Hepatitis A virus(HAV)is transmitted via the fecal-oral route,causing not only self-limited infectious hepatitis,but also epidemics through close personal contact(s).HAV infection is prevalent worldwide,and it is esti...Hepatitis A virus(HAV)is transmitted via the fecal-oral route,causing not only self-limited infectious hepatitis,but also epidemics through close personal contact(s).HAV infection is prevalent worldwide,and it is estimated that HAV infections account for 1.4 million sporadic or epidemic cases per year worldwide[1].展开更多
Objective This study aims to investigate the infection of Clonorchis sinensis(C.sinensis)in highincidence areas of Hunan Province,China.The phylogenetic analysis of the C.sinensis species in the highly infected areas ...Objective This study aims to investigate the infection of Clonorchis sinensis(C.sinensis)in highincidence areas of Hunan Province,China.The phylogenetic analysis of the C.sinensis species in the highly infected areas was carried out.Method Infection of the definitive human host and intermediate fish host by C.sinensis was investigated,and the mitochondrial genes cox1 and Nad1 were used as genetic markers for phylogenetic analysis.Results In 2016–2020,the average population infection rate of Hunan was 1.38%,while in Tongdao County the rate was up to 26.90%,and the highest fish infection rate was detected in Qiyang County(99.44%in the dorsal fin of crucian carp).High genetic sequence similarity was observed in the samples from Qiyang and Lengshuitan which exhibited high homology with those from Guangdong and Gansu,whereas the parasitic species from Tongdao was highly homologous with those located in high-latitude areas.Moreover,no significant difference was found in the gene sequence of the parasitic species in definitive hosts dogs and cats.Conclusion The systematically study of C.sinensis infection in the high-incidence areas will contribute greatly to the prevention and effectively controlling the spread of Clonorchis sinensis in Hunan Province The endemic of C.sinensis infection in Hunan Province is the result of co-action of local and foreign parasite species.展开更多
On December 14, 2017, a faculty member of a university in Hunan Province reported that an anthrax vaccine strain might have recovered virulence during an undergraduate experiment and potential exposure could not be ru...On December 14, 2017, a faculty member of a university in Hunan Province reported that an anthrax vaccine strain might have recovered virulence during an undergraduate experiment and potential exposure could not be ruled out for the students involved. Upon receiving the case report, the CDC, health bureaus, and local governments at the county, prefectural, and provincial levels promptly organized experts in different fields (including epidemiologists, biosafety experts, and laboratory testing experts) for case investigation, evaluation, and response. As the investigation results showed, no virulence recovery was identified in the involved anthrax vaccine strain;and no contamination of Bacillus anthracis was detected at the involved areas. Thus, the university returned to normal functioning.展开更多
Objective In March 2012, an H7N7 subtype avian influenza virus （AIV） named A/wild goose/Dongting/PC0360/2022 （H7N7） （DT/PC0360） was recovered from a wild goose in East Dongting Lake. We performed whole-genome se...Objective In March 2012, an H7N7 subtype avian influenza virus （AIV） named A/wild goose/Dongting/PC0360/2022 （H7N7） （DT/PC0360） was recovered from a wild goose in East Dongting Lake. We performed whole-genome sequencing of the isolate, and analyzed the phylogenetic and molecular characterization. Methods RNA was extracted from environment samples （including fecal samples from wild bird or domestic ducks, and water samples） for detecting the presence of Influenza A Virus targeting Matrix gene, using realtime RT-PCR assay. The positive samples were performed virus isolation with embryonated eggs. The subtype of the isolates were identified by RT-PCR assay with the HI-HI6 and N1-N9 primer set. The whole-genome sequencing of isolates were performed. Phylogenetic and molecular characterizations of the eight genes of the isolates were analyzed. Results Our results suggested that all the eight gene segments of DT/PC0360 belonged to the Eurasian gene pool, and the HA gene were belonged to distinct sublineage with H7N9 AIV which caused outbreaks in China's Mainland in 2013. The hemagglutinin cleavage site of HA of DT/PC0360 showed characterization of low pathogenic avian influenza virus. Conclusion Strengthening the surveillance of AlVs of wild waterfowl and poultry in this region is vita for our knowledge of the ecology and mechanism of transmission to prevent an influenza pandemic.展开更多
Introduction:Coxsackievirus A6(CVA6)has emerged as a significant pathogen responsible for severe cases of hand,foot,and mouth disease(HFMD).This study aims to delineate the demographic characteristics and analyze the ...Introduction:Coxsackievirus A6(CVA6)has emerged as a significant pathogen responsible for severe cases of hand,foot,and mouth disease(HFMD).This study aims to delineate the demographic characteristics and analyze the viral evolution of severe HFMD associated with CVA6,thereby assisting in its surveillance and management.Methods:In this investigation,74 strains of CVA6 were isolated from samples collected from severe HFMD cases between 2012 and 2023.The VP1 gene sequences of CVA6 were amplified and analyzed to assess population historical dynamics and evolutionary characteristics using BEAST,DnaSP6,and PopART.Results:A significant portion(94.4%)of severe CVA6-associated HFMD cases(51 out of 54,with 20 lacking age information)were children under 5 years old.Among the 74 CVA6 strains analyzed,72 belonged to the D3a sub-genotype,while only two strains were D2 sub-genotype.The average genetic distance between VP1 sequences prior to 2015 was 0.027,which increased to 0.051 when compared to sequences post-2015.Historical population dynamics analysis indicated three significant population expansions of severe CVA6-associated HFMD during 2012-2013,2013-2014,and 2019-2020,resulting in the formation of 65 distinct haplotypes.Consistent with the MCC tree findings,transitioning between regional haplotypes required multiple base substitutions,showcasing an increase in population diversity during the evolutionary process(from 14 haplotypes in 2013 to 55 haplotypes over the subsequent decade).Conclusions:CVA6,associated with severe HFMD,is evolving and presents a risk of outbreak occurrence.Thus,enhanced surveillance of severe HFMD is imperative.展开更多
Enteroviruses(EVs)species A are a major public health issue in the Asia–Pacific region and cause frequent epidemics of hand,foot and mouth disease(HFMD)in China.Mild infections are common in children;however,HFMD can...Enteroviruses(EVs)species A are a major public health issue in the Asia–Pacific region and cause frequent epidemics of hand,foot and mouth disease(HFMD)in China.Mild infections are common in children;however,HFMD can also cause severe illness that affects the central nervous system.To molecularly characterize EVs,a prospective HFMD virological surveillance program was performed in China between 2013 and 2016.Throat swabs,rectal swabs and stool samples were collected from suspected HFMD patients at participating hospitals.EVs were detected using generic real-time and nested reverse transcription-polymerase chain reactions(RT-PCRs).Then,the complete VP1 regions of enterovirus A71(EV-A71),coxsackievirus A16(CVA16)and CVA6 were sequenced to analyze amino acid changes and construct a viral molecular phylogeny.Of the 2836 enrolled HFMD patients,2,517(89%)were EV positive.The most frequently detected EVs were CVA16(32.5%,819),CVA6(31.2%,785),and EV-A71(20.4%,514).The subgenogroups CVA16B1 b,CVA6D3 a and EV-A71C4 a were predominant in China and recombination was not observed in the VP1 region.Sequence analysis revealed amino acid variations at the 30,29 and 44 positions in the VP1 region of EV-A71,CVA16 and CVA6(compared to the respective prototype strains Br Cr,G10 and Gdula),respectively.Furthermore,in 21 of 24(87.5%)identified EV-A71 samples,a known amino acid substitution(D31 N)that may enhance neurovirulence was detected.Our study provides insights about the genetic characteristics of common HFMD-associated EVs.However,the emergence and virulence of the described mutations require further investigation.展开更多
We studied the disinfection effect of a new ultraviolet （UV） sterilizer and its utilization on ultrasound probe surfaces. Carrier quantitative germicidal tests, simulated on-the-spot trials, and organic substance in...We studied the disinfection effect of a new ultraviolet （UV） sterilizer and its utilization on ultrasound probe surfaces. Carrier quantitative germicidal tests, simulated on-the-spot trials, and organic substance influence tests were used to carry out experimental observation. Artificially infected probes were disinfected using the sterilizer or a germicidal lamp for comparison. The total number and types of bacteria were determined and identified. Our results demonstrated the sterilizer had the best disinfection effect among three different disinfection methods in hospital. The sterilizer has been used in a hospital setting for 2 years with no notable damage to the ultrasound probe instrument. It has the advantages of fast disinfection, high disinfection effect, and good compatibility with the ultrasound instrument, worthy of being a promoted application in medical institutions.展开更多
Monitoring changes in the epidemiologic features between different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants is key to understanding the evolution of viral fitness in the host population.Here...Monitoring changes in the epidemiologic features between different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants is key to understanding the evolution of viral fitness in the host population.Here,we analyzed a successfully contained local outbreak of the Delta variant that took place in Hunan,China,in July–August,2021.Detailed data on SARS-CoV-2 infections and their contacts were collected during the outbreak.By leveraging these data,we estimated key epidemiological parameters,including the incubation period,serial interval,and generation time.We constructed a generalized linear mixed-effects model(GLMM)to quantify risk factors for Delta infection and transmission.Between July 28 and August 15,2021,a total of 129 infections and their 2,118 close contacts were identified during the outbreak in Hunan Province.展开更多
The coronavirus disease 2019(COVID-19)pandemic remains a significant global health challenge.Older adults are the population at high risk of developing severe COVID-19 or death[1–3].To date,dozens of vaccines for pro...The coronavirus disease 2019(COVID-19)pandemic remains a significant global health challenge.Older adults are the population at high risk of developing severe COVID-19 or death[1–3].To date,dozens of vaccines for prototype severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)have received emergency use authorization or conditional marketing approval in many countries[4].ZF2001,a protein subunit vaccine comprising two copies of tandem receptor-binding domain(RBD)from prototype SARS-CoV-2(HB-02 strain)[5,6],has demonstrated safety and immunogenicity in populations aged 3–17 and 18–59 after three doses of vaccination[7,8].Moreover,it has shown good efficacy in the prevention of symptomatic COVID-19 caused by infections from the alpha,kappa,and delta variants after a six-month follow-up for adults beyond 18 years of age in a phase 3 trial[9].ZF2001 was safe and well-tolerated in a large cohort of adults(R18 years of age),and the incidence of adverse events was lower among the participants 60 years of age or older than among those aged 18–59[9].However,its durability and immunogenicity in individuals 60 years of age and older have not been reported and need further investigation.Here,we reported the phase 1 trial of ZF2001 in adults aged 60 or older in China to determine the safety,tolerability,and immunogenicity of ZF2001 in older populations after short(1 month)-and long(6 months)-term follow-up.Moreover,we conducted a post-hoc analysis of serum samples to assess their neutralization capacity against omicron variants.展开更多
Background:Low-fee female sex workers(FSWs)are at high risk of acquiring and spreading human immunodeficiency virus(HIV)/sexually transmitted diseases(STDs)in China.There is an urgent need to develop comprehensive int...Background:Low-fee female sex workers(FSWs)are at high risk of acquiring and spreading human immunodeficiency virus(HIV)/sexually transmitted diseases(STDs)in China.There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections.Thus,this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair,comiDunity-based randomized intervention trial carried out in 12 cities in three provinces in China.Methods:Four cities from Guangxi Zhuang Autonomous Region,four from Yunnan Province,and four from Hunan Province were paired and participants received either the intervention package(including condom promotion,HIV and syphilis testing,reimbursement for syphilis treatment costs,and free anti-retroviral therapy or the current standard of care.Venue-based,convenience sampling was used to recruit FSWs.A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months.Generalized linear mixed models(GLMM)were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs.Results:A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up.GLMM results showed that syphilis infeaion was reduced by 49%in the intervention group compared to the current standard of care group(P=0.0378,OR=0.51;95%CI:0.27-0.96).FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old(P<0.0001,OR=2.38,95%CI:1.55-3.65).The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education(P<0.05,OR=0.43,95%CI:0.63-0.93).Conclusions:This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs.Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs.Trial registration:CHiCTR-TRC-12002655.展开更多
Biological experiments and epidemiological evidence indicate that variations in environment have important effect on the occurrence and transmission of epidemic influenza.It is therefore important to understand the ch...Biological experiments and epidemiological evidence indicate that variations in environment have important effect on the occurrence and transmission of epidemic influenza.It is therefore important to understand the characteristic patterns of transmission for prevention of disease and reduction of disease burden.Based on case records,we analyzed the environmental characteristics including climate variables in Changsha,and then constructed a meteorological anomaly susceptive-infective-removal (SIR) model on the basis of the results of influenza A (H1N1) transmission.The results showed that the outbreak of influenza A (H1N1) in Changsha showed significant correlation with meteorological conditions;the spread of influenza was sensitive to meteorological anomalies,and that the outbreak of influenza A (H1N1) in Changsha was influenced by a combination of absolute humidity anomalous weather conditions,contact rates of the influenza patients and changes in population movements.These findings will provide helpful information regarding prevention strategies under different conditions,a fresh understanding of the emergence and re-emergence of influenza outbreaks,and a new perspective on the transmission dynamics of influenza.展开更多
Summary What is already known about this topic?The number of newly diagnosed human immunodeficiency virus(HIV)cases among Chinese youth 15–24 years of age shows an upward trend between 2010 and 2019.What is added by ...Summary What is already known about this topic?The number of newly diagnosed human immunodeficiency virus(HIV)cases among Chinese youth 15–24 years of age shows an upward trend between 2010 and 2019.What is added by this report?This survey is on a larger scale as compared to previous studies.It shows inadequate HIV knowledge—especially on HIV treatment,self-testing,and postexposure prophylaxis—among college students.A significant gap exists between knowledge and behavior as indicated by the low condom use rate despite a high knowledge level.展开更多
Here,we report the identification of Histoplasma causing an unexplained disease cluster in Matthews Ridge,Guyana.In March 2019,14 employees of Chongqing Bosai Mining Company,China,working in a manganese mining of Guya...Here,we report the identification of Histoplasma causing an unexplained disease cluster in Matthews Ridge,Guyana.In March 2019,14 employees of Chongqing Bosai Mining Company,China,working in a manganese mining of Guyana,had unexplained fever,and two of them died.We obtained lung and brain tissues as well as the blood samples from the two deceased cases(patient No.1 and 2),and bronchoscopy lavages and cerebrospinal fluid samples from one severe case(patient No.3),respectively.All samples were tested by pathological examination,high-throughput sequencing,and real-time PCR.Pathological detection showed the presence of spore-like structures in the lung tissue of patient No.1,indicating a fungal infection in this patient.Nanopore sequencing identified the existing of H.capsulatum in the lung tissue sample within 13 h.Next-generation sequencing identified specific fragments of H.capsulatum in all of the samples tested(lung,brain and blood serum from the deceased cases,and plasma from the severe case).Real-time PCR assays did not reveal any viral infection related to transmission from bat feces.We conclude that H.capsulatum was the causative pathogen of this disease cluster based on epidemiologic,clinical,pathological and nucleic acid evidence.展开更多
Changsha was one of the most affected areas during the 2009 A(H1N1)influenza pandemic in China.Here,we analyze the spatial–temporal dynamics of the 2009 pandemic across Changsha municipal districts,evaluate the relat...Changsha was one of the most affected areas during the 2009 A(H1N1)influenza pandemic in China.Here,we analyze the spatial–temporal dynamics of the 2009 pandemic across Changsha municipal districts,evaluate the relationship between case incidence and the local urban spatial structure and predict high-risk areas of influenza A(H1N1).We obtained epidemiological data on all cases of influenza A(H1N1)reported across municipal districts in Changsha during period May 2009–December 2010 and data on population density and basic geographic characteristics for 239 primary schools,97 middle schools,347 universities,96 malls and markets,674 business districts and 121 hospitals.Spatial–temporal K functions,proximity models and logistic regression were used to analyze the spatial distribution pattern of influenza A(H1N1)incidence and the association between influenza A(H1N1)cases and spatial risk factors and predict the infection risks.We found that the 2009 influenza A(H1N1)was driven by a transmission wave from the center of the study area to surrounding areas and reported cases increased significantly after September 2009.We also found that the distribution of influenza A(H1N1)cases was associated with population density and the presence of nearest public places,especially universities(OR=10.166).The final predictive risk map based on the multivariate logistic analysis showed high-risk areas concentrated in the center areas of the study area associated with high population density.Our findings support the identification of spatial risk factors and highrisk areas to guide the prioritization of preventive and mitigation efforts against future influenza pandemics.展开更多
Background:The current outbreak of novel coronavirus disease 2019 has caused a seriousdisease burden worldwide.Vaccines are an important factor to sustain the epidemic.Although with a relatively high-vaccination world...Background:The current outbreak of novel coronavirus disease 2019 has caused a seriousdisease burden worldwide.Vaccines are an important factor to sustain the epidemic.Although with a relatively high-vaccination worldwide,the decay of vaccine efficacy andthe arising of new variants lead us to the challenge of maintaining a sufficient immunebarrier to protect the population.Method:A case-contact tracking data in Hunan,China,is used to estimate the contactpattern of cases for scenarios including school,workspace,etc,rather than ordinary susceptible population.Based on the estimated vaccine coverage and efficacy,a multi-groupvaccinated-exposed-presymptomatic-symptomatic-asymptomatic-removed model(VEFIAR)with 8 age groups,with each partitioned into 4 vaccination status groups isdeveloped.The optimal dose-wise vaccinating strategy is optimized based on the currentlyestimated immunity barrier of coverage and efficacy,using the greedy algorithm thatminimizes the cumulative cases,population size of hospitalization and fatality respectivelyin a certain future interval.Parameters of Delta and Omicron variants are used respectivelyin the optimization.Results:The estimated contact matrices of cases showed a concentration on middle ages,and has compatible magnitudes compared to estimations from contact surveys in otherstudies.The VEFIAR model is numerically stable.The optimal controled vaccination strategy requires immediate vaccination on the un-vaccinated high-contact population of age30e39 to reduce the cumulative cases,and is stable with different basic reproductionnumbers(R_(0)).As for minimizing hospitalization and fatality,the optimized strategy requires vaccination on the un-vaccinated of both aged 30e39 of high contact frequencyand the vulnerable older.Conclusion:The objective of reducing transmission requires vaccination in age groups ofthe highest contact frequency,with more priority for un-vaccinated than un-fully or fullyvaccinated.The objective of reducing total hospitalization and fatality requires not only toreduce transmission but also to protect the vulnerable older.The priority changes byvaccination progress.For any region,if the local contact pattern is available,then with thevaccination coverage,efficacy,and disease characteristics of relative risks in heterogeneouspopulations,the optimal dose-wise vaccinating process will be obtained and gives hintsfor decision-making.展开更多
Human influenza viruses preferentially bind to sialic acid-α2,6-galactose (SAα2,6Gal) receptors, which are predominant in human upper respiratory epithelia, whereas avian influenza viruses preferentially bind to SA...Human influenza viruses preferentially bind to sialic acid-α2,6-galactose (SAα2,6Gal) receptors, which are predominant in human upper respiratory epithelia, whereas avian influenza viruses preferentially bind to SAα2,3Gal receptors. However, variants with amino acid substitutions around the receptor-binding sites of the hemagglutinin (HA) protein can be selected after several passages of human influenza viruses from patients’ respiratory samples in the allantoic cavities of embryonated chicken eggs. In this study, we detected an egg-adapted HA S190R mutation in the pandemic H1N1 virus 2009 (pdmH1N1), and evaluated the effects of this mutation on receptor binding affinity and pathogenicity in mice. Our results revealed that residue 190 is located within the pocket structure of the receptor binding site. The single mutation to arginine at position 190 slightly increased the binding affinity of the virus to the avian receptor and decreased its binding to the long human α2,6-linked sialic acid receptor. Our study demonstrated that the S190R mutation resulted in earlier death and higher weight loss in mice compared with the wild-type virus. Higher viral titers at 1 dpi (days post infection) and diffuse damage at 4 dpi were observed in the lung tissues of mice infected with the mutant virus.展开更多
Since the epidemic of the severe acute respiratory syndrome coronavirus 2(SARS-COV-2),many governments have used reverse transcription polymerase chain reaction(RT-PCR)to detect the virus.However,there are fewer measu...Since the epidemic of the severe acute respiratory syndrome coronavirus 2(SARS-COV-2),many governments have used reverse transcription polymerase chain reaction(RT-PCR)to detect the virus.However,there are fewer measures of CT values information based on RT-PCR results,and the relationship between CT values and factors from consecutive tests is not clear enough.So in this study,we analyzed the connection between CT values and the factors based on cohort data from Delta variant of SARS-CoV-2 in Hunan Province.Previous studies have showed that the mean age of the cases was 33.34 years(±18.72 years),with a female predominance(55.03%,n=71),and the greatest proportion of clinical symptoms were of the common type(60.47%,n=78).There were statistical differences between the N and ORF1ab genes in the CT values for the cases.Based on the analysis of the association between CT values and the factors,the lowest CT values were obtained for the unvaccinated,older and clinically symptomatic group at 3e10 days,the maximum peak of viral load occurred.Therefore,it is recommended to use patient information to focus on older,clinically symptomatic,unvaccinated patients and to intervene promptly upon admission.展开更多
Jishou Municipal Center for Disease Control and Prevention(Jishou CDC)received a phone call at 7:30 a.m.on April 24,2020 from Xiangxi Tujia and Miao Autonomous Prefectural CDC(Xiangxi CDC)that avian influenza A/H9N2 v...Jishou Municipal Center for Disease Control and Prevention(Jishou CDC)received a phone call at 7:30 a.m.on April 24,2020 from Xiangxi Tujia and Miao Autonomous Prefectural CDC(Xiangxi CDC)that avian influenza A/H9N2 virus was detected by quantitative reverse transcription-polymerase chain reaction(RT-PCR)from the throat swab sample of an influenza-like illness in an outpatient in the Xiangxi Traditional Chinese Medicine Hospital.展开更多
The human immunodeficiency viruses-2(HIV-2)is endemic in West Africa and is a rarely imported infectious disease in China due to the small number of cases having had a history of living abroad(1–3).In 2007,through ro...The human immunodeficiency viruses-2(HIV-2)is endemic in West Africa and is a rarely imported infectious disease in China due to the small number of cases having had a history of living abroad(1–3).In 2007,through routine HIV surveillance,2 HIV-2 infected individuals were confirmed by serology and nucleic acid testing,becoming the first report of HIV-2 in China.Epidemiological case investigation showed that the two infected individuals had sexual contact.展开更多
Although numerous studies have investigated premature deaths attributable to temperature,effects of temperature on years of life lost(YLL)remain unclear.We estimated the relationship between temperatures and YLL,and q...Although numerous studies have investigated premature deaths attributable to temperature,effects of temperature on years of life lost(YLL)remain unclear.We estimated the relationship between temperatures and YLL,and quantified the YLL per death caused by temperature in China.We collected daily meteorological and mortality data,and calculated the daily YLL values for 364 locations(2013–2017 in Yunnan,Guangdong,Hunan,Zhejiang,and Jilin provinces,and 2006–2011 in other locations)in China.A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates(YLL/100,000 population),and a multivariate meta-analysis model was used to pool location-specific associations.Then,YLL per death caused by temperatures was calculated.The temperature and YLL rates consistently showed U-shaped associations.A mean of 1.02(95%confidence interval:0.67,1.37)YLL per death was attributable to temperature.Cold temperature caused 0.98 YLL per death with most from moderate cold(0.84).The mean YLL per death was higher in those with cardiovascular diseases(1.14),males(1.15),younger age categories(1.31 in people aged 65–74 years),and in central China(1.34)than in those with respiratory diseases(0.47),females(0.87),older people(0.85 in people R75 years old),and northern China(0.64)or southern China(1.19).The mortality burden was modified by annual temperature and temperature variability,relative humidity,latitude,longitude,altitude,education attainment,and central heating use.Temperatures caused substantial YLL per death in China,which was modified by demographic and regional characteristics.展开更多
文摘Hepatitis A virus(HAV)is transmitted via the fecal-oral route,causing not only self-limited infectious hepatitis,but also epidemics through close personal contact(s).HAV infection is prevalent worldwide,and it is estimated that HAV infections account for 1.4 million sporadic or epidemic cases per year worldwide[1].
文摘Objective This study aims to investigate the infection of Clonorchis sinensis(C.sinensis)in highincidence areas of Hunan Province,China.The phylogenetic analysis of the C.sinensis species in the highly infected areas was carried out.Method Infection of the definitive human host and intermediate fish host by C.sinensis was investigated,and the mitochondrial genes cox1 and Nad1 were used as genetic markers for phylogenetic analysis.Results In 2016–2020,the average population infection rate of Hunan was 1.38%,while in Tongdao County the rate was up to 26.90%,and the highest fish infection rate was detected in Qiyang County(99.44%in the dorsal fin of crucian carp).High genetic sequence similarity was observed in the samples from Qiyang and Lengshuitan which exhibited high homology with those from Guangdong and Gansu,whereas the parasitic species from Tongdao was highly homologous with those located in high-latitude areas.Moreover,no significant difference was found in the gene sequence of the parasitic species in definitive hosts dogs and cats.Conclusion The systematically study of C.sinensis infection in the high-incidence areas will contribute greatly to the prevention and effectively controlling the spread of Clonorchis sinensis in Hunan Province The endemic of C.sinensis infection in Hunan Province is the result of co-action of local and foreign parasite species.
基金supported by the National Science and Technology Major Project on Important Infectious Diseases Prevention and Control [2018ZX10734-404]Key technology research for standardized identification of important pathogens and establishment of relevant reference librariesthe National Health and Family Planning Commission [201302006]
文摘On December 14, 2017, a faculty member of a university in Hunan Province reported that an anthrax vaccine strain might have recovered virulence during an undergraduate experiment and potential exposure could not be ruled out for the students involved. Upon receiving the case report, the CDC, health bureaus, and local governments at the county, prefectural, and provincial levels promptly organized experts in different fields (including epidemiologists, biosafety experts, and laboratory testing experts) for case investigation, evaluation, and response. As the investigation results showed, no virulence recovery was identified in the involved anthrax vaccine strain;and no contamination of Bacillus anthracis was detected at the involved areas. Thus, the university returned to normal functioning.
文摘Objective In March 2012, an H7N7 subtype avian influenza virus （AIV） named A/wild goose/Dongting/PC0360/2022 （H7N7） （DT/PC0360） was recovered from a wild goose in East Dongting Lake. We performed whole-genome sequencing of the isolate, and analyzed the phylogenetic and molecular characterization. Methods RNA was extracted from environment samples （including fecal samples from wild bird or domestic ducks, and water samples） for detecting the presence of Influenza A Virus targeting Matrix gene, using realtime RT-PCR assay. The positive samples were performed virus isolation with embryonated eggs. The subtype of the isolates were identified by RT-PCR assay with the HI-HI6 and N1-N9 primer set. The whole-genome sequencing of isolates were performed. Phylogenetic and molecular characterizations of the eight genes of the isolates were analyzed. Results Our results suggested that all the eight gene segments of DT/PC0360 belonged to the Eurasian gene pool, and the HA gene were belonged to distinct sublineage with H7N9 AIV which caused outbreaks in China's Mainland in 2013. The hemagglutinin cleavage site of HA of DT/PC0360 showed characterization of low pathogenic avian influenza virus. Conclusion Strengthening the surveillance of AlVs of wild waterfowl and poultry in this region is vita for our knowledge of the ecology and mechanism of transmission to prevent an influenza pandemic.
基金Supported by the Beijing Natural Science Foundation(L234052)the National Key Research and Development Program of China(2021YFC2302003).
文摘Introduction:Coxsackievirus A6(CVA6)has emerged as a significant pathogen responsible for severe cases of hand,foot,and mouth disease(HFMD).This study aims to delineate the demographic characteristics and analyze the viral evolution of severe HFMD associated with CVA6,thereby assisting in its surveillance and management.Methods:In this investigation,74 strains of CVA6 were isolated from samples collected from severe HFMD cases between 2012 and 2023.The VP1 gene sequences of CVA6 were amplified and analyzed to assess population historical dynamics and evolutionary characteristics using BEAST,DnaSP6,and PopART.Results:A significant portion(94.4%)of severe CVA6-associated HFMD cases(51 out of 54,with 20 lacking age information)were children under 5 years old.Among the 74 CVA6 strains analyzed,72 belonged to the D3a sub-genotype,while only two strains were D2 sub-genotype.The average genetic distance between VP1 sequences prior to 2015 was 0.027,which increased to 0.051 when compared to sequences post-2015.Historical population dynamics analysis indicated three significant population expansions of severe CVA6-associated HFMD during 2012-2013,2013-2014,and 2019-2020,resulting in the formation of 65 distinct haplotypes.Consistent with the MCC tree findings,transitioning between regional haplotypes required multiple base substitutions,showcasing an increase in population diversity during the evolutionary process(from 14 haplotypes in 2013 to 55 haplotypes over the subsequent decade).Conclusions:CVA6,associated with severe HFMD,is evolving and presents a risk of outbreak occurrence.Thus,enhanced surveillance of severe HFMD is imperative.
基金supported by the National Science and Technology Major Project of China(No.2018ZX10201001-010,No.2017ZX10103009-005,No.2018ZX10713001-007)the National Natural Science Fund for Distinguished Young Scholars of China(No.81525023)+4 种基金the National Natural Science Foundation of China(No.81473031)the Program of Shanghai Academic/Technology Research Leader(No.18XD1400300)the Li Ka Shing Oxford Global Health Programme(No.B9RST00-B900.57)the Chinese Preventive Medicine Association(No:20101801)supported by CAS Pioneer Hundred Talents Program
文摘Enteroviruses(EVs)species A are a major public health issue in the Asia–Pacific region and cause frequent epidemics of hand,foot and mouth disease(HFMD)in China.Mild infections are common in children;however,HFMD can also cause severe illness that affects the central nervous system.To molecularly characterize EVs,a prospective HFMD virological surveillance program was performed in China between 2013 and 2016.Throat swabs,rectal swabs and stool samples were collected from suspected HFMD patients at participating hospitals.EVs were detected using generic real-time and nested reverse transcription-polymerase chain reactions(RT-PCRs).Then,the complete VP1 regions of enterovirus A71(EV-A71),coxsackievirus A16(CVA16)and CVA6 were sequenced to analyze amino acid changes and construct a viral molecular phylogeny.Of the 2836 enrolled HFMD patients,2,517(89%)were EV positive.The most frequently detected EVs were CVA16(32.5%,819),CVA6(31.2%,785),and EV-A71(20.4%,514).The subgenogroups CVA16B1 b,CVA6D3 a and EV-A71C4 a were predominant in China and recombination was not observed in the VP1 region.Sequence analysis revealed amino acid variations at the 30,29 and 44 positions in the VP1 region of EV-A71,CVA16 and CVA6(compared to the respective prototype strains Br Cr,G10 and Gdula),respectively.Furthermore,in 21 of 24(87.5%)identified EV-A71 samples,a known amino acid substitution(D31 N)that may enhance neurovirulence was detected.Our study provides insights about the genetic characteristics of common HFMD-associated EVs.However,the emergence and virulence of the described mutations require further investigation.
基金supported by Hunan Health and Family Planning Commission program[C2017060]
文摘We studied the disinfection effect of a new ultraviolet （UV） sterilizer and its utilization on ultrasound probe surfaces. Carrier quantitative germicidal tests, simulated on-the-spot trials, and organic substance influence tests were used to carry out experimental observation. Artificially infected probes were disinfected using the sterilizer or a germicidal lamp for comparison. The total number and types of bacteria were determined and identified. Our results demonstrated the sterilizer had the best disinfection effect among three different disinfection methods in hospital. The sterilizer has been used in a hospital setting for 2 years with no notable damage to the ultrasound probe instrument. It has the advantages of fast disinfection, high disinfection effect, and good compatibility with the ultrasound instrument, worthy of being a promoted application in medical institutions.
基金Supported by grants from the Key Program of the National Natural Science Foundation of China(82130093)Shanghai Municipal Science and Technology Major Project(ZD2021CY001)+1 种基金Hunan Provincial Innovative Construction Special Fund:Emergency response to COVID-19 outbreak(No.2020SK3012)Chinese Academy of Medical Sciences Coronavirus Disease 2019 Science and Technology Research Project in 2020(No.2020HY320003)。
文摘Monitoring changes in the epidemiologic features between different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants is key to understanding the evolution of viral fitness in the host population.Here,we analyzed a successfully contained local outbreak of the Delta variant that took place in Hunan,China,in July–August,2021.Detailed data on SARS-CoV-2 infections and their contacts were collected during the outbreak.By leveraging these data,we estimated key epidemiological parameters,including the incubation period,serial interval,and generation time.We constructed a generalized linear mixed-effects model(GLMM)to quantify risk factors for Delta infection and transmission.Between July 28 and August 15,2021,a total of 129 infections and their 2,118 close contacts were identified during the outbreak in Hunan Province.
基金This work is funded by Anhui Zhifei Longcom Biopharmaceutical,National Key R&D Program of China(2021YFA1300803)the National Natural Science Foundation of China(82122031)We thank the staff of the Biosafety Level 3 Laboratory(Institute of Microbiology,Chinese Academy of Sciences)for their help in live virus experiments,Yawen Liu for her help in pseudovirus experiments,and Grammarly for text improvement.
文摘The coronavirus disease 2019(COVID-19)pandemic remains a significant global health challenge.Older adults are the population at high risk of developing severe COVID-19 or death[1–3].To date,dozens of vaccines for prototype severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)have received emergency use authorization or conditional marketing approval in many countries[4].ZF2001,a protein subunit vaccine comprising two copies of tandem receptor-binding domain(RBD)from prototype SARS-CoV-2(HB-02 strain)[5,6],has demonstrated safety and immunogenicity in populations aged 3–17 and 18–59 after three doses of vaccination[7,8].Moreover,it has shown good efficacy in the prevention of symptomatic COVID-19 caused by infections from the alpha,kappa,and delta variants after a six-month follow-up for adults beyond 18 years of age in a phase 3 trial[9].ZF2001 was safe and well-tolerated in a large cohort of adults(R18 years of age),and the incidence of adverse events was lower among the participants 60 years of age or older than among those aged 18–59[9].However,its durability and immunogenicity in individuals 60 years of age and older have not been reported and need further investigation.Here,we reported the phase 1 trial of ZF2001 in adults aged 60 or older in China to determine the safety,tolerability,and immunogenicity of ZF2001 in older populations after short(1 month)-and long(6 months)-term follow-up.Moreover,we conducted a post-hoc analysis of serum samples to assess their neutralization capacity against omicron variants.
基金This work was supported by the program of com prehensive HIV intervention studies among high-risky groups in China for the 12th Five-Year National Science and Technology Major Projea(2012ZX10001-007)from National Health Commission and the Ministry of Science and Technology of the People's Republic of China.
文摘Background:Low-fee female sex workers(FSWs)are at high risk of acquiring and spreading human immunodeficiency virus(HIV)/sexually transmitted diseases(STDs)in China.There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections.Thus,this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair,comiDunity-based randomized intervention trial carried out in 12 cities in three provinces in China.Methods:Four cities from Guangxi Zhuang Autonomous Region,four from Yunnan Province,and four from Hunan Province were paired and participants received either the intervention package(including condom promotion,HIV and syphilis testing,reimbursement for syphilis treatment costs,and free anti-retroviral therapy or the current standard of care.Venue-based,convenience sampling was used to recruit FSWs.A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months.Generalized linear mixed models(GLMM)were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs.Results:A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up.GLMM results showed that syphilis infeaion was reduced by 49%in the intervention group compared to the current standard of care group(P=0.0378,OR=0.51;95%CI:0.27-0.96).FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old(P<0.0001,OR=2.38,95%CI:1.55-3.65).The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education(P<0.05,OR=0.43,95%CI:0.63-0.93).Conclusions:This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs.Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs.Trial registration:CHiCTR-TRC-12002655.
基金supported by Hunan Provincial Natural Science Foundation of China(11JJ3119)the Key Discipline Construction Project in Hunan Province(2008001)the Scientific Research Fund of Hunan Provincial Education Department(11K037)
文摘Biological experiments and epidemiological evidence indicate that variations in environment have important effect on the occurrence and transmission of epidemic influenza.It is therefore important to understand the characteristic patterns of transmission for prevention of disease and reduction of disease burden.Based on case records,we analyzed the environmental characteristics including climate variables in Changsha,and then constructed a meteorological anomaly susceptive-infective-removal (SIR) model on the basis of the results of influenza A (H1N1) transmission.The results showed that the outbreak of influenza A (H1N1) in Changsha showed significant correlation with meteorological conditions;the spread of influenza was sensitive to meteorological anomalies,and that the outbreak of influenza A (H1N1) in Changsha was influenced by a combination of absolute humidity anomalous weather conditions,contact rates of the influenza patients and changes in population movements.These findings will provide helpful information regarding prevention strategies under different conditions,a fresh understanding of the emergence and re-emergence of influenza outbreaks,and a new perspective on the transmission dynamics of influenza.
基金Provided by the Durex Public Welfare Foundation on college students'AIDS education.
文摘Summary What is already known about this topic?The number of newly diagnosed human immunodeficiency virus(HIV)cases among Chinese youth 15–24 years of age shows an upward trend between 2010 and 2019.What is added by this report?This survey is on a larger scale as compared to previous studies.It shows inadequate HIV knowledge—especially on HIV treatment,self-testing,and postexposure prophylaxis—among college students.A significant gap exists between knowledge and behavior as indicated by the low condom use rate despite a high knowledge level.
基金This work was supported by grants from the China MegaProjects for Infectious Disease(2018ZX10713-002,2018ZX10711001,2017ZX10104001,and 2017ZX10302301-004-002).
文摘Here,we report the identification of Histoplasma causing an unexplained disease cluster in Matthews Ridge,Guyana.In March 2019,14 employees of Chongqing Bosai Mining Company,China,working in a manganese mining of Guyana,had unexplained fever,and two of them died.We obtained lung and brain tissues as well as the blood samples from the two deceased cases(patient No.1 and 2),and bronchoscopy lavages and cerebrospinal fluid samples from one severe case(patient No.3),respectively.All samples were tested by pathological examination,high-throughput sequencing,and real-time PCR.Pathological detection showed the presence of spore-like structures in the lung tissue of patient No.1,indicating a fungal infection in this patient.Nanopore sequencing identified the existing of H.capsulatum in the lung tissue sample within 13 h.Next-generation sequencing identified specific fragments of H.capsulatum in all of the samples tested(lung,brain and blood serum from the deceased cases,and plasma from the severe case).Real-time PCR assays did not reveal any viral infection related to transmission from bat feces.We conclude that H.capsulatum was the causative pathogen of this disease cluster based on epidemiologic,clinical,pathological and nucleic acid evidence.
基金supported by the Key Discipline Construction Project in Hunan Province(2008001)the National Natural Science Foundation of China and the Scientific Research Fund of Hunan Provincial Education Department(13A051)
文摘Changsha was one of the most affected areas during the 2009 A(H1N1)influenza pandemic in China.Here,we analyze the spatial–temporal dynamics of the 2009 pandemic across Changsha municipal districts,evaluate the relationship between case incidence and the local urban spatial structure and predict high-risk areas of influenza A(H1N1).We obtained epidemiological data on all cases of influenza A(H1N1)reported across municipal districts in Changsha during period May 2009–December 2010 and data on population density and basic geographic characteristics for 239 primary schools,97 middle schools,347 universities,96 malls and markets,674 business districts and 121 hospitals.Spatial–temporal K functions,proximity models and logistic regression were used to analyze the spatial distribution pattern of influenza A(H1N1)incidence and the association between influenza A(H1N1)cases and spatial risk factors and predict the infection risks.We found that the 2009 influenza A(H1N1)was driven by a transmission wave from the center of the study area to surrounding areas and reported cases increased significantly after September 2009.We also found that the distribution of influenza A(H1N1)cases was associated with population density and the presence of nearest public places,especially universities(OR=10.166).The final predictive risk map based on the multivariate logistic analysis showed high-risk areas concentrated in the center areas of the study area associated with high population density.Our findings support the identification of spatial risk factors and highrisk areas to guide the prioritization of preventive and mitigation efforts against future influenza pandemics.
基金supported by the National Key Research and Development Program of China(2021YFC2301604)the Research Project on Education and Teaching Reform of Undergraduate Universities of Fujian Province,China(FBJG20210260)+2 种基金the Self-supporting Program of Guangzhou Laboratory(Grant No.SRPG22-007)the Bill&Melinda Gates Foundation(Grant INV-005834 to T.C.)the Research on the Precise Prevention and Control System of SARS-Cov-2(Grant No.35022022YJ07,Topic No.2022YJ-3).
文摘Background:The current outbreak of novel coronavirus disease 2019 has caused a seriousdisease burden worldwide.Vaccines are an important factor to sustain the epidemic.Although with a relatively high-vaccination worldwide,the decay of vaccine efficacy andthe arising of new variants lead us to the challenge of maintaining a sufficient immunebarrier to protect the population.Method:A case-contact tracking data in Hunan,China,is used to estimate the contactpattern of cases for scenarios including school,workspace,etc,rather than ordinary susceptible population.Based on the estimated vaccine coverage and efficacy,a multi-groupvaccinated-exposed-presymptomatic-symptomatic-asymptomatic-removed model(VEFIAR)with 8 age groups,with each partitioned into 4 vaccination status groups isdeveloped.The optimal dose-wise vaccinating strategy is optimized based on the currentlyestimated immunity barrier of coverage and efficacy,using the greedy algorithm thatminimizes the cumulative cases,population size of hospitalization and fatality respectivelyin a certain future interval.Parameters of Delta and Omicron variants are used respectivelyin the optimization.Results:The estimated contact matrices of cases showed a concentration on middle ages,and has compatible magnitudes compared to estimations from contact surveys in otherstudies.The VEFIAR model is numerically stable.The optimal controled vaccination strategy requires immediate vaccination on the un-vaccinated high-contact population of age30e39 to reduce the cumulative cases,and is stable with different basic reproductionnumbers(R_(0)).As for minimizing hospitalization and fatality,the optimized strategy requires vaccination on the un-vaccinated of both aged 30e39 of high contact frequencyand the vulnerable older.Conclusion:The objective of reducing transmission requires vaccination in age groups ofthe highest contact frequency,with more priority for un-vaccinated than un-fully or fullyvaccinated.The objective of reducing total hospitalization and fatality requires not only toreduce transmission but also to protect the vulnerable older.The priority changes byvaccination progress.For any region,if the local contact pattern is available,then with thevaccination coverage,efficacy,and disease characteristics of relative risks in heterogeneouspopulations,the optimal dose-wise vaccinating process will be obtained and gives hintsfor decision-making.
基金supported by the National Key Research and Development Program of China(2016YFC1200201 to Yuelong Shu)the National Mega-projects for Infectious Diseases(2014ZX10004002002 to Yuelong Shu)the young scientist fund of Chinese Center for Disease Control and Prevention(2016A103 to Wenfei Zhu)
文摘Human influenza viruses preferentially bind to sialic acid-α2,6-galactose (SAα2,6Gal) receptors, which are predominant in human upper respiratory epithelia, whereas avian influenza viruses preferentially bind to SAα2,3Gal receptors. However, variants with amino acid substitutions around the receptor-binding sites of the hemagglutinin (HA) protein can be selected after several passages of human influenza viruses from patients’ respiratory samples in the allantoic cavities of embryonated chicken eggs. In this study, we detected an egg-adapted HA S190R mutation in the pandemic H1N1 virus 2009 (pdmH1N1), and evaluated the effects of this mutation on receptor binding affinity and pathogenicity in mice. Our results revealed that residue 190 is located within the pocket structure of the receptor binding site. The single mutation to arginine at position 190 slightly increased the binding affinity of the virus to the avian receptor and decreased its binding to the long human α2,6-linked sialic acid receptor. Our study demonstrated that the S190R mutation resulted in earlier death and higher weight loss in mice compared with the wild-type virus. Higher viral titers at 1 dpi (days post infection) and diffuse damage at 4 dpi were observed in the lung tissues of mice infected with the mutant virus.
基金supported by The National Key Research and Development Program of China(2021YFC2301604)the Bill&Melinda Gates Foundation(INV-005834)+2 种基金Hunan Provincial Innovative Construction Special Fund:Emergency response to COVID-19 outbreak(No.2020SK3012)Chinese Academy of Medical Sciences Coronavirus Disease 2019 Science and Technology Research Project in 2020(No.2020HY320003)Hunan Workstation for Emerging Infectious Disease Control and Prevention,Chinese Academy of Medical Sciences.
文摘Since the epidemic of the severe acute respiratory syndrome coronavirus 2(SARS-COV-2),many governments have used reverse transcription polymerase chain reaction(RT-PCR)to detect the virus.However,there are fewer measures of CT values information based on RT-PCR results,and the relationship between CT values and factors from consecutive tests is not clear enough.So in this study,we analyzed the connection between CT values and the factors based on cohort data from Delta variant of SARS-CoV-2 in Hunan Province.Previous studies have showed that the mean age of the cases was 33.34 years(±18.72 years),with a female predominance(55.03%,n=71),and the greatest proportion of clinical symptoms were of the common type(60.47%,n=78).There were statistical differences between the N and ORF1ab genes in the CT values for the cases.Based on the analysis of the association between CT values and the factors,the lowest CT values were obtained for the unvaccinated,older and clinically symptomatic group at 3e10 days,the maximum peak of viral load occurred.Therefore,it is recommended to use patient information to focus on older,clinically symptomatic,unvaccinated patients and to intervene promptly upon admission.
基金We thank the colleagues from the Chinese National Influenza Center,who isolated and sequenced the full genome of A/Hunan/11173/2020(H9N2).
文摘Jishou Municipal Center for Disease Control and Prevention(Jishou CDC)received a phone call at 7:30 a.m.on April 24,2020 from Xiangxi Tujia and Miao Autonomous Prefectural CDC(Xiangxi CDC)that avian influenza A/H9N2 virus was detected by quantitative reverse transcription-polymerase chain reaction(RT-PCR)from the throat swab sample of an influenza-like illness in an outpatient in the Xiangxi Traditional Chinese Medicine Hospital.
文摘The human immunodeficiency viruses-2(HIV-2)is endemic in West Africa and is a rarely imported infectious disease in China due to the small number of cases having had a history of living abroad(1–3).In 2007,through routine HIV surveillance,2 HIV-2 infected individuals were confirmed by serology and nucleic acid testing,becoming the first report of HIV-2 in China.Epidemiological case investigation showed that the two infected individuals had sexual contact.
基金We thank Professor Antonio Gasparrini for providing assistance during statistical analysis.This work was supported by the National Key Research and Development Program of China(2018YFA0606200)Guangzhou Science and Technology Project(201704020194)+3 种基金and the Guangdong Health Innovation Platform.The funders were not involved in the research and preparation of the article,including study designcollection,analysis,and interpretation of datawriting of the articleand the decision to submit it for publication.
文摘Although numerous studies have investigated premature deaths attributable to temperature,effects of temperature on years of life lost(YLL)remain unclear.We estimated the relationship between temperatures and YLL,and quantified the YLL per death caused by temperature in China.We collected daily meteorological and mortality data,and calculated the daily YLL values for 364 locations(2013–2017 in Yunnan,Guangdong,Hunan,Zhejiang,and Jilin provinces,and 2006–2011 in other locations)in China.A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates(YLL/100,000 population),and a multivariate meta-analysis model was used to pool location-specific associations.Then,YLL per death caused by temperatures was calculated.The temperature and YLL rates consistently showed U-shaped associations.A mean of 1.02(95%confidence interval:0.67,1.37)YLL per death was attributable to temperature.Cold temperature caused 0.98 YLL per death with most from moderate cold(0.84).The mean YLL per death was higher in those with cardiovascular diseases(1.14),males(1.15),younger age categories(1.31 in people aged 65–74 years),and in central China(1.34)than in those with respiratory diseases(0.47),females(0.87),older people(0.85 in people R75 years old),and northern China(0.64)or southern China(1.19).The mortality burden was modified by annual temperature and temperature variability,relative humidity,latitude,longitude,altitude,education attainment,and central heating use.Temperatures caused substantial YLL per death in China,which was modified by demographic and regional characteristics.
