Characterization of a New HIV-1 Circulating Recombinant Form CRF142_BC—Yunnan,China,2015 and 2021

What is already known about this topic?Recombinant strains dominate the human immunodeficiency virus 1(HIV-1)epidemic in China.Yunnan Province was the first region in China to report HIV-1 infections in batches.The long-term HIV-1 epidemic led to the generation of various recombinant forms.Among the 47 circulating recombinant forms(CRFs)reported in China,more than 20 were first identified in Yunnan Province.What is added by this report?This study reported a previously unrecognized HIV-1 CRF(CRF142_BC)characterized by the insertion of four short subtype B fragments into the subtype C backbone.CRF142_BC was estimated to have emerged in the mid-1990s,close to the time of the emergence of most known CRF_BCs in China.What are the implications for public health practice?The discovery of new CRFs will provide a basis for HIV-1 molecular tracing and intervention research.In addition,HIV-1 recombination can alter viral biological properties.The study of HIV-1 gene variants needs to be intensified.

The active surveillance management approach for patients with low risk papillary thyroid microcarcinomas: is China ready?

Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immediate surgery for patients with low risk PTMC.With decreased doubts about the safety and validity due to evidence from a large number of studies,the AS approach has become increasingly popular worldwide.However,Chinese thyroid surgeons still lag behind other countries in their knowledge of clinical practices and research related to AS.To promote the implementation of AS in China,thyroid surgeons should understand the implications,advantages,and disadvantages of management approaches for AS,and should also consider the willingness of Chinese patients,the impact on the medical billing system,and the enthusiasm of doctors.Thus,a management approach for AS based on the Chinese population should be developed to reduce the risk of disease progression and enhance patient adherence.Herein,we summarize the recent research achievements and deficiencies in AS approaches,and describe the initial experiences regarding AS in the Chinese population,in order to assist Chinese thyroid surgeons in preparing for AS management in the era of PTMC precision medicine.

Advances in Acute Emerging Infectious Disease Symptom Monitoring

In recent years,the risk of acute emerging infectious diseases has increased significantly due to changes in environmental conditions and social factors,posing a serious threat to public health security and human health.The general susceptibility of the population and the unpredictability and increasing infectiousness of emerging infectious diseases reflect the inadequacy of the existing infectious disease surveillance system for timely detection and screening of emerging infectious diseases,often leading to a certain scale of epidemic outbreaks that seriously harm humans before being detected passively.This is a literature review on symptom surveillance of acute emerging infectious diseases at home and abroad,emphasizing on the subject matter and development of symptom surveillance of emerging infectious diseases,so as to provide a scientific basis for the establishment and improvement of symptom surveillance of acute emerging infectious diseases.

Trends and Spatial Pattern Analysis of Typhoid and Paratyphoid Fever Incidence — Yunnan Province, China, 1989–2022

Introduction:This study explored the incidence trends and spatial clustering of typhoid and paratyphoid fever(TPF)in Yunnan Province to provide scientific evidence for developing and improving prevention and control strategies.Methods:Temporal trends were investigated by calculating the annual percent change(APC)and average annual percent change(AAPC),along with their 95%confidence intervals(CIs).The spatial clustering of TPF across Yunnan Province was examined using global Moran’s I and local indicators of spatial association(LISA)statistics.Results:A total of 206,066 TPF cases were reported in Yunnan Province from 1989 to 2022,with an average annual incidence of 13.98 per 100,000 population and a case fatality rate of 2.5 per 1,000.The greatest number of cases was reported during July and August.The 25–34-year age group had the highest incidence,and farmers were prominently represented.TPF incidence in Yunnan Province showed a significant decrease and spatial clustering.From 2005 to 2022,13 county-level cities/counties/municipal districts in 5 prefectures(cities)in Yunnan Province were identified as statistically significant H-H spatial clusters of TPF incidence.A total of 24 TPF outbreaks were reported in Yunnan Province from 2005 to 2022.Conclusions:The incidence of TPF in Yunnan Province showed a significant decrease and spatial clustering.Control strategies should focus on highincidence areas,seasons,and populations to reduce the incidence of TPF.

中国六省儿童HIV感染者的流行病学调查

目的了解中国六省儿童HIV感染者的流行病学状况。方法对6个艾滋病高发省份的儿童感染者进行横断面调查,采集患者人口学、感染途径、诊断时间、临床分期、实验室检测等数据。结果共650例患儿入选,男405例,女245例,平均年龄(7.9±3.2)岁,可能感染到确诊的平均时间间隔为(7.1±3.2)年。依次分布于河南570例(87.7%),广西23例(3.5%),云南21例(3.2%),湖北19例(2.9%),安徽10例(1.5%),山西7例(1.1%)。其中母婴传播488例(75.1%),输血及血制品传播102例(15.7%),静脉吸毒传播3例(0.5%)。以采供血为主要传播途径的省份(包括河南、山西、湖北、安徽)和以静脉吸毒为主要传播途径的省份(包括广西、云南)感染者的平均年龄分别为(8.1±3.2)和(5.4±2.2)岁,两组相比差异有显著性(P<0.001)。178例(39.3%,178/453)符合接受抗病毒治疗标准,其中133例(74.7%,133/178)未接受治疗,45例(25.3%,45/178)采用成人药物治疗。结论母婴传播是儿童感染HIV的主要途径,应当加强我国儿童HIV感染者的诊断和治疗工作。

Factors influencing HIV infection in men who have sex with men in China

To identify risk factors for HIV infection among men who have sex with men （MSM） and to provide a theoretical basis for prevention interventions. Between December 2011 and August 2012, a case-control study was conducted among MSM who underwent voluntary counselling and testing for HIV. Confirmed HIV-positive MSM were included in the case group, and HIV-negative MSM were included in the control group. Information on possible risk factors was collected by a survey questionnaire and a qualitative interview. The results of a conditional logistic regression showed that the following were influencing factors for HIV infection： average monthly income between 2001 and 3000 Yuan （odds ratio （0R）=6.341, 95% Ch 1.714-12.544）, only sometimes using condoms when having anal sex with men in the last 6 months （0R=7.601, 95% Ch 1.359-23.083）, having HIV-positive sex partners （0R=5.273, 95% Ch 1.572- 17.691）, rectal trauma with bleeding in the last 6 months （0R=2.947, 95% Ch 1.308-6.638）, not using condoms at last sexual encounter （OR-- 1.278, 95% Ch 1.012-5.595）, engaging in commercial sex （0R=5.925, 95% Ch 1.923-13.890） and having more than 16 sex partners in the last 6 months （0R=1.175, 95% Ch 1.021-1.353）. These seven factors were the risk factors of HIV infection （OR〉l）. However, having anal sex less than 10 times in the previous 1 month （OR=O.O02, 95% CI： 0.000-0.287） was a protective factor against HIV infection among MSM （OR〈l）, and insertive （0R=0.116, 95% Ch 0.000-0.236） （OR〈l） anal intercourse influenced HIV infection. Interventions should be targeted at MSM whose average monthly income is between 2001 and 3000 Yuan, and who engage in commercial sex. In addition, the importance of using condoms at every sexual encounter should be emphasised in health education, as should the treatment of rectal trauma with bleeding. Finally, MSM should decrease the number of sex partners and frequency of anal sex to decrease the rate of HIV infection.

Herpes Simplex Virus Type 2 Risks in Female Sex Workers in the China-vietnam Border County of Hekou

Objective To survey the prevalence and risk factors of HSV-2 among Chinese and Vietnamese female sex workers （FSW） in the border county of Hekou, Yunnan Province, China. Methods A cross-sectional survey was conducted on demographics, sexual behavior, medical history, and drug use among FSWs. Laboratory samples were obtained to test for HSV-2 and other STIs such as HIV, Syphilis, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Bacterial vaginosis, and Yeast infections. Cervicitis and genital warts were also diagnosed. Results Of the 345 FSWs who participated in this study, 112 （32.5%） were ethnic Chinese and 233 （67.5） were Vietnamese. Among FSWs in Hekou, the prevalence rates were 58.3% for HSV-2, 5.5% for HIV, and 4.1% for bacterial vaginosis （BV）. Age 〈21 （OR： 0.5; 95% CI： 0.3, 0.8）, duration of commercial sex work 〈3 months （OR： 0.5; 95% CI： 0.3, 0.8）, oral and vaginal sex with the last client （as opposed to only vaginal sex） （OR： 1.6; 95% CI： 1.0, 2.7）, HIV （OR： 11.4; 95% Cl： 1.5, 87.2）, and bacterial vaginosis （BV） （OR 5.6; 95% CI： 1.2, 26.9） were significantly correlated with HSV-2 infection. Conclusion Multivariate analysis showed that several factors were significantly correlated with the high prevalence of HSV-2 in FSWs in the border area between China and Vietnam. Further studies and interventions are needed for HSV-2 epidemiology in the border area.

Reduction patterns of Japanese encephalitis incidence following vaccine introduction into long-term expanded program on immunization in Yunnan Province,China

Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in China.Vaccination is recommended as a key strategy to control JE.In China most JE cases have been reported in southwest provinces,which include Yunnan.In this study,we quantify the epidemiological shift of JE in Yunnan Province from 2005 to 2017,covering before and after the introduction of JE vaccination into routine Expanded Program on Immunization(EPI)in 2007.Methods:We used routinely collected data in the case-based JE surveillance system from 2005 through 2017 in Yunnan.Cases were reported from hospital and county-level Centers for Disease Control in line with the National JE Surveillance Guideline.Epidemiological data were extracted,analysed and presented in appropriate ways.Immunization coverage was estimated from actual JE doses administered and new births for each year.Results:A total 4780 JE cases(3077 laboratory-confirmed,1266 clinical and 437 suspected)were reported in the study period.Incidence of JE(per 100000 population)increased from 0.95 in 2005 to 1.69 in 2007.With increase in vaccination coverage,incidence rates decreased steadily from 1.16 in 2009 to 0.17 in 2017.However,seasonality remained similar across the years,peaking in June-September.Banna(bordering Myanmar and Laos),Dehong(bordering Myanmar),and Zhaotong(an inland prefecture)had the highest incidence rates of 2.3,1.9,and 1.6,respectively.97%of all cases were among local residents.As vaccination coverage increased(and incidence decreased),proportion of JE cases among children<10 years old decreased from 70%in 2005 to 32%in 2017,while that among adults>20 years old increased from 12 to 48%.There were a large number of JE cases with unknown treatment outcomes,especially in the earlier years of the surveillance system.Conclusions:The 13-year JE surveillance data in Yunnan Province showed dramatic decrease of total incidence and a shift from children to adults.Improving vaccination coverage,including access to adults at risk,and strengthening the JE surveillance system is needed to further control or eliminate JE in the province.

High seroprevalence of toxoplasma gondii and HIV-1 co-infection among drug users in Yunnan province, southwest China

Dear Editor, Toxoplasma gondii was discovered more than 100 years ago and has a broad-spectrum of intermediate hosts in addi- tion to its definitive host, felids. Although it does not cause symptomatic illness in most adults, it can lead to mental retardation in congenitally infected children and serious diseases in immunocompromised patients （Hill et al., 2005）. The first report of T. gondii infection in China was pub- lished in Chinese in 1964; subsequently, many other cases have been carried out. Currently, most publications about the seroprevalence of T. gondii infection in Yunnan have examined infections in pets, domestic animals, and wild animals; however, few previously published studies have assessed human T. gondii infection in Yunnan province.

The role of personality,social economic and prevention strategy effects on health-related quality of life among people living with HIV/AIDS

Background::HIV/AIDS has transformed into a chronic controllable but not yet curable infectious disease as other chronic diseases to some extent.The additional of so called fourth 90%that included the improved health-related quality of life(HRQoL)for people living with HIV(PLWHIV)required solutions beyond antiretroviral therapy and viral load suppression.This study will explore the role of personality,social economic and prevention strategy effection on HRQoL among people living with HIV/AIDS.Methods::A cross-sectional study was conducted among PLWHIV aged more than 16 years old in the 10 municipalities in Yunnan Province,China from October 2019 to May 2020,enrolling total 1997 participants.Individual-level HRQoL data were measured by 12-item Short Form Health Survey(SF-12)and EuroQol Five Dimensions Questionnaire(EQ-5D-5L).We assembled municipal-level data about social economic from Yunnan Statistical Yearbook in 2020 and strategy practice information from the self-evaluation system.We used the principal component analysis to build the social economic and strategy effect on each area respectively and one-way ANOVA was used to perform univariate analysis to identify the predictors with significant differences.Finally we used multi-level model(MLM)to explore the personality,social economic and strategy effects in health-related quality of life among PLWHIV.Results::The global score for quality of life measured using EQ-5D-5L had an estimated mean score(standard deviation,SD)of 0.901±0.146.The HRQoL score measured using PCS-12 had an estimated mean score(SD)of 46.62±8.55.The mean MCS-12 score(SD)was estimated to be 47.80±9.71.The area-level predictors explained a proportion of 13.6-17.2%for the between-area variation of the HRQoL scores,regardless of the total HRQoL,physical component and mental component.The impacts of stigma(P<0.01),social support(P<0.001),anxiety(P<0.001),depression(P<0.05)and social economic status(P<0.05)on HRQoL at the individual-level were significantly different.The plots visualized the impact of individual-level factors on a respondent’s HRQoL was modified by the area-level characteristics.Conclusions::The study identified the possible strategy determinant of individual HRQoL of PLWHIV and also the area effect on HRQoL.Stigma,social support,anxiety,depression and social economic status were the individual-level determinants on HRQoL.These could be a valuable resource for evaluating the overall health of the areas and help improve local decision making.

Role of Diabetes Mellitus on Treatment Effects in Drug-susceptible Initial Pulmonary Tuberculosis Patients in China

We assessed the role of diabetes mellitus（DM） on treatment effects in drug‐susceptible initial pulmonary tuberculosis（PTB） patients. A prospective study was conducted in eight provinces of China from October 2008 to December 2010. We enrolled 1,313 confirmed drug‐susceptible initial PTB patients, and all subjects received the treatment regimen（2 H3 R3 E3 Z3/4 H3 R3） as recommended by the national guidelines. Of the 1,313 PTB patients, 157（11.9%） had DM; these patients had more sputum smear‐positive rates at the end of the second month [adjusted odds ratios（aO R） 2.829, 95% confidence intervals（CI） 1.783‐4.490], and higher treatment failure（aO R 2.120, 95% CI 1.565‐3.477） and death rates（aO R 1.536, 95% CI 1.011‐2.628）. DM was a contributing factor for culture‐positive rates at the end of the second month and treatment failure and death of PTB patients, thus playing an unfavorable role in treatment effects of PTB.

Factors associated with needle sharing among people who inject drugs in Yunnan, China: a combined network and regression analysis

Background:Network analyses have been widely utilized to evaluate large datasets,but have not yet been used to explore factors associated with risk behaviours.In combination with traditional regression analysis,network analyses may provide useful information and highlight key factors for reducing needle sharing behaviours among people who inject drugs(PWID).Methods:Sociodemographic data,and information on injection behaviour and sexual practices were collected from a cross-sectional survey that was conducted with PWID in five prefectures of Yunnan province,China.A combination of logistic regression and correlation network analyses were used to explore key factors for reducing needle-sharing behaviours among PWID.Results:In a total of 1049 PWID,37.5%had a history of needle or syringe sharing.The logistic analysis showed that Zhaotong,Qujing,Dehong,or Lincang residents,diazepam use,longer injection duration,needle reuse,and infection with HIV,viral hepatitis,tuberculosis and/or malaria were independently associated with needle sharing.The correlation network analyses showed that,compared to PWID who had never shared needles,PWID who did share needles would achieve harm reduction goals faster and more permanently.HIV serostatus and marital status were found to be closely associated with other risk factors.By combining regression analyses with network analyses,it was shown that PWID who are HIV seropositive will be an ideal target group for harm reduction programs.Conclusion:Needle-sharing behaviours are common among PWID in Yunnan,and harm reduction programs may help PWID who are HIV seropositive reduce risk behaviours and prevent blood borne diseases.

Risk of Treatment Failure in Patients with Drug-susceptible Pulmonary Tuberculosis in China

The objective of this prospective study of the risks of treatment failure in patients with drug-susceptible pulmonary tuberculosis （PTB） was to provide reference data to help develop a disease control strategy. Participants were recruited in eight provinces of China from October 2008 to December 2010. A total of 1447 patients with drug-susceptible PTB and older than 15 years of age were enrolled.

Immunogenicity and Safety of Homologous Booster Doses of CoronaVac COVID-19 Vaccine in Elderly Individuals Aged 60 Years and Older:A Dosing Interval Study—Yunnan Province,China,2021–2022

Summary What is already known about this topic?Neutralization levels induced by inactivated vaccines rapidly wane after primary immunization,and a homologous booster can recall specific immune memory,resulting in a remarkable increase in antibody concentration.The optimal interval between primary and booster doses has yet to be determined.

地理距离对中国一个山区省结核病人延误的影响研究

背景:中国一个山区省—云南的129个县。目的:说明病人延误与病人到当地县级结核病(TB)中心的距离之间的关系。设计:对2005年登记的10 356例新涂阳结核病人的电子病历进行研究。结果:总延误的中位数是71 d(四分位数间距(IQR)为38～128),病人延误中位数为60 d(IQR为28～111),相对较短的医疗系统延误中位数为4 d(IQR为2～138)。农民和经济状况差的年长者(>40岁)与时间较长的病人延误明显相关。延误的风险随着地理距离的增加而增加,对相对较短的病人延误的影响更强。以距离的第一四分位数为对照组,短期病人延误(≤60 d)后续的四分位数的风险比分别为0.61(0.57～0.65),0.30(0.28～0.33)和0.15(0.14～0.17),长期病人延误(>60 d)后续的四分位数的风险比分别为1.04 (0.94～1.17),0.69(0.63～0.77)和0.43 (0.39～0.47)。结论:居住在边远地区的病人需要支持以克服地理距离带来的困难,这个困难对疾病早期影响更大。

Isolation of Leclercia adecarboxylata Producing Carbapenemases in A Newborn Female

Leclercia adecarboxylata is a Gram-negative bacterium belonging to the Enterobacteriaceae family.To our knowledge,this is the first report of a carbapenem-resistant L.adecarboxylata strain isolated from a healthy newborn.The L.adecarboxylata strain isolated in this study carried four plasmids that may serve as reservoirs for antibiotic resistance genes.Plasmids 2 and 4 did not harbor any antimicrobial resistance genes.Plasmid 3 is a novel plasmid containing three resistance genes.The bla IMP gene harbored in the strain was most similar to bla IMP-79 at the nucleotide level,with a similarity of 99.4%(737/741).This case highlights the importance of considering L.adecarboxylata as a potential cause of infections in children.

Implementing Routine HIV Screening in Hospitals:An Effective Practice to Expand HIV Testing—Xishuangbanna Prefecture,Yunnan Province,China,2019–2020

Summary What is already known about this topic?Research evidence is insufficient to suggest whether routine human immunodeficiency virus(HIV)screening in healthcare settings is effective in promoting greater awareness of HIV-positive status.What is added by this report?This study found that,following the implementation of routine HIV screening in hospitals in Xishuangbanna Prefecture,Yunnan Province,there was a significant increase in the number of HIV screenings,positive results,and the positive rate of HIV screening in primary-level hospitals.What are the implications for public health practice?Routine hospital-based HIV screening is effective in identifying HIV infections in areas with concentrated epidemics.

Uncovering the Impact of Control Strategies on the Transmission Pattern of SARS-CoV-2—Ruili City,Yunnan Province,China,February–March 2022

Introduction:The implementation of public health and social measures(PHSMs)was an effective option for controlling coronavirus disease 2019(COVID-19).However,evidence is needed to evaluate these PHSMs’effects on the recently emerged variant Omicron.Methods:This study investigated variant Omicron BA.2’s outbreak in Ruili City,Yunnan Province,China.The disease transmission dynamics,spatiotemporal interactions,and transmission networks were analyzed to illustrate the effect of PHSM strategies on Omicron spread.Results:A total of 387 cases were related to the outbreak.The time-varying reproduction number was synchronized with PHSM strategies.Spatiotemporal clustering strength presented heterogeneity and hotspots.Restricted strategies suppressed temporal and spatial relative risk compared with routine and upgraded strategies.The transmission network presented a steeper degree distribution and a heavier tail under upgraded strategies.Phase transformation and distinctive transmission patterns were observed from strategy-stratified subnetworks.Conclusions:The tightened response strategy contained reproduction of the virus,suppressed spatiotemporal clustering,and reshaped the networks of COVID-19 Omicron variant transmission.As such,PHSMs against Omicron are likely to benefit future responses as well.

Development and Application of a Multidrug-Resistant Tuberculosis Case Management System—Yunnan Province,China,2017–2020

Introduction:Treatment and case management of multidrug-resistant tuberculosis(MDR-TB)is a significant challenge in tuberculosis(TB)control and prevention.This pilot study aims to apply and test a new electronic information system in order to help bolster case management of MDR-TB.Methods:The MDR-TB Case Management System(CMS)was developed and piloted in the Yunnan Tuberculosis Clinical Center(TCC)in 2017.Next,5 sites in Yunnan were randomly selected and sampled as pilots in 2018.The real-time regular follow-up rate(RFUR)was calculated for pilot sites.Loss to follow-up(LTFU)rates of MDR-TB treatment cohorts between pilot and non-pilot sites were compared by a chi-square test.LTFU for MDR-TB treatment cohorts was then assessed by univariate and multivariate binary logistic regression.Results:The average regular follow-up rate was 90.7%in TCC and 73.7%in five other pilot sites of Yunnan Province respectively.The average LTFU rate for pilot sites(9.0%)was lower than non-pilot sites(20.6%,P<0.01).The risk of LTFU during MDR-TB treatment reduced 61.7%in CMS pilot cases(adjusted odds ratio:0.38,95%confidence interval:0.23–0.60)compared with non-pilot cases.Conclusions:As a significant supplement to the Tuberculosis Information Management System,the CMS strengthened the collection,analysis,and utilization of strategic information for MDR-TB cases.The system improved case management by embedding it as a tool of the Comprehensive Supportive Care service model.

Corrigendum to "Case report for human infection with a highly pathogenic avian influenza A(H5N6) virus in Beijing, China 2019" [Biosafety and Health 2 (2020) 49-52]

The authors regret that an ethics statement was missing from the above article.The Ethics Statement section should be added as follows:Ethics statement As a public health response to an emerging infectious disease outbreak,written informed consent could be waived.Data and sample collection of the human case were determined by the National Health Commission of the People's Republic of China to be part of a continuing public health outbreak investigation and were exempt from institutional review board approval.The authors would like to apologize for any inconvenience caused.