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Background: Following the COVID-19 pandemic, global interest in influenza vaccines and pneumonia vaccines has increased significantly. We aimed to examine public interest in and actual market circulation of influenza and pneumonia vaccines before and after the initial outbreak of COVID-19 and estimate the coverage and determinants of influenza and pneumonia vaccination uptake following the COVID-19 pandemic. Methods: We obtained search volume data for vaccines using the Baidu search index and collected the numbers of vaccines issued from the National Institutes for Food and Drug Control. We also conducted a cross-sectional survey among 3346 adult residents to evaluate the coverage and determinants of influenza and pneumonia vaccination uptake in the Yangtze River delta, China, from 29 January to 4 February 2021. Results: Public searches and the number of vaccines issued for the influenza vaccines and pneumonia vaccines obviously increased after the initial outbreak of COVID-19. In the total sample, 12.5% were vaccinated against influenza, and 21.5% had at least one family member vaccinated against pneumonia. A minority of participants perceived that they were highly or very highly susceptible to influenza (15.9%) and COVID-19 (6.7%). A range of socio-economic factors and perceived susceptibility to COVID-19 were associated with influenza and pneumonia vaccination uptake. Conclusions: Public interest in and issued volumes of influenza and pneumonia vaccines increased nationally following the COVID-19 pandemic. Perceptions of high susceptibility to COVID-19 were associated with the uptake of the influenza and pneumonia vaccines. Targeted interventions were needed to improve vaccination coverage. publishedVersion

Background: Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Few studies have focused on COVID-19 testing and vaccination uptake may change as the pandemic continues. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China. Methods: A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate the factors associated with willingness and uptake of the two measures. Findings: In early 2021, 52.45% of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) were willing to receive testing. 63.28% of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated. Interpretation: Chinese adults expressed almost universal willingness of COVID-19 testing and relatively low willingness of COVID-19 vaccination at the low-risk period of the COVID-19 pandemic, independent from their socio-demographic characteristics. Maintaining willingness of COVID-19 vaccination are key especially when the pandemic evolved into a low-risk period. Funding Information: ZH acknowledges financial support from the National Natural Science Foundation of China (No. 71874034) and the Three-Year Initiative Plan for Strengthening Public Health System Construction in Shanghai (2020-2022) (GWV-10.1-XK23). Declaration of Interests: None. Ethics Approval Statement: The study was approved by the Institutional Review Board of the School of Public Health, Fudan University (IRB#2020-12-0861). Respondents provided e-consent for their participation in the survey.

BACKGROUND Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Few studies have focused on COVID-19 testing and vaccination uptake may change as the pandemic continues. OBJECTIVE To examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China. METHODS A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate the factors associated with willingness and uptake of the two measures. RESULTS In early 2021, 52.45% of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) were willing to receive testing. 63.28% of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated. CONCLUSIONS Chinese adults expressed almost universal willingness of COVID-19 testing and relatively low willingness of COVID-19 vaccination at the low-risk period of the COVID-19 pandemic, independent from their socio-demographic characteristics. Maintaining willingness of COVID-19 vaccination is key especially when the pandemic evolved into a low-risk period.

Human infection associated with a novel reassortant avian influenza H7N9 virus has recently been identified in China. A total of 132 confirmed cases and 39 deaths have been reported. Most patients presented with severe pneumonia and acute respiratory distress syndrome. Although the first epidemic has subsided, the presence of a natural reservoir and the disease severity highlight the need to evaluate its risk on human public health and to understand the possible pathogenesis mechanism. Here we show that the emerging H7N9 avian influenza virus poses a potentially high risk to humans. We discover that the H7N9 virus can bind to both avian-type (α2,3-linked sialic acid) and human-type (α2,6-linked sialic acid) receptors. It can invade epithelial cells in the human lower respiratory tract and type II pneumonocytes in alveoli, and replicated efficiently in ex vivo lung and trachea explant culture and several mammalian cell lines. In acute serum samples of H7N9-infected patients, increased levels of the chemokines and cytokines IP-10, MIG, MIP-1β, MCP-1, IL-6, IL-8 and IFN-α were detected. We note that the human population is naive to the H7N9 virus, and current seasonal vaccination could not provide protection.

Highly pathogenic influenza A (H5N1) virus causes a widespread poultry deaths worldwide. The first human H5N1 infected case was reported in Hong Kong Special Administrative Region of China in 1997. Since then, the virus re-emerged in 2003 and continues to infect people worldwide. Currently, over 400 human infections have been reported in more than 15 countries and mortality rate is greater than 60%. H5N1 viruses still pose a potential pandemic threat in the future because of the continuing global spread and evolution. Here, we summarize the epidemiological, clinical and virological characteristics of human H5N1 infection in China monitored and identified by our national surveillance systems.

A novel hypoxanthine (Hx) sensor is constructed using a sodium montmorillonite-methyl viologen carbon paste modified electrode. Xanthine oxidase (XO) is immobilized within a polyaniline film on the electrode surface by electropolymerization. The hypoxanthine detection is based on the oxygen consumed due to the enzymatic reaction involving xanthine oxidase. Electrocatalytic reduction of oxygen and the response of the sensor are evaluated using cyclic voltammetry. The response of the sensor is linear in the range of 1 μM–0.4 mM hypoxanthine and the minimum detectable level is 0.8 μM. The sensor can be applied to the determination of hypoxanthine in fish meat, and it is effective for eliminating interferences from coexisting substances in the samples.

Background Adamantane-derived drugs have been used for treatment and prophylaxis of influenza A virus infection for many years worldwide. Rapid surveillance of antiviral drug resistance is important for appropriate clinical guideline development. Here, we retrospectively assessed adamantane resistance among different influenza A subtypes (H1N1, H3N2 and H5N1) over 53 years (1956–2009) in mainland China. Methods A total of 1,451 viruses, including 773 H3N2 viruses, 647 H1N1 viruses and 31 human H5N1 viruses, were analysed by matrix gene sequencing and assayed for drug resistance. Results Our results show that the prevalence of adamantane- resistant H3N2 viruses was low between 1956 and 2002, but substantially increased in 2003 to the extent that since 2006 all H3N2 viruses have been drug resistant. The percentage of adamantane- resistant H1N1 viruses also increased from 50.0% in 2004 to 98.7% in 2007; however, this decreased to 46.7% in 2009. Only three adamantane-resistant H5N1 viruses have been detected since 2003, when the first case of human H5N1 virus infection was detected in mainland China. Phylogenetic analysis demonstrated that the increase of adamantane-resistant isolates was caused by point mutations or intrasubtype reassortment instead of intersubtype reassortment. Conclusions Because of the high percentage of adamantane- resistant H3N2 and H1N1 viruses in mainland China, the use of amantadine and rimantadine drugs for prophylaxis and treatment of current seasonal influenza A infection is not recommended.

We investigated avian influenza infections in wild birds, poultry, and humans at Eastern Dongting Lake, China. We analyzed 6,621 environmental samples, including fresh fecal and water samples, from wild birds and domestic ducks that were collected from the Eastern Dongting Lake area from November 2011 to April 2012. We also conducted two cross-sectional serological studies in November 2011 and April 2012, with 1,050 serum samples collected from people exposed to wild birds and/or domestic ducks. Environmental samples were tested for the presence of avian influenza virus (AIV) using quantitative PCR assays and virus isolation techniques. Hemagglutination inhibition assays were used to detect antibodies against AIV H5N1, and microneutralization assays were used to confirm these results. Among the environmental samples from wild birds and domestic ducks, AIV prevalence was 5.19 and 5.32%, respectively. We isolated 39 and 5 AIVs from the fecal samples of wild birds and domestic ducks, respectively. Our analysis indicated 12 subtypes of AIV were present, suggesting that wild birds in the Eastern Dongting Lake area carried a diverse array of AIVs with low pathogenicity. We were unable to detect any antibodies against AIV H5N1 in humans, suggesting that human infection with H5N1 was rare in this region.