Progress in research of influenza vaccination in pregnant women / 中华流行病学杂志

Influenza is an acute respiratory infectious disease caused by influenza virus. Pregnancy is associated with physiologic and immunological changes that may increase the risk for influenza virus infection and influenza-related complications. Influenza vaccination is the most effective way to prevent influenza virus infection. WHO and many countries have classified pregnant women as a priority population for influenza vaccination, however, there are still many challenges for promoting influenza vaccination in pregnant women in China, influenza vaccination coverage in pregnant women remains low and some influenza vaccine package inserts list pregnancy as an absolute contraindication. In this paper, we summarize the research progress in the effects of influenza infection and influenza vaccination during pregnancy both at home and abroad, then discuss the strategies to promote influenza vaccination in pregnancy for the purpose of providing reference for the related research and policy development in China.

Molecular epidemiological characteristics of Streptococcus pyogenes strains involved in an outbreak of scarlet fever in China, 2011 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011.</p><p><b>METHODS</b>Seventy-four Streptococcal pyogenes involved in an outbreak of scarlet fever were isolated from pediatric patients in the areas with high incidence in China from May to August of 2011. Emm genotyping, pulsed-field gel electrophoresis (PFGE), superantigen (SAg) genes and antimicrobial susceptibility profiling were analyzed for these isolates.</p><p><b>RESULTS</b>A total of 4 different emm types were identified. Emm12 was the most prevalent type which contained four predominating PFGE patterns corresponding to four different virulence and superantigen profiles. Emm12 (79.7%) and emm1 (14.9%) accounted for approximately 94% of all the isolates. The speA gene was all negative in emm12 isolates and positive in emm1 isolates. All strains were resistant to erythromycin, and 89.4% of them were resistant to erythromycin, tracycline, and clindamycin simultaneously.</p><p><b>CONCLUSION</b>Several highly diversified clones with a high macrolide resistance rate comprise a predominant proportion of circulating strains, though no new emm type was found in this outbreak. The data provide a baseline for further surveillance of scarlet fever, which may contribute to the explanation of the outbreak and development of a GAS vaccine in China.</p>

Epidemiological characteristics on the clustering nature of pandemic (H1N1) 2009 in China / 中华流行病学杂志

Objective To study the epidemiological characteristics on the clustering nature of pandemic (H1N1) 2009 in China.Methods Time and place distribution of pandemic (H1N1) 2009on the nature of clustering through data from Public Health Emergency Management Information System were described.Results As of August 10,2010,2773 pandemic (H1N1) 2009 clusters,a total of 77363 cases (including 20 deaths) were reported in the mainland of China.The most reported number of clusters was from schools and kindergartens with the total number of 2498 (accounted for 90.08％ of the total number).Middle schools appeared the have the most clusters (1223,accounting for 48.96％ ).The number of clusters reported in the southern provinces (cities) accounted for 77.03％ of the total,and was more than that in the northern provinces (cities).Two reported peaks in the southern provinces (cities) were in June and November,2009,respectively.There was only one reported peakin the northern provinces in September,2009.Conclusion Time and place distribution characteristics on the clusters of pandemic (H1N1) 2009 were similar to the seasonal influenza,but the beginning of winter peak was much earlier and intensity of reporting was much higher on the clusters of pandemic (H1N1 ) 2009 than that of seasonal influenza.

Study on the seasonal distribution of human rabies in different regions of China / 中华流行病学杂志

Objective Using simple quantitative methods to describe the seasonal distribution of rabies in different provinces of China and to analyze how it was influenced by geographical settings,to provide evidence for risk assessment and prediction of potential epidemics of rabies.Methods A total number of 17 800 clinical and laboratory confirmed rabies cases,reported by 29 provinces,from 2005 to 2011 and related data were collected from National Disease Reporting Information System.Data on related latitudes and longitudes of different provinces were obtained from the National Geographic Information Center.Excel 2003 was used to draw the national and provincial seasonal distribution curves while SPSS 18.0 was used to calculate parameters as P25,P50,P75,inter-quartile range Q and kurtosis so as analyze the linear correlation between P25,kurtosis and the latitude of different provinces respectively.Results The nation-wide incidence of rabies was low in February.The peaks fell in summer and autumn,especially in August.Seasonal distribution curves of P25,P50,P75,inter-quartile range (Q) and kurtosis were different among provinces.Compared to the low latitude areas,high latitude areas had higher P25,smaller Q and higher kurtosis.In 9 provinces where the annual reported number of cases more than 100,the related coefficients (r) between latitude and both P25,kurtosis were 0.9342 and 0.8528 respectively (P＜0.05).Conclusion There was a distinct seasonality of rabies occurrence in China which was correlated to the geographical settings which was more obvious in the higher latitude areas.

The current epidemic situation and surveillance regarding hemorrhagic fever with renal syndrome in China, 2010 / 中华流行病学杂志

Objective To analyze the surveillance data on hemorrhagic fever with renal syndrome (HFRS) including the epidemiological characteristics and trend of the disease,in 2010.Methods Descriptive methods were conducted to analyze the surveillance data in 2010 which were collected from the internet-based National Notifiable Disease Reporting System and 40 HFRS sentinels in China.Results There were 9526 cases of HFRS reported in 2010 in the country with an annual morbidity of 0.71/105,which was higher than that reported in 2009.And the case fatality rate in 2010 was 1.24％.During the year 2010,most cases were reported in spring and autumn-winter season,with November as the peak month.The proportion of cases reported in autumn-winter season was higher than that in spring.The number of cases reported in males was higher than that in females among all the age groups,and similar pattern of mortality could be seen in most of the age groups.The percentage of cases over 60 years old had increased in recent years.Farmers were still under the highest risk.Density and the virus-carrying rate of animal hosts,as well as the infection rate were relatively stable and similar to the previous findings.As to the prevailing species,Apodemus agrarius and Rattus norvegicus were still the most common and leading animal hosts.However,the dominant species in sentinel of Yunnan were Rattus flavipectus and Eothenomys miletus respectively,and a new hantavirus called LUXV was found,namely Eothenomys miletus.Conclusion HFRS cases were widely distributed in most provinces of China,but cases mainly focus on certain areas and present the nature of aggregation.The risk of outbreak could not be ruled out for variety of factors.Population characteristics and seasonal fluctuation had been changing.

A survey of urolithiasis in young children fed infant formula contaminated with melamine in two townships of Gansu, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To determine the prevalence of urolithiasis in young children fed infant formula (IF) contaminated with melamine, and the association between IF consumption and urolithiasis.</p><p><b>DESIGN</b>A total of 2 733 children < or = 3 years of age on September 1, 2008 in two townships of Gansu Province, China were studied. Cases of urolithiasis were diagnosed by ultrasonography. Milk product consumption was determined by their caregivers. Remaining IF samples were tested for melamine and cyanuric acid.</p><p><b>RESULTS</b>Of 2 733 eligible children in the two townships, 2 186 (80%) were enrolled in our study. Overall, 16.6% (362) of 2 186 children had urolithiasis. The prevalence was 24.6% in children exclusively fed Sanlu brand IF, 9.7% in those fed other IF, and 8.5% in those fed exclusively on other milk products. For children exclusively breast-fed, no urolithiasis was found (P < 0.05). The prevalence of urolithiasis was 11.4% in children fed 400 g of Sanlu IF, rising to 37.5% in children fed over 25 600 g. Of 48 Sanlu IF samples, 91.7% contained melamine (median = 1 800 ppm; range = 45-4 700) and 66.7% contained cyanuric acid (median = 1.2 ppm; range = 0.4-6.3). Melamine was also detected in 22.2% of 36 other brand IF (median = 27.5 ppm, range = 4-50).</p><p><b>CONCLUSIONS</b>Urolithiasis was associated with melamine-contaminated IF. Although one product caused most morbidity, other milk products may have also contributed to the outbreak.</p>

Application of Bayesian spatio-temporal modeling in describing the brucellosis infections / 中华流行病学杂志

Based on the number of brucellosis cases reported from the national infectious diseases reporting system in Inner Mongolia from 2000 to 2007, a model was developed. Theories of spatial statistics were used, together with knowledge on infectious disease epidemiology and the frame of Bayesian statistics, before the Bayesian spatio-temporal models were respectively set. The effects of space, time, space-time and the relative covariates were also considered. These models were applied to analyze the brucellosis distribution and time trend in Inner Mongolia during 2000-2007. The results of Bayesian spatio-temporal models was expressed by mapping of the disease and compared to the conventional statistical methods. Results showed that the Bayesian models, under consideration of space-time effect and the relative covariates (deviance information criterion, DIC=2388.000) ,seemed to be the best way to serve the purpose. The county-level spatial correlation of brucellosis epidemics was positive and quite strong in Inner Mongolia. However, the spatial correlation varied with time and the coefficients ranged from 0.968 to 0.973, having a weakening trend during 2000-2007. Types of region and number of stock (cattle and sheep) might be related to the brucellosis epidemics, and the effect on the number of cattle and sheep changed by year. Compared to conventional statistical methods, Bayesian spatio-temporal modeling could precisely estimate the incidence relative risk and was an important tool to analyze the epidemic distribution patterns of infectious diseases and to estimate the incidence relative risk.

Using exploratory spatial data analysis(ESDA)on the regional distribution of human brucellosis in six provinces of north China: 2004-2007 / 中华流行病学杂志

Based on data related to human brucellosis which was collected from the national notifiable infectious disease reporting system in the 6 provinces(Inner Mongolia,Shanxi,Heilongjiang,Shaanxi,Jilin and Liaoning)of north China from 2004 to 2007,at the county scale.Data would include age and gender standardized mortality ratios(SMRs)while ESDA was including histograms,box plots and box maps,global and local Moran' s I statistics,etc.The global Moran' s I values from 2004 to 2007 were 0.2581,0.4574,0.4457,0.4841,respectively and all with statistically significant differences.Most of local Moran' s I values were significant positive statistically.High-high counties were mainly in the northeast,most of which were pastoral areas,but the farming-pastoral areas and agricultural areas/town had an increasing trend over time.Low-low counties were mainly in the western and southern areas and most of which were agricultural areas/towns.Low-high counties appeared to be rare,mainly around the counties with high incidence,mainly belonged to agricultural areas/towns.The incidence rates of brucellosis in the six provinces of north China had a trend of increase from 2004 to 2007,namely spreading from east to west,from south to north,and from pastoral areas to farming-pastoral areas and agricultural areas/towns.ESDA could be used to develop effective measures for prevention and control of brucellosis.

Application of Google Earth in the three dimensional visualization(TDV)of the warnings signaled by early warning system of infectious disease / 中华流行病学杂志

The purpose of this article was to investigate the application of Google Earth (GE)in the Three Dimensional Visualization(TDV)of the warnings signaled by early warning system of infectious disease.As an example.the prospective space-time scan statistics was used by mimicking daily prospective analyses of bacillary dysentery data from Shanghai municipality,Zhejiang province and Jiangsu province in 2005.Then one of the warnings was picked to illustrate the visualization of GE.GE could vividly display the results in three dimensions containing the complex information including date,areas,observed numbers,expected numbers ere.GE seemed a useful tool for infectious disease surveillance and had potential important values in reflecting the emergency response situation.The development of integrated system which consisted of GE,the infectious disease reporting system and cluster detection methods need to be emphasized for further research.

The feasibility of outpatient data used for respiratory syndromic surveillance in general hospital / 中华流行病学杂志

Objective To find out the data sources of respiratory syndromes and their components from the outpatients of general hospitals and to describe the time distribution and mutual relations of different respiratory syndromes. Feasibility of respiratory syndromes used for early warning surveillance on respiratory infectious disease was also under research. Methods Retrospective investigation on Hospital Information System (HIS) was implemented in a general hospital in Guangzhou, 2005, and data of outpatients was collected and classified into different syndromes. The respiratory syndromes with its time distribution similar to influenza like illness (ILI),were selected, and cross-correlation analyses were conducted to inveshgate the feasibility of respiratory syndromes for early warning surveillance on respiratory infection diseases (influenza as an example). Results Primary sub-classification of respiratory syndromes in outpatient department would include upper respiratory infection(URI)(51.20%), trachitis/bronchitis (18.80%), asthma ( 17.52% ), etc. Pulmonary infection accounted for only 2.26%. Time distributions of URI, trachitis/bronchitis, pulmonary infection, cough and asthma in outpatient department, X-ray tests and pneumonia/acute respiratory distress syndromes (ARDSs) in outpatient X-ray room were similar, with two peaks observed. Cross-correlation functions were calculated with the data sets of 1st-28th week.The most significant correlation was detected between the time series of outpatient pulmonary infections and ILIs moved 4 weeks backward (r＝0.739, P＜0.01 ), and that was detected between URIs and ILIs moved 5 weeks backward (r=0.714, P＜0.01 ). Correlation between X-ray tests,pneumonia/ARDSs in outpatient X-ray room and ILIs was the strongest when ILIs time series moved 1 week backward (r=0.858, P＜0.001; r=0.821, P＜0.001 ). Conclusion Outpatient data from HIS system in general hospital could be applied to syndromic surveillance on respiratory diseases. For early warning epidemics or outbreaks of influenza or other respiratory infectious diseases, data of outpatient pulmonary infection appeared to be the most feasible for its specificity and timeliness, followed by URI and cough. X-ray tests and pneumonia/ARDSs in outpatient X-ray findings were important supplementary to verify the respiratory disease epidemics or outbreaks for its good specificity, but with no advantage for early warning.

Self-management behaviors among children after exposure to rabies in two severe rabies epidemic areas of China / 中华流行病学杂志

Objective To understand the situation of rabies exposure and self-management behaviors among primary school students from rabies epidemic areas in China. Methods This population-based investigation was conducted in Guizhou and Guangdong provinces which had been severe epidemic areas of rabies in China from January 2007 to May 2008. Primary schools from two prefectural, two county, four township and four village levels were selected in the 2 provinces.Students were sampled from each grade of the 12 schools to collect information on post-exposure prophylaxis. Results In the 2408 primary school students interviewed, 290 person/times exposure were found from 2007 to 2008. The self wound-treatment rates was 47.93%, with 16.55% of themwent to the clinic for care-seeking initiatively and 63.79% informed their parents or teachers. However 23.10% of the students did nothing after exposure. Students in Guangdong province had lower exposure rate and higher rate of good management behaviors than in Guizhou. No significant statistical difference was found between the self-management behaviors among male and female students or among different levels of primary schools. The proportion of disinfection on wounds with alcohol and seeking medical treatment in rabies clinic initiatively were both low in all grades of the students but the proportion of telling their parents or teachers about the exposure among children was high in all grades of students. Conclusion Some students after rabies exposure did not have any disposal in Guangdong and Guizhou provinces. Related education should be strengthened.

A study regarding the applicability of WSARE algorithms in the early warning system of infectious disease outbreaks / 中华流行病学杂志

To investigate the application of WSARE (What' s Strange About Recent Events) algorithm in early warning on outbreaks of infectious diseases and to explore the multidimensional statistical methods for the detection of infectious diseases outbreak. Using WSARE algorithms based on historical data and Bayesian Network as baseline respectively, to analyze data on measles by mimicking the real-time monitoring and early warning system in Bao'an district,Shenzhen city, in 2007. WSARE algorithms were considered to be effective and timely in detecting the abnormally increase of measles among special population. WSARE algorithm could timely detect the abnormal increase of diseases among special local populations, thus having important value in the application of early warning system during the outbreak of infectious diseases.

Study on the timeliness of detection and reporting on public health emergency events in China / 中华流行病学杂志

Objective To analyze the timeliness of detection and reporting on public health emergency events, and to explore the effective strategies for improving the relative capacity on those issues. Methods We conducted a retrospective survey on 3275 emergency events reported through Public Health Emergency Events Surveillance System from 2005 to the first half of 2006. Developed by county Centers for Disease Control and Prevention, a uniformed self-administrated questionnaire was used to collect data, which would include information on the detection, reporting of the events. Results For communicable diseases events, the median of time interval between the occurrence of first case and the detection of event was 6 days (P25=2, P75=13). For food poisoning events and clusters of disease with unknown origin,the medians were 3 hours (P25=1, P75=16) and 1 days (P25=0,P75=5). 71.54% of the events were reported by the discoverers within 2 hours after the detection. Conclusion In general, the ranges of time intervals between the occurrence, detection or reporting of the events were different, according to the categories of events. The timeliness of detection and reporting of events could have been improved dramatically if the definition of events, according to their characteristics, had been more reasonable and accessible, as well as the improvement of training program for healthcare staff and teachers.

Study on the occupational distribution of discoverers and reporters of public health emergency events reported through Internet-based surveillance system / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the occupational distribution of staff who worked on detection and reporting on public health emergency events, and to explore the effective strategies for identification and reporting on emergency events.</p><p><b>METHODS</b>We conducted a retrospective survey on 3275 emergent events reported through Public Health Emergency Events Surveillance System from 2005 to the first half of 2006. Data were collected by uniform self-administrated questionnaires by county Centers for Disease Control and Prevention, including information on events detection and reporting, etc.</p><p><b>RESULTS</b>Among event discoverers, 56.40% (1847/3275) were healthcare staff, 20.58% (674/3275) were teachers, and 15.15% (496/3275) were staff from the disease control systems. Among those event reporters, 56.82% (1861/3275) were healthcare staff, 21.77% (713/3275) from disease control system and 10.75% (352/ 3275) were teachers.</p><p><b>CONCLUSION</b>Healthcare staff and teachers played the most important role in detection and reporting on events. It would be favorable to improve the ability of events detection and reporting if we could enhance the training program to the relative staff in medical facilities and school settings especially at the grass root level.</p>

The application of the prospective space-time statistic in early warning of infectious disease / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the application of prospective space-time scan statistic in the early stage of detecting infectious disease outbreaks.</p><p><b>METHODS</b>The prospective space-time scan statistic was tested by mimicking daily prospective analyses of bacillary dysentery data of Chengdu city in 2005 (3212 cases in 102 towns and villages). And the results were compared with that of purely temporal scan statistic.</p><p><b>RESULTS</b>The prospective space-time scan statistic could give specific messages both in spatial and temporal. The results of June indicated that the prospective space-time scan statistic could timely detect the outbreaks that started from the local site, and the early warning message was powerful (P = 0.007). When the merely temporal scan statistic for detecting the outbreak was sent two days later, and the signal was less powerful (P = 0.039).</p><p><b>CONCLUSION</b>The prospective space-time scan statistic could make full use of the spatial and temporal information in infectious disease data and could timely and effectively detect the outbreaks that start from the local sites. The prospective space-time scan statistic could be an important tool for local and national CDC to set up early detection surveillance systems.</p>

Study on the application of Rogerson Spatial Pattern Surveillance Method in real-time surveillance for infectious diseases / 中华流行病学杂志

Application of Rogerson Spatial Pattern Surveillance Method was discussed in real-time surveillance and early monitoring for infectious diseases. Theory of Rogerson Spatial Pattern Surveillance Method was introduced in detail. Data from the program on 'Monitoring epidemic cerebrospinal meningitis with Rogerson Spatial Pattern Surveillance Method' by the Chinese Center for Disease Control and Prevention provided evidence as how to choose crucial parameters such as K, H, n0 and tau, how to simulate surveillance process and how to interpret results. Rogerson Spatial Pattern Surveillance Method seemed to be able to continuously monitor the changes of infectious diseases. New cases could be added to this model at any moment and this model could provide early warning information in time when the excess of cases occurred. Simultaneously it could provide the time and site of the extra cases. Rogerson Spatial Pattern Surveillance Method could implement dynamic and real-time surveillance for infectious diseases. Simultaneously it could avoid the problem of multiple tests that causing large type I error. It greatly helped in providing reliable information for controlling infectious diseases in early epidemic period. Hence,it had important value of application in early warning on infectious diseases.

Study on the application of Knox method to temporal-spatial cluster for infectious diseases / 中华流行病学杂志

<p><b>OBJECTIVE</b>Application of Knox method was discussed in exploring temporal-spatial cluster for infectious diseases.</p><p><b>METHODS</b>The theory of Knox method was introduced in detail. As an example, the temporal-spatial cluster of epidemic cerebrospinal meningitis cases from April to May in 2005 was explored in Beijing and the statistical process of Knox method was clearly demonstrated with related results well interpreted.</p><p><b>RESULTS</b>Only when time and distance threshold values were set as 13 days and 29.67 km, potential temporal-spatial cluster could be detected in epidemic cerebrospinal meningitis cases.</p><p><b>CONCLUSION</b>According to the characteristics of the epidemics, under Knox method, if appropriate threshold values of time and distance were chosen, information on temporal-spatial cluster of infectious diseases could be obtained. According to the records of different time and distance threshold values, the nature of an infectious disease might be explored. Thus Knox method could help us to strengthen the early warning system on infectious disease control strategy.</p>

Feasibility study of enforcing immunization certificate check before primary school or kindergarten enrollment in Guizhou Province, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the feasibility of enforcing immunization certificate check before children enroll in primary schools or kindergartens in Guizhou Province.</p><p><b>METHODS</b>Quantitative and qualitative studies were conducted. The multi-stage and cluster sampling approach was adopted for the quantitative part of the study. A questionnaire was designed and 996 children and their keepers were interviewed. Principals, doctors or teachers of the primary schools, directors and child care nurses of kindergarten, and staff of immunization agencies were invited to take part in 12 focus group discussions; meanwhile, face-to-face individual in-depth interviews with 16 officials of the Health, Education and Governmental Departments at various levels were conducted.</p><p><b>RESULTS</b>The total number of subjects was 996. 16.7% of the children in the study completed all the procedures of the National Immunization Programme. 34.3% of them had immunization certificates while the remainder 44.7% registered in immunization agencies. Factors, including the migrant children, doubt about vaccine efficiency, mother's occupation and educational background, knowledge of the National Immunization Programme on targeted vaccines, played an important role in obtaining or not immunization certificates. 95% of the keepers interviewed thought the immunization certificates were useful; 94.8% of them considered the check was critical while only 3.6% of them thought it unnecessary. The first reason from those who found it unnecessary was that they feared that repeated immunization might affect their children's health. The second reason was the cost of immunization, which some of them could not afford to pay. However, the Health Department expressed a favorable attitude to the checking scheme. Though the Education Department agreed that the scheme was essential, they worried that it would affect the enrollment rate.</p><p><b>CONCLUSION</b>In spite of the difficulty in administering immunization certificate check, the effort would be rewarding for raising the immunization coverage rate among the children in Guizhou Province.</p>

The survey of 21 cases of human rabies in Anlong county in Guizhou province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze 21 cases of rabies from February 8 to May 1 in 2004 in Anlong county in Guizhou province, and to explore the possible factors causing the epidemics.</p><p><b>METHODS</b>21 cases of rabies were investigated. The canine brains were collected, and indirect immunofluorescence assay was used to detect rabies virus antigen in the brains.</p><p><b>RESULTS</b>From February 8 to May 1st in this year, 21 cases of rabies were reported, with 5.12/100,000 of the prevalence rate. Dogs accounted for 20 cases, and cat for one case. Median incubation period was 36.52 days, but less than 15 days in 6 cases. Among 21 cases, 17 cases were not correctly treated, and 9 cases received vaccine, with 3 cases vaccinated in time. No cases received passive immunization of antirabies serum or human antirabies immune globulin. A total of 73 dogs' brains were examined for rabies viral antigen by IFA, and 9 (12.33%) were positive.</p><p><b>CONCLUSION</b>The increasing number of dog, high rate of virus carrier in dogs, incorrect treatment of the wound, and as well as low inoculating rate of rabies vaccine might be responsible for the outbreak of rabies in Anlong county.</p>