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From 2003 until 2018, a total of 12 outbreaks with 1,654 confirmed dengue cases have been reported in Zhejiang Province. The emergence of insecticide resistance in mosquitoes will affect the control of dengue. Our study aims to investigate the current situation of insecticide resistance of Ae. albopictus in Zhejiang Province and compares it with the situation in 2016. Ae. albopictus were collected from 12 Zhejiang Province cities in 2019. Resistance to three major categories of insecticides, including 8 commonly used insecticides, was evaluated according to the tube test protocol recommended by China CDC. Ae. albopictus in all cities, except Hangzhou, Wenzhou, Lishui and Shaoxing, showed decreased susceptibility to beta-cypermethrin, deltamethrin and permethrin. For malathion, 3 cities Ae. albopictus have developed resistance, 3 cities Ae. albopictus have decreased susceptibility. For propoxur, in 3 cities Ae. albopictus showed decreased susceptibility with mortality ranging from 94.24% to 96.67%. The resistance to alpha-cypermethrin, lambda-cyhalothrin and fenitrothion is rare in Ae. albopictus in that only Zhoushan's mosquitoes showed decreased susceptibility to alpha-cypermethrin. The resistance to beta-cypermethrin, deltamethrin and permethrin was significantly correlated with each other. Compared to the situation in 2016, the insecticide resistance of Ae. albopictus in Zhejiang Province has become more common in 2019. In the emergency preparedness for future mosquito-borne diseases, two things should be done: 1) the selection of insecticides should be made based on information from insecticide resistance surveillance 2) the use of insecticide should follow scientific guidance.

The COVID-19 pandemic continues to ravage the world. As many countries have entered the postpandemic period, current efforts to prevent and control COVID-19 have gradually been normalized in many countries. Although the focus is on vaccines to achieve herd immunity, conventional physical containment strategies should be reassessed as part of efforts to prevent and control infectious diseases. Continued respiratory protective measures such as social distancing and the wearing of masks have been extensively accepted by the public in most countries. A point worth noticing is that the activities of influenza and other respiratory diseases have decreased as these strategies have been implemented. Public mobilization and large-scale campaigns to promote health are also important to interrupting the transmission of pathogens. A good example can be found in the achievements of China's Patriotic Public Health Campaign. These practices underscore the importance of enhancing physical containment strategies and public mobilization and management, with support from the legal system, to respond to any potential emerging infectious diseases.

Glioma is one of the most commonly diagnosed intracranial malignancies. The molecular mechanism underlying the development of glioma is still largely unknown. In this study, we present the first report concerning the function and mechanism of cyclin‐dependent kinase‐like 3 (CDKL3) in the development and prognosis of glioma. It is shown that CDKL3 was upregulated in glioma tissues and could independently predict poor prognosis of patients. Silencing CDKL3 in glioma cells could inhibit cell proliferation and migration and induce cell apoptosis and cell cycle arrest, whereas the overexpression of CDKL3 promoted cell proliferation. The in vivo experiments also indicated that knockdown of CDKL3 significantly suppressed tumor growth of glioma. Gene expression profiling of CDKL3 knockdown U87 cells identified RRM2 as a potential target of CDKL3, which was proved to have direct interaction with CDKL3. Given similar effects on glioma development with CDKL3, knockdown of RRM2 could rescue the effects of CDKL3 overexpression on glioma cells. Moreover, knockdown of CDKL3 or RRM2 suppressed the activity of JNK signaling, whereas CDKL3 overexpression produced the opposite effect. In conclusion, our results identified CDKL3 as a promotor for glioma, probably through the regulation of RRM2 and activation of the JNK signalling pathway, highlighting the significance of CDKL3 as a promising therapeutic target of glioma., Our results identified cyclin‐dependent kinase‐like 3 (CDKL3) as a tumor promotor for glioma, probably through the regulation of RRM2 and activation of the JNK signaling pathway. Our data reveal the role of CDKL3 in glioma, highlighting the significance of CDKL3 as a putative therapeutic target.

Aedes albopictusis the only vector that can transmit the dengue virus in Zhejiang Province, central China, and it can develop insecticide resistance due to long-term exposure to pyrethroids. The presence of knockdown resistance (kdr) mutations is one of the mechanisms responsible for pyrethroid resistance, and has been reported in someAe. albopictuspopulations in southern China. However, little is known about the DNA diversity of the voltage-gated sodium channel (VGSC) gene inAe. albopictuspopulations in central China. FourAe. albopictusfield populations were collected, in Yiwu (YW), Quzhou (QZ), Wenzhou (WZ), and Jiaxing (JX) from Zhejiang Province, central China. The susceptibility ofAe. albopictusadults to three pyrethroids (beta-cypermethrin, deltamethrin, and permethrin) was tested using the WHO tube assay, andKdrmutations were identifiedviaPCR and sequencing. The relationship betweenkdrmutations and pyrethroid phenotypes was also analyzed. Of the four populations, none was sensitive to any pyrethroid tested, and the YW population showed the strongest pyrethroid resistance. Non-synonymouskdrmutations were detected in codons 1532 and 1534, domain III. At codon 1534, one mutant allele, TCC(S), was detected in the four populations with a frequency of 42.08%, while at codon 1532, one mutant allele, ACC(T), was detected in the JX and QZ populations, with frequencies of 4.22 and 3.03%, respectively. The F1534S mutant allele was positively correlated with both beta-cypermethrin and deltamethrin resistance phenotypes (OR > 1, P < 0.05), whereas the I1532T mutant allele was possibly negatively correlated with beta-cypermethrin, deltamethrin, and permethrin resistance phenotypes (OR < 1, P > 0.05). In conclusion, resistance and resistance mutations regarding to three pyrethroids are already present in theAe. Albopictuspopulations from Zhejiang, central China, which prompts the need to use non-insecticide-based methods of insect control.

Background: Circ-SHPRH is a novel circular RNA which was down-regulated in various cancer tissues. Several recent studies hinted that circ-SHPRH might function as a diagnostic and prognostic biomarker for solid cancers. This meta-analysis was performed to determine the diagnostic and prognostic roles of circ-SHPRH for these solid cancers. Methods: Publications were searched in PubMed, MEDLINE, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang database. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (SROC) (AUC) with 95% confidence interval (95% CI) were calculated to evaluate the diagnostic value of circ-SHPRH. Pooled hazard ratio (HR) with 95% CI was applied to assess the prognostic value of circ-SHPRH. Results: Nine eligible studies, including 4 for diagnosis and 5 for prognosis, were included in this meta-analysis. Pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.79 (95% CI: 0.73-0.84), 0.75 (95% CI: 0.69-0.81), 3.20 (95% CI: 2.53-4.06), 0.28 (95% CI: 0.22-0.36), 11.27 (95% CI: 7.57-16.79), and 0.84 (95% CI: 0.80-0.87), respectively. Pooled HR indicated that low circ-SHPRH expression was significantly associated with poor overall survival (OS) (low vs high, HR=2.22, 95% CI: 1.60-3.09). Conclusion: The results of this meta-analysis indicate that circ-SHPRH might be an important diagnostic and prognostic biomarker for various solid cancers.

Mosquito-borne Diseases are a common but severe public health threat. However, there is a lack of consensus on the effect of different mosquito trapping devices in China. This study firstly compared the BGM trap with the CDC light trap, commonly used in Chinese mosquito surveillance. Field trials of traps' efficiency were conducted in Yiwu city, China, from May 21st, 2018 to November 31st, 2018. Sixty-five comparisons were completed in five different biotopes (an urban residential area, a rural residential area, a park, a hospital, and a pig shelter). Concerning the number of mosquitoes per trap, the BGM trap outperformed three out of five biotopes. In contrast, the CDC light trap only showed better performance in the pig shelter. For specific species, the BGM trap outperformed in capturing Ae. albopictus, while the CDC light trap caught significantly more Cx. tritaeniorhynchus. Regarding Ae. albopictus and Cx. pipiens s.l. surveillance, the BGM trap is more suitable. The BGM trap shows significantly higher or similar efficiency than the CDC light trap in trapping common mosquito species in China, except in the pig shelter. Therefore, we recommend that Chinese researchers and public health practitioners use the BGM trap in future mosquito surveillance.

Objective: Surgical removal of anterior clinoidal meningiomas (ACMs) remains a challenge because of its complicated relationship with surrounding meninges, major arteries and cranial nerves. This study aims to define the meningeal structures around the anterior clinoid process (ACP) and its surgical implications. Methods: Five dry skulls and 19 cadavers were used in the anatomical study. Cadavers were prepared as transverse, coronal, and sagittal plastinated sections, and the meningeal architecture around the ACP was studied with dissecting and confocal microscopies. The database of meningiomas in one single center was retrospectively reviewed, and the patients with ACMs were collected for clinical analysis. Results: The superior, lateral, medial surfaces, and the tip of ACP were covered by different layers and types of meninges. The ACMs were classified into four main types based on the sites of origin, possible extending pathways following meningeal dura. In the retrospective cohort of 131 ACMs, the percentage of types I, IIa, IIb, III, and IV were 42.0% (55/131), 19.8% (26/131), 9.2% (12/131), 16.8% (22/131), and 12.2% (16/131), respectively. We found that types IIa and I had higher chances for achieving Simpson grade 1–2 resection (92.3 and 85.4%, respectively), followed by type III (54.5%) and type IV (31.3%), while type IIb showed little chance of Simpson grade 1–2 resection. Univariate and multivariate analyses revealed ACM classification and tumor size (

Background The prognosis of the glioblastoma (GBM) is dismal. This study aims to select an optimal RNA signature for prognostic prediction of GBM patients. Methods For the training set, the long non-coding RNA (lncRNA) and mRNA expression profiles of 151 patients were downloaded from the TCGA. Differentially expressed mRNAs (DEGs) and lncRNAs (DE-lncRNAs) were identified between good prognosis and bad prognosis patients. Optimal prognostic mRNAs and lncRNAs were selected respectively, by using univariate Cox proportional-hazards (PH) regression model and LASSO Cox-PH model. Subsequently, four prognostic scoring models were built based on expression levels or expression status of the selected prognostic lncRNAs or mRNAs, separately. Each prognostic model was applied to the training set and an independent validation set. Function analysis was used to uncover the biological roles of these prognostic DEGs between different risk groups classified by the mRNA-based signature. Results We obtained 261 DEGs and 33 DE-lncRNAs between good prognosis and bad prognosis patients. A panel of eight mRNAs and a combination of ten lncRNAs were determined as predictive RNAs by LASSO Cox-PH model. Among the four prognostic scoring models using the eight-mRNA signature or the ten-lncRNA signature, the one based on the expression levels of the eight mRNAs showed the greatest predictive power. The DEGs between different risk groups using the eight prognostic mRNAs were functionally involved in calcium signaling pathway, neuroactive ligand-receptor interaction pathway, and Wnt signaling pathway. Conclusion The eight-mRNA signature has greater prognostic value than the ten-lncRNA-based signature for GBM patients based on bioinformatics analysis.

Since the 2019 novel coronavirus (2019-nCoV or officially named by the World Health Organization as COVID-19) outbreak in Wuhan, Hubei Province, China in 2019, there have been a few reports of its imaging findings. Here, we report two confirmed cases of 2019-nCoV pneumonia with chest computed tomography findings of multiple regions of patchy consolidation and ground-glass opacities in both lungs. These findings were characteristically located along the bronchial bundle or subpleural lungs.

ObjectivesLarval indices have been used for Ae. albopictus surveillance for many years, while there is limited use in assessing dengue transmission risk and adult mosquito emergence. This study is aimed to explore the relationships between larval indices and the Ae. albopictus density captured by BG-mosquito trap (BG-trap) method, with considering the meteorological factors.MethodsData on larval density, adult mosquito density and meteorology factors were collected in an entomological survey carried out in Quzhou City, Zhejiang Province of China in 2018. The Spearman's rank correlation and Pearson correlation were used for the analysis on the correlation of density indices. Generalized additive models were established to analyze the influencing factors of mosquito density.ResultsBreteau index (BI), House index (HI) and Container index (CI) were highly correlated with each other (r>0.7, pConclusionsThe adult Ae. albopictus density had low correlation with certain larval indices. Some of the meteorology factors played significant roles in the density of adult Ae. albopictus and larva with or without a time lag.

Cytoplasmic polyadenylation element binding protein 4 (CPEB4) is a regulator of gene expression at transcriptional level and has been reported to be associated with biological malignancy in cancers. However, little was known about the correlation between CPEB4 and glioblastoma cell proliferation and the prognostic significance in patients. Our aim was to investigate the functional role and prognostic value of CPEB4 in glioblastoma.We determined the expression of CPEB4 protein using immunohistochemistry in tissue microarrays containing 278 glioma patients (including 98 primary glioblastomas) and evaluated its association with pathological grades and clinical outcome by univariate and multivariate analyses. And then, lentiviral-mediated RNAi targeting CPEB4 was utilized to study the role of CPEB4 in glioblastoma cell proliferation.In our cohort, CPEB4 expression was positively related to glioma pathological grade (p 0.01) and elevated in glioblastoma (p 0.01). High expression of CPEB4 was associated with significantly poor prognosis, and could be identified as an independent risk factor for overall survival (OS) and progression-free survival (PFS) of glioblastoma patients (hazard ratio (HR) = 1.730, p = 0.014 and HR = 1.877, p = 0.004, respectively). In vitro studies further showed that downregulation of CPEB4 significantly reduced the growth rate of T98G and U251 cells comparing with the controls.Our study indicated that increased expression of CPEB4 in primary glioblastoma is a novel biomarker for predicting poor outcome of patients and suppression of CPEB4 inhibit tumor cell proliferation, suggesting a potential therapeutic target for glioblastoma.

Tumors located in the craniocervical junction region are significantly challenging for surgical resection. We shared our experience of a meningioma at craniocervical junction resected through far lateral approach in a 68-year-old female. The patient presented with intermittent headache with discomfort in the neck and shoulders for 3 years without any positive signs. Magnetic resonance imaging (MRI) revealed a tumor of 3.6 cm × 3.0 cm × 2.5 cm lying at the ventral side of medulla oblongata, with T1 hypointensity, T2 hyperintensity, and a significant enhancement on T1-contrast image. The far lateral approach on the right side was planned to resect the tumor with a park-bench position. The patient underwent a standard craniotomy using a lazy S-shaped incision. The transposition of vertebral artery was performed carefully therein, followed by removal of part of the arches of atlas and axis. After exposure of the tumor, vertebral artery (VA) and posterior inferior cerebellar artery (PICA) adhesive to the lesion could be seen operatively. Truncating the supplying blood vessels of the tumor was taken as the first step, followed by resecting the tumor mass in a piecemeal manner. While preserving VA, PICA, posterior nerves, medulla oblongata, and cervical cord, gross-total resection was achieved under the careful operation. The patient tolerated the procedure well without any neurological deficits. Histological examination confirmed the tumor as a meningioma (World Health Organization [WHO] grade I). Postoperative MRI scan depicted complete resection of the tumor. The patient remained symptom free without any evidence of recurrence during the follow-up period of 1 year. Informed consent was obtained from the patient.The link to the video can be found at: https://youtu.be/i9H-wS4fF10.

To investigate the prevalence of Anaplasma, Ehrlichia, Bartonella and Theileria, we collected ticks from small mammals in six counties of Zhejiang Province in southeastern China. Polymerase chain reaction (PCR) amplification was performed to test Anaplasma, Ehrlichia, Bartonella and Theileria in tick samples. Positive PCR products were sequenced and then compared with previously published sequences deposited in GenBank using BLAST. About 292 adult ticks were captured and the dominant tick species were Ixodes sinensis and Haemaphysalis longicornis. Overall, 34 ticks (11.6%) were tested positive for at least one pathogen of Anaplasma, Ehrlichia, Bartonella and Theileria. Rates of PCR-positivity to Anaplasma, Ehrlichia, Bartonella and Theileria were 5.5, 1.7, 2.4 and 2.4%, respectively. Positive rates of Anaplasma, Bartonella and Theileria were significantly different among ticks of different species. Prevalence of Anaplasma and Theileria varied significantly among ticks of different counties. Anaplasma, Ehrlichia, Bartonella and Theileria were widely prevalent in ticks in Zhejiang Province suggesting other tick-borne pathogens should also be suspected if patients had history of tick bites.

Objectives. High dependency on pesticides could cause selection pressure leading to the development of resistance. This study was conducted to assess the resistance of the house fly, Musca domestica, to five insecticides, namely, permethrin, deltamethrin, beta-cypermethrin, propoxur, and dichlorvos, in Zhejiang Province. Methods. Field strains of house flies were collected from the 12 administrative districts in Zhejiang Province in 2011, 2014, and 2017, respectively. Topical application method was adopted for the bioassays. The probit analysis was used to determine the median lethal doses with the 95% confidence interval, and then the resistance ratio (RR) was calculated. The insecticides resistance in different years and the correlations of the resistance between different insecticides were also analyzed. Results. The resistance of field strains house flies to insecticides in Zhejiang Province was relatively common, especially for permethrin, deltamethrin, and beta-cypermethrin. The reversion of the resistance to dichlorvos was found, and most of the field strains in Zhejiang Province became sensitive to dichlorvos in 2017. Propoxur was much easier to cause very high level of resistance; the Hangzhou strain had the highest RR value more than 1000 in 2014, and five field strains had the RR value more than 100 in 2017. Compared to 2011 and 2014, the resistance of the house flies to propoxur and deltamethrin increased significantly in 2017. The resistance of permethrin, deltamethrin, beta-cypermethrin, and propoxur was significantly correlated with each other, and the resistance of dichlorvos was significantly correlated with beta-cypermethrin. Conclusions. Our results suggested that resistance was existed in permethrin, deltamethrin, beta-cypermethrin, and propoxur in the house flies of Zhejiang Province, while the resistance reversion to dichlorvos was found.

BackgroundDengue is one of the most important vector-bore infectious diseases in China because of its drastic increase in incidence, geographic extension and profound influence on China's economy. This study aims to retrospectively uncover the epidemiological profile of dengue in Zhejiang, one of the most developed provinces in China, and to find the problem existing in dengue control and prevention.MethodologyDescriptive analyses on the dengue incidence and associated factors were performed. We also identified potential space-time cluster and generated the risk map of dengue.Principal findingsA total of 529 cases were reported in Zhejiang Province from 2005 to 2016, and 44.4% were imported. 67.7% of cases were 25~60 years old and the overall male-to-female sex ratio was 1.09:1. Dengue was reported all year round and 70.7% of cases occurred between August and October. Indigenous cases were only reported in the period between July to November and more than half occurred in September. Geographically, dengue was most distributed in Jinghua (3.62 per million), Shaoxing (1.00 per million) and Taizhou (0.81 per million) prefecture level cities. Outbreaks were confirmed in Yiwu, Keqiao and Huangyan counties in 2009, 2015, and 2016, respectively. 73.9% cases would seek medical advice within two days after onset and be confirmed within 9 days after onset. 75.6% would be recognized as dengue within 8 days after their first visit. The time intervals between onset and confirmation (median 7 vs 6 days; Wilcoxon rank sum test Z = -2.40, P = 0.016), first visit and confirmation (median 7 vs 6 days; Wilcoxon rank sum test Z = -2.59, P = 0.009) of indigenous cases were significantly longer than those of imported ones. However, the time intervals between onset and first visit for indigenous cases was shorter (median 0 vs 1 days; Wilcoxon rank sum test Z = -2.10, P = 0.036). Fever (99.1%), fatigue (81.9), rash (63.7%), headache (67.2%) and myalgia (52.60%) were the most frequently mentioned symptoms.ConclusionsZhejiang has recently witnessed an increase in incidence and geographic extension of dengue. Timely diagnosis is important to stop local transmission and outbreak.

Objective Patients receiving carbon-ion radiation therapy and astronauts exploring outer space are inevitably exposed to heavy ion radiation. The aim of this study was to develop radioprotectors to minimize the injuries induced by carbon ion radiation. Methods Heat-killed Salmonella Typhimurium (HKST) was administered to mice by gavage prior to irradiation with a 12C6+ heavy ion accelerator. Hematoxylin and eosin staining and immunofluorescence TdT-mediated dUTP Nick-End Labeling staining were used to assess the radioprotective effect of HKST on organ damage and levels of apoptosis, respectively, in mice. To investigate the mechanism underlying the radioprotective effect of HKST, levels of the pro-apoptotic proteins BAX and caspase 3 as well as interferon-regulatory factor (IRF) 3/7 in the femur, testis and intestine were assessed using immunofluorescence. Results Injuries induced by carbon ion radiation were significantly eased by pretreatment with HKST. Both apoptosis and high expression levels of pro-apoptotic proteins induced by heavy ion radiation were inhibited by HKST pretreatment. The radioprotective effect of HKST was associated with stimulation of Toll-like receptor signaling mediated by enhanced IRF3 and IRF7 signaling. Conclusion HKST was an effective radioprotector alleviating damage to multiple organs caused by heavy ion radiation.

Severe fever with thrombocytopenia syndrome (SFTS) has spread throughout Asia, including China, South Korea, and Japan. In China, the main victims of SFTS were farmers. Measures to protect farmers were urgently needed but limited, and health education and promotion was proposed as an option. A pilot community trial was conducted to provide health education about SFTS in 2013 in Daishan County, Zhejiang Province, China, and results indicated that health education had promise. An educational campaign was conducted for three years. The incidence of SFTS decreased 0.3 per 1,000 person-years, and rural residents' awareness of SFTS increased substantially. Numerous habits or work practices that increased the likelihood of tick bites have also been changed. In the future, education could emphasize adopting healthy habits or work practices to reduce tick bites and thus reduce the incidence of SFTS, like regularly weeding around a house surrounded by shrubs, not sitting or lying on the ground when resting, and protecting one's self when doing farm work.

G-protein-coupled receptors 65 (GPR65), identified as an acid-sensing receptor, is overexpressed in several malignancies and promote tumor development. Our aim was to investigate the expression and prognostic value of GPR65 in glioblastoma.We determined the expression of GPR65 protein using immunohistochemistry in tissue microarrays containing 11 Grade I, 107 Grade II, 47 Grade III, and 102 Grade IV gliomas and 16 normal brains. Then we evaluated its association with pathological grades, prognosis, and recurrence. The Cancer Genome Atlas (TCGA) group (N=528) was further employed to examine transcriptional level of GPR65 in glioblastoma and the correlation between GPR65 expression and clinical outcome.In our cohort, GPR65 expression was positively related to glioma pathological grade (p0.01) and elevated in glioblastoma (p0.01). High expression of GPR65 was associated with significantly short overall survival (OS) (p=0.013) and progression-free survival (PFS) (p=0.029), and could be identified as an independent risk factor for OS of glioblastoma patients (Hazard Ratio [HR]=1.596, p=0.037). As an aiding evidence, increased GPR65 mRNA expression was also found in TCGA glioblastoma group (p0.001) and its high level predicted a poor clinical outcome (OS, p=0.003; PFS, p=0.001).Our findings suggest that GPR65 is overexpressed in glioblastoma and its high expression predicts unfavorable clinical outcome for patients. Targeting GPR65 may serve as a potential therapy for treating glioblastoma.

Zika virus is currently causing extensive outbreaks in a number of countries in South and Central America and the Caribbean and has been associated with foetal abnormalities. We report an outbreak of Zika virus infection in a Chinese tour-group returning from a nine day holiday in Fiji and Samoa. The index case was a 38-year old male who developed symptoms while travelling back from Fiji to Hong Kong on the 14th February, 2016. A field investigation was initiated to define the epidemiological, clinical and virological characteristics of Zika virus infection in this tour group and revealed two further symptomatic infections and one asymptomatic infection among the 33 travellers; an overall infection attack rate of 12% in these travellers. Active surveillance led to detection of Zika virus RNA in the serum of one case four days prior to onset of symptoms and detection of Zika virus in saliva from one asymptomatic infection.

Background According to previously studies, nosocomial infections (NIs) surveillance could effectively reduce infection rates. As NIs surveillance systems have been implemented in some hospitals for several years, their impact on NIs need to be explored. Therefore, the purpose of this review is to evaluate the tendency of NI rates during the surveillance period and the impact of surveillance on NI rates. Methods A systematic literature search of the PubMed database to identify papers that evaluated effect of surveillance on NIs, all kinds of NIs occurred during hospitalization or discharged were included. Exclude articles investigated the surveillance combined with other infection control measures. Results Twenty-five articles were included. NI rates had different levels of reduction during surveillance period, the reduction were not limited by state, department, surveillance system, and NI type. Continuous surveillance had a positive impact on NI, OR/RR were ranged from 0.43 to 0.95. Conclusion Participation in NI surveillance is associated with reducing infection rates, though RCTs need to further prove the effective role of surveillance. Hospitals may consider to perform NIs surveillance systems according to its own conditions.

Brucellosis is an occupational disease affecting workers in butcher shops, the milking and dairy product industry, causing more than 500 000 new cases around the world. As a national statutory B infectious disease in China, morbidity of brucellosis is rapidly increasing in recent years. We report an occupational outbreak of brucellosis infection in a pharmaceutical factory. Exposure was a result of manual operation in the process line, close contact with sheep placentas, insufficient disinfection and repeated using of protective suits and infected by aerosol dissemination. Improved preventive methods, appropriate public health measures and spread of health education would be helpful to prevent the occupational outbreak of brucellosis in future.