1
|
Cheng L, Zhong S, Xu X, Li J, Xie F, Lin Y, Zhang D. Chinese parents' intention to vaccinate their 0-5-year-old children with the EV-71 vaccine against hand, foot, and mouth disease and willingness-to-pay. Front Public Health 2024; 12:1336687. [PMID: 38525345 PMCID: PMC10958786 DOI: 10.3389/fpubh.2024.1336687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/31/2024] [Indexed: 03/26/2024] Open
Abstract
Background This study aimed to determine the intention and willingness-to-pay (WTP) of Chinese parents/guardians to vaccinate their children with the EV-71 vaccine. Knowledge levels about hand, foot, and mouth disease (HFMD) and the EV-71 vaccine were also investigated. Methods A cross-sectional, self-administered online survey was conducted between November 2022 and March 2023. A stratified multi-stage random sampling method was used to recruit parents/guardians of children aged 0-5 years in southeastern China. Results A total of 3,626 complete responses were received. The mean knowledge score of HFMD was 9.99 (±4.23) out of a total of 14 points. The majority of the participants reported a somewhat willing intent (58.8%), followed by an extremely willing intent (28.9%). Participants who did not consider the EV-71 vaccine expensive (OR = 2.94, 95%CI 2.45-3.53) perceived that the EV-71 vaccine is effective (OR = 2.73, 95%CI 1.52-4.90), and a high knowledge level of HFMD (OR = 1.90, 95%CI 1.57-2.29) had the highest significant odds of having an extremely willing intent to vaccinate their children with the EV-71 vaccine. The median (interquartile range [IQR]) of WTP for the EV-71 vaccine was CNY¥200/USD$28 (IQR CNY¥100-400/USD$14-56). The highest marginal WTP for the vaccine was mainly influenced by the perceived high cost of the vaccine. Those participants who did not consider the EV-71 vaccine expensive had more than 10 times higher odds of vaccinating their children (OR = 10.86, 95%CI 8.49-13.88). Perceived susceptibility, perceived benefits, and perceived barriers were also significant influencing factors in the highest marginal WTP. Conclusion The findings demonstrate the importance of improving health promotion and reducing the barriers to EV-71 vaccination. Therefore, it is important to improve health promotion and reduce the barriers to EV-71 vaccination.
Collapse
Affiliation(s)
- Lu Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Sumei Zhong
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Xiaonan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Junrong Li
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Fangqin Xie
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Dongjuan Zhang
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| |
Collapse
|
2
|
Sainuddin SS, Abdul Kadir A, Zakaria R. Monkeypox or hand-foot-and-mouth-disease: A case report. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Monkeypox is a rare disease originating in Africa and has recently gained the spotlight globally because of the increasing cases reported in Western Europe and North America. However, since July 2022, the World Health Organization has declared this disease a public health emergency of international concern as the cases were rising globally. We report a case of the severe form of rashes of hand-foot-and-mouth-disease to distinguish it from current outbreaks of the monkeypox virus. Hopefully, this case report will aid primary care physicians in their ability to recognize and distinguish between a severe hand-foot-and-mouth-disease rash and an infection with the monkeypox virus. So, effective management and treatment may aid patients in enhancing their quality of life.
Collapse
Affiliation(s)
- Siti Syafiqah Sainuddin
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MALAYSIA
| | - Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MALAYSIA
| | - Rosnani Zakaria
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MALAYSIA
| |
Collapse
|
3
|
Chen Y, Xiao Y, Ye Y, Jiang F, He H, Luo L, Chen H, Shi L, Mu Q, Chen W, Guo X, Zhang M, Li J, Guan Q, Chen Z, Yang X. Immunogenicity and safety of an inactivated enterovirus 71 vaccine coadministered with trivalent split-virion inactivated influenza vaccine: A phase 4, multicenter, randomized, controlled trial in China. Front Immunol 2022; 13:1080408. [PMID: 36569946 PMCID: PMC9772018 DOI: 10.3389/fimmu.2022.1080408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background Few data exist on the immunogenicity and safety of an inactivated enterovirus 71 vaccine (EV71 vaccine) coadministered with trivalent split-virion inactivated influenza vaccine (IIV3) in infants. Methods This trial was a phase 4, randomized, controlled trial. Infants aged 6-11 months were eligible, with no history of hand, foot and mouth disease (HFMD) and no history of EV71 vaccine or any influenza vaccine. Eligible infants were randomly assigned to EV71+IIV3 group, EV71 group or IIV3 group. Blood samples were collected on day 0 and 56. Results Between September 2019 and June 2020, 1151 infants met eligibility criteria and 1134 infants were enrolled. 1045 infants were included in the per-protocol population, including 347 in the EV71+IIV3 group, 343 in the EV71 group, and 355 in the IIV3 group. The seroconversion rate (98.56% vs 98.54%; seroconversion rates difference of 0.02% [95% CI: 0.70-0.98]) and GMT (419.05 vs 503.72; GMT ratio of 0.83 [95% CI 0.70 - 0.98]) of EV71 neutralizing antibodies in the EV71+IIV3 group was not inferior to those in the EV71 group. The non-inferiority results for influenza virus antibodies (A/H1N1, A/H3N2 and B) showed that the seroconversion rates and GMTs of the EV71+IIV3 group were non-inferiority to those of the IIV3 group. Systemic and local adverse event rates were similar between groups. None of serious adverse events (SAEs) were related to vaccination. Conclusions Coadministration of the EV71 vaccine with IIV3 was safe and did not interfere with immunogenicity. These findings support a viable immunization strategy for infants with the EV71 vaccine coadministered with IIV3 in China. This trial is registered with ClinicalTrials.gov, number NCT04091880.
Collapse
Affiliation(s)
- Yaping Chen
- Immunization Programme Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yanhui Xiao
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Ying Ye
- Institute for Communicable Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Feng Jiang
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Hanqing He
- Immunization Programme Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Linyun Luo
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Haiping Chen
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Lubin Shi
- Institute of Expanded Programme on Immunization, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Qiuyue Mu
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Wei Chen
- Medical Affairs Department, Wuhan Institute of Biological Products Company Limited, Wuhan, Hubei, China
| | - Xue Guo
- Medical Affairs Department, Changchun Institute of Biological Products Company Limited, Changchun, Jilin, China
| | - Min Zhang
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Jun Li
- Institute of Expanded Programme on Immunization, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Qinghu Guan
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Zhiping Chen
- Immunization Programme Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China,*Correspondence: Xiaoming Yang, ; Zhiping Chen,
| | - Xiaoming Yang
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China,Research and Development Department, National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Company Limited, Wuhan, Hubei, China,*Correspondence: Xiaoming Yang, ; Zhiping Chen,
| |
Collapse
|
4
|
Tong Y, Zhang X, Chen J, Chen W, Wang Z, Li Q, Duan K, Wei S, Yang B, Qian X, Li J, Hang L, Deng S, Li X, Guo C, Shen H, Liu Y, Deng P, Xie T, Li Q, Li L, Du H, Mao Q, Gao F, Lu W, Guan X, Huang J, Li X, Chen X. Immunogenicity and safety of an enterovirus 71 vaccine in children aged 36-71 months: A double-blind, randomised, similar vaccine-controlled, non-inferiority phase III trial. EClinicalMedicine 2022; 52:101596. [PMID: 35923425 PMCID: PMC9340505 DOI: 10.1016/j.eclinm.2022.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The enterovirus 71 (EV71) vaccine produced by Wuhan Institute of Biological Products Co., Ltd. (WIBP) (B-EV71) has been given to children aged 6-35 months, and it has shown good safety, immunogenicity and efficacy. However, the administration of EV71 vaccine in children aged 36-71 months, which is another target population, needs further exploration. METHODS We conducted a double-blind, randomised, controlled, non-inferiority phase III clinical trial in children aged 36-71 months, with a further comparison group of children aged 6-35 months in China. Children aged 6-71 months with no history of hand, foot and mouth disease or prior-vaccination of EV71 vaccine were eligible and recruited. Eligible participants aged 36-71 months were randomly assigned (1:1) to receive two doses of the B-EV71 vaccine (Older-B group) or the control EV71 vaccine (C-EV71 vaccine, produced by Institute of Medical Biology, Chinese Academy of Medical Sciences) (Older-C group), administered at a 30-day interval. Eligible participants aged 6-35 months were enrolled consecutively to receive two doses of the B-EV71 vaccine (Younger-B group) at a 30-day interval. Participants, investigators and those assessing outcomes were masked to the vaccine received. Non-inferiority analyses were conducted to compare the immunogenicity of EV71 vaccine in the Older-B group with that in the Older-C and Younger-B groups. Non-inferiority margins were 10% for seroconversion rate differences and 0.5 for geometric mean titre (GMT) ratios. The primary endpoints were the GMT level and seroconversion rate of anti-EV71 neutralising antibody 30 days after the second dose of vaccination. The primary analysis was performed in the per-protocol population. Safety analyses were conducted amongst participants receiving at least one dose of vaccine. This trial was registered at Chinadrugtrials.org.cn (#CTR20192345). FINDINGS Between June 3 and June 30, 2020, 1600 participants were enrolled and assigned, including 625 participants in the Older-B group, 625 participants in the Older-C group and 350 participants in the Younger-B group. The seroconversion rate of anti-EV71 neutralising antibody in the Older-B group (99.66%; 95% CI: 99.18%-100.00%) was non-inferior to that of the Older-C (99.32%; 95% CI: 98.65%-99.98%) and Younger-B groups (100.00%; 95% CI: 100.00%-100.00%). The differences in seroconversion rates in the Older-B group to those in the Older-C and Younger-B groups were 0.34% (95%CI: -2.17%-2.86%) and -0.34% (95%CI: -2.78%-2.09%). The GMT of the anti-EV71 neutralising antibody in the Older-B group (693.87) was also non-inferior to that in the Older-C (289.37) and Younger-B groups (634.80). The ratios of GMTs in the Older-B group to those in the Older-C and Younger-B groups were 2.67 (95%CI: 2.00-3.00) and 1.00 (95%CI: 0.75-1.00), respectively. The incidence of any adverse event (AE) related to vaccination was similar amongst the three groups (34/625 [5.44%] in the Older-B group, 32/623 [5.14%] in the Older-C group, and 26/349 [7.45%] in the Younger-B group), with only 2 (0.57%) participants having grade 3 AEs in the Younger-B group. Fifteen (0.94%) participants from these three groups had reported serious AEs (SAEs), all of which were unrelated to vaccines. INTERPRETATION EV71 vaccine produced by WIBP could extend to be administered to children aged 36-71 months against EV71 infection. However, the persistence of vaccine-induced immunities needs to be further investigated. FUNDING Hubei Province's young medical talent program (20191229), Hubei Province's young talent program (2021), Hubei Province's young public health talent program (2021); and the Wuhan Institute of Biological Products Co., Ltd.
Collapse
Affiliation(s)
- Yeqing Tong
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Xinyue Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhua Chen
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Wei Chen
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Zhao Wang
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Qiong Li
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Kai Duan
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Sheng Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Beifang Yang
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Xiaoai Qian
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Jiahong Li
- Xiangzhou District Centre for Disease Control and Prevention, Wuhan, China
| | - Lianju Hang
- Xiangzhou District Centre for Disease Control and Prevention, Wuhan, China
| | - Shaoyong Deng
- Xiangzhou District Centre for Disease Control and Prevention, Wuhan, China
| | - Xinguo Li
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Changfu Guo
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Heng Shen
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Yan Liu
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Peng Deng
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Tingbo Xie
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Qingliang Li
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Li Li
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Hongqiao Du
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
| | - Qunying Mao
- National Institutes for Food and Drug Control, Beijing, China
| | - Fan Gao
- National Institutes for Food and Drug Control, Beijing, China
| | - Weiwei Lu
- National Vaccine &Serum Institute, Beijing, China
| | - Xuhua Guan
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
- Corresponding authors.
| | - Jiao Huang
- Centre for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Corresponding authors.
| | - Xiuling Li
- Shanghai Institute of Biological Products Co., Ltd, Shanghai, China
- Corresponding authors.
| | - Xiaoqi Chen
- Wuhan Institute of Biological Products Co., Ltd, Wuhan, China
- Corresponding authors.
| |
Collapse
|
5
|
Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Hand, Foot, and Mouth Disease: A Narrative Review. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2022; 16:77-95. [PMID: 36284392 DOI: 10.2174/1570180820666221024095837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some countries, early recognition of this disease is of paramount importance. OBJECTIVE This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease. METHODS A search was conducted in February 2022 in PubMed Clinical Queries using the key term "hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in English were included in this review. RESULTS Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease. CONCLUSION Familiarity of the disease including its atypical manifestations is crucial so that a correct diagnosis can be made, and appropriate treatment initiated. A timely diagnosis can help avoid contact with the affected individual and decrease the risk of an outbreak.
Collapse
Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Hong Kong Institute of Integrative Medicine, and the Jockey Club School of Public Health and Primary Care, The Chinese University Hong Kong, Hong Kong
| |
Collapse
|
6
|
Yi Z, Pei S, Suo W, Wang X, Huang Z, Yi A, Wang B, He Z, Wang R, Li Y, Fan W, Huang X. Epidemiological characteristics, routine laboratory diagnosis, clinical signs and risk factors for hand, -foot -and -mouth disease: A systematic review and meta-analysis. PLoS One 2022; 17:e0267716. [PMID: 35482791 PMCID: PMC9049560 DOI: 10.1371/journal.pone.0267716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background For the past few years, only a few monovalent EV71 vaccines have been developed, while other enterovirus vaccines are in short supply. We conducted a quantitative meta-analysis to explore the epidemiological characteristics, routine laboratory diagnosis, clinical signs and risk factors for hand, foot and mouth disease (HFMD). Methods PubMed, Embase and the Web of Science were searched for eligible reports published before April 16, 2021, with no publication time or language restrictions. The primary outcome was the odds ratio of the epidemiological characteristics, routine laboratory diagnosis, and clinical signs associated with HFMD severity and death. Results After screening 10522 records, we included 32 articles comprising 781903 cases of hand, foot and mouth disease. Patients with severe illness developed some clinical signs (hypersomnia (OR = 21.97, 95% CI: 4.13 to 116.74), convulsion (OR = 16.18, 95% CI: 5.30 to 49.39), limb shaking (OR = 47.96, 95% CI: 15.17 to 151.67), and breathlessness (OR = 7.48, 95% CI: 1.90 to 29.40)) and had some changes in laboratory parameters (interleukin-6 levels standardized mean difference (SMD) = 1.57, 95%CI: 0.55 to 2.60), an increased neutrophils ratio (SMD = 0.55, 95%CI: 0.17 to 0.93), cluster of differentiation 4 (CD4+) (SMD = -1.38, 95%CI: -2.33 to -0.43) and a reduced lymphocytes ratio (SMD = -0.48, 95%CI: -0.93 to -0.33)) compared with patients with mild illness. The risk factors for death included cyanosis (OR = 5.82, 95% CI: 2.29 to 14.81), a fast heart rate (OR = 3.22, 95% CI: 1.65 to 6.30), vomiting (OR = 2.70, 95% CI: 1.33 to 5.49) and an increased WBC count (SMD = 0.60, 95% CI: 0.27 to 0.93). Conclusions China has the highest incidence of HFMD. Our meta-analyses revealed important risk factors that are associated with the severity and mortality of HFMD.
Collapse
Affiliation(s)
- Zhijie Yi
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shujun Pei
- College of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Wenshuai Suo
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengyuan Huang
- Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Aihua Yi
- First Affiliated Hospital of Shaoyang University, Shaoyang, China
| | - Bohao Wang
- Quality Control Department of Henan Children’s Hospital, Zhengzhou, China
| | - Zhiquan He
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Ruolin Wang
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Yi Li
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Wei Fan
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Xueyong Huang
- College of Public Health, Zhengzhou University, Zhengzhou, China
- * E-mail:
| |
Collapse
|