Changes in prevalence of anxiety and depression among COVID-19 patients during a two-year recovery period: A systematic review and meta-analysis

OBJECTIVE

To analyze the temporal trend of anxiety and depression prevalences up to 2 years of follow-up for COVID-19 patients during the recovery period and to compare regional differences.

METHODS

We performed a systematic review from PubMed, Embase, Web of Science, CNKI, Wanfang, and VIP using keywords such as "COVID-19", "anxiety", "depression", and "cohort study". Meta-analysis was performed to estimate the pooled prevalence of anxiety and depression at five follow-up time intervals. Subgroup analyses were conducted by different regions.

RESULTS

34 cohort studies were included in the meta-analyses. The pooled anxiety prevalence rates at 0-1 month, 1-3 months, 3-6 months, 6-12 months and 12-24 months were 18% (95% CI: 11% to 28%), 18% (95% CI: 12% to 28%), 22% (95% CI: 16% to 29%), 15% (95% CI: 11% to 21%), and 10% (95% CI: 0.05% to 20%), respectively, and the pooled depression prevalence rates were 22% (95%CI: 15% to 33%), 19% (95% CI: 13% to 29%), 21% (95% CI: 15% to 28%), 15% (95% CI: 11% to 20%), and 9% (95% CI: 0.4% to 21%) respectively. The prevalence of depression in Asian and non-Asian countries was statistically different at 0-1 month (χ2 = 15.248, P < 0.001) and 1-3 months (χ2 = 28.298, P < 0.001), and prevalence of anxiety was statistically different at 3-6 months (χ2 = 9.986, P = 0.002) and 6-12 months (χ2 = 7.378, P = 0.007).

CONCLUSION

The prevalence of anxiety and depression in COVID-19 patients generally tends to decrease after 2 years of recovery, but may temporarily increase at 3-6 months. There are regional differences in the changes in prevalence of anxiety and depression.

Cost-effectiveness analysis of hepatitis E vaccination strategies among patients with chronic hepatitis B in China

AIM

This study aimed to evaluate the cost-effectiveness of hepatitis E vaccination strategies in chronic hepatitis B (CHB) patients.

METHODS

Based on the societal perspective, the cost-effectiveness of three hepatitis E vaccination strategies-vaccination without screening, screening-based vaccination, and no vaccination-among CHB patients was evaluated using a decision tree-Markov model, and incremental cost-effectiveness ratios (ICERs) were calculated. Values for treatment costs and health utilities were estimated from a prior investigation on disease burden, and values for transition probabilities and vaccination-related costs were obtained from previous studies and government agencies. Sensitivity analyses were undertaken for assessing model uncertainties.

RESULTS

It was estimated that CHB patients superinfected with hepatitis E virus (HEV) incurred significantly longer disease course, higher economic burden, and more health loss compared to those with HEV infection alone (all p < 0.05). The ICERs of vaccination without screening and screening-based vaccination compared to no vaccination were 41,843.01 yuan/quality-adjusted life year (QALY) and 29,147.32 yuan/QALY, respectively, both lower than China's per-capita gross domestic product (GDP) in 2018. The screening-based vaccination reduced the cost and gained more QALYs than vaccination without screening. One-way sensitivity analyses revealed that vaccine price, vaccine protection rate, and decay rate of vaccine protection had the greatest impact on the cost-effectiveness analysis. Probabilistic sensitivity analyses confirmed the base-case results, and if the willingness-to-pay value reached per-capita GDP, the probability that screening-based vaccination would be cost-effective was approaching 100%.

CONCLUSIONS

The disease burden in CHB patients superinfected with HEV is relatively heavy in China, and the screening-based hepatitis E vaccination strategy for CHB patients is the most cost-effective option.

Impact of vaccination on kinetics of neutralizing antibodies against SARS-CoV-2 by serum live neutralization test based on a prospective cohort

How much the vaccine contributes to the induction and development of neutralizing antibodies (NAbs) of breakthrough cases relative to those unvaccinated-infected cases is not fully understood. We conducted a prospective cohort study and collected serum samples from 576 individuals who were diagnosed with SARS-CoV-2 Delta strain infection, including 245 breakthrough cases and 331 unvaccinated-infected cases. NAbs were analysed by live virus microneutralization test and transformation of NAb titre. NAbs titres against SARS-CoV-2 ancestral and Delta variant in breakthrough cases were 7.8-fold and 4.0-fold higher than in unvaccinated-infected cases, respectively. NAbs titres in breakthrough cases peaked at the second week after onset/infection. However, the NAbs titres in the unvaccinated-infected cases reached their highest levels during the third week. Compared to those with higher levels of NAbs, those with lower levels of NAbs had no difference in viral clearance duration time (P>0.05), did exhibit higher viral load at the beginning of infection/maximum viral load of infection. NAb levels were statistically higher in the moderate cases than in the mild cases (P<0.0001). Notably, in breakthrough cases, NAb levels were highest longer than 4 months after vaccination (Delta strain: 53,118.2 U/mL), and lowest in breakthrough cases shorter than 1 month (Delta strain: 7551.2 U/mL). Cross-neutralization against the ancestral strain and the current circulating isolate (Omicron BA.5) was significantly lower than against the Delta variant in both breakthrough cases and unvaccinated-infected cases. Our study demonstrated that vaccination could induce immune responses more rapidly and greater which could be effective in controlling SARS-CoV-2.

The expression of GADA, ZnT8A and IA-2A in patients with type 1 diabetes mellitus with thyroid disease and their correlation with thyroid autoantibodies

OBJECTIVE

The aim of this research was to study the expression of anti-glutamate decarboxylase antibody (GADA), zinc transporter-8 autoantibody (ZnT8A), and insulinoma-associated protein-2 antibody (IA-2A) in patients with type 1 diabetes (T1DM) with thyroid disease (TD) and its correlation with thyroid autoantibodies.

PATIENTS AND METHODS

380 patients with T1DM were included in the study, of which 313 patients with T1DM alone were included in the control group. In the TD group, 41 patients with T1DM and Hashimoto's thyroiditis (HT) were included, and 26 cases of T1DM patients with Graves' disease were included in the Graves group. The clinical features of the control group, the HT group, and the Graves group were compared. The positive rates of insulin autoantibodies in the control group and the TD group were analyzed. The clinical characteristics of patients with and without insulin autoantibody positivity were compared. The positive rates of thyroid autoantibodies in T1DM patients with positive GADA, ZnT8A, IA-2A, and different numbers of positive insulin autoantibodies were analyzed.

RESULTS

The levels of total cholesterol (TC) and thyroid stimulating hormone (TSH) in the HT group were significantly higher than those in the control and Graves groups, and the levels of free thyroid hormone (FT4) and low-density lipoprotein cholesterol (LDL-C) were significantly lower than those in the control and Graves groups (p<0.001). The levels of TC and TSH in the Graves group were significantly lower than those in the control group, the levels of HbA1c, LDL-C, and FT4 were significantly higher than those in the control group, and the levels of FT3 were significantly higher than those in the control and HT groups (p<0.001). The levels of C peptide, triglyceride (TG), and LDL-C of insulin autoantibodies positive patients were significantly lower than those of negative patients (p<0.05). The positive rates of GADA, ZnT8A, and IA-2A in the TD group, as well as the positive rates of double antibodies and triple antibodies, were significantly higher than those of the control group (p<0.05). In T1DM patients, the positive rates of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in GADA and IA-2A-positive patients were significantly higher than those in GADA and IA-2A-negative patients (p<0.05). The positive rate of TPOAb in ZnT8A-positive patients was significantly higher than that in ZnT8A-negative patients (p<0.05). The positive rates of TRAb, TPOAb, and TGAb in T1DM patients positive for two of the three insulin autoantibodies and three insulin autoantibodies were significantly higher than those positive for one of the three insulin autoantibodies (p<0.001).

CONCLUSIONS

TD can exacerbate the disorder of glucose and lipid metabolism in patients with T1DM, and multiple insulin autoantibodies positive T1DM patients it is more likely to have thyroid autoantibody positivity. It is suggested that patients with aggravated glucose and lipid metabolism and multiple insulin autoantibody positivity should be routinely screened for thyroid antibodies to help early diagnosis of TD.

Annual incidence and fatality rates of notifiable infectious diseases in southeast China from 1950 to 2022 and relationship to socioeconomic development

Background

Over the past 70 years, China has advanced significantly in the prevention and treatment of infectious diseases while simultaneously undergoing a socioeconomic transformation, making it a useful source of data for analysing relationships between public health policy and the control of infectious diseases.

Methods

We collected data on the incidence of notifiable infectious diseases and associated fatalities in Jiangsu province in southeast China from the Provincial Center for Disease Control and Prevention, Provincial Institute of Parasitic Diseases, and the Nationwide Notifiable Infectious Diseases Reporting Information System. We compared data from different historical periods using descriptive statistical methods, joinpoint regression, and correlation analysis.

Results

During 1950-2022, 75 754 008 cases of 46 notifiable infectious diseases were reported in Jiangsu, with an average annual incidence was 1679.49 per 100 000 population and a fatality rate of 1.82 per 1000 persons. The incidence of classes A-B decreased (average annual percent change (AAPC) = -2.1) during the entire study period, while the incidence of class C increased (AAPC = 10.8) after 2004. The incidence of intestinal diseases (AAPC = -4.4) and vector-borne and zoonotic diseases (AAPC = -8.1) decreased rapidly, while the incidence of sexually transmitted and blood-borne diseases (AAPC = 1.8) increased. The number of medical and health institutions and the per capita gross domestic product correlated negatively with the annual incidence of diseases in classes A-B, but not with fatality rates.

Conclusions

Although the annual incidence of many severe infectious diseases has decreased in Jiangsu since 1950, the incidence of sexually transmitted and blood-borne diseases increased. Socioeconomic growth and sustainable investment in health systems are associated with better control of infectious diseases.

Unveiling a New Perspective on Distinguishing Omicron Breakthrough Cases and Postimmune COVID-19-Naive Individuals: Insights from Antibody Profiles

In the situation of mass vaccination against COVID-19, few studies have reported on the early kinetics of specific antibodies (IgG/IgM/IgA) of vaccine breakthrough cases. There is still a lack of epidemiological evidence about the value of serological indicators in the auxiliary diagnosis of COVID-19 infection, especially when the nucleic acid results were undetectable. Omicron breakthrough cases post-inactivated vaccination (n = 456) and COVID-19-naive individuals with two doses of inactivated vaccination (n = 693) were enrolled. Blood samples were collected and tested for SARS-CoV-2 antibody levels based on the magnetic chemiluminescence enzyme immunoassay. Among Omicron breakthrough cases, the serum IgG antibody level was 36.34 Sample/CutOff (S/CO) (95% confidence interval [CI], 31.89 to 40.79) in the acute phase and 88.45 S/CO (95% CI, 82.79 to 94.12) in the recovery phase. Serum IgA can be detected in the first week post-symptom onset (PSO) and showed an almost linear increase within 5 weeks PSO. Compared with those of breakthrough cases, IgG and IgA titers of the postimmune group were much lower (4.70 S/CO and 0.46 S/CO, respectively). Multivariate regression showed that serum IgG and IgA levels in Omicron breakthrough cases were mainly affected by the weeks PSO (P < 0.001). Receiver operating characteristic ROC0 curve analysis showed that the area under the curve (AUC) was 0.744 and 0.806 when the cutoff values of IgA and IgG were 1 S/CO and 15 S/CO, respectively. Omicron breakthrough infection can lead to a further increase in IgG and IgA levels relative to those of the immunized population. When nucleic acid real-time PCR was negative, we would use the kinetics of IgG and IgA levels to distinguish the breakthrough cases from the immunized population. IMPORTANCE This study fills a gap in the epidemiological evidence by investigating the value of serological indicators, particularly IgG and IgA levels, in the auxiliary diagnosis of COVID-19 infections when nucleic acid results are undetectable. The findings reveal that among Omicron breakthrough cases, both IgG and IgA antibody levels exhibit significant changes. Serum IgG levels increase during the acute phase and rise further in the recovery phase. Serum IgA can be detected as early as the first week post-symptom onset (PSO), showing a consistent linear increase within 5 weeks PSO. Furthermore, receiver operating characteristic (ROC) curve analysis demonstrates the potential of IgG and IgA cutoff values as diagnostic markers. The study's conclusion underscores the importance of monitoring IgG and IgA kinetics in distinguishing Omicron breakthrough cases from vaccinated individuals. These findings contribute to the development of more accurate diagnostic approaches and help inform public health strategies during the ongoing COVID-19 pandemic.

Analysis of the spatial-temporal distribution characteristics of hepatitis E in Jiangsu province from 2005 to 2020

Objective

This study attempts to analyze the spatial clustering and spatial-temporal distribution characteristics of hepatitis E (HE) at the county (city and district) level in Jiangsu province to provide a scientific basis for the prevention and control of HE.

Method

The information on HE cases reported in the Chinese Center for Disease Control and Prevention Information System from 2005 to 2020 was collected for spatial autocorrelation analysis and spatial-temporal clustering analysis.

Result

From 2005 to 2020, 48,456 HE cases were reported in Jiangsu province, with an average annual incidence rate of 3.87/100,000. Male cases outnumbered female cases (2.46:1), and the incidence was highest in the 30-70 years of age group (80.50%). Farmers accounted for more than half of all cases (59.86%), and in terms of the average annual incidence, the top three cities were all in Zhenjiang city. Spatial autocorrelation analysis showed that Global Moran's I of HE incidence varied from 0.232 to 0.513 for the years. From 2005 to 2020, 31 counties (cities and districts) had high and statistically significant HE incidence, and two clustering areas were detected by spatial-temporal scanning.

Conclusion

HE incidence in Jiangsu province from 2005 to 2020 was stable, with age and gender differences, regional clustering, and spatial-temporal clustering. Further investigation of HE clustering areas is necessary to formulate corresponding targeted prevention and control measures.

Machine-learning models for prediction of sepsis patients mortality

OBJECTIVES

Sepsis is an infection-caused syndrome, that leads to life-threatening organ damage. We aim to develop machine learning models with large-scale data to predict sepsis patients' mortality.

DESIGN

we extracted sepsis patients from two databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) as a train set and Philips eICU Collaborative Research Database as a test set.

SETTING

ICUs in multicenter hospitals in the USA during 2012-2019.

PATIENTS OR PARTICIPANTS

A total of 21,680 sepsis-3 patients are included in the study, in which, 3771 patients were dead and 17,909 survived during hospitalization, respectively.

INTERVENTIONS

No interventions.

MAIN VARIABLES OF INTEREST

Basic information, examination items during hospitalization and some medication and treatment information are incorporated into analyzed. Seven different models were built with a Support vector machine, Decision Tree Classifier, Random Forest, Gradients Boosting, Multiple Layer Perception, Xgboost, light Gradients Boosting to predict dead or live during hospitalization.

RESULTS

Algorithms with an AUC value in the test set of the top three: light GBM, GBM, Xgboost. Considering the performance of the training set and the test set, the light GBM model performs best, and then the parameters of the model were adjusted, after that the AUC value was 0.99 in the train set, 0.96 in the test set, respectively.

CONCLUSIONS

Models built with light GBM algorithm from real-world sepsis patients from electronic health records accurately predict whether sepsis patients are dead and can be incorporated into clinical decision tools to enhance the prognosis of the patient and prevent adverse outcomes.

B-Cell-Derived TGF-β1 Inhibits Osteogenesis and Contributes to Bone Loss in Periodontitis

B cells play a vital role in the elimination of periodontal pathogens, the regulation of the immune response, and the induction of tissue destruction. However, the role of B cells in the dysfunction of mesenchymal stem cell (MSC) differentiation to osteoblasts in periodontitis (PD) has been poorly studied. Here we show that the frequency of CD45^-CD105⁺CD73⁺ MSCs in inflamed periodontal tissues is significantly decreased in patients with PD compared with that of healthy controls. CD19⁺ B cells dominate the infiltrated immune cells in periodontal tissues of patients with PD. Besides, B-cell depletion therapy reduces the alveolar bone loss in a ligature-induced murine PD model. B cells from PD mice express a high level of TGF-β1 and inhibit osteoblast differentiation by upregulating p-Smad2/3 expression and downregulating Runx2 expression. The inhibitory effect of PD B cells on osteoblast differentiation is reduced by TGF-β1 neutralization or Smad2/3 inhibitor. Importantly, B-cell-specific knockout of TGF-β1 in PD mice significantly increases the number of CD45^-CD105⁺Sca1⁺ MSCs, ALP-positive osteoblast activity, and alveolar bone volume but decreases TRAP-positive osteoclast activity compared with that from control littermates. Lastly, CD19⁺CD27⁺CD38^- memory B cells dominate the B-cell infiltrates in periodontal tissues from both patients with PD and patients with PD after initial periodontal therapy. Memory B cells in periodontal tissues of patients with PD express a high level of TGF-β1 and inhibit MSC differentiation to osteoblasts. Thus, TGF-β1 produced by B cells may contribute to alveolar bone loss in periodontitis, in part, by suppressing osteoblast activity.

Analysis of fatal cases of severe fever with thrombocytopenia syndrome in Jiangsu province, China, between 2011 and 2022: A retrospective study

Introduction

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus (SFTSV), which has a high fatality rate. This disease has become increasingly prevalent in recent years in Jiangsu province, with a noticeable rise in its incidence. Notably, fatal cases have also been increasing. Our study aimed to analyze the epidemiological characteristics and risk factors associated with the fatal cases of SFTS in Jiangsu province from 2011 to September 2022.

Methods

A retrospective study was performed among 698 SFTS cases during 2011-2022 in Jiangsu Province, China. Cox regression analyses were used to determine the dependent and independent risk factors that affected patient survival time. ArcGIS 10.7 was used for the visualization of the geographical distribution of the deaths from SFTS.

Results

There were 698 SFTS cases reported, with an increasing incidence, over the 12-year period. Among these cases, 43 deaths were reported. Fatal cases of SFTS were reported in 12 district counties from 2011 to 2022. Notably, most of the deaths occurred in Lishui county of Nanjing City. The median age of those who died was 69 years, with age ranges from 50 to 83 years. Multivariable Cox regression analysis showed that older age (>70) and living in Lishui county were risk factors for death from SFTS in Jiangsu province. Therefore, older adults aged over 70 years and residing in Lishui county were the high-risk group for SFTS mortality.

Discussion

Over the past 12 years, we have observed a consistent rise in the incidence of SFTS, accompanied by a relatively high case fatality rate, making it a critical public health issue. Therefore, it is urgently necessary to study the impact of meteorological factors on SFTS epidemics and devise prevention and control strategies.

Epidemiological and spatiotemporal analysis of severe fever with thrombocytopenia syndrome in Eastern China, 2011-2021

BACKGROUND

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease, which is caused by severe fever with thrombocytopenia syndrome virus (SFTSV) with high fatality. Recently, the incidence of SFTS increased obviously in Jiangsu Province. However, the systematic and complete analysis of spatiotemporal patterns and clusters coupled with epidemiological characteristics of SFTS have not been reported so far.

METHODS

Data on SFTS cases were collected during 2011-2021. The changing epidemiological characteristics of SFTS were analyzed by adopting descriptive statistical methods. GeoDa 1.18 was applied for spatial autocorrelation analysis, and SaTScan 10.0 was used to identify spatio-temporal clustering of cases. The results were visualized in ArcMap.

RESULTS

The annual incidence of SFTS increased in Jiangsu Province from 2011 to 2021. Most cases (72.4%) occurred during May and August with the obvious peak months. Elderly farmers accounted for most cases, among which both males and females were susceptible. The spatial autocorrelation and spatio-temporal clustering analysis indicated that the distribution of SFTS was not random but clustered in space and time. The most likely cluster was observed in the western region of Jiangsu Province and covered one county (Xuyi county) (Relative risk = 8.18, Log likelihood ratio = 122.645, P < 0.001) located in southwestern Jiangsu Province from January 1, 2017 to December 31, 2021. The Secondary cluster also covered one county (Lishui county) (Relative risk = 7.70, Log likelihood ratio = 94.938, P < 0.001) from January 1, 2017 to December 31, 2021.

CONCLUSIONS

The annual number of SFTS cases showed an increasing tendency in Jiangsu Province from 2011 to 2021. Our study elucidated regions with SFTS clusters by means of ArcGIS in combination with spatial analysis. The results demonstrated solid evidences for the orientation of limited sanitary resources, surveillance in high-risk regions and early warning of epidemic seasons in future prevention and control of SFTS in Jiangsu Province.

Kinetics of SARS-CoV-2 neutralizing antibodies in Omicron breakthrough cases with inactivated vaccination: Role in inferring the history and duration of infection

Background

The quantitative level and kinetics of neutralizing antibodies (NAbs) in individuals with Omicron breakthrough infections may differ from those of vaccinated individuals without infection. Therefore, we aimed to evaluate the difference in NAb levels to distinguish the breakthrough cases from the post-immunized population to identify early infected person in an outbreak epidemic when nasal and/or pharyngeal swab nucleic acid real-time PCR results were negative.

Methods

We collected 1077 serum samples from 877 individuals, including 189 with Omicron BA.2 breakthrough infection and 688 post-immunized participants. NAb titers were detected using the surrogate virus neutralization test, and were log(2)-transformed to normalize prior to analysis using Student's unpaired t-tests. Geometric mean titers (GMT) were calculated with 95% confidence intervals (CI). Linear regression models were used to identify factors associated with NAb levels. We further conducted ROC curve analysis to evaluate the NAbs' ability to identify breakthrough infected individuals in the vaccinated population.

Results

The breakthrough infection group had a consistently higher NAb levels than the post-immunized group according to time since the last vaccination. NAb titers in the breakthrough infection group were 6.4-fold higher than those in the post-immunized group (GMT: 40.72 AU/mL and 6.38 AU/mL, respectively; p<0.0001). In the breakthrough infection group, the NAbs in the convalescent phase were 10.9-fold higher than in the acute phase (GMT: 200.48 AU/mL and 18.46 AU/mL, respectively; p<0.0001). In addition, the time since infection, booster vaccination, and the time since last vaccination were associated with log(2)-transformed NAb levels in the breakthrough infection group. ROC curve analysis showed that ROC area was largest (0.728) when the cut-off value of log(2)-transformed NAb was 6, which indicated that NAb levels could identify breakthrough infected individuals in the vaccinated population.

Conclusion

Our study demonstrates that the NAb titers of Omicron BA.2 variant breakthrough cases are higher than in the post-immunized group. The difference in NAb levels could be used to identify cases of breakthrough infection from the post-immunized population in an outbreak epidemic.

The Third dose of CoronVac vaccination induces broad and potent adaptive immune responses that recognize SARS-CoV-2 Delta and Omicron variants

The waning humoral immunity and emerging contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants resulted in the necessity of the booster vaccination of coronavirus disease 2019 (COVID-19). The inactivated vaccine, CoronaVac, is the most widely supplied COVID-19 vaccine globally. Whether the CoronaVac booster elicited adaptive responses that cross-recognize SARS-CoV-2 variants of concern (VoCs) among 77 healthy subjects receiving the third dose of CoronaVac were explored. After the boost, remarkable elevated spike-specific IgG and IgA responses, as well as boosted neutralization activities, were observed, despite 3.0-fold and 5.9-fold reduced neutralization activities against Delta and Omicron strains compared to that of the ancestral strain. Furthermore, the booster dose induced potent B cells and memory B cells that cross-bound receptor-binding domain (RBD) proteins derived from VoCs, while Delta and Omicron RBD-specific memory B cell recognitions were reduced by 2.7-fold and 4.2-fold compared to that of ancestral strain, respectively. Consistently, spike-specific circulating follicular helper T cells (cTfh) significantly increased and remained stable after the boost, with a predominant expansion towards cTfh17 subpopulations. Moreover, SARS-CoV-2-specific CD4⁺ and CD8⁺ T cells peaked and sustained after the booster. Notably, CD4⁺ and CD8⁺ T cell recognition of VoC spike was largely preserved compared to the ancestral strain. Individuals without generating Delta or Omicron neutralization activities had comparable levels of CD4⁺ and CD8⁺ T cells responses as those with detectable neutralizing activities. Our study demonstrated that the CoronaVac booster induced broad and potent adaptive immune responses that could be effective in controlling SARS-CoV-2 Delta and Omicron variants.

Repeated influenza vaccination induces similar immune protection as first-time vaccination but with differing immune responses

BACKGROUND

Recent seasonal epidemics of influenza have been caused by human influenza A viruses of the H1N1 and H3N2 subtypes and influenza B viruses. Annual vaccination is recommended to prevent infection; however, how annual influenza vaccination influences vaccine effectiveness is largely unknown.

METHODS

To investigate the impact of repeated vaccination on immune and protective effect, we performed a prospective seroepidemiologic study. Participants with or without prior vaccination (2018-2019) were enrolled during the 2019-2020 influenza season. Inactivated quadrivalent influenza vaccine (IIV4) was administered through the intramuscular route, and venous blood samples were collected regularly to test hemagglutination inhibition (HAI) titers.

RESULTS

The geometric mean titers and proportion with titers ≥40 against the influenza vaccine components peaked at 30 days post-vaccination. At Day 30, the geometric mean titer and proportion with titers ≥40 in participants who had been previously vaccinated were higher for H3N2 but similar for both B lineages (Victoria and Yamagata) as compared with participants vaccinated for the first time. As for H1N1, the geometric mean titer was lower in repeated vaccinated participants, but the proportion with titers ≥40 was consistent in both groups.

CONCLUSIONS

Repeated vaccination provides similar or enhanced protection as compared with single vaccination in first-time vaccinees.

Long-Term Kinetics of SARS-CoV-2 Antibodies and Impact of Inactivated Vaccine on SARS-CoV-2 Antibodies Based on a COVID-19 Patients Cohort

Background

Understanding the long-term kinetic characteristics of SARS-CoV-2 antibodies and the impact of inactivated vaccines on SARS-CoV-2 antibodies in convalescent patients can provide information for developing and improving vaccination strategies in such populations.

Methods

In this cohort, 402 convalescent patients who tested positive for SARS-CoV-2 by RT-PCR from 1 January to 22 June 2020 in Jiangsu, China, were enrolled. The epidemiological data included demographics, symptom onset, and vaccination history. Blood samples were collected and tested for antibody levels of specific IgG, IgM, RBD-IgG, S-IgG, and neutralizing antibodies using a the commercial magnetic chemiluminescence enzyme immunoassay.

Results

The median follow-up time after symptom onset was 15.6 months (IQR, 14.6 to 15.8). Of the 402 convalescent patients, 44 (13.84%) received an inactivated vaccine against COVID-19. A total of 255 (80.19%) patients were IgG-positive and 65 (20.44%) were IgM-positive. The neutralizing antibody was 83.02%. Compared with non-vaccinated individuals, the IgG antibody levels in vaccinated people were higher (P=0.007). Similarly, antibody levels for RBD-IgG, S-IgG, and neutralizing antibodies were all highly increased in vaccinated individuals (P<0.05). IgG levels were significantly higher after vaccination than before vaccination in the same population. IgG levels in those who received ‘single dose and ≥14d’ were similar to those with two doses (P>0.05). Similar conclusions were drawn for RBD-IgG and the neutralizing antibody.

Conclusion

15.6 months after symptom onset, the majority of participants remained positive for serum-specific IgG, RBD-IgG, S-IgG, and neutralizing antibodies. For convalescent patients, a single dose of inactivated vaccine against COVID-19 can further boost antibody titres.

A dynamic model for individualized prognosis prediction in patients with avian influenza A H7N9

Background

Avian influenza A H7N9 progresses rapidly and has a high case fatality rate. However, few models are available to predict the survival of individual patients with H7N9 infection in real-time. This study set out to construct a dynamic model for individual prognosis prediction based on multiple longitudinal measurements taken during hospitalization.

Methods

The clinical and laboratory characteristics of 96 patients with H7N9 who were admitted to hospitals in Jiangsu between January 2016 and May 2017 were retrospectively investigated. A random forest model was applied to longitudinal data to select the biomarkers associated with prognostic outcome. Finally, a multivariate joint model was used to describe the time-varying effects of the biomarkers and calculate individual survival probabilities.

Results

The random forest selected a set of significant biomarkers that had the lowest classification error rates in the feature selection phase, including C-reactive protein (CRP), blood urea nitrogen (BUN), procalcitonin (PCT), base excess (BE), lymphocyte count (LYMPH), white blood cell count (WBC), and creatine phosphokinase (CPK). The multivariate joint model was used to describe the effects of these biomarkers and characterize the dynamic progression of the prognosis. Combined with the covariates, the joint model displayed a good performance in discriminating survival outcomes in patients within a fixed time window of 3 days. During hospitalization, the areas under the curve were stable at 0.75.

Conclusions

Our study has established a novel model that is able to identify significant indicators associated with the prognostic outcomes of patients with H7N9, characterize the time-to-event process, and predict individual-level daily survival probabilities after admission.

Study of Risk Factors for Total Attack Rate and Transmission Dynamics of Norovirus Outbreaks, Jiangsu Province, China, From 2012 to 2018

Objective: To describe the epidemiological characteristics of norovirus outbreaks in Jiangsu Province, utilize the total attack rate (TAR) and transmissibility (R_unc) as the measurement indicators of the outbreak, and a statistical difference in risk factors associated with TAR and transmissibility was compared. Ultimately, this study aimed to provide scientific suggestions to develop the most appropriate prevention and control measures.

Method: We collected epidemiological data from investigation reports of all norovirus outbreaks in Jiangsu Province from 2012 to 2018 and performed epidemiological descriptions, sequenced the genes of the positive specimens collected that were eligible for sequencing, created a database and calculated the TAR, constructed SEIAR and SEIARW transmission dynamic models to calculate R_unc, and performed statistical analyses of risk factors associated with the TAR and R_unc.

Results: We collected a total of 206 reported outbreaks, of which 145 could be used to calculate transmissibility. The mean TAR in was 2.6% and the mean R_unc was 12.2. The epidemiological characteristics of norovirus outbreaks showed an overall increasing trend in the number of norovirus outbreaks from 2012 to 2018; more outbreaks in southern Jiangsu than northern Jiangsu; more outbreaks in urban areas than in rural areas; outbreaks occurred mostly in autumn and winter. Most of the sites where outbreaks occurred were schools, especially primary schools. Interpersonal transmission accounted for the majority. Analysis of the genotypes of noroviruses revealed that the major genotypes of the viruses changed every 3 years, with the GII.2 [P16] type of norovirus dominating from 2016 to 2018. Statistical analysis of TAR associated with risk factors found statistical differences in all risk factors, including time (year, month, season), location (geographic location, type of settlement, type of premises), population (total number of susceptible people at the outbreak site), transmission route, and genotype (P < 0.05). Statistical analysis of transmissibility associated with risk factors revealed that only transmissibility was statistically different between sites.

Conclusions: The number of norovirus outbreaks in Jiangsu Province continues to increase during the follow-up period. Our findings highlight the impact of different factors on norovirus outbreaks and identify the key points of prevention and control in Jiangsu Province.

Cost-Effectiveness of Public Health Measures to Control COVID-19 in China: A Microsimulation Modeling Study

This study aimed to assess the cost-effectiveness of various public health measures in dealing with coronavirus disease 2019 (COVID-19) in China. A stochastic agent-based model was used to simulate the progress of the COVID-19 outbreak in scenario I (imported one case) and scenario II (imported four cases) with a series of public health measures. The main outcomes included the avoided infections and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to assess uncertainty. The results indicated that isolation-and-quarantine averted the COVID-19 outbreak at the lowest ICERs. The joint strategy of personal protection and isolation-and-quarantine averted one more case than only isolation-and-quarantine with additional costs. The effectiveness of isolation-and-quarantine decreased with lowering quarantine probability and increasing delay time. The strategy that included community containment would be cost-effective when the number of imported cases was >65, or the delay time of the quarantine was more than 5 days, or the quarantine probability was below 25%, based on current assumptions. In conclusion, isolation-and-quarantine was the most cost-effective intervention. However, personal protection combined with isolation-and-quarantine was the optimal strategy for averting more cases. The community containment could be more cost-effective as the efficiency of isolation-and-quarantine drops and the imported cases increases.

Analysis of Clinical Characteristics and Virus Strains Variation of Patients Infected With SARS-CoV-2 in Jiangsu Province-A Retrospective Study

Background: At present, the global sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) situation is still grim, and the risk of local outbreaks caused by imported viruses is high. Therefore, it is necessary to monitor the genomic variation and genetic evolution characteristics of SARS-CoV-2. The main purpose of this study was to detect the entry of different SARS-CoV-2 variants into Jiangsu Province, China. Methods: First, oropharyngeal swabs were collected from 165 patients (55 locally confirmed cases and 110 imported cases with confirmed and asymptomatic infection) diagnosed with SARS-CoV-2 infection in Jiangsu Province, China between January 2020 and June 2021. Then, whole genome sequencing was used to explore the phylogeny and find potential mutations in genes of the SARS-CoV-2. Last, association analysis among clinical characteristics and SARS-CoV-2 Variant of Concern, pedigree surveillance analysis of SARS-COV-2, and single nucleotide polymorphisms (SNPs) detection in SARS-COV-2 samples was performed. Results: More men were infected with the SARS-CoV-2 when compared with women. The onset of the SARS-CoV-2 showed a trend of younger age. Moreover, the number of asymptomatic infected patients was large, similar to the number of common patients. Patients infected with Alpha (50%) and Beta (90%) variants were predominantly asymptomatic, while patients infected with Delta (17%) variant presented severe clinical features. A total of 935 SNPs were detected in 165 SARS-COV-2 samples. Among which, missense mutation (58%) was the dominant mutation type. About 56% of SNPs changes occurred in the open reading frame 1ab (ORF1ab) gene. Approximately, 20% of SNP changes occurred in spike glycoprotein (S) gene, such as p.Asp501Tyr, p.Pro681His, and p.Pro681Arg. In total, nine SNPs loci in S gene were significantly correlated with the severity of patients. It is worth mentioning that amino acid substitution of p.Asp614Gly was significantly positively correlated with the clinical severity of patients. The amino acid replacements of p.Ser316Thr and p.Lu484Lys were significantly negatively correlated with the course of disease. Conclusion: Sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may further undergo a variety of mutations in different hosts, countries, and weather conditions. Detecting the entry of different virus variants of SARS-CoV-2 into Jiangsu Province, China may help to monitor the spread of infection and the diversity of eventual recombination or genomic mutations.

Emergence of mcr-1-Harboring Salmonella enterica Serovar Sinstorf Type ST155 Isolated From Patients With Diarrhea in Jiangsu, China

Background: This study analyzed the antimicrobial resistance phenotypes and mechanisms of quinolone, cephalosporins, and colistin resistance in nontyphoidal Salmonella from patients with diarrhea in Jiangsu, China. Methods: A total of 741 nontyphoidal Salmonella isolates were collected from hospitals in major cities of Jiangsu Province, China between 2016 and 2017. Their susceptibility to commonly used antibiotics was evaluated by broth micro-dilution and sequencing analysis of resistance genes screened by a PCR method. For mcr-1 positive isolates, genetic relationship study was carried out by pulsed-field gel electrophoresis and multiloci sequence typing analysis. The transferability of these plasmids was measured with conjugation experiments and the genetic locations of mcr-1 were analyzed by pulsed-field gel electrophoresis profiles of S1-digested genomic DNA and subsequent Southern blot hybridization. Results: Among 741 nontyphoidal Salmonella isolates, the most common serotypes identified were S. Typhimurium (n=257, 34.7%) and S. Enteritidis (n=127, 17.1%), and the isolates showed 21.7, 20.6, and 5.0% resistance to cephalosporins, ciprofloxacin, and colistin, respectively. Among the 335 nalidixic acid-resistant Salmonella, 213 (63.6%) and 45 (13.4%) had at least one mutation in gyrA and parC. Among the plasmid-borne resistance, qnrS1 (85; 41.9%) and aac(6')-Ib-cr4 (75; 36.9%) were the most common quinolone resistance (PMQR) genes, while bla _CTX-M-14 (n=35) and bla _CTX-M-55 (n=46) were found to be dominant extended-spectrum beta-lactamase (ESBL) genes in nontyphoidal Salmonella. In addition, eight mcr-1-harboring strains were detected since 2016 and they were predominate in children under the age of 7years. Conjugation assays showed the donor Salmonella strain has functional and transferable colistin resistance and Southern blot hybridization revealed that mcr-1 was located in a high molecular weight plasmid. Conclusion: In nontyphoidal Salmonella, there is a rapidly increasing trend of colistin resistance and this is the first report of patients harboring mcr-1-positive Salmonella with a new ST type ST155 and new serotype S. Sinstorf. These findings demonstrate the necessity for cautious use and the continuous monitoring of colistin in clinical applications.

Impact of interventions on the incidence of natural focal diseases during the outbreak of COVID-19 in Jiangsu Province, China

BACKGROUND

During the period of the coronavirus disease 2019 (COVID-19) outbreak, strong intervention measures, such as lockdown, travel restriction, and suspension of work and production, may have curbed the spread of other infectious diseases, including natural focal diseases. In this study, we aimed to study the impact of COVID-19 prevention and control measures on the reported incidence of natural focal diseases (brucellosis, malaria, hemorrhagic fever with renal syndrome [HFRS], dengue, severe fever with thrombocytopenia syndrome [SFTS], rabies, tsutsugamushi and Japanese encephalitis [JE]).

METHODS

The data on daily COVID-19 confirmed cases and natural focal disease cases were collected from Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial CDC). We described and compared the difference between the incidence in 2020 and the incidence in 2015-2019 in four aspects: trend in reported incidence, age, sex, and urban and rural distribution. An autoregressive integrated moving average (ARIMA) (p, d, q) × (P, D, Q)_s model was adopted for natural focal diseases, malaria and severe fever with thrombocytopenia syndrome (SFTS), and an ARIMA (p, d, q) model was adopted for dengue. Nonparametric tests were used to compare the reported and the predicted incidence in 2020, the incidence in 2020 and the previous 4 years, and the difference between the duration from illness onset date to diagnosed date (DID) in 2020 and in the previous 4 years. The determination coefficient (R²) was used to evaluate the goodness of fit of the model simulation.

RESULTS

Natural focal diseases in Jiangsu Province showed a long-term seasonal trend. The reported incidence of natural focal diseases, malaria and dengue in 2020 was lower than the predicted incidence, and the difference was statistically significant (P < 0.05). The reported incidence of brucellosis in July, August, October and November 2020, and SFTS in May to November 2020 was higher than that in the same period in the previous 4 years (P < 0.05). The reported incidence of malaria in April to December 2020, HFRS in March, May and December 2020, and dengue in July to November 2020 was lower than that in the same period in the previous 4 years (P < 0.05). In males, the reported incidence of malaria in 2020 was lower than that in the previous 4 years, and the reported incidence of dengue in 2020 was lower than that in 2017-2019. The reported incidence of malaria in the 20-60-year age group was lower than that in the previous 4 years; the reported incidence of dengue in the 40-60-year age group was lower than that in 2016-2018. The reported cases of malaria in both urban and rural areas were lower than in the previous 4 years. The DID of brucellosis and SFTS in 2020 was shorter than that in 2015-2018; the DID of tsutsugamushi in 2020 was shorter than that in the previous 4 years.

CONCLUSIONS

Interventions for COVID-19 may help control the epidemics of natural focal diseases in Jiangsu Province. The reported incidence of natural focal diseases, especially malaria and dengue, decreased during the outbreak of COVID-19 in 2020. COVID-19 prevention and control measures had the greatest impact on the reported incidence of natural focal diseases in males and people in the 20-60-year age group.

AB0463 IMPROVEMENTS IN PATIENT-REPORTED OUTCOMES IN ANKYLOSING SPONDYLITIS PATIENTS TREATED WITH GOLIMUMAB: SUB-ANALYSIS OF ASIAN PATIENTS ENROLLED IN PHASE-3 CLINICAL TRIALS

Background:

Clinical efficacy and safety of golimumab (GLM) for patients with ankylosing spondylitis (AS) who have not received prior biologic therapy were studied in two phase-3 clinical trials (NCT00265083 - GO RAISE and NCT01248793). In both studies, a greater proportion of patients treated with GLM 50 mg every 4 weeks achieved improvement in clinical signs and symptoms measured by ASAS20 and in patient-reported outcomes, such as Health Related Quality of Life (HRQoL) and sleep disturbance when compared with placebo (PBO) at Weeks 14 and 24.

Objectives:

To assess the effect of GLM on HRQoL, back pain, and sleep disturbances in phase-3 studies in Asian patients with AS.

Methods:

Post-hoc sub-analysis to examine HRQoL, measured with the Short Form 36 (SF-36) Physical and Mental Component Summary (PCS and MCS), total back pain (VAS) and sleep disturbance, assessed with the Jenkins Sleep Evaluation Questionnaire (JSEQ) in active AS patients enrolled from Asian countries (China, including Taiwan region and South Korea). Improvement from baseline to Week 24 was expressed as mean and standard deviation (SD) for SF-36 PCS and MCS and total back pain. Reduction of sleep disturbance was expressed as the proportion of patients with improvement from baseline ≥2 points in the JSEQ, defined as baseline value minus post-baseline value with lower scores indicating the better sleep evaluation.

Results:

At Week 24, active AS patients treated with GLM 50 mg had greater mean improvements in SF-36 and total back pain than PBO. The pooled results were comparable with patients enrolled from other regions (Table 1). A higher proportion of Asian patients who received GLM had reduced sleep disturbance (JSEQ ≥2) after 24 weeks than PBO (59.7% [83/139] vs 38.5% [47/122]; Δ21.2) and the results were similar with AS patients on GLM (67.4% [64/95] vs 45.6% [26/57]; Δ21.8) pooled from other regions.

Conclusion:

Asian patients with AS treated with GLM demonstrated improved HRQoL, total back pain, and reduced sleep disturbance. The pooled results were comparable with other regions.

Table 1.

Mean Improvement from Baseline in HRQoL and total back pain at Week 24: Randomized Patients in AS Studies Pooled for Asia and all other regions

Pooled AS in APACPooled AS in All Other RegionsParameterPlaceboGLM 50 mgPlaceboGLM 50 mgNMean (SD)NMean (SD)NMean (SD)NMean (SD)SF-36 PCS1222.51 (6.372)1397.10 (8.434)581.91 (8.268)9910.12 (11.096)SF-36 MCS1220.22 (9.609)1393.32 (9.280)581.20 (9.705)991.98 (8.032)Total Back Pain1201.86 (2.469)1352.73 (2.607)580.79 (2.688)993.39 (3.210)

APAC, Asia-Pacific; AS, ankylosing spondylitis; GLM, golimumab; HRQoL, Health Related Quality of Life; MCS, mental component summary; PCS, physical component summary; SD, standard deviation; SF-36, Short Form 36

Disclosure of Interests:

Wen-Chan Tsai Consultant of: Pfizer, AbbVie, Roche, and Eli Lilly, Chunde Bao: None declared., Daniel Furtner Shareholder of: Johnson & Johnson, Employee of: Johnson & Johnson Pte. Ltd., Singapore, Kim Hung Lo Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Yiying Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC.

POS0664 A MULTICENTER RANDOMIZED STUDY IN RHEUMATOID ARTHRITIS TO COMPARE IGURATIMOD, METHOTREXATE, OR COMBINATION: 52 WEEK EFFICACY AND SAFETY RESULTS OF THE SMILE TRIAL

Background:

Iguratimod (IGU) has demonstrated efficacy and safety for active rheumatoid arthritis (RA) patients in double-blind clinical trials in China and Japan as a new disease-modifying anti-rheumatic drug (DMARD). There are no studies evaluating the radiographic progression of structural joint damage of IGU for the treatment of RA using the mTSS as the primary endpoint.

Objectives:

Our study was to evaluate the efficacy and safety of IGU monotherapy and IGU combined methotrexate (MTX) compared with MTX monotherapy, including the inhibitory effects of joint destruction.

Methods:

This randomized, double-blind, parallel-controlled, multicenter study in patients with active RA who have not previously used MTX and biological DMARDs (bDMARDs) (ClinicalTrials.gov Identifier NCT01548001) was carried out in China. Patients were randomized 1:1:1 to receive IGU 25 mg twice a day (bid), MTX 10mg once a week(qw) for the first 4 weeks and 15 mg once a week(qw) for week 5 to 52, or IGU combined MTX (IGU+MTX) for 52 weeks. The primary endpoints were to assess and compare American College of Rheumatology 20% (ACR20) response and the change of modified total Sharp scoring (mTSS) score over 52 weeks (Intention-to-treat, ITT analysis). The non-inferiority test was used to analyze the difference of ACR20 response at 52 weeks between the IGU monotherapy and the MTX monotherapy arms, and the non-inferiority limit value was 10%. The difference test was used for the comparison between the IGU+MTX and MTX monotherapy arms. Two-way ANOVA was used to analyze the difference of the changes of mTSS score of each arm compared with baseline value (0 week).

Results:

A total of 895 patients were randomized to IGU 25mg bid (n =297), MTX 10-15mg qw(n=293), and IGU+MTX (n=305). Baseline characteristics were comparable between the arms (Table 1).

Table 1.

Demographic and Other Baseline Characteristics (SAS)

IGUMTXIGU+MTXNumber of Subjects297293305Age, mean (SD) years46.87(10.67)47.63(10.70)48.37(10.69)Female/male, %77.44/22.5679.18/20.8278.03/21.97Duration of RA, mean(SD) years11.67±7.1611.60±7.9811.67±7.27CRP, mean(SD) mg/L222.32±35.4720.67±26.6119.74±31.38Tender joint count, mean (SD)14.59±9.1614.83±9.3014.93±9.88Swollen joint count, mean (SD)9.81±6.639.73±7.209.51±6.22DAS28-CRP, mean (SD)5.084±0.9945.102±0.9795.103±0.956HAQ score, mean (SD)15.82±11.2515.24±10.9316.06±10.92

SAS: Safety Analysis Set; CRP: C-reactive protein;

DAS28: disease activity score; HAQ: Health Assessment Questionnaire

The study met its primary endpoints. More concretely, IGU monotherapy and IGU+MTX were found to be superior to MTX at week 52 with a higher ACR20 response of 77.44%(230/297, P=0.0019) and 77.05%(235/305, P=0.0028) versus 65.87%(193/293) (fig 1). As shown in fig 1, the structural remission (ΔmTSS≤0.5) was statistically significant for IGU monotherapy (57.4%, P=0.0308) but not for IGU+MTX arm (55%) versus MTX monotherapy (47.8%).

Overall incidence of the adverse events (AEs) leading to study discontinuation were reported in 13.8% (41/297) in IGU monotherapy arm, 11.26% (33/293) in MTX monotherapy arm and 11.51% (35/305) patients in IGU+MTX arm. The incidence of adverse drug reactions (ADR) leading to study discontinuation were 11.45% (34/297), 8.53% (25/293) and 9.21% (28/305), respectively. There was no one death and no significant difference in all the safety indicators among the three arms.

Conclusion:

Iguratimod alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX for patients with active RA who have not previously used MTX bDMARDs.

Disclosure of Interests:

None declared

Evolution of the GII.3[P12] Norovirus from 2010 to 2019 in Jiangsu, China

Objectives

Norovirus genotype GII.3[P12] strains have been an important pathogen for sporadic gastroenteritis infection. In previous studies of GII.3[P12], the number of specimens and time span are relatively small, which is difficult to truly reflect the infection and evolution of this type of norovirus. Here we report a molecular epidemiological study of the NoVs prevalent in Jiangsu between 2010 and 2019 to investigate the evolution of the GII.3[P12] strains in China.

Methods

In this study 60 GII.3[P12] norovirus strains were sequenced and analyzed for evolution, recombination, and selection pressure using bioanalysis software.

Results

The GII.3[P12] strains were continuously detected during the study period, which showed a high constituent ratio in males, in winter and among children aged 0–11 months, respectively. A time-scaled evolutionary tree showed that both GII.P12 RdRp and GII.3 VP1 sequences were grouped into three major clusters (Cluster I–III). Most GII.3[P12] strains were mainly located in sub-cluster (SC) II of Cluster III. A SimPlot analysis identified GII.3[P12] strain to be as an ORF1-intragenic recombinant of GII.4[P12] and GII.3[P21]. The RdRp genes of the GII.3[P12] showed a higher mean substitution rate than those of all GII.P12, while the VP1 genes of the GII.3[P12] showed a lower mean substitution rate than those of all GII.3. Alignment of the GII.3 capsid sequences revealed that three HBGA binding sites of all known GII.3 strains remained conserved, while several amino acid mutations in the predicted antibody binding sites were detected. The mutation at 385 was within predicted antibody binding regions, close to host attachment factor binding sites. Positive and negative selection sites were estimated. Two common positively selected sites (sites 385 and 406) were located on the surface of the protruding domain. Moreover, an amino acid substitution (aa204) was estimated to be near the active site of the RdRp protein.

Conclusions

We conducted a comprehensive analysis on the epidemic and evolution of GII.3[P12] noroviruses and the results suggested that evolution was possibly driven by intergenic recombination and mutations in some key amino acid sites.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13099-021-00430-8.

Epidemiology of 631 Cases of COVID-19 Identified in Jiangsu Province Between January 1st and March 20th 2020: Factors Associated with Disease Severity and Analysis of Zero Mortality

BACKGROUND This retrospective study aimed to investigate the factors associated with disease severity and patient outcomes in 631 patients with COVID-19 who were reported to the Jiangsu Commission of Health between January 1 and March 20, 2020. MATERIAL AND METHODS We conducted an epidemiological investigation enrolling 631 patients with laboratory-confirmed COVID-19 from our clinic from January to March 2020. Patients' information was collected through a standard questionnaire. Then, we described the patients' epidemiological characteristics, analyzed risk factors associated with disease severity, and assessed causes of zero mortality. Additionally, some key technologies for epidemic prevention and control were identified. RESULTS Of the 631 patients, 8.46% (n=53) were severe cases, and no deaths were recorded (n=0). The epidemic of COVID-19 has gone through 4 stages: a sporadic phase, an exponential growth phase, a peak plateau phase, and a declining phase. The proportion of severe cases was significantly different among the 4 stages and 13 municipal prefectures (P<0.001). Factors including age >65 years old, underlying medical conditions, highest fever >39.0°C, dyspnea, and lymphocytopenia (<1.0×10⁹/L) were early warning signs of disease severity (P<0.05). In contrast, earlier clinic visits were associated with better patient outcomes (P=0.029). Further, the viral load was a potentially useful marker associated with COVID-19 infection severity. CONCLUSIONS The study findings from the beginning of the COVID-19 epidemic in Jiangsu Province, China showed that patients who were more than 65 years of age and with comorbidities and presented with a fever of more than 39.0°C developed more severe disease. However, mortality was prevented in this initial patient population by early supportive clinical management.

Epidemiological and clinical characteristics of severe fever with thrombocytopenia syndrome bunyavirus human-to-human transmission

BACKGROUND

Severe fever with thrombocytopenia syndrome (SFTS) was listed as one of the most severe infectious disease by world health organization in 2017. It can mostly be transmitted by tick bite, while human-to-human transmission has occurred on multiple occasions. This study aimed to explore the epidemiological and clinical characteristics and make risk analysis of SFTS human-to-human transmission.

METHODS

Descriptive and spatial methods were employed to illustrate the epidemiological and clinical characteristics of SFTS human-to-human transmission. The risk of SFTS human-to-human transmission was accessed through secondary attack rate (SAR) and basic reproductive number (R0). Logistic regression analysis was used to identify the associated risk factors.

RESULTS

A total of 27 clusters of SFTS human-to-human transmission were reported in China and South Korea during 1996-2019. It mainly occurred among elder people in May, June and October in central and eastern China. The secondary cases developed milder clinical manifestation and better outcome than the index cases. The incubation period was 10.0 days (IQR:8.0-12.0), SAR was 1.72%-55.00%, and the average R0 to be 0.13 (95%CI:0.11-0.16). Being blood relatives of the index case, direct blood/bloody secretion contact and bloody droplet contact had more risk of infection (OR = 6.35(95%CI:3.26-12.37), 38.01 (95%CI,19.73-73.23), 2.27 (95%CI,1.01-5.19)).

CONCLUSIONS

SFTS human-to-human transmission in China and South Korea during 1996-2019 had obvious spatio-temporal distinction. Ongoing assessment of this transmission risk is crucial for public health authorities though it continues to be low now.

Estimating the time interval between transmission generations and the presymptomatic period by contact tracing surveillance data from 31 provinces in the mainland of China

The global pandemic of 2019 coronavirus disease (COVID-19) is a great assault to public health. Presymptomatic transmission cannot be controlled with measures designed for symptomatic persons, such as isolation. This study aimed to estimate the interval of the transmission generation (TG) and the presymptomatic period of COVID-19, and compare the fitting effects of TG and serial interval (SI) based on the SEIHR model incorporating the surveillance data of 3453 cases in 31 provinces. These data were allocated into three distributions and the value of AIC presented that the Weibull distribution fitted well. The mean of TG was 5.2 days (95% CI: 4.6–5.8). The mean of the presymptomatic period was 2.4 days (95% CI: 1.5–3.2). The dynamic model using TG as the generation time performed well. Eight provinces exhibited a basic reproduction number from 2.16 to 3.14. Measures should be taken to control presymptomatic transmission in the COVID-19 pandemic.

Epidemiologic characteristics and influencing factors of cluster infection of COVID-19 in Jiangsu Province

To understand the characteristics and influencing factors related to cluster infections in Jiangsu Province, China, we investigated case reports to explore transmission dynamics and influencing factors of scales of cluster infection. The effectiveness of interventions was assessed by changes in the time-dependent reproductive number (Rt). From 25th January to 29th February, Jiangsu Province reported a total of 134 clusters involving 617 cases. Household clusters accounted for 79.85% of the total. The time interval from onset to report of index cases was 8 days, which was longer than that of secondary cases (4 days) (χ2 = 22.763, P < 0.001) and had a relationship with the number of secondary cases (the correlation coefficient (r) = 0.193, P = 0.040). The average interval from onset to report was different between family cluster cases (4 days) and community cluster cases (7 days) (χ2 = 28.072, P < 0.001). The average time interval from onset to isolation of patients with secondary infection (5 days) was longer than that of patients without secondary infection (3 days) (F = 9.761, P = 0.002). Asymptomatic patients and non-familial clusters had impacts on the size of the clusters. The average reduction in the Rt value in family clusters (26.00%, 0.26 ± 0.22) was lower than that in other clusters (37.00%, 0.37 ± 0.26) (F = 4.400, P = 0.039). Early detection of asymptomatic patients and early reports of non-family clusters can effectively weaken cluster infections.

Hydrogen gas (XEN) inhalation ameliorates airway inflammation in asthma and COPD patients

BACKGROUND

Hydrogen was proven to have anti-oxidative and anti-inflammation effects to various diseases.

AIM

We wish to investigate the acute effects of inhaled hydrogen on airway inflammation in patients with asthma and chronic obstructive pulmonary disease (COPD).

DESIGN

Prospective study.

METHODS

In total, 2.4% hydrogen containing steam mixed gas (XEN) was inhaled once for 45 min in 10 patients with asthma and 10 patients with COPD. The levels of granulocyte-macrophage colony stimulating factor, interferon-γ, interleukin-1β (IL-1β), IL-2, IL-4, IL-6 and so on in peripheral blood and exhaled breath condensate (EBC) before and after 'XEN' inhalation were measured.

RESULTS

45 minutes 'XEN' inhalation once decreased monocyte chemotactic protein 1 level in both COPD (564.70-451.51 pg/mL, P = 0.019) and asthma (386.39-332.76 pg/mL, P = 0.033) group, while decreased IL-8 level only in asthma group (5.25-4.49 pg/mL, P = 0.023). The level of EBC soluble cluster of differentiation-40 ligand in COPD group increased after inhalation (1.07-1.16 pg/mL, P = 0.031), while IL-4 and IL-6 levels in EBC were significantly lower after inhalation in the COPD (0.80-0.64 pg/mL, P = 0.025) and asthma (0.06-0.05 pg/mL, P = 0.007) group, respectively.

CONCLUSIONS

A single inhalation of hydrogen for 45 min attenuated inflammatory status in airways in patients with asthma and COPD.

A fatal paediatric case infected with reassortant avian influenza A(H5N6) virus in Eastern China

Avian influenza A(H5N6) keeps evolving, causing outbreaks in birds and sporadic infections in human. Here, we report a fatal paediatric infection caused by a novel reassortant H5N6 virus. The patient was an obese 9-year-old girl. She initiated with fever and cough, then developed pneumonia, acute respiratory distress syndrome (ARDS) and respiratory failure. Lower respiratory tract aspirates and anal swabs were serially taken till the patient's death. Viral isolation, genome sequencing and phylogenetic analysis were conducted. A novel reassortant H5N6 virus was isolated from the patient. Except the PA gene, all other 7 genes of the virus belonged to H5N6 genotype A (S4-like virus). The PA gene was probably obtained from Eurasian waterfowl influenza viruses. The H5N6 virus was consistently detected from the patient's respiratory samples till the 17th day after symptom onset, but not from anal swabs or urine sample by real-time reverse transcription polymerase chain reaction (RT-PCR). Significantly elevated (32-fold) serum antibodies to H5N6 virus were observed during the patient's course of disease. Aside from the identified novel reassortant H5N6 viral strain, obesity, delayed confirmation of aetiology and specific antiviral treatment, and prolonged virus shedding could have contributed to the poor clinical outcome.

COVID-19 outbreak following a single patient exposure at an entertainment site: An epidemiological study

We investigated an outbreak of COVID-19 infection, which was traced back to a bathing pool at an entertainment venue, to explore the epidemiology of the outbreak, understand the transmissibility of the virus and analyse the influencing factors. Contact investigation and management were conducted to identify potential cases. Epidemiological investigation was carried out to determine the epidemiological and demographic characteristics of the outbreak. We estimated the secondary attack rate (SAR), incubation time and time-dependent reproductive number (R_t ) and explored the predisposing factors for cluster infection. The incubation time was 5.4 days and the serial interval (SI) was 4.4 days, with the rate of negative-valued SIs at 24.5%. The SAR at the bathing pool (3.3%) was relatively low due to its high temperature and humidity. The SAR was higher in the colleagues' cluster (20.5%) than in the family cluster (11.8%). Super-spreaders had a longer isolation delay time (p = .004). The R_t of the cluster decreased from the highest value of 3.88 on January 27, 2020 to 1.22 on February 6. Our findings suggest that the predisposing factors of the outbreak included close contact with an infected person, airtight and crowded spaces, temperature and humidity in the space and untimely isolation of patients and quarantine of contacts at the early stage of transmission. Measures to reduce the risk of infection at these gatherings and subsequent tracking of close contacts were effective.

THU0270 ONLINE INTERACTION AND FREQUENT SELF-ASSESSMENTS PROMOTED TREAT-TO-TARGET FOR SLE VIA EMPOWERING PATIENTS: A COHORT STUDY FROM CHINA BY SMART SYSTEM OF DISEASE MANAGEMENT (SSDM)

Background:

Treating to target (T2T) is routine in RA, but no comparable standard has been defined for SLE. In 2015, the definition of Lupus Low Disease Activity State (LLDAS) was generated by Asia-Pacific Lupus Collaboration, and the preliminary validation demonstrated its attainment to be associated with improved outcomes in SLE. A SLEDAI-2K score lower than 4 is the main criteria for LLDAS. SSDM is an interactive mobile disease management application, including application systems for both the doctors and patients.

Objectives:

To evaluate the patterns of T2T and related influential factors among SLE patients after applying SSDM in real world.

Methods:

Patients were trained to master SSDM by healthcare professionals in clinics. The first assessment for SLEDAI-2K was performed as the baseline. Patients were required to perform repeated self-assessments after leaving the clinics. The data is synchronized to the SSDM of authorized rheumatologists. Based on the patients’ data, rheumatologists will provide medical advices to the patients.

Results:

From July 2015 to Jan 2020, 32,559 SLE patients enrolled in SSDM. The mean age is 36.35 years old and median disease duration is 3.85 years. Among them 1,937 SLE patients from 134 hospitals across China were followed up for more than 12 months, and the demographics were summarized in table 1.

Table 1.Baseline\Final follow-upn%x <= 4%5 <= x <= 9%10 <= x <= 14%15 <= x%x <= 4104053.69%82078.85%13512.98%504.81%353.37%5 <= x <= 935718.43%23064.43%6016.81%328.96%359.80%10 <= x <= 1422211.46%12054.05%3817.12%4018.02%2410.81%15 <= x31816.42%15649.06%4915.41%4714.78%6620.75%Total1937100%132668.46%28214.56%1698.72%1608.26%

The ratio of T2T achievers was 53.69% (1,040/1,937) at the baseline and improved significantly to 68.46% (1,326/1,937) after a 12-month follow-up, p<0.01. Among T2T achievers at the baseline, 78.85% (820/1,040) maintained T2T, and 21.15% (220/1,040) relapsed. Of patients who didn’t achieve T2T at baseline, 56.41% (506/897) of the patients achieve T2T after 12-month follow-up.

The impact of the online interaction and the frequency of self-assessment for SLEDAI-2K on T2T has been analyzed. Compared with 1,475 patients who didn’t interact online with their physicians through SSDM, 462 patients with online interaction achieved higher rate of T2T improvement (19.48% vs 13.29%, p<0.05). The more frequent of the self-assessments being performed by patients, the higher improvement of T2T rate will be. The improvement rates of T2T in the subgroups which self-assessed with SSDM by quarterly, bimonthly and monthly were 8.56%, 16.14% and 23.24% respectively. The improvement rate (y) of T2T was positively correlated with the frequency of self-assessment for SLEDAI-2K(x) independently, r = 0.9998. (Figure 1)

Conclusion:

After proactive disease management via SSDM for more than 12 months, the rate of T2T in SLE patients increased significantly. Online interaction between patients and physicians contributed in promoting T2T improvement rate. The patients who performed more self-assessments through SSDM had higher probability of T2T achievement. SSDM is a valuable tool for long term SLE follow-up through empowering patients.

References:

Acknowledgments:

SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

Surveillance on the Immune Effectiveness of Quadrivalent andTrivalent Split Influenza Vaccines - Shenzhen Cityand Changzhou City, China, 2018-2019

What is already known about this topic?

Vaccinations are the most effective way to prevent influenza virus infections and severe outcomes. Influenza vaccine effectiveness can vary by seasons.

What is added by this report?

This report monitors the antibody level among the population over time after administration of the quadrivalent or trivalent split influenza vaccine.

What are the implications for public health practice?

Real-time monitoring of serum antibody changes after vaccination provides important data for the development of reasonable and effective strategies for influenza prevention and control.

Discovery of seven novel mutations of gyrB, parC and parE in Salmonella Typhi and Paratyphi strains from Jiangsu Province of China

Objective: To investigate the prevalence of Salmonella Typhi and Paratyphi resistance to quinolones and characterize the underlying mechanism in Jiangsu Province of China. Methods: Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion system. Quinolone resistance-determining region (QRDR), plasmid-mediated quinolone resistance (PMQR) determinant genes were detected by PCR and sequencing. Results: Out of 239 Salmonella isolates, 164 were S. Typhi and 75 were S. Paratyphi. 128 (53.6%) Salmonella isolates were resistant to nalidixic acid; 11 (4.6%) isolates to ciprofloxacin and 66 (27.6%) isolates were intermediate to ciprofloxacin. QRDR were present in 69 S. Typhi isolates, among which mutation at codon 83 (n = 45) and 133 (n = 61) predominated. In S. Paratyphi, the most common mutations were detected in gyrA at codon 83(n = 24) and parC: T57S (n = 8). Seven mutations were first reported in Salmonella isolates including gyrB: S426G, parC: D79G and parE: [S498T, E543K, V560G, I444S, Y434S]. PMQR genes including qnrD1, qnrA1, qnrB4, aac (6′)-Ib-cr4 and qnrS1 were detected in 1, 2, 3, 7 and 9 isolates, relatively. Conclusions: High resistance to quinolones in Salmonella remains a serious problem in Jiangsu, China. The presence of the novel mutations increases the complexity of quinolone-resistant genotypes and poses a threat to public health. Subject terms: Salmonella Typhi, Salmonella Paratyphi, antimicrobial resistance, QRDR, PMQR.

Forecasting incidence of infectious diarrhea using random forest in Jiangsu Province, China

BACKGROUND

Infectious diarrhea can lead to a considerable global disease burden. Thus, the accurate prediction of an infectious diarrhea epidemic is crucial for public health authorities. This study was aimed at developing an optimal random forest (RF) model, considering meteorological factors used to predict an incidence of infectious diarrhea in Jiangsu Province, China.

METHODS

An RF model was developed and compared with classical autoregressive integrated moving average (ARIMA)/X models. Morbidity and meteorological data from 2012 to 2016 were used to construct the models and the data from 2017 were used for testing.

RESULTS

The RF model considered atmospheric pressure, precipitation, relative humidity, and their lagged terms, as well as 1-4 week lag morbidity and time variable as the predictors. Meanwhile, a univariate model ARIMA (1,0,1)(1,0,0)₅₂ (AIC = - 575.92, BIC = - 558.14) and a multivariable model ARIMAX (1,0,1)(1,0,0)₅₂ with 0-1 week lag precipitation (AIC = - 578.58, BIC = - 578.13) were developed as benchmarks. The RF model outperformed the ARIMA/X models with a mean absolute percentage error (MAPE) of approximately 20%. The performance of the ARIMAX model was comparable to that of the ARIMA model with a MAPE reaching approximately 30%.

CONCLUSIONS

The RF model fitted the dynamic nature of an infectious diarrhea epidemic well and delivered an ideal prediction accuracy. It comprehensively combined the synchronous and lagged effects of meteorological factors; it also integrated the autocorrelation and seasonality of the morbidity. The RF model can be used to predict the epidemic level and has a high potential for practical implementation.

Seroprevalence of H7N9 infection among humans: A systematic review and meta-analysis

In spring 2013, a novel avian-origin influenza A (H7N9) virus emerged in mainland China. The burden of H7N9 infection was estimated based on systematic review and meta-analysis. The systematic search for available literature was conducted using Chinese and English databases. We calculated the pooled seroprevalence of H7N9 infection and its 95% confidence interval by using Freeman-Tukey double arcsine transformation. Out of 16 890 records found using Chinese and English databases, 54 articles were included in the meta-analysis. These included studies of a total of 64 107 individuals. The pooled seroprevalence of H7N9 infection among humans was 0.122% (95% CI: 0.023, 0.275). In high-risk populations, the highest pooled seroprevalence was observed among close contacts (1.075%, 95% CI: 0.000, 4.357). The seroprevalence among general population was (0.077%, 95% CI: 0.011, 0.180). Our study discovered that asymptomatic infection of H7N9 virus did occur, even if the seroprevalence among humans was low.

A case-control study on the risk factors for hemorrhagic fever with renal syndrome

BACKGROUND

Hemorrhagic fever with renal syndrome (HFRS) is an endemic communicable disease in China, accounting for 90% of total reported cases worldwide. In this study, the authors want to investigate the risk factors for HFRS in recent years to provide the prevention and control advices.

METHODS

A community-based, 1:2 matched case-control study was carried out to investigate the risk factors for HFRS. Cases were defined as laboratory-confirmed cases that tested positive for hantavirus-specific IgM antibodies. Two neighbourhood controls of each case were selected by sex, age and occupation. Standardized questionnaires were used to collect information and identify the risk factors for HFRS.

RESULTS

Eighty-six matched pairs were investigated in the study. The median age of the cases was 55.0 years, 72.09% were male, and 73.26% were farmers. In the multivariate logistic regression analysis, cleaning spare room at home (OR = 3.310, 95%CI 1.335-8.210) was found to be risk factor for infection; storing food and crops properly (OR = 0.279 95%CI 0.097-0.804) provided protection from infection.

CONCLUSION

Storing food and crops properly seemed to be protective factor, which was important for HFRS prevention and control. More attention should be paid to promote comprehensive health education and behaviour change among high-risk populations in the HFRS endemic area.

Interventions in Live Poultry Markets for the Control of Avian Influenza: A Systematic Review and Meta-analysis

BACKGROUND

This review aimed to provide constructive suggestions for the control and management of avian influenza through quantitative and qualitative evaluation of the impact of different live poultry market (LPM) interventions.

METHODS

Both English and Chinese language databases were searched for articles that were published on or before 9 November 2018. After extraction and assessment of the included literature, Stata14.0 was applied to perform a meta-analysis to explore the impacts of LPM interventions.

RESULTS

A total of 19 studies were identified. In total, 224 human, 3550 poultry, and 13 773 environment samples were collected before the intervention; 181 people, 4519 poultry, and 9562 environments were sampled after LPM interventions. Avian influenza virus (AIV) detection rates in the LPM environment (odds ratio [OR], 0.393; 95% confidence interval [CI], 0.262-0.589) and the incidence of AIV infection (OR, 0.045; 95% CI, 0.025-0.079) were significantly lower after LPM interventions, while interventions were not significantly effective in reducing AIV detection in poultry samples (OR, 0.803; 95% CI, 0.403-1.597).

CONCLUSIONS

LPM interventions can reduce AIV human infections and the detection rate of AIV in market environments.

Increasing Recombinant Strains Emerged in Norovirus Outbreaks in Jiangsu, China: 2015-2018

From January 2015 to December 2018, 213 norovirus outbreaks with 3,951 patients were reported in Jiangsu, China. Based on viral RdRp and VP1 genes, eight genotypes, GII.2[P16] (144, 67.6%), GII.3[P12] (21, 9.9%), GII.6[P7] (5, 2.3%), GII.14[P7] (4, 1.9%), GII.4 Sydney[P31] (3, 1.4%), GII.1[P33] (1, 0.5%), GII.2[P2] (3, 1.4%), and GII.17[P17] (16, 7.5%) were identified throughout the study period. These genotypes were further regrouped as GII.R (Recombinant) and GII.Non-R (Non-recombinant) strains. In this report we showed that GII.R strains were responsible for at least 178 (83.6%) of 213 norovirus-positive outbreaks with a peak in 2017 and 2018. Most norovirus outbreaks occurred in primary schools and 94 of 109 (86.2%) outbreaks in primary schools were caused by GII.R, while GII.Non-R and GII.NT (not typed) strains accounted for 6 (5.5%) and 9 (8.3%) norovirus outbreaks, respectively. The SimPlot analysis showed recombination breakpoints near the ORF1/2 junction for all six recombinant strains. The recombination breakpoints were detected at positions varying from nucleotides 5009 to 5111, localized in the ORF1 region for four strains (GII.2[P16], GII.3[P12], GII.6[P7], and GII.14[P7]) and in the ORF2 region for the other (GII.4 Sydney[P31] and GII.1[P33]). We identified four clusters, Cluster I through IV, in the GII.P7 RdRp gene by phylogenetic analysis and the GII.14[P7] variants reported here belonged to Cluster IV in the RdRp tree. The HBGA binding site of all known GII.14 strains remained conserved with several point mutations found in the predicted conformational epitopes. In conclusion, gastroenteritis outbreaks caused by noroviruses increased rapidly in the last years and these viruses were classified into eight genotypes. Emerging recombinant noroviral strains have become a major concern and challenge to public health.

Epidemiology of infectious diarrhoea and the relationship with etiological and meteorological factors in Jiangsu Province, China

We depicted the epidemiological characteristics of infectious diarrhoea in Jiangsu Province, China. Generalized additive models were employed to evaluate the age-specific effects of etiological and meteorological factors on prevalence. A long-term increasing prevalence with strong seasonality was observed. In those aged 0–5 years, disease risk increased rapidly with the positive rate of virus (rotavirus, norovirus, sapovirus, astrovirus) in the 20–50% range. In those aged > 20 years, disease risk increased with the positive rate of adenovirus and bacteria (Vibrio parahaemolyticus, Salmonella, Escherichia coli, Campylobacter jejuni) until reaching 5%, and thereafter stayed stable. The mean temperature, relative humidity, temperature range, and rainfall were all related to two-month lag morbidity in the group aged 0–5 years. Disease risk increased with relative humidity between 67–78%. Synchronous climate affected the incidence in those aged >20 years. Mean temperature and rainfall showed U-shape associations with disease risk (with threshold 15 °C and 100 mm per month, respectively). Meanwhile, disease risk increased gradually with sunshine duration over 150 hours per month. However, no associations were found in the group aged 6–19 years. In brief, etiological and meteorological factors had age-specific effects on the prevalence of infectious diarrhoea in Jiangsu. Surveillance efforts are needed to prevent its spread.

Influenza activity prediction using meteorological factors in a warm temperate to subtropical transitional zone, Eastern China

Influenza activity is subject to environmental factors. Accurate forecasting of influenza epidemics would permit timely and effective implementation of public health interventions, but it remains challenging. In this study, we aimed to develop random forest (RF) regression models including meterological factors to predict seasonal influenza activity in Jiangsu provine, China. Coefficient of determination (R2) and mean absolute percentage error (MAPE) were employed to evaluate the models' performance. Three RF models with optimum parameters were constructed to predict influenza like illness (ILI) activity, influenza A and B (Flu-A and Flu-B) positive rates in Jiangsu. The models for Flu-B and ILI presented excellent performance with MAPEs <10%. The predicted values of the Flu-A model also matched the real trend very well, although its MAPE reached to 19.49% in the test set. The lagged dependent variables were vital predictors in each model. Seasonality was more pronounced in the models for ILI and Flu-A. The modification effects of the meteorological factors and their lagged terms on the prediction accuracy differed across the three models, while temperature always played an important role. Notably, atmospheric pressure made a major contribution to ILI and Flu-B forecasting. In brief, RF models performed well in influenza activity prediction. Impacts of meteorological factors on the predictive models for influenza activity are type-specific.

Disease burden concerning hepatitis E-infected inpatients in Jiangsu province, China

OBJECTIVE

This study aimed to determine the disease burden of hepatitis E virus (HEV)-infected inpatients in Jiangsu province, China.

METHODS

Between July 1, 2016 and October 31, 2018, 1152 HEV-infected inpatients were identified from four cities in Jiangsu province, namely, Nanjing, Suzhou, Yancheng, and Zhenjiang. The disease burden comprised the economic burden and loss of health due to HEV infection. Factors influencing the disease burden were analyzed using univariate and multivariate analyses.

RESULTS

The average direct, indirect, and total economic burden for 1152 HEV-infected inpatients was US$ 4,986.40, US$ 1,507.28, and US$ 6,493.68, respectively, accounting for 46.66%, 14.11%, and 60.77% of per capita disposable income (PCDI) in Jiangsu province, respectively. The disease burden for HEV-infected inpatients with hepatitis B was significantly higher than that for other inpatients. The average EQ-5D utility value of 1152 HEV-infected inpatients was 0.72 ± 0.18 quality-adjusted life years (QALYs) and the average EQ-visual analogue score (EQ-VAS) was 0.66 ± 0.17 points. Multivariate analysis showed that the direct economic burden and the total economic burden were influenced by variables such as hospitalization days, outcomes, past history of other diseases, and regions (P < 0.05). It was estimated the direct economic burden, the indirect economic burden, and the total economic burden for all HEV-infected inpatients in Jiangsu province in 2018 was approximately US$ 9.2 million, US$ 2.8 million and US$ 12.0 million, respectively.

CONCLUSION

The disease burden of HEV infection in Jiangsu province is severe, and more attention should be paid to the prevention of hepatitis E and the treatment of comorbidities.

Forecasting incidence of hand, foot and mouth disease using BP neural networks in Jiangsu province, China

Background

Hand, foot and mouth disease (HFMD) is a rising public health problem and has attracted considerable attention worldwide. The purpose of this study was to develop an optimal model with meteorological factors to predict the epidemic of HFMD.

Methods

Two types of methods, back propagation neural networks (BP) and auto-regressive integrated moving average (ARIMA), were employed to develop forecasting models, based on the monthly HFMD incidences and meteorological factors during 2009–2016 in Jiangsu province, China. Root mean square error (RMSE) and mean absolute percentage error (MAPE) were employed to select model and evaluate the performance of the models.

Results

Four models were constructed. The multivariate BP model was constructed using the HFMD incidences lagged from 1 to 4 months, mean temperature, rainfall and their one order lagged terms as inputs. The other BP model was fitted just using the lagged HFMD incidences as inputs. The univariate ARIMA model was specified as ARIMA (1,0,1)(1,1,0)¹² (AIC = 1132.12, BIC = 1440.43). And the multivariate ARIMAX with one order lagged temperature as external predictor was fitted based on this ARIMA model (AIC = 1132.37, BIC = 1142.76). The multivariate BP model performed the best in both model fitting stage and prospective forecasting stage, with a MAPE no more than 20%. The performance of the multivariate ARIMAX model was similar to that of the univariate ARIMA model. Both performed much worse than the two BP models, with a high MAPE near to 40%.

Conclusion

The multivariate BP model effectively integrated the autocorrelation of the HFMD incidence series. Meanwhile, it also comprehensively combined the climatic variables and their hysteresis effects. The introduction of the climate terms significantly improved the prediction accuracy of the BP model. This model could be an ideal method to predict the epidemic level of HFMD, which is of great importance for the public health authorities.