Factors Associated With the Spatial Distribution of Severe Fever With Thrombocytopenia Syndrome in Zhejiang Province, China: Risk Analysis Based on Maximum Entropy.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first identified in mainland China in 2009 and has been reported in Zhejiang Province, China, since 2011. However, few studies have focused on the association between ticks, host animals, and SFTS. Objective: In this study, we analyzed the influence of meteorological and environmental factors as well as the influence of ticks and host animals on SFTS. This can serve as a foundational basis for the development of strategic policies aimed at the prevention and control of SFTS. Methods: Data on SFTS incidence, tick density, cattle density, and meteorological and environmental factors were collected and analyzed using a maximum entropy-based model. Results: As of December 2019, 463 laboratory-confirmed SFTS cases were reported in Zhejiang Province. We found that the density of ticks, precipitation in the wettest month, average temperature, elevation, and the normalized difference vegetation index were significantly associated with SFTS spatial distribution. The niche model fitted accurately with good performance in predicting the potential risk areas of SFTS (the average test area under the receiver operating characteristic curve for the replicate runs was 0.803 and the SD was 0.013). The risk of SFTS occurrence increased with an increase in tick density, and the response curve indicated that the risk was greater than 0.5 when tick density exceeded 1.4. The risk of SFTS occurrence decreased with increased precipitation in the wettest month, and the risk was less than 0.5 when precipitation exceeded 224.4 mm. The relationship between elevation and SFTS occurrence showed a reverse V shape, and the risk peaked at approximately 400 m. Conclusions: Tick density, precipitation, and elevation were dominant influencing factors for SFTS, and comprehensive intervention measures should be adjusted according to these factors to reduce SFTS incidence in Zhejiang Province.

The epidemiology of Aedes-borne arboviral diseases in Zhejiang, Southeast China: a 20 years population-based surveillance study.

Objective: Aedes-borne arboviral diseases were important public health problems in Zhejiang before the coronavirus disease 2019 (COVID-19) pandemic. This study was conducted to investigate the characteristics and change of the epidemiology of Aedes-borne arboviral diseases in the province. Methods: Descriptive analyses were conducted to summarize the epidemiology of Aedes-borne arboviral diseases during 2003-2022. Results: A total of 3,125 cases, including 1,968 indigenous cases, were reported during 2003-2022. Approximately three-quarters of imported cases were infected from Southeast Asia. The number of annual imported cases increased during 2013-2019 (R2 = 0.801, p = 0.004) and peaked in 2019. When compared with 2003-2012, all prefecture-level cities witnessed an increase in the annual mean incidence of imported cases in 2013-2019 (0.11-0.42 per 100,000 population vs. 0-0.05 per 100,000 population) but a drastic decrease during 2020-2022 (0-0.03 per 100,000 population). The change in geographical distribution was similar, with 33/91 counties during 2003-2012, 86/91 during 2013-2019, and 14/91 during 2020-2022. The annual mean incidence of indigenous cases in 2013-2019 was 7.79 times that in 2003-2012 (0.44 vs. 0.06 per 100,000 population). No indigenous cases were reported between 2020-2022. Geographical extension of indigenous cases was also noted before 2020-from two counties during 2003-2012 to 44 during 2013-2019. Conclusion: Dengue, chikungunya fever, zika disease, and yellow fever are not endemic in Zhejiang but will be important public health problems for the province in the post-COVID-19 era.

A radiomics approach for predicting acute hematologic toxicity in patients with cervical or endometrial cancer undergoing external-beam radiotherapy.

PURPOSE: This study is purposed to establish a predictive model for acute severe hematologic toxicity (HT) during radiotherapy in patients with cervical or endometrial cancer and investigate whether the integration of clinical features and computed tomography (CT) radiomics features of the pelvic bone marrow (BM) could define a more precise model. METHODS: A total of 207 patients with cervical or endometrial cancer from three cohorts were retrospectively included in this study. Forty-one clinical variables and 2226 pelvic BM radiomic features that were extracted from planning CT scans were included in the model construction. Following feature selection, model training was performed on the clinical and radiomics features via machine learning, respectively. The radiomics score, which was the output of the final radiomics model, was integrated with the variables that were selected by the clinical model to construct a combined model. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS: The best-performing prediction model comprised two clinical features (FIGO stage and cycles of postoperative chemotherapy) and radiomics score and achieved an AUC of 0.88 (95% CI, 0.81-0.93) in the training set, 0.80 (95% CI, 0.62-0.92) in the internal-test set and 0.85 (95% CI, 0.71-0.94) in the external-test dataset. CONCLUSION: The proposed model which incorporates radiomics signature and clinical factors outperforms the models based on clinical or radiomics features alone in terms of the AUC. The value of the pelvic BM radiomics in chemoradiotherapy-induced HT is worthy of further investigation.

Chikungunya in Zhejiang Province, Southeast China.

Background: Chikungunya is emerging and reemerging word-widely in the past decades. It is non-endemic in Zhejiang Province, Southeast China. Aedes albopictus, one of major vectors of chikungunya, is widely-distribution in Zhejiang, and autochthonous transmission is possible after introducing chikungunya virus. Methods: Retrospectively collected the epidemiological, clinical and genetic data of chikungunya and conducted the descriptive analysis and gene sequence analysis. Results: From 2008 to 2022, 29 chikungunya cases, including 26 overseas imported and 3 local cases, were reported and no cases died of chikungunya. More than half of the imported cases (53.85%) were from Southeast Asia. Seasonal peak of the imported cases was noted between August and September, and 42.31% cases onset in those 2 months. Eight prefecture-level cities and 16 counties reported cases during the study period, with Jinghua (27.59%) and Hangzhou (24.14%) reporting the largest number of cases. The 3 local cases were all reported in Qujiang, Quzhou in 2017. For imported cases, the male-female gender ratio was 2.71:1, 20-30 years old cases (46.15%) and commercial service (42.31%) accounted for the highest proportion. Clinically, fever (100%), fatigue (94.44%), arthralgia (79.17%), headache (71.43%) and erythra (65.22%) were the most common reported symptoms. Eight whole-genome sequences were obtained and belonged to East/Central/South African (ECSA) or Asian genotype. Conclusions: With the change of immigration policy, the surveillance of chikungunya should be strengthened and the ability of the case discovery and diagnosis should be improved in Zhejiang in the post-COVID-19 era.

Epidemiology of Indigenous Dengue Cases in Zhejiang Province, Southeast China.

Objective: Autochthonous transmission of the dengue virus (DENV) occurred each year from 2014 to 2018 in Zhejiang province, and became an emerging public health problem. We characterized the autochthonous transmission of the DENV and traced the source of infection for further control and prevention of dengue. Methods: Descriptive and spatiotemporal cluster analyses were conducted to characterize the epidemiology of autochthonous transmission of the DENV. Molecular epidemiology was used to identify the infection source. Results: In total, 1,654 indigenous cases and 12 outbreaks, with no deaths, were reported during 2004-2018. Before 2017, all outbreaks occurred in suburban areas. During 2017-2018, five out of eight outbreaks occurred in urban areas. The median duration of outbreaks (28 days) in 2017-2018 was shortened significantly (P = 0.028) in comparison with that in 2004-2016 (71 days). The median onset-visiting time, visiting-confirmation time, and onset-confirmation time was 1, 3, and 4 days, respectively. The DENV serotypes responsible for autochthonous transmission in Zhejiang Province were DENV 1, DENV 2, and DENV 3, with DENV 1 being the most frequently reported. Southeast Asia was the predominant source of indigenous infection. Conclusions: Zhejiang Province witnessed an increase in the frequency, incidence, and geographic expansion of indigenous Dengue cases in recent years. The more developed coastal and central region of Zhejiang Province was impacted the most.

The changing epidemiology of hemorrhagic fever with renal syndrome in Southeastern China during 1963-2020: A retrospective analysis of surveillance data.

BACKGROUND: Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by hantavirus which was endemic Zhejiang Province, China. In this study, we aim to explore the changing epidemiology of HFRS in Zhejiang, identify high-risk areas and populations, and evaluate relevant policies and interventions to better improve HFRS control and prevention. METHODS: Surveillance data on HFRS during 1963-2020 in Zhejiang Province were extracted from Zhejiang Provincial Center for Disease Control and Prevention archives and the Chinese Notifiable Disease Reporting System. The changing epidemiological characteristics of HFRS including seasonal distribution, geographical distribution, and demographic features, were analyzed using joinpoint regression, autoregressive integrated moving average model, descriptive statistical methods, and Spatio-temporal cluster analysis. RESULTS: From 1963 to 2020, 114 071 HFRS cases and 1269 deaths were reported in Zhejiang Province. The incidence increased sharply from 1973 and peaked in 1986, then decreased steadily and maintained a stable incidence from 2004. HFRS cases were reported in all 11 prefecture-level cities of Zhejiang Province from 1963 to 2020. The joint region (Shengzhou, Xinchang, Tiantai, and surrounding areas), and Kaihua County are the most seriously affected regions throughout time. After 1990, the first HFRS incidence peak was in May-June, with another one from November to January. Most HFRS cases occurred in 21- (26.48%) and 30- years group (24.25%) from 1991 to 2004, but 41- (25.75%) and 51-years (23.30%) had the highest proportion from 2005 to 2020. Farmers accounted for most cases (78.10%), and cases are predominantly males with a male-to-female ratio of 2.6:1. It was found that the median time from onset to diagnosis was 6.5 days (IQR 3.75-10.42), and the time from diagnosis to disease report was significantly shortened after 2011. CONCLUSIONS: We observed dynamic changes in the seasonal distribution, geographical distribution, and demographic features of HFRS, which should be well considered in the development of control and prevention strategies in future. Additional researches are warranted to elucidate the environmental, meteorological, and social factors associated with HFRS incidence in different decades.

Characteristics of Three Person-to-Person Transmission Clusters of Severe Fever with Thrombocytopenia Syndrome in Southeastern China.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease worldwide. It can be transmitted from person to person, and the fatality rate is very high. During this study, three SFTS clusters including 12 associated cases were identified in three counties in Zhejiang Province from 2018 to 2020. The median age of the three index patients was 70 years, and that of secondary case patients was 59 years. Of note, the mortality rate of the index patients was 100%. The mortality rate of secondary case patients was 11%. The total secondary attack rate (SAR) was 30% (9/30). The SARs of cluster A, cluster B, and cluster C were 38% (3/8), 21% (3/14), and 38% (3/8), respectively. Additionally, the interval from onset to diagnosis was 4 days. The intervals from disease onset to confirmation of the index cases and secondary cases were 7 days and 4 days, respectively. All secondary case patients had a history of close contact with blood or body fluids of the index patients. These results indicate that SFTS patients should not be discharged until recovery. When SFTS patients die, the corpses should be transferred directly from the hospital to the crematorium for cremation by persons wearing proper protective equipment to prevent virus transmission.

Severe Fever With Thrombocytopenia Syndrome in Southeastern China, 2011-2019.

INTRODUCTION: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease, and the number of cases has increased in recent years in Zhejiang Province, China. However, whether the seasonal distribution, geographic distribution, and demographic characteristics of SFTS have changed with the increase of incidence was unclear. MATERIALS AND METHODS: Data on SFTS cases in Zhejiang Province and tick density in Daishan County from 2011 to 2019 were collected. The changing epidemiological characteristics of SFTS including seasonal distribution, geographical distribution, and demographic features were analyzed using descriptive statistical methods, Global Moran's I, local Getis-Ord G i* statistic, and spatial scan statistic. RESULTS: A total of 463 SFTS cases including 53 (11.45%) deaths were reported from 2011 to 2019 in Zhejiang Province, and the annual number of cases showed increasing tendency. SFTS cases were reported in almost half of the counties (40/89) of Zhejiang Province. Elderly farmers accounted for most cases and the proportion of farmers has increased. Most cases (81.21%) occurred during April and August. The interval from illness onset to confirmation was significantly shortened (Z = 5.194, p < 0.001). The majority of cases were reported in Zhoushan City from 2011 to 2016, but most cases were reported in Taizhou City since 2017. DISCUSSION: We observed dynamic changes in the seasonal distribution, geographical distribution, and demographic features of SFTS, and comprehensive intervention measures, such as clearance of breeding sites, killing of tick adults, and health education should be strengthened in farmers of the key areas according to the changed epidemiological characteristics.

Factors associated with spatial distribution of severe fever with thrombocytopenia syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) was firstly identified in mainland China in 2009 and the geographic distribution has expanded in recent years. In this study, we constructed ecological niche models (ENM) of SFTS with meteorological factors, environmental factor, and density of domestic animals using MaxEnt. We found four significant associated factors including altitude, yearly average temperature, yearly accumulated precipitation, and yearly average relative humidity which accounted for 94.1% percent contribution. SFTS occurrence probability was high when altitude was between -100 m and 100 m, and the probability was nearly 0 when altitude was beyond 3000 m. Response curves of SFTS to the yearly average temperature, yearly accumulated precipitation, and yearly average relative humidity were all reversed V-shape. SFTS occurrence probability was high where the yearly average temperature, yearly accumulated precipitation, and yearly relative humidity were 12.5-17.5 °C, 700-2250 mm and 63-82%, respectively. ENMs predicted that the potential high-risk areas were mainly distributed in eastern areas and central areas of China. But there were some predicted potential high-risk areas where no SFTS case was reported up to date. More researches should be done to make clear whether SFTS case had occurred in these areas.

A Cluster of Novel Coronavirus Disease 2019 Infections Indicating Person-to-Person Transmission Among Casual Contacts From Social Gatherings: An Outbreak Case-Contact Investigation.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2, the pathogen causing novel coronavirus disease of 2019 (COVID-19), efficiently spreads from person to person in close contact settings. Transmission among casual contacts in settings such as during social gatherings is not well understood. METHODS: We report several transmission events to both close and casual contacts from a cluster of 7 COVID-19 cases occurring from mid-January to early February 2020. A total of 539 social and family contacts of the index patient's, including members of a 2-day wedding and a family party, were contacted and screened through epidemiologic surveys. The clinical progression of all cases is described. RESULTS: We estimate the secondary attack rate among close contacts to be 29% (2 of 7) and for the casual contacts to be 0.6% (3 of 473). The incubation period of our case cluster was 4-12 days (median, 7 days). CONCLUSIONS: Transmission efficiency among close contacts was higher than among casual contacts; however, transmission from second-generation cases may help spread the virus during the incubation period.

Re-emergence of scrub typhus in Zhejiang Province, southern China: A 45-year population-based surveillance study.

BACKGROUND: Scrub typhus is the leading cause of treatable unidentified febrile illnesses in Southeast Asia. This study was conducted to document the epidemiological characteristics of scrub typhus and its change in Zhejiang, one of traditional epidemic provinces in China. METHODS: Scrub typhus surveillance data in Zhejiang province during 1957-1989 and 2006-2012 were obtained. Descriptive analysis was conducted to characterize the epidemiology of scrub typhus. The spatial distributions over the periods were explored using spatial autocorrelation analysis and spatiotemporal cluster analysis. RESULTS: A total of 4104 cases and 7 deaths were reported from 1957 to 1989 and 2006 to 2017. The incidence declined since 1959, remained low from 1967 to 1989, and then exponentially increased after 2006. The seasonality changed from a summer pattern between 1957 and 1989 to a bimodal peak pattern in July to August and October to November from 2006 to 2017. One primary and three secondary high-risk clusters were affirmed in both periods from 1980 to 1989 and 2006 to 2017. The primary cluster expanded southwestward and the time span of the secondary clusters extended in the later period compared to the clusters in the previous time frame. CONCLUSION: Zhejiang recently underwent a seasonality change, geographic extension, and incidence increase in scrub typhus. More attention should be paid to controlling scrub typhus.

Different Associations between DC-SIGN Promoter-336G/A (rs4804803) Polymorphism with Severe Dengue in Asians and South-Central Americans: a Meta-Analysis.

Objective: This study was conducted to identify the association between rs4804803 polymorphism in DC-SIGN with the susceptibility of severe dengue. Methods: A comprehensive search was conducted to identify all eligible papers in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Google Scholar. Odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were used to assess the association. Subgroup analyses were performed by ethnicity. Sensitivity analyses were performed through employing different statistical models (fixed versus random effect model). Results: A total of nine papers and 12 studies, with 1520 severe dengue and 1496 clinical dengue infection were included. The overall meta-analysis revealed significant associations between rs4804803 and severe dengue under the recession (GG versus GA/AA: OR = 0.44, 95%CI, 0.23-0.82) and a codominant model (GG versus AA: OR = 0.43, 95%CI, 0.23-0.81), but sensitivity analysis indicated that the significant pooled ORs were not robust. The subgroup analysis suggested that the carrier of G in rs4804803 was a risk factor for severe dengue under dominant (GG/GA versus AA: OR = 1.86,95%CI, 1.01-3.45), superdominant (GA versus GG/AA: OR = 1.81,95%CI, 1.02-3.21) and a codominant (GA versus AA: OR=1.82,95%CI, 1.02-3.26) models in Asians, while it was a protective factor for severe dengue in South-central Americans under recessive (GG versus GA/AA: OR = 0.27,95%CI, 0.10-0.70) and codominant (GG versus AA: OR=0.24,95%CI, 0.09-0.64) models. The results from subgroup analysis were robust. Conclusions: Dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN) promoter-336G/A (rs4804803) polymorphism is association with severe dengue, and it acts in different directions for Asians and South-central Americans.

Epidemiological profile of dengue in Zhejiang Province, southeast China.

BACKGROUND: Dengue is one of the most important vector-bore infectious diseases in China because of its drastic increase in incidence, geographic extension and profound influence on China's economy. This study aims to retrospectively uncover the epidemiological profile of dengue in Zhejiang, one of the most developed provinces in China, and to find the problem existing in dengue control and prevention. METHODOLOGY: Descriptive analyses on the dengue incidence and associated factors were performed. We also identified potential space-time cluster and generated the risk map of dengue. PRINCIPAL FINDINGS: A total of 529 cases were reported in Zhejiang Province from 2005 to 2016, and 44.4% were imported. 67.7% of cases were 25~60 years old and the overall male-to-female sex ratio was 1.09:1. Dengue was reported all year round and 70.7% of cases occurred between August and October. Indigenous cases were only reported in the period between July to November and more than half occurred in September. Geographically, dengue was most distributed in Jinghua (3.62 per million), Shaoxing (1.00 per million) and Taizhou (0.81 per million) prefecture level cities. Outbreaks were confirmed in Yiwu, Keqiao and Huangyan counties in 2009, 2015, and 2016, respectively. 73.9% cases would seek medical advice within two days after onset and be confirmed within 9 days after onset. 75.6% would be recognized as dengue within 8 days after their first visit. The time intervals between onset and confirmation (median 7 vs 6 days; Wilcoxon rank sum test Z = -2.40, P = 0.016), first visit and confirmation (median 7 vs 6 days; Wilcoxon rank sum test Z = -2.59, P = 0.009) of indigenous cases were significantly longer than those of imported ones. However, the time intervals between onset and first visit for indigenous cases was shorter (median 0 vs 1 days; Wilcoxon rank sum test Z = -2.10, P = 0.036). Fever (99.1%), fatigue (81.9), rash (63.7%), headache (67.2%) and myalgia (52.60%) were the most frequently mentioned symptoms. CONCLUSIONS: Zhejiang has recently witnessed an increase in incidence and geographic extension of dengue. Timely diagnosis is important to stop local transmission and outbreak.

Seroprevalence of dengue IgG antibodies in symptomatic and asymptomatic individuals three years after an outbreak in Zhejiang Province, China.

BACKGROUND: Cross-reacting antibodies enhanced dengue infection in humans and antibody dependent enhancement (ADE) have been proposed as early mechanisms underlying DHF/DSS. However, the duration of dengue IgG antibodies in the body as well as factors associated with said duration remain unclear. METHODS: Blood samples from 59 dengue symptomatic persons and 48 asymptomatic individuals were collected. Study participant demographic information (including age in 2009, gender, and place of residence) were also collected. Serum samples were tested for dengue specific IgG by Panbio dengue IgG indirect enzyme-linked immunosorbent assay (ELISA). Chi-square tests and logistic regression analysis of dengue IgG antibodies seroprevalence divided by gender, age groups, and symptomatic or asymptomatic infection were conducted using the Statistical Package for the Social Sciences. RESULTS: Overall, 70 (65.42%) blood samples were seropositive for dengue IgG antibodies with similar seroprevalences found when dividing by gender and different age groups. However, seroprevalence of dengue IgG antibodies in samples from dengue symptomatic persons was significantly higher than that in samples from asymptomatic individuals (96.61% vs 27.08%) according to multivariable logistic regression analysis, the odds ratio (OR) of the factor was 76.731. CONCLUSIONS: Dengue IgG antibodies were detectable in samples from most individuals three years after infection. Dengue symptomatic persons had a higher dengue IgG prevalence compared to asymptomatic individuals.

The changing epidemiological characteristics of severe fever with thrombocytopenia syndrome in China, 2011-2016.

Severe fever with thrombocytopenia syndrome (SFTS) is emerging and the number of SFTS cases increased year by year in China. In order to explore the epidemiology trend, we analyzed the changing epidemiological characteristics of SFTS cases in different years and compare characteristics in different provinces. From 2011 to 2016, a total of 5360 laboratory-confirmed SFTS cases were reported and annual case numbers increased year by year. Most SFTS cases occurred in individuals aged between 40 years and 80 years (91.57%), but age distributions of SFTS cases in different years were significantly different and the median ages increased slightly year by year. The numbers of affected counties from 2011 to 2016 increased sharply from 98 to 167. Of note, the seasonal distributions of SFTS cases in different provinces were significantly different (Fisher = 712.157, P = 0.000) and provinces in south regions showed earlier epidemic peak and longer epidemics durations. The median time from illness onset to confirmation of different years was significantly different (χ2 = 896.088, P = 0.000) and it peaked in 2014. Furthermore, case fatality rate was associated with province, year, and age of SFTS cases. These results may be helpful for authorities to better preventive strategy and improve interventions against SFTS.

Human rabies in Zhejiang Province, China.

OBJECTIVES: To explore the epidemiological characteristics of human rabies in Zhejiang Province, China. METHODS: Descriptive and statistical analyses were performed using data collected through interview with human rabies cases or their relatives during 2007 to 2014. A standardized questionnaire was used to collect the data. RESULTS: Two hundred and one cases of human rabies were diagnosed in Zhejiang Province between 2007 and 2014, with a gradually declining annual incidence. Of the rabies cases identified, 61.2% were aged 40-65 years, and the male to female ratio was 2.30:1; 63.7% of cases occurred in the summer and autumn. The two most reported occupations were farmer (69.2%) and rural laborer (15.4%). Wenzhou, Jinhua, and Huzhou were the three cities with the most reported cases. The majority of cases (92.8%) were attributed to canines, and 71.0% of animal vectors were household animals. Less than half of the cases (41.4%) sought wound treatment after exposure. Post-exposure passive immunization was given to 9.7% and active immunization to 2.3%. Cases with a wound on the head/face only had a significantly shorter incubation than those with wounds at other sites (p<0.05); cases with a wound on the hand only had a significantly shorter incubation than those with a wound on the lower limb below the knee only (p<0.001). Non-resident cases were significantly younger (p<0.001) and had a shorter disease duration (p=0.015) than locally resident cases. CONCLUSIONS: The majority of rabies cases occurred among 40-65-year-old male residents of northern, mid-west, and southeast Zhejiang Province. Further health education is needed to increase the coverage of post-exposure prophylaxis (PEP) in people exposed to possible rabid animals and rabies vaccine use in household animals.

Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination.

The Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination, was developed by I. Vodopija and colleagues of the Zagreb Institute of Public Health in Croatia in the 1980s. It was recommended by WHO as one of the intramuscular (IM) schedules for rabies vaccination in 2010. We reviewed the literature on the immunogenicity, safety, economic burden, and compliance of the Zagreb 2-1-1 regimen. Compared to Essen, another IM schedule recommended by WHO, Zagreb has higher compliance, lower medical cost, and better immunogenicity at an early stage.

Characterization and subcellular localization of two 14-3-3 genes and their response to abiotic stress in wheat.

In order to investigate biological functions of the 14-3-3 genes and their response to abiotic stress, two cDNAs (designated as Ta14R1 and Ta14R2) encoding putative 14-3-3 proteins were isolated from wheat by PCR and rapid amplification of cDNA end (RACE) technique. The cDNA of Ta14R1 is 999bp and encodes a protein of 262 amino acids, while the cDNA of Ta14R2 is 897bp in length and encodes a protein of 261 amino acids. Transient expression assays using Ta14R1/Ta14R2-GFP fusion constructs indicated that Ta14R1 and Ta14R2 were located in cytoplasm and cell membrane but not in chloroplasts. Real-time quantitative (RT-PCR) analysis revealed that Ta14R1 and Ta14R2 were differentially expressed in wheat tissues and significantly up-regulated in roots and shoots 1d after germination, indicating they may play a role in process of seed germination. The expression of the two genes in roots and leaves were significantly induced by plant hormone ABA, as well as heat, cold and drought treatments, suggesting that the two 14-3-3 genes in wheat may be involved in ABA dependent stress-responding pathway and response to heat, cold and drought stress.

Comparison of characteristics between patients with H7N9 living in rural and urban areas of Zhejiang Province, China: a preliminary report.

A total of 134 cases of H7N9 influenza infection were identified in 12 provinces of China between March 25 and September 31, 2013. Of these, 46 cases occurred in Zhejiang Province. We carried out a preliminary comparison of characteristics between rural and urban H7N9 cases from Zhejiang Province, China. Field investigations were conducted for each confirmed H7N9 case. A standardized questionnaire was used to collect information about demographics, exposure history, clinical signs and symptoms, timelines of medical visits and care after onset of illness. Of the 46 H7N9 cases in Zhejiang Province identified between March 25 and September 31, 2013, there were 16 rural cases and 30 urban cases. Compared to urban cases, there was a higher proportion of females among the rural cases [11/16 (69%) vs. 6/30 (20%), P = 0.001]. Among the rural cases, 14/15 (93%) with available data had a history of recent poultry exposure, which was significantly higher than that among urban cases (64%, P = 0.038). More patients from the rural group had a history of breeding poultry compared with those from the urban group [38% (6/16) vs. 10% (3/30), respectively; P = 0.025]. Interestingly, the median number of medical visits of patients from rural areas was higher than that of patients from urban areas (P = 0.046). There was no difference between the two groups in terms of age distribution, fatality rate, incubation period, symptoms, and underlying medical conditions. In conclusion, compared to patients from urban areas, more patients from rural areas were female, had an exposure history, had a history of breeding poultry, and had a higher number of medical visits. These findings indicate that there are different exposure patterns between patients living in rural and urban areas and that more rural cases were infected through backyard poultry breeding.

[Meta analysis on the immunogenicity of domestic influenza virus vaccines].

OBJECTIVE: To evaluate the immunogenicity of domestic influenza virus vaccines. METHODS: The published studies that compared the immunogenicity between domestic and imported influenza virus vaccines in Chinese population before September 2012 were collected and evaluated with meta analysis using Stata 10.0 software package. RESULTS: A total of 20 studies that met inclusion criteria were included in this review. The meta analysis result showed that the positive seroconversion rate of B flu virus strain of domestic influenza virus vaccines was significantly higher than that of imported influenza virus vaccines (P=0.036, RR=1.036, 95%CI: 1.002-1.070). No significant difference in three strains' protective rate, H1N1 and H3N2 positive seroconversion rate was found between the domestic and imported influenza virus vaccines (P>0.05). Stratified analysis showed that domestic whole influenza virus vaccine had significantly higher protective rate (P=0.031, RR=1.059, 95%CI: 1.005-1.116), positive seroconversion rate (P=0.024, RR=1.040, 95%CI: 1.005-1.077) of B flu virus strain, and protective rate of H3N2 flu virus strain (P=0.019, RR=1.053, 95%CI: 1.009-1.098) than imported influenza virus vaccines. CONCLUSION: Domestic influenza virus vaccines have desirable immunogenicity.