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Heterologous boosting is suggested to be of use in populations who have received inactivated COVID-19 vaccines. We aimed to assess the safety and immunogenicity of a heterologous vaccination with the mRNA vaccine CS-2034 versus the inactivated BBIBP-CorV as a fourth dose, as well as the efficacy against the SARS-CoV-2 omicron (BA.5) variant. This trial contains a randomised, double-blind, parallel-controlled study in healthy participants aged 18 years or older (group A) and an open-label cohort in participants 60 years and older (group B), who had received three doses of inactivated whole-virion vaccines at least 6 months before enrolment. Pregnant women and people with major chronic illnesses or a history of allergies were excluded. Eligible participants in group A were stratified by age (18–59 years and ≥60 years) and then randomised by SAS 9.4 in a ratio of 3:1 to receive a dose of the mRNA vaccine (CS-2034, CanSino, Shanghai, China) or inactivated vaccine (BBIBP-CorV, Sinopharm, Beijing, China). Safety and immunogenicity against omicron variants of the fourth dose were evaluated in group A. Participants 60 years and older were involved in group B for safety observations. The primary outcome was geometric mean titres (GMTs) of the neutralising antibodies against omicron and seroconversion rates against BA.5 variant 28 days after the boosting, and incidence of adverse reactions within 28 days. The intention-to-treat group was involved in the safety analysis, while all patients in group A who had blood samples taken before and after the booster were involved in the immunogenicity analysis. This trial was registered at the Chinese Clinical Trial Registry Centre (ChiCTR2200064575). Between Oct 13, and Nov 22, 2022, 320 participants were enrolled in group A (240 in the CS-2034 group and 80 in the BBIBP-CorV group) and 113 in group B. Adverse reactions after vaccination were more frequent in CS-2034 recipients (158 [44·8%]) than BBIBP-CorV recipients (17 [21·3%], p<0·0001). However, most adverse reactions were mild or moderate, with grade 3 adverse reactions only reported by eight (2%) of 353 participants receiving CS-2034. Heterologous boosting with CS-2034 elicited 14·4-fold (GMT 229·3, 95% CI 202·7–259·4 vs 15·9, 13·1–19·4) higher concentration of neutralising antibodies to SARS-CoV-2 omicron variant BA.5 than did homologous boosting with BBIBP-CorV. The seroconversion rates of SARS-CoV-2-specific neutralising antibody responses were much higher in the mRNA heterologous booster regimen compared with BBIBP-CorV homologous booster regimen (original strain 47 [100%] of 47 vs three [18·8%] of 16; BA.1 45 [95·8%] of 48 vs two [12·5%] 16; and BA.5 233 [98·3%] of 240 vs 15 [18·8%] of 80 by day 28). Both the administration of mRNA vaccine CS-2034 and inactivated vaccine BBIBP-CorV as a fourth dose were well tolerated. Heterologous boosting with mRNA vaccine CS-2034 induced higher immune responses and protection against symptomatic SARS-CoV-2 omicron infections compared with homologous boosting, which could support the emergency use authorisation of CS-2034 in adults. Science and Technology Commission of Shanghai, National Natural Science Foundation of China, Jiangsu Provincial Science Fund for Distinguished Young Scholars, and Jiangsu Provincial Key Project of Science and Technology Plan. For the Chinese translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

• A total of 78% of asymptomatic infections with Omicron was in presymptomatic stage. • The proportion of asymptomatic Omicron infections was 17.5%. • The infectivity of asymptomatic and mild Omicron infections was similar. • More attention should be paid to asymptomatic cases during quarantine. Asymptomatic infections and mild diseases were more common during the Omicron outbreak in Shanghai, China in 2022. This study aimed to assess the characteristics and viral RNA decay between patients with asymptomatic and mild infections. A total of 55,111 patients infected with SARS-CoV-2 who were quarantined in the National Exhibition & Convention Center (Shanghai) Fangcang shelter hospital within 3 days after diagnosis from April 9 to May 23, 2022 were enrolled. The kinetics of cycle threshold (Ct) values of reverse transcription-polymerase chain reaction were assessed. The influencing factors for disease progression and the risk factors for the viral RNA shedding time (VST) were investigated. On admission, 79.6% (43,852/55,111) of the cases were diagnosed with asymptomatic infections, and 20.4% were mild diseases. However, 78.0% of initially asymptomatic subjects developed mild diseases at the follow-up. The final proportion of asymptomatic infections was 17.5%. The median time of symptom onset, the duration of symptoms, and the VST were 2 days, 5 days, and 7 days, respectively. Female, age 19-40 years, underlying comorbidities with hypertension and diabetes, and vaccination were associated with higher risks of progressing to mildly symptomatic infections. In addition, mildly symptomatic infections were found to be associated with prolonged VST compared with asymptomatic infections. However, the kinetics of viral RNA decay and dynamics of Ct values were similar among asymptomatic subjects, patients with asymptomatic-to-mild infection, and patients with mild infection. A large proportion of initially diagnosed asymptomatic Omicron infections is in the presymptomatic stage. The Omicron infection has a much shorter incubation period and VST than previous variants. The infectivity of asymptomatic infections and mildly symptomatic infections with Omicron is similar. [ABSTRACT FROM AUTHOR]

Mycobacterium kansasii pulmonary disease is frequently misdiagnosed and treated as tuberculosis, especially in countries with high tuberculosis burden. This study aimed to investigate the drug resistance profile of M. kansasii in patients with M. kansasii pulmonary disease in Shanghai and to determine the variations in drug resistance after 2 months of antimycobacterial treatment. All patients with a diagnosis of M. kansasii pulmonary disease from 2017 to 2019 in Shanghai were retrospectively analysed. Whole-genome sequencing was performed, and the minimum inhibitory concentration (MIC) to antimycobacterial drugs was measured using the broth microdilution method. In total, 191 patients had a diagnosis of M. kansasii pulmonary disease. Of them, 24.1% (46/191) had persistent positive culture after 2 months of antimycobacterial treatment. Whole-genome sequencing revealed that the 46 paired isolates had a difference of <17 single nucleotide polymorphisms, thus excluding the possibility of exogenous reinfection. More than 90% of the baseline isolates were sensitive to rifampin, clarithromycin, moxifloxacin, or amikacin, whereas a high resistance to ethambutol (118/191, 61.8%) and 4 μg/mL of isoniazid (32/191, 16.8%) were observed. Two isolates presented high resistance to rifamycin (i.e. a rifampin MIC of >8 μg/mL and a rifabutin MIC of 8 μg/mL) both containing the rpoB mutation (S454L). The increase of MIC to rifampin, ethambutol, and/or isoniazid was identified in 50.0% (23/46) of the patients. A high prevalence of innate resistance to ethambutol and isoniazid was observed among circulating M. kansasii clinical strains in Shanghai. The increase in drug resistance under empirical antimycobacterial treatment highlighted the urgency of definitive species identification before initiating treatment. [ABSTRACT FROM AUTHOR]

• Revealed spatial heterogeneity of NTM-PD, focusing on MKC-PD, MAC-PD, and MABC-PD. • Utilized Bayesian spatial disease mapping to highlight high-risk NTM-PD areas. • Demonstrated distinct demographic and clinical characteristics of NTM-PD patients. • Linked environmental factors to varying NTM-PD distribution patterns. To investigate the spatial heterogeneity of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Shanghai. A population-based retrospective study was conducted using presumptive pulmonary tuberculosis surveillance data of Shanghai between 2010 and 2019. The study described the spatial distribution of NTM-PD notification rates, employing hierarchical Bayesian mapping for high-risk areas and the Getis-Ord Gi* statistic to identify hot spots and explore associated factors. Of 1652 NTM-PD cases, the most common species was Mycobacterium kansasii complex (MKC) (41.9%), followed by Mycobacterium avium complex (MAC) (27.1%) and Mycobacterium abscessus complex (MABC) (16.2%). MKC-PD patients were generally younger males with a higher incidence of pulmonary cavities, while MAC-PD patients were more often farmers or had a history of tuberculosis treatment. MKC-PD hot spots were primarily located in the areas alongside the Huangpu River, while MAC-PD hot spots were mainly in the western agricultural areas. Patients with MKC-PD and MAC-PD exhibited a higher risk of spatial clustering compared to those with MABC-PD. Different types of NTM-PD exhibit distinct patterns of spatial clustering and are associated with various factors. These findings underscore the importance of environmental and host factors in the epidemic of NTM-PD. [Display omitted] [ABSTRACT FROM AUTHOR]

Using energy conservation measures (ECMs) for building retrofit can significantly reduce building operational carbon emissions (BOCEs) and contribute to Chinese carbon neutrality by 2060. This paper involves 11 feasible ECMs for commercial buildings in hot-summer and cold-winter zone, China, and proposes a quick assessment approach to BOCEs reduction. Prototypical models are simulated for ECMs using EnergyPlus and the emission intensity is corrected by the building shape factor and window-to-wall ratio. Based on pre-simulated results, effects on reducing emissions of individual measures and packages of them are studied to develop regression models in SPSS. The results show that decreasing the U-factor of external walls, lighting power density (LPD), or shading coefficient can reduce BOCEs linearly. BOCEs are most sensitive to LPD and using daylighting control can reduce emissions by 5–15%. In addition, increasing the boilers' efficiency reduces emissions linearly, while performance improvement of chillers or heat pumps reduces emissions logarithmically. Furthermore, utilizing variable speed pumps, heat recovery ventilation, and air-side economizers can reduce emissions by 3.8%, 6.6%, and 15.2%, respectively. Finally, significant interactions exist among measures of enhancing glazing U-factor, adding external shading, using energy-saving lamps, and improving cooling/heating system efficiencies. The developed regression models are validated in a retrofit case in Shanghai. Through assessment, the case can reduce BOCEs by 15.9 kgCO 2 /m2, with a reduction rate of 20.8%. Compared with recorded data, the relative error of assessing emission reduction is −13.0% and that of assessing reduction rate is 0.5%, which are acceptable in the decision-making stage of retrofit strategies. [ABSTRACT FROM AUTHOR]

• The Coupled Map Lattices model is proposed based on anti-risk ability of station. • The relationship between perturbation index and passenger flow is quantified. • The higher topological redundancy, the stronger the anti-risk ability of stations. • The anti-risk ability of stations could resist the spread of failures in the early stage. • The propagation of cascading failures depends on the location and type of stations. In terms of urban rail transit network vulnerability, most studies have focused on the changes of network topology and functional characteristics under disruptive events while ignoring the impacts of cascading failures on network performance. In this study, an improved Coupled Map Lattices model is proposed to address the evolution process of cascading failures on rail transit network. Particularly, the model quantifies important factors of cascading failures integrating quantitative failure spreading mode, anti-risk ability of stations, and perturbation index. The rail transit network vulnerability is then modeled addressing numbers of failed stations, degree of affected passengers, and loss of passenger travel time as a result of cascading failures. The methodology is applied to the metro network of Shanghai, China. Results show that the propagation of network cascading failure depends on the station's anti-risk ability, geographical location, and type of adjacent stations. Stations located in the urban center area are more susceptible to failures of adjacent stations. Furthermore, higher affected passenger volume and station coupling strength would lead to more serious and rapid spreading of failures, and thus more vulnerable of the metro system. However, the anti-risk ability of stations could effectively resist the spread of failures in the early stage, and stations with higher topology redundancy demonstrate stronger anti-risk ability. [ABSTRACT FROM AUTHOR]