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Scarlet fever has resurged in China starting in 2011, and the environment is one of the potential reasons. Nationwide data on 655,039 scarlet fever cases and six air pollutants were retrieved. Exposure risks were evaluated by multivariate distributed lag nonlinear models and a meta-regression model. We show that the average incidence in 2011–2018 was twice that in 2004–2010 [RR = 2.30 (4.40 vs. 1.91), 95% CI: 2.29–2.31; p, The reason for a re-emergence of scarlet fever in China remains unclear. Here the authors show that the number of scarlet fever cases surged in 2011 peaking in 2018, this correlates with an increase in NO2 and O3 but does not necessarily imply causation.

Background Influenza is a disease under surveillance worldwide with different seasonal patterns in temperate and tropical regions. Previous studies have conducted modeling of influenza seasonality using climate variables. This study aimed to identify potential meteorological factors that are associated with influenza seasonality in Jinan, China. Methods Data from three influenza sentinel hospitals and respective climate factors (average temperature, relatively humidity (RH), absolute humidity (AH), sunshine duration, accumulated rainfall and speed of wind), from 2013 to 2016, were collected. Statistical and wavelet analyses were used to explore the epidemiological characteristics of influenza virus and its potential association with climate factors. Results The dynamic of influenza was characterized by annual cycle, with remarkable winter epidemic peaks from December to February. Spearman’s correlation and wavelet coherence analysis illuminated that temperature, AH and atmospheric pressure were main influencing factors. Multiple wavelet coherence analysis showed that temperature and atmospheric pressure might be the main influencing factors of influenza virus A(H3N2) and influenza virus B, whereas temperature and AH might best shape the seasonality of influenza virus A(H1N1)pdm09. During the epidemic season, the prevalence of influenza virus lagged behind the change of temperature by 1–8 weeks and atmospheric pressure by 0.5–3 weeks for different influenza viruses. Conclusion Climate factors were significantly associated with influenza seasonality in Jinan during the influenza epidemic season and the optional time for influenza vaccination is before November. These finding should be considered in influenza planning of control and prevention.

Although vaccination is available, mumps remains a public health concern in many countries including China. Previous studies have indicated the impact of meteorological factors and mumps, but findings vary across different regions with limited evidence to inform local public health responses. We aim to examine the impacts of meteorological variables on mumps in Jinan, a temperate city of China, and explore the interactions of temperature with humidity or wind speed. Weekly meteorological data and notified cases of mumps in Jinan were collected for 2014–2018. Regression analyses using the generalized additive model were performed with considerations of multicollinearity, lag effects, school holidays, long-term trend, and seasonality. A stratification model was applied to investigate the interaction. We found a non-linear relationship between weekly mean temperature and the number of cases. Between 1.2 and 24.5 °C, the excess risk (ER) of mumps for a 1 °C increase in weekly mean temperature was 3.08% (95% CI 1.32 to 4.87%) at 0-week lag. The lagged effects could last for 3 weeks. There were interactions between mean temperature and relative humidity or wind speed. The effect of mean temperature was enhanced in days with low relative humidity or high wind speed. This study suggests that temperature is positively associated with mumps cases with thresholds in the temperate city of China, and the effect can be modified by relative humidity and wind speed and is independent of vaccine coverage. Findings could be integrated into current early warning systems of mumps in order to protect people’s health from the risk of changing climate.

Summary Background A re-emergence of scarlet fever has been noted in Hong Kong, South Korea, and England, UK, since 2008. China also had a sudden increase in the incidence of the disease in 2011. In this study, we aimed to assess the epidemiological changes before and after the upsurge. We also aimed to explore the reasons for the upsurge in disease in 2011, the epidemiological factors that contributed to it, and assess how these could be managed to prevent future epidemics. Methods In this observational study, we extracted the epidemiological data for all cases of scarlet fever between 2004 and 2016 in China from the Chinese Public Health Science Data Center, the official website of National Health Commission of the People's Republic of China, and the National Notifiable Infectious Disease Surveillance System. These data had been collected from 31 provinces and regions in China and included geographical, seasonal, and patient demographic information. We used descriptive statistical methods and joinpoint regression to examine the spatiotemporal patterns and annual percentage change in incidence of the upsurge of disease across China. Findings Between Jan 1, 2004, and Dec 31, 2016, 502 723 cases of scarlet fever, with ten fatalities, were reported in China, resulting in an annualised average incidence of 2·8807 per 100 000 people. The annual average incidence increased from 1·457 per 100 000 people in 2004 to 4·7638 per 100 000 people in 2011 (incidence rate ratio [IRR] 3·27, 95% CI 3·22–3·32; p

Background There is valid evidence that air pollution is associated with respiratory disease. However, few studies have quantified the short-term effects of six air pollutants on influenza-like illness (ILI). This study explores the potential relationship between air pollutants and ILI in Jinan, China. Methods Daily data on the concentration of particulate matters 2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) and ILI counts from 2016 to 2017 were retrieved. The wavelet coherence analysis and generalized poisson additive regression model were employed to qualify the relationship between air pollutants and ILI risk. The effects of air pollutants on different age groups were investigated. Results A total of 81,459 ILI counts were collected, and the average concentrations of PM2.5, PM10, O3, CO, SO2 and NO2 were 67.8 μg/m3, 131.76 μg/ m3, 109.85 μg/ m3, 1133 μg/ m3, 33.06 μg/ m3 and 44.38 μg/ m3, respectively. A 10 μg/ m3 increase in concentration of PM2.5, PM10, CO at lag0 and SO2 at lag01, was positively associated with a 1.0137 (95% confidence interval (CI): 1.0083–1.0192), 1.0074 (95% CI: 1.0041–1.0107), 1.0288 (95% CI: 1.0127–1.0451), and 1.0008 (95% CI: 1.0003–1.0012) of the relative risk (RR) of ILI, respectively. While, O3 (lag5) was negatively associated with ILI (RR 0.9863; 95%CI: 0.9787–0.9939), and no significant association was observed with NO2, which can increase the incidence of ILI in the two-pollutant model. A short-term delayed impact of PM2.5, PM10, SO2 at lag02 and CO, O3 at lag05 was also observed. People aged 25–59, 5–14 and 0–4 were found to be significantly susceptible to PM2.5, PM10, CO; and all age groups were significantly susceptible to SO2; People aged ≥60 year, 5–14 and 0–4 were found to be significantly negative associations with O3. Conclusion Air pollutants, especially PM2.5, PM10, CO and SO2, can increase the risk of ILI in Jinan. The government should create regulatory policies to reduce the level of air pollutants and remind people to practice preventative and control measures to decrease the incidence of ILI on pollution days.

Background Existing studies exploring the association between low birth weight (LBW) and maternal fine particulate matter (aerodynamic diameter 2.5 ) exposure have presented equivocal results, and one of the possible reasons for this finding might be due to relatively low maternal exposures. In addition, relatively narrow maternal exposure windows to PM 2.5 have not been well established for LBW. Methods We employed a nested matched case-control design among 43,855 term births in a large maternity and child care hospital in Jinan, China. A total of 369 cases were identified, and four controls per case matched by maternal age were randomly selected among those with normal birth weight (n = 1,476) from 2014 to 2016. Ambient air monitoring data on continuous measures of PM 2.5 , nitrogen dioxide (NO 2 ), and sulfur dioxide (SO 2 ) (24-h average concentrations) from 2013 to 2016 were collected from thirteen local monitoring stations. An inverse distance weighting method based on both home and work addresses was adopted to estimate the individual daily exposures to these air pollutants during pregnancy by weighting the average of the twelve nearest monitoring stations within 30 km of each 100 m × 100 m grid cell by an inverse squared distance, and then the average exposure concentrations for gestational months, trimesters and the entire pregnancy were calculated. Adjusted conditional logistic regression models were used to estimate the odds ratios (ORs) per 10 μg/m 3 increment in PM 2.5 and by PM 2.5 quartiles during different gestational periods. Results In this study, the estimated mean values of PM 2.5 , NO 2 , and SO 2 exposure during the entire pregnancy were 88.0, 54.6, and 63.1 μg/m 3 , respectively. Term low birth weight (TLBW) increased in association with per 10 μg/m 3 increment in PM 2.5 for the 8th month [OR = 1.13, 95% confidence interval (CI): 1.04, 1.22], the 9th month (OR = 1.06, 95% CI: 0.99, 1.15), the third trimester (OR = 1.17, 95% CI: 1.05, 1.29), and the entire pregnancy (OR = 1.38, 95% CI: 1.07, 1.77) in models adjusted for one pollutant (PM 2.5 ). In models categorizing the PM 2.5 exposure by quartiles, comparing the second, third, and highest with the lowest PM 2.5 exposure quartile, the PM 2.5 was positively associated with TLBW during the 8th month (OR: 1.77, 95% CI: 1.09, 2.88; OR: 1.77, 95% CI: 1.03, 3.04; OR: 1.92, 95% CI: 1.04, 3.55, respectively) and for the 9th month, only association for exposure in the third versus the lowest quartile was significant (OR: 1.91, 95% CI: 1.02, 3.58). Conclusions The study provides evidence that exposure to PM 2.5 during pregnancy might be associated with the risk of TLBW in the context of very high pollution level of PM 2.5 , and the 8th and 9th months were identified as potentially relevant exposure windows.

This study aimed at clarifying the association of maternal and neonatal methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms with preterm birth (PTB) and low birth weight (LBW) susceptibility, respectively. A systematic search of Embase, Medline, China Biological Medicine Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang Database was performed before June, 2016. The frequencies of maternal and neonatal MTHFR C677T genotypes in the cases and controls and other information were extracted by two independent investigators. Odds ratios (ORs) with 95% confidence intervals (CIs) were adopted to estimate the relationships between MTHFR C677T polymorphisms and PTB as well as LBW by random or fixed effect models. Twenty-five studies from 20 articles concerning maternal and neonatal MTHFR C677T gene polymorphism with PTB and LBW were included in this study. Maternal MTHFR C677T polymorphism was associated with PTB risk under allele contrast (T vs. C, OR = 1.36, 95% CI 1.02–1.81), homozygote (TT vs. CC, OR = 1.70, 95% CI 1.07–2.68), and recessive (TT vs. CT + CC, OR = 1.49, 95% CI 1.00–2.22) model, but not dominant or heterozygote model. Maternal MTHFR C677T polymorphism was also associated with LBW risk under allele contrast (OR = 1.69, 95% CI 1.25–2.28), homozygote (OR = 2.26, 95% CI 1.44–3.54), dominant (OR = 1.71, 95% CI 1.19–2.47), recessive (OR = 1.79, 95% CI 1.42–2.26) model, but not heterozygote model. No associations between neonatal MTHFR C677T polymorphism and PTB or LBW were found under all genetic models. Identification of maternal MTHFR C677T mutation may play a key role for primary prevention of PTB as well as LBW and screening pregnant women of high risk in developing countries.

Middle East respiratory syndrome coronavirus (MERS-CoV) was first isolated in 2012. The largest known outbreak outside the Middle East occurred in South Korea in 2015. As of 29 June 2016, 1769 laboratory-confirmed cases (630 deaths; 35.6 % case fatality rate [CFR]) had been reported from 26 countries, particularly in the Middle East. However, the CFR for hospital outbreaks was higher than that of family clusters in the Middle East and Korea. Here, we compared the mortality rates for 51 nosocomial outbreaks in the Middle East and one outbreak of MERS-CoV in South Korea. Our findings showed the CFR in the Middle East was much higher than that in South Korea (25.9 % [56/216] vs. 13.8 % [24/174], p = 0.003). Infected individuals who died were, on average, older than those who survived in both the Middle East (64 years [25–98] vs. 46 years [2–85], p = 0.000) and South Korea (68 years [49–82] vs. 53.5 years [16–87], p = 0.000). Similarly, the co-morbidity rates for the fatal cases were statistically higher than for the nonfatal cases in both the Middle East (64.3 % [36/56] vs. 28.1 % [45/160], p = 0.000) and South Korea (45.8 % [11/24] vs. 12.0 % [18/150], p = 0.000). The median number of days from onset to confirmation of infection in the fatal cases was longer than that for survivors from the Middle East (8 days [1–47] vs. 4 days [0–14], p = 0.009). Thus, older age, pre-existing concurrent diseases, and delayed confirmation increase the odds of a fatal outcome in nosocomial MERS-CoV outbreaks in the Middle East and South Korea. Electronic supplementary material The online version of this article (doi:10.1007/s00705-016-3062-x) contains supplementary material, which is available to authorized users.

Background: Aimed to investigate the association between the resurgence of scarlet fever and long-term exposure to air pollutants and weather conditions in China. Methods: Data on scarlet fever were from the National Notifiable Disease Reporting System. Air pollutants were from the National Environmental Protection Department, and weather conditions were from the National Meteorological Information Center. A lag non-linear model (DLNM) was used to estimate the excess risk of scarlet fever associated with air pollutants and weather conditions. Findings: 655,039 scarlet fever cases were reported during 2004-18. It started to surge in 2011 (4.7638 per 100 000), and peaked in 2018 (5.6736 per 100 000). The average incidence in 2011-18 was twice that in 2004-10 (rate ratio=2.302; 95% CI: 2.289-2.314; p

Background: To estimate age-standardized mortality rates and trends by province, year and age between 2004 to 2017 for 10 respiratory infectious diseases, including tuberculosis (TB), meningitis, seasonal influenza, 2009 pandemic influenza A (pH1N1), H5N1 avian influenza, measles, mumps, rubella, pertussis, and scarlet fever. Methods: This study used de-identified death records from the Notifiable Infectious Diseases Report Database, from the National Public Health Sciences Data Center, and from the official website of the National and Local Health Commissions of the People's Republic of China. Age-standardized mortality rates of 10 respiratory infections were analyzed by province, year, and age. Differences between provinces were tested over time by ArcGIS and a Poisson-based space-time scan statistics model, and trends in subcategories of respiratory related diseases assessed by Joinpoint Regression Analysis software. Findings: During 2004-2017, a total of 42 002 deaths due to 10 respiratory infectious diseases were recorded, accounting for 20.58% (42 002/204 087) of 39 notifiable infectious deaths in China. The age-standardized death rate was 0.3470/100 000 (95% CI (confidence interval): 0.2134-0.4805) nationally. Overall mortality of respiratory infectious diseases decreased across China, with an annual percentage change (APC) of -3.9% (95% CI: -9 to 1.5; P=0.1000) during 2004-2017. There were substantial differences among provinces in death rates from all respiratory infectious diseases. The highest mortality occurred in northwestern, western, and northern China. Tuberculosis was the leading cause of infectious disease mortality, accounting for 0.2512 (95% CI: 0.1554-0.3469) deaths per 100 000 persons (93.58%, 39 305/42 002 of total respiratory deaths). Mortality from tuberculosis decreased during 2004 to 2017, with APC (annual percent change) of -3.4% (95% CI -8.6 to 2, P=0.2000). Mortality from meningitis, pH1N1, H5N1, measles, mumps, rubella, pertussis, and scarlet fever also significantly decreased over the study period in China, nationwide. Influenza was the only cause of infectious disease mortality that increased from 2004 to 2017, reaching an annual age-standardized mortality rate of 0.0007/100 000 (95% CI: 0.0003-0.0011) and with APC of 16.90% (95% CI 4.60% to 30.70%; P=0.0103) across the whole of China. Interpretation: Between 2004 and 2017, there were declines in age-standardized death rates of nine categories of respiratory infectious diseases, with large differences among Chinese provinces. However, during this time there was an increase in mortality for seasonal influenza. Specific strategies and measures should be taken to reverse the increasing trends, e.g. expanding vaccination programs, early surveillance, and improved health care systems. Funding Statement: This work was supported by Zhejiang Provincial Natural Science Foundation (Grant number: LY17H260001) and Zhejiang Provincial Medical and Health Science and Technology program (Grant number: 2017KYA033). Declaration of Interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Ethical Approval Statement: This study was conducted according to the principles and guidelines of the Declaration of Helsinki, and was approved by the Research Ethics Committee of the Zhejiang Provincial Center for Disease Control and Prevention. All initial information identifying patients was anonymized in this study.

To understand control interventions, the molecular epidemiology of acute hemorrhagic conjunctivitis (AHC) was investigated from 2004 to 2014.A total of 613,485 AHC cases (annualized cases 55,771) with two deaths were included. Our findings showed that AHC was reported in all provinces, predominantly in Southern and Eastern China. The incidence rates were highest in 2007 (5.65/100,000) and 2010 (21.78/100,000) respectively. A clear seasonal pattern was identified with a peak from August to October. AHC cases occurred in all age groups; however, five to 14 years was the predominant group [23.06%, 133, 510/578,909]. The median age was 24 years (one month~97 years). The median duration from onset to diagnosis was 1.5 days, and there was no difference between the 60-year-old patients [p = 0.0653]. The phylogenetic analysis of 100 nonstructural proteins (3C) and 84 structural proteins (VP1) revealed that AHC outbreaks were caused by Coxsackievirus A24 variant. Genotypes G4-c5a, G4-c5b, and G4-c3 co-circulated with both temporal and geographical overlaps. In conclusion, despite the overall steady decline in the number of AHC cases since the peak in 2010, it still remains a serious public health problem in Southern and Eastern China that targets on the school aged children under 15 years old.

Objective: An epidemiological investigation was carried out in school X in Jinan, Shandong Province, China, to identify the cause, epidemiology, and etiological characteristics of a febrile respiratory disease outbreak; and therefore to control the dissemination. Methods: Both field epidemiological investigations and laboratory examinations were carried out. Results: Forty cases were identified, in which 38 cases were students and two were teachers. Clinical manifestations included fever, coughing, headache, and sore throat. A total of 21 pharyngeal swab specimens were collected and 18 tested positive for adenovirus. The adenovirus hexon gene was sequenced in three of the 18 positive specimens and the results showed a 100% homology with the standard HAdV-55 HEXO. Conclusions: The outbreak originated from an adenovirus-infected student, who spread the pathogen to her classmates and teacher. The teacher then further disseminated the disease within the school which led to 40 febrile respiratory infections.

Use of inactivated poliovirus vaccine (IPV) in Jinan during the polio eradication endgame has not been previously documented. Two IPV-containing vaccines were made available as an option for Jinan parents in 2009. We describe coverage levels and patterns of use of IPV over time using data from the Jinan Childhood Immunization Information Management System (JNCIIMS).Children born between January 2010 and December 2014 who were registered in JNCIIMS were included in this study. Vaccination records were obtained from JNCIIMS on April 30, 2015. JNCIIMS distinguishes among available poliovirus vaccines; doses administered data were used to describe IPV usage over time. We identified the polio vaccination sequences used by children in the 2012 and 2013 birth cohorts. Coverage estimates were analyzed by birth cohort and migration status. We developed 3 categories for analysis: "resident child," "migrant child" and "other child" according to migration status.In total, 12,354 (11.7%) IPV, 5,893(5.6%) DTP-IPV-Hib vaccine and 87,054(82.7%) OPV doses were administered to children in the 2010 to 2014 birth cohorts. The proportion of children using an IPV-only schedule increased each year, consistent with the introduction of IPV that is called for by the Polio Eradication Endgame Strategic Plan 2013-2018. During this time, 4.7% children used a schedule containing both IPV and oral poliovirus vaccine (OPV). In the 2012 to 2013 birth cohorts, 14.4% children used an IPV-only schedule; 5.7% children used a sequential schedule, and 79.9% used OPV-only schedule. Use of IPV only schedules was higher among migrant children than among resident children. Among those sequential schedule using both IPV and OPV, 87.2% children used IPV for the first dose and 12.8% used OPV for the first dose.JNCIIMS provided a mechanism for tracking IPV and OPV vaccination patterns, and showed areas in need of improvement. Ensuring appropriately sequenced IPV and OPV supports reduction of risk of vaccine associated paralytic polio.

Background Varicella remains an important public health issue in China. In this study we explored the effect of weather conditions on the incidence of varicella in the temperate city of Jinan, Eastern China during 2012–2014 to inform public health prevention and control measures. Methods Data on reported cases of varicella were obtained from National Notifiable Disease Report System. Meteorological data for the same time period were obtained from the Jinan Meteorological Bureau. A negative binomial regression model was used to assess the relationships between meteorological variables and the incidence of varicella. Given collinearity between average temperature and atmospheric pressure, separate models were constructed: one including average temperature without atmospheric pressure, the other including atmospheric pressure but without average temperature. Both models included relative humidity, wind velocity, rainfall, sunshine, and year as independent variables. Results Annual incidence rates of varicella were 44.47, 53.69, and 46.81 per 100,000 for 2012, 2013, and 2014, respectively. Each increase of 100 Pa (hPa) in atmospheric pressure was estimated to be associated with an increase in weekly incidence of 3.35 % (95 % CI = 2.94–3.67 %), while a 1 °C rise in temperature was associated with a decrease of 3.44 % (95 % CI = −3.73–3.15 %) in the weekly incidence of varicella. Similarly, a 1 % rise in relative humidity corresponded to a decrease of 0.50 % or 1.00 %, a 1 h rise in sunshine corresponded to an increase of 1.10 % or 0.50 %, and a 1 mm rise in rainfall corresponded to an increase of 0.20 % or 0.30 %, in the weekly incidence of varicella cases, depending on the variable considered in the model. Conclusion Our findings show that weather factors have a significant influence on the incidence of varicella. Meteorological conditions should be considered as important predictors of varicella incidence in Jinan, Eastern China.

To analyze the status of acute upper respiratory infection and influenza-like illness (ILI) among community residents in Jinan in 2015, and to make a understand of the patient's medical treatment behavior and influenza vaccination coverage status in 2014.Balloting method and convenient sampling method were used to launch a household survey. The residents who had been in Jinan for more than 3 months were selected, to investigate the residents' attack ratio of acute upper respiratory and influenza-like from Jan. 8 to Feb. 7, 2015. Totally, 1 300 persons from 410 families were involved in this survey which recovered 1 241 valid questionnaires with the efficiency of 95.5%. Based on the national age-urban demographic statistics in 2010, the attack rates of acute respiratory infections, influenza-like illness were estimated by the direct standardization method, and the influenza vaccination rates were also calculated in this study. χ(2)-test method was used to compare the different status of incidence and vaccination among residents with different features.The attack rate of acute upper respiratory infection and influenza-like illness in Jinan from January 8, 2015 to February 7, 2015 were 30.2% (375 cases), and 6.1% (76 cases), respectively, with a standardized rate of 29.1% and 5.4%. 5.3% (66 cases) of the residents have vaccinated with the influenza vaccine inoculation, with an adjusted rate of 3.8%. The attack rate difference of acute upper respiratory tract infections was statistically significant between each age group (χ(2)=17.121, P= 0.002). The 0-4 age group had a highest attack rate (45.4%) of acute respiratory infection, while the 15-24 age group got the lowest (26.5%). 38.9% (146 cases) of patients went for a treatment in hospital. Among them, 37.7% (55 cases) of them selected the county level hospitals for treatment, 37.7% (55 cases) selected the community level hospitals, and 24.6% (36 cases) selected the individual clinic. Significant differences of influenza-like illness attack rate between each age group were also found in this study (χ(2)=76.79, P0.001). 0-4 age group had the highest attack rate (22.7%). 81.6% (62 cases) of the ILI sought treatment in the hospital, of which 53.2% (33 cases) selected county level hospital or above, and 33.9% (21 cases) selected community hospital, and 12.9% (8 cases) selected the individual clinic.The attack rate of acute upper respiratory infections among the residents of Jinan was high, whereas that of influenza-like illness was relatively low. 0-4 age group had a higher risk of ILI than other age groups. Most of the cases were likely to take the treatment in large hospitals. In general, the coverage rate of influenza vaccination was relatively low.

To investigate the effect of weather patterns on the incidence of hand foot and mouth disease (HFMD) in Jinan.HFMD confirmed cases aged ≤5 years old for the period of 2012-2014 were collected from National Notifiable Disease Report System (NNDRS). Simultaneous meteorological data, including daily average temperature, relative humidity, atmospheric pressure, wind velocity, rainfall and duration of sunshine were obtained from the website of Jinan meteorological bureau. A negative binomial multivariable regression was used to identify the relationship between meteorological variables and HFMD.During the study period, a total of 40 405 HFMD cases aged ≤5 years old were reported. The incident peak occurred from May to July, a total of 22 254 cases were reported during this period, which accounted for 55.08% of whole cases. After adjusting by "year", each 1 °C rise of weekly average temperature corresponded to an increase of 6.70% (95%CI:6.35% to 7.06%) in the weekly number of HFMD cases, while a 1 kPa rise of weekly average atmospheric pressure corresponded to a decrease in the number of cases by 44.77% (95%CI: -46.23% to -41.91%). Likewise, a one percent rise in weekly average relative humidity corresponded to an increase of 1.96% (95%CI: 1.84% to 2.09%), a 1 m/h rise in weekly average wind velocity corresponded to an increase of 16.63% (95% CI:14.08% to 19.25%), a hour add in weekly duration of sunshine corresponded to a decrease of 0.82% (95% CI : -0.93% to -0.72%), in the weekly number of HFMD cases.Weather factors including temperature, atmospheric pressure, relative humidity, wind velocity, and duration of sunshine had a significant influence on occurrence and transmission of HFMD in Jinan city.

The largest nosocomial outbreak of Middle East respiratory syndrome (MERS) occurred in South Korea in 2015. Health Care Personnel (HCP) are at high risk of acquiring MERS-Coronavirus (MERS-CoV) infections, similar to the severe acute respiratory syndrome (SARS)-Coronavirus (SARS-CoV) infections first identified in 2003. This study described the similarities and differences in epidemiological and clinical characteristics of 183 confirmed global MERS cases and 98 SARS cases in Taiwan associated with HCP. The epidemiological findings showed that the mean age of MERS-HCP and total MERS cases were 40 (24~74) and 49 (2~90) years, respectively, much older than those in SARS [SARS-HCP: 35 (21~68) years, p = 0.006; total SARS: 42 (0~94) years, p = 0.0002]. The case fatality rates (CFR) was much lower in MERS-HCP [7.03% (9/128)] or SARS-HCP [12.24% (12/98)] than the MERS-non-HCP [36.96% (34/92), p

When discussing the association between birth weight and air pollution, previous studies mainly focus on the maternal trimester-specific exposures during pregnancy, whereas the possible associations between birth weight and weekly-specific exposures have been largely neglected. We conducted a nested 1:4 matched case-control study in Jinan, China to examine the weekly-specific associations during pregnancy between maternal fine particulate matter (aerodynamic diameter

To investigate the epidemiological characteristics of human infections with avian influenza A (H7N9) in China and to provide scientific evidence for the adjustment of preventive strategy and control measures.Demographic and epidemiologic information on human cases were collected from both reported data of field epidemiological investigation and the reporting system for infectious diseases.A total of 433 cases including 163 deaths were reported in mainland China before June 4, 2014. Two obvious epidemic peaks were noticed, in March to April, 2013 and January to February, 2014. Confirmed cases emerged in 14 areas of China. Five provinces, including Zhejiang, Guangdong, Jiangsu, Shanghai, and Hunan, reported about 85% of the total cases. Median age of the confirmed cases was 58 years (range, 1-91), with 70% as males. Of the 418 cases with available data, 87% had ever exposed to live poultry or contaminated environments. 14 clusters were identified but human to human transmission could not be ruled out in 9 clusters.Human infections with avian influenza A (H7N9) virus showed the characteristics of obvious seasonal distribution, with certain regional clusters. The majority of confirmed cases were among the elderly, with more males seen than the females. Data showed that main source of infection was live poultry and the live poultry market had played a significant role in the transmission of the virus.

To the Editor: Since the first avian influenza virus (H5N1) was isolated from a goose in the southern region of the People’s Republic of China a decade ago (1), no poultry outbreak has been reported in Shandong Province in eastern China, although adjacent provinces have experienced an avian influenza epidemic (2). In fall 2008, several rounds of investigation of poultry farms and markets were conducted in Jinan, Shandong Province, and no influenza virus (H5N1) was isolated by reverse transcription–PCR (RT-PCR) from 19,340 poultry oropharyngeal, cloacal, and cage specimens. However, a fatal influenza (H5N1) infection in a human was identified on January 17, 2009 (3). The patient was a 27-year-old woman from Jinan. Influenza-like illness (ILI) developed on January 5, and the patient received intravenous ribavirin and cephalosporins on January 9. On January 11, she was hospitalized for fever (41°C) and respiratory symptoms. On January 15, extensive infiltration in both lungs developed; the diagnosis was pneumonia of unknown etiology. Early on January 17, she underwent endotracheal intubation. She died of acute respiratory distress syndrome and multiple organ failure later that day. Two endotracheal aspirates collected on January 17 were positive for influenza virus (H5N1) and for genes encoding matrix protein by real-time PCR and RT-PCR. However, throat swabs collected on January 15 and 16 had been negative even after repeated testing (Table). The influenza virus (H5N1) was isolated on January 22 after 48-hour culture and named A/Shandong/1/2009(H5N1). Whole-genome sequencing showed that all segments were of avian origin. The hemagglutinin gene and amino acid sequences of this virus were highly homologous with 24 strains of influenza virus (H5N1) isolated during 2005–2008 in China. There was no change in the hemagglutinin cleavage or the receptor binding sites or in the neuraminidase gene conferring oseltamivir resistance (4). Nevertheless, mutations in the matrix 2 gene indicated amantadine resistance (5). Table Clinical specimens collected from patient with fatal avian influenza virus (H5N1) infection and test results, Shandong Province, China* The patient was a stay-at-home mother with a daughter 20 months of age. Her husband operated a barbecue food stand. The raw poultry ingredients (duck blood and chicken hearts) for the barbecue were washed and processed at home, and the patient may have had unprotected contact with raw poultry products. However, the patient did not raise poultry, did not have contact with sick or dead poultry, had not visited a poultry market recently, and had not consumed sick or dead poultry or raw poultry food. No influenza virus (H5N1) was detected by RT-PCR from the raw duck blood and chicken hearts saved in the patient’s home refrigerator or at the poultry seller where the duck blood and chicken hearts originated. No influenza virus (H5N1) was detected by RT-PCR from 448 poultry oropharayngeal and cloacal specimens collected from the live poultry markets immediately after the virus was identified in the patient. The patient’s close contacts (157 persons), including family members and healthcare professionals, were isolated and monitored medically for 7 days according to the Chinese Center for Disease Control and Prevention guidelines, but without chemoprophylaxis because oseltamivir was unavailable. ILI did not develop in any of these persons, and all had negative results for immunoglobulin M against influenza (H5N1) virus. During January 17–23, all 9,865 clinic or hospital visitors with respiratory symptoms in the patient’s residential region were interviewed; 829 had fever and 586 had ILI. All recovered quickly without treatment. Persons (537) with frequent exposure to poultry were monitored; ILI did not develop in any person. This case was comparable to some other influenza (H5N1) infections in humans without identified sources of exposure (6,7). The virus for this case might have come from infected poultry products in the barbecue raw ingredients. Viremic blood from infected poultry can contaminate raw poultry products. It is also possible that blood was contaminated from poultry struggling during blood collection. The shared kitchen for cooking and raw poultry product processing might be the place where viral transmission occurred. Although the patient had no direct contact with raw poultry products, the shared utensils might have acted as vectors for transmission. Consequently, Jinan enhanced public education to increase awareness of personal protection for persons with direct contact with poultry or poultry raw products and their family members. The failure to use oseltamivir resulted from lack of alertness and preparedness by healthcare professionals for influenza (H5N1) infection because no human influenza (H5N1) infection had been reported in Shandong Province. The lack of a local oseltamivir reserve also precluded timely oseltamivir use. In response to this public health incident, Jinan enhanced education on self-protection, case management, empirical oseltamivir use, and emergency response to influenza by healthcare and public health professionals, in addition to building a local oseltamivir reserve. These efforts led to preparedness and timely treatment with oseltamivir during the second case of influenza pandemic (H1N1) 2009 infection in China on May 11, 2009 (8). Because influenza viruses (H5N1) can replicate efficiently only in cells of the lower respiratory tract where the avian virus receptor is prevalent (9), it is better to collect lower respiratory tract specimens early for laboratory testing. Given that early oseltamivir administration is critical and most effective (10), oseltamivir should be administered quickly to patients with pneumonia of unknown etiology without waiting for laboratory confirmation of influenza infection.

Background H7N9 human cases were first detected in mainland China in March 2013. Circulation of this virus has continued each year shifting to typical winter months. We compared the clinical and epidemiologic characteristics for the first three waves of virus circulation. Methods The first wave was defined as reported cases with onset dates between March 31-September 30, 2013, the second wave was defined as October 1, 2013-September 30, 2014 and the third wave was defined as October 1, 2014-September 30, 2015. We used simple descriptive statistics to compare characteristics of the three distinct waves of virus circulation. Results In mainland China, 134 cases, 306 cases and 219 cases were detected and reported in first three waves, respectively. The median age of cases was statistically significantly older in the first wave (61 years vs. 56 years, 56 years, p