Combating infectious disease epidemics through China's Belt and Road Initiative

Epidemiological Characteristics of Overseas-Imported Infectious Diseases Identified through Airport Health-Screening Measures: A Case Study on Fuzhou, China

BACKGROUND

This study aimed to examine the epidemiological characteristics of imported infections and assess the effectiveness of border health screening in detecting imported diseases.

METHODS

We obtained infection data for 2016 to 2019 from the Fuzhou Changle International Airport Infection Reporting System. The demographic, temporal, and spatial characteristics of travel-related infections were analyzed using r×c contingency tables, the Cochran-Armitage trend test, and seasonal-trend decomposition using LOESS (STL). Detection rates were used as a proxy for the effectiveness of border health-screening measures.

RESULTS

Overall, 559 travel-related infections were identified during the study period, with 94.3% being imported infections. Airport health screening demonstrated an overall effectiveness of 23.7% in identifying travel-associated infections. Imported infections were predominantly identified in males, with 55.8% of cases occurring in individuals aged 20-49. The peak periods of infection importation were from January to February and from May to August. The infectious diseases identified were imported from 25 different countries and regions. All dengue fever cases were imported from Southeast Asia. Most notifiable infections (76.0%) were identified through fever screening at the airport.

CONCLUSION

The increasing number of imported infections poses a growing challenge for public health systems. Multifaceted efforts including surveillance, vaccination, international collaboration, and public awareness are required to mitigate the importation and spread of infectious diseases from overseas sources.

Machine learning-assisted serum SERS strategy for rapid and non-invasive screening of early cystic echinococcosis

Early and accurate diagnosis of cystic echinococcosis (CE) with existing technologies is still challenging. Herein, we proposed a novel strategy based on the combination of label-free serum surface-enhanced Raman scattering (SERS) spectroscopy and machine learning for rapid and non-invasive diagnosis of early-stage CE. Specifically, by establishing early- and middle-stage mouse models, the corresponding CE-infected and normal control serum samples were collected, and silver nanoparticles (AgNPs) were utilized as the substrate to obtain SERS spectra. The early- and middle-stage discriminant models were developed using a support vector machine, with diagnostic accuracies of 91.7% and 95.7%, respectively. Furthermore, by analyzing the serum SERS spectra, some biomarkers that may be related to early CE were found, including purine metabolites and protein-related amide bands, which was consistent with other biochemical studies. Thus, our findings indicate that label-free serum SERS analysis is a potential early-stage CE detection method that is promising for clinical translation.

Geospatial analysis of spatial distribution, patterns, and relationships of health status in the belt and road initiative

The Health Silk Road plays a crucial role in the Belt and Road Initiative, and comprehending the health status within the participating countries is fundamental for fostering cooperation in public health. This paper collected five health indicators to represent the health status of the Belt and Road countries. Employing spatial statistics, the spatial patterns of health indicators and the associations with influencing factors were investigated. The utilized spatial statistics encompass spatial autocorrelation methods, geographical detector and spatial lag model. The results revealed obvious disparities and significant positive spatial autocorrelation of health indicators within the Belt and Road countries. Specifically, countries in Sub-Saharan Africa exhibited significant clustering of limited health indicators, while countries in Europe and Central Asia demonstrated significant clustering of robust health indicators. Furthermore, the health indicators exhibited significant spatial heterogeneity and association with the influencing factors. Universal health coverage, household air pollution, and the prevalence of undernourishment emerge as influential factors affecting health indicators. Overall, our findings highlighted complex influencing factors that contributed to the profound health inequalities across the Belt and Road countries. These factors should be duly considered in public health collaborations within the Belt and Road Initiative.

China's hidden role in malaria control and elimination in Africa

BACKGROUND

Insufficient funding is hindering the achievement of malaria elimination targets in Africa, despite the pressing need for increased investment in malaria control. While Western donors attribute their inaction to financial constraints, the global health community has limited knowledge of China's expanding role in malaria prevention. This knowledge gap arises from the fact that China does not consistently report its foreign development assistance activities to established aid transparency initiatives. Our work focuses on identifying Chinese-funded malaria control projects throughout Africa and linking them to official data on malaria prevalence. By doing so, we aim to shed light on China's contributions to malaria control efforts, analysing their investments and assessing their impact. This would provide valuable insights into the development of effective financing mechanisms for future malaria control in Africa.

METHODS

Our research used AidData' s recently released Global Chinese Development Finance Dataset V.2.0 providing comprehensive coverage of all official sector Chinese development financing across Africa, from which we identify 224 Chinese-funded malaria projects in Sub-Saharan Africa (SSA) committed between 2002 and 2017. We conducted an analysis of the spending patterns by year, country and regions within Africa and compared it with data on population-adjusted malaria prevalence, sourced from the Malaria Atlas Project.

RESULTS

Chinese-financed malaria projects Africa mainly focused on three areas: the provision of medical supplies (72.32%), the construction of basic health infrastructure (17.86%) and the deployment of anti-malaria experts (3.57%). Moreover, nearly 39% of the initiatives were concentrated in just four countries: the Democratic Republic of Congo, Central African Republic, Uganda and Liberia. Additionally, China's development financing amount showed a weak negative correlation (-0.2393) with population-weighted malaria prevalence. We concluded that the extent and direction of China's support are not adequately tailored to address malaria challenges in different countries.

CONCLUSION

With China's increasing engagement in global health, it is anticipated that malaria control will continue to be a prominent priority on its development assistance agenda. This is attributed to China's vast expertise in malaria elimination, coupled with its substantial contribution as a major producer of malaria diagnostics and treatments.

Poor performance of malaria rapid diagnostic tests for the detection of Plasmodium malariae among returned international travellers in China

BACKGROUND

Malaria is a worldwide infectious disease. For countries that have achieved malaria elimination, the prevention of re-establishment due to infections in returned travellers has become important. The accurate and timely diagnosis of malaria is the key in preventing re-establishment, and malaria rapid diagnostic tests (RDTs) are frequently used due to their convenience. However, the RDT performance in Plasmodium malariae (P. malariae) infection diagnosis remains unknown.

METHODS

This study analysed epidemiological features and diagnosis patterns of imported P. malariae cases from 2013 to 2020 in Jiangsu Province and evaluated the sensitivity of four parasite enzyme lactate dehydrogenase (pLDH)-targeting RDTs (Wondfo, SD BIONLINE, CareStart and BioPerfectus) and one aldolase-targeting RDT(BinaxNOW) for P. malariae detection. Furthermore, influential factors were investigated, including parasitaemia load, pLDH concentration and target gene polymorphisms.

RESULTS

The median duration from symptom onset to diagnosis among patients with P. malariae infection was 3 days, which was longer than that with Plasmodium falciparum (P. falciparum) infection. The RDTs had a low detection rate (39/69, 56.5%) among P. malariae cases. All tested RDT brands had poor performance in P. malariae detection. All the brands except the worst-performing SD BIOLINE, achieved 75% sensitivity only when the parasite density was higher than 5000 parasites/μL. Both pLDH and aldolase showed relatively conserved and low gene polymorphism rates.

CONCLUSIONS

The diagnosis of imported P. malariae cases was delayed. The RDTs had poor performance in P. malariae diagnosis and may threaten the prevention of malaria re-establishment from returned travellers. The improved RDTs or nucleic acid tests for P. malariae cases are urgently needed for the detection of imported cases in the future.

The Belt and Road Initiative, Public Health Expenditure and Economic Growth: Evidence from Quasi-Natural Experiments

The United Nations 2030 Sustainable Development Goals (SDGs) involve society, economy, and environment, and the Belt and Road Initiative (BRI) is an important path to implement the SDGs. Moreover, the BRI is a vision for economic development of countries along the route. Although many studies documented the effect of the BRI on environment and economic performance, few studies have discussed the effect of the BRI on social and economic benefits. Therefore, we introduce the public health expenditure to explore the relationship between the BRI and the public health and economic growth of countries along the route from the dual perspective of social development and economic growth. Based on a panel data from 171 countries from 2010 to 2018, the current research explores whether the BRI can boost public health and promote economic growth in the belt-road countries. As a result, we found that the BRI boosted the expenditure of public health and effectively spurred economic growth in the belt-road countries. Furthermore, the effect of the BRI on the economic growth in the countries along the route depends on the level of public health expenditure in each country; the positive effect of the BRI on economic growth is significant when the public health expenditure level is moderate instead of low or high. The findings provide theoretical and practical insights into the SDGs of the BRI.

The Efficiency of Commercial Immunodiagnostic Assays for the Field Detection of Schistosoma japonicum Human Infections: A Meta-Analysis

Although great strides have been achieved, schistosomiasis japonica remains a major public health concern in China. Immunodiagnostics have been widely accepted as the first choice in large-scale screening of Schistosoma japonicum human infections, and indirect hemagglutination test (IHA), enzyme-linked immunosorbent assay (ELISA), and dipstick dye immunoassay (DDIA) are currently the three most common immunological tests for the diagnosis of S. japonicum human infections in China. This meta-analysis aimed to comprehensively assess the performance of IHA, ELISA, and DDIA for the field diagnosis of S. japonicum human infections. A total of 37 eligible publications were enrolled in the final analysis, including 29 Chinese publications and 8 English publications. No significant heterogeneities were detected among the studies reporting ELISA (I2 = 88%, p < 0.05), IHA (I2 = 95%, p < 0.05), or DDIA (I2 = 84%, p < 0.05). DDIA showed the highest pooled sensitivity (90.8%, 95% CI: 84.6% to 94.7%) and IHA presented the highest pooled specificity for detection of S. japonicum human infections (71.6%, 95% CI: 65.9% to 76.7%). Summary receiver operating characteristic (SROC) curve analysis showed that IHA exhibited the highest area under the SROC curve (AUC) (0.88, 95% CI: 0.85 to 0.9), and ELISA presented the lowest AUC (0.85, 95% CI: 0.82 to 0.88). Deeks’ funnel plots indicated no publication bias. IHA presented the highest sensitivity in medium-endemicity regions and the highest specificity for diagnosis of S. japonicum human infections in low-endemicity regions, and ELISA showed the highest diagnostic sensitivity in high-endemicity regions and the highest specificity in medium-endemicity regions, while DDIA exhibited the highest diagnostic sensitivity in high-endemicity regions and the highest specificity in low-endemicity regions. IHA and DDIA presented a higher efficiency for the diagnosis of S. japonicum human infections in marshland and lake regions than in hilly and mountainous regions, while ELISA showed a comparable diagnostic sensitivity between in marshland and lake regions and hilly and mountainous regions (88.3% vs. 88.6%), and a higher specificity in marshland and lake regions than in hilly and mountainous regions (60% vs. 48%). Our meta-analysis demonstrates a comparable diagnostic accuracy of IHA, ELISA, and DDIA for S. japonicum human infections, and the diagnostic sensitivity and specificity of IHA, ELISA, and DDIA vary in types and infection prevalence of endemic regions. DDIA combined with IHA is recommended as a tool for screening chemotherapy targets and seroepidemiological surveys during the stage moving towards schistosomiasis elimination in China. Further studies to examine the effectiveness of combinations of two or three immunological tests for diagnosis of S. japonicum human infections are warranted.

Trends in Under-5 Mortality Rates and Their Associations with Socioeconomic Factors Among Countries Participating in the Belt and Road Initiative: A Panel Data Analysis

Purpose

The Belt and Road Initiative (BRI) provided a platform to promote trade and economic collaboration, with health promotion also being an important component. This study examined the burden of the under-5 mortality rate (U5MR) among BRI countries and studied the impact of socioeconomic development on the U5MR.

Patients and Methods

Data were collected from 137 BRI countries for the period 2000–2018. The temporal changes in the U5MR and the estimated annual percentage change (EAPC) were used to assess the U5MR burden. A quantile fixed-effects model was used to access the associations between socioeconomic factors and the U5MR.

Results

The U5MR varied widely among the 137 analyzed countries in 2018, being highest in Somalia (121.5 per 1000) and lowest in Slovenia (2.1 per 1000). The decreasing trend in U5MR was largest in Montenegro (EAPC = –9.6, 95% confidence interval [CI] = –10.2 to –9.0), while the increasing trend was largest in Dominica (EAPC = 6.0, 95% CI = 5.3 to 6.7). Countries with higher U5MRs in 2000 experienced more rapid decreases in the U5MR from 2000 to 2018. The influence of socioeconomic factors on U5MR was related to the distribution of U5MR.

Conclusion

The U5MR remains a major public-health issue in some BRI countries. Improving the economic situation will benefit child health in BRI countries in the long run.

Research capacity of global health institutions in China: a gap analysis focusing on their collaboration with other low-income and middle-income countries

Introduction

This paper presented qualitative and quantitative data collected on the research capacity of global health institutions in China and aimed to provide a landscaping review of the development of global health as a new discipline in the largest emerging economy of the world.

Methods

Mixed methods were used and they included a bibliometric analysis, a standardised survey and indepth interviews with top officials of 11 selected global health research and educational institutions in mainland China.

Results

The bibliometric analysis revealed that each institution had its own focus areas, some with a balanced focus among chronic illness, infectious disease and health systems, while others only focused on one of these areas. Interviews of key staff from each institution showed common themes: recognition that the current research capacity in global health is relatively weak, optimism towards the future, as well as an emphasis on mutual beneficial networking with other countries. Specific obstacles raised and the solutions applied by each institution were listed and discussed.

Conclusion

Global health institutions in China are going through a transition from learning and following established protocols to taking a more leading role in setting up China’s own footprint in this area. Gaps still remain, both in comparison with international institutions, as well as between the leading Chinese institutions and those that have just started. More investment needs to be made, from both public and private domains, to improve the overall capacity as well as the mutual learning and communication within the academic community in China.

Helminthiases in the People's Republic of China: Status and prospects

Helminth infections, many of them listed as neglected tropical diseases by the World Health Organization, remain a public health issue in many parts of the world. The People's Republic of China (P.R. China) stands out due to impressive progress in the control and local elimination of helminth infections. An important contextual factor is P.R. China's sustained social and economic development that allowed implementation of health-related poverty alleviation, improving water, sanitation and hygiene, enhancing information, education and communication, coupled with major engineering and infrastructure development and intersectoral collaboration. Nonetheless, food-borne trematodiases, soil-transmitted helminthiases, echinococcosis, cysticercosis/taeniasis and schistosomiasis still exert a considerable burden in P.R. China, even though the numbers of infected people have decreased substantially since the new millennium. This special issue of Acta Tropica provides a comprehensive update of the current knowledge of the main helminth infections in P.R. China, summarises progress in research and discusses future prospects for gaining and sustaining control towards the final goal of breaking transmission and hence, eliminating helminthiases. It consists of 34 articles with a wide coverage that can be grouped into six domains: (i) epidemiological assessment and disease burden estimates; (ii) diagnostics and antigen characterisation; (iii) drug and vaccine development; (iv) host-parasite interactions and snail genetics; (v) surveillance and public health response; and (vi) capacity building and international cooperation. The control and elimination of helminthiases not only furthers the health and wellbeing of the Chinese people, but also provides innovative approaches, tools and strategies, which can be adopted and applied in other countries and regions of the world where helminthiases still prevail.

Seventy years' achievements of international cooperation by the National Institute of Parasitic Diseases at the Chinese Center for Disease Control and Prevention

BACKGROUND

With the promotion of national control programs on parasitic and tropical diseases in China, the National Institute of Parasitic Diseases (NIPD), Chinese Center for Disease Control and Prevention has gained significant experience in the global health arena through international cooperation over the last seven decades allowing a multilateral impact in the elimination of major endemic diseases.

METHODS

The achievements of NIPD since 1950 has been analyzed with emphasis on the various stages that started with research and control of the endemic parasitic and other tropical diseases at the national level and progressed via international cooperation into a global presence.

RESULTS

The major achievements contributed by NIPD consist of (i) improving technical capability; (ii) promoting control and elimination of parasitic and tropical diseases; (iii) participating in global health governance and cooperation; and (iv) developing a cooperation model for technical assistance and global public health development. It is expected that NIPD's experience of international cooperation will be essential for the dissemination of China's successful experience in global health governance, emergency response and development, with focus on malaria and neglected tropical diseases such as schistosomiasis, soil-borne and food-borne helminthiases and echinococcosis.

CONCLUSIONS

NIPD's new tasks will not only continue to promote national control of endemic parasitic infections and disease elimination programs in China, but also play a leading role in global health and disease elimination programs in the future.

Contribution of NIPD-CTDR to the parasitic diseases control and elimination in China: Memory of the 70th anniversary for NIPD-CTDR

China has achieved a great success in control and elimination of key parasitic diseases. In 2007, the elimination of lymphatic filariasis was verified by WHO. The schistosomiasis incidence and snail-distributed areas have reduced to the lowest level in the history. The transmission and disease burden of echinococcosis have been contained largely, and the populations infected with soil-transmitted trematode and food-borne parasites have also shown a significantly declining trend. Because of rapid globalization and climate changes, however, many new challenges have arisen. In his paper, the 2020-2030 roadmaps towards the control and elimination of these key parasitic diseases are described. Moreover, China is actively implementing its global health strategy, and will be more and more engaged into global health affairs, in which a series of China-Africa health cooperation projects have been in planning with a wish of making a greater contribution to the SDGs.

Establishment and application of the National Parasitic Resource Center (NPRC) in China

The National Parasitic Resource Center (NPRC) was created in 2004. It is a first-level platform under the Basic Condition Platform Center of the Ministry of Science and Technology of China. The resource centre involves 21 depository institutions in 15 regions of the country, including human parasite and vector depository, animal parasite depository, plant nematode characteristic specimen library, medical insect characteristic specimen library, trematode model specimen library, parasite-vector/snail model specimen library, etc. After nearly 15 years of operation, the resource centre has been built into a physical library with a database of 11 phyla, 23 classes, 1115 species and 117,814 pieces of parasitic germplasm resources, and three live collection bases of parasitic germplasm resources. A variety of new parasite-related immunological and molecular biological detection and identification technologies produced by the resource centre are widely used in the fields of public health responses, risk assessments on food safety, and animal or plant quarantine. The NPRC is the largest and top level resource centre on parasitology in China, and it is a leading technology platform for collecting and identifying parasitic resources.

Characterization of Ebinur Lake Virus and Its Human Seroprevalence at the China-Kazakhstan Border

In recent years, rapidly increasing trade and travel across the China–Kazakhstan border has increased the potential risk of the introduction and exportation of vectors and their related diseases. The Ebinur Lake Nature Reserve is located in Xinjiang Uygur Autonomous Region, near the China–Kazakhstan border, with a suitable ecosystem for mosquito breeding. In our previous work, a novel Orthobunyavirus species named Ebinur Lake virus (EBIV) was isolated in the reserve. To gain insights into the potential risk of EBIV in this region, we conducted a study that aimed to clearly outline EBIV’s biological characteristics and its human seroprevalence in this region. Phylogenetically, the analysis of all three segments of EBIV demonstrated that it belongs to the genus Orthobunyavirus, which is clustered in the Bunyamwera serogroup. EBIV replicated efficiently and caused cytopathic effects (CPEs) in vertebrate cells. The survival rates of the EBIV-challenged mice were 0 and 20% when inoculated with viral concentrations ≥10⁴ or 10² plaque-forming units, respectively. For EBIV-infected mice, internal bleeding and pathological changes were observed. In addition, the overall immunoglobulin M (IgM) antibody [1:4 by immunofluorescence assay (IFA)], immunoglobulin G (IgG) antibody (1:10 by IFA), and neutralizing antibody [90% plaque reduction neutralization test (PRNT)] prevalence was 8.05, 12.3, and 0.95%, respectively, in the studied residents. In summary, EBIV is a new member of the Bunyamwera serogroup and is able to competently infect cells derived from mosquitoes, rodents, monkeys, or humans. Furthermore, EBIV caused severe disease and even death in challenged Kunming mice, and the antibodies against EBIV have been detected in local residents, indicating that the virus is a potential animal or human pathogen.

From parasitic disease control to global health: New orientation of the National Institute of Parasitic Diseases, China CDC

As the only specialized institution for research and control of parasitic diseases at the national level in China for almost 70 years, the National Institute of Parasitic Diseases (NIPD) at the Chinese Center for Disease Control and Prevention (China CDC) has been instrumental in supporting the remarkable progress from high prevalence to transmission interruption or low endemicity of several diseases, lymphatic filariasis, malaria and schistosomiasis in particular. This has taken place through technical guidance, emergency response and scientific research as well as providing technical service, education, training, health promotion and international cooperation. With China's increasing involvement in international cooperation and the increased risk for (re)emerging tropical diseases in mind, the Chinese Government designated in 2017 a new Chinese Center for Tropical Disease Research to NIPD. Responding to the expanded responsibilities, the institute is scaling up its activities in several ways: from parasitic diseases to the wider area of tropical diseases; from disease control to disease elimination; from biological research to policy evidences accumulation; and from public health to global health. Based on this new vision and China's previous accomplishments in the areas mentioned, the institute is in a position to move forward with respect to global health and equitable development according to the central principles of the United Nations' Sustainable Development Goals.

Neglected tropical diseases in the People's Republic of China: progress towards elimination

Since the founding of the People's Republic of China in 1949, considerable progress has been made in the control and elimination of the country's initial set of 11 neglected tropical diseases. Indeed, elimination as a public health problem has been declared for lymphatic filariasis in 2007 and for trachoma in 2015. The remaining numbers of people affected by soil-transmitted helminth infection, clonorchiasis, taeniasis, and echinococcosis in 2015 were 29.1 million, 6.0 million, 366 200, and 166 100, respectively. In 2017, after more than 60 years of uninterrupted, multifaceted schistosomiasis control, has seen the number of cases dwindling from more than 10 million to 37 600. Meanwhile, about 6000 dengue cases are reported, while the incidence of leishmaniasis, leprosy, and rabies are down at 600 or fewer per year. Sustained social and economic development, going hand-in-hand with improvement of water, sanitation, and hygiene provide the foundation for continued progress, while rigorous surveillance and specific public health responses will consolidate achievements and shape the elimination agenda. Targets for poverty elimination and strategic plans and intervention packages post-2020 are important opportunities for further control and elimination, when remaining challenges call for sustainable efforts.

A China - Vietnam collaboration for public health care: a preliminary study

Background

Vietnam has achieved significant results in terms of improving population health and sustainable development goals (SDGs). However, several public health problems remain such as high mortality deriving from non-communicable diseases (NCDs). As part of their long-standing relationship, Vietnam and China have collaborated in various health fields. The objective of this study was to examine the current situation of public health cooperation between Vietnam and China and suggest ways to deepen future co-operations.

Methods

Between March and May 2018, we conducted 14 in-depth interviews with key informants from Vietnam and China. The inclusion criteria in this study were as follows: 1) researchers who worked at research institutes or universities and were engaged in health cooperation research, 2) officers who were from government agencies or international organizations (IOs) and had been involved in, or were familiar with the health cooperation projects between China and Vietnam. The interviews were audiotaped and transcribed verbatim, and then analyzed to identify current cooperation strategies and cooperation fields, as well as to provide suggestions for future collaborations.

Results

Current health cooperation mechanisms between China and Vietnam include bilateral and multilateral cooperation such as ASEAN Plus Three (China, Japan and ROK), ASEAN Plus One (China), the Greater Mekong sub-region, and the Lancang-Mekong Cooperation. This health cooperation can be summarized in terms of health security, health development, and health-related innovation. The health cooperation priorities outlined by our informants consisted of unimplemented SDGs such as NCD problems and the public health system. A proposal for future health collaboration was to establish a triangular cooperation between China, IOs/non-government organizations (NGOs) and Vietnam.

Conclusions

The existing cooperation between China and Vietnam in bilateral and multilateral levels has provided a good foundation for a deeper and more extensive future partnership. Key areas of future cooperation would be to achieve SDGs and solve NCD related problems, which can be accelerated through favorable cooperation and reliable partnerships. A triangular cooperation between China, Vietnam, and IOs/NGOs was considered as a suitable future mechanism.