Impact of herpes zoster and post-herpetic neuralgia on health-related quality of life in Miyun District of Beijing, China: An EQ-5D survey.

Background: Herpes zoster (HZ) and post-herpetic neuralgia (PHN) cause considerable morbidity, especially in elderly adults, but the burden is under-recognized in mainland China. Methods: We conducted a case registry and follow-up study of HZ in Miyun District, Beijing from January 1, 2017 through December 31, 2018. Registered HZ cases were followed-up for pain to 365 days. The first 50 patients with HZ in each age group (≤14, 15-29, 30-39, 40-49, 50-59, 60- 69, 70-79, ≥80 years) and all those with PHN completed the EuroQoL five dimensions questionnaire (EQ-5D) to evaluate health-related quality of life (HRQoL) in patients with HZ and PHN. Ratings using the EQ-5D dimensions, visual analogue scale (VAS), health utility score (HUS) and quality-adjusted life years (QALYs) lost were compared among age groups. Results: In total, 2008 patients with HZ were followed for a median 22 days (interquartile range[IQR] = 20-90), with an estimated incidence of 4.39 per 1000 person-years. We identified 122 (6.08 %) PHN cases. The median age of patients with PHN (65 years, IQR = 55-71) was older than that of patients with HZ (54 years, IQR = 43-64) (P < 0.001). The median duration of pain was 170 days (IQR = 144-355.5) for PHN and 15 days (IQR = 9-25) for HZ. All 95 patients with PHN and 319 sampled patients with HZ completed the EQ-5D survey. The median QALY loss of HZ increased from 0.004 (IQR = 0.001-0.02) in patients 50-59 years old to 0.02 (IQR = 0.01-0.06) in those ≥ 80 years old (P < 0.01). After weighting for age, the mean QALY loss per HZ case was estimated at 0.02 (standard deviation [SD] 0.04). The mean QALY loss per PHN case was 0.13 years (SD 0.12). Conclusions: HZ and PHN caused a substantial burden, especially among adults aged ≥ 50 years in Miyun District, Beijing, China. Vaccination should be considered to alleviate the burden of this painful disease.

Associated Factors and Immune Response to the Hepatitis B Vaccine with a Standard Schedule: A Prospective Study of People with HIV in China.

Hepatitis B (HB) vaccination is recommended for people with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). We aimed to assess the immune response to the HB vaccine and associated factors using the standard vaccination schedule among people with HIV (PWH) in China. A prospective study was carried out from 2016 to 2020 in Beijing, China. PWH were given three 20 µg doses of recombinant HB vaccine at 0, 1, and 6 months. Blood samples were taken within 4-6 weeks after each dose to evaluate the anti-HBs levels. A total of 312 participants completed vaccination and serologic testing. The seroconversion (anti-HBs ≥ 10 IU/L) rates following the first, second, and third doses of the vaccine were 35.6% (95% CI: 30.3-40.9%), 55.1% (95% CI: 49.6-60.7%), and 86.5% (95% CI: 82.8-90.3%), respectively, and the geometric means of the anti-HBs titers were 0.8 IU/L (95% CI: 0.5-1.6 IU/L), 15.7 IU/L (95% CI: 9.4-26.3 IU/L), and 241.0 IU/L (95% CI: 170.3-341.1 IU/L), respectively. In multivariate analysis, after three doses of vaccination, age, CD4 cell count, and HIV-RNA viral load were significantly associated with strong, moderate, and weak response, respectively. These findings confirm that these personal health conditions are related to the HB response. HB vaccination in PWH using the standard schedule was still highly effective in the context of early treatment initiation, especially among participants aged 30 years and younger.

Immune Persistence against SARS-CoV-2 after Primary and Booster Immunization in Humans: A Large-Scale Prospective Cohort Study.

Amid the ongoing global COVID-19 pandemic, limited literature exists on immune persistence after primary immunization and the immunogenic features of booster vaccines administered at different time intervals. Therefore, this study aimed to determine the immune attenuation of neutralizing antibodies against the SARS-CoV-2 wild-type strain, and Delta and Omicron variants 12 months after the primary administration of the COVID-19 inactivated vaccine and evaluate the immune response after a booster administration at different time intervals. A total of 514 individuals were followed up after primary immunization and were vaccinated with a booster. Neutralizing antibodies against the wild-type strain and Delta and Omicron variant spike proteins were measured using pseudovirus neutralization assays. The geometric mean titers (GMTs) after the primary and booster immunizations were 12.09 and 61.48 for the wild-type strain, 11.67 and 40.33 for the Delta variant, and 8.51 and 29.31 for the Omicron variant, respectively. The GMTs against the wild-type strain declined gradually during the 12 months after the primary immunization, and were lower against the two variants. After implementing a booster immunization with a 6 month interval, the GMTs against the wild-type strain were higher than those obtained beyond the 7 month interval; however, the GMTs against the two variants were not statistically different across 3-12 month intervals. Overall, SARS-CoV-2 variants showed remarkable declines in immune persistence, especially against the Omicron variant. The booster administration interval could be shortened to 3 months in endemic areas of the Omicron variant, whereas an appropriate prolonging of the booster administration interval did not affect the booster immunization effect.

Norovirus outbreaks in China, 2000-2018: A systematic review.

To understand epidemiological characteristics of norovirus outbreaks in China from 2000 to 2018 the literature on norovirus outbreaks was identified by searching WANFANG, CNKI, PubMed, and Web of Science databases before 31 December 2018. Statistical analyses were performed using Statistical Product Service Solutions software. RStudio1.4.1717 and ArcGIS trial version were used for plotting bar graphs and maps. A total of 419 norovirus outbreaks were reported in the 394 included articles, which occurred between June 2000 and October 2018, showing an overall increasing trend. The majority of outbreaks occurred in schools (52.28%, 218/417) and kindergartens (55/417, 13.19%). Person-to-person transmission (41.64%, 137/329) was most common, followed by food-borne transmission (75/329, 22.80%) and water-borne transmission (72/329, 21.88%). GII was the most predominant norovirus genogroup, with GII.4, GII.17 and GII.2 being the dominant genotypes in 2007-2013, 2014-2015, 2016-2017, respectively. Increased outbreaks were associated with the prevalence of new variants. Most norovirus outbreaks were reported in the southeast of the country. The number of norovirus outbreaks was positively associated with the per capita gross domestic product and the year-end resident population. Norovirus outbreaks have become an important public health problem in China. It is necessary to establish surveillance in hospitals and nursing homes. Genotyping of noroviruses is important for monitoring the circulating strains and improving the vaccine design, so it should be carried out in more regions.

[Survey on infection source of a cold-chain product associated COVID-19 epidemic caused by 2019-nCoV Delta variant in Beijing].

Objective: To investigate the source and the transmission chain of a cold-chain product associated COVID-19 epidemic caused by 2019-nCoV Delta variant in Beijing. Methods: Epidemiological investigation were used to verify the exposure points of the cases. Close contacts were traced from the exposure points, and human and environmental samples were collected for nucleic acid tests. Positive samples were analyzed by gene sequencing. Results: A total of 112 cases of COVID-19 were reported in the epidemic from January 18 to February 6, 2022 in Beijing. Except for 1 case was uncertain, there were epidemiological links among 111 cases. The source of infection was the packages of imported cold-chain products from Southeast Asia, which were harvested and stored in a local cold-storage in January 2021, and packaged and sent to the cold-storage A in A district in June 2021, and then sold in batches in cold-storage B in B district from January 2022. The first case was infected in the handling of positive frozen products, and then 77 cases occurred due to working, eating and living together with the index case in the cold-storage B, cold-storage C and restaurant D. Besides the cold-storage B, C and the restaurant D, there were 16 sub-transmission chains, resulting in additional 35 cases. Conclusion: The epidemic indicated that the risk of 2019-nCoV infection from imported cold-chain products contaminated by package and highlighted the importance to strengthen the management of cold-chain industry in future.

[Survey of possible aerosol transmission of a COVID-19 epidemic caused by 2019-nCoV Delta variant].

Objective: To investigate the epidemiological characteristics and the transmission chain of a family clustering of COVID-19 cases caused by severe acute respiratory 2019-nCoV Delta variant in Changping district of Beijing. Methods: Epidemiological investigation was conducted and big data were used to reveal the exposure history of the cases. Close contacts were screened according to the investigation results, and human and environmental samples were collected for nucleic acid tests. Positive samples were analyzed by gene sequencing. Results: On November 1, 2021, a total of 5 COVID-19 cases caused by 2019-nCoV Delta variant were reported in a family detected through active screening. The infection source was a person in the same designated isolation hotel where the first case of the family cluster was isolated from 22 to 27, October. The first case was possibly infected through aerosol particles in the ventilation duct system of the isolation hotel. After the isolation discharge on October 27, and the first case caused secondary infections of four family members while living together from October 27 to November 1, 2021. Conclusion: 2019-nCoV Delta variant is prone to cause family cluster, and close attention needs to be paid to virus transmission through ventilation duct system in isolation hotels.

Hepatitis B Vaccination Coverage Rates and Associated Factors: A Community-Based, Cross-Sectional Study Conducted in Beijing, 2019-2020.

Hepatitis B vaccination coverage rates are low throughout most populations in China. Factors influencing low coverage rates, including population-specific hepatitis B vaccination barriers, may inform policies that promote vaccination. A cross-sectional survey of residents from 43 communities assessed their vaccination status and identified associated factors via uni- and multivariable logistic regression and subgroup analyses. In total, 11,280 of 36,007 respondents received a hepatitis B vaccine, indicating a 31.33% coverage rate. Multivariable logistic regression revealed non-Beijing (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.76-0.85) and residents who self-rated their health as very healthy (OR = 0.82; 95% CI: 0.68-0.99) were unlikely to be vaccinated. Farmers (OR = 1.68; 95% CI: 1.51-1.86), commerce and service workers (OR = 1.82; 95% CI, 1.63-2.04), government employees (OR = 1.56; 95% CI: 1.38-1.77), professionals and technicians (OR = 1.85; 95% CI: 1.63-2.09), and students (OR = 1.69; 95% CI: 1.10-2.59) had increased hepatitis B vaccination rates. The multivariable assessment revealed hepatitis B vaccination coverage rates are associated with confirmed or suspected family cases, vaccination unwillingness or uncertainty, and unawareness of its prevention of the hepatitis B virus. Low hepatitis B vaccination coverage rates among Beijing subpopulations highlight the need for improved strategies, including those that target specific populations.

Effect of Earlier Vaccination and a Two-Dose Varicella Vaccine Schedule on Varicella Incidence - Beijing Municipality, 2007-2018.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The World Health Organization (WHO) varicella vaccines position paper states that countries where varicella is an important public health burden could consider introducing varicella vaccine (VarV) in the routine childhood immunization program (1). VarV has been available for many years in China but is not included in most routine immunization programs in China. As a result, substantial heterogeneity in vaccination coverage exists across regions. WHAT IS ADDED BY THIS REPORT?: In Beijing, adding a second dose of VarV for children and increasing coverage reduced the incidence of varicella. Lowering the age of the first dose of VarV to 12 months could further reduce varicella, especially among toddlers. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Governments should use economic analysis to consider inclusion of VarV into the routine children immunization program as a free vaccine and adopting a 2-dose schedule that starts at 12 months of age.

Willingness of the General Public to Receive the COVID-19 Vaccine During a Second-Level Alert - Beijing Municipality, China, May 2020.

WHAT IS ALREADY KNOWN ON THIS TOPIC?: Preclinical trials showed the effectiveness of domestic inactivated vaccine candidates for coronavirus disease 2019 (COVID-19). However, it is necessary to evaluate the willingness of the public to receive future domestic vaccines and to understand factors associated with willingness at the early stages of vaccine development. WHAT IS ADDED BY THIS REPORT?: Through May 25, 2020, 70.48% were willing to receive future domestic COVID-19 vaccines. Confidence in vaccines had the largest impact on public willingness, while age and presence of underlying chronic disease did not significantly increase public willingness. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: It is necessary to increase awareness of COVID-19 vaccines among people with high risk of severe infection and to build public confidence in vaccines. Releasing accurate, timely, and reliable data to the public can help increase willingness to get vaccinated.

Perception of the COVID-19 Epidemic and Acceptance of Vaccination Among Healthcare Workers Prior to Vaccine Licensure - Beijing Municipality, China, May-July 2020.

What is already known about this topic? The coronavirus disease 2019 (COVID-19) vaccine development has been progressing, but acceptance of the new vaccines by healthcare workers (HCWs) was not well known prior to approval of COVID-19 vaccines in China. What is added by this report? This study found that before vaccine approval, Beijing HCWs expressed moderate willingness to get vaccinated. Factors positively influencing willingness included free vaccination and belief that the vaccine had been fully evaluated. A negatively influencing factor was presence of an underlying disease. Trust in vaccines, in general, was positively associated with willingness to get new vaccines. What are the implications for public health practice? COVID-19 vaccines should be provided at no cost to HCWs. Effective measures should be taken to enhance the acceptance of COVID-19 vaccination among HCWs in China.

Evolutionary analysis and lineage designation of SARS-CoV-2 genomes.

The pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of coronavirus disease 2019 (COVID-19), has caused immense global disruption. With the rapid accumulation of SARS-CoV-2 genome sequences, however, thousands of genomic variants of SARS-CoV-2 are now publicly available. To improve the tracing of the viral genomes' evolution during the development of the pandemic, we analyzed single nucleotide variants (SNVs) in 121,618 high-quality SARS-CoV-2 genomes. We divided these viral genomes into two major lineages (L and S) based on variants at sites 8782 and 28144, and further divided the L lineage into two major sublineages (L1 and L2) using SNVs at sites 3037, 14408, and 23403. Subsequently, we categorized them into 130 sublineages (37 in S, 35 in L1, and 58 in L2) based on marker SNVs at 201 additional genomic sites. This lineage/sublineage designation system has a hierarchical structure and reflects the relatedness among the subclades of the major lineages. We also provide a companion website (www.covid19evolution.net) that allows users to visualize sublineage information and upload their own SARS-CoV-2 genomes for sublineage classification. Finally, we discussed the possible roles of compensatory mutations and natural selection during SARS-CoV-2's evolution. These efforts will improve our understanding of the temporal and spatial dynamics of SARS-CoV-2's genome evolution.

Impact of a 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, 2011-2017.

BACKGROUND: One-dose voluntary varicella vaccination for children was introduced in Beijing since 1998. In Oct 2012, a second dose varicella vaccine (VarV) was recommended to further decrease varicella disease and the outbreaks. We describe the impact of the 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, China. METHODS: Varicella incidence rates and outbreak characteristics in 2011-2017 was examined using surveillance data. Varicella vaccination coverage among children born in 2007-2012 was estimated through Beijing children immunization registry system. Vaccine effectiveness (VE) for VarV2 was estimated by screening method. RESULTS: Overall varicella incidence decreased by 37.8% from 103.2 per 100,000 population in 2011 to 64.2 per 100,000 population in 2017. Incidence declines in children aged <15 years with most significantly decrease by 82.3% in children aged 5-9 years, while no significant change happened in adolescent and adults. A total of 251 outbreaks with 3239 outbreak-related cases were reported in 2011-2017, the number of outbreaks decreased significantly by 50.7% from 69 in 2011 to 34 in 2017. The VarV1 coverage ranged from 85.4% to 92.6% among children 4 year of age and the VarV2 coverage ranged from 40.1% to 72.9% among children 6 year of age in the 2007-2012 birth cohort. Overall VE estimates against all varicella disease was 94.4% (95% CI: 89.9-98.9%) for VarV2. CONCLUSIONS: Moderate VarV2 coverage has been achieved in Beijing resulting in remarkable declining of the incidence in children. Varicella outbreaks has not been eliminated suggested that measures such as including a 2-dose varicella vaccination in routine immunization program should be taken in the future.

Establishment and development of national community-based collaborative innovation demonstration areas to achieve the control target of hepatitis B in China.

BACKGROUND: The major infectious diseases of hepatitis B has constituted an acute public health challenge in China. An effective and affordable HBV control model is urgently needed. A national project of Community-based Collaborative Innovation HBV (CCI-HBV) demonstration areas has optimized the existing community healthcare resources and obtained initial results in HBV control. METHODS: Based on the existing community healthcare network, CCI-HBV project combined the community health management and health contract signing service for long-staying residents in hepatitis B screening. Moreover, HBV field research strategy was popularized in CCI-HBV areas. After screening, patients with seropositive results were enrolled in corresponding cohorts and received treatment at an early stage. And the uninfected people received medical supports including health education through new media, behavior intervention and HBV vaccinations. In this process, a cloud-based National Information Platform (NIP) was established to collect and store residents' epidemiological data. In addition, a special quality control team was set up for CCI project. RESULTS: After two rounds of screening, HBsAg positive rate dropped from 5.05% (with 5,173,003 people screened) to 4.57% (with 3,819,675 people screened), while the rate of new HBV infections was 0.28 per 100 person-years in the fixed cohorts of 2,584,322 people. The quality control team completed PPS sampling simultaneously and established the serum sample database with 2,800,000 serum samples for unified testing. CONCLUSIONS: CCI-HBV project has established a large-scale field research to conduct whole-population screening and intervention. We analyzed the HBsAg prevalence and new infection rate of HBV in the fixed population for the epidemic trend and intervention effect. The purpose of CCI-HBV project is to establish and evaluate a practical model of grid management and field strategy, to realize the new goal to control hepatitis B in China. To provide policymakers with a feasible model, our results are directly applicable. TRIAL REGISTRATION: The project was funded by the Major Projects of Science Research for the 11th and 12th five-year plans of China, entitled "The prevention and control of AIDS, viral hepatitis and other major infectious diseases", Grant Nos. 2009ZX10004901, 2011ZX10004901, 2013ZX10004904, 2014ZX10004007 and 2014ZX10004008.

Evaluation of the adequacy of measles laboratory diagnostic tests in the era of accelerating measles elimination in Beijing, China.

BACKGROUND: Measles-containing vaccine (MCV) was introduced in 1965 in Beijing and given to the children aged 8m-14y. In population-based surveillance system, real-time polymerase chain reaction (RT-PCR) and immunoglobulin M(IgM) serology tests have been conducted for each suspected case since 2013. We used the surveillance data to evaluate the adequacy of the tests for laboratory confirmation during 2014-2016. METHODS: Informations on IgM tests, RT-PCR, age, vaccination history for confirmed cases were from the surveillance system. Laboratory confirmed cases were defined as cases with positive IgM serology and/or positive RT-PCR. All tests were conducted in the laboratories accredited by Beijing CDC or Beijing CDC laboratory. RESULTS: Totally 4600 cases were confirmed. Sensitivities of IgM tests within 0-3 days post rash, IgM tests within 4-28 days post rash and RT-PCR within 0-3 days post rash were 56.53%, 82.06% and 94.39%, respectively. The combined sensitivity of IgM tests and RT-PCR decreased by the interval between rash onset and collection of virologic specimen. MCV immunization history lowered sensitivity of IgM tests and RT-PCR. Among the cases aged ≥ 15 years, around 95% had no written immunization records. The sensitivity of IgM tests within 0-3 days post rash was less than 60%. Around 60% had unknown immunization histories. Compared with unvaccinated cases based on written records, unvaccinated cases based on recollection had no significantly different sensitivity of laboratory tests. But unknown immunization history significantly lowered sensitivity of RT-PCR within 0-3 days post rash. CONCLUSIONS: Neither IgM tests nor RT-PCR reached 100% sensitive for confirmed cases. Virologic specimen should be collected as early as possible to achieve maxim sensitivity. Cases with unknown immunization history could not be treated as unvaccinated. Combination of the two tests and further laboratory assays were needed especially for vaccinated cases or cases aged ≥15 years.

Norovirus outbreaks in Beijing, China, from 2014 to 2017.

OBJECTIVES: Noroviruses are a leading cause of acute gastroenteritis (AGE) outbreaks worldwide. This study examined the epidemiology and genetic characteristics of norovirus outbreaks in Beijing, China. METHODS: Epidemiological data and fecal specimens were collected through the AGE outbreak surveillance system in Beijing. GI and GII genogroup noroviruses were detected and genotyped. The data were analyzed using descriptive statistics. RESULTS: Between September 2014 and August 2017, 762 AGE outbreaks were reported in Beijing, of which 661 (86.7%) were laboratory-confirmed as norovirus. Most norovirus outbreaks were reported during the spring (66.9%, 442/661), occurred in kindergartens and elementary schools (92.3%, 610/661), and were caused by GII genogroup noroviruses (95.6%; 632/661). The genotypes of the norovirus strains were determined in 468 outbreaks, and GII.P16-GII.2 and GII.P17-GII.17 strains were the most commonly identified. GII.P17-GII.17 and GII.P16-GII.2 strains predominated in 2014-2015 and 2016-2017 outbreaks, respectively. GII.P16-GII.2 noroviruses were responsible for a steep increase in AGE outbreaks in Beijing: 549 norovirus outbreaks were reported from 2016 to 2017, 9.2 times the number that occurred during the previous year. CONCLUSIONS: Norovirus causes a large disease burden in Beijing, and the prevalence of non-GII.4 noroviruses presents a new challenge for the development of vaccines.

Changing epidemiological characteristics of Hepatitis A and warning of Anti-HAV immunity in Beijing, China: a comparison of prevalence from 1990 to 2017.

Backgroud: Beijing was hyper-endemic for hepatitis A until the 1990s and has been vaccinating against hepatitis A since 1994. The objective is to study the epidemiology and changes of antibody level of hepatitis A from 1990 to 2017. METHODS: A multistage randomized cluster sampling serological cross-sectional study was conducted in individuals over one year old in 1992, 2006 and 2014 in Beijing. Venous blood samples were collected to test anti-HAV antibody. The incidence data of hepatitis A were obtained from National Notifiable Disease Reporting System (NNDRS) and CDC statistics in Beijing. The vaccination data of hepatitis A immunization were acquired from Beijing Immune Information System. RESULTS: From 1990 to 2017, the reported incidence rate of HAV in Beijing declined from 59.41/100,000 in 1990 to 0.80/100,000 in 2017. The average age of HAV infection was postponed from individuals under 20 years old to individuals over 20 years old. After hepatitis A vaccine was introduced to Beijing, the outbreak of hepatitis A decreased sharply. Adjusted anti-HAV positive rate in general population was 68.23%, 81.73% and 82.47% respectively in 1992, 2006 and 2014. Due to hepatitis A vaccination conducted in children, the anti-HAV positive rate in individuals under 20 years old increased from 1992 to 2014, while in individuals over 20, this rate was barely changed. The coverage rate in target population was higher than 99% after hepatitis A vaccine was integrated into Expanded Program on Immunization (EPI). CONCLUSION: Incidence rate of hepatitis A in Beijing has decreased dramatically from 1990 to 2017. Hepatitis A vaccine plays an important role in protecting individuals under 20 years old. A higher proportion of adults will be susceptible to hepatitis A virus due to the decay of antibodies as they grow up from childhood to adulthood, which may result in possible outbreak of hepatitis A.

A retrospective survey on herpes zoster disease burden and characteristics in Beijing, China.

Little data are available on the overall incidence and characteristics of herpes zoster (HZ) in China, thus a community-based retrospective survey was conducted during December 2012 to March 2013 to collect HZ incident data over the past year in selected districts of Beijing, China. A total of 237 incident HZ cases were identified from 118,220 residents and majority of HZ patients (219/237, 92.4%) sought healthcare. Annual HZ incident rates were 1.90/1000 after adjusted and higher among females (2.4/1000) than males (1.7/1000). HZ rates increased with age and with a sharply rise among those aged ≥50 years particular for female. 217 cases were available for interview with 193 (88.9%) primary, 24 (11.1%) recurrent and 10 (4.6%) postherpetic neuralgia (PHN) cases respectively. No difference was shown between the primary and recurrent HZ cases in sex (P = 0.42), age (P = 0.72), times of healthcare seeking (P = 0.45), number of dermatome (P = 0.72), pain degree (P = 0.54), and hospitalization (P = 1.0). According to the survey, it can be speculated that disease burden of HZ is serious and caused at least 2.77 million cases annually in China. The recurrent HZ cases has similar characteristics to primary HZ cases. High proportion of healthcare seeking reminds that HIS records would be a feasible source for HZ surveillance to evaluate the trends and changes in China.

Maternal folic acid supplementation and antibody persistence 5 years after hepatitis B vaccination among infants.

BACKGROUND: Maternal exposure to dietary factors during pregnancy may modulate the immunity of offspring by epigenetic programming. But the relationship between intrauterine environment and persistence of protective antibody after hepatitis B vaccination has not been reported. This study was to investigate the 5-year persistence of protective antibody response after primary hepatitis B vaccination, and its relationship with maternal folic acid supplementation. MATERIALS AND METHODS: A total of 1461 children who completed a 3-dose 10 µg recombinant hepatitis B vaccine at birth and did not infect hepatitis B virus were followed up. Logistic regression and mediation analysis was used to explore the relationship between 5-year persistence of protective antibody and maternal nutrition. RESULTS: Of 1403 children who did not revaccinated during the follow-up, 76.1% had protective hepatitis B surface antibody (anti-HBs) levels. Twenty percent of mothers did not take folate during pregnancy. Mediation analysis showed a total effect of folic acid supplementation on good persistence (odds ratio: 1.10, 95% CI: 1.03-1.17, p = 0.0010), a direct effect was 1.07 (95% CI: 1.01-1.13, p = 0.0128) and an indirect effect was 1.03 (95% CI: 1.00-1.06, p = 0.0672); the proportion of good persistence mediated by primary response was 30.3%. CONCLUSION: This study indicated a good protective anti-HBs persistence at year 5 after 10 µg recombination hepatitis B vaccination in infants. Maternal folic acid supplementation may improve the persistence of protective antibodies through other pathways. Multi-center cohort studies should be conducted to verify this conclusion.

Mumps disease in Beijing in the era of two-dose vaccination policy, 2005-2016.

BACKGROUND: Since the introduction of mumps-containing vaccines (MuCV) in 1995 in Beijing, two-dose MuCV vaccination policy has been used, with the 1st and 2nd doses given at 18 months and 6 years of age, respectively. METHODS: Mumps epidemiology during 2005-2016 was described using surveillance data. Vaccine effectiveness (VE) of MuCV against disease was estimated for cases born during 2002-2009 and reported in 2016. VE against complications was estimated for all cases. MuCV coverage was estimated for children born during 1999-2015 using data from Beijing Immunization Information System. RESULTS: Overall mumps incidence decreased from 30.38/100,000 persons in 2005 to 10.26/100,000 persons in 2016. Incidence declines in children aged <15 years. No significant incidence change occurred in adults aged ≥20 years. Incidence in persons aged 15-19 years increased by 132.73% in 2012 when compared with in 2005. Rates of meningitis/encephalitis, orchitis, and other complications among cases decreased during 2005-2016. The majority (97%) of outbreaks occurred in schools. Total number of outbreaks and average outbreak size decreased during 2005-2016. Among outbreak-related cases, 69.54%, 29.67% and 0.79% had received 0 dose, 1dose and 2 doses of MuCV, respectively. Coverage of the 1st MuCV dose at 2-5 years of age increased by 42.75% during 2005-2016. Coverage of the 2nd MuCV dose at 6-14 years of age increased by 12.87% during 2013-2016. Overall VE estimates of MuCV against mumps disease were 74.51% (95% CI: 65.57-81.34%) for 1 dose and 83.16% (95% CI: 78.60-86.31%) for 2 doses. Both VE estimates increased by birth cohorts. VE estimate against complications for 2-dose MuCV was higher than for 1 dose. CONCLUSIONS: Increasing MuCV coverage achieved declining mumps incidence and complication rate. Current epidemiology supported 2-dose MuCV vaccination policy. The incidence rise in persons aged 15-19 years in 2012 and waning immunity for the 2nd MuCV dose merited close follow-up.