[Epidemic trend of tuberculosis in adolescents in China, 2000-2019]

Objective: To analyze the epidemic trend of tuberculosis (TB) in adolescents in China from 2000 to 2019. Methods: We used data from Global Burden of Disease Study 2019 to describe the epidemic trend of TB. The estimated annual percentage changes (EAPC) of the morbidity and mortality were calculated to assess epidemic trends from 2000 to 2019. Results: In 2019, a total of 37 815.670 TB cases and 213.629 deaths were reported in adolescents in China, the morbidity was 25.938/100 000 and the mortality was 0.147/100 000. The cases and deaths of TB in 2019 decreased by 71.84% and 89.90% respectively compared with 2000. In 2019, the incident case number (21 371.747) was 1.30 times higher in male adolescents than in female adolescents (16 443.923), and was 4.11 times higher in age group 15-19 years (30 420.054) than in age group 10-14 years (7 395.616). From 2000 to 2019, the morbidity (EAPC=-3.95, 95%CI: -4.34- -3.55) and mortality (EAPC=-9.18, 95%CI: -9.33- -9.02) of TB in the adolescents showed decreasing trends. The morbidity and mortality of drug-sensitive TB, extensively drug-resistant TB and multidrug-resistant TB all showed decreasing trends. Conclusions: The morbidity and mortality of TB and its subtypes among adolescents in China decreased during 2000-2019. More attention should be paid to male adolescents and adolescents aged 15-19 years due to relatively higher incidence intensity of TB.

[Epidemic situation of malaria and change trend in Belt and Road countries]

Objective: To understand the epidemic situation of malaria and its change trend in the Belt and Road countries. Methods: The 145 countries with which China has signed cooperation documents on the Belt and Road Initiative were selected for this study, and their malaria incidence data were collected from the Global Burden of Disease 2019. The age-standardized incidence rate (ASR) was used to describe the epidemic situation of malaria in 2019. The estimated annual percentage change (EAPC) of the ASR was calculated to assess the incidence trend of malaria from 2013 to 2019. Results: Among the 145 countries, 74 (51.03%) countries had malaria epidemics, mainly in Africa (60.81%, 45/74) and Asia (22.97%, 17/74). The countries with malaria incidence of ≥10 000 per 100 000 in 2019 were mainly distributed in Africa (96.15%, 25/26). From 2013 to 2019, the incidence rates of malaria showed decreasing trends in 32 countries (43.24%), and the incidence rates of malaria in 23 countries (31.08%) showed no significant change, while the incidence rates of malaria in 19 countries (25.68%) showed increasing trends. The obvious increasing trends were observed in Cape Verde (EAPC=151.46, 95%CI: 47.15-329.71), South Africa (EAPC=98.61, 95%CI: 32.11-198.58) and Namibia (EAPC=78.03, 95%CI: 54.30-105.42). Conclusion: About half of the Belt and Road countries had malaria epidemics in 2019, in which 1/4 had increased incidence of malaria. China should continue to strengthen the prevention and control of malaria, especially imported malaria, to maintain the achievements of malaria elimination.

[Epidemic situation of HIV/AIDS and change trend in Belt and Road countries]

Objective: To understand the epidemic situation of HIV/AIDS and its change trend in the Belt and Road countries and provide evidence for the improvement of prevention and control of the cross-border transmission of HIV/AIDS. Methods: The 145 countries that have signed the cooperation document of the Belt and Road initiative with China were selected in our study. Age-standardized incidence rate and prevalence rate of HIV/AIDS in the 145 countries from 2013 to 2019 were downloaded from the Global Burden of Disease Study 2019. Age-standardized incidence rate and prevalence rate of HIV/AIDS in 2019 were used to describe the HIV/AIDS epidemics in 145 countries, and the estimated annual percentage change (EAPC) of incidence was calculated to analyze the trend of HIV/AIDS incidence from 2013 to 2019. Results: In 2019, Africa had the highest proportion of countries with HIV/AIDS incidence exceeding 40.00 per 100 000 (56.86%, 29/51), and Asia had the lowest proportion (5.41%, 2/37). The countries with the prevalence rate of HIV/AIDS exceeding 100.00 per 10 000 were almost distributed in Africa, accounting for 20.69% (30/145). From 2013 to 2019, the incidence rate of HIV/AIDS increased in 50 countries, accounting for 34.48% (50/145). The incidence rate of HIV/AIDS showed downward trends in 69 countries (47.59%, 69/145), and showed no significant change in 26 countries (17.93%, 26/145). The most obvious increase of incidence rate of HIV/AIDS was observed in Comoros (EAPC=15.60, 95%CI: 5.84-26.26) and the most obvious decrease was observed in Burundi (EAPC=-14.27, 95%CI: -15.21 to -13.31). Conclusions: In the Belt and Road countries, the most severe disease burden of HIV/AIDS was observed in countries in Africa, and the incidences of HIV/AIDS increased rapidly in some European countries, which means the risk of cross-border transmission still exists. Hence, the prevention and control of HIV/AIDS in China should be further strengthened in the future.

[Epidemic situation of multidrug-resistant tuberculosis and change trend in Belt and Road countries]

Objective: To analyze the epidemic situation of multidrug-resistant tuberculosis in 2019 and the incidence trends from 2013 to 2019 in the Belt and Road countries. Methods: The 145 countries that have signed cooperation documents of the Belt and Road Initiative with China were selected. Age-standardized incidence and prevalence rate of multidrug-resistant tuberculosis from the Global Burden of Disease Study were used to describe the epidemic situation of multidrug-resistant tuberculosis in 2019. The annual percentage changes of the age-standardized incidence rate were calculated to assess incidence trends of multidrug-resistant tuberculosis from 2013 to 2019. Results: In 2019, of the 145 countries, Somalia had the highest incidence rate (30.42 per 100 000) and prevalence rate (48.86 per 100 000) of multidrug-resistant tuberculosis, while Slovenia had the lowest incidence rate (0.01 per 100 000) and prevalence rate (0.01 per 100 000). The incidence trends of multidrug-resistant tuberculosis in six continents from 2013 to 2019 were as follows: multidrug-resistant tuberculosis incidence rates showed increasing trends in 14 countries (27.45%) and decreasing trends in 22 countries (43.14%) in Africa, showed increasing trends in 2 countries (18.18%) and decreasing trends in 3 countries (27.27%) in North America and showed increasing trends in 2 countries (5.41%) and decreasing trends in 23 countries (62.16%) in Asia. The increasing trends were observed in Europe, Oceania, and South America, but it was found that 26 countries (96.30%) in Europe, 2 countries (18.18%) in Oceania, and 1 country (12.50%) in South America had decreasing trends of multidrug-resistant tuberculosis incidence rates. Conclusion: Multidrug-resistant tuberculosis is endemic in 145 Belt and Road countries with the prevalence increasing year by year in some countries in central and southern Africa and decreasing in European countries except Ukraine.

[Epidemic situation and trend of dengue fever in Belt and Road countries]

Objective: To analyze epidemic situation of dengue fever in 2019 and the incidence trends from 2013 to 2019 in the Belt and Road countries. Methods: We used age-standardized incidence rate (ASR) which was from Global Burden of Disease Study 2019 to describe the epidemic situation of dengue fever in 2019. The estimated annual percentage change(EAPC) of the ASR was calculated to assess dengue fever incidence trends from 2013 to 2019. Results: The 2019 GBD dengue fever incidence records showed that in 145 Belt and Road countries, 93 (64.14%) countries had dengue fever epidemics. In 2019, there were 11 countries with the incidence >3 000.00 per 100 000, including 9 countries in Oceania; 16 countries with the incidence of 1 000.00 per 100 000-2 999.99 per 100 000, including 10 countries in Asia. The incidence rates in most countries in Africa (58.14%,25/43), North America (72.73%,8/11) and South America (66.67%,4/6) ranged from 500.00 per 100 000 to 999.99 per 100 000. The incidence rates of dengue fever in 90.00% (9/10) of countries in Oceania showed increasing trend, and the increasing trend in Fiji was most obvious (EAPC=18.22,95%CI:12.91-23.77), and the incidence rates of dengue fever in 18.18% (4/22) of countries in Asia showed increasing trend, the increasing trend in the Philippines was most obvious (EAPC=3.09,95%CI:1.74-4.45), and the incidence rates of dengue fever in 4.65% (2/43) of countries in Africa showed increasing trend, and the increasing trend in Seychelles was most obvious (EAPC=18.20,95%CI:7.82-29.58). The incidence rates of dengue fever showed no increasing trend in countries in South America and North America. Conclusions: In 2019, more than 60% of the Belt and Road countries had dengue fever epidemics. The incidences of dengue fever were high and showed increasing trends in most Oceanian countries, but the dengue fever epidemics in the countries in Asia, Africa and Americas were relatively mild.

[The analysis on the change and trend of the congenital heart disease mortality rate in children aged 0-1 in China from 2004 to 2018]

Objective: To analyze the trend of the congenital heart disease mortality rate in children aged under 1 year old from 2004 to 2018. Methods: The mortality rate and constituent ratio of congenital heart disease in different genders, urban and rural areas and regions were calculated by using the publicly available Dataset of National Mortality Surveillance in China from 2004 to 2018. The Joinpoint regression model was used to analyze the changing trend of mortality rate and constituent ratio, and calculate the annual percentage change (APC) in each time period, the average annual percentage change (AAPC) in all time period and their 95% values. Results: From 2004 to 2018, a total of 15 969 children aged 0 to 1 years died of congenital heart disease, of which 58.12% (9 281) were boys and 71.79% (11 464) were in rural areas. The deaths of congenital heart disease in eastern, central and western regions accounted for 34.30%, 37.06% and 28.64% of total deaths, respectively. From 2004 to 2018, the mortality rate of congenital heart disease in children decreased from 106.81 per 100 000 to 38.70 per 100 000, with an AAPC (95%) about -7.2% (-11.5%, -2.6%). The mortality rate of congenital heart disease showed a downward trend in girls [AAPC (95%) =-7.7% (-13.0%, -2.0%)], boys [AAPC (95%)=-6.8% (-12.0%, -1.2%)], urban areas [AAPC (95%) =-5.9% (-9.9%, -1.7%)], rural areas [AAPC (95%) =-7.4% (-10.5%, -4.2%)], eastern region [AAPC (95%)=-8.6% (-14.2%, -2.6%)], and central region [AAPC (95%)=-7.8% (-11.5%, -4.0%)]. The gaps of mortality rate gradually shrank in different genders, urban and rural areas and regions. From 2004 to 2018, the constituent ratio of congenital heart disease in children showed an upward trend [AAPC (95%) = 3.3% (1.7%, 4.9%)]. Conclusion: From 2004 to 2018, the mortality rate of congenital heart disease in children aged 0 to 1 years showed a downward trend, and the constituent ratio showed an upward trend.

Association of FLAIR vascular hyperintensity and acute MCA stroke outcome changes with the severity of leukoaraiosis

PURPOSE

The clinical significance of FLAIR vascular hyperintensity (FVH), a marker of collateral circulation in ischaemic stroke, remains controversial. We hypothesised that the association between FVH and outcomes varies with the severity of leukoaraiosis (LA), another marker of collaterals, and that their combined significance may vary with time.

METHODS

We included 459 consecutive patients with middle cerebral artery (MCA) stroke. Proximal and distal FVHs were distinguished based on location. LA was divided into two grades, according to Fazekas scores of 0-2 and 3-6. Symptom-to-MRI time was divided into two categories: ≤ 14 days and ≥ 15 days.

RESULTS

We found no difference in FVH proportion according to LA grade. Multivariate analysis revealed that LA and FVH status were independently associated with unfavourable outcomes (modified Rankin scale ≥ 2) in patients with symptom-to-MRI times ≤ 14 days (P = 0.008), but not in those with symptom-to-MRI times ≥15 days (P = 0.61). In the group with symptom-to-MRI times ≤14 days, patients with LA 3-6 and FVH(+) (OR, 3.044; 95% CI, 1.116-8.305) were more likely to have unfavourable clinical outcomes compared with patients with LA 0-2 and FVH(+) but not compared with those with LA 0-2 and FVH(-) or LA 3-6 and FVH(-). In addition, FVH location did not influence the relationship between FVH and outcomes.

CONCLUSIONS

The association between FVH and outcomes was influenced by the degree of LA in the acute but not in the subacute and chronic stages of MCA infarction. FVH predicts clinical outcomes independently only in those with more extensive LA.

The Association between FLAIR Vascular Hyperintensity and Stroke Outcome Varies with Time from Onset

BACKGROUND AND PURPOSE

FLAIR vascular hyperintensity has been recognized as a marker of collaterals in ischemic stroke, but the impact on outcome is still controversial. We hypothesized that the association between FLAIR vascular hyperintensity and outcome varies with time.

MATERIALS AND METHODS

We included 459 consecutive patients with middle cerebral artery stroke and divided them into 3 groups by symptom-to-MR imaging time (group 1, ≤7 days; group 2, 8-14 days; group 3, ≥15 days). The FLAIR vascular hyperintensity score, ranging from 0 to 3 points, was based on territory distributions of different MCA segments. The associations between FLAIR vascular hyperintensity and outcome with time were analyzed qualitatively and quantitatively.

RESULTS

No patients underwent MR imaging within 6 hours of onset. The proportion of FLAIR vascular hyperintensity (+) and severe stenosis or occlusion of MCA was not significantly dependent on time. In groups 1 and 2, FLAIR vascular hyperintensity (+) was significantly associated with larger lesions, the prevalence of flow injury, and unfavorable outcome (mRS ≥ 2). There were no such associations in group 3. Multiple logistic regressions demonstrated that FLAIR vascular hyperintensity (+) was an independent risk factor for unfavorable outcome in group 2. Infarction volume tended to increase with the increase of the distal FLAIR vascular hyperintensity score in groups 1 and 2, while declining in group 3.

CONCLUSIONS

FLAIR vascular hyperintensity is associated with unfavorable outcome within 6 hours to 14 days of onset, while the wider distribution of distal FLAIR vascular hyperintensity may be favorable beyond 14 days of onset in MCA infarction. Symptom-to-MR imaging time should be considered when assessing the prognostic value of FLAIR vascular hyperintensity.

Verticillium Wilt of Redbud in China Caused by Verticillium dahliae

Chinese redbud (Cercis chinensis Bunge), a member of the Fabaceae, is an important ornamental plant native to China with reported desirable medicinal effects, including stimulating blood circulation, detumescence, and detoxification (1). In October 2011, wilt symptoms of gradual leaf yellowing, wilting, scorching (marginal browning), and twig dieback were observed on plants in Yangling, Shaanxi, China. The incidence of diseased plants was about 20% in two main areas (about 20 ha in Zijingshan Park in Zhengzhou, Henan Province; and about 3,000 ha in Taiping National Forest Park in Xi'an, Shaanxi Province). Wilted leaves of diseased plant senesced and died, but defoliation was not observed. Brown discoloration was observed in vascular tissues of petioles, twigs, and stems of diseased plants, sometimes in a ring pattern. The symptoms were often restricted to the lower part of the tree or a few branches. To identify the causal agent, six twigs (each approximately 50 mm in diameter and 10 cm long) sampled from an infected tree in Yangling were rinsed in running water, surface-sterilized with 75% ethanol for 2 min, rinsed in sterilized water three times, dried, cut into 1 cm long segments, and the segments put onto potato dextrose agar (PDA) medium. A fungal isolate was recovered from diseased vascular tissues of each sample when cultured on PDA in the dark at 25°C. After 5 days, colonies changed from white to black as a result of production of microsclerotia. Microscopic observation revealed that conidiophores were hyaline and verticillate, with three to four phialides at each node. Conidia were ellipsoidal, hyaline, single-celled, and 2.5 to 7.5 × 1.25 to 4.5 μm. On the basis of these morphological characteristics, the fungus was identified as Verticillium dahliae (3). To prove Koch's postulates, the roots of 10 healthy, 1-year-old C. chinensis plants were each irrigated in a greenhouse with 50 ml of a conidial suspension (1.0 × 10⁷ spores/ml) of an isolate recovered from an infected plant (2); five control plants were inoculated similarly with sterilized water. Fifteen days after inoculation, the same wilt symptoms observed on the original plants had developed on 9 of the 10 inoculated plants, whereas the control plants remained healthy. The pathogen was recovered 15 days after inoculation by isolating from petiole and stem tissues of symptomatic plants, but was not isolated from the control plants. The internal transcribed spacer (ITS) region (ITS1-5.8S-ITS2) of the nuclear ribosomal DNA was PCR-amplified with primers ITS1 and ITS4 (4), and sequenced. BLAST analysis of the ITS sequence (GenBank Accession No. AB735536) showed 100% homology with that of an isolate of V. dahliae (FJ572050). To our knowledge, this is the first report of Verticillium wilt on C. chinensis in China. References: (1) Y. Li et al. J. Integr. Plant Biol. 47:1021, 2005. (2) H. A. Melouk and C. E. Horner. Phytopathology 65:767, 1975. (3) G. F. Pegg and B. L. Brady. Verticillium Wilts, CABI Publishing, Oxford, UK, 2002. (4) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, CA, 1990.