Characterization of Avian Influenza A(H7N9) Virus Prevalence in Humans and Poultry in Huai′an,China：Molecular Epidemiology,Phylogenetic,and Dynamics Analyses

Objective To trace the source of human H7N9 cases in Huai＇an and elucidate the genetic characterization of Huai＇an strains associated with both humans and birds in live poultry market.Methods An enhanced surveillance was implemented when the first human H7N9 case was confirmed in Huai＇an.Clinical specimens,cloacal swabs,and fecal samples were collected and screened by real-time reverse transcription-polymerase chain reaction（RT-PCR） for H7N9 virus.The positive samples were subjected to further RT-PCR and genome sequencing.The phylodynamic patterns of H7N9 virus within and separated from Huai＇an and evolutionary dynamics of the virus were analyzed.Results Six patients with H7N9 infection were previously exposed to live poultry market and presented symptoms such as fever（〉38.0 °C） and headaches.Results of this study support the hypothesis that live poultry markets were the source of human H7N9 exposure.Phylogenetic analysis revealed that all novel H7N9 viruses,including Huai＇an strains,could be classified into two distinct clades,A and B.Additionally,the diversified H7N9 virus circulated in live poultry markets in Huai＇an.Interestingly,the common ancestors of the Huai＇an H7N9 virus existed in January 2012.The mean nucleotide substitution rates for each gene segment of the H7N9 virus were（3.09-7.26）×10-3 substitutions/site per year（95% HPD：1.72×10-3 to 1.16×10-2）.Conclusion Overall,the source of exposure of human H7N9 cases in Huai＇an was live poultry market,and our study highlights the presence of divergent genetic lineage of H7N9 virus in both humans and poultry specimens in Huai＇an.

中国淮安地区2009年至2011年恶性肿瘤的发病率及死亡率分析(英文)

Objective: The aim of the study was to investigate the cancer incidence and mortality in Huai'an area, China, from 2009 to 2011. Methods: The data about cancer incidence and mortality were provided by Huai'an Cancer Registry, China. In- cidence and mortality rates, and standardized rates were calculated by age, gender, areas (urban and rural areas of Huai'an) and cancer sites. Results: The crude incidence rate for all cancer sites was 205.60/10 5 and the standardized incidence rate was 166.22/10 5 . Both the crude and standardized rates were higher in urban area than in rural area for both sexes. The inci- dence rates increased in people aged 40 and over, and the peak ages of incidence were between 70-75 in both males and females. The crude mortality rate for all cancer sites was 153.88/10 5 and the standardized mortality rate was 122.14/10 5 . Both the crude and standardized rates were similar in urban and rural areas for both men and women. The mortality rates were at low level under the age 50 in both sexes, but increased after the age 50, reaching the peak at the ages of 80-85 in both males and females. The top 10 most common cancer sites in rank were esophagus, stomach, lung, liver, colon-rectum, breast, pancreas, cervix uteri, brain and central nervous system, and leukemia, accounting for 87.56% of all cancers. The top 10 most leading causes of cancer death in order were cancers of esophagus, lung, liver, stomach, colon-rectum, pancreas, brain and central nervous system, leukemia, breast and lymphoma, accounting for 90.53% of all cancer deaths. Conclusion: Cancer is one kind of major diseases threatening people's health in Huai'an area, China. Cancer prevention and control should be enhanced, especially for esophageal cancer.

Impact of multiple policy interventions on the screening and diagnosis of drug-resistant tuberculosis patients:a cascade analysis on six prefectures in China

Background:The detection of drug-resistant tuberculosis(DR-TB)is a major health concern in China.We aim to summarize interventions related to the screening and detection of DR-TB in Jiangsu Province,analyse their impact,and highlight policy implications for improving the prevention and control of DR-TB.Methods:We selected six prefectures from south,central and no「th Jiangsu Province.We reviewed policy documents between 2008 and 2019,and extracted routineTB patient registration data from theTB Information Management System(TBIMS)between 2013 and 2019.We used the High-quality Health System Framework to structure the analysis.We performed statistical analysis and logistic regression to assess the impact of different policy interventions on DR-TB detection.Results:Three prefectures in Jiangsu introduced DR-TB related interventions between 2008 and 2010 in partnership with the Global Fund to Fight AIDS,Tuberculosis and Malaria(the Global Fund)and the Bill&Melinda Gates Foundation(Gates Foundation).By 2017,all prefectures in Jiangsu had implemented provincial level DR-TB policies,such as use of rapid molecular tests(RMT),and expanded drug susceptibility testing(DST)for populations at risk of DR-TB.The percentage of pulmonary TB cases con firmed by bacteriology in creased from 30.0%in 2013 to over 50.0%in all prefectures by 2019,indicating that the implementation of new diagnostics has provided more sensitive testing results than the traditional smear microscopy.At the same time,the proportion of bacteriologically confirmed cases tested for drug resistance has increased substantially,indicating that the intervention of expanding the coverage of DST has reached more of the population at risk of DR-TB.Prefectures that implemented interventions with support from the Global Fund and the Gates Foundation had better detection performance of DR-TB patiens compared to those did not receive external support.However,the disparities in DR-TB detection across prefectures significantly narrowed after the implementation of provincial DR-TB polices.Con elusions:The introduction of new diagnostics,including RMT,have improved the detection of DR-TB.Prefectures that received support from the Global Fund and the Gates Foundation had better detection of DR-TB.Additionally,the implementation of provincial DR-TB polices led to improvements in the detection of DR-TB across all prefectures.