Emergence, circulation, and spatiotemporal phylogenetic analysis of coxsackievirus a6- and coxsackievirus a10-associated hand, foot, and mouth disease infections from 2008 to 2012 in Shenzhen, China.

Sporadic hand, foot, and mouth disease (HFMD) outbreaks and other infectious diseases in recent years have frequently been associated with certain human enterovirus (HEV) serotypes. This study explored the prevalences and genetic characteristics of non-HEV71 and non-coxsackievirus A16 (CV-A16) human enterovirus-associated HFMD infections in Shenzhen, China. A total of 2,411 clinical stool specimens were collected from hospital-based surveillance for HFMD from 2008 to 2012. The detection of HEV was performed by real-time reverse transcription-PCR (RT-PCR) and RT-seminested PCR, and spatiotemporal phylogenetic analysis was performed based on the VP1 genes. A total of 1,803 (74.8%) strains comprising 28 different serotypes were detected. In the past 5 years, the predominant serotypes were HEV71 (60.0%), followed by CV-A16 (21.2%) and two uncommon serotypes, CV-A6 (13.0%) and CV-A10 (3.3%). However, CV-A6 replaced CV-A16 as the second most common serotype between 2010 and 2012. As an emerging pathogen, CV-A6 became as common a causative agent of HFMD as HEV71 in Shenzhen in 2012. Phylogenetic analysis revealed that little variation occurred in the Chinese HEV71 and CV-A16 strains. The genetic characteristics of the Chinese CV-A6 and CV-A10 strains displayed geographic differences. The CV-A6 and CV-A10 strains circulating in Shenzhen likely originated in Europe. It was found that human enteroviruses have a high mutation rate due to evolutionary pressure and frequent recombination (3.2 × 10(-3) to 6.4 ×10(-3) substitutions per site per year for HEV71, CV-A6, CV-A16, and CV-A10). Since certain serotypes are potential threats to the public health, this study provides further insights into the significance of the epidemiological surveillance of HFMD.

Mortality from road traffic accidents in a rapidly urbanizing Chinese city: A 20-year analysis in Shenzhen, 1994-2013.

OBJECTIVE: This study aimed to describe the trends of motorization and mortality rates from road traffic accidents and examine their associations in a rapidly urbanizing city in China, Shenzhen. METHODS: Using data from the Shenzhen Deaths Registry between 1994 and 2013, we calculated the annual mortality rates of road traffic accidents, in addition to the age- and sex-specific mortality rates and their annual percentage changes (APCs) for the period of 2000-2013. We also examined the associations between mortality rate of road traffic accidents and traffic growth with Spearman's rank correlation analysis and a log-linear model derived from Smeed's law. RESULTS: A total of 20,196 deaths due to road traffic accidents, including 14,391 (71.3%) male deaths and 5,805 (28.7%) female deaths, were recorded in Shenzhen from 1994 to 2013. The annual mortality rates in terms of deaths per population and deaths per vehicle changed in similar patterns, demonstrating an increase since 1994 and peaking in 1997, followed by a steady decrease thereafter. The decrease in mortality was faster in individuals aged 20 year or older compared to those younger than 20 years. The mortality rates in term of deaths per population were positively correlated with the total number of vehicles per kilometer of road but negatively correlated with the motorization rate in term of vehicles per population. The estimated model for deaths due to road traffic accidents in relation to the total population and the number of registered vehicles was ln (deaths/10,000 vehicles) = -1.902 × ln (vehicles/population) - 1.961. The coefficient was statistically significant (P < .001) and the coefficient of determination was 0.966, indicating a good model fit. CONCLUSIONS: We described a generally decreasing trend in the mortality rates of road traffic accidents in a rapidly urbanizing Chinese city based observations in the 20-year period from 1994 to 2013. The decreased mortality rate may be explained by the expansion of road network construction, improved road safety regulations and management, as well as more accessible ambulance services in recent years. Nevertheless, road traffic accidents remain a universal problem of great public health concern in the whole population.

Identification and Whole-Genome Sequencing of Four Enterovirus D68 Strains in Southern China in Late 2015.

Four enterovirus D68 (EV-D68) strains from four children with influenza-like illness were identified in Shenzhen, southern China, in late 2015. Here, we announce the availability of these viral genomes in GenBank. The genomic sequences of these EV-D68 strains showed the closest phylogenetic relationship to strains from northern China.

Epidemiological investigation of a norovirus GII.4 Sydney outbreak in a China elder care facility.

An outbreak of norovirus GII.4/Sydney_2012 affected a China elder care facility in December 2012. A total of 39 elderly people and staff met the outbreak case definition. The attack rates in the elderly and the staff were 15.9% (31/195) and 23.2% (19/82), respectively, including 13 asymptomatic cases in the staff. The result of gene sequencing revealed that the outbreak was caused by norovirus GII.4 Sydney. The mode of transmission of this outbreak was proven to be person-to-person. The first case (a self-cared elder) was affected outside the elder care facility and was not isolated after returning. Norovirus was transmitted via close contact among the self-cared elderly. Then, through service-related close contact, the attendants promoted the cross-transmission between the self-cared elderly and the nursed elderly. The virus was also spread among the staff via daily contact. In the elder care facility, the asymptomatic cases in the attendants played an important role in the transmission of norovirus, which deserves high attention.

Forecasting influenza epidemics from multi-stream surveillance data in a subtropical city of China.

BACKGROUND: Influenza has been associated with heavy burden of mortality and morbidity in subtropical regions. However, timely forecast of influenza epidemic in these regions has been hindered by unclear seasonality of influenza viruses. In this study, we developed a forecasting model by integrating multiple sentinel surveillance data to predict influenza epidemics in a subtropical city Shenzhen, China. METHODS: Dynamic linear models with the predictors of single or multiple surveillance data for influenza-like illness (ILI) were adopted to forecast influenza epidemics from 2006 to 2012 in Shenzhen. Temporal coherence of these surveillance data with laboratory-confirmed influenza cases was evaluated by wavelet analysis and only the coherent data streams were entered into the model. Timeliness, sensitivity and specificity of these models were also evaluated to compare their performance. RESULTS: Both influenza virology data and ILI consultation rates in Shenzhen demonstrated a significant annual seasonal cycle (p<0.05) during the entire study period, with occasional deviations observed in some data streams. The forecasting models that combined multi-stream ILI surveillance data generally outperformed the models with single-stream ILI data, by providing more timely, sensitive and specific alerts. CONCLUSIONS: Forecasting models that combine multiple sentinel surveillance data can be considered to generate timely alerts for influenza epidemics in subtropical regions like Shenzhen.

[Sero-epidemiological investigation on hepatitis B among permanent residents in Shenzhen area].

OBJECTIVE: To understand the infection status and epidemiological features of HBV in permanent residents of Shenzhen city. METHODS: A multi-stage stratified random sampling method was performed for questionnaire survey to permanently-registered residents of 1-59 years old in Luohu and Baoan district of Shenzhen in 2010, and blood samples of the subjects were collected. Hepatitis B virus-related surface antigen (HBsAg) and hepatitis B virus surface antibody (anti-HBs) were detected with ELISA. RESULTS: The total 3771 studied population showed 252 HBsAg positive and 2712 anti-HBs positive residents with the standardization prevalence as 9.73% and 72.83% , respectively. The difference of the prevalence of HBsAg and anti-HBs between males and females were not statistically significant (P > 0.05). The prevalence of HBsAg was reduced with increasing age. The differences of the prevalence of HBsAg between Shenzhen permanent registered and non-permanent registered population were not significant, but the prevalence of anti-HBs in Permanent registered residents (78.32%) was higher than in non-permanent (66.03%, χ(2) = 41.613, P < 0.001). The prevalence of HBsAg was significantly different in various occupational and educational levels. Peasants had the highest prevalence (24.13%) and medical workers had the highest prevalence of anti-HBs (89.10% ). People with junior high school education had the highest prevalence of HBsAg (12.76%) and the lowest of anti-HBs (62.45%). Population with high-level education had the highest prevalence of anti-HBs(81.00% average). The prevalence of HBsAg was over 10% in people who were born in Shenzhen and Guangdong province, and the anti-HBs was the highest in Shenzhen population with the prevalence as 74.48% and 76.47% , respectively. CONCLUSION: In the Shenzhen resident population, the overall prevalence of HBV was lower than the average level of Guangdong province, but higher than the national wide.

[Etiologic and molecular characteristics of Vibrio parahaemolyticus strains isolated from diarrheal patients in Shenzhen, in 2007 - 2008].

OBJECTIVE: To study the infection status and the molecular characteristics of Vibrio parahaemolyticus isolated from diarrheal patients in Shenzhen, in 2007 to 2008 and to provide evidence for the prevention and control of diarrheal diseases caused by Vibrio parahaemolyticus. METHODS: More than 80 fecal specimens from four sentinel surveillance hospitals were collected and cultured each month. A total of 361 isolates of Vibrio parahaemolyticus were sero-typed and examined by real-time PCR for the presence of two major virulence genes, tdh and trh. Of 361 strains, 60 O3: K6 strains isolated from six suspected outbreaks in August, 2007 and in September, 2008 were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: 4384 stool samples were detected in four sentinel surveillance hospitals and with 361 Vibrio parahaemolyticus strains isolated that belonged to 28 serotypes. Serotype O3:K6, O4:K8 and O1:KUT accounted for 67.90%, 7.50% and 6.10%, respectively. Of 361 strains, 337 strains belonged to tdh+trh-, 11 strains were tdh-trh- and 13 strains were tdh+trh+. The most prevalent serotype which caused diarrheal diseases was tdh+trh in Shenzhen. The 60 isolates were discriminated into twenty different PFGE patterns, which belonged to three clones. Among the 60 isolates, most of the PFGE patterns of isolates from the suspected outbreak locations were identical and some strains isolated from different year were different. CONCLUSION: Vibrio parahaemolyticus isolates in Shenzhen were dominated by O3:K6 strains. Most of these isolates carried tdh gene and few carried trh gene. Meanwhile, the identical patterns of isolates from 6 suspected outbreaks locations demonstrated that Vibrio parahaemolyticus outbreaks occurred in July 2007 and in September 2008 in Shenzhen. However, the dominated strains' PFGE patterns were different each year, indicating that the sources of Vibrio parahaemolyticus had a multiplex nature and the multiplex sources such as water, sea food and pickled products should be integrated monitored. Laboratory based surveillance of diarrheal diseases could contribute in establishing early warning system for the better prevention and control of diarrheal diseases.

[A case of human highly pathogenic avian influenza in Shenzhen, China: application of field epidemiological study].

OBJECTIVE: Based on analyzing the characteristics of a case with human avian influenza and the effects of field epidemiological study. METHODS: An emergency-response-system was started up to follow the probable human Highly Pathogenic Avian Influenza case initially detected by the "Undefined Pneumonia Surveillance System of Shenzhen". Public health professionals administered several epidemiologic investigations and giving all the contacts of the patient with a 7-day-long medical observation for temporally related influenza-like illness. Reverse transcriptase-polymerase chain reaction (RT-PCR) with primers for H5 and N1 was applied to test respiratory tract samples and/or throat swabs of the patient and all his contacts specific for the hemagglutinin gene of influenza A H5N1. Activities and strategies such as media response,notification in the public, communications with multiple related sectors, social participation and information exchange with Hong Kong were involved in field control and management. RESULTS: The patient was a male, 31 years old,with an occupation as a truck driver in a factory,and had been residing in Shenzhen for 7 years. Started with an influenza-like syndrome, the patient received treatment on the 4th day of the onset, from a clinic and on the 6th day from a regular hospital. On the 8th day of the disease course, he was confirmed by Shenzhen Center for Disease Control and Prevention as human avian flu case and was then transferred to Intensive Care Unit (ICU). On the 83rd day of commence, the patients was healed and released from the hospital. The patient had no significant exposure to sick poultry or poultry that died from the illness before the onset of the disease. The patient and five family members lived together, but no family member was affected and no contact showed positive results for H5N1. A small food market with live poultry, which was under formal supervision and before illness the patient once visited, located near his apartment. Totally, 35 swabs from live birds and bird's coops in the market for H5 nucleic acid were tested and all were negative. The influenza H5N1 virus isolated for the case was named as A/Guangdong/02/2006 (H5N1) or GD/2/06. Phylogenetic relationships and molecular characterization analysis revealed that all the segments of the H5N1 virus named GD/2/06 still belonged to avian segments. Investigation process and control measures were released to the general public through the media. Soon after the laboratory confirmation, information was released to the society, as well as Hong Kong Center for Health Protection. Local Departments of Agriculture, Industries & Business, and Entry-Exit Inspection & Quarantine Bureau together with the Public Health Department put up combined actions. A computer-based telephone survey was initiated to investigate attitudes and knowledge of residents in town, revealing that positive atmosphere dominated and no panic existed. CONCLUSION: Rapid laboratory diagnosis of the virus was the key for successful treatment and survival result of the case. Still, the pathogen was from birds resources. No human-to-human transmission was observed, however, source of infection was unclear. Field epidemiological study could offer special methods for the responses of emergency public health problems.