An expensive adult measles outbreak and response in office buildings during the era of accelerated measles elimination, Beijing, China

BACKGROUND

Few measles outbreaks among adults are reported in China, and outbreak response costs are seldom documented. We report an adult measles outbreak and response in 4 linked office buildings in Beijing and its associated costs.

METHOD

The World Health Organization measles case definitions were used to determine suspected and confirmed measles cases. Surveillance data were used to describe the outbreak, and records and interviews of response staff were used to describe the response. Costs were determined by use of retrospective surveys of cases, review of records, and interviews of staff.

RESULTS

The outbreak lasted 19days, and involved 22 cases aged 23-49years. Nineteen cases had a local household registration. All cases were employed by 8 companies in 4 linked office buildings. Among the 22 cases, 8 had temperature less than 38.5 degree, 18 had no Koplik spots and none had complications or hospitalizations. A total of 7930 contacts were identified, and of these, 6869 were employees in the office buildings. All the child contacts aged 8months-14years had been up-to-date for measles-containing vaccine (MCV); no adult could document their vaccination or measles history. Of contacts, about 96% were offered post-exposure vaccination. The total household costs were $13,298, or $605 per case. Control costs were $384,594, or $17,481 per case. Involved companies paid for 90.7% of control costs.

CONCLUSION

Office buildings provide a mechanism for measles transmission. Timely control activities were challenged by the highly infectious nature of measles and mild presentations of cases. The outbreak response was very costly. Financial support by involved companies can provide needed resources for outbreak management.

Antioxidative effect of ginseng stem-leaf saponins on oxidative stress induced by cyclophosphamide in chickens

Previous investigation demonstrated that oral administration of ginseng stem-leaf saponins in chickens could enhance the immune response. The present study was designed to evaluate the effects of ginseng stem-leaf saponins on oxidative stress induced by cyclophosphamide in chickens. One hundred and twenty chickens were randomly divided into 5 groups. Groups 1 to 4 received intramuscular injection of cyclophosphamide to induce oxidative stress while group 5 was injected with saline solution and served as control. Following administration of cyclophosphamide, groups 1 to 3 were orally administered ginseng stem-leaf saponins at 2.5, 5, and 10 mg/kg BW in drinking water for 7 d, respectively. After that, the spleen, thymus, bursa, and serum were collected to measure the indices of the organs and oxidative parameters. The results showed that ginseng stem-leaf saponins significantly inhibited cyclophosphamide-induced oxidative stress by increasing the organ indices, total antioxidant capacity, and the levels of glutathione, ascorbic acid, and α-tocopherol, while elevating the activity of total superoxide dismutase, catalase, and glutathione peroxidase, as well as decreasing the protein carbonyl content and malondialdehyde. Therefore, ginseng stem-leaf saponins could be a promising agent against oxidative stress in the poultry industry.

Apoptotic effects of platelet factor VIII on megakaryopoiesis: implications for a modified human FVIII for platelet-based gene therapy

BACKGROUND

Ectopically expressed B-domainless factor VIII in megakaryocytes is stored in α-granules, is effective in a number of murine hemostatic models, and is protected from circulating inhibitors. However, this platelet (p) FVIII has different temporal-spatial availability from plasma FVIII, with limited efficacy in other murine hemostatic models.

OBJECTIVES AND METHODS

We sought to improve pFVIII hemostatic efficacy by expressing canine (c) FVIII, which has higher stability and activity than human (h) FVIII in FVIII(null) mice.

RESULTS AND CONCLUSIONS

We found that pcFVIII was more effective than phFVIII at restoring hemostasis, but peak pcFVIII antigen levels were lower and were associated with greater megakaryocyte apoptosis than phFVIII. These new insights suggest that pFVIII gene therapy strategies should focus on enhancing activity rather than levels. We previously showed that modification of the PACE/furin cleavage site in hFVIII resulted in secretion of hFVIII primarily as a single-chain molecule with increased biological activity. In megakaryocytes, this variant was expressed at the same level as phFVIII with a lentiviral bone marrow transplant approach to reconstitute FVIII(null) mice, but was more effective, resulting in near-normal hemostasis in the cremaster laser injury model. These studies may have implications for pFVIII gene therapy in hemophilia A.

Enhanced immune responses of chickens to oral vaccination against infectious bursal disease by ginseng stem-leaf saponins

Infectious bursal disease (IBD), caused by infectious bursal disease virus (IBDV), is an immunosuppressive infectious disease of global economic importance in poultry. This study was designed to evaluate the effect of oral administration of ginseng stem-leaf saponins (GSLS) on humoral and gut mucosal immunity in chickens vaccinated with live IBDV vaccine, and furthermore, to test its protective efficacy against virulent IBDV challenge following vaccination. In experiment 1, chickens were orally administered with GSLS at 5 mg/kg of BW for 7 d, and then immunized with live IBDV vaccine via the oral route. Serum was sampled on 0, 1, 2, 3, 4, and 5 wk postvaccination for detecting antibody titers by ELISA, and intestinal tissues were collected on 0, 1, 3, and 5 wk postvaccination for measurement of IgA-positive cells and intestinal intraepithelial lymphocytes by immunohistochemical and hematoxylin-eosin staining, respectively. Result showed that antibody titers, IgA-positive cells and intestinal intraepithelial lymphocytes were significantly higher in chickens drinking GSLS than the control, suggesting an enhanced effect of GSLS on humoral and gut mucosal immune responses. In experiment 2, chickens were delivered with GSLS and then vaccinated in the same way as in experiment 1. The birds were challenged with virulent IBDV at wk 3 postvaccination. Then the birds were weighed, bled, and necropsied at d 3 postchallenge and the bursae were sampled for gross and histopathological examination. Results demonstrated that GSLS provided a better protection against virulent IBDV challenge following vaccination than the control. In conclusion, oral administration of GSLS enhances both humoral and gut mucosal immune responses to IBDV and offers a better protection against virulent IBDV challenge. Considering its immunomodulatory properties to IBDV vaccine, GSLS might be a promising oral adjuvant for vaccination against infectious diseases in poultry.

Influence of indoor formaldehyde pollution on respiratory system health in the urban area of Shenyang, China

BACKGROUND

The decoration of interior spaces can lead to dangerous levels of indoor formaldehyde pollution. Exposure to indoor air pollution may be responsible for nearly 2 million deaths per year in developing countries.

OBJECTIVES

To assess the prevalence of indoor formaldehyde pollution caused by decoration and resultant respiratory system symptoms exhibited in exposed adults and children, due to indoor formaldehyde pollution caused by decoration.

METHODS

Survey sites were chosen and indoor formaldehyde concentrations determined according to the standard of formaldehyde in GB50325-2001. Logistic regression models were used to derive odds ratios (ORs) and 95% confidence intervals (95% CIs) after adjusting for potential confounders for this survey.

RESULTS

Formaldehyde concentration was above the standard in 64% of Shenyang City. Some adults surveyed complained of common respiratory system disorders, including coughing (11.8%), nasal irritation (39.2%), Heterosmia (14.51%), and throat irritation (25.27%); 12% of children suffered from asthma. The analysis identified formaldehyde pollution and ventilation frequency as risk factors for respiratory system disorders in both adults (OR=2.603, [95% CI: 1.770-3.828], OR=1.604, [95% CI: 1.146-2.244], respectively) and children (OR=4.250, [2.064-8.753], OR=1.831, [1.006-3.333], respectively).

CONCLUSION

The prevalence of common respiratory system disorders was related both to formaldehyde pollution and insufficient ventilation after decorating.

Inhibition of vascular endothelial growth factor A expression in mouse granulosa cells by lentivector-mediated RNAi

Vascular endothelial growth factor (VEGF) has been found responsible for the induction of proliferation and differentiation in granulosa cells. We constructed four short hairpin RNA (shRNA) expression plasmids targeting the mouse VEGFA gene, and examined their effect on VEGF expression in mouse granulosa cells (MGC) in vitro. Four different shRNA oligonucleotides targeting the coding sequence of mouse VEGFA mRNA and one negative control (shNC) were designed and cloned into a pGPU6/GFP/Neo siRNA expression vector, and transiently transfected into MGC. At 48 h post-transfection, total RNA was extracted from the cells and subjected to qRT-PCR analysis. The most effective interference vector, shVEGF1487 was chosen for lentiviral construction. The recombinant plasmid was then transfected into 293FT cells via Lipofectamine(TM) 2000-mediated gene transfer, for the production of lentivirus, and then concentrated via ultracentrifugation. This lentiviral vector was then used for the transduction of MGC. VEGFA gene expression, apoptosis genes and VEGFA receptor genes were detected by qRT-PCR, the VEGFA protein level in culture media by ELISA assay and protein levels in MGC by Western blot analysis. The four VEGFA expression plasmids were successfully constructed and the most effective interference vector, shVEGF1487, was chosen for lentiviral production and MGC transduction. There was significant knockdown of the VEGFA gene, receptor genes and apoptosis genes for all the shVEGF constructs, compared with the shNC and Mock controls. The lentiviral vector also gave significant knockdown of the VEGFA gene. Protein levels were lower for most of the shVEGFs based on Western blot analysis with exception of VEGF1359; in this case, it was higher than shNC but lower than for the Mock group. Lentivector-transduced MGC also gave lower levels of protein. We conclude that shVEGF expression plasmids and lentivector carrying RNAi are promising tools for the inhibition of VEGF, the corresponding receptor genes, and apoptosis gene expression in MGC.

A varicella outbreak in a school with high one-dose vaccination coverage, Beijing, China

BACKGROUND

Varicella vaccine is available in the private sector in China, with a single dose currently recommended for children aged ≥12 months. We investigated a varicella outbreak in a school in Beijing with high varicella vaccination coverage to describe the outbreak, examine risk factors for vaccine failure, and calculate vaccine effectiveness.

METHODS

A varicella case was defined as an acute generalized maculopapular rash without other apparent cause in a student without prior varicella attending the elementary school during August 30-December 28, 2010. Varicella among vaccinated students (breakthrough varicella) was defined as varicella occurring >42 days after vaccination. Students' vaccination status was verified with immunization records and clinical presentations were collected from health care practitioners.

RESULTS

Of the 951 students, 934 (98%) had no prior varicella history. Among these students, 916 had received 1 dose of varicella vaccine and 2 had received 2 doses (98% vaccination coverage) before the outbreak. A total of 87 cases occurred during the outbreak; most had breakthrough varicella (86/87, 99%) and mild disease (83/87, 95%). Age at vaccination (<15 months vs. ≥15 months) and time since vaccination before outbreak (<5 years vs. ≥5 years) were not associated with development of breakthrough varicella. Single-dose varicella vaccination was 89% effective in preventing any varicella and 99% in preventing moderate/severe varicella.

CONCLUSION

Single-dose varicella vaccination is highly effective in reducing varicella incidence and mitigating disease severity, but not high enough to prevent outbreak. A two-dose program might help to prevent varicella outbreaks in Beijing.

Enhancement of humoral immune responses to inactivated Newcastle disease and avian influenza vaccines by oral administration of ginseng stem-and-leaf saponins in chickens

Newcastle disease (ND) and avian influenza (AI) are common in the poultry industry. The objective of this study was to evaluate the effect of oral administration of ginseng stem-and-leaf saponins (GSLS) on the humoral immune responses of chickens to inactivated ND and AI vaccines. In experiment 1, oral administration of GSLS at a dose of 5 mg/kg of BW for 7 d on the immune response in chickens intramuscularly injected with inactivated ND vaccine was evaluated. Results showed that GSLS significantly increased the antibody level against ND in the serum of chickens. In experiment 2, the same regimen of GSLS was administered to chickens inoculated with inactivated AI vaccines, and an enhanced serum antibody response to AI vaccination was also observed. Considering the safety of GSLS, because no adverse effect was found throughout the experiments, GSLS may be a promising oral adjuvant to improve immunization in poultry.

Much more than a ratio: multivariate selection on female bodies

Studies of the attractiveness of female bodies have focussed strongly on the waist, hips and bust, but sexual selection operates on whole phenotypes rather than the relative proportions of just two or three body parts. Here, we use body scanners to extract computer-generated images of 96 Chinese women's bodies with all traits unrelated to body shape removed. We first show that Chinese and Australian men and women rate the attractiveness of these bodies the same. We then statistically explore the roles of age, body weight and a range of length and girth measures on ratings of attractiveness. Last, we use nonlinear selection analysis, a statistical approach developed by evolutionary biologists to explore the interacting effects of suites of traits on fitness, to study how body traits interact to determine attractiveness. Established proxies of adiposity and reproductive value, including age, body mass index and waist-to-hip ratio, were all correlated with attractiveness. Nonlinear response surface methods using the original traits consistently outperform all of these indices and ratios, suggesting that indices of youth and abdominal adiposity tell only part of the story of body attractiveness. In particular, our findings draw attention to the importance of integration between abdominal measures, including the bust, and the length and girth of limbs. Our results provide the most comprehensive analysis to date of the effect of body shape and fat deposition on female attractiveness.

Prognostic value of different B symptoms in upper aerodigestive tract NK/T-cell lymphoma

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Background: Extranodal NK/T-cell lymphoma (ENKL) is a rare disease originated from NK or toxic T cells. ENKL arising from the upper aerodigestive tract (UNKTL) is a newly recognized subtype and commonly presents with B symptoms. This study is to investigate the prognostic value of different B symptoms in UNKTL. Methods: UNKTL cases with detailed clinical, pathological and prognostic data in our center since 2001 to 2007 were retrospectively analyzed with the major study endpoint of overall survival (OS). Central pathological review was performed. Survival curves were estimated by Kaplan-Meier method and tested by Log Rank method. Statistically significant factors in univariate analysis were then included in multivariate analysis. B symptoms were defined as fever, night sweat and weight loss according to the Ann Arbor Cotswolds meeting. The predictive values of survival for each type of B symptoms were studied independently. Results: 172 cases of UNKTL with a median follow-up duration of 27.4 months were included. 45 ladies and 127 gentlemen had a median age of 43 years. 98 cases were Ann Arbor stage I, 54 were stage II and the remaining 20 cases were stage III or IV. About half of the patients present B symptoms: 82 had fever, 5 had night sweat and 6 present weight loss. Totally 18 patients had ECOG PS larger than 1. The 5-year OS rate of the whole group is 41.8%. Patients with persistent fever before treatment indicated a poor outcome in the univariate analysis (p=.033) and its prognostic value was also confirmed by the Cox regression (p=.030) whereas those of night sweat and weight loss were not (p= .960 and .824 respectively). Conclusions: B symptoms were common in UNKTL patients. Our data suggested that only fever among the three types of B symptoms was independent prognostic factor for UNKTL but it still needs further confirmation.

No significant financial relationships to disclose.

Effects of pig antibacterial peptides on growth performance and intestine mucosal immune of broiler chickens

Currently, substitutions for antibiotic growth promoters in animals are attracting interest. This study investigated the effects of pig antibacterial peptides (PABP) on growth performance and small intestine mucosal immune responses in broilers. Three hundred 1-d-old Arbor Acre male broiler chickens were randomly allocated to 5 groups with 60 birds per group. The groups were control group; PABP administered in drinking water at 20 and 30 mg/L of water; or PABP supplemented in feed at 150 and 200 mg/kg of diet. The birds were fed a corn-soybean based diet for 6 wk. Chickens were weighed weekly and killed after 42 d of feeding, and growth performance was measured. Samples of the duodenum and jejunum were collected. The villus height, mucosa thickness, alkaline phosphatase activity, and numbers of secreting IgA and goblet cells were evaluated. The PABP-treated groups had greater BW and average daily gain, greater height of villus and thickness of gut mucosa, greater activity of alkaline phosphatase, higher ratio of secreting IgA, and a greater number of goblet cells compared with the control group (P<0.05). In conclusion, PABP can improve the growth performance, increase the intestinal ability to absorb nutrients, and improve the mucosal immunity of the intestine.

CHOP compared to THP-COP regimen: Long-term outcome in Chinese non-Hodgkin lymphoma (NHL) patients

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Background: THP-ADM (Pirarubicin) has potential to replace conventional ADM (Adriamycin) because of less severe toxicities. However, only a few studies have compared the long-term outcome between patients receiving the two drugs. A Japanese trial (JGTLE) shows the CR rate of THP-COP group was greater than CHOP group in elderly T-cell Non-Hodgkin's Lymphoma (NHL) patients. The current study was aimed at comparing the long-term outcome and toxicities between NHL patients receiving CHOP and THP-COP regimens within similar age-groups and pathological sub-types. Methods: 505 previously untreated NHL patients receiving either standard CHOP or THP-COP regimen (cyclophosphamide 750 mg/m2, doxorubicin or pirarubicin 50 mg/m2, vincristine 1.4 mg/m2and prednisone 40 mg/m2 for 5 days) were enrolled. Results: Patients’ characteristics between CHOP group(n=279) and THP-COP (n=228) group were well balanced. There were no differences in CR rate (54.8% vs. 54.0%, p=0.85) and response rate (82.1% vs. 84.1%, p=0.55). With a median follow-up of 59.7months, survival rate was similar (5-year OS: 56.7% vs. 55.8%, 5-year PFS: 43.5% vs. 47.3%, 5-year DFS: 54.0% vs. 54.7%). The incidence of cardiotoxicity(myocardial dysfunction and arrhythmia)was almost the same (10.0% vs10.2 %; P=0.958). Less Alopecia (39.1% vs. 28.8%, p= 0.015)and gastrointestinal toxicities(63.1% vs. 50.0%, p=0.003) were observed in THP-COP group. No differences between the two groups were observed within different pathological subtypes (B-cell subtype: CR rate 58.2% vs. 56.7%, 5-year OS 59.2% vs. 60.0%; T-cell subtype: CR rate 47.0% vs. 45.5%, 5-year OS 50.5% vs. 43.4%) and age-groups (<60 years group: CR rate 51.6% vs. 53.7%, p= 0.684; 5y OS 58.9% vs.61.1%, p= 0.570; =60 years group: CR rate 67.9% vs. 54.8 %, p= 0.148; 5y OS 48.0% vs. 42.1 %, p= 0.314). In the 33 elderly patients of T-cell subtype, CR rates were almost the same. (73.7% vs. 42.9%, p=0.073). Conclusions: The long-term outcome of NHL patients receiving THP-COP is similar to those receiving CHOP within similar age groups and pathologic subtypes. Cardiotoxicity occurs at a similar rate in both groups, while a lower incidence of alopecia and gastrointestinal toxicities was observed in THP-COP group.

No significant financial relationships to disclose.

Prognostic value of hemoglobin in natural killer cell lymphoma

17557

Background: Natural Killer (NK) cell lymphoma is a group of increasingly recognized but poorly defined disease entities. This study investigated its clinical features and prognostic factors for southern China population. Methods: Patients with pathologically confirmed NK cell lymphoma in one center since 1999 to 2004 were included. Central histological and immunohistochemical review was undertaken to every case. The major study endpoint was overall survival. Survival curves were estimated by the Kaplan-Meier method. Detailed clinical, pathological and laboratory data were included in univariate analysis and statistically significant factors in univariate analysis were then included in multivariate analysis. Results: Totally 64 eligible patients were identified. Of these, 59 patients were extranodal NK cell lymphoma nasal type, 3 patients were aggressive NK cell lymphoma and 2 patients were blastic NK cell lymphoma. From the basic analysis, 47% of the patients had stage I disease, 42% were stage II, 11% were stage III or IV. B-symptoms were present in 39%. 73% of these patients had International Prognostic Index (IPI) 0 or 1. Before treatment, 25% complicated with anemia. As to the therapy, 38% received chemotherapy alone, 3% received radiotherapy alone and 59% received a multidisciplinary therapy. After initial therapy, 59% achieved CR, 22% achieved PR and 19% were refractory disease. With a median follow-up duration of 20 months, the median overall survival was 28 months (95% CI: 10, 45). Hb lower than 110 g/l before treatment was statistically significant in multivariate analysis (p = 0.031). Presenting B-symptoms and ECOG PS score higher than 1 were also independent prognostic factors (P = 0.001 and 0.006 respectively). Conclusions: The outcome of patients with NK cell lymphoma was poor even for Stage I or II cases. Our data suggested Hemoglobin < 110 g/l had more prognostic value than IPI and Ann Arbor staging system for NK cell lymphoma in southern China, but it needs further confirmation.

No significant financial relationships to disclose.

Involvement of LEU13 in interferon-induced refractoriness of human RSa cells to cell killing by X rays

Culture of human cells with human interferon alpha and beta (IFNA and IFNB) results in increased resistance of the cells to cell killing by X rays. To identify candidate genes responsible for the IFN-induced X-ray resistance, we searched for genes whose expression levels are increased in human RSa cells treated with IFNA, using an mRNA differential display method and Northern blotting analysis. RSa cells, which showed increased survival (assayed by colony formation) after X irradiation when they were treated with IFNA prior to irradiation, showed increased expression levels of LEU13 (IFITM1) mRNA after IFNA treatment alone. In contrast, IF(r) and F-IF(r) cells, both of which are derived from RSa cells, showed increased X-ray resistance and high constitutive LEU13 mRNA expression levels compared to the parental RSa cells. Furthermore, the IFNA-induced resistance of RSa cells to killing by X rays was suppressed by antisense oligonucleotides for LEU13 mRNA. LEU13, a leukocyte surface protein, was previously reported to mediate the actions of IFN such as inhibition of cell proliferation. The present results suggest a novel role of LEU13 different from that in the inhibition of cell proliferation, involved in IFNA-induced refractoriness of RSa cells to X rays.

Purification and enzymatic activity of an NADH-fumarate reductase and other mitochondrial activities of Leishmania parasites

A 65 kD membrane-associated NADH-fumarate reductase subunit, which has a molecular weight similar to that of one of the enzyme subunits from bacteria, was purified from Leishmania donovani promastigotes. NADH-fumarate reductase and other mitochondrial enzymatic activities of L. major and L. donovani promastigotes and amastigotes were investigated. The presence of NADH-fumarate reductase was demonstrated in digitonin-permeabilized L. major promastigotes and mitochondria of L. major and L. donovani promastigotes and amastigotes. The activity of solubilized NADH-fumarate reductase was measured in L. major and L. donovani promastigotes. Succinate exhibited a clear concentration-dependent inhibitory effect on fumarate reductase, whereas fumarate also exhibited a clear concentration-dependent inhibitory effect on succinate dehydrogenase. The data indicate that fumarate reductase is an obligatory component of the respiratory chain of the parasite. Since the enzyme is an important component in the intermediate metabolism in the Leishmania parasite and is absent in mammalian cells, it could be a potential target for antileishmanial drugs.