浙江省2002--20 1 0年急性出血性结膜炎暴发疫情病原体CA24v的全基因组序列分析

目的 分析2002--2010年浙江省急性出血性结膜炎(AHC)暴发疫情病原柯萨奇病毒A组24型变种(CA24v)流行株的全基因组序列与遗传特性。方法 选取浙江省不同年份的CA24v流行株,采用RT-PCR扩增基因序列,并与国内外流行株进行全基因组及VPl、3C区序列比较分析。结果 浙江省2002年和2010年CA24v全序列为7456～7458 bp,编码含2214个氨基酸残基的多聚蛋白,2010年的Zhejiang／08／10较2002年的毒株在5’端非编码区的第97、119位各存在一个T碱基插入,Zhejiang／08／10与2002年以来的分离株各区段氨基酸同源性为94．7％～100．0％,与近60年来CA24流行代表株全序列中各区段氨基酸的平均差异率以2A区与3A区最大,分别达8．4％和7．3％。3D区最小,仅为1．9％。1987年与2002年以来的CA24v毒株在全序列上共存在38个和20个氨基酸的稳定变异。2002--2010年CA24v的组间遗传距离分析表明,3c区较VPl区更为稳定,CA24v的早年流行株Jamaica／10628／87在3D区上可能存在重组,而在近年流行株中未发现该现象。结论 CA24v以时间序列为主逐年进化,地域间虽存在差异,但影响较小。自2002年起,由CA24v引起的AHC一直在浙江省本地散在流行。     

浙江省43家公共场所被动吸烟调查分析

目的了解浙江省公共场所被动吸烟现况，为制定浙江省被动吸烟控烟政策提供依据。方法采用现场观察法，收集全省车站等候室、商场、医院、学校、疾病预防控制机构、政府对外办公楼等场所共6类43家公共场所禁烟的情况，并采用拦截式调查方法问卷调查629名成年人，了解其被动吸烟的相关信息。结果34．88％的公共场所为禁烟场所，16．28％的公共场所划分了无烟区。成人烟草烟雾的接触情况是：67．24％的被调查者为被动吸烟者，77．42％的被调查者家庭室内可以吸烟，76．47％的人报告常去的娱乐场所室内可以吸烟，62．17％的人报告工作场所室内可以吸烟。在支持公共场所禁烟方面，89．51％的人支持在公共交通工具上禁烟，88．71％的人支持在学校里禁烟，83．15％的人支持在医院里禁烟，92．53％的人支持在办公室全部或者部分禁烟，79．33％的人支持在餐厅全部或者部分禁烟，61．37％的人支持在酒吧全部或者部分禁烟。单因素分析结果表明，非吸烟者、高学历者、对被动吸烟的危害有认知的人更加支持餐厅禁烟，OR值分别是2．689、1．393和2．670。结论浙江省公共场所被动吸烟情况比较严重，群众普遍支持在公共场所开展禁烟工作。     

应对新型冠状病毒肺炎防护服的选择和使用

防护服是医务人员抗击传染病疫情中非常重要的个人防护用品，特别是在应对传播途径未知的新发传染病，以及传播风险很高的传染病中。防护服可以阻止各类可能携带病原体的分泌物、喷溅物、颗粒物等接触人体，保护医务人员健康，是战胜新冠肺炎疫情的重要防护用品。由于本次疫情播散范围大、感染人数较多，对于防护服的需求巨大，符合国家标准的医用防护服供不应求，一些符合国外标准的防护服也逐渐被使用。作者查阅和比较各国防护服的应用范围和评价指标，以期为医务人员选择符合要求的防护服提供帮助。     

Prevalence of factor H Binding Protein sub-variants among Neisseria meningitidis in China

ObjectiveTo study the prevalence of the fHbp genes in Neisseria meningitidis (N. meningitidis) isolates for further evaluation and development of serogroup B meningococcal vaccines in China.MethodsA panel of 1012 N. meningitidis strains was selected from the national culture collection from 1956 to 2016, according to the years of isolation, locations, and strain sources. These were tested by FHbp variant typing. Multi-locus sequence typing (MLST) was performed on 822 of these samples, including 242 strains from clinical strains and 580 carrier-derived strains. Analysis based on sequence types, serogroups, and FHbp variations were used to summarize the prevalence and characteristics of N. meningitidis.ResultsThere were 8 serogroups of N. meningitidis as well as a collection of nongroupable strains in this study. 1008 of 1012 N. meningitidis strains tested were positive for the fHbp gene. Serogroup A N. meningitidis (MenA) strains belonging to ST-1 and ST-5 clonal complexes harbored genes only encoding variant 1 (v1) FHbp. All MenW strains encoded v2 FHbp. 61.9% of clinical MenB strains were positive for v2 FHbp vs. 32.1% that were positive for v1. Among fHbp-positive carrier-derived MenB strains, v2 FHbp accounted for 90.8%. 79.7% of clinical MenC strains were positive for v1 FHbp and 20.3% were positive for v2 FHbp. Among carrier-derived MenC strains, v2 FHbp predominated. The number of major serogroups of N. meningitidis analyzed by MLST was 822, and the encoded FHbp showed CC- or ST-specific characteristics.ConclusionfHbp genes were detected in almost all N. meningitidis strains in this study. Therefore, it is possible that a vaccine against MenB or meningococci irrespective of serogroups, which includes FHbp, could be developed. Meningococcal vaccine development for China is a complex issue and these findings warrant further attention with respect to vaccine development.     

Evaluating the effectiveness and cost-effectiveness of free influenza vaccination policy for older adults in Yinzhou,China: Study protocol of a real-world analyses

BackgroundInfluenza causes excessive morbidity and mortality among older adults. While influenza vaccine provides protection against its infection, the vaccination coverage in China among older adults has been very low. Previous evidence on the cost-effectiveness of government-sponsored free influenza vaccination programs in China was primarily based on literature data, which might not always reflect real-world patient populations. The Yinzhou Health Information System (YHIS) is a regional database that captures electronic health records, insurance claims data, etc. for all residents in Yinzhou district, Zhejiang province, China. We will use YHIS to study the effectiveness, influenza-related direct medical cost and cost-effectiveness analysis (CEA) of the free influenza vaccination program for older adults. In this paper, we describe the study design and innovations in detail.MethodsWe will establish a retrospective cohort of permanent older residents aged 65 and over, using YHIS between 2016 and 2021. We will estimate the vaccine coverage rate, influenza incidence rate and influenza-related direct medical cost from 2016 to 2021. Regression discontinuity will be used to estimate vaccine effectiveness for the 2020/2021 season. We will build a decision tree model to compare the cost-effectiveness of three influenza vaccination options (free trivalent influenza vaccine, free quadrivalent influenza vaccine, and no policy) from both societal and health system perspectives. Parameter inputs will be gathered from both YHIS and published literature. We will calculate the incremental cost-effectiveness ratio with cost and quality-adjusted life years (QALYs) discounted at 5 % annually.DiscussionOur CEA solidifies multiple sources including regional real-world data and literature for a rigorous evaluation of the government-sponsored free influenza vaccination program. The results will provide real-world evidence from real-world data on the cost-effectiveness of a real-world policy. Our findings are expected to support evidence-based policy making and to promote health for older adults.     

Waning of measles maternal antibody in infants in measles elimination settings – A systematic literature review

IntroductionMost infants are born with immunity to measles through maternal antibodies transferred in pregnancy, which decay over time. However, in measles elimination settings, where measles does not circulate endemically and most immunity is from immunization rather than infection, maternal antibody levels are lower. This results in infant immunity that wanes earlier, and a wider susceptibility gap between maternal antibody decay and infant immunization than in non-eliminated settings. We aimed to systematically quantify the extent and duration of protection from measles in infants in settings that have sustained measles elimination.MethodsWe conducted a systematic review of studies of measles maternal antibody waning in infants in measles elimination settings. We searched MEDLINE, Embase, CINAHL, Scopus, BIOSIS Previews, and Global Health databases for relevant studies. Studies were included if they were set in countries that had eliminated measles for ≥3 years, and if the study cohort included healthy, full-term, unvaccinated infants ≤12 months, born to healthy mothers, and reported a relevant measure of measles maternal antibody in infants. We assessed study quality using the MetaQAT tool.ResultsWe identified 4692 unique citations, eight of which met inclusion criteria. One study reported anti-measles antibody in cord blood, six reported antibody in infant sera, and one reported both. Two studies reported that 80 and 100% of infants were protected from measles at birth. One study reported no protection amongst 3–7 month old infants, and another reported limited protection in infants >4 months. The remaining studies reported the proportion of infants with detected antibody, but not the proportion immune.ConclusionAlthough limited, these data suggest that in settings that have sustained measles elimination, some infants are susceptible to measles well before the age of routine measles immunization. Setting-specific seroprevalence and vaccine effectiveness studies are required to evaluate this in different jurisdictions.     

Consequence of enhanced LC3-trafficking for a live,attenuated M. tuberculosis vaccine

Development of a new vaccine against tuberculosis is urgently needed. Recent work has demonstrated that two related LC3-associated trafficking pathways, autophagy and LC3-associated phagocytosis (LAP), enhance antigen presentation and might play a role in vaccine efficacy. Mycobacterium tuberculosis inhibits both LC3-trafficking pathways. Moreover, the vaccine strain, BCG, induces even less LC3-trafficking than M. tuberculosis, which may help explain its limited efficacy. To determine whether enhanced LC3-trafficking can improve efficacy of a live, attenuated M. tuberculosis vaccine, we took advantage of our recent finding that the bacterial virulence factor CpsA inhibits LAP. When we deleted cpsA in the mc²6206 vaccine strain, it dramatically increased LC3-trafficking. We compared the protective efficacy of the strain lacking cpsA to the parent strain and to BCG in mice challenged with M. tuberculosis. We found that the strain lacking cpsA generated modestly enhanced protection in the spleen, but overall did not outperform BCG.     

2016-2020年浙江省肾综合征出血热监测分析

  目的   了解浙江省肾综合征出血热（HFRS）病例流行特征和宿主动物种群、密度和病毒携带状况,为制定防控措施提供科学依据。  方法   收集2016 — 2020年浙江省HFRS疫情资料,描述性流行病学方法分析疫情的三间分布特征,并在浙江省5个监测点开展宿主动物调查,采用夹夜法调查捕获率,采集鼠形动物肺脏和血,分别检测汉坦病毒抗原和抗体,分析浙江省鼠形动物种群分布和带病毒情况。  结果  浙江省2016 — 2020年全省报告病例数（发病率）分别为349例（0.62/10万）、353例（0.63/10万）、327例（0.59/10万）、369例（0.63/10万）和260例（0.46/10万）。 2016 — 2020年5个监测点在居民区布放鼠夹14 068夹,捕鼠数622只,捕获率4.42%;野外布放鼠夹31875夹,捕鼠数2112只,捕获率6.63%,5个监测点室外鼠密度,差异有统计学意义（F=2.941,P=0.046）。 5个监测点共捕鼠3065只,野外优势鼠种黑线姬鼠1 830只,占捕获总数的59.71%;居民区优势鼠种褐家鼠330只,占捕获总数的10.77%,不同监测点的鼠种构成有差异（χ2=1 675.401,P＜0.001）。 全省5个监测点共检测鼠血清2808份,监测点平均抗体阳性率8.4%（236/2808）;共检测鼠肺标本2815份,监测点平均抗原阳性率3.66%（103/2815）。 对5个监测点的抗体阳性的鼠种比较,差异有统计学意义（χ2=235.762,P＜0.001）;对5个监测点的抗原阳性的鼠种比较,差异有统计学意义（χ2=116.195,P＜0.001）。  结论   浙江省疫情高发地区捕获率和鼠带病毒率均较高,需要对疫情高发地区采取针对性防控措施,利于疫情防控。