Effect of EV71 Vaccination on Transmission Dynamics of Hand, Foot, and Mouth Disease and Its Epidemic Prevention Threshold.

OBJECTIVE: To investigate the effect of Enterovirus A71 (EV71) vaccination on the transmissibility of different enterovirus serotypes of hand, foot, and mouth disease (HFMD) in Zhejiang, China. METHODS: Daily surveillance data of HFMD and EV71 vaccination from August 2016 to December 2019 were collected. Epidemic periods for each HFMD type were defined, and the time-varying effective reproduction number (Rt) was estimated, which could provide more direct evidence of disease epidemics than case number. General additive models (GAMs) were employed to analyze associations between EV71 vaccination quantity and rate and HFMD transmissibility. The epidemic prevention threshold, represented by required vaccination numbers and rates, was also estimated. RESULTS: Vaccinating every 100,000 children ≤ 5 years could lead to a decrease in the Rt of EV71-associated HFMD by 14.44% (95%CI: 6.76%, 21.42%). Additionally, a positive correlation was observed between vaccinations among children ≤ 5 years old (per 100,000) and the increased transmissibility of other HFMD types (caused by enteroviruses other than EV71 and CA16) at 1.82% (95%CI: 0.80%, 2.84%). It was estimated that an additional 362,381 vaccinations, corresponding to increased vaccine coverage to 54.51% among children ≤ 5 years could effectively prevent EV71 epidemics in Zhejiang. CONCLUSIONS: Our findings highlight the importance of enhancing EV71 vaccine coverage for controlling the epidemic of EV71-HFMD and assisting government officials in developing strategies to prevent HFMD.

Novel Human Milk Fat Substitutes Based on Medium- and Long-Chain Triacylglycerol Regulate Thermogenesis, Lipid Metabolism, and Gut Microbiota Diversity in C57BL/6J Mice.

Human milk is naturally rich in medium- and long-chain triacylglycerols (MLCT), accounting for approximately 30% of the total fat. However, infant formula fat is prepared using a physical blend of vegetable oils, which rarely contains MLCT, similar to human milk. The differences in MLCT between human milk and infant formulas may cause different lipid metabolisms and physiological effects on infants, which are unknown. This study aimed to analyze the metabolic characteristics of formula lipid containing novel human milk fat substitutes based on MLCT (FL-MLCT) and compare their effects with those of the physical blend of vegetable oils (FL-PB) on lipid metabolism and gut microbiota in mice. Compared with the FL-PB group, the FL-MLCT group showed increased energy expenditure, decreased serum triacylglycerol level, and significantly lower aspartate aminotransferase level, epididymal and perirenal fat weight, and adipocyte size. Moreover, the abundances of Firmicutes/Bacteroidota, Actinobacteriota, and Desulfovibrionaceae were significantly decreased in the FL-MLCT group. Novel human milk fat substitutes MLCT could inhibit visceral fat accumulation, improve liver function, and modulate the mice gut microbiota composition, which may contribute to controlling obesity.

The impact of EV71 vaccination program on hand, foot and mouth disease in Zhejiang Province, China: A negative control study.

Objective: To estimate the potential causal impact of Enterovirus A71 (EV71) vaccination program on the reduction of EV71-infected hand, foot, and mouth disease (HFMD) in Zhejiang Province. Methods: We utilized the longitudinal surveillance dataset of HFMD and EV71 vaccination in Zhejiang Province during 2010-2019. We estimated vaccine efficacy using a Bayesian structured time series (BSTS) model, and employed a negative control outcome (NCO) model to detect unmeasured confounding and reveal potential causal association. Results: We estimated that 20,132 EV71 cases (95% CI: 16,733, 23,532) were prevented by vaccination program during 2017-2019, corresponding to a reduction of 29% (95% CI: 24%, 34%). The effectiveness of vaccination increased annually, with reductions of 11% (95% CI: 6%, 16%) in 2017 and 66% (95% CI: 61%, 71%) in 2019. Children under 5 years old obtained greater benefits compared to those over 5 years. Cities with higher vaccination coverage experienced a sharper EV71 reduction compared to those with lower coverage. The NCO model detected no confounding factors in the association between vaccination and EV71 cases reduction. Conclusions: This study suggested a potential causal effect of the EV71 vaccination, highlighting the importance of achieving higher vaccine coverage to control the HFMD.

Signatures of immune cell infiltration for predicting immune escape and immunotherapy in cervical cancer.

The cervical cancer tumor microenvironment is a diverse and complex ecosystem. Tumor-immune cell infiltration (ICI) may influence immune escape and immunotherapeutic responses. However, the relationship between immune cell infiltrations, immune escape, and immunotherapy in cervical cancer has not been fully clarified. Here, Principal component analysis (PCA) and Tumor immune dysfunction and exclusion (TIDE) were applied to calculate individual ICI scores and probabilities of immune escape, respectively. Through the IMvigor210 and the Cancer Immunome Atlas (TCIA) datasets, we validated the different responses to immunotherapy in two subgroups of patients. Furthermore, therapeutic benefits of different patients were predicted by the pRRophetic package. We found that patients with high ICI scores were prone to immune escape due to the activated JAK-STAT signaling pathway, along with lower CD8+ T cells. High ICI scores patients could benefit more from anti-PD-L1 immunotherapy, and individuals with low scores may be better candidates for the anti-CTLA-4 treatment. Combinations of immunotherapies with targeted inhibitors may improve clinical efficacy and reduce the risk of tumor recurrence. The ICI model not only helps us enhance the cognition of immune escape, but also guides the application of immunotherapy in cervical cancer patients.

Real-world safety profile of the 9-valent human papillomavirus vaccine: A study in Zhejiang, China from 2019 to 2021.

The safety profile of the 9-valent human papillomavirus vaccine (9vHPV) was evaluated based on the reporting rate of adverse events following immunization (AEFI) obtained from the passive surveillance data in Zhejiang. The 9vHPV AEFI reports in Zhejiang were collected and reviewed from the National Adverse Event Following Immunization Surveillance System (NAEFISS) from 2019 to 2021. Reporting rates of AEFI were analyzed under multiple aspects, including age, city, number of vaccinations, AEFI categories, and diagnosis categories. This study used the reporting odds ratio (ROR) for anomalous signal assessment. The NAEFISS collected 331 AEFI reports after administering 1,064,851 doses of 9vHPV, with a crude AEFI rate of 3.12/10,000 doses. The third dose had the highest reporting rate of minor vaccine-related reaction (n = 80, 3.06 per 10,000), followed by the first dose (n = 134, 2.98 per 10,000), and second dose (n = 76, 2.15 per 10,000). Fever/redness/induration was the most common minor adverse event (281 records, 2.64/10,000 doses). Nine cases of urticaria, ten cases of allergic rash, and ten cases of syncope were recorded. This study found a positive signal association between 9vHPV immunization and adverse events such as syncope, encephalitis, sterile abscess, and urticaria. This study did not identify any new emerging safety concerns. In the future, more research is needed to validate and further explore adverse reactions associated with 9vHPV.

Modeling long-term persistence after 8 years of hepatitis B booster vaccination in 5- to 15-year-old children.

Vaccination remains the most effective and cost-saving measure to protect against hepatitis B, a global health problem. It is crucial to characterize the persistence of the immune response after booster vaccination. This study aimed to quantify the persistence through mathematical modeling. Booster vaccination against hepatitis B was conducted in children 5-15 years in 2009-10 in Zhejiang Province. There were four dosage formulations of hepatitis B vaccines [Shenzhenkangtai Biotechnology Co. Ltd. Dalianhanxin Biotechnology Co. Ltd. NCPC GeneTech Biotechnology Pharmaceutical Co. Ltd. Sinovac Biotech Co. LTD. China]: 5, 10, and 20 µg hepatitis B vaccines or 5 µg hepatitis A and B (HAB) combination vaccine with a 0-1-6-month schedule. These were randomly administered to children negative for all hepatitis B markers, named as the schedule 2 group. Anti-HBs positive subjects were given one dose of booster, named as the schedule 1 group. Anti-HBs antibody was measured 1, 7, 18, 66, and 102 months after the first booster dose. A linear mixed-effects model was proposed to predict long-term persistence. One hundred two months after the booster dose, the mean anti-HBs levels were 33.8 mIU/mL, with 73.7 mIU/mL for the schedule 1 group and 20.2 mIU/mL for the schedule 2 group. The model predicted that 99.5% of subjects would remain seropositive (≥10mIU/mL) at year 20 post booster vaccination, with 100.0% and 98.8% for the schedule 1 group and the schedule 2 group, respectively, whereas at year 30, the seropositivity rates would decrease to 76.8%, with 99.4% for the schedule 1 group and 62.5% for the schedule 2 group. The immunogenicity of the booster vaccination could persist for at least 8 years. Mathematical modeling may predict even longer, up to 30 years of protection.

The impact of a closed-loop electronic blood transfusion system on transfusion errors and staff time in a children's hospital.

OBJECTIVES: To assess the impact of a closed-loop electronic blood transfusion system on transfusion errors and staff time. MATERIALS AND METHODS: Before and after study in all wards of a children's hospital, involving patients and staff of all the wards. The changes were closed-loop electronic blood transfusion, barcode patient identification, electronic blood transfusion administration records and error pop-up warning. The main outcome measures were percentage of blood transfusion errors, time spent on transfusion tasks. RESULTS: Transfusion errors were identified in 3.87% of 2556 blood transfusion orders pre-intervention and 0.78% of 2577 orders afterwards (P<0.01). Phlebotomists, nurses, and physicians may make mistakes, including wrong blood type when apply for blood, wrong patient when blood draw or transfusion, wrong dose when apply for blood and the wrong tube label when blood draw or cross-matching, which are significantly reduced after change (1.09% vs 0.31%, 1.13% vs 0%, 0.31% vs 0%, 1.33% vs.0.78%, P<0.01). Time spent on blood apply was 5.3±1.2min, hand over blood bag at the transfusion department was 14.9±1.4min and blood transfusion was 15.8±2.4min. Time per transfusion round decreased to 2.6±1.0min, 6.3±1.6min and 9.3±2.2min respectively (P<0.01). CONCLUSIONS: A closed-loop electronic blood transfusion, barcode patient identification and error pop-up warning reduced transfusion errors, and increased confirmation of patient and blood types identity before transfusion. Time spent on blood transfusion tasks reduced.

The effect of hepatitis B vaccination after five years on an entire population in an insular region of Southeast China.

Prevalence of hepatitis B (HB) remains high among adults in insular regions of southeast China. To address this issue, large-scale HB vaccination was implemented in Putuo County of Zhoushan City in 2013. To examine the effects of this large-scale HB vaccination, a cross-sectional serological survey was conducted on two isolated islands, Putuo (intervention group) and Dinghai (control group) Counties of Zhoushan City in southeastern China five years later. The data showed lower prevalence of HBsAg and negative results for all HBV markers in the intervention group compared to the control group (4.2% and 6.0%, 20.8% and 33.0%), while the positive rate for anti-HBs and only anti-HBs were higher (68.4% and 53.4%, 47.9% and 34.3%). Therefore, large-scale adult HB vaccination could lower the HB epidemic level. However, the proportion of susceptible people who were negative for all HBV markers remained high. Hence, several additional measures to limit the spread of HBV should be taken by the government.

Strategies for hepatitis B booster vaccination among children: an 8-year prospective cohort study.

Debate continues regarding the need for a booster vaccination in children who received a universal infant hepatitis B virus (HBV) vaccination. The aim was to explore the need and the strategies for the booster HBV vaccination. 8-year prospective cohort study was conducted among children aged 5-15 years in 2009-2010 in Zhejiang Province. The participants were divided into groups A (<0.1 mIU/mL), B (0.1 to < 1 mIU/mL) and C (1 to <10 mIU/mL) according to the pre-booster anti-HBs antibody levels. 5 µg (group I), 10 µg (group II), 20 µg hepatitis B vaccines (group III) or 5 µg hepatitis A and B (HAB) vaccines (group IV) with 0-1-6-month schedule were randomly administered to children negative for all markers. Blood samples were collected at baseline HBV marker testing, 1 month after the first dose, 1 month, 1 year, 5 years and 8 years after the third dose. Among 4170 children, 2326 (55.8%) were negative for all HBV markers. Group II showed the highest seropositive rates of 92.8%, 99.7%, 97.6%, 90.3% and 83.4% with GMTs of 4194.5 mIU/ml, 4163.9 mIU/ml, 466.9 mIU/ml, 190.6 mIU/ml, 122.6 mIU/ml from 1 month after dose 1 to 8 years after dose 3, respectively (P < .01). Participants in group C showed seropositive rates of 98.9%, 99.9%, 99.5%, 95.5%, 92.8% after the revaccination with GMTs of 6519.6 mIU/ml, 5267.4 mIU/ml, 547.1 mIU/ml, 249.5 mIU/ml, 155.3 mIU/ml, respectively, higher than group A and B (P < .001), except 1 month after the third dose. The 10 µg of HBV vaccine with a 0-1-6-month booster regimen may elicit robust responses and persist for 8 years or longer. Additionally, 1-dose revaccination maybe suitable for children with 1 to < 10 mIU/ml anti-HBs titers.

Long-term persistence of anti-HBs after hepatitis B vaccination among adults: 8-year results.

The long-term persistence of hepatitis B surface antibody (anti-HBs) after hepatitis B vaccination among adults was not known clearly. This study aimed to assess the immunogenicity and persistence of antibodies 8 years after hepatitis B immunization with different vaccination schedules among adults who tested negative for hepatitis B surface antigen (HBsAg), anti-HBs, and hepatitis B core antibody (anti-HBc). A total of 771 participants who received the full vaccination course (three doses) and also had a blood sample taken 1 month after the first vaccination were recruited. Of these, 529 were excluded due to the missing data of anti-HBs 8 years after the first vaccination. Vaccinations were carried out at 0-1-3, 0-1-6 and 0-1-12 month vaccination schedules, and 104, 45, and 93 participants were included, respectively. The positive seroprotection rate was 85.9% 1 month after the third vaccination, and 58.3% 8 years later (χ2 = 54.52, P < .001), while the geometric mean titer (GMT) of anti-HBs was 158.49 mIU/mL [95% confidence interval (CI): 131.83-190.55)] and 15.14 mIU/mL (95% CI: 10.96-20.42) after 1 month and 8 years, respectively. Compared with the standard 0-1-6 month vaccination schedule, the positive seroprotection rate and the GMT of the 0-1-3 month vaccination schedule had no difference. The long-term immune effect of the 0-1-3 month vaccination schedule was better than that of the 0-1-12 month vaccination schedule. No correlation was found between the GMT of anti-HBs 1 month and 8 years later.

Safety and immunogenicity of hepatitis E vaccine in elderly people older than 65 years.

BACKGROUND: Hepatitis E virus (HEV) infection is a leading cause of acute hepatitis worldwide, and results in high morbidity and mortality rates among elderly people in China. The hepatitis E vaccine, Hecolin®, has been shown to be safe and highly efficacious among healthy adults aged 16-65 years old. However, there is no data about Hecolin® vaccination in elderly people older than 65 years (y). METHODS: An open-labeled, controlled trial was conducted to evaluate the safety and immunogenicity of Hecolin® among the elderly aged >65 y. A total of 601 eligible participants were enrolled. Among them, 200 elderly people aged >65 y and 201 adults aged 18-65 y were assigned to the Hecolin® groups and vaccinated at day 0, month 1 and month 6. Serum samples were collected for anti-HEV IgG determination at day 0 prior to immunization and at month 7. The remaining 200 elderly people aged >65 y were assigned to the safety control group and received no intervention but were instructed to report any adverse events that occurred during the whole study period in the same way as those in the Hecolin® groups. RESULTS: After receiving 3 doses of Hecolin® with the standard schedule, most (96.7%) of the vaccinated elderly people aged >65 y seroconverted at one month after the final dose (month 7). At month 7, the geometric mean concentrations of anti-HEV IgG were 5.36 (95% CI, 3.88-7.41) and 19.65 (95% CI, 16.81-22.98) among the baseline seronegative and seropositive elderly, respectively. Of the vaccinated elderly, 97.3% (177/182) had anti-HEV IgG levels higher than 1.0 WU/ml at month 7. Hecolin® was very well tolerated in this population. No vaccine-related SAEs were reported. CONCLUSIONS: Hecolin® is immunogenic and well tolerated in elderly people aged greater than 65 years.

[Research progress of pyroptosis in sepsis].

OBJECTIVE: Sepsis is an organ dysfunction syndrome caused by an abnormal host immune response because of infection. Pyroptosis is a newly discovered programmed cell death relies on caspase-1, caspase-11, caspase-4, caspase-5 and is characterized by the release of inflammatory cytokines interleukin-1ß (IL-1ß) and IL-18. The exploration of the molecular mechanisms of pyroptosis and the correlation between pyroptosis and sepsis can provide new ideas and new targets for the treatment of sepsis.

Insights into the synergetic mechanism of a combined vis-RGO/TiO2/peroxodisulfate system for the degradation of PPCPs: Kinetics, environmental factors and products.

In recent years, how to effectively remove emerging organic pollutants in water bodies has been studied extensively, especially in the actual complex water environment. In the present study, an effective wastewater treatment system that combined photocatalysis and an oxidizing agent was investigated. Specifically, visible-light driven reduced graphene oxide (RGO)/TiO2 composites were prepared, and peroxodisulfate (PDS) was used as electron acceptor to accelerate the photocatalytic activity of this material. The vis-RGO/TiO2/PDS system exhibited outstanding properties in the degradation of diclofenac (DCF), which was also facilitated by acidic conditions and Cl-. Lake water, tap water, river water and HCO3- decreased the DCF degradation rate, while NO3- affected the system only slightly. Low concentrations of fulvic acid (FA) promoted the degradation of DCF via the generation of excited states, whereas a high concentration of FA inhibited the degradation, which was likely due to the light screening effect. The photocatalytic mechanism revealed that PDS served as an electron acceptor for the promotion of electron-hole pair separation and the generation of additional reactive oxygen species, while the RGO served as an electric conductor. The active substances, h+, OH, 1O2, SO4- and O2- were generated in this system, O2- and h+ played significant roles in the degradation of DCF based electron spin resonance tests and radical quenching results. According to the mass spectrometry results, the amide bond cleavage, dechlorination reaction, hydroxyl addition reaction, and decarboxylation reaction were the primary transformative pathways.

Photocatalytic degradation of clofibric acid by g-C3N4/P25 composites under simulated sunlight irradiation: The significant effects of reactive species.

Pharmaceutically emerging micropollutants have become an environmental concern in recent years. In the present paper, the reactive species (RSs)-induced degradation mechanism of clofibric acid (CA) was investigated using a newly sunlight-driven g-C3N4/P25 photocatalyst. A very low g-C3N4 content of 8.0 weight percent resulted in a 3.36 and a 2.29 times faster reaction rate for CA photodegradation than for pristine g-C3N4 and P25, respectively. Electron spin resonance and quenching experiments demonstrated the participation of HO, h+, e-, 1O2 and O2·- in the photocatalytic system, and the contribution rates were calculated to 73.3%, 15.3%, 5.1%, 6.7% and 33.1%, respectively. According to the pulse radiolysis measurements and the competitive kinetics approaches, the bimolecular reaction rate constants for HO, e-, and 1O2 with CA were (8.47 ± 0.33) × 109 M-1s-1, (6.41 ± 0.48) × 109 M-1s-1 and (6.6 ± 0.37) × 106 M-1s-1, respectively. RSs were found to significantly influence the degradation of CA, and the degradation pathways occurred primarily via e- reduction, HO addition and 1O2 attack reactions on the basis of mass spectrometry and theoretical calculations.

Responses to hepatitis B vaccine in isolated anti-HBc positive adults.

Immune responses of isolated anti-HBc subjects are not well characterized in populations in China. This study aimed to evaluate immune responses to hepatitis B vaccination in isolated anti-HBc positive subjects. A cohort of 608 subjects were selected and separated into isolated anti-HBc (negative for HBsAg and anti-HBs, positive for anti-HBc) and control (negative for HBsAg, anti-HBs, and anti-HBc) groups, who were matched by age and sex. All subjects received 3 doses of hepatitis B vaccine (20µg) at months 0, 1, and 3, followed by testing for serological responses 1 month after the third vaccination. The positive seroprotection rate and geometric mean titer (GMT) for hepatitis B surface antibody (anti-HBs) of isolated anti-HBc subjects were significantly lower than those in the control group(86.2% vs.92.1%, P = 0.02; 47.26 vs.97.81 mIU/mL, P < 0.001). When stratified by age, positive seroprotection rate in the isolated anti-HBc group were 92%, 88.5% and 79.4% in the 20-34, 35-49, and 50-60 y old subgroups, respectively (χ2 = 5.919, P = 0.04). Additionally, the GMT level for anti-HBs in the isolated anti-HBc group for different age subgroups were 104.43, 47.87 and 31.79 mIU/mL respectively (χ2 = 19.44, P < 0.001). The GMT level for anti-HBc before vaccination were negatively correlated with GMT for anti-HBs after 3 doses of hepatitis B vaccine (r = -0.165, P < 0.001). In conclusion, isolated anti-HBc positive subjects can achieve good immune responses after hepatitis B vaccination, and the positive seroprotection rate and GMT level for anti-HBs were lower than the control group. Better responses could be observed in young adults, and significant negative correlations were found between GMT of anti-HBc before vaccination and GMT of anti-HBs after vaccination.

Optimal vaccination program for healthy adults in China.

There is still no suitable routine hepatitis B immunization strategy for adults in China. To establish an optimal vaccination schedule for healthy adults, we investigated various schedules in healthy adults. In this randomized 5143 healthy adults received 10 µg hepatitis B vaccine at 0, 1 and 3 months(group A), 0, 1 and 6 months(group B), or 0, 1 and 12 months(group C). Blood samples were collected after 1 month and 12 months after the third dose. The geometric mean titer (GMT), seroconversion rate (levels of anti-HBs ≥ 10 mIU/mL) and high response rate (levels of anti-HBs ≥ 100 mIU/mL) were assayed. In our study, 2438 healthy adults finished the full vaccination program and follow-up. The seroconversion/sero-protective rate of groups A-C at one and 12 month after administration of the third vaccine dose was 100%, 99.9% and 97.9% verse 64.9%, 75.7% and 79.0%, respectively. GMT for anti-HBs tested in group A to C within 1 or 12 month after the third vaccination was 213.16, 432.58 and 451.47 mIU/ml verse 22.07, 46.70 and 56.18 mIU/ml, respectively. There were significant differences of seroconversion/sero-protective rate and GMT among the 3 groups (p < 0.01). Given the high anti-HBs seroconversion rate and GMT in all 3 groups, a flexible schedule for Hepatitis B vaccine should be recommended to adults, but 0-1-12 schedule is a better choice.

A hospital-associated measles outbreak among individuals not targeted for vaccination in eastern China, 2014.

BACKGROUND: An outbreak of measles occurred in early 2014 among individuals not targeted for vaccination-adults, and infants too young to vaccinate, in Xiangshan County, Zhejiang Province, in eastern China. OBJECTIVE: We conducted an investigation to identify risk factors responsible for this outbreak and to provide evidence-based recommendations for measles elimination strategies in China. METHODS: Measles was diagnosed using national standard case definitions. In a case-control study, 20 randomly selected measles patients were matched with controls selected from the same village or community as each case in a 1:2 case-to-control ratio. Controls were matched on age, within 5 years, and gender. We compared exposure histories during the 7-21 days before rash onset of the case and the same time period for the matched controls. We also conducted a measles antibody seroprevalence survey of a convenient sample of residual serum obtained from healthy patients during routine care in a hospital. RESULTS: The outbreak consisted of 45 measles cases, with an attack rate of 8.9/100,000 total population. Among cases, 91.1% (41/45) were adults (ranged 23-51 years) who had unknown vaccination histories; the other cases were infants younger than 8 months of age. The case-control study showed major risk factors to be a visit to Hospital X (OR(MH)=7.3, 95% CI: 1.8-30.7) and treatment in an IV room in Hospital X (OR(MH)=11.0, 95% CI: 1.3-96.1). The seroprevalence survey showed that 88.8% of adults had measles IgG antibodies, and that 100% of children 2-19 years of age were seropositive. CONCLUSIONS: The outbreak was primarily among age groups not targeted for vaccination-primarily adults, but with some children too young to vaccinate. Visiting a hospital was the major risk factor for measles transmission. We conclude that in addition to maintaining high 2-dose coverage with measles vaccine, working with hospital infection control programs to implement evidence-based strategies to prevent or limit hospital transmission is an important action for eliminating measles in eastern China.

Public health workers and vaccination coverage in Eastern China: a health economic analysis.

BACKGROUND: Vaccine-preventable diseases cause more than one million deaths among children under 5 years of age every year. Public Health Workers (PHWs) are needed to provide immunization services, but the role of human resources for public health as a determinant of vaccination coverage at the population level has not been assessed in China. The objective of this study was to test whether PHW density was positively associated with childhood vaccination coverage in Zhejiang Province, East China. METHODS: The vaccination coverage rates of Measles Containing Vaccine (MCV), Diphtheria, Tetanus and Pertussis combined vaccine (DTP), and Poliomyelitis Vaccine (PV) were chosen as the dependent variables. Vaccination coverage data of children aged 13-24 months for each county in Zhejiang Province were taken from the Zhejiang Immunization Information System (ZJIIS). Aggregate PHW density was an independent variable in one set of regressions, and Vaccine Personnel (VP) and other PHW densities were used separately in another set. Data on densities of PHW and VP were taken from a national investigation on EPI launched by Ministry of Health of China in 2013. We controlled other determinants that may influence the vaccination coverage like Gross Domestic Product (GDP) per person, proportion of migrant children aged <7 years, and land area. These data were taken from Zhejiang Provincial Bureau of Statistics and ZJIIS. RESULTS: PHW density was significantly influence the coverage rates of MCV [Adjusted Odds Ratio(AOR) = 4.29], DTP3(AOR = 2.16), and PV3 (AOR = 3.30). However, when the effects of VPs and other PHWs were assessed separately, we found that VP density was significantly associated with coverage of all three vaccinations (MCV AOR = 7.05; DTP3 AOR = 1.82; PV3 AOR = 4.83), while other PHW density was not. Proportion of migrant children < 7 years and Land area were found as negative and significant determinants for vaccination coverage, while GDP per person had no effect on vaccination coverage. CONCLUSIONS: A higher density of PHWs (VP) would improve the availability of immunization services over time and space, which may increase the possibility of achieving a higher childhood vaccination coverage rate. It was indicated that the level of GDP per person had no association with the improved vaccination coverage after controlling for other potential factors. Our findings implicated that PHW density was a major constraint on immunization coverage in Zhejiang Province.

Levels, composition profiles and risk assessment of polycyclic aromatic hydrocarbons (PAHs) in sludge from ten textile dyeing plants.

As components of synthetic dyes, polycyclic aromatic hydrocarbons (PAHs) are present as contaminants in textile dyeing sludge due to the recalcitrance in wastewater treatment process, which may pose a threat to environment in the process of sludge disposal. In order to evaluate PAHs in textile dyeing sludge, comprehensive investigation comprising 10 textile dyeing plants was undertaken. Levels, composition profiles and risk assessment of 16 EPA-priority PAHs were analyzed in this study. The total concentrations of 16 PAHs (∑16 PAHs) varied from 1463 ± 177 ng g(-1) to 16,714 ± 1,507 ng g(-1) with a mean value of 6386 ng g(-1). The composition profiles of PAHs were characterized by 3- and 4-ring PAHs, among which phenanthrene, anthracene and fluoranthene were the most dominant components. The mean benzo[a]pyrene equivalent (BaPeq) concentration of ∑16 PAHs in textile dyeing sludge was 423 ng g(-1), which was 2-3 times higher than concentrations reported for urban soil. According to ecological risk assessment, the levels of PAHs in the textile dyeing sludge may cause a significant risk to soil ecosystem after landfill or dumping on soil.

Using the Immunization Information System to determine vaccination coverage rates among children aged 1-7 years: a report from Zhejiang Province, China.

BACKGROUND: The Zhejiang Immunization Information System (ZJIIS) was established in 2004. This study described the coverage rates of NIP vaccines in Zhejiang Province using the ZJIIS. METHODS: Children aged 1-7 years (born from 1 January 2005 to 31 December 2011) registered in ZJIIS were enrolled in this study. All immunization records were obtained from the ZJIIS on 31 December 2012. The cohort method had been used for identifying trends and patterns in vaccine administration. Immunization coverage estimates were analyzed for both individual NIP vaccines and "Fully immunized" by age group, birth cohort, immigration status, and geography area. We also examined the timeliness vaccination for the 2010 birth cohort. RESULTS: A total of 3,579,896 children were registered in ZJIIS. All the vaccines and doses which scheduled to be given at ≤ 12 months of age exceeded 90%. There was substantial decrease trend in the vaccines scheduled at >12 months of age and most of these vaccines were below 90%. The coverage of migrant children was lower than for resident children and the coverage of WenZhou (WZ), Zhoushan (ZS) and TaiZhou (TZ) was lower than other municipalities for most of vaccines across all the birth cohorts. Nearly 20%-30% of children of 2010 birth cohort delayed for the primary series vaccination scheduled at ≤ 12 months of age, especially among migrant children. CONCLUSIONS: The ZJIIS is useful in tracking vaccine coverage of children aged 1-7 years and the data provided by ZJIIS reflected the fact that NIP delivery was improving in Zhejiang Province, while identifying some areas for improvement. We recommend continuing surveillance to estimate of vaccine coverage through ZJIIS. Immunization strategies such as Assessment, Feedback, Incentives, and Exchange program, reminder/recall activity, home visits, school entry requirements and school-based clinics could be used to reach a higher coverage of the population.