Challenges to global pertussis prevention and control / 中华流行病学杂志

Pertussis is an acute, highly infectious respiratory disease caused by Bordetella pertussis, and is one of the leading causes of infant disease and death worldwide. The pertussis vaccine has been used in the expanded program on immunization globally since 1974 and the vaccination coverage remains high. In recent years, the pertussis incidence rate increased, even pertussis outbreaks occurred, in more and more countries or areas after years with low incidence level. The disease burden of pertussis has been seriously underestimated, and the prevention and control of pertussis is facing many challenges. This article reviews the epidemic status of pertussis worldwide, the factors affecting the reemergence of pertussis, and the challenges in the prevention and control to provide a reference for prevention and control of pertussis.

A Centralized Report on Pediatric Japanese Encephalitis Cases from Beijing Children's Hospital, 2013 / 生物医学与环境科学（英文）

Fifteen pediatric cases of suspected Japanese encephalitis (JE) were reported in Beijing Children's Hospital during the late summer of 2013. The clinical manifestations in most cases included high fever, seizures, and abnormal magnetic resonance imaging findings. Twelve of 15 cases were laboratory-confirmed as JE cases by pathogen identification. Epidemiological investigations showed that five of the 12 laboratory-confirmed patients had an incomplete JE vaccination history. Follow-up investigations after discharge indicated that seven laboratory-confirmed JE patients without JE vaccinations had relatively poor prognoses, with an average Modified Rankin Scale (MRS) score of 2.6 when compared with the other five laboratory-confirmed, JE-vaccinated patients with an average MRS score of 0.5. The observation of pediatric JE cases among those with a history of JE vaccination warrants further attention.

A new diterpene from the stems of Trigonostemon heterophyllus / 中国天然药物

AIM@#To investigate the chemical constituents in the stems of Trigonostemon heterophyllus.@*METHOD@#The chemical constituents were isolated by column chromatography on silica gel, Rp-18, and Sephadex LH-20, and their structures were elucidated on the basis of spectroscopic analysis.@*RESULTS@#Three compounds were isolated and identified as a new diterpene, trigonoheterene B (1), together with two known compounds, trigonostemone (2) and trigonochinene B (3).@*CONCLUSION@#Compound 1 is new. Compounds 2 and 3 showed antibacterial activities.

Epidemiological characteristics of Japanese encephalitis in Guizhou Province, China, 1971-2009 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The aim of the study was to establish the contemporary epidemiological characteristics of Japanese encephalitis (JE) in Guizhou Province.</p><p><b>METHODS</b>A retrospective study of National Notifiable Disease Reporting System (NNDRS) data from 1971 through 2009, was conducted to ascertain the geographical, seasonal, and age distributions of JE incidence in Guizhou Province, China.</p><p><b>RESULTS</b>A total of 68 425 JE cases were reported in Guizhou from 1971-2009. The JE cases occurred sporadically in all 9 prefectures of Guizhou, mostly among residents of rural areas. Seasonal distribution of JE remained consistent over the period from 1971-2009 with the main transmission season starting from June to September and peaking in August. JE occurred mainly in children under the age of 15 years with peak incidence in the 0-6-year age group. Pearson's correlation analysis showed that JE vaccine distribution had a negative correlation with JE incidence rates during 1971-2009 (coefficient of correlation=-0.475, P<0.01).</p><p><b>CONCLUSION</b>Over the period of 1971-2009, the JE incidence rate had declined dramatically in terms of geographical and age distributions due to JE vaccination to children at risk.</p>

Surveillance and research on acute meningitis, encephalitis syndrome in Guangxi, China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To estimate disease burden and epidemiological characteristics of acute meningitis/encephalitis, and provide the basis for the disease control strategy development.</p><p><b>METHODS</b>A syndrome surveillance system was established in Guigang city with a population of 5 020 000. For the suspected cases, serum and CSF were collected, and bacterial culture, latex agglutination test, real-time PCR and ELISA tests were carried out. All involved cases were identified to 6 categories according to WHO case definition.</p><p><b>RESULTS</b>1424 suspected cases were evaluated in a surveillance of 30 months, yielding the incidence, mortality and mortality of 11.35/100 000 (1424/12 546 500 person years), 0.43/100 000 (54/12 546 500 person years), 3.79% (54/1424) respectively. A total of 103 and 51 cases were confirmed for JE, bacterial meningitis, with a incidence of 0.82/100 000 (103/12 546 500 person years), 0.41/100 000 (51/12 546 500 person years). 96.10% (99/103) of JE cases and 37.30% (19/51) bacterial meningitis cases occurred in < 10 years old children and < 5 years old children. A clinical misdiagnosis rate of 19.42% (20/103) and 15.69% (8/51) were observed for JE and bacterial meningitis.</p><p><b>CONCLUSION</b>Acute encephalitis, meningitis syndrome can cause a higher burden of disease, of which the main components of viral encephalitis. Most of syndrome is occurred in summer and autumn, mainly reported in children of younger than 10 years old. A quite misdiagnosis would be made among meningitis and encephalitis syndrome cases.</p>

On-site assessment on the definition and classification of suspected cases in the manual of WHO Japanese Encephalitis Surveillance Standards / 中华流行病学杂志

Objective To assess the new edition of WHO Japanese Encephalitis (JE) Surveillance Standards (WHO Standards) based on syndrome surveillance data and to provide field evidence regarding the standards. Methods Based on syndrome surveillance data, acute encephalitis syndrome (AES) case was categorized, according to the WHO Standards. A cohort study was applied to estimate the AES definition set in the Standard and relative risk was computed to estimate the existence and intensity of statistical correlation between AES and JE cases. Percentage of attributable risk was counted to describe the coverage of AES for JE cases in the studied population. Sensitivity,specificity, Youden index and positive predictive value of AES components were calculated for the purpose of identifying the clinical values under the screening program. Results 1424 suspected cases were evaluated in the surveillance program and 1396 cases with ELISA result, of which 109 positive cases were detected. According to the "standardized" classification, a total of 706 cases in line with AES case deftuition, were categorized into 83 cases of JE, 425 cases of AES unknown and 198 cases of AES other agent. In the cohort study,a relative risk of 4.62 (95% CI:2.80-7.63 ) and the percentage of attributable risk as 78.35% (95% CI: 64.25% -86.89% ) were observed. Conclusion The AES definition for JE was significantly effecting on the screening programs and a strong correlation strength was observed in the study. AES syndrome could cover most of the JE cases. "Convulsions",with appreciative screening value, was recommended to be involved into the new version of the WHO Standards.

Analysis on data from the clinical acute viral encephalitis surveillance system in three prefectures in shaanxi during 2005-2006 / 中华流行病学杂志

Objective To describe the epidemiologieal features of viral encephalitis and burden of Japanese encephalitis (JE),and to identify potential strategies for effective JE control measures,using data from the Viral Encephalitis Surveillance Program (VESP) launched in Ankang,Baoji,and Weinan prefectures,Shaanxi province.Methods Data was gathered from sentinel hospitals reporting system on all the viral encephalitis (VE) eases identified between June 2005 and May 2007.County Center for Disease Control and Prevention (CDC) investigated the cases,drawing blood and cerebrospinal fluid (CSF) samples from the hospitals,and testing IgM antibody against JE using ELISA.We used Epi Data and Excel for data entry and analysis.Results A total of 1097 VEs were reported and 1053 (96.0%) had blood or CSF samples collected and tested for IgM antibody against JE.Three hundred and eleven cases (29.5%) showed JE antibody positive (JE confirmed case).Among the JE confirmed cases,numbers of those under 15 year of age accounted for 33.7%,43.9%and 88.3%in Baoji,Weinan and Ankang prefectures respectively.The rest were mainly children aged 5-14 years old (53.3%).Toddlers,farmers and children accounted for 85.2%in JE confirmed cases.About half of other VE cases (51.0%) were students of all age.Data an investigation on 398 reported VE cases at discharge,showed that 67.1%of JE confirmed cases recovered while 83.7%of the other VE cases fully recovered.The case fatality rates were 9.2%for JE confirmed cases and 3.1%for other VE cases.578 cases were followed up at 90-days after discharge,69.6%of JE confirmed cases and 90.2%of other VE cases recovered,with case fatality rates were 13.6%and 3.6%for JE confirmed cases and for other VE cases,respectively.The sequelae rates were 10.0%for JE confirmed cases and 4.5%for other VE cases.Conclusion The peak of the VE season was the sameas that of JE.There were 45.6%of reported JE cases with negative JE IgM,suggesting that it is necessary to carry out laboratory testing for clinical diagnosis cases.The fact that high risk population was different at prefectures levels suggested that more attention be paid in JE control and prevention.

Molecular typing of Neisseria meningitidis serogroup C strains with pulsed field gel electrophoresis in China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the characteristics of epidemiology and molecular typing on Neisseria meningitidis serogroup C strains associated with outbreaks of Anhui province and sporadic cases in China, using pulsed field gel electrophoresis (PFGE).</p><p><b>METHODS</b>212 Neisseria meningitidis serogroup C strains were isolated from invasive meningococcal cases, close contacts and healthy carriers, including 48 strains from Anhui province with 38 strains associated with serogroup C outbreaks. PFGE were performed by genomic DNA digestion with Nhe I restriction enzyme. The results of PFGE were analyzed by BioNumerics software (Version 4.0, Applied Maths BVBA, Belgium).</p><p><b>RESULTS</b>A total number of 212 Neisseria meningitidis serogroup C isolates were typed by 43 patterns, named AH1 to AH43. In China, AH1 pattern was the major PFGE pattern with 69.3% (n = 147) of all strains, distributed in 11 provinces. Three types of PFGE patterns (AH1 to AH3) were found in 48 strains from Anhui province, in which, 93.8% (n = 45) belonged to AH1. 97.4% (n = 37) of 38 strains associated with serogroup C outbreaks in Anhui province showed AH1 pattern. A total of 53 serogroup C strains were isolated from invasive meningococcal cases with 67.9% (36/53) of AH pattern. 71.9% (87/121) of serogroup C strains isolated from contacts of invasive meningococcal cases was AH1 pattern and 63.2% (24/38) of the strains from healthy carriers showed AH1 pattern.</p><p><b>CONCLUSION</b>By PFGE typing and analysis, AH1 pattern of Neisseria meningitidis serogroup C strains was proved to be the main clone which causing the outbreaks in Anhui province and might be responsible for the sporadic serogroup C meningococcal disease epidemics else where in the country.</p>