Differential impacts of vaccine scandal by ethnic and socioeconomic factors: Evidence from China.

Widespread vaccination against important diseases plays a key role for global health security, particularly in the context of the COVID-19 pandemic. However, building and maintaining trust in immunization services remains challenging because of doubts about quality and safety of vaccines. China has periodically faced mounting pressure and even public outrage triggered by incidents of poor-quality vaccines. We aimed to evaluate the impact of the diphtheria, pertussis, and tetanus (DPT) vaccine scandal of 2018 in China and the ensuing misinformation on vaccination, and investigate differential responses to the scandal by ethnic and socioeconomic factors. With data from January 2017 to December 2018 in Sichuan province, China, we used a difference-in-differences (DID) method to compare the changes in the county-level monthly DPT vaccinations against the hepatitis B vaccinations, both before and after the DPT vaccine scandal. We found that the number of DPT vaccinations decreased by 14.0 percent in response to the vaccine scandal and ensuing misinformation. The number of vaccinations in minority regions, under-developed regions, and regions with poor medical resources decreased more than in non-minority regions, developed regions, and regions with good medical resources (24.5 versus 10.1 percent, 17.3 versus 8.3 percent, and 17.0 versus 8.7 percent, respectively). People did more online searching for "Substandard vaccine" and "DPT vaccine" after the scandal, with the socioeconomically advantaged group searching more compared with the socioeconomically disadvantaged group. The results suggest the urgent need to make true information about the vaccine easily accessible over the internet, especially for the socioeconomically disadvantaged groups. Our findings for China can also have implications for immunization service planning for better safeguarding public health in other countries, particularly developing ones.

Analysis of a Sabin-Strain Inactivated Poliovirus Vaccine Response to a Circulating Type 2 Vaccine-Derived Poliovirus Event in Sichuan Province, China 2019-2021.

Importance: The Sabin-strain inactivated poliovirus vaccine (IPV) may be a tool for polio outbreak response in certain situations. Objective: To investigate the response to a type 2 vaccine-derived poliovirus (VDPV2) outbreak. Design, Setting, and Participants: This case series was conducted in China after a VDPV2 was detected in stool specimens from a child with acute flaccid paralysis (AFP) in Sichuan Province in 2019, 3 years after the global withdrawal of live, attenuated type 2 oral poliovirus vaccine (OPV). Investigation followed National Health Commission and World Health Organization guidance and included searching hospitals for unreported AFP cases; testing stool specimens from the child, his contacts, and local children; enhanced environmental surveillance for VDPV2s in wastewater; and measuring vaccination coverage. Sabin-strain IPV campaigns were conducted in a wide geographic area. Main Outcomes and Measures: Any VDPV2 detection after completion of the supplementary immunization activities. Results: A 28-nucleotide-change VDPV2 was isolated from a young boy. Three VDPV2s were detected in healthy children; 2 were contacts of the original child, and none had paralysis. A search of 31 million hospital records found 10 unreported AFP cases; none were polio. No type 2 polioviruses were found in wastewater. Prior to the event, polio vaccine coverage was 65% among children younger than 5 years. Sabin-strain IPV campaigns reached more than 97% of targeted children, administering 1.4 million doses. No transmission source was identified. More than 1 year of enhanced poliovirus environmental and AFP surveillance detected no additional VDPVs. Conclusions and Relevance: These findings suggest that the circulating VPDV2 outbreak in 2019 was associated with low vaccine coverage. An investigation discovered 3 infected but otherwise healthy children and no evidence of the virus in wastewater. Following Sabin-strain IPV-only campaigns expanding from county to prefecture, the poliovirus was not detected, and the outbreak response was considered by an expert panel and the World Health Organization to have been successful. This success suggests that the Sabin-strain IPV may be a useful tool for responding to circulating VDPV2 outbreaks when high-quality supplementary immunization activities can be conducted and carefully monitored in settings with good sanitation.

Chinese expert consensus on immunoprophylaxis of common respiratory pathogens in children (2021 edition).

Respiratory tract infections are infectious diseases involving the respiratory tract (such as the sinuses, throat, airways or lungs), which are the common respiratory disorders in children. With the development of society and the improvement of economic conditions, great progress has been made in China in the prevention of common respiratory pathogens in children. As a result, the incidence and mortality of respiratory tract infections in children have dropped sharply in the past decades. However, there is still a certain gap compared with the international leading levels, which can be partly attribute to insufficient public awareness of vaccination, uneven vaccination services of vaccinators, and so on. On the basis of comprehensive analysis of the clinical evidence of immunoprophylaxis of common respiratory pathogens among children in China and abroad, combined with the clinical situation and the experience of experts, the consensus focuses on the characteristics of transmission, clinical manifestations and immunoprophylaxis of common respiratory pathogens in children, so as to provide reference for clinical practice. This consensus document applies to all Centers for Disease Control and Prevention (CDC) staff levels engaged in the prevention and control of related pathogens, vaccinators at vaccination sites, and medical staff in pediatric, respiratory, and infectious diseases departments at all levels in medical institutions.

Symptom Clustering Patterns and Population Characteristics of COVID-19 Based on Text Clustering Method.

Background: Descriptions of single clinical symptoms of coronavirus disease 2019 (COVID-19) have been widely reported. However, evidence of symptoms associations was still limited. We sought to explore the potential symptom clustering patterns and high-frequency symptom combinations of COVID-19 to enhance the understanding of people of this disease. Methods: In this retrospective cohort study, a total of 1,067 COVID-19 cases were enrolled. Symptom clustering patterns were first explored by a text clustering method. Then, a multinomial logistic regression was applied to reveal the population characteristics of different symptom groups. In addition, time intervals between symptoms onset and the first visit were analyzed to consider the effect of time interval extension on the progression of symptoms. Results: Based on text clustering, the symptoms were summarized into four groups. Group 1: no-obvious symptoms; Group 2: mainly fever and/or dry cough; Group 3: mainly upper respiratory tract infection symptoms; Group 4: mainly cardiopulmonary, systemic, and/or gastrointestinal symptoms. Apart from Group 1 with no obvious symptoms, the most frequent symptom combinations were fever only (64 cases, 47.8%), followed by dry cough only (42 cases, 31.3%) in Group 2; expectoration only (21 cases, 19.8%), followed by expectoration complicated with fever (10 cases, 9.4%) in Group 3; fatigue complicated with fever (12 cases, 4.2%), followed by headache complicated with fever was also high (11 cases, 3.8%) in Group 4. People aged 45-64 years were more likely to have symptoms of Group 4 than those aged 65 years or older (odds ratio [OR] = 2.66, 95% CI: 1.21-5.85) and at the same time had longer time intervals. Conclusions: Symptoms of COVID-19 could be divided into four clustering groups with different symptom combinations. The Group 4 symptoms (i.e., mainly cardiopulmonary, systemic, and/or gastrointestinal symptoms) happened more frequently in COVID-19 than in influenza. This distinction could help deepen the understanding of this disease. The middle-aged people have a longer time interval for medical visit and was a group that deserve more attention, from the perspective of medical delays.

Sepsis-related hospital admissions and ambient air pollution: a time series analysis in 6 Chinese cities.

BACKGROUND: Some prevalent but rarely studied causes of hospital admissions, such as sepsis is still unknown whether affected by air pollution. METHODS: We used time-series regression within generalized additive models to estimate the effect of air pollutant level on the sepsis-related hospital admissions, for the years 2017-18, using data from six cities in Sichuan, China. Potential effect modifications by age and sex were also explored. The effects of air pollutant on hospital stays for sepsis were also quantified. RESULTS: Positive associations between short-term exposure to NO2 and O3 and risk of sepsis-related hospital admissions and stays were found. Each 10 µg/m3 increase in short-term NO2 at lag 03 and O3 at lag 4 was associated with an increase of 2.76% (95% CI: 0.67, 4.84%) and 0.64% (95% CI: 0.14, 1.14%) hospital admissions, respectively. An increase of 0.72% (95% CI: 0.05, 1.40%) hospital stay was associated with 10 µg/m3 increase in O3 concentration at lag 4. Besides, the adverse effect of exposure to NO2 was more significant in males and population aged less than 14 years; while more significant in females and population aged 14 ~ 65 and over 65 years for exposure to O3. These associations remained stable after the adjustment of other air pollutants.8. CONCLUSION: Exposure to ambient NO2 and O3 may cause substantial sepsis hospitalizations, and hospital stays in Sichuan, China. These associations were different in subgroup by age and sex.

Detection and Initial Response to a Type 2 Vaccine-Derived Poliovirus - Sichuan Province, China, 2019.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: After the type 2 strain of the live, attenuated poliovirus vaccine was withdrawn globally in 2016, any identification of a type 2 poliovirus is a Public Health Emergency of International Concern. A vaccine-derived type 2 poliovirus (VDPV2) was identified in Sichuan, prompting an urgent, comprehensive investigation and response. WHAT IS ADDED BY THIS REPORT?: Type 2 monovalent, live, attenuated oral poliovirus vaccine (mOPV2) is being used to respond to the numerous VDPV2 outbreaks seen around the world. In contrast, the response in Sichuan used Sabin strain inactivated poliovirus (sIPV) to stop circulation of the VDPV2. In the 6 months following the vaccination response, there have been no VDPV2s detected in Sichuan, despite extensive search. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICES?: Further search for the VDPV2 must continue in order to determine whether transmission has been stopped. The ongoing investigation and response to the Sichuan VDPV2 is providing evidence to the Global Polio Eradication Initiative on managing VDPV2 outbreaks.

Electrochemically modified graphite for fast preparation of large-sized graphene oxide.

Large-sized graphene oxide (LGO) is desirable for many graphene-based applications. Herein, for the first time, we synthesized LGO (83 µm average size) using electrochemically modified graphite as the precursor. With this strategy, we could reduce both the oxidation time (1 h) and oxidant dosage (2 equiv.) while achieving a fast and high-yield (∼90.3 wt%) LGO preparation. LGO papers show much better mechanical properties and nearly four times higher conductivity (after reduction) than their counterparts assembled using small-sized GO. The results demonstrated that electrochemical pre-treatment is an efficient approach to accelerate the oxidation of graphite at low oxidant dosages and to control the size of the resulting GO.

Phase-Separation-Induced PVDF/Graphene Coating on Fabrics toward Flexible Piezoelectric Sensors.

Clothing-integrated piezoelectric sensors possess great potential for future wearable electronics. In this paper, we reported a phase-separation approach to fabricate flexible piezoelectric sensors based on poly(vinylidene fluoride) (PVDF)/graphene composite coating on commercially available fabrics (PVDF/graphene@F). The structural units of -CH2- and -CF2- of PVDF chains were arranged directionally due to the structural induction of graphene and water during phase separation, which is the key for electroactive phase enrichment. In optimized case, integrating into fabric substrates endows the phase-out PVDF/graphene composite coating 4 times higher voltage output than its film counterpart. Piezoelectric sensor based on PVDF/graphene@F exhibits a sensitivity of 34 V N-1, which is higher than many reports. It also shows low detecting threshold (0.6 mN), which can be applied to distinguish the voices or monitor the motion of body. This simple and effective approach toward PVDF/graphene@F with excellent flexibility provides a promising route toward the development of wearable piezoelectric sensors.

Risk factors for HIV/syphilis infection and male circumcision practices and preferences among men who have sex with men in China.

OBJECTIVE: To investigate factors associated with HIV infection and the frequency and willingness of male circumcision among men who have sex with men (MSM) in Chengdu city, China. METHODS: A cross-sectional survey provided information on participants' demographics, risk behaviors, circumcision, and uptake of HIV prevention services. RESULTS: Of 570 participants, 13.3% were infected with HIV and 15.9% with syphilis. An estimated 43.0% of respondents reported having unprotected receptive anal intercourse, and 58.9% reported having ≥2 male sexual partners in the past 6 months. Multivariable logistic regression revealed that syphilis, more male sex partners, predominantly receptive anal intercourse, and exclusively receptive male sex were associated with HIV infection. Higher level of education and peer education service were inversely associated with HIV infection. Nearly a fifth (18.0%) of participants were circumcised. More than half of uncircumcised participants expressed willingness to be circumcised. CONCLUSION: This study reveals a high prevalence of HIV and syphilis among MSM in Chengdu province of China. The frequency of unprotected receptive anal intercourse and multiple male sexual partnerships highlight the urgency for an effective comprehensive HIV prevention strategy. Although the willingness to accept male circumcision (MC) is high, further research is needed to assess the protective effective of MC among MSM.

Mixed carbon source control strategy for enhancing alginate lyase production by marine Vibrio sp. QY102.

Medium and culture conditions for alginate lyase production by marine Vibrio sp. QY102 were first optimized using statistical methods including Plackett-Burman design and central composite design. Then, fermentation in 5-L bioreactor showed that alginate acted as easily used carbohydrate for Vibrio sp. QY102, while starch extended its growth phase and stabilized pH variations. Thus, a novel strategy using mixed carbon sources was proposed that starch supported growth while enzyme synthesis was induced by pulse feedings of solid alginate. The optimized process followed that Vibrio sp. QY102 grew on starch until the end of the logarithmic growth phase, and then solid alginate was added as 1 g/L every 3 h. Meanwhile, initial pH 5.0 and natural pH during fermentation was favorable for alginate lyase production. After optimization, the highest alginate lyase production reached 52.8 U/mL, which was 329 % higher than the control. Finally, fermentation scale-up was performed in 30-L bioreactor and the maximum alginate lyase production was obtained as 46.8 U/mL.

Nutrition and bioprocess development for efficient biosynthesis of an antitumor compound from marine-derived fungus.

An integrated nutrition and bioprocess strategy was developed for improving the biosynthesis of an antitumor compound, 1403C, by a marine-derived fungus, Halorosellinia sp. (no. 1403). First, statistical design strategies were synthetically applied to optimize the nutritional composition. The resulting 1403C production reached 2.07 g/l, which was 143.5 % higher than the original production. However, it only produced 0.44 g/l of 1403C in 5-l bioreactor fermentation. Thus, the operating parameters including culture pH, dissolved oxygen, agitation speed, impeller type and inoculum level were considered to improve the fermentation process, and an effective control strategy for 1403C production by Halorosellinia sp. submerged in a 5-l bioreactor was established. When inoculating 0.22 g/l dry biomass, controlling dissolved oxygen not lower than 30 % during the growth phase but ranging between 30 and 40 % during the stationary phase, using a double-layer six-flat-blade Rushton disc turbine agitated at 400 rpm, keeping short-term low pH and rapid-rising pH with glucose starvation, the highest 1403C production was finally obtained at 1.32 g/l, which was promoted by 200 % compared to before optimization. Fermentation scale-up was finally performed in a 500-l bioreactor, and 1403C production of 1.09 g/l was obtained.

An integrated control strategy for the fermentation of the marine-derived fungus Aspergillus glaucus for the production of anti-cancer polyketide.

An integrated control strategy of pH, shear stress, and dissolved oxygen tension (DOT) for fermentation scale-up of the marine-derived fungus Aspergillus glaucus HB 1­19 for the production of the anti-cancer compound aspergiolide A was studied. Keeping initial pH of 6.5 and shifting pH from 6.0 to 7.0 intermittently during the production phase greatly facilitated biosynthesis of aspergiolide A in shake flask cultures. Thus, a pH-shift strategy was proposed that shifting pH to 7.0 once it went lower than 6.0 by pulsed feeding NaOH solution during the production phase in bioreactor fermentation of A. glaucus HB 1­19. As a result, aspergiolide A production in a 30-L bioreactor was increased to 37.6 mg/L, which was 48.6% higher than that in 5-L bioreactor without pH shift. Fermentation scale-up was then performed in a 500-L bioreactor on the basis of an integrated criterion of near-same impeller tip velocity of early phase, DOT levels, and pH shift. The production of aspergiolide A was successfully obtained as 32.0 mg/L, which was well maintained during the process scale-up. This work offers useful information for process development of large-scale production of marine microbial metabolites.

Conflict of interest and FCTC implementation in China.

OBJECTIVE: To critically review the structure of tobacco control policy making in China, examine conflicts of interest within this structure, and consider how these affected the introduction of on-pack warnings. METHODS: Government policy documents and warning labels were obtained and critically reviewed. RESULTS: Few differences exist between the on-pack warnings formerly used in China and those introduced ostensibly to meet Framework Convention on Tobacco Control (FCTC) obligations. Comparison with tobacco manufactured for export or overseas consumption shows the new Chinese domestic on-pack warnings are demonstrably inferior to those required internationally. The inherent conflict of interest in the Chinese tobacco control agency structure, which must meet commercial and public health objectives, undermined the introduction of new health warnings. CONCLUSIONS: To promote more effective tobacco control policies, the conflict of interest inhibiting the public health function of the State Tobacco Monopoly Administration (STMA) must be removed. Specifically, the public health function must be separated from oversight of commercial production, and packaging must be redesigned with pictorial warnings and messages compliant with Article 11 of the FCTC.

Enhancing aspergiolide A production from a shear-sensitive and easy-foaming marine-derived filamentous fungus Aspergillus glaucus by oxygen carrier addition and impeller combination in a bioreactor.

Production enhancement of a novel antitumor compound aspergiolide A from shear-sensitive and easy-foaming marine-derived fungus Aspergillus glaucus HB1-19 in a 5-l stirred bioreactor was investigated. Two types of impellers, i.e., six-flat-blade disc turbine impeller (DT) and three-sector-blade pitched blade turbine impeller (PB) were used in this work. In cultures with fermentation medium, the combination of upper PB and lower DT led to the maximum dry biomass (13.8 g/l) and aspergiolide A production (19.3 mg/l). However, two PBs brought the highest aspergiolide A yield coefficient (1.9 mg/g dry biomass) despite it produced the lowest dry biomass (5.3 g/l). By contrast, two DTs and the upper DT and lower PB showed insignificant results. Feeding 0.35% (v/v) n-dodecane in cultures with upper PB and lower DT further improved aspergiolide A production by 31.0%, i.e., 25.3 mg/l, which is also 322% higher than that in the ordinary cultures with two DTs.

Efficient strategy for enhancing aspergiolide A production by citrate feedings and its effects on sexual development and growth of marine-derived fungus Aspergillus glaucus.

Aspergiolide A production enhancement by citrate and its effects on growth and sexual development of marine-derived fungus Aspergillus glaucus HB1-19 were investigated. In agar plate culture, 15 mM citric acid decreased colony radial growth and aspergiolide A production by 31.5% and 23.0%, respectively. It also improved sexual cleistothecium formation by 360% but depressed asexual conidiospore generation by 84.8%. In submerged culture, adding 40 mM citric acid finally promoted aspergiolide A production by 80.0%, which accompanied with 16.7% increase of biomass and 10.0% enhancement of sugar utilization. Differently, sodium citrate made no obvious or even opposite effects. Citrate and low pH could significantly improve pyruvate accumulation but inhibit succinate and fumarate production. Moreover, low pH was favorable to citrate utilization. Organic acids changes were closely related to aspergiolide A biosynthesis. Comparing to pH controls, effects of citric acid comprised pH decrease solicitation and citrate utilization enhancement.

Significant stimulation of o-phthalic acid in biosynthesis of aspergiolide A by a marine fungus Aspergillus glaucus.

The effect of o-phthalic acid (o-PA) on the production of the anti-tumor polyketide compound aspergiolide A by the marine fungus Aspergillus glaucus was investigated. o-PA at 12mM increased the aspergiolide A production by 77%. A combination of 12mM acetate with 12mM o-PA increased the production by 126%, i.e., from 27.1mg/l to 60.9mg/l, which was 27% and 75% higher than adding either 12mM o-PA or 12mM acetate, respectively. It was also found that A. glaucus could use o-PA as the sole carbon source on Minimal Medium. Ninety percent of o-PA was degraded by the fungus strain, especially when 12mM acetate was supplemented simultaneously. In culture medium supplemented with o-PA addition, sugar consumption decreased with increasing o-PA concentration, at the same time, the oxalacetate and pyruvate levels increased and the concentration of fumarate decreased. The results indicated that o-PA could stimulate biosynthesis of aspergiolide A effectively by regulating the metabolic pathway.