Molecular epidemiology of hepatitis B virus genotypes and subgenotypes in ethnic minority populations, Yunnan province, China.

The aim of our study was to determine the distribution of hepatitis B virus (HBV) genotypes and subgenotypes in ethnic minorities in Yunnan province to provide evidence supporting the theoretical basis for hepatitis B prevention and control. We obtained serum samples and demographic data from 765 individuals reported by Yunnan province who had either acute or chronic HBV infection and were from one of 20 ethnic minority populations: Achang, Bai, Brown, Tibetan, Dai, Deang, Dulong, Hani, Hui, Jingpo, Lahu, Yi, Lisu Miao, Naxi, Nu, Pumi, Wa, Yao, or Zhuang people. We sequenced the HBV DNA and determined the genotypes and subgenotypes of the isolated HBVs. We mapped the genotype and subgenotype distribution by ethnic minority population and conducted descriptive analyses. There were four genotypes among the 20 ethnic groups: genotype B (21.3% of samples), C (76.6%), D (1.8%) and I (0.3%). The most common subgenotype was C1. There were no genotype differences by gender (P = 0.954) or age (P = 0.274), but there were differences by region (P < 0.001). There were differences in genotype distribution (P < 0.001) and subgenotype distribution (P = 0.011) by ethnic group. Genotype D was most prominent in Tibet and most HBV isolates were C/D recombinant viruses. The only two genotype I virus isolates were in Zhuang people. Susceptibility and geographic patterns may influence HBV prevalence in different ethnic populations, but additional research is needed for such a determination.

Reduction patterns of Japanese encephalitis incidence following vaccine introduction into long-term expanded program on immunization in Yunnan Province, China.

BACKGROUND: Japanese encephalitis (JE) is a leading cause of childhood viral encephalitis both at global level and in China. Vaccination is recommended as a key strategy to control JE. In China most JE cases have been reported in southwest provinces, which include Yunnan. In this study, we quantify the epidemiological shift of JE in Yunnan Province from 2005 to 2017, covering before and after the introduction of JE vaccination into routine Expanded Program on Immunization (EPI) in 2007. METHODS: We used routinely collected data in the case-based JE surveillance system from 2005 through 2017 in Yunnan. Cases were reported from hospital and county-level Centers for Disease Control in line with the National JE Surveillance Guideline. Epidemiological data were extracted, analysed and presented in appropriate ways. Immunization coverage was estimated from actual JE doses administered and new births for each year. RESULTS: A total 4780 JE cases (3077 laboratory-confirmed, 1266 clinical and 437 suspected) were reported in the study period. Incidence of JE (per 100 000 population) increased from 0.95 in 2005 to 1.69 in 2007. With increase in vaccination coverage, incidence rates decreased steadily from 1.16 in 2009 to 0.17 in 2017. However, seasonality remained similar across the years, peaking in June-September. Banna (bordering Myanmar and Laos), Dehong (bordering Myanmar), and Zhaotong (an inland prefecture) had the highest incidence rates of 2.3, 1.9, and 1.6, respectively. 97% of all cases were among local residents. As vaccination coverage increased (and incidence decreased), proportion of JE cases among children < 10 years old decreased from 70% in 2005 to 32% in 2017, while that among adults ≥20 years old increased from 12 to 48%. There were a large number of JE cases with unknown treatment outcomes, especially in the earlier years of the surveillance system. CONCLUSIONS: The 13-year JE surveillance data in Yunnan Province showed dramatic decrease of total incidence and a shift from children to adults. Improving vaccination coverage, including access to adults at risk, and strengthening the JE surveillance system is needed to further control or eliminate JE in the province.

[Effect of resuscitation strategy based on the early goal directed therapy on the prognosis of patients with shock].

OBJECTIVE: To evaluate the effects of fluid management strategies in early goal directed therapy (EGDT) on the prognosis of patients with shock. METHODS: Clinical data of 79 patients with septic shock or hemorrhagic shock admitted to emergency intensive care unit (EICU) of the First People's Hospital of Yunnan Province were retrospectively analyzed. Patients were divided into continual fluid administrating group (n=41) in accordance with protocol calculating approximating fluid volume and adjust the infusion speed based on blood pressure, heart rate, pulse saturation of blood oxygen (SpO(2)) and urine output with the end of fluid resuscitation was set to restore spontaneous circulation function and wean off vasoactive drugs, and the conservative fluid resuscitation group (n=38) by means of using vasoactive agents to maintenance blood pressure after infusing amount (20 ml/kg) of liquid early, respectively. The 28-day mortality and the time of using pressure agents were compared between two groups. According to the 28-day mortality, patients were further divided into the survival group (n=37) and death group (n=42), and acute physiology and chronic health evaluation II (APACHEII) score was compared between two groups. Logistic regression analysis of prognostic factors was conducted to identify and describe the relationship between the prognosis and fluid resuscitation methods and strategies. RESULTS: The 28-day mortality of continual fluid administrating group was significantly lower than that of the conservative fluid resuscitation group (14.63% vs. 94.74%, P<0.01), total drugs supporting time (hours) was significantly shorter than that in conservative fluid resuscitation group (33.24±17.56 vs. 58.29±34.78, P<0.05). Thirty-six cases of 42 death patients received conservative fluid resuscitation (85.7%), but 35 cases of 37 survival patients received continual fluid administration (94.6%). Logistic regression analysis showed that odds ratio (OR) of brain natriuretic peptide before death or shifted out ICU was 0.9136, 95% confidence interval (95%CI) was 0.8125 to 0.9986, regression coefficient was -0.0931, P=0.0478, OR of procalcitonin before death or shifted out ICU was 0.9095, 95%CI was 0.8294 to 0.9973, regression coefficient was -0.0949, P=0.0436, and OR of blood lactate level before death or shifted out ICU was 0.5023, 95%CI was 0.2833 to 0.8905, regression coefficient was -0.6885, P=0.0184. CONCLUSIONS: Ongoing fluid resuscitation early in accordance with method to theoretically calculate fluid volume and to adjust infusion speed based on blood pressure, heart rate, SpO(2) and urine, withdrawal of vasoactive drugs, the mortality of patients with shock was significantly reduced.