Descriptive Study of Foodborne Disease Using Case Monitoring Data in Shandong Province, China, 2016-2017.

BACKGROUND: In order to generate data on the burden of foodborne diseases in Shandong Province, we aimed to use the case monitoring data of foodborne diseases from 2016 to 2017 to estimate. METHODS: Data were obtained from the foodborne disease surveillance reporting system with dates of onset from Jan 1, 2016, to Dec 31, 2017, in Shandong, China. RESULTS: The places of food exposure were categorized by settings as follows: private home, catering facility, collective canteens, retail markets, rural banquets and other. Exposed food is divided into 23 categories. Overall incidence rate and proportions by exposure categories, age, and sex-specific incidence rates were calculated and sex proportions compared. Approximately 75.00% of cases who had at least one exposure settings were in private homes. The most frequently reported exposed food was a variety of food (meaning more than two kinds of food). The two-year average incidence rate was 75.78/100,000, sex-specific incidence rate was much higher for females compared to males (78.23 vs. 74.69 cases per 100,000 population). An age-specific trend was observed in the cases reported (Chi-Square for linear trend, χ2=4.39, P=0.036<0.05). CONCLUSION: A preliminary estimate of 14 million cases of foodborne diseases in Shandong province each year. Future studies should focus on cross-sectional and cohort studies to facilitate the assessment of the distribution and burden of foodborne disease of the population in Shandong. Considering strengthening the burden of foodborne diseases in foodborne disease surveillance is also a feasible way.

[Risk assessment of nonylphenol exposure in vegetable oil of residents in six cities of Shandong Province in 2014-2015].

OBJECTIVE: To investigate the level of nonylphenol dietary exposure in vegetable oils of 6 cities in Shandong Province and to evaluate the contribution of risk. METHODS: The data of Total Dietary Study and Health Status Survey of Shandong Province and nonylphenol test data were used to evaluate the exposure. A total of 3468 people from6 cities of Shandong province were selected for food survey by stratified multistage cluster random sampling method in 2014-2015. The consumption of vegetable oil was investigated by weighing and accounting method. Nonylphenol content in dietary samples was detected by high performance liquid chromatography-mass spectrometry( HPLC-MS). RESULTS: The exposure level of nonylphenol in vegetable oil was 0-0. 44 µg/kg, and the risk index of the highest point of exposure was 0. 088. CONCLUSION: Risk caused by vegetable oil intake of nonylphenol in Shandong Province 6 city residents is extremely low.

Epidemiology of foodborne disease outbreaks from 2011 to 2016 in Shandong Province, China.

Foodborne disease is a major public health concern in both developed and developing countries. China has established a nationwide Foodborne Disease Outbreak Surveillance System (FDOSS) for collection and periodic reporting of data on the occurrence and causes of foodborne disease outbreaks in China. Each provincial Centers for Disease Control and Prevention (CDC) conducts the system working.We reviewed foodborne disease outbreaks that occurred during 2011 to 2016 in Shandong Province from the FDOSS. The Wilcoxon test was used to compare the median number of ill persons in outbreaks. All data analysis was performed using Epi Info 7.During 2011 to 2016, Shandong CDC received reports of 1043 foodborne disease outbreaks, resulting in 8078 illnesses, 2442 hospitalizations, and 17 deaths. There were a median of 69 outbreaks annually [interquartile range (IQR) 10-342], resulting in 335 to 3824 illnesses each year. The median outbreak size was 3 persons (IQR 2-7). Hotels (including cruise ships, hotpot restaurants, barbecue shops) were the most common setting. Among the 744 (71.3%) outbreaks with an implicated food or contaminated ingredient reported, 704 (94.6%) could be assigned to one of 17 predefined commodity categories. Of the 280 outbreaks with a known etiology, 117 (41.8%) were caused by poisonous plants and animals and their toxins, 39 (13.9) were caused by nitrite, and 27 (9.6%) were caused by vibrio parahaemolyticus. Of the 491 (47.1%) outbreaks with at least a contributing factor to cause outbreak, 168 (34.2%) were caused by improper processing, and 100 (20.4) were caused by inedible and misuse.Timely investigation, disposal and reporting of foodborne disease outbreaks provides information that might help FDOSS to make full use of efficiency and FDOSS should be continued and strengthened even more in Shandong Province, such as an increase in diagnostic laboratory capacities.

Association between serum magnesium and blood lipids: influence of type 2 diabetes and central obesity.

To assess the changes in the relationship between serum Mg and blood lipids of Chinese adults with type 2 diabetes (T2D) or central obesity, a total of 8163 subjects (mean age 59·6 years, 54·9 % men) were analysed. Participants were classified according to blood Mg (below 0·65 mmol/l, 0·65-0·95 mmol/l and above 0·95 mmol/l), T2D (yes/no) and central obesity (yes/no). Blood lipids (TAG, total cholesterol (TC), HDL-cholesterol and LDL-cholesterol) were determined by standardised methods and conditions. A significant increase in blood lipids, with the exception of HDL-cholesterol, across progressive Mg groups in all subjects was noted (P0·05). TAG, TC, HDL-cholesterol and LDL-cholesterol were significantly higher among subjects with T2D than those without T2D (P<0·05). Multivariable models for TAG and LDL-cholesterol failed to attain statistical significance in diabetics, by using a generalised linear or parsimonious model. TAG, TC, HDL-cholesterol and LDL-cholesterol were significantly higher among subjects with T2D or central obesity. Blood lipids, with the exception of HDL-cholesterol, were associated with serum Mg, but this association was somehow influenced by T2D in LDL-cholesterol. In addition, multivariable models for both TAG and LDL-cholesterol failed to attain statistical significance among subjects with T2D, different from subjects without T2D.

Secular trends in salt and soy sauce intake among Chinese adults, 1997-2011.

Salt and soy sauce are the main ways of sodium intake in Chinese dietary. In this study, we used the data of the China Health and Nutrition Surveys to describe the secular trends of salt and soy sauce intake among Chinese adults from 1997 to 2011. Trends were tested by multiple linear regression models. During the past 14 years, the consumption of sodium, salt and soy sauce intake values decreased significantly across the six study periods (p < .0001) among both men and women. Averaged salt values decreased by 4.9 g/d in men and 4.1 g/d in women. Mean soy sauce intake values decreased by 9.0 g/d among men and 7.3 g/d among women. Similar significant trends were observed in all age groups, activity levels and regions (p < .0001).

Health risk assessment of rare earth elements in cereals from mining area in Shandong, China.

To investigate the concentrations of rare earth elements in cereals and assess human health risk through cereal consumption, a total of 327 cereal samples were collected from rare earth mining area and control area in Shandong, China. The contents of 14 rare earth elements were determined by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The medians of total rare earth elements in cereals from mining and control areas were 74.22 µg/kg and 47.83 µg/kg, respectively, and the difference was statistically significant (P < 0.05). The wheat had the highest rare earth elements concentrations (109.39 µg/kg and 77.96 µg/kg for mining and control areas, respectively) and maize had the lowest rare earth elements concentrations (42.88 µg/kg and 30.25 µg/kg for mining and control areas, respectively). The rare earth elements distribution patterns for both areas were characterized by enrichment of light rare earth elements. The health risk assessment demonstrated that the estimated daily intakes of rare earth elements through cereal consumption were considerably lower than the acceptable daily intake (70 µg/kg bw). The damage to adults can be neglected, but more attention should be paid to the effects of continuous exposure to rare earth elements on children.

Concentrations and health risk assessment of rare earth elements in vegetables from mining area in Shandong, China.

To investigate the concentrations of rare earth elements in vegetables and assess human health risk through vegetable consumption, a total of 301 vegetable samples were collected from mining area and control area in Shandong, China. The contents of 14 rare earth elements were determined by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The total rare earth elements in vegetables from mining and control areas were 94.08 µg kg-1 and 38.67 µg kg-1, respectively, and the difference was statistically significant (p < 0.05). The leaf vegetable had the highest rare earth elements concentration (984.24 µg kg-1 and 81.24 µg kg-1 for mining and control areas, respectively) and gourd vegetable had the lowest rare earth elements concentration (37.34 µg kg-1 and 24.63 µg kg-1 for mining and control areas, respectively). For both areas, the rare earth elements concentration in vegetables declined in the order of leaf vegetable > taproot vegetable > alliaceous vegetable > gourd vegetable. The rare earth elements distribution patterns for both areas were characterized by enrichment of light rare earth elements. The health risk assessment demonstrated that the estimated daily intakes (0.69 µg kg-1 d-1 and 0.28 µg kg-1 d-1 for mining and control areas, respectively) of rare earth elements through vegetable consumption were significantly lower than the acceptable daily intake (70 µg kg-1 d-1). The damage to adults can be neglected, but more attention should be paid to the effects of continuous exposure to low levels of rare earth elements on children.

[Epidemiology of hand, foot, and mouth disease and genetic characterization of enterovirus A71: a survey from 2007 to 2012 in Linyi of Shandong Province, China].

To investigate the epidemiology of hand, foot, and mouth disease (HFMD) and the genetic characteristics of enterovirus A71 (EV-A71) in Linyi of Shandong Province, China during 2007-2012. The number of reported HFMD cases were obtained from the National Notifiable Disease Reporting System (NNDRS) were analyzed by descriptive epidemiology method; the VP1 region of EV-A71 isolated from HFMD patients in Linyi was amplified and sequenced. Finally, the genetic variability and phylogenecity of VP1 sequences of EV-A71 were analyzed by MEGA 5.0. The results showed that HFMD incidence was reported in each year from 2007 to 2012 in Linyi, and the highest incidence and mortality were reported in 2009, when there were total 14697 cases and 9 of death. The reported incidence was 140.28/100000, and the mortality was 0.086/100000. The peak incidence usually occurred between April and July, and the summit occurred in May. Scattered children accounted for 77.37%-92.00% of all cases. The peak age was 2.5 years during 2007-2009 and 1.5 years during 2010-2012. A total of 1365 laboratory-confirmed HFMD cases were reported in the 6 consecutive years, accounting for 2.98% of the gross number. Among these reports, the ratio of EV-A71 was 44.18%, and the ratio of coxsackievirus A16 (CVA16) was 46.59%. All EV-A71 strains isolated in Linyi during 2007-2012 belonged to the C4a evolutionary branch of C4 genotype. In conclusion, HFMD outbreaks occurred every year in Linyi during 2007-2012. Incidence varied significantly among different counties. The peak incidence in each year lasted from April to July. Most of the patients were children under 3 years of age, and scattered children took the highest proportion. Co-circulation of EV-A71 and CVA16 was the major cause of HFMD in each year. Since the first report of HFMD prevalence caused by EV-A71 (C4a) in 2007, the virus has been prevalent continuously in Linyi for 6 years.

One family cluster of avian influenza A(H7N9) virus infection in Shandong, China.

BACKGROUND: The first case of human infection with avian influenza A (H7N9) virus was identified in March, 2013 and the new H7N9 virus infected 134 patients and killed 45 people in China as of September 30, 2013. Family clusters with confirmed or suspected the new H7N9 virus infection were previously reported, but the family cluster of H7N9 virus infection in Shandong Province was first reported. CASE PRESENTATION: A 36-year-old man was admitted to Zaozhuang City Hospital with progressive respiratory distress and suspicion of impending acute respiratory distress syndrome on April 21. The chest radiography revealed bilateral ground-glass opacities and pulmonary lesions. The second case, the first case's 4 year old son, was admitted to the same hospital on April 28 with fever and multiple patchy shadows in the bilateral lungs. Both of the two cases were confirmed to infect with H7N9 virus by the results of real-time reverse transcriptase-polymerase-chain reaction (rRT-PCR), virus isolation and serum antibody titer. At the same time, one environment samples was detected positive for H7N9 virus in the living poultry market in Zaozhuang. The homologous analysis of the full genome sequence indicated that both viruses from the patients were almost genetically identical. The field epidemiology investigation showed that the two cases had no recognized exposure to poultry, but had the exposure to the environment. The second case had substantial unprotected close exposure to his ill father and developed symptoms seven days after his last contact with his father. After surgery, the index case and his son were discharged on May 16 and May 6, respectively. 11 close contacts of both patients were identified and tested negative both the throat swabs and the serum antibody. CONCLUSION: The infection of the index case probably resulted from contact with environmentally contaminated material. For the son, the probable infection source was from the index case during unprotected exposure, but the possibility from the environment or other sources could not be completely ruled out.

[Analysis of clinical features and early warning indicators of death from hand, foot and mouth disease in Shandong province].

OBJECTIVE: To understand the clinical features of death from hand, foot and mouth disease (HFMD) and to explore the early warning index of HFMD death. METHODS: A total of 41 HFMD death cases were collected as case group in Shandong province between 2009 and 2011, and another 123 serious HFMD cases were selected as control group according to the similar gender, place of origin and hospital level, with the ratio at 1:3. We investigated the general situation, clinical treatment, past medical history, clinical symptoms and signs of the ill children, and applied the conditional logistic regression to explore early warning index of HFMD death. RESULTS: The rate of patients who had symptoms in nervous system, digestive system, circulatory system and respiratory system were separately 90.2% (37/41), 58.5% (24/41), 53.7% (22/41) and 90.2% (37/41) in case group; and the proportions were 44.7% (55/123), 13.8% (17/123), 10.6% (13/123) and 12.2% (15/123) respectively in control group. The difference between the two groups showed statistical significance (χ(2) = 25.881, 32.791, 34.011, 86.505, P < 0.05). In case group, 37 patients had neurogenic pulmonary edema, 26 patients got encephalitis, 15 patients had respiratory and circulatory failure, 7 patients got pulmonary hemorrhage, 4 patients had multiple organ failure, 4 patients got myocarditis and 1 patient had cerebral hernia. According to multi-factor logistic regression analysis, the early warning indicators of HFMD death included neck resistance (case group: 34.1% (14/41), control group: 4.1% (5/123); OR = 7.145, 95%CI: 1.748 - 29.204), vomiting (case group: 58.5% (24/41), control group: 13.8% (17/123); OR = 5.632, 95%CI: 1.793 - 17.685) and increase of heart rate (case group: 53.7% (22/41), control group: 10.6% (14/123), OR = 6.370, 95%CI: 1.517 - 26.743). CONCLUSION: In the process of clinical treatment and care, we should interfere the serious HFMD patients with neck resistance, vomiting and increase of heart rate, and thereby reduce the death from HFMD.

Human rabies epidemiology in Shandong Province, China.

Rabies has reemerged in China. National rabies surveillance is centralized and based mainly on six provincial stations, including one in Shandong Province, which are selected and monitored by the China CDC. Data collection includes human rabies cases (diagnosed by local hospitals on the basis of signs or symptoms), documentation of post-exposure prophylaxis, primary laboratory diagnosis of suspect animal cases, and investigation of dog or other animal bites in viral transmission. Of the 408 human rabies cases reported during the period 2003-2007, most involved middle-aged male farmers bitten by their own unvaccinated dogs, with a seasonal peak in the autumn. These data provide key pointers regarding rabies prevention and control based upon an objective evidence-based framework.