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Yao P, Millwood I, Kartsonaki C, Mentzer AJ, Allen N, Jeske R, Butt J, Guo Y, Chen Y, Walters R, Lv J, Yu C, Plummer M, de Martel C, Clifford G, Li LM, Waterboer T, Yang L, Chen Z. Sero-prevalence of 19 infectious pathogens and associated factors among middle-aged and elderly Chinese adults: a cross-sectional study. BMJ Open 2022; 12:e058353. [PMID: 35534062 PMCID: PMC9086621 DOI: 10.1136/bmjopen-2021-058353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To systematically assess the sero-prevalence and associated factors of major infectious pathogens in China, where there are high incidence rates of certain infection-related cancers. DESIGN Cross-sectional study. SETTING 10 (5 urban, 5 rural) geographically diverse areas in China. PARTICIPANTS A subcohort of 2000 participants from the China Kadoorie Biobank. PRIMARY MEASURES Sero-prevalence of 19 pathogens using a custom-designed multiplex serology panel and associated factors. RESULTS Of the 19 pathogens investigated, the mean number of sero-positive pathogens was 9.4 (SD 1.7), with 24.4% of participants being sero-positive for >10 pathogens. For individual pathogens, the sero-prevalence varied, being for example, 0.05% for HIV, 6.4% for human papillomavirus (HPV)-16, 53.5% for Helicobacter pylori (H. pylori) and 99.8% for Epstein-Barr virus . The sero-prevalence of human herpesviruses (HHV)-6, HHV-7 and HPV-16 was higher in women than men. Several pathogens showed a decreasing trend in sero-prevalence by birth cohort, including hepatitis B virus (HBV) (51.6% vs 38.7% in those born <1940 vs >1970), HPV-16 (11.4% vs 5.4%), HHV-2 (15.1% vs 8.1%), Chlamydia trachomatis (65.6% vs 28.8%) and Toxoplasma gondii (22.0% vs 9.0%). Across the 10 study areas, sero-prevalence varied twofold to fourfold for HBV (22.5% to 60.7%), HPV-16 (3.4% to 10.9%), H. pylori (16.2% to 71.1%) and C. trachomatis (32.5% to 66.5%). Participants with chronic liver diseases had >7-fold higher sero-positivity for HBV (OR=7.51; 95% CI 2.55 to 22.13). CONCLUSIONS Among Chinese adults, previous and current infections with certain pathogens were common and varied by area, sex and birth cohort. These infections may contribute to the burden of certain cancers and other non-communicable chronic diseases.
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Affiliation(s)
- Pang Yao
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Naomi Allen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rima Jeske
- Infections and Cancer Epidemiology Division, German Cancer Research Center, Heidelberg, Germany
| | - Julia Butt
- Infections and Cancer Epidemiology Division, German Cancer Research Center, Heidelberg, Germany
| | - Yu Guo
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin Walters
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Martyn Plummer
- Department of Statistics, University of Warwick, Coventry, UK
| | - Catherine de Martel
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Gary Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Li-Ming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center, Heidelberg, Germany
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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2
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Brown DR, Castellsagué X, Ferris D, Garland SM, Huh W, Steben M, Wheeler CM, Saah A, Luxembourg A, Li S, Velicer C. Human papillomavirus seroprevalence and seroconversion following baseline detection of nine human papillomavirus types in young women. Tumour Virus Res 2022; 13:200236. [PMID: 35525430 PMCID: PMC9172167 DOI: 10.1016/j.tvr.2022.200236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Estimates of the humoral immune response to incident human papillomavirus (HPV) infections are limited. Methods In this post hoc analysis of 3875 women aged 16–23 years from a 4-valent HPV vaccine trial (NCT00092482), HPV seroprevalence on day 1 was measured with a 9-valent HPV (HPV 6/11/16/18/31/33/45/52/58) competitive Luminex immunoassay and compared with cervical/external genital HPV detection by polymerase chain reaction. In the control group, among women who were HPV DNA‒negative on day 1, seroconversion following initial HPV detection was estimated using Kaplan-Meier methods. Results Type-specific HPV seropositivity among women with no day 1 cervical/external genital HPV detection was 0.6%–3.6%. Women with any 9-valent HPV (9vHPV) cervical/external genital detection (796/3875; 20.5%) had concordant seropositivity ranging from 13.4% (HPV 45) to 38.5% (HPV 6). Among women in the control group who were negative for all HPV types on day 1, seroconversion by month 30 after initial detection ranged from 29% (HPV 45) to 75% (HPV 16). Conclusions Humoral immune response to HPV is variable and dynamic, depending on type-specific exposure. This longitudinal analysis provides insight into the relationship between incident infection and seropositivity. ClinicalTrials.gov; NCT00092482 https://clinicaltrials.gov/ct2/show/NCT00092482. Research on humoral immune responses to HPV infection are limited. HPV-related serologic responses were analyzed in women aged 16–23 years. Type-specific HPV seropositivity was low in women without initial HPV DNA detection. Concordant seropositivity in women with any 9vHPV DNA detection ranged from 13% to 40%. Seroconversion to the same genotype within 30 months of an infection was common.
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Affiliation(s)
- Darron R Brown
- Department of Medicine, Indiana University School of Medicine, Van Nuys Med Science Building, Suite 224, 635 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Xavier Castellsagué
- Institut Catala D'Oncologia, IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Granvia de L'Hospitalet 199-203, Barcelona, Catalonia, 08908, Spain
| | - Daron Ferris
- Clinica CerviCusco, Calle Los Saucos B-8-2, Larapa, Curco, Peru
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Infection and Immunity, Murdoch Children's Research Institute, Department of Obstetrics and Gynaecology, The University of Melbourne, Murdoch Children's Research Institute, The Royal Women's Hospital, Locked Bag 300
- Corner Grattan Street and Flemington Road, Parkville, VIC, 3052, Australia
| | - Warner Huh
- Division of Gynecologic Oncology, University of Alabama, 1700 6th Avenue South, Birmingham, AL, 35233, USA
| | - Marc Steben
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, 1851 East Sherbrooke Street, Montréal, Quebec, H2K 4L5, Canada
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Comprehensive Cancer Center, 1201 Camino de Salud NE, Albuquerque, NM, 87102, USA
| | - Alfred Saah
- Merck & Co., Inc., 126 E Lincoln Ave, Rahway, NJ, 07065, USA
| | | | - Se Li
- Merck & Co., Inc., 126 E Lincoln Ave, Rahway, NJ, 07065, USA
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Trevisan A, Candeias JMG, Thomann P, Villa LL, Franco EL, Trottier H, The Ludwig-McGill Study Group. Correlation between cervical HPV DNA detection and HPV16 seroreactivity measured with L1-only and L1+L2 viral capsid antigens. J Med Microbiol 2020; 69:960-970. [PMID: 32510304 DOI: 10.1099/jmm.0.001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Persistent human papillomavirus (HPV) type 16 infection is the main causal agent of cervical cancer. Most HPV infections clear spontaneously within 1-2 years. Although not all infected women develop detectable HPV antibodies, about 60-70 % seroconvert and retain their antibodies at low levels.Aim. We investigated if cervical HPV16 DNA positivity was associated with HPV16 seroreactivity measured with two different antigen formulations. We assessed if associations were influenced by co-infection with other HPV types and HPV16 viral load.Methodology. We used baseline data for women participating in the Ludwig-McGill cohort, a longitudinal investigation of the natural history of HPV infection and cervical neoplasia. The study enrolled 2462 Brazilian women from 1993 to 1997 (pre-vaccination). ELISA assays were based on L1-only or L1+L2 virus-like particles (VLPs). Seroreactivity was expressed as normalized absorbance ratios. HPV genotyping and viral load were evaluated by PCR protocols. Pearson's r was used to measure correlations between interval-scaled variables. Serological accuracy in HPV16 DNA detection was assessed using receiver operating characteristic (ROC) curves. We analysed the association between HPV DNA positivity and HPV16 seroreactivity by linear regression.Results. Correlations between L1+L2 and L1-only VLPs for detection of HPV16 were poor (r=0.43 and 0.44 for dilutions 1 : 10 and 1 : 50, respectively). The protocol with the best accuracy was L1+L2 VLPs at serum dilution 1 : 10 (ROC area=0.73, 95 % CI: 0.65-0.85). HPV16 DNA positivity was correlated with HPV16 seroreactivity and was not influenced by co-infection or viral load. To a lesser degree, HPV16 seroreactivity was correlated with infection by other Alpha-9 papillomavirus species.Conclusion. HPV16 DNA positivity and HPV16 seroreactivity are strongly correlated. L1+L2 VLPs perform better than L1-only VLPs for detecting IgG antibodies to HPV16 in women infected with HPV16 or other Alpha-9 HPV species. This study advances our understanding of humoral immune responses against HPV16 by providing insights about the influence of VLP antigen composition to measure humoral immune response against naturally acquired HPV infection.
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Affiliation(s)
- Andrea Trevisan
- Sainte-Justine Hospital Research Center, Université de Montréal, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - João M G Candeias
- Department of Microbiology and Immunology, Institute of Biosciences, Universidade Estadual Paulista, Botucatu, Brazil
| | | | - Luisa L Villa
- Dept of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.,Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, Sao Paulo, Brazil
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.,Sainte-Justine Hospital Research Center, Université de Montréal, Montreal, Canada
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4
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Newman H, Hu J, Li X, He J, Bradford L, Shan S, Wu X, Zhu B, Yang W, Fu B, Zhu B, Gao G. Evaluation of portable colposcopy and human papillomavirus testing for screening of cervical cancer in rural China. Int J Gynecol Cancer 2020; 29:23-27. [PMID: 30640679 DOI: 10.1136/ijgc-2018-000006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the use of a portable, rechargeable colposcope combined with human papillomavirus (HPV) testing, as compared with HPV testing alone, for screening of cervical cancer and pre-cancerous lesions. METHODS This was a cross-sectional study among 488 women in Baoshan County, Yunnan. The women underwent HPV testing followed by Gynocular portable colposcopy with visual inspection with acetic acid. Obvious lesions were biopsied. If portable colposcopy testing was negative but HPV testing was positive, the women underwent follow-up testing with thin-prep cytology and traditional colposcopy. Cervical biopsies were performed for any abnormalities. Histopathology was followed up with diagnosis and treatment. RESULTS Among 488 women screened with portable colposcopy, 24 women underwent biopsy based on positive colposcopy screening. Of these 24 women, three were HPV positive and 21 were HPV negative. Five women had cervical intra-epithelial neoplasia (CIN) I and one had advanced cervical cancer. Forty-six women tested positive for HPV. Three of these women had screened positive on preliminary colposcopy, with one positive for CIN III/squamous cell carcinoma and one woman with CIN I. Forty-three women underwent follow-up testing with thin-prep cytology. Two women had atypical squamous cells of undetermined significance and five had low-grade squamous intra-epithelial lesions and were biopsied; three women had CIN I, one had CIN II and one had CIN III. HPV testing and portable colposcopy was more sensitive but slightly less specific than portable colposcopy or HPV testing alone. CONCLUSION While HPV testing has high sensitivity and specificity for the detection of pre-cancerous and cancerous lesions and portable colposcopy has lower specificity, both methods of detection have low positive predictive value and high negative predictive value. In tandem, HPV testing and portable colposcopy had higher sensitivity for detection among women who underwent biopsies. In clinical practice, portable colposcopy was an effective, easy and affordable tool to transport to villages where cytology is not currently feasible.
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Affiliation(s)
- Haley Newman
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jilin Hu
- Kunming University of Science and Technology, Kunming, China
| | - Xiao Li
- Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Jing He
- Kunming University of Science and Technology, Kunming, China.,Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Leslie Bradford
- Maine Medical Partners Women's Health Division of Gynecologic Oncology, Portland, Maine, USA
| | - Songmei Shan
- Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Xiaomei Wu
- Kunming University of Science and Technology, Kunming, China.,Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Bin Zhu
- Maternal and Child Health and Family Planning Service Center of Longyang District, Yunnan, China
| | - Wenyang Yang
- Maternal and Child Health and Family Planning Service Center of Longyang District, Yunnan, China
| | - Bingqin Fu
- Maternal and Child Health and Family Planning Service Center of Longyang District, Yunnan, China
| | - Baosheng Zhu
- Kunming University of Science and Technology, Kunming, China .,Department of Obstetrics and Gynecology, National Health Commission's Key Laboratory for Healthy Births in Western China, First People's Hospital of Yunnan Province, Yunnan, China
| | - Guangping Gao
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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5
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Wei LH, Su YY, Hu YM, Li RC, Chen W, Pan QJ, Zhang X, Zhao FH, Zhao YQ, Li Q, Hong Y, Zhao C, Li MQ, Liu WY, Li CH, Guo DP, Ke LD, Lin BZ, Lin ZJ, Chen S, Sheng W, Zheng ZZ, Zhuang SJ, Zhu FC, Pan HR, Li YM, Huang SJ, Zhang J, Qiao YL, Wu T, Xia NS. Age distribution of human papillomavirus infection and neutralizing antibodies in healthy Chinese women aged 18-45 years enrolled in a clinical trial. Clin Microbiol Infect 2020; 26:1069-1075. [PMID: 31904566 DOI: 10.1016/j.cmi.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Data from clinical trials of human papillomavirus (HPV) vaccines showed that women naïve (negative for both type-specific antibodies and DNA) to vaccine types would derive benefit from vaccination; therefore, an understanding of the proportion of naïve women in different age groups is important for developing HPV vaccination strategies. METHODS From November 2012 to April 2013, a total of 7372 healthy women aged 18-45 years were recruited in five provinces in China. Cervical specimens and serum samples were collected for each woman at entry. Cervical specimens were first tested by the HPV DNA enzyme immunoassay method; if positive, the specimens were then tested by reverse hybridization line probe assay and HPV-16 and HPV-18 specific polymerase chain reactions. Neutralizing antibodies against HPV-16 or HPV-18 were tested with a pseudovirion-based neutralization assay. RESULTS The overall prevalence of high-risk HPV DNA was 14.8% (1088/7367, 95% CI 14.0-15.6), and the seroprevalence of neutralizing antibodies against HPV-16 and HPV-18 was 12.6% (925/7367) and 4.9% (364/7367), respectively. In younger women (18-26 years) and middle-aged women (27-45 years), 83.8% (3116/3719) and 81.4% (2968/3648) were naïve to both HPV-16 and HPV-18 (both neutralizing antibodies and DNA were negative), respectively. In addition, 98.5% (3664/3719) and 98.0% (3575/3648) of the younger or middle-aged women were naïve to at least one HPV type (HPV-16 or HPV-18). DISCUSSION This study revealed that the majority of Chinese women aged 18-26 years and 27-45 years were naïve to both HPV-16 and HPV-18 and would thus derive full benefit from bivalent HPV vaccination.
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Affiliation(s)
- L-H Wei
- Peking University People's Hospital, Beijing, China
| | - Y-Y Su
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Y-M Hu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - R-C Li
- Guangxi Centre for Disease Control and Prevention, Nanning, Guangxi, China
| | - W Chen
- National Cancer Centre, National Centre for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Q-J Pan
- National Cancer Centre, National Centre for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - X Zhang
- National Cancer Centre, National Centre for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - F-H Zhao
- National Cancer Centre, National Centre for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Y-Q Zhao
- National Cancer Centre, National Centre for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Q Li
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Y Hong
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - C Zhao
- Peking University People's Hospital, Beijing, China
| | - M-Q Li
- Liuzhou Centre for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - W-Y Liu
- Funing Centre for Disease Control and Prevention, Funing, Jiangsu, China
| | - C-H Li
- Xinmi Maternal and Child Health Hospital, Xinmi, Henan, China
| | - D-P Guo
- Yangcheng Maternal and Child Health Hospital, Yangcheng, Shanxi, China
| | - L-D Ke
- Fengning Hospital of Traditional Chinese Medicine, Fengning, Hebei, China
| | - B-Z Lin
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Z-J Lin
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - S Chen
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - W Sheng
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Z-Z Zheng
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - S-J Zhuang
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - F-C Zhu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - H-R Pan
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Y-M Li
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - S-J Huang
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - J Zhang
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Y-L Qiao
- National Cancer Centre, National Centre for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
| | - T Wu
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China.
| | - N-S Xia
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Centre of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
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