Clinical Characteristics and Treatment Overview in Hand-Foot-and-Mouth Disease Using Real-World Evidence Based on Hospital Information System.

Objectives: To describe the epidemiological characteristics and medication overview of HFMD in Guangzhou and analyze the factors of length of stay (LOS) based on TCM usage. Method: From January 1, 2014, to June 30, 2019, clinical data of HFMD (ICD-10 B08.401) as the initial diagnosis, based on HIS of five medical institutions for outpatient and inpatient cases, was collected. The inpatient cases of the five hospitals in Guangzhou were utilized for hospitalization analysis. Information extracted from the warehouse was standardized. Descriptive analysis was used for baseline characteristics, medication usage, and inpatient characteristics. Potential factors were analyzed by bivariate analysis. COX regression analysis and Kaplan-Meier analysis for calculating HRs and 95% CIs were adopted to determine the predictors of LOS. Stratified COX regression was applied to analyze the relationship between predictors and LOS and to calculate interaction. Results: A total of 14172 patients with HFMD were included. It showed that HFMD would occur in males, infants, and summer. Cause and symptoms are the two aspects of conventional Western medicine treatments, while TCM treatment of HFMD took clearing heat and detoxification as the basic principle. Inpatients with HFMD were divided into two groups by the use ratio of TCM. Age, season, and disease severity were possible correlated factors of LOS, extrapolating from their disparity in distribution. By stratified Cox regression, three factors following presented as possible contributions to shortening LOS, including TCM ≥ 0.1 (HR = 1.79, 95% CI (1.67-1.92), P < 0.01), winter (HR = 1.28, 95% CI (1.12-1.47)), P < 0.01), mild HFMD (HR = 1.93, 95% CI (1.69-2.22), P < 0.01). Additive interaction of TCM use and disease severity was significant (RERI = 1.014 (0.493-1.534), P < 0.01). Conclusion: Young children and high temperature were the risk factors of HFMD infection, which suggests that increasing surveillance for susceptible particular-age individuals and season is indispensable. Favorable factors to decrease LOS included a higher proportion of TCM use, mild HFMD, and onset in winter. The proportion of TCM use had additive interaction with disease severity, indicating that TCM may have antiviral and other biological effects on HFMD. Increasing the proportion of TCM use was probably beneficial to shortening LOS.

Co-benefits of nonpharmaceutical intervention against COVID-19 on infectious diseases in China: A large population-based observational study.

Background: Nonpharmaceutical interventions (NPIs) are public health measures that aim to suppress the transmission of infectious diseases, including border restrictions, quarantine and isolation, community management, social distancing, face mask usage, and personal hygiene. This research aimed to assess the co-benefits of NPIs against COVID-19 on notifiable infectious diseases (NIDs) in Guangdong Province, China. Methods: Based on NID data from the Notifiable Infectious Diseases Surveillance System in Guangdong, we first compared the incidence of NIDs during the emergency response period (weeks 4-53 of 2020) with those in the same period of 2015-2019 and then compared that with the expected incidence during the synchronous period of 2020 for each city by using a Bayesian structural time series model. Findings: A total of 514,341 cases of 39 types of NIDs were reported in Guangdong during the emergency response period in 2020, which decreased by 50·7% compared with the synchronous period during 2015-2019. It was estimated that the number of 39 NIDs during the emergency response in 2020 was 65·6% (95% credible interval [CI]: 64·0% - 68·2%) lower than expected, which means that 982,356 (95% CI: 913,443 - 1,105,170) cases were averted. The largest reduction (82·1%) was found for children aged 0-14 years. For different categories of NIDs, natural focal diseases and insect-borne infectious diseases had the greatest reduction (89·4%), followed by respiratory infectious diseases (87·4%), intestinal infectious diseases (59·4%), and blood-borne and sexually transmitted infections (18·2%). Dengue, influenza, and hand-foot-and-mouth disease were reduced by 99·3%, 95·1%, and 76·2%, respectively. Larger reductions were found in the regions with developed economies and a higher number of COVID-19 cases. Interpretation: NPIs against COVID-19 may have a large co-benefit on the prevention of other infectious diseases in Guangdong, China, and the effects have heterogeneity in populations, diseases, time and space. Funding: Key-Area Research and Development Program of Guangdong Province.

Returning ex-patriot Chinese to Guangdong, China, increase the risk for local transmission of Zika virus.

OBJECTIVES: Fast expansion and linkage to microcephaly and Guillain Barre syndrome have made Zika virus (ZIKV) track attention of global health authority concerns. The epidemiology, virological characteristics and genetic evolution of introduced ZIKV to Guangdong, China, were investigated. METHODS: Analyses of the epidemiological characteristics and genetic diversity of ZIKV isolates were performed. RESULTS: A total of twenty-eight confirmed ZIKV infection cases were imported into China in 2016, of which 19 were imported into Guangdong, China from Venezuela (16), the Samoa Islands (1), Suriname (1) and Guatemala (1). Serial sampling studies of the cases indicated longer shedding times of ZIKV particles from urine and saliva samples than from serum and conjunctiva swab samples. Seven ZIKV strains were successfully isolated from serum, urine and conjunctiva swab samples using cell culture and neonatal mouse injection methods. Genomic analysis indicated that all viruses belonged to the Asian lineage but had different evolutionary transmission routes with different geographic origins. The molecular clock phylogenetic analysis of the ZIKV genomes indicated independent local transmission that appeared to have been previously established in Venezuela and Samoa. Additionally, we found 7 unique non-synonymous mutations in the genomes of ZIKV that were imported to China. The mutations may indicate that ZIKV has undergone independent evolutionary history not caused by sudden adaptation to Chinese hosts. CONCLUSION: The increasing number of ex-patriot Chinese returning from ZIKV hyper-endemic areas to Guangdong combined with the presence of a variety of Aedes species indicate the potential for autochthonous transmission of ZIKV in Guangdong.