Decreasing Trends in the Incidence of Age-and Sex-specific Hepatitis A Virus Infection in Hunan Province,China,from 2004-2020:A Joinpoint Analysis

Hepatitis A virus(HAV)is transmitted via the fecal-oral route,causing not only self-limited infectious hepatitis,but also epidemics through close personal contact(s).HAV infection is prevalent worldwide,and it is estimated that HAV infections account for 1.4 million sporadic or epidemic cases per year worldwide[1].

Interspecies Phylogenetic Analysis of Clonorchis sinensis in High-incidence Areas of Hunan Province, China

Objective This study aims to investigate the infection of Clonorchis sinensis(C.sinensis)in highincidence areas of Hunan Province,China.The phylogenetic analysis of the C.sinensis species in the highly infected areas was carried out.Method Infection of the definitive human host and intermediate fish host by C.sinensis was investigated,and the mitochondrial genes cox1 and Nad1 were used as genetic markers for phylogenetic analysis.Results In 2016–2020,the average population infection rate of Hunan was 1.38%,while in Tongdao County the rate was up to 26.90%,and the highest fish infection rate was detected in Qiyang County(99.44%in the dorsal fin of crucian carp).High genetic sequence similarity was observed in the samples from Qiyang and Lengshuitan which exhibited high homology with those from Guangdong and Gansu,whereas the parasitic species from Tongdao was highly homologous with those located in high-latitude areas.Moreover,no significant difference was found in the gene sequence of the parasitic species in definitive hosts dogs and cats.Conclusion The systematically study of C.sinensis infection in the high-incidence areas will contribute greatly to the prevention and effectively controlling the spread of Clonorchis sinensis in Hunan Province The endemic of C.sinensis infection in Hunan Province is the result of co-action of local and foreign parasite species.

Phylogenetic and Molecular Analysis of an H7N7 Avian Influenza Virus Isolated in East Dongting Lake in 2012

Objective In March 2012, an H7N7 subtype avian influenza virus （AIV） named A/wild goose/Dongting/PC0360/2022 （H7N7） （DT/PC0360） was recovered from a wild goose in East Dongting Lake. We performed whole-genome sequencing of the isolate, and analyzed the phylogenetic and molecular characterization. Methods RNA was extracted from environment samples （including fecal samples from wild bird or domestic ducks, and water samples） for detecting the presence of Influenza A Virus targeting Matrix gene, using realtime RT-PCR assay. The positive samples were performed virus isolation with embryonated eggs. The subtype of the isolates were identified by RT-PCR assay with the HI-HI6 and N1-N9 primer set. The whole-genome sequencing of isolates were performed. Phylogenetic and molecular characterizations of the eight genes of the isolates were analyzed. Results Our results suggested that all the eight gene segments of DT/PC0360 belonged to the Eurasian gene pool, and the HA gene were belonged to distinct sublineage with H7N9 AIV which caused outbreaks in China's Mainland in 2013. The hemagglutinin cleavage site of HA of DT/PC0360 showed characterization of low pathogenic avian influenza virus. Conclusion Strengthening the surveillance of AlVs of wild waterfowl and poultry in this region is vita for our knowledge of the ecology and mechanism of transmission to prevent an influenza pandemic.

Emergency Response for a Laboratory Biosafety Incident

On December 14, 2017, a faculty member of a university in Hunan Province reported that an anthrax vaccine strain might have recovered virulence during an undergraduate experiment and potential exposure could not be ruled out for the students involved. Upon receiving the case report, the CDC, health bureaus, and local governments at the county, prefectural, and provincial levels promptly organized experts in different fields (including epidemiologists, biosafety experts, and laboratory testing experts) for case investigation, evaluation, and response. As the investigation results showed, no virulence recovery was identified in the involved anthrax vaccine strain;and no contamination of Bacillus anthracis was detected at the involved areas. Thus, the university returned to normal functioning.

Transmission Dynamics and Epidemiological Characteristics of the SARS-CoV-2 Delta Variant ― Hunan Province, China, 2021

Monitoring changes in the epidemiologic features between different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants is key to understanding the evolution of viral fitness in the host population.Here,we analyzed a successfully contained local outbreak of the Delta variant that took place in Hunan,China,in July–August,2021.Detailed data on SARS-CoV-2 infections and their contacts were collected during the outbreak.By leveraging these data,we estimated key epidemiological parameters,including the incubation period,serial interval,and generation time.We constructed a generalized linear mixed-effects model(GLMM)to quantify risk factors for Delta infection and transmission.Between July 28 and August 15,2021,a total of 129 infections and their 2,118 close contacts were identified during the outbreak in Hunan Province.

Genetic Variation of Multiple Serotypes of Enteroviruses Associated with Hand, Foot and Mouth Disease in Southern China

Enteroviruses(EVs)species A are a major public health issue in the Asia–Pacific region and cause frequent epidemics of hand,foot and mouth disease(HFMD)in China.Mild infections are common in children;however,HFMD can also cause severe illness that affects the central nervous system.To molecularly characterize EVs,a prospective HFMD virological surveillance program was performed in China between 2013 and 2016.Throat swabs,rectal swabs and stool samples were collected from suspected HFMD patients at participating hospitals.EVs were detected using generic real-time and nested reverse transcription-polymerase chain reactions(RT-PCRs).Then,the complete VP1 regions of enterovirus A71(EV-A71),coxsackievirus A16(CVA16)and CVA6 were sequenced to analyze amino acid changes and construct a viral molecular phylogeny.Of the 2836 enrolled HFMD patients,2,517(89%)were EV positive.The most frequently detected EVs were CVA16(32.5%,819),CVA6(31.2%,785),and EV-A71(20.4%,514).The subgenogroups CVA16B1 b,CVA6D3 a and EV-A71C4 a were predominant in China and recombination was not observed in the VP1 region.Sequence analysis revealed amino acid variations at the 30,29 and 44 positions in the VP1 region of EV-A71,CVA16 and CVA6(compared to the respective prototype strains Br Cr,G10 and Gdula),respectively.Furthermore,in 21 of 24(87.5%)identified EV-A71 samples,a known amino acid substitution(D31 N)that may enhance neurovirulence was detected.Our study provides insights about the genetic characteristics of common HFMD-associated EVs.However,the emergence and virulence of the described mutations require further investigation.

Study on a New Ultraviolet Sterilizer to the Surface Disinfection of the Ultrasound Probe

We studied the disinfection effect of a new ultraviolet （UV） sterilizer and its utilization on ultrasound probe surfaces. Carrier quantitative germicidal tests, simulated on-the-spot trials, and organic substance influence tests were used to carry out experimental observation. Artificially infected probes were disinfected using the sterilizer or a germicidal lamp for comparison. The total number and types of bacteria were determined and identified. Our results demonstrated the sterilizer had the best disinfection effect among three different disinfection methods in hospital. The sterilizer has been used in a hospital setting for 2 years with no notable damage to the ultrasound probe instrument. It has the advantages of fast disinfection, high disinfection effect, and good compatibility with the ultrasound instrument, worthy of being a promoted application in medical institutions.

Contact pattern,current immune barrier,and pathogen virulence determines the optimal strategy of further vaccination

Background:The current outbreak of novel coronavirus disease 2019 has caused a seriousdisease burden worldwide.Vaccines are an important factor to sustain the epidemic.Although with a relatively high-vaccination worldwide,the decay of vaccine efficacy andthe arising of new variants lead us to the challenge of maintaining a sufficient immunebarrier to protect the population.Method:A case-contact tracking data in Hunan,China,is used to estimate the contactpattern of cases for scenarios including school,workspace,etc,rather than ordinary susceptible population.Based on the estimated vaccine coverage and efficacy,a multi-groupvaccinated-exposed-presymptomatic-symptomatic-asymptomatic-removed model(VEFIAR)with 8 age groups,with each partitioned into 4 vaccination status groups isdeveloped.The optimal dose-wise vaccinating strategy is optimized based on the currentlyestimated immunity barrier of coverage and efficacy,using the greedy algorithm thatminimizes the cumulative cases,population size of hospitalization and fatality respectivelyin a certain future interval.Parameters of Delta and Omicron variants are used respectivelyin the optimization.Results:The estimated contact matrices of cases showed a concentration on middle ages,and has compatible magnitudes compared to estimations from contact surveys in otherstudies.The VEFIAR model is numerically stable.The optimal controled vaccination strategy requires immediate vaccination on the un-vaccinated high-contact population of age30e39 to reduce the cumulative cases,and is stable with different basic reproductionnumbers(R_(0)).As for minimizing hospitalization and fatality,the optimized strategy requires vaccination on the un-vaccinated of both aged 30e39 of high contact frequencyand the vulnerable older.Conclusion:The objective of reducing transmission requires vaccination in age groups ofthe highest contact frequency,with more priority for un-vaccinated than un-fully or fullyvaccinated.The objective of reducing total hospitalization and fatality requires not only toreduce transmission but also to protect the vulnerable older.The priority changes byvaccination progress.For any region,if the local contact pattern is available,then with thevaccination coverage,efficacy,and disease characteristics of relative risks in heterogeneouspopulations,the optimal dose-wise vaccinating process will be obtained and gives hintsfor decision-making.

A follow up study of cycle threshold values of SARS-CoV-2 in Hunan Province,China

Since the epidemic of the severe acute respiratory syndrome coronavirus 2(SARS-COV-2),many governments have used reverse transcription polymerase chain reaction(RT-PCR)to detect the virus.However,there are fewer measures of CT values information based on RT-PCR results,and the relationship between CT values and factors from consecutive tests is not clear enough.So in this study,we analyzed the connection between CT values and the factors based on cohort data from Delta variant of SARS-CoV-2 in Hunan Province.Previous studies have showed that the mean age of the cases was 33.34 years(±18.72 years),with a female predominance(55.03%,n=71),and the greatest proportion of clinical symptoms were of the common type(60.47%,n=78).There were statistical differences between the N and ORF1ab genes in the CT values for the cases.Based on the analysis of the association between CT values and the factors,the lowest CT values were obtained for the unvaccinated,older and clinically symptomatic group at 3e10 days,the maximum peak of viral load occurred.Therefore,it is recommended to use patient information to focus on older,clinically symptomatic,unvaccinated patients and to intervene promptly upon admission.

Influence of extreme weather and meteorological anomalies on outbreaks of influenza A (H1N1)

Biological experiments and epidemiological evidence indicate that variations in environment have important effect on the occurrence and transmission of epidemic influenza.It is therefore important to understand the characteristic patterns of transmission for prevention of disease and reduction of disease burden.Based on case records,we analyzed the environmental characteristics including climate variables in Changsha,and then constructed a meteorological anomaly susceptive-infective-removal (SIR) model on the basis of the results of influenza A (H1N1) transmission.The results showed that the outbreak of influenza A (H1N1) in Changsha showed significant correlation with meteorological conditions;the spread of influenza was sensitive to meteorological anomalies,and that the outbreak of influenza A (H1N1) in Changsha was influenced by a combination of absolute humidity anomalous weather conditions,contact rates of the influenza patients and changes in population movements.These findings will provide helpful information regarding prevention strategies under different conditions,a fresh understanding of the emergence and re-emergence of influenza outbreaks,and a new perspective on the transmission dynamics of influenza.

A community-based comprehensive intervention to reduce syphilis infection—among low-fee female sex workers in China:a matched-pair,community-based randomized study

Background:Low-fee female sex workers(FSWs)are at high risk of acquiring and spreading human immunodeficiency virus(HIV)/sexually transmitted diseases(STDs)in China.There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections.Thus,this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair,comiDunity-based randomized intervention trial carried out in 12 cities in three provinces in China.Methods:Four cities from Guangxi Zhuang Autonomous Region,four from Yunnan Province,and four from Hunan Province were paired and participants received either the intervention package(including condom promotion,HIV and syphilis testing,reimbursement for syphilis treatment costs,and free anti-retroviral therapy or the current standard of care.Venue-based,convenience sampling was used to recruit FSWs.A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months.Generalized linear mixed models(GLMM)were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs.Results:A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up.GLMM results showed that syphilis infeaion was reduced by 49%in the intervention group compared to the current standard of care group(P=0.0378,OR=0.51;95%CI:0.27-0.96).FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old(P<0.0001,OR=2.38,95%CI:1.55-3.65).The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education(P<0.05,OR=0.43,95%CI:0.63-0.93).Conclusions:This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs.Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs.Trial registration:CHiCTR-TRC-12002655.

Identification of Histoplasma causing an unexplained disease cluster in Matthews Ridge, Guyana

Here,we report the identification of Histoplasma causing an unexplained disease cluster in Matthews Ridge,Guyana.In March 2019,14 employees of Chongqing Bosai Mining Company,China,working in a manganese mining of Guyana,had unexplained fever,and two of them died.We obtained lung and brain tissues as well as the blood samples from the two deceased cases(patient No.1 and 2),and bronchoscopy lavages and cerebrospinal fluid samples from one severe case(patient No.3),respectively.All samples were tested by pathological examination,high-throughput sequencing,and real-time PCR.Pathological detection showed the presence of spore-like structures in the lung tissue of patient No.1,indicating a fungal infection in this patient.Nanopore sequencing identified the existing of H.capsulatum in the lung tissue sample within 13 h.Next-generation sequencing identified specific fragments of H.capsulatum in all of the samples tested(lung,brain and blood serum from the deceased cases,and plasma from the severe case).Real-time PCR assays did not reveal any viral infection related to transmission from bat feces.We conclude that H.capsulatum was the causative pathogen of this disease cluster based on epidemiologic,clinical,pathological and nucleic acid evidence.

Urban structure and the risk of influenza A(H1N1) outbreaks in municipal districts

Changsha was one of the most affected areas during the 2009 A(H1N1)influenza pandemic in China.Here,we analyze the spatial–temporal dynamics of the 2009 pandemic across Changsha municipal districts,evaluate the relationship between case incidence and the local urban spatial structure and predict high-risk areas of influenza A(H1N1).We obtained epidemiological data on all cases of influenza A(H1N1)reported across municipal districts in Changsha during period May 2009–December 2010 and data on population density and basic geographic characteristics for 239 primary schools,97 middle schools,347 universities,96 malls and markets,674 business districts and 121 hospitals.Spatial–temporal K functions,proximity models and logistic regression were used to analyze the spatial distribution pattern of influenza A(H1N1)incidence and the association between influenza A(H1N1)cases and spatial risk factors and predict the infection risks.We found that the 2009 influenza A(H1N1)was driven by a transmission wave from the center of the study area to surrounding areas and reported cases increased significantly after September 2009.We also found that the distribution of influenza A(H1N1)cases was associated with population density and the presence of nearest public places,especially universities(OR=10.166).The final predictive risk map based on the multivariate logistic analysis showed high-risk areas concentrated in the center areas of the study area associated with high population density.Our findings support the identification of spatial risk factors and highrisk areas to guide the prioritization of preventive and mitigation efforts against future influenza pandemics.

The S190R mutation in the hemagglutinin protein of pandemic H1N1 2009 influenza virus increased its pathogenicity in mice

Human influenza viruses preferentially bind to sialic acid-α2,6-galactose (SAα2,6Gal) receptors, which are predominant in human upper respiratory epithelia, whereas avian influenza viruses preferentially bind to SAα2,3Gal receptors. However, variants with amino acid substitutions around the receptor-binding sites of the hemagglutinin (HA) protein can be selected after several passages of human influenza viruses from patients’ respiratory samples in the allantoic cavities of embryonated chicken eggs. In this study, we detected an egg-adapted HA S190R mutation in the pandemic H1N1 virus 2009 (pdmH1N1), and evaluated the effects of this mutation on receptor binding affinity and pathogenicity in mice. Our results revealed that residue 190 is located within the pocket structure of the receptor binding site. The single mutation to arginine at position 190 slightly increased the binding affinity of the virus to the avian receptor and decreased its binding to the long human α2,6-linked sialic acid receptor. Our study demonstrated that the S190R mutation resulted in earlier death and higher weight loss in mice compared with the wild-type virus. Higher viral titers at 1 dpi (days post infection) and diffuse damage at 4 dpi were observed in the lung tissues of mice infected with the mutant virus.

HIV-Related Knowledge, Attitude, and Practices Research Among College Students-Six Chinese Cities, 2021

Summary What is already known about this topic?The number of newly diagnosed human immunodeficiency virus(HIV)cases among Chinese youth 15–24 years of age shows an upward trend between 2010 and 2019.What is added by this report?This survey is on a larger scale as compared to previous studies.It shows inadequate HIV knowledge—especially on HIV treatment,self-testing,and postexposure prophylaxis—among college students.A significant gap exists between knowledge and behavior as indicated by the low condom use rate despite a high knowledge level.

A Detected Case of Avian Influenza H9N2 from Influenza-Like Illness Surveillance--Hunan Province, 2020

Jishou Municipal Center for Disease Control and Prevention(Jishou CDC)received a phone call at 7:30 a.m.on April 24,2020 from Xiangxi Tujia and Miao Autonomous Prefectural CDC(Xiangxi CDC)that avian influenza A/H9N2 virus was detected by quantitative reverse transcription-polymerase chain reaction(RT-PCR)from the throat swab sample of an influenza-like illness in an outpatient in the Xiangxi Traditional Chinese Medicine Hospital.

HIV-2 Seroepidemiological Evidence in Hunan Province—China,2003–2020

The human immunodeficiency viruses-2(HIV-2)is endemic in West Africa and is a rarely imported infectious disease in China due to the small number of cases having had a history of living abroad(1–3).In 2007,through routine HIV surveillance,2 HIV-2 infected individuals were confirmed by serology and nucleic acid testing,becoming the first report of HIV-2 in China.Epidemiological case investigation showed that the two infected individuals had sexual contact.

Ambient Temperature and Years of Life Lost:A National Study in China

Although numerous studies have investigated premature deaths attributable to temperature,effects of temperature on years of life lost(YLL)remain unclear.We estimated the relationship between temperatures and YLL,and quantified the YLL per death caused by temperature in China.We collected daily meteorological and mortality data,and calculated the daily YLL values for 364 locations(2013–2017 in Yunnan,Guangdong,Hunan,Zhejiang,and Jilin provinces,and 2006–2011 in other locations)in China.A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates(YLL/100,000 population),and a multivariate meta-analysis model was used to pool location-specific associations.Then,YLL per death caused by temperatures was calculated.The temperature and YLL rates consistently showed U-shaped associations.A mean of 1.02(95%confidence interval:0.67,1.37)YLL per death was attributable to temperature.Cold temperature caused 0.98 YLL per death with most from moderate cold(0.84).The mean YLL per death was higher in those with cardiovascular diseases(1.14),males(1.15),younger age categories(1.31 in people aged 65–74 years),and in central China(1.34)than in those with respiratory diseases(0.47),females(0.87),older people(0.85 in people R75 years old),and northern China(0.64)or southern China(1.19).The mortality burden was modified by annual temperature and temperature variability,relative humidity,latitude,longitude,altitude,education attainment,and central heating use.Temperatures caused substantial YLL per death in China,which was modified by demographic and regional characteristics.

Epidemiological Evaluation of Bacillus cereus-Induced Foodborne Outbreaks — China, 2010–2020

Introduction:Bacillus cereus(B.cereus)is a common gram-positive bacterium that contaminates starch-rich food and can cause outbreaks of foodborne diseases.This study describes characteristics of outbreaks caused by B.cereus in China during 2010–2020 and explore the possible reasons for changes in the number of outbreaks over time.Results of this analysis can efficiently help guide and allocate public resources to prevent B.cereus caused foodborne diseases.Methods:Descriptive statistical methods were used to analysis the data on B.cereus outbreaks in China during this period.The data were identified,reported at all levels in China through National Foodborne Disease Outbreak Surveillance System.Results:From 2010 to 2020,a total of 419 foodborne outbreaks prompted by B.cereus were reported in China,leading to 7,892 cases,2,786 hospital admissions,and 5 fatalities.The bulk of the outbreaks were recorded in the summer,primarily between May and September.The most recurrent food vehicle was linked with rice or flour-based products,notably those made with rice or fried rice.School canteens bore the brunt of the B.cereus outbreaks.In multifactor outbreaks,food contamination was identified as the most common culprit;while in instances where only one factor contributed,improper storage was most frequently implicated.Conclusion:The prevalence of B.cereus outbreaks remained relatively consistent throughout the studied period.Understanding the types of foods,causative factors,and contributing elements leading to B.cereus outbreaks can help inform prevention strategies for foodborne illnesses.The majority of outbreaks were associated with rice-or flour-based foods in school canteens,suggesting contamination and improper storage during food preparation.Consequently,it is essential to prioritize continuous education for canteen staff on food safety,efficacious management,and proper practices.The implementation of comprehensive guidelines,encompassing multiple critical aspects,can potentially reduce the occurrence of B.cereus outbreaks.

The history of the elimination of lymphatic filariasis in China

China used to be one of the most heavily endemic countries for lymphatic filariasis(LF)in the world.There were 864 endemic counties/cities in 16 provinces/autonomous regions/municipalities(P/A/M)with a total population of 330 million at risk of infection.Since the founding of the People’s Republic of China in 1949,the Chinese Government has designated the control of the disease to be a top priority.Due to decades of sustained efforts,close cooperation related to LF control among government departments,and active participation of endemic populations,an all-round campaign for prevention and control has been carried out vigorously and successfully.Over many years,great achievements have been made through persistent endeavors of Chinese scientists and disease control workers.The ultimate goal to eliminate LF in the country was achieved in 2006.