Evaluation of scrub typhus diagnosis in China:analysis of nationwide surveillance data from 2006 to 2016

Background:Scrub typhus is a life-threatening disease caused by O rientia tsu tsu gom u sh i,and specific antimicrobial medicine is available.Early and accurate diagnosis is essential for reducing the risk of severe complications and death.In this study,we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China,and the results will benefit both clinical practice and the disease surveillance system.Methods:We extracted individual scrub typhus case data 2006-2016 from a national disease surveillance system in China.The diagnosis category and interval time from illness onset to diagnosis were compared among three levels of medical care institutions and provinces.The descriptive analysis method was performed in our study.Results:During the 11-year study period,93481 scrub typhus cases,including 57 deaths,were recorded in the nationwide surveillance system.The overall proportion of laboratory-confirmed cases was only 4.7%,and this proportion varied greatly among primary medical centres(2.8%),county level hospitals(4.2%),and city level hospitals(6.3%).Notably,the proportion of laboratory-confirmed cases has consistently decreased from 16.3%in 2006 to 2.6%in 2016,and the same decreasing trend was found among all three levels of medical care institutions.The interval from illness onset to case diagnosis(Tdiag)for all cases was 5 days(interquartile range[IQR]:2-9 days)and decreased from 7 days(IQR:3-11 days)in 2006 to 5 days(IQR:2-8 days)in 2016.The risk of death for patients with a Tdiag of>7 days was 2.2 times higher(OR=22),(95%CI:1.05-5.21)than that of patients with a Tdiag of<2 days.Conclusions:The interval time from illness onset to diagnosis for scrub typhus cases decreased greatly in China;however,the diagnosis rate of cases with laboratory-confirmed results must be increased among all levels of medical care institutions to reduce both the risk of death and the misuse of antibiotics associated with scrub typhus.

Comparative evaluation of the diagnosis, reporting and investigation of malaria cases in China, 2005–2014: transition from control to elimination for the national malaria programme

Background:The elimination of malaria requires high-quality surveillance data to enable rapid detection and response to individual cases.Evaluation of the performance of a national malaria surveillance system could identify shortcomings which,if addressed,will improve the surveillance program for malaria elimination.Methods:Case-level data for the period 2005–2014 were extracted from the China National Notifiable Infectious Disease Reporting Information System and Malaria Enhanced Surveillance Information System.The occurrence of cases,accuracy and timeliness of case diagnosis,reporting and investigation,were assessed and compared between the malaria control stage(2005–2010)and elimination stage(2011–2014)in China's Mainland.Results:A total of 210730 malaria cases were reported in China's Mainland in 2005–2014.The average annual incidence declined dramatically from 2.5 per 100000 people at the control stage to 0.2 per 100000 at the elimination stage,but the proportion of migrant cases increased from 9.8%to 41.0%.Since the initiation of the National Malaria Elimination Programme in 2010,the overall proportion of cases diagnosed by laboratory testing consistently improved,with the highest of 99.0%in 2014.However,this proportion was significantly lower in non-endemic provinces(79.0%)than that in endemic provinces(91.4%)during 2011–2014.The median interval from illness onset to diagnosis was 3 days at the elimination stage,with one day earlier than that at the control stage.Since 2011,more than 99%cases were reported within 1 day after being diagnosed,while the proportion of cases that were reported within one day after diagnosis was lowest in Tibet(37.5%).The predominant source of cases reporting shifted from town-level hospitals at the control stage(67.9%cases)to city-level hospitals and public health institutes at the eliminate stage(69.4%cases).The proportion of investigation within 3 days after case reporting has improved,from 74.6%in 2010 to 98.5%in 2014.Conclusions:The individual case-based malaria surveillance system in China operated well during the malaria elimination stage.This ensured that malaria cases could be diagnosed,reported and timely investigated at local level.However,domestic migrants and overseas populations,as well as cases in the historically malarial non-endemic areas and hard-to-reach area are new challenges in the surveillance for malaria elimination.

Non-monotonous Sequential Subgradient Projection Algorithm for Convex Feasibility Problem

The existing methods of projection for solving convex feasibility problem may lead to slow conver- gence when the sequences enter some narrow＂corridor＂ between two or more convex sets. In this paper, we apply a technique that may interrupt the monotonity of the constructed sequence to the sequential subgradient pro- jection algorithm to construct a nommonotonous sequential subgradient projection algorithm for solving convex feasibility problem, which can leave such corridor by taking a big step at different steps during the iteration. Under some suitable conditions, the convergence is proved.We also compare the numerical performance of the proposed algorithm with that of the monotonous algorithm by numerical experiments.

Erratum to:Comparative evaluation of the diagnosis,reporting and investigation of malaria cases in China,2005-2014:transition from control to elimination for the national malaria programme

Erratum After publication of this article[1]it was noticed that the wrong figure was used for Fig.3.Please see the correct Fig.3 below.