[Situation and trends in dietary minerals intakes of adults aged 18-35 years in 15 provinces (autonomous regions, municipalities) of China in 1989-2018].

OBJECTIVE: To analyze the current situation and long term trends in minerals intakes from 1989 to 2018 in adults aged 18 to 35 years in 15 provinces(autonomous regions, municipalities) of China. METHODS: Based on the data of China Health and Nutrition Survey from 1989 to 2018. Adults aged 18 to 35 were selected as study subjects. According to the dietary survey result of 3-day 24-hour dietary review method and weighing accounting method, the mineral intake was calculated and analyzed. Nonparametric statistical method was used to analyze the trend of dietary minerals intake with years. Comparing the dietary minerals intake with the dietary reference intakes, the trend of the proportion of people at risk of insufficient dietary minerals intake was analyzed by Cochran-Armitage trend test. According to the different demographic characteristics in 2018, the minerals intake status and the proportion of people with insufficient dietary minerals intake were analyzed. RESULTS: In 2018, the median intakes of dietary minerals of adults were 302.96 mg/d of calcium, 887.91 mg/d of phosphorus, 1451.69 mg/d of potassium, 3760.09 mg/d of sodium, 238.50 mg/d of magnesium, 19.40 mg/d of iron, 9.91 mg/d of zinc, 43.54 µg/d of selenium, 1.41 mg/d of copper and 4.59 mg/d of manganese, respectively, with significant gender differences(P<0.05). The intakes of dietary calcium, phosphorus, magnesium, potassium, selenium and copper in urban areas were significantly higher than those in rural areas(Z values were 3.00, 2.04 and 3.10, respectively, P<0.05). The dietary intakes of calcium, phosphorus, magnesium, potassium, selenium and copper showed significant differences among regions, education levels and income levels. From 1989 to 2018, the dietary mineral intake of calcium, phosphorus, potassium, sodium, magnesium, iron, zinc, copper and manganese of adults aged 18-35 in 15 provinces(autonomous regions and municipalities) of China showed a downward trend, only selenium intake showed an upward trend, and the intake of men was higher than that of women. The proportion of people at risk of inadequate intake of dietary phosphorus, magnesium, iron, zinc and copper showed an increasing trend year by year. In each survey year, the proportion of people at risk of insufficient calcium intake was more than 90%. CONCLUSION: From 1989 to 2018, there was a risk of insufficient intake of minerals in adults aged 18-35 in 15 provinces(autonomous regions, municipalities) in China, and the problem of inadequate calcium intake was serious.

[Dietary recommendation-related knowledge level of Chinese adults in 2021].

OBJECTIVE: To analyze the knowledge level and related factors related to dietary recommendations for Chinese residents aged 18-64 years in 2021. METHODS: A multi-stage cluster random sampling was used to select 302 survey sites across the country, there were 102 398 people surveyed, with 98 567 valid questionnaires, 49.4% male and 41.9% urban, and an average age of(38.5±12.2) years. A standardized questionnaire certified by experts and evaluated for reliability and validity was used to conduct the face-to-face survey. The questionnaire was scored out of 100 points; dietary recommendation-related knowledge was scored out of 30 points, and a score of 22.5 points or above was judged as acquiring relevant knowledge. Descriptive statistics were used to report the values of relevant knowledge level of respondents with different characteristics, and univariate and multi-variate Logistic regression models were used to analyze the factors influencing relevant knowledge level. RESULTS: The average score of dietary recommendation-related knowledge was(17.9±4.2), and the knowledge awareness rate was 14.7%. The five knowledge points with the lowest correct rates were the recommended intakes of soybeans and products(21.1%), added sugars(22.6%), milk(25.5%), food groups(27.6%), and cooking oils(31.4%) and the recommended intakes of fruits and salt were also less correct(56.9% and 58.5%). Multi-variate analysis revealed that the knowledge of dietary recommendations was lower among residents in rural(OR=0.945, 95%CI 0.944-0.945), central(OR=0.863, 95%CI 0.863-0.864) and western(OR=0.983, 95%CI 0.982-0.983) areas, those with chronic diseases(OR=0.784, 95%CI 0.783-0.784) and those who did not know about chronic diseases(OR=0.694, 95%CI 0.694-0.694) compared to the counterparts; female(OR=1.090, 95%CI 1.090-1.091) had a higher knowledge rate compared to male. The awareness rate of residents increased with the level of education, and the trend was statistically significant(P<0.001). CONCLUSION: The level of knowledge related to dietary recommendations for the adult population in China in 2021 is low, especially for the recommended intake of dairy, soybeans and products, and cooking oils, and the knowledge level of men, rural, central and western, and less educated populations is even lower.

[Geographical distribution differences of nutrition and health knowledge among Chinese adults in 2021].

OBJECTIVE: To explore the geographical distribution of nutrition and health knowledge among 18-64 years old adults in China. METHODS: A total of 102 398 residents aged 18-64 from 302 survey sites were selected by multi-stage cluster random sampling method, a total of 98 567 respondents were included in the study. Both mean and rate were calculated by complex sampling weighting. RESULTS: The nutrition and health knowledge score in eastern region(65.5±12.0) was higher than that in central(62.4±11.9) and western(61.4±12.9), and the score in northern region(63.9±11.8) was higher than that in southern(63.1±12.8). In the seven geographical regions, the highest score was in north(65.8±11.4), and the lowest score was in northwest(61.6±12.2). The awareness rate of nutrition and health in eastern region(22.4%) was higher than that in central(14.7%) and western(14.9%), the highest awareness rate among the seven geographic regions was in east(23.2%), followed by north(22.5%) and the lowest was in northwest(13.2%). There were also differences in nutritional health knowledge levels of residents in different regions in the five dimensions(P<0.001). Northwest China had the lowest awareness of food characteristics and nutrition and disease dimensions, South China had the lowest awareness of dietary recommendations and food choices dimensions, and Southwest China had the lowest awareness of food safety dimensions. CONCLUSION: The level of nutrition and health knowledge of Chinese adults have large geographical differences.

[Status and trends in dietary vitamin intakes of adults aged 18 to 35 in 15 provinces (autonomous regions, municipalities) of China during 1989-2015].

OBJECTIVE: To analyze the status and long-term trends in dietary vitamin intakes from 1989 to 2015 in adults aged 18 to 35 in 15 provinces(autonomous regions, municipalities) of China. METHODS: Based on the data of "China Health and Nutrition Surveys" from 1989 to 2015 and "cohort study on the changes of nutritional status of Chinese residents" in 2015, covering 15 provinces(autonomous regions, municipalities) in China. Adults aged 18 to 35 were selected as study subjects. Nonparametric statistical method was used to analyze the trend of dietary vitamin intake with years. Comparing the dietary vitamin intake with the dietary reference intakes, the trend of the proportion of people at risk of insufficient dietary vitamin intake was analyzed by Cochran Armitage trend test. According to the different demographic characteristics in 2015, the vitamin intake status and the proportion of people with insufficient dietary vitamin intake were analyzed. RESULTS: From 1989 to 2015, the overall dietary vitamin intake of adults aged 18-35 in 15 provinces(autonomous regions, municipalities) of China showed a downward trend. The median vitamin intake of adults in 2015 were vitamin A 361. 28 µg RAE/d(based on vitamin A activity equivalent), vitamin B_1 0. 75 mg/d, vitamin B_2 0. 67 mg/d, nicotinic acid 13. 61 mg/d, vitamin C 56. 41 mg/d and vitamin E 21. 04 mg α-TE/d. In 2015, there were significant differences in dietary vitamin A, vitamin B_2, niacin and vitamin C intakes between the North and the South and the distribution of education level, in which the intakes of vitamin A, vitamin B_2, niacin and vitamin C in the South were significantly higher than those in the North; the intakes of dietary vitamin B_1 in the low education level group were significantly lower than those in the middle and high education level; the intakes of dietary vitamin B_1 in urban areas were significantly higher than those in the North. The intakes of vitamin A, vitamin B_2, niacin and vitamin E were significantly higher than those in rural areas. From 1989 to 2015, the proportion of people with insufficient intake of vitamin B_2 remained above 80%, and the proportion of adults with the risk of insufficient intake of dietary vitamin A, vitamin B_1 and vitamin C showed an increasing trend year by year. In 2015, the proportion of people at risk of insufficient intake of dietary vitamin A, vitamin B_2 and vitamin C in northern China was significantly higher than that in southern China. CONCLUSION: From 1989 to 2015, there was a risk of insufficient intake of micronutrients in adults aged 18-35 in 15 provinces(autonomous regions, municipalities) in China, and the problem of insufficient calcium intake was serious.

[Trend of food intake from Chinese 15 provinces (autonomous regions, municipalities) adults aged 18 to 35 in 1989-2015].

OBJECTIVE: To analyze the trend of food intake from Chinese 15 provinces(autonomous regions, municipalities) adult aged 18 to 35. METHODS: Based on the data from 10 rounds follow-up survey conducted by China Health and Nutrition Survey between 1989 and 2015, adults aged 18 to 35 were selected according to the multi-stage stratified random cluster sampling method. Dietary surveys were conducted using 24-hour dietary recall in three consecutive days, and weighing accounting method was used to investigate the consumption of condiments. Wilcoxon rank sum trend was used to test the variation trend of food intake, Cochran-Armitage trend test and Spearman rank test were used to analyze the trend of different type of food intake and the recommended intakes of dietary pagoda for Chinese residents(2016). RESULTS: The intake of fruits, livestock and poultry meat, aquatic products, eggs, milk and dairy products, soybeans and nuts and sugar for adults aged 18-35 in China has been increasing. Cereals and potatoes, vegetables, edible oil, cooking salt, alcohols showed a downward trend. Compared with Chinese Dietary Guidelines(2016)-summary, the number of people whose milk and dairy products lower than EAR has always exceeded 99%. The number of people whose cereals, potatoes and vegetables lower than EAR has increased from 4. 1% and 42. 3% in 1989 to 19. 2% and 67. 0% in 2015, respectively. The proportion of people whose edible oil lower than EAR and whose cooking salt higher than EAR increased, whose livestock and poultry meat higher than EAR increased from 34. 10% in 1989 to 64. 49% in 2015. CONCLUSION: There is still a high proportion of Chinese adults aged 18 to 35 who consume overmuch fat but deficiency in dietary fiber. The proportion of whose consumed cereals, potatoes, vegetables and dairy products lower than EAR and exceed EAR of meat and cooking salt shows an increasing trend. The problem of unreasonable dietary structure is still serious.

[Anxiety and depression on gestational diabetes mellitus in early pregnancy].

OBJECTIVE: To investigate the effects of anxiety and depression on gestational diabetes mellitus(GDM) in early pregnancy. METHODS: A prospective study was conducted in 2017 to select 1426 single-child healthy pregnant women of 8-14 weeks from the Sichuan Provincial Hospital for Women and Children through a deliberate sampling method. The age was(28. 6±4. 0) years old. Basic information such as age, pre-pregnancy weight, parity, and gravidity of pregnant women was collected through questionnaire survey. The anxiety self-rating scale(SAS) and depression self-rating scale(SDS) were used to collect information of anxiety and depression in pregnant women, and their anxiety and depressive symptoms were evaluated according to the result of Chinese norm. At 24 to 28 weeks of gestation, the oral glucose tolerance test(OGTT) was conducted. GDM was diagnosed according to the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China(2014). Multivariate unconditional Logistic regression was adopted to analyze the effects of anxiety and depression on GDM in pregnant women. RESULTS: The incidence of GDM in early pregnancy anxiety group and depression group was 41. 8% and 33. 6%, respectively. The incidence of anxiety, depression, and anxiety combined with depression were 7. 7%, 10. 5% and 4. 8%, respectively. The incidence of anxiety and depression in the group of pregnant women younger than 30 years old(9. 0% and 11. 7%) was higher than that in the group of pregnant women older than 30 years old(5. 3% and 8. 1%). The prevalence of anxiety and depression in the group of nulliparous women(8. 8% and 11. 9%) was higher than that in the group of multiparous women(5. 4% and 6. 4%). The difference was statistically significant(P<0. 05). After adjusting the confounding factors such as age, pre-pregnancy body mass index, family history of diabetes, gravidity, parity, energy intake, conception, education, occupation, smoking and drinking, the result showed that the risk of GDM in anxious pregnant women was increased, compared with that in non-anxious pregnant women in early pregnancy(OR=1. 556, 95% CI 1. 014-2. 387). However, the association between early pregnancy depression and the occurrence of GDM was not found(P>0. 05). Compared with the non-anxiety group in the early pregnancy, the risk of GDM in the anxiety group was increased both in pregnant women under 30 years old(OR=1. 654, 95% CI 1. 004-2. 726) and nulliparous women(OR=1. 633, 95% CI 1. 013-2. 634). No correlation between anxiety and risk of GDM was observed in pregnant women over 30 years old and multiparous women(P>0. 05). CONCLUSION: Anxiety in early pregnancy increases the risk of GDM. Pregnant women under 30 years old and and nulliparous women are at high risk of anxiety.

[Effects of iron supplement intake on gestational diabetes mellitus in early and middle pregnancy in Chengdu City in 2017].

OBJECTIVE: To explore the effect of iron supplement intake on gestational diabetes mellitus(GDM) in early and middle pregnancy. METHODS: From February to April 2017, a prospective study was conducted among 807 early pregnant women in a prenatal clinic of a maternal and child medical institution in Chengdu City through purposive sampling. Data on maternal demographic characteristics was collected through questionnaire in early pregnancy. In early and middle pregnancy, the information of iron supplement intake were collected with questionnaire, 3-day 24 hour dietary recall method was used to assess maternal diet. According to the WHO recommendation, 60 mg/d iron supplementation during pregnancy was used as the dividing point, <60 mg/d iron supplementation was used as the low level group, and ≥60 mg/d iron supplementation was used as the high level group. At the 24 th to 28 th pregnant week, the oral glucose tolerance test(OGTT) was conducted, and GDM was diagnosed according to the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China(2014). Multivariate unconditional Logistic regression model was used to analyze the effect of iron supplement intake on gestational diabetes mellitus(GDM) in early and middle pregnancy. RESULTS: A total of 739 valid samples were followed up, the age was(28. 22±3. 75) years old. In early and middle pregnancy, the rate of taking iron supplementation was 5. 0% and 67. 9%, 3. 8% and 47. 1% of them iron supplement intake was more than 60 mg/d. After adjustmenting for body mass index, age, dietary iron, etc. Multivariate unconditional Logistic regression analysis showed that there was a positive correlation between the average intake of iron supplement and the occurrence of GDM in women during the second trimester of pregnancy(OR=1. 059, 95%CI 1. 016-1. 104). Compared with the lower iron supplement intake(<60 mg/d) women in midpregnancy, the risk of GDM was 1. 406 times(95%CI 1. 019-1. 939)in the higher iron supplement intake(≥60 mg/d) women. No correlation was found between iron intake in early pregnancy and the occurrence of GDM. CONCLUSION: Iron supplement intake during pregnancy may increase the risk of GDM. Appropriate intake of iron supplement for pregnant women is worth discussing.

[Associations of Dairy Consumption during Pregnancy and Neonatal Birth Body Mass: a Prospective Study].

OBJECTIVE: To investigate the dairy product intake during pregnancy in Southwest China and to explore its relationship with neonatal birth body mass. METHODS: A prospective study was conducted to select healthy singleton pregnant women at 8-14 weeks of gestation in a maternal and fetal health care institution in Chengdu City. Dairy product consumption during the first, second, third trimester of pregnancy were collected by 24-hour dietary recalls at 8-14 weeks, 24-28 weeks and 32-36 weeks of pregnancy, respectively, and the total milk intake and milk consumption rate were calculated. According to the dietary guidelines for Chinese pregnant women (2016), the recommended amount of milk (300 g/d) was used as the standard to calculate the compliance rate. The respondents were divided into three groups: no dairy consumption group, insufficient dairy consumption group and suitable dairy consumption group. The gestational age at delivery and neonatal birth body mass were collected by the hospital information system. Logistic regression model was used to analyze the association between milk intake during pregnancy and neonatal birth body mass. RESULTS: A total of 962 pregnant women were included. The average milk intake in the first, second and third trimester of pregnancy were 125.0 (0, 236.1) g/d, 208.3 (0, 284.7) g/d and 250.0 (150.0, 416.7) g/d, respectively, with the compliance rates of 12.6%, 33.2% and 48.4%, respectively. The average neonatal birth body mass was (3 225.0±399.8) g. The incidence of small for gestational age (SGA) and large for gestational age (LGA) was 8.3% and 3.9%, respectively. Compared with no dairy consumption group in the second trimester of pregnancy, the risk of SGA was lower in suitable dairy consumption group (odds ratio (OR)=0.786, 95% confidence interval (CI): 0.385-0.976). Compared with no dairy consumption group in the third trimester of pregnancy, the risk of SGA was lower in insufficient dairy consumption group and suitable dairy consumption group (OR=0.672, 95%CI: 0.477-0.821 and OR=0.497, 95%CI: 0.116-0.807, respectively). No association was observed between milk intake in the first trimester and neonatal birth body mass, and milk intake in the second and third trimester of pregnancy was not associated with the risk of LGA. CONCLUSION: Insufficient milk intake of pregnant women is a significant problem in southwest China and needs to be improved. Milk intake during pregnancy is associated with neonatal birth body mass, and increased milk intake in the second and third trimester of pregnancy may reduce the risk of SGA.

Progress Toward Measles Elimination - China, January 2013-June 2019.

In 2005, the World Health Organization (WHO) Western Pacific Region countries, including China, resolved to eliminate measles by 2012 or as soon as feasible thereafter (1). As of 2018, nine* of the 37 Western Pacific Region countries or areas† had eliminated§ measles. China's Measles Elimination Action Plan 2006-2012 included strengthening routine immunization; conducting measles risk assessments, followed by supplementary immunization activities (SIAs) with measles-containing vaccine (MCV) at national and subnational levels; strengthening surveillance and laboratory capacity; and investigating and responding to measles outbreaks. Most recently, progress toward measles elimination in China was described in a 2014 report documenting measles elimination efforts in China during 2008-2012 and a resurgence in 2013 (2). This report describes progress toward measles elimination in China during January 2013-June 2019.¶ Measles incidence per million persons decreased from 20.4 in 2013 to 2.8 in 2018; reported measles-related deaths decreased from 32 in 2015 to one in 2018 and no deaths in 2019 through June. Measles elimination in China can be achieved through strengthening the immunization program's existing strategy by ensuring sufficient vaccine supply; continuing to improve laboratory-supported surveillance, outbreak investigation and response; strengthening school entry vaccination record checks; vaccinating students who do not have documentation of receipt of 2 doses of measles-rubella vaccine; and vaccinating health care professionals and other adults at risk for measles.

Transmission of measles among healthcare Workers in Hospital W, Xinjiang Autonomous Region, China, 2016.

BACKGROUND: As China approaches the elimination of measles, outbreaks of measles continue to occur. Healthcare workers (HCWs) are known to be at high risk of infection and transmission of measles virus. A measles outbreak occurred in a hospital in Xinjiang Uighur Autonomous Region of the People's Republic of China. We report an investigation of this outbreak and its implications for measles elimination and outbreak preparedness. METHODS: We conducted a retrospective search for measles cases using hospital records. Information on cases was collected by interview, and was used to determine epidemiological linkages. We surveyed HCWs to determine their demographic characteristics, disease history and vaccination status, and knowledge about measles. RESULTS: We identified 19 cases, ages 18 to 45 years, in Hospital W between December 2015 and January 2016; 14 were laboratory-confirmed, and 5 were epidemiologically linked. The primary case was a 25-year-old neurology department nurse who developed a rash on 22 December 2015 that was reported on 11 January 2016. She continued working and living with her workmates in a dormitory during her measles transmission period. Among the 19 infected HCWs, 2 had received a dose of measles-containing vaccine (MCV) before the outbreak, and 16 had unknown vaccination status. Outbreak response immunization activities were started on 8 January in a non-selective manner by offering vaccine regardless of vaccination history; 605(68%) of 890 HCWs were vaccinated. The HCW survey had a 73% response rate (646/890); 41% of HCWs reported that they had received MCV before outbreak, and 56% exhibited good knowledge of measles symptoms, transmission, complications, and vaccination. CONCLUSIONS: Low MCV coverage, low measles knowledge among HCWs, delayed reporting of measles cases, and absence of proper case management were associated with this outbreak. Training and vaccinating HCWs against measles are essential activities to prevent measles virus transmission among HCWs.

Demographic transition and the dynamics of measles in six provinces in China: A modeling study.

BACKGROUND: Industrialization and demographic transition generate nonstationary dynamics in human populations that can affect the transmission and persistence of infectious diseases. Decades of increasing vaccination and development have led to dramatic declines in the global burden of measles, but the virus remains persistent in much of the world. Here we show that a combination of demographic transition, as a result of declining birth rates, and reduced measles prevalence, due to improved vaccination, has shifted the age distribution of susceptibility to measles throughout China. METHODS AND FINDINGS: We fit a novel time-varying catalytic model to three decades of age-specific measles case reporting in six provinces in China to quantify the change in the age-specific force of infection for measles virus over time. We further quantified the impact of supplemental vaccination campaigns on the reduction of susceptible individuals. The force of infection of measles has declined dramatically (90%-97% reduction in transmission rate) in three industrialized eastern provinces during the last decade, driving a concomitant increase in both the relative proportion and absolute number of adult cases, while three central and western provinces exhibited dynamics consistent with endemic persistence (24%-73% reduction in transmission rate). The reduction in susceptible individuals due to supplemental vaccination campaigns is frequently below the nominal campaign coverage, likely because campaigns necessarily vaccinate those who may already be immune. The impact of these campaigns has significantly improved over time: campaigns prior to 2005 were estimated to have achieved less than 50% reductions in the proportion susceptible in the target age classes, but campaigns from 2005 onwards reduced the susceptible proportion by 32%-87%. A limitation of this study is that it relies on case surveillance, and thus inference may be biased by age-specific variation in measles reporting. CONCLUSIONS: The age distribution of measles cases changes in response to both demographic and vaccination processes. Combining both processes in a novel catalytic model, we illustrate that age-specific incidence patterns reveal regional differences in the progress to measles elimination and the impact of vaccination controls in China. The shift in the age distribution of measles susceptibility in response to demographic and vaccination processes emphasizes the importance of progressive control strategies and measures to evaluate program success that anticipate and react to this transition in observed incidence.

Vaccine-derived poliovirus surveillance in China during 2001-2013: the potential challenge for maintaining polio free status.

BACKGROUND: The goal of polio eradication is to complete elimination and containment of all wild, vaccine-related and Sabin polioviruses. Vaccine-derived poliovirus (VDPV) surveillance in China from 2001-2013 is summarized in this report, which has important implications for the global polio eradication initiative. METHODS: Acute flaccid paralysis (AFP) cases and their contacts with VDPVs isolated from fecal specimens were identified in our AFP surveillance system or by field investigation. Epidemiological and laboratory information for these children were analyzed and the reasons for the VDPV outbreak was explored. RESULTS: VDPVs were isolated from a total of 49 children in more than two-thirds of Chinese provinces from 2001-2013, including 15 VDPV cases, 15 non-polio AFP cases and 19 contacts of AFP cases or healthy subjects. A total of 3 circulating VDPVs (cVDPVs) outbreaks were reported in China, resulting in 6 cVDPVs cases who had not been vaccinated with oral attenuated poliomyelitis vaccine. Among the 4 immunodeficiency-associated VDPVs (iVDPVs) cases, the longest duration of virus excretion was about 20 months. In addition, one imported VDPV case from Myanmar was detected in Yunnan Province. CONCLUSIONS: Until all wild, vaccine-related and Sabin polioviruses are eradicated in the world, high quality routine immunization and sensitive AFP surveillance should be maintained, focusing efforts on underserved populations in high risk areas.

Report - In vitro immune potentials of a water-soluble polysaccharide extract from Dioscorea opposita planted in Henan Province, China.

Dioscorea opposita is an edible and medicinal plant available in many areas of China. This study aimed to assess in vitro immune potentials of a water-soluble polysaccharide extract from D. opposita planted in Henan Province, China. In vitro effects of the extract on three immune cells (macrophages, natural killer cells and splenocytes) from mice and secretion of eight immune-related molecules in macrophages and splenocytes were evaluated. In total, the extract exhibited a dose-dependent manner on these immunological responses. The extract at dose level of 50µg/ml enhanced respective splenocyte proliferation, macrophage phagocytosis, and natural killer cell activity by 150%, 18% and 47%, increased secretion of interleukin-2 and interferon-γ (from 41.4 and 24.6 pg/ml to 48.8 and 91.5 pg/ml, respectively) but decreased secretion of interleukin-4 (from 38.9 to 27.9 pg/ml) in splenocytes. The extract at the same dose level also stimulated inducible nitric oxide synthase and lysozyme in macrophages, and enhanced secretion of interleukin-6, interleukin-1ß and tumor necrosis factor-α (from 26.6, 73.4 and 39.6 pg/ml to 60.2, 131.0 and 144.7 pg/ml, respectively). It is concluded that water-soluble polysaccharides from D. opposita have immune potentials to the body, via activating immune cells and regulating the secretion of immune-related molecules.

Identification and control of a poliomyelitis outbreak in Xinjiang, China.

BACKGROUND: The last case of infection with wild-type poliovirus indigenous to China was reported in 1994, and China was certified as a poliomyelitis-free region in 2000. In 2011, an outbreak of infection with imported wild-type poliovirus occurred in the province of Xinjiang. METHODS: We conducted an investigation to guide the response to the outbreak, performed sequence analysis of the poliovirus type 1 capsid protein VP1 to determine the source, and carried out serologic and coverage surveys to assess the risk of viral propagation. Surveillance for acute flaccid paralysis was intensified to enhance case ascertainment. RESULTS: Between July 3 and October 9, 2011, investigators identified 21 cases of infection with wild-type poliovirus and 23 clinically compatible cases in southern Xinjiang. Wild-type poliovirus type 1 was isolated from 14 of 673 contacts of patients with acute flaccid paralysis (2.1%) and from 13 of 491 healthy persons who were not in contact with affected persons (2.6%). Sequence analysis implicated an imported wild-type poliovirus that originated in Pakistan as the cause of the outbreak. A public health emergency was declared in Xinjiang after the outbreak was confirmed. Surveillance for acute flaccid paralysis was enhanced, with daily reporting from all public and private hospitals. Five rounds of vaccination with live, attenuated oral poliovirus vaccine (OPV) were conducted among children and adults, and 43 million doses of OPV were administered. Trivalent OPV was used in three rounds, and monovalent OPV type 1 was used in two rounds. The outbreak was stopped 1.5 months after laboratory confirmation of the index case. CONCLUSIONS: The 2011 outbreak in China showed that poliomyelitis-free countries remain at risk for outbreaks while the poliovirus circulates anywhere in the world. Global eradication of poliomyelitis will benefit all countries, even those that are currently free of poliomyelitis.

Measles vaccine coverage estimates in an outbreak three years after the nation-wide campaign in China: implications for measles elimination, 2013.

BACKGROUND: China is approaching measles elimination, but indigenous measles still circulates. County L in China has reported measles-containing vaccine (MCV) coverage rates >95% since 2000. Despite high reported coverage, a large measles outbreak occurred among young children in L County. We measured MCV coverage using 5 different methods during an investigation on this outbreak and compared our estimates with reported rates. METHODS: Reported coverage rates are determined by aggregating clinic-based data across the county: doses administered in each clinic divided by the number of children registered in each clinic. Our methods estimated coverage for the 2010-2012 birth cohort, and were (1) administrative method: doses administered in clinics divided by the birth cohort recorded in the Statistical Year Book, (2) house-to-house convenience-sample survey of children living near cases, (3) vaccination clinic records review, (4) determination of a convenience sample of measles outbreak cases' vaccination statuses and using the field vaccine efficacy outbreak equation to estimate population coverage, and (5) a seroprevalence survey using a convenience sample of residual blood samples from hospitals. RESULTS: The measles outbreak totaled 215 cases, representing an incidence of 195.8 per million population. Our estimated MCV coverage rates were: (1) administrative method: 84.1%-87.0% for MCV1 and 80.3%-90.0% for MCV2, (2) in-house survey: 83.3% of 9-17 month children received MCV1, and 74.5% of 24-47 month children received MCV2, (3) clinic record review: 85.5% of 9-17 month children received MCV1, and 73.2% of 24-59 month children received MCV2, (4) field VE method: 83.6% of 9-47 month children received one or more MCV doses, and (5) serology: seropositive rates were <80% in the 12-17 and 18-23 month age cohorts. CONCLUSIONS: Compared with reported coverage >95%, our 5 coverage assessments all showed substantially lower coverage. China should evaluate guidelines for reporting vaccination coverage and identify feasible improvements to the assessment methods.

Rice cytokinin GATA transcription Factor1 regulates chloroplast development and plant architecture.

Chloroplast biogenesis has been well documented in higher plants, yet the complex methods used to regulate chloroplast activity under fluctuating environmental conditions are not well understood. In rice (Oryza sativa), the CYTOKININ-RESPONSIVE GATA TRANSCRIPTION FACTOR1 (Cga1) shows increased expression following light, nitrogen, and cytokinin treatments, while darkness and gibberellin reduce expression. Strong overexpression of Cga1 produces dark green, semidwarf plants with reduced tillering, whereas RNA interference knockdown results in reduced chlorophyll and increased tillering. Coexpression, microarray, and real-time expression analyses demonstrate a correlation between Cga1 expression and the expression of important nucleus-encoded, chloroplast-localized genes. Constitutive Cga1 overexpression increases both chloroplast biogenesis and starch production but also results in delayed senescence and reduced grain filling. Growing the transgenic lines under different nitrogen regimes indicates potential agricultural applications for Cga1, including manipulation of biomass, chlorophyll/chloroplast content, and harvest index. These results indicate a conserved mechanism by which Cga1 regulates chloroplast development in higher plants.

Monitoring progress towards the elimination of measles in China: an analysis of measles surveillance data.

OBJECTIVE: To analyse the epidemiology of measles in China and determine the progress made towards the national elimination of the disease. METHODS: We analysed measles surveillance data - on the age, sex, residence and vaccination status of each case and the corresponding outcome, dates of onset and report and laboratory results - collected between January 2005 and October 2013. FINDINGS: Between 2005 and October 2013, 596 391 measles cases and 368 measles-related deaths were reported in China. Annual incidence, in cases per 100 000 population, decreased from 9.95 in 2008 to 0.46 in 2012 but then rose to more than 1.96 in 2013. The number of provinces that reported an annual incidence of less than one case per million population increased from one in 2009 to 15 in 2012 but fell back to one in 2013. Median case age decreased from 83 months in 2005 to 14 months in 2012 and 11 months in January to October 2013. Between 2008 and 2012, the incidence of measles in all age groups, including those not targeted for vaccination, decreased by at least 93.6%. However, resurgence started in late 2012 and continued into 2013. Of the cases reported in January to October 2013, 40% were aged 8 months to 6 years. CONCLUSION: Although there is evidence of progress towards the elimination of measles from China, resurgence in 2013 indicated that many children were still not being vaccinated on time. Routine immunization must be strengthened and the remaining immunity gaps need to be identified and filled.

Enhanced surveillance of acute flaccid paralysis following importation of wild poliovirus in Xinjiang Uygur Autonomous Region, China.

BACKGROUND: After being polio free for more than 10 years, an outbreak occurred in China in 2011 in Xinjiang Uygur Autonomous Region (Xinjiang) following the importation of wild poliovirus (WPV) originating from neighboring Pakistan. METHODS: To strengthen acute flaccid paralysis (AFP) surveillance in Xinjiang, "zero case daily reporting" and retrospective searching of AFP cases were initiated after the confirmation of the WPV outbreak. To pinpoint all the polio cases in time, AFP surveillance system was expanded to include persons of all ages in the entire population in Xinjiang. RESULTS: Totally, 578 AFP cases were reported in 2011 in Xinjiang, including 21 WPV cases, 23 clinical compatible polio cases and 534 non-polio AFP cases. Of the 44 polio cases, 27 (61.4%) cases were reported among adults aged 15-53 years. Strengthening AFP surveillance resulted in an increase in the number of non-polio AFP cases in 2011 (148 children < 15 years) compared with 76 cases < 15 years in 2010. The AFP surveillance system in Xinjiang was sensitive enough to detect polio cases, with the AFP incidence of 3.28/100,000 among children < 15 years of age. CONCLUSIONS: Incorporating adult cases into the AFP surveillance system is of potential value to understand the overall characteristics of the epidemic and to guide emergency responses, especially in countries facing WPV outbreak following long-term polio free status. The AFP surveillance system in Xinjiang was satisfactory despite limitations in biological sample collection.

Impact of National Immunization Strategies on Vaccine-Preventable Diseases - China, 1950-2021.

What is already known about this topic?: The incidences of vaccine-preventable diseases (VPDs) included in the Expanded Program on Immunization in China have decreased significantly in recent decades. What is added by this report?: This study summarizes the national incidences of nine VPDs and the seroprevalence of hepatitis B surface antigen (HBsAg) under different immunization strategies from 1950 through 2021 in China. The sharpest decreases in VPD incidence and under-5-year HBsAg seroprevalence occurred during the latest stage of the National Immunization Program. The decreases in VPD incidence were most prominent among children under five years of age. What are the implications for public health practice?: These findings provide valuable insights for vaccine value assessment and emphasize the importance of implementing immunization strategies in targeted populations.

Thirty Years of Experience of Acute Flaccid Paralysis Surveillance for Polio - China, 1993-2022.

Introduction: Detecting poliovirus infections proves to be highly challenging due to their asymptomatic nature and infectious potential, highlighting the crucial importance of effective detection methods in the context of polio eradication efforts. In many countries, including China, the primary approach for identifying polio outbreaks has been through acute flaccid paralysis (AFP) surveillance. In this study, we conducted an evaluation spanning three decades (1993-2022) to assess the effectiveness of AFP surveillance in China. Methods: Data on all AFP cases identified since 1993 and national-level AFP surveillance system quality indicators aligned with the World Health Organization (WHO) standards were collected for analysis. The quality indicators assess surveillance sensitivity, completeness, timeliness of detection notification, case investigation, and laboratory workup. Surveillance sensitivity is determined by the non-polio AFP (NPAFP) detection rate among children under 15 years of age. Results: Between 1993 and 2022, a total of 150,779 AFP cases were identified and reported. Within this pool, surveillance identified 95 cases of wild poliovirus (WPV) and 24 cases due to vaccine-derived poliovirus. From 1995 onwards, the detection rate of NPAFP cases consistently adhered to the WHO and national standards of ≥1 case per 100,000, falling between 1.38 and 2.76. Starting in 1997, all timeliness indicators consistently achieved the criteria of 80%, apart from the consistency in meeting standards set for the rate of positive specimens sent to the national laboratory. Conclusions: AFP surveillance has been instrumental in China's accomplishment of maintaining a polio-free status. The ongoing adherence to key performance indicators, ensuring sensitivity and prompt specimen collection, demonstrates that AFP surveillance is proficient in detecting poliovirus in China. As we move into the post-eradication phase, AFP surveillance remains crucial for the sustained absence of polioviruses in the long term.