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Background: A variety of viruses can cause acute respiratory infections (ARIs), resulting in a high disease burden worldwide. To explore the dominant viruses and their prevalence characteristics in children with ARIs, comprehensive surveillance was carried out in the Pudong New Area of Shanghai. Methods: Between January 2013 and December 2022, the basic and clinical information, and respiratory tract specimens of 0–14 years old children with ARIs were collected in five sentinel hospitals in Shanghai Pudong. Each specimen was tested for eight respiratory viruses, and the positive rates of different age groups, case types (inpatient or outpatient) were analyzed. Results: In our study, 30.67% (1294/4219) children with ARIs were positive for at least one virus. Influenza virus (IFV) was the most commonly detected respiratory virus (349/4219, 8.27%), followed by respiratory syncytial virus (RSV) (217/4219, 5.14%), para‐influenza virus (PIV) (215/4219, 5.10%), and human coronavirus (HCoV, including 229E, OC43, NL63, and HKU1) (184/4219, 4.36%). IFV was the leading respiratory virus in outpatients aged 5–14 years (201/1673, 12.01%); RSV was the most prevalent respiratory virus in both inpatients (61/238, 25.63%) and outpatients (4/50, 8.00%) for ARI patients aged <6 months old. For PIV, HMPV, HCoV, and HRV, the risk of infection usually was higher among young children. Co‐infection with more than two viruses was seen in 3.25% (137/4219). Conclusions: IFV and RSV played important roles in ARIs among children, but the risk populations were different. There are needs for targeted diagnosis and treatment and necessary immunization and non‐pharmaceutical interventions. [ABSTRACT FROM AUTHOR]

Sixty norovirus outbreaks that occurred in Pudong District, Shanghai in 2017 and affected 959 people were summarised. Of the outbreaks, 29 (48.3%), 27 (45.0%), and 4 (6.7%) occurred in kindergartens, primary schools, and middle schools, respectively. Although the total number of outbreaks peaked in March (13/60, 21.7%), outbreaks in kindergartens and primary schools peaked in April (6/29, 20.7%) and March (8/27, 29.6%), respectively. Primary schools had the highest median number of cases per outbreak (19) and the highest proportion of cases (54.6%). The male-to-female case ratio differed among school classifications, with the highest male case ratio (69.2%) occurring in middle schools. Primary symptoms also differed across the school classifications. Molecular virology analysis showed that a single viral strain caused each outbreak at each school. In turn, 50.6, 28.8, and 20.6% of cases were infected by GII.4, GII.2, and GII.17, respectively. Vomiting was seen in 98.2, 97.3, and 88.6% of the subjects infected with noroviruses GII.17, GII.4, and GII.2, respectively, and nausea in 73.6, 43.9, and 39.0%. In conclusion, noroviruses mainly affect primary school and kindergarten students. GII.4, GII.2, and GII.17 are the main epidemic strains in the local area, and the primary symptoms differed by age and genotype. [ABSTRACT FROM AUTHOR]

Introduction: In developing and underdeveloped countries, undernutrition plays a major role in subverting the immune system, leading to an increase in TB infections; this study investigated the associations between dietary patterns and latent tuberculosis infection risk among young adults in Shanghai. Methodology: In a case-control study, 96 cases of latent tuberculosis infection and 192 healthy controls were studied among contacts of students in clusters of tuberculosis epidemics in colleges from January 2021 to March 2023. A standardized questionnaire assessing sociodemographic, lifestyle, and dietary characteristics was applied. Food intake was estimated using a 95-item semiquantitative Food Frequency Questionnaire. Using the principal component analysis to extract dietary patterns from food groups intake. Logistic regression models were applied. Results: Four dietary patterns were identified: "traditional balanced" pattern, "unsaturated fatty acid" pattern, "snack" pattern, and "protein and fruit" pattern. Four components explaining 64.52% of the total variation in consumption were derived. In a conditional logistic regression analysis, three models were created. After adjusting for various confounders, compared to "snack" pattern, the risk of latent TB infection was 91% lower in the "traditional balanced" pattern (OR 0.05, 95% CI 0.01, 0.38, p = 0.004). Conclusions: To prevent TB infection among young adults living in high TB burden areas, a balanced dietary pattern rather than a "snack" pattern should be promoted in school settings. Future research should explore the risk of developing active tuberculosis in Mtb-infected people with different dietary patterns and the prevention of this risk by healthy dietary patterns. [ABSTRACT FROM AUTHOR]

Background: Life expectancy at birth (LE) is a comprehensive measure that accounts for age-specific death rates in a population. Shanghai has ranked first in LE in China mainland for decades. Understanding the reasons behind its sustained gain in LE provides a good reflection of many other cities in China. The aim of this study is intended to explore temporal trend in age- and cause-specific gains in LE in Shanghai and the probable reasons lay behind.Methods: Joinpoint regression was applied to evaluate temporal trend in LE and the long time span was then divided accordingly. Contributions to change in LE (1973-2015) were decomposed by age and cause at corresponding periods.Results: LE in Shanghai could be divided into four phases ie., descent (1973-1976), recovery (1976-1998), rapid rise (1998-2004) and slow rise (2004-2015). The growing LE was mainly attributed to reductions in mortality from the elderly populations and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers (stomach, liver and esophageal cancer).Conclusions: The four-decade sustained gain in LE in Shanghai is due to the reductions in mortality from the elderly and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers. Further growth momentum still comes from the elderly population. [ABSTRACT FROM AUTHOR]

Few studies have investigated respiratory effects of particulate matter air pollution using a full range of particle size distribution. To explore the short-term associations between size-fractionated particle number concentration (PNC) and chronic obstructive pulmonary disease (COPD) mortality. We conducted a time-series study to explore the associations between size-fractionated PNC and daily COPD mortality in the Pudong New Area of Shanghai, China, from 2014 to 2016. We evaluated particle size distribution from 0.01 μm to 10 μm, which was segregated into 7 ranges to better explore the size-dependent associations. We used over-dispersed generalized additive models to estimate the associations after controlling for time trends, temperature, humidity, day of the week and holidays. A total of 5430 deaths due to COPD were identified during the study period. For size ranges from 2.5 – 10 μm, 1–2.5 μm to 0.3–1 μm, there were stronger associations between PNC and COPD mortality, but the associations were statistically insignificant. However, for the smaller size ranges from 0.3 to 0.01 μm, the associations became statistically significant and the magnitude of association remained stable. An interquartile range increase in PNC at lag 0–1 day for size ranges 0.01–0.03 μm, 0.03–0.05 μm, 0.05–0.1 μm and 0.1–0.3 μm was associated with increments of 4.44% (95% CI: 1.16%, 7.73%), 4.31% (95% CI: 1.16%, 7.47%), 4.22% (95% CI: 1.05%, 7.40%), and 4.28% (95% CI: 0.48%, 8.09%) in COPD mortality, respectively. This study suggested that particles below 0.3 μm in diameter might be mainly responsible for the adverse effect of particulate air pollution on CDPD mortality in Shanghai, China. • A study linking a full range of particle size distribution and COPD mortality. • The associations generally increased with smaller particle size. • Particles below 0.3 μm in diameter may be mainly responsible for the associations. • Particles above 0.3 μm in diameter showed no significant associations. [ABSTRACT FROM AUTHOR]

• The seasonality of influenza activity in Shanghai, China after the 2009 A/H1N1 pandemic is complex. • Annual winter epidemics were found and lasted into spring in some years. • Co-circulation of A/H3N2, A/H1N1, and two lineages of influenza B contributed to the annual winter epidemics. • Semiannual epidemics in the summer, which were found in four of the six surveillance years, were only attributable to A/H3N2. • The current one-season vaccination program in Shanghai, China should be carefully reconsidered. Understanding the complexity of influenza subtype seasonality is critical to promoting a suitable vaccination program. The aim of this study was to identify and compare the seasonality and epidemiological features of seasonal influenza subtypes after the 2009 A/H1N1 pandemic and to lay a foundation for further investigation into the social and environmental factors affecting seasonal influenza virus transmission. Influenza-like illness (ILI) case surveillance was conducted in two sentinel hospitals in Pudong New Area, Shanghai between 2012 and 2018. Weekly data on ILI cases were analyzed. A time-series seasonal decomposition analysis was used to reveal the seasonality of influenza and epidemiological features among different subtypes. In total, 10 977 ILI patients were enrolled of whom 2385 (21.7%) had laboratory-confirmed influenza. Compared to influenza A (16.3%), influenza B (5.4%) was less frequently detected among the ILI patients (p < 0.001). Semiannual epidemic peaks were identified in four of the years during the 6-year study period, while only one annual epidemic peak was found in the other two years. An epidemic peak occurred in each winter season, and a secondary peak also occasionally occurred in summer or spring. A/H3N2 predominated in both summer and winter, while A/H1N1, B/Yamagata, and B/Victoria circulated almost exclusively in winter or spring. Two lineages of influenza B seemed to predominate in alternating years. This study highlights the complexity of seasonal influenza virus activity in a subtropical region of China, presenting both semiannual and annual epidemic peaks in different years. The results of this study may provide further insight into possible improvements in the timing of influenza vaccination in Shanghai, China. [ABSTRACT FROM AUTHOR]

Humans are exposed to disinfection by-products through oral, inhalation, and dermal routes, during bathing and swimming, potentially causing skin lesions, asthma, and bladder cancer. Nuclear factor E2-related factor 2 (NRF2) is a master regulator of the adaptive antioxidant response via the antioxidant reaction elements (ARE) orchestrating the transcription of a large group of antioxidant and detoxification genes. Here we used an immortalized human keratinocyte model HaCaT cells to investigate NRF2-ARE as a responder and protector in the acute cytotoxicity of seven haloacetonitriles (HANs), including chloroacetonitrile (CAN), bromoacetonitrile (BAN), iodoacetonitrile (IAN), bromochloroacetonitrile (BCAN), dichloroacetonitrile (DCAN), dibromoacetonitrile (DBAN), and trichloroacetonitrile (TCAN) found in drinking water and swimming pools. The rank order of cytotoxicity among the HANs tested was IAN ≈ BAN ˃ DBAN ˃ BCAN ˃ CAN ˃ TCAN ˃ DCAN based on their LC 50. The HANs induced intracellular reactive oxygen species accumulation and activated cellular antioxidant responses in concentration- and time-dependent fashions, showing elevated NRF2 protein levels and ARE activity, induction of antioxidant genes, and increased glutathione levels. Additionally, knockdown of NRF2 by lentiviral shRNAs sensitized the HaCaT cells to HANs-induced cytotoxicity, emphasizing a protective role of NRF2 against the cytotoxicity of HANs. These results indicate that HANs cause oxidative stress and activate NRF2-ARE-mediated antioxidant response, which in turn protects the cells from HANs-induced cytotoxicity, highlighting that NRF2-ARE activity could be a sensitive indicator to identify and characterize the oxidative stress induced by HANs and other environmental pollutants. [Display omitted] • Haloacetonitriles cause acute cytotoxicity and oxidative stress in HaCaT cells. • Haloacetonitriles induce NRF2-ARE-mediated antioxidant response in HaCaT cells. • NRF2 protects human keratinocytes from HANs-induced acute cell damage. • NRF2-ARE activity is an indicator for the oxidative stress caused by haloacetonitriles. [ABSTRACT FROM AUTHOR]

X-axis: The value of climate variable; Y-axis: 2-weeks lagged cumulative relative risk (RR), indicating the number of times more likely to have influenza compared to reference value (Ref); Solid line: RR value; Grey shadow: 95% confidence interval (95% CI). • High temperature only associated with influenza A occurrence. • High diurnal temperature range (DTR) causes more influenza A cases. • Low DTR causes more influenza B cases. • High DTR and low temperature were the key drivers for influenza A and B separately. Most previous studies focused on the association between climate variables and seasonal influenza activity in tropical or temperate zones, little is known about the associations in different influenza types in subtropical China. The study aimed to explore the associations of multiple climate variables with influenza A (Flu-A) and B virus (Flu-B) transmissions in Shanghai, China. Weekly influenza virus and climate data (mean temperature (MeanT), diurnal temperature range (DTR), relative humidity (RH) and wind velocity (Wv)) were collected between June 2012 and December 2018. Generalized linear models (GLMs), distributed lag non-linear models (DLNMs) and regression tree models were developed to assess such associations. MeanT exerted the peaking risk of Flu-A at 1.4 °C (2-weeks' cumulative relative risk (RR): 14.88, 95% confidence interval (CI): 8.67–23.31) and 25.8 °C (RR: 12.21, 95%CI: 6.64–19.83), Flu-B had the peak at 1.4 °C (RR: 26.44, 95%CI: 11.52–51.86). The highest RR of Flu-A was 23.05 (95%CI: 5.12–88.45) at DTR of 15.8 °C, that of Flu-B was 38.25 (95%CI: 15.82–87.61) at 3.2 °C. RH of 51.5% had the highest RR of Flu-A (9.98, 95%CI: 4.03–26.28) and Flu-B (4.63, 95%CI: 1.95–11.27). Wv of 3.5 m/s exerted the peaking RR of Flu-A (7.48, 95%CI: 2.73–30.04) and Flu-B (7.87, 95%CI: 5.53–11.91). DTR ≥ 12 °C and MeanT <22 °C were the key drivers for Flu-A and Flu-B, separately. The study found complex non-linear relationships between climate variability and different influenza types in Shanghai. We suggest the careful use of meteorological variables in influenza prediction in subtropical regions, considering such complex associations, which may facilitate government and health authorities to better minimize the impacts of seasonal influenza. [ABSTRACT FROM AUTHOR]