How does the SARS-CoV-2 reinfection rate change over time? The global evidence from systematic review and meta-analysis.

BACKGROUND: There is a significant increase in the number of SARS-CoV-2 reinfection reports in various countries. However, the trend of reinfection rate over time is not clear. METHODS: We searched PubMed, Web of Science, Medline, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang for cohort studies, case-control studies, and cross-sectional studies up to March 16, 2023, to conduct a meta-analysis of global SARS-CoV-2 reinfection rate. Subgroup analyses were performed for age, country, study type, and study population, and time-varying reinfection rates of SARS-CoV-2 were estimated using meta-regression. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute critical appraisal tool. RESULT: A total of 55 studies involving 111,846 cases of SARS-CoV-2 reinfection were included. The pooled SARS-CoV-2 reinfection rate was 0.94% (95% CI: 0.65 -1.35%). In the subgroup analyses, there were statistically significant differences in the pooled reinfection rates by reinfection variant, and study type (P < 0.05). Based on meta-regression, the reinfection rate fluctuated with time. CONCLUSION: Meta-regression analysis found that the overall reinfection rate increased and then decreased over time, followed by a period of plateauing and then a trend of increasing and then decreasing, but the peak of the second wave of reinfection rate was lower than the first wave. SARS-CoV-2 is at risk of reinfection and the Omicron variant has a higher reinfection rate than other currently known variants. The results of this study could help guide public health measures and vaccination strategies in response to the Coronavirus Disease 2019 (COVID-19) pandemic.

Epidemiological analysis and risk prediction of scrub typhus from 2006 to 2021 in Sichuan, China.

Background: In the past decade, the number of reported cases of scrub typhus (ST) has increased dramatically in Sichuan Province. We aimed to overview the epidemiological characteristics of ST, identify the variables contributing to the spatial distribution, and estimate the risk areas of ST occurrence. Methods: Daily ST cases reported at the county level from 2006 to 2021 and datasets on environmental and socioeconomic variables were obtained. Joinpoint regression model was utilized to examine the incidence trends and to calculate the annual percentage change. Global spatial autocorrelation analysis was employed to explore the spatial temporal patterns. Then BRT model was employed to identify variables that make sense and predict the risk areas of ST occurrence. Result: It has been reported that there were 6,338 ST cases in Sichuan Province from 2006 to 2021, and the incidence rates continued to rise. Most cases were distributed between June and October each year, peaking in August. During the study period, the cases showed spatial clustering at the county level, mainly in the Panxi area, and then slowly spread to the northwest and northeast. Shrubs, precipitation, farmland and maximum temperature were the primary variables that affected the spatial distribution of this disease. It was estimated that the areas including Liangshan, Panzhihua, Bazhong, and Guangyuan were most at risk of transmission. and there were approximately 32.315 million people living in the areas with potential risk of infection throughout Sichuan. Conclusion: Many counties in Sichuan Province were estimated to be susceptible to ST. Our found in this data-driven study could be used to guide the implementation of targeted prevention and control measures in high-risk areas.

Spatio-temporal analysis of bacillary dysentery in Sichuan province, China, 2011-2019.

BACKGROUND: Bacillary dysentery (BD) is a common infectious disease in China and causes enormous economic burdens. The purpose of this study was to describe the epidemiological characteristics of BD and to identify its possible hot spots and potentially high-risk areas in Sichuan province of China. METHODS: In this study, we collected monthly BD incidence reports of 181 counties in Sichuan province, China, from January 2011 to December 2019. Descriptive statistics were used to evaluate the epidemic characteristics of BD. Moran's I index was applied to investigate the yearly patterns of the spatial distribution. And spatio-temporal scanning statistics with the spatial unit set as county and the temporal unit set as month were used to investigate the possible high-risk region. Meanwhile, the circular moving windows were also employed in the spatio-temporal scanning to scan the study areas. RESULTS: The annual incidence of BD ranged between 16.13/100,000 and 6.17/100,000 person-years from 2011 to 2019 in Sichuan. The majority of the cases were children aged 5 years or younger. For the descriptive statistics, a peak from May to October was observed in temporal analysis, the epidemics were mainly concentrated in the northwest and southwest of Sichuan in spatial analysis. After 2016, the scope of BD significantly narrowed and severe epidemic areas were relatively stable. For the spatial autocorrelation analysis, a high global autocorrelation was observed at the county level, and the high-high clusters mainly distributed in the northwest and southwest of Sichuan. For the spatio-temporal scanning, the spatiotemporal clusters of BD occurred every year from 2011 to 2019. The most likely cluster areas mainly distributed in the southwest and northwest of Sichuan at the beginning, and then gradually concentrated in the southwest. The secondary cluster mainly concentrated in the northwest and its surrounding areas. Moreover, the 2nd secondary cluster was relatively small and mainly distributed in the central area. No clusters were noted in eastern Sichuan. CONCLUSIONS: Based on our current analysis, BD is still a common challenge in Sichuan, especially for counties in the southwest and northwest in summer and autumn. More disease prevention and control measures should be taken in such higher-risk susceptible areas at a certain time to allocate the public health resources rationally, and finally reduce the spread of BD.

Niche modeling predictions of the potential distribution of Marmota himalayana, the host animal of plague in Yushu County of Qinghai.

BACKGROUND: After the earthquake on 14, April 2010 at Yushu in China, a plague epidemic hosted by Himalayan marmot (Marmota himalayana) became a major public health concern during the reconstruction period. A rapid assessment of the distribution of Himalayan marmot in the area was urgent. The aims of this study were to analyze the relationship between environmental factors and the distribution of burrow systems of the marmot and to predict the distribution of marmots. METHODS: Two types of marmot burrows (hibernation and temporary) in Yushu County were investigated from June to September in 2011. The location of every burrow was recorded with a global positioning system receiver. An ecological niche model was used to determine the relationship between the burrow occurrence data and environmental variables, such as land surface temperature (LST) in winter and summer, normalized difference vegetation index (NDVI) in winter and summer, elevation, and soil type. The predictive accuracies of the models were assessed by the area under the curve of the receiving operator curve. RESULTS: The models for hibernation and temporary burrows both performed well. The contribution orders of the variables were LST in winter and soil type, NDVI in winter and elevation for the hibernation burrow model, and LST in summer, NDVI in summer, soil type and elevation in the temporary burrow model. There were non-linear relationships between the probability of burrow presence and LST, NDVI and elevation. LST of 14 and 23 °C, NDVI of 0.22 and 0.60, and 4100 m were inflection points. A substantially higher probability of burrow presence was observed in swamp soil and dark felty soil than in other soil types. The potential area for hibernation burrows was 5696 km(2) (37.7% of Yushu County), and the area for temporary burrows was 7711 km(2) (51.0% of Yushu County). CONCLUSIONS: The results suggested that marmots preferred warm areas with relatively low altitudes and good vegetation conditions in Yushu County. Based on these results, the present research is useful in understanding the niche selection and distribution pattern of marmots in this region.

[Study of the plasmid profiles and geographical distribution of Yersinia pestis in China].

OBJECTIVE: To analyze the plasmid features and geographical distribution characteristics of Yersinia pestis of different plague foci in China. METHODS: A total of 2 213 Yersinia pestis strains were colected from 11 Chinese plague foci separated during 1943 to 2012, and plasmid DNA according to alkali cracking method, and measured the relative molecular mass (Mr) of plasmid DNA based on the standard plasmid contrast method, then analyzed the plasmid profiles by agar gel electrophoresis. RESULTS: A total of 2 213 strains had 16 kinds of plasmids with different Mr, including 4×10(6), 6×10(6), 7×10(6), 13×10(6), 16×10(6), 20×10(6), 22×10(6), 23×10(6), 27×10(6), 30×10(6), 36×10(6), 45×10(6), 52×10(6), 65×10(6), 72×10(6) and 90×10(6). Plasmid were classified into 26 kinds of plasmid profiles. A total of 2 213 Yersinia pestis strains contained 4 large plasmids, 52×10(6), 65×10(6), 72×10(6) and 90×10(6), whose ratio was 22.10% (589/2 213), 75.60% (1 672/2 213), 0.17% (4/2 213), 2.12% (47/2 213), respectively. Among which, strains with plasmid 52×10(6), 65×10(6), 90×10(6) distributed in Qinghai-Tibet plateau Himalayan Marmot natural plague foci, strains with 72×10(6) plasmid only distributed in Inner Mongolia Meriones unguiculatus natural plague foci and Junggar Basin R. opimus natural plague foci, and 65×10(6) plasmid distributed in all the other foci. CONCLUSION: Strains in Chinese 11 plague foci contained 4 kinds of large plasmid, the Mr respectively were 52×10(6), 65×10(6), 72×10(6), 90×10(6), which were classified into 26 kinds of plasmid profiles with other plasmid. These plasmid profiles distributed in relatively independent epidemic focus.

Multilocus sequence typing analysis of Cronobacter spp. isolated from China.

Multilocus sequence typing (MLST) has proven to be an effective approach for the subtyping isolates of the Cronobacter genus and to exhibit a high level of discrimination between isolates. In this study, 151 Cronobacter strains were isolated from different sources and provinces across China from 2010 to 2012 and analyzed by MLST. Their sequence type profiles were compared with strains from other countries which were widely geographically and temporally distributed. Out of 151 strains in this study, the majority of strains were Cronobacter sakazakii (70.9 %), C. malonaticus (15.9 %), C. dublinensis (10.6 %), C. turicensis (2.0 %), and C. muytjensii (0.7 %). The strains were divided into 85 sequence types (STs), among which only 17 had previously been reported in other countries. The 85 identified STs for the Cronobacter genus were grouped into 14 clonal complexes and 47 singletons according to eBURST algorithm. The Cronobacter isolated from China showed a high diversity when they were subtyped using the MLST method. When compared to the Cronobacter PubMLST database, some sequence types of strains cultured from food and/or water in this study were also the same with strains isolated from patients in other countries as reported previously. This result showed the potential hazard of strains contaminating water and weaning food from China.

Prevalence and characteristics of Shiga toxin-producing Escherichia coli isolated from retail raw meats in China.

Shiga toxin-producing Escherichia coli (STEC) causes diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome in humans. Most human infections are attributed to consumption of STEC-contaminated foodstuffs of animal origin. In this study, we evaluated the prevalence of STEC from retail raw meats collected from two geographical regions in China. The results revealed that 166 out of 853 samples were stx-positive; 63 STEC isolates were recovered from 58 stx-positive samples including pork (4.4%, 14/318), beef (11.0%, 21/191), mutton (20.6%, 26/126), chicken (0.5%, 1/205), and duck (7.7%, 1/13). Twenty-six O serogroups and 33 O:H serotypes were identified. All three stx1 subtypes and five stx2 subtypes (2a to 2e) were found in the 63 STEC isolates, among which stx2e-positive STEC isolates were the most predominant (39.7%), followed by stx1c only (20.6%), stx1c+stx2b (14.3%), and stx1a only (9.5%). STEC isolates carried virulence genes eae (6.3%), ehxA (36.5%), katP (4.8%), astA (11.1%), and subA (36.5%). Of the four adherence-associated genes tested, toxB was absent, whereas saa, paa, and efa1 were present in 28, three, and one STEC isolates respectively. The STEC isolates were divided into 50 PFGE patterns and 33 sequence types. STEC from different sources and geographical regions were separated by PFGE and MLST. Our results revealed that there is a high genetic diversity of STEC in retail raw meats, some of which have potential to cause human diseases.

[Regional genotyping and the geographical distribution regarding Yersinia pestis isolates in China].

OBJECTIVE: To type Yersinia (Y.) pestis isolates under different regions (DFR) and to observe their geographical distributions in China. METHODS: 23 DFRs primers and PMT1 (plasmid) primer were used to verify the DFR genomovars of Y. pestiss strains from 11 plague foci in China. A total of 3 044 Y. pestis isolates were involved for analysis on DFR profiles with the characteristics of geographical distribution. RESULTS: 52 genomovars were verified in 3 044 Y. pestis strains in China in which 19 genomovars as major and 33 genomovars as minor genomovar. 21 new genomovars, namely genomovar 32 to genomovar 52 were described on the basis of 31 genomovars previously confirmed. Three new genomovars belonged to new major genomovars, namely Himalayan marmot natural plague foci of the Qinghai-Tibet plateau newly added genomovar 32 and genomovar 44 as major genomovars. Mongolian gerbil natural plague foci of Inner Mongolia plateau were newly added genomovar 50 as one of the major genomovars. CONCLUSION: Among 21 new genomovars, 3 were major genomovars, with Chinese Y. pestis DFR as the major genomovars which had obvious distribution characteristics.

[Analysis on the results of etiology and serology of plague in Qinghai province from 2001 to 2010].

OBJECTIVE: To analyze the results of etiology and serology of plague among human and infected animals in Qinghai province from 2001 to 2010. METHODS: Thirty-seven cases of human infected with plague, 53 541 different animal samples, 5 685 sets of vector insects flea and 49 039 different animal serum samples were obtained between 2001 and 2010. A total of 7 811 samples of serum from healthy farmers and herdsmen in 14 counties in Qinghai from 2005 to 2007 were collected. Yersinia pestis (Y. pestis) were detected in visceral and secretions from human, infected animals and vector insects, respectively. Plague antigen was detected by reverse indirect hemagglutination assay (RIHA) in those samples. Indirect hemagglutination assay (IHA) was used to test plague FI antibody in serum of human and infected animals. RESULTS: 37 human plague cases were confirmed, 21 strains of plague Y. pestis were isolated from human cases and 14 positive were detected out. 133 of 7 811 samples of human serum were IHA positive, with the positive rate at 1.7%. A total of 146 strains of plague were isolated from infected animals and vector insects, 99 out of which were from infected animals, with a ratio of Marmota himalayan at 72.7% (72/99) and the other 47 were from vector insects, with a ratio of callopsylla solaris at 68.1% (32/47). The number of IHA and PIHA positive were 300 and 10, respectively. A total of 3 animals and 3 insects species were identified as new epidemic hosts for plague. The natural plague focus of Microtus fuscus was discovered and confirmed and coexisted with natural focus of Marmota himalayan in Chengduo county, Yushu prefecture. The epidemic situation of plague is distributed mainly in Haixi, Yushu and Hainan prefectures. CONCLUSION: From 2001 to 2010, animal infected with plague was detected in successive years and human plague was very common in Qinghai. New infected animals and vector insects species and new epidemic areas were confirmed, hence the trend of plague prevalence for humans and animals is very active in Qinghai province.

[Sources of infection on human plague in Qinghai province].

OBJECTIVE: To study the biological and genetic characteristics of 119 strains of Yersinia (Y.) pestis isolated from plague patients in Qinghai province, from 1958-2012. METHODS: Both regular methods and different region(DFR)molecular typing techniques were used to study the epidemiological characteristics on 119 strains of Y. pesticin Qinghai during 1958-2012. Sources of Y. pestis from two outbreaks, in Nangqian county in 2004 and in Xinghai county in 2009,Qinghai province were also analyzed. RESULTS: 105 strains of Y. pestis were identified as Qinghai-Tibet Plateau Ecotype while the other 6 strains as Qilian Mountains Ecotype. 84.03% (100/119) of the tested strains carried 4 virulence factors F1(+), Pst I(+), VW(+) and Pgm(+)). 97.30% (72/74) of the tested strains showed high virulence. Strains that carrying 52×10(6), 65×10(6), 92×10(6) plasmids were distributed in Hainan, Haibei, Haixi,Yushu,Guoluo, Huangnan and Huangyuan counties. Genomovar 5 and 8 were the main gene types that circling around Qinghai Lake. Genomovar 10 was found in strains of Y. pesticin Nangqian county while Genomovar 8 was found in the strains isolated from human plague patient during the epidemics in Xinghai county in Qinghai. CONCLUSION: Data from biological and genetic analyses on the epidemics of human plague in Nangqian county in 2004 and in Xinghai county in 2009 demonstrated that methods as DFR genotyping and virulence factors profiles, as well as plasmids profiles were powerful tools in confirming the human plague epidemics and sources of infection.

[The pathogenic ecology research on plague in Qinghai plateau].

OBJECTIVE: To study the pathogenic ecology characteristics of plague in Qinghai plateau. METHODS: Applied molecular biology techniques, conventional technologies and geographic information system (GIS) to study phenotypic traits, plasmid spectrum, genotype, infected host and media spectrum etc.of 952 Yersinia pestis strains in Qinghai plateau plague foci, which were separated from different host and media in different regions during 1954 to 2012. RESULTS: The ecotypes of these strains were Qingzang plateau (91.49%, 871/952),Qilian mountain (6.41%, 61/952) and Microtus fuscus (1.26%, 12/952).83.6% (796/952) of these strains contained all the 4 virulence factors (Fr1, Pesticin1,Virulence antigen, and Pigmentation), 93.26% (367/392) were velogenic strains confirmed by virulence test.725 Yersinia pestis strains were separated from Qinghai plateau plague foci carried 9 kinds of plasmid, among which 713 strains from Marmot himalayan plague foci carried 9 kinds of plasmid, the Mr were 6×10(6), 7×10(6), 23×10(6), 27×10(6), 30×10(6), 45×10(6), 52×10(6), 65×10(6) and 92×10(6) respectively. 12 Yersinia pestis strains were separated from Microtus fuscus plague foci carried only 3 kinds of plasmid, the Mr were 6×10(6), 45×10(6), 65×10(6). Meanwhile, the strains carrying large plasmid (52×10(6), 65×10(6) and 92×10(6)) were only distributed in particular geographical location, which had the category property. The research also confirmed that 841 Yersinia pestis strains from two kinds of plague foci in Qinghai plateau had 11 genomovars. The strains of Marmot himalayan plague foci were given priority to genomovar 5 and 8, amounted to 611 strains, genomovar 8 accounted for 56.00% (471/841), genomovar 5 accounted for 23.07% (194/841). Besides, 3 new genomovars, including new 1(62 strains), new 2(52 strains), new 3(48 strains) were newly founded, and 12 strains of Microtus fuscus plague foci were genomovar 14. CONCLUSION: The main host and media of Qinghai plateau plague foci directly affected the spatial distribution regularities of plague epidemic and the pathogens characteristics, meanwhile the polymorphism of plague ecological geographic landscape leds to the complexity of Yersinia pestis' genotype.

[Study on the pathogen of plague in Sanjiangyuan area in Qinghai province].

OBJECTIVE: To study the biological characteristics of Yersinia pestis and to develop prevention and control program on plague in Sanjiangyuan areas, Qinghai province. METHODS: To identify the biologic types and molecular biological features of Y.pestis isolated in Sanjiangyuan area from 1954-2007. RESULTS: Among the 411 strains of Y. pestis, 12 strains belonged to the microtus type Y. pestis with denitrification (-) and donkey-hide gelatin carbohydrate (-) and glycerine (+). 399 strains belonged to classic type Y. pestis with denitrification (+) and donkey-hide gelatin carbohydrate (+) and glycerine (+). 411 Y. pestis strains had factor F I and Pst I. Among them, VW+ strains of Y. pestis accounted for 95.13% (391/411), VW-accounted for 4.87% (20/411), Pgm(+) accounted for 80.78% (332/ 411), Pgm(+/-) accounted for 9% (37/411) and Pgm(-) accounted for 10.22% (42/411) respectively. 96.82% (213/220) of the Y. pestis strains showed strong virulence to laboratory mice while 3.18% (7/220) of the strains carried medium virulence. 90.02% of the tested Y. pestis (370/411) strains had 6 x10(6), 45 x 10(6), 65 x 10(6) plasmids. 8 types of genome were found among 80 strains of Y. pestis, with 6 of them resembling ZHOU Dongsheng' s classification. Two new genome types were found. CONCLUSION: The Y. pestis in the Sanjiangyuan area had the characteristics of plague pathogen, identified in Qinghai-Tibet plateau. It is estimated that human beings are highly susceptible to the disease which spread fast, causing serious signs and symptoms with high death rate.