An outbreak following importation of wild poliovirus in Xinjiang Uyghur Autonomous Region, China, 2011

Red cell distribution width as a prognostic marker for complications of community-acquired pneumonia in children: a comparison with Proadrenomedullin and Copeptin

BACKGROUND

Community-acquired pneumonia (CAP) is the most common leading cause of morbidity and mortality in children; so, early identification of patients with CAP, who are at risk of complications or high mortality, is very critical to identify patients who need early admission to the intensive care unit.

PURPOSE OF THE STUDY

To explore the prognostic value of Red Cell Distribution Width (RDW), Proadrenomedullin and Copeptin in the prediction of complicated CAP in children.

METHODS

99 children were enrolled in the study, which was done at the Pediatric Department of Minia University Hospital. Measurement of serum Proadrenomedullin, Copeptin, and RDW was done to all participating children in the first 24 h of admission. Assessment of the severity of CAP was done using the Pediatric Respiratory Severity Score (PRESS).

RESULTS

The values of RDW, Proadrenomedullin, and Copeptin were significantly higher in the complicated CAP group than in the uncomplicated one (P value < 0.01). There were significant positive correlations between RDW and Proadrenomedullin with PRESS (r 0.56 for both). For the prediction of complications, RDW at cutoff point > 17.4, has 77.7% of sensitivity and 98.6% of specificity, followed by Pro ADM at cutoff point > 5.1 nmol/L, of 74% of sensitivity and 90.2% of specificity. For the prediction of mortality, RDW at cutoff point > 17.4 has 81.25% of sensitivity and 89.16% of specificity.

CONCLUSION

The RDW is a reliable predictor of poor outcomes in pediatric CAP.

How can imported monkeypox break the borders? A rapid systematic review

BACKGROUND

Monkeypox was designated as an emerging illness in 2018 by the World Health Organization Research and Development Blueprint, necessitating expedited research, development, and public health action. In this review, we aim to shed the light on the imported cases of monkeypox in attempt to prevent the further spread of the disease. Methodology An electronic search in the relevant database (Web of Science, PubMed Medline, PubMed Central, Google scholar, and Embase) was conducted to identify eligible articles. In addition to searching the grey literature, manual searching was carried out using the reference chain approach.

RESULTS

A total of 1886 articles were retrieved using the search strategy with 21 studies included in the systematic review. A total of 113 cases of imported monkeypox were confirmed worldwide. Nineteen patients mentioned a travel history from Nigeria, thirty-eight infected cases had travel destinations from Europe, fifty-four cases traveled from European countries such as; Spain, France, and the Netherlands, one case from Portugal, and another one from the United Kingdom (UK). All reported clades of the virus were West African clade. Nine studies showed the source of infection was sexual contact, especially with male partners. Six studies mentioned the cause of infection was contact with an individual with monkeypox symptoms. Two studies considered cases due to acquired nosocomial infection. Ingestion of barbecued bushmeat was the source of infection in three studies and rodent carcasses were the source of infection in the other two studies.

CONCLUSION

The development of functioning surveillance systems and point-of-entry screening is essential for worldwide health security. This necessitates ongoing training of front-line health professionals to ensure that imported monkeypox is properly diagnosed and managed. In addition, implementing effective health communication about monkeypox prevention and control is mandatory to help individuals to make informed decisions to protect their own and their communities' health.

Epidemiological characteristics and trends of notifiable infectious diseases in China from 1986 to 2016

Background

Since the 1980s, China has undergone significant social change and the incidence of infectious diseases has also changed considerably. Here, we report the epidemiological features and changes in notifiable infectious diseases in China from 1986 to 2016 to explore the factors contributing to the successful control of infectious diseases and the challenges faced in the prevention and control of infectious diseases.

Methods

The data of notifiable infectious diseases in China from 1986 to 2016 were collected from the monthly analysis report of the National Infectious Disease Surveillance System. Joinpoint regression models were used to examine incidence and mortality trends from 1986 to 2016. IBM SPSS Statistics version 22.0, Excel 2010 and R x64 3.5.2 were used for data analysis.

Results

A total of 132 858 005 cases of notifiable infectious diseases were reported over these 31 years, with an average yearly incidence of 342.14/100 000. There were 284 694 deaths with an average yearly mortality rate of 0.73/100 000. The overall incidence and overall mortality of notifiable infectious diseases both showed a "U" distribution (ie, a decrease, stable, an increase, stable again). The top five diseases in terms of incidence were hand, foot and mouth disease, viral hepatitis, tuberculosis, other infectious causes of diarrhea and dysentery, accounting for 78.0% of all reported cases. The top five causes of death were HIV/AIDS, rabies, tuberculosis, viral hepatitis and epidemic encephalitis B, which accounted for 76.07% of all mortalities. The diseases with the top five fatality rates were rabies, H5N1, H7N9, HIV/AIDS and plague, with rates of 91.06%, 66.07%, 38.51%, 25.19% and 10.31%, respectively.

Conclusions

This analysis will benefit the future monitoring of infectious diseases and public health measures in China.

Seroprevalence of poliovirus antibodies before and after polio vaccine switch in 2012 and 2017 in Beijing

In 2000, China was declared polio-free. However, in 2018, wild poliovirus (WPV) was still endemic in two of its neighboring countries, making WPV importation and outbreak alarming possibilities. This study documents the seroprevalence of poliovirus antibodies before and after the polio vaccine switch in 2012 and 2017 in Beijing. Cross-sectional population-based serologic surveys were conducted in 2012 and 2017 in Beijing. The study subjects were selected from 10 different age groups (<1, 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, and ≥40 y) using a multi-stage-stratified sampling method. Neutralizing antibody titers against poliovirus serotypes 1 (P1), 2 (P2), and 3 (P3) were assayed by World Health Organization standards. The seropositive rates (SR) and geometric mean titer (GMT) of the neutralizing antibodies were 91.71% and 1:130.26, respectively, for P1, 94.09% and 1:113.39, respectively, for P2, and 88.78% and 1:79.65, respectively, for P3 before the switch in 2012, and 87.78% and 1:108.93, respectively, for P1, and 81.67% and 1:70.56, respectively, for P3 after the switch in 2017, with a statistically significant difference for P1 and P3 between 2012 and 2017. The neutralizing antibodies for all poliovirus serotypes differed among different age and vaccination groups in both 2012 and 2017. After switching polio vaccines twice in 2014 and 2016, the P1 and P3 polio antibody levels were lower in 2017 than in 2012. The P2 antibody levels were determined from the first dose of IPV. The seroprevalence of poliovirus antibodies after adjustment of the immunization schedule of the polio vaccine on January 1, 2020, must be further monitored.

Epidemiology of Imported Infectious Diseases, China, 2005-2016

Imported infectious diseases are becoming a serious public health threat in China. However, limited information concerning the epidemiologic characteristics of imported infectious diseases is available. In this study, we collected data related to imported infectious diseases in mainland China from the National Information Reporting System of Infectious Diseases and analyzed demographic, temporal, and spatial distributions. The number of types of imported infectious diseases reported increased from 2 in 2005 to 11 in 2016. A total of 31,740 cases of infectious disease were imported to mainland China during 2005–2016; most of them were found in Yunnan Province. The cases were imported mainly from Africa and Asia. As a key and effective measure, pretravel education should be strengthened for all migrant workers and tourists in China, and border screening, cross-border international cooperation, and early warning should be further improved.

Modeling the costs and benefits of temporary recommendations for poliovirus exporting countries to vaccinate international travelers

Recognizing that infectious agents readily cross international borders, the International Health Regulations Emergency Committee issues Temporary Recommendations (TRs) that include vaccination of travelers from countries affected by public health emergencies, including serotype 1 wild polioviruses (WPV1s). This analysis estimates the costs and benefits of TRs implemented by countries with reported WPV1 during 2014-2016 while accounting for numerous uncertainties. We estimate the TR costs based on programmatic data and prior economic analyses and TR benefits by simulating potential WPV1 outbreaks in the absence of the TRs using the rate and extent of WPV1 importation outbreaks per reported WPV1 case during 2004-2013 and the number of reported WPV1 cases that occurred in countries with active TRs. The benefits of TRs outweigh the costs in 77% of model iterations, resulting in expected incremental net economic benefits of $210 million. Inclusion of indirect costs increases the costs by 13%, the expected savings from prevented outbreaks by 4%, and the expected incremental net benefits by 3%. Despite the considerable costs of implementing TRs, this study provides health and economic justification for these investments in the context of managing a disease in advanced stages of its global eradication.

Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study

Background

The model of infectious disease prevention and control changed significantly in China after the outbreak in 2003 of severe acute respiratory syndrome (SARS), but trends and epidemiological features of infectious diseases are rarely studied. In this study, we aimed to assess specific incidence and mortality trends of 45 notifiable infectious diseases from 2004 to 2013 in China and to investigate the overall effectiveness of current prevention and control strategies.

Methods

Incidence and mortality data for 45 notifiable infectious diseases were extracted from a WChinese public health science data centre from 2004 to 2013, which covers 31 provinces in mainland China. We estimated the annual percentage change in incidence of each infectious disease using joinpoint regression.

Findings

Between January, 2004, and December, 2013, 54 984 661 cases of 45 infectious diseases were reported (average yearly incidence 417·98 per 100 000). The infectious diseases with the highest yearly incidence were hand, foot, and mouth disease (114·48 per 100 000), hepatitis B (81·57 per 100 000), and tuberculosis (80·33 per 100 000). 132 681 deaths were reported among the 54 984 661 cases (average yearly mortality 1·01 deaths per 100 000; average case fatality 2·4 per 1000). Overall yearly incidence of infectious disease was higher among males than females and was highest among children younger than 10 years. Overall yearly mortality was higher among males than females older than 20 years and highest among individuals older than 80 years. Average yearly incidence rose from 300·54 per 100 000 in 2004 to 483·63 per 100 000 in 2013 (annual percentage change 5·9%); hydatid disease (echinococcosis), hepatitis C, and syphilis showed the fastest growth. The overall increasing trend changed after 2009, and the annual percentage change in incidence of infectious disease in 2009–13 (2·3%) was significantly lower than in 2004–08 (6·2%).

Interpretation

Although the overall incidence of infectious diseases was increasing from 2004, the rate levelled off after 2009. Effective prevention and control strategies are needed for diseases with the highest incidence—including hand, foot, and mouth disease, hepatitis B, and tuberculosis—and those with the fastest rates of increase (including hydatid disease, hepatitis C, and syphilis).

Funding

Chinese Ministry of Science and Technology, National Natural Science Foundation (China).

Primary and booster vaccination with an inactivated poliovirus vaccine (IPV) is immunogenic and well-tolerated in infants and toddlers in China

INTRODUCTION

Replacing live-attenuated oral poliovirus vaccines (OPV) with inactivated poliovirus vaccines (IPV) is part of the global strategy to eradicate poliomyelitis. China was declared polio-free in 2000 but continues to record cases of vaccine-associated-poliomyelitis and vaccine-derived-poliovirus outbreaks. Two pilot safety studies and two larger immunogenicity trials evaluated the non-inferiority of IPV (Poliorix™, GSK Vaccines, Belgium) versus OPV in infants and booster vaccination in toddlers primed with either IPV or OPV in China.

METHODS

In pilot safety studies, 25 infants received 3-dose IPV primary vaccination (Study A, www.clinicaltrial.gov NCT00937404) and 25 received an IPV booster after priming with three OPV doses (Study B, NCT01021293). In the randomised, controlled immunogenicity and safety trial (Study C, NCT00920439), infants received 3-dose primary vaccination with IPV (N=541) or OPV (N=535) at 2,3,4 months of age, and a booster IPV dose at 18-24 months (N=470, Study D, NCT01323647: extension of study C). Blood samples were collected before and one month post-dose-3 and booster. Reactogenicity was assessed using diary cards. Serious adverse events (SAEs) were captured throughout each study.

RESULTS

Study A and B showed that IPV priming and IPV boosting (after OPV) was safe. Study C: One month post-dose-3, all IPV and ≥ 98.3% OPV recipients had seroprotective antibody titres towards each poliovirus type. The immune response elicited by IPV was non-inferior to Chinese OPV. Seroprotective antibody titres persisted in ≥ 94.7% IPV and ≥ 96.1% OPV recipients at 18-24 months (Study D). IPV had a clinically acceptable safety profile in all studies. Grade 3 local and systemic reactions were uncommon. No SAEs were related to IPV administration.

CONCLUSION

Trivalent IPV is non-inferior to OPV in terms of seroprotection (in the Chinese vaccination schedule) in infant and toddlers, with a clinically acceptable safety profile.