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Since the Global Polio Eradication Initiative was launched by the World Health Assembly in 1988, significant progress has been made in global polio prevention and control. But the occurrence of vaccine-associated paralytic poliomyelitis cases and vaccine-derived poliovirus related cases have become a major challenge during the post-polio era. While coronavirus disease 2019(COVID-19) has brought serious disease burden and economic burden to all countries in the world, prevention and control of vaccine-preventable infectious diseases such as polio should not be neglected under the background of the global common fight against COVID-19. Taking the type Ⅲ VDPV cycle event in Shanghai as an example, the paper discussed how to do a good job of routine inoculation under the prevention and control of COVID-19 to strictly prevent the outbreak of vaccine-preventable infectious diseases.
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Humans , COVID-19 , China , Poliovirus , Poliovirus Vaccine, Oral , SARS-CoV-2 , VaccinationABSTRACT
Objective@#To evaluate the immunogenicity of different strains of inactivated poliomyelitis vaccines (IPV) by sequential program.@*Methods@#This parallel-group controlled trial was conducted in immunization clinics in Shanghai from March 2016 to September 2017. Sabin strains inactivated poliomyelitis vaccines (sIPV), WPV strains inactivated poliomyelitis vaccines (wIPV) and live poliomyelitis Type Ⅰ Type Ⅲ vaccine (bOPV) as the investigational vaccine were used at 2, 3, 4 months old in 325 infants in Shanghai. Infants vaccinated by four sequential program were divided into 4 groups: sIPV+sIPV+bOPV, sIPV+wIPV+bOPV, wIPV+sIPV+bOPV and wIPV+wIPV+bOPV. A total of 230 investigators′ blood samples were collected before primary immunization and 163 investigators′ blood samples were collected after primary immunization. A total of 151 investigators (36, 44, 30 and 41 in each group) finished primary immunization and blood sampling before and after the primary immunization. The geometric mean titer (GMT) of poliovirus typesⅠ and Ⅲ neutralizing antibody was tested and calculated, and the positive results of antibody before and after primary immunization were analyzed.@*Results@#Among the 151 investigators, the age were (2.27±0.61) months and birth weight were (3.27±0.43) kg, and 70 were male. The positive rates of typeⅠwas 98.68% (149 cases), and type Ⅲ was 97.35% (147 cases); the number of investigators tested in each group was 36, 44, 30 and 41, respectively; the positive rates of typeⅠwas 97.22% (35 cases), 100.00% (44 cases), 96.67% (29 cases) and 100.00% (41 cases) (P=0.345); the positive rates of type Ⅲ were 97.22% (35 cases), 95.45% (42 cases), 96.67% (29 cases) and 100.00% (41 cases) (P=0.614).@*Conclusion@#Using sIPV and wIPV simultaneously or alternately for sequential immunization of poliomyelitis vaccines showed good immunogenicity for infants at appropriate age.
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Objective@#To evaluate the safety of population based sequential vaccination schedule of inactivated poliovirus vaccines prepared with different strains.@*Methods@#This randomized, parallel-group controlled trial was conducted from March, 2017 to May, 2018, in Shanghai. Adverse reaction data of Sabin strain inactivated polio vaccine (sIPV), wild strains inactivated polio vaccines (wIPV) and bivalent types Ⅰ and Ⅲ oral poliomyelitis vaccine (bOPV) were systematically collected through active observation in 1 917 infants in Shanghai after the vaccination at 2, 3, 4 months old. The eligible infants aged 2 months were divided into 4 groups: ①sIPV+sIPV+bOPV group; ②sIPV+wIPV+bOPV group; ③wIPV+sIPV+bOPV group; ④wIPV+wIPV+bOPV group.@*Results@#The incidence of adverse reaction 30 days later after 3 basic dose vaccinations was 16.79% (946/5 633). No serious adverse reaction was reported. Local and systemic reactions were mainly mild. Common local reactions were pain, erythema, cutaneous nodule, etc.; and common systemic reactions were abnormal crying, drowsiness, diarrhea and appetite lost, etc.. The incidence of local reactions 30 days later after 3 basic dose vaccinations was 1.65% (93/5 633), and the incidence rates of grade 1-3 reactions were1.26% (71/5 633), 0.21% (12/5 633) and 0.20% (11/5 633) respectively. The incidence rate of systemic reactions 30 days later after 3 basic vaccinations was 15.14% (853/5 633), and the incidence rates of grade 1-3 reactions were 11.33% (638/5 633), 3.18% (179/5 633) and 0.64% (36/5 633) respectively. There were no significant differences in the rate of grade 3 reaction among different groups (χ2=4.17, P=0.24).@*Conclusions@#No severe adverse reactions related to sequential vaccination of different strain inactivated polio vaccines were observed, most of reactions were mild and all of them were cured. It is safe to use sIPV and wIPV simultaneously or alternately for childhood sequential vaccination.
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Objective To establish the musculoskeletal multi-body dynamic foot-ground contact model and explore its applicability at different speed. Methods The gait data of the subjects at different speed were collected, and the foot-ground contact model was established based on the full body model from the musculoskeletal multibody dynamic software AnyBody. Then the calculated ground reaction forces (GRFs) and ground reaction moments (GRMs) at different speed (slow walking, normal walking, fast walking and jogging) were compared with the measurements from the force plates. Results The predicted GRFs and GRMs correlated well with the experimental measurements at slow, normal and fast speed (stride speed ranged from 0.69 to 1.68 m/s). The correlation coefficients between predicted and measured GRFs were greater than 0.875 and the correlation coefficients for GRMs were greater than 0.9. Conclusions The developed foot-ground contact model could simultaneously predict GRFs and GRMs with good accuracy, thus eliminating the dependency on force plates. The model could be applied to low-speed gait conditions, such as the elderly and pathological gait.
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Objective To systemically analyze family burden,quality of life of chronic hepatitis B and C patients in Shanghai and related influencing factors.Methods A representative sample of chronic hepatitis patients (n=1 478) and their family members (n=1 478) was randomly selected through a multi-stage cluster sampling from 30 communities in 10 districts of Shanghai.One patient and one family member of each family were interviewed using different questionnaires to collect related information.Based on Bronfenbrenner's ecological systems,psychological measurement,two-level random intercept model and multivariable structural equation model were applied to determine the effects and directions of the factors between life quality of chronic hepatitis patients and family burden.Results The mean score of quality of life of chronic hepatitis patients in Shanghai was 78.70 ± 13.25,the score of "specific module" was highest and the score of "social function" was lowest.Additionally,the mean score of burden reported by the family members was 12.62 ± 10.74,the score of"financial burden" was highest,and the score of"effect on family member's health" was lowest.Multivariable structural equation model indicated that eight factors were related with life quality and family burden of patients with chronic hepatitis.Among them,HCV infection,elevated serum alanine aminotransferase level,average monthly cost for patient ＞3 000 yuan (RMB) and poor health of family members were the direct risk factors for the life quality of the patients as well as family burden.The factor of drinking more than once a week influenced the patients' life quality directly and family burden indirectly.On the contrary,the factors of local household registration,hospitalization and family member's indifferent attitude to hepatitis B vaccination influenced the family burden of the chronic hepatitis patients directly and the life quality of the patients indirectly.Conclusion The findings could be used in the development of community based management and intervention of chronic hepatitis patients in Shanghai.
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Objective To systemically analyze family burden,quality of life of chronic hepatitis B and C patients in Shanghai and related influencing factors.Methods A representative sample of chronic hepatitis patients (n=1 478) and their family members (n=1 478) was randomly selected through a multi-stage cluster sampling from 30 communities in 10 districts of Shanghai.One patient and one family member of each family were interviewed using different questionnaires to collect related information.Based on Bronfenbrenner's ecological systems,psychological measurement,two-level random intercept model and multivariable structural equation model were applied to determine the effects and directions of the factors between life quality of chronic hepatitis patients and family burden.Results The mean score of quality of life of chronic hepatitis patients in Shanghai was 78.70 ± 13.25,the score of "specific module" was highest and the score of "social function" was lowest.Additionally,the mean score of burden reported by the family members was 12.62 ± 10.74,the score of"financial burden" was highest,and the score of"effect on family member's health" was lowest.Multivariable structural equation model indicated that eight factors were related with life quality and family burden of patients with chronic hepatitis.Among them,HCV infection,elevated serum alanine aminotransferase level,average monthly cost for patient ＞3 000 yuan (RMB) and poor health of family members were the direct risk factors for the life quality of the patients as well as family burden.The factor of drinking more than once a week influenced the patients' life quality directly and family burden indirectly.On the contrary,the factors of local household registration,hospitalization and family member's indifferent attitude to hepatitis B vaccination influenced the family burden of the chronic hepatitis patients directly and the life quality of the patients indirectly.Conclusion The findings could be used in the development of community based management and intervention of chronic hepatitis patients in Shanghai.
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Objective To understand the pathogen spectrum and epidemiological characteristics of diarrhea cases in Shanghai from August 2013 to July 2014.Methods The survey was conducted in 23 hospitals at different levels randomly selected in Shanghai,the diarrhea cases seeking medical care in these hospitals were sampled,and stool samples were collected from them for pathogen isolation.Results Among 3 467 stool samples detected,1 561 were positive for at least 1 pathogen (45.02％).A total of 6 kinds of bacteria and 5 kinds of viruses were detected.The positive rate for bacterium was 13.46％,mainly Vibrio parahaemolyticus (172 cases) and Salmonella (143 cases).The positive rate for virus was 27.75％,mainly Norovirus (471 cases) and Rotavirus (312 cases).The positive rates peaked obviously in summer and during autumn-winter.The positive rate of virus was higher than that of bacterium during autumn-winter,and the positive rate of bacterium was higher than that of virus in summer,the differences were statistically significant (P＜0.05).Stratified analysis showed the constituent ratio of virus positive samples during November-February was highest among all age groups,however,the difference was not statistically significant (P＞0.05).The constituent ratio of bacterium positive samples during June-September was highest in all age groups,the difference was statistically significant (P＜0.05).The proportion of the cases with fever in bacterium positive group (19.06％) was higher than those in virus positive group (10.91％),the difference had statistically significance (P＜0.05).Conclusion The pathogen spectrum of diarrhea was relatively wide in Shanghai and the seasonality of the incidence was obvious.Specific etiological surveillance and control strategies should be strengthened among risk groups in different seasons.
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Objective To understand the epidemiologic characteristics of confirmed and suspected norovirus outbreaks in Shanghai during 2010-2014.Methods The investigation reports of confirmed and suspected norovirus outbreaks in Shanghai from 2010 to 2014 were analyzed.Results A total of 80 norovirus outbreaks, involving 2 399 cases, were reported during this period, and the overall attack rate was 4.17％.The median of the outbreak duration was 4.5 days and the incidence peaked 2 days later averagety for an outbreak.The outbreaks mainly occurred in autumn and winter,53 outbreaks occurred during October-February, accounting for 66.25％.Seventy five outbreaks occurred in schools, child care settings and nursing houses, accounting for 93.75％.The attack rates in hospitalized patients and the elders in nursing houses were higher than those in pre-school and school aged children, the differences were statistically significant (x2=683.12, P＜0.01).The attack rates in medical staff and nurses in hospitals and nursing houses or staff in pre-schools and schools were lower.Vomiting, the main clinical symptom, occurred in 1 900 cases (79.20％), diarrhea and fever developed in 694 cases (28.93％) and 364 cases (15.17％) respectively.The differences were statistically significant (x2 =2 251.48, P＜0.01).The outbreaks were mainly caused by short common exposures and contact with cases.Conclusion The surveillance for norovirus infection should be strengthened in hospitals, schools and others with the crowed during autumn-winter.The protection of risk population should be enhanced.
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<p><b>OBJECTIVE</b>To understand the distribution of diarrheagenic Escherichia (E.) coli in population in Shanghai and discuss the practice model of cooperation in enteric infectious disease prevention and control between public health institution and hospital.</p><p><b>METHODS</b>Sentinel hospitals were assigned, standard detection and identification of diarrheagenic E. coli were conducted, incidence curve of diarrheagenic E. coli infection was drawn and epidemiologic survey and laboratory detection were conducted for suspect diarrheagenic E. coli infection outbreaks.</p><p><b>RESULTS</b>A total of 7 204 stool specimens were collected from diarrhea patients in 4 hospitals during 2012-2013, in which 712 (9.9% ) were diarrheagenic E. coli positive, including 351 enteropathogenic E. coli (EPEC) strains, 292 enterotoxigenic E. coli (ETEC) strains, 32 enteroinvasive E. coli(EIEC) strains and 6 Shiga toxin-producing E. coli (STEC/EHEC) strains, as well as 31 mixed strains. EPEC infection mainly occurred in children aged 1-5 years; and all of these infections were caused by aEPEC. The incidence peak of ETEC infection was during August, the positive rate was >20%. The ETEC infection mainly occurred in infants aged 1-28 days in 2012 and in people aged 20-60 years in 2013 (P<0.05). ST was the major type (59.6%), followed by LT (27.8%) and ST/LT (12.6%). EIEC infection increased in children obviously in 2013 (P<0.01). No EHEC O157:H7 case was detected, but two EHEC O26:H11 (eae-hlyA-stx1a) cases in children were reported for the first time in Shanghai. The survey result indicated that the multidrug-resistant ETEC (STh-CS21-CFA/I-ClyA-EatA-ST2332-SHNL0005) strain causing outbreak in 15 newborns in Shanghai in 2012 was in the same clone as the strain detected in Zigong in Sichuan province.</p><p><b>CONCLUSION</b>Significant change has occurred in diarrheagenic E. coli distribution in Shanghai in recent years, ETEC has potential risk to cause outbreak of hospital acquired infection in neonates and food borne infection. The active surveillance on ETEC and other enteric pathogens by both public health institutions and hospitals need to be improved.</p>
Subject(s)
Adult , Child, Preschool , Humans , Infant , Infant, Newborn , Middle Aged , Young Adult , China , Epidemiology , Diarrhea , Microbiology , Disease Outbreaks , Enteropathogenic Escherichia coli , Enterotoxigenic Escherichia coli , Escherichia coli Infections , Epidemiology , Incidence , Sentinel SurveillanceABSTRACT
<p><b>OBJECTIVE</b>To understand the epidemiological profiles of hand, foot and mouth disease (HFMD) and the major enteroviruses causing the epidemics of HFMD in Shanghai from 2010 to 2014.</p><p><b>METHOD</b>The city-wide surveillance data between 2010 and 2014 were used to analyze the epidemiologic characteristics of the HFMD outbreaks in Shanghai. The annual incidence of HFMD was estimated based on the 2010 Shanghai Census data.</p><p><b>RESULT</b>From 2010 to 2014, the reported HFMD cases were 41 080, 37 323, 51 172, 42 198, and 65 018, respectively; the severe cases (case-severity ratio) were 469 (1.14%), 456 (1.22%), 318 (0.62%), 104 (0.25%) and 248 (0.38%), respectively. Based on Shanghai census data by the end of 2010, the attack rates of HFMD in Shanghai were 0.16%-0.28% in the entire population. In terms of the proportion of HFMD cases and severe cases in the specific population, male accounted for 59.62%-61.48% and 62.26%-73.08%, migrant population accounted for 51.86%-62.40% and 72.01%-80.38%; children aged 1.0-1.9 years comprised the highest proportion, up to 22.70%-27.00% and 32.08%-36.40%. HFMD peaked from April to July, in parallel with the peak circulation of enterovirus (EV) 71, and a small peak usually occurred in autumn and winter. All the critically severe and fatal cases were caused by EV71. The detection rates of EV71 and Coxsackievirus A (CA) 16 were 73.08%-88.09% and 1.12%-2.90% in severe HFMD cases, 19.75%-48.74% and 2.02%-23.69% in uncomplicated inpatients, and 16.78%-40.08% and 8.36%-33.39% in mild community cases, respectively. The detection rates of CA6 and CA10 in the mild community cases in 2014 were 18.38% and 1.43%, respectively. In 2013 non-EV71 and non-CA16 enteroviruses comprised 74.86% in the community cases.</p><p><b>CONCLUSION</b>The annual HFMD outbreaks occurred in Shanghai during 2010-2014. Children under 5 years of age, migrant population and male were the major susceptible population. EV71 and CA16 were the predominant pathogens causing the epidemics of HFMD except in 2013, and CA6 was prevalent in the community cases in 2014. The major peak season of HFMD usually overlapped with the peak of EV71 circulation and the majority of severe HFMD cases were associated with EV71 infection.</p>
Subject(s)
Child , Female , Humans , Male , China , Epidemiology , Disease Outbreaks , Enterovirus A, Human , Hand, Foot and Mouth Disease , Epidemiology , Incidence , Prevalence , SeasonsABSTRACT
Objective To investigate the pathotypes,epidemiological characteristics and antimicrobial resistance of diarrheagenic Escherichia coli (DEC) in children with acute bacterial diarrhea in Shanghai.Methods A total of 2 071 outpatient children with probable acute bacterial diarrhea referred to the enteric clinic of Children's Hospital of Fudan University during June 2012 to June 2014 were enrolled in our study.The stool samples were processed for routine microbiologic and biochemistry tests to identify enteric bacteria,including enteropathogenic Escherichia coli (EPEC),enterotoxigenic Escherichia coli (ETEC),enteroinvasive Escherichia coli (EIEC) and enterohemorrhagic Escherichia coli (EHEC).Kirby-Bauer method was used to identify the antibiotic sensitivity.Difference of means between groups was compared by chi-square test.Results Of 2 071 enrolled children,DEC were identified in 145 (7.0 ％)cases.148 strains were isolated with three of mix infection strains.All DEC isolates in this study included 106 (71.6％) EPEC,24 (16.2％) ETEC,16(10.8％) EIEC and 2(1.4％) EHEC.The median ages of diarrheal children with DEC infections were 14 months (range:3 months to 13 years) and 62.8％ of them were ＜2 years.Among 125 DEC isolates tested for antimicrobial susceptibility,the rates of resistance to ampicillin,trimethoprim-sulfamethoxazole,cefotaxime,cefepime,gentamicin,ceftazidime,amoxicillinclavulanate,ciprofloxacin,and ofloxacin in a descending order were 55.2％,35.2％,28.0％,27.2％,23.2％,8.8％,5.6％,4.0％ and 4.0％,respectively.Resistance rates of EIEC to cefotaxime,cefepime and ceftazidime were 50.0％,43.8％ and 25.0％,respectively,which were higher than those of EPEC,ETEC and EHEC.Conclusion DEC is the important enteric bacteria that causes bacterial diarrhea in children in this study.