Publications by authors named "Zhongjie Li"

140 Publications

Analysis on the trend of AIDS incidence in Zhejiang, China based on the age-period-cohort model (2004-2018).

BMC Public Health 2021 06 5;21(1):1077. Epub 2021 Jun 5.

Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.

Objective: To predict the trend of AIDS in specific age groups and to determine the objective population for AIDS screening, this study explored the three transmission routes and characterized each patient group using the APC model based on the whole, local, and immigrant populations in Zhejiang, China.

Methods: The data recruited in this paper was obtained from the national Comprehensive AIDS Prevention and Control Information System - Antiviral Therapy Management database and the Chinese Disease Prevention and Control Information System and the Statistical Yearbook of Zhejiang, China. An APC model was used to estimate the impact of age, period, and cohort on the incidence of AIDS, as well as to predict the AIDS incidence in specific age groups based on different sexes with different transmission routes.

Results: The AIDS incidence peaked in males aged 20-35 years; the incidence of males was higher than that of females due to the impact of period; obvious cohort effect was observed among the immigrants. In the whole and local populations, the incidences of males in all age groups and females in both the 35-year-old group and the whole age group were predicted to increase sharply in 5 years. In the immigrant population, the AIDS incidences in both sexes in all age groups were expected to increase significantly in 5 years. Under the influence of period, the incidence of AIDS via homosexual transmission in the whole population and the local population increased and remained stable after 2015. At the same time, the incidence of AIDS transmitted by homosexual and heterosexual routes in the immigrants also showed an increasing trend.

Conclusions: The results elucidate that there are sex differences in AIDS incidence, and the incidence of AIDS through various transmission routes in all groups is predicted to exhibit an upward trend in the 5 years to come. Effective intervention strategies should be developed and implemented by the public health departments in Zhejiang to control the epidemic of AIDS.
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http://dx.doi.org/10.1186/s12889-021-11050-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180133PMC
June 2021

Impact of COVID-19 outbreaks and interventions on influenza in China and the United States.

Nat Commun 2021 05 31;12(1):3249. Epub 2021 May 31.

National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention/Chinese National Influenza Center, Beijing, China.

Coronavirus disease 2019 (COVID-19) was detected in China during the 2019-2020 seasonal influenza epidemic. Non-pharmaceutical interventions (NPIs) and behavioral changes to mitigate COVID-19 could have affected transmission dynamics of influenza and other respiratory diseases. By comparing 2019-2020 seasonal influenza activity through March 29, 2020 with the 2011-2019 seasons, we found that COVID-19 outbreaks and related NPIs may have reduced influenza in Southern and Northern China and the United States by 79.2% (lower and upper bounds: 48.8%-87.2%), 79.4% (44.9%-87.4%) and 67.2% (11.5%-80.5%). Decreases in influenza virus infection were also associated with the timing of NPIs. Without COVID-19 NPIs, influenza activity in China and the United States would likely have remained high during the 2019-2020 season. Our findings provide evidence that NPIs can partially mitigate seasonal and, potentially, pandemic influenza.
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http://dx.doi.org/10.1038/s41467-021-23440-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167168PMC
May 2021

Risk Factors for Death Among the First 80 543 COVID-19 Cases in China: Relationships Between Age, Underlying Disease, Case Severity, and Region.

Clin Infect Dis 2021 May 27. Epub 2021 May 27.

Hubei Center for Disease Control and Prevention, 6 North Zuodaoquan, Hongshan District, Wuhan 430079, China.

Background: Knowledge of COVID-19 epidemiology remains incomplete and crucial questions persist. We aimed to examine risk factors for COVID-19 death.

Methods: A total of 80 543 COVID-19 cases reported in China, nationwide, through April 8, 2020 were included. Risk factors for death were investigated by Cox proportional hazards regression and stratified analyses.

Results: Overall national case fatality ratio (CFR) was 5.64%. Risk factors for death were older age (≥80: adjusted hazard ratio [aHR]=12.58, 95% confidence interval [CI]=6.78-23.33), presence of underlying disease (aHR=1.33, CI=1.19-1.49), worse case severity (severe: aHR=3.86, CI=3.15-4.73; critical: aHR=11.34, CI=9.22-13.95), and near-epicenter region (Hubei: aHR=2.64, CI=2.11-3.30; Wuhan: aHR=6.35, CI=5.04-8.00). CFR increased from 0.35% (30-39 years) to 18.21% (≥70 years) without underlying disease. Regardless of age, CFR increased from 2.50% for no underlying disease to 7.72% for 1, 13.99% for 2, and 21.99% for ≥3. CFR increased with worse case severity from 2.80% (mild), to 12.51% (severe) and 48.60% (critical) regardless of region. Compared to other regions, CFR was much higher in Wuhan regardless of case severity (mild: 3.83% versus 0.14% in Hubei and 0.03% elsewhere; moderate: 4.60% versus 0.21% and 0.06%; severe: 15.92% versus 5.84% and 1.86%; and critical: 58.57% versus 49.80% and 18.39%).

Conclusions: Older patients regardless of underlying disease and patients with underlying disease regardless of age were at elevated risk of death. Higher death rates near the outbreak epicenter and during the surge of cases reflect the deleterious effects of allowing health systems to become overwhelmed.
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http://dx.doi.org/10.1093/cid/ciab493DOI Listing
May 2021

Findings from the initial Stepwise Approach to Rabies Elimination (SARE) Assessment in China, 2019.

PLoS Negl Trop Dis 2021 03 29;15(3):e0009274. Epub 2021 Mar 29.

Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, United States of America.

In 2015, China and other member states of the United Nations adopted the goal of eliminating dog-mediated rabies by 2030. China has made substantial progress in reducing dog-mediated human rabies since peaking with more than 3,300 reported cases in 2007. To further improve coordination and planning, the Chinese Center for Disease Control and Prevention, in collaboration with the United States Centers for Disease Control and Prevention, conducted a Stepwise Approach towards Rabies Elimination (SARE) assessment in March 2019. Assessment goals included outlining progress and identifying activities critical for eliminating dog-mediated rabies. Participants representing national, provincial and local human and animal health sectors in China used the SARE assessment tool to answer 115 questions about the current dog-mediated rabies control and prevention programs in China. The established surveillance system for human rabies cases and availability of post-exposure prophylaxis were identified as strengths. Low dog vaccination coverage and limited laboratory confirmation of rabid dogs were identified gaps, resulting in an overall score of 1.5 on a scale of 0 to 5. Participants outlined steps to increase cross-sectoral information sharing, improve surveillance for dog rabies, increase dog vaccination coverage, and increase laboratory capacity to diagnose rabies at the provincial level. All assessment participants committed to strengthening cross-sector collaboration using a One Health approach to achieve dog-mediated human rabies elimination by 2030.
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http://dx.doi.org/10.1371/journal.pntd.0009274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006992PMC
March 2021

Assessing asymptomatic, pre-symptomatic and symptomatic transmission risk of SARS-CoV-2.

Clin Infect Dis 2021 Mar 27. Epub 2021 Mar 27.

Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.

Background: The relative contributions of asymptomatic, pre-symptomatic and symptomatic transmission of SARS-CoV-2 have not been clearly measured although control measures may differ in response to the risk of spread posed by different types of cases.

Methods: We collected detailed information on transmission events and symptom status based on laboratory-confirmed patient data and contact tracing data from four provinces and one municipality in China. We estimated the variation in risk of transmission over time, and the severity of secondary infections, by symptomatic status of the infector.

Results: There were 393 symptomatic index cases with 3136 close contacts and 185 asymptomatic index cases with 1078 close contacts included into the study. The secondary attack rate among close contacts of symptomatic and asymptomatic index cases were 4.1% (128/3136) and 1.1% (12/1078), respectively, corresponding to a higher transmission risk from symptomatic cases than from asymptomatic cases (OR: 3.79, 95% CI: 2.06, 6.95). Approximately 25% (32/128) and 50% (6/12) of the infected close contacts were asymptomatic from symptomatic and asymptomatic index cases, respectively, while more than one third (38%) of the infections in the close contacts of symptomatic cases were attributable to exposure to the index cases before symptom onset. Infected contacts of asymptomatic index cases were more likely to be asymptomatic and less likely to be severe.

Conclusions: Asymptomatic and pre-symptomatic transmission play an important role in spreading infection, although asymptomatic cases pose a lower risk of transmission than symptomatic cases. Early case detection and effective test-and-trace measures are important to reduce transmission.
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http://dx.doi.org/10.1093/cid/ciab271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083716PMC
March 2021

Seasonal association between viral causes of hospitalised acute lower respiratory infections and meteorological factors in China: a retrospective study.

Lancet Planet Health 2021 03;5(3):e154-e163

School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.

Background: Acute lower respiratory infections (ALRIs) caused by respiratory viruses are common and persistent infectious diseases worldwide and in China, which have pronounced seasonal patterns. Meteorological factors have important roles in the seasonality of some major viruses, especially respiratory syncytial virus (RSV) and influenza virus. Our aim was to identify the dominant meteorological factors and to model their effects on common respiratory viruses in different regions of China.

Methods: We analysed monthly virus data on patients hospitalised with ALRI from 81 sentinel hospitals in 22 provinces in mainland China from Jan 1, 2009, to Sept 30, 2013. We considered seven common respiratory viruses: RSV, influenza virus, human parainfluenza virus, adenovirus, human metapneumovirus, human bocavirus, and human coronavirus. Meteorological data of the same period were used to analyse relationships between virus seasonality and seven meteorological factors according to region (southern vs northern China). The geographical detector method was used to quantify the explanatory power of each meteorological factor, individually and interacting in pairs, on the respiratory viruses.

Findings: 28 369 hospitalised patients with ALRI were tested, 10 387 (36·6%) of whom were positive for at least one virus, including RSV (4091 [32·0%] patients), influenza virus (2665 [20·8%]), human parainfluenza virus (2185 [17·1%]), adenovirus (1478 [11·6%]), human bocavirus (1120 [8·8%]), human coronavirus (637 [5·0%]), and human metapneumovirus (615 [4·8%]). RSV and influenza virus had annual peaks in the north and biannual peaks in the south. Human parainfluenza virus and human bocavirus had higher positive rates in the spring-summer months. Human metapneumovirus had an annual peak in winter-spring, especially in the north. Adenovirus and human coronavirus exhibited no clear annual seasonality. Temperature, atmospheric pressure, vapour pressure, and rainfall had most explanatory power on most respiratory viruses in each region. Relative humidity was only dominant in the north, but had no significant explanatory power for most viruses in the south. Hours of sunlight had significant explanatory power for RSV and influenza virus in the north, and for most viruses in the south. Wind speed was the only factor with significant explanatory power for human coronavirus in the south. For all viruses, interactions between any two of the paired factors resulted in enhanced explanatory power, either bivariately or non-linearly.

Interpretation: Spatiotemporal heterogeneity was detected for most viruses in this study, and interactions between pairs of meteorological factors were found to enhance their influence on virus variation. These findings might be helpful to guide government planning, such as public health interventions, infection control practice, and timing of passive immunoprophylaxis, and might facilitate the development of future vaccine strategies.

Funding: National Natural Science Foundation of China, the Ministry of Science and Technology of China, and the Technology Major Project of China.

Translation: For the Chinese translation of the abstract see Supplementary Materials section.
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http://dx.doi.org/10.1016/S2542-5196(20)30297-7DOI Listing
March 2021

An investigation of prevalence in an Endemic County in Guangxi Zhuang Autonomous Region, China, 2016.

Food Waterborne Parasitol 2021 Mar 8;22:e00109. Epub 2021 Jan 8.

Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.

To effectively promote the implementation of interventions, the identification of high-risk groups and the characteristics of infection in endemic regions are needed. In a clonorchiasis-endemic area, local residents were randomly enrolled for helminth egg examination in June 2016. The prevalence in subpopulations as well as the knowledge, attitudes, and behaviours and the factors influencing clonorchiasis in egg-positive populations were analysed. A total of 2282 local residents participated in the survey; the prevalence was 48.6% (1109 persons). A higher prevalence was found in males (62.6%) than in females (29.7%). People older than 30 years had the highest prevalence (52.7%-57.6%). Among the 888 persons who were infected with and participated the questionnaire investigation, 19.0% (169/888) knew that it could cause cancer. In addition, 60.6% of people reported that they intended to keep eating raw fish despite knowing the risk of infection. The two primary reasons for continuing to eat raw fish were the disease being regarded as not serious (38.3%) and the belief that anti-parasite medications are effective (39.6%). A total of 94.4% (797/844) of responders reported eating raw fish more frequently in the home than outside of the home. Our study revealed a notably high prevalence in the study area. Awareness of clonorchiasis disease severity should be increased among high-risk individuals and families in highly endemic areas.
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http://dx.doi.org/10.1016/j.fawpar.2020.e00109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930122PMC
March 2021

Extreme weather conditions and dengue outbreak in Guangdong, China: Spatial heterogeneity based on climate variability.

Environ Res 2021 05 24;196:110900. Epub 2021 Feb 24.

School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. Electronic address:

Background: Previous studies have shown associations between local weather factors and dengue incidence in tropical and subtropical regions. However, spatial variability in those associations remains unclear and evidence is scarce regarding the effects of weather extremes.

Objectives: We examined spatial variability in the effects of various weather conditions on the unprecedented dengue outbreak in Guangdong province of China in 2014 and explored how city characteristics modify weather-related risk.

Methods: A Bayesian spatial conditional autoregressive model was used to examine the overall and city-specific associations of dengue incidence with weather conditions including (1) average temperature, temperature variation, and average rainfall; and (2) weather extremes including numbers of days of extremely high temperature and high rainfall (both used 95th percentile as the cut-off). This model was run for cumulative dengue cases during five months from July to November (accounting for 99.8% of all dengue cases). A further analysis based on spatial variability was used to validate the modification effects by economic, demographic and environmental factors.

Results: We found a positive association of dengue incidence with average temperature in seven cities (relative risk (RR) range: 1.032 to 1.153), a positive association with average rainfall in seven cities (RR range: 1.237 to 1.974), and a negative association with temperature variation in four cities (RR range: 0.315 to 0.593). There was an overall positive association of dengue incidence with extremely high temperature (RR:1.054, 95% credible interval (CI): 1.016 to 1.094), without evidence of variation across cities, and an overall positive association of dengue with extremely high rainfall (RR:1.505, 95% CI: 1.096 to 2.080), with seven regions having stronger associations (RR range: 1.237 to 1.418). Greater effects of weather conditions appeared to occur in cities with higher economic level, lower green space coverage and lower elevation.

Conclusions: Spatially varied effects of weather conditions on dengue outbreaks necessitate area-specific dengue prevention and control measures. Extremes of temperature and rainfall have strong and positive associations with dengue outbreaks.
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http://dx.doi.org/10.1016/j.envres.2021.110900DOI Listing
May 2021

Integrated vaccination and physical distancing interventions to prevent future COVID-19 waves in Chinese cities.

Nat Hum Behav 2021 Jun 18;5(6):695-705. Epub 2021 Feb 18.

WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK.

The coronavirus disease 2019 (COVID-19) pandemic has posed substantial challenges to the formulation of preventive interventions, particularly since the effects of physical distancing measures and upcoming vaccines on reducing susceptible social contacts and eventually halting transmission remain unclear. Here, using anonymized mobile geolocation data in China, we devise a mobility-associated social contact index to quantify the impact of both physical distancing and vaccination measures in a unified way. Building on this index, our epidemiological model reveals that vaccination combined with physical distancing can contain resurgences without relying on stay-at-home restrictions, whereas a gradual vaccination process alone cannot achieve this. Further, for cities with medium population density, vaccination can reduce the duration of physical distancing by 36% to 78%, whereas for cities with high population density, infection numbers can be well-controlled through moderate physical distancing. These findings improve our understanding of the joint effects of vaccination and physical distancing with respect to a city's population density and social contact patterns.
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http://dx.doi.org/10.1038/s41562-021-01063-2DOI Listing
June 2021

Extreme weather events and dengue outbreaks in Guangzhou, China: a time-series quasi-binomial distributed lag non-linear model.

Int J Biometeorol 2021 Jul 17;65(7):1033-1042. Epub 2021 Feb 17.

School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, 4059, Australia.

Dengue transmission is climate-sensitive and permissive conditions regularly cause large outbreaks in Asia-Pacific area. As climate change progresses, extreme weather events such as heatwaves and unusually high rainfall are predicted more intense and frequent, but their impacts on dengue outbreaks remain unclear so far. This paper aimed to investigate the relationship between extreme weather events (i.e., heatwaves, extremely high rainfall and extremely high humidity) and dengue outbreaks in China. We obtained daily number of locally acquired dengue cases and weather factors for Guangzhou, China, for the period 2006-2015. The definition of dengue outbreaks was based on daily number of locally acquired cases above the threshold (i.e., mean + 2SD of daily distribution of dengue cases during peaking period). Heatwave was defined as ≥2 days with temperature ≥ 95th percentile, and extreme rainfall and humidity defined as daily values ≥95th percentile during 2006-2015. A generalized additive model was used to examine the associations between extreme weather events and dengue outbreaks. Results showed that all three extreme weather events were associated with increased risk of dengue outbreaks, with a risk increase of 115-251% around 6 weeks after heatwaves, 173-258% around 6-13 weeks after extremely high rainfall, and 572-587% around 6-13 weeks after extremely high humidity. Each extreme weather event also had good capacity in predicting dengue outbreaks, with the model's sensitivity, specificity, accuracy, and area under the receiver operating characteristics curve all exceeding 86%. This study found that heatwaves, extremely high rainfall, and extremely high humidity could act as potential drivers of dengue outbreaks.
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http://dx.doi.org/10.1007/s00484-021-02085-1DOI Listing
July 2021

Antibody seroprevalence in the epicenter Wuhan, Hubei, and six selected provinces after containment of the first epidemic wave of COVID-19 in China.

Lancet Reg Health West Pac 2021 Mar 5;8:100094. Epub 2021 Feb 5.

National Institute for Viral Disease Control and Prevention (China CDC), Beijing, China.

Background: China implemented containment measures to stop SARS-CoV-2 transmission in response to the COVID-19 epidemic. After the first epidemic wave, we conducted population-based serological surveys to determine extent of infection, risk factors for infection, and neutralization antibody levels to assess the real infections in the random sampled population.

Methods: We used a multistage, stratified cluster random sampling strategy to conduct serological surveys in three areas - Wuhan, Hubei Province outside Wuhan, and six provinces selected on COVID-19 incidence and containment strategy. Participants were consenting individuals >1 year old who resided in the survey area >14 days during the epidemic. Provinces screened sera for SARS-CoV-2-specific IgM, IgG, and total antibody by two lateral flow immunoassays and one magnetic chemiluminescence enzyme immunoassay; positive samples were verified by micro-neutralization assay.

Findings: We enrolled 34,857 participants (overall response rate, 92%); 427 were positive by micro-neutralization assay. Wuhan had the highest weighted seroprevalence (4•43%, 95% confidence interval [95%CI]=3•48%-5•62%), followed by Hubei-ex-Wuhan (0•44%, 95%CI=0•26%-0•76%), and the other provinces (<0•1%). Living in Wuhan (adjusted odds ratio aOR=13•70, 95%CI= 7•91-23•75), contact with COVID-19 patients (aOR=7•35, 95%CI=5•05-10•69), and age over 40 (aOR=1•36, 95%CI=1•07-1•72) were significantly associated with SARS-CoV-2 infection. Among seropositives, 101 (24%) reported symptoms and had higher geometric mean neutralizing antibody titers than among the 326 (76%) without symptoms (30±2•4 vs 15±2•1, <0•001).

Interpretation: The low overall extent of infection and steep gradient of seropositivity from Wuhan to the outer provinces provide evidence supporting the success of containment of the first wave of COVID-19 in China. SARS-CoV-2 infection was largely asymptomatic, emphasizing the importance of active case finding and physical distancing. Virtually the entire population of China remains susceptible to SARS-CoV-2; vaccination will be needed for long-term protection.

Funding: This study was supported by the Ministry of Science and Technology (2020YFC0846900) and the National Natural Science Foundation of China (82041026, 82041027, 82041028, 82041029, 82041030, 82041032, 82041033).
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http://dx.doi.org/10.1016/j.lanwpc.2021.100094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864613PMC
March 2021

A regional suitable conditions index to forecast the impact of climate change on dengue vectorial capacity.

Environ Res 2021 04 6;195:110849. Epub 2021 Feb 6.

School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. Electronic address:

Background: The mosquitoes Aedes aegypti and Ae. albopictus are the primary vectors of dengue virus, and their geographic distributions are predicted to expand further with economic development, and in response to climate change. We aimed to estimate the impact of future climate change on dengue transmission through the development of a Suitable Conditions Index (SCI), based on climatic variables known to support vectorial capacity. We calculated the SCI based on various climate change scenarios for six countries in the Asia-Pacific region (Australia, China, Indonesia, The Philippines, Thailand and Vietnam).

Methods: Monthly raster climate data (temperature and precipitation) were collected for the period January 2005 to December 2018 along with projected climate estimates for the years 2030, 2050 and 2070 using Representative Concentration Pathway (RCP) 4·5, 6·0 and 8·5 emissions scenarios. We defined suitable temperature ranges for dengue transmission of between 17·05-34·61 °C for Ae. aegypti and 15·84-31·51 °C for Ae. albopictus and then developed a historical and predicted SCI based on weather variability to measure the expected geographic limits of dengue vectorial capacity. Historical and projected SCI values were compared through difference maps for the six countries.

Findings: Comparing different emission scenarios across all countries, we found that most South East Asian countries showed either a stable pattern of high suitability, or a potential decline in suitability for both vectors from 2030 to 2070, with a declining pattern particularly evident for Ae. albopictus. Temperate areas of both China and Australia showed a less stable pattern, with both moderate increases and decreases in suitability for each vector in different regions between 2030 and 2070.

Interpretation: The SCI will be a useful index for forecasting potential dengue risk distributions in response to climate change, and independently of the effects of human activity. When considered alongside additional correlates of infection such as human population density and socioeconomic development indicators, the SCI could be used to develop an early warning system for dengue transmission.
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http://dx.doi.org/10.1016/j.envres.2021.110849DOI Listing
April 2021

Purification of Gekko Small Peptide Fraction and Its Effect of Inducing Apoptosis of EC 9706 Esophageal Cancer Cells by Inhibiting PI3K/Akt/GLUT1 Signaling Pathway.

Chem Biodivers 2021 Mar 17;18(3):e2000720. Epub 2021 Feb 17.

Department of Pharmacology, Medical College, Henan University of Science and Technology, KaiYuan Road 263, Luoyang, 471023, Henan Province, P. R. China.

This study aimed to isolate and purify a cytotoxic extraction from Gekko japonicus, identify its components and determine its cytotoxic activity in vitro. We isolated and identified the most potent cytotoxic Gekko small peptide LH-20-15. The identification and analysis of peptide sequences of LH-20-15 were performed by de novo peptide sequencing, and two new peptides were found. LH-20-15 significantly inhibited the proliferation of human esophageal squamous carcinoma EC 9706 cells in a dose-dependent manner. Furthermore, LH-20-15 induced apoptosis in esophageal cancer cells by activating the mitochondrial apoptotic pathway. Further research showed that LH-20-15 inhibited the PI3 K/Akt/GLUT1 signaling pathway. In conclusion, LH-20-15 from Gekko japonicus is a peptide mixture and may inhibit EC 9706 cell proliferation and induce apoptosis by activating the mitochondrial apoptotic pathway. It also regulates glucose metabolism by targeting the PI3 K/Akt/GLUT1 signaling pathway. These small peptides could be new sources of natural cytotoxic ingredients against esophageal cancer with potential drug values.
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http://dx.doi.org/10.1002/cbdv.202000720DOI Listing
March 2021

One Hundred Days of Coronavirus Disease 2019 Prevention and Control in China.

Clin Infect Dis 2021 01;72(2):332-339

Chinese Center for Disease Control and Prevention, Beijing, China.

The epidemic of novel coronavirus disease was first reported in China in late December 2019 and was brought under control after some 2 months in China. However, it has become a global pandemic, and the number of cases and deaths continues to increase outside of China. We describe the emergence of the pandemic, detail the first 100 days of China's response as a phase 1 containment strategy followed by phase 2 containment, and briefly highlight areas of focus for the future. Specific, simple, and pragmatic strategies used in China for risk assessment, prioritization, and deployment of resources are described. Details of implementation, at different risk levels, of the traditional public health interventions are shared. Involvement of society in mounting a whole country response and challenges experienced with logistics and supply chains are described. Finally, the methods China is employing to cautiously restart social life and economic activity are outlined.
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http://dx.doi.org/10.1093/cid/ciaa725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314211PMC
January 2021

Influenza Vaccine Effectiveness in Mainland China: A Systematic Review and Meta-Analysis.

Vaccines (Basel) 2021 Jan 23;9(2). Epub 2021 Jan 23.

Chinese Center for Disease Control and Prevention, Beijing 102206, China.

Influenza endangers human health but can be prevented in part by vaccination. Assessing influenza vaccine effectiveness (VE) provides scientific evidence for developing influenza vaccination policy. We conducted a systematic review and meta-analysis of studies that evaluated influenza VE in mainland China. We searched six relevant databases as of 30 August 2019 to identify studies and used Review Manager 5.3 software to analyze the included studies. The Newcastle-Ottawa scale was used to assess the risk of publication bias. We identified 1408 publications, and after removing duplicates and screening full texts, we included 21 studies in the analyses. Studies were conducted in Beijing, Guangzhou, Suzhou, and Zhejiang province from the 2010/11 influenza season through the 2017/18 influenza season. Overall influenza VE for laboratory confirmed influenza was 36% (95% CI: 25-46%). In the subgroup analysis, VE was 45% (95% CI: 18-64%) for children 6-35 months who received one dose of influenza vaccine, and 57% (95% CI: 50-64%) who received two doses. VE was 47% (95% CI: 39-54%) for children 6 months to 8 years, and 18% (95% CI: 0-33%) for adults ≥60 years. For inpatients, VE was 21% (95% CI: -11-44%). We conclude that influenza vaccines that were used in mainland China had a moderate effectiveness, with VE being higher among children than the elderly. Influenza VE should be continuously monitored in mainland China to provide evidence for policy making and improving uptake of the influenza vaccine.
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http://dx.doi.org/10.3390/vaccines9020079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912587PMC
January 2021

Basic Reproduction Number of Enterovirus 71 Coxsackievirus A16 and A6: Evidence from Outbreaks of Hand, Foot and Mouth Disease in China between 2011 and 2018.

Clin Infect Dis 2020 Dec 15. Epub 2020 Dec 15.

Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.

Background: Enterovirus 71 (EV-A71), Coxsackievirus A16 (CV-A16) and Coxsackievirus A6 (CV-A6) are common serotypes causing hand, foot, and mouth disease (HFMD). Analyses on the basic reproduction number (R0) of common pathogens causing HFMD are limited and there are no related studies using field data from outbreaks in mainland China.

Methods: We estimated the pathogen-specific basic reproduction number based on laboratory-confirmed HFMD outbreaks (clusters of ≥10 HFMD cases) reported to the national surveillance system between 2011 and 2018. The reproduction numbers were calculated using a mathematical model and the cumulative cases during the initial growth periods.

Results: This study included 539 outbreaks, of which 198 were caused by EV-A71, 316 by CV-A16, and 25 by CV-A6. All 10417 cases involved were children. Assuming the outbreaks occurred in closed systems and the incubation period is 5 days, the median R0s of EV-A71, CV-A16, and CV-A6 were 5.06 [2.81, 10.20], 4.84 [3.00, 9.00] and 5.94 [3.27, 10.00] (Median [IQR]). After adjusting for seroprevalences, the R0s for EV-A71, CV-A16 (optimistic and conservative scenarios), and CV-A6 were 12.60 [IQR: 7.35, 25.40], 9.29 [IQR: 6.01, 19.20], 15.50 [IQR: 9.77, 30.40], and 25.80 [IQR: 14.20, 43.50], respectively. We did not observe changes in the R0s of EV-A71 after vaccine licensure (p-value = 0.67).

Conclusions: HFMD is highly transmissible when caused by the three most common serotypes. In mainland China, it primarily affects young children. Although a vaccine became available in 2016, we have not yet observed any related changes in the disease dynamics.
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http://dx.doi.org/10.1093/cid/ciaa1853DOI Listing
December 2020

Strengthening public health at the community-level in China.

Lancet Public Health 2020 12;5(12):e629-e630

Chinese Center for Disease Control and Prevention, Beijing 102206, China. Electronic address:

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http://dx.doi.org/10.1016/S2468-2667(20)30266-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836695PMC
December 2020

Risk mapping of scrub typhus infections in Qingdao city, China.

PLoS Negl Trop Dis 2020 12 2;14(12):e0008757. Epub 2020 Dec 2.

Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.

Background: The emergence and re-emergence of scrub typhus has been reported in the past decade in many global regions. In this study, we aim to identify potential scrub typhus infection risk zones with high spatial resolution in Qingdao city, in which scrub typhus is endemic, to guide local prevention and control strategies.

Methodology/principal Findings: Scrub typhus cases in Qingdao city during 2006-2018 were retrieved from the Chinese National Infectious Diseases Reporting System. We divided Qingdao city into 1,101 gridded squares and classified them into two categories: areas with and without recorded scrub typhus cases. A boosted regression tree model was used to explore environmental and socioeconomic covariates associated with scrub typhus occurrence and predict the risk of scrub typhus infection across the whole area of Qingdao city. A total of 989 scrub typhus cases were reported in Qingdao from 2006-2018, with most cases located in rural and suburban areas. The predicted risk map generated by the boosted regression tree models indicated that the highest infection risk areas were mainly concentrated in the mid-east and northeast regions of Qingdao, with gross domestic product (20.9%±1.8% standard error) and annual cumulative precipitation (20.3%±1.1%) contributing the most to the variation in the models. By using a threshold environmental suitability value of 0.26, we identified 757 squares (68.7% of the total) with a favourable environment for scrub typhus infection; 66.2% (501/757) of the squares had not yet recorded cases. It is estimated that 6.32 million people (72.5% of the total population) reside in areas with a high risk of scrub typhus infection.

Conclusions/significance: Many locations in Qingdao city with no recorded scrub typhus cases were identified as being at risk for scrub typhus occurrence. In these at-risk areas, awareness and capacity for case diagnosis and treatment should be enhanced in the local medical service institutes.
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http://dx.doi.org/10.1371/journal.pntd.0008757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735632PMC
December 2020

Rosthorin A inhibits non-small cell lung cancer cell growth and metastasis through repressing epithelial-mesenchymal transition via downregulating Slug.

Anticancer Drugs 2020 11;31(10):997-1003

Department of Basic Medicine, Wuxi School of Medicine, Jiangnan University.

Lung cancer always ranks first in the number of cancer deaths every year, accounting for 18.4% of total cancer deaths in 2018. Metastasis is the main cause of death in lung cancer patients. The identification of bioactive components of traditional Chinese medicine is very important for the development of novel reagents against non-small cell lung cancer (NSCLC). Rosthorin A has originated from Rabdosia rosthornii (Diels) Hara which excerpts from 'Chinese materia medica', and is known to have 'clear heat phlegm' properties in the folk. Little is known about the biological functions and mechanisms of Rosthorin A in cancer cells at present. The role of EMT in metastasis of a tumor cell is self-evident. Slug is an important EMT inducer, which is related to the development of lung cancer. Cell growth, clone assay, cell migration, cell invasion, and protein expression, and NSCLC transplanted tumor growth were performed in A549, H1299, and H1975 cells. Rosthorin A significantly inhibited the growth of NSCLC cells, it could prolong the survival of nude mice. Rosthorin A inhibited the migration and invasion of A549, H1299, and H1975 cells. Rosthorin A up-regulated E-cadherin expression level and down-regulated the expression of β-catenin, N-cadherin, vimentin, Slug, and Twist. Rosthorin A could promote the expression of E-cadherin and inhibit the development of EMT by downregulating Slug, to inhibit the development and metastasis of NSCLC cells. In summary, Rosthorin A could be used as a promising candidate for the treatment of NSCLC patients with recurrence and metastasis.
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http://dx.doi.org/10.1097/CAD.0000000000000973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566306PMC
November 2020

High endemicity of Clonorchis sinensis infection in Binyang County, southern China.

PLoS Negl Trop Dis 2020 08 10;14(8):e0008540. Epub 2020 Aug 10.

Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.

High-intensity clonorchiasis infection is associated with serious outcomes, including cancer. Understanding the infection intensity of Clonorchis sinensis and its risk factors in local endemic regions could facilitate effective control measures. In a county located in a highly endemic area in Guangxi Province, P. R. China, local residents were randomly enrolled in the study; helminth egg examinations were performed with the Kato-Katz method, and the intensity of infection was identified as mild, moderate or heavy. Knowledge, attitudes, and high-risk behaviours were investigated among those infected with Clonorchis sinensis. A total of 2521 local residents participated in this study, and the Clonorchis sinensis-positive proportion was 28.9% (728 persons). Among the infected persons, the percentages of mild, moderate and heavy infections were 66.2%, 28.4% and 5.4%, respectively. Males experienced a higher proportion of moderate and heavy infections (37.5%) than females (18.1%) (p<0.05). The highest infection proportion among the different levels of infection intensity was identified among persons aged 30-59 years (15.7% for moderate and heavy infections). Among the 509 persons who reported eating raw fish, 302 persons (59.3%) had eaten raw fresh fish for more than 10 years, and 131 (25.7%) persons ate raw fish ≥12 times a year. Multivariate logistic regression revealed that eating raw fish 12-50 times in the last year (adjusted odds ratio [aOR] = 1.74, 95%CI: 1.09-2.80) and eating raw fish >50 times in the last year (aOR = 2.89, 95%CI: 1.20-7.50) were risk factors for high-intensity infections (moderate and heavy). The overall infection proportion was high in the study area, with a large group of residents experiencing high-intensity infections. High frequency of raw fish consumption was associated with high-intensity infections. Intervention strategies targeting people with a high frequency of raw fish consumption should be implemented to reduce the probability of severe consequences.
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http://dx.doi.org/10.1371/journal.pntd.0008540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446930PMC
August 2020

Antibacterial activity of a scorpion-derived peptide and its derivatives in vitro and in vivo.

Toxicon 2020 Oct 5;186:35-41. Epub 2020 Aug 5.

Medical College, Henan University of Science and Technology, Luoyang, 471003, China.

Antimicrobial peptides have recently become extremely popular as a novel class of antimicrobial agents. AMP MK049518 (FLGLLGSVLGSVLPSIFK), identified from the crab-scorpion Didymocentrus krausi, only possesses significant antibacterial activity against Gram-positive bacteria. In this study, a derivative G2K-S3K was designed with an excellent antibacterial spectrum and significantly higher antibacterial activity compared to the natural peptide. G2K-S3K also demonstrated excellent serum- and thermal-stability and did not induce bacterial resistance. In the Staphylococcus aureus and Pseudomonas aeruginosa -induced skin infection in mice, G2K-S3K significantly decreased bacterial counts in the wound by topical application. Thus, G2K-S3K could be a potent topical anti-infective agent against the skin infection caused by S. aureus and P. aeruginosa.
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http://dx.doi.org/10.1016/j.toxicon.2020.07.028DOI Listing
October 2020

Evidence for pre-symptomatic transmission of coronavirus disease 2019 (COVID-19) in China.

Influenza Other Respir Viruses 2021 01 7;15(1):19-26. Epub 2020 Aug 7.

The Chinese Center for Disease Control and Prevention, Beijing, China.

Background: Between mid-January and early February, provinces of mainland China outside the epicentre in Hubei province were on high alert for importations and transmission of COVID-19. Many properties of COVID-19 infection and transmission were still not yet established.

Methods: We collated and analysed data on 449 of the earliest COVID-19 cases detected outside Hubei province to make inferences about transmission dynamics and severity of infection. We analysed 64 clusters to make inferences on serial interval and potential role of pre-symptomatic transmission.

Results: We estimated an epidemic doubling time of 5.3 days (95% confidence interval (CI): 4.3, 6.7) and a median incubation period of 4.6 days (95% CI: 4.0, 5.2). We estimated a serial interval distribution with mean 5.7 days (95% CI: 4.7, 6.8) and standard deviation 3.5 days, and effective reproductive number was 1.98 (95% CI: 1.68, 2.35). We estimated that 32/80 (40%) of transmission events were likely to have occurred prior to symptoms onset in primary cases. Secondary cases in clusters had less severe illness on average than cluster primary cases.

Conclusions: The majority of transmissions are occurring around illness onset in an infected person, and pre-symptomatic transmission does play a role. Detection of milder infections among the secondary cases may be more reflective of true disease severity.
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http://dx.doi.org/10.1111/irv.12787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436222PMC
January 2021

Oral rehabilitation following successful TMD treatment with condylar position changes: A case report.

Cranio 2020 Jul 30:1-6. Epub 2020 Jul 30.

Department of Temporomandibular Joint, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.

Background: A 31-year-old woman with crowns, fixed partial prostheses, and dental restorations complained of recurrent pain in the left and right temporomandibular joints during the last 2 years.

Clinical Presentation: The symptoms of temporomandibular disorder (TMD) resolved successfully after a 3-month-long treatment with a repositioning splint. Pre- and post-operative cone-beam computed tomography revealed slight changes in the condylar position after splint use. Minimally invasive oral rehabilitation guided by digital design was performed to maintain the acquired stable position. The status of the restorations was good, and the TMD symptoms did not relapse during the 3-year follow-up.

Conclusion: This case report demonstrates the importance of a stable adapted condylar position after extensive prosthodontic treatment.
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http://dx.doi.org/10.1080/08869634.2020.1795589DOI Listing
July 2020

The transcriptome analysis of the whole-body of the gastropod mollusk Limax flavus and screening of putative antimicrobial peptide and protein genes.

Genomics 2020 11 7;112(6):3991-3999. Epub 2020 Jul 7.

Medical College, Henan University of Science and Technology, Luoyang 471023, PR China.

The gastropod mollusk Limax flavus, one of the most widespread pests in China, is used to treat infectious diseases in traditional Chinese medicine. However, little genomic information is available for this non-model species. In this study, the whole-body transcriptome of L. flavus was sequenced using next generation sequencing technology. A total of 6.81 Gb clean reads were obtained, which were assembled into 150,766 transcripts with 132,206 annotated unigenes. Functionally classification assigned 30,542 unigenes to 56 Gene Ontology terms, 16,745 unigenes were divided into 26 euKaryotic Ortholog Groups of proteins categories, and 13,854 unigenes were assigned to 230 Kyoto Encyclopedia of Genes and Genomes pathways. Furthermore, we identified 17,251 simple sequence repeats and several kinds of antimicrobial peptide and protein (AMPs) genes. The transcriptome data of L. flavus will provide a valuable genomic resource for further studies on this species, and the AMPs identified in L. flavus will support its medical potential.
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http://dx.doi.org/10.1016/j.ygeno.2020.06.046DOI Listing
November 2020

Piezoelectric Energy Harvesting from Suspension Structures with Piezoelectric Layers.

Sensors (Basel) 2020 Jul 4;20(13). Epub 2020 Jul 4.

School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China.

In this paper, we propose a generator for piezoelectric energy harvesting from suspension structures. This device consists of a leaf spring and eight pairs of piezoelectric layers attached to inner and outer surfaces. We present a special type of leaf spring, which can magnify the force from the workload to allow the piezoelectric layers to achieve larger deformation. The generator is to solve the problem of vibration energy reutilization in a low-frequency vibration system. To verify the efficiency of the proposed configuration, a series of experiments are operated. The results indicate that the resonance frequency (25.2 Hz) obtained from the sweep experiment is close to the simulation result (26.1 Hz). Impedance-matching experiments show that the sum of the output power attains 1.7 mW, and the maximum single layer reaches 0.6 mW with an impedance matching of 610 KΩ, and the instantaneous peak-peak power density is 3.82 mW/cm. The capacitor-charging performance of the generator is also excellent under the series condition. For a 4.7 μF capacitor, the voltage is charged to 25 V in 30 s and limited at 32 V in 80 s. These results demonstrate the exploitable potential of piezoelectric energy harvesting from suspension structures.
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http://dx.doi.org/10.3390/s20133755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374371PMC
July 2020

De novo transcriptome of the whole-body of the gastropod mollusk Philomycus bilineatus, a pest with medical potential in China.

J Appl Genet 2020 Sep 18;61(3):439-449. Epub 2020 Jun 18.

Medical College, Henan University of Science and Technology, Luoyang, 471000, People's Republic of China.

Philomycus bilineatus is a highly common gastropod mollusk pest in China and is also utilized to treat infectious diseases. However, no genomic resources are available for this non-model species. In the present study, the transcriptomic analysis of P. bilineatus was completed. After sequencing using the next generation sequencing technology, 9.11 Gb of clean reads were obtained, which led to the assembly and annotation of 145,523 transcripts and 125,690 unigenes. Unigenes were functionally classified using Gene Ontology (GO), euKaryotic Ortholog Groups of proteins (KOG), and Kyoto Encyclopedia of Genes and Genomes (KEGG). A total of 27,554 unigenes were assigned into 55 GO terms, 13,989 unigenes were differentiated into 26 KOG categories, and 16,368 unigenes were assigned to 229 KEGG pathways. Furthermore, 16,614 simple sequence repeats (SSRs), 38 olfactory genes, and 40 antimicrobial peptide/protein genes were identified. The transcriptome profile of P. bilineatus will provide a valuable genomic resource for further study, will promote the development of new pest management strategies through interference of chemosensory communication, and will support potential medicinal uses of this species.
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http://dx.doi.org/10.1007/s13353-020-00566-4DOI Listing
September 2020

Microstructure and properties of TC4/TNTZO multi-layered composite by direct laser deposition.

J Mech Behav Biomed Mater 2020 09 12;109:103842. Epub 2020 May 12.

Shanghai Key Lab of Advanced High-temperature Materials and Precision Forming, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, PR China.

In this work, TC4/TNTZO multi-layered composite as well as TNTZO and TC4 alloys were prepared by direct laser deposition (DLD) to investigate the microstructure, mechanical properties and in vitro bioactivity. The microstructure characterization shows that the multi-layered material is free of cracks and intermetallics while the interface is metallurgically bonded. The fine microstructure was observed in TC4 layer of the TC4/TNTZO multi-layered material, and a large amount of α' martensite exists in the transition zone. Different from the single β phase cellular arrays in the DLD-ed TNTZO alloy, α″ martensite with high volume content formed at the cellular grain boundary in TNTZO zone of DLD-ed TC4/TNTZO. The elastic modulus of the DLD-ed TC4/TNTZO is 64 GPa, decreased about 45% compared to the DLD-ed TC4. The tensile yield strength and elongation along the printing direction are up to 789 MPa and 7%, which are 12% higher than the tensile yield strength of DLD-ed TNTZO and 61% higher than the elongation of DLD-ed TC4 respectively. Moreover, the DLD-ed TC4/TNTZO shows good in vitro bioactivity. The TC4/TNTZO multi-layered composite fabricated by DLD can be regarded as a potential candidate to integrate the advantages of the two Ti-base alloys for application in the biomedical field.
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http://dx.doi.org/10.1016/j.jmbbm.2020.103842DOI Listing
September 2020

Active case finding with case management: the key to tackling the COVID-19 pandemic.

Lancet 2020 07 4;396(10243):63-70. Epub 2020 Jun 4.

Chinese Center for Disease Control and Prevention, Beijing, China.

COVID-19 was declared a pandemic by WHO on March 11, 2020, the first non-influenza pandemic, affecting more than 200 countries and areas, with more than 5·9 million cases by May 31, 2020. Countries have developed strategies to deal with the COVID-19 pandemic that fit their epidemiological situations, capacities, and values. We describe China's strategies for prevention and control of COVID-19 (containment and suppression) and their application, from the perspective of the COVID-19 experience to date in China. Although China has contained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and nearly stopped indigenous transmission, a strong suppression effort must continue to prevent re-establishment of community transmission from importation-related cases. We believe that case finding and management, with identification and quarantine of close contacts, are vitally important containment measures and are essential in China's pathway forward. We describe the next steps planned in China that follow the containment effort. We believe that sharing countries' experiences will help the global community manage the COVID-19 pandemic by identifying what works in the struggle against SARS-CoV-2.
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http://dx.doi.org/10.1016/S0140-6736(20)31278-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272157PMC
July 2020

Epidemiologic Changes of Scrub Typhus in China, 1952-2016.

Emerg Infect Dis 2020 06;26(6):1091-1101

Scrub typhus, a miteborne rickettsiosis, has emerged in many areas globally. We analyzed the incidence and spatial-temporal distribution of scrub typhus in China during 1952-1989 and 2006-2016 using national disease surveillance data. A total of 133,623 cases and 174 deaths were recorded. The average annual incidence was 0.13 cases/100,000 population during 1952-1989; incidence increased sharply from 0.09/100,000 population in 2006 to 1.60/100,000 population in 2016. The disease, historically endemic to southern China, has expanded to all the provinces across both rural and urban areas. We identified 3 distinct seasonal patterns nationwide; infections peaked in summer in the southwest, summer-autumn in the southeast, and autumn in the middle-east. Persons >40 years of age and in nonfarming occupations had a higher risk for death. The changing epidemiology of scrub typhus in China warrants an enhanced disease control and prevention program.
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http://dx.doi.org/10.3201/eid2606.191168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258452PMC
June 2020