Outbreak of macrolide-resistant mycoplasma pneumoniae in a primary school in Beijing, China in 2018.

BACKGROUND: On 7th June, 2018, a primary school in Beijing, China notified Shunyi CDC of an outbreak of acute respiratory disease characterized by fever and cough among students and resulting in nine hospitalization cases during the preceding 2 weeks. We started an investigation to identify the etiologic agent, find additional cases, develop and implement control measures. METHODS: We defined probable cases as students, teachers and other staffs in the school developed fever (T ≥ 37.5 °C) with cough or sore throat; or a diagnosis of pneumonia during May 1-June 31, 2018. Confirmed cases were probable cases with Mycoplasma pneumoniae detected in oropharyngeal (OP) swabs by quantitative real-time polymerase chain reaction (qPCR). We searched case by reviewing school absenteeism records and interviewing students, teachers and staff in this school. Oropharyngeal swabs were collected from symptomatic students. Two qPCR) assay, a duplex qPCR assay, and sequencing were performed to determine the pathogen, genotype and macrolide resistance at the gene level, respectively. RESULTS: From May 1st to June 31st, 2018, we identified 55 cases (36 probable and 19 confirmed), of whom 25 (45%) were hospitalized for complications. All cases were students, none of the teachers and other staffs in the school were with similar symptoms. The attack rate (AR) was 3.9% (55/1398) for all students. The cases were mainly male (58%), with an age range of 7-8 years (median: 7 years). 72% (18/25) of inpatients had radiograph findings consistent with pneumonia, and some cases were hospitalized for up to 4 weeks. Pathogen detection results indicated that Mycoplasma pneumonia (M. pneumoniae) P1 type 1 was the causative agent in this outbreak, and the strain harbored one point mutation of A to G at position 2063. CONCLUSIONS: The infections by macrolide-resistant M. pneumoniae are not always mild and pneumonia was common and M. pneumoniae could causes serious complications which require long-term hospitalization. In the future infectious disease prevention and control practice, M. pneumoniae should be paid more attention. It is necessary to establish and improve the pathogen and drug resistance surveillance system in order to prevent and control such mutated strains of M. pneumoniae from causing future outbreaks or epidemics in China.

Analysis of an Imported Subgenotype C2 Strain of Human Enterovirus 71 in Beijing, China, 2015.

Background: Subgenotype C4 of enterovirus 71 (EV71) is the predominant agent of Hand Foot and Mouth disease (HFMD) circulating in the mainland of China. For the first time, a subgenotype C2 of EV71 named SY30-2 was isolated from a HFMD case in Beijing, China. Since it is uncertain whether antibodies raised against subgenotype C4 of EV71 can protect C2 EV71, it is important to monitor and check the presence of cross-reactive antibodies against new EV71 subgenotypes. To find out the causes for the different NtAb, this study is to investigate the relationships between amino acid residue variations and cross-reactive antibodies against EV71 subgenotypes C2 and C4. Methods: Nucleotide and amino acid sequences from full-length genome sequence of SY30-2 were compared to EV71 reference strains. A microneutralization test was used to detect neutralizing antibody (NTAb) in the sera of subgenotype C4 of EV71 infected cases against SY30-2 and FY17 (a C4 isolate). The 3D structure of the viral capsid protein of SY30-2 was constructed. Results: Genome sequence and similarity plot analyses showed that SY30-2 shared the highest identity with subgenotype C2 of EV71 strains in every fragment of the genome. While the microneutralization test result showed that children infected with subgenotype C4 of EV71 had higher NTAb titers against FY17 than SY30-2 (p < 0.001). The amino acid sequence comparison revealed that four amino acid residues VP1-22, VP1-31, VP1-249 and VP3-93 were highly conserved in subgenotype C4 of EV71 compared with the corresponding amino acid residues on subgenotype C2 of EV71 (p < 0.05). Furthermore, the 3D-structure of viral capsid protein showed that VP1-22, VP1-31 and VP3-93 were located on the surface of virion. Conclusion: This is the first report of an EV71 subgenotype C2 isolated from HFMD in Beijing, China. Only a few antigenic variations on subgenotype C2 of EV71 could have led to a great decrease in NTAb titer. Thus, imported new genotypes and subgenotypes of EV71 should be closely monitored. The efficacy of available vaccines against new viruses should be evaluated as well.

[Application of modified adjustable skin stretching and secure wound-closure system in repairing of skin and soft tissue defect].

Objective: To investigate the application of modified adjustable skin stretching and secure wound-closure system in repairing of skin and soft tissue defect. Methods: Between March 2016 and April 2017, 21 cases of skin and soft tissue defects were repaired with the modified adjustable skin stretching and secure wound-closure system (the size of regulating pressure and the times of adjustment were determined according to the color, temperature, capillary response, and swelling degree of the skin edge). There were 11 males and 10 females, with an average age of 49.2 years (range, 21-67 years). Among them, 1 case was the residual wound after amputation of leg; 18 cases were the wounds after traumatic injury operation, including 4 cases in the lower leg, 3 cases in the knee joint, 7 cases in the upper limb, and 4 cases in the foot; and 2 cases were diabetic feet. The skin defect area ranged from 4.0 cm×2.5 cm to 21.0 cm×10.0 cm. Results: Skin defect wounds closed directly in one stage in 4 cases; 12 cases were closed after continuously stretching for 5-14 days (mean, 10 days); 5 cases were reduced to less than one-half area, and the wound healed after the second skin grafting or flap repairing. All the 21 patients were followed up 3-12 months (mean, 5.2 months). The wound was linear healing with small scar, and no invasive margin, poor blood flow, necrosis, and poor sensory function happened. Conclusion: The modified adjustable skin stretching and secure wound-closure system can reduce the skin and soft tissue defects or close the wound directly, and even replace the skin graft and skin flap repairing. It was a good method for the treatment of skin and soft tissue defect.

[Exposure to avian influenza virus and the infection status of virus among people breeding or butchering ducks in the suburb of Beijing].

OBJECTIVE: To understand the exposure and the infection status of virus among people engaging in breeding or butchering ducks in the suburb of Beijing. METHODS: People from six districts (Daxing, Fangshan, Huairou, Miyun, Shunyi, Tongzhou) who engaged in breeding or butchering ducks were studied and the status of infecting avian influenza virus was obtained by testing antibody level in serum. Information on demographic characteristics, status of regular exposure and exposure to sick or dead poultry were collected through a self-designed questionnaire. RESULTS: 1741 people were involved in this study in which 313 (18.0%) were workers in duck-breeding enterprise, 562 (32.3%) were workers in duck slaughterhouse, 261 (15.0%) farmers were in individual small-scale duck farms, 605 (34.7%) were farmers raising duck in backyard. Among farmers raising duck in backyard, the percentage of people whose ducks ever contacted with wild birds was higher than the other three groups (66.8%) (P<0.05). Among farmers who bred their ducks in the backyard (35.2%) and those abattoir workers (31.3%), the percentage of people who had contacted ducks but not been vaccinated with avian influenza vaccine was higher than the other two groups (P<0.05). Regarding the status on cleaning and disinfection among the studied farmers who had bred their ducks in the backyard, the percentage of people who had closer contact with ducks would clean the settings more than 4 times per month (8.8%) and disinfected those places more than 12 times per year (27.3%) but still lower than the other three groups (P<0.05). Among those farmers who bred ducks in the backyard, the percentage of people who had ever touched duck with their hands was high (34.4%) (P<0.05). Regarding exposure to sick or dead poultry, higher proportion was found among those who had ever closely contacted sick or dead poultry commercial duck raisers (36.1%) and individuals who raise large amount of ducks (36.0%). 70.8% of the individual duck raisers had never taken any protective measures when closely contacting the sick or dead poultry. Among 1741 samples, 0 were positive to avian influenza virus H5 and H7 subtypes. 12 were positive to H9 subtype (positive rate was 0.7%), in which 10 were farmers raising ducks in backyard (the positive rate of 1.7%). Differences between H9 subtype antibody positive rates difference in 4 population groups were statistically significant (χ2=13.699, P<0.05). CONCLUSION: Farmers who bred their ducks in the backyard had greater risk of contracting the avian influenza. Individual duckers who raise ducks in large scale and the farmers who bred their ducks in the backyard were in lack of protective measures when contacting the sick or dead poultry. Our findings suggested that some intervention measures should be taken to reduce the risk of avian influenza infection.