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(1) Background: Tornadoes are one of the deadliest disasters but their health impacts in China are poorly investigated. This study aimed to assess the public health risks and impact of an EF-4 tornado outbreak in Funing, China; (2) Methods: A retrospective analysis on the characteristics of tornado-related deaths and injuries was conducted based on the database from the Funing's Center for Disease Control and Prevention (CDC) and Funing People's Hospital. A change-point time-series analysis of weekly incidence for the period January 2010 to September 2016 was used to identify sensitive infectious diseases to the tornado; (3) Results: The 75 to 84 years old group was at the highest risk of both death (RR = 82.16; 95% CIs = 19.66, 343.33) and injury (RR = 31.80; 95% CI = 17.26, 58.61), and females were at 53% higher risk of death than males (RR = 1.53; 95% CIs = 1.02, 2.29). Of the 337 injuries, 274 injuries (81%) were minor. Most deaths occurred indoors (87%) and the head (74%) was the most frequent site of trauma during the tornado. Five diseases showed downward change-points; (4) Conclusions: The experience of the Funing tornado underscores the relative danger of being indoors during a tornado and is successful in avoiding epidemics post-tornado. Current international safety guidelines need modification when generalized to China.

In 2005, a survey was conducted in two hospitals to find out the practical data sources of respiratory and gastrointestinal syndromic surveillance, and to explore their applicability for early warning on infectious diseases. Since patients’ symptoms had not been electronically recorded normally in Chinese hospitals until then, information of preliminary diagnosis and clinical examination/test was considered to be reliable data sources for syndromic surveillance. Hospitals with HIS management are recommended for syndromic surveillance practice for their good integral, representative and regular data sources. For warning influenza epidemics, among all the candidate data sources, data of outpatient pneumonia/pulmonary infection was better than others for its representativeness and timeliness, followed by upper respiratory tract infection (URI). Data of outpatient pneumonia/acute respiratory distress syndrome (ARDS) and X-ray examination could be supplemental sources for verifying influenza epidemics, but with no advantage for early alert. Primary data sources of gastrointestinal syndromic surveillance include preliminary diagnosis/symptoms in outpatient clinics such as enteritis/colonitis and diarrhea; data of abnormal stools. Data of outpatient enteritis/colonitis was used for indicating bacillary dysentery and infectious diarrhea (two of the notifiable infectious diseases in China) epidemics, with good timeliness for infectious diarrhea but not for bacillary dysentery. Data of stool routine tests had a high specificity for gastrointestinal syndromic surveillance, but the timeliness was not good enough.

Summary Background In December, 2007, a family cluster of two individuals infected with highly pathogenic avian influenza A (H5N1) virus was identified in Jiangsu Province, China. Field and laboratory investigations were implemented immediately by public-health authorities. Methods Epidemiological, clinical, and virological data were collected and analysed. Respiratory specimens from the patients were tested by reverse transcriptase (RT) PCR and by viral culture for the presence of H5N1 virus. Contacts of cases were monitored for symptoms of illness for 10 days. Any contacts who became ill had respiratory specimens collected for H5N1 testing by RT PCR. Sera were obtained from contacts for H5N1 serological testing by microneutralisation and horse red-blood-cell haemagglutinin inhibition assays. Findings The 24-year-old index case died, and the second case, his 52-year-old father, survived after receiving early antiviral treatment and post-vaccination plasma from a participant in an H5N1 vaccine trial. The index case's only plausible exposure to H5N1 virus was a poultry market visit 6 days before the onset of illness. The second case had substantial unprotected close exposure to his ill son. 91 contacts with close exposure to one or both cases without adequate protective equipment provided consent for serological investigation. Of these individuals, 78 (86%) received oseltamivir chemoprophylaxis and two had mild illness. Both ill contacts tested negative for H5N1 by RT PCR. All 91 close contacts tested negative for H5N1 antibodies. H5N1 viruses isolated from the two cases were genetically identical except for one non-synonymous nucleotide substitution. Interpretation Limited, non-sustained person-to-person transmission of H5N1 virus probably occurred in this family cluster. Funding Chinese Ministry of Science and Technology; US National Institute of Allergy and Infectious Diseases, National Institutes of Health; China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases.

Streptococcus suis outbreak was associated with exposure to sick or dead pigs., From mid-July to the end of August 2005, a total of 215 cases of human Streptococcus suis infections, 66 of which were laboratory confirmed, were reported in Sichuan, China. All infections occurred in backyard farmers who were directly exposed to infection during the slaughtering process of pigs that had died of unknown causes or been killed for food because they were ill. Sixty-one (28%) of the farmers had streptococcal toxic shock syndrome; 38 (62%) of them died. The other illnesses reported were sepsis (24%) and meningitis (48%) or both. All isolates tested positive for genes for tuf, species-specific 16S rRNA, cps2J, mrp, ef, and sly. A single strain of S. suis caused the outbreak, as shown by the identification of a single ribotype. The high death ratio was of concern; prohibiting backyard slaughtering ended the outbreak.

To estimate the rates due to influenza-associated-excess-hospitalization in children aged 0-14 years in Wuxi city,Jiangsu province in 2005-2010.We collected data on hospitalization due to influenza, pneumonia and other respiratory diseases from fourteen 2nd level or above hospitals in Wuxi, as well as data on influenza virological surveillance in southern China to fit the negative binomial regression models, to estimate the rate on influenza-associated-excess hospitalization.During 2005-2010, an average annual hospitalization rate appeared as 91.6‰ (79.2‰ -99.3‰). Among the total hospitalization eases, respiratory diseases accounted for 54.2%, while both influenza and pneumonia accounted for 38.1%. The average annual influenza- associated-excess-hospitalization rates due to influenza and pneumonia appeared as 1.28‰ (95% CI:0.29‰ -4.84‰), while 2.18‰ (95% CI:0.61‰ -6.79‰) due to respiratory diseases. In 2009, A (H1N1) pdm induced influenza pandemic caused 993 excess hospitalizations due to influenza/pneumonia and 1 042 excess hospitalizations due to respiratory diseases, with rates as 1.14‰ and 1.20‰ respectively.Both seasonal and pandemic A(H1N1)pdm influenza caused considerable burden on hospitalization in children aged 0-14 years inWuxi.

Background Pigs are considered to be “mixing vessels” for the emergence of influenza viruses with pandemic potential. 2009 Pandemic Influenza H1N1 further proved this hypothesis, and raised the needs for risk assessment of human cases caused by swine influenza virus. Methods A field investigation was conducted after a case identified with infection of European avian-like swine influenza H1N1 virus. The diagnosis was confirmed by real-time PCR, virus isolation, whole genome sequencing and serological assays. Samples from local pigs and close contacts were tested to identify the source of infection and route of transmission. Results The virus from the index case was similar to viruses circulating in the local pigs. The case's grandfather was asymptomatic with sero-conversion. A total of 42.8% of swine sera were positive for European avian-like swine H1N1. Conclusions This study highlighted the importance of performing surveillance on swine influenza to monitor new virus emergence in humans.

Cross-species transmission of influenza A viruses from swine to human occurs occasionally. In 2011, an influenza A H1N1 virus, A/Jiangsu/ALS1/2011 (JS/ALS1/2011), was isolated from a boy who suffered from severe pneumonia in China. The virus is closely related antigenically and genetically to avian-like swine H1N1 viruses that have recently been circulating in pigs in China and that were initially detected in European pig populations in 1979. The isolation of JS/ALS1/2011 provides additional evidence that swine influenza viruses can occasionally infect humans and emphasizes the importance of reinforcing influenza virus surveillance in both pigs and humans.

Pathogens of the first influenza pandemic this century belong to influenza A H1N1 viruses, which are different from human seasonal H1N1 viruses in antigenic and genetic characterization. To better understand the genetic characteristics and evolution, timely detect variant strains with epidemiological importance, we analyzed in detail the molecular characterization of the early influenza A H1N1 (2009) virus.Genomic sequences of reference influenza viruses were obtained from Influenza Resource Center of GenBank. Sequences were analyzed using the EditSeq and Megalign program with the Lasergene sequence analysis software package (DNAStar, Madison, WI, USA). A/California/07/2009 (H1N1) was selected as a representative strains of the novel influenza A H1N1 (2009) virus, and its molecular characteristics was determined.A/California/07/2009 do not contained the molecular characteristics of highly pathogenic influenza virus, and its 11 proteins retained most of the molecular characteristics of swine influenza virus, but also had some characteristics of avian and human influenza viruses. With a classical swine H1N1 and human H1N1 dual character, PB1-F2 protein of A/California/07/2009 terminates after 11aa, 57aa and 87aa, which is a unique molecular characteristics of influenza H1N1 (2009) virus.This is the first report for detailed analysis of Molecular characteristics of the novel influenza A H1N1 (2009) virus. As the virus further adapt and persist in human populations, its molecular characteristics will change accordingly. So we should pay special attention to the effect on virus transmission and pathogenesis.

BACKGROUND: We investigated the seropositive rates and persistence of antibody against pandemic (H1N1) 2009 virus (pH1N1) in pregnant women and voluntary blood donors after the second wave of the pandemic in Nanjing, China. METHODOLOGY/PRINCIPAL FINDINGS: Serum samples of unvaccinated pregnant women (n = 720) and voluntary blood donors (n = 320) were collected after the second wave of 2009 pandemic in Nanjing. All samples were tested against pH1N1 strain (A/California/7/2009) with hemagglutination inhibition assay. A significant decline in seropositive rates, from above 50% to about 20%, was observed in pregnant women and voluntary blood donors fifteen weeks after the second wave of the pandemic. A quarter of the samples were tested against a seasonal H1N1 strain (A/Brisbane/59/2007). The antibody titers against pH1N1 strain were found to correlate positively with those against seasonal H1N1 strain. The correlation was modest but statistically significant. CONCLUSIONS AND SIGNIFICANCE: The high seropositive rates in both pregnant women and voluntary blood donors suggested that the pH1N1 virus had widely spread in these two populations. Immunity derived from natural infection seemed not to be persistent well.