Influenza-associated excess mortality in Zhejiang Province from 2016 to 2019 / 预防医学

Objective@#To estimate the influenza-associated excess mortality (IEM) in Zhejiang Province from 2016 to 2019, so as to provide insights into estimates of mortality burden due to influenza. @* Methods@#The data pertaining to all-cause death and influenza surveillance in Zhejiang Province from 2016 to 2019 were retrieved from Zhejiang Provincial Cause of Death Registration System and Influenza Surveillance System to create distributed lag non-linear models (DLNMs). The year-, influenza subtype- and age-specific IEM rates were estimated.@*Results@#The overall IEM was 18.67/105 (95%CI: 15.32/105-21.97/105) in Zhejiang Province from 2016 to 2019, with the lowest in 2016 (14.19/105, 95%CI: 12.00/105-16.37/105) and the highest in 2018 (22.92/105, 95%CI: 19.23/105-26.56/105). The IEM rates of influenza A (H1N1), influenza A (H3N2) and influenza B were 9.32/105 (95%CI: 7.65/105-10.98/105), 5.68/105 (95%CI: 4.24/105-7.11/105), and 3.66/105 (95%CI: 2.13/105-5.18/105). The greatest IEM was seen among residents at ages of 65 years and older (142.91/105, 95%CI: (115.99/105-169.55/105, followed by among individuals at ages of 15 to 64 years (2.74/105, 95%CI: 1.87/105-3.61/105), and the lowest was seen among individuals under 15 years of age (0.41/105, 95%CI: -0.33/105-1.14/105). @*Conclusions@#From 2016 to 2019, the highest IEM was seen in Zhejiang Province in 2018, and the elderly residents at ages of 65 years and above presented the greatest IEM, with influenza A (H1N1) as the predominant influenza subtype. Influenza surveillance and vaccination is recommended to be reinforced.

Epidemiological investigation of the first reported case of coronavirus disease 2019（COVID-19）in Zhejiang Province / 预防医学

Objective@# To conduct an epidemiological investigation on the first reported case of coronavirus disease 2019 （COVID-19） in Zhejiang Province, so as to provide reference for prevention and control of the disease.@*Methods @#According to the COVID-19 Diagnosis and Treatment Program （Trial） and the COVID-19 Prevention and Control Program （Trial） issued by National Health Commission of China, a field investigation was employed on a case of fever from Wuhan reported by Wenzhou in January 15, 2020; the real-time reverse transcription polymerase chain reaction （RT-PCR） assay was performed to detect the nucleic acid of severe acute respiratory syndrome coronavirus 2 （SARS-CoV-2） from the sputum specimens or throat swabs of the case; the close contacts of the case were tracked down; relevant prevention and control measures were implemented. @*Results @#The case had lived in Wuhan for long. On January 4 of 2020, he felt cold and uncomfortable without obvious inducement, and drove back to Wenzhou with his wife. He had fever （up to 39 ℃）, cough and expectoration on the next day. On January 9, the chest computed tomographic （CT） scan showed bilateral high-density patchy shadowing with blurred edges. On January 16, his throat swab and sputum samples were collected and sent to Zhejiang Provincial Center for Disease Control and Prevention （CDC） for detection of SARS-CoV-2. The result turned out to be positive on January 17, then was rechecked and confirmed by Chinese CDC on January 20. Two weeks before the onset of the disease, the patient was engaged in the door-to-door persuasion of installing elevators in an old residential area of Wuhan, and he denied any connection with other COVID-19 cases,markets,（sick or dead） poultry or poultry products. Totally 26 close contacts were identified and kept in quarantine. During this period,three of them developed fever or respiratory symptoms, but were excluded from COVID-19. On the afternoon of January 16,the health system of Zhejiang Province and Wenzhou City launched an emergency plan and implemented a series of prevention and control measures such as isolation and treatment of cases,screening and isolation of close contacts,and public health education. @*Conclusion @#According to the epidemiological history,clinical features and laboratory test Results,the patient was identified as the first reported case of COVID-19 in Zhejiang Province.

Current situation and prospect of respiratory syncytial virus surveillance system / 预防医学

@#Respiratory syncytial virus（RSV）is the most common pathogen of lower respiratory infection among infants,leading to serious burden of disease all over the world. The surveillance of RSV plays an important role in preventing and controlling its epidemic. At present,the surveillance systems of RSV are not as global as that of influenza,which have been established much more and earlier in the developed countries. The RSV surveillance system are manifested in two types：specific and standard surveillance systems established by very few developed countries and surveillance systems based on the influenza surveillance established by most other countries. This article reviews the current status and prospect of RSV surveillance systems to provide reference for the development of RSV surveillance system in the future.

Advances on epidemiological research of human infections with novel avian influenza A (H7N9) virus / 中华预防医学杂志

Human infections with novel avian influenza A(H7N9)virus was an emerging infectious disease discovered in March, 2013. As of June30, 2016, 770 cases of H7N9 were reported in worldwide including 315 deaths with 40.9% of high case fatality rate. Yangtze River Delta and Pearl River Delta were the high-prevalence area. Formerly, the cases of H7N9 were concentrated on the municipalities. However, most of the case-patients were from smaller cities or rural areas nowadays. The H7N9 human infections mainly occurred in winter and spring every waves as similar as seasonal and H5N1 human infections. Middle aged and old (the median age was 61 years) male patients were occupied the large proportion among the cases of H7N9. In addition, the phenomenon of the limited and unsustained human-to-human transmission were existed. At present, the 4 major epidemic waves had happened and human infections with novel avian influenza A (H7N9) virus could be outbreak regularly in China. In this paper, the pathogenic characteristics and disease distribution of H7N9 influenza A viruses were elaborated, with both transmission factors and control measures, which were helpful to provide the scientific evidence for prevention and control in H7N9avian influenza epidemic.

Clinical features of sporadic cases with H7N9 avian influenza in Taizhou city of Zhejiang province and characteristics of viral gene / 中华临床感染病杂志

Objective To examine the clinical features of sporadic patients with H7N9 avian influenzain Taizhou city of Zhejiang province and to characterize its viral genes.Methods Fifteen patients with H7N9 influenza infection confirmed by Zhejiang Provincial Centre for Disease Control and Prevention during January 201 4 and January 201 5 were included in the study.The basic diseases,poultry exposure history,clinical manifestation,laboratory examination,imaging features,treatment and outcome and viral gene sequencing were analyzed retrospectively.Results The first clinical symptoms were fever and cough in all patients,acuterespiratory distress syndrome(ARDS)occurred in 1 3 patients,the average time from onset to antiviral therapy was (7 ±2)d.Among 1 5 patients,9 survived and 6 died,including 2 died of multiple organ failure (MOF).The phylogenetic tree showed that there was highly homologous in hemagglutinin (HA)and neuraminidase(NA)genes between human H7N9 virus strains and poultry reference strains.The result of genetic sequencing indicated that human H7N9 virus strains had mutations at 226 (Q226L)sites in HA protein.Conclusions ARDS is likely to occur in patients with H7N9 viral infection,and early antiviral treatment usually leads to a good prognosis.With the occurrence of adaptive mutation in avian influenza virus H7N9,spread from poultry to the human beings may take place.

Clinical characteristics of adult influenza inpatients in ten provinces in China and analysis of severe risk factors / 中华流行病学杂志

<p><b>OBJECTIVE</b>To identity the clinical characteristics and severe case risk factors for the adult inpatient cases confirmed of influenza monitored by the sentinel surveillance system for severe acute respiratory infection (SARI) inpatient cases in ten provinces in China.</p><p><b>METHODS</b>Epidemiology and clinical information surveys were conducted for adult cases (≥ 15 year old) consistent with SARI case definition, who were monitored by SARI sentinel hospitals in ten cities in China from December 2009 to June 2014, with their respiratory tract specimens collected for influenza RNA detection. Adult SARI cases were classified into influenza inpatient group and outpatient group by the detection outcomes, analyzing their demographic information, clinical and epidemiology characteristics respectively, in addition to risk factors for severe inpatient cases.</p><p><b>RESULTS</b>3 071 adult SARI cases were recruited from ten hospitals, including 240 (7.8%) cases of laboratory-confirmed influenza, most of them being A (H1N1) pdm2009 and A (H3N2) sub-types. Age M of the included influenza cases was 63 year old, 47.1% of them being ≥ 65 seniors. 144 (60.0%) cases of the influenza inpatients suffered from at least one chronic underlying condition, and the proportion of emphysema (7.9%) was higher than non-influenza inpatient cases (3.8%), being statistically significant (χ(2) = 3.963, P = 0.047). 19.4% of the women of childbearing age infected of influenza were in pregnancy, and only 1.1% of the 240 influenza cases had been vaccinated against influenza. The proportion of sore throat and dyspnea found among influenza inpatients was higher than inpatients without influenza. 17.4% of the influenza cases were accepted into ICU for treatment, with no statistical significance with non-influenza inpatient cases (P = 0.160). 23.1% of the influenza inpatients received an antiviral drug therapy, a figure higher than the non-influenza inpatient cases (4.8%) (P < 0.001). 41.5% of the inpatients developed complications, with the proportion of viral pneumonia significantly higher than the non-influenza inpatient cases (P < 0.001). Asthma (RR = 15.200, 95% CI: 1.157-199.633), immunosuppressive diseases (RR = 5.250, 95% CI: 1.255-21.960), pregnancy (RR = 21.000, 95% CI: 1.734-254.275), time interval from onset to admission less 7 days (RR = 1.673, 95% CI: 1.071-2.614) were identified as risk factors of severely-ill influenza cases.</p><p><b>CONCLUSION</b>It was found that adult influenza inpatients were mostly ≥ 65 year old seniors. The influenza vaccination rate among the influenza cases was very low, and antivirus drugs were used less than necessary. In this regard, influenza vaccination was recommended for high risk groups of pregnant women, seniors and chronic disease patients on annual basis, while influenza inpatients were advised to use antiviral drugs as early as possible.</p>

Outbreaks of norovirus infections in Zhejiang province during 2004-2014 / 中华临床感染病杂志

Objective To review the epidemiologic features of norovirus infection outbreaks in Zhejiang province during 2004-2014.Methods Epidemiological data of norovirus infection outbreaks in Zhejiang province from January 2004 to February 2014 were collected from the Emergency Public Reporting System in Zhejiang Provincial CDC.The distribution of time,area,population,route of transmission and genotype of norovirus were analyzed.Results There were 16 outbreaks of norovirus infections with 2 037 cases during 2004-2014 in Zhejiang province.Eleven outbreaks occurred during February and April,and 13 outbreaks occurred in schools.The outbreaks in schools mainly involved students aged 15-20 years,while other outbreaks took place mainly in the young and middle-aged population.The sex ratio of male to female was 1.05 ∶ 1.Among 16 outbreaks,10 were induced by norovirus G Ⅱ infections,3 were induced by norovirus G Ⅰ infections and 3 were induced by norovirus G Ⅰ and G Ⅱ infections.Fourteen outbreaks were caused by water pollution.Conclusion Outbreak of norovirus infection usually occurs in schools during winter and spring in Zhejiang province,and the epidemic of disease is mainly associated with polluted water.

Molecular epidemiology of hepatitis B virus in child carriers / 中华临床感染病杂志

Objective To investigate the molecular epidemiology of hepatitis B virus(HBV) in child carriers. Methods Blood samples were collected from children under 15 in Jiangsu and Zhejiang provinces. Enzyme immunoassay(EIA) and microparticle enzyme immunoassay(MEIA) were applied to screen hepatitis B surface antigen(HBsAg) positive children. Nested-PCR and real time PCR were used to amplify the HBV S gene and detected HBV DNA loads. S gene sequence and three-dimensional structure were analyzed by the DNASTAR and VMD1.8.6, respectively. SPSS 12.0 software was applied for data processing. Results A total of 64 HBsAg-positive cases were found in the screened children, from which 41 HBV S gene sequences were obtained. The average HBV DNA loads were(4.15±0.79)×10~7 copies/mL in 64 HBV carriers. Among 41 sequences. genotype C, B and B+C accounted for 82.93%(34/41), 12.19%(5/41)and 4.88%(2/41), respectively; and the serotypes were adr(34/39,87.18%), adw(4/39,10.24%) and ayr (1/39, 2.56%) with 2 strains unable to be sub-typed. The most common variants of "a" determinant in HBV S gene were 129 site Q→F(glutamine→phenylalanine), 145 site G→R(glycine→lysine), 131 site S→N(serine→asparagine)and 144 site C→A(cysteine→alanine), and the mutation frequencies were 12.20%(5/41), 4.88%(2/41), 2.27%(1/41)and 2.27%(1/41), respectively . The total mutation frequency was 21.95%(9/41). The S protein spatial structures of 129 site "Q→F" and 145 site "G→R" were entirely different from that of the wild strain. Conclusion Wild strain of HBV(C/adr) is predominant in the children HBV carriers, exhibiting a high replication, and the HBV vaccine should be still effective.

Prevention of bone loss by selective estrogen receptor modulators: raloxifene in the ovariectomized rat / 中华老年医学杂志

Objective Bone loss due to estrogen deficiency can be prevented by estrogen replacement therapy. But it produces a number of side effects associated with the cancer of breast and uterus which limits its application. Selective estrogen receptor modulators(SERMs) are a new category of therapeutic agents, they could bind to estrogen receptors with high affinity and mimic the effects of estrogen in some tissue but act as estrogen antagonists in others. This study was designed to observe the effect of Raloxifene on osteoporosis of the OVX rat model and probe into its mechanism. Methods Thirty-two 3-month-old female SD rats were randomly divided into four groups: the basal control, the OVX, OVX with RLX,OVX with DES. All rats were killed at the end of the experiment five months later. Body weight, bone mineral density (BMD), bone histomorphometry, uterine weight were measured. Results BMD of total body, lumbar spine and femur in OVX rats was significantly lower than that of rats treated with RLX by decreasing 21%, 35%, 40%, respectively. The number of osteoclast was significantly decreased in RLX-treated-OVX rats compared to OVX rats (P

5-HT_3 receptor of hippocampus mediate immunomodulation in rat / 中国免疫学杂志

Objective:The study is designed to explore the neuroimmunomodulation mediated by 5 HT 3 receptor of hippocampus in rats.Methods:ConA or lipopolysaccharide stimulated splenocytes proliferative responses are measured by TdR incorporation.Results:1 phenylbiguanide(PBG) 1 mg/kg,ip,10 ?g,icv and microinjection in the ventral hippocampus could enhance the splenocyte proliferative responses stimulated by ConA and LPS in mice and rats respectively.But the inhibitory effect on ConA stimulated response was only obtained by bilateral microinfusion of PBG in the dorsal hippocampus,while had no effect on the LPS induced proliferative responses.All of effects on mitogen stimulated splenocyte proliferation could be antiagonized by coadministration of a selective 5 HT 3 antiagonist tropisetron.Conclusion:It suggested that the 5 HT 3 receptors in the hippocampus might mediate neuro immuno modulation in which ventral and dorsal hippocampus have different effects.