[Disease burden of acute viral hepatitis in Guangdong Province, 1990-2019].

Objective: To examine the burden and trends of acute viral hepatitis in Guangdong Province from 1990 to 2019, and provide reference evidences for hepatitis prevention and control in the province. Methods: Data on acute viral hepatitis (hepatitis A, B, C, and E) in Guangdong from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 database. The incidence, prevalence, mortality, and disability-adjusted life years (DALY) data were analyzed by age and gender, and the estimated annual percentage change (EAPC) was calculated to describe the changing trends in disease burden. Results: From 1999 to 2019, the standardized incidence, prevalence, mortality, and DALY of acute viral hepatitis in Guangdong were higher than the national averages. In 2019, 51.43% (2 245 087/4 365 221) of acute viral hepatitis cases in Guangdong Province were mainly attributed to hepatitis B, and 77.18% (106/138) of deaths were due to acute hepatitis B. In different age groups, except for acute hepatitis B, which was more common in adults, the incidence rates of other types of viral hepatitis such as hepatitis A, B, and E showed an overall decreasing trend with age. The mortality rates of different types of acute viral hepatitis, except for the <5 age group, increased with age. The overall incidence and mortality rates of acute viral hepatitis were higher in men than in women. Conclusions: The overall burden of acute viral hepatitis in Guangdong declined in 2019, but remained higher than the national level. Further efforts are needed to strengthen hepatitis prevention and screening in different population in Guangdong Province, especially in children and the elderly.

[Analysis and prediction of disease burden of cirrhosis and other chronic liver diseases due to alcohol use in China from 1990 to 2030].

Objective: To comprehensively understand the disease burden of liver cirrhosis and other chronic liver diseases caused by alcohol use in China from 1990 to 2019, as well as to predict the trends in disease burden from 2020 to 2030. Methods: The analysis utilized data from the Global Burden of Disease study in 2019 (GBD2019). Key indicators such as incidence rate, mortality rate, disability-adjusted life years (DALY), years of life lost due to premature mortality, and years lived with disability were selected to describe the disease burden of alcohol-related liver cirrhosis and other chronic liver diseases in China from 1990 to 2019. The estimated annual percentage change (EAPC) was used to depict the temporal trends in disease burden. Furthermore, a Bayesian age-period-cohort (BAPC) model was constructed using R software to predict the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of alcohol-related liver cirrhosis and other chronic liver diseases in China from 2020 to 2030. Results: From 1990 to 2019, the incidence of alcohol-related liver cirrhosis and other chronic liver diseases in China showed an upward trend, with an EAPC of 0.31% (95%CI: 0.10%-0.52%). However, the DALY declined, with an EAPC of -2.81% (95%CI: -2.92% - -2.70%). The ASMR showed a downward trend, with an EAPC of -2.55% (95%CI: -2.66% - -2.45%). The highest incidence of cirrhosis of liver caused by alcohol and other chronic liver diseases was reported in the age group of 35-49 years, while the ASMR increased gradually with age, with a significant rise after the age of 30. The age-standardized DALY rate peaked between the ages of 55 and 64. The disease burden indicators for males were consistently higher than those for females during the same period. According to the predictions of the BAPC model, from 2020 to 2030, the ASIR for cirrhosis of liver caused by alcohol and other chronic liver diseases in the entire population of China was projected to increase from 3.45/100 000 in 2020 to 3.78/100 000 in 2030, a growth of 9.57%. Conversely, the ASMR was expected to decrease from 1.45/100 000 in 2020 to 1.24/100 000 in 2030, a reduction of 14.48%. Conclusions: The disease burden of cirrhosis of liver caused by alcohol and other chronic liver diseases remained serious in China, especially in men and the middle-aged to elderly population. There is a pressing need to prioritize attention and resources towards these groups. Despite the projected decrease in ASMR, the ASIR continued to rise and is expected to persist in its upward trend until 2030.

[Analysis of the direct economic burden of measles cases and its influencing factors in Shanghai from 2017 to 2019].

Objective: To analyze the direct economic burden caused by measles cases in Shanghai from 2017 to 2019 and its influencing factors. Methods: A total of 161 laboratory-confirmed measles cases reported from January 1, 2017, to December 31, 2019, in Shanghai were included in the study through the "Measles Surveillance Information Reporting and Management System" of the "China Disease Surveillance Information Reporting and Management System". Through telephone follow-up and consulting hospital data, the basic information of population, medical treatment situation, medical treatment costs and other information were collected, and the direct economic burden of cases was calculated, including registration fees, examination fees, hospitalization fees, medical fees and other disease treatment expenses, as well as transportation and other expenses of cases. The multiple linear regression model was used to analyze the main influencing factors of the direct economic burden. Results: The age of 161 measles cases M (Q1, Q3) was 28.21 (13.33, 37.00) years. Male cases (56.52%) were more than female cases (43.48%). The largest number of cases was≥18 years old (70.81%). The total direct economic burden of 161 measles cases was 540 851.14 yuan, and the per capita direct economic burden was 3 359.32 yuan. The direct economic burden M (Q1, Q3) was 873.00 (245.01, 4 014.79) yuan per person. The results of multiple linear regression model analysis showed that compared with other and unknown occupations, central areas and non-hospitalized cases, the direct economic burden of measles cases was higher in scattered children, childcare children, students, and cadre staff in the occupational distribution, suburban areas and hospitalized, with the coefficient of ß (95%CI) values of 0.388 (0.150-0.627), 0.297 (0.025-0.569), 0.327 (0.148-0.506) and 1.031 (0.853-1.209), respectively (all P values<0.05). Conclusion: The direct economic burden of some measles cases in Shanghai is relatively high. Occupation, area of residence and hospitalization are the main factors influencing the direct economic burden of measles cases.

[Persistence follow-up of immune memory to hepatitis B vaccine among infants with non- and low-response to primary vaccination after revaccination with three doses].

This study followed up the immune memory after 3-dose revaccination among infants with non-and low-response following primary hepatitis B (HepB) vaccination. About 120 children without self-booster doses were finally included who had anti-HBs<10 mIU/ml (anti-HBs negative) at the time of follow-up, of whom 86 children completed blood sampling and anti-HBs testing. Before the challenge dose, all 86 children were negative for anti-HBs, and the GMC of anti-HBs was<10 mIU/ml. The seropositive conversion rate of anti-HBs was 100% and the GMC of anti-HBs was 886.11 (95%CI: 678.15-1 157.84) mIU/ml after the challenge dose. Compared with those with GMC<7 mIU/ml before the challenge dose, infants with GMC>7 mIU/ml had a higher anti-HBs level after the challenge dose. The ß value (95%CI) was 0.82 (0.18-1.46) (P=0.012). Compared with those with GMC<1 000 mIU/ml at primary vaccination, infants with GMC≥1 000 mIU/ml had a higher anti-HBs level after the challenge dose. The ß value (95%CI) was 0.78 (0.18-1.38)(P=0.012). The results showed a stronger immune memory was found at 9 years after revaccination among infants with non-and low-response to HepB.

[Current status of public health system in Guangdong-Hong Kong-Macao Greater Bay Area and improvement suggestion].

Guangdong-Hong Kong-Macao Greater Bay Area (GBA) has three public health systems under different systems, which plays an important role in the construction of the public health system in China. Further strengthening the construction of the public health system in the GBA will play an important reference role in the optimization and upgrade of China's public health system in the future. Based on the key consulting project of "research on the strategy of the modern public health system and capacity building in China" by Chinese Academy of Engineering, this paper deeply analyzes the current status and existing problems of public health system construction in GBA and suggests to improve and innovate the mechanisms of collaborative prevention and control of public health risks, resource coordination and joint research and result sharing, information sharing and exchange, personnel training and team building in order to comprehensively improve the capacity of public health system in GBA, and promote the construction of Healthy China.

[Challenges to global pertussis prevention and control].

Pertussis is an acute, highly infectious respiratory disease caused by Bordetella pertussis, and is one of the leading causes of infant disease and death worldwide. The pertussis vaccine has been used in the expanded program on immunization globally since 1974 and the vaccination coverage remains high. In recent years, the pertussis incidence rate increased, even pertussis outbreaks occurred, in more and more countries or areas after years with low incidence level. The disease burden of pertussis has been seriously underestimated, and the prevention and control of pertussis is facing many challenges. This article reviews the epidemic status of pertussis worldwide, the factors affecting the reemergence of pertussis, and the challenges in the prevention and control to provide a reference for prevention and control of pertussis.

[Study on the willingness to quit smoking and its influencing factors among current smokers in rural areas in China].

Objective: To study the willingness of current smokers to quit smoking in rural areas and related factors to provide a reference for tobacco control. Methods: The data were collected from the China Chronic Disease and Risk Factor Surveillance in 2018. A multi-stage stratified cluster sampling was used to select 184 509 residents (≥18 years old); among the residents, 10 241 current smokers in rural areas were included in the study. χ2/F test was used to analyze the factors such as willingness to quit smoking and demographic information, tobacco use, cognition of tobacco-related hazard knowledge, the prevalence of chronic diseases, and other factors. Unconditional multifactor logistic regression analysis was used in multivariate analysis. Results: A total of 3 453 (37.46%) considered quitting smoking in the next 12 months. Logistic regression analysis showed that occasional smokers were more willing to quit smoking than daily smokers (OR=0.693, 95%CI: 0.494-0.971), and those who smoked less than 1 pack per day were more willing to quit than those who smoked 1 pack or more per day (OR=0.628,95%CI: 0.511-0.771), those who had quit smoking within 12 months were more willing to quit than those who had not quit within 12 months (OR=0.438, 95%CI: 0.357-0.537), and those with high awareness of tobacco hazards were more willing to quit smoking (OR=1.056, 95%CI: 1.028-1.086). The differences were statistically significant (P<0.05). Conclusions: The willingness of current smokers in rural areas to quit smoking is related to the smoking situation, smoking intensity, previous smoking cession experience, and knowledge of the specific health effects of smoking. It suggests that health education should be strengthened through more efficient health communication methods in rural areas and provide brief smoking cessation interventions to improve rural smokers' willingness to quit smoking.

[Anti-HBs persistence after primary vaccination with three doses of 5 µg recombinant hepatitis B vaccine among normal and high-responder infants: 10-year of follow-up].

Objective: Assess the 10-year Immune persistence and the predictors after primary vaccination hepatitis B vaccine (HepB) among normal and high-responder infants. Methods: A total of 1 838 Infants of 7-12 months old located in Jinan, Weifang, Yantai and Weihai of Shandong Province who were induced normal or high antibody response (anti-HBs titer ≥ 100 mIU/ml) after primary vaccination (three dose with 0-1-6 procedure) with 5 µg recombinant HepB among newborns were included in the study, in 2009. 3 ml of venous blood samples were collected at baseline survey (T0) and antibodies against hepatitis B surface antigen (anti-HBs), antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected using chemiluminescence microparticle immunoassay (CMIA) method. A self-designed questionnaire was used to collect information including the infant's age, sex, birth weight, premature birth, birth number, delivery location and mother's HBV infection status. In 2014 (followed up for 5 years) and in 2019 (followed up for 10 years) (T1), 2 ml of venous blood samples were collected. Anti HBS and anti HBC were detected by CMIA method. Those with anti HBS<10 mIU/ml were detected by CMIA method. Multivariate unconditional logistic and linear regression models were used to analyze the influencing factors of anti-HBs positive rate and geometric mean concentration (GMC) at T1. Results: After 10 years follow-up, 73.94% of the subjects (1 359/1 835) finished the follow-up. 51.15% of the subjects, a total of 625 were boys. The positive rate of anti-HBs was 100% at T0 and decreased to 53.44% (95%CI: 50.59%-56.26%) at T1. The average annual decline rate of anti-HBs positive rate from T0 to T1 was 6.07%. The GMC of anti-HBs decreased from 607.89 (95%CI: 579.01-642.62) mIU/ml to 16.44 (95%CI: 15.06-18.00) mIU/ml. The average annual decline rate of anti-HBs GMC in 10-year follow-up was 30.30%. Multivariate logistic analysis showed that the positive rate of anti-HBs at T1 was lower in those who did not vaccinate the first dose in time (OR=0.25, 95%CI:0.07-0.71). Compared with those with GMC<1 000 mIU/ml at T0, those with GMC ≥ 1 000 mIU/ml had a higher positive rate of anti-HBs at T1 (OR=2.29, 95%CI:1.76-2.97). Multivariate regression analysis showed that the GMC of anti-HBs at T1 was lower in those who did not vaccinate the first dose in time (ß=-0.50, 95%CI:-1.24-0.24). Compared with those with GMC<1 000 mIU/ml at T0, those with GMC ≥ 1 000 mIU/ml had a higher GMC of anti-HBs at T1 (ß=0.81, 95%CI: 0.62-1.05). Conclusion: Anti-HBs GMC decreased in 10 years after primary vaccination of 5 µg recombinant hepatitis B vaccine among normal and high-responders. The anti-HBs persistence was mainly associated with whether the first dose was vaccinated in time and the level of anti-HBs at the end of primary vaccination.

[Research on COVID-19 vaccination strategies in Singapore].

As of December 31, 2021, Singapore reported that 4 758 601 had completed at least one dose of COVID-19 vaccination, 4 714 655 had completed two doses of COVID-19 vaccination, and 2 207 341 had received one booster shot of COVID-19 vaccine. This article analyses the current performance of COVID-19 vaccination in Singapore, interprets the content of Singapore's National Vaccination Programme, and systematically introduces specific measures of COVID-19 vaccination in Singapore, such as door-to-door vaccination, vaccination differentiated management, and self-payment of medical expenses for those who refuse to be vaccinated, to provide reference for the COVID-19 vaccination in China.

[The epidemic situation and intervention countermeasures of stroke in Japan].

From 1951 to 1980, stroke was the main cause of disability and death among middle-aged and elderly residents in Japan. Its mortality once stood in the first place among all the developed countries, with the mortality of hemorrhagic stroke significantly higher than that of the western countries. In 1965, the mortality of stroke in Japan reached a peak of 175.8 per 100 000. Since then, it began to decline rapidly with a range of 5%-7%, and dropped to 139.5 per 100 000 in 1980, and from the top cause of death to the third place. By 2010, the mortality had dropped to 97.7 per 100 000. The significant decline in stroke morbidity and mortality in Japan is mainly attributed to controlling important risk factors and the public health service system's improvement. Setting up related policies and regulations to ensure comprehensive interventions and using the existing monitoring systems and surveys to assess interventions' effectiveness also contributes. Given the similarities of epidemiological characteristics and risk factors on stroke in Japan and China, strategies and measures adopted in Japan will have certain positive significance for China.

[Survey on provincial disease prevention and control professionals' attitudes and cognition to public health physician standardized training in China].

Objective: To understand the attitudes and cognition of disease control and prevention professionals at provincial level on public health physician standardized training and provide evidence for the improvement of the standardized training and exploration of more effective training mode in China. Methods: By cluster sampling, 2 193 professionals at provincial centers for disease control and prevention (CDC) in 6 provinces, including Jiangsu and Guangdong, Shanxi and Hubei,Sichuan and Xinjiang were selected as the study subjects, the sample size was estimated to be 1 933 persons. Results: A total of 1 716 provincial-level CDC professionals were surveyed, the support rate to the standardized training was 70.7%(1 213/1 716). The level of support was negatively associated with the educational level of professionals and their specialty of public health and preventive medicine. Of 875 public health and preventive medicine professionals, 61.6%(318/516) of those with master's degree or above supported the standard training for public health physicians, which was lower than 73.1%(225/308) of those with bachelor's degree and 86.3%(44/51) of those with college degree or below. There were 14.9%(232/1 555) of the respondents suggested a two year training, and 60.4%(933/1 544) suggesting a field training mode. In terms of training content, 86.6%(1 355/1 564) suggesting "epidemiological survey and public health practice", and 76.7%(1 199/1 564) suggesting "basic theories and methodology". Conclusions: In general, the professionals of provincial CDC showed a relatively low interest in the standardized training for public health physicians and failed to reach a consensus. Besides, they were ill-informed about current training duration, method and content. Thas, the professionals at provincial CDC are suggested to be the key target-population whom should be mobilized during the training pilot period, especially the highly educated ones with relevant specialties of public health. It is suggested that public health physician standardized training should to be implemented in whole CDC system to reach full consensus based on its practical achievements and effects. It is also suggested to establish public health graduate medical education system in China.

[Introduction of World Health Organization Strategies and the Technical Advisory Committee actions on viral hepatitis control and status of the elimination of viral hepatitis in China].

Viral hepatitis has been causing big threat to public health globally. The number of annual deaths caused by hepatitis surpassed the deaths caused by AIDS, tuberculosis, and malaria. World Health Organization (WHO) issued the global health sector strategy on viral hepatitis 2016-2020 (GHSS) to control its epidemic. It established the Strategies and Technical Advisory Committee on HIV, viral hepatitis, and sexually transmitted infections (STAC). This paper summarizes the GHSS goals and the keynote of the 2020 STAC meeting, analyzes the challenges and opportunities faced by China in eliminating viral hepatitis, and provides the comments on the papers on this issue, which could guide further actions.

[Cost-benefit analysis of the hepatitis B vaccination to prevent mother-to-child transmission strategies in China, 1992-2019].

Objective: To make a cost-benefit analysis of the hepatitis B vaccination (HepB) to prevent mother-to-child transmission (PMTCT) strategies in China, 1992-2019. Methods: We built a decision analytic-Markov model to estimate the birth cohorts of 1992-2019. The parameters in our model were referred from literature, published yearbooks, and data from Chinese Center for Disease Control and Prevention. We conducted a univariate sensitivity analysis to test the robustness of the model. Results: For the 28 birth cohorts, the Chinese government has invested 37.43 billion RMB Yuan in direct costs and 47.61 billion RMB Yuan in societal costs on HepB vaccination and HBV prevention of mother to child transmission (PMTCT). And we estimated that about 50 million chronic HBV infections and 12.5 million premature deaths due to HBV-related diseases would be averted. China would save 2.89 trillion RMB Yuan and 6.92 trillion RMB Yuan for the direct and societal medical burden on HBV-related conditions. The direct and societal net benefit was 2.85 trillion RMB yuan 6.87 trillion RMB yuan, respectively. The direct and societal benefit-cost ratios (BCRs) were 77.21 and 145.29, respectively. Conclusion: The strategies of HepB vaccination for HBV PMTCT prevention were cost-effective in China during 1992-2019.

[Analysis on hepatitis B cases reported from surveillance points in China, 2019].

Objective: To understand the characteristics of hepatitis B cases reported through the National Notifiable Disease Reported System (NNDRS) of China in 2019, analyze the quality of hepatitis B reporting. Methods: The survey forms and reporting cards of hepatitis B cases in 200 surveillance points in China in 2019 were collected from NNDRS, the completeness rate of the reporting card was calculated, and the reported hepatitis B cases were verified based on the diagnostic criteria (WS 299-2008). The clinical types of the cases after verification were compared with the reported ones, the consistency was evaluated with Kappa test. The reasons for the inconsistent clinical types of the cases were analyzed. Results: In 2019, a total of 64 686 hepatitis B cases were reported through NNDRS. Acute, chronic and unclassified hepatitis B cases accounted for 5.8%, 92.4% and 1.8%, respectively. The average age of reported cases was 47 (47±15) years, and males accounted for 64.4%. The average level of alanine aminotransferase was 214.2 (214.2±1 253.4) U/L. The reported cases mainly worked in agriculture, forestry, animal husbandry, fishery, and water conservancy (50.6%, 32 722). The proportions of cases reported from the eastern, western and central regions were 42.5% (27 501),22.1% (14 315) and 35.4% (22 870), respectively. The consistent rate of the clinical types between the reported cases and the verified cases was 58.8%, with a Kappa value of 0.15. For the 39 271 cases confirmed as acute and chronic hepatitis B cases in the reporting cards, the consistent rate of the clinical types between the reported cases and the verified cases was 96.9%, with a Kappa value of 0.73. In 94.5% (24 267/25 681) of the cases with inconsistent clinical types, the reporting card information were incomplete. Conclusion: The diagnosis of hepatitis B has been improved in the hepatitis B surveillance in China, but it is necessary to improve the completeness of the reporting cards of hepatitis B cases to NNDRS.

[Antibodies persistence after revaccination with three doses of hepatitis B vaccine in non-responsive adults: results from 8-year follow-up study].

Objective: To evaluate the persistence of HBsAg-specific antibodies eight years after revaccination with hepatitis B vaccine (HepB) among adults who were non-responsive to primary immunization. Methods: From August to September 2009, rural communities in Zhangqiu district of Ji'nan city were selected as the study site. The subject's inclusion criteria were 18 to 49 years old, local resident population, without HBV infection history and HepB vaccination history, and good health status. Antibodies against hepatitis B surface antigen (anti-HBs) were detected in adults following the standard primary vaccination. Those who were non-responders (anti-HBs titer <10 mIU/ml) were revaccinated with three doses of HepB and included in the study. Blood samples were collected from all of them at one month (T1), two years, four years, and eight years after revaccination. The three indexes of anti-HBs, hepatitis B surface antigen (HBsAg), together with antibody against hepatitis B core antigen (anti-HBc), were measured by chemiluminescence microparticle immunoassay (CMIA). Results: The proportion of subjects with anti-HBs titers ≥10 mIU/ml was 85.12% (549/645) at T1, 60.60% (283/467) at two years, 55.90% (199/356) at four years and 55.09% (222/403) at eight years after revaccination. The first two years' annual decline rates, three to four years and five to eight years, were 15.62%, 3.96%, and 0.36%. The GMC of anti-HBs was 153.92 mIU/ml at T1, 21.43 mIU/ml at two years, 15.02 mIU/ml at four years, and 13.68 mIU/ml at eight years. In the first two years, three to four years and five to eight years, the annual decline rate of GMC was 62.69%,16.28%, and 2.31%, respectively. Multivariable analysis showed that the titer of anti-HBs at T1 was independently associated with the persistence of anti-HBs at eight years after revaccination. Compared with anti-HBs titer <100 mIU/ml , those whose anti-HBs titers were 100-mIU/ml and ≥1 000 mIU/ml at T1 had a higher positive rate of anti-HBs (OR=14.13, P<0.001; OR= 62.91, P<0.001) and a higher probability of anti-HBs titer (ß=1.88, P<0.001; ß=3.24, P<0.001) at 8 years after revaccination. Nobody was found seroconversion of HBsAg, and the anti-HBc positive rate was 14.14% (57/403). Conclusions: Following revaccination with three doses of HepB in adults who were non-responsive to primary immunization, anti-HBs titers declined rapidly within the first four years. They then maintained a stable level after the fifth year. More than half still kept anti-HBs protective titer at eight years after revaccination. The immunity persistence was associated with anti-HBs titer at one month after revaccination.

[Current situation and suggestions of public health personnel training in disease control and prevention institutions].

Under the background that the national health has become the national priority development strategy, it is essential to speed up public health ability among talents. Based on the consulting project of the Chinese Academy of Engineering, "Research on the training strategy of medical and health personnel in China", this paper analyzes the current situation and existing problems of public health personnel training in disease control and prevention institutions. Based on three stages of public health education, this paper puts forward that the public health personnel training should first solve the problem of public health personnel team construction and create programs on college education-post graduate education-continuing education. Through the personnel training system, different training modes are designed for other groups of people to improve the ability of public health personnel in an all-around way.

[Spatio-temporal clustering of hepatitis A in Gansu provice, 2004-2018].

Objective: To understand the characteristics of spatiotemporal clustering on hepatitis A in Gansu province and to provide evidence for hepatitis A prevention and control. Methods: Data related to hepatitis A were retrieved from National Notifiable Disease Report System, ArcGIS 10.3 and SaTScan 9.1 in Gansu province from 2004 to 2018. Results: The annual average report incidence rate of hepatitis A was 10.91/100 000, showing a descending trend with no periodic or seasonal features. After the implementation of national expanded immunization program, high annual incidence rates had been seen in Linxia Hui autonomous prefecture and Gannan Tibetan autonomous prefecture. From 2004 to 2012, the lowest RR value appeared in the 0-9 age group (P=0.000) while the highest RR value was in the over 60 age group during 2013-2018 except for the age 0-9 group in 2015. The annual average incidence rate was increasing from south to north and west to east, across the territory. Results from the temporal scanning program revealed that the incidence of hepatitis A was temporally aggregated from 2004 to 2018. For spatio-temporal scanning of 2004-2008, data showed one most likely cluster area (radius: 91.95 km, Time frame: 2004-2005), apparel mainly in Linxia and Longnan cities. Results from the spatio-temporal scanning program of 2009-2018 also showed that the most likely cluster areas (radius: 183.26 km, Time frame: 2009-2012) were in Gannan, Linxia, Dingxi and Longnan areas. Conclusions: The reported incidence rates of hepatitis A were declining, without significant periodic or seasonal pattern in Gansu province from 2004 to 2018. In the 0-9 years-old group, the incidence rate showed the lowest, while the highest was in the 60 year-olds group. Spatio-temporal clustering of hepatitis A was observed in Gansu province from 2004 to 2018. Strategies on prevention and control of the disease should be targeted in the southwest regions of the province.

Plant protein diet-induced hypoimmunity by affecting the spiral valve intestinal microbiota and bile acid enterohepatic circulation in Amur sturgeon (Acipenser schrenckii).

An 8-week growth trial was conducted to study enterohepatic recirculation of bile acid metabolism and the intestinal microbiota of Amur sturgeon (Acipenser schrenckii) fed with three diets, including 540 g/kg, 270 g/kg or 0 g/kg fishmeal, which was correspondingly replaced by a plant protein blend (named P0, P50 and P100, respectively). The diets were designed to be isonitrogenous, isoenergetic and essential nutrients balanced. With rising levels of dietary plant protein, disruption of the spiral valve intestinal microbiota and more morbidity with liver disease were observed in the P100 group, although there were no haematological abnormalities observed. An obvious bile acids enterohepatic circulation disorder was found with phenotypes of increased liver bile acids compensatory synthesis, and reduced expression of bile acid receptors (FXR and TGR5), which induced BA accumulative toxicity. Accompanied by increased oxidative stress, it further induced hepatic lesions and hypoimmunity, which were non-negligible reasons for the high mortality and low utilization ability of plant protein by Amur sturgeon.

[A prospective cohort study on blood pressure control and risk of ischemic stroke in patients with hypertension].

Objective: To explore the association between blood pressure control and risk of ischemic stroke (IS) in patients with hypertension. Methods: A total of 5 488 patients with hypertension from 60 communities were randomly selected from 101 communities in 8 streets of Nanshan District in Shenzhen City by using two-stage sampling method. The social demographic characteristics, behavior and life style, coronary heart disease and diabetes were collected and the physical condition, blood pressure and blood biochemical indexes were measured. From April 1, 2010 to August 31, 2017 as the follow-up period, the incidence of IS was annually collected by using telephone survey. Cox proportional hazard regression model was used to analyze the relationship between blood pressure control, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the risk of IS. Results: The age of all patients was (58.50±12.14) years old, including 2 712 males (49.42%) and 3 112 patients with well-controlled blood pressure (56.71%). During the follow-up period, 358 new cases of IS were confirmed, and the incidence density was 1 346.27/100 000 person-years. Cox proportional hazard regression model analysis showed after adjusting for confounding factors, unstable blood pressure control, SBP≥150 mmHg (1 mmHg=0.133 kPa; compared with SBP<120 mmHg), and DBP≥95 mmHg (compared with DBP<80 mmHg) were associated with risk of IS. The HR (95%CI) was 1.29 (1.04, 1.59), 2.00 (1.26, 3.17) and 1.52 (1.01, 2.64), respectively. Subgroup analyses showed these associations only existed in female patients with hypertension. The HR (95%CI) was 1.39 (1.05, 1.85), 2.53 (1.41, 4.56) and 1.73 (1.00, 3.36), respectively. Conclusion: Unstable blood pressure control increases the risk of IS in female patients with hypertension.

[Sero-epidemiological characteristics of hepatitis E in population aged 1-29 years in China, 2014].

Objective: To analyze the epidemiological characteristics of hepatitis E Virus antibody (anti-HEV) in people aged 1-29 years in China in 2014. Methods: Based on database of the national serologic survey of hepatitis B in people aged 1-29 years in China, in 2014, the sample size was estimated. The serum samples of the people surveyed were randomly selected to detect anti-HEV IgG by using enzyme- linked immunosorbent assay (ELISA). Statistical software SAS 9.1.3 was used to calculate the positive rate of anti-HEV and 95% confidence interval (CI) in different age, gender groups, urban and rural areas and geographic areas by using the Taylor series linear method with sampling weight. The difference was determined by comparing 95%CI. Results: A total of 14 106 serum samples were detected from people aged 1-29 years, including 6 996 males (49.60%), 7 013 urban residents (49.72%). The positive rate of anti-HEV was 8.12%(95%CI: 7.19-9.15) in people aged 1-29 years. There was no statistical difference between the men and women, between urban area and rural area. The positive rates of anti-HEV in western area(11.36%, 95%CI: 9.45-13.62) was higher than those in eastern and central areas. The positive rates of anti-HEV were 2.46%, 2.24%, 4.50%, 7.58%, 11.89% and 17.27% in people aged 1-, 5-, 10-, 15-, 20- and 25-29 years, respectively. As the age increased, the positive rate of anti-HEV gradually increased. In different ethnic groups, the positive rate of anti-HEV was higher in Tibetan (18.32%, 95%CI: 12.02-26.90), Zhuang (9.54%, 95%CI: 4.33-19.73) ethnic groups. Conclusion: The positive rate of anti-HEV declined slightly in China in 2014. It is still necessary to pay close attention to the HEV infection, morbidity of hepatitis E and risk factors in people aged 1-29 years.