[Sequence analysis of Paragonimus internal transcribed spacer 2 and cyclooxygenase 1 genes in freshwater crabs in Henan Province]

OBJECTIVE

To investigate the sequences of internal transcribed spacer 2 (ITS2) and cyclooxygenase 1 (COX1) genes of Paragonimus metacercariae in freshwater crabs in Henan Province, identify the species of Paragonimus and evaluate its genetic relationships with Paragonimus isolates from other provinces in China.

METHODS

Freshwater crabs were collected from 8 survey sites in Zhengzhou, Luoyang, Pingdingshan, Nanyang and Jiyuan cities of Henan Province from 2016 to 2021, and Paragonimus metacercariae were detected in freshwater crabs. Genomic DNA was extracted from Paragonimus metacercariae, and the ITS2 and COX1 genes were amplified using PCR assay, followed by sequencing of PCR amplification products. The gene sequences were spliced and aligned using the software DNASTAR, and aligned with the sequences of Paragonimus genes in the GenBank. Phylogenetic trees were created using the MEGA6 software with the Neighbor-Joining method based on ITS2 and COX1 gene sequences, with Fasciola hepatica as the outgroup.

RESULTS

The detection rates of Paragonimus metacercariae were 6.83% (11/161), 50.82% (31/61), 18.52% (5/26), 8.76% (12/137), 14.29% (9/63), 17.76% (19/105), 18.50% (32/173) and 42.71% (41/96) in freshwater crabs from 8 survey sites in Zhengzhou, Luoyang, Pingdingshan, Nanyang and Jiyuan cities of Henan Province, with a mean detection rate of 19.46% (160/822), and a mean infection intensity of 0.57 metacercariae/g. The amplified ITS2 and COX1 gene fragments of Paragonimus were approximately 500 bp and 450 bp in lengths, respectively. The ITS2 gene sequences of Paragonimus metacercariae from 8 survey sites of Henan Province showed the highest homology (99.8% to 100.0%) with the gene sequence of P. skrjabini (GenBank accession number: MW960209.1), and phylogenetic analysis showed that the Paragonimus in this study was clustered into the same clade with P. skrjabini from Sichuan Province (GenBank accession number: AY618747.1), Guangxi Zhuang Autonomous Region (GenBank accession number: AY618729.1) and Hubei Province (GenBank accession number: AY618751.1), and P. miyazaki from Fujian Province (GenBank accession number: AY618741.1) and Japan (GenBank accession number: AB713405.1). The COX1 gene sequences of Paragonimus metacercariae from 8 survey sites of Henan Province showed the highest homology (90.0% to 100.0%) with the gene sequence of P. skrjabini (GenBank accession number: AY618798.1), and phylogenetic analysis showed that the Paragonimus in this study was clustered into the same clade with all P. skrjabini and clustered into the same sub-clade with P. skrjabini from Hubei Province (GenBank accession numbers: AY618782.1 and AY618764.1).

CONCLUSIONS

Paragonimus species from freshwater crabs in Henan Province were all characterized as P. skrjabini, and the ITS2 and COX1 gene sequences had the highest homology to those of P. skrjabini from Hubei Province. The results provide insights into study of Paragonimus in Henan Province and China.

Comprehensive evaluation of water resources carrying capacity in Henan Province based on entropy weight TOPSIS - coupling coordination - obstacle model

This study aims to investigate the water resource carrying capacity (WRCC) of Henan Province, identify its main obstacles, and provide suggestions for optimizing its WRCC. The article constructs a WRCC evaluation system with 20 indicators for the four subsystems of water resources, economy, society, and ecology based on literature and the actual situation of Henan Province. The entropy weighted TOPSIS method is used to calculate the WRCC of Henan Province from 2005 to 2021. The coupling coordination model is used to explore the degree of coupling coordination among internal systems, while the obstacle model is used to study its restrictive influencing factors. The study found that (1) the WRCC fluctuated in a U-shaped pattern around 0.5 during the study period; (2) the coupling and coordination degree of each subsystem is generally good, except for 2012 and 2013, which showed basic coordination; (3) currently, the main obstacles to the WRCC are ecosystems and water resources. The main indicators are afforestation area, proportion of the tertiary industry, fertilizer usage, and urban sewage treatment rate. Therefore, Henan Province should take measures such as reducing fertilizer usage, standardizing urban sewage treatment, improving water efficiency, and optimizing industrial structure to optimize its WRCC and promote comprehensive utilization of water resources.

[Impact of COVID-19 pandemic on the management of imported malaria in China]

OBJECTIVE

To examine the impact of COVID-19 pandemic on the epidemic status of imported malaria and national malaria control program in China, so as to provide insights into post-elimination malaria surveillance.

METHODS

All data pertaining to imported malaria cases were collected from Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 through December 31, 2021. The number of malaria cases, species of malaria parasites, country where malaria parasite were infected, diagnosis and treatment after returning to China, and response were compared before (from January 1, 2018 to January 22, 2020) and after the COVID-19 pandemic (from January 23, 2020 to December 31, 2021).

RESULTS

A total of 2 054 imported malaria cases were reported in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region during the period from January 1, 2018 to December 31, 2021, and there were 1 722 cases and 332 cases reported before and after the COVID-19 pandemic, respectively. All cases were reported within one day after definitive diagnosis. The annual mean number of reported malaria cases reduced by 79.30% in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region after the COVID-19 pandemic (171 cases) than before the pandemic (826 cases), and the number of monthly reported malaria cases significantly reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region since February 2020. There was a significant difference in the constituent ratio of species of malaria parasites among the imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 146.70, P < 0.05), and P. falciparum malaria was predominant before the COVID-19 pandemic (72.30%), while P. ovale malaria (44.28%) was predominant after the COVID-19 pandemic, followed by P. falciparum malaria (37.65%). There was a significant difference in the constituent ratio of country where malaria parasites were infected among imported malaria cases in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region before and after the COVID-19 pandemic (χ2 = 13.83, P < 0.05), and the proportion of malaria cases that acquired Plasmodium infections in western Africa reduced after the COVID-19 pandemic that before the pandemic (44.13% vs. 37.95%; χ2 = 4.34, P < 0.05), while the proportion of malaria cases that acquired Plasmodium infections in eastern Africa increased after the COVID-19 pandemic that before the pandemic (9.58% vs. 15.36%; χ2 = 9.88, P = 0.02). The proportion of completing case investigation within 3 days was significantly lower after the COVID-19 pandemic than before the pandemic (96.69% vs. 98.32%; χ2= 3.87, P < 0.05), while the proportion of finishing foci investigation and response within 7 days was significantly higher after the COVID-19 pandemic than before the pandemic (100.00% vs. 98.43%; χ2 = 3.95, P < 0.05).

CONCLUSIONS

The number of imported malaria cases remarkably reduced in Anhui Province, Hubei Province, Henan Province, Zhejiang Province and Guangxi Zhuang Autonomous Region of China during the COVID-19 pandemic, with a decreased proportion of completing case investigations within 3 days. The sensitivity of the malaria surveillance-response system requires to be improved to prevent the risk of secondary transmission of malaria due to the sharp increase in the number of imported malaria cases following the change of the COVID-19 containment policy.

Spatial difference of carbon budget and carbon balance zoning based on land use change: a case study of Henan Province, China

Land use change is one of the key reasons for the rise in global carbon emissions. Incorporating practical methods for carbon governance into the major strategic decisions of countries around the world is important for controlling carbon emissions. This study aims to carry out a regional land use carbon budget assessment and build a carbon balance zoning optimization framework. As a result, China will be better able to implement low-carbon strategies and reach carbon peaking and carbon neutrality. Using the data of land use and energy consumption for Henan Province from 2000 to 2020, a carbon budget assessment system was constructed. According to the analysis of the geographical distribution of carbon budget, an evaluation system was developed and a carbon balance partition was established from the natural, economic, ecological and resource structure. A regionally differentiated development strategy was proposed. The findings revealed that: (1) Land use carbon emissions of Henan Province reflected a significant increasing trend, while the variation in carbon absorption of land use was stable. Carbon emissions increased by 87,120.25×104 t in 2020 compared to 2000, but the carbon absorption remained at approximately 1735×104 t over the years and there was an overall state of carbon deficit. (2) The geographical distribution of carbon emissions in Henan Province was characterized by higher in the central part and lower in the surroundings, and the distribution of carbon absorption was higher in the west and lower in the east. The distribution pattern was closely related to the level of land use and the structure of energy consumption. (3) From the carbon balance analysis, the 158 counties in Henan Province were divided into four carbon balance functional areas, namely the carbon sink functional area, low-carbon development area, carbon intensity control area, and high-carbon optimization area. Different optimized development strategies were proposed for each functional area.

Clinical and genetic characteristics of children with cystic fibrosis in Henan China: A single-center retrospective analysis

BACKGROUND

Despite the growing awareness of cystic fibrosis (CF) in China, few cases have been reported in Henan, which is the most populous province in the country. This study aimed to describe the clinical phenotype and genotype of children with CF in Henan.

METHODS

We retrospectively recruited 18 Chinese children with CF who presented to Children's Hospital affiliated to Zhengzhou University from January 2019 to June 2023. The demographic data, imaging examinations, and laboratory tests of the patients were reviewed to clarify the clinical phenotype. Whole exome sequencing was conducted to identify the genotype.

RESULTS

Respiratory diseases were the main clinical manifestation, including recurrent/persistent pneumonia (88.9%), sinusitis (77.8%), bronchiectasis (77.8%). CF-related liver disease and pancreatic insufficiency were less common. Infant cases had high frequency of pseudo-Bartter Syndrome (80.0%). Chest computed tomography showed bronchiectasis in older children and air trapping in infant cases. The most common pathogens in the airway were Pseudomonas aeruginosa (72.2%) and Staphylococcus aureus (66.7%). Twenty-five different cystic fibrosis transmembrane conductance regulator (CFTR) gene variants were detected, including five novel observations (c.1064C>G[p. Pro355Arg], c.1209+1G>C, c.1925C>G[p. Ser642X], c.2810T>G[p. Leu937Arg], and c.3792delA[p. Gly1265GlufsX13]). The most common variant was c.2909G>A(p. Gly970Asp), with a detected rate of 21.9%.

CONCLUSION

Children with CF in Henan had varied clinical phenotypes by age, with respiratory disease being predominant. The most frequent CFTR gene variant was c.2909G>A(p. Gly970Asp). This study is the first and most comprehensive one on the clinical phenotype and genotype of children with CF in Henan, China. We also reported the first CF case of Mycobacterium abscessus infection in China.

[Molecular detection and phylogenetic analysis of Wolbachia infection in common mosquito species in Henan Province]

OBJECTIVE

To investigate the infection and genotypes of Wolbachia in common mosquito species in Henan Province, so as to provide insights into management of mosquito-borne diseases.

METHODS

Aedes, Culex and Anopheles samples were collected from cowsheds, sheepfolds and human houses in Puyang, Nanyang City and Xuchang cities of Henan Province from July to September, 2022, and the infection of Wolbachia was detected. The 16S rDNA and wsp genes of Wolbachia were amplified and sequenced. Sequence alignment was performed using the BLAST software, and the obtained 16S rDNA gene sequence was compared with the sequence of the 16S rDNA gene in GenBank database. In addition, the phylogenetic trees were created based on 16S rDNA and wsp gene sequences using the software MEGA 11.0.

RESULTS

A total 506 female adult mosquitoes were collected from three sampling sites in Nanyang, Xuchang City and Puyang cities from July to September, 2022. The overall detection of Wolbachia was 45.1% (228/506) in mosquitoes, with a higher detection rate in A. albopictus than in Cx. pipiens pallens [97.9% (143/146) vs. 50.6% (85/168); χ2 = 88.064, P < 0.01]. The detection of Wolbachia in Cx. pipiens pallens was higher in Xuchang City (96.8%, 62/64) than in Nanyang (15.6%, 7/45) and Puyang cities (27.1%, 16/59) (χ2 = 89.950, P < 0.01). The homologies of obtained Wolbachia 16S rDNA and wsp gene sequences were 95.3% to 100.0% and 81.7% to 99.8%. Phylogenetic analysis based on wsp gene sequences showed Wolbachia supergroups A and B in mosquito samples, with wAlbA and wMors strains in supergroup A and wPip and wAlbB strains in supergroup B. Wolbachia strain wAlbB infection was detected in A. albopictus in Puyang and Nanyang Cities, while Wolbachia strain wPip infection was identified in A. albopictus in Xuchang City. Wolbachia strain wAlbA infection was detected in Cx. pipiens pallens sampled from three cities, and one Cx. pipiens pallens was found to be infected with Wolbachia strain wMors in Nanyang City.

CONCLUSIONS

Wolbachia infection is commonly prevalent in Ae. albopictus and Cx. pipiens pallens from Henan Province, and Wolbachia strains wAlbB and wAlbA are predominant in Ae. albopictus, while wPip strain is predominant in Cx. pipiens pallens. This is the first report to present Wolbachia wMors strain infection in Cx. pipiens pallens in Henan Province.

Insecticide resistance of Anopheles sinensis after elimination of malaria in Henan Province, China

BACKGROUND

Historically, malaria due to Plasmodium vivax has been epidemic in Henan Province, China, with Anopheles sinensis as the main vector. The most effective measures to prevent malaria transmission are based on vector control through the use of insecticides. However, insecticides exert a strong selective pressure on mosquito populations for insecticide resistance. The aim of this study was to investigate the susceptibility profile and population genetic characteristics of An. sinensis to provide basic data and scientific guidance for the study of resistance mechanisms and the control of An. sinensis in Henan Province.

METHODS

Adult Anopheles mosquitoes were collected at sites near local farmers' sheepfolds, pigsties and/or cowsheds located in Pingqiao, Xiangfu, Xiangcheng and Tanghe counties/districts of Henan Province during July-September 2021 for insecticide susceptibility testing. Molecular identification of collected mosquitoes as belonging to genus Anopheles was by PCR, and the frequencies of mutations in the knockdown resistance gene (kdr) and acetylcholinesterase-1 gene (ace-1) were detected using gene amplification. The mitochondrial DNA cytochrome oxidase subunit I (COI) gene was amplified in deltamethrin-resistant and deltamethrin-sensitive mosquitoes to analyze the genetic evolutionary relationship.

RESULTS

A total of 1409 Anopheles mosquitoes were identified by molecular identification, of which 1334 (94.68%) were An. sinensis, 28 (1.99%) were An. yatsushiroensis, 43 (3.05%) were An. anthropophagus and four (0.28%) were An. belenrae. The 24-h mortality rates of An. sinensis in Pingqiao, Tanghe, Xiangcheng and Xiangfu counties/districts exposed to deltamethrin were 85.85%, 25.38%, 29.73% and 7.66%, respectively; to beta-cyfluthrin, 36.24%, 70.91%, 34.33% and 3.28%, respectively; to propoxur, 68.39%, 80.60%, 37.62% and 9.29%, respectively; and to malathion, 97.43%, 97.67%, 99.21% and 64.23%, respectively. One mutation, G119S, was detected in the ace-1 gene. The frequencies of the main genotypes were 84.21% of specimens collected in Xiangfu (G/S), 90.63% of speciments collected in Xiangcheng (G/G) and 2.44% of speciments collected in Tanghe (S/S). Significantly higher G119S allele frequencies were observed in both propoxur- and malathion-resistant mosquitoes than in their sensitive counterparts in the Tanghe population (P < 0.05). Three mutations, L1014F (41.38%), L1014C (9.15%) and L1014W (0.12%), were detected in the kdr gene. The genotypes with the highest frequency in the populations of An. sinensis in Xiangfu and Tanghe were the mutant TTT (F/F) and wild-type TTG (L/L), at 67.86% (57/84) and 74.29% (52/70), respectively. In Pingqiao and Xiangfu, higher frequencies of the L1014F allele and lower frequencies of the L1014C allele were observed in mosquitoes resistant for beta-cyfluthrin than in those which were sensitive for this insecticide (P < 0.05). The results of Tajima's D and of Fu and Li's D and F were not significantly negative (P > 0.10), and each haplotype was interlaced and did not form two distinct branches.

CONCLUSIONS

High resistance to pyrethroids and propoxur was observed at four sites, but the resistance to malathion varied according to the location. Anopheles belenrae and the L1014W (TGG) mutation in An. sinensis were first discovered in Henan Province. The deltamethrin-resistant and deltamethrin-sensitive mosquito populations showed no genetic differentiation. The generation of resistance might be the result of the combination of multiple factors.

Driving forces and relationship between air pollution and economic growth based on EKC hypothesis and STIRPAT model: evidence from Henan Province, China

The aim of this research is to analyze the main influencing factors and relationship between atmospheric environment and economic society. Using the panel data of 18 cities in Henan Province from 2006 to 2020, this paper employed some advanced econometric estimation included entropy method, extended environmental Kuznets curve (EKC) and STIRPAT model to conduct empirical estimations. The results show that most regions in Henan Province have verified the existence of the EKC hypothesis; and the peak of air pollution level in all cities of Henan Province generally occurred in around 2014. Multiple linear Ridge regression indicated that the positive driving forces of air pollution in most cities in Henan Province are industrial structure and population size; the negative driving forces are urbanization level, technical level and greening degree. Finally, we used the grey GM (1, 1) model to predict the atmospheric environment of Henan Province in 2025, 2030, 2035 and 2040. What should pay close attention to is that air pollution levels in northeastern and central Henan Province will continue to remain high.

Decoupling relationship between carbon emissions and economic development and prediction of carbon emissions in Henan Province: based on Tapio method and STIRPAT model

In order to cope with global warming, China has put forward the "30 · 60" plan. We take Henan Province as an example to explore the accessibility of the plan. Tapio decoupling model is used to discuss the relationship between carbon emissions and economy in Henan Province. The influence factors of carbon emissions in Henan Province were studied by using STIRPAT extended model and ridge regression method, and the carbon emission prediction equation was obtained. On this basis, the standard development scenario, low-carbon development scenario, and high-speed development scenario are set according to the economic development model to analyze and predict the carbon emissions of Henan Province from 2020 to 2040. The results show that energy intensity effect and energy structure effect can promote the optimization of the relationship between economy and carbon emissions in Henan Province. Energy structure and carbon emission intensity have a significant negative impact on carbon emissions, while industrial structure has a significant positive impact on carbon emissions. Henan Province can achieve the "carbon peak" goal by 2030 years under the standard and low-carbon development scenario, but it cannot achieve this goal under the high-speed development scenario. Therefore, in order to achieve the goals of "carbon peaking" and "carbon neutralization" as scheduled, Henan Province must adjust its industrial structure, optimize its energy consumption structure, improve energy efficiency, and reduce energy intensity.

Spatio-Temporal Distribution Characteristics and Drivers of PM2.5 Pollution in Henan Province, Central China, before and during the COVID-19 Epidemic

PM_2.5 is the main cause of haze pollution, and studying its spatio-temporal distribution and driving factors can provide a scientific basis for prevention and control policies. Therefore, this study uses air quality monitoring information and socioeconomic data before and during the COVID-19 outbreak in 18 prefecture-level cities in Henan Province from 2017 to 2020, using spatial autocorrelation analysis, ArcGIS mapping, and the spatial autocorrelation analysis. ArcGIS mapping and the Durbin model were used to reveal the characteristics of PM_2.5 pollution in Henan Province in terms of spatial and temporal distribution characteristics and analyze its causes. The results show that: (1) The annual average PM_2.5 concentration in Henan Province fluctuates, but decreases from 2017 to 2020, and is higher in the north and lower in the south. (2) The PM_2.5 concentrations in Henan Province in 2017-2020 are positively autocorrelated spatially, with an obvious spatial spillover effect. Areas characterized by a high concentration saw an increase between 2017 and 2019, and a decrease in 2020; values in low-concentration areas remained stable, and the spatial range showed a decreasing trend. (3) The coefficients of socio-economic factors that increased the PM_2.5 concentration were construction output value > industrial electricity consumption > energy intensity; those with negative effects were: environmental regulation > green space coverage ratio > population density. Lastly, PM_2.5 concentrations were negatively correlated with precipitation and temperature, and positively correlated with humidity. Traffic and production restrictions during the COVID-19 epidemic also improved air quality.

The impact of irrigation modes on agricultural water-energy‑carbon nexus

Despite the tremendous contribution of irrigated agriculture in addressing global food security, there is still confusion for farmers and governments about the choice of irrigation mode owing to the drastic environmental impacts of irrigation, including water shortage, energy crisis, and global warming. Exploring the agricultural water-energy‑carbon (WEC) nexus under different irrigation modes helps to accomplish the multi-objective of water & energy saving and carbon emission reduction. In this paper, a conceptual framework was nominated to evaluate the water & energy consumption and carbon emissions for winter wheat irrigation at township level and quantitatively discuss the complex interaction by the coupling coordination degree (CCD) of the WEC system under different irrigation modes in Henan Province, China. We discovered that irrigation modes profoundly affect water and energy consumption and carbon emissions in agriculture, as well as the spatial distribution of CCD from WEC system. Townships under irrigation mode with diversion and irrigation projects as the primary method (WDI) clustered together in the north and east with highest water consumption and carbon emissions, while townships under irrigation mode with rain-fed agriculture as the primary method (PI) accumulated in the west and south with lower water consumption and carbon emissions. Meanwhile, the CCD of the WEC nexus system was in basic coordination (0.40) and showed an unbalanced spatial distribution pattern with high in the southeast and low in the northwest. By comparing four irrigation modes, the coupling level of the WEC nexus system under irrigation mode with groundwater irrigation as the primary method (GI) was better and PI mode was the least ideal. This study helps to further understand agricultural WEC nexus under different irrigation modes and provide references for local governments in selecting appropriate irrigation modes to realize water-energy saving and carbon emission reduction in agricultural activities.

[Epidemiological features of echinococcosis cases reported in the National Notifiable Disease Report System in Henan Province from 2010 to 2021]

OBJECTIVE

To analyze the epidemiological characteristics of echinococcosis cases reported in the National Notifiable Disease Report System in Henan Province from 2010 to 2011, so as to provide insights into for echinococcosis control and surveillance.

METHODS

The data pertaining to reported echinococcosis cases in Henan Province from 2010 to 2021 were retrieved from the National Notifiable Disease Report System, and a descriptive epidemiological analysis was performed using the software SPSS 22.0.

RESULTS

A total of 150 echinococcosis cases were reported in Henan Province from 2010 to 2021, including 88 confirmed cases (58.67%) and 62 clinically diagnosed cases (41.33%), 77 cases reported by Henan Province (51.33%) and 73 cases reported by other provinces (48.67%). Echinococcosis cases were reported in each month, with 8 to 21 cases reported in each month, and the number of reported echinococcosis cases appeared no remarkable temporal changes. The echinococcosis cases were reported across 18 cities of Henan Province, with the highest number of cases reported in Zhoukou (17.33%) and Nanyang cities (17.33%) and the lowest number reported in Sanmenxia City (0.67%). The reported echinococcosis cases had a male to female ratio of 1.17:1, and the cases were found at each age group, with the the highest number of cases seen at ages of 20 to 59 years (73.33%). Farmer was the predominant occupation (63.33%), followed by housekeepers and the unemployed (12.67%). Of all reported echinococcosis cases, there were 25 local cases (16.67%) and 125 imported cases (83.33%), 144 cases reported by medical institutions (96.00%) and 6 cases reported by centers for disease control and prevention (4.00%).

CONCLUSIONS

Although imported echinococcosis cases were the predominant source of echinococcosis cases reported in the National Notifiable Disease Report System in Henan Province from 2010 to 2021, there were still sporadic local cases, and the emergence of local sources of infection cannot be excluded. Further expanded field surveys and surveillance of echinococcosis are required.

The forecasting model research of rural energy transformation in Henan Province based on STIRPAT model

In order to find the model of rural energy transformation in Henan Province. In this paper, Tapio decoupling model is employed to investigate the pivotal factors affecting rural power consumption (PC) and total energy consumption (TEC) in Henan Province. In addition, PSO-BP is used to predict the values of each influencing factor in 2020-2025. Last, the STIRPAT model is used to forecast TEC and PC from 2020 to 2025 based on the data of rural energy consumption in Henan Province from 2009-2019. The results show that other factors besides population promote TEC and PC to different degrees. Moreover, the influencing factors, TEC and PC, form a virtuous cycle of mutual promotion. Then, TEC and PC consumption show an increasing trend year by year in 2020-2025. It is worth noting that after 2022, the variation of PC is greater than that of TEC. To sum up, improving rural electrification level is a necessary way to realize its low-carbon energy transition.

[Epidemic trend and control progress of taeniasis and cysticercosis in Henan Province]

Henan Province is one of the provinces where taeniasis and cysticercosis were historically highly prevalent, and Taenia solium is the dominant species of tapeworm. Following the concerted efforts since 1970s, the prevalence of human taeniasis and cysticercosis has been maintained at a low level in Henan Province, which facilitates the national taeniasis and cysticercosis elimination program in China. Following the implementation of the policy of aeniasis and cysticercosis elimination and classified guidance, a great success has been achieved in aeniasis and cysticercosis control in Henan Province. With continuous promotion of the opening-up policy and the Belt and Road Initiative, there are still challenges in taeniasis and cysticercosis control. This review summarizes the control progress of taeniasis and cysticercosis and proposes the challenges of taeniasis and cysticercosis control in Henan Province.

Genetic polymorphism of circumsporozoite protein of Plasmodium falciparum among Chinese migrant workers returning from Africa to Henan Province

BACKGROUND

Plasmodium falciparum malaria is recognized as a major global public health problem. The malaria vaccine was important because the case fatality rate of falciparum malaria was high. Plasmodium falciparum circumsporozoite protein (PfCSP) is one of the potential vaccine candidates, but the genetic polymorphism of PfCSP raises concerns regarding the efficacy of the vaccine. This study aimed to investigate the genetic polymorphism of PfCSP and provide data for the improvement of PfCSP-based vaccine (RTS,S malaria vaccine).

METHODS

Blood samples were collected from 287 Chinese migrant workers who were infected with P. falciparum and returning from Africa to Henan Province during 2016-2018. The Pfcsp genes were analysed to estimate the genetic diversity of this parasite.

RESULTS

The results showed that there were two mutations at the N-terminus of imported Pfcsp in Henan Province, including insertion amino acids (58.71%, 118/201) and A → G (38.81%, 78/201). The number of repeats of tetrapeptide motifs (NANP/NVDP/NPNP/NVDA) in the central repeat region ranged mainly from 39 to 42 (97.51%, 196/201). A total of 14 nonsynonymous amino acid changes were found at the C-terminus. The average nucleotide difference (K) of imported Pfcsp in Henan Province was 5.719, and the haplotype diversity (Hd) was 0.964 ± 0.004. The estimated value of dN-dS was 0.047, indicating that the region may be affected by positive natural selection. The minimum number of recombination events (Rm) of imported Pfcsp in Henan Province was close to that in Africa. The analysis of genetic differentiation showed that there may be moderate differentiation between East Africa and North Africa (Fst = 0.06484), and the levels of differentiation in the other regions were very small (Fst < 0.05).

CONCLUSIONS

The N-terminus of Pfcsp was relatively conserved, and the central repeat region and the Th2R and Th3R regions of the C-terminus were highly polymorphic. The gene polymorphism pattern among Chinese migrant workers returning from Africa to Henan Province was consistent with that in Africa. The geographical pattern of population differentiation and the evidence of natural selection and gene recombination suggested that the effect of polymorphism on the efficacy of PfCSP-based vaccines should be considered.

[Prevalence and risk factors of Giardia lamblia infections among colorectal cancer patients in Henan Province]

OBJECTIVE

To investigate the epidemiological characteristics and identify the risk factors of Giardia lamblia infections among patients with colorectal cancer in Henan Province.

METHODS

A cross-sectional study was performed for questionnaire surveys among colorectal cancer patients in Henan Cancer Hospital during the period from March to July, 2021. Patients' stool samples were collected, and the triosephosphate isomerase (tpi) gene of G. lamblia was amplified in stool samples using nested PCR assay to characterize the parasite genotype. Univariate analysis and multivariate logistic regression analyses were employed to identify the risk factors of G. lamblia infections among colorectal cancer patients.

RESULTS

A total of 307 colorectal cancer patients were investigated, including 176 males (57.3%) and 131 females (42.7%). PCR assay detected 8.1% [95% confidential interval (CI): (0.056, 0.117)] prevalence of G. lamblia infections among the study subjects, and there was no significant difference in the prevalence between men [9.1%, 95% CI: (0.057, 0.143)] and women [6.9%, 95% CI: (0.037, 0.125)] (χ² = 0.495, P = 0.482). In addition, there was no age-specific prevalence of G. lamblia infections among the participants (χ² = 1.534, P = 0.675). Multivariate logistic regression analysis identified use of septic tanks [odds ratio (OR) = 3.336, 95% CI: (1.201, 9.267)], daily use of well water [OR = 3.042, 95% CI: (1.093, 8.465)] and raising livestock [OR = 3.740, 95% CI: (1.154, 12.121)] as risk factors of G. lamblia infections among colorectal cancer patients, and the prevalence of abdominal pain was significantly greater in colorectal cancer patients with G. lamblia infections than in those without infections (P = 0.017). Among the 25 patients with G. lamblia infections, assemblage A was characterized in 24 (96.0%) cases and assemblage B in one case (4.0%).

CONCLUSIONS

The prevalence of G. lamblia is high among colorectal cancer patients in Henan Province, and assemblage A is the dominant genotype of G. lamblia. Use of septic tanks, daily use of well water and raising livestock are risk factors of G. lamblia infections among patients with colorectal cancer.

Screening of gene detection of monogenic inherited disorder in an infertile population in Henan Province: an autosomal recessive disorder carried by maple syrup urine disease

Not required for Clinical Vignette.

Spatio-temporal variations of the major meteorological disasters and its response to climate change in Henan Province during the past two millennia

In China, historical documents have recorded large quantities of information related to natural disasters, and these disasters have had long-lasting effects on economic and social activities. Understanding the occurrence of the natural disasters and their spatio-temporal variation characters is crucial for sustainable of our society. Therefore, based on the collection and collation of historical documents, and adopting mathematical statistics, Kriging interpolation, correlation analysis and other methods, we systematically explored the meteorological disasters in Henan Province during the past two millennia in analyzing their spatio-temporal distribution characters and driving forces. The results demonstrate that there were five major types of meteorological disasters in Henan Province, including drought, flood, hails, low temperature and frost and insect pests, which presented obvious spatio-temporal variations and have occurred frequently during the past two millennia. According to the historical documents, the major meteorological disasters occurred 1,929 times in Henan from 221 BCE to 2000 CE. On the whole, the disaster frequency show that the occurrence cycle of the meteorological disasters has obvious changes, which mainly occurred in the middle and late stages during the past two millennia, especially after 1300 CE. Furthermore, we also find that the variation of meteorological disaster events is consistent with the variation of temperature in eastern China and the frequency of meteorological disaster increases in the cold period, but decreases in the warm period. In addition, there are obvious differences in the spatial distribution of the major meteorological disaster, which were mainly distributed in the northwest and southern part region of the Henan Province before 1911 CE. While after 1911 CE, the northern and southeastern parts were the meteorological disaster-prone areas in this region during this period. Spatial correlation analysis of each meteorological disaster before and after 1911 CE points out the droughts disaster frequency-occurring district has transferred in different periods, while the hail and low temperature and frost disasters just have a smaller transferred during these two periods. Conversely, the frequency-occurring districts of floods and insect pest disasters have no obviously transferred in different periods. These results can provide an important scientific basis for governmental decision makers and local people to prevent and mitigate meteorological disaster in the future.

The influence and countermeasures of digital economy on cultivating new driving force of high-quality economic development in Henan Province under the background of "double circulation"

This article focuses on the impact of the digital economy on cultivating new driving force of high-quality economic development in Henan Province and the countermeasures under the background of the "double circulation". Through the research on the status quo of Henan Province's digital economy and high-quality economic development, it is concluded that since the reform and opening up, Henan Province has achieved rapid and steady development at the macroeconomic level. Since the reform and opening up, the output value of the three main industries in Henan Province has continued to grow and the industrial structure has continuously optimized. However, in the domestic horizontal comparison, the economic development of Henan Province has not yet formed a prominent advantage. Henan Province still needs to further optimize the economic development structure and promote high-quality economic development. Through the theoretical and empirical analysis of the digital economy's high-quality economic development in Henan Province under the background of the "double circulation", this project found that the development of the digital economy promotes the cultivation of new driving force of high-quality economic development in Henan Province under the background of the "double circulation". Henan Province needs to make full use of the development opportunities of the digital economy under the background of the "double circulation", and adopts a variety of comprehensive measures to take advantage of the situation to promote the high-quality development of the province's economy. The research of this project believes that under the background of "double circulation", Henan Province uses the digital economy to cultivate New driving force for high-quality economic development. Although certain results have achieved, some problems have exposed, mainly including the lagging foundation of using the digital economy to cultivate high-quality economic development. Failed to make full use of the digital economy to cultivate leading companies that promote high-quality economic development, the government has not fully adapted to the digital economy's demand for cultivating new driving force of high-quality economic development, and companies lack the talents to use the digital economy to promote their own innovation and high-quality development. Further in-depth exploration found that the factors for the above problems mainly include not deeply the dual nature of production and consumption of digital infrastructure construction under the background of "double circulation", but ignoring the "pull the ox by the nose (grasp the key link)" status of leading enterprises in the cultivation of new driving force of high-quality economic development. The enthusiasm for the transformation of government functions and the adjustment of organizational structure is insufficient, and there are obstacles, and the introduction and training system of high-quality professionals in the field of digital economy is lacking. Through the mechanism analysis of the digital economy on the high-quality economic development of Henan Province under the background of the "double circulation", the analysis of development issues and causes combined with relevant literature analysis and field investigations. The project puts forward the use of digital in Henan Province Countermeasures for the economy to cultivate new driving force of high-quality economic development. Henan Province's digital infrastructure construction builds a solid foundation for high-quality economic development. The consumption upgrades as the engine used to cultivate a group of leading companies at the high end of the industrial value chain, improves the government support system, builds a support system for high-quality economic development in Henan Province, and strengthens the digital economy of enterprises by the use of professional talent team building.

Functional Assessment and Coordination Characteristics of Production, Living, Ecological Function-A Case Study of Henan Province, China

Multifunctional state assessment was the basis of time sequence design of territory spatial development and overall utilisation. This study aimed to identify the ecological-production-living (PLE) territory spatial function to provide a basis for territory spatial planning. It took Henan Province as the research area. This study developed a methodology to assess differentiation characteristics for PLE function, a method that integrates functional merging and geographic information technology. We used the coordination degree model and spatial autocorrelation analysis to reveal the coordination of spatial functions of the province. The results were as follows: (1) During the study period, the land production function of main grain-producing areas decreased slowly, and production and living function values of the Central Plains urban agglomeration with Zhengzhou as the centre were in an upward trend. The characteristics of urban-rural dualization were prominent, and ecological function value decreased year by year. (2) The laws of territorial spatial functions had different manifestations in different stages (1990–2005 and 2005–2018). By different characteristic laws, the change in production function in the later period was bigger than that in the previous period. The living function maintained a good continuity expansion characteristic before and after. The spatial regularity distribution characteristics of ecological function were weak, and the overall environment became worse than before. (3) The territory space of middle and low coordination function types was the most important type, and the aggregation was relatively weak. Xuchang County and Weihui City showed better states of functional coordination aggregation. Lushi County, Xinxian County, and Shangcheng County, which were in the western and southern mountainous and hilly areas, showed low-low aggregation characteristics. Thus, the government will strengthen targeted control over territorial space. This study provides a reference for the overall deployment of the development and utilisation of territory space in Henan Province.

[Prevalence of intestinal protozoan infections among rural children in Henan Province from 2014 to 2015]

OBJECTIVE

To investigate the prevalence and influencing factors of intestinal protozoan infections among rural children in Henan Province.

METHODS

A total of 104 survey sites were sampled from 35 counties (cities) in Henan Province using the stratified cluster sampling method to investigate the prevalence of intestinal protozoan infections among rural children from 2014 to 2015. The trophozoites and cysts of intestinal protozoa were identified using the iodine staining method and the physiological saline direct smear method (one detection for one stool sample). The prevalence of intestinal protozoan infections was compared among rural children with different characteristics, and the factors affecting intestinal protozoan infections among rural children were identified.

RESULTS

The overall prevalence of intestinal protozoan infections was 0.60% (40/6 771) among rural children in Henan Province from 2014 to 2015. There were 7 species of intestinal protozoa identified, and there was no species-specific prevalence (χ² = 37.732, P = 0.000). No significant differences were found in prevalence of intestinal protozoan infections among rural children in terms of gender (χ² = 1.793, P = 0.181), age (χ² = 1.443, P = 0.486), occupation (χ² = 0.219, P = 0.896) or ecological region (χ² = 1.700, P = 0.637). In addition, terrain (χ² = 2.311, P = 0.510), economic level (χ² = 4.322, P = 0.229), source of drinking water (χ² = 0.731, P = 0.393), eating raw vegetables (χ² = 1.134, P = 0.287) and deworming (χ² = 1.089, P = 0.297) had no remarkable effects on the prevalence of intestinal protozoan infections among rural children in Henan Province; however, the prevalence of intestinal protozoan infections varied significantly among rural children living in regions with different coverage of non-harmless toilets (χ² = 10.050, P = 0.018).

CONCLUSIONS

The prevalence of intestinal protozoan infections is low among rural children in Henan Province.

Genomic Epidemiology of SARS-CoV-2 From Mainland China With Newly Obtained Genomes From Henan Province

Even though the COVID-19 epidemic in China has been successfully put under control within a few months, it is still very important to infer the origin time and genetic diversity from the perspective of the whole genome sequence of its agent, SARS-CoV-2. Yet, the sequence of the entire virus genome from China in the current public database is very unevenly distributed with reference to time and place of collection. In particular, only one sequence was obtained in Henan province, adjacent to China's worst-case province, Hubei Province. Herein, we used high-throughput sequencing techniques to get 19 whole-genome sequences of SARS-CoV-2 from 18 severe patients admitted to the First Affiliated Hospital of Zhengzhou University, a provincial designated hospital for the treatment of severe COVID-19 cases in Henan province. The demographic, baseline, and clinical characteristics of these patients were described. To investigate the molecular epidemiology of SARS-CoV-2 of the current COVID-19 outbreak in China, 729 genome sequences (including 19 sequences from this study) sampled from Mainland China were analyzed with state-of-the-art comprehensive methods, including likelihood-mapping, split network, ML phylogenetic, and Bayesian time-scaled phylogenetic analyses. We estimated that the evolutionary rate and the time to the most recent common ancestor (TMRCA) of SARS-CoV-2 from Mainland China were 9.25 × 10⁻⁴ substitutions per site per year (95% BCI: 6.75 × 10⁻⁴ to 1.28 × 10⁻³) and October 1, 2019 (95% BCI: August 22, 2019 to November 6, 2019), respectively. Our results contribute to studying the molecular epidemiology and genetic diversity of SARS-CoV-2 over time in Mainland China.

First Report of Fusarium Root Rot of Tobacco Caused by Fusarium sinensis in Henan Province China

Tobacco (Nicotiana tabacum L.) is an economically important crop in China, with an estimated production of 2.2 million tons every year. In June 2018, tobacco plants within the municipality of Sanmenxia (Henan, China) showed symptoms of wilting with leaf yellowing and stunting. Diseased plants exhibited severe necrosis that advanced through the main root (Figure 1 A). The symptoms were observed in nineteen surveyed tobacco fields, 60 ha in total, and approximately 25% of the plants were symptomatic. The disease resulted in a severe loss in tobacco leaf production. Five symptomatic tobacco plants were sampled. Diseased tissues from roots were surface sterilized in 75% ethanol and placed on potato dextrose agar (PDA) medium. Eighteen of the 25 diseased tissues had cultures growing from them, and all the cultures were white colonies with abundant aerial mycelium produced scarlet pigmentation on PDA. One pure culture was obtained by single-spore culturing (SL1). A 10-day-old culture grown on CLA (carnation leaf agar) produced macroconidia that were falcate, straight or slightly curved, 3-septate, 25-35×3.5-4.5 μm (average 26.8×3.7 μm) (n=50). Two types of microconidia (napiform and fusiform) were formed on CLA that were hyaline, with one to two cells. Napiform conidia were 4.5-9.3×3.8-5.9 (average 7.3×5.0 μm) (n=50); fusiform conidia were 6.9-15.8×1.8-3.1 (average 9.9×2.5 μm). Spherical chlamydospores (7-12.5 μm) (n=50) were terminal or intercalary and produced in clumps or in chains (Figure1 B-D). Morphological characteristics of the isolate were similar to the features of Fusarium sinensis previously described by Zhao and Lu (2008). Molecular identification was performed using partial sequences of EF1-α gene (primers EF1/EF2, O'Donnell et al. 1998). Maximum parsimony and maximum likelihood-based methods were fitted using MEGA 7 (Moreira et al. 2019，Figure 2). The isolate was also sequenced for β-tubulin (primers T1/Bt-2b, O'Donnell & Cigelnik 1997)，ribosomal RNA gene (LSU, LROR/LR5 primers, Vu et al. 2019) and rDNA-ITS (ITS 1/ ITS 4 primers, White et al. 1990). Sequences were deposited in GenBank under accession numbers MT947797 (EF1-α), MW484999 (β-tubulin), MW486649 (LSU) and MT907471 (ITS). The obtained EF1-α sequence was 98.10% identity with those of F. sinensis (MG670388.1) in the GenBank database, whereas the β-tubulin, LSU and ITS sequences showed 100% identities to the corresponding DNA sequences in F. sinensis (GenBank Acc. Nos. KX880370.1, NG_067454.1 and MH863232.1, respectively). Morphological and molecular results confirmed this species as F. sinensis (Zhao and Lu 2008). Pathogenicity tests were performed on tobacco seedlings grown on an autoclaved matrix (YC/T310-2009). Healthy 6-leaf stage tobacco seedlings were inoculated by pouring a 20 mL conidial suspension (1×106 conidia/mL-1) around the stem base of each plant, 30 plant were inoculated. Thirty control seedlings received sterilized water. All treatments were maintained for 30 days under greenhouse conditions with a 12-h light/dark photoperiod at 25±0.5℃ and 70% relative humidity. The assay was conducted three times. Root rot and foliage chlorosis similar to the ones observed on infected plants in the field were observed on the inoculated tobacco seedlings, whereas the control seedlings remained asymptomatic after 30 days (Figure1 E). The pathogen isolated from the inoculated plant exhibited morphological characteristics identical to F. sinensis and was identified by a partial EF1-α gene sequence. This disease has previously been reported as the causal agent of root and crown rot of wheat in China (Zhao and Lu 2008; Xu et al. 2018). To our knowledge, this is the first report of F. sinensis causing root rot on tobacco in China. Funding: Funding was provided by the Science and Technology Project of Henan Provincial Tobacco Company (2020410000270012), Independent Innovation Project of Hennan Academy of Agricultural Sciences (2020ZC18) and Research and Development project of Henan Academy of Agricultural Sciences (2020CY010). References: Moreira, G.M., et al. 2019 Plant Dis. O'Donnell, K., et al. 1998. Proc. Natl. Acad. Sci. USA 95:2011. O'Donnell, K., et al. 2008. J. Clin. Microbiol. 46:2477. Xu, F., et al. 2018. Front Microbiol. 9:1054. Zhao, Z.H., and Lu, G. Z., 2008. Mycologia, 100:746. The author(s) declare no conflict of interest. Keywords: tobacco root rot, Henan Province, Fusarium sinensis.

On the nonlinear relationship between energy consumption and economic and social development: evidence from Henan Province, China

The sustainable development of China's economy and society has been restricted by energy and environmental issues. With the implementation of the Rise of Central China strategy, Henan, a populous province in China, is facing the threat of an energy shortage as its economy grows steadily and the urbanization process accelerates. Using panel data of 18 cities in Henan Province for the period of 2006-2018, this study investigates the relationship between energy consumption and economic and social development variables based on the extended Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model and threshold regression method. The empirical results indicate that economic and social development are significantly positively correlated with total electricity consumption, although there is regional heterogeneity in this relationship. Moreover, there is evidence for a nonlinear relationship between economic and social development and urban energy consumption. These conclusions not only promote the healthy and sustainable economic development of Henan Province but also provide a reference for other provinces and cities that are experiencing rapid development in China.

[Epidemiological characteristics of malaria in Henan Province from 1950 to 2019]

OBJECTIVE

To analyze the epidemiological characteristics of malaria in Henan Province from 1950 to 2019, so as to provide the scientific evidence for consolidating malaria elimination achievements in the province.

METHODS

The epidemiological situation of malaria and demographic data in Henan Province from 1950 to 2019 were collected, and the statistical analyses were performed using a descriptive epidemiological method. The spatial temporal distribution of malaria cases was identified using the software ArcGIS version 10.3.

RESULTS

During the period from 1950 through 2019, the progress of malaria elimination was divided into 4 stages in Henan Province, including the baseline-survey and key-control stage, morbidity-control and incidence-reduction stage, basic-eradication and achievement-consolidation stage and elimination stage. The spatial distribution of malaria cases shifted from south of the Huai River and the plain regions between the Yellow River and Taihang Mountain to the Huang-Huai-Hai Plain and Nanyang Basin, then was concentrated in eastern part of southern Huai River where Anopheles anthropophagus was distributed, and finally was gradually under control following malaria outbreak in Eastern Henan Plain. In addition, the species of Plasmodium changed from P. vivax, P. falciparum and P. malariae co-endemics to a single P. vivax infection, and the current co-endemics of 5 invasive malaria parasites, and the malaria vectors shifted from co-existence of Anopheles sinensis and An. anthropophagus to An. sinensis alone.

CONCLUSIONS

There has been a large change in the epidemiological characteristics of malaria in Henan Province from 1950 to 2019. Although malaria has been eliminated in Henan Province, the consolidation of the malaria elimination achievements remain a great challenge due to overseas imported malaria.

Epidemiological Investigation and Prevention Control Analysis of the Longitudinal Distribution of COVID-19 in Henan Province, China

Epidemic prevention and control in China have entered a new stage of normalization. This article analyzes the epidemiological characteristics of COVID-19 in Henan Province and summarizes the effective disease prevention and control means and measures at the prefecture level; the normalized private data provide a theoretical reference for the formulation and conduct of future prevention and control work. At the same time, these epidemic prevention and control findings can also be used for reference in other countries and regions.

The objective was to analyze the longitudinal distribution, epidemiological characteristics, and local prevention and control measures of coronavirus disease 2019 (COVID-19) in six cities in Henan Province, China, from 21 January 2020 to 17 June 2020: Xinyang City (including Gushi County), Nanyang City (including Dengzhou City), Zhumadian City (including Xincai County), Zhengzhou City (including Gongyi City), Puyang City, and Anyang City (including Hua County). Data were collected and analyzed through the COVID-19 information published on the official websites of the health commissions in the six selected cities of Henan Province. As of 17 June 2020, the cumulative incidence rate of COVID-19 in Henan Province was 1.33/100,000, the cumulative cure rate was 98.27%, the cumulative mortality rate was 1.73%, the age range of diagnosed cases was 5 days to 85 years old, and the male-to-female ratio was 1.09:1. The confirmed cases of COVID-19 in Henan Province were mainly imported cases from Hubei, accounting for 87.74% of all cases, of which the highest proportion was 70.50% in Zhumadian. The contact cases and local cases increased in a fluctuating manner over time. In this paper, epidemiological characteristics of COVID-19 in Henan Province were analyzed from the onset of the outbreak to the effective control within 60 days, and effective and distinctive prevention and control measures in various cities were summarized to provide a favorable useful reference for the further formulation and implementation of epidemic prevention and control and a valuable theoretical basis for effectively avoiding a second outbreak.

IMPORTANCE Epidemic prevention and control in China have entered a new stage of normalization. This article analyzes the epidemiological characteristics of COVID-19 in Henan Province and summarizes the effective disease prevention and control means and measures at the prefecture level; the normalized private data provide a theoretical reference for the formulation and conduct of future prevention and control work. At the same time, these epidemic prevention and control findings can also be used for reference in other countries and regions.

[Diagnosis of imported malaria cases in Henan Province from 2015 to 2019]

OBJECTIVE

To analyze the diagnosis of imported malaria cases in Henan Province from 2015 to 2019, so as to provide the evidence for malaria surveillance during the post-elimination stage.

METHODS

The data pertaining to malaria cases in Henan Province from 2015 to 2019 were extracted via the web-based Chinese Information System for Infectious Diseases Control and Prevention and the Parasitic Diseases Information Reporting Management System (PDIRMS) of Chinese Center for Disease Control and Prevention, and the diagnostic methods, diagnostic institutions and diagnostic time of imported malaria cases were analyzed.

RESULTS

A total of 952 imported malaria cases were reported in Henan Province during the period from 2015 through 2019, and all cases were laboratory-confirmed. The positive rate of malaria rapid diagnostic tests (RDTs) was 98.61% (779/790), which was significantly greater than that (94.22%, 897/952) of microscopic examinations (χ² = 22.773, P < 0.05). The proportion of imported malaria cases diagnosed in medical institutions increased from 65.22% (120/184) in 2015 to 81.50% (185/227) in 2019. Among the 238 imported malaria cases diagnosed in centers for disease control and prevention (CDC), 71.01% (169/238) were diagnosed in county-level CDC, and among the 704 cases diagnosed in medical institutions, only 8.38% (59/704) were diagnosed at county-level medical institutions. The median time from onset to definitive diagnosis of malaria was 3 days, and the median duration between onset and initial diagnosis of malaria was 1 day. The duration between initial diagnosis and definitive diagnosis of malaria varied significantly among years (χ² = 24.956, P < 0.05), and the interquartile range from initial diagnosis to definitive diagnosis reduced from 4 days in 2016 to 2 days in 2019. In addition, the median time from initial diagnosis to definitive diagnosis was significantly longer in severe falciparum malaria cases than in non-severe falciparum malaria cases (2 days vs. 1 day; Z = 7.557, P < 0.05).

CONCLUSIONS

Medical institutions play a more and more important role in the identification and surveillance of malaria cases; however, the diagnostic capability of malaria remains low in county-level medical institutions. The diagnostic awareness and capability of county-level medical institutions requires to be improved, in order to play their roles as sentinel hospitals in the malaria surveillance during the post-elimination stage.

Application and Preliminary Outcomes of Remote Diagnosis and Treatment During the COVID-19 Outbreak: Retrospective Cohort Study

BACKGROUND

The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated.

OBJECTIVE

The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic.

METHODS

Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes.

RESULTS

Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received.

CONCLUSIONS

Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management.

Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate Data Analysis of a Case Series in Henan Province

Background

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has been declared a global pandemic. Identifying individuals whose infection can potentially become severe is critical to control the case fatality rate of COVID-19. However, knowledge of symptoms that are prognostic of COVID-19 severity is lacking.

Objective

The objective of our study was to identify symptoms prognostic of COVID-19 infection severity.

Methods

We analyzed documented symptoms, including fever, cough, fatigue, expectoration, sore throat, chest distress, headache, diarrhea, rhinorrhea, stuffed nose, nausea, vomiting, muscle or joint ache, shortness of breath, and their associations with disease severity using a case series, including 655 confirmed cases from January 23 to February 5, 2020 in Henan Province, China. We also analyzed the influence of individual characteristics, including age, gender, and comorbidities, on symptoms with prognostic value.

Results

Fatigue (95% CI 0.141 to 0.334, P<.001), expectoration (95% CI 0.107 to 0.305, P<.001) and stuffed nose (95% CI –0.499 to –0.082, P=.006) were identified as the prognostic symptoms of COVID-19 patients from the multivariate analysis. Fever occurred in 603/655 (92.1%) of the patients but was not associated with disease severity. Fatigue accounted for 184/655 (28.1%) of the patients and was linearly associated with infection severity with statistical significance. Expectoration occurred in 169/655 (25.8%) patients in the cohort and was the sole prognostic factor for patients with cardiovascular complications, including hypertension. Shortness of breath, chest distress, muscle or joint ache, and dry cough, which occurred in 33 (5%), 83 (12.7%), 78 (11.9%), and 276 (42.1%) of the 655 patients, respectively, were significantly enriched among patients classified as severe. Stuffed nose and nausea were associated with favorable disease severity, especially among male patients. More female than male patients were documented as having muscle or joint ache. Headache was most enriched in patents aged 15 to 39 years, followed by those aged 40 to 64 years, with statistical significance.

Conclusions

Fatigue and expectoration are signs of severe COVID-19 infection. Shortness of breath, chest distress, muscle or joint ache, and dry cough are prevalent in severe patients. Expectoration is commonly present in older individuals and patients with cardiovascular disorders, including hypertension. Shortness of breath is prognostic of severe infection in male patients. Stuffed nose and nausea are favorable prognostic factors of severe infection, especially among male patients.

Clinical course and treatment efficacy of COVID-19 near Hubei Province, China: A multicentre, retrospective study

Currently, COVID‐19 has been reported in nearly all countries globally. To date, little is known about the viral shedding duration, clinical course and treatment efficacy of COVID‐19 near Hubei Province, China. This multicentre, retrospective study was performed in 12 hospitals in Henan and Shaanxi Provinces from 20 January to 8 February 2020. Clinical outcomes were followed up until 26 March 2020. The viral shedding duration, full clinical course and treatment efficacy were analysed in different subgroups of patients. A total of 149 COVID‐19 patients were enrolled. The median age was 42 years, and 61.1% (91) were males. Of them, 133 (89.3%) had fever, 131 of 144 (91%) had pneumonia, 27 (18.1%) required intensive care unit (ICU) management, 3 (2%) were pregnant, and 3 (2%) died. Two premature newborns were negative for SARS‐CoV‐2. In total, the median SARS‐CoV‐2 shedding period and clinical course were 12 (IQR: 9–17; mean: 13.4, 95% CI: 12.5, 14.2) and 20 (IQR: 16–24; mean: 21.2, 95% CI: 20.1, 22.3) days, respectively, and ICU patients had longer median viral shedding periods (21 [17–24] versus 11 [9–15]) and clinical courses (30 [22–33] vs. 19 [15.8–22]) than non‐ICU patients (both p < .0001). SARS‐CoV‐2 clearances occurred at least 2 days before fatality in 3 non‐survivors. Current treatment with any anti‐viral agent or combination did not present the benefit of shortening viral shedding period and clinical course (all p > .05) in real‐life settings. In conclusion, the viral shedding duration and clinical course in Henan and Shaanxi Provinces were shorter than those in Hubei Province, and current anti‐viral therapies were ineffective for shortening viral shedding duration and clinical course in real‐world settings. These findings expand our knowledge of the SARS‐CoV‐2 infection and may be helpful for management of the epidemic outbreak of COVID‐19 worldwide. Further studies concerning effective anti‐viral agents and vaccines are urgently needed.

[Epidemic status of malaria and progress of malaria elimination in Henan Province, 2018]

OBJECTIVE

To understand the epidemic status of malaria and progress of malaria elimination in Henan Province in 2018, so as to provide the scientific evidence for formulating the control strategy of malaria.

METHODS

All data pertaining to the epidemic status of malaria and malaria case were captured from Henan Province in 2018, and the epidemic status of malaria and the diagnosis and treatment of malaria cases were analyzed using a descriptive epidemiological method.

RESULTS

A total of 174 malaria cases were reported in Henan Province in 2018, with a male-to-female ratio of 33.8∶1. The cases were predominantly found at 30- and 40- years, and farmer was the highest-risk population. All cases were imported for overseas countries and 96.55% (168/174) were from Africa. The cases were reported across 17 cities of the province, and 63.22% (110 cases) were detected in 4 cities of Zhengzhou, Luoyang, Xuchang and Puyang. Both the median duration from onset to initial admission and the median time from the initial admission to definitive diagnosis were 1 d. There were 6 cases (3.45%) with more than 7 days to visit a doctor, and there were 13 cases (7.47%) with definitive diagnosis of over 7 days (delay in definitive diagnosis). All malaria cases were reported within 24 h, and 98.28% (171/174) completed case investigations within 3 d. All 18 cities had achieved malaria elimination by December 2018.

CONCLUSIONS

All malaria cases reported in Henan Province in 2018 are imported from overseas countries. Intensifying malaria surveillance among returnees from Africa and Southeast Asia and timely identification and treatment of imported malaria cases are required to prevent the development of secondary malaria cases, so as to ensure the achievement of malaria elimination in Henan Province on schedule.

Performance Evaluation of Regional Water Environment Integrated Governance: Case Study from Henan Province, China

The performance of the regional water environment integrated governance is affected by many factors. This study took place in Henan Province, China, as the research area, and constructed an index system through the comprehensive consideration of three target layers based on the Ecological-Social-Economic (ESE) framework. Due to advantages such as strong objectivity and operability, the improved entropy-weight technique for the order of preference by similarity to the ideal solution (TOPSIS) model can greatly overcome subjective human interference and render the evaluation results more reliable. Therefore, it was introduced to evaluate the water environment integrated governance in Henan from 2007 to 2016. By applying the obstacle degree model, the obstacle factors were then diagnosed. The results of this study show that the overall performance of the integrated governance was generally improved in Henan from 2007 to 2016. Performance levels of the three target layers exhibited different trends, of which the social and economic benefits presented a linear increase year by year, but the ecological benefits presented a fluctuating downward trend. The obstacle on the Henan water environment integrated governance mainly comes from the ecological and economic benefits index. Therefore, a series of countermeasures have been proposed as a means of improving the governance performance in Henan.

Spatial Association Pattern of Air Pollution and Influencing Factors in the Beijing-Tianjin-Hebei Air Pollution Transmission Channel: A Case Study in Henan Province

The Beijing–Tianjin–Hebei (BTH) air pollution transmission channel and its surrounding areas are of importance to air pollution control in China. Based on daily data of air quality index (AQI) and air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃) from 2015 to 2016, this study analyzed the spatial and temporal characteristics of air pollution and influencing factors in Henan Province, a key region of the BTH air pollution transmission channel. The result showed that non-attainment days and NAQI were slightly improved at the provincial scale during the study period, whereas that in Hebi, Puyang, and Anyang became worse. PM_2.5 was the largest contributor to the air pollution in all cities based on the number of non-attainment days, but its mean frequency decreased by 21.62%, with the mean occurrence of O₃ doubled. The spatial distribution of NAQI presented a spatial agglomeration pattern, with high-high agglomeration area varying from Jiaozuo, Xinxiang, and Zhengzhou to Anyang and Hebi. In addition, the NAQI was negatively correlated with sunshine duration, temperature, relative humidity, wind speed, and positively to atmospheric pressure and relative humidity in all four clusters, whereas relationships between socioeconomic factors and NAQI differed among them. These findings highlight the need to establish and adjust regional joint prevention and control of air pollution as well as suggest that it is crucially important for implementing effective strategies for O₃ pollution control.

[Analysis of Characteristics and Meteorological Influence Factors of Ozone Pollution in Henan Province]

The spatio-temporal characteristics of ozone (O₃) pollution in the Henan Province in 2017 and its relationship with particulate matter, precursors, and meteorological factors were studied using the data obtained from the air quality monitoring station and national baseline ground climate station. Results showed that the annual mean O₃ concentration of a maximum daily 8-h average (MDA8) was 108 μg·m^-3 in the Henan Province with the trend of summer > spring > autumn > winter. Different levels of O₃ were observed in various cities. The number of days exceeding the standard was up to 88 days in Anyang, while the lowest was found in Xinyang with 17 days. The most severe of O₃ pollution occurred during late spring and early summer. During this period, the average monthly concentration of O₃ MDA8 was above 140 μg·m^-3, and peaked in June. The qualitative and quantitative analysis showed that the monthly average concentration of O₃ MDA8 was negatively correlated with particulate matter, and the O₃ hourly concentration was also negatively correlated with CO and NO₂. The O₃ MDA8 concentration and meteorological factors (sunshine duration, temperature, rainfall, visibility, humidity, and wind speed) had different correlations during different seasons and various cities.

[Spatio-Temporal Distribution and Variation Characteristics of Aerosol Optical Properties in Henan Province]

The temporal variation and spatial distribution characteristics of aerosol optical depth (AOD), aerosol column mass concentration (AMC), and fine mode fraction (FMF) were analyzed based on the aerosol product information obtained from MODIS/Terra C6.1 from 2001 to 2018 in the Henan province. The spatial distribution of AOD and AMC in all seasons are high in the east and low in the west, and high in the north and low in the south, which was related to the special topography, population distribution, and number of enterprises in each region. Meanwhile, the spatial distribution of FMF is opposite to that of AOD and AMC. In spring, AMC was the highest, while FMF was the lowest, indicating that it was mainly affected by dust aerosol in spring. AOD and FMF were the highest in summer, while the AMC was lower, mainly because the high values of AOD in summer were caused by the hygroscopic growth of aerosol. The increase of rainwater scouring and secondary aerosol generation led to the domination of fine-mode aerosols in summer. In autumn and winter, the AOD and AMC were relatively low, and the FMF was slightly higher than in spring. The AOD and AMC in the Henan Province showed a decreasing annual trend, while the FMF exhibited an increasing trend. The average monthly peak-valley difference of AOD, AMC, and FMF decreased after 2011.

The Occurrence and Risks of Selected Emerging Pollutants in Drinking Water Source Areas in Henan, China

The occurrence of organic micropollutants (OMPs) in aqueous environments has potential effects on ecological safety and human health. Three kinds of OMPs (namely, pharmaceuticals, ultraviolet (UV) filters and organophosphate esters (OPEs)) in four drinking water source areas in Henan Province of China were analyzed, and their potential risks were evaluated. Among 48 target chemicals, 37 pollutants with total concentrations ranging from 403.0 to 1751.6 ng/L were detected in water, and 13 contaminants with total concentrations from 326.0 to 1465.4 ng/g (dry weight) were observed in sediment. The aqueous pollution levels in Jiangang Reservoir and Shahe Water Source Area were higher than that in Nanwan Reservoir and Baiguishan Reservoir, while the highest total amount of pollutants in sediment was found in Baiguishan Reservoir. Compared with pharmaceuticals and UV filters, OPEs presented higher concentrations in all investigated drinking water source areas. The highest observed concentration was triphenylphosphine oxide (TPPO, 865.2 ng/L) in water and tripentyl phosphate (TPeP, 1289.8 ng/g) in sediment. Moreover, the risk quotient (RQ) analysis implies that the determined aqueous contaminants exhibited high risks to algae and invertebrates, whereas moderate risk to fish was exhibited. The health risk assessment of aqueous OMPs by means of the hazard index (HI) indicates that the risks to adults and children were negligible. These observations are expected to provide useful information for the assessment of water quality in drinking water sources in Henan, China.

[Prevalence and influencing factors of intestinal parasitic diseases among rural children in Henan Province]

OBJECTIVE

To understand the epidemic status and influencing factors of intestinal parasitic diseases among rural children in Henan Province.

METHODS

According to the Scheme for The National Survey on Current Status of Major Human Parasitic Diseases in China, the survey counties were selected based on the ecological zones and economic levels in Henan Province between 2014 and 2015. Then, the included counties were stratified according to the topography and economic levels. A township was randomly sampled from each stratum, and a village was randomly sampled from each township as the study site. Finally, a total of 104 study sites from 35 counties were enrolled for the survey of intestinal parasitic diseases in children. At least 250 fresh stool samples were collected from each study site for detection of intestinal helminth eggs with the Kato-Katz technique, for the identification of Necator americanus and Ancylostoma duodenale with the fecal culture method, and for the detection of intestinal protozoa trophozoite and cyst with the physiological saline smear and iodine staining techniques. In addition, the Enterobius vermicularis and tapeworm eggs were detected in children aged 3 to 6 years using the adhesive cellophane-tape perianal swab method.

RESULTS

The overall prevalence of intestinal parasitic infections was 3.21% (214/6 671) among rural children in Henan Province, and the prevalence of intestinal helminthes (2.62%, 175/6 671) was higher than that of intestinal protozoa (0.60%, 40/6 671). A total of 12 species of intestinal parasites were found, including 4 nematodes species, one trematode species, and 7 protozoa species, and the highest infection was seen in E. vermicularis (2.47%, 161/6 671). Among the four ecological zones in Henan Province, the greatest prevalence of intestinal parasitic infections was detected among children in the Qinba Mountain Ecological Zone (5.85%, 90/1 538). There was no gender-specific difference in the prevalence of intestinal parasitic infections in children (P > 0.05); however, there were age- (χ² = 32.762, P < 0.05) and education level-specific differences in the prevalence of intestinal parasitic infections in children (χ² = 67.507, P < 0.05), with the greatest prevalence of E. vermicularis infection seen in all species of intestinal parasites in children at all age groups. Multivariate non-conditional logistic regression analysis showed that high education level, high coverage of harmless toilets, drinking tap water and deworming were protective factors for intestinal parasitic infections in children in Henan Province. The overall prevalence of intestinal parasitic infections appeared a tendency towards a gradual decline among children in Henan Province as compared to the previous two surveys.

CONCLUSIONS

The overall prevalence of intestinal parasitic infections shows a tendency towards a remarkable decline among children in Henan Province. E. vermicularis infection should be given a priority for future parasitic disease control activities among rural children in Henan Province.

[Investigation on human intestinal parasitic diseases in ecological regions of Qinba Mountains in Henan Province in 2015]

OBJECTIVE

To understand and analyze the epidemic status of human intestinal parasitic diseases in the ecological region of the Qinba Mountains in Henan Province, so as to provide the evidence for the control of the diseases in this region.

METHODS

According to the methods of National Survey Scheme on Major Human Parasitic Diseases, 26 survey spots were selected in 8 counties (cities) in ecological regions of Qinba Mountains in Henan Province in 2015. After collecting the human fecal samples, the eggs of intestinal helminthes were detected with the modified Kato-Katz thick smear method, the species of Ancylostoma of the hookworm egg-positive samples were identified with the tube fecal culture method, the eggs of Enterobius vermicularis were detected by using the adhesive tape method in children aged 3 to 6 years, and the cyst and trophozoite of intestinal protozoa were examined by iodine staining. The infections of intestinal parasites in different populations and the related influencing factors were analyzed.

RESULTS

Totally 6 706 residents were recruited in this study, 8 kinds of parasites were found including 3 species of helminthes and 5 species of protozoans. The overall infection rate of intestinal parasites was 3.39%, covering 2.92% for helminthes and 0.49% for protozoans. The infection rate of E. vermicularis in children aged 3 to 6 years was 3.93%. The 3 identified helminthes were Ascaris lumbricoides, E. vermicularis, and Dicrocoelium dendriticum, with the highest infection rate of E. vermicularis (2.68%, χ² = 306.362, P < 0.05). The 5 identified protozoans were Entamoeba hartmani, E. coli, Endolimax nana, Giardia lamblia, and Blastocystis hominis, and the infection rate of E. nana was the highest (χ² = 23.842, P < 0.05). Among the 8 counties (cities), the highest infection rate of helminthes, mainly with Enterobius infection, existed in Ruyang County, and the infection rate of protozoans in Xin'an County was the highest, mainly with E. nana infection. There was a significant difference in the infection rates of helminthes and protozoans among the 8 counties (cities) (helminthes: χ² = 357.525, P < 0.05; protozoans: χ² = 38.795, P < 0.05). There was no significant difference in the helminth infection rate between males and females ( χ² = 0.034, P > 0.05), but the protozoan infection rate of the males was higher than that of the females ( χ² = 12.946, P < 0.05). The helminth infection rate of the 0-9 years old group was the highest ( χ² = 62.600, P < 0.05), up to 6.60%, mainly with E. vermicularis infection. There was no significant difference in the infection rate of intestinal parasites among nationalities ( χ² = 0.212, P > 0.05). The helminth infection rate of preschool children was the highest and up to 8.43%, mainly with E. vermicularis infection. The infection of A. lumbricoides was mainly happened among farmers, with the infection rate of 0.31%. There was a significant difference in the helminth infection rate among different occupations (χ² = 84.333, P < 0.05). The intestinal parasites infection rate of the illiterate population was the highest and up to 7.63%, there was a significant difference among the populations with different educational levels (χ² = 72.013, P < 0.05). The helminth infection rate of plain areas was higher than that of valley and hill ( χ² = 11.690, P < 0.05). The helminth infection rate of people with low-income was the highest and up to 10.32% (χ² = 244.999, P < 0.05). The protozoan infection rate of people with middle-income was the highest, who had the annual per capita net income of 6 000 to 7 999 Yuan ( χ² = 24.749, P < 0.05). The helminth infection rate of people drinking well water was much higher than that of people drinking tap water (χ² = 62.255, P < 0.05). The protozoan infection rate of people without insect repellent was higher than that of people with insect repellent (χ² = 5.235, P < 0.05).

CONCLUSIONS

The infection rates of human intestinal parasites in the ecological region of the Qinba Mountains in Henan Province have decreased sharply. E. vermicularis infection in children should be the main point of prevention and treatment of parasitic diseases in the future.

Inequality and Influencing Factors of Spatial Accessibility of Medical Facilities in Rural Areas of China: A Case Study of Henan Province

The equalization of medical services has received increasing attention, and improving the accessibility of medical facilities in rural areas is key for the realization of fairness with regard to medical services. This study studies the rural areas of Henan Province, China, and uses unincorporated villages as the basic unit. The spatial pattern of accessibility in rural areas was comprehensively analyzed via geographic information system spatial analysis and coefficient of variation. The spatial heterogeneity of relevant influencing factors was assessed by using the geographically weighted regression model. The results show that: (1) The distance cost of medical treatment in rural areas is normally distributed, and most areas are within a range of 2-6 km. (2) The accessibility in rural areas has clear spatial differences, is significantly affected by terrain, and shows characteristics of significant spatial agglomeration. The eastern and central regions have good spatial accessibility, while the western regions have poor spatial accessibility. Furthermore, regions with poor accessibility are mainly located in mountainous areas. (3) The spatial equilibrium of accessibility follows a pattern of gradual deterioration from east to west. The better accessibility-unbalanced type is mostly located in the center of Henan Province, while the poor accessibility-unbalanced type is concentrated in mountainous areas. (4) The area, elevation, residential density, and per capita industrial output are positively correlated with spatial accessibility, while road network density and population density are negatively correlated.

Low prevalence of antibodies against Toxoplasma gondii in dairy cattle from China's central region

Background

Toxoplasma gondii is an intracellular protozoan that can infect humans and other animals, including cattle. Cattle are one of the world’s main sources of meat, and people who consume raw or undercooked meat and milk of cattle infected with T. gondii can become infected. In this study, a total of 5292 dairy cattle serum samples, collected from 17 cities (Henan Province, China) from January 2015 to September 2017, were screened for antibodies against T. gondii.

Results

Antibodies to T. gondii were found in 1.93% (102/5292) (95% CI, 1.56–2.30) of dairy cattle using a modified agglutination test (cut-off 1:100). The results showed that geographic location and season may be risk factors for T. gondii infection of cattle (P < 0.05), and the seroprevalence of T. gondii in cattle along the Yellow River is higher than other areas.

Conclusions

This is the first large-scale investigation on the seroprevalence of T. gondii infection in cattle from Central China. This survey shows that the T. gondii infection rate of dairy cattle is low; however, these findings provide additional information on the epidemiology of Chinese T. gondii. The possibility of dairy cattle exposure to T. gondii in Central China can not be ignored, and the consumption of raw or undercooked beef or milk may pose a risk to human health.

Molecular investigation of the Pfmdr1 gene of Plasmodium falciparum isolates in Henan Province imported from Africa

Efficacious antimalarial drugs are important for malaria control and elimination, and continuous monitoring of their efficacy is essential. The prevalence and distribution of Pfmdr1 were evaluated in African migrant workers in Henan Province. Among 632 isolates, 13 haplotypes were identified, NYSND (39.87%, 252/632), YYSND (2.85%, 18/632), NFSND (31.01%, 196/632), NYSNY (0.47%, 3/632), YFSND (13.77%, 87/632), NFSNY (0.32%, 2/632), YYSNY (2.06%, 13/632), YFSNY (0.16%, 1/632), N/Y YSND (1.90%, 12/632), N Y/F SND (6.17%, 39/632), N/Y Y/F SND (0.47%, 3/632), YYSN D/Y (0.16%, 1/632) and N/Y FSND (0.79%, 5/632). The highest frequency of NYSND was observed in individuals from North Africa (63.64%, 7/11), followed by South Africa (61.33%, 111/181), Central Africa (33.33%, 56/168), West Africa (28.94%, 68/235) and East Africa (27.03%, 10/37) (χ2 = 54.605, P &lt; 0.05). The highest frequency of NFSND was observed in East Africa (48.65%, 18/37), followed by West Africa (39.14%, 92/235), Central Africa (26.79%, 45/168), South Africa (22.65%, 41/181) and North Africa (9.09%, 1/11) (χ2 = 22.368 P &lt; 0.05). The mutant prevalence of codons 86 and 184 decreased. These data may provide complementary information on antimalarial resistance that may be utilized in the development of a treatment regimen for Henan Province.

[Analysis of malaria death cases in Henan Province from 2010 to 2015]

OBJECTIVE

To retrospectively overview the malaria death cases reported in Henan Province and analyze the cause of death.

METHODS

The data including basic information, epidemiological survey and medical records of malaria death cases in Henan Province from 2010 to 2015 were collected and analyzed.

RESULTS

In the six years, a total of 14 malaria patients were dead. All the death patients were adult males and imported from Africa. They had definite histories of living in malaria-epidemic areas and the symptoms of fever. Twelve patients were diagnosed as malaria after at least twice diagnoses. The average time from symptom appearing to correct diagnosis was 6.5 d. The causes of deaths were misdiagnosis and delayed treatment.

CONCLUSIONS

The major reasons of malaria death cases in Henan Province are the failure of correct diagnosis and prompt treatment. Health education of malaria prevention and diagnosis and treatment training of malaria should be strengthened in order to improve the public awareness and the diagnosis ability of clinical doctors for malaria, which can prevent the death of imported malaria cases.

Role of MIRU-VNTR and spoligotyping in assessing the genetic diversity of Mycobacterium tuberculosis in Henan Province, China

Background

Tuberculosis remains a serious threat to human health as an infectious disease in China. Henan, a most populated province in China, has a high incidence of tuberculosis (TB). Though the genetic diversity of Mycobacterium tuberculosis (MTB) has been investigated in many regions, there have been only a few studies on the molecular characteristics and drug resistance phenotypes in Henan. This is the first study on the genetic profile of MTB from Henan.

Methods

A total of 668 MTB isolates from various areas were genotyped with spoligotyping and 26-locus MIRU-VNTR (classical 24-locus MIRU-VNTR and 2 other loci). The association between TB spoligotype signatures and drug-resistant profiles was analysed.

Results

Our data revealed that MTB isolates circulating in Henan had a high degree of genetic variation. The Beijing family was the most predominant genotype (83.53%,n = 558), and the typical Beijing type(ST1) was the major sublineage (81.73%,n = 546). In total,668 isolates were divided into 567 different types, forming 38 clusters (2–15 isolates per cluster), and 529 unique types by 26-locus MIRU-VNTR analysis. There was no correlation between the Beijing family and gender, age at diagnosis or treatment history, whereas the Beijing family was significantly associated with all four first-line drug resistance and multidrug-resistant phenotypes. For these samples, 15 of 26 MIRU-VNTR loci had high or moderate discriminatory power according to the Hunter-Gaston discriminatory index. A combination of the 10 most polymorphic loci had similar discriminatory power as the 26-locus set.

Conclusion

The Beijing genotype is the most prevalent family. Ten-locus MIRU-VNTR in combination with spoligotyping can efficiently classify the molecular type of MTB in Henan Province.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3351-y) contains supplementary material, which is available to authorized users.

[Investigation and analysis of overseas imported malaria prevalence in Henan Province from 2012 to 2014]

OBJECTIVE

To understand the epidemic characteristics of imported malaria in Henan Province from 2012 to 2014, so as to provide the evidence for proposing the reasonable suggestions for imported malaria prevention and control.

METHODS

The data of imported malaria were collected and the epidemic characteristics were analyzed in Henan Province from 2012 to 2014.

RESULTS

A total of 569 imported malaria cases were reported in Henan Province from 2012 to 2014, including 445 cases of falciparum malaria, 48 cases of vivax malaria, 61 cases of ovale malaria, 14 cases of quartan malaria, and 1 case of mixed infection. All the malaria cases were confirmed in laboratory. During the three years, the time of higher incidence was in Spring Festival, and May and June, and the cases mainly distributed in Luoyang, Zhengzhou, Puyang, Xinxiang, Anyang, Xuchang and Nanyang cities, accounting for 68.54%. Totally 82.43% of the patients were male youth and middle-aged. Of the 569 patients, 534 (93.85%) returned from Africa and 35 (6.15%) returned from Southeast Asian countries. The average time was 6.22 d and the median was 4 d from the onset to diagnosis. Among 569 cases, 290 (50.97%) were confirmed by different levels of centers for disease prevention and control, and 279 (49.03%) were diagnosed by different levels of medical institutions.

CONCLUSIONS

The imported malaria cases have been increased obviously in recent 3 years in Henan Province. Therefore, the health education for the knowledge about malaria prevention and control, and the technician training should be strengthened.

Polymorphisms of Plasmodium falciparum k13-propeller gene among migrant workers returning to Henan Province, China from Africa

BACKGROUND

Henan Province has been in the malaria elimination stage, with all reports of the disease being imported since 2012 and over 90% coming from Africa. Surveillance and population studies are essential for the early detection and subsequent prevention of the spread of drug resistance. The K13-propeller gene was recently identified as a proposed molecular marker of artemisinin (ART) resistance. In this study, we detected mutations of the K13-propeller gene in samples taken from imported malaria cases in Henan Province from 2012 to 2015.

METHODS

There were 483 samples that were obtained from Plasmodium falciparum-infected malaria migrant workers who returned to Henan Province from Africa between 2012 and 2015. The single nucleotide polymorphisms in the K13-propeller gene were assessed by nested PCR with DNA sequencing. Frequency and geographic difference of K13-propeller gene mutant types were analyzed.

RESULTS

Of 483 patients, 476 were cured and 7 died. There were no K13-propeller mutations in the blood samples from the 7 patients who died, but there were 23 different genotypes of the K13-propeller that were observed in 24 (4.97%) of the samples. C580Y, which was the predominant one in the resistance of ART, was not detected in the samples, but R539T and P574L which have also been associated with ART resistance, were observed in two samples from Angola and Equatorial Guinea. No mutations were detected in 11 samples from North Africa. The frequency of the K13-propeller was 6.50% (8/123) in Central Africa, followed by East Africa (1/19, 5.26%), West Africa (9/198, 4.55%) and South Africa (6/132, 4.55%). There was no significant difference among these four areas (P = 0.795).

CONCLUSION

R539T and P574L were found in migrant workers who traveled from Africa to Henan Province, although the frequency of the K13-propeller mutants was low. These data may enrich the molecular surveillance of antimalarial resistance and will be helpful for developing and updating the antimalarial policy in Henan Province.

[Monitoring results of soil-transmitted nematodiasis in national surveillance site of Huaiyang County in Henan Province, 2006-2015]

OBJECTIVE

To understand the epidemic situation of soil-transmitted nematodiasis in the national surveillance site in Henan Province.

METHODS

Over 1 000 fecal samples from inhabitants in Huaiyang County of Henan Province, which was a national surveillance site, were collected each year from 2006 to 2015, the eggs of soil-transmitted nematodes and other intestinal helminths were examined by Kato-Kats technique. The cellophane swab method was used to detect Enterobius vermicularis eggs in children aged 3 to 12 years. In addition, the soil samples were collected from vegetable fields, lavatories, courtyards and kitchens of 10 families randomly selected in each year to examine Ascaris eggs by a modified saturated sodium nitrate floatation method.

RESULTS

From 2006 to 2015, 10 419 persons were investigated, and the eggs of five species of intestinal helminths, Ascaris lumbricoides, Trichuris trichiura, hookworm, E. vermicularis, and Trichostrongylus orientalis, were detected, The average infection rate of soil-transmitted nematodes in residents in Huaiyang County was 3.69%. The intensity of infection was mild and a family clustering was obvious. Both the infection rates of E. vermicularis in children and soil-transmitted nematodes in villagers had no significant differences between different genders (both P＞0.05). The infection rates of soil-transmitted nematodes, A. lumbricoides and E. vermicularis all reached the highest in the age group of 1-10 years. For different education back-ground, the people with primary school education had the highest infection rate, and the infection rate showed a decreasing trend with the increase of the educational level. The infection rate of soil-transmitted nematodes in the national surveillance site in Henan Province showed a decreasing trend from 2006 to 2015. Unfertilized and fertilized A. lumbricoides eggs were detected in the soil samples, but the positive rate was very low.

CONCLUSIONS

In the recent 10 years, the infection rate of soil-transmitted nematodes in the national surveillance site in Henan Province shows a decreasing trend and maintains at a low level. The infection shows a family clustering. The children, especially those aged 3-9 years are the main infected population, and E. vermicularis infection is the key point of prevention and control.

[Survey and analysis of epidemic status of principal human parasitosis in ecological region of Huaiyang hills of Henan Province in 2015]

OBJECTIVE

To understand the epidemic status of principal human parasitosis in the ecological region of Huaiyang hills of Henan Province.

METHODS

According to the scheme of The 3rd National Survey of Principal Human Parasites made by National Institute of Parasitic Diseases, the survey was performed based on the ecological regions. The stratified cluster sampling was made combined with the economic and geographical conditions. The infections of intestinal helminths and protozoans in permanent residents were respectively detected by Kato-Kats technique and iodine solution. Trichuris trichiura infection was detected by the cellophane swab method in children aged 3 to 6 years.

RESULTS

Totally 6 710 residents in 26 survey spots from 9 counties were detected, in which 528 children aged 3 to 6 years were detected for T. trichiura infection. Eleven kinds of parasites were found in this survey, including 5 species of helminthes and 6 species of protozoans. The infection rates of overall parasites, helminthes and protozoans were respectively 1.65%, 1.07% and 0.61%. The infection rate of T. trichiura in the children aged 3 to 6 years was 3.79%. Only 0.10 percent of the infections were co-infection, and all were infected by 2 kinds of parasites. The principal parasites in this district were Ascaris lumbricoides (0.31%), Blastocystis hominis (0.28%) and hookworm (0.27%). The T. trichiura infection rate among children was 3.79% by the cellophane swab method. The infections of protozoans were found in all age groups. In the group aged 9 years and below, the maximum kinds of parasites were found.

CONCLUSIONS

The infection rates of principal human parasites in Huaiyang hilly ecological region of Henan have decreased sharply, but more efforts still should be paid on the prevention and control of parasitosis in children.

A large outbreak of acute gastroenteritis caused by the human norovirus GII.17 strain at a university in Henan Province, China

Background

Human noroviruses are a major cause of viral gastroenteritis and are the main etiological agents of acute gastroenteritis outbreaks. An increasing number of outbreaks and sporadic cases of norovirus have been reported in China in recent years. There was a large acute gastroenteritis outbreak at a university in Henan Province, China in the past five years. We want to identify the source, transmission routes of the outbreak by epidemiological investigation and laboratory testing in order to provide the effective control measures.

Methods

The clinical cases were investigated, and analysed by descriptive epidemiological methods according to factors such as time, department, grade and so on. Samples were collected from clinical cases, healthy persons, the environment, water, and food at the university. These samples were tested for potential bacteria and viruses. The samples that tested positive for norovirus were selected for whole genome sequencing and the sequences were then analysed.

Results

From 4 March to 3 April 2015, a total of 753 acute diarrhoea cases were reported at the university; the attack rate was 3.29%. The epidemic curve showed two peaks, with the main peak occurring between 10 and 20 March, accounting for 85.26% of reported cases. The rates of norovirus detection in samples from confirmed cases, people without symptoms, and environmental samples were 32.72%, 17.39%, and 9.17%, respectively. The phylogenetic analysis showed that the norovirus belonged to the genotype GII.17.

Conclusions

This is the largest and most severe outbreak caused by genotype GII.17 norovirus in recent years in China. The GII.17 viruses displayed high epidemic activity and have become a dominant strain in China since the winter of 2014, having replaced the previously dominant GII.4 Sydney 2012 strain.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-017-0236-z) contains supplementary material, which is available to authorized users.

Reperfusion times of ST-Segment elevation myocardial infarction in hospitals

Objective: To investigate the reperfusion time in patients with ST-segment elevation myocardial infarction (STEMI) in Henan Province, China, and discuss the strategies for shortening that period.

Methods: The reperfusion times of 1556 STEMI cases in 30 hospitals in Henan Province were analyzed from January 2008 to August 2012, including 736 cases from provincial hospitals, 462 cases from municipal hospitals and 358 cases from country hospitals. The following data: Time period 1 (from symptom onset to first medical contact), Time period 2 (from first medical contact to diagnosis), Time period 3 (from the diagnosis to providing consent), Time period 4 (from the time of providing consent to the beginning of treatment) and Time period 5 (from the beginning of treatment to the patency) were recorded and analyzed.

Results: In patients receiving primary percutaneous coronary intervention, the door-to-balloon time of provincial hospitals and municipal hospitals was 172±13 minutes and 251±14 minutes, respectively. The hospitals at both levels had a delay comparison of 90 minutes largely caused by the delay in the time for obtaining consent. In patients receiving thrombolysis treatment, the door-to-needle times of provincial hospitals, municipal hospitals and country hospitals were 86±7, 91±7 and 123±11 minutes, respectively. The hospitals at all levels had delays lasting more than 30 minutes, which was mainly attributed to the delay in the time for providing consent. Compared with the time required by the guidelines, the reperfusion time of patients with STEMI in China is evidently delayed. In terms of China's national conditions, the door-to-balloon time is too general. Therefore, we suggest refining this time as the first medical contact–diagnosis time, consent provision time, therapy preparation time and the start of therapy balloon time.

Conclusion: Compared to the time required by the guidelines, the reperfusion time of patients with STEMI in China was obviously greater. In terms of China's national conditions, the door to balloon time is not applicable. So it is suggested to refine it as the first medical contact-diagnosis time, providing consent time, therapy prepare time and the start of therapy – balloon time.