Major changes in prevalence and genotypes of rotavirus diarrhea in Beijing, China after RV5 rotavirus vaccine introduction.

To analyze the epidemiological characteristics of group A rotavirus (RVA) diarrhea in Beijing between 2019 and 2022 and evaluate the effectiveness of the RV5 vaccine. Stool specimens were collected from patients with acute diarrhea, and RVA was detected and genotyped. The whole genome of RVA was sequenced by fragment amplification and Sanger sequencing. Phylogenetic trees were constructed using Bayesian and maximum likelihood methods. Descriptive epidemiological methods were used to analyze the characteristics of RVA diarrhea. Test-negative design was used to evaluate the vaccine effectiveness (VE) of the RV5. Compared with 2011-2018, RVA-positive rates in patients with acute diarrhea under 5 years of age and adults decreased significantly between 2019 and 2022, to 9.45% (249/634) and 3.66% (220/6016), respectively. The predominant genotype of RVA had changed from G9-VIP[8]-III between 2019 and 2021 to G8-VP[8]-III in 2022, and P[8] sequences from G8-VP[8]-III strains formed a new branch called P[8]-IIIb. The complete genotype of G8-VP[8]-III was G8-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2. The VE of 3 doses of RV5 was 90.4% (95% CI: 28.8%-98.7%) against RVA diarrhea. The prevalence of RVA decreased in Beijing between 2019 and 2022, and the predominant genotype changed to G8P[8], which may be related to RV5 vaccination. Continuous surveillance is necessary to evaluate vaccine effectiveness and improve vaccine design.

The contributions of vaccination and natural infection to the production of neutralizing antibodies against the SARS-CoV-2 prototype strain and variants.

OBJECTIVES: To evaluate the neutralizing antibody (NAb) levels against the SARS-CoV-2 Omicron variants BF.7, BQ.1, BQ.1.1, XBB.1, and XBB.1.5 after vaccination and natural infection. METHODS: The NAbs against the different viral strains of 490 individuals with SARS-CoV-2 and 187 without SARS-CoV-2 in the Beijing COVID-19 outbreak during December 2022 to January 2023 were analyzed. RESULTS: In uninfected individuals, limited levels of NAbs were produced against the prototype and variant strains after two doses vaccine but significantly increased after three or four doses of the vaccine. The infected individuals had high NAbs levels against the BF.7, BQ.1, and BQ.1.1 variants and moderate NAbs levels against the XBB.1 and XBB.1.5 variants. The highest NAbs levels were observed after two inoculation doses. The third and fourth doses vaccine did not result in a significant increase the NAbs levels. After the last dose of vaccination, the NAbs levels peaked at 12 months for the prototype and BF.7 and between 6 to 12 months for the BQ.1, BQ.1.1, XBB.1, and XBB.1.5 variants. CONCLUSIONS: The immune response decreases as the virus mutates. If booster vaccination is considered necessary, it is suggested for at least 6 months after infection.

Increase of respiratory illnesses among children in Beijing, China, during the autumn and winter of 2023.

In 2023, through an ongoing respiratory pathogen surveillance system, we observed from mid-September onwards, an increase of respiratory illness among children aged ≤ 15 years presenting at hospital outpatient clinics in Beijing, China. Data indicated that illness was caused by multiple pathogens, predominantly Mycoplasma pneumoniae. Seasonality, periodicity and high prevalence of resistance to macrolide (30 of 30 strains sequenced with the A2063G mutation) were important characteristics of the M. pneumoniae epidemic, which resulted in a rise in consultations at specialised paediatric hospitals.

Impact of the COVID-19 pandemic on routine vaccination coverage under varying prevalence Conditions: A cohort study in Beijing, China.

BACKGROUND: The COVID-19 pandemic has experienced various phases including outbreaks, a global health crisis, and eventual de-escalation from a public health emergency of international concern, significantly affecting the delivery and utilization of healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on the coverage rate of routine immunization in children under varying prevalence conditions. METHODS: We conducted a retrospective, population-based cohort study in Beijing, China, utilizing stratified random sampling by birthdate to obtain a sample of 29,811 participants. Subjects were categorized into four cohorts based on when they became eligible for vaccination: the Pre-COVID Period cohort, the COVID-19 Low Epidemic Period cohort, the COVID-19 Surging Period cohort, and the COVID-19 Slowing Down Period cohort. A one-month follow-up was conducted. Cox proportional hazards model was employed to examine associations between the COVID-19 epidemic status and timely vaccination. RESULTS: Participants age-eligible for vaccination during the COVID-19 Low Epidemic Period demonstrated higher rates of timely vaccination (HR 1.18, 95% CI 1.15-1.22) compared to those eligible during the Pre-COVID Period. Conversely, those eligible during the COVID-19 Surging Period displayed lower rates (HR 0.73, 95% CI 0.66-0.82). No significant difference in vaccination timeliness was observed for those eligible during the COVID-19 Slowing Down Period in comparison to the Pre-COVID Period (HR 0.99, 95% CI 0.91-1.09). By the end of May 2023, DTP3 rate among eligible children during the COVID-19 Surging Period had surpassed 90%. CONCLUSIONS: Significantly declining rates of timely vaccination were observed during the COVID-19 Surging Period, which lasted two months, but not during the nearly three-year-long COVID-19 Low Epidemic Period. An upward trend in vaccination timeliness followed, culminating in a return to baseline levels over the subsequent 3-4 months. Our findings suggested that the pandemic exerted a decreasing and recoverable impact on the coverage rate of routine immunizations in China.

Impact of herpes zoster and post-herpetic neuralgia on health-related quality of life in Miyun District of Beijing, China: An EQ-5D survey.

Background: Herpes zoster (HZ) and post-herpetic neuralgia (PHN) cause considerable morbidity, especially in elderly adults, but the burden is under-recognized in mainland China. Methods: We conducted a case registry and follow-up study of HZ in Miyun District, Beijing from January 1, 2017 through December 31, 2018. Registered HZ cases were followed-up for pain to 365 days. The first 50 patients with HZ in each age group (≤14, 15-29, 30-39, 40-49, 50-59, 60- 69, 70-79, ≥80 years) and all those with PHN completed the EuroQoL five dimensions questionnaire (EQ-5D) to evaluate health-related quality of life (HRQoL) in patients with HZ and PHN. Ratings using the EQ-5D dimensions, visual analogue scale (VAS), health utility score (HUS) and quality-adjusted life years (QALYs) lost were compared among age groups. Results: In total, 2008 patients with HZ were followed for a median 22 days (interquartile range[IQR] = 20-90), with an estimated incidence of 4.39 per 1000 person-years. We identified 122 (6.08 %) PHN cases. The median age of patients with PHN (65 years, IQR = 55-71) was older than that of patients with HZ (54 years, IQR = 43-64) (P < 0.001). The median duration of pain was 170 days (IQR = 144-355.5) for PHN and 15 days (IQR = 9-25) for HZ. All 95 patients with PHN and 319 sampled patients with HZ completed the EQ-5D survey. The median QALY loss of HZ increased from 0.004 (IQR = 0.001-0.02) in patients 50-59 years old to 0.02 (IQR = 0.01-0.06) in those ≥ 80 years old (P < 0.01). After weighting for age, the mean QALY loss per HZ case was estimated at 0.02 (standard deviation [SD] 0.04). The mean QALY loss per PHN case was 0.13 years (SD 0.12). Conclusions: HZ and PHN caused a substantial burden, especially among adults aged ≥ 50 years in Miyun District, Beijing, China. Vaccination should be considered to alleviate the burden of this painful disease.

Evaluating the accessibility and capacity of SARS-CoV-2 vaccination and analyzing convenience-related factors during the Omicron variant epidemic in Beijing, China.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination service system lacks standardized indicators to assess resource allocation. Moreover, data on specific vaccination-promoting measures is limited. This study aimed to evaluate vaccination accessibility and capacity and investigate convenience-related factors in China during the Omicron variant epidemic. We collected information on SARS-CoV-2 vaccination services among vaccination sites in Beijing. Analysis was performed using nearest neighbor, Ripley's K, hot spot analysis, and generalized estimating equations. Overall, 299 vaccination sites were included. The demand for the SARS-CoV-2 vaccine increased with the increase in daily new cases, and the number of staff administering vaccines should be increased in urban areas at the beginning of the epidemic. Providing vaccination for both children and adults, extending vaccination service hours, and offering a wider range of vaccine categories significantly increased the doses of vaccines administered (all P < .05). The provision of mobile vaccination vehicles effectively increased the doses of vaccines administered to individuals aged ≥ 60 years (P < .05). The allocation of SARS-CoV-2 vaccination services should be adjusted according to geographic location, population size, and vaccination demands. Simultaneous provision of vaccination services for children and their guardians, flexible service hours, prompt innovative vaccine production, and tailored vaccination strategies can foster vaccination uptake.

Vaccination coverage survey of children aged 1-3 years in Beijing, China, 2005-2021.

BACKGROUND: The routine immunization program for children is a primary strategy and a core part of vaccination. Achieving and maintaining high level of vaccination coverage are important to reduce morbidity and mortality caused by vaccine-preventable diseases. In Beijing, annual coverage surveys have been conducted since 2005. It is necessary and possible to assess the level and trend of routine vaccination coverage of children in Beijing as well as the disruption of coronavirus disease 2019 (COVID-19) pandemic and provide the reference for the further improve the vaccination coverage. METHODS: The data of 61,521 children aged 1-3 years in the vaccination coverage surveys during 2005-2021 were analyzed by Beijing Center for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the data and the difference of vaccination coverage within the time period. RESULTS: More than 99 % of participants had immunization cards and electronic immunization records. The concordance rate of both records were also over 99 %. During 2011-2019, the rates of on-time and in-time vaccination of each routine vaccine reached 96 % or more and increased significantly (all P values <0.05), compared with that of 2005-2010. All rates of the investigated vaccine, except for Bacillus Calmette-Guérin vaccine (BCG) and the first dose of hepatitis B vaccine (HepB), decreased in 2020-2021 significantly (all P values <0.05). For the causes of failing to vaccinate on time, delayed vaccination accounted for 47.82 %. The top two vaccines to be missed were the first dose of hepatitis A vaccine and the 4th dose of diphtheria-tetanus-acellular pertussis vaccine, accounting for 21.41 % and 20.79 %, respectively. The main reason for zero-dose/drop-out vaccination was "Guardians regarded the immunization service time as inappropriate", accounting for 72.27 %. CONCLUSION: The coverage level and service quality of routine immunization in Beijing were relatively high. However, as influenced by COVID-19 epidemics, both on-time and in-time vaccination rates decreased significantly, except for BCG and HepB. Under the background of COVID-19 pandemic, the keys to maintain high level of vaccination coverage include flexible immunization service time to ensure the guardians bringing their children for vaccination timely, and more attention from providers to the doses after children's first birthday.

The incidence of herpes zoster in China: A meta-analysis and evidence quality assessment.

This review aimed to estimate the disease burden of herpes zoster (HZ) in China and explore the application of the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach in studies of disease burden. We searched for the literature of observational studies analyzing HZ incidence in populations of all ages in China. Meta-analysis models were constructed to calculate the pooled incidence of HZ and pooled risks of postherpetic neuralgia (PHN), HZ recurrence, and hospitalization. Subgroup analysis was performed according to gender, age, and quality assessment score. The quality of evidence for incidence was rated using the GRADE system. Twelve studies with a total of 25,928,408 participants were included in this review. The pooled incidence for all ages was 4.28/1000 person years (95% CI 1.22-7.35). It increased with the increasing in age especially for individuals aged ≥60 y, which was 11.69/1000 person years (95% CI 6.56-16.81). The pooled risks of PHN, recurrence, and hospitalization were 12.6% (95% CI 10.1-15.1), 9.7% (95% CI 3.2-16.2), and 6.0/100,000 population (95% CI 2.3-14.2), respectively. The quality of the evidence assessment of the pooled incidence by the GRADE for all ages was 'low'; however, it was 'moderate' for the ≥60 yold subgroup. HZ is a serious public health problem in China and is more significant in individuals older than 60 y. Therefore, an immunization strategy for the zoster vaccine should be considered. The evidence quality assessment by the GRADE approach indicated that we had more confidence in the estimation of aged population.

Acceptability for the influenza virus vector COVID-19 vaccine for intranasal spray: A cross-sectional survey in Beijing, China.

The intranasal spray COVID-19 vaccine was made available for the first time in China, it is necessary to understand receivers' satisfaction and experience toward the vaccine to help optimize vaccination service. A self-administered multicenter cross-sectional questionnaire survey was conducted in Beijing, China, in December 2022. The vaccination experience was evaluated through three dimensions: immediate tolerance, smooth progress, and time-saving. Vaccine acceptability was measured by receivers' preference for the intranasal spray over intramuscular injection after vaccination and their recommendation willingness. Stepwise multinomial and binary logistic regression models were applied to investigate factors associated with vaccine acceptability. Among 10,452 participants included in the analysis, 92.6% felt no discomfort during the inoculation, 99.8% thought the vaccination process went well, and 89.4% deemed it a time-saving option. For vaccine acceptability, 5566 (53.3%) participants were willing to recommend the vaccine to others, 534 (5.1%) refused, and 4352 (41.6%) had not decided yet; 6142 (58.8%) participants preferred the intranasal spray, 873 (8.4%) preferred the intramuscular injection, and 3437 (32.9%) had no preferences. The most concerned aspects of the intranasal spray vaccine were vaccine effectiveness and safety. Receivers who perceived higher vaccine effectiveness or safety were more likely to recommend it to others (OR, 95%CI: 4.41, 3.24-6.00; 6.11, 4.52-8.27) or prefer it over intramuscular injection after vaccination (OR, 95%CI: 5.94, 4.62-7.65; 8.50, 6.70-10.78). Receivers showed good acceptability and experience toward the intranasal spray COVID-19 vaccine. Vaccine effectiveness and safety were the most concerned aspects, and corresponding publicity and education efforts may help improve vaccine acceptability.

Molecular surveillance of rubella virus in Beijing, China during 2010-2021: Progress and challenges in rubella elimination.

Rubella is listed by the World Health Organization (WHO) as a disease that needs to be eliminated worldwide. The aim of this study was to understand the progress and challenges towards rubella elimination in Beijing, China, by analyzing molecular surveillance data combined with immunization and surveillance strategies as well as epidemiological data. With high immunization coverage under the 3-dose policy (8 months, 18 months, and 6 years) and supplementary immunization activities for the floating population, rubella incidence showed a downward trend since 2010, despite two epidemics that occurred in 2014-2015 and 2019. The reported rubella cases were generally concentrated in the age group of 15-34 years. Although citywide surveillance for congenital rubella syndrome (CRS) has been carried out since 2016, only one case has been confirmed by laboratory testing. Furthermore, molecular surveillance data showed that rubella viruses (RVs) circulating in Beijing during 2010-2020 were evidently heterogeneous; the domestic lineage 1E-L1 and multiple imported lineages, including 2B-L1, 1E-L2, and 2B-L2c, were identified in the last decade. Meanwhile, two lineage-related switches were determined, including the displacement of lineage 1E-L1 with lineage 2B-L1 around 2014 and the transition between lineage 2B-L1 and lineage 1E-L2 and 2B-L2c in 2018-2019. This RV transmission pattern was similar to that observed across the country, whereas lineages 1E-L1 and 2B-L2c were prevalent in Beijing for a shorter period. Overall, these results indicate the need to maintain routine immunization with rubella-containing vaccines, promote regular supplementaryimmunizationactivities, and enhance rubella and CRS surveillance even in order to accelerate rubella elimination in Beijing. Further, the existing immunization strategies must be optimized to further close the immunity gap.

Protective Effect of Inactivated COVID-19 Vaccines against Progression of SARS-CoV-2 Omicron and Delta Variant Infections to Pneumonia in Beijing, China, in 2022.

This real-world study explores the effect of coronavirus disease 2019 (COVID-19) inactivated vaccines on the prevention of asymptomatic or mild Delta or Omicron variant infections progressing to pneumonia. Association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases and vaccination was measured with a multivariable logistic regression, stratified by genotype and age groups. We recruited 265 cases (111 (41.9%) infected with Delta and 154 (58.1%) with Omicron variants). There were 22 asymptomatic infected individuals, 156 mild cases without pneumonia, and 87 moderate cases with pneumonia. There was a markedly increased risk of progression to pneumonia in Delta infected cases, unvaccinated, or partially vaccinated COVID-19 patients with diabetes and those aged ≥60 years. Patients who had completed booster doses of inactivated vaccines had a reduced risk of 81.6% (95% CI: 55.6−92.4%) in progressing to pneumonia over those who were unvaccinated or partially vaccinated. The risk of progressing to pneumonia was less reduced by 88.7% (95% CI: 56.6−97%) and 73.9% (95% CI: 1.4−93.1%) among Delta and Omicron-infected patients, and was reduced by 78.5% (95% CI: 45.3−91.6%) and 94.1% (95% CI: 21.5−99.6%) among patients aged <60 and ≥60 years, respectively. Our data indicated that a complete vaccination with a booster reduced the risk of asymptomatic or mild Delta or Omicron variant COVID-19 progressing to pneumonia and, thus, reduced the pressure of severe illness on medical resources.

Effect of Earlier Vaccination and a Two-Dose Varicella Vaccine Schedule on Varicella Incidence - Beijing Municipality, 2007-2018.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The World Health Organization (WHO) varicella vaccines position paper states that countries where varicella is an important public health burden could consider introducing varicella vaccine (VarV) in the routine childhood immunization program (1). VarV has been available for many years in China but is not included in most routine immunization programs in China. As a result, substantial heterogeneity in vaccination coverage exists across regions. WHAT IS ADDED BY THIS REPORT?: In Beijing, adding a second dose of VarV for children and increasing coverage reduced the incidence of varicella. Lowering the age of the first dose of VarV to 12 months could further reduce varicella, especially among toddlers. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Governments should use economic analysis to consider inclusion of VarV into the routine children immunization program as a free vaccine and adopting a 2-dose schedule that starts at 12 months of age.

Willingness of the General Public to Receive the COVID-19 Vaccine During a Second-Level Alert - Beijing Municipality, China, May 2020.

WHAT IS ALREADY KNOWN ON THIS TOPIC?: Preclinical trials showed the effectiveness of domestic inactivated vaccine candidates for coronavirus disease 2019 (COVID-19). However, it is necessary to evaluate the willingness of the public to receive future domestic vaccines and to understand factors associated with willingness at the early stages of vaccine development. WHAT IS ADDED BY THIS REPORT?: Through May 25, 2020, 70.48% were willing to receive future domestic COVID-19 vaccines. Confidence in vaccines had the largest impact on public willingness, while age and presence of underlying chronic disease did not significantly increase public willingness. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: It is necessary to increase awareness of COVID-19 vaccines among people with high risk of severe infection and to build public confidence in vaccines. Releasing accurate, timely, and reliable data to the public can help increase willingness to get vaccinated.

Perception of the COVID-19 Epidemic and Acceptance of Vaccination Among Healthcare Workers Prior to Vaccine Licensure - Beijing Municipality, China, May-July 2020.

What is already known about this topic? The coronavirus disease 2019 (COVID-19) vaccine development has been progressing, but acceptance of the new vaccines by healthcare workers (HCWs) was not well known prior to approval of COVID-19 vaccines in China. What is added by this report? This study found that before vaccine approval, Beijing HCWs expressed moderate willingness to get vaccinated. Factors positively influencing willingness included free vaccination and belief that the vaccine had been fully evaluated. A negatively influencing factor was presence of an underlying disease. Trust in vaccines, in general, was positively associated with willingness to get new vaccines. What are the implications for public health practice? COVID-19 vaccines should be provided at no cost to HCWs. Effective measures should be taken to enhance the acceptance of COVID-19 vaccination among HCWs in China.

Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment.

BACKGROUND: The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. METHODS: We searched for observational studies on two-dose varicella VE for children in China aged 1-12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. RESULTS: A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69-97%). The VE of outbreak studies (87% [95% CI: 76-93%]) was lower than non-outbreak studies (99% [95% CI: 98-99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was "low", which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was "moderate". CONCLUSIONS: The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.

Impact of a 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, 2011-2017.

BACKGROUND: One-dose voluntary varicella vaccination for children was introduced in Beijing since 1998. In Oct 2012, a second dose varicella vaccine (VarV) was recommended to further decrease varicella disease and the outbreaks. We describe the impact of the 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, China. METHODS: Varicella incidence rates and outbreak characteristics in 2011-2017 was examined using surveillance data. Varicella vaccination coverage among children born in 2007-2012 was estimated through Beijing children immunization registry system. Vaccine effectiveness (VE) for VarV2 was estimated by screening method. RESULTS: Overall varicella incidence decreased by 37.8% from 103.2 per 100,000 population in 2011 to 64.2 per 100,000 population in 2017. Incidence declines in children aged <15 years with most significantly decrease by 82.3% in children aged 5-9 years, while no significant change happened in adolescent and adults. A total of 251 outbreaks with 3239 outbreak-related cases were reported in 2011-2017, the number of outbreaks decreased significantly by 50.7% from 69 in 2011 to 34 in 2017. The VarV1 coverage ranged from 85.4% to 92.6% among children 4 year of age and the VarV2 coverage ranged from 40.1% to 72.9% among children 6 year of age in the 2007-2012 birth cohort. Overall VE estimates against all varicella disease was 94.4% (95% CI: 89.9-98.9%) for VarV2. CONCLUSIONS: Moderate VarV2 coverage has been achieved in Beijing resulting in remarkable declining of the incidence in children. Varicella outbreaks has not been eliminated suggested that measures such as including a 2-dose varicella vaccination in routine immunization program should be taken in the future.

Outbreak of measles among persons with secondary vaccine failure, China, 2018.

Although the incidence of measles has been dramatically reduced by the highly effective measles vaccine, cases of measles and outbreaks continue to occur in vaccinated population because of immunization failure. We report on an outbreak in which two cases had previous evidence of measles immunity and then one of them transmitted measles infection to an unvaccinated contact. The cases and contacts exposed during the outbreak were investigated. Clinical information and epidemiological information were obtained. Serum samples were collected for measles-specific immunoglobulin M (IgM), immunoglobulin G (IgG) and IgG avidity. Throat swabs were obtained to test for measles virus RNA. Two measles cases (case 1 and case 2) who have received one dose of MCV in past 5 years, and both working at a hospital in Beijing, occurred in 18th and 20nd of January, respectively. Out of the 102 contacts, one additional case (case 3) who had a close, long-term co-exposure with case 1 was reported subsequently. No additional cases of measles occurred among 15 contacts of case 3. The index case was not ascertained through the outbreak review. All three cases had laboratory confirmation of measles infection. Both case 1 and case 2 had high-avidity IgG antibody characteristic of a secondary immune response and developed a modified clinical presentation. This report confirms that a vaccinated individual with documented secondary vaccine failure (SVF) could transmit measles and is the second report since a New York City outbreak (the first report in China). The outbreak represented a series of rare events, so we can conclude that the SVF individuals in the transmission chain of measles are unlikely to threaten measles elimination. The importance of the herd immunity in preventing transmission and sensitive surveillance activities in case of misdiagnosis is emphasized.

Evaluation of the adequacy of measles laboratory diagnostic tests in the era of accelerating measles elimination in Beijing, China.

BACKGROUND: Measles-containing vaccine (MCV) was introduced in 1965 in Beijing and given to the children aged 8m-14y. In population-based surveillance system, real-time polymerase chain reaction (RT-PCR) and immunoglobulin M(IgM) serology tests have been conducted for each suspected case since 2013. We used the surveillance data to evaluate the adequacy of the tests for laboratory confirmation during 2014-2016. METHODS: Informations on IgM tests, RT-PCR, age, vaccination history for confirmed cases were from the surveillance system. Laboratory confirmed cases were defined as cases with positive IgM serology and/or positive RT-PCR. All tests were conducted in the laboratories accredited by Beijing CDC or Beijing CDC laboratory. RESULTS: Totally 4600 cases were confirmed. Sensitivities of IgM tests within 0-3 days post rash, IgM tests within 4-28 days post rash and RT-PCR within 0-3 days post rash were 56.53%, 82.06% and 94.39%, respectively. The combined sensitivity of IgM tests and RT-PCR decreased by the interval between rash onset and collection of virologic specimen. MCV immunization history lowered sensitivity of IgM tests and RT-PCR. Among the cases aged ≥ 15 years, around 95% had no written immunization records. The sensitivity of IgM tests within 0-3 days post rash was less than 60%. Around 60% had unknown immunization histories. Compared with unvaccinated cases based on written records, unvaccinated cases based on recollection had no significantly different sensitivity of laboratory tests. But unknown immunization history significantly lowered sensitivity of RT-PCR within 0-3 days post rash. CONCLUSIONS: Neither IgM tests nor RT-PCR reached 100% sensitive for confirmed cases. Virologic specimen should be collected as early as possible to achieve maxim sensitivity. Cases with unknown immunization history could not be treated as unvaccinated. Combination of the two tests and further laboratory assays were needed especially for vaccinated cases or cases aged ≥15 years.

A retrospective survey on herpes zoster disease burden and characteristics in Beijing, China.

Little data are available on the overall incidence and characteristics of herpes zoster (HZ) in China, thus a community-based retrospective survey was conducted during December 2012 to March 2013 to collect HZ incident data over the past year in selected districts of Beijing, China. A total of 237 incident HZ cases were identified from 118,220 residents and majority of HZ patients (219/237, 92.4%) sought healthcare. Annual HZ incident rates were 1.90/1000 after adjusted and higher among females (2.4/1000) than males (1.7/1000). HZ rates increased with age and with a sharply rise among those aged ≥50 years particular for female. 217 cases were available for interview with 193 (88.9%) primary, 24 (11.1%) recurrent and 10 (4.6%) postherpetic neuralgia (PHN) cases respectively. No difference was shown between the primary and recurrent HZ cases in sex (P = 0.42), age (P = 0.72), times of healthcare seeking (P = 0.45), number of dermatome (P = 0.72), pain degree (P = 0.54), and hospitalization (P = 1.0). According to the survey, it can be speculated that disease burden of HZ is serious and caused at least 2.77 million cases annually in China. The recurrent HZ cases has similar characteristics to primary HZ cases. High proportion of healthcare seeking reminds that HIS records would be a feasible source for HZ surveillance to evaluate the trends and changes in China.