Economic burden of measles and its influencing factors in Fujian, China.

BACKGROUND: Measles is a highly-contagious, serious diseases that can lead to potentially fatal illness, disability and death . We conducted an investigation to calculate the economic burden of measles cases from 2018 to 2019 and to analyze factors that influenced the total costs of measles cases in Fujian Province, China. METHODS: We investigated confirmed cases of measles by telephone interview, from 2018 to 2019, including demographic characteristics, therapeutic measures, self-treatment and nutritional supplement expenditure, transportation fees, and lost wages. Medical expenses in the hospitals were obtained from the hospital service charge system. RESULTS: A total of 131 measles cases were investigated, the average direct cost, indirect cost, and total cost were $518, $284, and $802, respectively. The total cost was 15.5% of Annual Per Capita Disposable Income of Households ($5 162) in Fujian. Hospitalization (OR = 98.6, 95%CI: 21.1 ~ 460.6) and complication (OR = 8.7, 95%CI: 1.3 ~ 58.0) significantly influenced the total cost according to binary logistic regression, and an outbreak of measles may pose a significant threat to household finances in a short term. CONCLUSIONS: The economic burden of measles was high when compared with Annual Per Capita Disposable Income of Households. The resurgence of measles and measles outbreaks increased economic burden of household finances.

Knowledge, attitudes, and practices regarding hepatitis B vaccination among hospital-based doctors and nurses in China: Results of a multi-site survey.

BACKGROUND: Hepatitis B virus (HBV) can cause chronic HBV infection, which may lead to advanced cirrhosis and liver cancer. Healthcare workers (HCWs) are at risk HBV infection as an occupational hazard. Hepatitis B vaccination of HCWs is recommended by WHO, but the status of hepatitis B vaccination among HCWs in China is seldom reported. METHODOLOGY: We conducted a cross-sectional study in 22 hospitals of 3 developed cities in China. We interviewed managers in infectious diseases and occupational health departments, and at least 40 HCWs per hospital. RESULTS: We interviewed 929 HCWs; 80.8% were vaccinated against hepatitis B and 96.7% were willing to be vaccinated; 38.2% of HCWs reported having at least one needle stick or sharps injury. Three hospitals provide free hepatitis B vaccination for HCWs; hospitals with a hepatitis B vaccination policy, more HCWs reported being vaccinated (91.7% vs 79.0%, P < 0.001). HCWs in high risk departments (P = 0.011), with more knowledge of hepatitis B vaccine (P < 0.001), and with fewer working years (P = 0.002) were more likely to be vaccinated against HBV. Infectious diseases and occupational health managers had positive attitudes towards hepatitis B vaccination. CONCLUSIONS: Hepatitis B vaccination was well accepted among HCWs. Hospital provision of free vaccine, greater HCW knowledge of HBV, and working in higher-risk settings were associated with being vaccinated. A national policy of offering hepatitis B vaccine to HCWs should be considered in China. Provision of free hepatitis B vaccine for HBsAb negative HCWs may be acceptable. Education about HBV and hepatitis B vaccine may help promote policy implementation.

Transmission of measles among healthcare Workers in Hospital W, Xinjiang Autonomous Region, China, 2016.

BACKGROUND: As China approaches the elimination of measles, outbreaks of measles continue to occur. Healthcare workers (HCWs) are known to be at high risk of infection and transmission of measles virus. A measles outbreak occurred in a hospital in Xinjiang Uighur Autonomous Region of the People's Republic of China. We report an investigation of this outbreak and its implications for measles elimination and outbreak preparedness. METHODS: We conducted a retrospective search for measles cases using hospital records. Information on cases was collected by interview, and was used to determine epidemiological linkages. We surveyed HCWs to determine their demographic characteristics, disease history and vaccination status, and knowledge about measles. RESULTS: We identified 19 cases, ages 18 to 45 years, in Hospital W between December 2015 and January 2016; 14 were laboratory-confirmed, and 5 were epidemiologically linked. The primary case was a 25-year-old neurology department nurse who developed a rash on 22 December 2015 that was reported on 11 January 2016. She continued working and living with her workmates in a dormitory during her measles transmission period. Among the 19 infected HCWs, 2 had received a dose of measles-containing vaccine (MCV) before the outbreak, and 16 had unknown vaccination status. Outbreak response immunization activities were started on 8 January in a non-selective manner by offering vaccine regardless of vaccination history; 605(68%) of 890 HCWs were vaccinated. The HCW survey had a 73% response rate (646/890); 41% of HCWs reported that they had received MCV before outbreak, and 56% exhibited good knowledge of measles symptoms, transmission, complications, and vaccination. CONCLUSIONS: Low MCV coverage, low measles knowledge among HCWs, delayed reporting of measles cases, and absence of proper case management were associated with this outbreak. Training and vaccinating HCWs against measles are essential activities to prevent measles virus transmission among HCWs.

Assessment of mumps-containing vaccine effectiveness during an outbreak: Importance to introduce the 2-dose schedule for China.

INTRODUCTION: China has used 3 different mumps-containing vaccines (MuCV) since 1990: monovalent mumps vaccine, measles-mumps (MM) vaccine, and measles-mumps-rubella (MMR) vaccine, and one dose MuCV (using MMR at 18 months) has been included in the EPI since 2007. MuCV effectiveness has been of concern following large-scale mumps outbreaks. In 2015, an outbreak of mumps occurred in a primary school, which allow us assess vaccine effectiveness of different MuCVs. METHOD: All children in the school were studied as a retrospective cohort. Vaccination histories and case information were obtained from vaccination records and clinic/hospital logs. Parental questionnaires were used to confirm students' illnesses and calculate attack rate (AR). VE was assessed using the formula, VE = (AR in unvaccinated students- AR in the vaccinated students) / (AR in unvaccinated students). VEs of different type of MuCV were compared. RESULTS: In total, 283 students were identified as clinical mumps among the 2370 students, and 1908 students were included for MuCV VE assessment. 213 (including 21 [8.9%] patients) were 2-dose MuCV recipients (AR: 9.9%), 1165 (including 123 [51.9%] patients) were 1-dose recipients (AR: 10.6%), and 530 (including 93 [39.2%] patients) were unvaccinated (AR: 17.5%). VE was 44% for 2 doses and 40% for one dose. For one-MuCV-dose students, estimated mumps VE was 63% for vaccinated within 3 years (between vaccination and this outbreak); 50% for vaccinated within 3 to 5 years; and 34% for vaccinated more than 5 years. Comparing VE by vaccine type and 5-year interval since vaccination, VE for MMR was 60%, which was consistently higher than VE for monovalent mumps vaccine (22%) and MM (2%). CONCLUSION: This outbreak was associated with low and declining 1-dose MuCV effectiveness. China's immunization program should evaluate the potential of a 2-dose MMR schedule to adequately control mumps.

Zika virus infection in travelers returning from countries with local transmission, Guangdong, China, 2016.

BACKGROUND: Zika virus (ZIKV) is a mosquito-borne virus spreading rapidly in the Americas, Africa, and Asia. No indigenous ZIKV infection had been seen in China. We monitored ZIKV infection among travelers returning to Enping county from ZIKV transmitting countries from 1 March to 10 April 2016. METHODS: We analyzed data including interviews; conducted laboratory test on blood, urine, saliva, conjunctival swab or semen specimens for evidence of ZIKV infection; evaluated household for presence of Aedes mosquitoes or larvae. RESULTS: A total of 925 individuals were screened, 507 (54.8%) were interviewed, 400 (43.2%) provided samples, of which 13 (3.3%) tested positive for ZIKV including 3 asymptomatic. Rash, conjunctivitis, sore throat, fever were the common symptoms; rash was more pronounced in adults than in children. ZIKV RNA was detected for 1-4 days in blood, but longer in urine and saliva (3-32 days and 2-10 days). Among interviewed, 57.0% had good knowledge about ZIKV, 45.8% were worried about ZIKV, 99.2% would go to hospital if they had infection. Aedes mosquitoes or larvae were detected in townships of infected returners. CONCLUSIONS: ZIKV was imported to China. Screening by symptoms alone is inadequate for detecting ZIKV infection. ZIKV surveillance, health-education, and vector control are necessary to decrease risk of ZIKV transmission.

Comparative studies on the increase of uterine weight and related mechanisms of cadmium and p-nonylphenol.

The research was designed to compare the effect of cadmium and p-nonylphenol on the increase of uterine weight and to study the related mechanisms. It provided basic evidence for us to understand the possible different mechanisms among different EEDs. In this study, both ovaries of 60 Wistar rats (28 days age) were ectomized, and after 21 days recovery, the rats were randomly assigned into six groups and exposed to cadmium (0.12, 1.20mg/kg), NP (100, 200mg/kg), control (sterile PBS), and positive control (17beta-estradiol) per day for 3 days, respectively, then related indexes were detected. The results showed that the increase of uterine weight induced by cadmium was accompanied by the increase of the thickness of luminal epithelium cell and endometrium but the decrease of nuclear/cytoplasm of luminal epithelium cell and endometrium, while the increase of uterine weight induced by p-nonylphenol was accompanied by the increase of the thickness of luminal epithelium cell, endometrium, and myometrium but the decrease of nuclear/cytoplasm of luminal epithelium cell and endometrium. Cadmium could inhibit the positive expression of PCNA while p-nonylphenol prompted it. Exposure to cadmium and NP both could also stimulate phosphorylation of ERK mitogen-activated protein kinases, implying that this signal pathway had an effect on the increase of the uterine weight induced by cadmium and p-nonylphenol. The results indicate that cadmium may induce the increase of uterine weight, which is accompanied with toxic effect on endometrium, while NP's effect of the increase of uterine weight is due to cell proliferation of endometrium, the mechanisms of which are the same as estrogen, but they may both activate ERK signal pathway.

Effect and mechanism of cadmium on the progesterone synthesis of ovaries.

The paper presents results of the effect of cadmium on the progesterone synthesis of ovaries. In the current study, we investigated whether Cd also disrupts progesterone synthesis via steroidogenic acute regulatory protein (StAR) and P450 cholesterol side-chain cleavage (P450scc), which play important roles in progesterone synthesis. The Wistar rats were exposed to cadmium in vivo (at 2.5, 5, 7.5mg/kg, as a single s.c. dose). We showed that the serum P(4) and granule cells P(4) of rats were significantly lower than control group. Ovaries granule cells were incubated in Dulbecco-modified Eagle medium +15% fetal bovine serum with 0, 10, 20, or 40 microM CdCl(2) in vitro, progesterone levels were declined in a dose-dependent manner. Our data showed that the expression of StAR and P450scc in vivo or in vitro were inhibited when treated with CdCl(2) (p<0.05). Coculture with 8-bromo-cAMP enhanced progesterone secretion in untreated cultures and reversed the decline in progesterone secretion induced by CdCl(2) treatment; the expression of StAR mRNA and P450scc mRNA in 8-Br-cAMP+40 microM CdCl(2) were significantly higher than 40 microM CdCl(2), and were lower than control group. We concluded that StAR, which delivers cholesterol to the inner mitochondrial membrane, is one site at which Cd interferes with progesterone production in cultured rats ovarian granule cells; P450scc, which conveys cholesterol to pregnenolone, is anther site. The mechanisms were mainly controlled by the cAMP-dependent pathway.