Epidemiological and etiological characteristics of diarrheal disease among children under 5 years of age in Guangdong province, in 2012 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the epidemiological and etiological characteristics of diarrheal disease among children under 5 years of age in Guangdong province, in 2012.</p><p><b>METHODS</b>64 hospitals in 21 cities were chosen as the diarrheal syndromic surveillance sites, of which 14 hospitals were selected to carry out etiological surveillance among children under 5 years of age, including isolation and culture of both Vibrio cholera and Shigella as well as nucleic acid detection of rotavirus and norovirus by PCR. Descriptive method was used to analyze data from syndromic and etiological surveillance programs on diarrheal, from 1932 parents of the children.</p><p><b>RESULTS</b>In 2012, the outpatient attendance rate on diarrheal among children under 5 years was 0.8%. The proportion of diarrheal in children under 5-year-olds was 63.5%, among the total number of diarrheal outpatients at the outpatient clinics under surveillance program. The morbidity of infectious diarrhea was 1454.5/10 million in children under 5 years of age. A total number of 1932 specimens were collected from children under 5 years of age, in the outpatient department. Among these specimens,Vibrio cholera appeared all negative but one was Shigella positive and proved to be Sh. sonnei. The positive rates of rotavirus and norovirus were 14.1% (273/1932)and 16.9% (326/1932). Both rotavirus and norovirus were found in 24 specimens, with a positive rate as 1.2% . 112 specimens were successfully gene sequenced for rotavirus, of which 33.9% as G1[P8] genotype, 25.9% as G9[P8], 12.5% as G2[P4] and 9.8% as G3[P8] respectively. 90 specimens were successfully gene-sequenced for norovirus, of which 76.7% as G II.4 genotype. Genetic subtypes of G II. 4/2006b, accounted for 50.0% and could be detected around the year except for June and December. New G II. 4/Sydney Strain_2012 was first detected in August and became the predominant in December. In addition, 5 specimens belonged to G I genotype with other 16 subtypes of G II.</p><p><b>CONCLUSION</b>Results from our study proved that children under 5 years of age belonged to high-risk group for diarrheal disease in Guangdong province. Rotavirus and norovirus were both diverse in terms of genome.</p>

Current situation on the China infectious disease automated-alert and response system in Guangdong Province, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the current situation on China Infectious Disease Automated-alert and Response System (CIDARS) in Guangdong province, China.</p><p><b>METHODS</b>Early-warning signals and response time were analyzed by using three approaches of CIDARS. Positive rates of early-warning signals and error early-warning rates prior and after the adjustment,were compared.</p><p><b>RESULTS</b>Totally, 114 585 early-warning signals appeared, with an average response time of 1.35 hours from April 21, 2008 to December 31, 2012. There were 12,394 early-warning signals in terms of fixed threshold method with a positive rate of 7.96%. 85 727 early-warning signals appeared under the mobile percentile method with a positive rate of 0.85%. There were 16,464 early-warning signals by using accumulation and control chart methods,with a positive rate of 1.82%. Results showed there was a positive correlation between the number of reported cases and the number of early-warning signals (r = 0.924, P < 0.01). The overall positive rate in Guangdong province increased from 1.48% to 2.14%, after the adjustment done by the Chinese Center for Disease Control and Prevention in 2010. The error early-warning rates regarding eight infectious diseases including hepatitis A, bacillary or amebic dysentery, both typhoid and paratyphoid fevers had reduced.</p><p><b>CONCLUSION</b>The early-warning signal response appeared timely in CIDARS with good operation. However, despite the improvement on the efficacy of CIDARS, some functions and parameters of the systems still need to be adjusted.</p>

Survey on the recessive infection of pathogen to hand-foot-mouth disease among healthy adults and children in Guangdong province / 中华流行病学杂志

Objective To understand the pathogen-carrying status of hand-foot-mouth disease (HFMD) among healthy people in Guangdong province.Methods Stool specimens were collected randomly on 7 age groups from 7 cities in Guangdong province.Real-time RT-PCR was used to detect enterovirus (EV),enterovirus 71 (EV71) and coxsackie virus A16 (CA16).Results Altogether,1285 stool specimens were collected.The positive rates of EV71,CA16 and other enterovirus were 0.39％ (5/1285),0.23％ (3/1285) and 7.00％ (90/1285),respectively.The highest EV71 positive rate (1.79％) was among the 4-6-year-old group,followed by the age group 0-3 with positive rate as 0.67％.EV71 was not found among the rest age groups.The highest CA16 positive rate (1.35％) was among the 4-6 year-olds group,but the CA16 was not found among the rest age groups.EV71 was only found among native population,with the positive-rate as 0.47％.CA16-positive rate was 0.19％ among the native population and 0.85％ among floating population,with no significant difference found (P＞0.05).The EV71 positive rate was 0.36％ among rural residents and 0.54％ among urban residents,but with no significant difference (P＞0.05).All CA16 was found among the urban residents.Conclusion Recessive infection of EV71 and CA16 were only found among 0-6 year-old group but not found among other groups,which suggested that the approaches on prevention and control should be targeted to all children especially on pre-school children.

Sero-epidemiological survey on general community population to understand the infection status after the first wave of pandemic 2009 H1N1 influenza in Guangdong province / 中华流行病学杂志

Objective To understand the infection status of pandemic 2009 H1N1 influenza after the first epidemic wave and to estimate the infected population. Methods Multi-stage stratified random sampling was introduced with 4500 subjects chosen in Guangdong province. 1500 people were selected from 5 districts (3 streets were selected in every district) in Guangzhou city which was representing the large cities. 1500 people were respectively selected from medium-sized city and rural areas, including 20 cities (1 county or district was selected in every city, at least 1 street or town was selected in every county or district respectively and then 1-2 residential area or county was selected in every street or township, respectively). Every sample was selected in accordance with the principle of random sampling, excluding those who had injected with novel H1N1 vaccine. We used hemagglutination inhibition test to understand the serum antibody level of novel H1N1, with title of 1∶40 as positive. Results A number of 4319 specimens, distributed in 21 cities, 25 counties, 85 streets or townships, 144 residential areas, were tested, with an overall positive rate as 22.82% (985/4319). The positive rate of those who had no symptoms of cold since June was 23.47% (471/2007).The positive rate of those who had fever, cough or sore throat was 26.25% (714/2720). The positive rate of those who had influenza-like illness (ILI) was 29.69% (337/1135 ). Conclusion The infection rate in the first epidemic wave of the novel influenza A (H1N1) pandemic in Guangdong province was 22.82%(985/4317). Based on the number of residonts in Guangdong province, the number of natural was estimated to have reached 21.78 million.

Effectiveness of personal protective measures in prevention of nosocomial transmission of severe acute respiratory syndrome / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of personal protective measures of health care workers (HCWs) against severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>A case-control study from ten hospitals in Guangdong, with 180 non-infected and 77 infected staff members that accessed the isolation unit every day, and participated in direct first aid for severe SARS patients. All participants were surveyed about how they were using personal protective equipment (PPE), protective drugs and hygiene habits when caring for patients with SARS. Statistical analysis was done with either chi(2) or Fisher's exact test for univariate analysis, whereas we used forward stepwise selection (Waldesian) for logistic regression.</p><p><b>RESULTS</b>Univariate analysis showed that mask, gown, gloves, goggles, footwear, "hand-washing and disinfecting", gargle, "membrane protection", "taking shower and changing clothing after work", "avoid from eating and drinking in ward", oseltamivir phospha tall had protective effects (P < 0.05), but stepwise logistic regression showed significant differences for mask (OR = 0.78, 95% CI: 0.60 - 0.99), goggles (OR = 0.20, 95% CI: 0.10 - 0.41) and footwear (OR = 0.58, 95% CI: 0.39 - 0.86). Analysis for linear trend in proportions showed that dose response relationship existed in mask, gown, gloves, goggles, footwear, gargle, "membrane protection" and "taking shower and changing dree after work" (P < 0.01). The attack rate of HCWs who were rescuing severe SARS patients without any PPE was 61.5% (16/26). It seemed that the more the protective measures were used, the higher the protective effect was (P < 0.001), and could reach 100% if mask, gown, gloves, goggles, footwear, "hand-washing and disinfecting" were all used at the same time.</p><p><b>CONCLUSIONS</b>Nosocomial infection of SARS can be prevented effectively by precautions against droplets and personal contact. HCWs must take strict protection according to the guidance of WHO or Chinese MOH and pay attention to personal hygiene.</p>

An investigation on nosocomial infection with severe acute respiratory syndrome in health-care workers at 13 key hospitals in Guangdong Province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analysis the risk factors influencing nosocomial infection of severe acute respiratory syndrome (SARS) in health-care workers and to evaluate effectiveness of its control and preventive measures in 13 key hospitals caring for SARS patients.</p><p><b>METHODS</b>Number of SARS patients, clinical conditions of them, its attack rate in health-care workers, and characteristics of hospitals, including their environment, isolating measures, etc. were investigated at the 13 hospital in Guangzhou to analyze the risk factors influencing nosocomial infection of SARS and its attack rates in health-care workers before and after implementation of preventive measures and to evaluate their effectiveness.</p><p><b>RESULTS</b>Totally, 841 patients with SARS were treated at the 13 hospitals in Guangzhou and 285 health-care workers caring for them infected nosocomially. Attack rate in health-care workers was higher at general hospitals, hospital accepting more cases in critical conditions and hospitals with poor precautious measures, and lower in hospitals with isolated wards or areas, or department of infection, specially caring for SARS patients, and those with effective intervention measures to prevent secondary infection.</p><p><b>CONCLUSION</b>Nosocomial infection of SARS in health-care workers was affected by clinical condition of SARS patients, characteristics and environment of hospitals and their personal protective measures adopted.</p>

Severe acute respiratory syndrome in Guangdong Province of China: epidemiology and control measures / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore epidemiological features and risk factors of severe acute respiratory syndrome (SARS) in Guangdong Province of China, so as to work out effective strategies for its better control.</p><p><b>METHODS</b>A total of 1 511 clinically confirmed SARS cases in Guangdong Province of China from November 16, 2002 to Jun 15, 2003 were retrospectively analyzed.</p><p><b>RESULTS</b>The first SARS case was identified in Foshan municipality on November 16, 2002, followed by 1 511 clinically confirmed cases (including 58 deaths) up to May 15, 2003. Of all cases, health care workers and community family cluster cases accounted for 19.38% and 12.04%. 65.86% SARS patients aged 20 - 49 years, and increased incidence was positively related to their ages. 95.97% cases lived in the following five cities around Pearl Delta Area: Foshan, Guangzhou, Shenzhen, Zhongshan, and Jiangmen. Eleven early reported cases in the communities took animal-related positions. Face-to-face contacts with infected droplets were the main transmission route. An epidemic peak occurred during January 28 to February 26, and those cases accounted for 50.69% of total. Incidence, mortality, and case fatality of SARS were 1.77/100,000, 0.07/100,000, and 3.84% respectively. The mean incubation period was 4.5 days.</p><p><b>CONCLUSION</b>The most effective way to control SARS is to break the chain of transmission from infected to healthy persons-early identification, prompt and effective isolation, and vigorous close contact tracing. Hospital infections among health care workers is critical. Several observations support the hypothesis of an animal origin for the disease.</p>

Epidemiological study on severe acute respiratory syndrome in Guangdong province / 中华流行病学杂志

<p><b>OBJECTIVES</b>To understand the epidemiological characteristics of severe acute respiratory syndrome (SARS) outbreaks in some areas of Guangdong province and to provide scientific basis for prevention and control measures against it.</p><p><b>METHODS</b>Standardized questionnaire was used on individual cases. Data on the epidemiological characteristics as time, place, persons and aggregation status of SARS cases, development of the epidemics, were analyzed with software EPI 6.0.</p><p><b>RESULTS</b>The incidence of SARS in Guangdong province was 1.72/100,000 with case fatality rate as 3.64%. Most cases of SARS occurred between the last ten days of January and the first ten days of February with the peak (61.88% of the patients) occurred in the first ten days of February. As to the distribution of place, Pearl river delta region-economically developed with great number of mobile population-was heavily affected areas (account for 96.66% of the total patients). The majority of patients were young adults and medical staff seemed to be the most affected subgroup (account for 24.9% of the patients in total). Family and hospital aggregation of patients comprised the another two important characteristics of SARS (account for 37.1% of the total patients).</p><p><b>CONCLUSION</b>Current knowledge on SARS suggested that it was an air-borne infectious disease with human beings served as the source of infection. The incubation period of the disease was from 1 to 12 days with a median of 4 days. Respiratory secretions and close contact contributed to person-to-person transmission. Most cases were distributed in Pearl river delta region, an area famous for its economic development and heavy flow of mobile population.</p>