Hospital and community surveys reveal the severe public health problem and socio-economic impact of human echinococcosis in Ningxia Hui Autonomous Region, China

A comprehensive study of human echinococcosis (caused by Echinococcus granulosus or E. multilocularis), including assessment of hospital records, community surveys and patient follow-up, was conducted in Ningxia Hui Autonomous Region (NHAR), China. In contrast to hospital records that showed 96% of echinococcosis cases were caused by cystic echinococcosis (CE), 56% of cases detected in active community surveys were caused by alveolar echinococcosis (AE). The AE and CE cases co-existed frequently in the same village, even occurring in the same patient. A serious public health problem caused by echinococcosis was evident in southern NHAR, typified by: a long diagnostic history for both AE and CE (7.5 years) compared with a shorter treatment history (4.7 years); a significant mortality rate (39%) caused by AE in one surveyed village, where patients had no previous access to treatment; family aggregation of CE and AE cases; a high proportion of both AE (62.5%) and CE (58%) in females; a high rate of recurrent surgery (30%) for CE demonstrated by surgical records; and frequent symptomatic recurrences (51%) because of discontinuous or sporadic access to chemotherapy for AE. The disease burden for both human AE and CE is thus very severe among these rural communities in NHAR, and this study provides the first attempt to determine the costs of morbidity and surgical intervention of human CE and AE cases both at the hospital and community level in this setting. This information may be useful for assessing the cost effectiveness of designing effective public health programs to control echinococcosis in this and other endemic areas in China and elsewhere.     

A correlative study of ultrasound with serology in an area in China co-endemic for human alveolar and cystic echinococcosis

We correlated ultrasound (US) imaging classifications for human alveolar echinococcosis (AE) and cystic echinococcosis (CE) with serology (ELISA and immunoblotting (IB) incorporating native and recombinant/purified echinococcal antigens) in community surveys (2001-2003) and follow-up (2002 and 2003) of US-confirmed cases in Ningxia, China. One hundred and seventy-one cases (96 with AE, 75 with CE) were identified; of these, US classification and serological data were obtained for 142 and 112 cases, respectively. Seropositive-rates increased in CE patients with highly viable unilocular cyst lesions (Types CL, CE 1 or CE 2) to degenerating primary lesions (CE 3), but then decreased in subjects with inactive (CE 4) or dead (CE 5) cysts. In contrast, there was a constant increase in seropositivity from the early (P1, P2) to the advanced stages (P3, P4) with AE cases. For US-confirmed cases, follow-up by US combined with serology is invaluable for studying the clinical progression of echinococcosis and for detecting recurrent cysts or reinfection post-treatment.     

A hospital-based retrospective survey of human cystic and alveolar echinococcosis in Ningxia Hui Autonomous Region, PR China

A retrospective study of in-patient records for the period 1985-2001 collected from 11 hospitals in Ningxia Hui Autonomous Region (NHAR), China revealed a total of 2216 cases of echinococcosis. The survey showed that cystic echinococcosis (CE) occurs throughout NHAR but that human alveolar echinococcosis (AE) cases were only located in a confluence area of three counties, Xiji, Haiyuan and Guyuan. Incidence rates between counties within southern NHAR showed a highly heterogeneous distribution of cases, suggestive of different echinococcal transmission patterns. There was a significant difference in incidence between males and females, and farm labourers accounted for the majority of cases. Radical surgery with or without albendazole/mebendazole drug treatment was the major method of treatment for CE and repeat surgery was common; drug treatment alone was used mainly for AE. Epigastric pain was the main reason for patients seeking medical advice, the liver was the primary location of echinococcosis lesions and the majority of echinococcosis cases were diagnosed by ultrasound. Over a 12 year period, the average bed utilization rate in the Second Provincial Hospital of NHAR for patients with echinococcosis was 78% and echinococcosis cases accounted, on average, for 0.7% among the total hospital in-patients. Taking inflation into account, charges for echinococcosis hospitalization and treatment increased three-fold over the period 1994-2002. This study indicates that echinococcosisis is a significant public health problem in NHAR, especially in the south. The data from the hospital retrospective study are clearly underestimates and community surveys are required to determine the true echinococcosis prevalence levels, especially in the more remote areas of NHAR.     

Hepatitis C virus infection among healthy Egyptian children: prevalence and risk factors

Summary. The aim of this study was to estimate the prevalence and identify the risk factors of hepatitis C virus (HCV) infection among healthy Egyptian children. A representative random sample of 500 children, age between 6 and 15 years, was selected from 10 schools in Alexandria, Egypt. A questionnaire was used to collect demographic data and potential risk factors, while blood samples were collected and analyzed for antibodies to HCV (anti‐HCV). Positive sera were further confirmed by HCV‐RNA. HCV seroprevalence of 5.8% was found, with HCV viraemia in 75% of the studied children. The prevalence of anti‐HCV increased with age from 0% in children aged 6–7 years to 16% in those of 15 years old. It was also shown that history of previous blood transfusion (odds ratio[OR] = 34.8, 95% CI = 4.39–272.95), intravenous injections (OR = 4.68, 1.89–11.59), surgical intervention (OR = 5.64, 2.55–12.52), dental treatment (OR = 6.81, 2.64–17.39), injection (OR = 2.29, 1.08–4.89) and circumcision for boys by informal health care providers (OR = 2.6, 1.0–6.73), age above 10 years (OR = 6.83, 2.44–19.07), very low socioeconomic class (OR = 5.92, 1.3–25.2) and rural area residence (OR = 2.49,1.61–5.29) are the most significant risk factors for HCV infection. Adjusting for all other risk factors by multivariate logistic regression analysis, it has been shown that blood transfusion, surgical procedures, dental treatment, and age above 10 years are still significant risk factors associated with anti‐HCV (P < 0.05). The current study reveals the extremely high HCV seroprevalence among Egyptian children. This mandates immediate preventive strategies to limit further HCV spread.     

A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China

Background

Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care.

Objective

To prospectively determine PICU CAP admission features and outcomes.

Methods

A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics.

Results

Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co‐morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3–27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings.

Conclusions

Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. Pediatr Pulmonol. 2013; 48:390–397. © 2012 Wiley Periodicals, Inc.

     

Serological prevalence and risk factor analysis of hepatitis G virus infection in Hubei Province of China

Hepatitis G virus (HGV),also known as GB virus C, is a recently cloned virus which may be associated with human non A-E hepatitis[1,2] It is parenterally transmitted and usually coinfected or superinfected with hepatitis B or hepatitis C virus[3-5]. Some investigations have been reported on the seroprevalence and molecular prevalence of HGV infection in different areas and different population[6-15]. Current infection of HGV is diagnosed by detection of HGV RNA, and past infection with HGV is detectable by testing anti-HGV envelope protein (E2)[16-17]. To investigate the prevalence of HGV in Hubei Province, a central area of the People's Republic of China, ELISA and RT-PCR were employed to detect serum anti-HGV and HGV RNA in 1516 patients who were divided into 16 groups.     

Period prevalence of abnormal glucose tolerance and cardiovascular risk factors among obese children attending an obesity centre in Italy

BACKGROUND AND AIM: Several reports have described an increasing prevalence and incidence of type 2 diabetes among children. Limited information is available about the prevalence of impaired glucose tolerance (IGT) and type 2 diabetes in obese children, particularly in Europe. The aim of this study was to examine the prevalence of glucose intolerance and other cardiovascular risk factors in obese children over a 24-year period. METHODS AND RESULTS: The study population consisted of 1376 consecutive subjects who attended a national centre for the study of obesity between 1979 and 2002. Subjects were divided into three successive 8-year cohorts: cohort 1 (period 1979-1986, n=453, male: 39%), cohort 2 (period 1987-1994, n=409, male: 46%), cohort 3 (period 1995-2002, n=514, male: 48%). All subjects underwent an oral glucose tolerance test. Lipids, blood pressure, uric acid, C-reactive protein (CRP), fasting insulin and birth weight were recorded. Insulin resistance was measured by homeostasis model assessment (HOMA-IR). The degree of obesity was higher in the more recent cohorts (standard deviation score of body mass index: 3.3+/-0.04 vs. 3.7+/-0.04 vs. 3.8+/-0.03, P<0.0001). The proportion of subjects with glucose intolerance was lower in the last two cohorts compared with the first one (11.2% vs. 3.9% vs. 6.0%, P<0.0001). This was predominantly due to changes in the frequency of IGT (9.1% vs. 3.2% vs. 5.4%, P<0.001 in cohorts 1, 2 and 3, respectively) while the prevalence of undiagnosed type 2 diabetes and impaired fasting glucose was similar in the three cohorts (0.9% vs. 0% vs. 0.2% and 1.3% vs. 0.7% vs. 0.4%, respectively). After adjustment for differences in age, sex, pubertal status and birth weight the levels of fasting insulin, HOMA-IR, total cholesterol, triglycerides and blood pressure, were significantly lower in cohorts 2 and 3 than in cohort 1 while CRP and uric acid were higher in the last two cohorts. CONCLUSION: Over a recent period spanning 24 years, the degree of obesity has risen but the prevalence of glucose intolerance has fallen in obese children admitted to an obesity centre. This was accompanied by an improvement in traditional but a worsening in non-traditional risk factors for cardiovascular disease.     

Seroprevalence of dengue antibodies, annual incidence and risk factors among children in southern Vietnam

Dengue is highly endemic in southern Vietnam and all four serotypes of dengue virus have already been identified. To determine the age-specific prevalence of dengue and associated risk factors, we conducted a serological study at two primary schools and assessed risk factors by analysing children's questionnaires and household surveys. Sera were collected from 961 primary schoolchildren in Binh Thuan Province and tested for the presence of dengue virus serum antibodies using an indirect immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). The antibody prevalence of the total population was 65.7% (n=631) which increased from 53.0 to 88.2% with age. The annual incidence of a first dengue infection, estimated by binary regression of the seroprevalence by age, was 11.7%. Interestingly, the prevalence of dengue IgG antibodies was significantly higher in children who confirmed using a pit latrine (RR 1.467, 95% CI: 1.245-1.730) and whose domestic environment contained discarded cans (RR 1.238, 95% CI: 1.042-1.470) and pigs (RR 1.228, 95% CI: 1.002-1.504). The epidemiology of dengue in southern Vietnam is stable with a constantly high annual incidence of first infections. Transmission occurs mainly peri-domestically, which has important public health implications.     

新疆儿童KSHV血清阳性率及危险因素研究

目的 了解新疆儿童卡波氏肉瘤相关疱疹病毒(KSHV)的血清阳性率及危险因素。方法 以新疆维吾尔族和哈萨克族为主要人口构成的伊宁地区新源县和伽师县6个月至5周岁的儿童为研究对象,采用调查问卷收集家庭一般信息。采集儿童及其母亲的静脉血323份(其中儿童171份,与之对应的母亲152份)。采用单克隆免疫增强荧光(monoclonal-enhanced immunofluorescence assay mIFAs)技术检测血清KSHV抗体。Logistic回归分析儿童血清KSHV抗体阳性的影响因素。结果 母亲血清样本阳性率为66.5%(101/152),儿童血清样本阳性率为51.5%(88/171)。多因素分析发现儿童吃硬质食物(OR=2.61, 95%CI=1.06~6.42;P=0.04)及与嚼碎食物喂给孩子吃(OR=5.65,95%CI =1.58~13.75;P=0.005)是感染KSHV病毒的危险因素,具有统计学意义。结论 新疆KSHV感染发生在儿童早期,唾液接触可能是重要的传播途径。     

Ascaris lumbricoides among children in rural communities in the Northern Area,Pakistan: prevalence,intensity, and associated socio-cultural and behavioral risk factors

The prevalence and intensity of Ascaris lumbricoides in 492 children from five rural villages in the Northern Area of Pakistan was examined. The overall prevalence of A. lumbricoides was 91% (95%CI 88.6-93.6) with geometric mean (GM) egg count intensities of 3985 eggs per g (epg). The most intense A. lumbricoides infections were found in children aged 5-8 years. We also investigated selected socio-cultural and behavioral variables for A. lumbricoides infections that might be relevant for the design of appropriate prevention and control programs. Univariate analysis associated A. lumbricoides intensity with age (P=0.004), location of household (P<0.01), defecation practices (P=0.02), soil eating habit (P<0.01), hand washing after defecation (P<0.01), and living with children under 5 years old (P=0.02). Multivariate analysis identified the children's age 5-8 (P<0.01), location of household in Surngo, Askole, and Stakchun where the pilot health care model activities were not done (P<0.01), and living with children under 5 years old (P=0.03) as variables statistically associated with the intensity of A. lumbricoides. The results indicated that there were certain clear risk factors in A. lumbricoides transmission, and that its intensity was influenced by age-related behavioral and environmental factors that contribute to exposure.     

Comparison of prevalence of life style risk factors and 10 year risk of CVD event among rural and tribal population of Kollegal Taluk,Chamrajanagar district,South India

ContextCardiovascular diseases have been recognized as leading cause of death. Three-fourths of CVD deaths occur in low and middle income countries. Surveillance of CVD risk factors is a key strategy for effective CVD prevention. Aims: To identify the extent of CVD risk factors and 10 year risk of developing Cardiovascular Disease events among rural and tribal population. Subjects and methods: This community based cross sectional study was conducted on a total of 482 rural and 415 tribal subjects aged above 30 years from Kollegal taluk, Chamrajanagar, Karnataka, India. Tobacco and alcohol consumption, BMI, blood pressure and capillary blood glucose were estimated. WHO/ISH risk prediction chart was used to predict 10 year risk of MI/stroke.ResultsTobacco consumption was 15.4% (rural) and 90.8% (tribal). Alcohol consumption was 10.8% (rural) and 21.9% (tribal), Obesity was 40.2% (rural) and 14.0% (tribal). Prevalence of Hypertension was 49.8% (rural) and 32.2% (Tribal) and diabetes 8.3% (rural) and 2.9% (tribal). Nearly one fourth of the population are at moderate risk (10–30%) and one tenth are at high risk (30%) of MI/Stroke within 10 years.ConclusionsHigh prevalence of tobacco consumption among tribal and high prevalence of hypertension and diabetes among rural predisposes 10% of population to moderate to high risk of stroke/MI within 10 years.     

Trends in prevalence and risk factors of childhood asthma in Fuzhou,a city in Southeastern China

Abstract

Objective: The prevalence of asthma in children age 0–14 years in Fuzhou, a city in Southeast China, was 1.57% in 1990 and 3.28% in 2000. The aim of this study was to investigate the asthma prevalence and risk factors in children in the same city in 2010. Methods: This was a cross-sectional study with a two-stage, clustered, stratified random sample design. Parents of 12?235 children 0–14 years of age in Fuzhou were surveyed using a questionnaire. Children with history and/or symptoms of asthma were then interviewed by pediatricians in a nearby clinic to confirm the diagnosis of asthma, and a second questionnaire listing reported risk factors of asthma was completed by the parents in the clinic. Results: About 11?738 questionnaires were completed with a response rate of 95.9%. Among the responders, 648 children had history and/or symptoms of asthma but only 485 (4.13%) were confirmed with asthma. The prevalence was 1.83%, 7.64% and 6.27% in the age groups of 0–1 years, 3–4 years and 13–14 years, respectively. The most significant (binary logistic regression test) factors associated with asthma were presence of atopic or allergic diseases (OR?=?21.5, 95% CI: 12–38.5), family history of allergy or asthma (OR?=?29.4, 95% CI: 12.6–68.6), use of at least one course of antibiotics in the first year of life (OR?=?7.61, 95% CI: 3.4–17.06), supplementary protein feedings before 6 months (OR?=?1.90, 95% CI: 1.23–2.95). Natural ventilation at home (versus frequent use of air-conditioning) appeared to be a protective factor (OR?=?0.5, 95% CI: 0.3–0.8). Conclusion: The prevalence of asthma in childhood has increased significantly during the past 20 years in Fuzhou.     

Prevalence and risk factors for human papillomavirus infection among Chinese ethnic women in southern of Yunnan,China

Background

Dai is a major Chinese ethnic minority group residing in rural areas of the southern part of Yunnan. However, no data exist on the Human Papillomavirus (HPV) prevalence and genotype distribution among Dai women.

农村已婚妇女阴道毛滴虫感染现状及危险因素调查

目的了解农村已婚妇女阴道毛滴虫感染现状及影响因素，为实施干预措施提供依据。方法按经济水平分层整群随机抽样，以抽样村60岁以下已婚妇女为调查对象，进行阴道毛滴虫感染流行病学基线调查，同时采取阴道后穹窿阴道分泌物，悬滴法镜检阴道毛滴虫。结果在5781名被调查者中，共检出阴道毛滴虫感染者212例，总感染率3．67％。影响农村已婚妇女阴道毛滴虫感染的主要因素为：洁阴用具是否专用、每周清洗会阴次数、性病知识知晓水平。结论农村已婚妇女阴道毛滴虫感染与性病知识和洁阴习惯有关。     

滨州市流动人口的结核病耐药状况及相关因素分析

目的了解滨州市流动人口的结核病耐药状况及相关因素。方法将滨州市各区县结核病定点医院2004年2月至2005年1月诊治的流动人口中所有新发及复治的痰培养阳性肺结核病例作为研究对象,并对所有分离培养阳性菌株进行菌型鉴定及药物敏感性测试,分析流动人口耐药结核病的流行状况。结果所入选493例培养阳性肺结核患者,最后获得431例（占87.4%）患者的菌型鉴定及药敏结果,其中结核分枝杆菌427例（占99.1%）,非结核分枝杆菌4例（占0.9%）。肺结核患者的总耐药率为18.3%（78/427）,耐多药率为5.9%（25/427）;新发患者的耐药率为16.0%（62/387）,耐多药率为4.1%（16/387）;复治患者的耐药率为40.0%（16/40）,耐多药率为22.5%（9/40）。结论滨州市流动人口的结核病耐药率较高,要加强防治措施。     

Seroprevalence and risk factors of Chlamydia infection in dogs in Southwestern China

Chlamydia spp. are obligate intracellular bacteria distributed globally, known to cause various forms of diseases in animals and humans. To date, there is limited information about the seroprevalence of Chlamydia and the risk factors associated with Chlamydia infection in dogs in the world. In the present study, a serological survey was undertaken to examine the seroprevalence and risk factors associated with dog chlamydiosis in Yunnan Province, southwestern China. A total of 591 dogs were sampled, antibodies to Chlamydia were determined by indirect hemagglutination assay (IHA). The overall seroprevalence was estimated at 17.6%. The risk factors associated with seroprevalence were determined by a multivariate logistic regression analysis. Gender and age of dogs were not significant in the logistic regression analysis (P > 0.05) and left out of the final model. Type and geographical origin of dogs were considered as main risk factors associated with Chlamydia infection, stray dogs (31.37%) were more than 16 times (OR = 16.167, 95% CI = 6.283–41.599, P < 0.01) at risk of acquiring the infection compared to the police dogs (7.62%), while pet dogs (14.41%) had a 3 times (OR = 2.968, 95% CI = 1.349–6.529, P = 0.007) higher risk. Positive dogs were found in 5 districts of Yunnan Province with prevalence ranging from 2.56% to 31.67% except Diqing (0/56). Dogs in Kunming (20.21%) had a 9 times higher risk of being seropositive compared to dogs in Lijiang (2.56%) (OR = 9.057, 95% CI = 1.211–67.714, P = 0.032), although no regional differences were found in other 4 administrative divisions compared to Lijiang (P > 0.05). Our study revealed a widespread and high prevalence of Chlamydia infection in dogs in Yunnan Province, southwestern China, with higher exposure risk in stray dogs and distinct geographical distribution. These findings suggest the potential importance of dogs in the transmission of zoonotic Chlamydia infection, and thus Chlamydia should be taken into consideration in diagnosing dog diseases.     

Correlates of chronic hepatitis B virus infection in the general adult population of China: Systematic review and meta-analysis

Chronic infection with hepatitis B virus (HBV) is a significant public health issue in China. Understanding factors associated with chronic HBV is important to enable targeted screening and education and to improve early diagnosis and prevention of disease progression. This systematic review and meta-analysis aimed to identify and describe correlates of chronic HBV among Chinese adults. Searches were conducted in MEDLINE, EMBASE and grey literature up to 25 June 2020. Eligible papers included observational studies in adults of the general population in China that reported factors associated with chronic HBV, measured by Hepatitis B surface antigen (HBsAg). Meta-analysis was performed using fixed-effect models of HBsAg prevalence among factors, and of adjusted odds ratios (ORs) for chronic HBV associated with each factor. Overall 39 articles were included, covering 22 factors, including a range of sociodemographic, behavioural and medical factors. In meta-analysis of eligible studies, a range of factors were significantly associated with higher HBsAg prevalence, including middle age, male sex, being married, rural residence, lower education, smoking, having a HBsAg positive household contact, family history of HBV, history of surgery or blood transfusion. The adjusted ORs varied, from 1.11 (95% CI 1.05–1.18) for smoking to 5.13 (95% CI 4.99–5.26) for having a HBsAg positive household contact. In Chinese adults, a range of factors are associated with chronic HBV infection, which may help inform targeted screening in the general population.