New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020.

Background: Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the first time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys. Methods: Consistent with previous national surveys, the 2020 survey used a stratified, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease Control and Prevention of China CDC. HBsAg positive subjects aged ≥15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals. Findings: HBsAg prevalence in 1-69-year-olds was 5.86%; in children 1-4 years of age, seroprevalence was 0.30%; 75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware; 38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals. Interpretation: The decline in HBsAg prevalence in the general population, from 9.72% in 1992 to 5.86% in 2020, and in 1-4-year-olds from 9.67% in 1992 to 0.30% in 2020, shows progress that continues on track toward WHO targets for prevention of new infections. Implementation of acceptable strategies to identify infected individuals and offer long-term medical monitoring and management will be important to prevent complications from hepatitis B infection and for meeting WHO cascade-of-care targets. Funding: The study was funded by the Major Science and Technology Special Project of China's 13th 5-Year Plan (grant no. 2017ZX10105015); Central finance-operation of public health emergency response mechanism of Chinese Center for Disease Control and Prevention (131031001000200001, 102393220020010000017).

PVP magnetic nanospheres: biocompatibility, in vitro and in vivo bleomycin release.

PURPOSE: To synthesize and characterize a magnetic micromolecular delivery system based on PVP hydrogel with polyvinyl alcohol (PVA) as the crosslinker. METHODS: The microparticles were successfully prepared using 25 kGy Co-60 gamma-ray irradiation and characterized. Biocompatibility, in vitro and in vivo drug release tests were carried out. RESULTS AND DISCUSSION: Bleomycin was quantitatively released with in slightly over 8 h (hours) from the nanospheres containing 1mg bleomycin while the time was longer for those containing 5 mg. On the other hand free bleomycin quantitatively passed through the dialysis baffle with in only 3.5 h. For both 5 and 1 mg of bound bleomycin, it took up to 2 h to reach peak concentration compared to 30 min for the free drug. CONCLUSION: The PVP hydrogel magnetic nanospheres exhibited passive drug release that could be exploited to enhance therapeutic efficacy. The present results indicate that PVP hydrogel based magnetic nanospheres have potential as drug carriers in magnetic guided chemotherapeutic drug delivery.

Spatio-temporal distribution and correlation of reported cases of hepatitis C and HIV/AIDS in China, 2012-2017 / 中华流行病学杂志

Objective To compare the time and spatial distribution of hepatitis C and HIV/AIDS cases and its correlation,in China from 2012 to 2017.Methods Data on reported hepatitis C and HIV/AIDS cases was gathered from the Direct Reporting System of Infectious Diseases Information Network in China,2012 to 2017 while annually collected provincial data was based on the date of review and current address.Correlation of the data was analyzed,using both simple correlation and linear regression methods.Results The number of reported cases of hepatitis C remained stable in China,in 2012-2017,with the number of annual reported cases as 201 622,203 155,202 803,207 897,206 832 and 214 023,respectively.The number of reported cases on HIV/AIDS showed a steady growing trend,from 82 434,90 119,103 501,115 465,124 555 to 134 512.However,the numbers of hepatitis C and HIV/AIDS cases were in the same,top six provinces:Henan,Guangdong,Xinjiang,Guangxi,Hunan and Yunnan.Results from the simple correlation analysis indicated that there was a positive correlation (r＞0.5,P＜0.01) existed between the above-said two kinds of cases at the provincial level in China,in 2012-2017.Again,results from the linear regression analysis also showed that the correlation coefficient r,and year was strongly correlated (r=0.966) while rs had been linearly increasing with time.Conclusions Our data showed that there were temporal and spatial correlations existed between the reported cases of hepatitis C and HIV/AIDS at the provincial level,suggesting that relevant prevention and control programs be carried out in areas with serious epidemics.Combination of the two strategies should be encouraged,especially on prevention and treatment measures related to blood transmission.

Sentinel surveillance for viral hepatitis C in China, 2016-2017 / 中华流行病学杂志

Objective To understand the prevalence of hepatitis C virus (HCV) infection in 5 populations in China during 2016-2017 and provide evidence for the estimation of prevalence trend of hepatitis C and evaluation on the prevention and control effect.Methods A total of 87 national sentinel surveillance sites for hepatitis C were set up in 31 provinces (autonomous regions and municipalities) of China to obtain the information about HCV infection prevalence in 5 populations,including volunteer blood donors,people receiving physical examination,patients receiving invasive diagnosis and treatment,patients receiving hemodialysis,and clients visiting family planning outpatient clinics.From April to June,2016 and 2017,cross-sectional surveys were repeatedly conducted in the 5 populations and blood samples were collected from them for HCV antibody detection.Results In 2016,86 sentinel sites completed the surveillance (one sentinel site was not investigated),and 115 841 persons were surveyed.The overall HCV positive rate was 0.38％ (442/115 841,95％CI:0.23％-0.53％).In 2017,all the 87 sentinel sites completed the surveillance,and 120 486 persons were surveyed.The overall HCV positive rate was 0.37％ (449/120 486,95％CI:0.23％-0.52％).In 2016 and 2017,the anti-HCV positive rates were 4.46％ (223/5 005,95％CI:2.18％-6.73％) and 4.39％ (216/4 919,95％ CI:2.29％-6.50％) respectively in hemodialysis patients,0.85％ (44/5 200,95％ CI:0.27％-1.42％) and 0.70％ (36/5 150,95％ CI:0.15％-1.24％) respectively in patients receiving invasive diagnosis and treatment and remained to be ≤0.25％ in volunteer blood donors,people receiving physical examination and clients visiting family planning outpatient clinics.Results for the comparison of the anti-HCV positive rates in the 5 populations indicated that the differences were significant (F=23.091,P＜0.001 in 2016 and F=20.181,P＜0.001 in 2017).Conclusions Data from the sentinel surveillance of HCV infection on prevalence in China showed that the anti-HCV positive rates varied in the 5 populations during 2016-2017.The anti-HCV positive rate appeared the highest in the hemodialysis patients,followed by that in the patients receiving invasive diagnosis and treatment,and the prevalence of HCV infection in other 3 populations were at low levels.

Spatio-temporal distribution and correlation of reported cases of hepatitis C and HIV/AIDS in China, 2012-2017 / 中华流行病学杂志

Objective: To compare the time and spatial distribution of hepatitis C and HIV/AIDS cases and its correlation, in China from 2012 to 2017. Methods: Data on reported hepatitis C and HIV/AIDS cases was gathered from the Direct Reporting System of Infectious Diseases Information Network in China, 2012 to 2017 while annually collected provincial data was based on the date of review and current address. Correlation of the data was analyzed, using both simple correlation and linear regression methods. Results: The number of reported cases of hepatitis C remained stable in China, in 2012-2017, with the number of annual reported cases as 201 622, 203 155, 202 803, 207 897, 206 832 and 214 023, respectively. The number of reported cases on HIV/AIDS showed a steady growing trend, from 82 434, 90 119, 103 501, 115 465, 124 555 to 134 512. However, the numbers of hepatitis C and HIV/AIDS cases were in the same, top six provinces: Henan, Guangdong, Xinjiang, Guangxi, Hunan and Yunnan. Results from the simple correlation analysis indicated that there was a positive correlation (r>0.5, P<0.01) existed between the above-said two kinds of cases at the provincial level in China, in 2012-2017. Again, results from the linear regression analysis also showed that the correlation coefficient r(s) and year was strongly correlated (r=0.966) while r(s) had been linearly increasing with time. Conclusions: Our data showed that there were temporal and spatial correlations existed between the reported cases of hepatitis C and HIV/AIDS at the provincial level, suggesting that relevant prevention and control programs be carried out in areas with serious epidemics. Combination of the two strategies should be encouraged, especially on prevention and treatment measures related to blood transmission.

Sentinel surveillance for viral hepatitis C in China, 2016-2017 / 中华流行病学杂志

Objective: To understand the prevalence of hepatitis C virus (HCV) infection in 5 populations in China during 2016-2017 and provide evidence for the estimation of prevalence trend of hepatitis C and evaluation on the prevention and control effect. Methods: A total of 87 national sentinel surveillance sites for hepatitis C were set up in 31 provinces (autonomous regions and municipalities) of China to obtain the information about HCV infection prevalence in 5 populations, including volunteer blood donors, people receiving physical examination, patients receiving invasive diagnosis and treatment, patients receiving hemodialysis, and clients visiting family planning outpatient clinics. From April to June, 2016 and 2017, cross-sectional surveys were repeatedly conducted in the 5 populations and blood samples were collected from them for HCV antibody detection. Results: In 2016, 86 sentinel sites completed the surveillance (one sentinel site was not investigated), and 115 841 persons were surveyed. The overall HCV positive rate was 0.38% (442/115 841, 95%CI: 0.23%-0.53%). In 2017, all the 87 sentinel sites completed the surveillance, and 120 486 persons were surveyed. The overall HCV positive rate was 0.37% (449/120 486, 95%CI: 0.23%-0.52%). In 2016 and 2017, the anti-HCV positive rates were 4.46% (223/5 005, 95%CI: 2.18%-6.73%) and 4.39% (216/4 919, 95%CI: 2.29%-6.50%) respectively in hemodialysis patients, 0.85% (44/5 200, 95%CI: 0.27%-1.42%) and 0.70% (36/5 150, 95%CI: 0.15%-1.24%) respectively in patients receiving invasive diagnosis and treatment and remained to be ≤0.25% in volunteer blood donors, people receiving physical examination and clients visiting family planning outpatient clinics. Results for the comparison of the anti-HCV positive rates in the 5 populations indicated that the differences were significant (F=23.091, P<0.001 in 2016 and F=20.181, P<0.001 in 2017). Conclusions: Data from the sentinel surveillance of HCV infection on prevalence in China showed that the anti-HCV positive rates varied in the 5 populations during 2016-2017. The anti-HCV positive rate appeared the highest in the hemodialysis patients, followed by that in the patients receiving invasive diagnosis and treatment, and the prevalence of HCV infection in other 3 populations were at low levels.

Analysis of related factors for primary hepatic carcinoma caused by chronic hepatitis B and hepatitis C / 中华预防医学杂志

Objective@#To explore the related factors for primary hepatic carcinoma (PHC) caused by chronic hepatitis B (CHB) and hepatitis C (CHC).@*Methods@#According to the principle of cross-sectional study, a cluster random sample method was used, a total of 366 chronic hepatitis patients in hospitals were recruited from three provincial tertiary hospitals in Shanxi, Henan and Jilin between July 2016 and October 2016, respectively. Using a self-designed unified questionnaire, face-to-face interviews was conducted on subjects, including sex, age, alcohol consumption, coffee consumption, green tea consumption, fish consumption, smoking, HBV/HCV diagnosis and treatment, diabetes mellitus, family history of PHC (whether PHC in first-degree relatives), etc. Multivariate unconditional logistic regression were performed to identify the related factors for PHC with CHB and CHC. According to the clinical diagnosis the patients were divided into a chronic hepatitis group (not developing to PHC) and a PHC group.@*Results@#Among 366 cases patients, 287 (78.4%) cases were male, 79 cases were female (21.6%), average age was (52.7±9.3) years. 202 cases were chronic hepatitis group, 164 cases were PHC group. Multivariate unconditional logistics regression analysis indicated that alcohol consumption (odds ratio (OR)=2.11, 95%CI: 1.18-3.75), family history of PHC (OR=5.12, 95%CI: 2.60-10.08) were positively correlated with the development of PHC in chronic b, green tea consumption (OR=0.45, 95%CI: 0.23-0.88), antiviral treatment (OR=0.19, 95%CI: 0.11-0.32) were negatively correlated. Alcohol consumption (OR=3.98, 95%CI: 1.14-13.85) was positively correlated with the development of PHC in chronic c, antiviral treatment (OR=0.14, 95%CI: 0.04-0.50) was negatively correlated.@*Conclusion@#Alcohol consumption, family history of PHC, green tea consumption and antiviral treatment were the related factors for the development of PHC in chronic hepatitis b. Alcohol consumption and antiviral treatment were the related factors for the development of PHC in chronic hepatitis c.

Influencing factors for loss to follow-up in a longitudinal study on HIV incidence of female sex workers / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the loss to follow-up (LTF) rate, HIV emerging incidence and influencing factors in the longitudinal study of female sex workers (FSWs) in Kaiyuan, Yunnan, and their influence on HIV emerging incidence estimate.</p><p><b>METHODS</b>The open cohort study on FSWs was launched in March 2006 and ended in June 2013 in Kaiyuan, Yunnan. Investigations were made every six months and lasted for 7 years. 661 FSWs found as HIV negative in the baseline study in March 2006 were chosen to study their LTF in the 7 year follow-up investigation. The Cox regression model was used to explore risk factors for HIV emerging infection and those for LTF. In June 2013, a survey was also conducted to explore the detailed reasons for loss to follow-up by contacting FSWs themselves.</p><p><b>RESULTS</b>During 1 238.5 person-years of follow-up among 661 HIV negative FSWs, the HIV incidence rate was 1.29 (95% CI: 0.74-2.10)/100 person-year, and the LFT incidence rate was 48.68 (95% CI: 44.88-52.73) /100 person-year. The multivariate analysis showed drug abuse as an independent risk factor for FSWs' infection of HIV (adjusted risk ratio = 4.15, 95% CI: 1.43-12.02); FSWs over 25 years old (adjusted risk ratio = 0.68, 95% CI: 0.57-0.81), and drug abuse (adjusted risk ratio = 0.52, 95% CI: 0.35-0.79) were found with lower LFT rate to remain in the cohort.</p><p><b>CONCLUSION</b>High LFT rate was found in FSW cohort study in Kaiyuan, Yunnan, while the HIV infection risk exposure of the LFT group was lower than the groups of HIV follow-up. HIV prevalence of FSWs in the city might be overestimated. Causes of LFT of FSWs group required further study in the future, and the cohort follow-up retention strategy for FSWs needs to be developed.</p>

Estimation and projection of the HIV epidemic trend among the migrant population in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The migrant population is a vulnerable group for HIV infection in China. Understanding potential epidemic trends among migrants is critical for developing HIV preventative measures in this population.</p><p><b>METHODS</b>The Estimation and Projection Package (EPP) model was used to process prefecture and county-level surveillance data to generate HIV prevalence and epidemic trends for migrant populations in China.</p><p><b>RESULTS</b>The prevalence of HIV among migrants in 2009 was estimated at 0.075% (95% CI: 0.042%, 0.108%) in China. The HIV epidemic among migrants is likely to increase over the next 5 years, with the prevalence expected to reach 0.110% (95% CI: 0.070%, 0.150%) by 2015.</p><p><b>CONCLUSION</b>Although the 2009 estimates for the HIV/AIDS epidemic in China indicate a slower rate of increase compared with the national HIV/AIDS epidemic, it is estimated to persistently increase among migrants over the next 5 years. Migrants will have a strong impact on the overall future of the HIV epidemic trend in China and evidence-based prevention and monitoring efforts should be expanded for this vulnerable population.</p>

Current state of and need for general practice training in the communities of 3 cities / 中华医院管理杂志

Objective To find out about the current state of and need for general practice training in communities so as to provide basis for the formulation of relevant training strategies and methods. Methods A qualitative and quantitative investigation was made on the state of and need for general practice training at the community based health services centers or stations in the 3 cities of Chengdu, Shenyang and Shanghai. Results Of the 171 physicians surveyed, 39.8% once received general practice training; of the 162 nursing personnel surveyed, 12.3% once received general practice training; of the 67 preventive healthcare personnel surveyed, 35.8% once received general practice training. While the medical personnel who once received general practice training did not think highly of the training result, they did have high demands for general practice training. Conclusion It is suggested that centers for training general practitioners be established, training of community health services personnel strengthened, and their quality improved.