Profiles and transplacental transfer of per- and polyfluoroalkyl substances in maternal and umbilical cord blood: A birth cohort study in Zhoushan, Zhejiang Province, China.

Per- and polyfluoroalkyl substances (PFAS) can pass through the placental barrier and pose health risks to fetuses. However, exposure and transplacental transfer patterns of emerging PFAS remain unclear. Here, 24 PFAS were measured in paired maternal whole blood (n = 228), umbilical cord whole blood (n = 119) and serum (n = 120). Orthogonal partial least-squares discriminant analysis (OPLS-DA) was used to differentiate PFAS between different matrices. The transplacental transfer (TPT) of PFAS was calculated using cord to maternal whole blood concentration ratios. PFOS and PFOA were still the dominant PFAS in maternal samples. The emerging PFAS had higher TPT than PFOS and PFOA. Moreover, PFAS with the same chain length but different functional groups and C-F bonds showed different TPT, such as PFOS and PFOSA (C8, median: 0.090 vs. 0.305, p < 0.05) and PFHxS and 4:2 FTS (C6, median: 0.220 vs. 1.190, p < 0.05). A significant sex difference in 4:2 FTS (median: boys 1.250, girls 1.010, p < 0.05) were found. Furthermore, we observed a significant U-shaped trend for the TPT of carboxylates with increasing carbon chain length. PFAS showed a compound-specific transfer through placental barrier and a compound-specific distribution between different matrices in this study.

SARS-CoV-2 viral shedding characteristics and potential evidence for the priority for faecal specimen testing in diagnosis.

This study aimed to identify the specimen type that has high positivity and its proper sampling time for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing to promote diagnostic efficiency. All SARS-CoV-2-infected patients with a laboratory-confirmed diagnosis in Zhoushan City were followed up for viral shedding in respiratory tract specimens and faecal samples. Positivity was analysed both qualitatively and quantitatively by proper statistical approaches with strong testing power. Viral shedding in respiratory tract and faecal specimens was prolonged to 45 and 40 days after the last exposure, respectively. The overall positive rate in respiratory tract specimens was low and relatively unstable, being higher in the early-to-mid stage than in the mid-to-late stage of the disease course. Compared with respiratory tract specimens, faecal samples had a higher viral load, higher overall positive rate, and more stable positivity in different disease courses and varied symptomatic status. Faecal specimens have the potential ability to surpass respiratory tract specimens in virus detection. Testing of faecal specimens in diagnosis, especially for identifying asymptomatic carriers, is recommended. Simultaneously, testing respiratory tract specimens at the early-to-mid stage is better than testing at the mid-to-late stage of the disease course. A relatively small sample size was noted, and statistical approaches were used to address it. Information was missing for both specimen types at different stages of the disease course due to censored data. Our research extends the observed viral shedding in both specimen types and highlights the importance of faecal specimen testing in SARS-CoV-2 diagnosis. Healthcare workers, patients, and the general public may all benefit from our study findings. Disposal of sewage from hospitals and residential areas should be performed cautiously because the virus sheds in faeces and can last for a long time.

Estimation of sarcopenia prevalence in individuals at different ages from Zheijang province in China.

In this study, we analyzed sarcopenia prevalence and the cut-off points for skeletal muscle mass index (SMI), gait speed, and handgrip strength in young (18-39 years), middle-aged (40-59 years), and elderly (>60 years) individuals (n=1685) from Zhejiang Province in China. The prevalence of sarcopenia among individuals above 65 years was 2.21%, 4.87%, 5.31%, 14.16%, and 16.37% according to five diagnostic criteria (AWGS2019, AWGS2014, EWGSOP1, EWGSOP2, and local standard). The mean SMI (Kg/m2) was 7.961±0.7966, 7.801±0.7276, and 7.544±0.7493, respectively, in young, middle-aged, and elderly males. The mean SMI in young, middle-aged, and elderly females was 6.1570±0.5658, 6.604±0.5658, and 6.248±0.7483, respectively. SMI correlated negatively with age (r=-0.2344, P<0.001), but was not associated with age in females (r=0.0573, P=0.1463). The cut-off point of SMI for sarcopenia was ≤6.3678 kg/m2 in males and ≤5.0254 kg/m2 in females. These findings shows that the prevalence of sarcopenia increased gradually with age and varied significantly based on the diagnostic criteria used for this analysis. The mean SMI of young women was lower than in middle-aged women, making them an unsuitable reference population for determining cut-off values for sarcopenia diagnosis.

Infantile phthalate metabolism and toxico/pharmacokinetic implications within the first year of life.

BACKGROUND: Infantile development of phthalate metabolism is crucial for risk assessment of endocrine disruption and has important toxico/pharmacokinetic implications. OBJECTIVES: To characterize temporal variability in urinary phthalate metabolites in infants and to examine their growth-dependent detoxification. METHODS: In this cohort study, urine samples (n = 876) from 155 healthy Chinese infants were collected serially at eight time points from birth to one year old. Free and total (i.e., free plus glucuronide conjugated) phthalate metabolites (PMEs) were measured by LC/MS/MS. Time variability in PMEs and PME metabolism capacity was characterized using intraclass correlation coefficients (ICCs) and linear mixed regression models. RESULTS: Concentrations of most PMEs changed significantly, with ICCs ranging from 0.213 to 0.318, and trends increased significantly over time (p < 0.001), while MEHP showed fair reproducibility (ICC = 0.480). Glucuronidation increased considerably (ICC ≤ 0.250; p < 0.001) for most PMEs but not for MMP or MEHP. Ester-chain ω-/ω-1-oxidation and α-/ß-oxidation patterns of MEHP steeply increased from 3 months to 8 months, where they peaked, resulting in a molar percentage of MEHP in ΣDEHP showing the inversion pattern. MEHP detoxification through oxidation of the hydrophobic ester-chain is apparently a priority for carboxyl glucuronidation in infants. CONCLUSIONS: Infant phthalate exposure is prevalent, but they cannot metabolize or eliminate these compounds as efficiently as adults, especially during the first 6 months of life. From an environmental biomonitoring view, age-dependent phthalate metabolism provides crucial implications for infantile ontogeny and health risk assessment within the first year of life.

Transmission of COVID-19 in the terminal stages of the incubation period: A familial cluster.

We report a familial cluster of 2019 novel coronavirus disease (COVID-19) to assess its potential transmission during the incubation period. The first patient in this familial cluster was identified during the presymptomatic period, as a close contact of a confirmed patient. Five family members had close contact with this first patient during his incubation period, with four of them confirmed positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the subsequent sampling tests.

Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China.

We report an asymptomatic child who was positive for a coronavirus by reverse transcription PCR in a stool specimen 17 days after the last virus exposure. The child was virus positive in stool specimens for at least an additional 9 days. Respiratory tract specimens were negative by reverse transcription PCR.

Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020.

We report a 2-family cluster of persons infected with severe acute respiratory syndrome coronavirus 2 in the city of Zhoushan, Zhejiang Province, China, during January 2020. The infections resulted from contact with an infected but potentially presymptomatic traveler from the city of Wuhan in Hubei Province.

Community-based comprehensive measures to prevent severe fever with thrombocytopenia syndrome, China.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease caused by the SFTS virus (SFTSV) of the family Bunyaviridae. Since the virus was first isolated in 2009, it has become widespread in China, with an increasing number of cases year on year. Although the disease has been researched extensively in past years, there are still no effective measures to suppress the epidemic situation. This article reports a pilot study of comprehensive measures, including health education and risk communication, weed removal, livestock management, and tick control, to prevent this emerging disease in an endemic region of China. The density of ticks decreased dramatically month by month after acaricides were sprayed in the areas surrounding recreational and agricultural settings. The number of SFTS cases and villages involved declined in the years after the integrated measures were applied. Comprehensive measures, especially community-based tick control, may be a promising means of preventing SFTS in endemic regions.

A Comparison of China's Risk Communication in Response to SARS and H7N9 Using Principles Drawn From International Practice.

BACKGROUND: China's emergency management of severe acute respiratory syndrome (SARS) was heavily criticized, whereas the H7N9 response was praised by the international community.AimsThe aims of this study were to examine and compare the strengths and weaknesses of risk communication conducted in response to SARS and H7N9 and their associated social impacts on affected communities in China. METHOD: A qualitative comparative case study approach was employed in the present study, using a set of 8 risk communication principles selected from international literature to suit the Chinese context for the comparative analysis of emergency responses of SARS and H7N9. RESULTS: The study found significant differences in the risk communication conducted in the 2 cases. The SARS outbreak fully exposed China's lack of experience in public health risk communication. By contrast, the Chinese government's risk communication strategies had improved significantly during the H7N9 outbreak.DiscussionTrust is the basis for communication. Maintaining an open and honest attitude and actively engaging stakeholders to address their risk information needs will serve to build trust and facilitate multi-sector collaborations in dealing with a public health crisis. CONCLUSIONS: From SARS to H7N9, risk communication practices in China greatly improved, which, in turn, lessened adverse social impacts and improved outcomes in emergency management of public health crises. (Disaster Med Public Health Preparedness. 2018;12:587-598).

Urinary sexual steroids associated with bisphenol A (BPA) exposure in the early infant stage: Preliminary results from a Daishan birth cohort.

BACKGROUND: Many surveys have shown that older children are ubiquitously exposed to bisphenol A (BPA), and many laboratory studies have shown that BPA exposure has adverse effects related to estrogenic disruption, whereas the evidence in infants has not yet been observed. METHODS: Women in early pregnancy were recruited by the Maternal and Child Health and Family Planning Service Center, Daishan, China, from March 2012 to December 2014. After delivery, urine samples were collected from the diapers of 59 infants (0 to 6months of age). Urinary BPA, estradiol (E2), testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and creatinine were analyzed. The partial correlation and multivariable linear regression were applied to assess the associations of BPA with E2, T, FSH, and LH for each of the development stages: at birth, 14days, 28days, 42days, 3months, and 6months. RESULTS: For both genders from birth to 6months, infants showed randomly changed urinary BPA but regularly changed hormones, i.e., the monotonic decreasing E2 and T, the "U" shaping E2/T and upside down "U" shaping FSH and LH with extreme values at approximately the 14-day stage, respectively. However, the creatinine-adjusted FSH for all stages and E2 from 6months were genders different. After adjustment for creatinine, gender, and infant body mass index, BPA was positively associated with E2 both in male (for 14-, 28-, and 42-day stages) and female (for 14-, 28-, 42-day, and 3-month stages) infants; positively associated with E2/T ratio in both male (for 14- and 28-day stages) and female (for 14-day stage) infants; and positively associated with T in female (for 3-month stage) infants. CONCLUSIONS: To the best of our knowledge, this is the first time that associations of BPA with E2, E2/T, and T in infant urine were observed. The results suggested that the infants first demonstrate a surge of steroids after leaving the maternal uterus's steroidogenic environment (i.e., mini-puberty) and may be affected by BPA; this pollution may disrupt the premature gonad function at some important developmental windows.

Seroprevalence of severe fever with thrombocytopenia syndrome virus in China: A systematic review and meta-analysis.

OBJECTIVE: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus-SFTSV. The seroprevalence of anti-SFTSV antibodies including immunoglobulin G (IgG) and immunoglobulin M (IgM), specific to SFTSV in the general population has been investigated in various epidemiological studies with inconsistent results. Here, we clarify this discrepancy and reach a more comprehensive result by mean of a meta-analysis. METHODS: All relevant articles were searched in the electronic databases (PubMed, Web of science, Embase, Chinese National Knowledge Infrastructure database, Chinese Wanfang database) up to November 2016. The pooled seroprevalence and 95% confidence intervals (95% CIs) were calculated by random- or fixed- model on the basis of heterogeneity. RESULTS: In total, 21 studies containing 23,848 blood samples from 7 provinces were included in this meta-analysis. The minimum and maximum reported seroprevalences of SFTSV among humans in China were 0.23% and 9.17%, respectively. The overall pooled seroprevalence of SFTSV antibodies was 4.3% (95%CI: 3.2%-5.5%). The pooled prevalence was 5.9% (95%CI: 4.7%-7.0%) in Zhejiang province, 4.9% (95%CI: 4.1-5.8%) in Anhui province, 3.9% (95%CI: 1.3%-6.4%) in Shandong province, and 0.7% (95%CI: 0.2%-1.1%) in Jiangsu province. Stratified by occupation, the pooled prevalence of farmer was 6.1% (95%CI: 3.4%-8.9%) and others (mainly are students) was 3.3% (95%CI: 2.4%-4.2%). Additionally, seroprevalence of SFTSV in people who lived in the same village with the patient were higher than that of people who lived in a different village. Seropositive rates in sampling years after 2012 were higher than that before 2012. The prevalence of SFTSV did not differ by age or gender. Sensitive analysis by omitting one study at a time indicated the results of the pooled seroprevalence were robust. CONCLUSIONS: Seroprevalence of SFTSV among healthy population in central and eastern China is high. Surveillance efforts on mild or asymptomatic infections among endemic persons are needed.

Factors associated with Severe Fever with Thrombocytopenia Syndrome infection and fatal outcome.

Severe fever with thrombocytopenia syndrome (SFTS) is emerging in China and the incidence increased year by year. In this study, we conducted case control study to explore factors associated with SFTS virus (SFTSV) infection and fatal outcome. In the study of factors associated with SFTSV infection, a total of 216 individuals participated the study, including 72 cases and 144 matched controls. There were significant differences in proportion of history of tick bite and breeding domestic animals between cases and controls. Of note, individuals who were unclear whether they had been bitten by ticks had the highest risk of SFTSV infection and odds ratio (OR) was 10.222. In the study of factors associated with SFTS fatal outcome, a total of 129 cases participated the study including 16 deaths and 113 survivors. Significant differences were observed in body mass index (BMI), intervals from illness onset to confirmation, and proportion of gingival hemorrhage between deaths and survivors, whose ORs of these factors were 3.903, 1.996, and 3.826, respectively. Our results suggest that all patients with fever, thrombocytopenia and leukocytopenia in SFTS endemic areas should be suspected of SFTS, even they don't have history of tick bite, and more intense treatment should be administered to patients with abnormal BMI before laboratory parameters are detected.

Detection of a Novel Ehrlichia Species in Haemaphysalis longicornis Tick from China.

We collected 2460 Haemaphysalis longicornis ticks from vegetation in Jiaonan County, Shandong Province, in June of 2013 and Daishan County, Zhejiang Province, China, in May of 2015. The tick DNA was subsequently amplified with nested polymerase chain reaction using Ehrlichia common 16S rRNA gene primers and Ehrlichia ewingii species-specific groEL and gltA primers. We found 0.4% (3/780) of the ticks from Zhejiang Province contained Ehrlichia DNA that was different from all known Ehrlichia species, but most closely related to E. ewingii. We concluded that a novel Ehrlichia species exists in H. longicornis ticks in China.

Assessment on dioxin-like compounds intake from various marine fish from Zhoushan Fishery, China.

Sea fish consuming is an important intake source of dioxin-like compounds, especially for the coastal residents. To assess the intake levels of these contaminants from sea fish and to provide risk-based consumption advice, concentrations of 17 polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and 12 dioxin-like polychlorinated biphenyls (dl-PCBs) were measured in 32 commonly consumed fish species from Zhoushan Fishery, China. Due to the different accumulation influenced by fat content, feed habits and living zone in the sea area, the levels of PCDDs, PCDFs and dl-PCBs in different fish species varied significantly ranging from 0.002 to 0.078pg WHO-TEQ/g fresh weight, from 0.002 to 0.553pg WHO-TEQ/g fresh weight and from 0.003 to 2.059pg WHO-TEQ/g fresh weight, respectively. Based on mean fish consuming rate in China, the estimated maximum possible dioxin-like compounds intake through different fish species ranged from 0.26 to 65.61pgTEQkg(-1)bwmonth(-1). Bullet mackerel has the highest monthly intake level which was much higher than other fish species and very close to the provisional tolerable monthly intake (70pgTEQkg(-)(1)bwmonth(-)(1)) proposed by the Joint FAO/WHO Expert Committee on Food Additives. Hence, comparing to other fish species, the consumption of Bullet mackerel from Zhoushan Fishery should be cautious to reduce the potential health risk.

[Epidemiological characteristics of severe fever with thrombocytopenia syndrome in Zhoushan, Zhejiang, 2011-2013].

OBJECTIVE: To analyze the epidemiological characteristics of severe fever cases, with thrombocytopenia syndrome (SFTS) in Zhoushan,Zhejiang, 2011-2013 and to provide evidence for the development of related strategies for prevention and control of the disease. METHODS: Data was collected from the studies and related demography of the cases with SFTS in Zhoushan, 2011-2013. Clinical and epidemiological characteristics of the cases with SFTS were analyzed descriptively. RESULTS: During 2011-2013, 45 SFTS cases were reported in Zhoushan city, with fatality rate as 11.11% (5/45), including 41 cases(91.11%)reported in Daishan county. Most cases aged 50 or over, residing in hilly regions (93.33%). The epidemic peak was seen from May to July (84.44%). Incidence rates of the disease did not show significant statistical differences between males and females. Most cases were farmers (42.22% ) and housewives (31.11% ). Most patients complained of fever (97.78%), anorexia (91.11%), fatigue (62.22%), chill (44.44%) and other non-specific clinical manifestations but all appeared progressive thrombocytopenia and leucopenia. Sanitation condition of the patients was generally poor. 68.89% (31/45) of cases had farmed, mowed or involved in other outdoor activities in the previous two weeks, with some of them reported having exposed to tick bites. Three events were reported, epidemiologically. CONCLUSION: SFTS in Zhoushan was a infectious disease with natural foci and caused by SFTSV. Ticks might serve as the main vectors for SFTSV, and might cause direct transmission between humans. Improving the environment for living and carrying out essential protective measures in outdoor activities seemed to be significant in decreasing the incidence rate of the disease.

China belting up or down? Seat belt wearing trends in Nanjing and Zhoushan.

National seat belt wearing legislation became effective in China May 2004 and associated provincial and city regulations followed. Despite rapid motorisation seat belt studies in China have been scarce. Patterns and trends in urban seat belt wearing were observed for all driver, front and rear seating positions over the years 2005-2007 in two eastern cities Nanjing (Jiangsu Province) and Zhoushan (Zhejiang Province). There were 35,256 vehicles observed in Nanjing, 20,939 in Zhoushan and 95,933 occupants overall. Males dominated all seating positions, especially drivers. Seat belt wearing overall was significantly higher for drivers (49.9% Nanjing, 47.4% Zhoushan) than for front seat passengers (9.1% Nanjing, 1.0% Zhoushan) and virtually nonexistent for rear passengers (0.5% Nanjing, 0.2% Zhoushan). Generally levels declined significantly from year to year (drivers Nanjing 66.7%, 47.7%, 38.6%; Zhoushan 57.4%, 57.9%, 30.6%; front passengers Nanjing 19.2%, 6.6%, 3.2%). Zhoushan wearing did not initially decline, 2006 observations coinciding with anticipation of provincial regulations (July 2006). Observations revealed an absence of child restraints. Pretend wearing/belt tampering was observed almost exclusively in taxi drivers (14.2% of Nanjing taxi drivers, 11.3% of Zhoushan's). Awareness of and attitudes to urban seat belt laws should be investigated, appropriate countermeasures developed and enforcement reassessed.

[Study on the relationship between contents of poison in fishes and the levels of ocean pollutants in Zhoushan Fishery].

OBJECTIVE: To investigate the contents of poison in fishes in the Zhoushan Fishery and to analysis its relationship with the degree of ocean pollution. METHOD: Nine kinds of major fishes in the Zhoushan Fishery were sampled and tested. Canonical correlation was conducted to evaluate the correlation between contents of poison in fishes and the degree of ocean pollution. RESULTS: The average contents of nickel among 9 kinds of fishes exceeded normal value by 1.177 times. No significantly statistical differences were found between the levels of poison contents in nine kinds of major fishes during 1997 to 2003 in the Zhoushan Fishery (the P values are all less than 0.05), except that the levels of cadmium and hydrargyrum in some fishes (the P values are all more than 0.05). The coefficient of fishes accumulated from different poisons ranged from 101.80 to 71 210.97. The canonical correlation coefficients of the variables of the contents of plumbum, arsenic and benzene hexachloride, chlorophennothane between fishes and ocean were 0.784 and 0.808 respectively. Positive correlation between them was shown (chi(2) = 20.994, P < 0.01; chi(2) = 38.017, P < 0.01). CONCLUSION: The sanitary quality indexes of all poisons which had been tested fell in the normal ranges except for nickel. The degrees of poisons accumulated among distinct fishes varied, showing the relationship of medium positive correlation between the poison contents of fishes and the degree of the ocean pollution.