An outbreak of cutaneous anthraxcaused by slaughter sick cow in Xinjiang, China, 2016 / 中国人兽共患病学报

On June 6,2016,an outbreak of suspected cutaneous anthrax was reported by T County CDC,Xinjiang Uygur Autonomous,China.An investigation was carried out to determine the magnitude and risk factors and to recommend control measures.Suspected cases were defined as any villager in T county residents whose skin appeared rash,blisters,ulceration,swelling of black eschar or ulcer between May 1 and June 8.Confirmed case were defined as suspected case plus serological positive,real-time polymerase chain reaction (PCR) positive or Bacillus anthraci isolated.We interviewed clinicians and reviewed medical files in the township and city hospital,and visited all households searching for cases.A case-control study was conducted to investigate the risk factors of human anthrax infection.Three types of specimens were collected and tested by serological detection,real-time polymerase chain reaction (PCR) and bacterial culture.Through epidemiological investigation,15 families purchased beef of a sick cow on May 26,2016.Between 29 May and 3 June,ten people from these families were diagnosed as skin anthrax.Among them,six were confirmed cases and four were suspected cases.The attack rate was 20％.The incubation period was 3 to 7 days with average incubation 5 days.The nain clinical manifestations were hand skin anthrax carbuncle.Case control study showed that the incidences of people who exposing or not exposing to contaminated beefs significantly different,with 53％ and 0％ respectively.Blood serums from six patients showed that specific antibody titer appeared to increase more than 4 times.B.anthraci was isolated from herpes fluid of one patient.B.anthraci nucleic acid was detected from beef collected from four families.The outbreak was caused by the villagers exposed sick cow which infected by B.anthraci.Contaminated beef caused the infections.

Brucellosis epidemiological characteristics in Kashgar,Xinjiang, China, 2005-2016 / 中国人兽共患病学报

We investigated brucellosis incidence trends in Kashgar,Xinjiang in 2005-2016 for further prevention and control,and analyzed the brucellosis epidemiological characteristics there,by using the descriptive epidemiology method.A total of 767 cases were reported,with an average annual incidence of 1.68/100 000,and incidence of annual report showed a relatively stable trend (Z:29.49,P＜0.001).The maximum number of reported cases was mainly concentrated from May to July.Incidence ratio of the male and female was 1.81:1.Cases were identified in each age group,the minimum age was five months,and the maximum age was 85 years old,with the median of 39.The highest proportion of reported cases was peasant.The top five average annual incidence counties (cities) were the Markit County,Yopurga County,Tashikuergan Tajik Autonomous County,Bachu County and Kashgar City.The brucellosis incidence increased year by year,especially during 2012-2016.We need further analysis for the data from increasing brucellosis outbreak and further strengthen the prevention and control of that in Kashgar area.

An Investigation of the First Case of Human Rabies Caused by a Fox in China in May 2016 / 生物医学与环境科学（英文）

This study assesses the causes and prevention measures of rabies through epidemiological investigation and analysis. A field epidemiological survey was conducted to investigate a case of rabies by fox bite. The onset of symptoms began 50 days after the bite. The patient did not receive standard treatment, rabies vaccination, or rabies immunoglobulin injection. The fox was killed on the spot. Saliva and pre-death blood samples were collected at different periods, and only blood RT-PCR tests yielded positive results. Wild fox bite is a major risk factor of rabies infection in Xinjiang Province, China.

Epidemiological features of typhoid/paratyphoid fever in provinces with high incidence rate and in the whole country, in 2012 / 中华流行病学杂志

Objective Through analyzing the national statutory reporting data on typhoid,paratyphoid fever in 2012,we were trying to understand the whole picture of typhoid,paratyphoid fever at the national level as well as to understand the trends and characteristics of typhoid and paratyphoid fever in provinces with high incidence rate,so as to the development of prevention and control strategies of the diseases in those high-incidence rate provinces.Methods We descriptively analyzed the national typhoid and paratyphoid fever statutory reporting data which was reported through disease surveillance information reporting system in 2012.Results 11 998 cases with typhoid and paratyphoid fever were reported with 3 fatal ones,in 2012 in the whole country.The incidence rate was 0.89 per 100 000.Compared to the data gathered in 2011,the incidence rates of typhoid/paratyphoid fever increased by 1.20％.The total number of the confirmed cases on typhoid and paratyphoid fever was 6522 and was accounted for 54.36％ of the total cases,in which paratyphoid fever accounted for 36.86％.Cases were mainly involved farmers and followed by students and children.Incidence rates of typhoid and paratyphoid fever in children aged 0-4 years old appeared the highest (respectively 1.31/100 000 and 0.46/100 000).Yunnan,Guizhou,Guangdong,Guangxi,Zhejiang,Hunan and Xinjiang provinces (autonomous regions) were identified as provinces with high-incidence rates of typhoid and paratyphoid fever.During 2005-2012,the incidence rates in most of the above high-incidence provinces showed a downward trend,except for in Guangdong which had only showed a slight change.There were variations on peak period and highly-hit population in seven high-incidence provinces.Conclusion The incidence rate of typhoid/paratyphoid fever was in a relatively low level in China.Prevention and control strategies on the diseases in children under 5 years old remained a challenge,warranted more work to be done.The epidemiological situation is still severe in some high-incidence rate provinces.

A norovirus-borne outbreak caused by contaminated bottled spring water in a school, Zhejiang province / 中华流行病学杂志

Objective To study a local hospital reported acute gastroenteritis in a boarding school on its source of infection, mode of transmission and risk factors of the infection. Methods A suspected case was defined as who had developed diarrhea (≥3 times/day) or vomiting among teachers or students of the school, during April 19-30, 2010. A confirmed case was from a probable case plus tested positive for norovirus in stool specimens by using RT-PCR. Stool specimens of cases and environmental specimens were collected for laboratory diagnosis. In a ease-control study, we compared exposures to sources of bottled water, consumption of bottled water, and hygienic habits of 220 probable or confirmed cases from April 21-23 in the peak of the outbreak, together with another 220 controls, with frequency-matched by school grade. Results 20.3% of the 1536 students but none of the teachers developed the disease. 98.6% of the cases (n=217) and 85.5% (n=188) of the controls had drunk bottled water in the classroom (ORM-H= 12.3,95%CI: 3.7-40.9). 47.9% (n= 104)of the cases and 41.5% (n=78)of the controls had drunk unboiled bottled water in classroom (ORM-H=3.8,95%CI: 1.5-9.6). 47.9% (n=104) of the cases and 48.4% (n=91) of the controls had drunk bottled mixed water (boiled and unboiled) in the classroom (ORM-H=2.8, 95%CI: 1.1-7.0).Stool specimens from 3 cases and one bottle of uncovered bottled water in classroom showed positive of having norovirus genotype Ⅱ. Coliforms was cultured much higher rates than standard deviations in the bottled water. The factory making the bottled water was not licensed or having strict disinfection facilities. Conclusion Bottled spring water contaminated by norovirus was responsible for this outbreak.

A hepatitis A outbreak caused by contaminated well water in a primary school of Jiangxi province, China, 2009 / 中华流行病学杂志

Objective A hepatitis A outbreak in a primary school was reported by Gan County Center for Disease Control and Province (CDC) and an investigation was conducted to identify the possible source of infection and risk factors for transmission.Methods A probable case was defined as having onset of jaundice (yellow urine,sclera or skin) or a 2-fold increase in Alanine aminotransferase with 2 or more,of the followings symptoms:anorexia,disgust of oil,abdominal pain,nausea,fatigue,vomiting,in students and staff of the primary school between 1 November 2008 and 14 February 2009.A confirmed case was IgM positive for hepatitis A,added on a probable case.We searched for cases through reviewing medical records in the township hospital and village clinics and conducting symptom screening among students or teachers.We also conducted a case-control study to compare the exposure histories of 19 cases and 53 anti-HAV-IgM negative controls randomly selected from those asymptomatic students in the same grade.Results 21 cases from all the students was identified,with the attack rate as 3.5％.The epidemic curve showed the two peaks of the outbreak were 28 days apart,both indicating that they were related to the exposure of the source of origin.74％of the case-students drank the unboiled Well B water,compared to 42％ of control-students (OR=4.0,95％CI:1.1-15).The total bacterial count was 600 cfu/ml and the total coliform was 23 MPN/100 ml in one sample collected from the well water.Conclusion This hepatitis A outbreak was caused by drinking contaminated water in Well B.We recommended that all the schools should use chlorinated municipal pipe water.Public health authorities should strengthen the supervision of quality of water in schools.

An outbreak of human orf disease caused by introduced black goats / 中华流行病学杂志

Objective To identify risk factors for a human orf disease outbreak in a village in Chongqing city. Methods Standardized case-definition was set and a case-finding program was conducted among all the residents of the village. All the patients were interviewed using a standardized questionnaire and collected fluids in the skin rash for laboratory testing. A retrospective cohort investigation was conducted among all the village residents who introduced the black goats to analyze the risk of orf infection, in relation to the mode and frequency of contacts to the infected goats. Results We found 18 cases (including 16 suspected cases and 2 confirmed cases) among the members of 10 families that introduced the black goats. Village residents who had ever used their legs to grip the goats were nearly five times as likely to develop orf disease as those who did not (RR=4.98, 95％CI: 1.34-75.27). Village residents who had ever washed and wiped the goats were three times as likely to develop orf disease as those who had not (RR = 3.09,95％CI: 0.98-45.38). The frequency of contacts with the infected goats was associated with the risk of developing orf disease in a dose-response fashion (x2 test for trends: P= 0.006).Frequently wearing long trousers when dealing with the goats appeared as a protective factor (RR=0.30,95％CI: 0.15-0.78). Conclusion This outbreak was caused by the introduced black goats which carried and infected by the orf virus. Direct physical contact with infected goats but without wearing protective clothing were risk factors for the development of human orf disease.

Study on an outbreak of food poisoning caused by Salmonella blegdam / 中华流行病学杂志

objective To identify the bacterial pathogen in food and the source of infection that might be responsible for a food poisoning outbreak.Methods All the probable cases that had attended the banquet in a villige of Sichuan province who had developed fever(≥37.5℃),diarrhea (≥3 times/dav)and vomiting since August 1,2009,were identified.A case-control study was conducted to identify the foods that might be responsible for this food poisoning event.50 cases were randomly selected from the probable cases and 50 controls were randomly selected from those without the symptoms.Results The attack rate of this food poisoning event was 43.4%(132/304).86.0%(43/50)of the cases and 34.0%(17/50)of the controls had eaten pork-mixed-vermicelli(OR=12.0,95%CI:4.4-32).Data from further tests showed that dose-effect relation existing between eating pork mixing vermicelli behavior and the incidence rates(Chi-square trend:x2=21.06,P=0.00)of the disease.94.0%(47/50)of the cases and 68.0%(34/50)of the controls had eaten mushroom braising chicken(OR=7.4.95%CI:2.0-27).Data from the crossover analysis showed that there appeared an effect modification between behaviors of eating pork-mixed-vermicelli and eating mushroom braising chicken.Three cases were detected carrying Salmonella blegdam from their anus swabs and the same bacteria type was also detected in the pork-mixed-vermicelli. Conclusion This outbreak of salmonellosis was caused by Salmonella blegdam contaminated pork-mixed-vermicelli or mushroom braising chicken during food processing.

Study on the score criteria of severe hand, foot and mouth disease cases / 中华流行病学杂志

Objective To explore the score criteria of severe hand, foot and mouth disease (HFMD) cases and to provide evidence for unified criteria and treatment on severe HFMD cases.Methods All severe cases and partial mild cases reported by two designated hospitals of HFMD in Fuyang during March to June, 2008 were scored by the methods of criteria constructed in advance.ROC curve was adopted to evaluate the score criteria and the gold standard was defined according to ICU, intubation and clinical outcomes, etc. Sensitivity, specificity and Youden' s index were used to determine the division scores on critical, severe and mild cases. Results 97% of the cases (34 cases) were scored less than 6 points. 88% of cases (24 cases) who were intubated or mechanical ventilated had the scores of 6 points or higher. 79% of deaths (11 cases) were scored 10 points or higher. The area of receiver operation characteristic (ROC) curve was 0.90 (95% CI: 0.83-0.98)between severe and mild cases and the area of ROC curve was 0.95 (95%CI: 0.92-0.98) between critical and severe, mild cases. When comprehensively considering the sensitivity and specificity,severe cases were best judged when score was 4 points (sensitivity, specificity and Youden' s index were 0.94, 0.68 and 0.62 respectively). When score was 6 points, critical cases were judged very well (sensitivity, specificity and Youden' s index were 0.92, 0.84 and 0.76 respectively). Conclusion Score criteria could be quantified to determine the degree of seriousness and with high-value for diagnosis on HFMD.

An outbreak of gastroenteritis caused by contaminated well water in a village, Henan province / 中华流行病学杂志

Objective To identify the cause and mode of transmission of a gastroenteritis outbreak in a village, Henan province. Methods Gastroenteritis patients were identified through family visits, interviewing the village doctors and reviewing diagnosis and prescription records at the village health clinic. Cases were defined as onset of one of the four symptoms from the village resident during July 20 to August 12,2010. The symptoms would include diarrhea ( ≥ 3 times/day), abdominal pain, nausea or vomiting. A retrospective cohort study was conducted to assess the association between drinking raw well water or eating noodles rinsed by raw well water and gastroenteritis. Stools or vomits of the ease-patients and the well water samples were tested for bacterial pathogens. Results Data for 60 case-patients were collected. All cases occurred in the northern part of the village. Persons who used water from a public well in the northern part of the village had an attack rate of 55%, which was 3.5 times of those who did not use the well water (16%) (RR=3.5,95%CI: 1.2-10). Results from the retrospective cohort study showed that drinking un-boiled water from the well was a risk factor (RR=1.7,95%CI: 1.3-2.3). Laboratory testing showed that total coliform and E. coli both greatly exceeded the limit considered safe for drinking, indicating there was fecal contamination in the well water. No bacterial pathogens were detected in the patients' stools or vomits. Conclusion The outbreak was mainly caused by drinking contaminated water from the public well in the northern part of the village.

An outbreak of measles among unvaccinated migrant population in Zhejiang province, from June to August, 2010 / 中华流行病学杂志

Objective On July 6, 2010, the parents of a patient with confirmed measles reported several suspected measles patients with fever and rash in their village. An investigation was carried out to verify and understand the cause of the outbreak. Methods Several suspected cases had an onset of fever and rash in this and other neighboring villages during June 1 to August 3,2010. A confirmed case was a suspected case with measles-specific IgM identified in the serum. We conducted door-to-door visits and searched the Chinese Center for Disease Control and Prevention Information System to identify cases, also conducted a retrospective cohort study among migrant children aged 8 months-14 years to identify risk factors related to measles. Results We identified 19 measles cases (17 confirmed case, 2 suspected cases)in the village, and all of them were migrants. Children aged 1-2 years had the highest attack rate(13%). The primary case-patient had onset on the day she arrived in this village(June 4,2010). Caretakers from an unlicensed private clinic were providing service in the village but did not report the outbreak to the public health authority. The outbreak was identified only after receiving a report from the parents of one of the patients, by that time the outbreak had lasted for one month. The measles vaccine coverage rate was 81% among the 315 migrant children aged 8 months-14 years. Among the 61 unvaccinated children, those who reportedly being contacted a measles patient had a higher attack rate(14/16, 88%)than those who did not(2/45, 4.4%)(Relative risk=20, Fisher' s exact 95% confidence interval: 5.7-94). Conclusion The low measles vaccine coverage among migrant children and lack of measures taken on the incident, timely isolation diagnosis/reporting by the caretakers from the unlicensed private clinic etc. had contributed to this prolonged outbreak. Measures need to be taken to improve the immunization services for migrant populations and to enhance measles surveillance programs in the area.

Non-airborne transmission during outbreak of pandemic (H1N1) 2009 among tour group members, China, June 2009 / 中华流行病学杂志

Objective During June 2-8, 2009, 11 cases of the novel influenza A (H1N1)occurred in Sichuan Province, China. We investigated this outbreak to identify the source of infection,mode of transmission and risk factors for infection. Methods The primary case, a U.S. citizen,developed disease on June 2. From June 3 to 5, she joined Tour Group A for a trip to Jiuzhaigou. We telephoned passengers of the three flights on which the primary case had traveled in China, and members of Tour Group A. We asked whether they had any influenza-like symptoms during May 27 to June 12. Health authorities placed passengers whose seats were within three rows of the primary case on flights and members of Tour Group A on medical observation, and isolated individuals if they developed symptoms. We used real-time RT-PCR to test the throat swabs from symptomatic persons for the novel influenza virus and defined a confirmed case as one with influenza-like symptoms and laboratory confirmation. A retrospective cohort investigation to identify the risk factors for infection was conducted. We interviewed all members of Tour Group A about their detailed contact history with the primary case. Results During June 5 to 6, 9 (30%) of the primary case' s 30 fellow tour group members developed disease, compared with none of her 87 fellow passengers to Jiuzhaigou and 1 of her 87 fellow passengers on the returning trip (when several of the members of Tour Group A were symptomatic). 56% of the tourists who had talked with the primary case in close range ( ＜2 m) for ≥2 minutes developed disease, whereas none of the 14 other tour group members developed disease (RR= ∞; exact 95%CI: 2.0- ∞ ). Having conversed with the primary case for ≥ 10 minutes (vs. 2-9 minutes) increased the risk by almost five fold (RR=4.8, exact 95%CI: 1.3-180). Conversely, other kinds of contact, such as dining at the same table, receiving chewing gum from the primary case and sharing bus rides or planes with the primary case played no roles during this outbreak. Conclusion This novel influenza A (H1N1) outbreak was caused by an imported case, and transmitted mainly via droplet transmission when the primary case was talking with her fellow tourists during a tour. These findings highlight the importance of preventing droplet transmission during a pandemic.

Outbreak of cholera associated with consumption of soft-shelled turtles, Sichuan province, China, 2009 / 中华流行病学杂志

Objective Vibrio cholera was extremely rare in Sichuan province (no cases in 2008). Any outbreak could indicate contamination through the food supply system. In July 2009, a hospital reported a cluster of 7 diarrhea patients; all attended the same banquet. One patient was confirmed to have Vibrio cholera (O139). We conducted this investigation to identify the source of this possible cholera outbreak. Methods We defined a suspect case as any banquet attendee with diarrhea ( ≥3 times/day). A confirmed case was a suspect case with a positive Vibrio cholera culture. We took stool samples or rectal swabs from all attendees for cholera culture and interviewed 272 banquet attendees about foods they ate at the banquet and kitchen workers about food preparation. Results 7.1% (24/337) of attendees developed cases within an average of 65 hours after eating. Three meals were served. All patients had the lunch whereas no patients only ate breakfast and/or dinner. Of 180 attendees who ate turtle meat 12% were case-patients, compared to 3.3% of 92 attendees who did not (RR=3.6,95%CI: 1.1-12). Of the 150 attendees who ate peanuts 13% were cases compared to 4.1%of 122 attendees who did not eat peanuts (RR=3.1,95%CI: 1.2-8.0). During preparation, the same utensil was used for fresh turtle meat and peanuts without washing in-between the process. Turtle meat and peanuts were stored for ＞ 16 hours at room temperature after cooking before consumption. All 33 turtles originated from commercial production in another province. Conclusion This outbreak was likely caused by poor food handling of commercially produced turtles. We proposed that to improve microbiologic monitoring of aquatic food animals, and raise the awareness of good handling practices at mass gathering in rural China.

Personal protective and healthcare seeking behaviors urban residents before and during an influenza pandemic in Beijing / 中华流行病学杂志

Objective To provide evidence-based recommendations to the government on strategies for reducing the impact of the imminent influenza pandemic, we conducted a survey on the personal protective and healthcare seeking behaviors of Beijing residents in the wake of the worldwide epidemic of the novel 2009 H1N1 influenza virus, and potential changes in these behaviors during a full-blown pandemic. Methods We used a two-stage Mitofsky-Waksberg telephone survey to collect information for Beijing residents ≥ 18 years of age and weighted the sample by the census estimate of Beijing population for 2008. A structured questionnaire was used to collect information about the respondents' knowledge regarding the novel influenza virus, current personal protective and healthcare seeking behaviors during a full-blown influenza pandemic. Results 286 Beijing urban residents were interviewed during May 15 to 18 (response rate: 62%). 77%(95%CI: 71%-82%) of the residents that they would cover their sneezes at home, and 93%(95%CI: 89%-96%) would do so in a public place. Of the residents would cover their sneezes at home, 66% (95%CI: 57%-74%) would covered their sneezes by hand, 33% (95%CI:25%-42%) by facial tissue, and only 0.4% (95%CI: 0.1%-2.9%) by sleeves. Similarly, of the residents would cover their sneezes at a public place, 64% (95%CI: 56%-71%) would cover their sneezes by hand, 33%(95%CI: 26%-41%) by facial tissue and 0% by sleeves. 46% (95% CI: 32%-59%) of the residents would wash their hands after covering their sneezes with hand in public places, and 77% (95%CI: 64%-89%) would do so at home. Higher percentages of residents would wear a mask (63%, 95% CI: 56%-70%) and get vaccinated (43%, 95% CI: 37%-50%) during a pandemic than under currently situation (3.5%, 95% CI: 1.7%-7.0% for wearing a mask; 13%, 95% CI: 9.8%-18% for getting vaccinated). 86% (95% CI: 81%-89%) of the residents would visit a doctor for an influenza-like illness during a pandemic, similar to the percentage currently seen (76%, 95%CI: 70%-81%). 71%(95%CI: 63%-78%) of the residents would visit a doctor for influenza-like illness and would choose a tertiary medical center; with percentage (74% , 95% CI: 66%-80%) similar to the one during a pandemic. Conclusion Beijing residents need to be aware of the proper ways to cover their noses when sneezing (especially using their sleeves more), and to wash their hands. An effective plan to triage patients should be immediately established to efficiently utilize the limited healthcare resources, which would likely be further strained during a pandemic.

Assessment of current hospital capacity in Beijing in responding to potential influenza pandemic: an application on Flu Surge model / 中华流行病学杂志

<p><b>INTRODUCTION</b>Based on the estimate results of the capacity and preparedness of Beijing hospitals to respond to pandemic influenza, using flu surge model to evaluate its applicable hypothesis and to provide government with sentient strategy in planning pandemic influenza. Through collection of medical resources information, we calculated the possible impaction on hospitals by Flu Surge model and explored the applicable hypothesis in model operation through a questionnaire, direct observation and group discussion in 3 hospitals in Beijing. Based on flu surge model estimation during a 6-week epidemic from a pandemic virus with 35% attack rate, Beijing would have had an estimation of 5 383 000 influenza illnesses, 2 691 500 influenza outpatients, 76 450 influenza hospitalizations and 14 508 excess deaths. For a 6-week period with 35% attack rate, there would be a peak demand for 8% of beds, 210% of ICU beds, and 128% of ventilators estimated. Outpatients in different level hospital were quite disproportionated with 1742/ hospital/day, 650/hospital/day, and 139/hospital/day respectively. The sampled health workers had a mastery of 63.4% of the total knowledge and skills of diagnosing and treating of influenza, 73.5% of them washed their hands and 63.5% used PPE correctly. The total beds capacity, medical beds capacity and respiratory medical beds capacity would increase 8%, 35% and 128% respectively.</p><p><b>CONCLUSION</b>The estimation results could be referenced when planning the pandemic strategy, but the results should be treated objectively when considering the hypothesis and practical situation in this model being used.</p>