Analysis of the direct economic burden of measles cases and its influencing factors in Shanghai from 2017 to 2019 / 中华预防医学杂志

Objective: To analyze the direct economic burden caused by measles cases in Shanghai from 2017 to 2019 and its influencing factors. Methods: A total of 161 laboratory-confirmed measles cases reported from January 1, 2017, to December 31, 2019, in Shanghai were included in the study through the "Measles Surveillance Information Reporting and Management System" of the "China Disease Surveillance Information Reporting and Management System". Through telephone follow-up and consulting hospital data, the basic information of population, medical treatment situation, medical treatment costs and other information were collected, and the direct economic burden of cases was calculated, including registration fees, examination fees, hospitalization fees, medical fees and other disease treatment expenses, as well as transportation and other expenses of cases. The multiple linear regression model was used to analyze the main influencing factors of the direct economic burden. Results: The age of 161 measles cases M (Q1, Q3) was 28.21 (13.33, 37.00) years. Male cases (56.52%) were more than female cases (43.48%). The largest number of cases was≥18 years old (70.81%). The total direct economic burden of 161 measles cases was 540 851.14 yuan, and the per capita direct economic burden was 3 359.32 yuan. The direct economic burden M (Q1, Q3) was 873.00 (245.01, 4 014.79) yuan per person. The results of multiple linear regression model analysis showed that compared with other and unknown occupations, central areas and non-hospitalized cases, the direct economic burden of measles cases was higher in scattered children, childcare children, students, and cadre staff in the occupational distribution, suburban areas and hospitalized, with the coefficient of β (95%CI) values of 0.388 (0.150-0.627), 0.297 (0.025-0.569), 0.327 (0.148-0.506) and 1.031 (0.853-1.209), respectively (all P values<0.05). Conclusion: The direct economic burden of some measles cases in Shanghai is relatively high. Occupation, area of residence and hospitalization are the main factors influencing the direct economic burden of measles cases.

Study and application of transmission tracking analysis technique during incubation period of respiratory infectious diseases / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop a new transmission tracking analysis technique during incubation period of respiratory infectious diseases, and to discuss its practical value in the field survey of infectious diseases.</p><p><b>METHODS</b>The classical epidemiological theory was integrated with geographic information system. The transmission tracking analysis technique was established based on the modeling platform ArcGIS Engine Developer Kit 9.3, using the techniques of address matching, shortest path analysis and buffer analysis, and programming by Visual C++. Eight serious sever acute respiratory syndrome (SARS) cases in Shanghai in year 2003 were then chose as prototype to set up the test cases A-H. The electronic map and population density data were separately collected from Institute of Surveying and Mapping in Shanghai and Shanghai statistical yearbook 2003, to calculate and explore the parameters as length of transmission path, area of buffer zone and key departments by single and multi case analysis module.</p><p><b>RESULTS</b>The single case transmission tracking analysis showed that the length of transmission track of case A was 129.89 km during April 25th to 29th in 2003, including 12 tracing point and 108 intimate contacts, and the total area of buffer zone was 7.11 km(2) including 81 important institutes, naming 72 schools, 6 kindergartens and 3 gerocomiums. The multi-case transmission tracking analysis showed that the 8 cases shared 5 tracks without any temporal communication. However, there was a spatial communication whose length was 1.42 km and area was 0.60 km(2). There were no important institutes found in this communication area.</p><p><b>CONCLUSION</b>Transmission tracking technique is practicable and efficient to trace the source of infection, analyze the transmission tracks, establish the isolation buffer area and explore the important geographic positions in epidemiological investigation.</p>

Preliminary application of Back-Propagation artificial neural network model on the prediction of infectious diarrhea incidence in Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To establish BP artificial neural network predicting model regarding the daily cases of infectious diarrhea in Shanghai.</p><p><b>METHODS</b>Data regarding both the incidence of infectious diarrhea from 2005 to 2008 in Shanghai and meteorological factors including temperature, relative humidity, rainfall, atmospheric pressure, duration of sunshine and wind speed within the same periods were collected and analyzed with the MatLab R2012b software. Meteorological factors that were correlated with infectious diarrhea were screened by Spearman correlation analysis. Principal component analysis (PCA) was used to remove the multi-colinearities between meteorological factors. Back-Propagation (BP) neural network was employed to establish related prediction models regarding the daily infectious diarrhea incidence, using artificial neural networks toolbox. The established models were evaluated through the fitting, predicting and forecasting processes.</p><p><b>RESULTS</b>Data from Spearman correlation analysis indicated that the incidence of infectious diarrhea had a highly positive correlation with factors as daily maximum temperature, minimum temperature, average temperature, minimum relative humidity and average relative humidity in the previous two days (P < 0.01), and a relatively high negative correlation with the daily average air pressure in the previous two days (P < 0.01). Factors as mean absolute error, root mean square error, correlation coefficient(r), and the coefficient of determination (r(2)) of BP neural network model were established under the input of 4 meteorological principal components, extracted by PCA and used for training and prediction. Then appeared to be 4.7811, 6.8921,0.7918,0.8418 and 5.8163, 7.8062,0.7202,0.8180, respectively. The rate on mean error regarding the predictive value to actual incidence in 2008 was 5.30% and the forecasting precision reached 95.63% .</p><p><b>CONCLUSION</b>Temperature and air pressure showed important impact on the incidence of infectious diarrhea. The BP neural network model had the advantages of low simulation forecasting errors and high forecasting hit rate that could ideally predict and forecast the effects on the incidence of infectious diarrhea.</p>

Study on patients with Creutzfeldt-Jakob disease in Shanghai, 2006-2012 / 中华流行病学杂志

Objective To describe the epidemiological characteristics of patients with Creutzfeldt-Jakob disease (CJD) in Shanghai from 2006 to 2012.Methods Clinical and epidemiological information on CJD patients from Shanghai CJD Surveillance Network was analyzed.Cerebral spinal fluid (CSF) and blood specimens from patients were collected and used for detecting the 14-3-3 protein,and polymorphism of 129 amino acid and mutation of PRNP genes.Data was processed by EpiData (V3.0) and analyzed by SPSS (V17.0).Results In totally,one definite CJD patient together with 56 probable and 17 possible sporadic CJD patients were identified.One E200K genetic CJD case was diagnosed and another one was clinically diagnosed.No period-or geographic-related events were observed for these cases,but the houses of the two genetic CJD cases were close to each other.The mean age of onset of the probable CJD patients was 62 years old which was significantly older than that of those possible CJD patients.Conclusion Most of the CJD patients identified in Shanghai were sporadic and the number was stable from 2006 to 2012.The mean age of onset of those probable CJD patients was older than that of the possible CJD patients.

Prediction of influenza-like illness in Shanghai based on the generalized additive method / 中华流行病学杂志

The aim of the current research topic was to test the generalized additive method (GAM),using data from the analysis and prediction on influenza-like illness (ILI) in Shanghai.Through collecting the meteorological data as well as the ILI from 2006 to 2010,we established several nonlinear regression candidate models based on the GAM.These models considered factors as:the nonlinear dependence on the meteorological data,i.e.weekly average temperature and weekly average (maximum) temperature differences and the ILI.The AIC (Akaike information criterion) involved two simplified models which were implemented for further analysis and prediction.Finally,numerical examples showed that the proposed models could shed light on the connection between the meteorological data and the ILI.GAM could be used to fit the frequencies of ILI and meteorological factors in Shanghai.The proposed models were able to accurately analyze the onset of ILI,implying that GAM might be suitable for the prediction and analysis of those meteorological correlative diseases.

Assessment and application of a molecular diagnostic method on the detection of four types of diarrheagenic Escherichia coli / 中华流行病学杂志

<p><b>OBJECTIVE</b>To establish and evaluate a molecular diagnostic method for routine monitoring of four types of diarrheagenic Escherichia (E.) coli (DEC)and to study the distribution of four types of DEC isolated from diarrheal patients in Shanghai.</p><p><b>METHODS</b>DEC-PCR standard operation procedure(SOP)had been developed for DEC detection and isolation, using the Statens Serum Institute (SSI) DEC PCR kits with multiplex PCR technique after verification tests on reference strains. Diarrhea specimens from 3 clinical hospitals in Shanghai were tested from June to September, 2012.</p><p><b>RESULTS</b>Specificity of the PCR kit was 100% by verification on the 26 DEC reference strains. A total number of 218 DEC isolates, including 181 fermented lactose and 37 unfermented lactose were identified from the 1887 stool specimens of diarrhea patients, with positive rate as 11.6%. The most common pathogen(54.1%, 118/218)was enteropathogenic E. coli(EPEC), followed by enterotoxigenic E. coli(ETEC, 41.3%, 90/218), enteroinvasive E. coli (EIEC, 4.1%, 9/ 218) and Shigatoxin-producing E. coli(STEC, 0.5%, 1/218)in addition to 18 Shigella isolates. ETEC dominated in diarrhea patients with foreign residency, as well as 1/3 were perinatal stage of neonatal ETEC of all diarrhea cases under the age of 5, while EPEC dominated in the Chinese diarrhea patients especially among young kids under the age of 2.</p><p><b>CONCLUSION</b>Data was reliable after assessment on this molecular diagnostics and seperation procedures used for the routine monitoring on four types of DEC, while the diagnosis and reference ability of DEC regarding the laboratories net-working on food-borne pathogens need to be built up and improved.</p>

Study on the epidemiological characteristics and incidence trend of scarlet fever in Shanghai,2005-2012 / 中华流行病学杂志

Objective To systemically analyze the epidemiological characteristics,molecular markers of circulating group A Streptococcus (GAS) isolates and the incidence trend of scarlet fever in Shanghai from 2005 to 2012 as well as to explore the practice of GAS isolates surveillance program and the combined mathematical model in the early warning of scarlet fever.Methods The morbidity series of scarlet fever were retrieved to analyze and fit the combined mathematical model which comprised an autoregressive integrated moving average (ARIMA) model and a neural network.GAS isolates surveillances programs were implemented on community healthy population,using the emm typing and superantigens detecting method in Shanghai during the epidemic period of scarlet fever in 2008,2010 and 2012.The standardized prevalence of GAS isolates was estimated with the demographic data.Results From 2005 to 2012,there were a total of 9410 scarlet fever cases reported in Shanghai including local registered residents and immigrant population,showing that the distribution of patients as sporadic.The morbidity kept rising with seasonal and periodical variations and the peak was in 2011.The average morbidity was 6.012 per 100 000 persons.Morbidity in the the suburban was significantly higher than that in the urban areas.Children at 4 to 8 years old were easy to be involved.The mean error rate of single ARIMA model,ARIMA-GRNN and back propagation artificial neural network combined model were 0.268,0.432 and 0.131 respectively.The predicted incidence of scarlet fever in 2013 would keep fluctuating within a narrow range from 0.446 to 3.467 per 100 000 persons.A total number of 4409 throat swab samples were collected through the GAS isolates surveillance programs in 2008,2010 and 2012.The standardized prevalence of GAS isolates in each year were 0.000％,0.000％ and 1.092％.18 GAS isolates were identified and 15 isolates (83.33％) belonged to emm 12.0.Conclusion The morbidity of scarlet fever would continue to maintain an upward trend in Shanghai and the techniques used in GAS isolates surveillance program and in the combined mathematical model could be applied for the early warning system on scarlet fever.

Study on the status of HBV infection and its determinants among family members with HBV infected persons in Shanghai / 中华流行病学杂志

Objective To understand the status of HBV infection among family members with HBV infected persons in Shanghai and to probe the determinants of HBV infection so as to provide evidence for improving the related strategies on hepatitis B prevention and control.Methods Three hundred and four hepatitis B patients together with 288 HBsAg carriers from 6 districts in Shanghai were randomly sampled in 2010.All the said persons and their families members were asked to fill in questionnaires and to be drawn 5 ml venous blood for HBV serologic indicators detection.The subjects were divided into case group and control group according to their status of HBV infection.Univariate analysis and multivariate logistic regression analysis were carried out to identify the determinants of HBV infection among family members.Results Among 1485 subjects from 592 households,a total of 1137 persons were infected by HBV,with the overall infection rate as 76.57％.Fifteen infection modes were noticed,in which double positive of anti-HBs and anti-HBc,triple positive of HBsAg,anti-HBe and anti-HBc,together with triple positive of anti-HBs,anti-HBe and anti-HBc accounted for the top three,with the proportions as 30.69％,26.65％ and 10.03％ respectively.The differences between the years of carrying HBV and the proportions of numbers that carrying HBV in families,were not statistically significant.The infection rate among children (42.86％) was significantly lower than that of their parents (87.54％)(P＜0.001).Results from both univariate and multivariate analysis showed that gender,age,utensil sharing,histories of receiving hepatitis B vaccines and dental outpatient service were determinants of HBV infection among families members (P＜0.05),with OR values being 9.009 for persons without immunization history of hepatitis B vaccines,3.817 for persons above 40 years old and 2.283 for persons of 21-40 years old,2.222 for families members who sharing utensil,2.124 for persons with history of dental outpatient service and 1.339 for male members,respectively.Conclusion Family clustering of HBV infection in was seen in Shanghai.In order to reduce the number of HBV infection in families,hepatitis B vaccination program need to be carried out.Healthy lifestyle should be emphasized to prevent HBV infection due to close contact.The risk of iatrogenic HBV transmission should also be prevented.

A case-control study on risk factors that associated with severe hand-foot-mouth disease in Shanghai / 中华流行病学杂志

Objective To explore the factors associated with severe hand-food-mouth disease (HFMD) case in Shanghai.Methods A total of 105 severe HFMD cases diagnosed from May to July,2011 in Shanghai were enrolled as case group while another 210 mild HFMD cases were randomly selected as control group in the same period.All subject' s parents or babysitters were asked to fill in the questionnaire in which including demography,ways of babysitting,behavior and the like.All HFMD cases were diagnosed by both clinical symptom and nuclear acid testing.Data was processed by EpiData (V3.0) and analyzed by SPSS (V17.0).Results Factors as age,gender,Diaspora pattern,migrant,size of house,numbers of family member,numbers of children,frequency of seeing doctor,dishware that sharing with babysitter,food chewed by babysitter,dirty hand,EV71 virus type and diagnosis on HFMD in the fist visit to hospital were found associated with severe HFMD by univariate analysis.Results through multivariate logistic regression showed that factors including:being the only male kid,more than 3 children in the family,dirty hands,unable to be diagnosed as HFMD in the first visit to the hospital,visiting doctor during the past 6 months for 2 and 3 times etc.could be kept in the model with statistical threshold of 0.05.Adjusted ORs and confidence intervals of them were 2.431 ( 1.317-4.487),2.661 (1.332-5.315),3.403 ( 1.871-6.191 ),6.607 (3.011-14.500),2.431 ( 1.111-5.321 ),2.628 ( 1.137-6.071 ) respectively.Being Infected by EV71 was also found a very important risk factor compared with CoxA16 or other enteroviruses,and its adjusted OR was 5.614 (2.409-13.082).Conclusion It was necessary to implement molecular diagnosis for identifying the virus type of HFMD,together with improvement on the capacity of clinical diagnosis in order to diagnose the HFMD cases earlier.More attention should be paid to these HFMD cases with EV71 infection as well as prompting frequent visits to hospitals on those families with more children.

Study on the epidemiological characteristics of rubella from 1990-2006 in Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>This paper analyzed the epidemiological characteristics of rubella in Shanghai from 1990 to 2006.</p><p><b>METHODS</b>Descriptive epidemiological study was applied to analyze the cases from infectious diseases reported system on rubella during 1990-2006 in Shanghai. Excel was used for data analysis.</p><p><b>RESULTS</b>The reported rubella incidence rate in Shanghai was 0.15-451.57 per 100,000 during the period from 1990 to 2006. A rubella epidemic happened in 1993, with the number of reported cases as 58,104. The year 1998 was the low year on rubella with only 19 reported cases. In the years without rubella vaccine (RV), that was, from 1990 to 1994, the annual reported incidence rate of rubella was 93 per 100,000, and there was a distinct characteristic of seasonal difference, with peak in march through June each year. Rubella cases mostly affected children aged 5-9 and adolescent of 10-14 years old. Since the wide use of RV in Shanghai since 1995, RV and measles, mumps, rubella (MMR) had been widely accepted by parents. The vaccination rate of MMR reached up to 85 percent. The incidence of rubella was descending as year went by. The annual reported cases were less than 100 since then (with exception in the year 1995). Local outbreaks were further reduced and the age group structure had also changed since the adoption of RV. Patients with RV fallen into the age group of 0-4 were increasing quickly, accounting for 21.00% percent of all the patients and the age become older. 31.62% of the patients fell into 20 years of age and above. During 1995-2006, the incidence rates of rubella in age 25-29 and 30-34 were both much higher than that in the year without vaccine.</p><p><b>CONCLUSION</b>The trend of older age among patients wilt Rubella increased the risk on fertile woman and geting congenital rebella syndrome.</p>

Detection of enterovirus 71 and coxsackievirus A16 from children with hand, foot and mouth disease in Shanghai, 2002 / 中华儿科杂志

<p><b>OBJECTIVE</b>It was noticed that coxsackievirus A16 (CA16) and enterovirus 71 (EV71) were two major etiological agents of hand, foot and mouth disease (HFMD) in children. Recently there were several large outbreaks of HFMD in the Asia-Pacific region, and there was a propensity to cause severe complications or death in children under 5 years of age. The severe forms were associated with EV71 infection. Although epidemics of HFMD have been reported in the mainland of China, few reports about EV71 as the pathogen of HFMD epidemics are available. The present study was conducted to investigate the causal agent of an HFMD epidemic in children in Shanghai from April to June of 2002.</p><p><b>METHODS</b>Totally 102 specimens (including vesicle fluid, stool and throat swabs) were collected from 72 patients with HFMD. The specimens were inoculated into Vero and/or RD cells. At first all the isolates were respectively neutralized by the RIVM pools of enterovirus antiserum, the type-specific antisera to EV71 or to CA16. Secondly all untyped isolates were tested by RT-PCR assay with two specific primer pairs for VP1 genes of EV71 and CA16 respectively. The EV71 and CA16 were identified depending on the size of PCR products. Sequence analyses of VP1 genes of 9 virus strains were performed by the laboratory of China CDC.</p><p><b>RESULTS</b>Viruses were isolated from 91 specimens from 67 patients. Serotyping by neutralization failed for all the isolates. But the RT-PCR results indicated that the viruses isolated from 78 specimens from 58 patients were identified as positive for CA16 and the isolates from 13 specimens from 9 patients were identified as positive for EV71, the ratio between CA16 and EV71 was 6.4:1. The results of sequence analyses were consistent with those of PCR assay. Two EV71 strains isolated in this study belonged to a new lineage (C4) within genogroup C. One patient with EV71-associated HFMD had a complication of encephalitis with convulsion, shock, coma and dyspnea.</p><p><b>CONCLUSION</b>CA16 and EV71 were the primary causes of HFMD during the epidemic. It was the first report of EV71-associated severe encephalitis occurred in patients with HFMD in Shanghai.</p>