboratory test was conducted for the index case and 203 close contacts, including M. tuberculosis antibody detection, γ-interferon detection, sputum smear and culture, as well as the identification, molecular typing and cluster analysis of positive strains.   Results   According to the gold standard for culture positive in laboratory, a total of 6 TB cases, including the index cases, were identified. In the culture-positive group, the immunological examination showed that the positive rate of M. tuberculosis antibody was 50%, and the positive rate of γ-interferon was 66.7%. After DNA extraction of the 6 positive strains, all the strains were identified as M. tuberculosis by multi-loci PCR. At the same time, and the 6 strains were detected by 12 loci variable number tandem repeat sequence analysis (MLVA) and the spacer (Spoligotyping) oligonucleotide method. The results showed that 5 strains belonged to Beijing genotype, and 1 strain had no result. It was found that 4 strains had same VNTR pattern of 12 loci, and one strain had 1.6 variant in Qub11a locus, another strain showed a difference of one copy number at ETR-A and MIRU27, but the copy numbers at other sites were same.   Conclusion   The 6 positive isolates identified in this laboratory were all M. tuberculosis, and 5 strains belonged to Beijing genotype. MLVA typing analysis indicated that 4 strains shared high homology, suggesting the possibility of recent transmission and the necessity of further sequencing analysis.
Epidemiological investigation of an imported COVID-19 case infected with Delta variant from Nepal in Chongqing of China
Zhou Yi, Li Tingting, Tang Yun, Liu Fen, Chen Shuang, Wen Zeli, Zhang Lie, Zhao Yong, Tang Ping, Qi Li
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  Objective  To analyze the epidemiological characteristics of a COVID-19 case imported from Nepal in Chongqing of China, and provide evidence for the prevention and control of imported COVID-19.   Methods  Field epidemiological investigation was conducted for the case and the close contacts. Respiratory tract samples, such as throat swabs and nasopharyngeal swabs, were collected. Real-time fluorescent RT-PCR was used to detect the nucleic acid of SARS-CoV-2. The whole genome sequencing of SARS-CoV-2 was performed. Chemiluminescent fluorescence was used to detect the specific IgM and IgG antibodies to SARS-CoV-2.   Results  The COVID-19 case imported from Nepal belonged to common type. The results of two SARS-CoV-2 nucleic acid tests and two IgM antibody tests of the cases were all negative within the 72 hours before returning to China, and the results of above tests of the case were all negative at airport customs after entering China. On the fifth day of centralized isolation, the test result of SARS-CoV-2 nucleic acid of the case was positive, and the gene sequencing found b.1.617.2 evolutionary clade of the Delta variant circulating in India recently. On the first day after admission to hospital, the case’s IgM test result was negative and the IgG test result was positive.   Conclusion  The Delta variant spread fast, the prevention of imported cases should be strengthened through precise and area specific measures. It is necessary to strengthen the personal protection in the closed-loop management process at air port, such as quarantine, transfer and isolation, and hospital infection control, medical observation and nucleic acid and antibody detections in the centralized isolation. Full doses of COVID-19 vaccination should be completed in time. At the same time, nasopharyngeal swab specimens should be collected form some travelers entering China.
Epidemiological characteristics of hemorrhagic fever with renal syndromes in Changli county of Qinhuangdao, Hebei, 2008–2020
Zheng Shaojun, Zhang Xiaojing
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  Objective  To understand the epidemiological characteristics and trends of hemorrhagic fever with renal syndrome in Changli county, Qinhuangdao of Hebei province, and provide evidence basis for the development of targeted prevention and control measures.   Methods  The incidence data of HFRS in Changli from 2008 to 2020 were collected for a descriptive epidemiological analysis.   Results  A total of 577 cases of HFRS were reported from 2008 to 2020 in Changli, with an annual incidence of 7.93/100,000. There were two deaths with a case fatality rate of 0.35%. The top 5 townships with high incidences were Jing 'an (14.03/100,000), Liutaizhuang (13.11/100,000), Ruhe (12.82/100,000), Tuanlin (12.15/100,000) and Nijing (11.18/100,000).The cumulative case number was highest in northwestern area (244 cases), followed by northeastern area (193 cases), southeastern area (84 cases) and southwestern area (56 cases). Cluster analysis on cases showed that 40 villages/communities had more than 3 cases accumulatively, in which 27, 9 and 4 villages/communities had accumulative case numbers of 3, 4 and 5, respectively. The incidence was highest in 2011 (21.64/100 000). The median of annual case number was 28 and the median of case number in peak month was 5. The incidence peaked in March and April. The male to female ratio of the cases was 2.41∶1. The age of the cases ranged from 2 years to 92 years. Most cases occurred in the age group 35~65 years, accounting for 73.00% (422/577) of the total cases. In the HFRS cases, farmers accounted for 86.00% (497/577), followed by students (4.51%) and workers (2.25%).   Conclusion  The incidence of HFRS was high in Changli. Young and middle-aged farmers and middle school students were at high risk. The highest incidence was in the northwestern and northeastern townships. There were 40 villages/communities where HFRS cases occurred. It is suggested to carry out surveillance on rodents in the cluster areas of HFRS cases. To reduce the risk of HFRS, a unified large-scale anti-rodent campaign should be carried out before the Spring Festival every year, and health education and vaccination should be conducted for high-risk population.
An outbreak of varicella caused by herpes zoster in a welfare house
Shi Jing, Zhao Chunyan, Zhang Jianming, Zhang Guofeng, Zhao Dan
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  Objective  To analyze the investigation and response of an outbreak of varicella caused by herpes zoster case in a social welfare house and provide reference for the prevention and control of similar outbreaks.  Methods  The case definition was developed, and the health monitoring forms, attendance records and the infectious disease surveillance system of the welfare house were checked. Active case finding and investigation were conducted. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of the epidemic.  Results  From March 28 to April 28, 2020, a total of 1 case of herpes zoster and 17 cases of varicella occurred in the welfare house. The attack rate of varicella was 27.87% (17/61), and the attack rate in children living in the welfare house was 55.56% (15/27), higher than that in workers (5.88% 2/34), the difference was significant (2=18.47, P<0.01) . Among the children living in the welfare house, the attack rate in those aged ≤14 years was higher, and the difference was not statistically significant(P=0.45). The rate of varicella vaccination in the children was 11.11%, and the full course immunization rate was only 3.70%. The attack rate in the children without immunization history was 58.33% (14/24), higher than that in those with immunization history (33.33%, 1/3), the difference had no significance (P=0.57). The health status of the children varied, the duration of the illness was 11–41 days, and the illness lasts for a long time. Samples were collected from the index case and 9 clinically diagnosed varicella cases, and these samples were varicella zoster virus (VZV) nucleic acid positive by RT-PCR.  Conclusion  The source of the varicella outbreak in the welfare house was a nursing assistant suffering from herpes zoster. The health status of the children in the welfare home varied and they had a collective lifestyle, which was the risk factor for the spread of infectious diseases. Increasing the vaccination rate of school-age children, reducing the gaps in immunization, strengthening the prevention and control of infection, and encouraging relevant staff to be vaccinated with zoster vaccine before employment can effectively prevent and control the spread of VZV in welfare house and other similar settings.
Trends of morbidity and mortality of hand foot and mouth disease in China, 2008–2017
Li Jialing, Wei Yujia, Dong Baiqing, Chen Minmei, Chen Min, Li Hai, Su Yongjian, Li Rongxiu
, DOI: 10.3784/jbjc.202107090395
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  Objective   To analyze the trends of morbidity and mortality of hand foot and mouth disease (HFMD) in China from 2008 to 2017, and provide scientific evidence for the development of HFMD prevention and control strategies.   Methods   The morbidity and mortality data of HFMD in China during this period were collected from China Public Health Science Data Center and the demographic data were collected from National Bureau of Statistics. Software Excel 2016 was used to establish the morbidity and mortality database of HFMD reports. Software JoinPoint 4.9.0.0 was used for JoinPoint regression analysis to estimate the annual average percentage change (AAPC) of reported morbidity and mortality of HFMD in different age groups and in different provinces in China from 2008 to 2017, and analyze the changing trend of HFMD morbidity and mortality.   Results   A total of 18 183 889 cases of HFMD were reported from January 2008 to December 2017, the average annual reported morbidity was 134.75/100 000. A total of 3 632 deaths were reported, with an annual average reported mortality of 0.027/100 000. The morbidity and mortality were stable from 2008 to 2017 (P>0.05), but the mortality showed a decreasing trend from 2010 to 2017 (APC: −22.98%, 95%CI: −29.64% to −15.70%, P<0.05). The morbidity in 10 provinces (municipalities) showed an increasing trend (P<0.05), the morbidity in 4 provinces (municipalities) showed decreasing trend (P<0.05), the morbidity in 18 provinces (municipalities) remained stable, and the mortality showed decreasing trend in 5 provinces (P<0.05). The incidence of HFMD was high in children aged 0–7 years, and the highest morbidity was in children aged 1 year (3 184.19/100 000). The average annual morbidity of HFMD decreased with age (t=−2.97, P<0.05). The case fatality rate of HFMD in age group <20 years decreased with age (t=−3.18, P<0.05). The annual morbidity of HFMD in 14 age groups showed an increasing trend (P<0.05), and the annual morbidity of HFMD in 12 age groups remained stable (P>0.05). The mortality in age group 0–7 years remained stable (P>0.05).   Conclusion   The overall HFMD morbidity and mortality in China from 2008 to 2017 were relatively stable, but the mortality showed a decreasing trend from 2010 to 2017. The morbidity of HFMD showed increasing trend in Southern China, Southwestern China, Central China and Eastern China, but the morbidity of HFMD declined in northern China and northeastern China. The morbidity of HFMD was higher in children aged 0 to 7 years. It is suggested that HFMD prevention and control should be strengthened according to the change of HFMD epidemic in different areas to reduce the morbidity and mortality of HFMD.
Performance of new tuberculosis control service system in Qingyang, Gansu
Shi Huailu, Fan Jingyu, Li Jincheng, Liu Beiqin
, DOI: 10.3784/jbjc.202103090107
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  Objective  To evaluate the performance of new tuberculosis prevention and control service system in Qingyang of Gansu province and provide evidence for the development of tuberculosis prevention and control strategies.  Methods  The overall successful referral rate of TB/suspected TB patients reported by non-TB prevention institutions, initial hospital visit rate of TB/suspected TB patients, registration rate of active TB patients, pathogenic positive rate of active TB patients, and the success rate of treatment before (2014–2016) and after (2017–2019) the implementation of new tuberculosis prevention and control service system in Qingyang were compared.  Results  The overall successful referral rate of TB/suspected TB patients was higher during 2017–2019 than that during 20142016 (97.60 % vs. 93.11 %, χ2=158.901, P<0.05), the initial hospital visit rate was lower during 2017–2019 than that during 20142016 (505.87/100 000 vs. 761.71/100 000, χ2=1309.486, P<0.05), the registration rate of active TB patients was lower during 2017–2019 than that during 2014–2016 (95.32/100 000 vs. 151.55/100 000, χ2=323.159, P<0.05), the pathogenic positive rate of active TB patients was significantly higher during 2017–2019 than that during 2014–2016 (29.60% vs. 13.04%, χ2=51.029, P<0.05), and the success rate of treatment was lower during 2017–2019 than that during 2014–2016 (91.12% vs. 95.29%, χ2=51.029, P<0.05).  Conclusion  The performance of the new tuberculosis prevention and control service system in Qingyang is well, but the burden of TB patients′ medical care should be alleviated by increasing investment for TB prevention and control. Besides, the coordination among designated hospital, disease control and prevention institution and primary medical and health institutions and the health education department should be strengthened to further improve the quality of TB prevention and control.
Comprehensive evaluation of quality of infectious disease information reporting system in Aksu, Xinjiang, 2016–2019
Zhou Quan, Luo Wenwei, Shen Xinxiu, Tuerhong ·musa, Xirenguli ·rusuli, Aikebaier ·aihemaiti
, DOI: 10.3784/jbjc.202007070234
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  Objective  To understand the current status of infectious disease information report quality management in Aksu, find out the existing problems, and provide reference for improving the local information report quality of infectious disease.  Methods  The infectious disease report card data and field supervision table in Aksu from January 1, 2016 to December 31, 2019 were collected from the subsystem of infectious disease report information management of national information system of disease prevention and control system for the description epidemiological analysis. Trendχ2 test was used to analyze the influencing the factors for the reporting timeliness, verifying timeliness, reporting card completeness and comprehensive evaluation index.  Results  From January 1, 2016 to December 31, 2019, the comprehensive evaluation index of infectious disease information report in Aksu ranked 3rd among the 14 prefectures in Xinjiang. However, there were still some problems, such as the failure of timely reporting, the failure of timely verifying or the incomplete filling of valid ID number. Among them, the rate of non-timely reporting was on the rise, and the difference was significant (trend χ2=21.173, P<0.05). The failure rate of timely verification showed a downward trend, and the difference was significant (trend χ2=150.571, P<0.05). The incomplete rate of valid ID number filling showed a downward trend, and the difference was significant (trend χ2=270.824, P<0.05). The comprehensive evaluation index increased by 1.16%, 0.25% and 0.18% respectively, from 2016 to 2019.  Conclusion  The quality of infectious disease information report in Aksu was good, and the stabilities of reporting and verifying were good. However, there were reporting cards with poor reporting timeliness, incompleteness of valid ID number filling, and untimely verification, which were the important factors affecting the improvement of the comprehensive evaluation index.
Spatiotemporal distribution of influenza temporal risk characteristics in Gansu
Liu Haixia, Yang Xiaoting, Zhang Hong, Liu Xinfeng
, DOI: 10.3784/jbjc.202105260306
[Abstract](257) [FullText HTML](139) [PDF 9914KB](57) [Peer reviewing opinions] Related References Share
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  Objective  To understand the spatiotemporal distribution of influenza in Gansu province and evaluate the effects of influenza prevention and control measures.  Methods  The incidence data of influenza in 87 counties of Gansu from 2016 to 2020 were collected for spatial scanning analysis, and the temporal risk characteristic index (frequency index, duration index and intensity index) of influenza was analyzed by spatial autocorrelation method.  Results  A total of 46 043 cases of influenza were reported in Gansu from 2016 to 2020, with an average annual incidence rate of 35.09/100 000. The areas with high incidence of influenza in Gansu from 2016 to 2020 might be in Dingxi and Tianshui. The frequency index, duration index and intensity index of influenza were 0.58, 5.73 and 10.49 respectively. The global autocorrelation showed that the frequency index and intensity index had positive spatial autocorrelation, and local autocorrelation showed that the hot spots of frequency index and intensity index were mainly in Dingxi.  Conclusion  The incidence of influenza in Gansu showed spatiotemporal clustering. Dingxi was a high-risk area of influenza, and the prevention and control measures in different risk areas had different effects.
Medical care seeking delay and related factors in pulmonary tuberculosis patients in Chaoyang district, Beijing, 2014–2020
Yu Nan, Wei Yunfang
, DOI: 10.3784/jbjc.202107270417
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  Objective   To analyze the characteristics and trend of medical care-seeking delay, and related factors in pulmonary tuberculosis (TB) patients in Chaoyang district of Beijing from 2014 to 2020 and provide scientific evidence for the early detection and control of pulmonary TB.   Methods   The information of pulmonary TB patients registered in Chaoyang from 2014–2020, including age, gender, occupation, current address, date of onset, date of first visit and results of etiological examination, were collected from National Information System for Disease Control and Prevention,. The factors associated with the medical care seeking delay in pulmonary TB patients were analyzed by multivariate Logistic regression model.   Results   The median interval (quartiles) from symptom onset to seeking health care was 9 (0, 33) days in pulmonary TB patients in Chaoyang during 2014–2020, the medical care seeking delay rate was 42.60% (4 269/10 020), and the prevalence of medical care seeking delay showed a downward trend from 2014 to 2020 (trend χ2=111.002, P<0.001). The results from the multivariate Logistic regression analysis showed that the odds ratio (OR) and 95% confidence interval (CI) of non-local household registered patients was 1.189 (1.076–1.315); the ORs and 95% CI of retired personnel, students/children outside child care settings, the jobless/unemployed, staff member/teacher/doctor and other occupation were 1.396 (1.149–1.696), 1.282 (1.009–1.628), 1.507 (1.307–1.739), 1.787 (1.532–2.085) and 1.978 (1.558–2.512); the OR and 95% CI of retreated patients was 1.631(1.275–2.088).   Conclusion   The overall medical care-seeking delay rate in pulmonary TB patients in Chaoyang showed a downward trend. Non-local household registration, being retired personnel, being students/children outside child care settings, being the jobless/unemployed, being staff member/teacher/doctor, and being retreated patients were the risk factors of the medical care-seeking delay in pulmonary TB patients in Chaoyang.
Analysis of influencing factors and Bayesian network model study of treatment outcome in tuberculosis patients in Qinghai
Liang Da, Zhao Xiaoyin, Shang Yue, Wang Zhaofen, Ma Binzhong
, DOI: 10.3784/jbjc.202103230151
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  Objective  To analyze the influencing factors for treatment outcome in tuberculosis (TB) patients registered in Qinghai province from 2011 to 2019, infer the causal effect by establishing the Bayesian network model, and provide scientific evidence for the TB prevention and control in Qinghai.  Methods  The TB cases information registered in Qinghai from 2011 to 2019 were collected from the National Tuberculosis Management System for a descriptive analysis on the treatment outcomes of TB patients, and multivariate Logistic regression analysis was used to identify the factors affecting the treatment outcomes of TB patients. The influencing factors with statistical significance were used in the Bayesian network model for causal correlation and conditional probability inferences.  Results  There were 35 910 TB patients in Qinghai from 2011 to 2019, and 31 908 cases were treated successfully, with a success rate of 88.86%. The results of multivariate Logistic regression analysis showed that clinical consultation, referral, follow-up and diagnostic type were protective factors affecting the treatment outcomes in TB patients, while older age (≥ 55 years old), being farmers and herdsmen, being detected in health examination and other contact examination, severe disease, retreatment and non-full course management were the risk factors. The Bayesian network model concluded that the source of patients, disease severity and management mode had casual correlation with the treatment outcomes in TB patients. The mild TB patients who had sought medical care and received full cause supervision management had highest treatment success rate (95.63%) and the lowest probability of adverse outcome (4.37%).  Conclusion  Age, occupation, source of patients, diagnostic type, disease severity, treatment classification and management mode were the influencing factors of treatment outcomes in TB patients. The causal relationship and intensity between TB patient treatment outcome and influencing factors were revealed by establishing Bayesian network model. The model showed that the treatment success rate was highest in mild TB patients who sought medical care due to illness and received full-cause supervision management.
Drug resistance and drug resistance genes of Mycobacterium tuberculosis in three surveillance areas in Jiangxi
Zhao Jingnan, Jiang Youqiao, Wu Wenhua, Xiao Gang, Huang Rui
, DOI: 10.3784/jbjc.202107140397
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  Objective  To understand the drug resistance and drug resistance gene mutations of Mycobacterium tuberculosis isolates from three national tuberculosis (TB) drug resistance surveillance areas of Dayu, Jinxian counties and Guangfeng district of Jiangxi province, and provide scientific evidence for the prevention and treatment of drug-resistant tuberculosis.   Methods  The drug susceptibility of the Mycobacterium tuberculosis in three surveillance areas in Jiangxi was detected by proportional drug sensitivity test and the gene mutations were identified by PCR-linear hybridization enzyme method.   Results  A total of 280 TB cases from the 3 surveillance areas were included in the study, and 264 strains were isolated, including 250 M. tuberculosis strains and 14 strains of non-tuberculosis mycobacteria. For the M. tuberculosis strains, the overall dug-resistance rate was 25.6% (64/250), the mono-drug resistance rate was 16.8% (42/250), the poly-drug resistance rate was 3.2% (8/250), and the rate of MDR was 5.6% (14/250). The detection rate of drug resistance in men was higher than that in women. S315T1 was the main feature of isoniazid resistance gene mutation in this area, and gyrA gene mutation was the main mechanism of M. tuberculosis resistance to fluoroquinolones in Jiangxi.   Conclusion  The use of PCR-linear hybridization enzyme method to screen first-line drug and second-line drug resistance gene mutations was of great significance for determining treatment options and the prevention and control of TB. It is necessary to strengthen the management of drug resistant TB cases and control the infection sources to reduce the incidence and spread of drug resistant TB in Jiangxi.
Current status and development trend of botulinum antitoxin
Zhang Huajie, Yang Yingchao, Ma Xiao
, DOI: 10.3784/jbjc.202012300448
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Botulism is a rare, potentially fatal disease caused by botulinum toxin, a strongest biotoxin produced by Clostridium botulinum. Botulinum antitoxin is the only specific treatment for botulism. Early administration of botulinum antitoxin is essential for the therapeutic effect of botulism. At present, almost all the approved botulinum antitoxins are equine plasma derived products, which have the potential risk of adverse reactions, including allergic reactions. This paper summarizes the current status of production technique, quality control and clinical application of botulinum antitoxin both at home and abroad, and introduce the application prospect of botulinum antitoxin.
Spatiotemporal distribution of dengue fever in Hangzhou, Zhejiang, 2017–2019
Liu Muwen, Sun Zhou, Kao Qingjun, Yang Xuhui, Song Shujuan, Huang Renjie.
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  Objective  To understand the epidemiological characteristics and spatiotemporal distribution of imported and local dengue fever cases in Hangzhou, Zhejiang province, from 2017 to 2019.   Methods   The incidence data of dengue fever in Hangzhou from 2017 to 2019 were collected from Infectious Disease Reporting Information Management System. According to the epidemiological survey data, the cases were divided into imported cases and local cases. Software ArcGIS 10.2 was used for spatial autocorrelation analysis and visual presentation. Software Satscan 9.4 was used for spatiotemporal scan analysis.   Results   A total of 1,424 cases of dengue fever were reported in Hangzhou from 2017 to 2019, including 223 imported cases and 1,201 local cases. The incidence in 2017 and 2019 showed significant spatial clustering, with a total of 36 high-high clusters of local cases and 37 high-high clusters of imported cases. Spatiotemporal scanning analysis showed that a total of 3 clusters of local cases were detected, and the clustering time was between August and October in 2017. The class I cluster area was in Zhanongkou of Jianggan district, involving 31 sub-districts in the urban area, and 3 clusters of imported cases were detected, and the clustering time was between May and November in 2019. The class I cluster area was in Tangqi of Yuhang District, involving 29 sub-district.   Conclusion   Obvious spatiotemporal clustering of dengue fever cases was found in Hangzhou. There were some differences in spatiotemporal clustering and population distribution between local cases and imported cases. Different response measures should be taken in different areas for more precise prevention and control of dengue fever.
Quality evaluation and analysis of hepatitis C report data of medical institutions in Shanxi Province
Jie Yanru, Zhang Fei, Nie Xiaoyong, Wang Liping, Yuan Chenli, Meng Jun
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  Objective  To understand the reporting of hepatitis C cases in some hospitals in Shanxi province, find out the existing problems and improve the quality of the reported data.   Methods  The data of hepatitis C cases were collected from 51 hospitals in 11 cities in Shanxi from July 1, 2019 to June 30, 2020. According to the diagnostic criteria of hepatitis C (WS213-2018), the correct reporting rate of acute hepatitis C cases, the correct reporting rate of hepatitis C cases in children, the correct reporting rate of confirmed hepatitis C cases, the underreporting rate of HCV RNA positive cases and the correct reporting rate of HCVRNA positive cases were used to analyze the quality of hepatitis C reporting in some hospitals of Shanxi.   Results  For the 17 acute hepatitis C cases, the correct reporting rate was 35.29%; For the 24 hepatitis C cases in children, the correct reporting rate was 54.17%. For the 1324 confirmed hepatitis C cases, the correct reporting rate was 61.78%. For the 1037 HCV RNA positive cases, the underreporting rate was 6.36%, the correct reporting rate was 72.81%. The correct reporting rate of hepatitis C in children in class III hospitals was higher than that in class II hospitals, the difference was significant (χ2=10.752, P =0.002); The correct reporting rate of confirmed hepatitis C cases in class III hospitals was higher than that in the class II hospitals, the difference was significant (χ2=136.953, P<0.001). The underreporting rate of HCV RNA positive cases in class III hospitals was lower than that in class II hospitals, The difference was significant (χ2=13.484, P<0.001); Suspected hepatitis C cases were still reported in some hospitals.   Conclusion  The quality of hepatitis C case reporting in some hospitals in Shanxi was low, especially in class II hospitals. It is suggested to standardize the reporting of hepatitis C in health supervision, medical treatment and disease control by the training at different levels.
Mental health status and influential factors of employees of Chinese enterprises in Ethiopia
Chen Shuo, Wang Xiaochun, Pang Mingfan, Qi Xiaopeng, Wang Lili
, DOI: 10.3784/jbjc.202104190202
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  Objective  To understand the mental health status and its influential factors of staff of Chinese enterprises in Ethiopia.  Methods  This study selected employees of Chinese enterprises still in Ethiopia to conduct the mental health questionnaire survey from June 27 to 28, 2020, and multiple linear stepwise regression model is performed to analyze the influential factors of the mental health.  Results  Among 671 employees, 38.75% had mental health problems. The anxiety and depression of the employees in the last 2 weeks was relatively prominent. The results of multivariate logistic regression analysis showed that the epidemic had an impact on the plan of returning home (OR=3.293, 95%CI: 1.897–5.714), employees worried about being in Africa and unable to take care of their family members in China (OR=2.329, 95%CI: 1.198–4.528), and the company did not take any measures (OR=4.697, 95%CI: 1.080–20.435) were risk factors of mental health. Employees had no physical symptoms in the past month (OR=0.305, 95%CI: 0.171–0.543), worked normally (OR=0.517, 95%CI: 0.322–0.831), the company guaranteed the necessities of life supply (OR=0.609, 95%CI: 0.371–1.000) and conducted COVID-19 knowledge promotion (OR=0.335, 95%CI: 0.183–0.614) were the protective factors of mental health.  Conclusion  The mental health status of employees of Chinese enterprises in Ethiopia is poor, and their mental health is affected by various factors. We should attach importance to their mental health and take various mental health interventions to reduce their anxiety and depression and other negative emotions.
Economic burden of 192 varicella cases in Taizhou
Hu Yafei, Li Chunxia, Lin Haijiang
, DOI: 10.3784/jbjc.202103090106
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  Objective  To evaluate the economic burden of varicella cases with different vaccination status in Taizhou.  Methods  We selected varicella cases in 3 counties (dsitrict) with different economic levels in Taizhou for a questionnaire survey to collect the information about cases’ varicella vaccination status, economic burden and school absences.  Results  A total of 192 varicella cases were investigated. The cases with 0, 1 and 2 doses of varicella vaccination accounted for 44.79%, 46.88% and 8.33%. The average direct economic cost was 262.66 yuan RMB, the average school absence days was 7.50 days. The average indirect economic cost was 718.46 yuan RMB, 2.73 times higher than the direct economic cost. The cases who received vaccination had lower direct medical cost and less school absence days compared with those who received no vaccination (P<0.05).  Conclusion  The indirect economic cost of varicella cases in Taizhou was higher than the direct economic cost, and varicella vaccination can reduce school absence days. Varicella vaccination should be further promoted.
Characteristics of pulmonary tuberculosis in medical staff in Liaoning, 2014–2019
Mao Ning, Zhong Wei, Ding Hongfang, Jiang Yiwen.
, DOI: 10.3784/jbjc.202106160339
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  Objective  To understand the registered incidence and epidemiological characteristics of pulmonary tuberculosis (TB) in medical staff in Liaoning province and provide evidence for the development of effective protective countermeasures for medical staff.   Methods  The incidence data of TB in medical staff in Liaoning from 2014 to 2019 were collected for a descriptive epidemiological analysis.   Results  From 2014 to 2019, a total of 537 pulmonary TB cases were registered in medical staff in Liaoning, including 19 cases of rifampicin-resistant TB, 94 cases of etiologic positive pulmonary TB, 354 cases of etiologic negative pulmonary TB and 70 cases without etiologic results. The registration rate of pulmonary TB in medical staff in TB hospitals was higher than that in medical staff of other medical institutions (χ2=282.18, P<0.05). In the past 6 years, the average annual registration rate of pulmonary TB in medical staff was 31.19/100 000, with an increasing trend (χ2=10.01, P<0.05). TB cases were registered in all the areas in Liaoning, with a relatively high proportion of the cases in the first quarter (34.45%), and the male to female ratio of the cases was 1∶3.07. The average age of pulmonary TB cases in medical staff was 33.56 years, and the median age was 30 years. The cases in age group 25–34 years accounted for the highest proportion (47.30%). The cases with the interval between onset and the first medical care seeking >2 weeks accounted for 55.68%. There was no significant difference in medical care seeking delay rate between medical staff in TB hospitals and medical staff in other medical institutions (χ2=0.69, P>0.05), and the medical care seeking delay rate in medical staff was lower than that in general population during the same period (χ2=7.27, P<0.05).   Conclusion  Medical staff are at high-risk for TB, and the medical care seeking delay rate of medical staff was high. It is necessary to strengthen the prevention and control of TB in medical institutions and carry out health education about TB prevention and control in medical staff.
Review on Clostridium botulinum and its toxin typing methods
Yang Yingchao, Zhang Huajie, Ma Xiao
, DOI: 10.3784/jbjc.202011300401
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Since Ermengem isolated and reported that the spore-forming Clostridium botulinum caused human poison in 1897, researchers found that there are 7 types of Clostridium botulinum in nature through serum neutralization methods. Subsequently, serological methods were also used to discover Clostridium botulinum that can produce bivalent toxins such as Ab, Ba, AB, Af and Bf. With the gradual maturity and improvement of gene sequencing technology, whole-genome sequencing by extracting Clostridium botulinum genomic DNA can not only identify the genetic composition of different serotypes of botulinum toxin, but also carry out typing studies at the nucleic acid or protein molecular level. Compared with serum neutralization methods, these newly emerging typing techniques and methods can not only solve the problems encountered in serological classification, but also quickly and accurately identify and track food or drug poisoning caused by Clostridium botulinum and the application of corresponding medications. In addition, different typing methods provide new tools and ideas for the identification and use of Clostridium botulinum strains and the development of new toxins.
Information quality evaluation of COVID-19 direct online reporting in Guangzhou
Hu Wensui, Liu Yuan, Liu Wei, Yang Zhicong, Zhou Qin
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  Objective  To evaluate the quality of direct online reporting of COVID-19, sum up experience, find existing problems, identify influencing factors, and suggest improvement measures to better guide future epidemic information reporting.   Methods  The COVID-19 reporting cards in Guangzhou were obtained from the China Disease Information Reporting and Management System, and the field epidemiological investigation data of the centers for disease control and prevention at all levels in Guangzhou were collected. The evaluation index system of underreporting, delayed reporting, incomplete reporting, inaccurate reporting, inconsistency between reporting card and epidemiological survey data, and repeated reporting were applied to evaluate the quality of COVID-19 direct online reporting in Guangzhou by using software SPSS 16.0.   Results  The underreporting rate was 0, the delayed reporting rate was 0.05%, the incomplete rate of reporting card was 1.62%, the inaccurate rate of reporting card was 3.97%, the inconsistent rate of reporting card and epidemiological survey data was 3.88%, and the repeated report rate was 13.25%.   Conclusion   The timeliness of COVID-19 reporting in Guangzhou was good, but the quality of reporting card needs to be improved. In the future, effective measures should be taken for weak links, and the system needs to be further improved in order to provide important support for timely analysis on the incidence and epidemic trend of COVID-19 .
Analysis on condom use in 424 male college students with casual heterosexual behaviors in Zhejiang
Chen Weiyong, Ma Qiaoqin, Zhou Xin, Chen Wanjun, Jiang Tingting, Wang Hui, Guo Zhihong, Chai Chengliang
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  Objective   To understand condom use and related factors in male college students with casual heterosexual behaviors in Zhejiang provinceand provide evidence for development of HIV/AIDs prevention strategy in male college students.   Methods   Stratified cluster random sampling survey was conducted among male students with casual heterosexual behaviors from 13 colleges and universities in Zhejiang in 2018. The information about their demographic characteristics, sexual attitude, sexual behaviors, intervention acceptance, condom use status were used in the data analysis by using software SPSS 21.0.   Results   A total of 424 college male students with casual heterosexual behaviors and mean age of 20.08±1.34 years were included in the study, , accounting for 15.91% of all male college students, and 40.09% of them (170 male students) used condoms in all casual heterosexual behaviors. Multivariate analysis showed being ages 20-21 years (compared with being aged 19 years) (aOR=2.52, 95% CI=1.47~4.30)、knowing to evaluate a person whether infected with HIV from appearance”(aOR=2.46, 95% CI=1.28~3.71),sex with student casual sexual partners(aOR=2.08, 95%CI=1.08~4.01),sex with social person(aOR=3.32, 95% CI=1.41~7.78)(compared with having sex with students and social persons), seeking casual sexual partners through other ways(compared with seeking casual sexual partners through internet)(aOR=2.18, 95% CI=1.29~3.70),non-post drinking casual sexual behavior compared with causal sex after drinking(aOR=2.62, 95% CI=1.56~4.40)having confidence with condom use after self-efficacy test(aOR=1.99, 95% CI =1.04~3.81)were the protected factors related with condom using in male students who have casual heterosexual behaviors.   Conclusion   Some male college students had high risk sex behaviors in this study, including casual heterosexual behavior, poor condom using, sexual behavior after drinking, seeking sexual partners through internet, and varied sexual partners. Further health education and intervention are needed for promoting condom using in male college students.
Mortality and years of life lost of pancreatic cancer in Huzhou, Zhejiang, 2013–2020
Ding Jingying, Yu Meihua
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  Objective  To investigate the mortality and years of life lost of pancreatic cancer in Huzhou, Zhejiang province, from 2013 to 2020, and provide scientific evidence for the prevention and control of  pancreatic cancer in the future.  Methods  The death surveillance data in Huzhou from 2013 to 2020 were collected from Zhejiang Chronic Disease Surveillance Information Management System (ICD-10 code C25.0-C25.9), the crude mortality, standardized mortality, potential years of life lost (PYLL)、working potential years of life lost (WPYLL) were calculated to understand the death level of pancreatic cancer and its effect on population health, the annual percentage change ( APC) was used to analyze the trend of pancreatic cancer death.  Results  From 2013 to 2020, a total of 2,455 deaths of pancreatic cancer were reported in Huzhou, accounting for 6.34% of all cancer deaths, the average age of the death cases was 70.45±10.95 years. The youngest was 27 years old and the oldest was 97 years old. The death component ratio of pancreatic cancer increased with time (p<0.05), and the average death age of women was higher than that of men (p<0.05). From 2013 to 2020, the crude mortality and the standardized mortality of pancreatic cancer in residents in Huzhou were 11.58/100 000 and 8.02/100 000. The crude mortality showed an upward trend (P<0.05), but the difference in standardized mortality of pancreatic cancer had no significant difference. The crude mortality of pancreatic cancer was 13.48/100 000 in men and 9.68/100 000 in women, and the difference was significant (P<0.05). Pancreatic cancer ranked fifth of death causes, but the ranking in women rose from fifth in 2013 to fourth in 2020. The crude mortality rate of pancreatic cancer increased with age (P<0.05). The deaths mainly occurred after the age of 45 years and peaked in age group 80-years.  From 2013 to 2020, the mortality rate in the three groups (young, middle aged and old) of residents in Huzhou showed a significant increase. The mortality rate in the elderly group was highest, reaching 504.1/100,000. The PYLL and WPYLL caused by pancreatic cancer death were 10002.50 and 3903 person-years, the rates of PYLL and WPYLL were 0.52‰ and 0.20‰. The PYLL and WPYLL were higher in men than in women.  Conclusion  The mortality rate of pancreatic cancer in Huzhou showed an increasing trend from 2013 to 2020> The ranking of pancreatic cancer in death causes in women moved ahead, and the elderly and men were the high-risk groups, the mortality rate in women showed an upward trend, to which close attention needs to paid. It is necessary to strengthen the health education about healthy life style, rational diet, limited smoking and alcohol, moderate exercise for the primary prevention of pancreatic cancer.
Epidemiological characteristics and spatiotemporal distribution of hepatitis B in Chongqing, 2016–2020
Wu Weidong, Li Qin, Qi Li, Zhao Han, Li Baisong, Yang Lin, Wang Ju.,
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  Objective   To describe the epidemiological characteristics and spatiotemporal distributions of hepatitis B in Chongqing from 2009 to 2016, and provide information and evidence for guiding public health response and intervention.   Methods   We retrieved the hepatitis B surveillance data during January 2016 to December 2020 from “National Disease Reporting Information System”. Descriptive analysis was conducted to evaluate the epidemiological characteristics of hepatitis B in Chongqing. The spatial autocorrelation analysis was carried out by software GeoDa 1.14, and the spatiotemporal scan statistics were performed by software SaTScan 9.6.   Results   A total of 73 847 cases of hepatitis B were reported in Chongqing during 2016–2020. The average annual incidence rate was 48.26/100,000, which decreased from 67.54/100,000 in 2016 to 27.56/100,000 in 2020. The male-to-female ratio of the cases was 1.96:1. In the reported cases, 44.53% were aged 41–60 years and 51.07% were farmers. High-incidence clustering areas were identified in southeastern and northeastern Chongqing. Three statically significant hepatitis B clustering areas were identified by the spatiotemporal scan, and most of these clustering areas were in southeastern Chongqing during 2016–2017.   Conclusion  The incidence of hepatitis B decreased gradually in Chongqing from 2012 to 2020. Men aged 41–60 years in rural area were most affected by hepatitis B. The distribution of hepatitis B in Chongqing showed spatiotemporal clustering. It is necessary to strengthen the prevention and control of hepatitis B in southeastern and northeastern Chongqing to reduce the disease burden. It suggested to strengthen the hepatitis B vaccination and health education in population at high risk in these areas.
Analysis on characteristics of Creutzfeldt-Jakob disease cases reported by surveillance network in China, 2020
Gao Liping, Xiao Kang, Zhou Wei, Wang Yuan, Dong Xiaoping, Shi Qi
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  Objective  To investigate the incidence, epidemiology and clinical characteristics of Creutzfeldt-Jakob disease (CJD) in China in 2020.   Methods  Clinical and epidemiological data of CJD patients obtained from the CJD surveillance network in China in 2020 were analyzed. Blood and cerebrospinal fluid of the patients were collected. The amino acid polymorphisms at 129 and 219 sites of PRNP gene were analyzed by PCR and DNA sequencing using extracted from whole blood genome. The 14-3-3 protein in cerebrospinal fluid was detected by Western Blot.   Results  A total of 458 CJD cases were reported by the CJD surveillance network in 2020, in which 179 (39.08%) were probable sporadic CJD cases, 12 (2.62%) were possible cases, 18 (3.93%) were genetic CJD cases, and 1 (0.22%) was Gerstmann-Straussler-Scheinker syndrome case. Case reporting showed no seasonality, the long-term residence of the cases showed sporadic distribution, and the occupation distribution showed no clustering The median age of probable cases was 63.14 (43, 87) years, and the male-to-female ratio of the cases was 0.97∶1.The median age of possible cases was 68.08 (54, 77) years, and the male-to-female ratio of the cases was 1:1. Rapid-progressive dementia was the most common initial symptom. For the three test results of 14-3-3 protein in CSF, electroencephalogram and cranial magnetic resonance imaging, the patients with more positive results also had more typical symptoms. PRNP gene was detected in 439 blood samples. There were 434 cases of M/M homozygous amino acids, 3 cases of M/V heterozygous amino acids, and 2 cases of V/V homozygous amino acids at 129 position. There were 435 cases of E/E homozygous amino acids at 219 position, and 4 E/K cases of homozygous amino acids.   Conclusions  The reporting time, distribution of long-term residence, occupation, sex ratio and age distribution of CJD cases detected in China in 2020 were all consistent with the characteristics of CJD.
Genetic characteristics of hepatitis E virus isolated from human and swine in Shanghai, 2017–2020
Wang Wei, Chen Kaiyun, Wu Limeng, Ren Hong, Teng Zheng
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  Objective  To analyze the genetic characteristics of hepatitis E virus (HEV) isolated from human and swine samples collected in Shanghai during 2017–2020.   Methods  IgM and IgG against HEV were detected with enzyme-linked immunosorbent assay, HEV RNA was detected using qPCR assay, a partial 137-nt sequence of HEV was obtained using nested RT-PCR. Genetic characteristics of HEV isolates were further studied through phylogenetic analysis, including genotype, subtype and nucleotide sequence homology analyses.   Results  In this study, 191 human HEV isolates and 8 swine HEV isolates were obtained from serum samples of 525 acute hepatitis E patients and bile samples of 2400 pigs respectively. Phylogenetic analysis revealed that 98.43% of human HEV isolates belonged to genotype 4, including subtypes 4a, 4c, 4d, 4e, 4f and 4g, and 3 human isolates and 4 swine isolates belonged to genotype 3, including subtypes 3b, 3c and 3e. The nucleotide sequences of human and swine isolates shared 93.36%-100% homology.   Conclusion  Genotype 4 HEV was predominant in patients. Human genotype 3 HEV isolates were first reported in Shanghai. Human and swine isolates shared high sequence homology, suggesting the possible zoonotic transmission of HEV between swine and humans.
Disease burden of Parkinson’s disease in Beijing and Shanghai, 1990 and 2019
Wu Luli, Li Jie, You Jinling, Liu Yunning, Liu Jiangmei, Zhou Maigeng, Niu Peiye
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  Objective   To analyze the disease burden of Parkinson’s disease and its trend in Beijing and Shanghai from 1990 to 2019.  Methods   The prevalence data of Parkinson’s disease in Beijing and Shanghai were obtained from the Global Burden of Disease study (GBD) 2019. The prevalence rate, mortality rate, disability-adjusted life years (DALYs) were used to analyze the disease burden of Parkinson’s disease in Beijing and Shanghai, the percentage change between 1990 and 2019 were compared. Moreover, we also analyzed the gender and age specific disease burden of Parkinson's disease in Beijing and Shanghai.   Results   In Beijing, there were 47,800 cases of Parkinson's disease in 2019, an increase of 397.68% compared with 1990, and the standardized prevalence rate was 146.21/100,000, an increase of 24.26% compared with 1990; the number of deaths was 1,107, an increase of 171.06% compared with 1990, and the standardized death rate was 3.76/100,000, a decrease of 42.74% compared with 1990; the DALYs was 21,900 person-years, an increase of 165.36% compared with 1990, and the standardized DALY rate was 69.51/100,000, a decrease of 36.28% compared with 1990. In Shanghai, there were 56,500 cases of Parkinson's disease in 2019, an increase of 331.17% compared with 1990, and the standardized prevalence rate was 132.99/100,000, an increase of 35.71% compared with 1990; the number of deaths was 1,655, an increase of 121.15% compared with 1990, the standardized mortality rate was 4.17/100,000, a decrease of 41.19% compared with 1990; the DALYs was 30,000 person-years, an increase of 120.93% compared with 1990, and the age-standardized DALY rate was 73.01/100,000, a decrease of 33.46%compared with 1990. In 2019, the age-standardized prevalence, mortality and DALY rates of Parkinson's disease in men were 1.51, 2.62 and 2.12 times higher than that in women, respectively, in Beijing, and the age-standardized prevalence, mortality and DALY rates in men were 1.48, 2.03 and 1.76 times higher than that in women, respectively, in Shanghai. The prevalence, mortality and DALY rates of Parkinson's disease were highest in the age group ≥75 years, followed by those in age group 50~74 years, and in age group 15~49 years.   Conclusion   The disease burden of Parkinson's disease was more serious in Shanghai than in Beijing in 2019. From 1990 to 2019, the standardized prevalence rate of Parkinson's disease showed an increasing trend, while the standardized mortality rate and DALY rate showed a decreasing trend in Beijing and Shanghai. The disease burden of Parkinson's disease was more serious in men than in women, and more serious in people aged ≥75 years than in other age groups. The management and prevention of Parkinson's disease should be strengthened.
Epidemiology of HFMD caused by Cox A6 in Guangdong, 2017–2019
Wu Yanfei, Chen Xuguang, Liu Dongmei, Li Jiansen, Tan Xiaohua, Yang Fen
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  Objective  To understand the epidemiological characteristics of hand foot and mouth disease (HFMD) caused by coxsackievirus A6 (Cox A6) in Guangdong province from 2017 to 2019.   Methods  A total of 22 sentinel hospitals in 21 cities and Shunde district of Foshan were selected to conduct surveillance for common type of HFMD caused by Cox A6. The incidence of HFMD caused by Cox A6 was estimated and the population and time distribution characteristics of the disease were analyzed based on the case number and outbreak data.   Results  The annual proportions of HFMD caused by Cox A6 in Guangdong were 57.1%, 23.0% and 47.4% during 2017-2019. The proportion of HFMD outbreak due to Cox A6 was 18.5% (12/65), ranking only second to that by Cox A16, and HFMD caused by Cox A6 mainly occurred in September and June. The estimated incidence showed a decreasing trend with age (χ2=2683320.62, P<0.001). The incidence was highest in age group 1 year (4092.17/100 000), followed by that age group 2 years (2057.02/100 000), 0 year (1650.29/100,000) and 3 years (1530.23/100 000). There was an increasing trend with month age (χ2=771.58, P<0.001).The incidence was highest in age group 11 months (4982.7/100 000), followed by that in age group 10 months (4150.7/100 000) , 9 months (3523.2/100 000), 8 months (2684.97/100 000) and 7 months (1813.01/100 000). The incidence was highest in September (34.99/100 000), followed by that in July (30.98/100 000), October (28.88/100 000), August (24.18/100 000) and June (22.04/100 000). The proportion of severe and death cases due to Cox A6 was 25.2% (86/341), ranking only second to that by EV-A71 (35.5%, 121/341).   Conclusion  Cox A6 infection has become one of the main types of HFMD in Guangdong, and the epidemic intensity of Cox A6 infection varied from year to year. The outbreak intensity ranked only second to that of Cox A6 infection. When the Cox A6 infection level was high, the number of outbreaks increased, which mainly occurred in child care settings, and Cox A6 infection was common in September and June. Children aged 0—3 years and 6—11 months are at high risk. The intensity of severe disease and death was lower than that of EV-A71 but higher than that of Cox A16. The proportion of severe and death cases was higher than those reported by previous studies.
Investigation of latent infection of norovirus in canteen workers in primary and secondary schools in Haidian district, Beijing, 2019–2020
Guo Li, Cai Wei, Shao Yunping
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  Objective  To understand the latent infection status of norovirus and the incidence of norovirus infection in canteen workers in primary and secondary schools in Haidian district of Beijing from 2019 to 2020, analyze the influencing factors of norovirus infection and provide scientific basis for effective prevention and control of norovirus infection.   Methods  Stratified sampling and cross-sectional survey were used to collect stool samples or anal swabs of canteen workers in primary and secondary schools for norovirus nucleic acid detection. At the same time, questionnaire survey was used to collect personal basic information and awareness of norovirus of the canteen workers. The latent infection status of norovirus in the canteen workers from 2019 to 2020 was statistically analyzed, and the influencing factors of the infection were further analyzed.   Results  A total of 785 canteen workers from 30 primary and secondary schools participated in the survey. A total of 785 questionnaires were delivered, 777 were returned, in which 740 were valid (94.27%). Two norovirus nucleic acid positive samples were detected in 740 samples (0.27%). Through statistical analysis, there were no significant differences in gender, age, education level, norovirus positive time, working clothes wearing, disposable mask wearing, hand washing before entering the food operation room, hand washing before meals, raw and cold seafood product eating, and hand washing after defecation, awareness of the risk of norovirus and medical care seeking due to acute gastroenteritis between positive group and negative group(P>0.05). There was significant difference in timely reporting acute gastroenteritis symptoms, such as vomiting and diarrhea, to canteen managers between positive group and negative group (X2=27.044, P<0.05). The difference in incidence rate of norovirus infection between the canteen workers and non-canteen workers was significant (X2=264.184, P<0.05). The differences in positive rate among schools reporting epidemics were significant (X2=61.75, P<0.05).   Conclusion  The latent infection rate of norovirus in canteen workers in primary and secondary schools in Haidian district was 0.27%, indicating the risk of the epidemic caused by norovirus infection. Therefore, it is necessary to strengthen the health education about norovirus infection prevention and health status monitoring in canteen workers, the timely reporting and isolation of the cases with gastrointestinal symptoms. In the period with high incidence of norovirus infection, regular sampling detection should be conducted in canteen workers, and strict isolation measures of positive cases should be implemented to effectively prevent the incidence and spread of norovirus infection.
Detection of Quang Binh virus from mosquitoes in northwestern China
Li Fan, Yin Qikai, Hu Weijun, Zhou Liwei, Fu Shihong, Zhang Shaobai, Han Kun, Nie Kai, He Ying, Xu Xiaoguang, Xu Songtao, Liang Guodong, Wang Hunanyu
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  Objective  To investigate the diversity of mosquito-borne virus in northwestern China, and identify important mosquito-borne viruses.   Methods  The mosquitoes were identified according to morphological methods, the mosquito-borne virus was identified by deep sequencing and metagenomic analysis. Molecular genetic characteristics of identified virus were analyzed by phylogenetic method.   Results  Quang Binh virus was detected from Anopheles sinensis collected in Shaanxi province and Culex tritaeniorhynchus collected in Ningxia Hui autonomous region in July 2019. Phylogenetic analysis showed that the two strains shared the same evolutionary branch with the JM17156 strain of Quang Binh virus identified in Liaoning province, China, with nucleotide sequence homologous of 99.8%.   Conclusion  Quang Binh Virus were first successfully identified from Anopheles sinensis and Culex tritaeniorhynchus in Northwestern China.
Epidemiological characteristics of diarrhea in Zhejiang, 2013–2019
Cai Jian, Sun Jimin, Feng Yan, Miao Ziping, Qin Shuwen, Chen Yijuan, Cao Yanli, Shi Liyi, Ling Feng
[Abstract](207) [FullText HTML](104) [PDF 3638KB](37) [Peer reviewing opinions] Related References Share
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  Objective   To understand the types and epidemiological characteristics of diarrhea outbreaks in Zhejiang province, and provide evidence for diarrhea outbreak control.   Methods   The incidence data of diarrhea outbreaks reported in Zhejiang from 2013 to 2019 were collected. The outbreak time, space distribution, attack rate, duration, clinical symptoms of the cases, and laboratory results were described and compared.   Results   In 851 reported public health emergencies, 317 diarrhea outbreaks were identified, which were caused by 16 diseases or conditions, i.e. acute gastroenteritis caused by norovirus, cholera, influenza, dengue fever, Salmonella gastroenteritis, adenovirus infection, diarrheagenic Escherichia coli infection, acute gastroenteritis caused by sapovirus, severe fever with thrombocytopenia syndrome, Campylobacter jejuni infection, food poisoning due to Vibrio parahaemolyticus, Staphylococcus aureus infection, suspected abnormal reaction after vaccination, mushroom poisoning, hand foot mouth disease and chickenpox. The annual incidence had two peaks, one was during March-May and another one was during October-December. The outbreaks were reported in all the 11 prefectures (municipality) in Zhejiang. In the outbreaks, 264 (83.28%) occurred in schools. The outbreaks with attack rate more than 10% were caused by acute gastroenteritis caused by norovirus, cholera, influenza, adenovirus infection, Salmonella gastroenteritis, and diarrheagenic E. coli infection. The outbreaks with average duration of more than one week were caused by influenza, dengue fever, adenovirus infection, C. jejuni infection, and severe fever with thrombocytopenia syndrome. The proportions of the outbreaks in which cases had symptoms of vomiting, abdominal pain and fever were 87.38% (277), 71.61% (227) and 65.93% (209), respectively.   Conclusion   The diarrhea outbreaks were mainly caused by gastrointestinal pathogens, but other kinds of pathogens were also found. For disease surveillance and outbreak response, the epidemiological characteristics of the diseases should be considered beside clinical symptoms.
Evaluation of multiplex combined real-time PCR detection kit for nucleic acid detection of 22 respiratory pathogens
Luo Qin, Xie Hui, Luo Ming, Li Aihua, Huang Qi, Gong Cheng, Wang Xue, Li Maozhong
[Abstract](282) [FullText HTML](167) [PDF 2483KB](54) [Peer reviewing opinions] Related References Share
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  Objective  To evaluate the detection consistency and power of a multiplex combined real-time PCR detection kits, and provide reference for the prevention and control of influenza plus SARS-CoV-2 infection.   Methods  A total of 252 acute respiratory infectious samples were collected in Beijing. Four nucleic acid detection kits (A, B, C for multi nucleic acids and D for nucleic acid of SARS-CoV-2) were used for real time PCR, respectively, to evaluate the consistency of the test results. Three nucleic acid samples of respiratory pathogens in 10-fold dilutions with RNase-free water and 1 nucleic acid samples of SARS-CoV-2 in dilution of 10—1 ~ 10—6 folds were used to evaluate the detection power and intra-batch repeatability of kit A.   Results  The positive coincidence rates of kit A, B and C to detect influenza A virus, rhinovirus, adenovirus, enterovirus, human metapneumovirus, parainfluenza virus type 3 and 4 and coronavirus NL63 were 100% (all kappa values =1). The detection power of three assays for influenza B virus, respiratory syncytial virus, parainfluenza virus type 1 and 2, coronavirus OC43, 229E, HKU1 were similar, with the overall consistency rates of 99.17%—100.00% (all kappa values ≥0.91). The detection power of kit A, B and C were similar(P>0.05). The SARS-CoV-2 negative and positive coincidence rates tested by kit A and kit D were 100%, the intra-batch repeatability showed the CVs of viral loads tested by these two kits were less than 5% in the dilution range of 10−1 ~ 10−3. In the dilution range of 10−4 ~ 10−5, the detection power of kit A for open reading frame (ORF)1ab gene was higher (40%) than kit D (30%), as well as for N gene (80% vs 20%).   Conclusion  There were no significant differences in the accuracy of the kit A and other three kits for positive samples with high viral loads, and the detection power were similar. This study provided a multiple choice for large-scale nucleic acid detection and provided reference for the prevention and control of SARS-CoV-2 infection.
Serological diagnosis of tsutsugamushi disease and gene sequence analysis of Orientia tsutsugamushi in northern area of Anhui
Chen Qingqing, Zhang Yonggen, Liu Yimei, Shi Yonglin, Gong Lei, Wu Xiaomin, Sun Yong
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  Objective  To analyze the serotype and gene sequence of Orientia tsutsugamushi detected and understand the genotype characteristics of Orientia tsutsugamushi infection in northern area of Anhui province,   Methods  A total of 92 blood samples were collected from patients with clinically diagnosed tsutsugamushi disease in Fuyang, Bengbu, Suzhou of Anhui in 2018. The IgM antibodies and partial tsa56 genes of Orientia tsutsugamushi were tested respectively with indirect immunofluorescence assay (IFA) and nested-polymerase chain reaction (nPCR). The sequences of tsa56 genes were analyzed.   Results  In 92 serum samples, 61 were IgM positive, Gilliam was the main serotype of Orientia tsutsugamushi detected, and 48 were nucleic acid positive in PCR, the genotypes of all the strains belonged to Kawasaki-related.   Conclusion  The genotypes of Orientia tsutsugamushi detected in Fuyang, Bengbu, and Suzhou were Kawasaki-related, it is necessary to strengthen the surveillance for Orientia tsutsugamushi to prevent the outbreak of tsutsugamushi disease in Anhui.
Partial biological characteristics and genomic analysis of Vibrio cholerae typing phage VP2
Sun Huihui, Fan Yufeng, Li Zhenpeng, Zhao Shuo, Wang Xiaoxun, Pang Bo, Kan Biao
, DOI: 10.3784/jbjc.202105190282
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  Objective  This study aimed to further understand the genetic information of VP2 by analyzing the whole genome of Vibrio cholerae typing phage VP2, and analyzing the protein of mature particles in combination with biological characteristics.  Methods  The morphology of phage VP2 was observed under electron microscope, and some of its biological characteristics were determined. Online RAST (https://rast.nmpdr.org/) was used to predict and annotate the encoding genes of the phage VP2 genome, and the proteins in the mature VP2 particles were analyzed by mass spectrometry. Phage genome average nucleotide consistency (ANI, business, nucleotide identity) was analysis by pyani (https://github.com/widdowquinn/pyani).  Results  Phage VP2 was a typical 20-hedron short-tailed phage, the optimal MOI is 0.01. One step growth curve showed that incubation period is about 60 minutes, 60 minutes to 120 minutes for the outbreak period, after 120 minutes for the stable period. Forty-nine open reading frames (ORFs) were predicted. Protein spectrum analysis of mature VP2 particles showed that 34 proteins corresponded to the predicted genes. ANI cluster analysis showed that ANI was the highest in VP2 and vibro phage CJY.  Conclusion  The morphological and genomic characteristics of typing phage VP2 were identified, which laid a foundation for the further study of homologous phage and its interaction with Vibrio cholerae.
Etiological analysis on an outbreak of suspected food poisoning
Li Na, Guan Hengyun, Shi Yuwen, Liu Lanzheng, Jiang Huiyu, Liu Ming, Yin Xiaoyu, Chen Xiao, Song Xuanli, Liu Hui
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  Objective  To understand the etiological characteristics of an outbreak of food poisoning suspected to be caused by Bacillus cereus contaminated milk, and provide theoretical basis for food poisoning source identification and clinical treatment.   Method  An epidemiological investigation was carried out in 198 cases, and suspected dairy product samples and case samples were collected for pathogen isolation. The isolates of Bacillus cereus were molecularly classified by pulsed field gel electrophoresis (PFGE). The whole genome sequencing (WGS) was carried out and the virulence genes were analyzed. Micro broth dilution method was used for the drug susceptibility test of the isolates.   Results  The epidemiological investigation indicated that all the 198 cases showed abdominal pain, diarrhea, and fever at different degree, which met the definition of foodborne disease outbreak. A total of 25 strains of B. cereus were isolated, in which 5 were isolated from dairy products, and 20 were isolated from case samples. PFGE analysis showed that there was a high similarity between 13 strains from cases samples and 5 strains from dairy product samples. The drug susceptibility test showed that the 25 B. cereus stains were sensitive to ciprofloxacin, vancomycin, tetracycline, chloramphenicol, gentamicin and imipenem, but completely resistant to ampicillin and penicillin.   Conclusion  The outbreak of food poisoning was caused by B. cereus contamination. It is necessary to strengthen the health education about food safety to prevent the outbreaks of food borne diseases.
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.
Analysis on seven virus detection results of 15 636 children with respiratory tract infection in Wuhan Children's Hospital, 2019
Chen Hongwei, Lu Xiaoxia, Li Ying, Du Qing, Huang Peiqi, Hu Ruohui
[Abstract](185) [FullText HTML](99) [PDF 2251KB](23) [Peer reviewing opinions] Related References Share
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  Objective  To analyze the epidemiologic characteristics of common respiratory virus infection in hospitalized children in Wuhan Children's Hospital from January to December 2019, and provide evidence for clinical diagnosis and treatment.   Methods  Nasopharyngeal swabs were collected from the hospitalized children with respiratory infection from January to December 2019. Seven respiratory virus antigens of parainfluenza virus type 1, type 2, type 3 (PIV1, 2, 3), influenza virus A, influenza virus B, adenovirus (ADV) and respiratory syncytial virus (RSV) were detected by direct immunofluorescence assay, and the general information of the children were collected and analyzed.   Results  A total of 15 636 nasopharyngeal swabs were collected from the hospitalized children with respiratory infection in Wuhan Children's Hospital in 2019, and the total positive rate was 27.26%. The positive rates of RSV, ADV, PIV 3, influenza virus B, influenza virus A, PIV 1 and PIV 2 were 8.58% (1 341/15 636), 8.06% (1 261/15 636), 6.47% (1 012/15 636), 1.27% (198/15 636), 1.20% (188/15 636), 1.15% (181/15 636), and 0.83% (129/15 636), respectively. The positive rate of RSV was highest. The overall positive rate of seven viruses in boys was higher than that in girls, and the difference was significant (χ2= 21.031, P<0.001). Among the seven viruses, only the positive rate of RSV in boys was higher than that in girls, and the difference was significant (χ2=12.442, P<0.001). There was no gender specific difference in the positive rate of other respiratory viruses (P > 0.05). In all age groups, the detection rates in age groups 6 months-1 year and < 6 months were 33.85% (717/2 118) and 31.68% (1 027/3 242), respectively, which were significantly higher than those of other age groups. But there was no significant difference between age group < 6 months and age group 6 months-1 year(χ2=2.760, P=0.097). The overall positive rate was highest in spring and lowest in autumn, but the detection rate of RSV was higher in winter and spring. The detection rates of PIV3 and ADV were higher in summer and autumn with obvious seasonality. There were 48 cases of co-infections, and the most common co-infection type was PIV3 plus RSV, accounting for 50% (24/48).   Conclusion  The overall positive rate of the seven viruses in children with respiratory tract infection in 2019 varied with gender, age and season in Wuhan, to which physicians should paid attention in clinical diagnosis.
Epidemiological characteristics and clinical severity of respiratory syncytial virus and influenza virus infections in hospitalized old patients with respiratory infection in Guiyang, 2016–2020
Zeng Qiangwu, Zhang Fengdan, An Shigang, Jiang Xiaoli, Li Furong
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  Objective  To describe the epidemiological characteristics of respiratory syncytial virus (RSV) infection in hospitalized old patients with respiratory tract infections, compare the differences of clinical characteristics and severity between respiratory syncytial virus (RSV) infection and influenza virus infection, and identify the risk factors of in-hospital-death of respiratory tract infection in the elderly.   Methods  The clinical data of 5131 hospitalized patients aged ≥60 years with respiratory tract infection in two hospitals from January 1, 2016 to December 31, 2020 were collected. We compared the differences in demographics, underlying disease, clinical symptom/sign, length of hospital stay and death during hospitalization in the elderly with RSV infection and influenza virus infection, and a multivariate Logistic regression model was used to identify the risk factors of deaths in the elderly with respiratory tract infection.   Results  Among the 5 131 hospitalized patients aged ≥60 years with respiratory tract infections, 104 were tested positive for RSV (2%) and 497 were tested positive for influenza virus (10%). During this period, 77% (80/104) of RSV infections and 63% (312/497) of influenza virus infections occurred during November - February, showing obvious seasonality. The differences in the median of age (73 years old vs. 74 years old, P=0.997), ICU admission proportion (7% vs. 6%, P=0.822) and in-hospital death rate (6% vs. 3%, P=0.233) were not significant between the old patients infected with RSV or influenza virus. Compared with the old patients infected with influenza virus, the old patients infected with RSV had longer hospitalization length median (14 d vs. 12 d, P=0.041) and lower proportion of fever at hospital admission (50% vs. 61%, P=0.048). Among the 5131 patients, 114 died during hospitalization (2%), including 6 deaths due to RDV infection (6%) and 15 deaths due to influenza virus infection (3%). The results of multivariate Logistic regression analysis showed that, after adjusting for gender and antibiotic usage before admission, age ≥80 years [adjusted odds ratio (aOR)= 3.41, 95%CI=1.84~14.26], underlying medical condition (aOR=2.34, 95%CI=1.12~4.91), interval between illness onset and diagnosis ≥7 days (aOR=8.94, 95% CI=1.60~29.99), blood oxygen saturation <90% (aOR=4.05, 95%CI=1.33~12.34) and RSV infection (aOR=5.38, 95%CI=1.65~17.51) were independent risk factors of death in the elderly with respiratory tract infection.   Conclusion  The study highlighted that RSV as an important infection increased the risk for death in the elderly hospitalized due to respiratory infection in Guiyang. Close attention needs to be paid to RSV infection in the elderly, and RSV infection surveillance, prevention and diagnosis need to be strengthened.
Molecular etiologic investigation of an acute gastroenteritis epidemic caused by multi genotype norovirus in a university in Gansu
Kang Qian, Wang Xueying, Lyu Caixia, Wang Peng, Zhang Huimin, Yu Deshan
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  Objective   To analyze the genetic characteristics of norovirus detected in an acute gastroenteritis epidemic in an university in Gansu province in September 2-10, 2020, and provide evidence for the prevention and control of viral diarrhea caused by norovirus.   Methods   A total of 232 stool samples were collected from the acute gastroenteritis cases with symptoms of vomiting and diarrhea in this epidemic. Real-time fluorescent PCR was used for preliminary screening and genome identification, and then reverse transcription polymerase chain reaction (RT-PCR) was used for positives sample amplification, and sequence determination of part of the polymerase region and capsid region was performed for the products with CT value less than 37, and software MEGA-X was used to construct a phylogenetic tree for genetic evolution analysis using the neighboring method.   Results   The rate of diarrhea was 92.55%, the rate of abdominal pain was 88.94%, the rate of vomiting was 87.66%, and the rate of nausea was 78.09% in this acute gastroenteritis epidemic. The epidemic in the university was caused by co-infection of norovirus GⅠ and GⅡ. The detection rate of norovirus in 232 stool samples was 77.59% (180/232), and the detection rate of GⅠ was 16.38% (38/232), the detection rate of GⅡ was 44.83% (104/232) and the co-infection rate of GⅠ and GⅡ was 16.38% (38/232). As of 18:00 on September 10, 2020, a total of 470 students had been diagnosed with acute gastroenteritis, most were mild cases, among them 33 were admitted in hospital for observation and treatment. Based on sequencing, the genotypes of norovirus causing the epidemic were GI.3[P10], GⅠ.3[P13], GI.5[P4], GII.10[16], GⅡ.17[P17], GII.22[PNA5]and GIX.1[GII.P15].   Conclusion   There were 7 genotypes of norovirus detected in the acute gastroenteritis epidemic in this university, the first three were GII.22[PNA5], GⅠ.3[P13], GIX.1[GII.P15]. It is necessary to further strengthen the surveillance level and genotype analysis of norovirus in Gansu.
Incidence trend and potential life loss of injury death in Huzhou, 2014–2020
Yu Meihua, Din Jingying
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  Objective  To study the morality and life loss of injury death in Huzhou, Zhejiang province, and provide scientific evidence for the prevention and control of injury.   Methods  The injury death data in residents in Huzhou from 2014 to 2020 were collected and the data were classified according to the international classification of diseases, 10th edition(ICD-10); The mortality and death cause constituent were calculated, and the mortality trend was evaluated by using χ2 test. The average years of life lost (AYLL) and potential years of life lost rate (PYLLR) were calculated, and the trend of AYLL and PYLLR were evaluated by using annual percent change (APC).   Results  The average mortality rate of injury was 69.82/100 000 in residents in Huzhou during 2014-2020, which showed a upward trend year by year(χ2trend=244.537, P<0.001). The injury mortality was higher in males than in females(χ2=233.771, P<0.001). The first five injury death causes were accidental fall, traffic accident, shipping accident except motor vehicle, suicide, drowning. The mortality rates of deaths caused by accidental fall in entire population and drowning in females increased with year(χ2trend=474.799, P<0.001, χ2trend=6.711, P<0.05). Drowning was the major death cause in age group 0-14 years, traffic accident was the major death cause in age group 15-64 years and accidental fall was the major death cause in age group > 65 years. The average years of life lost by injury was 18.15 years, the potential years of life lost rate was 5.67‰, the first three leading injury related death causes were traffic accident, shipping accident except motor vehicle and suicide.   Conclusion  Injury has become one of major death causes in Huzhou, causing great loss of life expectancy, targeted prevention and control measures for traffic accident, accidental fall, drowning and other key injuries should be conducted to reduce the burden of injury effectively.
Analysis on characteristics of HIV-1 molecular transmission network and cluster in people aged ≥50 years in Shaoxing, Zhejiang
Yang Zuokai, Lu Qiaoling, Shan Xingren, Xu Shuhong, Cao Dongqing
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  Objective  To analyze the characteristics of HIV-1 molecular network in the people aged ≥50 years from July 2018 to June 2020 in Shaoxing, Zhejiang province, explore the risk factors associated with HIV-1 transmission network and provide evidence for the effective intervention.   Methods  A total of 147 samples of newly reported HIV-1 positive cases were consecutively collected, the POL gene fragments of HIV-1 were amplified by reverse transcription polymerase chain reaction (PCR) and nested PCR. The phylogenetic tree constructed to analyze the molecular transmission network for subtypes and different gene distances. The factors associated with the subjects entering network and characteristics of cluster were further analyzed.   Results  Four subtypes were found in the samples, CRF07_BC (76, 51.70%) were the major subtypes, followed by CRF_AE (36, 24.49%), CRF08_BC (33, 22.45%) and B (2, 1.36%). A total of 74 sequences entered the network, with an entry rate of 50.34%, forming 12 clusters with the number of individuals in the cluster ranging from 2 to 30. The analysis on the factors associated with entering network showed that those with lower education level and awareness rate of AIDS knowledge, paying no attention to AIDS topics, commercial sexual behavior without condoms and female sex workers with payment less than 50 yuan at each sex were more likely to be found in HIV-1 molecular networks. The results of multivariate logistics model analysis showed that female sex workers with payment less than 50 yuan more easily entered molecular network. CRF07_BC had the highest cluster proportion (30, 40.54%) and formed a large cluster with 30 cases, most of these cases lived in and near Chengnan Street of Yuecheng district and had commercial sex. CRF01_AE had a cluster of 7 cases, including 1 female sex worker, and these cases lived in and near Qixian Street of Keqiao district. There were twelve positive couples in all clusters, the family transmission were caused by male commercial sex.   Conclusion  The genotypes of HIV-1 in the people aged ≥50 years in Shaoxing have become complex, the risk factors associated with transmission network included lack of AIDS prevention knowledge and unprotected sex with lower grade female sex workers. The geographical distribution of cluster cases was obvious, in order to effectively control the spread of AIDS, more attention should be paid to intervention and HIV screening in areas with case clusters.
Etiological analysis on a bacillary dysentery outbreak caused by Shigella sonnei in Beijing
Lyv Bing, Tian Yi, Yang Yanna, Zhen Bojun, Jia Lei, Lin Changying, Zhang Xin, Huang Ying, Qu Mei
[Abstract](258) [FullText HTML](110) [PDF 1997KB](22) [Peer reviewing opinions] Related References Share
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  Objective  To investigate the etiologic and epidemiologic characteristics of an outbreak of bacillary dysentery caused by Shigella sonnei in a boarding school in Beijing, China.   Methods  Stool samples of the cases and cookers, water samples and environment smear samples were collected from 5th to 20th September, 2019 for pathogen isolation and identification. Drug susceptibility test, pulsed-field gel electrophoresis(PFGE), whole genome sequencing(WGS), multi-locus sequence type (MLST), drug resistance related gene and virulence gene detection were performed, and the phylogenetic tree was constructed by whole genome single nucleotide polymorphism(wgSNP).   Results  In this outbreak, 16 Shigella sonnei strains and 1 enterotoxigenic Escherichia coli(ETEC)strain were isolated. The antibiotic susceptibility testing revealed that 16 S. sonnei isolates were resistant to ampicillin, tetracycline, trimethoprim and sulphame-thoxazole, cephazoline, cefotaxime, gentamicin, nalidixic acid, azithromycin, doxycycline. Further tests confirmed these isolates to be extended-spectrum beta-lactamase (ESBLs) producing strains. MLST unfolded that all isolated S. sonnei strains in this outbreak belonged to ST152, a common epidemic sequence type in China. An insertion sequence was found in a S. sonnei strain and the ETEC strain, but not in other S. sonnei strains.   Conclusion  It was confirmed that the pathogen of this outbreak was S. sonnei. In addition to PFGE, WGS is necessary for epidemiological investigation.
Meeting of the WHO Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH), June 2020 Conclusions and advice—Gong Zhenyu(Selective Translation), Gong Xunliang(Reviser)
Gong Zhenyu, Gong Xunliang
, DOI: 10.3784/jbjc.2021
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Abstract:
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Seasonality, epidemiological characteristics and dynamic changes of influenza viruses subtypes/lineages in Guangdong, 2014–2020
Tan Xiaohua, Ye Meiyun, Zhuang Yali, Deng Aiping, Yang Yuwei, Zhang Yingtao, Kang Min
[Abstract](246) [FullText HTML](142) [PDF 2756KB](35) [Peer reviewing opinions] Related References Share
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  Objective  To explore the seasonality, epidemiological characteristics and dynamic changes of different subtypes/lineages of influenza viruses in Guangdong Province and provide evidences for precise prevention and control of influenza in Guangdong.   Methods  Data on weekly influenza pathogen surveillance from the week 36of 2014 to the week 35 of 2020 were collected in Guangdong. The moving epidemic method (MEM) was used to determine annual epidemic period, and characteristic of seasonality were analyzed. The epidemiologic characteristics and dynamic change of different subtypes/lineages of influenza viruses were compared and analyzed with χ2 test.   Results  Influenza mainly occurred in winter, spring and summer in Guangdong. The incidence peaks mainly occurred in summer before and during 2016–2017 and in winter during and after 2017–2018. Based on data of the epidemic seasons from 2014–2015 to 2018–2019, the positive rate was lowest in age group 0–2 years, but increased with age and reached the peak in age group 7–18 years, then decreased. The distribution of the virus subtypes/lineages varied in different age groups, the proportion of influenza A virus was higher than influenza B virus. Influenza A (H1N1) pdm09 virus and influenza B virus (Yamagata lineage) were mainly detected in winter, influenza A (H3N2) virus in summer, and influenza B virus (Victoria lineage) in spring. Compared with results during before and during 2016–2017, the proportions of infections in age groups 7–18 years and 19–59 years increased, while the proportions of infections in other age groups decreased, and influenza A (H1N1) pdm09 virus and influenza B virus (Yamagata lineage) were mainly detected in winter, influenza A(H3N2) virus in spring, but influenza B virus (Victoria lineage) still in spring during and after 2017–2018.   Conclusion  From 2017–2018 to now, the annual incidence peak of influenza all occurred in winter. Different subtypes/lineages of influenza viruses had specific epidemiological characteristics and trends. It is necessary to continue to strengthen influenza pathogen surveillance for the precise evaluation of incidence trend and control of influenza.
Bibliometric analysis of diabetes Economics Evaluation Literature
Xiao Jun, Sun Jinfang, Zhou Zhichao, Shi Shuangqing, Zheng Jie, Li Guoxing
, DOI: 10.3784/jbjc.202103100110
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  Objective  To describe the current status of diabetes economics evaluation research through bibliometric analysis and provide information for medical researchers and policy makers.  Method  In the Web of Science platform, bibliometric analysis and visualization technologies with the DDA and Pajek's tools were used to analyze the publication year and journals, countries, core authors and research hotspots of the literatures of diabetes economics evaluation published since 1980.  Result  The earliest literature in this field was published in 1980 and the number of literatures has increased rapidly since 2002. Nearly 20% of the literatures on diabetes economics evaluation were published in the top 15 journals and 150 core authors were found in this field. The developed countries had outstanding performance on diabetes economics evaluation. The institutions with the highest number of publications were Harvard University and University of London. In the co-occurrence network constructed by keywords, there were 4 subject concepts: “Evaluation of Diabetes Economics”, “Diabetes Self-management and Drug Treatment”, “Diabetes Prevention and Early Warning”, “Diabetes Related Metabolic Diseases” and “Diabetes Screening Indicators”.  Conclusion  The research of diabetes economics evaluation has developed rapidly since 2000. There have been some specialized journals, core authors and research institutions with global influence in this field. The developed countries, such as the United States and the United Kingdom, play an important role in the international cooperation on diabetes economics evaluation., but there is still less focused research hotspots.
Epidemiological and evolutionary analysis on influenza A (H3N2) virus in Hubei, 2017–2020
Xie Mengsheng, Fang Bin, Huang Chengjing, Yu Tiantian, Han Shi, Chen Dan
, DOI: 10.3784/jbjc.
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  Objective  To investigate the epidemiological distribution and gene evolution of influenza A (H3N2) virus in Hubei province from 2017 to 2020.  Methods  Based on the influenza etiological surveillance data in Hubei, the epidemiological distribution of influenza A (H3N2) virus in Hubei during 2017–2020 was analyzed. A total of 38 strains of influenza A (H3N2) virus sent by the influenza surveillance network laboratories in Hubei during 2017–2020 were selected for gene sequencing according to the annual distribution and area distribution. The amino acid sequences of HA and NA were obtained and their antigens were analyzed, the changes of amino acid sites in clusters were analyzed, and gene evolution and 3D modeling analyses were conducted.  Results  There were three detection peaks of influenza A (H3N2) virus in Hubei from 2017 to 2020. The first peak was predominated by 3C. 2a1 virus cluster, the second peak was predominated by 3C.2a1b +T131K virus cluster and the third peak was predominated by 3C.2a1b +T135K virus cluster. 3C.2a1b +T131K virus cluster and 3C.2a1b +T135K virus cluster had 8 different amino acid mutation sites on 3 antigenic determinants of HA protein. There were significant differences among sites 50, 131, 135, 140 of 3C.2a1b +T131K virus cluster and 3C.2a1b +T135K virus cluster in the three-dimensional simulation structure diagram.  Conclusion  The cluster of influenza A (H3N2) virus in Hubei evolved continuously from 2017 to 2020. Enhancement of evolutionary surveillance and antigen mutation analysis of the recent cluster of 3C. 2a1b +T135K virus would improve the epidemiological and gene evolution surveillance of influenza viruses in Hubei.
Spatial analysis on birth defects in Guangxi based on geographic information system
Peng Zhenren, Wei Jie, Chen Biyan, Huang Xiuning, Song Pengshu, Liang Lifang, Wei Hui, Qiu Xiaoxia, Liang Junrong, He Sheng
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  Objective  To understand the spatial distribution of the incidence of birth defects in Guangxi, and provide scientific evidences for the prevention and control of birth defects.   Methods  The spatial database of birth defects of Guangxi from 2016 to 2020 was established and used for the spatial analyses. The Kriging interpolation was used to plot the map of birth defects in Guangxi. And then the trend surface analysis, spatial autocorrelation analysis and hotspot analysis were conducted to understand the spatial distribution of the incidence of birth defects.   Results  The trend surface analysis showed that the incidence of birth defects increased first and then decreased from west to east and from north to south. The global spatial autocorrelation analysis showed that there was a positive spatial autocorrelation in the incidence of birth defects (Moran's I = 0.308, Z = 6.066, P < 0.001). The local spatial autocorrelation analysis indicated that the incidence of birth defects showed High-High and High-Low spatial clustering patterns (Z > 1.96, P < 0.05) in Guangxi. The hot spot analysis showed that the incidence of birth defects had both hot spots and cold spots (Z > 1.65, P < 0.10) in Guangxi.   Conclusion  The obvious spatial distribution of the incidence of birth defects was observed in Guangxi, and the incidences were high in some counties or districts. So, it is necessary to strengthen the prevention and control of birth defects in these areas
Analysis on epidemiologic characteristics and disease burden of infectious diarrhea in Jiangjin, Chongqing, 2016–2019
Liu Xun, Meng Qiuyu, Huang Kaixiong, Kang Jiming
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  Objective  To analyze the epidemiiologic characteristics of infectious diarrhea in Jiangjin district, Chongqing, from 2016 to 2019, and provide scientific basis and support for infectious diarrhea prevention and control.  Methods  The incidence data of infectious diarrhoea in Jiangjin from 2016 to 2019 were collected from National Disease Control and Prevention Information System. The descriptive epidemiology method was used to analyze the characteristics of infectious diarrhoea. The disability adjusted life year (DALY) was estimated to evalaute the disease burden caused by infectious diarrhea in each year. The spatiotemporal scan statistic was used to explore the spatiotemporal clustering of cases, and ArcMap 10.2 was used to visualize the analysis results.  Results  From 2016 to 2019, a total of 4 670 cases of infectious diarrhoea were reported in Jiangjin, including 1 death, and the annual average incidence rate was 84.72/100 000. The male to female ratio of infectious diarrhea cases was 1.174: 1, and the incidence rate was highest in the age group <5 years (1128.69/100, 000). The cases in children outside child care settings accounted for the highest proportion (73.30%). The incidence peak was during November-March. Spatiotemporal scanning further found that the most likely clustering areas were 4 streets including Jijiang, Dingshan, Shuangfu and Degan (LLR=281.73, RR=4.44, P<0.01). The cases with definite etiological diagnosis accounted for 5.89%, most cases were rotavirus infections (87.91%). The years of life lost (YLL) due to infectious diarrhoea was 22.53 person-years, and the years lived with disability (YLD) was 9.42 person-years. Children aged <5 years were at high risk for infectious diarrhea with cumulative YLD of 7.21 person-years (76.54%). People aged >60 years old were also a risk group for infectious diarrhea with YLD of 0.82 person-years (8.70%).  Conclusion  The main urban area of Jiangjin should be regarded as the key area for the prevention and control of infectious diarrhea. The relevant departments should further improve the etiological diagnosis and take targeted measures to control the incidence and spread of infectious diarrhea in children aged <5 years and children outside child care settings according to the epidemilogic and etilogic characterisrics of infectious diarrhea.
Analysis on oral health behavior and knowledge awareness of students aged 12-15 years in Hainan
Wang Yuanyuan, Xie Lili, Guo Dongmei, Guo Qiuyun, Quan Tao, Xie Qi, Bao Bocheng
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  Objective  To understand the oral health behavior, knowledge awareness and attitude of students aged 12~15 years in Hainan province and provide reference for the targeted health education and prevention of oral diseases.  Methods  According to the program of the fourth national epidemiological survey of oral health, a total of 3479 students aged 12~15 years in Hainan were selected by an equal-sized stratified multistage randomly sampling. All of them were surveyed with questionnaires regarding oral health behaviors, knowledge awareness and attitude. The collected data were analyzed by descriptive statistics and χ2 test.  Results  Among the students, 40.50% brushed their teeth twice a day or more, only 4.17% brushed their teeth with fluoride toothpaste and only 0.55% used flossed every day. The students who eat dessert and sweets, sweet drinks, sweetened milk and other foods once or more per day accounted for 39.15%, 27.48% and 28.08% respectively.; The awareness rates of oral disease related knowledge was less than 70%, the awareness rates of "fluoride is useful for protecting teeth" and "pits and fissure sealing can protect teeth" were 29.58% and 12.96%, respectively. For oral health concept, 61.54% of them agreed that "regular oral examination is very necessary” and more than 90% answered the other three questions correctly. In general, the oral health behavior, knowledge awareness and attitude of the urban students were better than those of the rural students, and the girl students had better oral health concept compared with boy students.  Conclusion  The 12~15 year old students in Hainan have poor oral health behaviors, poor diet habits, insufficient knowledge awareness of oral diseases, and it is necessary to improve their knowledge awareness of oral health. New targeted oral health intervention measures should be developed according to the urban-rural and gender specific differences in oral health behavior and knowledge awareness of students.
Summary of global surveillance data of infectious diseases in May 2021
Han Hui, Wu Bo, Wu Hailei, Zhang Jin, Jia Jiaojiao
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In May 2021, a total of 67 infectious diseases were reported globally, affecting 225 countries and regions. Except for influenza, the top five infectious diseases affecting greatest number of countries and regions were corona virus disease 2019(COVID-19, 225), dengue fever (30), measles (29), poliomyelitis (15) and malaria (9). The top five infectious diseases with highest case fatality rates were Ebola virus disease (52.2%), Middle East respiratory syndrome (34.4%), lassa fever (20.3%), plague (6.0%) and Crimean-Congo hemorrhagic fever (5.3%). The top five infectious diseases with greatest number of deaths were COVID-19, malaria, measles, dengue fever and cholera. The prevalent infectious diseases in Asia were COVID-19 and dengue fever, the prevalent infectious diseases in Africa were COVID-19, Ebola virus disease, plague, cholera, yellow fever, lassa fever and Rift valley fever, the prevalent infectious diseases in America were COVID-19 and dengue fever, the prevalent infectious disease in Europe was COVID-19.
Analysis on sequences of PRNP and amino acid of blue sheep on Qinghai-Tibet Plateau
Wu Jingxing, Gao Liping, Chen Dongdong, Xiao Kang, Wu Yuezhang, Dong Xiaoping, Shi Qi
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  Objective  To analyze the prion protein gene (PRNP) sequence of blue sheep and evaluate the susceptibility of blue sheep to scrapie.  Methods  The primers were designed according to the PRNP sequence of sheep published on GenBank, and then the PRNP sequence of blue sheep was amplified, sequenced, and compared with the PRNP sequence of 11 species of mammals published on GenBank.  Results  Gene sequencing results showed that the PRNP of blue sheep consists of 771 nucleotides and encodes 256 amino acids. Sequence analysis showed that the amino acid sequences of prion protein (PrP) in four blue sheep were completely homologous, and were consistent with those of wild-type sheep. In addition, the amino acid sequence of PrP in blue sheep showed high homology with goat (99.2%), reindeer (98%) and cattle (97.7%).  Conclusion  Four blue sheep enrolled in this study might be susceptible to scrapie as wild-type sheep, and have the potential to transmit scrapie between blue sheep and sheep.
Epidemiological characteristics and case investigation of rabies in Yunnan, 2015–2019
Yang Weihong, Jiang Han, Feng Yun, Wang Juan, Pan Hong
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  Objective  To analyze the epidemiological characteristics and morbidity and mortality of rabies in Yunnan province in recent five years, and provide scientific basis for the prevention and control of rabies in Yunnan.  Methods  The incidence data of rabies in Yunnan from 2015 to 2019 were collected, a database was established and a chart was drawn. Descriptive epidemiological methods were used to analyze these data.  Results  A total of 167 cases of rabies deaths were reported in Yunnan from 2015 to 2019, with an average annual incidence of 0.07/100, 000. The cases were mainly reported from June to August, the annual incidence peak of the disease usually occurred in same period. The male to female ratio of the cases was 2.21∶1, and the cases occurred in all age groups, mainly in middle-aged and elderly residents and children in rural area. Most cases were still mainly caused by dog bite. Among the cases, 148 had clear exposure time, the median incubation period was 73 days, and the median course of disease after onset was 3 days. Six cases were laboratory confirmed. Only 10 of the cases with exposure Ⅱ or above were vaccinated with rabies vaccine. Thirty one dead animals with rabies virus or being suspected to carry virus were treated innocuously.  Conclusion  The incidence of rabies in Yunnan decreased year by year, but the area affected expanded, the treatment after dog bite was not standardized, and the management of dogs in rural areas is not fully implemented. Therefore, rabies is still an important public health problem in Yunnan.
Detection of virulence of Pasteurella multocida isolates from wild rodents in Yunnan
Du Chunhong, Wang Peng, Yang Shan, He Lichun, Chen Chaonian, Liang Yun, Wang Anwei, Gao Zihou
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  Objective  To understand the virulence of Pasteurella multocida isolates from the wild rodents in a rodent epidemic in Simao of Yunnan province in 2016.  Methods  Two strains of P. multocida were isolated from dead wild rodents, which belonged to serotype A and F by molecular typing. Balb/C mice were inoculated with the two strains and their mixture (1∶1) by routine challenge test, and the median lethal dose (LD50) of each group was calculated.  Results  The LD50 of P. multocida serotype A, serotype F strains and their mixture to Balb/C mice were 1.1×102, 5.0×106 and 5.8×102. By statistical analysis, the virulence of serotype A strain was strongest, and the virulence of serotype F strain was lower than that of serotype A strain and the mixture.  Conclusion  P. multocida serogroup A and F strains isolated in this rodent epidemic had strong virulence to Balb/C mice, especially serotype A strain, belonging to very virulent P. multocida.
Discussion on prevention and control of COVID-19 epidemic in primary medical institutions
Zhang Yan, Li Jing, Zuo Bojun, Huang Xinling, Ma Wenbo
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Since late 2019, Coronavirus disease 2019(COVID-19)has rapidly spread across the world as a new infectious disease, Xinjiang autonomous region has also experienced three epidemic periods. The Epidemic Prevention Leading Group of Xinjiang and Xinjiang Production and Construction Corps established a special supervision group in time to conduct investigation and guide the performance of COVID-19 prevention and control in primary medical institutions, including pre-inspection and triage of fever cases, the use of protective equipment, hand hygiene, and environmental disinfection, to minimize the risk of nosocomial infection, effectively control the epidemic in Xinjiang, and restart the normal production and life.
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.
Chinese reference list of core health indicators
, DOI: 10.3784/jbjc.202011300402
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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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《疾病监测》杂志稿约
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cover
2021-12期封面
2021, 36(12): 0-0.
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contents
2021-12期目录
2021, 36(12): 1-3.
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Risk Assessment
Risk assessment of global Coronavirus disease 2019 pandemic in November 2021
Wu Jiewen, Ji Hanran, Fang Yuansheng, Pang Mingfan, Liang Zuoru, Yang Xinping, Zhang Rongna, Zhao Qing, Li Jie, Yang Rendong, Qi Xiaopeng
2021, 36(12): 1235-1239. DOI: 10.3784/jbjc.202112200651
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  Objective   To assess the global epidemic of Coronavirus disease 2019(COVID-19) in November 2021 and the risk of importation.   Methods   According to the daily COVID-19 data publicly released by Johns Hopkins University, combined with the policy stringency index published by the University of Oxford, an epidemiological description method was used to provide a comprehensive and timely assessment of the global epidemic risk through a general overview, a comprehensive assessment of the epidemic trends in WHO regions and key countries, as well as a comprehensive analysis of the epidemic and prevention and control policies in 14 neighbouring countries. The assessment results for each country are expressed as “countries of global concern”, “countries of the general concern in each WHO sub-region” and “neighbouring countries of special concern”.   Results   Compared with the previous month, the number of confirmed cases increased by 20.78% and deaths decreased by 0.8% globally in November 2021. The number of newly confirmed cases increased by 53.5% and deaths increased by 38.6% in the European region, and all other regions showed a downward trend. Globally, there was trend that it took much less time for a 10 million case increasing. Germany and Poland were countries with global concern. Chile, Colombia, Jordan, Lebanon, South Africa, Vietnam and South Korea were the countries of general concern in each WHO sub-region.   Conclusion   The world is in the fourth wave of COVID-19. It is necessary to continuously monitor countries with global focus, adjust entry control policies in real time, and establish a communication mechanism with relevant agencies to exchange information and provide timely warnings.
A Centery of Commitment to People's Health by the Communist' Party of China
High-throughput molecular diagnostics for diarrheal pathogens and the development of an early warning system for implementation
Hu Qinghua, Li Yinghui
2021, 36(12): 1240-1246. DOI: 10.3784/jbjc.202112100638
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Brucellosis Surveillance Subject
导读
Jiang Hai
2021, 36(12): 1247-1247.
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Application of fluorescence polarization assay in diagnosis of brucellosis
Liu Jiayin, Jiang Hai, Yang Wenjie
2021, 36(12): 1248-1251. DOI: 10.3784/jbjc.202103220144
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Brucellosis is a widespread zoonotic disease and a serious public health problem in developingcountries. Rapid diagnosis and precise quarantine are the keys to the prevention and control of brucellosis. Fluorescence polarization assay (FPA) is a method approved by the World Organization for Animal Health (OIE) to detect animal brucellosis. In recent years, there have been reports of using this assay to detect human brucellosis. This article summarizes the principle of FPA, the progress in research of humans and animal brucellosis to provide a theoretical basis for the future development of FPA in China.
Epidemiological characteristics and spatial distribution of human brucellosis in Heilongjiang, 2016–2019
Yin Shihui, Tang Lei, Yu Yanling, Xing Zhifeng, Yuan Shuang, Ge Jingxue
2021, 36(12): 1252-1256. DOI: 10.3784/jbjc.202105260299
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  Objective   To understand the epidemiological characteristics and spatial distribution of human brucellosis in Heilongjiang province in recent years, and provide scientific evidence for the development of human brucellosis prevention and control strategies.   Methods   The incidence data of human brucellosis in Heilongjiang from 2016 to 2019 were collected. Excel 2016 was used for data process and descriptive epidemiological analysis. The thematic map of human brucellosis incidence was generated by software QGIS 3.8. Software GeoDa 1.16 was used for global and local spatial autocorrelation analyses.   Results   A total of 18 096 cases of human brucellosis were reported in Heilongjiang from 2016 to 2019. The annual incidence showed a fluctuating downward trend. Human brucellosis occurred all the year round during this period, and the peak of incidence was during March–July, accounting for 56.76% (10 272/18 096) of the total cases. The male to female ratio of the cases was 2.87∶1. The cases mainly occurred in age group 20–69 years, accounting for 94.71% of the total cases (17 139/18 096). The cases were mainly reported in farmers, accounting for 83.84% (15 172/18 096) of the total cases. A total of 129 counties (cities and districts) reported human brucellosis cases, and the top five counties (cities and districts) in terms of cumulative reported cases were Durbert, Nenjiang, Longjiang, Gannan and Zhaodong, with the cases accounting for 21.46% (3 884/18 096) of the total cases. The results of global spatial autocorrelation analysis showed that the annual incidence of human brucellosis in Heilongjiang was spatially clustered. Local spatial autocorrelation analysis and hotspot analysis indicated that the high incidence areas of human brucellosis in Heilongjiang were mainly in the southwest and southeast of the province.   Conclusion   The annual incidence of human brucellosis in Heilongjiang showed a fluctuating decline trend. Spring and summer were the seasons with high incidence of human brucellosis. The populations at high risk were those aged 20–60 years, males and farmers, and the areas with high incidence of human brucellosis were in the southwestern and southeastern of Heilongjiang province.
Epidemiological characteristics of human brucellosis in Liaoning province, 2016–2020
Yu Weijun, Wang Zijiang, Mao Lingling, Lei Lu, Sun Sinong, Wang Bo, Song Ge, Wang Zhouchao, Sun Yingwei
2021, 36(12): 1257-1260. DOI: 10.3784/jbjc.202110220326
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  Objective   To analyze the epidemic dynamics and regularity of human brucellosis in Liaoning province from 2016 to 2020, and provide scientific evidence for the formulation and improvement of prevention and control strategies and measures, so as to reduce the loss caused to national health and economy.   Methods   The data that the confirmed human brucellosis cases and the surveillance information of key populations with occupational exposure in Liaoning province from 2016 to 2020 were collected to describe and analyze three-dimension distribution and surveillance results.   Results   A total of 11569 confirmed human cases and 1 death were reported in 14 cities of Liaoning province during the study period. The peak incidence of brucellosis was March to August, and the disease were mainly found focused on 40 to 64 years old people, mainly in farmers. In the monitoring of key populations with occupational exposure, epidemiological investigation included 68804 people, among which 32559 were tested serologically, and 1708 were positive, with a positive rate of 5.25%. Total of 830 samples were detected by etiology, and 210 strains of Brucella were isolated.   Conclusion   The cases and incidence of brucellosis in Liaoning province increased year by year and reached a record high in 2020. The epidemic situation of human brucellosis is complicated, and the prevention and control situation of brucellosis is very grim. The strategies and measures need to be further optimized and improved.
Investigation and response of a brucellosis outbreak in Dalad, Inner Mongolia
Ta Na, Zhang Wenqiang, Mi Jingchuan, Fan Mengguang
2021, 36(12): 1261-1264. DOI: 10.3784/jbjc.202104060176
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  Objective  To understand the cause of an outbreak of brucellosis in Dalad banner of Inner Mongolia, and suggest prevention and control measures.  Methods  Epidemiological survey and laboratory test were conducted for the brucellosis outbreak in a natural village in Dalad in April 2020.  Results  Three human brucellosis cases were reported in the village from 28 February to 5 March 2020,the epidemiological survey in April found another 4 confirmed cases and 3 unapparent infection cases. and the strains of Br melitensis 1 and 3 were detected. All the patients were traced, recorded and treated, key populations were monitored, terminal spray disinfections were conducted for people living environment and livestock sheds, face to face health education was conducted for the villagers and protective materials were provided by local health sector. Strict livestock quarantine and sick animal weeding out and animal epidemic surveillance were conducted by local animal husbandry and veterinary sector.  Conclusion  The outbreak was related with the importation of sick livestock without quarantine, resulting in human infection. It is necessary to strengthen the strengthen the disease surveillance, management in sheep and sick animal weeding out, interrupt infection source and strengthen the joint prevention and control by health sector and animal husbandry and veterinary sector.
Epidemiological characteristics of brucellosis in Shaanxi, 2019 – 2020
Luo Boyan, Nie Shoumin, Sun Yangxin, Sun Jie, An Cuihong, Wang Wenjing, Fan Suoping
2021, 36(12): 1265-1269. DOI: 10.3784/jbjc.202105070252
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  Objective  To understand the epidemiological characteristics and incidence trend of brucellosis in Shaanxi province from 2019 to 2020 and provide evidence for the targeted brucellosis prevention and control.  Methods  The incidence data of brucellosis cases and outbreaks in Shaanxi from 2019 to 2020 were collected for a descriptive epidemiological analysis to understand the population, area and time distributions of brucellosis cases in Shaanxi by using software SPSS 25.0 and ArcGIS 10.8. At the same time, the characteristics of outbreaks and risk of different infection routes were also analyzed.  Results  A total of 2 254 brucellosis cases were reported in Shaanxi from 2019 to 2020, with an annual incidence rate of 2.92/100 000. The cases were mainly reported from April to September, which were mainly distributed in Guanzhong and northern Shaanxi, and there was statistically significant difference in the annual incidence rate among Guanzhong, northern Shaanxi and southern Shaanxi ( χ2=1338.771, P<0.001). Most patients were men, the difference in annual incidence rate between men and women had statistical significance (χ2=440.140, P<0.001), and most cases (71.25%) were aged 40–69 years. Farmers were mostly affected. A total of 27 outbreaks were reported during 2019–2020, involving 218 serum positive cases, including 175 cases and 43 latent infections. The small-scale outbreaks with 3–5 cases accounted for 51.85%. The places where the outbreaks occurred were mainly family farms (48.15%), the infection route of direct contact with skin and mucous membranes accounted for 44.44%. The differences in infection rate through direct contact with skin and mucous membrane, respiratory tract and digestive tract were significant (P<0.001). The relative risk of brucellosis risk through direct contact with skin and mucous membrane, respiratory tract and digestive tract were 21.257 (95% CI: 13.621–33.183), 15.408 (95% CI: 8.927–26.600) and 15.895 (95% CI: 10.117–24.957) respectively. A total of 10 273 livestock were detected, in which 349 were killed in 27 outbreaks. A total of 69 Brucella strains were isolated and identified, which were mainly Br melitensis type 3.  Conclusion  It is necessary to adhere and improve the joint prevention and control mechanism, strengthen the quarantine of sick animal and improve people′s knowledge, attitude and practice of brucellosis prevention and control to prevent and control brucellosis in Shaanxi.
Epidemiological characteristics of brucellosis in Xinjiang, 2016–2020
Cheng Xia, Muheta· Aishan, Ayixiamu· Keyoumu, Shi Guangzhong, Wang Shuo, He Haibo, Maimaitijiang· Wumaer, Zhang Haiting, Zhao Jiangshan
2021, 36(12): 1270-1273. DOI: 10.3784/jbjc.202108310475
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  Objective   To understand the epidemiological characteristics of human brucellosis in Xinjiang, and provide scientific basis for the development of the prevention and control strategies of human brucellosis in the future.   Methods   The epidemiological characteristics of brucellosis cases reported in Xinjiang from 2016 to 2020 were analyzed by using descriptive methods.   Results   From 2016 to 2010, a total of 23 045 brucellosis cases were reported in 14 prefectures in Xinjiang, mainly distributed in Yili, Changji, Tcheng and Aksu, accounting for 59.12% (13 625 cases) of the total cases. The number of reported cases showed a decreasing trend year by year, and the incidence rate decreased from 31.14/100 000 in 2016 to 10.19/100 000 in 2020. The annual incidence peak of brucellosis was during May–August, and cases were reported in all age groups, the youngest one was 1 month, the oldest one was 94 years old, the average age of the cases was 41 years , and the most cases were aged 30–50 years (66.70%). In the reported cases, there were 16 347 males and 6698 females with a gender ratio of 2.44∶1. The cases in farmers and herdsmen accounted for 68.90%.   Conclusion   The reported case number and incidence rate of brucellosis in Xinjiang decreased year by year, but the reported cases were widely distributed. It is suggested to strengthen the joint prevention and control of multiple departments and fully implement relevant prevention and control measures.
Investigation of seroepidemiology and awareness of brucellosis in mutton restaurant employees in Sichuan
Li Fan, Liu Lunguang, Wu Chaoxue, Jiang Deyong, Yue Yong, Liu Juan, Deng Yong, Chen Xi
2021, 36(12): 1274-1276. DOI: 10.3784/jbjc.202104020175
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  Objective   To understand the prevalence and awareness of brucellosis in mutton restaurant employees in Sichuan province, evaluate the reliability of brucellosis surveillance in local occupational population, and provide evidence for the prevention and control of brucellosis.   Methods   The cross sectional investigation was conducted in the counties or districts where mutton restaurants provide services all the year round in Sichuan in forms of field sampling and questionnaire survey. Venous blood sample was collected from each survey subject for Brucella antibody detection.   Results   A total of 362 questionnaires were completed and 362 blood samples were collected from the employees in 145 restaurants in 6 counties or districts of Zigong, Liangshan, Neijiang, Luzhou and Chengdu in Sichuan. Eight positive serum samples with the highest titer of 1:400 were detected in Chengdu, Zigong and Neijiang. The average positive rate was 2.21%. All the sero positive employees had no brucellosis related clinical manifestations. In the awareness survey, 85.64% of the employees had never heard of brucellosis. In terms of protective measures, 46.69% of the employees never wore masks during processing, 55.52% never wear gloves. The risk for brucellosis was higher in those who had worked in mutton restaurants for more than 5 years (χ2=7.29, P<0.05). The awareness rate of brucellosis prevention and control related knowledge was associated with the level of education; The awareness rate of brucellosis was higher in Chengdu than in other areas, the differences in awareness rate were significant among different areas (χ2=51.70, P<0.05).   Conclusion   At present, the representativeness of brucellosis surveillance sites in Sichuan is not so good, so the mutton restaurant employees should be included in the surveillance of occupational population. The health education about brucellosis in catering workers needs to be strengthened.
Duplicated reporting of brucellosis in Shaanxi, 2005–2020
Yang Guojing, Zhu Ni, Li Xinxin, Chen Sa, Cao Lei, Zhang Yi
2021, 36(12): 1277-1280. DOI: 10.3784/jbjc.202104160200
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Abstract:
  Objective  To understand the impact of duplicated reporting of brucellosis on its incidence in Shaanxi province, and improve the quality of brucellosis surveillance data.   Methods  The reporting cards of brucellosis in Shaanxi from 2005 to 2020 were collected. SQL statements called by sqldf package of software R3.5.1 were used to analyze the duplicated reporting of brucellosis.   Results  A total of 14 282 brucellosis cases were reported in Shaanxi and the number of duplicated reporting of brucellosis cases was 333. The number of duplicated reporting of brucellosis cards within a year was 216, which was higher than that in multi years (117). The overall duplicated reporting rate was 2.33%, showing an increasing trend from 2005 to 2020 except 2010. Up to 94.94% of brucellosis cases were reported twice. The number of duplicated reporting cards of brucellosis by CDCs and hospitals were higher, which were 173 (51.95%), and 156 (46.85%), respectively. The number of duplicated reporting cards of brucellosis in Yulin (253) was highest. The rates of duplicated reporting of brucellosis in Fugu, Yulin and Shenmu were higher. From 2005 to 2020, the average brucellosis incidence in Shaanxi was 2.36 per 100 000, and it decreased by 2.33% after eliminating the duplicated reporting cards.   Conclusion  From 2005 to 2020, the overall duplicated reporting rate of brucellosis in Shaanxi showed an increasing trend. The duplicated reporting of brucellosis had some influence on the brucellosis incidence in Shaanxi, especially in Fugu, Yulin and Shenmu. Therefore, it is necessary to strengthen the infectious disease reporting management and complete the system function to improve the quality of surveillance data.
Multiple locus variable-number tandem repeat analysis on Brucella isolated in Sichuan, 2015–2019
Li Wenbo, Zhou Hanhong, Yan Guodong, Hu Xinyue, Luo Chunhua, Tian Guozhong, Yang Xiaorong, Zeng Linzi, Liao Hongyu, Qi Teng, Jiang Hai
2021, 36(12): 1281-1285. DOI: 10.3784/jbjc.202104010174
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  Objective  To understand the genotype of Brucella isolated in Sichuan Province and provide scientific evidence for the prevention and control of brucellosis.  Methods  A total of 33 Brucella isolates were genotyped by multiple locus variable-number tandem repeat analysis (MLVA)-16. MLVA-8 genotype was queried by online public database, and cluster analysis of MLVA-16 was performed with UPGMA using software Bio Numerics.  Results  The Brucella isolates were divided into 29 MLVA-16 genotypes with genetic similarity ranging from 74.6% to 100.0%. There were three MLVA-8 genotypes, including 42, 43 and 83, all of which originated from the Eastern Mediterranean group, and type 42 was predominant. The Simpson's index of MLVA-8 was 0.356, while that of MLVA-16 was 0.991. MLVA-16 can be used for local outbreak investigation and sporadic case surveillance.  Conclusion  Brucella melitensis was the main pathogen causing brucellosis in Sichuan, and type 42 (MLVA-8 genotype) was the predominant genotype, consistent with strains isolated in other areas in China, suggesting that there was a correlation in incidence of brucellosis between Sichuan and provinces in northern China. For the first time, Brucella strains isolated in Sichuan were classified by MLVA, and the database constructed by them would provide basic data support for the surveillance and molecular traceability of brucellosis.
Sensitivity of Brucella melitensis isolates to antibiotics in vitro
Yang Xiaowen, Jiang Xia, An Cuihong, Sun Changyun, Li Qiaoling, Li Wenbo, Cai Yinggui, Jiang Hai
2021, 36(12): 1286-1290. DOI: 10.3784/jbjc.202105200283
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  Objective   To study the common antibiotics susceptibility of Brucella isolates.   Methods   This study used the broth dilution method to detect the minimum inhibitory concentration of clinically common drugs for brucellosis in clinical isolates.   Results   This study had been found that under the current inflection point of resistance of Brucella, the Brucella isolates were all sensitive to common antibiotics. Among these, the minimum inhibitory concentration value range of doxycycline (0.06−0.12 μg/mL), tetracycline (0.06−0.25 μg/mL) and gentamicin (0.015−0.03 μg/mL) was relatively low; Analyzing the isolated ampicillin MIC values, this study found that Sichuan Province and Shaanxi Province (P=0.0001), Hebei Province (P=0.0001) and Hunan Province (P=0.04) were significantly difference, and Hebei Province and Guangdong Province (P=0.02) were significant difference. In addition, this study also found isolates with higher minimum inhibitory concentration values of erythromycin (32 μg/mL) and compound trimethoprim (0.25/4.8 μg/mL).   Conclusion   The Brucella isolates in China involved in this study were sensitive to common clinical treatment drugs. However, some isolates were less sensitive to compound trimethoprim. Therefore, follow-up surveillance should be strengthened to prevent bacterial resistance. This study provided basic data for the monitoring of the resistance level of Brucella in China, and at the same time provided ideas for the screening, prevention and control of resistant strains.
COVID-19 Analysis
Pathogen spectrum in lower respiratory tracts of suspected case infected with SARS-CoV-2
Gu Lin, Song Yanyan, Zhang Shiyao, Hao Min, Li Li, Li Qian, Sun Lingli
2021, 36(12): 1291-1294. DOI: 10.3784/jbjc.202012230431
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Abstract:
  Objective  To understand the pathogen spectrum in the lower respiratory tracts of 100 suspected cases infected with SARS-CoV-2 in Chaoyang district of Beijing from January to March, 2020.  Methods  A total of 28 kinds of respiratory pathogens were detected by real-time fluorescent quantitative polymerase chain reaction (PCR), including 14 viruses and 11 bacteria, as well as Mycoplasma pneumoniae, Chlamydia pneumoniae and fungi.  Results  The positive rate of nucleic acid of detected pathogens in 100 sputum samples of the suspected cases was 72.00% (72/100). The positive rate of SARS-CoV-2 was 15.00% (15/100). The positive rates of gram-negative bacteria, gram-positive bacteria, fungi, Mycoplasma pneumoniae and Chlamydia pneumoniae were 32.00% (32/100), 24.00% (24/100), 39.00% (39/100), 6.00% (6/100) and 3.00% (3/100), respectively. Influenza A virus, influenza B virus, adenovirus, respiratory syncytial virus and rhinovirus were also detected. A total of 13 samples were positive with both SARS-CoV-2 and other pathogens.  Conclusion  The pathogens detected in the lower respiratory tracts of 100 suspected cases infected with SARS-CoV-2 in Chaoyang from January to March in 2020 was diverse. Fungi, SARS-CoV-2, Staphylococcus aureus and Haemophilus influenzae were the main pathogens. S. aureus and fungi were the main co-infected pathogens detected in the lower respiratory tracts of suspected SARS-CoV-2 infection cases.
Simulation study of incidence and spread of COVID-19 epidemic under routine prevention and control
Lei Jinzhi, Xu Chuang, Liu Shengqiang, Pei Yongzhen
2021, 36(12): 1295-1301. DOI: 10.3784/jbjc.202101230038
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Abstract:
  Objective  To explore the routine prevention and control measures for COVID-19 and to evaluate the epidemic spread in different simulated emergency status through an established computational model based on contact network and individual state changes, and provide theory evidence and method for the prevention and control of COVID-19 and epidemic prediction.  Methods  The impacts of close contact isolation and secondary close contact isolation on the prevention and control of COVID-19 were evaluated based on an individual based model. The dynamics of the epidemic in the context of sporadic cases, cluster, or continuous case importation under routine prevention and control were studied through model simulation, respectively.  Results  Model simulations showed that the effect of the secondary close contact isolation was obvious, which could greatly reduce the epidemic level compared with close contact isolation alone. According to model simulation, the proposed prevention and control strategy can effectively control the epidemic caused by sporadic cases, clusters, and continuous imported cases.  Conclusion  Based on the model simulation of epidemic spread under different status, the effect of COVID-19 epidemic prevention and control by routine measures was evaluated, indicating that secondary close contact quarantine is necessary to control the disease spreading, and it is suggested to conduct early isolation of close contacts as early as possible after the epidemic occur in the routine prevention and control of COVID-19.
Infectious Disease Surveillance
Influenza-like illness and etiological surveillance in Zhenjiang, Jiangsu, 2013–2020
Sun Lina, Yuan Zhaohu, Liu Jin, Miao Chunhua
2021, 36(12): 1302-1307. DOI: 10.3784/jbjc.202102220084
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Abstract:
  Objective  To understand the epidemiological and etiological characteristics of influenza-like illness (ILI) in Zhenjiang, Jiangsu province, during 2013–2020, and provide scientific basis for the prevention and control of influenza.  Methods  ILI surveillance system consisting of influenza surveillance sentinel hospitals and influenza laboratory network in Zhenjiang was used to collect the surveillance data of ILI cases and pathogens in Zhenjiang from 2013 to 2020 for a statistical analysis.  Results  A total of 207 252 ILI cases were reported by sentinel hospitals in Zhenjiang during 2013–2020, and the average ILI% during 2013–2020 was 3.50%, showing an increase trend (trend χ2=30554.00, P<0.001). The ILI cases in age groups 0–4, 5–14, 15–24, 25–59 and ≥60 years accounted for 39.91%, 27.53%, 7.40%, 17.93%, 7.23% respectively. There were two peaks of ILI% in the same influenza surveillance year, December-February and June-September. A total of 25 318 ILI samples were tested in Zhenjiang during 2013–2020, in which 2 780 were influenza virus positive (10.98%). The detection rate of influenza A virus (7.08%) was higher than influenza B virus (3.90%). Influenza A (H1N1) virus was mainly detected during January-March, influenza A (H3N2) was mainly detected during July-December, influenza B virus Victoria lineage was mainly detected during April-June, and influenza B virus Yamagata lineage was mainly detected during January-March. There were two types of influenza virus epidemics, one was caused by single influenza virus, and another one was caused by multi influenza viruses. A total of 39 ILI outbreaks were reported during 2013–2019 in Zhenjiang, in which 37 occurred in schools and child care settings, no ILI outbreak was reported in 2020. During COVID-19 epidemic period in 2020, the ILI% (6.82%) was 125.08% higher than the average during 2013–2019 (3.03%), and the increase was highest in age group ≥60 years (176.61%). The positive rate of influenza virus was 52.21% in January, 11.20% in February, 0.37% in March, 0 in April-December in 2020, the positive rate in 2020 (5.37%) was 54.41% lower than the average during 2013–2019 (11.79%).  Conclusion  It is necessary to strengthen the prevention and control of influenza according to the epidemiological characteristics of ILI and influenza virus in Zhenjiang. The prevention and control measures for COVID-19 can be used for reference.
Characteristics of tuberculosis cases detected by large-scale active screening in the elderly in rural area of Quzhou, Zhejiang
Wang Wei, Hao Xiaogang, Zhu Ping
2021, 36(12): 1308-1311. DOI: 10.3784/jbjc.202101270049
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Abstract:
  Objective  To analyze the demographic and clinical characteristics of pulmonary tuberculosis (TB) cases detected through active screening in elderly population in rural area of Quzhou, Zhejiang province and discuss the prevention and control strategies of pulmonary TB.  Methods  In physical examination for rural residents, chest X-ray examinations were performed for elderly people aged 65 years and over in rural area of Quzhou. Descriptive epidemiological analyses were conducted for the pulmonary TB cases detected in the elderly in the active screening.  Results  A total of 186 096 people were actively screened and 174 cases of active TB were detected, with a detection rate of 93.50/100 000. Among elderly pulmonary TB cases, 66.67% were pathogenic positive, 30.46% showed cavities in the lungs on imaging examination, 42.53% had clinical symptoms of pulmonary TB, and 68.39% had no chest imaging in the past 5 years. There were significant differences in the detection rate of pulmonary TB and the age specific positive rates of the pathogen between men and women.  Conclusion  It is necessary to include chest X-ray examination in the basic elderly health management services in areas with high prevalence of pulmonary TB in the elderly. Active screening, can facilitate the early detection TB cases in elderly population to prevent further transmission.
Effect of prevention and control measures of a norovirus infectious outbreak based on dynamic model
Yu Guolong, Chen Tianmu, Zhu Yuanzhao, Shi Rongjie, Liu Fengren, Ye Bili, Liu Feng, Lin Haiduan
2021, 36(12): 1312-1318. DOI: 10.3784/jbjc.202103040101
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Abstract:
  Objective  To use a dynamic model to simulate the prevention and control effects of different interventions in the management of norovirus infection outbreaks, and explore the best prevention and control methods.   Methods  According to the natural history of norovirus infectious, a SEIAR model was establish to analyze the effects of isolation, class suspension and vomit disposal in a norovirus infection outbreak.   Results  Without intervention, the basic reproduction of this outbreak (R0) of the epidemic would be 9.63 and the epidemic would lasted for 4 days. The population infection rate was 97.38%. If the isolation measures were taken, the later the measures were implemented, the more infections occurred, and the duration would has no obvious change. If the isolation started in the afternoon of the second day after the outbreak, the scale of the epidemic would be close to the scale of that without intervention, and the isolation measure would fail. If the class suspension was taken on the second day after the outbreak (the actual start of class suspension), the number of infections and the duration of the epidemic would close to the actual ones, if the class suspension started on the second day afternoon after the outbreak, the epidemic scale would be very close to that under no intervention, and the suspension would fail. Taking no disinfection measures had no influence on the epidemic scale. As the disinfection was strengthened, the number of infections decreased, When the disinfection effect reached more than 90%, there were nearly no cases reported.   Conclusion  When an outbreak of norovirus infectious occurred, the control effect would be better if prompt case isolation and class suspension are implemented, and the standardized disposal of case vomit is needed. The SEIAR model established in this study can be used to evaluate the effect of prevention and control measures such as isolation and class suspension.
Experiment Research
Detection of Staphylococcus succinus strains isolated from mice of natural death from Sonid Left Banner
Bai Xuefeng, Wu Caixia, Ding Shaohuan, Ren Guangjun, Xu Rune, Maowuliji, Fan Mengguang, Xia Lianxu, Wang Yanhua
2021, 36(12): 1319-1323. DOI: 10.3784/jbjc.202112070470
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Abstract:
  Objective  To explore the cause of the mass death of Meriones unguiculatus from Sunite Left Banner in 2019 through the laboratory testing.   Methods  After all mice of natural death were dissected, their organs were inoculated on Hirsch medium and cysteine heart agar media enriched with blood(CHAB). Being considered not to be Yersinia pestis, the isolate was inoculated on CHAB supplemented with antibiotics, and tested by Francisella tularensis-specific antigen latex agglutination. Secondly, for all isolates DNA was extracted, and then amplified using universal primers of 16S rRNA gene. The PCR products amplified with target fragment were sequenced, and then their nucleotide sequences obtained were aligned and performed phylogenetic analysis with published 16S rRNA gene sequences of Staphylococcus succinus online. In addition, the experimental mice were infected with the S. succinus suspension, and their mental and physical conditions were observed within 14 days.   Results  All isolated strains did not grow on the selective medium for F. tularensis and were negative for F. tularensis-specific antigens in latex agglutination, so they were not F. tularensis. After sequencing and alignment of 16S rRNA gene, all isolates were identified as 4 strains of S. succinus, 1 strain of Lactobacillus reuteri, L. vaginalis and Enterococcus faecalis. The phylogenetic analysis indicated that 3 strains of S. succinus obtained in this study were clustered with 9 from the rest of the world on the clade of the major lineage. The rest strain of S. succinus was assigned to a clade with that from Xinjiang. Through the experimental mouse infected model it was found that the minimum lethal dose of S. succinus is 5×108 CFU/mL, and the sublethal dose is 108 CFU/mL.   Conclusion  For the first time, the strains of S. succinus were isolated from mice of natural death from Sonid Left Banner in Inner Mongolia Autonomous Region. It is speculated that infection of S. succinis may be the cause of mass death of local Meriones Unguiculatus.
Drug Resistance Monitoring
Drug resistance characteristics of Diarrheagenic Escherichia coli isolated from patients with diarrhea in Shunyi district of Beijing, 2013–2019
Wang Yuanyuan, Lin Fan, Wang Miao, Kang Ying, Li Ying, Ma Hongmei
2021, 36(12): 1324-1330. DOI: 10.3784/jbjc.202102190075
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Abstract:
  Objective  To study the drug resistance characteristics of Diarrheagenic Escherichia coli (DEC) isolated from patients with diarrhea in two sentinel hospitals in Shunyi district of Beijing during 2013–2019.  Methods  Stool samples of diarrhea patients were collected in the two sentinel hospitals during this period. Isolation, bacterial identification and PCR typing were conducted for DEC strains. Antimicrobial susceptibility tests were carried out using micro broth method to analyze the drug resistance characteristics of the isolated strains, including resistance rate, non-sensitive rate, multi-drug resistance rate and drug resistance spectrum.  Results  The detection rate of DEC in diarrhea patients was 9.53% (232/2434). The proportions of Enterotoxic Escherichia coli (ETEC), Enteropathogenic Escherichia coli (EPEC), and Enteroaggregative Escherichia coli (EAEC) were 56.47% (131/232), 27.16% (63/232) and 16.38% (38/232), respectively. The multi-drug resistance rates of DEC with 90 drug resistance spectrum, ETEC with 36 drug resistance spectrum, EPEC with 42 drug resistance spectrum, and EAEC with 23 drug resistance spectrum were 33.19% (77/232), 17.56% (23/131), 58.73% (37/63), 44.74% (17/38), respectively. Antibacterial drugs with resistance rate ≥30% included nudicacid (NAL) and ampicillin (AMP) for ETEC; AMP, tetracycline (TET), sulfamethoxazole tablets (SXT), sulfamethoxazole (Sul), NAL for EPEC; NAL, AMP, SXT, Sul, TET for EAEC. A comparison of the differences in the antimicrobial susceptibility tests during 2013–2016 and during 2017–2019 found that the resistance of ETEC to AMP, cefazolin (CFZ), TET, cefepime (FEP), aztreonam (AZM), and ampicillin/sulbactam (AMS) increased, while the resistance to Sul decreased; the resistance of EPEC to gentamicin (GEN) decreased; the resistance of EAEC to cefotaxime (CTX), GEN, and doxycycline (DOX) decreased.  Conclusion  Among the diarrhea cases in Shunyi, the intensity of DEC spread was high, and the spread and the drug resistances of ETEC, EPEC and EAEC had unique characteristics. The drug resistance was serious, to which close attention should be paid.
STD/AIDS Surveillance
HIV infection status and influencing factors in men who have sex with men receiving the first and non-first HIV testing in Taizhou, Zhejiang, 2016–2020
Mei Huijuan, He Chunyan, Li Jing, Li Guixia, Wang Yanling, Xu Yuanyuan, Shen Weiwei, Weng Jian, Chen Xiaoxiao
2021, 36(12): 1331-1336. DOI: 10.3784/jbjc.202102070064
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Abstract:
  Objective  To understand the HIV infection status and the influencing factors in men who have sex with men (MSM) receiving the first and non-first HIV-test in Taizhou, Zhejiang province, from 2016 to 2020.  Methods  A cross-sectional study was conducted in MSM selected through through snowball sampling, health education and field recruitment in Taizhou during 2016–2020 according to the requirements of the national HIV sentinel surveillance protocol.  Results  A total of 1 870 MSM with mean age of (34.99±13.39) years were surveyed and included in the analysis, in whom, 27.4% (505/1 870) received the first HIV testing in this survey. The positive rates of HIV in the MSM receiving the first and non-first HIV testing were 13.7% and 8.4%, respectively, the difference was significant ( χ2=11.40, P<0.001). Among MSM who received the first HIV testing, the HIV positive rate was lower in those with senor high school, secondary technical school and college and higher education levels than in those with junior high school or lower education levels (OR=0.46, 95% CI: 0.23–0.92, P=0.029; OR=0.37, 95% CI: 0.16–0.84, P=0.017) and in those without STD diagnoses than in those with STD diagnosis in last year STD (OR=0.29, 95% CI: 0.09–0.92, P=0.036), but the HIV positive rate was higher in samples from volunteer consulting and surveillance sites than in samples obtained at bars/dance clubs/tea rooms/clubs (OR=2.35, 95% CI: 1.21–4.56, P=0.011) and in MSM who received no HIV prevention services than in those who received HIV prevention services (OR=1.83, 95% CI: 1.07–3.11, P=0.026).  Conclusion  The risk of HIV infection was higher in MSM who received HIV testing for the first time in Taizhou. It is necessary to strengthen the HIV counseling and sentinel surveillance for MSM with lower education level and history of STDs.
Chronic Noncommunicable Disease Surveillance
Risk factors of depression in elderly diabetic patients in the community
Zhang Xiujuan, Li Haihui, Gao Xin, Yang Huan, Yin Zhaoxue
2021, 36(12): 1337-1340. DOI: 10.3784/jbjc.202111230610
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Abstract:
  Objective  To explore risk factors of depression among the elderly diabetic patients in the community.   Methods  All elderly diabetic patients (n=714) from the baseline survey of community-based Healthy Aging Evaluation Longitudinal Study in China (HAELS) were included, information including socio-demographic variables, behavior and lifestyles, food intake, treatment for diabetes and prevalence of other disease was collected, physical examination was conducted, and depression status was assessed using the Geriatric Depression Scale (GDS). Multiple linear regression models and logistic regression models were run to analyze the potential risk factors.   Results  Both multiple linear regression models and logistic regression models showed, high education level, married marriage status, self-reported high wealth rank and adherence to physical exercise were all protective factors; while sleep disorder and insulin treatment were all risk factors, with OR (95%CI) of 3.08 (2.10–4.51) and 1.66 (1.09–2.52), respectively.   Conclusion  The risk factors of depression in diabetic patients were very complicated, including education level, marital status, self-reported wealth rank, adherence to physical exercise, sleep disorder and insulin treatment.
Cardio-cerebral Vessels Disease Surveillance
Data quality of acute stroke and myocardial infarction events registry in China, 2015–2019
Yan Liuxia, Chen Xiaorong, Qin Yu, Gong Weiwei, Shi Weiwei, Li Qian, He Yujin, Wu Jing
2021, 36(12): 1341-1346. DOI: 10.3784/jbjc.202101130020
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Abstract:
  Objective  To evaluate the data quality of acute stroke and myocardial infarction (MI) events records in China.  Methods  Ten surveillance hospitals in Hebei, Jiangsu, Zhejiang, Hubei and Sichuan provinces were selected for this study. Stroke and MI event records reported between January 2015 and December 2019 were selected by quota sampling in each hospital. Data for stroke and MI event records were obtained from 'National Surveillance System for Chronic Disease, China Center for Disease Control and Prevention'. The completeness and accuracy of the event records were verified according to the electronic health records via a self-developed online quality assessment system.  Results  A total of 2184 acute stroke records were evaluated and data were 100.00% complete for the key variables. The consistency of key variables between the reported and the actual records were 79.21%–95.15%. A total of 2 062 acute stroke events were verified, the average positive predictive value was 94.41%, ranging from 93.07% to 96.14%. During 2015–2019, the accuracy of key variables of stroke reports significantly increased (P<0.001). A total of 699 acute MI event records were evaluated and all the data were completed. The consistency of key variables between the reported and the actual records were 75.10%–95.42%. A total of 668 acute MI events were verified, the average positive predictive value was 95.57%, ranging from 92.86% to 97.45%. During 2015–2019, the completeness of diagnostic criteria and the accuracy of key variables of acute MI reports significantly increased (P<0.001).  Conclusion  The completeness of stroke and MI events reports were high in China during 2015–2019, and the report accuracy gradually increased, yet false positive reports still existed. It is necessary to strengthen the standardized reporting of stroke and MI events.
Adolescent Vision Health Monitoring
Prevalence of myopia in school students in Yuyao, Zhejiang
Zhang Yi, Zhou Gaoxiang, Miao Chao, Shi Yafeng
2021, 36(12): 1347-1350. DOI: 10.3784/jbjc.202101190031
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Abstract:
  Objective  To understand the prevalence of myopia in school students in Yuyao, Zhejiang province, and provide the scientific basis for further prevention and control of myopia in students.  Methods  A cross-sectional study of myopia was carried, all the students in Yuyao received visual acuity and refraction tests.  Results  A total 109088 students were surveyed by using questionnaire in Yuyao with 104 800 valid questionnaires returned. The prevalence rate of myopia in the students was 51.96%. The prevalence rate was significantly higher in girl students than in boy students (H=345, P<0.01). The prevalence rate in Han ethnic students was significantly higher than that in students in other ethnic groups (H=663, P<0.01). The prevalence rate of students in public schools was significantly lower than that of students in private schools(H=122, P<0.01). The prevalence rate was significantly higher in urban students than in rural students (H=1182, P<0.01). Senior high students had highest prevalence rate of myopia, followed by vocational senior high school students, junior high school students and primary school students. With the increase of school age, the prevalence rate of myopia also increased significantly (r=0.90). In low school aged students (1–6 years), mild myopia was common, while in high school aged students (7–12 years), moderate and severe myopia were common.  Conclusion  The prevalence of myopia was higher in students in Yuyao, with a younger age and severity trend. In order to reduce the prevalence of myopia in students, it is necessary to take further comprehensive intervention measures.
Overseas Dynamic
Update on excess deaths associated with the COVID-19 pandemic—United States, January 26, 2020—February 27, 2021
Gong Zhenyu, Gong Xunliang
2021, 36(12): 1351-1352. DOI: 10.3784/jbjc.202105050244
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Abstract:
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