Analysis on the characteristics of suspected vaccine-related deaths in Fujian Province, 2012-2017 / 中华预防医学杂志

Objective@#To analyze the characterisitics of the death cases suspected to be related to vaccination in Fujian Province from 2012 to 2017.@*Methods@#A total of 33 death cases information which was suspected to be related to the vaccinations from 2012 to 2017 were extracted from Chinese Adverse Events Following Immunization Information System (AEFI). The autopsy reports and the conclusions made by AEFI investigation diagnosis expert committee were collected at the same time. The inoculation data were obtained through the Fujian province Immunization Program Information System. The AEFI incidence, rare vaccine reaction incidences and mortality rates following immunization were figured out to analyze the characterisitics of the death cases associated with vaccination.@*Results@#The age of deuths cases was from 26 days to 52 months. Among 33 cases, 23 were males, and 8 were due to vaccine-related reaction, and the others were due to coincidental events. The number of rare vaccine reaction cases from 2012 to 2017 were 2,3,6,8,7 and 7, respectively. The highest AEFI incidence was measles and rubella combined attenuated live vaccine [38.88 (95%CI: 36.85-40.91)/100 000 dose], and the lowest was trivalent oral poliomyelitis attenuated live vaccine [2.01 (95%CI: 1.73-2.30)/100 000 dose]. The highest rare vaccine reaction incidence was measles and rubella combined attenuated live vaccine [15.04 (95%CI: 13.78-16.30)/100 000 dose], and the lowest was trivalent oral poliomyelitis attenuated live vaccine [0.38 (95%CI: 0.25-0.50)/100 000]. The highest mortality rate was inactivated poliomyelitis vaccine [0.26 (95%CI: 0.04-0.54)/100 000 doses], and the lowest mortality rate was measles, mumps and rubella combined attenuated live vaccine [0.01 (95%CI: 0.00-0.08)/100 000 doses]. The Spearman correlation analysis showed that there were correlations between AEFI incidence and rare vaccine reaction incidence (r=0.64, P=0.048), there were no correlations between AEFI incidence and mortality rate (r=-0.34, P=0.329), and there were no correlations between rare vaccine reaction incidence and mortality rate (r=-0.25, P=0.484).@*Conclusion@#Neither AEFI incidence nor rare vaccine reaction incidence was correlation with mortality rate. The main causes of death following vaccination were coincidental events.

A large scale cohort study on the immunization effect of hepatitis B vaccine in Fujian province / 中华流行病学杂志

Objective: To evaluate the effectiveness of hepatitis B vaccination in Fujian province. Methods: Based on the hepatitis B immunization strategy of China, a cohort study was designed, involving the population in Fujian province. The population under study was divided into natural exposure birth cohort before 1992 and the immunization birth cohort after 1992 (including voluntary vaccination cohort and standardized vaccination cohort). By cleaning the database of hepatitis B cases which directly reported through network and looked into the incidence and related death outcomes of acute hepatitis B from 2004 to 2017, the incidence levels of hepatitis B and immunization effects were analyzed and evaluated among different birth cohorts. Results: During the observation period, the overall prevalence of hepatitis B in Fujian province was 44.594 per 100 000, with mortality rate as 0.010 per 100 000. The incidence of natural exposure cohort of birth was 56.885 per 100 000. The incidence of voluntary vaccination cohort of birth was 14.502 per 100 000. Compared with the voluntary vaccination cohort, the risk of hepatitis B increased significantly in the natural exposed cohort (RR=3.923), and the difference was statistically significant (P=0.000 7), with attributable risk as 42.383 per 100 000. The attributable risk ratio was 74.507. The population attributable risk ratio was 70.967%. The population attributable risk was 35.448 per 100 000. The attributable rate in standardized vaccination cohorts born after 2002 was 2.336 per 100 000. Compared with the cohorts born before 1992, the RR was 24.347 (P=0.000 0), the attributable risk was 54.549 per 100 000, and the attributable risk ratio was 95.893%, the population attributable risk ratio was 95.300%, the population attributable risk was 47.371 per 100 000, comparing to the natural exposed population. Conclusions: The effectiveness of hepatitis B immunization program had been remarkable in Fujian province since 1992. However, further studies on the persistency of hepatitis B vaccine immunization and its public health significance still needed to be carried out.

A large scale cohort study on the immunization effect of hepatitis B vaccine in Fujian province / 中华流行病学杂志

Objective To evaluate the effectiveness of hepatitis B vaccination in Fujian province.Methods Based on the hepatitis B immunization strategy of China,a cohort study was designed,involving the population in Fujian province.The population under study was divided into natural exposure birth cohort before 1992 and the immunization birth cohort after 1992 (including voluntary vaccination cohort and standardized vaccination cohort).By cleaning the database of hepatitis B cases which directly reported through network and looked into the incidence and related death outcomes of acute hepatitis B from 2004 to 2017,the incidence levels of hepatitis B and immunization effects were analyzed and evaluated among different birth cohorts.Results During the observation period,the overall prevalence of hepatitis B in Fujian province was 44.594 per 100 000,with mortality rate as 0.010 per 100 000.The incidence of natural exposure cohort of birth was 56.885 per 100 000.The incidence of voluntary vaccination cohort of birth was 14.502 per 100 000.Compared with the voluntary vaccination cohort,the risk of hepatitis B increased significantly in the natural exposed cohort (RR=3.923),and the difference was statistically significant (P=0.000 7),with attributable risk as 42.383 per 100 000.The attributable risk ratio was 74.507.The population attributable risk ratio was 70.967％.The population attributable risk was 35.448 per 100 000.The attributable rate in standardized vaccination cohorts born after 2002 was 2.336 per 100 000.Compared with the cohorts bom before 1992,the RR was 24.347 (P=0.000 0),the attributable risk was 54.549 per 100 000,and the attributable risk ratio was 95.893％,the population attributable risk ratio was 95.300％,the population attributable risk was 47.371 per 100 000,comparing to the natural exposed population.Conclusions The effectiveness of hepatitis B immunization program had been remarkable in Fujian province since 1992.However,further studies on the persistency of hepatitis B vaccine immunization and its public health significance still needed to be carried out.

Efficacy and safety evaluation of mobilization and collection of unrelated allogeneic peripheral blood stem cells / 白血病·淋巴瘤

Objective To evaluate the efficacy and safety of the mobilization and collection of unrelated allogeneic peripheral blood stem cells. Methods The suitable stem cell mobilization plan was made in accordance with the hematopoietic stem cell mobilization plan of China Marrow Donor Program, the ruler of the hospital, and the donor's constitution. The unrelated allogeneic peripheral blood stem cells of 64 healthy donors were collected in the second Hospital of Shanxi Medical University from May 2012 to January 2017. The donor was infected one or several times with the mobilization agent granulocyte colony stimulating factor (G-CSF) by 5-10 μg·kg-1·d-1. After 3-4 days, peripheral blood hematopoietic stem cells were collected using COBE Spectra blood cell separator. Then, the effect and adverse reaction of donors were analyzed from different age and sex. Results It can achieve the acquisition requirements using 3 or 4 days of mobilization programs, mononuclear cells≥5.0×108/kg, CD34+cells≥2.0×106/kg. The single acquisition success rate (the target acquisition of the number of mononuclear cells and CD34+) up to 65 ％, collection efficiency reached 52％, which could reduce the risk of donor and the cost of patients. The quality of donor stem cell of young was better than that of older persons. Sixteen donors (25％) had mild adverse reactions, and no special treatment was required. Conclusions Allogeneic stem cell mobilization is safe. Starting from save medical resources and the interests of the donor the 3 day or 4 days of mobilization scheme could improve the success rate of the single mobilization. During the collection process, the condition of donor hypocalcemia should be observed and health education should be given to relieve the tension of donor.

Establishment and application of a database for hepatitis C virus NS3/4A protease inhibitors and their drug resistance data / 临床肝胆病杂志

ObjectiveTo establish a database for direct-acting antiviral agents (DAAs) targeting hepatitis C virus (HCV) NS3/4A protease and related resistance-associated variants, and to investigate its application in drug resistance analysis. MethodsThe published data and information of anti-NS3/4A DAAs and related drug resistance data were collected and mined. The in vitro data of viral drug-resistant mutations and resistance-associated variants identified in clinical treatment were entered into the database, and a statistical analysis was performed based on the type of drugs, HCV genotypes, positions of drug-resistant mutations, and type of substituted amino acids. Some of the results were available for online query on a website. Then the database was used to perform a multi-data analysis of the drug resistance of genotype 3 HCV, a well-known difficult-to-treat viral genotype. ResultsA database for anti-NS3/4A DAAs and their drug resistance data was established and some data were available for online query on a website (http://www.biosino.org/hcv/). This database consisted of the following four parts, with over ten thousands of pieces of information: the information of DAAs; the in vitro drug-resistance data of viral strains with different genotypes containing drug-resistant mutations; the prevalence of pre-existing resistance-associated variants and their detection rates in patients with treatment failure; the three-dimensional structures of the DAA-NS3/4A protease complex. This database was used to analyze drug resistance of all genotypes of HCV, and it was found that anti-NS3/4A DAAs had the poorest therapeutic effect in patients with genotype 3 HCV. Although the third-generation anti-NS3/4A DAAs had a good antiviral effect in patients with wild-type genotype 3 HCV, drug-resistant mutations might occur. ConclusionThis database is the first one in China for anti-NS3/4A DAAs and their drug-resistance data and provides an important resource of information and guidance for research on drug resistance and clinical treatment of HCV.

Thyroid function of patients with chronic hepatitis C after antiviral treatment:dynamic changes,prognosis and influencing factors / 吉林大学学报(医学版)

Objective To investigate the dynamic changes and prognosis of thyroid function in the patients with chronic hepatitis C (CHC)after antiviral treatment,and to clarify the influence of baseline factors in the changes of thyroid function.Methods 243 CHC patients with normal baseline thyroid function were enrolled. All patients were treated with IFN-alpha-2b(IFN-α2b)combined with ribavirin for 48 weeks.The thyroid function and serum HCV RNA level were assessed at 12,24,36,48,60 and 72 weeks.According to the changes in thyroid function after treatment,the patients were divided into continued normal,subclinical hypothyroidism,hypothyroidism and hyperthyroidism groups.The regularity of the changes of thyroid function of the patients in various groups were observed.Results Among 243 CHC patients,82(33.7%)patients had thyroid dysfunction.The prevalence of subclinical hypothyroidism,hypothyroidism and hyperthyroidism were 20.9%(51/243),5.3%(13/243)and 7.4%(18/243),respectively. At the end of 72 weeks,there were 32 (39.0%)patients suffering from subclinical hypothyroidism,12 (14.6%) patients with hypothyroidism and 7 (8.5%) patients with hyperthyroidism rehabilitated.6(7.3%)patients suffering from hypothyroidism turned to subclinical hypothyroidism,and 3(3.7%) patients suffering from hyperthyroidism turned to subclinical hypothyroidism.19(23.2%)patients had no significant change,they performed for continued subclinical hypothyroidism (1,1.2%),hypothyroidism (13,15.9%)and hyperthyroidism (5 , 6.1%).In addition, 3 (3.7%)patients with hyperthyroidism turned to hypothyroidism.An increased risk for hypothyroidism was found in female patients compared with males (P<0.05);the average age of the patients with hyperthyroidism was lower than those of the patients with hypothyroidism, subclinical hypothyroidism and continued normal (P<0.05);the baseline levels of GGT in the patients with hyperthyroidism and hypothyroidism were lower than those of the patients with subclinical hypothyroidism and continued normal(P<0.05).The ratio of the patients with HCV 2a to the patients with hypertyroidism was higher than those of the patients with hypothyroidism,subclinical hypothyroidism and continued normal(P<0.05).Conclusion Thyroid function in the CHC patients can be affected by antiviral treatment. Gender, age, liver function, genotype of HCV are influencing factors for the changes of thyroid function.

EV71 infection and viral features in patients with acute flaccid paralysis in Fujian,China,2003-2012 / 中国人兽共患病学报

The prevalence of acute flaccid paralysis (AFP) associated with EV71 and the genetic variation in Fujian , China from 2003 to 2012 was investigated in this study .Descriptive epidemiology was used to analyze the epidemiologic and clinical features of AFP cases associated with EV 71 .Phylogenetic analysis was performed to explore the genetical characteris-tics of EV71 based on the complete VP1 nucleotide and amino acid sequences .Results showed that the mean incidence of EV71-associated AFP in children under 15 years old was 2 .24/10 000 000 in Fujian Province during 2003 and 2012 ,based on the number of EV71 isolates and the reported AFP cases .And the incidence has increased since 2008 .The EV71 strains isolated from the AFP cases or from the healthy contacts were distributed in 9 prefectures of Fujian Province ,most in the months of May and June .Of 76 .0% (19/25) of AFP cases associated with EV 71 were the children under 3 years and the male-to-female ratio was 1 .5 :1 .Twenty out of twenty-two cases (90 .91% ) had fevers before the onset of paralysis .Most cases had unilater-al limb paralysis (14/22 ,63 .6% ) .Typical manifestations of hand-foot-and-mouth disease (HFMD) were observed in five cases before the onset of paralysis .Residual paralysis was observed in two cases during the follow-up visits .The strains isolated from 25 cases belonged to genotype C4 .All other strains belonged to subtype C4a except the subtype C4b strains isolated in 2003 .The homology among the strains was high in 2009-2011 ,and the homology among these strains and the representative strains in Fuyang ,Anhui Province was also in the high level .Therefore ,it was possible that the isolated strains had the same origin and might cause the epidemic .In conclusion ,an AFP surveillance system could be developed for analyzing the incidence of AFP associated with EV71 ,determining the features of the isolates ,and describing the intensity and trends of EV71 epidem-ics .