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Li T, Li F, Guo X, Hong C, Yu X, Wu B, Lian S, Song L, Tang J, Wen S, Gao K, Hao M, Cheng W, Su Y, Zhang S, Huang S, Fang M, Wang Y, Ng MH, Chen H, Luo W, Ge S, Zhang J, Xia N, Ji M. Anti-Epstein-Barr Virus BNLF2b for Mass Screening for Nasopharyngeal Cancer. N Engl J Med 2023; 389:808-819. [PMID: 37646678 DOI: 10.1056/nejmoa2301496] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Population screening of asymptomatic persons with Epstein-Barr virus (EBV) DNA or antibodies has improved the diagnosis of nasopharyngeal carcinoma and survival among affected persons. However, the positive predictive value of current screening strategies is unsatisfactory even in areas where nasopharyngeal carcinoma is endemic. METHODS We designed a peptide library representing highly ranked B-cell epitopes of EBV coding sequences to identify novel serologic biomarkers for nasopharyngeal carcinoma. After a retrospective case-control study, the performance of the novel biomarker anti-BNLF2b total antibody (P85-Ab) was validated through a large-scale prospective screening program and compared with that of the standard two-antibody-based screening method (EBV nuclear antigen 1 [EBNA1]-IgA and EBV-specific viral capsid antigen [VCA]-IgA). RESULTS P85-Ab was the most promising biomarker for nasopharyngeal carcinoma screening, with high sensitivity (94.4%; 95% confidence interval [CI], 86.4 to 97.8) and specificity (99.6%; 95% CI, 97.8 to 99.9) in the retrospective case-control study. Among the 24,852 eligible participants in the prospective cohort, 47 cases of nasopharyngeal carcinoma (38 at an early stage) were identified. P85-Ab showed higher sensitivity than the two-antibody method (97.9% vs. 72.3%; ratio, 1.4 [95% CI, 1.1 to 1.6]), higher specificity (98.3% vs. 97.0%; ratio, 1.01 [95% CI, 1.01 to 1.02]), and a higher positive predictive value (10.0% vs. 4.3%; ratio, 2.3 [95% CI, 1.8 to 2.8]). The combination of P85-Ab and the two-antibody method markedly increased the positive predictive value to 44.6% (95% CI, 33.8 to 55.9), with sensitivity of 70.2% (95% CI, 56.0 to 81.4). CONCLUSIONS Our results suggest that P85-Ab is a promising novel biomarker for nasopharyngeal carcinoma screening, with higher sensitivity, specificity, and positive predictive value than the standard two-antibody method. (Funded by the National Key Research and Development Program of China and others; ClinicalTrials.gov number, NCT04085900.).
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Affiliation(s)
- Tingdong Li
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Fugui Li
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Xiaoyi Guo
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Congming Hong
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Xia Yu
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Biaohua Wu
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Shifeng Lian
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Liuwei Song
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Jiabao Tang
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Shunhua Wen
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Kaimin Gao
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Mengling Hao
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Weimin Cheng
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Yingying Su
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Shiyin Zhang
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Shoujie Huang
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Mujin Fang
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Yingbin Wang
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Mun-Hon Ng
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Honglin Chen
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Wenxin Luo
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Shengxiang Ge
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Jun Zhang
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Ningshao Xia
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
| | - Mingfang Ji
- From the State Key Laboratory of Vaccines for Infectious Diseases, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Department of Laboratory Medicine, School of Public Health, Xiamen University (T.L., X.G., C.H., J.T., M.H., Y.S., S.Z., S.H., M.F., Y.W., M.-H.N., W.L., S.G., J.Z., N.X.), and Xiamen Innodx Biotechnology (L.S., S.W., K.G.), Xiamen, the Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan (F.L., X.Y., B.W., W.C., M.J.), and the State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (H.C.) - all in China; and the Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm (S.L.)
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