[Technical guidelines for seasonal influenza vaccination in China (2018-2019)]

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. Except for a few major cities, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients must pay for it. To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" . The main updates in this version include: epidemiology, disease burden, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, IIV3 and IIV4 immune response, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The influenza vaccine TWG provided the recommendations for influenza vaccination for the 2018-2019 influenza season based on existing scientific evidence. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-59 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in 2017-2018 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the Centers for Disease Control and Prevention at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels.

[Seasonal, avian and pandemic influenza: are we prepared?]

China experienced a very high and severe influenza seasonal epidemics during the past winter and spring of 2017-2018 season. This year of 2018 is the 100(th) anniversary of the 1918 "Spanish influenza" pandemic, a series of papers under the topic "One Hundred Years of Influenza Pandemics" are produced to demonstrate the impact, characteristics and responses of the past influenza pandemics in global and China, to review the progress and experiences of influenza surveillance, prevention and control strategies, vaccination and antivirus in China, and to discuss the gap and challenges of the prevention, control and response to the seasonal influenza, human avian influenza infection and influenza pandemics. We hope this series could help to raise the awareness of the seasonal and pandemic influenza in publics, and to improve the pandemic preparedness in China.

miRNA-31 over-expression improve synovial cells apoptosis induced by RA

OBJECTIVE

The aim of this study was to evaluate the effects and mechanism of miRNA-31 in synovial cells apoptosis induced by RA.

METHODS

The miRNA-31 gene expressions were extracted from synovial tissues of normal and RA patients by RT-PCR and H et E staining. The synovial cells of RA patients were isolated and randomly divided into Control, Blank and miRNA groups. The cell apoptosis of difference groups were measured by flow cytometry; the TNF-α and IL-1β concentrations of difference groups were measured by Elisa assay; TLR4 and NF-κB proteins expressions were measured by WB assay and the correlation between TLR4 and miRNA-31 were evaluated by double luciferase target experiment.

RESULTS

The miRNA-31 gene expression was significantly suppressed in RA tissues (p<0.001); Compared with control group, the cell apoptosis rate of miRNA group was significantly suppressed (p<0.001); TNF-α and IL-1β concentrations were significantly down-regulation in culture fluid (p<0.001, respectively) and TLR4 and NF-κB proteins expressions were significantly depressed (p<0.001, respectively) in miRNA group. By double luciferase target experiment, the TLR4 was a target gene of miRNA-31.

CONCLUSION

miRNA-31 is a key role in synovial cells apoptosis induced by RA (Fig. 7, Ref. 23).

Immunogenicity and safety of purified vero cell rabies vaccine (PVRV) produced by Liaoning Cheng Da Co. under Zagreb 2-1-1 or 5-dose Essen regimen in Chinese adults aged 50 and above

BACKGROUND

Two kinds of regimens (2-1-1 and 1-1-1-1-1) can be selected after Zagreb regimen(2-1-1)of PVRV was officially approved in Beijing in January 2015. Up to now, the subjects for most studies about the comparison between Zagreb and Essen regimen are under 50 y old, rarely at and above. Aging of the immune system may result in decreasing efficacy of vaccination, especially for adults aged above 65-70 y. This study compared the safety and immunogenicity of the Zagreb and Essen regimen in Chinese adults aged 50 and above with the goal to provide a supplemental data for this age group.

METHODS

A total of 114 cases were divided into 2 groups randomly, received PVRV under the Zagreb and Essen regimens respectively. Serum samples were collected at D0, D7, D14, D42, D180 and D365 to determine the rabies serum neutralizing antibody by rapid fluorescent focus inhibition test (RFFIT). Safety analyses were made by comparing the AEs in day-3, day-7, and day-(7 + 21) in Zagreb or day-(7 + 28) in Essen by gender and age cohorts.

RESULTS

617 blood samples were obtained. Two groups showed similar immunogenicity, the neutralizing antibody titer of all subjects at D14 and D42 showed >0.5 IU/ml. Under the same regimen, Subjects ≥65 y had lower GMC than those who <65 years from D7 to D365 within 2 groups. This difference was significantly shown on D7, D14, D180 in Zagreb group, and on D180 in Essen group (t = 2.38, p = 0.02; t = 3.78, p < 0.001; t = 2.30, p = 0.03; t = 4.42, p < 0.001). Subjects<65 years had higher seroconversion rate compared to ≥65 y on D7, D180 and D365 in both 2 groups, this difference was also significantly shown on D180, D365 in Zagreb group and on D180 in Essen group (χ² = 20.66, p < 0.001; χ² = 6.56, p = 0.02; χ² = 10.96, p = 0.002). Two regimens all showed favorable performances with mildly or common adverse events (AEs). The incidence of local AEs after 3 d in Essen group was higher than Zagreb group (χ² = 9.69, p = 0.002). The most common local AE was pain, the incidences (8.8%) in Zagreb group was higher than Essen group (8.4%, χ² = 5.12, p = 0.02). All AEs for Zagreb group and 52.3% of AEs for Essen group occurred during the first 72 hours. During the first 72 hours, subjects aged <65 in Zagreb group (16.26%) had higher incidences of AEs than Essen group (8.57%, χ² = 4.54, p = 0.03), males in Zagreb group (16.05%) had higher incidence of AEs than Essen group (5.71%, χ² = 5.34, p = 0.02). The incidences of AEs close in during the first 7 d.

CONCLUSION

The Zagreb and Essen regimens demonstrated the similar safety and efficacy of PVRV in Chinese adults aged 50 and above. People ≥65 y showed reduced immune response to both regimens. More AEs for the Zagreb regimen were observed within the first 72 hours, especially for male and people < 65 y.

Risk factors for bunyavirus-associated severe Fever with thrombocytopenia syndrome, china

Background

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease that is caused by a novel bunyavirus, referred to as SFTS virus. During January 2011 to December 2011 we conducted a case-control study in Henan, Hubei and Shandong Provinces of China to determine the risk factors for SFTS.

Methods

Case-patients were identified in hospitals and reported to provincial Centers for Disease Control and Prevention while being notified electronically to the National Surveillance System. Controls were randomly selected from a pool of patients admitted to the same hospital ward within one week of the inclusion of the cases. They were matched by age (+/−5 years) and gender.

Results

A total of 422 patients participated in the study including 134 cases and 288 matched controls. The median age of the cases was 58.8 years, ranging from 47.6 to 70.1 years; 54.5% were male. No differences in demographics were observed between cases and controls; however, farmers were frequent and more common among cases (88.8%) than controls (58.7%). In multivariate analysis, the odds for SFTS was 2.4∼4.5 fold higher with patients who reported tick bites or presence of tick in the living area. Other independent risk factors included cat or cattle ownership and reported presence of weeds and shrubs in the working environment.

Conclusions

Our findings support the hypothesis that ticks are important vectors of SFTS virus. Further investigations are warranted to understand the detailed modes of transmission of SFTS virus while vector management, education on tick bites prevention and personal hygiene management should be implemented for high-risk groups in high incidence areas.

Since 2009, an emerging infectious disease which was identified as the severe fever with thrombocytopenia syndrome (SFTS) was reported in rural areas of Hubei, Shandong and Henan provinces in China. A novel bunyavirus designated severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) had been identified to be the etiological cause of SFTS. But what risk factors lead to the disease is still not clear. Further investigations for risk factors are needed to effectively prevent and control the disease. Here we have designed case-control study to try to develop the risk factors of the spread of SFTSV. It is hoped that our research could provide epidemiological evidence for further study. Also help to determine the spread of the virus in the environment.

Clinical and epidemiological characteristics of a fatal case of avian influenza A H10N8 virus infection: a descriptive study

BACKGROUND

Human infections with different avian influenza viruses--eg, H5N1, H9N2, and H7N9--have raised concerns about pandemic potential worldwide. We report the first human infection with a novel reassortant avian influenza A H10N8 virus.

METHODS

We obtained and analysed clinical, epidemiological, and virological data from a patient from Nanchang City, China. Tracheal aspirate specimens were tested for influenza virus and other possible pathogens by RT-PCR, viral culture, and sequence analyses. A maximum likelihood phylogenetic tree was constructed.

FINDINGS

A woman aged 73 years presented with fever and was admitted to hospital on Nov 30, 2013. She developed multiple organ failure and died 9 days after illness onset. A novel reassortant avian influenza A H10N8 virus was isolated from the tracheal aspirate specimen obtained from the patient 7 days after onset of illness. Sequence analyses revealed that all the genes of the virus were of avian origin, with six internal genes from avian influenza A H9N2 viruses. The aminoacid motif GlnSerGly at residues 226-228 of the haemagglutinin protein indicated avian-like receptor binding preference. A mixture of glutamic acid and lysine at residue 627 in PB2 protein--which is associated with mammalian adaptation--was detected in the original tracheal aspirate samples. The virus was sensitive to neuraminidase inhibitors. Sputum and blood cultures and deep sequencing analysis indicated no co-infection with bacteria or fungi. Epidemiological investigation established that the patient had visited a live poultry market 4 days before illness onset.

INTERPRETATION

The novel reassortant H10N8 virus obtained is distinct from previously reported H10N8 viruses. The virus caused human infection and could have been associated with the death of a patient.

FUNDING

Emergency Research Project on human infection with avian influenza H7N9 virus, the National Basic Research Program of China, and the National Mega-projects for Infectious Diseases.

Identification and control of a poliomyelitis outbreak in Xinjiang, China

BACKGROUND

The last case of infection with wild-type poliovirus indigenous to China was reported in 1994, and China was certified as a poliomyelitis-free region in 2000. In 2011, an outbreak of infection with imported wild-type poliovirus occurred in the province of Xinjiang.

METHODS

We conducted an investigation to guide the response to the outbreak, performed sequence analysis of the poliovirus type 1 capsid protein VP1 to determine the source, and carried out serologic and coverage surveys to assess the risk of viral propagation. Surveillance for acute flaccid paralysis was intensified to enhance case ascertainment.

RESULTS

Between July 3 and October 9, 2011, investigators identified 21 cases of infection with wild-type poliovirus and 23 clinically compatible cases in southern Xinjiang. Wild-type poliovirus type 1 was isolated from 14 of 673 contacts of patients with acute flaccid paralysis (2.1%) and from 13 of 491 healthy persons who were not in contact with affected persons (2.6%). Sequence analysis implicated an imported wild-type poliovirus that originated in Pakistan as the cause of the outbreak. A public health emergency was declared in Xinjiang after the outbreak was confirmed. Surveillance for acute flaccid paralysis was enhanced, with daily reporting from all public and private hospitals. Five rounds of vaccination with live, attenuated oral poliovirus vaccine (OPV) were conducted among children and adults, and 43 million doses of OPV were administered. Trivalent OPV was used in three rounds, and monovalent OPV type 1 was used in two rounds. The outbreak was stopped 1.5 months after laboratory confirmation of the index case.

CONCLUSIONS

The 2011 outbreak in China showed that poliomyelitis-free countries remain at risk for outbreaks while the poliovirus circulates anywhere in the world. Global eradication of poliomyelitis will benefit all countries, even those that are currently free of poliomyelitis.

Mapping spread and risk of avian influenza A (H7N9) in China

The outbreak of human infections with an emerging avian influenza A (H7N9) virus occurred in China in early 2013. It remains unknown what and how the underlying risk factors were involved in the bird-to-human cross-species transmission. To illustrate the dynamics of viral spread, we created a thematic map displaying the distribution of affected counties and plotted epidemic curves for the three most affected provinces and the whole country. We then collected data of agro-ecological, environmental and meteorological factors at the county level, and used boosted regression tree (BRT) models to examine the relative contribution of each factor and map the probability of occurrence of human H7N9 infection. We found that live poultry markets, human population density, irrigated croplands, built-up land, relative humidity and temperature significantly contributed to the occurrence of human infection with H7N9 virus. The discriminatory ability of the model was up to 97.4%. A map showing the areas with high risk for human H7N9 infection was created based on the model. These findings could be used to inform targeted surveillance and control efforts in both human and animal populations to reduce the risk of future human infections.

[The current epidemic situation and surveillance regarding hemorrhagic fever with renal syndrome in China, 2010]

OBJECTIVE

To analyze the surveillance data on hemorrhagic fever with renal syndrome (HFRS) including the epidemiological characteristics and trend of the disease, in 2010.

METHODS

Descriptive methods were conducted to analyze the surveillance data in 2010 which were collected from the internet-based National Notifiable Disease Reporting System and 40 HFRS sentinels in China.

RESULTS

There were 9526 cases of HFRS reported in 2010 in the country with an annual morbidity of 0.71/10(5), which was higher than that reported in 2009. And the case fatality rate in 2010 was 1.24%. During the year 2010, most cases were reported in spring and autumn-winter season, with November as the peak month. The proportion of cases reported in autumn-winter season was higher than that in spring. The number of cases reported in males was higher than that in females among all the age groups, and similar pattern of mortality could be seen in most of the age groups. The percentage of cases over 60 years old had increased in recent years. Farmers were still under the highest risk. Density and the virus-carrying rate of animal hosts, as well as the infection rate were relatively stable and similar to the previous findings. As to the prevailing species, Apodemus agrarius and Rattus norvegicus were still the most common and leading animal hosts. However, the dominant species in sentinel of Yunnan were Rattus flavipectus and Eothenomys miletus respectively, and a new hantavirus called LUXV was found, namely Eothenomys miletus.

CONCLUSION

HFRS cases were widely distributed in most provinces of China, but cases mainly focus on certain areas and present the nature of aggregation. The risk of outbreak could not be ruled out for variety of factors. Population characteristics and seasonal fluctuation had been changing.

[Application of wavelet neural networks model to forecast incidence of syphilis]

OBJECTIVE

To apply Wavelet Neural Networks (WNN) model to forecast incidence of Syphilis.

METHODS

Back Propagation Neural Network (BPNN) and WNN were developed based on the monthly incidence of Syphilis in Sichuan province from 2004 to 2008. The accuracy of forecast was compared between the two models.

RESULTS

In the training approximation, the mean absolute error (MAE), rooted mean square error (RMSE) and mean absolute percentage error (MAPE) were 0.0719, 0.0862 and 11.52% respectively for WNN, and 0.0892, 0.1183 and 14.87% respectively for BPNN. The three indexes for generalization of models were 0.0497, 0.0513 and 4.60% for WNN, and 0.0816, 0.1119 and 7.25% for BPNN.

CONCLUSION

WNN is a better model for short-term forecasting of Syphilis.

[Application of Rogerson spatial pattern surveillance in monitoring infectious diseases: parameter setting and choice of scales of analysis]

OBJECTIVE

To set up appropriate parameters and scales of analysis for monitoring infectious diseases using Rogerson spatial pattern surveillance method.

METHODS

Hepatitis data in Henan provinces from 2006 to 2009 were tested using Rogerson spatial patterns surveillance method.

RESULTS

When the parameters were set with n0 = 12, K= 0.5, H = 7.17, r = 25 and analyzed at city level, 26 alarms were triggered. When the parameters were set with n0 = 4, K = 0.5, H = 8.26, r = 15 and analyzed at county level, 115 alarms were triggered.

CONCLUSION

K and a need to be set first, followed by n0 and r with adaptation to the anticipated numbers of alarm. Then, the parameters of ARL0, ARL1, and H can be calculated. For the surveillance of hepatitis A, county level analysis is more reasonable than city level.

Fever with thrombocytopenia associated with a novel bunyavirus in China

BACKGROUND

Heightened surveillance of acute febrile illness in China since 2009 has led to the identification of a severe fever with thrombocytopenia syndrome (SFTS) with an unknown cause. Infection with Anaplasma phagocytophilum has been suggested as a cause, but the pathogen has not been detected in most patients on laboratory testing.

METHODS

We obtained blood samples from patients with the case definition of SFTS in six provinces in China. The blood samples were used to isolate the causal pathogen by inoculation of cell culture and for detection of viral RNA on polymerase-chain-reaction assay. The pathogen was characterized on electron microscopy and nucleic acid sequencing. We used enzyme-linked immunosorbent assay, indirect immunofluorescence assay, and neutralization testing to analyze the level of virus-specific antibody in patients' serum samples.

RESULTS

We isolated a novel virus, designated SFTS bunyavirus, from patients who presented with fever, thrombocytopenia, leukocytopenia, and multiorgan dysfunction. RNA sequence analysis revealed that the virus was a newly identified member of the genus phlebovirus in the Bunyaviridae family. Electron-microscopical examination revealed virions with the morphologic characteristics of a bunyavirus. The presence of the virus was confirmed in 171 patients with SFTS from six provinces by detection of viral RNA, specific antibodies to the virus in blood, or both. Serologic assays showed a virus-specific immune response in all 35 pairs of serum samples collected from patients during the acute and convalescent phases of the illness.

CONCLUSIONS

A novel phlebovirus was identified in patients with a life-threatening illness associated with fever and thrombocytopenia in China. (Funded by the China Mega-Project for Infectious Diseases and others.).

[Application of Google Earth in the three dimensional visualization (TDV) of the warnings signaled by early warning system of infectious disease]

The purpose of this article was to investigate the application of Google Earth (GE) in the Three Dimensional Visualization (TDV) of the warnings signaled by early warning system of infectious disease. As an example, the prospective space-time scan statistics was used by mimicking daily prospective analyses of bacillary dysentery data from Shanghai municipality, Zhejiang province and Jiangsu province in 2005. Then one of the warnings was picked to illustrate the visualization of GE. GE could vividly display the results in three dimensions containing the complex information including date, areas, observed numbers, expected numbers etc. GE seemed a useful tool for infectious disease surveillance and had potential important values in reflecting the emergency response situation. The development of integrated system which consisted of GE, the infectious disease reporting system and cluster detection methods need to be emphasized for further research.

[A study regarding the applicability of WSARE algorithms in the early warning system of infectious disease outbreaks]

To investigate the application of WSARE (What's Strange About Recent Events) algorithm in early warning on outbreaks of infectious diseases and to explore the multi-dimensional statistical methods for the detection of infectious diseases outbreak. Using WSARE algorithms based on historical data and Bayesian Network as baseline respectively, to analyze data on measles by mimicking the real-time monitoring and early warning system in Bao'an district, Shenzhen city, in 2007. WSARE algorithms were considered to be effective and timely in detecting the abnormally increase of measles among special population. WSARE algorithm could timely detect the abnormal increase of diseases among special local populations, thus having important value in the application of early warning system during the outbreak of infectious diseases.

[Self-management behaviors among children after exposure to rabies in two severe rabies epidemic areas of China]

OBJECTIVE

To understand the situation of rabies exposure and self-management behaviors among primary school students from rabies epidemic areas in China.

METHODS

This population-based investigation was conducted in Guizhou and Guangdong provinces which had been severe epidemic areas of rabies in China from January 2007 to May 2008. Primary schools from two prefectural, two county, four township and four village levels were selected in the 2 provinces. Students were sampled from each grade of the 12 schools to collect information on post-exposure prophylaxis.

RESULTS

In the 2408 primary school students interviewed, 290 person/times exposure were found from 2007 to 2008. The self wound-treatment rates was 47.93%, with 16.55% of them went to the clinic for care-seeking initiatively and 63.79% informed their parents or teachers. However 23.10% of the students did nothing after exposure. Students in Guangdong province had lower exposure rate and higher rate of good management behaviors than in Guizhou. No significant statistical difference was found between the self-management behaviors among male and female students or among different levels of primary schools. The proportion of disinfection on wounds with alcohol and seeking medical treatment in rabies clinic initiatively were both low in all grades of the students but the proportion of telling their parents or teachers about the exposure among children was high in all grades of students.

CONCLUSION

Some students after rabies exposure did not have any disposal in Guangdong and Guizhou provinces. Related education should be strengthened.

Epidemiological investigations of human rabies in China

BACKGROUND

The epidemic of rabies showed a rising trend in China in recent years. To identify the potential factors involved in the emergence, we investigated and analyzed the status and characteristics of human rabies between 1996 and 2008. Moreover, the status of rabies infection and vaccination in dogs, and prophylaxis of humans after rabies exposure were analyzed.

METHODS

Human rabies data in China between 1996 and 2008 collected from the annual reports of Chinese Center for Disease Control and Prevention (China CDC) were analyzed. To investigate the status of dogs and postexposure prophylaxis (PEP) of humans, brain specimens of domestic dogs were collected and detected, and the demographic details, exposure status and PEP of rabies patients were obtained in 2005 and 2006 in Guangxi, Hunan and Guizhou provinces.

RESULTS

The results showed 19,806 human rabies cases were reported in China from 1996 to 2008, with an average of 1,524 cases each year, and the incidence almost was rising rapidly, with the peak in 2007 (3,300 cases). It was notable that nearly 50% of the total rabies cases nationwide were reported in Guangxi, Hunan and Guizhou provinces. In these three provinces, the rabies infection rate in dogs was 2.3%, and 60% investigated cities had a dog vaccination rate of below 70%; among the 315 recorded human cases, 66.3% did not receive any PEP at all, 27.6% received inadequate PEP, and only 6.0% received a full regime of PEP.

CONCLUSIONS

In recent years, rabies is reemerging and becoming a major public-health problem in China. Our analysis showed that unsuccessful control of dog rabies and inadequate PEP of patients were the main factors leading to the high incidence of human rabies in China, then there are following suggestions: (1) Strict control of free-ranging dogs and mandatory rabies vaccination should be enforced. (2)Establishing national animal rabies surveillance network is imperative. (3) PEP should be decided to initiate or withhold according to postmortem diagnosis of the biting animal. (4) The cost of PEP should be decreased or free, especially in rural areas. (5)Education of the public and health care staff should be enhanced.

Analysis of the pathogens in infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) cases reported in China in 2008

AIM: To analyze the etiological and epidemiological characteristics of infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) cases reported in China in 2008.

METHODS: The data of infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) cases reported in China in 2008 were retrieved from Chinese Information System for Diseases Control and Prevention and analyzed.

RESULTS: Of more than 70 million cases of infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) reported, 50.98% of the cases and 69.64 % of the deaths occurred in children aged ≤ 5 years. In nearly 30000 cases with pathogen information, viruses (90.65%) and bacteria (8.97%) were found to be major pathogens. In bacterial diarrhea, Vibrio parahaemolyticus (65.26%) and Salmonella (20.70%) are major pathogens, accounting for 85.96%. In viral diarrhea, rotavirus (92.75%) and adenovirus (4.34%) are major pathogens, accounting for 97.09%.

CONCLUSION: Infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) mainly affects children aged less than 5 years. The diagnostic information concerning the pathogens of infectious diarrhea has important implications for public health. However, the quality and timeliness of the reported information need to be improved, and the data need to be enriched.

Immunogenicity, safety, and cross-reactivity of an inactivated, adjuvanted, prototype pandemic influenza (H5N1) vaccine: a phase II, double-blind, randomized trial

BACKGROUND

Avian influenza A virus H5N1 has the potential to cause a pandemic. Adjuvants and whole-virion vaccines are regarded as antigen sparing for pandemic vaccines.

METHODS

A double-blind, randomized trial was performed from 28 August to 22 December 2007 in 402 adults; 301 adults were randomly assigned to receive 2 doses of an inactivated, aluminum-adjuvanted, whole-virion H5N1 vaccine containing 5, 10, or 15 microg of hemagglutinin per dose 28 days apart, and 101 of them received 2 doses of 10 microg of vaccine 14 days apart. The vaccine was manufactured from the recombinant A/Vietman/1194/2004 (NIBRG14) strain. Blood samples were collected for hemagglutination inhibition and microneutralization assays.

RESULTS

All formulations were well tolerated, with no serious adverse events. Most local and systemic reactions were mild or moderate. Immune responses were induced after 1 dose in all vaccination groups. The highest immune response was seen after 2 doses of 15 microg of vaccine, with 90% and 100% seroconversion rates and 90% and 100% of participants having a titer of > or = 1:40 for hemagglutination inhibition and microneutralization assays, respectively. Both the 10- and 15-microg doses met or exceeded European Union licensure criteria. Generally, higher immune responses were elicited in participants vaccinated 28 days apart than those vaccinated 14 days apart. Cross-reaction assays showed that after 2 doses of 10 microg of vaccine, 98% and 87% of participants had a microneutralization titer of > or = 1:40 against heterologous Indonesia and Anhui strains, respectively.

CONCLUSIONS

The inactivated, aluminum-adjuvanted, whole-virion H5N1 vaccine not only showed good immunogenicity and safety but also elicited significant cross-reactivity against heterologous H5N1 strains in clade 2.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00535665.

[Study on the timeliness of detection and reporting on public health emergency events in China]

OBJECTIVE

To analyze the timeliness of detection and reporting on public health emergency events, and to explore the effective strategies for improving the relative capacity on those issues.

METHODS

We conducted a retrospective survey on 3275 emergency events reported through Public Health Emergency Events Surveillance System from 2005 to the first half of 2006. Developed by county Centers for Disease Control and Prevention, a uniformed self-administrated questionnaire was used to collect data, which would include information on the detection, reporting of the events.

RESULTS

For communicable diseases events, the median of time interval between the occurrence of first case and the detection of event was 6 days (P25 = 2, P75 = 13). For food poisoning events and clusters of disease with unknown origin, the medians were 3 hours (P25, P75 = 16) and 1 days (P25 = 0, P75 = 5). 71.54% of the events were reported by the discoverers within 2 hours after the detection.

CONCLUSION

In general, the ranges of time intervals between the occurrence, detection or reporting of the events were different, according to the categories of events. The timeliness of detection and reporting of events could have been improved dramatically if the definition of events, according to their characteristics, had been more reasonable and accessible, as well as the improvement of training program for healthcare staff and teachers.

[The meta analysis on the safety and immunogenicity of domestic and imported split influenza virus vaccines]

OBJECTIVE

To compare the safety and immunogenicity between domestic and imported, imported and imported split influenza virus vaccine in Chinese population.

METHODS

The published studies during January 1996 and June 2008 on the comparison between split influenza virus vaccine were screened and evaluated. The meta analysis was performed on safety and immunogenicity using fixed model or random model according the heterogeneity of the studies.

RESULTS

12 studies which were all random controlled trials between split vaccine were included. 10 trials were between domestic and imported vaccine, and 2 trials were between imported and imported vaccine. For 10 domestic and imported vaccine trials, the local reaction pooled OR = 0.81, 95% CI (0.59, 1.11); the systemic reaction the pooled OR = 0.78, 95% CI (0.50, 1.03); the H1N1 subtype seroconversion pooled OR = 0.94, 95% CI (0.78, 1.14); the H3N2 subtype seroconversion pooled OR = 1.01, 95% CI (0.87,1.17); the B type seroconversion total OR = 1.35, 95% CI (0.98,1.85). For 2 imported and imported vaccine trials,the local reaction pooled OR = 1.19, 95% CI (0.60, 2.37); the systemic reaction the pooled OR = 1.15, 95% CI (0.71,1.87); the H1N1 subtype seroconversion pooled OR = 1.27, 95% CI (0.37, 4.37); the H3N2 subtype seroconversion pooled OR = 1.29, 95% CI (0.39, 4.33); the B type seroconversion pooled OR = 0.95, 95% CI (0.46, 1.37).

CONCLUSIONS

were no statistical difference on the safety and immunogenicity between domestic and imported, imported and imported split influenza vaccine in Chinese population.

Detection of human cytomegalovirus in the atherosclerotic cerebral arteries in Han population in China

The association of atherosclerosis (AS) and Human cytomegalovirus (HCMV) infection was studied. AS plays an important role in the brain stroke and HCMV infection is supposed to be involved in the process of atherosclerotic formation. The presence of HCMV DNA and antigens was examined in the internal carotid arteries collected from 35 patients with ischemic stroke and from 20 patients from the control population. All patients belonged to the ethnic Han population in China. Three methods, immunohistochemistry (IHC), hybridization in situ (HIS), and PCR were used to detect the HCMV immediate early (IE) and late (L) antigens as well as viral DNA in vessel walls. Levels of HCMV IE gene/protein were significantly higher in the stroke group than in control group detected by the three methods (IHC 34.3% vs. 10.0%; HIS 40.0% vs. 10.0; PCR 60.0% vs. 30.0%). However, there was no significant difference in the levels of HCMV L gene/protein between these two groups of patients (IHC 11.4% vs. 5.0%; HIS 11.4% vs. 10.0%; PCR 20.0% vs. 20.0%). We concluded that the presence of HCMV IE antigen and HCMV DNA in the vessel wall was associated with the pathological process of AS formation.

Feasibility study of enforcing immunization certificate check before primary school or kindergarten enrollment in Guizhou Province, China

OBJECTIVE

To study the feasibility of enforcing immunization certificate check before children enroll in primary schools or kindergartens in Guizhou Province.

METHODS

Quantitative and qualitative studies were conducted. The multi-stage and cluster sampling approach was adopted for the quantitative part of the study. A questionnaire was designed and 996 children and their keepers were interviewed. Principals, doctors or teachers of the primary schools, directors and child care nurses of kindergarten, and staff of immunization agencies were invited to take part in 12 focus group discussions; meanwhile, face-to-face individual in-depth interviews with 16 officials of the Health, Education and Governmental Departments at various levels were conducted.

RESULTS

The total number of subjects was 996. 16.7% of the children in the study completed all the procedures of the National Immunization Programme. 34.3% of them had immunization certificates while the remainder 44.7% registered in immunization agencies. Factors, including the migrant children, doubt about vaccine efficiency, mother's occupation and educational background, knowledge of the National Immunization Programme on targeted vaccines, played an important role in obtaining or not immunization certificates. 95% of the keepers interviewed thought the immunization certificates were useful; 94.8% of them considered the check was critical while only 3.6% of them thought it unnecessary. The first reason from those who found it unnecessary was that they feared that repeated immunization might affect their children's health. The second reason was the cost of immunization, which some of them could not afford to pay. However, the Health Department expressed a favorable attitude to the checking scheme. Though the Education Department agreed that the scheme was essential, they worried that it would affect the enrollment rate.

CONCLUSION

In spite of the difficulty in administering immunization certificate check, the effort would be rewarding for raising the immunization coverage rate among the children in Guizhou Province.

[Study on the application of Knox method to temporal-spatial cluster for infectious diseases]

OBJECTIVE

Application of Knox method was discussed in exploring temporal-spatial cluster for infectious diseases.

METHODS

The theory of Knox method was introduced in detail. As an example, the temporal-spatial cluster of epidemic cerebrospinal meningitis cases from April to May in 2005 was explored in Beijing and the statistical process of Knox method was clearly demonstrated with related results well interpreted.

RESULTS

Only when time and distance threshold values were set as 13 days and 29.67 km, potential temporal-spatial cluster could be detected in epidemic cerebrospinal meningitis cases.

CONCLUSION

According to the characteristics of the epidemics, under Knox method, if appropriate threshold values of time and distance were chosen, information on temporal-spatial cluster of infectious diseases could be obtained. According to the records of different time and distance threshold values, the nature of an infectious disease might be explored. Thus Knox method could help us to strengthen the early warning system on infectious disease control strategy.