Risk Factors for Death Among the First 80 543 Coronavirus Disease 2019 (COVID-19) Cases in China: Relationships Between Age, Underlying Disease, Case Severity, and Region.

BACKGROUND: Knowledge of COVID-19 epidemiology remains incomplete and crucial questions persist. We aimed to examine risk factors for COVID-19 death. METHODS: A total of 80 543 COVID-19 cases reported in China, nationwide, through 8 April 2020 were included. Risk factors for death were investigated by Cox proportional hazards regression and stratified analyses. RESULTS: Overall national case-fatality ratio (CFR) was 5.64%. Risk factors for death were older age (≥80: adjusted hazard ratio, 12.58; 95% confidence interval, 6.78-23.33), presence of underlying disease (1.33; 1.19-1.49), worse case severity (severe: 3.86; 3.15-4.73; critical: 11.34; 9.22-13.95), and near-epicenter region (Hubei: 2.64; 2.11-3.30; Wuhan: 6.35; 5.04-8.00). CFR increased from 0.35% (30-39 years) to 18.21% (≥70 years) without underlying disease. Regardless of age, CFR increased from 2.50% for no underlying disease to 7.72% for 1, 13.99% for 2, and 21.99% for ≥3 underlying diseases. CFR increased with worse case severity from 2.80% (mild) to 12.51% (severe) and 48.60% (critical), regardless of region. Compared with other regions, CFR was much higher in Wuhan regardless of case severity (mild: 3.83% vs 0.14% in Hubei and 0.03% elsewhere; moderate: 4.60% vs 0.21% and 0.06%; severe: 15.92% vs 5.84% and 1.86%; and critical: 58.57% vs 49.80% and 18.39%). CONCLUSIONS: Older patients regardless of underlying disease and patients with underlying disease regardless of age were at elevated risk of death. Higher death rates near the outbreak epicenter and during the surge of cases reflect the deleterious effects of allowing health systems to become overwhelmed.

Three Zr(IV)-Substituted Polyoxotungstate Aggregates: Structural Transformation from Tungstoantimonate to Tungstophosphate Induced by pH.

Three novel Zr-substituted polyoxotungstate aggregates [H2N(CH3)2]7NaH2[Zr2Sb2O3(A-α-PW9O34)2]·16H2O (1), [H2N(CH3)2]6H12[ZrSb4(OH)O2(A-α-PW8O32)(A-α-PW9O34)]2·33H2O (2), and [H2N(CH3)2]4Na11.5H4.5[Zr4W8Sb4P5O49(OH)5(B-α-SbW9O33)2]·53H2O (3) have been made in hydrothermal reactions of the [B-α-SbW9O33]9- precursor with Zr4+ cations and PO43- anions in the presence of dimethylamine hydrochloride and sodium acetate buffer (pH = 4.8) and structurally characterized. Different pH values induce structural transformation from tungstoantimonate (TA) to tungstophosphate (TP). 1 is a di-Zr-substituted sandwich-type TP, the tetranuclear heterometallic [Zr2Sb2O3]8+ entity sandwiched by two [A-α-PW9O34]9- moieties. 2 is a double sandwich-type structure, which can be perceived as two equivalent sandwiched [Sb3(PW8O32)(PW9O34)]11- further sandwiching one [Sb2Zr2(OH)2O4]4+ core to form a novel large-size sandwich-type architecture. Different from 1 and 2, 3 is a tetra-Zr-substituted sandwiched configuration, in which two [B-α-SbW9O33]9- fragments sandwich a unique 21-core Sb-P-W-Zr oxo cluster ({Zr4W8Sb4P5}). Furthermore, the catalytic oxidation of aromatic thioethers by 3 as the heterogeneous catalyst has been investigated, showing high conversion and remarkable selectivity as well as excellent recyclability.

Nonanuclear Heterometal Five-Layer Sandwich-Type Polyoxometalate.

A new nonanuclear heterometal five-layer sandwich silicotungstate [H2N(CH3)2]6H5NaK{[NaMn8O6(OAc)6][A-α-SiW9O34]2}·34H2O (1) has been made under hydrothermal reactions of MnCl2·4H2O, KMnO4, trivacant [A-α-SiW9O34]10- {SiW9} fragment, and [H2N(CH3)2]·Cl in NaOAc-HOAc buffer (pH = 4.8). The polyoxoanion of 1 is a sandwich architecture, in which the nonanuclear heterometal cluster [NaMn8O6(OAc)6]7+ made of two triangular pyramid clusters [Mn4O3(OAc)3]3+ {Mn4} via a hexacoordinate antitrigonal prism Na+ linkage is encapsulated by two trivacant fragments of {SiW9}. Furthermore, magnetic measurements of compound 1 reveal the existence of antiferromagnetic exchange interactions between the metal centers.

Effect of Shaft Diameter on the Hydrodynamic Torque of Butterfly Valve Disk.

In this study, computational fluid dynamics (cfd) software and detached eddy simulation turbulence model were used to simulate butterfly valves with different designs. The effects of shaft diameters on the value and the fluctuation of valve disk torque were studied, and the physical reason was discussed. The simulation results were verified by comparing with the experimental data. The findings revealed that with the closing of the valve, the hydraulic torque of the valve disk first increases and then decreases. Meanwhile, the torque decreases gradually with the increase of the shaft diameter. The variation of torque is caused by the change of pressure on both sides of the valve disk. The result also indicates that the fluctuation of torque is induced by the flow separation phenomenon occurs on the valve disk. The fluctuation is significant for the valve opening from 20% to 60%. The strength of the torque fluctuation is greater for the smaller shaft diameter. This study provides a theoretical basis for the design and optimization of butterfly valves.

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.

Safety of influenza A (H1N1) vaccine in postmarketing surveillance in China.

BACKGROUND: On September 21, 2009, China began administering vaccines, obtained from 10 different manufacturers, against 2009 pandemic influenza A (H1N1) virus infection in priority populations. We aimed to assess the safety of this vaccination program. METHODS: We designed a plan for passive surveillance for adverse events after immunization with the influenza A (H1N1) vaccine. Physicians or vaccination providers were required to report the numbers of vaccinees and all adverse events to their local Center for Disease Control and Prevention (CDC), which then reported the data to the Chinese CDC through the online National Immunization Information System's National Adverse Event Following Immunization Surveillance System. Data were collected through March 21, 2010, and were verified and analyzed by the Chinese CDC. RESULTS: A total of 89.6 million doses of vaccine were administered from September 21, 2009, through March 21, 2010, and 8067 vaccinees reported having an adverse event, for a rate of 90.0 per 1 million doses. The age-specific rates of adverse events ranged from 31.4 per 1 million doses among persons 60 years of age or older to 130.6 per 1 million doses among persons 9 years of age or younger, and the manufacturer-specific rates ranged from 4.6 to 185.4 per 1 million doses. A total of 6552 of the 8067 adverse events (81.2%; rate, 73.1 per 1 million doses) were verified as vaccine reactions; 1083 of the 8067 (13.4%; rate, 12.1 per 1 million doses) were rare and more serious (vs. common, minor events), most of which (1050) were allergic reactions. Eleven cases of the Guillain-Barré syndrome were reported, for a rate of 0.1 per 1 million doses, which is lower than the background rate in China. CONCLUSIONS: No pattern of adverse events that would be of concern was observed after the administration of influenza A (H1N1) vaccine, nor was there evidence of an increased risk of the Guillain-Barré syndrome.

Trends and Age-Period-Cohort Effect on Incidence of Varicella Under Age 35 - China, 2005-2021.

What is already known about this topic?: Varicella is an acute respiratory infectious disease primarily affecting children. However, recent studies have indicated an increasing susceptibility to varicella among older age groups. What is added by this report?: The findings demonstrate a significant rise in the incidence rate among individuals aged 15-19. Males under 20 years old were found to have a higher risk compared to females, whereas males had a lower risk compared to females aged 20-35 years. What are the implications for public health practice?: This study is the first comparative analysis using varicella data reported between 2005 and 2021 to examine the contributions of age, period, and birth cohort to varicella incidence in China. This study aims to provide a comprehensive analysis of the epidemiological characteristics of varicella in China and identify high-risk groups. The results of this study will contribute valuable information for the development of varicella prevention policies.

Toward tuberculosis elimination by understanding epidemiologic characteristics and risk factors in Hainan Province, China.

BACKGROUND: The disease burden of tuberculosis (TB) was heavy in Hainan Province, China, and the information on transmission patterns was limited with few studies. This atudy aims to further explore the epidemiological characteristics and influencing factors of TB in Hainan Province, and thereby contribute valuable scientific evidences for TB elimination in Hainan Province. METHODS: The TB notification data in Hainan Province from 2013 to 2022 were collected from the Chinese National Disease Control Information System Tuberculosis Surveillance System, along with socio-economic data. The spatial-temporal and population distributions were analyzed, and spatial autocorrelation analysis was conducted to explore TB notification rate clustering. In addition, the epidemiological characteristics of the cases among in-country migrants were described, and the delay pattern in seeking medical care was investigated. Finally, a geographically and temporally weighted regression (GTWR) model was adopted to analyze the relationship between TB notification rate and socio-economic indicators. The tailored control suggestions in different regions for TB elimination was provided by understanding epidemiological characteristics and risk factors obtained by GTWR. RESULTS: From 2013 to 2022, 64,042 cases of TB were notified in Hainan Province. The estimated annual percentage change of TB notification rate in Hainan Province from 2013 to 2020 was - 6.88% [95% confidence interval (CI): - 5.30%, - 3.69%], with higher rates in central and southern regions. The majority of patients were males (76.33%) and farmers (67.80%). Cases among in-country migrants primarily originated from Sichuan (369 cases), Heilongjiang (267 cases), Hunan (236 cases), Guangdong (174 cases), and Guangxi (139 cases), accounting for 53%. The majority (98.83%) of TB cases were notified through passive case finding approaches, with delay in seeking care. The GTWR analysis showed that gross domestic product per capita, the number of medical institutions and health personnel per 10,000 people were main factors affecting the high TB notification rates in some regions in Hainan Province. Different regional tailored measures such as more TB specialized hospitals were proposed based on the characteristics of each region. CONCLUSIONS: The notification rate of TB in Hainan Province has been declining overall but still remained high in central and southern regions. Particular attention should be paid to the prevalence of TB among males, farmers, and out-of-province migrant populations. The notification rate was also influenced by economic development and medical conditions, indicating the need of more TB specialized hospitals, active surveillance and other tailored prevention and control measures to promote the progress of TB elimination in Hainan Province.

Associations Between Air Temperature and Daily Varicella Cases - Jinan City, Shandong Province, China, 2019-2021.

What is already known about this topic?: The impact of air temperature on varicella has been studied, but there is limited research exploring its effect on varicella by gender and age group. What is added by this report?: We conducted a time series analysis to examine the differential effects of air temperature on varicella infection across different demographic groups. Our findings indicate that lower temperatures have a more pronounced influence on varicella incidence among males and children compared to females and adults. What are the implications for public health practice?: These findings can assist in identifying populations that are vulnerable to temperature-related varicella and in guiding the implementation of effective measures for varicella control.

Clickable X-ray Nanoprobes for Nanoscopic Bioimaging of Cellular Structures.

Synchrotron-based X-ray microscopy (XRM) has garnered widespread attention from researchers due to its high spatial resolution and excellent energy (element) resolution. Existing molecular probes suitable for XRM include immune probes and genetic labeling probes, enabling the precise imaging of various biological targets within cells. However, immune labeling techniques are prone to cross-interference between antigens and antibodies. Genetic labeling technologies have limited systems that allow express markers independently, and moreover, genetically encoded labels based on catalytic polymerization lack a fixed morphology. When applied to cell imaging, this can result in reduced localization accuracy due to the diffusion of labels within the cells. Therefore, both techniques face challenges in simultaneously labeling multiple biotargets within cells and achieving high-precision imaging. In this work, we applied the click reaction and developed a third category of imaging probes suitable for XRM, termed clickable X-ray nanoprobes (Click-XRN). Click-XRN consists of two components: an X-ray-sensitive multicolor imaging module and a particle-size-controllable morphology module. Efficient identification of intra- and extracellular biotargets is achieved through click reactions between the probe and biomolecules. Click-XRN possesses a controllable particle size, and its loading of various metal ions provides distinctive signals for imaging under XRM. Based on this, we optimized the imaging energy of Click-XRN with different particle sizes, enabling single-color and two-color imaging of the cell membrane, cell nucleus, and mitochondria with nanoscale spatial nanometers. Our work provides a potent molecular tool for investigating cellular activities through XRM.

Identification of biomarkers and prediction of upstream miRNAs in diabetic nephropathy.

Objective: To explore biomarkers of diabetic nephropathy (DN) and predict upstream miRNAs. Methods: The data sets GSE142025 and GSE96804 were obtained from Gene Expression Omnibus database. Subsequently, common differentially expressed genes (DEGs) of renal tissue in DN and control group were identified and protein-protein interaction network (PPI) was constructed. Hub genes were screened from in DEGs and made an investigation on functional enrichment and pathway research. Finally, the target gene was selected for further study. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of target gene and predicted its upstream miRNAs. Results: 130 common DEGs were obtained through analysis, and 10 Hub genes were further identified. The function of Hub genes was mainly related to extracellular matrix (ECM), collagen fibrous tissue, transforming growth factor (TGF) -ß, advanced glycosylation end product (AGE) -receptor (RAGE) and so on. Research showed that the expression level of Hub genes in DN group was significantly higher than that in control group. (all P<0.05). The target gene matrix metalloproteinase 2 (MMP2) was selected for further study, and it was found to be related to the fibrosis process and the genes regulating fibrosis. Meanwhile, ROC curve analysis showed that MMP2 had a good predictive value for DN. miRNA prediction suggested that miR-106b-5p and miR-93-5p could regulate the expression of MMP2. Conclusion: MMP2 can be used as a biomarker for DN to participate in the pathogenesis of fibrosis, and miR-106b-5p and miR-93-5p may regulate the expression of MMP2 as upstream signals.

National and provincial burden of varicella disease and cost-effectiveness of childhood varicella vaccination in China from 2019 to 2049: a modelling analysis.

Background: In China, varicella is the third most frequently reported vaccine-preventable infectious disease after tuberculosis and influenza, and imposes a heavy burden on families and society. To inform future immunization policy, we investigated disease burden of varicella in China and explored cost-effectiveness of different varicella vaccination strategies at national and provincial levels. Methods: A dynamic transmission model was developed to assess disease burden of varicella and the impact of varicella vaccination in China. A cost-effectiveness analysis of three alternative vaccination strategies in China's National Immunization Program (NIP) compared with no vaccination was conducted. Scenario analyses and sensitivity analyses were performed to check the robustness of the results. Findings: It was estimated that 3.35 million new varicella cases occurred in 2019, more than three times of 982 thousand cases officially reported from National Notifiable Infectious Disease Surveillance System (NNIDSS). The under-reported rate was approximately 71%. The economic analysis revealed that from the societal perspective, the incremental cost-effectiveness ratio (ICER) for one dose of varicella vaccination in NIP was US$ 2357 per QALY at the national level and it was cost-effective in 22 of 31 provinces. The ICER for one dose varicella vaccination plus a mass catch-up for unvaccinated children aged 2-11 years old would be US$ -5260 per QALY, cost-saving at the national level. The one dose plus mass catch-up NIP strategy was also cost-saving in 24 of the 31 provinces. Interpretation: Varicella incident cases were substantially under-reported in China. Varicella vaccination in the NIP could significantly contribute to reducing the burden of varicella disease. From the societal perspective, including varicella vaccination into China's NIP was highly cost-effective at the national level and in most provinces. Funding: Bill & Melinda Gates Foundation.

The Spectrum and Age-Sex Patterns Among Outpatients with Allergic Diseases - Yichang City, Hubei Province, China, 2018-2021.

What is already known about this topic?: Allergic diseases have affected an estimated 40% of the population in China. However, our understanding of the full spectrum of these diseases remains insufficient. What is added by this report?: Between 2018 and 2021, Yichang City documented 625,929 outpatient visits mainly related to skin and mucous membrane allergies (77.90%) and allergic respiratory conditions (19.64%). In 2021, the occurrence of outpatient visits for conditions such as allergic rhinitis, acute atopic conjunctivitis, and atopic dermatitis increased. The demographic analysis revealed that male patients comprised the majority of the under 18 age bracket (56.05%), while female patients were predominantly represented in the 18 to 65 age bracket (61.79%). What are the implications for public health practice?: This constitutes the first analysis of the spectrum of allergic diseases, utilizing regional outpatient data, which has substantial implications for understanding the disease burden.

An Autoregressive Integrated Moving Average Model for Predicting Varicella Outbreaks - China, 2019.

Introduction: Varicella, a prevalent respiratory infection among children, has become an escalating public health issue in China. The potential to considerably mitigate and control these outbreaks lies in surveillance-based early warning systems. This research employed an autoregressive integrated moving average (ARIMA) model with the objective of predicting future varicella outbreaks in the country. Methods: An ARIMA model was developed and fine-tuned using historical data on the monthly instances of varicella outbreaks reported in China from 2005 to 2018. To determine statistically significant models, parameter and Ljung-Box tests were employed. The coefficients of determination (R2) and the normalized Bayesian Information Criterion (BIC) were compared to selecting an optimal model. This chosen model was subsequently utilized to forecast varicella outbreak cases for the year 2019. Results: Four models passed parameter (all P<0.05) and Ljung-Box tests (all P>0.05). ARIMA (1, 1, 1)×(0, 1, 1)12 was determined to be the optimal model based on its coefficient of determination R2 (0.271) and standardized BIC (14.970). Fitted values made by the ARIMA (1, 1, 1)×(0, 1, 1)12 model closely followed the values observed in 2019, the average relative error between the actual value and the predicted value is 15.2%. Conclusion: The ARIMA model can be employed to predict impending trends in varicella outbreaks. This serves to offer a scientific benchmark for strategies concerning varicella prevention and control.

Epidemiological Characteristics of Varicella Outbreaks - China, 2006-2022.

Introduction: Varicella outbreaks significantly disrupt schools and other child-centered institutions. This study aimed to identify patterns and epidemiological features of varicella outbreaks in China from 2006 to 2022. Methods: Data were extracted from outbreak reports submitted to the Public Health Emergency Reporting Management Information System within the specified timeframe. Analytical methods included Spearman correlation tests and the Mann-Kendall trend tests, conducted using R software to analyze and summarize reported data. Additionally, statistical analyses of trends and epidemiological characteristics were performed using SPSS software. Results: Between 2006 and 2022, a total of 11,990 varicella outbreaks were reported in China, resulting in 354,082 cases. The attack rates showed a decreasing trend over the years (Z=-4.49, P<0.05). These outbreaks occurred in two peaks annually. The eastern region accounted for the highest number of outbreaks (31.53%), followed by the southwestern (24.22%) and southern (17.93%) regions. Varicella outbreaks were most common in elementary schools. Most of the outbreaks (60.43%) were classified as Grade IV (general) severity, with 86.41% of the outbreaks having 10-49 cases. The median and inter-quartile ranges (IQR) of the duration of outbreaks, response time, and case counts were 21 (10, 39) days, 4 (0, 12) days, and 23 (16, 35) cases, respectively. These variables showed a positive correlation (P<0.001). Conclusions: Varicella outbreaks exhibited fluctuating trends, initially decreasing until 2012, followed by an increase, reaching the highest peak in 2018-2019. Continual monitoring of varicella epidemiology is necessary to assess the burden of the disease and formulate evidence-based strategies and policies for its prevention and control.

Impacts of COVID-19 Prevention and Control Measures on Asthma-Related Hospital and Outpatient Visits in Yichang, China.

This article investigates the impact of COVID-19 lockdown and regular epidemic prevention and control after lifting lockdown on asthma-related hospital and outpatient visits in Yichang. Data on the general outpatient department (GOPD), emergency department (ED) and intensive care unit (ICU) visits for asthma from 15 November 2019 to 21 May 2020 and the corresponding from 2018 to 2019 were collected from eight tertiary hospitals in municipal districts. The controlled interrupted time series (CITS) analysis was used to investigate the level and long-term trend changes of weekly asthma visits during lockdown and regular epidemic prevention and control, and stratified by type of visits and age. A total of 9347 asthma-related hospital and outpatient visits were analyzed. The CITS showed that after the implementation of lockdown, the weekly visits of asthma patients immediately decreased by 127.32 (p = 0.002), and the level of GOPD and ED/ICU visits immediately decreased significantly. After implementation of regular prevention, the level and trend of overall weekly visits changed insignificantly compared with the lockdown period. The weekly visits of GOPD adults immediately increased by 51.46 (p < 0.001), and the trend of ED/ICU adults decreased by 5.06 (p = 0.003) visits per week compared with lockdown period. The COVID-19 lockdown in Yichang was related to the decrease in hospital and outpatient visits for asthma. After the implementation of subsequent regular prevention and control measure, only the GOPD visits of adults increased compared with lockdown period.

Identifying the Optimal Age for Herpes Zoster Vaccination - Yichang City, Hubei Province, China, 2017-2019.

What is already known about this topic?: Herpes zoster (shingles) is a common skin condition in older adults, which usually presents as a painful rash with blisters. Vaccination is the most effective method to prevent shingles. However, there is not sufficient population-based epidemiological data in China to optimize the timing of zoster vaccination. What is added by this report?: Clustering analyses of population-wide epidemiological data from the Healthcare Big Data Platform in Yichang, China showed that the average annual zoster incidence is the highest among people 55 years or older, at 10 cases per thousand persons per year, making this age group the optimal target population for vaccination. Incidence was lower but increased with age among younger adults, 28-54 years old. What are the implications for public health practice?: With limited vaccination resources, zoster vaccinations should be targeted at adults 55 years or older who are at the greatest risk for shingles. Research should be conducted to understand the risk of shingles among young and middle-aged adults and identify triggers of shingles: potentially leading to preventive measures.

Transmission of pandemic influenza A (H1N1) virus in a train in China.

BACKGROUND: Pandemic influenza A (H1N1) virus emerged in North America in April 2009 and spread globally. We describe the epidemiology and public health response to the first known outbreak of 2009 H1N1 in a train, which occurred in June 2009 in China. METHODS: After 2 provinces provided initial reports of 2009 H1N1 infection in 2 persons who had travelled on the same train, we conducted a retrospective epidemiologic investigation to collect information from the passengers, crew members, contacts, and health care providers. We explored the source of infection and possible routes of transmission in the train. All cases were confirmed by real-time reverse transcription polymerase chain reaction testing. RESULTS: Train #1223 traveled 40 hours, made 28 stops in 4 Chinese provinces, and boarded 2,555 passengers, who logged a total of 59,144 person-hours of travel time. Nineteen confirmed 2009 H1N1 cases were identified. Of these, 13 were infected and developed symptoms on the train and 6 occurred among contacts who developed illness during medical monitoring. In addition, 3 asymptomatic cases were identified based on RT-PCR testing of respiratory swabs from contacts. The attack rate among contacts of confirmed cases in the same car was higher than that among contacts in other cars (3.15% vs. 0%, P < 0.001). Attack rates increased with exposure time. CONCLUSIONS: Close contact and long exposure may have contributed to the transmission of 2009 H1N1 virus in the train. Trains may have played an important role in the 2009 influenza pandemic.

Different Percentile Regression of Blood Glucose Among Adolescents Aged 12-20 - United States, 1999-2018.

WHAT IS ALREADY KNOWN ON THIS TOPIC?: The incidence of diabetes is on the rise in the world, and it is increasingly affecting young people. The American Diabetes Association (ADA) has published the 2020 Diabetes Medical Standard, but there is no blood glucose standard for teenagers by age and sex. WHAT IS ADDED BY THIS REPORT?: In this study, quantile regression was used to analyze the data of National Health and Nutrition Examination Survey (NHANES) and found that blood glucose varied significantly based on demographics. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: This study provides reference for formulating the normal ranges of adolescent blood glucose and helping to screen out high-risk groups at an early stage for key interventions. The quantile regression method can give a set of curves, which could better describe the situation.

COVID-19 Super Spreading Event Amongst Elderly Individuals - Jilin Province, China, January 2021.

SUMMARY: What is already known on this topic? Clusters of COVID-19 cases often happened in small settings (e.g., families, offices, school, or workplaces) that facilitate person-to-person virus transmission, especially from a common exposure. What is added by this report? On January 10 and 11, 2021, an individual gave three product promotional lectures in Tonghua City, Jilin Province, that ultimately led to a 74-case cluster of COVID-19. Our investigation determined the outbreak to be an import-related COVID-19 superspreading cluster event in which elderly, retired people were exposed to the infected individual during his promotional lectures, which were delivered in a confined space and lasted several hours. What are the implications for public health practice? Routine activities, such as attending a lecture in a classroom, can provide an environment conducive to COVID-19 superspreading events because respiratory viruses can spread easily and widely. We suggest local government to strengthen infection control management, reduce unnecessary indoor large gathering activities, and promote wearing of masks, especially during wintertime in the north of China. Health education for elderly people should promote use of effective personal protection and emphasize the importance of wearing masks.