Detecting spatial-temporal cluster of hand foot and mouth disease in Beijing, China, 2009-2014.

BACKGROUND: The incidence of hand, foot, and mouth disease (HFMD) is extremely high, and has constituted a huge disease burden throughout Beijing in recent years. This study aimed to determine the spatiotemporal distribution and epidemic characteristics of HFMD. METHODS: Descriptive statistics was used to analyze the data and estimate the epidemic peaks in 2009-2014. Space-time scanning detected spatiotemporal clusters and identified high-risk locations. Global and local Moran's I statistics were used to measure the spatial autocorrelation. Geocoding was performed in ArcGIS, based on the present address codes of the patients and the centroids of the towns. Maps were created in ArcGIS to show the geographic spread of HFMD. RESULTS: In total, 220,451probable cases of HFMD were reported in Beijing between January 2009 and December 2014: 12,749 (5.78 %) were laboratory confirmed, and 35 (0.02 %) were fatal. The median age of reported cases was 3.12 years (interquartile range 1.96-4.39). Coxsackievirus A16 (CV-A16), enterovirus 71 (EV-A71), and other enteroviruses accounted for 39.31, 35.36, and 25.33 % of the 12,749 confirmed cases, respectively. Many more severe cases were caused by EV-A71 (χ (2) = 186.41, df = 1, P < 0.001) and other enteroviruses (χ (2) = 156.44, df = 1, P < 0.001) than by CV-A16. A large single distinct peak occurred between May and July each year. Spatiotemporal clusters of HFMD were identified in Beijing during 2009-2014. The most likely clusters were detected and tended to move from the southwest (Fengtai and Daxing) southeastwards to Daxing and Tongzhou in 2009-2014. The incidence of HFMD was not randomly distributed, but showed global and local spatial autocorrelations. CONCLUSIONS: There were obvious spatiotemporal clusters of HFMD in Beijing in 2009-2014. High-incidence areas mainly occurred at the junctions of urban and rural zones. More attention should be paid to the epidemiological and spatiotemporal characteristics of HFMD to establish new strategies for its control. Health issues should be especially promoted in kindergartens and at urban-rural junctions.

Human calicivirus occurrence among outpatients with diarrhea in Beijing, China, between April 2011 and March 2013.

Human caliciviruses (HuCVs), including noroviruses (NoVs) and sapoviruses (SaVs), are the most common cause of diarrhea in adults and the second most common cause of diarrhea in children. Between April 2011 and March 2013, 3,832 fecal specimens were collected from outpatients with diarrhea from 17 hospitals in Beijing, China, and 669 specimens (17.5%) were positive for HuCV. Of the 287 HuCV-positive specimens, 263 (91.6%) were identified to be NoV, 23 (8.0%) were identified to be SaV, and one (0.3%) was identified to be a mixed infection of NoV and SaV. Of the 263 NoV-positive specimens, 237 (90.1%) were NoV GII, 21 (8.0%) were NoV GI, and 5 (1.9%) were a combination of NoV GI and GII. Among the 216 sequenced GII-positive samples, GII.4 was the most common genotype (70.4%, 152/216), followed by GII.13 (9.3%, 20/216). GII.4 Sydney_2012 was first detected in August 2012 and replaced GII.4 Den Haag_2006b as the predominant variant between September 2012 and March 2013. With the emergence of the GII.4 Sydney_2012 variant, 44.6% more patients with diarrhea visited the 17 hospitals (9,931 cases) than in the previous year (6,866 cases) between October and December 2012.

Estimating the number of hand, foot and mouth disease amongst children aged under-five in Beijing during 2012, based on a telephone survey of healthcare seeking behavior.

BACKGROUND: Over the last decade, increases in the number of outbreaks of hand, foot and mouth disease (HFMD) have shifted the disease into the public health spotlight in China. Children under the age of five years are particularly susceptible, with fatalities recorded. However, estimating the burden of HFMD has been difficult to conduct to date. METHODS: In 2012, a cross-sectional survey of healthcare-seeking behaviour for HFMD was undertaken, using computer assisted telephone interviewing (CATI) technology. Sample of telephone numbers was obtained from the Beijing Immunization Information System. Respondents were parents or guardians of children under the age of five. Multiplier model was used to estimate the number of HFMD case, following the telephone survey of healthcare-seeking behavior. The number of laboratory-confirmed cases was also estimated based on the monthly positive rate of each subtype of virus causing HFMD. The age-specific case fatality rate (CFR) was calculated based on the ratio of reported deaths to the estimated number of cases. RESULTS: For children under five, the consultation rate of parent-defined cases was estimated at 77.8% ((95% CI = [75.2, 80.4]). Parents or legal guardians of children aged between two and four years were more likely to seek healthcare than those of children aged less than two years. For children under the age of five, we estimated that there were 40,165 (95% CI = [38,471, 41,974]) HFMD cases, with an incidence rate of 5.6%, and 22,166 (95% CI = [21,150, 23,295]) laboratory-confirmed cases in Beijing during 2012. The overall CFR was estimated at 10 deaths per 100,000 cases, while for children aged less than two years it was 15.6 deaths per 100,000 cases. CONCLUSIONS: Given the public health impact of HFMD in China, control measures need to be prioritized for children < 2 years, due to the higher CFR in this age group. Sentinel surveillance approaches could be used to monitor trends and the impact of control measures.

Efficacy of Chemoimmunotherapy versus Chemotherapy for Gastric Cancer: A Meta-Analysis of Survival Outcomes.

BACKGROUND: Gastric cancer has been traditionally treated with chemotherapy as the primary mode of treatment. However, recent studies have shown that chemoimmunotherapy is also effective and, in some cases, better than chemotherapy treatment. Current study aimed to find the efficacy of chemoimmunotherapy versus chemotherapy in the treatment of gastric cancer. METHODS: Using electronic databases, including PubMed, Embase, and EBSCO, a thorough literature search was carried out for the years 2006 to 2023. The search strategy was designed to identify relevant studies based on chemoimmunotherapy and chemotherapy intervention, and the search was conducted using appropriate keywords and MeSH terms. The retrieved studies were screened for relevance based on their titles, abstracts, and full texts. The studies' inclusion criteria were predefined, and the selected studies were then subjected to a quality assessment using GradePro GDT. The data from selected studies were extracted and analyzed using Revman version 5.4. RESULTS: The study found that chemoimmunotherapy treatment resulted in a significant improvement in overall survival (OS) with a risk ratio (RR) of 1.54 and a 95% Confidence Interval (CI) of 1.25 to 1.89. The overall effect was also found to be significant, with a p-value of less than 0.001. Furthermore, we also observed an improvement in the 1-year, 3-year, and 5-year survival rates with risk ratio (RR) of 1.09 (95% CI: 1.01, 1.17), 1.43 (95% CI: 1.28, 1.60), and 1.59 (95% CI: 1.10, 2.30), respectively. In addition, it's also found that chemoimmunotherapy treatment also resulted in an improvement in DFS with an RR of 1.94 and a 95% CI of 1.44 to 2.59. Overall, these results suggest that chemoimmunotherapy treatment can be an effective approach in comparison to chemotherapy for improving overall survival and disease-free survival in the studied population. CONCLUSION: This study comparing chemoimmunotherapy versus chemotherapy for gastric cancer showed that both treatments were effective, but chemoimmunotherapy had more significant efficacy. To support these results, additional studies with a large sample size and a longer follow-up time are required.

Excretion of enterovirus 71 in persons infected with hand, foot and mouth disease.

BACKGROUND: Hand, foot and mouth disease (HFMD) is a common illness in young children. It also can be seen in adults occasionally. Enterovirus 71 (EV71), a pathogen that causes not only HFMD but also neurological complications and even death, has caused many HFMD outbreaks in China. However, till now the data about the duration of EV71 shedding is very limited. RESULTS: A total of 136 throat swabs and fecal samples were collected from 27 children and 3 adults, which includs 7 close contacts, 9 mild cases and 14 severe cases,. The participants were divided into three groups namely, severe case group, mild case group and close contact group. All the samples were assayed with real-time polymerase chain reaction (PCR). Kruskal-Wallis Test was employed to compare the difference in duration of viral RNA shedding among three groups. The results showed that significant difference in duration of EV71 shedding was found among three groups (P < 0.01). The longest duration of EV71 shedding in fecal samples is 54 days and 30 days in throat swabs. CONCLUSIONS: HFMD is characterized by extended excretion of EV71. Our results suggest that the duration of EV71 shedding is correlated with the severity of the disease. EV71 shedding through feces can persist more than 54 days. Prolonged virus shedding is a potential risk factor of proliferating HFMD epidemic.

[Multilocus variable-number tandem-repeat analysis for molecular subtypes of Shigella isolates in Beijing].

OBJECTIVE: Selecting variable-number tandem-repeat (VNTR) loci for different serogroups of Shigella spp to explore and establish multilocus variable-number tandem-repeat analysis (MLVA) method, in order to study the molecular characteristic of the isolated strains. METHODS: Of the Shigella strains found by dysentery surveillance in Beijing from 2001 to 2009, 180 strains were selected for this study, according to the number and serotypes of the surveillant strains, at the ratio of 15%; including 50 strains of Shigella sonnei and 130 strains of Shigella flexneri. After screening the polymorphism of the 18 VNTR loci, 10 VNTR loci (sh1-sh10) were retained and constructed three groups of multi-PCR methods to detect all he 180 strains and analyze MLVA molecular subtypes using capillary segments. RESULTS: A range of 2 to 11 alleles were found on the 10 VNTR loci among the 180 Shigella strains, with a diversity index value between 0.158 and 0.766. The 10 loci showed diversity in different serogroups, such as only one allele found in sh6 of Shigella flexneri, sh2 and sh3 of Shigella sonnei individually. The isolated 180 strains were divided into 84 MLVA subtypes, with a resolution ratio D value at 0.967 (95%CI: 0.956 - 0.978). The 130 strains of Shigella flexneri were divided into 63 subtypes, named as TF001-TF063; among which TF001, TF002 and TF 005 were the dominant subtypes, accounting to 17, 16 and 15 strains respectively. The 50 strains of Shigella sonnei were divided into 21 subtypes, named as TS001-TS021; among which TS002 (14 strains) and TS001 (7 strains) were the dominant subtypes. CONCLUSION: MLVA subtyping method including 10 VNTR loci was preliminarily developed. The MLVA cluster analysis revealed that the subtypes of Shigella strains isolated in Beijing were diverse, and suggested the possibility of multiple-clone source.

[Etiological surveillance and analysis of infectious diarrhea in Beijing in year 2010].

OBJECTIVE: To explore the pathogenic form, epidemic features and serotype distribution of the pathogenic bacteria causing infectious diarrhea in Beijing. METHODS: A total of 2118 samples of rectal swabs and stool specimens of diarrheal patients were collected from 6 surveillant intestinal tract clinics during the period between April and October, 2010. Enteric multiple pathogens including Vibrio cholerae, Vibrio parahaemolyticus, Salmonella, Shigella and diarrheagenic Escherichia coli were detected by the isolation culture, biochemical identification and serotyping methods. The population distribution, temporal distribution and serotype distribution of the above pathogenic bacteria were analyzed by descriptive statistical methods. RESULTS: 478 strains isolated from the total 2118 specimens were positive for pathogen detection, accounting to 22.6%. Among the 478 strains of pathogenic bacteria, Shigella accounting for 40.8% (195/478) was the most frequent pathogen, followed by Vibrio parahaemolyticus accouting for 23.8% (114/478), Salmonella accounting for 19.0% (91/478) and diarrheagenic Escherichia coli accounting for 4.8% (23/478). Enteric pathogenic bacteria spread mainly among adults aging between 20 and 39; and the distribution was different among different age groups, while the highest detected rate was in 30 - 39 age group, accounting for 27.2% (92/338). The detected rate of pathogenic bacteria showed evident seasonal variations, with a peak from July to October, whose detected rates were 23.5% (114/486), 32.8% (176/536), 36.1% (90/249) and 25.9% (29/112) respectively. The detected rates in other months were all under 16.0%. Shigella Sonnei was the dominant serotype, accounting for 83.1% (162/195). O3:K6 was the dominant serotype among Vibrio parahaemolyticus, accounting for 63.2% (72/114). Salmonella Enteritidis and Salmonella Typhimurium were dominant serotypes among Salmonella, accounting for 13.2% (12/91) and 12.1% (11/91) separately. Enterpathogenic Escherichia coli and enterotoxigenic Escherichia coli were the dominant serotypes among Diarrheagenic Escherichia coli, accounting for 69.6% (16/23) and 30.4% (7/23) respectively. CONCLUSION: The three main pathogenic bacteria causing infectious diarrhea in Beijing are Shigella, Vibrio parahaemolyticus, Salmonella; and there are obvious changes in the serotype distribution of Shigella and Samonella compared to previous years.

The first imported case of Rift Valley fever in China reveals a genetic reassortment of different viral lineages.

We report the first imported case of Rift Valley fever (RVF) in China. The patient returned from Angola, a non-epidemic country, with an infection of a new reassortant from different lineages of Rift Valley fever viruses (RVFVs). The patient developed multiorgan dysfunction and gradually recovered with continuous renal replacement therapy and a short regimen of methylprednisolone treatment. The disordered cytokines and chemokines in the plasma of the patient revealed hypercytokinemia, but the levels of protective cytokines were low upon admission and fluctuated as the disease improved. Whole-genome sequencing and phylogenetic analysis revealed that the imported strain was a reassortant comprising the L and M genes from lineage E and the S gene from lineage A. This case highlights that RVFV had undergone genetic reassortment, which could potentially alter its biological properties, cause large outbreaks and pose a serious threat to global public health as well as the livestock breeding industry.

[Epidemiological and clinical features of norovirus infection among diarrhea patients from the enteric clinics in Beijing, 2013-2014].

OBJECTIVE: To investigate the epidemiological and clinical characteristics of norovirus infection on diarrhea patients from the enteric clinics in Beijing. METHODS: From April 2013 to March 2014, 1 892 fecal specimens and related epidemiological information were collected among diarrhea patients visiting the enteric clinics in Beijing. Norovirus was detected by real time RT-PCR, and data was analyzed under the descriptive epidemiological method. RESULTS: A total of 269 positive cases were found among 1 892 diarrhea patients, with a positive rate as 14.2%. Norovirus caused diarrhea mainly occurred in seasons with lower temperature. Higher positive rates of norovirus were found in northwest mountainous area. Norovirus diarrhea was more commonly seen in children between 6 month and 5 years old, with differences between the two groups statistically significant (P = 0.006). Compared with other occupation, a higher infection rate was identified in children, with differences between the two groups statistically significant (P = 0.025). Nausea and vomiting appeared more common in diarrhea patients with norovirus infection, with differences between the two groups statistically significant (P < 0.05). CONCLUSION: Norovirus was an important pathogen which causing diarrhea in patients visiting the enteric clinics in Beijing. The virus was seen more in patients aged between 6 months and 5 years old. Nausea and vomiting were the common symptoms seen in patients with norovirus diarrhea.

Etiology of acute conjunctivitis due to coxsackievirus A24 variant, human adenovirus, herpes simplex virus, and Chlamydia in Beijing, China.

Acute conjunctivitis is a common disease associated with high morbidity and economic burden. To clarify the etiological characteristics of acute conjunctivitis in Beijing, surveillance of acute conjunctivitis was conducted from July to October during 2007-2012 by collecting eye swabs from patients treated at surveillance hospitals affiliated with a surveillance program of 18 districts Center for Disease Prevention and Control in Beijing. Coxsackievirus A24 variant (CA24v), enterovirus 70 (EV70), human adenovirus (HAdV), herpes simplex virus (HSV), and chlamydia were identified by PCR. Phylogenetic analysis of the VP1 region of CA24v was conducted. Comparisons of proportions and statistical significance were performed using the chi-square test. HAdV was found to be the most prevalent pathogen, followed by CA24v, chlamydia, and HSV. Significant differences in the symptoms of ocular pain, photophobia, and epiphora were identified among the 4 agents. The prevalence of HAdV- and CA24v-mediated conjunctivitis peaked in July or August and September or October, respectively. Nucleotide sequences of the VP1 regions among the isolated CA24v strains shared 92.8%-100% homology. In conclusion, HAdV followed by CA24v, chlamydia, and HSV were the most common causative agents of acute conjunctivitis in Beijing. Comprehensive, continuous surveillance and advanced laboratory techniques are needed for further studies.

An eight-year study of Shigella species in Beijing, China: serodiversity, virulence genes, and antimicrobial resistance.

INTRODUCTION: This study was conducted to determine the prevalence of serotypes, virulence factors, and antimicrobial resistance patterns of Shigella spp. in Beijing, China, from 2004 to 2011. METHODOLOGY: Real-time PCR assays were used to detect virulent genes, and the Kirby-Bauer disk diffusion method was used to evaluate antimicrobial resistance. RESULTS: Among the total of 1,652 Shigella isolates, S. sonnei (57.1%) was the predominant species, followed by S. flexneri (42.3%), S. dysenteriae (0.4%), and S. boydii (0.2%). Nineteen serotypes were discovered among S. flexneri strains. The virulence gene ipaH was the most frequent, followed by sen and set. The presence of set showed significant difference in two dominant serogroups, S. flexneri and S. sonnei. Over 90% of Shigella isolates showed resistance to at least three drugs with widened spectrum. High-level antimicrobial resistance to single and multiple antibiotics was more common among S. sonnei than S. flexneri. CONCLUSION: There was an obvious serotype change and a dramatic increase of antibiotic resistance in Shigella prevalence in Beijing.

Etiology of acute diarrhea due to enteropathogenic bacteria in Beijing, China.

OBJECTIVES: Acute diarrhea is of great concern due to considerable morbidity and mortality worldwide. The causative bacteria leading to acute diarrhea in general population remains unclear in China. This study was conducted to determine the etiology of acute diarrhea using a sentinel hospital-based surveillance network in Beijing. METHODS: Active surveillance was implemented from April 2010 to December 2011 on two random days per week by enrolling every tenth diarrheal patients admitted to seventeen intestinal clinics. Shigella spp., Vibrio spp, Salmonella spp., diarrheagenic Escherichia coli and other genera of bacteria, were investigated from 4803 outpatients with acute diarrhea by microbiological methods. RESULTS: The pathogenic bacteria recovered out from fecal samples of 968 (20.2%) patients had the following profile: Shigella spp. (5.9%) was the most prevalent pathogen, Vibrio parahaemolyticus (5.2%), Salmonella spp. (3.9%) and enteropathogenic E. coli (EPEC) (0.9%) had from the second to fourth highest prevalence, respectively. Of the 55 co-infections detected, V. parahaemolyticus was the most common pathogen from 28 cases (50.9%), with the main combination of V. parahaemolyticus and Salmonella. The highest proportion of all causative bacteria was found in adults aged 20-39 year and in summer as well as early autumn. The clinical symptoms associated with specific bacterial infection, such as fever, abdominal pain, tenesmus, nausea, vomiting, and watery and bloody stool, were observed frequently in diarrheal patients. CONCLUSION: Shigella spp., V. parahaemolyticus, Salmonella spp., and EPEC are important enteropathogenic bacteria causing acute diarrhea in Beijing. To execute reasonable interventions, the comprehensive and continuous surveillance is needed to identify the prevalence of different enteropathogeic bacteria.

Epidemiological characteristics of public health emergencies of infectious diseases in schools of Beijing from 2010 to 2020 / 中国学校卫生

Objective@#To analyze the epidemiological characteristics of infectious diseases at schools in Beijing from 2010 to 2020, providing evidence for the prevention and control strategies in school infectious diseases.@*Methods@#Information on public health emergencies was collected from Public Health Emergency Reporting System (the subsystem of Chinese Disease Prevention and Control Information System) reported from 2010 to 2020.@*Results@#A total of 146 public health emergencies and 138 public health emergencies of infectious diseases in schools were reported in Beijing from 2010 to 2020, including 4 291 cases with the rate of 2.32% and affected or exposed 185 179 cases. There were significant difference in mean annual incidence rates( χ 2=782.46, P <0.01). There were 71 events of respiratory infectious diseases and 66 events of intestinal infectious diseases, accounting for 51.45% and 47.83%, respectively. The annual incidence peaks of public health emergencies of infectious diseases were during March-June and October-December. The events mainly occurred in kindergartens and primary schools among each stage of school periods with 51 and 46 incidences respectively, which accounted for 70.29% of the total number of public health emergencies in schools. The leading infectious diseases among all the reported events in kindergartens and primary schools were hand foot mouth disease and varicella. Varicella and other infectious diarrhoeal diseases were at the top lists of infectious disease outbreaks at the secondary and university stages.@*Conclusion@#Infectious diseases events were the major type of public health emergencies at schools in Beijing from 2010 to 2020. Respiratory infectious diseases and intestinal infectious diseases were the keys to the prevention and control of public health emergencies related to school. It is necessary to strengthen the surveillance for public health emergencies especially for symptom surveillance. The prevention and control measures should be taken according to the characteristics of different age groups. At the same time, the prevention and control of school infectious diseases and the drill of the plan during peak periods need to be particularly strengthened.

[Analysis on the etiological and molecular epidemiological characteristics of Vibrio parahaemolyticus in Beijing].

OBJECTIVE: To understand the etiological and molecular-epidemiological characteristics of Vibrio parahaemolyticus in Beijing. METHODS: Stool specimens from sporadic diarrheal patients were collected during April to December, 2010. Culture and serotyping were used to detect the Vibrio parahaemolyticus from the 2118 specimens. All the positive strains were tested for drug sensitivity by Kirby-Bauer method. Real-time PCR was used to detect the existence of three virulence genes tlh, tdh and trh. Molecular typing on Vibrio parahaemolyticus isolates was completed by pulsed field gel electrophoresis (PFGE). RESULTS: 114 out of the 2118 specimens were Vibrio parahaemolyticus positive, with the positive rate as 5.38%. 114 isolates belonged to 23 serotypes, with the dominant (63.16%) serotype as O3:K6. Strains isolated from clinical manifestation patients were resistant to antibiotics-ampicillin and gentamicin, while with high sensitivity to amoxicillin, ceftriaxone, chloromycetin, imipenem, nalidixic acid and tetracycline. Virulence gene detection was positive to tlh for all the strains, but most to tdh, while only one strain to trh. The positive rate of tdh among O3:K6 strains (98.61%) was higher than that in those non-O3:K6 strains (85.71%) (P = 0.0098). 114 isolates were discriminated into 54 different PFGE patterns, while 72 O3:K6 strains into 34 patterns without the clustering characteristic. CONCLUSION: Vibrio parahaemolyticus strains isolated from diarrheal patients in Beijing were dominated by O3:K6 strains, with stronger virulence. The positive rates of genes tlh and tdh were high. Vibrio parahaemolyticus strains showed high sensitivity to most antibiotics. The prevalent Vibrio parahaemolyticus strains in Beijing had various sources of clones.

[Etiology of hand-foot-and-mouth disease and genetic characteristics of Coxsackievirus A16 in Beijing, 2009].

This study aimed to reveal the pathogen spectrum of hand-foot-and-mouth disease (HFMD) and genetic characteristics of Coxsackievirus A16 (CoxA16) isolates in Beijing in 2009. From 1044 clinical specimens collected from 975 HFMD cases at Beijing Pediatrics Hospital, Beijing You'an Hospital and Beijing Ditan Hospital in 2009, viral nucleic acids of enterovirus were detected by reverse transcriptase polymerase chain reaction (RT-PCR). Enterovirus isolations were conducted with rhabdomyosarcoma (RD) cell line on 200 throat swabs having positive RT-PCR results. Sequencing and analyses of VP1 encoding gene were performed on 9 CoxA16 isolates in this study. The results showed that CoxA16 (49.4%) and EV71 (36.4%) were the major pathogens for the epidemics of HFMD in 2009 in Beijing, and CoxA16 was the predominant serotype, while there were also other enterovirus co-circulating, such as CoxA4, CoxA10, and CoxA9; the CoxA16 strains prevalent in Beijing in 2009 belonged to subgenotype B1a and B1b.

[Logistic analysis on risk factors related to smear positive pulmonary tuberculosis].

OBJECTIVE: To explore the risk factors on relapsing tuberculosis related to smear positive pulmonary tuberculosis which had been cured for five years. METHODS: Patients with smear positive pulmonary tuberculosis registered in 1995 from ten countries in Hubei province were studied and logistic regression was used for data analysis. RESULTS: The 5-year relapse rate of smear positive pulmonary tuberculosis was 3.85 percent. Risk factors related to relapse would include being non-modeled county, negative smear after treated for three months, the class of retreatment, management of non-DOTS, method of chemotherapy and patients that did not get treated by the tuberculosis institute, with odds ratios of 0.15, 4.62, 3.68, 5.88 and 6.47, respectively. CONCLUSION: Effect standard, regulation DOTS and the centralized management measure might have had effects on decreasing the relapse rate.