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Introduction: Streptococcus pneumoniaeis the leading cause of meningitis, with a case fatality of up to about 50%. Children younger than 5 years are at greater risk for pneumococcal meningitis compared with other populations. It is of significant importance to provide a comprehensive understanding of the burden of pneumococcal meningitis among under-fives in the low pneumococcal conjugate vaccine (PCV) coverage period in China. Methods: A systematic review was conducted. We searched both English (PubMed, Ovid-EMBASE, Biosis, Web of Science, and Cochrane) and Chinese (CNKI, Wanfang, and ViP) databases for studies on bacterial meningitis in China published between January 1980 and July 2022. Ineligible studies were excluded based on study design and data integrity. Heterogeneity was assessed with I2and estimates of bacterial meningitis morbidity and mortality were pooled using random-effects models. Subgroup analysis was conducted to trace the source of the heterogeneity and summarize average estimates. Results: A total of 13,082 studies were identified in the literature, and 56 studies were finally included for data analysis. The estimated incidence of pneumococcal meningitis was 2.10 cases per 100,000 children younger than 5 years each year (95% CI: 0.59–7.46), with a pooled case fatality rate of 24.59% (95%CI: 19.35–30.28%) in China. It was estimated that 1617.16 (95% CI: 454.35–5744.78) pneumococcal meningitis cases and 548.86 (95% CI: 474.80–627.62) deaths occurred among under-fives in China in 2020. Streptococcus pneumoniaeplayed an important role in the etiology of confirmed bacterial meningitis cases, with a pooled proportion of 22.05% (95% CI: 17.83–26.27%). The most prevalent serotypes were 6B, 14, 19F, 19A, and 23F, which were preventable with a vaccine. Conclusions: Pneumococcal meningitis remains one of the most important health problems among children younger than 5 years in China. Immunization programs should be promoted to avoid preventable cases and deaths.

OBJECTIVE--Both in vitro and in vivo studies indicate that metformin inhibits cancer cell growth and reduces cancer risk. Recent epidemiological studies suggest that metformin therapy may reduce the risks of [...]

Aim: To investigate the attack rate of active tuberculosis (TB) cases and detection rate of latent tuberculosis infection (LTBI) cases, and to identify possible factors contributed to the outbreak in a high school. Subject and methods: We analyzed the investigation data of 35 teachers and 108 students, including active TB cases and their close contacts. The symptoms inquiry, tuberculin skin test (TST), and chest X-ray/CT scan were conducted in the close contact screening. We did variable-number-of-tandem-repeat genotyping and whole-genome sequencing of isolates. Results: The time interval between the onset of symptoms and diagnosis was 36 days. The total attack rate of active TB was 7.69% (11/143), with a class attack rate of 27.78% (10/36) among students. The genetic differences between any two available isolates were less than 5 SNPs. Approximately 15.38% (22/143) of persons were LTBI cases, and the total detection rates of LTBI for students and teachers were 7.40% (8/108) and 40% (14/35), respectively. Being in the same class as the index case resulted in a significantly higher risk of being diagnosed with active TB (P= 0.0001, RR = 18.51, 95%CI (2.44,140.42)) and either LTBI and MTB infection (RR = 14.40, RR = 16.46, respectively) compared with that of students in a non-index class. Conclusion: The case-finding delay should be reduced to prevent the spread in classes and schools. Effective surveillance and regulated screening for student contacts should be strengthened in schools to detect infections early.

Objectives We conducted a cross-sectional study to explore the effect of a hypothetical tobacco retail price increase on smoking habit change intention, and the role of smoking duration and intensity in smoking change intention.Methods In 2016 and 2017, we collected questionnaire data from 36,698 residents aged over 18 years in Songjiang district, Shanghai. Chi-square tests and weighted logistic regression were used for data analyses.Results The prevalence of current smoking was 19.78% (men: 48.36% and women: 0.22%). A total of 10.83% (men: 10.89% and women: 2.04%) and 9.39% of smokers (men: 9.42% and women: 6.12%) expressed the intention to smoke less or quit, respectively, given tobacco retail price increases. If the current tobacco retail price doubled, 75% of smokers stated that they would smoke less and 60% of smokers would consider quitting. Smokers with longer smoking duration and lower smoking intensity were more sensitive to tobacco price increases and more likely to change their smoking habits.Conclusions An increase in tobacco retail prices could induce some smokers to change their smoking behavior, particularly those with longer smoking duration and lower smoking intensity. A tobacco retail price increase is recommended, which should apply to all cigarette brands.

An extensive exposure to antibiotics has been demonstrated in children and pregnant women by biomonitoring, but data from general adults remain limited. In the current study, we studied 822 adults aged 21–75 years in Shanghai in 2017 and analyzed 18 common antibiotics (five veterinary antibiotics (VAs), four human antibiotics (HAs), and nine human/veterinary antibiotics (H/VAs)) in spot urine by liquid chromatography coupled to high-resolution mass spectrometry. All 18 antibiotics were detected in urine with an overall detection frequency of 45.9% and the detection frequency for each ranged from 0.1% to 15.2%. HAs, VAs, H/VAs, and VAs+H/VAs were detected in 4.4%, 11.6%, 38.0, and 44.5% of urine samples, respectively. Adults with the sum of estimated daily exposure dose of all the antibiotics below 1.55 μg/kg/day accounted for 89.1% of adults tested positive. A hazard index value beyond one was seen in 7.2% of adults based on microbiological effect. Ciprofloxacin was the biggest contributor to HI and its hazard quotient value more than one was seen in 5.6% of adults. These findings indicated an extensive exposure to low-dose multiple antibiotics in adults in Shanghai and some adults were at health risk related to the disturbance of gut microbiota.

ABSTRACTBackground: Older individuals are at high risk for morbidity and mortality due to influenza, and the most effective way to prevent influenza is yearly vaccination. In China, the influenza vaccine is not covered by the national Expanded Program on Immunization, and more evidence is needed about influenza vaccine usage among older individuals.Objective: To determine the influenza vaccination coverage and its influencing factors, and understand barriers to older adults receiving influenza vaccinations in Shanghai, China.Methods: A cross-sectional survey was conducted with residents aged 60 and older. Vaccination status in the 2016–17 influenza season and reasons for or against vaccination were surveyed. The vaccination coverage rates were adjusted by gender, age and community distribution, and potential factors influencing vaccination uptake were determined by bivariate logistic regression.Results: In total, 253 of the 4417 respondents received an influenza vaccine during the 2016–17 season, yielding an adjusted coverage rate of 5.2% (95% CI, 4.5-5.8). The frequency of receiving the vaccine was higher for older individuals living with family/friends than that for those living alone (p< 0.05), and lower among individuals with chronic respiratory diseases (p< 0.05). Among unvaccinated respondents, lack of influenza vaccine awareness was the most common reason for being unvaccinated (48.3%, 2012/4164).Conclusion: Influenza vaccination coverage is extremely low among older people in Shanghai, and lack of awareness of the influenza vaccine might be a potential barrier to vaccination. Our study highlights the need for an appropriate influenza vaccination strategy and program targeting the older population.

ABSTRACTObjective: Thirteen-valent pneumococcal conjugate vaccines (PCV13) was licensed for optional use in mainland China since 2017, but the uptake is low. To update the research evidence for the pneumococcal serotype distribution of pre-PCV era and to estimate the potential impact of PCVs, we performed a meta-analysis on the relevant publications concerning the Chinese population.Methods: This systematic review and meta-analysis were conducted on the pneumococcal serotype distribution publications in mainland China from 2000 to 2016. The literature was searched in PubMed, Ovid-EMBASE, Web of Science, CNKI and Wanfang. Heterogeneity and publication bias were tested by I2, meta-regression, Egger's and Begg's test. The pneumococcal serotype and vaccine serotype coverage rates were pooled using the random-effects model in Stata SE 12.0.Results: In total, 85 publications were included. Of all 16,945 includedpneumococcal isolates, the most common serotypes/serogroups were 19F, 19A, 23F, 14, and 6B, thatfrom children were the same as above, that from adults≥18 years were 19, 3, 6, 23, and 14. Among isolates from children <18 years, the pooled coverage for PCV10 serotypes was 52.3%, that for PCV13 was 68.4% and that for PPSV23 was 65.5%. Regarding individuals ≥18 years, the pooled coverage for PCV10 serotypes was 29.7%, that for PCV13 was 49.5% and that for PPSV23 was 50.7%. Serotype prevalence and vaccine serotype coverage varied by age group, source, and region.Conclusions: The most common pneumococcal serotype in mainland China was 19F. The serotype coverage rates of PCV13 and PPSV23 were 50%–68% in mainland China.

ABSTRACTBackground: We actively followed a cohort of nursery school children in Suzhou, China to assess the impact of vaccination with trivalent influenza vaccine on the prevention of influenza like illness (ILI).Methods: We enrolled children aged 36 to 72 months from 13 nursery schools in Suzhou starting two weeks after vaccination during October 2015-February 2016. Every school-day, teachers reported the names of students with ILI to study clinicians, who collected the student's nasopharyngeal swab or throat swab, either at a study clinic or the child's home. Swabs were sent to the Suzhou Center for Disease Control and Prevention's laboratory for influenza testing by RT-PCR.Results: In total, 3278 children were enrolled; 83 (3%) were lost to follow-up, while 3195 (vaccinated: 1492, unvaccinated: 1703) were followed for 24 weeks. During the study, 40 samples tested positive; 17 in the vaccinated (B Victoria: 12; A(H1N1)pdm09: 5) and 23 in the unvaccinated group (B Victoria: 10; B Yamagata: 2; A(H1N1)pdm09: 11). The VE estimates were: 16% overall (95%CI:-58%,56%), 48% (−47%,84%) for influenza A(H1N1)pdm09, 43% (−650%,98%) for influenza B Yamagata, and −37% (−227%,42%) for influenza B Victoria. Data were analyzed by vaccinated and unvaccinated groups based on enrollees' vaccination records.Conclusions: The VE for A(H1N1)pdm09 was moderate but not significant. Mismatching of B lineage may have compromised trivalent influenza vaccine effectiveness during the 2015–2016 influenza season among nursery school children in Suzhou, China. Additional larger studies are warranted to inform policy related to quadrivalent influenza vaccine licensure in China in the future.

Objective The Chinese Center for Disease Control and Prevention developed the China Infectious Disease Automated-alert and Response System (CIDARS) in 2008. The CIDARS can detect outbreak signals in a timely manner but generates many false-positive signals, especially for diseases with seasonality. We assessed the influence of seasonality on infectious disease outbreak detection performance.Methods Chickenpox surveillance data in Songjiang District, Shanghai were used. The optimized early alert thresholds for chickenpox were selected according to three algorithm evaluation indexes: sensitivity (Se), false alarm rate (FAR), and time to detection (TTD). Performance of selected proper thresholds was assessed by data external to the study period.Results The optimized early alert threshold for chickenpox during the epidemic season was the percentile P65, which demonstrated an Se of 93.33%, FAR of 0%, and TTD of 0 days. The optimized early alert threshold in the nonepidemic season was P50, demonstrating an Se of 100%, FAR of 18.94%, and TTD was 2.5 days. The performance evaluation demonstrated that the use of an optimized threshold adjusted for seasonality could reduce the FAR and shorten the TTD.Conclusions Selection of optimized early alert thresholds based on local infectious disease seasonality could improve the performance of the CIDARS.

Little is known about the participation rate of newly implemented colorectal cancer (CRC) screening programs in China. Our goals were to identify factors associated with nonparticipation for CRC screening in Songjiang District, Shanghai.We analyzed individuals included in an observational cohort study from 4 towns (Xin Qiao, She Shan, Mao Gang, and Zhong Shan) in Songjiang District. The participation rate was calculated for the CRC screening program based on a fecal immunochemical test and a risk assessment questionnaire between 2015 and 2017 inclusive.Of the 27,130 individuals eligible for inclusion in this study, 20,863 (76.9%) participated in CRC screening at least once during 2015 and 2017. The factors linked with nonparticipation were; being male (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.82–0.93, P< .01), unmarried (OR 0.71, 95% CI 0.64–0.80, P< .01), having a high education level (middle school, OR 0.82, 95% CI 0.74–0.90, P< .01, high school or above, OR 0.64, 95% CI 0.57–0.73, P< .01), absence of chronic disease (OR 0.90, 95% CI 0.85–0.96, P< .01), and living in 2 out of the 4 towns covered (Xin Qiao, OR 0.72, 95% CI 0.66–0.78, P< .01, Zhong Shan, OR 0.29, 95% CI 0.26–0.31, P< .01).The current study revealed several associated factors with nonparticipation for the CRC screening in Songjiang district. These findings will help identify target populations that require an individualized approach to increase the participation rate.

Influenza, caused by the influenza virus, is a respiratory infectious disease that can severely affect human health. Influenza viruses undergo frequent antigenic changes, thus could spread quickly. Influenza causes seasonal epidemics and outbreaks in public gatherings such as schools, kindergartens, and nursing homes. Certain populations are at risk for severe illness from influenza, including pregnant women, young children, the elderly, and people in any ages with certain chronic diseases.

There are scare data about bacterial etiology and the antibiotic susceptibility, serotype distribution and molecular characteristics of pneumococci in children with acute otitis media (AOM) in China.

There have been few studies on children hospitalized with respiratory syncytial virus (RSV) published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven RSV children hospitalized in Suzhou, China.

Objectives: Hepatitis B virus (HBV) infection is one of the most important risk factors for hepatocellular carcinoma (HCC). The specific aim of this study is to assess the influence of HBV infection on familial aggregation of HCC. Methods: We conducted a population-based case-control family study of liver cancer in Taixing, China, in 2001-2002, with a total of 3611 individuals from 202 case families and 202 control families. Conditional logistic regression was used for the case-control data. The approach of GEE2 was used to analyze the family data and age and sex were adjusted in all marginal regression models. Results: The odds ratio for HBV associated with HCC was 41.39 (95% confidence interval (CI): 23.03-74.30). The relatives of cases had a higher risk of liver cancer compared with the relatives of controls with a conditional odds-ratio of 3.06 (95% CI: 1.48-6.33). The association parameters among first- and second-degree relatives were no longer statistically significant when HbsAg was taken into consideration. Conclusion: HBV infection was likely a main reason for the familial aggregation of liver cancer in Southern China.

The transmission pattern of drug resistant Mycobacterium tuberculosis(MTB) might vary due to the differences in geographic features, socio-economic development and TB epidemic in specific areas and populations. This might also reflect how effectively a TB control program would work. This study aimed to investigate the transmission pattern of drug resistant TB, especially multidrug-resistant (MDR)-TB, and to discuss its implications for an effective TB control program in rural China.