The spatial-temporal distribution and aetiological characteristics of hand, foot, and mouth disease before and after the EV‑A71 vaccination and COVID-19 pandemic in Kunming, China, 2017–2020 (preprint)

Background: After the vaccination enterovirus 71 (EV-A71) vaccine and Corona Virus Disease 2019 (COVID-19) outbreak, the prevalence of Hand, foot, and mouth disease (HFMD) remained high and the spatial-temporal distribution of enteroviruses changed. Therefore, it is essential to define the temporal features, spatial distributions, epidemiological and aetiological characteristics of HFMD of Kunming. Methods Between 2017 and 2020, a total of 36540 HFMD children cases diagnosed with HFMD in Kunming, including 32754 enteroviruses positive clinical samples. Demographic, geographical, epidemiological and aetiological data of the cases were acquired and analyzed. Results Other enteroviruses replaced EV-A71 and the incidence of EV-A71 has decreased dramatically, while, coxsackievirus A6 (Cox A6) and coxsackievirus A16 (Cox A16) with significant outbreaks in 2018 and 2019, respectively. The major and junior peaks all extended for 2-4 months than before that vaccination EV-A71 vaccine. After the COVID-19 outbreak, Cox A6 as the predominant serotype pathogens, and only single peaks appeared in 2019 and 2020. Although the high incidence of HFMD areas were Guandu, Chenggong and Xishan, the annual incidence of different enterovirus serotype appeard in different regions. In 2017, other enteroviruses prevailed in Shilin; In 2018, Cox A16 and Cox A6 prevailed in Luquan and Shilin, respectively; In 2019, Cox A16 prevailed in Jinning; In 2020, Cox A6 and coxsackievirus A10 (Cox A10) prevailed in Luquan and Shilin, respectively. Meanwhile, the epidemic cycle of Cox A6 and Cox A16 was only 1 year, and Cox A10 and other enteroviruses were potential risk pathogens. Conclusions The spatial and temporal distribution of HFMD varies at different scales, and the incidence of different pathogens associated HFMD has obvious regional differences and seasonal trends. Therefore, the research of multivalent combined vaccines are urgently needed, while, proper preventive and protective measures could effectively control the incidence of HFMD-like diseases.

Why tobacco control should be a priority agenda item of Joint External Monitoring Missions for TB control?

INTRODUCTION: Tobacco smoking is a significant risk factor for developing tuberculosis (TB), contributing to diagnostic delays, poor treatment outcomes and an increased risk of death and relapse. The World Health Organization (WHO) has reported that TB rates could decline by as much as 20% if smoking were eliminated. Tobacco smoking was a risk factor in at least 860,000 TB cases in 2018, and has been documented as one of the leading contributors to TB in India, Indonesia, Myanmar, Nepal and Philippines. METHODS: Joint External Monitoring Missions (JEMM) are arranged by WHO to review the progress, challenges and plans for national TB control programs and provide guidance for improvement of policies, planning and implementation. During May and June 2021, JEMM reports from five South-East Asian countries that had a JEMM in 2019 and early 2020 were reviewed. Reports reviewed from India, Indonesia, Myanmar, Nepal and the Philippines. Any mention of the association of TB and smoking, TB and tobacco use, impact of tobacco use/smoking on TB outcomes, current practices and challenges of TB and tobacco in the TB control program and proposed actions were documented. RESULTS: Of the five country JEMM, Myanmar's did not recognise the impact of smoking tobacco on TB at all, and only one of the five countries, India, identified a very limited number of current TB-Tobacco practises including that a collaborative framework for TB/tobacco was in place. Nepal's 2019 JEMM acknowledged that there was no smoking cessation within the TB Control program and health providers were not aware about the brief advice and smoking cessation program. The Philippines and Myanmar reported neither current practices nor challenges in implementing tobacco intervention in TB control programs. CONCLUSION: Given the importance of tobacco smoking as a key risk factor for TB, assessing its burden on the national TB epidemic should be included as one of the key indicators in the JEMM framework. Key interventions include brief cessation support through regular TB services and the use of Nicotine Replacement Therapy (NRT) and other medications as part of a comprehensive package of care for people with TB to improve the quality of the services they receive. Multisectoral efforts to stop smoking also contribute the non-communicable disease agenda as well as protecting against poor outcomes for COVID-19. The support of TB programs to integrate tobacco control is critical and will contribute to national TB control program targets that support WHO's End TB Strategy.

Duodenal Perforation Caused Septic Shock: a Rare Case Combined With Coronavirus Disease 2019 (preprint)

Background: Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy, which is especially easy to be overlooked during the outbreak of 2019 novel coronavirus (2019-nCoV) after delivery.Case presentation: Here, we report a case of duodenal perforation-induced septic shock with coronavirus disease 2019 (COVID-19), and the patient underwent emergency laparotomy after reporting to the hospital management department under strict protection. Her recovery in postoperative period in Medical Intensive Care Unit (MICU) was uneventful and she was transferred to a designated hospital for treatment of COVID-19 5 days later.Conclusions: The establishment of emergency green channel for maternal health care, and timely and comprehensive multidisciplinary cooperation during the epidemic period, strengthen the standardized management of high-risk pregnancy, and better guarantee the safety of mothers and infants.

Clinical Features of Pregnant Women and Neonates with COVID-19 in Wuhan: a paired comparison study (preprint)

Background Our study aimed to find symptoms unique in pregnancy and to help the early diagnosis in pregnant women and to evaluate the impact of COVID-19 in postpartum women and their newborns.Methods Clinical data were reviewed and collected for 11 pregnant women with laboratory-confirmed COVID-19 who were consecutively admitted to Zhongnan Hospital of Wuhan University and Women and Children’s Hospital of Hubei Province, from Jan 26 to Feb 26, 2020.Results All the confirmed women didn’t have any exposure history and their early symptoms were mildly elevated temperate and fatigue. The chest CT scans of confirmed women can be atypical manifestations, such as bilateral pleural effusions and slightly increased densities. Eight of eleven confirmed women did not feel anything unusual until abnormalities were found on chest CT scans on admission screening test. All three groups had elevated white blood cell count, neutrophil count and lactate dehydrogenase, and reduced total protein.The infection did not increase the risk for premature delivery, premature rupture of membrane, or comorbidities in pregnancy.Conclusions Pregnant women were often asymptomatic and accidentally detected abnormalities on chest CT scan on admission which emphasize the importance of CT scan in prevalent areas of the COVID-19. Even after the laboratory confirmation, the manifestation of the CT scan could be atypical, which alerted the necessity of protection for healthcare workers. The COVID-19 did not increase the risk of complications in pregnant women and their neonates.Trial registration: This case series was approved by the institutional ethics board of Zhongnan Hospital of Wuhan University (No. 2020020) and Women and Children’s Hospital of Hubei Province(NO. LW035).