Unilateral acute idiopathic maculopathy related to hand-foot-mouth disease: Case report and literature review.

Unilateral acute idiopathic maculopathy (UAIM) is a rare disease that may cause unilateral vision loss in young adults after a flu-like illness. Occasionally, it is associated with hand-foot-mouth disease (HFMD) and is often underdiagnosed. Herein, we report a case with characteristics of UAIM associated with HFMD with acute enteroviral infection. On the basis of the clinical findings using multimodality diagnostic imaging, including fundus image, optical coherence tomography, fluorescence angiography, and serological test for pan-enterovirus RNA polymerase chain reaction, we detailed the clinical course and postulated the pathogenesis of UAIM with choroiditis associated with HFMD. This study could remind every doctor of the potential visual loss caused by UAIM in HFMD, and referring patients to the ophthalmologic survey is important to eliminate potential visual impairment.

Epidemiological and genetic characteristics of sapovirus clusters in Changzhou schools from 2019 to 2022 / 中国学校卫生

Objective@#To analyze the epidemiological characteristics and genetic characteristics of sapovirus (SaV) in a cluster of schools in Changzhou, so as to provide a reference for the treatment of clustered vomiting and diarrhea events in schools.@*Methods@#The epidemiological data and laboratory test data of sapovirus clusters in Changzhou from 2019 to 2022 were collected and analyzed. Partial VP1 genes of SaV positive samples were amplified and sequenced for phylogenetic analysis.@*Results@#A total of 8 cases of clusters of SaV epidemics were reported in Changzhou City from 2019 to 2022, with 118 reported cases. The total attack rate was 1.47%, and the median of the attack number was 15. There were 6 outbreaks in kindergartens and 2 outbreaks in primary schools, which were reported in the epidemic period from September to December. The main clinical manifestations were vomiting (113 cases, 95.76 %), abdominal pain (39 cases, 33.05%), and diarrhea (16 cases, 13.56%). Among the 8 outbreaks, 17 sample strains were successfully sequenced. 5 outbreaks were GII.3 , and the other 3 outbreaks were GI.1, GI .3 and GII.2. GI and GII were the main genotypes in this area, and GII .3 was the predominant strain.@*Conclusion@#SaV is an important pathogen in the clusters of vomiting and diarrhea in schools after the transmission of norovirus. Continuous surveillance of SaV should be carried out to further understand its epidemiological characteristics and genotype distribution, so as to provide scientific basis for the prevention and control of the epidemic in schools.

Association between Norovirus epidemics and school toilets design and management in Chengdu City / 中国学校卫生

Objective@#To analyze the relationship between the toilet design and sanitary condition of primary and secondary schools in Chengdu and the epidemic situation of Norovirus infection, so as to provide scientific references for school toilet design and Norovirus prevention and control.@*Methods@#A total of 78 cases of norovirus epidemics from 2019 to 2020 were included in this study. These epidemics happened in 78 schools and the causes were indicated as human-to-human transmission. The Chi square and Mann-Whitney U test were used to compare categorical and continuous data respectively. Unconditional binary Logistic regression was used to examine the multivariate associations.@*Results@#Most epidemics happened from October in 2019 to March in 2020(79.49%, 62 cases), in primary schools (71.79%, 56 cases) and in the center area (52.56%, 41 cases). The median of the case number in each epidemic was 10. Overall, 56 schools (71.79%) were equipped with toilets which were flushed independently, and 22 schools (28.21%) were equipped with toilets which were flushed uniformly. There were 27 schools (34.62%) that did not have enough water taps. Logistic regression analysis found that those with toilets flushed uniformly had a stronger epidemic, compared to the schools with toilets flushed independently( OR=5.53, 95%CI=1.63-18.76, P <0.05).@*Conclusion@#In order to prevent intestinal infectious diseases , it is suggested that schools should design or reconstruct independent flushing toilets with adequate faucets.

Investigation of an acute gastroenteritis outbreak caused by Norovirus infection in a university / 中国学校卫生

Objective@#To investigate an acute gastroenteritis outbreak caused by Norovirus, and to provide evidence for effective school infectious outbreak prevention and control.@*Methods@#In March 2019, basic information of Huzhou Normal University and related data of cases were collected. Epidemiological characteristics were analyzed. Anal swabs of the 10 cases were collected for laboratory detection. Case definitions, specific detection criteria and procedures were based on the Diagnostic Criteria for Infectious Diarrhea (WS 271-2007) and the Technical Guidelines for the Investigation, Prevention and Control of Outbreaks of Norovirus Infection (2015 edition).@*Results@#During March 15 to March 20, a total of 13 (12 girls and 1 boy) confirmed cases were reported, all of them were from the same class, with the incidence rate being 25.00% (1/4) and 37.50% (12/32) in boys and girls, respectively. No significant sex difference was found ( χ 2=2.05， P >0.05). Anal swab specimens of 10 students were collected from laboratory were positive for Norovirus GII and have an identity of 100%.@*Conclusion@#The gastroenteritis outbreak was deduced to be attributed to GII Norovirus infection, which are likely caused by fecal contamination through person to person contact. It is suggested that schools should strengthen knowledge education on the prevention and control of infectious diseases and improve the protection awareness and ability of teachers and students to protect them.

Circulation of enterovirus D68 (EV-D68) causing respiratory illness in New South Wales, Australia, between August 2018 and November 2019.

The incidence of enterovirus D68 (EV-D68) in New South Wales, Australia, is unknown. As part of a state-wide surveillance program, enterovirus positive diagnostic specimens were assessed from patients presenting to hospitals with respiratory and meningitis syndromes from August 2018 to November 2019. Diagnostic enterovirus positive samples were collected from 339 patients and re-extracted followed by targeted PCR across the whole EV-D68 genome (7.4 kb). Obtained amplicons (n=208) were sequenced using Illumina sequencing technology and the phylogenetic relationships analysed relative to EV-D68 Fermon strain. We identified EV-D68 in 31 patients, both children (n=27) and adults (n=4). Phylogenetically, the majority (n=30) were from subclade B3, the same as that causing outbreaks of EV-D68 across the USA and Europe during 2018. These data strengthen the importance of having an active enterovirus surveillance network.

Using the Acute Flaccid Paralysis Surveillance System to Identify Cases of Acute Flaccid Myelitis, Australia, 2000‒2018.

Since 2012, the United States has reported a distinct syndrome of acute flaccid paralysis (AFP) with anterior myelitis, predominantly in children. This polio-like syndrome was termed acute flaccid myelitis (AFM). Australia routinely conducts AFP surveillance to exclude poliomyelitis. We reviewed 915 AFP cases in Australia for children <15 years of age during 2000‒2018 and reclassified a subset to AFM by using the US Council of State and Territorial Epidemiologists case definition. We confirmed 37 AFM cases by using magnetic resonance imaging findings and 4 probable AFM cases on the basis of cerebrospinal fluid pleocytosis. Nonpolio enteroviruses were detected in 33% of AFM cases from which stool samples were tested. Average annual AFM incidence was 0.07 cases/100,000 person-years in children <15 years of age. AFM occurred sporadically in Australia before 2010 but regularly since then, indicating sustained, albeit rare, clinical manifestation in children. The AFP surveillance system in Australia is well-positioned to identify future AFM cases.

Epidemiological characteristics of 14 clusters and outbreaks of Norovirus infection in Nan an District of Chongqing in 2018 / 中国学校卫生

Objective@#To analyze of epidemiological and etiological characteristics of 14 norovirus clusters or outbreak in Nan an District, for comprehensive prevention and control measures for norovirus infections in the region.@*Methods@#Data were collected from the emergency public health event management information system of China Disease Prevention and Control Information System, and were analyzed by using descriptive epidemiological method.@*Results@#In 2018, 14 cases of norovirus infection clusters and outbreaks were reported in Nan an District, accounting for 63.64% of the total number of incidents in the region. A total of 268 cases were reported, with an average incidence of 2.19%; the outbreak occurred mainly in November(n=6); kindergartens reported the most outbreak(n=7), followed by primary schools(n=5); the median duration of the outbreak was 2.80 days; and 14 outbreaks were caused by the GII-type genome of norovirus, with the main transmission routes being human-to-hnuman transmission.@*Conclusion@#The prevalence of norovirus outbreaks tends to be higher in schools, it is necessary to strengthen the monitoring of vomiting and diarrhea symptoms in collective units such as schools, and efforts should be promoted for implementation of all levels of prevention and control measures in school.

Agentes infecciosos en muestras biológicas de pacientes con síndrome de Guillain-Barré en Perú, 2018-2019 / Infectious agents in biological samples from patients with Guillain-Barré syndrome in Peru, 2018-2019

RESUMEN Objetivo: Describir los resultados de los exámenes de laboratorio realizados en muestras biológicas de pacientes con síndrome de Guillain-Barré (SGB), recibidas en el Instituto Nacional de Salud (INS) entre los años 2018 y 2019. Materiales y métodos: Se realizó un estudio observacional en pacientes con SGB notificados en el sistema de vigilancia epidemiológica. Se obtuvieron muestras biológicas analizadas en el INS para investigar arbovirus, virus respiratorios, enterovirus y enterobacterias, entre otros. Resultados: Se recibió un total de 2051 especímenes clínicos de 906 pacientes con SGB. Tres pacientes dieron positivo al dengue y tres pacientes al Zika. En 19 pacientes, el cultivo en heces fue positivo para Campylobacter jejuni. El análisis filogenético de diez cepas de Campylobacter jejuni las clasificó como genotipo ST2993, reportado previamente en China y asociado a un brote de SGB. En 2018, hubo 12 muestras que habían dado positivo al PCR para enterovirus en el líquido cefalorraquídeo, pero ninguna pudo corroborarse con el cultivo respectivo ni con secuenciamiento de genoma completo. Un paciente dio positivo por virus de la influenza A, dos por virus de la influenza B, dos por adenovirus, cinco por virus respiratorio sincicial, y diez por rinovirus. Conclusión: Se han encontrado diversos agentes patógenos en especímenes de pacientes con SGB, sin embargo, la presencia de Campylobacter jejuni genotipo ST2993, un patógeno relacionado a brotes de SGB en varios continentes, sería el probable agente causal. Es necesario confirmar esta hipótesis con estudios analíticos y determinar la cadena de transmisión de este agente para implementar las medidas de prevención y control.

ABSTRACT Objective: To describe the results of laboratory tests performed on biological samples from patients with Guillain-Barré syndrome (GBS) submitted to the Instituto Nacional de Salud (INS) between 2018 and 2019. Materials and methods: We conducted an observational study on patients with GBS, by using data from the epidemiological surveillance system. Biological samples, previously analyzed at the INS, were obtained to study arboviruses, respiratory viruses, enteroviruses and enterobacteria, among others. Results: A total of 2,051 specimens were obtained from 906 patients with GBS. Three patients tested positive for dengue and three for Zika. In 19 patients, the stool culture was positive for Campylobacter jejuni. Phylogenetic analysis of 10 Campylobacter jejuni strains classified them as genotype ST2993, which was previously reported in China and associated to a GBS outbreak. Twelve cerebrospinal fluid samples tested positive for enterovirus by PCR in 2018, but none could be verified by culture or complete genome sequencing during the study. One patient was positive for influenza A, two for influenza B, two for adenovirus, five for respiratory syncytial virus, and ten for rinovirus. Conclusion: Several pathogens were found in samples from patients with GBS. However, we found that the genotype ST2993 of Campylobacter jejuni was the most likely causal agent, a pathogen that is related to GBS outbreaks in different continents. It is necessary to confirm this hypothesis with additional analytical studies and it is important to describe the transmission mechanism of C. jejuni genotype ST2993 in order to implement prevention and control measures.

Enterovirus D68-Associated Acute Flaccid Myelitis, United States, 2020.

Acute flaccid myelitis (AFM) is a serious neurologic condition that causes limb weakness or paralysis in previously healthy children. Since clusters of cases were first reported in 2014, nationwide surveillance has demonstrated sharp increases in AFM cases in the United States every 2 years, most occurring during late summer and early fall. Given this current biennial pattern, another peak AFM season is expected during fall 2020 in the United States. Scientific understanding of the etiology and the factors driving the biennial increases in AFM has advanced rapidly in the past few years, although areas of uncertainty remain. The Centers for Disease Control and Prevention and AFM partners are focused on answering key questions about AFM epidemiology and mechanisms of disease. This article summarizes the current understanding of AFM etiology and outlines priorities for surveillance and research as we prepare for a likely surge in cases in 2020.

The Epidemiological and Clinical Characteristics of Hand, Foot, and Mouth Disease in Hangzhou, China, 2016 to 2018.

Hand, foot, and mouth disease (HFMD) is most frequently caused by several serotypes of human enterovirus (EV) including Enterovirus 71 (EV-A71), coxsackievirus A16 (CV-A16), or other types of EV. The aim of this study was to determine the epidemiological characteristics of HFMD and to describe the epidemiologic characteristics of HFMD among severe and mild cases. We collected 4760 HFMD cases in Hangzhou from 2016 to 2018. Specimens from these cases were collected and tested for EV-A71, CV-A16, CV-A6, CV-A10, CV-A2, and CV-A5 by reverse transcriptase polymerase chain reaction. From 2016 to 2018, the prevalence of HFMD was seasonal each year. Among the 4760 probable HFMD cases, 3559 cases were confirmed (74.8%), including 426 cases of EV-A71 infections (8.9%), 249 cases of CV-A16 infections (5.2%), and 2884 cases of other EV infections (60.6%). The percentage of other EV infections was more than 80%, which increased year by year. Random selection of samples for detection of other EV infections in 2017 and 2018, among the 1297 cases, showed there were 835 (64.4%) cases of CV-A6 infections, 177 (13.6%) cases of CV-A10 infections, 100 (7.7%) cases of CV-A2 infections, 40 (3.1%) cases of CV-A5 infections, 3 (0.02 %) cases of mixed infections, and 11.0% untyped EV infections. Preschool children were still the primary population susceptible to HFMD. In severe cases, EV-A71 infection was the main cause. Characterizing the epidemiology and the relationship between severe and common cases of HFMD would provide relevant evidences for the prevention and treatment of HFMD.

Determinants of awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region, Guangdong / 中国学校卫生

Objective@#To investigate factors associated with awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region，to provide evidence for Norovirus outbreaks prevention and control.@*Methods@#A total of 320 primary and middle school staffs from 48 schools in 3 cities in the pearl river delta region were selected by multistage quota random sampling method and were interviewed face to face with questionnaire about knowledge of Norovirus and prevention and control of Norovirus outbreaks.@*Results@#The awareness rate of Norovirus knowledge and prevention and control of Norovirus outbreaks among primary middle school and the total school staffs in the pearl river delta region were 35.37%,57.63% and 48.42%,respectively. The results of univariate analysis showed that the awareness rate of prevention and control of Norovirus outbreaks was significantly affected by duties, the total awareness rate among teachers(OR =0.22，95%CI=0.09-0.55),cooks(OR=0.09，95%CI=0.04-0.23)and cleaners(OR=0.02，95%CI=0.00-0.07)were far lower than school doctors(P<0.05).@*Conclusion@#The awareness of prevention and control of Norovirus outbreak among primary and middle school staffs in the Pearl River Delta region was needed to be improved. Valid implements, such as operation procedure, to build up prevention and control capability should be carried out that focus on specific job responsibilities.

Analysis of the duration of Noravirus shedding among infected kindergarten children during an outbreak / 中国学校卫生

Objective@#To investigate the duration of Norovirus (NoV) shedding among infected school children during a NoV outbreak in a kindergarten,and to provide scientitic basis for epidemic prevention and control.@*Methods@#Specimens and epidemiological data were collected from suspected cases, and specimens were detected using real-time RT-PCR to determine whether or not infecting with NoV. Specimens were collected every 3-7 days from NoV-infected children until specimens became negative for NoV.@*Results@#A total of 14 suspected cases were reported, and 12 of them were infected with NoV. The average duration of NoV shedding was (26.58±17.94)d. The specimens among 9 from 12 Nov-infected cases were positive at 7 days, 8 NoV-intected cased remained positive at 14 days and 7 Non-infected cased at least 21 days.@*Conclusion@#Since NoV shedding duration among NoV-infected children tends to longer than their isolation time during outbreaks, reinforcement of hygiene practices among these school children is especially necessary to reduce the risk of virus secondary transmissions after their return to school.

Epidemiological characteristics and influencing factors of Norovirus outbreaks in primary and secondary schools in Haidian District, Beijing,2015-2018 / 中国学校卫生

Objective@#To analyze the epidemiological characteristics and influencing factors of norovirus aggregation in primary and secondary schools in Haidian District of Beijing from 2015 to 2018,and to provide scientific basis for the prevention and control of school aggregation epidemic situation.@*Methods@#An epidemiological method was used to analyze the epidemic characteristics of norovirus aggregation in the primary and secondary schools in Haidian District of Beijing from January 2015 to December 2018. Multivariate Logistic was used to analyze the influencing factors of norovirus aggregation.@*Results@#A total of 74 cases of norovirus aggregation in primary and secondary schools in Haidian District of Beijing from 2015 to 2018 were reported, involving 52 primary and secondary schools. Totally 1 291 suspected cases and a median of 12.5 cases of single epidemic were reported. Winter and spring were high incidence season. There was significant difference in the incidence rate of epidemic situation in primary and secondary schools(χ2=98.82, P<0.01). There was significant difference in the incidence rate between men and women(χ2=55.56, P<0.01). A total of 648 samples and 486 positive samples were collected, with a positive rate of 75.00%, mainly GⅡ virus, accounting for 87.45%. Multivariate Logistic regression showed that the scale of school(>2 000，1 000~2 000), student’s hand hygiene habit,requirement for medical care after the outbreak is the influence factor of the outbreak(OR=3.78，2.95，8.25，2.88).@*Conclusion@#Poor hand hygiene habits are the most important risk factors for the outbreak, so schools and parents should cultivate children to develop good hygiene habits of washing hands before and after meals, and timely isolation of cases found in schools is also an important measure to prevent and control the epidemic.

Estimated economic burden of disease of Norovirus gastroenteritis of schools in the Pearl River Delta Region / 中国学校卫生

Objective@#This study aims to estimate the economic burden of disease of outbreak of norovirus gastroenteritis in the Pearl River Delta Region, and provide scientific evidence for the government’s decision-making and control measures.@*Methods@#Using a unified questionnaire, a survey was conducted to the schools and students’ families which had suffered an outbreak of norovirus gastroenteritis in the Pearl River Delta Region from October 2017 to April 2018.@*Results@#The survey found that the mean total economic burden of sick students was 720.41(95%UI=640.45-804.63)RMB. The mean economic burden of sick students who were inpatient, outpatient and self-treatment were 1 712.75(95%UI=328.50-34 00.00), 213.70(95%UI=191.83-236.33) and 58.97(95%UI=43.00-77.69)RMB, respectively. The mean economic burden of transport, extra tutoring and cost of lost labor were 53.63(95%UI=43.98-63.58), 558.49(95%UI=381.40-774.01) and 695.62(95UI=630.25-767.29)RMB. The mean total economic burden of health students was 382.62(95%UI=343.29-424.45)RMB. The mean total economic burden of school was 49 264.53(95%UI=22 363.38-79 976.25)RMB. The total economic burden of disease increases as the level of outbreak increases. The larger the epidemic level, the proportion of sick students’ financial burden gradually decreased, 56.58%,23.27% and 10.93%.@*Conclusion@#The high economic burden of disease of norovirus gastroenteritis in the Pearl River Delta Region, respectively, indicating that relevant departments should strengthen the prevention, control and education in order to mitigate the disease economic burden.

Analysis on epidemiological and etiology characteristics of 34 aggregation epidemics induced by Norovirus infection / 中国学校卫生

Objective@#To analyze the epidemiological and etiological characteristics of aggregation epidemics of infectious diarrhea induced by norovirus, and to provide the scientific basis for the prevention and control.@*Methods@#A descriptive epidemiological analysis of aggregation epidemics events occurred during 2016-2018 in Longhua District of Shenzhen was carried out, with subtypes identified by real-time fluorescence quantitative PCR, Region B and Region C fragment sequence determination.@*Results@#There were 34 aggregation epidemic events,including 448 cases, the mean attack rate was 18.26%(448/2 454). The median duration of aggregation epidemic was 3 days. The peak season appeared in autumn and winter, and the peak of epidemic emerged from December 2016 to April 2017. About 91.18% (31/34) of the epidemics occurred in schools and child care centers, and among children aged 3-6 years (78.79%, 353/448). The clinical symptoms were mainly nausea and vomiting (95.77%, 408/426) in children and adolescents but diarrhea in adult group (95.45%, 21/22). The differences between vomiting and diarrhea were both statistically significant in the two age groups (χ2=98.89，99.61，P<0.01). 29 cases were transmitted through interpersonal network, of which 21 cases were found to have unregulated treatment of vomit on campus. The detection rate of biological samples was 49.15% (203/413), all of which were G Ⅱ norovirus. The genotype was mainly GⅡ.P16-G Ⅱ.2(n=49)from November 2016 to April 2017.@*Conclusion@#Norovirus can cause large-scale outbreaks in child care centers and schools easily. Early standardized patient isolation and proper management of vomit and diarrhea are the key steps in prevention and control measures.

[Clinical analysis of 555 outpatients with hand, foot and mouth diseases caused by different enteroviruses].

Objective: To study the clinical characteristics of outpatients with hand, foot and mouth disease (HFMD) caused by different serotypes of enteroviruses. Methods: This was a prospective study. From February 2017 to March 2018, 563 outpatients with HFMD were enrolled by systematic sampling in the Department of Infectious Diseases, Henan Children's Hospital. Throat swabs were collected to determine the serotypes via PCR. Demographic, clinical, and laboratory data were collected by standard questionnaire. All cases were followed up twice at 2 and 9 weeks after the initial outpatient visit through telephone interview. A total of 563 cases were enrolled and 555 (98.6%) cases were positive for human enteroviruses, including 338 (60.9%) males. Analyses were stratified by enterovirus serotypes, Chi square test or Fisher's exact test, Rank sum test was used for comparison among different groups. Results: The age of 555 cases was 24.2 (16.4, 41.3) months. Among them 44.0% (224 cases) were identified as coxsackievirus (CV)-A6, while 189 cases, 35 cases, 14 cases and 73 cases were identified as CV-A16, enterovirus (EV)-A71, CV-A10 and other serotypes, respectively. Fever (≥37.5 ℃) was present in 51.4% (285/555) of laboratory confirmed cases. The proportions of fever in cases of CV-A6 (68.9%(168/244)) and CV-A10 (12/14) were significantly higher than those in cases of CV-A16 (31.7%(60/189),χ(2)=57.344,14.313,both P=0.000), other serotypes (43.8%(32/73),χ(2)=15.101 and 8.242, P=0.000 and 0.004) and EV-A71 (37.1%(13/35), χ(2)=13.506 and 9.441, P=0.000 and 0.002) respectively. There was no significant difference between CV-A6 and CV-A10 in presentation of fever (χ(2)=1.785, P=0.182). There were 359 cases (64.7%) with eruptions in mouth, hands, feet and buttocks. Cases infected with EV-A71 had the highest proportions (74.3%(26/35)) of rash emerging simultaneously in mouth, hands, feet, and buttocks. The proportion in cases of CV-A16, CV-A6, CVA10 and other serotype were 73.5% (139/189), 61.9% (151/244), 7/14 and 49.3% (36/73), respectively. The proportion of rash on other parts of body, such as face, limbs or torso in cases infected with CV-A6 (16.8% (41/244)) was the higherest and the proportion in cases of CV-A16, EV-A71, CV-A10 or other serotypes were 8.5% (16/189) , 5.7% (2/35) , 1/14, 6.8% (5/73) , respectively. None of these cases developed serious complications. Desquamation occurred in 45.5% (179/393) cases 7.5 (5.0, 9.0) days after disease onset and 13.5% (53/393) cases showed onychomadesis 31.0 (18.0, 33.5) days after disease onset. The proportion of desquamation and onychomadesis associated with CV-A6 (64.2% (95/148) and 31.8% (47/148)) was significantly higher than CV-A16 (31.8% (49/154) and 1.3% (2/154), χ(2)=33.601 and 52.482, both P=0.000) and other serotypes (38.0%(19/50) and 6.0%(3/50),χ(2)=10.236 and 12.988, P=0.001 and 0.000). Desquamation appeared more in cases of CV-A6 than in cases of CV-A10 (2/11,χ(2)=9.386, P=0.002), with the proportion of onychomadesis higher in CV-A6 than in EV-A71 (3.3% (1/30),χ(2)=11.088, P=0.001). Conclusion: Clinical manifestation such as fever, rash emerging parts, desquamation and onychomadesis are different among outpatient HFMD cases infected with CV-A16, CV-A6, EV-A71, CV-A10 and other enteroviruses.

Enterovirus A71 vaccine effectiveness in preventing enterovirus A71 infection among medically-attended hand, foot, and mouth disease cases, Beijing, China.

INTRODUCTION: Enterovirus A71(EV-A71)-associated hand, foot, and mouth disease (HFMD) has been reported worldwide, and poses a particularly heavy burden on patients, families, and society in China. Three Chinese companies have licensed inactivated EV-A71 vaccines, all of which have demonstrated good efficacy for preventing EV-A71-associated disease in clinical trials. However, real-world performance of EV-A71 vaccine has not been evaluated. METHODS: We used a test-negative design case-control study to estimate vaccine effectiveness (VE) against medically attended EV-A71-associated HFMD. Subjects were children 5 years of age and under who had been in health facilities participating in the HFMD case and virologic surveillance platforms in Beijing. Enterovirus infections were laboratory confirmed, and EV-A71 vaccination status was extracted from electronic immunization records. Children testing positive for EV-A71 were cases; controls were children testing negative for EV-A71 infection. Logistic regression was used to estimate VE. We assessed sensitivity of VE estimates to control group inclusion criteria by repeating the regression analyses with two alternative control groups. RESULTS: A total of 2,184 HFMD patients aged 5 years and under were enrolled in the study; 24 were severe, and 2,160 were mild. For severe cases, two-dose VE estimate was 100% (95% CI: -68.1%, 100%). For mild cases, 1-dose and 2-dose adjusted VE estimates were 69.8% and 83.7%, respectively. Two-dose VE estimates varied by less than 4 percentage points regardless of control group definition. CONCLUSIONS: Our findings suggested the vaccines performed well in the real world for children 5 years of age and under in Beijing, China.

Epidemiologic characteristics of Norovirus outbreak in schools and kindergardens in China during 2014-2018 / 中国学校卫生

Objective@#To investigate the epidemiological characteristics of norovirus clustering and outbreaks in schools and kindergartens in China, so as to provide references for prevention and control of outbreaks.@*Methods@#A descriptive epidemiological method was used to analyze outbreaks of Norovirus in schools and kindergartens in China during 2014-2018 , the indicators which was analyzed and compared including attack rate, duration of the outbreak, reporting interval.@*Results@#A total of 832 Norovirus outbreaks were reported by schools and kindergartens in China from 2014 to 2018. The total number of outbreaks showed an upward trend with an average annual growth rate of 58%. The number of reported cases was 40 445 but there was no death. Norovirus outbreaks mainly occurred in primary schools (42%), followed by kindergartens and middle schools (both 24%), university (6%) and 77 outbreaks (4%) were reported in universities and other schools. The peak seasons were March to May, November and December each year. Jiangsu Province and Guangdong Province (both 22%) reported the largest number of outbreaks. The main transmission of norovirus outbreaks was through direct person contact (72%), foodborne (4%) and waterborne (3%) caused fewer outbreaks than direct person contact. The duration of the epidemic was positively correlated with the reporting interval (r=0.63, P<0.05) and the number of cases per outbreak (r=0.51, P<0.05).@*Conclusion@#Disinfection treatment of vomitus should be standardized in schools and kindergartens. Timely detection, reporting, disposal of the epidemic can effectively control the spread of norovirus outbreaks.

Relationship between hs - CRP and the etiology of children with hand - foot - and - mouth disease / 中国基层医药

Objective To explore the relationship between hs - CRP and the etiology of children with hand- foot - and - mouth disease(HFMD). Methods A total of 1156 laboratory - confirmed children diagnosed with HFMD by pathogenic detection(detection methods include EV71 - CA16 IgM antibody detection and universal real -time fluorescent quantitative RT - PCR detection of enterovirus nucleic acid EV71/ CA16/ EV) in the Children′s Hospital of Hangzhou were involved in the research from September 2014 to July 2016. The hs - CRP levels in the early days(≤5 days) were recorded,and all data were analyzed with SPSS16. 0. Results Of all the 1156 cases,there were 642 cases with hs - CRP level more than 10mg/ dL,of whom 37 cases were infected by EV71(5. 8％ ),552 cases were infected by EV(86. 0％ ),53 cases were infected by CA16(8. 2％ ). In 514 cases with hs - CRP level less than 10mg/ dL,of whom 298 cases were infected by EV71(58. 0％ ),152 cases were infected by EV(29. 6％ ),64 cases were infected by CA16(12.4％). Of cases with hs - CRP >10mg/ dL,EV universal type got a significantly higher rate,with statistically significant difference(P < 0. 05). Of cases with hs - CRP < 10mg/ dL,EV71 got a significantly higher rate,with statistically significant difference(P < 0. 05). Conclusion The higher the hs - CRP level of the HFMD,the higher infection rate of EV. The lower the hs - CRP level of the HFMD,the higher infection rate of EV71.