Emergence of norovirus GII.P16-GII.2 strains in patients with acute gastroenteritis in Huzhou, China, 2016-2017.

BACKGROUND: In late 2016, an uncommon recombinant NoV genotype called GII.P16-GII.2 caused a sharp increase in outbreaks of acute gastroenteritis in different countries of Asia and Europe, including China. However, we did not observe a drastic increase in sporadic norovirus cases in the winter of 2016 in Huzhou. Therefore, we investigate the prevalence and genetic diversity of NoVs in the sporadic acute gastroenteritis (AGE) cases from January 2016 to December 2017 in Huzhou City, Zhejiang, China. METHODS: From January 2016 to December 2017, a total of 1001 specimens collected from patients with AGE were screened for NoV by real-time RT-PCR. Partial sequences of the RNA-dependent RNA polymerase (RdRp) and capsid gene of the positive samples were amplified by RT-PCR and sequenced. Genotypes of NoV were confirmed by online NoV typing tool and phylogenetic analysis. Complete VP1 sequences of GII.P16-GII.2 strains detected in this study were further obtained and subjected into sequence analysis. RESULTS: In total, 204 (20.4%) specimens were identified as NoV-positive. GII genogroup accounted for most of the NoV-infected cases (98.0%, 200/204). NoV infection was found in all age groups tested (< 5, 5-15, 16-20, 21-30, 31-40, 41-50, 51-60, and >60 years), with the 5-15 year age group having the highest detection rate (17/49, 34.7%). Higher activity of NoV infection could be seen in winter-spring season. The predominant NoV genotypes have changed from GII.Pe-GII.4 Sydney2012 and GII.P17-GII.17 in 2016 to GII.P16-GII.2, GII.Pe-GII.4 Sydney2012 and GII.P17-GII.17 in 2017. Phylogenetic analyses revealed that 2016-2017 GII.P16-GII.2 strains were most closely related to Japan 2010-2012 cluster in VP1 region and no common mutations were found in the amino acids of the HBGA-binding sites and the predicted epitopes. CONCLUSIONS: We report the emergence of GII.P16-GII.2 strains and characterize the molecular epidemiological patterns NoV infection between January 2016 and December 2017 in Huzhou. The predominant genotypes of NoV during our study period are diverse. VP1 amino acid sequences of 2016-2017 GII.P16-GII.2 strains remain static after one year of circulation.

Clinical and molecular analyses of norovirus-associated sporadic acute gastroenteritis: the emergence of GII.17 over GII.4, Huzhou, China, 2015.

BACKGROUND: Noroviruses (NoVs) are the most common cause of non-bacterial acute gastroenteritis (AGE) in all age groups worldwide. The NoVs circulating in Huzhou over the past 7 years were predominantly GII.4 genotypes. In the winter of 2014-2015, a novel variant of NoV GII.17 emerged and became predominant. We report the epidemiological patterns and genetic characteristics of NoV after the appearance of GII.17 in Huzhou City, Zhejiang, China. METHODS: Between January and December 2015, 746 stool specimens collected from patients with acute gastroenteritis were screened for NoV. Real-time RT-PCR (qPCR) was performed for NoV detection. RT-PCR was used for genomic amplification and sequencing. Genogroups and genotypes were assigned using an online NoV typing tool ( http://www.rivm.nl/mpf/norovirus/typingtool ). Phylogenetic analyses were conducted using MEGA (ver. 6.06). RESULTS: In total, 196 (26.3%) specimens were identified as NoV-positive. NoV infection was found in all age groups tested (≤5, 6-15, 16-40, 41-60, and ≥60 years), with the 16-40-year age group having the highest detection rate (117/196, 59.7%). Of the 196 NoV-positive specimens, 191 (97.5%) viruses belonged to GII, and 4 (2.0%) to GI; one sample showed GI and GII co-infection. Overall, 117 (59.7%) viruses were sequenced, and new GII.P17/GII.17 variants were the dominant genotype, accounting for 75.2%, followed by GII.Pe/GII.4 Sydney 2012 strains (11.11%). AGE patients infected with the GII.P17/GII.17 genotypes almost all had abdominal pain and watery stools. CONCLUSIONS: We report the epidemiological patterns and genetic characteristics of the emergence GII.17 over the GII.4 in Huzhou between January and December 2015. After the emergence of GII.17 in October 2014, it steadily replaced the previously circulating GII.4 Sydney 2012 strain, and continued to be dominant in 2015.

Cocirculation of three hemagglutinin and two neuraminidase subtypes of avian influenza viruses in Huzhou, China, April 2013: implication for the origin of the novel H7N9 virus.

We detected three avian influenza hemagglutinin (HA) subtypes (H7, H9, and H5) and two neuraminidase (NA) subtypes (N9 and N2), as well as H7N9-related H9N9 reassortant intermediates, cocirculating among poultry in Huzhou, China, during April 2013. The results of our study reveal not only that Huzhou is one of the geographic origins of the novel H7N9 virus but also that cocirculation poses a potential threat to humans in the future.

Emergence and predominance of norovirus GII.17 in Huzhou, China, 2014-2015.

BACKGROUND: Norovirus (NoV) has been recognized as the leading cause of both outbreaks and sporadic cases of acute gastroenteritis in children and adults worldwide. Stool samples collected from outpatients with clinical symptoms of acute gastroenteritis in all age groups at the First People's Hospital in Huzhou, Huzhou, China between March 2014 and February 2015 were analyzed to gain insight into the epidemiology and genetic variation in NoV strains circulating in China. METHOD: Real-time RT-PCR (qPCR) was performed for Norovirus detection. RT-PCR were used for genomic amplification and sequencing. Genogroup and genotype were assigned using the NoV Noronet typing tool and the strains were named according to the time of isolation. The phylogenetic analysis was conducted using MEGA 5. RESULTS: Of the 809 specimens, 193 (23.9 %) were positive for NoV, with GII.4 and GII.17 the most commonly identified strains. Phylogenetic analysis confirmed the presence of five recombinant strains in Huzhou. Recombinants GII.P13/GII.17 and GII.P12/GII.4 were newly detected in China. The GII.P13/GII.17 recombinant was first identified in October 2014 and steadily replaced GII.Pe/GII.4 (GII.4 Sydney 2012) as the predominant circulating NoV genotype. CONCLUSION: This is the first report of the detection of GII.17 in the Huzhou area and of a NoV genotype being detected in greater numbers than GII.4. Furthermore, our results indicated that following the emergence of GII.17 in October 2014, it steadily replaced the previous circulating GII.4 Sydney2012 strain, which was the dominant circulating genotype for the past 2 years. As norovirus are the important cause of nonbacterial gastroenteritis, continuous and comprehensive study of the norovirus strains involved in large and cost-effective acute gastroenteritis would help understanding the molecular epidemiology of norovirus infections and development of improved prevention and control measures.

A cross-priming amplification assay coupled with vertical flow visualization for detection of Vibrio parahaemolyticus.

Vibrio parahaemolyticus is a marine seafood-borne pathogen that causes gastrointestinal disorders in humans. In this study, we developed a cross-priming amplification (CPA) assay coupled with vertical flow (VF) visualization for rapid and sensitive detection of V. parahaemolyticus. This assay correctly detected all target strains (n = 13) and none of the non-target strains (n = 27). Small concentrations of V. parahaemolyticus (1.8 CFU/mL for pure cultures and 18 CFU/g for reconstituted samples) were detected within 1 h. CPA-VF can be applied at a large scale and can be used to detect V. parahaemolyticus strains rapidly in seafood and environmental samples, being especially useful in the field.

Prevalence and genetic diversity of noroviruses in adults with acute gastroenteritis in Huzhou, China, 2013-2014.

Norovirus (NoV) infection is the most common cause of nonbacterial acute gastroenteritis, which affects both adults and children. However, the molecular epidemiology of NoV in adults with acute gastroenteritis in China has not been investigated extensively. In this study, we investigated the occurrence of NoV infections and analyzed the genetic diversity of NoV in adults with acute gastroenteritis in Huzhou, China. A total of 796 fecal samples were collected from outpatients (≥16 years of age) between March 2013 and February 2014. Real-time RT-PCR was performed to detect NoV genogroups I (GI) and II (GII). For genotyping, the capsid and RNA-dependent RNA polymerase (RdRp) genes were partially amplified and sequenced for phylogenetic analysis. NoVs were detected in 26.51% (211/796) of the specimens, with GII being predominant, representing 96.20% of the NoV infections. At least nine genotypes were identified among GI and GII specimens, including GI.P2/GI.2, GI.P3/GI.3, GI.P4/GI.4, GII.Pe/GII.4 Sydney_2012, GII.P12/GII.3, GII.P7/GII.6, GII.P16/GII.13, GII.Pe, and GII.Pg (RdRp only). This is the first report of a GII.P16/GII.13 recombinant virus in adults in China. GII.Pe/GII.4 Sydney_2012 was the most prevalent genotype and the only GII.4 variant identified during the study period. Our findings suggested that NoV was a common causative agent of acute gastroenteritis in adults in Huzhou, China. During the study period, the NoVs circulating in adults in Huzhou were predominantly GII.4 Sydney_2012 variants and GII NoV recombinants.

Prevalence of high-risky behaviors in transmission of HIV among high school and college student MSM in China: a meta-analysis.

BACKGROUND: The aim of this study was to investigate the prevalence of high-risky behaviors, such as unprotected anal intercourse (UAI) in the last 6 months, condom using in their last homosexual anal intercourse, No. of male partners in the last 6 months among high school and college male students who have sex with men (MSM) in China. METHODS: The relevant trials were retrieved up to June 2015 from several public databases, and a meta-analysis was conducted according to the published studies. The estimated rate and its 95 % confidence intervals (CI) of the relevant indexes among high school and college student MSM were collected and calculated using a fixed-effects model (the Mantel-Haenszel method) or a random-effects model (the DerSimonian and Laird method) when appropriate. RESULTS: A total of 15 studies (18 research data), including 3297 student MSM, were performed in this meta-analysis. The overall results showed that the rate of student MSM who reported having had UAI in the last 6 months was 65.2 % (95 % CI = 60.2 % to 70.1 %), the prevalence of student MSM having more than one male partner in the last 6 months was 58.2 % (95 % CI = 51.1 % to 65.4 %), the rate of student MSM who reported using a condom in their last homosexual anal intercourse experience was 57.5 % (95 % CI = 49.8 % to 65.1 %), the prevalence of student MSM who were infected with HIV was 3.8 % (95 % CI = 2.5 % to 5.1 %), and the rate of student MSM who were infected with syphilis was 4.6 % (95 % CI = 3.8 % to 5.4 %). CONCLUSIONS: There are high UAI prevalence and low condom using rate in the last homosexual anal intercourse experience among high school and college student MSM in China, and corresponding control measures for this group and more effective health education of student MSM are required to prevent HIV or sexually transmitted diseases from spreading to the general population.

Enterovirus infection in children attending two outpatient clinics in Zhejiang Province, China.

Enteroviruses are responsible for hand, foot, and mouth disease, and have caused many deaths in China during recent years. But the natural history of enterovirus infection in children, especially asymptomatic children, is not yet clear. From April 2011 to May 2012, 505 stool and throat swab samples of children attending outpatients clinics in two hospitals were collected weekly to test for Enterovirus 71, Coxsackievirus A16, and other enterovirus nucleic acids by real-time RT-PCR. Two hundred sixty-four patients were enterovirus positive, the positive rate was 52.3%, 27.5% (22/80) in children without a rash and 56.9% (242/425) in children with a rash. Coxsackievirus A16 positive rate of male (24%, 61/254) was higher than that of female (15.2%, 26/171) (χ(2) = 4.87, P = 0.027). The highest positive rate of enterovirus infection was 63.5% in the 2-year-old age group. Comparing children with and without a rash, within the same age groups, no statistical difference was found (P > 0.05). The seasonal distribution of Enterovirus 71 had only one peak in May, but Coxsackievirus A16 had two peaks in April and October. In patients with a rash, the frequency of Enterovirus 71 was relatively high before July, and then that of Coxsackievirus A16 increased gradually. In the case of Enterovirus 71 and Coxsackievirus A16, stool specimens had a higher positive rate than throat swab specimens' (χ(2) = 3.88, P = 0.05; χ(2) = 15.13, P < 0.001). Enterovirus infection was more frequent in males 2-3 year-old children, with the implicated virus varying by season. Targeted prevention and control measures should be carried out.

Epidemiology of the avian influenza A (H7N9) outbreak in Zhejiang Province, China.

BACKGROUND: A novel influenza A virus infection was identified on March 31, 2013 in China and a total of 134 cases were identified in 12 provinces of China between March 25 and September 31, 2013. Of these, 46 cases occurred in Zhejiang Province and the number of patients is the largest in China. METHODS: 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, and close contacts. Descriptive statistics were used to analyze the epidemiological and clinical characteristics. Samples from the patients were collected and tested by real time reverse transcriptase-polymerase chain reaction and viral culture. RESULTS: A total of 46 laboratory confirmed cases of H7N9 influenza infection were identified in the Zhejiang province between March 31 and September 31, 2013 of which 29 were male and 17 were female. The median age of patients was 61.5 years and 76.09% of cases occurred in persons aged ≥50 years old. Unlike other province, 34.78% of cases in Zhejiang Province were rural residents. Among 11 deaths, 9 were male, 10 were older than 60 years old, and 10 had underlying diseases. 30 of 38 cases with available data had a recent history of poultry exposures and 8 cases had multi-exposure history. The estimated median incubation period was two days which was shorter than corresponding data in other provinces. All cases were hospitalized and the median time from illness onset to hospitalization was 5 days. Symptoms at the onset of the illness included fever, cough, expectoration, shivering, fatigue, muscular aches, nausea, vomiting. Only 4.91% contacts developed respiratory symptoms, but their samples were tested negative for H7N9 virus designating lack of human-to-human transmission of the virus. CONCLUSIONS: All cases were sporadic and there was no evidence of an epidemiologic link between them. Control measures including closing affected poultry and slaughtering backyard poultry are needed not only in urban areas but also in rural areas to reduce human H7N9 infection risk.

Prevalence of unprotected anal intercourse in men who have sex with men recruited online versus offline: a meta-analysis.

BACKGROUND: Men who have sex with men (MSM) are a high risk population for human immunodeficiency virus (HIV) infection. Our study aims to find whether MSM who were recruited online had a higher prevalence of self-reported unprotected anal intercourse (UAI) than those who were recruited offline. METHODS: A meta-analysis was conducted from the results of published studies. The analysis was stratified by the participants' geographic location, the sample size and the date of the last reported UAI. RESULTS: Based on fourteen studies, MSM who were recruited online (online-based group) reported that 33.9% (5,961/17,580) of them had UAI versus 24.9% (2,700/10,853) of MSM who were recruited offline (offline-based group). The results showed that it is more likely for an online-based MSM group to have UAI with male partners than an offline-based MSM group [odds ratio (OR) = 1.35, 95% CI = 1.13-1.62, P < 0.01]. The subgroup analysis results also showed that the prevalence of UAI was higher in the European subsample (OR = 1.38, 95% CI = 1.17-1.63, P < 0.01) and in sample sizes of more than 500 individuals (OR = 1.32, 95% CI = 1.09-1.61, P < 0.01) in the online group compared to the offline group. The prevalence of UAI was also significantly higher when the time of the last UAI was during the last 3 or more months (OR = 1.40, 95% CI = 1.13-1.74, P < 0.05) in the online group compared to the offline group. A sensitivity analysis was used to test the reliability of the results, and it reported that the results remained unchanged and had the same estimates after deleting any one of the included studies. CONCLUSIONS: A substantial percentage of MSM were recruited online, and they were more inclined to engage in UAI than MSM who were recruited offline. Targeted interventions of HIV prevention programs or services are recommended when designing preventive interventions to be delivered via the Internet.

Bioinformatics analysis of the epitope regions for norovirus capsid protein.

BACKGROUND: Norovirus is the major cause of nonbacterial epidemic gastroenteritis, being highly prevalent in both developing and developed countries. Despite of the available monoclonal antibodies (MAbs) for different sub-genogroups, a comprehensive epitope analysis based on various bioinformatics technology is highly desired for future potential antibody development in clinical diagonosis and treatment. METHODS: A total of 18 full-length human norovirus capsid protein sequences were downloaded from GenBank. Protein modeling was performed with program Modeller 9.9. The modeled 3D structures of capsid protein of norovirus were submitted to the protein antigen spatial epitope prediction webserver (SEPPA) for predicting the possible spatial epitopes with the default threshold. The results were processed using the Biosoftware. RESULTS: Compared with GI, we found that the GII genogroup had four deletions and two special insertions in the VP1 region. The predicted conformational epitope regions mainly concentrated on N-terminal (1~96), Middle Part (298~305, 355~375) and C-terminal (560~570). We find two common epitope regions on sequences for GI and GII genogroup, and also found an exclusive epitope region for GII genogroup. CONCLUSIONS: The predicted conformational epitope regions of norovirus VP1 mainly concentrated on N-terminal, Middle Part and C-terminal. We find two common epitope regions on sequences for GI and GII genogroup, and also found an exclusive epitope region for GII genogroup. The overlapping with experimental epitopes indicates the important role of latest computational technologies. With the fast development of computational immunology tools, the bioinformatics pipeline will be more and more critical to vaccine design.

Mild illness in avian influenza A(H7N9) virus-infected poultry worker, Huzhou, China, April 2013.

During April 2013 in China, mild respiratory symptoms developed in 1/61 workers who had culled influenza A(H7N9) virus-infected poultry. Laboratory testing confirmed A(H7N9) infection in the worker and showed that the virus persisted longer in sputum than pharyngeal swab samples. Pharyngeal swab samples from the other workers were negative for A(H7N9) virus.

Correlates of consistent condom use among men who have sex with men recruited through the Internet in Huzhou city: a cross-sectional survey.

BACKGROUND: There is growing evidence that men who have sex with men (MSM) are currently a group at high risk of HIV infection in China. Our study aims to know the factors affecting consistent condom use among MSM recruited through the internet in Huzhou city. METHODS: An anonymous cross-sectional study was conducted by recruiting 410 MSM living in Huzhou city via the Internet. The socio-demographic profiles (age, education level, employment status, etc.) and sexual risk behaviors of the respondents were investigated. Bivariate logistic regression analyses were performed to compare the differences between consistent condom users and inconsistent condom users. Variables with significant bivariate between groups' differences were used as candidate variables in a stepwise multivariate logistic regression model. All statistical analyses were performed using SPSS for Windows 17.0, and a p value < 0.05 was considered to be statistically significant. RESULTS: According to their condom use, sixty-eight respondents were classified into two groups. One is consistent condom users, and the other is inconsistent condom users. Multivariate logistic regression showed that respondents who had a comprehensive knowledge of HIV (OR = 4.08, 95% CI: 1.85-8.99), who had sex with male sex workers (OR = 15.30, 95% CI: 5.89-39.75) and who had not drunk alcohol before sex (OR = 3.10, 95% CI: 1.38-6.95) were more likely to be consistent condom users. CONCLUSIONS: Consistent condom use among MSM was associated with comprehensive knowledge of HIV and a lack of alcohol use before sexual contact. As a result, reducing alcohol consumption and enhancing education regarding the risks of HIV among sexually active MSM would be effective in preventing of HIV transmission.

Association between the various mutations in viral core promoter region to different stages of hepatitis B, ranging of asymptomatic carrier state to hepatocellular carcinoma.

OBJECTIVES: The objective of this study was to determine the association of 19 mutations with frequencies ≥ 10% in the core promoter region of hepatitis B virus (HBV) with chronic hepatitis B (CHB), liver cirrhosis, and hepatocellular carcinoma (HCC). METHODS: Eight hundred forty-six asymptomatic hepatitis B surface antigen carriers (ASCs), 235 CHB patients, 188 cirrhosis patients, and 190 HCC patients with intact data of HBV genotyping, DNA sequencing, and serological parameters were studied. Nucleotides with the highest frequencies in HBV genotypes B and C from all ASCs were treated as wild-type nucleotides. RESULTS: Mutations at nt.1674, nt.1719, nt.1762, nt.1764, nt.1846, nt.1896, and nt.1913 in genotype C were significantly associated with CHB, cirrhosis, and HCC, as compared with ASCs. C1673T, A1726C, A1727T, C1730G, C1766T, T1768A, C1773T, and C1799G in genotype C were significantly associated with cirrhosis compared with the CHB patients, whereas these mutations were inversely associated with HCC compared with the cirrhosis patients. Multivariate regression analyses showed that age, male, abnormal alanine aminotransferase (ALT), T1768A, A1762T/G1764A, and A1846T were independently associated with cirrhosis compared with ASCs and the patients with CHB. Age, abnormal ALT, HBV DNA (≥10(4) copies/ml), genotype C, C1653T, T1674C/G, T1753V, and A1762T/G1764A were independently associated with HCC compared with those without HCC. Haplotypic carriages with two or more HBV mutations were significantly associated with HCC. T1674C/G, C1653T, and T1753V were specific for HCC. A1762T/G1764A had a moderate sensitivity and specificity for HCC. CONCLUSIONS: C1673T, A1726C, A1727T, C1730G, C1766T, T1768A, C1773T, and C1799G in genotype C are specific for cirrhosis. A1846T and T1674C/G are novel factors independently associated with cirrhosis and HCC, respectively.

Nearly complete genome sequence of one GII.17 Norovirus identified by direct sequencing from HuZhou, China.

BACKGROUND: Human norovirus is the leading cause of acute gastroenteritis worldwide. However, in vitro culture system is complicated for human norovirus. Sequence analysis became more useful for norovirus research, particularly when using complete genomic sequences. METHODS: Real-time RT-PCR (qPCR) was performed for norovirus detection. Three modified paris of PCR primes were designed based on the alignment of the novel GII.17 norovirus complete sequence available in Genbank., which could amplify three overlapping fragments cover the whole genome. The PCR fragments were sequencing by Sanger sequence with Primer walking methods. Genogroup and genotype were assigned using the Norovirus Noronet typing tool and the strains were named according to the time of isolation. The phylogenetic analysis was conducted using MEGA software (ver. 6.06). RESULTS: One nearly complete genome sequence were obtained from sample collected from Huzhou, China. The partial genome sequence of the HuzhouNS2014603 strain is composed of 7556 nucleotides (nt).The strain was classified as GII.17 genotype both in ORF1 and ORF2, and was most closely related to the LC037415.1/Hu/GII.17/Kawasaki308 strain. Within the GII.17 cluster, the 2013/14 season strains were grouped separately from the GII.17 strains detected in 2014/15. HuzhouNS2014603 was clustered with the 2014/15 season strains. Compared with other strains selected, there are 98 variable residues across the VP1 domain. Among the 98 variable amino acids, 13 (13.3%) were observed in the shell domain and 22 (22.4%) in the P1domain; most of the substitutions and insertions were located in the P2 domain, account for 63 (64.3%). CONCLUSIONS: This is the first report of the nearly complete genome of the novel GII.17 by direct sequencing method in the Huzhou area. The results of this study could be helpful for the study of the genetic evolution of the virus, the development of rapid diagnostic reagents and the design of vaccine.

[Complete Genome Analysis of a Recombinant GI Norovirus Identified in Huzhou,China].

To study the genotype and genomic and molecular organization of a GI norovirus isolate from Huzhou, China, the genomic sequence of 2008/Huzhou/N11 was amplified by RT-PCR, then the PCR product was purified,sequenced, and input into phylogenetic and Simplot analyses. The complete genomic sequence of the 2008/Huzhou/N11 strain was 7691nucleotides (nt) long. It contained three open reading frames(ORFs):ORF1,ORF2,and ORF3,with lengths of 5367,1623,and 630 nt, respectively. Phylogenetic analysis revealed that the RdRp region of 2008/Huzhou/N11 belonged to genotype GI.2,and the VP1 and VP2regions belonged to genotype GI.6.The SimPlot analysis indicated that potential recombination points in 2008/Huzhou/N11 were located upstream of the ORF1/ORF2 overlap. The complete genomic sequence of this recombinant GI.2/GI.6 strain can serve as a reference sequence for the phylogenetic analysis of norovirus evolution.

The Uptake of Prevention of Mother-to-Child HIV Transmission Programs in China: A Systematic Review and Meta-Analysis.

BACKGROUND: No systematic review of prevention of mother to child transmission (PMTCT) in China has been performed. We aimed to estimate the uptake of PMTCT programs services in China. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang (Chinese) to identify research studies. Only descriptive epidemiological studies were eligible for this study. RESULTS: A total of 57 eligible cross-section studies were finally included. We estimated that the mean HIV-positive rate of exposed infants was 4.4% (95% CI = 3.2-5.5), and more than 33% of exposed infants had not undergone HIV diagnostic testing. The percentage of initiating antiretroviral therapy (ART) in HIV-positive women was 71.0% (95% CI = 66.3-75.8), and that for initiating antiretroviral prophylaxis (ARP) in exposed infants was 78.3% (95% CI = 74.9-81.8); also, 31.3% (95% CI = 15.5-47.0) of women with HIV and < 1% of exposed infants received the combination of three antiretroviral drugs. There were bigger gap of uptake of PMTCT programs between income levels, and cities with a low income level had a higher percentage of initiating ART in HIV-positive women (80%) and ARP in exposed infants (85%) compared to cities with high-middle income (57% and 65%, respectively) (P<0.05). CONCLUSIONS: This paper highlights the need to further scale up PMTCT services in China, especially in regions with the lowest coverage, so that more women can access and utilize them. However, some estimated outcome should be interpreted with caution due to the high level of heterogeneity and the small number of studies.

Persistent detection of avian influenza A/H7N9 virus among poultry in Huzhou City, China, in the summer of 2013.

In eastern China, live poultry markets were successively re-opened in the summer of 2013 following their closure in April 2013. We detected influenza A/H7N9 RNA with positive rates from 4% to 22.2% among poultry samples in targeted markets in Huzhou City, China, from August 6 to September 24, 2013. Phylogenetic analyses of hemagglutinin and neuraminidase genes confirmed that the strain prevalent among poultry in Huzhou City in the summer of 2013 belonged to the same genotype as those capable of infecting humans. These results raise concern for a further outbreak of H7N9 in the cooler season.

Th2-type inflammation under conditions of pre-existing chronic disease is associated with liver damage in patients with avian influenza H7N9 virus.

Most patients infected with avian H7N9 influenza virus develop severe disease, including respiratory failure, acute respiratory distress syndrome (ARDS), and multi-organ failure. The pathogenesis of H7N9 infection is not fully understood. This study revealed that H7N9-infected patients who had fatal outcomes or critical illness all had pre-existing chronic diseases. The patients did not have obvious systemic inflammation compared to the healthy controls. However, their fatal outcomes and critically severe illness were significantly associated with high serum levels of tumor necrosis factor (TNF)-α. Interestingly, the degree of liver damage in these patients significantly correlated with their serum levels of Th2 cytokines, interleukin (IL)-4, and IL-9. Taken together, our results suggest that Th2-type inflammation in H7N9-infected patients with pre-existing chronic diseases likely contributes to the pathogenesis of H7N9 infection and is linked to poor clinical outcomes.

Isolation and characterization of H7N9 avian influenza A virus from humans with respiratory diseases in Zhejiang, China.

In 2013, the novel reassortant avian-origin influenza A (H7N9) virus was reported in China. Through enhanced surveillance, infection by the H7N9 virus in humans was first identified in Zhejiang Province. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) was used to confirm the infection. Embryonated chicken eggs were used for virus isolation from pharyngeal swabs taken from infected human patients. The H7N9 isolates were first identified by the hemagglutination test and electron microscopy, then used for whole genome sequencing. Bioinformatics software was used to construct the phylogenetic tree and for computing the mean rate of evolution of the HA gene in H7Nx and NA in HxN9. Two novel H7N9 avian influenza A viruses (A/Zhejiang/1/2013 and A/Zhejiang/2/2013) were isolated from the positive infection cases. Substitutions were found in both Zhejiang isolates and were identified as human-type viruses. All phylogenetic results indicated that the novel reassortant in H7N9 originated in viruses that infected birds. The sequencing and phylogenetic analysis of the whole genome revealed the mean rate of evolution of the HA gene in H7NX to be 5.74E-3 (95% Highest posterior density: 3.8218E-3 to 7.7873E-3) while the NA gene showed 2.243E-3 (4.378E-4 to 3.79E-3) substitutions per nucleotide site per year. The novel reassortant H7N9 virus was confirmed by molecular methods to have originated in poultry, with the mutations occurring during the spread of the H7N9 virus infection. Live poultry markets played an important role in whole H7N9 circulation.