[Clinical and epidemiological characteristics of the 6 confirmed human cases with novel influenza A (H7N9) virus infection in Zhejiang].

OBJECTIVE: To explore the clinical spectrum, geographic location of human H7N9 avian influenza as well as the characteristics of population at high risk of infection, in order to develop strategies for the prevention and control of the infection. Clinical and epidemiological characteristics on the 6 confirmed human cases in Zhejiang were also analyzed. METHODS: Real-time fluorescent quantitative PCR was used to test the nucleic acid of human H7N9 avian influenza infection, from pharyngeal swabs of the patients and their close contacts. Face to face interview and descriptive method were used to collect related clinical and epidemiological data. Statistical analysis was performed by SPSS 17.0. RESULTS: Six confirmed cases were distributed in Hangzhou and Huzhou cities. The 6 confirmed human cases, including 5 males and 1 female were all confirmed with novel influenza A (H7N9) virus infection, with an average age as 60.83 years (with median as 64.50 years). Cough was the most common initial symptom to be noticed. The clinical manifestations would include fever, dizziness, pain of muscles, coughing, expectoration and short of breath. All the X-ray chest films showed severe pneumonia, and 5 of them having had other chronic diseases. None of the cases admitted to have had a history of exposure to ill/death avians. However, all of the cases had been frequently exposed to the agricultural-byproduct-trading-markets where the positive rate of novel influenza A (H7N9) virus in environmental specimens was up to 43.21%. 32 of the 375 close contacts (8.53%) to the 6 cases appeared abnormal symptoms, but no positive result related to novel influenza A (H7N9) virus nucleic acid was detected from their throat swabs. CONCLUSION: Acute infection on the respiratory system seemed the main clinical manifestation. Elderly men, especially those with chronic diseases were under high risk of human infection with H7N9 avian influenza. The source of infection might be associated with the exposure to poultry. There was still lack of evidence to confirm the route of person to person transmission on H7N9 avian influenza.

[Retrospective analysis of clinical and epidemiological characteristics of hand-foot-and-mouth disease deceased cases in Zhejiang Province].

OBJECTIVE: To understand the clinical and epidemiological characteristics of hand-foot-and-mouth disease (HFMD) deceased cases. METHOD: Information of demographics, diagnosis and treatment, clinical symptoms and signs, laboratory test results, and epidemiological contact history of 72 HFMD cases who died between May 2008 and September 2011, in Zhejiang Province, were collected and analyzed. RESULT: The average age of the 72 cases was 1.8 years, 45 were males, accounting for 62.5%, 63 (87.5%) of the cases were scattered children. Eighteen counties reported 2 or more deaths, accounting for 46.1% (18/39) among the counties where the deaths were reported. The deaths occurred mainly in April to August, the peak occurred in May and June. Fever (98.4%, 63/64) and rash (95.1%, 58/61) were the most common symptoms, but the rash was not obvious at the first diagnosis. Fever occurred before the rash (79.0%, 49/62), persisted for 4 days in average. Vomiting (71.9%, 46/64), dyspnea (65.6%, 42/64), cyanosis (53.1%, 34/64) and impaired consciousness (51.6%, 33/64) were often seen among the cases; 53.1% (34/64) cases went to see the doctor on the first day, but 82.5%(52/63)cases were misdiagnosed. Time to diagnosis of HFMD was in average 3 days. About 3 to 4 days after the onset, the disease deteriorated sharply, deaths occurred within 1 day after admission in 78.9%(45/57)of the deceased cases; 85.0% (34/40) cases had high white blood cells level, mainly neutrophils increased, the ratio of neutrophil was more than 70% in 55.6% (15/27) of cases. Enterovirus 71 (EV71) infection was found in 93.3% (56/60) cases, the deceased cases often died of pulmonary hemorrhage (42.9%, 21/49) and encephalitis (34.7%, 17/49). The sanitary conditions of the cases' family were poor (65.5%, 36/55), but 73.3% (33/45) cases had no exposure history. CONCLUSION: The HFMD deceased cases were mostly younger aged boys, scattered children, nonlocal-residents, and had poor sanitation. They were often infected with EV71, had high fever but had no typical rash, no clear exposure history, they had increased leukocyte, and were often misdiagnosed. Three or 4 days after onset, the disease deteriorated abruptly, most cases died within 1 week after onset. To decrease the HFMD mortality, early detection of severe cases should be stressed, and relative measures should be taken. The guardian should be aware of having good sanitary situation and healthy habits.

[Etiological and molecular-epidemiological analysis on enterovirus associated encephalitis in Zhejiang, 2008-2012].

OBJECTIVE: In order to investigate etiology and molecular-epidemiological characteristics of enterovirus associated encephalitis (EAE) in Zhejiang, 2008-2012. Method Cerebrospinal fluid and stool specimens were collected from suspected EAE patients, who were admitted to our hospitals. RD and Hep-2 cell lines were used to isolate enterovirus (EV). Serotypes of these EV isolates were identified through neutralization test by using serotype specific anti-sera. VP1 genes of these isolates were sequenced, compared and used for the construction of phylogenetic tree. RESULTS: 127 (20.6%) human enterovirus (HEV) strains were isolated from 616 samples, which were collected from 610 patients. Serotypes of these EV isolates, including 60 coxsackievirus (CV), and 67 Echovirus (E)appeared to be CVA9, CVB1, CVB3-5, E3, E4, E6, E9, E14, E25 and E30, respectively. Predominant EV serotypes on EAE from 2008 to 2012 were seen as CVB3, CVB5, E6, E30 and E30, respectively. The full length of VP1 genes from different EV isolates was between 834 and 918 nucleotides. The VP1 gene similarities between these isolates and the reference strains were from 76.7% to 85.0% (nucleotides level) and 91.1% to 97.9% (amino acids level). The VP1 genes from E6 serotype isolates appeared most diverged, reaching 20.4% (nucleotides level) and 4.8% (amino acids level). Based on the generated phylogenetic tree, all the EV isolates were fallen on the same branch of HEV-B, and the isolates in the same serotype formed one sub-branch, suggesting there existed geographical and temporal effects. E6 isolates diverged into two branchlets. CONCLUSION: EVs from HEV-B were the etiologic agents for EAE in Zhejiang province from 2008 to 2012. All these EV isolates showed 12 serotypes, with predominant isolates varied every year. E30 was determined as the most dominant serotype while serotype E6 diverged into two sub-gene types.

[Investigation on vibrio cholera carried in aquatic products of littoral areas, Zhejiang Province].

OBJECTIVE: To examine vibrio cholera (V.C) in aquatic products of littoral area, Zhejiang Province and to provide scientific evidence for administration of aquatic products and cholera epidemic control. METHODS: All 990 samples of aquatic products collected from local markets, eateries and aquafarms in three chosen areas. Samples were proliferated in alkaline liquid medium, and purified in NO: 4 medium, the isolations were identified biochemically, and phenotype of strains were defined by phagocyte and coagulation with V.C. diagnostic serum. Three virulence genes (ctx, ace, zct) of the isolated strains were detected by polymerase chain reaction (PCR). RESULTS: There were 1.41% samples caught by V.C., having a carrying rate highest in turtles of 8.9%. 14 strains were defined as three serogroups, and the numbers of Inaba, Ogawa, and Hikojima types were 2, 2, 10 respectively. Virulence genes had detected in 9 of 12 stains. All genes were detected in 5 strains, only ZOT genes in 3 strains, and both CTX and ACE genes in 1 strain. CONCLUSIONS: Aquatic products from inshore in Zhejiang Province caught with V.C. strains might be divided into three serogroups. Most of them should be virulence genes. Cholera epidemic outbreak might be caused by those contaminated products.