Effects of different levels of non-pharmaceutical interventions on hand, foot and mouth disease in Guangzhou, China.

BACKGROUND: Non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 (COVID-19) may have suppressed the transmission of other infectious diseases. This study aimed to evaluate the impact of different degrees of NPIs during the COVID-19 pandemic on hand, foot and mouth disease (HFMD) in Guangzhou, China. METHODS: Weekly reported HFMD cases and pathogens information during 2015-2021 in Guangzhou were collected from the China National Notifiable Disease Reporting System. The observed number of HFMD cases in 2020 and 2021 was compared to the average level in the same period during 2015-2019. Then, an interrupted time-series segmented regression analysis was applied to estimate the impact of NPIs on HFMD, such as social distancing, suspension of schools, community management and mask wearing. The effects across different subgroups stratified by gender, children groups and enterovirus subtype of HFMD were also examined. RESULTS: A total of 13,224 and 36,353 HFMD cases were reported in 2020 and 2021, which decreased by 80.80% and 15.06% respectively compared with the average number of cases in the same period during 2015-2019. A significant drop in the number of HFMD cases during time when strict NPIs were applied (relative change: 69.07% [95% confidence interval (CI): 68.84%-69.30%]). The HFMD incidence rebounded to historical levels in 2021 as the lockdown eased. The slightest reduction of HFMD cases was found among children at kindergartens or childcare centres among the three children groups (children at kindergartens or childcare centres: 55.50% [95% CI: 54.96%-56.03%]; children living at home: 72.64% [95% CI: 72.38%-72.89%]; others: 74.06% [95% CI: 73.19%-74.91%]). CONCLUSIONS: The strong NPIs during the COVID-19 epidemic may have a significant beneficial effect on mitigating HFMD. However, the incidence of HFMD rebounded as the NPIs became less stringent. Authorities should consider applying these NPIs during HFMD outbreaks and strengthening personal hygiene in routine prevention.

Correction: Incidence, clinical course and risk factor for recurrent PCR positivity in discharged COVID-19 patients in Guangzhou, China: A prospective cohort study.

[This corrects the article DOI: 10.1371/journal.pntd.0008648.].

Peanut Butter Food Safety Concerns-Prevalence, Mitigation and Control of Salmonella spp., and Aflatoxins in Peanut Butter.

Peanut butter has a very large and continuously increasing global market. The food safety risks associated with its consumption are also likely to have impacts on a correspondingly large global population. In terms of prevalence and potential magnitude of impact, contamination by Salmonella spp., and aflatoxins, are the major food safety risks associated with peanut butter consumption. The inherent nature of the Salmonella spp., coupled with the unique chemical composition and structure of peanut butter, present serious technical challenges when inactivating Salmonella spp. in contaminated peanut butter. Thermal treatment, microwave, radiofrequency, irradiation, and high-pressure processing all are of limited efficacy in inactivating Salmonella spp. in contaminated peanut butter. The removal of aflatoxins in contaminated peanut butter is equally problematic and for all practical purposes almost impossible at the moment. Adopting good manufacturing hygiene practices from farm to table and avoiding the processing of contaminated peanuts are probably some of the few practically viable strategies for minimising these peanut butter food safety risks. The purpose of this review is to highlight the nature of food safety risks associated with peanut butter and to discuss the effectiveness of the initiatives that are aimed at minimising these risks.

COVID-19 vaccine acceptance among cold-chain workers in Shenzhen, China: A cross-sectional survey.

Given the high level of exposure to SARS-CoV-2, cold-chain workers are considered priority vaccination groups. To date, many studies have reported on the willingness within distinct populations to be vaccinated against COVID-19, whereas it has not been reported among cold-chain workers worldwide. To address this void, we conducted a cross-sectional survey to gather general information, COVID-19-related knowledge, attitudes, and practices (KAP), and willingness to receive a COVID-19 vaccine among cold-chain workers in Shenzhen, China. Binary logistic analyses were conducted to explore the associations between COVID-19-related KAP factors and the willingness for COVID-19 vaccination. Among 244 cold-chain workers, 76% indicated that they were willing to be vaccinated. Knowledge about SARS-CoV-2, comprehending the most effective prevention, understanding the transmission routes, and recognizing the priority vaccination groups were positively associated with willingness to be vaccinated against COVID-19. Regarding attitude factors, perceiving the social harmfulness and severity of COVID-19 were related to a higher willingness to vaccination. Participants considering themselves a priority group for COVID-19 vaccination were more likely to get vaccinated. For practice factors, attaining more knowledge and higher self-reported compliance with maintaining adequate ventilation were also positively associated with the dependent variable. Agreement on the importance of COVID-19 vaccination was the most frequent reason for accepting the COVID-19 vaccine; additionally, concerns about side effects and insufficient understanding of efficacy were the main factors contributing to vaccine refusal. Enhancing KAP levels related to COVID-19 helps promote vaccine acceptance. Health authorities should promptly implement educational activities following the updated vaccine status among cold-chain workers.

Clinical and virological impact of single and dual infections with influenza A (H1N1) and SARS-CoV-2 in adult inpatients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mimics the influenza A (H1N1) virus in terms of clinical presentation, transmission mechanism, and seasonal coincidence. Comprehensive data for the clinical severity of adult patients co-infected by both H1N1 and SARS-CoV-2, and, particularly, the relationship with PCR cycle threshold (Ct) values are not yet available. All participants in this study were tested for H1N1 and SARS-CoV-2 simultaneously at admission. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults hospitalized for H1N1 infection, SARS-CoV-2 infection and co-infection with both viruses. Ct values for viral RNA detection were further compared within SARS-CoV-2 and co-infection groups. Score on seven-category ordinal scale of clinical status at day 7 and day 14 were assessed. Among patients with monoinfection, H1N1 infection had higher frequency of onset symptoms but lower incidence of adverse events during hospitalization than SAR-CoV-2 infection (P < 0.05). Co-infection had an increased odds of acute kidney injury, acute heart failure, secondary bacterial infections, multilobar infiltrates and admittance to ICU than monoinfection. Score on seven-category scale at day 7 and day 14 was higher in patients with coinfection than patients with SAR-CoV-2 monoinfection (P<0.05). Co-infected patients had lower initial Ct values (referring to higher viral load) (median 32) than patients with SAR-CoV-2 monoinfection (median 36). Among co-infected patients, low Ct values were significantly and positively correlated with acute kidney injury and ARDS (P = 0.03 and 0.02, respectively). Co-infection by SARS-CoV-2 and H1N1 caused more severe disease than monoinfection by either virus in adult inpatients. Early Ct value could provide clues for the later trajectory of the co-infection. Multiplex molecular diagnostics for both viruses and early assessment of SAR-CoV-2 Ct values are recommended to achieve optimal treatment for improved clinical outcome.

Knowledge, Attitudes, and Practices Toward COVID-19 Among Chinese Teachers, Shenzhen: An Online Cross-sectional Study During the Global Outbreak of COVID-19.

Background: Adequate understanding and precautionary behaviors are of vital importance to contain the spread of coronavirus disease 2019 (COVID-19). To date, the knowledge, attitudes, and practices (KAP) toward COVID-19 among different populations have been reported, whereas such information is unavailable in teachers. We aimed to investigate the KAP of teachers associated with COVID-19 during the global outbreak. Methods: A large-scale population-based survey was conducted to gather information on COVID-19-related KAP among Chinese teachers using a self-administered questionnaire. We received 10,658 responses in April 2020, out of which 8,248 were enrolled in the final analysis. Participants responded to a self-administered questionnaire concerning demographic characteristics and KAP associated with COVID-19. Results: This work included 4,252 (51.6%) teachers in kindergartens, 2,644 (32.1%) teachers in primary schools, and 1,352 (16.4%) teachers in secondary schools. The knowledge level (mean: 4.46 out of seven points) was relatively lower than the levels of attitudes (mean: 3.27 out of four points) and practices (mean: 4.29 out of five points) toward COVID-19. Knowledge scores significantly varied by the collected demographic variables except education worksite (p < 0.05), whereas practice scores significantly differed in age groups (p < 0.05), education level (p < 0.001), education worksite (p < 0.001), and years of teaching (p < 0.001). The multivariate logistic analysis indicated that poor knowledge related to COVID-19 was common among men, younger, and less-educated teachers. In contrast, female teachers and those with higher education levels tend to have good practices against COVID-19. Conclusion: The present work suggested the knowledge gaps regarding COVID-19 were needed to be corrected immediately in teachers. Given the critical role of teachers in the education system, health authorities should take gender, age, and education level into account when developing suitable health interventions.

Incidence, clinical course and risk factor for recurrent PCR positivity in discharged COVID-19 patients in Guangzhou, China: A prospective cohort study.

The phenomenon of COVID-19 patients tested positive for SARS-CoV-2 after discharge (redetectable as positive, RP) emerged globally. The data of incidence rate and risk factors for RP event and the clinical features of RP patients may provide recommendations for virus containment and cases management for COVID-19. We prospectively collected and analyzed the epidemiological, clinical and virological data from 285 adult patients with COVID-19 and acquired their definite clinical outcome (getting PCR positive or not during post-discharge surveillance). By March 10, 27 (9.5%) discharged patients had tested positive for SARS-CoV-2 in their nasopharyngeal swab after a median duration of 7·0 days (IQR 5·0-8·0). Compared to first admission, RP patients generally had milder clinical symptoms, lower viral load, shorter length of stay and improved pulmonary conditions at readmission (p<0.05). Elder RP patients (≥ 60 years old) were more likely to be symptomatic compared to younger patients (7/8, 87.5% vs. 3/19, 18.8%, p = 0.001) at readmission. Age, sex, epidemiological history, clinical symptoms and underlying diseases were similar between RP and non-RP patients (p>0.05). A prolonged duration of viral shedding (>10 days) during the first hospitalization [adjusted odds ratio [aOR]: 5.82, 95% confidence interval [CI]: 2.50-13.57 for N gene; aOR: 9.64, 95% CI: 3.91-23.73 for ORF gene] and higher Ct value (ORF) in the third week of the first hospitalization (aOR: 0.69; 95% CI: 0.50-0.95) were associated with RP events. In conclusion, RP events occurred in nearly 10% of COVID-19 patients shortly after the negative tests, were not associated with worsening symptoms and unlikely reflect reinfection. Patients' lack of efficiency in virus clearance was a risk factor for RP result. It is noteworthy that elder RP patients (≥ 60 years old) were more susceptible to clinical symptoms at readmission.

Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China : A Prospective Cohort Study.

BACKGROUND: Risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to close contacts of infected persons has not been well estimated. OBJECTIVE: To evaluate the risk for transmission of SARS-CoV-2 to close contacts in different settings. DESIGN: Prospective cohort study. SETTING: Close contacts of persons infected with SARS-CoV-2 in Guangzhou, China. PARTICIPANTS: 3410 close contacts of 391 index cases were traced between 13 January and 6 March 2020. Data on the setting of the exposure, reverse transcriptase polymerase chain reaction testing, and clinical characteristics of index and secondary cases were collected. MEASUREMENT: Coronavirus disease 2019 (COVID-19) cases were confirmed by guidelines issued by China. Secondary attack rates in different settings were calculated. RESULTS: Among 3410 close contacts, 127 (3.7% [95% CI, 3.1% to 4.4%]) were secondarily infected. Of these 127 persons, 8 (6.3% [CI, 2.1% to 10.5%]) were asymptomatic. Of the 119 symptomatic cases, 20 (16.8%) were defined as mild, 87 (73.1%) as moderate, and 12 (10.1%) as severe or critical. Compared with the household setting (10.3%), the secondary attack rate was lower for exposures in health care settings (1.0%; odds ratio [OR], 0.09 [CI, 0.04 to 0.20]) and on public transportation (0.1%; OR, 0.01 [CI, 0.00 to 0.08]). The secondary attack rate increased with the severity of index cases, from 0.3% (CI, 0.0% to 1.0%) for asymptomatic to 3.3% (CI, 1.8% to 4.8%) for mild, 5.6% (CI, 4.4% to 6.8%) for moderate, and 6.2% (CI, 3.2% to 9.1%) for severe or critical cases. Index cases with expectoration were associated with higher risk for secondary infection (13.6% vs. 3.0% for index cases without expectoration; OR, 4.81 [CI, 3.35 to 6.93]). LIMITATION: There was potential recall bias regarding symptom onset among patients with COVID-19, and the symptoms and severity of index cases were not assessed at the time of exposure to contacts. CONCLUSION: Household contact was the main setting for transmission of SARS-CoV-2, and the risk for transmission of SARS-CoV-2 among close contacts increased with the severity of index cases. PRIMARY FUNDING SOURCE: Guangdong Province Higher Vocational Colleges and Schools Pearl River Scholar Funded Scheme.

Viral dynamics in asymptomatic patients with COVID-19.

Data are limited on the viral load, viral shedding patterns, and potential infectivity of asymptomatic patients (APs) with coronavirus disease 2019 (COVID-19). This study included 31 adult patients who were virologically confirmed to have COVID-19 but were asymptomatic on admission. Among these 31 patients, 22 presented symptoms after admission and were defined as asymptomatic patients in the incubation period (APIs); the other nine patients remained asymptomatic during hospitalization and were defined as asymptomatic patients (APs). The median cycle threshold (Ct) value of APs (39.0, interquartile range (IQR) 37.5-39.5) was significantly higher than that of APIs (34.5, IQR 32.2-37.0), indicating a lower viral load in APs. However, the duration of viral shedding remained similar in the two groups (7 days, IQR 5-14 days vs. 8 days, IQR 5-16 days). The study findings demonstrated that although APs with COVID-19 have a lower viral load, they still have certain period of viral shedding, which suggests the possibility of transmission during their asymptomatic period. Further longitudinal surveillance of these asymptomatic cases via virus nucleic acid testing are warranted.