Study on the impact of long-term blood glucose fluctuations and blood glucose control on the occurrence of stroke in patients with type 2 diabetes mellitus / 中国糖尿病杂志

Objective Explore the impact of long-term blood glucose fluctuations and blood glucose control on the stroke incidence in patients with type 2 diabetes mellitus(T2DM).Methods An observa-tional cohort of patients with T2DM was established based on"Shanghai Community Chronic Disease Health Management Service Objects"on October 1st,2018.Follow-ups were conducted every three months,and fasting blood glucose(FBG)were tested at each visit.Basic epidemiological data were collected via the Shanghai Community Health Management Information Platform or survey questionnaires,and stroke incidents were gathered via the"Shanghai Cardio-Cerebrovascular Event Monitoring System".The first reported stroke incident within the observation period was considered.The observational deadline was December 31st,2021.Standard deviation of FBG was used to evaluate blood glucose fluctuation and FBG control rate was used to reflect blood glucose control status.Cox Proportional Hazards Model was utilized to analyze the impacts.Results The cumulative observation time was 91,826.1 person-years for the study,in which there were 1785 cases of stroke events observed,implying a cumulative incidence of 5.73%and incidence rate of 1943.9/100000 person-years.The mean number of follow-ups(10.29±3.07)per patient was recorded.The details of the stroke cases were as follows:transient ischemic attacks(n=111,6.22%),non-lacunar brain infarctions(n=754,42.24%),lacunar brain infarctions(n=798,44.71%),intracerebral hemorrhages(n=80,4.48%),non-intracerebral hemorrhages(n=8,0.45%),subarachnoid hemorrhages(n=12,0.67%),and unclassified strokes(n=22,1.23%).After excluding subjects with less than five follow-ups,the Cox Proportional Hazards Model suggested that increased standard deviation of FBG was an independent risk factor for the first stroke incident,and an increased blood glucose control rate was an independent protective factor.Both the standard deviation of FBG and the blood glucose control rate were not correlated with stroke recurrence.Conclusion Long-term blood glucose fluctuations and blood glucose control can predict the risk of a first stroke in patients with T2DM.The relationship between blood glucose fluctuations,blood glucose management,and stroke recurrence requires further studies.

Cinobufacini inhibits the metastasis of colorectal cancer by regulating polarization of M2 macrophages / 安徽医科大学学报

Objective To investigate the effect of cinobufacini on inhibiting colorectal cancer metastasis by regula-ting the polarization of M2 macrophages.Methods THP-1 was induced into M0 type macrophages.The condi-tioned medium of HCT116 cells was collected to stimulate M0 type macrophages.The polarization of M2 type mac-rophages was observed by flow cytometry,real-time quantitative PCR and ELISA experiments.The conditioned me-dium of M0 type macrophages and HCT116-Mφ cells was collected to stimulate HCT116 cells.The ability of migra-tion and invasion was observed by wound healing assay and Transwell assay.The effect of cinobufacini on the via-bility of HCT116 cells was detected by CCK-8 assay.The conditioned medium of HCT116 and HCT116+cinobufa-cini was collected to stimulate M0 type macrophages.The polarization of M2 type macrophages was observed by flow cytometry,real-time quantitative PCR and ELISA experiments.The conditioned media of HCT116-Mφ cells and(HCT116+cinobufacini)-Mφ cells were collected to stimulate HCT116 cells.The changes of migration and inva-sion ability were observed by wound healing assay and Transwell assay.Results After stimulation of M0 type mac-rophages in HCT116 cell conditioned medium,the morphology of M0 macrophages turned into fusiform cells,the proportion of CD11b+CD206+cells increased,and the expression of M2 macrophage markers IL-10 and TGF-β in-creased.The migration and invasion ability of HCT116 cells were significantly enhanced after stimulation in the conditioned medium of HCT1 16-Mφ cells.After the addition of cinobufacini,not only the polarization proportion of M2 macrophages decreased,but also the metastatic effect mediated by M2 macrophages was inhibited.Conclusion HCT116 cells can induce the polarization of M2 macrophages,while cinobufacini can inhibit the tumor metastasis mediated by M2 macrophages by inhibiting the polarization of M2 macrophages.

Hospitalization burden of hand, foot and mouth disease in Anhua county of Hunan province,2013-2016 / 中华流行病学杂志

Objective To estimate the serotype and age-specific hospitalization burden associated with hand,foot and mouth disease (HFMD) in Anhua county of Hunan province,between October 2013 and September 2016.Methods We collected hospitalization records of HFMD patients from 6 virological surveillance hospitals,and reimbursement records through new rural cooperative medical system from 23 township health centers to estimate the age-specific hospitalization burden of HFMD in Anhua.Combined with the results of virological surveillance,the serotype-specific hospitalization burden of HFMD in Anhua,was estimated.Results During the three years,it was estimated that 3 541 clinical diagnosed HFMD cases,including 3 146 laboratory-confirmed HFMD cases,were hospitalized in Anhua,but only one was diaguosed as being severe.The estimated average hospitalization rate was 723/100 000(95％C1:699/100 000-747/100 000) for clinical diagnosed HFMD and 642/100 000 (95％ CI:620/100 000-665/100 000) for laboratory-confirmed HFMD between October 2013 and September 2016.The cases caused by Cox A16 (208/100 000) and Cox A6 (202/100 000) had higher hospitalization rates compared with the cases caused by EV71 (130/100 000),Cox A10 (38/100 000) and other enterovirus (64/100 000),and the difference was statistically significant (P＜0.001).HFMD-associated hospitalization rates peaked in children aged 1 year (3 845/100 000),and then decreased with age.Compared with the hospitalized HFMD caused by EV71 and Cox A16,Cox A6-associated hospitalizations mainly occurred in younger age groups (P＜0.001).Conclusion Our study revealed a substantial hospitalization burden associated with mild HFMD caused by EV71,Cox A16,Cox A6 and Cox A10,especially in young children,in Anhua.

M2 macrophage marker CD206 and tumor / 国际肿瘤学杂志

Tumor-associated macrophages exist in all stages of tumor progression,and stimulate angiogenesis and invasion of tissues.M2 macrophages are predominant.CD206 is a M2 macrophage marker with high specificity and plays an important role in tumor cell proliferation and metastasis.Studies have shown that CD206 is closely related to malignant tumors such as breast cancer,ovarian cancer,pancreatic cancer and prostate cancer.Deepening the research on CD206 has certain clinical guiding significance for expounding the formation mechanism of tumor immune microenvironment and finding more targeted drugs.

Cost-effectiveness of potential government fully-funded influenza vaccination in population with diabetes in China / 中华预防医学杂志

Objective@#To evaluate the cost-effectiveness of potential government fully-funded influenza vaccination for diabetics in our country.@*Methods@#From the societal perspective, a decision tree model was developed to compare outcomes (including impact on the influenza-related outpatient consultation, hospitalization and excess mortality, and quality-adjusted life years (QALY), as well as incremental cost-effectiveness ratio (ICER)) of a national fully-funded vaccination programme in the population with diabetes and status quo (i.e., vaccinated with out-of-pocket payment, with a uptake rate of zero), using the published data with regarding to influenza related ILI (influenza-like illness) consultation rate, hospitalization rate and excess mortality rate, health-related quality of life and economic burden, diabetes prevalence, population size, health seeking behaviour, vaccine uptake rate, vaccine efficacy/effectiveness, etc. A time horizon of 1 year was used in the present analysis, and all costs were expressed in CNY in 2016 using the consumer price index. All results are presented in M (P25, P75).@*Results@#In the scenario of 40% vaccination coverage in the population with diabetes, government fully-funded vaccination programme was estimated to cost 1.71 (1.67, 1.75) billions CNY, and expected to prevent 110 000 (81 000, 143 000) influenza-related ILI consultations, 36 000 (28 000, 44 000) influenza-related SARI hospitalizations and 12 000 (9 000, 16 000) influenza-related deaths due to respiratory and cardiovascular diseases. A total of 108 000 (82 000, 142 000) QALY were estimated to be gained. The ICER was 10 088 (7 365, 14 046) CNY per QALY gained. The probability of cost-effectiveness of the fully-funded vaccination programme was 99.1% at a threshold of 53 680 CNY per QALY gained (GDP per capita in 2016).@*Conclusion@#Government fully-funded influenza vaccination in population with diabetes is cost-effective, and thus is recommended as the key strategy of diabetes prevention and control.

Hospitalization burden of hand, foot and mouth disease in Anhua county of Hunan province, 2013-2016 / 中华流行病学杂志

Objective: To estimate the serotype and age-specific hospitalization burden associated with hand, foot and mouth disease (HFMD) in Anhua county of Hunan province, between October 2013 and September 2016. Methods: We collected hospitalization records of HFMD patients from 6 virological surveillance hospitals, and reimbursement records through new rural cooperative medical system from 23 township health centers to estimate the age-specific hospitalization burden of HFMD in Anhua. Combined with the results of virological surveillance, the serotype-specific hospitalization burden of HFMD in Anhua, was estimated. Results: During the three years, it was estimated that 3 541 clinical diagnosed HFMD cases, including 3 146 laboratory-confirmed HFMD cases, were hospitalized in Anhua, but only one was diaguosed as being severe. The estimated average hospitalization rate was 723/100 000(95%CI: 699/100 000-747/100 000) for clinical diagnosed HFMD and 642/100 000 (95%CI: 620/100 000-665/100 000) for laboratory-confirmed HFMD between October 2013 and September 2016. The cases caused by Cox A16 (208/100 000) and Cox A6 (202/100 000) had higher hospitalization rates compared with the cases caused by EV71 (130/100 000), Cox A10 (38/100 000) and other enterovirus (64/100 000), and the difference was statistically significant (P<0.001). HFMD-associated hospitalization rates peaked in children aged 1 year (3 845/100 000), and then decreased with age. Compared with the hospitalized HFMD caused by EV71 and Cox A16, Cox A6-associated hospitalizations mainly occurred in younger age groups (P<0.001). Conclusion: Our study revealed a substantial hospitalization burden associated with mild HFMD caused by EV71, Cox A16, Cox A6 and Cox A10, especially in young children, in Anhua.

Strategy for prevention and control of imported infectious disease / 中华流行病学杂志

The process of globalization increases the risk of global transmission of infectious diseases,resulting in pressure for country's prevention and control of imported infectious disease.Based on the risk assessment of disease importation and local transmission,a strategy that conducting importation prevention and routine prevention and control before the importation of disease and taking emergency control measures after the importation of disease was developed.In addition,it is important to take part in global infectious disease response action,aid the countries with outbreak or epidemic to actively decrease the risk of disease importation.

Comparison of epidemiological characteristics of human infection with avian influenza A (H5N1) virus in five countries of Asia and Africa / 中华预防医学杂志

Objective@#To understand characteristics of demographic, seasonal and spatial distribution of H5N1 cases in major countries of Asia (Indonesia, Cambodia, Vietnam, China) and Africa (Egypt).@*Methods@#Through searching public data resource and published papers, we collected cases information in five countries from May 1st, 1997 to November 6th, 2017, including general characteristics, diagnosis, onset and exposure history, etc. Different characteristics of survived and death cases in different countries were described and χ2 test was used to compare the differences among death cases and odds ratio (OR) and 95%CI value was used to compare death risk in different countries.@*Results@#A total of 856 cases were reported in five countries with Egypt had the most cases (44.3%). The highest number of cases were reported in 2015 (18.3%). 53% cases were reported from January to March, and 96.1% of cases had the history of poultry exposure. 64.2% (43 cases) cases in China had live poultry market exposure, but the sick/dead poultry exposure was the major exposure for cases in other four countries. 452 death cases were reported in five countries, and the fatality rate was 52.8%. With Egypt as the reference group, the highest death risk was seen in Indonesia (OR (95%CI): 11.52 (7.46-17.77)), followed by Cambodia (OR (95%CI): 4.27(2.37-7.69)) and China (OR (95%CI): 2.87 (1.73-4.74)). The age distribution of death cases among 5 countries was statistically significant, and the highest fatality rate was in 15-54 years group in Egypt (83.6%, 102 cases), while in Cambodia the highest fatality rate was in 0-14 years group (76.9%, 30 cases). The highest number of deaths were reported in 2006, and 48.3% were reported from January to March. There was difference in exposure routes among 5 countries (χ2=43.85, P=0.001), 63.2% (24 cases) of the death cases in China had live poultry market exposure. 92.9% (79 cases), 83.3% (40 cases) and 100.0% (38 cases) death cases in Indonesia, Vietnam and Camodia had sick/dead poultry exposure, respectively;and 81.6% (31 cases) of the death cases in Egypt had backyard poultry exposure.@*Conclusion@#The geographical distribution, seasonal age, gender, exposure matter and outcome of H5N1 cases in five countries were different.

Strategy for prevention and control of imported infectious disease / 中华流行病学杂志

The process of globalization increases the risk of global transmission of infectious diseases, resulting in pressure for country's prevention and control of imported infectious disease. Based on the risk assessment of disease importation and local transmission, a strategy that conducting importation prevention and routine prevention and control before the importation of disease and taking emergency control measures after the importation of disease was developed. In addition, it is important to take part in global infectious disease response action, aid the countries with outbreak or epidemic to actively decrease the risk of disease importation.

Analysis on the epidemiological features of human brucellosis in northern and southern areas of China, 2015-2016 / 中华流行病学杂志

Objective To analyze the epidemiological characteristics of human brucellosis in northern and southern areas of China,and to develop national strategies for brucellosis prevention and control.Methods Individual data on human brucellosis was collected from the National Notifiable Infectious Disease Reporting Information System to describe the situation of brucellosis in China during 2015-2016.Epidemiological features of the disease in northem and southern areas of China were analyzed.Results A total of 104 125 cases were reported in mainland China during 2015-2016,with an average incidence rate as 3.81/100 000.The overall incidence rate from the northem provinces was 7.77/100 000 in 2016,a 18.6％ decrease from 2015 (9.55/100 000),whereas the incidence rate in the southern provinces was 0.27/100 000 in 2016,with an increase of 28.6％ than 0.21/100 000 in 2015.90.0％ of the newly infected counties mainly distributed in southern China.As for the locations of reporting cases,most of them were in the same counties in the northern areas (52.3％) while most cases in the southern areas (59.6％) were imported from other counties.The median age of the cases was 48 (IQR:38-58) years,with male-to-female ratios as 2.7 ∶ 1 in the north and 2.2 ∶ 1 in the south.Majority of the cases were occupation-related,from both the northern (86.8％) and southern (62.7％) areas.Human brucellosis occurred every month throughout the year but with an obvious seasonal increase between March and July.Conclusions Different epidemiological features of human brucellosis appeared in both northern and southern areas of China.The disease was seen endemic in the northem and dispersal in the southem provinces.Appropriate strategies for brucellosis prevention and control should be developed,according to the different epidemiological characteristics in the northcm or southcm areas.

Analysis on the epidemiological features of human brucellosis in northern and southern areas of China, 2015-2016 / 中华流行病学杂志

Objective To analyze the epidemiological characteristics of human brucellosis in northern and southern areas of China,and to develop national strategies for brucellosis prevention and control.Methods Individual data on human brucellosis was collected from the National Notifiable Infectious Disease Reporting Information System to describe the situation of brucellosis in China during 2015-2016.Epidemiological features of the disease in northem and southern areas of China were analyzed.Results A total of 104 125 cases were reported in mainland China during 2015-2016,with an average incidence rate as 3.81/100 000.The overall incidence rate from the northem provinces was 7.77/100 000 in 2016,a 18.6％ decrease from 2015 (9.55/100 000),whereas the incidence rate in the southern provinces was 0.27/100 000 in 2016,with an increase of 28.6％ than 0.21/100 000 in 2015.90.0％ of the newly infected counties mainly distributed in southern China.As for the locations of reporting cases,most of them were in the same counties in the northern areas (52.3％) while most cases in the southern areas (59.6％) were imported from other counties.The median age of the cases was 48 (IQR:38-58) years,with male-to-female ratios as 2.7 ∶ 1 in the north and 2.2 ∶ 1 in the south.Majority of the cases were occupation-related,from both the northern (86.8％) and southern (62.7％) areas.Human brucellosis occurred every month throughout the year but with an obvious seasonal increase between March and July.Conclusions Different epidemiological features of human brucellosis appeared in both northern and southern areas of China.The disease was seen endemic in the northem and dispersal in the southem provinces.Appropriate strategies for brucellosis prevention and control should be developed,according to the different epidemiological characteristics in the northcm or southcm areas.

Epidemiological analysis on severe fever with thrombocytopenia syndrome under the national surveillance data from 2011 to 2014, China / 中华流行病学杂志

Objective To analyze the epidemiological features and surveillance management programs on severe fever with thrombocytopenia syndrome (SFTS) in China from 2011 to 2014.Methods The analysis of epidemiological characteristics and surveillance management programs was based on the annual reporting data collected from the National Disease Reporting Information System while the description of cluster incidents was based on those reports collected from the Public Health Emergency Information Management System (PHEIMS).Association between age groups and fatality rate was tested under the Cochran-Armitage Trend Test.The difference of fatality rates between differing groups was analyzed,using the chi-square test,with statistical significance on α=0.05.Results Between 2011 and 2014,5 352 suspected,probable and lab-confirmed cases of SFTS were reported in 23 provinces,of which 16 provinces reported 2 750 lab-confirmed cases with a fatality of 7.9％,accounting for 51.4％ of all the cases,nation-wide.Henan,Shandong,Hubei,Anhui,Liaoning,Zhejiang and Jiangsu reported 99.3％ of those lab-confirmed cases.The period between April and October appeared the epidemic season,with its peak from May to July.Most cases were farmers,accounted for 88.3％ of the lab-confirmed cases.People at the age between 50-74 occupied 67.6％ of all the cases.Fatality of the disease continually increased from 3.7％ in the age group 40-44 to 13.5％ in the age group older than 80.Fatality rates appeared statistically different between the groups with or without misdiagnosis,with OR as 3.06 (95％CI:1.61-5.90).Secondary cases of the cluster incidents were most likely to result from contacting the blood of the index cases.Conclusion Number of reported SFTS cases showed a rising trend in China.Henan,Hubei,Anhui,Shandong and Liaoning provinces appeared at high risk of the disease.Geographical distribution of the SFTS cases' seemed highly sporadic,with May to July being the peak season.Farmers and elderly were considered as high risk population.Occasionally,cluster incidents might be seen,as the result of contacting the blood of cases or corpses.Being at older age and misdiagnosis seemed to be risk factors for fatality.

Estimation of hospitalization rate of laboratory confirmed influenza cases in Jingzhou city, Hubei province, 2010-2012 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To estimate the hospitalization rate of severe acute respiratory infection (SARI) cases attributable to influenza in Jingzhou city, Hubei province from 2010 to 2012.</p><p><b>METHODS</b>SARI surveillance was conducted at four hospitals in Jingzhou city, Hubei province from 2010 to 2012. Inpatients meeting the SARI case definition and with informed consent were enrolled to collect their demographic information, clinical features, treatment, and disease outcomes, with their respiratory tract specimens collected for PCR test of influenza virus.</p><p><b>RESULTS</b>From April, 2010 to September, 2012, 19 679 SARI cases enrolled were residents of Jingzhou, and nasopharyngeal swab was collected from 18 412 (93.6%) cases of them to test influenza virus and 13.3% were positive for influenza. During the three consecutive 2010-2012 flu seasons, laboratory-confirmed influenza was associated with 102 per 100 000, 132 per 100 000 and 244 per 100 000, respectively. As for the hospitalization rate attributable to specific type/subtype of influenza virus, 48 per 100 000, 30 per 100 000 and 24 per 100 000 were attributable to A (H3N2), A (H1N1) pdm2009, and influenza B, respectively in 2010-2011 season; 42 per 100 000 [A (H3N2)] and 90 per 100 000 (influenza B) in 2011-2012 season; 90 per 100 000 [A (H3N2)] and one per 100 000 [influenza B] from April, 2010 to September, 2012. SARI hospitalization caused by influenza A or B occurred both mainly among children younger than five years old, with the peak in children aged 0.5 year old.</p><p><b>CONCLUSION</b>Influenza could cause a substantial number of hospitalizations and different viral type/subtype result in different hospitalizations over influenza seasons in Jingzhou city, Hubei province. Children less than five years old should be prioritized for influenza vaccination in China.</p>

Clinical characteristics of adult influenza inpatients in ten provinces in China and analysis of severe risk factors / 中华流行病学杂志

<p><b>OBJECTIVE</b>To identity the clinical characteristics and severe case risk factors for the adult inpatient cases confirmed of influenza monitored by the sentinel surveillance system for severe acute respiratory infection (SARI) inpatient cases in ten provinces in China.</p><p><b>METHODS</b>Epidemiology and clinical information surveys were conducted for adult cases (≥ 15 year old) consistent with SARI case definition, who were monitored by SARI sentinel hospitals in ten cities in China from December 2009 to June 2014, with their respiratory tract specimens collected for influenza RNA detection. Adult SARI cases were classified into influenza inpatient group and outpatient group by the detection outcomes, analyzing their demographic information, clinical and epidemiology characteristics respectively, in addition to risk factors for severe inpatient cases.</p><p><b>RESULTS</b>3 071 adult SARI cases were recruited from ten hospitals, including 240 (7.8%) cases of laboratory-confirmed influenza, most of them being A (H1N1) pdm2009 and A (H3N2) sub-types. Age M of the included influenza cases was 63 year old, 47.1% of them being ≥ 65 seniors. 144 (60.0%) cases of the influenza inpatients suffered from at least one chronic underlying condition, and the proportion of emphysema (7.9%) was higher than non-influenza inpatient cases (3.8%), being statistically significant (χ(2) = 3.963, P = 0.047). 19.4% of the women of childbearing age infected of influenza were in pregnancy, and only 1.1% of the 240 influenza cases had been vaccinated against influenza. The proportion of sore throat and dyspnea found among influenza inpatients was higher than inpatients without influenza. 17.4% of the influenza cases were accepted into ICU for treatment, with no statistical significance with non-influenza inpatient cases (P = 0.160). 23.1% of the influenza inpatients received an antiviral drug therapy, a figure higher than the non-influenza inpatient cases (4.8%) (P < 0.001). 41.5% of the inpatients developed complications, with the proportion of viral pneumonia significantly higher than the non-influenza inpatient cases (P < 0.001). Asthma (RR = 15.200, 95% CI: 1.157-199.633), immunosuppressive diseases (RR = 5.250, 95% CI: 1.255-21.960), pregnancy (RR = 21.000, 95% CI: 1.734-254.275), time interval from onset to admission less 7 days (RR = 1.673, 95% CI: 1.071-2.614) were identified as risk factors of severely-ill influenza cases.</p><p><b>CONCLUSION</b>It was found that adult influenza inpatients were mostly ≥ 65 year old seniors. The influenza vaccination rate among the influenza cases was very low, and antivirus drugs were used less than necessary. In this regard, influenza vaccination was recommended for high risk groups of pregnant women, seniors and chronic disease patients on annual basis, while influenza inpatients were advised to use antiviral drugs as early as possible.</p>

Clinical characteristics of hospitalized cases of severe acute respiratory infection with laboratory-confirmed influenza and the risk factors analysis of influenza infection for children under 15 years old in ten provinces in China during 2009-2014 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To identify clinical characteristics of hospitalized laboratory-confirmed influenza cases of children under 15 years old, and their risk factors of influenza infection.</p><p><b>METHODS</b>Analyzing the reports of hospitalized laboratory-confirmed influenza cases of children under 15 years old who were detected by the sentinel surveillance systems in 10 provinces from December 2009 to June 2014. Such data as their demographic, medical history, clinical symptoms and signs, treatment and outcome were collected using questionnaires, with their clinical characteristics and their risk factors of influenza infection described.</p><p><b>RESULTS</b>Of the 2 937 severe acute respiratory infection inpatients, 190 (6.5%) were laboratory-confirmed influenza cases. 123 (64.7%) of such confirmed cases were male, and 139 (73.2%) were children under 5 years old, with age median of 3.0 years (IQR: 1.0-5.0 years). 20 (10.5%) of them had at least one chronic medical condition, mostly chronic cardiovascular disease (3.2%), immunosuppressive disease (3.2%), and cancer/tumor (2.6%). Most common clinical symptoms of the cases were fever (92.6%) and cough (88.8%), of which abnormal pulmonary auscultation (51.1%) and abnormal chest X-ray performance (36.1%) were the most common clinical signs. 29 cases (15.8%) had complications, of which pneumonia (15.3%) was most common. 16 cases (8.6%) used antiviral drugs, and 4 cases (2.2%) were admitted into ICU. Risk factor analysis suggested that age < 6 months (OR = 0.406, 95% CI: 0.203-0.815) was a protective factor against influenza infection; and age 5-9 years old (OR = 2.535, 95% CI: 1.059-6.066) was a risk factor for influenza infection.</p><p><b>CONCLUSION</b>Hospitalized laboratory-confirmed influenza cases were found mostly in children under 5 years old. Risk exposure for influenza infection varied among age groups.</p>

Analysis of epidemiological features of human rabies in China, 2012 / 中华流行病学杂志

Objective To analyze epidemiological characteristics and trends of rabies and explore control and prevention measures based on the rabies surveillance data of 2012 in China.Methods Data of 2012 from China' s infectious disease surveillance reporting and management system and sentinel surveillance systems in 6 provinces were used,for a retrospective analysis in descriptive epidemiological methods.Results 1 425 cases were reported in 731 counties of 27 provinces in 2012 and 1 361 deaths were reported due to rabies,with the rabies incidence rate and mortality rate of 0.11/100 000 and 0.10/100 000 respectively,decreasing by 26.0％ and 27.9％ respectively from 2011.Rabies epidemic was mainly found in southern regions,followed by middle and eastern regions in China.49.6％ of total rabies cases were found in Guangxi,Guangdong,Hunan,Guizhou,and Henan province,which were the top five provinces.The rabies cases were mainly peasants,students and scattered children,accounting for 70.9％,8.3％ and 5.8％ of total cases respectively.The male-female ratio in rabies cases was 2.6:1.In 2012,294 epidemiological questionnaires were collected,revealing that 92.1％ of the exposure was caused by dogs and 6.8％ by cats.The median of latent period was 70 days.62.4％ of the cases were exposed in upper limb,and only 6.9％ of such cases were vaccinated after exposure while the proportion of passive immunity biological vaccination was 2.9％ for cases with exposure of category Ⅲ.Surveillance data from PEP (post-exposure prophylaxis) clinics showed that 81.7％ of the visitors were hurt by dogs and the exposure categories Ⅰ,Ⅱ and Ⅲ accounted for 7.0％,50.5％ and 42.5％ respectively.The proportion of of the exposure categories varied by PEP surveillance clinics.Conclusion Despite continuing decrease of rabies cases in China in 2012,the number of counties (districts) affected failed relatively slow,with a tendency of rabies spreading to the western and northern regions in China.There were more rabies cases in rural areas than urban ones,and children and elderly people constitute the high-risk population.Animal reservoir of rabies was still dogs as before.Poor PEP and insufficient use of vaccination and passive immunity preparations were main causes for onset of human rabies.

Analysis of epidemiology characteristics of norovirus among diarrheal outpatients in 27 provinces in China, 2009-2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the epidemiology characteristics of norovirus among diarrheal outpatients in China.</p><p><b>METHODS</b>Diarrhea cases were monitored at emergency/outpatient departments at 173 hospitals in 27 provinces of China, with clinical and epidemiological data, and fecal specimens collected and sent to 58 network-laboratories to detect norovirus by RT-PCR method, and to analyze the positive rate of norovirus in various regions, population and time during 2009-2013.</p><p><b>RESULTS</b>11.6% of the 34 031 diarrheal cases under surveillance were found with norovirus. Age group of 6-23 month-old children and that of people over 45 years old were found with the highest positive percentage, 13.7% and 12.4% respectively. Positive percentage of norovirus peaks in autumn and winter in a year; it peaks in mid-temperate zones (10.7%) and warm-temperate zones (11.6%) in winter. It peaks in sub-tropical zones in autumn (14.3%). The most prevalent genogroups detected were norovirus G II, accounting for 89.9% of identified strains.</p><p><b>CONCLUSION</b>Norovirus affects all ages and was most prevalent in children and the elderly among diarrhea outpatients. Norovirus' positive percentage showed strong seasonal pattern, and peaks at different times of a year in different climate zones of China. Since no effective preventive measures existed, further study on norovirus epidemiology and intervention strategies should be conducted in future.</p>

Analysis of morbidity and mortality characteristics of the notifiable diseases reported in 2013 in China / 中华流行病学杂志

Objective To learn the characteristics of morbidity and mortality of notifiable diseases reported in China in 2013.Methods Descriptive analysis method was used to analyze the morbidity and mortality of notifiable diseases in China in 2013,with Microsoft Excel 2010 and ArcGIS 10.0 used to develop statistical charts.Results In 2013,the morbidity of the nationwide notifiable diseases was 473.87/100 000,a decrease of 3％ below the average of the recent 3 years,while the mortality was 1.23/100 000,an increase of 2％ over the average of the recent 3 years.The rate of laboratory diagnosis of the reported cases was 38.4％.Top 5 diseases of the reported incidence were hand foot and mouth disease,other infectious diarrhea,hepatitis B,tuberculosis and syphilis.The death cases reported were mainly AIDS,tuberculosis and rabies.As classified by the transmission route analysis,intestinal infectious diseases accounted for 49％ of the total incidence reported for the year,followed by the blood and sexually transmitted infectious diseases,respiratory infectious diseases,animal and vector borne infectious diseases.According to the pathogenic analysis,virus infectious diseases accounted for 68％ of the total cases,higher than bacterial infectious diseases and animal-borne/vector-borne infectious diseases.In Shanghai,Zhejiang and Jiangsu,human infection with avian influenza A (H7N9) virus was emerging,as epidemic situation of measles,dengue fever and brucellosis were on the rise significantly nationwide,while the morbidity of infectious diseases decreased,namely pulmonary tuberculosis,hepatitis B among others.Morbidity of the top 5 provinces for notifiable infectious diseases were Hainan,Guangxi,Guangdong,Xinjiang and Zhejiang,respectively.Conclusion The proportion of laboratory confirmed cases among totals was still low in 2013.The morbidity of the infectious diseases was higher in western provinces and parts of south-eastern province,the mortality was higher in westem provinces.The emerging human infection with avian influenza A (H7N9) virus,and the high epidemic of measles,dengue fever and brucellosis in some areas had caught the society concerns.

Epidemiological characteristics of influenza outbreaks in China, 2005-2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the epidemiological characteristics of influenza outbreaks in China from 2005 to 2013.</p><p><b>METHODS</b>The data of influenza-like illness outbreaks involving 10 or more cases were collected through Public Health Emergency Management Information System and National Influenza Surveillance Information System in China, and the influenza outbreaks were identified according to the laboratory detection results. Descriptive epidemiological analysis was conducted to understand the type/subtype of influenza virus and outbreak time, area, place and extent.</p><p><b>RESULTS</b>From 2005 to 2013, a total of 3 252 influenza-like illness outbreaks were reported in the mainland of China, in which 2 915 influenza outbreaks were laboratory confirmed, and influenza A (H1N1) pdm09 virus and influenza B virus were predominant. More influenza outbreaks were reported in the influenza A (H1N1) pandemic during 2009-2010. Influenza outbreaks mainly occurred during winter-spring, and less influenza outbreaks occurred in winter and summer vacations of schools. More influenza outbreaks were reported in southern provinces, accounting for 79% of the total. Influenza outbreaks mainly occurred in primary and middle schools, where 2 763 outbreaks were reported, accounting for 85% of the total. Average 30-99 people were involved in an outbreak.</p><p><b>CONCLUSION</b>A large number of influenza outbreaks occur during influenza season every year in China, the predominant virus type or subtype varies with season. Primary and middle schools are mainly affected by influenza outbreaks.</p>

Clinical characteristics of hospitalized severe acute respiratory illnesses (SARI) in children and risk factors analysis of severe illness: results from SARI patients under 15-year-old of sentinel surveillance in 10 cities, China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate clinical and epidemiological characteristics of hospitalized severe acute respiratory illnesses (SARI) patients under 15 years old registered by sentinel hospitals at 10 cities and risk factors analysis of severe illness.</p><p><b>METHODS</b>The objects of this study were 2 937 SARI patients under 15 years old registered by sentinel surveillance in internal wards, pediatrics wards and intensive care units (ICU) of 10 sentinel hospitals in 10 cities during the period from December 2009 to June 2014. We also collected case report form (CRF) of them and their throat swabs for influenza testing. The inclusion criteria was hospitalized patients who were admitted by surveillance departments, registered by SARI surveillance system, under 15 years old, meeting SARI case definition and with complete CRF. Rank-sum test was used to compare the difference of age, the duration including from onset to admission, hospital stay and from onset to discharging/death between mild illness and severe illness. Chi-square test was used to compare the difference of demographic characteristics, influenza psoitive rate, vaccination rate of influenza, chronic medical conditions and clinical characteristics between mild illness and severe illness. Logistic regression was used to analysis risk factors associated with severe illness by two stratifications from SARI surveillance protocol (< 2 years old and ≥ 2 years old).</p><p><b>RESULTS</b>Among 2 937 SARI patients under 15 years old, 97.7% (2 872/2 937) was mild illnesses, and 2.3% (65/2 937) was severe illnesses. 78.8% (2 315/2 937) was under 5 years old. The median ages of severe illness and mild illness were 0.4 and 2.0 years old (U = -6.23, P < 0.001). The proportions of severe illness and mild illness with at least one chronic medical condition were 32.3% (21/65) and 8.4% (240/2 872) (χ² = 45.03, P < 0.001). The positive rate of influenza virus was 6.5% (190/2 937), which was 6.5% (186/2 858) for mild illness and 6.2% (4/65) for severe illness (χ² = 0.08, P = 0.961). The proportion of seasonal influenza vaccination was 1.5% (42/2 853), which was 1.5% (42/2 788) for mild illness and higher than that for severe illness (0) (χ² = 6.09, P = 0.048). For under 2 years old patients, age < 11 months and with at least one chronic medical condition were risk factors for severe SARI illness, and the risk for SARI patients who was 12-23 months and without medical condition was 14.71 (5.35-40.44) and 5.61 (2.96-10.63). For ≥ 2 years old patients, age, with at least one chronic medical condition and seasonal influenza vaccination history have no association with severe illness, OR (95% CI) was 0.92 (0.80-1.05), 0.67 (0.09-5.05) and 0.85 (0.31-2.35), respectively.</p><p><b>CONCLUSION</b>Most of SARI patients registered by 10 urban sentinel hospitals were patients under 5 years old. Age < 11 months and with at least chronic medical conditions were possible risk factors of severe illness of SARI patients.</p>