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2022, 38(8)
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2022, 38(8): 1-1.
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All for People′s Health – All-Out Response to COVID-19 Epidemic
Effectiveness of centralized quarantine for close contacts′ close contacts: an evaluation on a Delta variant-induced local COVID-19 outbreak
PAN Jin-ren, CHEN En-fu
2022, 38(8): 961-964. doi: 10.11847/zgggws1139183
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  Objective  To evaluate the effectiveness of centralized quarantine for close contacts′ close contacts (sub-contacts) in coronavirus disease 2019 (COVID-19) epidemic.   Methods  The definition of sub-contacts for this study is based on the State Council′s Joint Prevention and Control Protocol for Prevention and Control of COVID-19 (Edition 8). The information on 8 192 sub-contacts were extracted from the dataset of a COVID-19 epidemic caused by a Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a district of Shaoxing city, Zhejiang province in December 2021. All the sub-contacts were followed retrospectively; the epidemiologic survey reports of all sub-contacts with subsequent SARS-CoV-2 infection and the infected sub-contacts′ related cases/close contacts were reviewed and analyzed. The effect of the centralized quarantine for the sub-contacts was assessed as effective, ineffective, adverse effect, and uncertain, respectively based on outcomes (SARS-CoV-2 infection incidence) of follow ups on both the close contacts and the sub-contacts.   Results  Totally 387 confirmed SARS-CoV-2 infections were reported in the epidemic and averagely 21 sub-contacts were associated with one confirmed infection in the epidemic. Of all the sub-contacts, 99.8% were negative for SARS-CoV-2 nucleic acid in multiple successive PCR tests, suggesting an unnecessity of the centralized quarantine. By the end of the retrospective follow-up period, 18 (0.2%) of the sub-contacts were with positive result of SARS-CoV-2 nucleic acid test and all the positive sub-contacts were associated close contacts′ familial cohabitants. Among the 18 SARS-CoV-2 nucleic acid positive sub-contacts, 9 were identified being with the associated close contacts never being positive for SARS-CoV-2 nucleic acid test throughout the retrospective follow-up period, indicating that the sub-contacts might be infected during the transfer or centralized quarantine period. The analysis results suggest that among the 18 SARS-CoV-2 nucleic acid positive sub-contacts, the centralized quarantine is not necessary for all the sub-contacts, ineffective for 3 (16.7%) sub-contacts, with an adverse effect for 9 (50.0%) sub-contacts, and with uncertain effect for 6 (33.3%) sub-contacts, respectively.   Conclusion  The analysis showed no evidence of positive control effect of centralized quarantine for sub-contacts in a Delta variant induced COVID-19 epidemic but that a few sub-contacts could be infected in the process of transfer and centralized quarantine. The analysis results suggest that centralized quarantine for close contacts′ close contacts could be suspended and more studies are needed for effective management on sub-contacts, such as home quarantine in containment of COVID-19 epidemic.
Efficiency of dual test of SARS-CoV-2 antigen and nucleic acid among freight truck drivers and workers passing through expressway toll gates
HONG Hang, FANG Ting, DING Ke-qin,
2022, 38(8): 965-967. doi: 10.11847/zgggws1139218
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  Objective  To evaluate the efficiency of dual test of severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antigen and nucleic acid among freight truck drivers and workers passing through expressway toll gates.   Methods  Dual tests of SARS-CoV-2 antigen and nucleic acid were conducted among 48 734 freight truck drivers and workers passing through 8 expressway toll gates in Ningbo city from provinces other than Zhejiang province during the period of March 20 – April 17, 2022. The test results were statistically analyzed.   Results  Totally 9 infections of SARS-CoV-2 Omicron variant were detected; of which, 6 were diagnosed clinically as mild coronavirus disease 2019 (COVID-19) case and 3 as asymptomatic infection. No subsequent COVID-19 case was confirmed. For the SARS-CoV-2 antigen test, the sensitivity and specificity were 55.5% (5/9) and 99.9% (48 717/48 725); the positive and negative predictive value were 38.5% (5/13) and 99.9% (48 717/48 721), respectively. For multiplex fluorescence PCR test of SARS-CoV-2 nucleic acid among the participants with positive SARS-CoV-2 antigen result, the Ct values of ORF1ab and N gene M (25th percentile, 75th percentile) were 19.0 (17.1, 21.5) and 19.0 (16.6, 22.5); while, the Ct values of the participants with negative result was significantly higher than those of the participants with positive SARS-CoV-2 antigen result (P < 0.05).   Conclusion  In this study, the sensitivity of SARS-CoV-2 antigen test is low but the specificity of the test is high for the detection of SARS-CoV-2 infection. The results suggest that dual test of SARS-CoV-2 antigen and nucleic acid should be implemented to reduce the risk of imported case-induced local COVID-19 epidemic.
Clinical symptoms and severity of elderly COVID-19 patients infected with different SARS-CoV-2 variants
WANG Hai-feng, LI Ya-fei, PAN Jing-jing, You Aiguo, Wang RuoLin, Fan Wei, Wang Wenhua, Wang Yingying, Ye Ying, Huang Xueyong, Guo Wanshen
2022, 38(8): 968-974. doi: 10.11847/zgggws1138940
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  Objective   To analyze differences in clinical symptoms and severity of elderly coronvirus disease 2019 (COVID-19) patients infected with Delta, Omicron BA.1 and Omicron BA.2 variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).   Methods  From China′s Infectious Disease Information System, provincial center for disease control and prevention, and local designated hospitals, we collected socio-demographic and clinical information on 60 years and older COVID-19 patients reported in the four large-scale COVID-19 epidemics in Henan province during 2022 and the SARS-CoV-2 variants for the patients′ infections were identified based on gene sequencing in combination with epidemi-ological investigation. Chi-square and Fisher′s precision probability test were used to compare the differences in the incidence of patients infected with different variants and multivariate logistic regression was adopted analyze the influencing factors of disease severity.   Results  The total number of elderly cases for the four local COVID-19 epidemics was 234, including 118, 36, and 80 cases infected with SARS-CoV-2 Delta, Omicron BA.1, and Omicron BA.2 variant. Of all the cases, 56.8% were female; 47.6% suffered from underlying diseases; and 88.0% had COVID-19 vaccination. The main clinical manifestations for all the cases were fever, fatigue and upper respiratory symptoms such as cough, sore and dry throat. The symptomatic proportion in the cases with Delta variant infection was significantly higher than that in the cases with Omicron variant infection (34.7% vs. 19.0%, P = 0.007). The proportion of severe or critical conditions was significantly higher in the cases with Delta variant infection than that in the cases with Omicron variant infection (12.7% vs. 1.7%, P = 0.002). The results of multivariate logistic regression analysis revealed following risk factors for the occurrence of severe or critical conditions among the elderly cases: infected with Delta variant (odds ratio [OR] = 5.7, 95% confidence interval [95% CI]: 1.1 – 31.2), aged ≥ 80 years (OR = 8.4, 95% CI = 2.0 – 34.4), suffering from dyskinesia (OR = 5.3, 95% CI: 1.5 – 18.3), and suffering from diabetes (OR = 5.7, 95% CI: 1.1 – 31.3).   Conclusion  In COVID-19 patients aged 60 years and above, clinical symptoms and the occurrence of server or critical conditions differ by different SARS-CoV-2 variants and the patients with Delta variant infection, at older age, and with underlying diseases are at a higher risk of having severe or critical conditions.
Epidemiological characteristics of a local COVID-19 outbreak caused by Omicron (BA.2.2) variant in Henan province
PAN Jing-jing, WANG Ying-ying, WANG Wen-hua,
2022, 38(8): 975-979. doi: 10.11847/zgggws1138726
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  Objective  To analyze epidemiological characteristic and transmission process of a local coronavirus disease 2019 (COVID-19) outbreak induced by imported cases from other provinces in Henan province.   Methods  The data on all local COVID-19 cases in Xiuwu county, Henan province reported during March 18 – 28, 2022 were extracted from National Notifiable Disease Report System. The results of field investigations on the cases were also collected simultaneously. Descriptive statistics was performed on the data collected with SPSS 22.0.   Results  Totally 45 cases (16 males and 29 females, 14 minor or common patients and 31 asymptomatic infections) were reported during the 11-day outbreak period. The median age (25th percentile [P25], 75 percentile [P75]) of the cases was 23.02 (18.57, 28.64) years. The median (P25, P75) of cycle threshold (Ct) value for Orf1ab gene and N gene for positive cases in primary screening were 23.02 (18.57, 28.64) and 23.10 (18.63, 28.03), respectively. A case clustering involving 18 cases was identified in a local textile factory, with an incidence rate of 6.6%; seven family clusters were also identified, with a family secondary attack rate of 20.78% and a secondary attack rate of 3.79% among close contacts. Of all the cases, 12.5% could attributed the infection to the exposure to the asymptomatic infections being negative for nucleic acid test at that time. The results of genome second generation sequencing for the isolates from 29 infections indicated that the pathogen of the outbreak was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant Omicron (BA.2.2) and the local transmission of the virus variant was traced back to the 2 first generation cases returning home from other epidemic area. The median (P25, P75) of incubation period was 3 (2, 4.25) days and that of generation interval was 3 (2, 3) days. Five generations of transmission were identified for the outbreak . The estimated basic reproductive number (R0) of this epidemic was 6.14, and the effective reproduction number (Rt) decreased 2 days after the control measures were taken and declined to less than 1 in 8 days after the implementa-tion of control measures.   Conclusion  The reported COVID-19 outbreak in Henan province was caused by imported cases from other epidemic area and spread mainly in factories, families and schools. The control measures on the outbreak were effective and subsequent transmission was prevented.
Spatial-temporal clustering of cases in a COVID-19 outbreak in Guangzhou city
ZHANG Qian, CHEN Xu-guang, HU Jian-xiong,
2022, 38(8): 980-984. doi: 10.11847/zgggws1137165
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  Objective   To explore spatial-temporal clustering of coronavirus disease 2019 (COVID-19) cases in an outbreak epidemic in Guangzhou city, Guangdong province and to provide evidences for developing COVID-19 prevention and control measures.   Methods  The data on 215 local COVID-19 cases reported in Guangzhou city from April 4 to May 2, 2020 were collected and the cases′ demographics and spatial-temporal distribution were described statistically. Knox test was used to identify possible spatial-temporal clustering of the cases by given specific critical thresholds. The spatial thresholds for the distance between the two cases′ residential address were set varying from 0 to 1000 meters (m) with an interval of 100 m; the temporal thresholds for the time interval between the two cases′ incident time were set varying from 1 to 15 days with an interval of 1 day. The strength of clustering (S-value) and relative risk (RR) of clustering for each gender- and age-group-specific case pair were calculated to analyze temporal-spatial clustering of case pairs.   Results  The S-value and RR of the COVID-19 case pairs decreased with the increment in pairs′ spatial distance and time interval. The RR value was the highest for a pair with the nearest spatial distance under the interval time of 1 day. For a case pair with the time interval of 1 day, the RR was 2.4 when the spatial distance between the pair′s two cases being 100 m, while the RR was only 1.2 when the spatial distance being 3 kilometers (km). For male-male pairs, the S-value was higher under the time interval of 1 – 5 days with a spatial distance less than 300 m; for female-female pairs, the S-value was higher under the time interval of 1 – 7 days with a spatial distance less than 400 m; and for male-female pairs, the S-value was higher under the time interval of 1 – 4 days with a spatial distance less than 500 m. A stronger trend of spatial-temporal clustering was observed among female-female case pairs than among male-male case pairs. For age-group-specific case pairs, the S-value of child-child pairs with the time interval of 1 day was significantly higher than that of other age-group pairs and the S-value of middle-aged-youth pairs was higher under the time interval of 1 – 5 days with a spatial distance of less than 300 m.   Conclusion  Spatial-temporal clustering with between gender and age group differences was observed among the COVID-19 cases of an outbreak epidemic in Guangzhou city.
Safety of inactivated COVID-19 vaccine in 3 – 17 years old healthy children
LI Min-jie, WANG Lei, WU Zhi-wei,
2022, 38(8): 985-989. doi: 10.11847/zgggws1138965
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  Objective  To evaluate the safety of an inactivated coronavirus disease 2019 (COVID-19) vaccine in healthy children and adolescents aged 3 – 17 years.   Methods  Totally 500 healthy children and adolescents aged 3 – 17 years were recruited in Zanhuang county of Hebei province and randomly assigned into a vaccination group (n = 375) and a placebo group (n = 125) during May 2021. Two doses of inactivated COVID-19 vaccine (Sinovac Life Sciences Co., Ltd, Beijing) or placebo (day 0 and day 28) were administered to the participants. The participants were observed for adverse reactions within 30 minutes after each vaccination. The participants′ information on local and systemic solicited adverse events from day 0 to day 7, and unsolicited adverse events from day 0 to day 28 were collected after the vaccination. Serious adverse events were recorded from the beginning of vaccination to 6 months after the second dose vaccination to evaluate the safety of the vaccine.  Results  The incidence of adverse reactions was 19.2% (72/375) in the vaccination group and 15.2% (19/125) in the placebo group, without significant difference between the incidence of the two groups (P > 0.05). The most common adverse reactions were injection site pain and fever. There was no significant statistical difference in the incidence of other adverse reactions between the two groups except for pain at the injection site. Most observed adverse reactions were grade 1 and 2 in severity, only 3 participants reported grade 3 adverse reactions. The vaccination group′s incidences of adverse reactions of grade 1 (14.93% vs. 12.8%), grade 2 (7.73% vs. 4%), and grade 3 (0.53% vs. 0.8%) were not significantly different from those of the placebo group. No serious vaccination-related adverse event was reported in either group. The incidence of adverse reactions was higher (28%) in the 3 – 5 years old participants than those in the participants aged 6 – 11 and 12 – 17 years (16% and 15.5%) and the age-group-specific adverse reaction incidences were not significantly different between vaccination group and placebo group. The incidence of adverse reactions for the first dose vaccination was significantly higher than that for the second dose (14.6% vs. 5.69%, P < 0.05) and there was no significant difference in the dose order-specific adverse reaction incidence between the vaccination group and the placebo group.  Conclusion  The inactivated COVID-19 vaccine is of good safety when administered in 3 to 17 years old healthy children.
Characteristics of SARS-CoV-2 vaccine breakthrough infections among Chinese travelers entering China via Chengdu city
LONG Lu, LIU Zhu, MAO Yi,
2022, 38(8): 990-995. doi: 10.11847/zgggws1137924
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  Objective  To investigate the characteristics and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine breakthrough infections for providing a reference for coronavirus disease 19 (COVID-19) epidemic prevention and control.   Methods  We collected the information on 38 SARS-CoV-2 infections laboratory-confirmed among Chinese travelers entering China via Chengdu city, Sichuan province during the period from December 10, 2020 to July 7, 2021 and divided the infections into a vaccine breakthrough group (14 male cases ever receiving domestic inactivated COVID-19 vaccine and with confirmed genotype of SARS-CoV-2 strains inducing the infections) and a natural infection group (18 male and 6 female cases reporting no COVID-19 vaccination history). Comparison analyses were conducted to examine differences between the two groups in epidemiological characteristics, clinical/laboratory indicators and treatment outcomes.   Results  The participants arrived at Chengdu from 15 foreign countries during December 10, 2020 – July 7, 2021 and were diagnosed with SARS-CoV-2 infection within the period of December 11, 2020 – July 12, 2021; all the participants reported no history of SARS-CoV-2 infection/nucleic acid positive before entering China. In the vaccine breakthrough group, 9 participants had two doses of COVID-19 vaccine by separate inoculations with the interval of 56 days, 3 had two doses in one inoculation and only 2 had one dose; the interval from the last vaccination to the confirmation of SARS-CoV-2 infection ranged 8 – 173 days, with a median of 100 days. No statistically significant between-group differences were observed in the distribution of age (35.0 ± 7.7 vs. 35.8 ± 10.9 years), Pangolin-based genotyping of SARS-CoV-2 strains isolated, and the time of nucleic acid negative conversion from the first positive detection (t = 1.106, P > 0.05). Compared to the participants of natural infection, the participants with vaccine breakthrough infection had following significantly higher indicators: Ct value for N gene (26.8 ± 4.1 vs. 22.4 ± 7.4) and ORF1ab gene (29.4 ± 4.5 vs. 24.8 ± 6.9) of SARS-CoV-2 (t = 2.376 and t = 2.228, both P < 0.05); 50th percentile (P50), (25th percentile [P25], 75th percentile [P75]) of immunoglobulin M (IgM) antibody titer (0.9 [0.3, 11.6] vs. 0.040 [0.027, 0.096]); P50 (P25, P75) of immunoglobulin G (IgG) antibody titer (4.5 [1.7, 7.6] vs. 0.006 [0.003, 0.052]); total antibody titer (31.9 [4.6, 916.4] vs. 0.015 [0.010, 0.038]) (P < 0.05 for all); and the counts of lymphocyte, CD3+ T lymphocyte, CD3+/CD4+ T lymphocyte, CD3+/CD8+T lymphocyte detected at the time of hospital admission (all P < 0.05). While the participants of vaccine breakthrough infection had significantly lower peripheral blood eosinophil count and neutrophil percentage than those of the participants with natural infection (both P < 0.05). Although there was no significant between-group difference in the duration of hospitalization (t = 1.889, P > 0.05), the proportion of the participants being hospitalized less than 20 days was significantly higher for the vaccine breakthrough group than that for the natural infection group.   Conclusion  For COVID-19 vaccine breakthrough infections, the vaccination helps to reduce viral load and may enhance the vaccinees′ T-cell immune response and exert a positive impact on vaccinees′ outcome of the infection treatment.
Vaccination-related contamination-induced false positive SARS-CoV-2 specimen from a suspected COVID-19 case in Chengdu city: a gene tracing-based analysis
XIE Wen-jun, CHEN Heng, FENG Jing,
2022, 38(8): 996-1000. doi: 10.11847/zgggws1137810
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  Objective  To conduct a gene tracing-based analysis on a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive oropharyngeal swab specimen from a suspected coronavirus disease 2019 (COVID-19) case without epidemiologically-confirmed exposure history and with negative results in confirmation tests in Chengdu city, Sichuan province for providing evidence to the operation of clinics engaged in COVID-19 vaccination.  Methods  An epidemiological investigation was conducted on a suspected COVID-19 case reported by a medical institution providing both COVID-19 vaccination and SARS-CoV-2 nucleic acid screening services in a district of Chengdu city, Sichuan province on February 24, 2021. The information on case′s onset and treatment, travel and close contacts within 14 days before the onset were collected and analyzed. Specimen collection and laboratory nucleic acid testing were conducted for the case, the case′s close contacts and living environment, and the environment and work clothes of medical staff of the reporting medical institution. Second generation gene sequencing and gene tracing analysis were performed for the case′s positive specimen collected for the screening test.   Results  The suspected case was a 57-year old man seeking medication for cough, throat discomfort, and runny nose at a medical institution provided both COVID-19 vaccination and SARS-CoV-2 nucleic acid screening services and having a oropharyngeal swab test for screening SARS-CoV-2 infection at the medical institution on February 23, 2021. The case reported no history of travelling abroad himself and his close contacts, contacting with confirmed/suspected COVID-19 patients, potential exposure to SARS-CoV-2, and COVID-19 vaccination. No positive results of SARS-CoV-2 nucleic acid were detected for case′s oropharyngeal/nasal and anal swab specimens, close contacts′ oropharyngeal swab specimens, swab specimens of living/working/relevant public place environment, swab specimens of environment and working clothes of the staff of the medical institution for retests performed one day after the case′s screening test. The results of gene sequencing for the case′s positive specimen at the screening test showed a 99.99% sequence homology with the sample of COVID-19 vaccine for inoculation service at the medical institution. The Pangolin type was B for both the case′s specimen and the vaccine sample.   Conclusion  The clinical manifestation and laboratory test of the suspected case were not consistent with the diagnosis criterion for COVID-19 patient and asymptomatic SARS-CoV-2 infection. The case′s false SARS-CoV-2 positivity of the suspected specimen at the screening test probably results from vaccination related contamination of the case′s oropharyngeal swab specimen at the medical institution proving both COVID-19 vaccination and SARS-CoV-2 nucleic acid screening services. The result needs to be concerned when conducting SARS-CoV-2 nucleic acid screening.
Construction of grounded theory-based vaccination decision-making process model for the public: a empirical study in college students
FAN Kai-sheng, HAO Yan-hua, GUAN Han-wen,
2022, 38(8): 1001-1006. doi: 10.11847/zgggws1136354
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  Objective  To construct a decision-making process model on vaccination of coronavirus disease 2019 (COVID-19) vaccine and to explore reasons of unwilling to have the vaccination from public perspective for providing theoretical evidences to COVID-19 vaccination promotion.   Methods  Using a self-designed open-ended questionnaire on COVID-19 vaccine hesitancy, we conducted a survey among 347 students in a medical university during March 27 – 29, 2021 – one week after the students′ applying voluntarily for COVID-19 vaccination. Word frequency and text node analysis on collected information were carried out and word cloud maps were generated with NVivo 12 software. A theoretical framework for vaccination decision-making process model was constructed based on grounded theory.   Results  Valid information were collected from all the participants. In the respondents′ responses in writing about reasons for having COVID-19 vaccination, the words with high frequency included COVID-19, prevention, vaccination, and free of charge; while, safety, vaccine, effectiveness and adverse reaction were among the high frequency words in the writings on COVID-19 vaccine hesitancy. In the respondents′ writing texts, 3 parent nodes and 9 child nodes were identified. According to theoretical models of bio-psycho-social medicine, protective behavior decision, and vaccine hesitation/vaccination willingness and considering the results of previous studies, the public motivation for COVID-19 vaccination could be summarized into three aspects with nine causal factors as following: objective biological determination (factors relevant to virology/pharmacology and physiology/pathology), subjective psychological determination (personal risk and benefit judgment, vaccine safety, vaccine efficacy, and perceived social responsibility), and social determination (service accessibility, information accessibility). The three determinant aspects with nine relevant factors ought to be concerned in the construction of theoretical framework of vaccination decision-making process model for the public.   Conclusion  A vaccination decision-making process model for the public was preliminarily constructed for the promotion of COVID-19 vaccination willingness and behavior in Chinese population.
Positivity of SARS-CoV-2 nucleic acid and antibody of different biological specimens from COVID-19 cases in Dongguan city – a comparative analysis
XU Lin, CHEN Rong, HONG Yun,
2022, 38(8): 1007-1010. doi: 10.11847/zgggws1136175
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  Objective  To investigate positive rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid and antibody of different biological samples from diagnosed coronavirus disease 2019 (COVID-19) patients.   Methods  A variety of biological samples were collected from 101 confirmed COVID-19 cases and 35 asymptomatic infected persons in Dongguan city, Guangdong province from January 23 to October 9, 2020. SARS-CoV-2 nucleic acid was detected with real-time fluorescence quantitative reverse transcriptase polymerase chain reaction (RT-PCR); serum immunoglobulin M (IgM) and IgG antibodies against SARS-CoV-2 were measured with colloidal gold method. The detection results were analyzed statistically.   Results  The median duration of persistent positivity of SARS-CoV-2 nucleic acid the was 7.00 days (interquartile range: 0.00 – 27.00 days) for all the patients. Within 0 – 7 days after the onset of COVID-19, the positive rates were 48.21% (121/251), 36.00% (9/25), and 31.82% (7/22) for pharyngeal, anal, and nasopharyngeal swab specimens, respectively. No SARS-CoV-2 nucleic acid positive urine samples were detected during whole course of the disease for all the patients. SARS-CoV-2 nucleic acid positive pharyngeal, anal, and nasopharyngeal swab specimens were detected but no positive sputum and feces samples were detected among the asymptomatic patients.   Conclusion  With the progress of disease, the positive rate of SARS-CoV-2 nucleic acid decreases for pharyngeal, anal, and nasopharyngeal swab specimens from COVID-19 patients but that of serum IgG antibody against SARS-CoV-2 increases.
Transmission route of SARS-CoV-2 and personal health intervention: a review on research advances
TU Hong-wei, GAN Ping, ZHONG Ruo-xi,
2022, 38(8): 1011-1017. doi: 10.11847/zgggws1138953
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The conronavirus disease 2019 (COVID-19) pandemic exerts a major impact on the world. Understanding the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can help public health personnel to define the prevention and control priorities in practical work. This study summarized the existing literature (update to May 2, 2022) and analyzed and classified the main transmission routes of SARS-CoV-2 based on typical cases and laboratory studies, and proposed relevant prevention and personal protection strategies to provide a basis for more accurate and effective control of SARS-CoV-2 transmission.
Epidemiological Research
Revision and an empirical evaluation of the Chinese Patient Health Literacy Scale
CHEN Ying, DONG Jian, TIAN Xiang-yang,
2022, 38(8): 1018-1023. doi: 10.11847/zgggws1136236
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  Objective   To modify the Chinese Patient Health Literacy Scale (CPHLS) for improving the reliability and validity of the scale.   Methods   From January to May 2021, t he CPHLS was preliminarily revised by expert consultation and the revised electronic scale was employed to measure the health literacy of 2 808 outpatients randomly selected at 14 hospitals in eastern, central and western China. SPSS 23.0 was utilized for Cronbach′s α calculation and exploratory factor analysis (EFA) to further improve the revised scale; AMOS 23.0 was applied to build a structural equation model (SEM) to test the validity of the scale.   Results   The Cronbach′s α coefficient of the preliminarily revised CPHLS was 0.841 and the α coefficients of the scale′s five dimensions were 0.751 for concept of medical science, 0.787 for disease self-management skills, 0.568 for medical common sense, 0.725 for self-efficacy , and 0.412 for medical information cognition, respectively, with an overall cumulative proportion of variance of 62.538%. Three common factors of the revised scale (e.g. self-efficacy, disease self-management skills and medical common sense) were extracted according to the results of EFA. After deleting four original items, the α coefficient of the revised scale was raised to 0.845, the α coefficients of the three dimensions were 0.926, 0.831, and 0.753 and the cumulative proportion of variance was 67.228%. The SEM analysis on the revised scale demonstrated that the dimension-specific factor load capability ranged 0.53 – 0.90 and the constructed SEM is of good overall goodness of fit, with the root mean square residual (RMR) of 0.083, root mean square error of approximation (RMSEA) of 0.086, goodness-of-fit index (GFI) of 0.926, adjusted goodness-of-fit index (AGFI) of 0.891, normed fit index (NFI) of 0.928, relative fit index (RFI) of 0.909, incremental fit index (IFI) of 0.931, the Tacker-Lewis index/non-normed fit index (TLI/NNFI) of 0.913, comparative fit index (CFI) of 0.931, parsimony goodness-of-fit index (PGFI) of 0.631, parsimony-adjusted normed fit index (PNFI) of 0.737, parsimony-adjusted comparative fit index (PCFI) of 0.740, and the critical number (CN) of 171, respectively.   Conclusion   The revised Chinese Patient Health Literacy Scale is of good internal consistency reliability and construct validity, indicating a potential application in the evaluation on patients' health literacy.
Knowledge on contraception and safe sex among college students in Shanghai: a network-based cross-sectional survey
XIA Wen-rong, ZHAN Chun-lin, ZHOU Hai-wang,
2022, 38(8): 1024-1029. doi: 10.11847/zgggws1136687
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  Objective   To examine the knowledge on contraception and safe sex among college students in Shanghai for providing evidences to promote reproductive health of college students in China.   Methods  An onsite/online network-based anonymous survey was conducted among 16 235 students of various degrees in 62 colleges and universities during June – November, 2019. A self-designed questionnaire on knowledge, attitude and behaviors about safe sex and contraception was used in the survey.   Results  Of the 14 612 students (4 829 males and 9 783 females averagely aged 21.63 years) with valid replies, 24.93% reported ever having sexual behavior. Among the respondents with sex experiences, 66.80% reported adopting contraceptive measures every time but 3.46% stated never taking contraceptive measures when having sex; and unintended pregnancy was reported by 7.24% of the respondents. For all the respondents in terms of contraceptive measures, the knowledge rate was 82.90% for condom, 26.51% for spermicide, 17.72% for contraceptive injections, and 15.30% for contraceptive subcutaneous implant. The reported knowledge about induced abortion was higher among the female respondents than among the males. There were 47.16% of all the respondents not having sufficient knowledge about sexually transmitted disease and AIDS and the ratio was lower among male respondents than among the females.   Conclusion  In colleges or universities of Shanghai, the students are open in their attitude about sex and active in sexual relationships but the students are lack of knowledge about contraception and avoidance of unintended pregnancy. The results suggest that specific education on safe sex and a better reproductive health services should be promoted among the students.
Physical activity parenting practice and its influencing factors among parents of preschool children in southern cities, China
WU Hua, RUAN Hui, WANG Shan-shan,
2022, 38(8): 1030-1034. doi: 10.11847/zgggws1137782
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Abstract:
  Objective  To examine the prevalence and influencing factors of physical activity (PA) parenting practice among urban parents of preschool children for providing evidences to develop strategies on promoting PA of the children in China.   Methods  Using non-probabilistic sampling and a self-designed questionnaire, we conducted an online survey among 4 074 parents of healthy kindergarten children at 9 large and medium-sized cities in southern regions of China during February 2021. Contingency table chi-square test was adopted to explore the influence of different PA parenting practices on young children′s PA.   Results  Of the 3 959 participants with valid responses, 39.28% and 27.12% reported having a at least 30 minutes′ leisure-time physical activity (LTPA) 2 – 3 times and once a week; while, 20.86% reported not having LTPA every week. Among all the participants, 58.59% reported the PA parenting practice at the frequency of 1 – 2 times/week and aerobic exercise and chasing/role-playing game were the most popular parent-child PA, being reported by 55.83% and 52.68% of the participants having the practice. In terms of family support to children′s PA, the top three considerations of the parents were allowing a child to play in parks or other outdoor places frequently (selected by 87.82% of all the participants), buying sports equipment to meet children′s PA needs (69.87%), and encouraging children to play freely (69.21%); only 26.02% of the participants chose financially supporting children to take program in sports training facilities. Significant impact factors for PA parenting practice included parental role disparity (χ2 = 23.31, P < 0.001), gender stereotype-related differences in parents′ cognition on required PA time (χ2 = 9.91,P = 0.042) and intensity (χ2 = 17.14, P = 0.001) for the boys or girls.   Conclusion  Physical activity parental practice may be more effective in family-based support to young children′s physical exercise if the parents could have correct cognition about parental role and gender stereotype.
Effectiveness and operability of different screening methods for diabetes in community populations: a comparative analysis
LI Yan-yun, WANG Si-yuan, YANG Qin-ping,
2022, 38(8): 1035-1038. doi: 10.11847/zgggws1135267
Abstract:
  Objective  To evaluate the efficiency and practical significance of different diabetes screening methods in community population and to provide evidences for the establishment of community diabetes screening process.   Methods  Using multistage cluster random sampling, we recruited 23 940 permanent residents aged ≥ 35 years and without acute or serious chronic diseases/type I diabetes in urban communities and rural villages of 7 districts of Shanghai for a questionnaire survey, physical examination and blood glucose measurement during October – December, 2017. The effectiveness and operability of an early-detecting process, risk score assessment and fast plasma glucose (FPG) screening for type 2 diabetes (T2DM) were evaluated by comparing the three methods′ sensitivity, specificity, Youden index , area under the receiver operating characteristic curve (AUROC), the proportion of abnormal FPG and oral glucose tolerance test (OGTT).   Results  Of the 17 981 previously undiagnosed diabetics identified among the residents and included in the analysis, 4 129 prediabetics and 2 213 diabetes were detected, with the prevalence rates of 22.96% and 12.31%, respectively. For the three methods (early-detecting process vs. risk score assessment vs. FPG screening) in detections of diabetes/prediabetic in previously undiagnosed diabetic population, the sensitivities (%) were 87.3/61.0 vs. 96.7/93.3 vs. 82.5/47.8; the specificities (%) were 60.2/58.9 vs. 15.2/15.8 vs. 87.5/86.0; the Youden indexes were 0.479/0.199 vs. 0.119/0.091 vs. 0.700/0.338, and the values of AUROC were 0.858/0.620 vs. 0.680/0.602 vs. 0.922/0.708; also for the three methods, the proportions (%) of the examinees requiring FPG/2-hour plasma glucose detection of OGTT were 45.7/42.6 vs. 86.3/86.3 vs. 100/21.1, respectively.   Conclusion  In diabetes screening among community residents, early-detecting process could achieve a higher detection rate of abnormal glucose metabolism with a minimum number of venous blood glucose detection and simplified on-site implementation procedures and the process could be adopted effectively in large-scale prediabetics and diabetes screening in community populations.
Experimental Study
Expression and significance of inflammatory markers in rats with arsenic-induced lung injury
WANG Wen-juan, ZHENG Fan-yan, WANG Qing-ling,
2022, 38(8): 1039-1042. doi: 10.11847/zgggws1136963
Abstract:
  Objective  To investigate lung injury effect of sodium arsenite (NaAsO2) in rats and the expression and significance of inflammatory markers associated with the injury.   Methods  Thirty-two Wistar rats were randomly divided into four groups according to body weight: a control group and three groups with 4-month gavage administration of NaAsO2 at dosages of 2.5, 5, and 10 mg/kg per day. The expression of Clara cell secretory protein (CC16), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in lung tissue and serum were detected with immunofluorescence assay and enzyme-linked immunosorbent assay (ELISA). Pearson correlation analysis was adopted to assess the association between expressions of the markers in lung tissues and serum.   Results  After 90 days′ treatment, the body weight of the rats exposed to moderate- and high-dose NaAsO2 decreased significantly (P < 0.05). For the rats with NaAsO2 treatment, the expression of CC16 in lung tissue and serum of reduced significantly (P < 0.05) and the expression of CC16 in lung tissue was positively correlated with that in serum (r = 0.89, P < 0.05); while, the expression of MMP-9 in lung tissue and serum increased significantly (P < 0.05) and MMP-9 expression in lung tissue was positively correlated with that in serum (r = 0.50, P < 0.05); the ratio of MMP-9/TIMP-1 expression in lung tissue was positively correlated with the ratio of the expressions in serum (r = 0.38, P < 0.05).   Conclusion  Arsenic exposure can induce lung injury in rats and expressions of inflammatory markers in lung tissue and serum are associated with the development of arsenic-induced lung injury.
Survey and Report
Effective utilization of infectious disease surveillance system in China: a literature study-based analysis
HU Yi-ming, SHI Pei-wu, SHEN Qun-hong,
2022, 38(8): 1043-1047. doi: 10.11847/zgggws1138155
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Abstract:
  Objective  To analyze current situation, development trend and regional disparity about effective utilization of infectious disease surveillance system and the effect of the utilization on infectious disease prevention and control in China.   Methods  Relevant literatures and reports on infectious disease risk monitoring and early warning issued during 2004 – 2019 by infectious disease surveillance system in 31 provincial-level administrative divisions in China were systemically retrieved through searching websites of governmental agencies, professional organizations, China National Knowledge Infrastructure and Web of Science. The data on infectious disease incidence were extracted from China Health Statistics Yearbook for years from 2005 to 2020. The information collected were quantitatively analyzed to assess effective utilization of the infectious disease monitoring system. Spearman correlation and linear regression were adopted to explore the association of effective utilization of surveillance systems and infectious disease morbidity.   Results  The average index for countrywide effective utilization of infectious disease surveillance system was 9.64% in 2019, with an increment of 1 338.81% compared with that in 2004; the average index for eastern region was relatively higher (11.73%) than that for other regions of China. Correlation and regression analysis showed that there was a reverse correlation between the effective utilization of infectious disease surveillance system and the incidence of infectious diseases at regional and national level, with the nationwide correlation coefficient of − 0.88 (P < 0.01) and standardized regression coefficient of − 6.87 (P < 0.001).   Conclusion  The utilization of infectious disease surveillance system has been improved steadily during 2004 – 2019 in China, but regional difference for the utilization still exists and continuous efforts should be made for effective utilization of the surveillance system.
Population life expectancy and mortality in main countries along the "Belt and Road": a comparison analysis
LONG Zheng, LIU Wei, WANG Li-jun,
2022, 38(8): 1048-1053. doi: 10.11847/zgggws1136718
Abstract:
  Objective  To compare life expectancy and mortality among populations in main countries along "Belt and Road" between 2009 and 2019 for providing evidences to promote sustained health cooperation with the countries and active participation in global health governance.   Methods  Data on life expectancy and mortality of residents in 13 major countries along the “Belt and Road” were collected from the Global Burden of Disease Study 2019 (GBD 2019). Life expectancy and mortality of infectious diseases, maternal and infant diseases, nutritional deficiencies, chronic diseases, and injury in 2009 and 2019 were compared among these countries.   Results  The life expectancy of residents in all the 13 major countries along the “Belt and Road” in 2019 increased compared with those in 2009, with the highest increment in Myanmar (5.5 years), and the lowest in Vietnam and the Philippines (both 1.4 years). Compared with those in 2009, the age standardized mortality rate of infectious diseases, maternal and infant diseases, nutritional deficiencies, chronic diseases, and injury among residents of 13 major countries along the “Belt and Road” have decreased in 2019, and the highest decline in the age standardized mortality rate of infectious diseases, maternal and infant diseases and nutritional deficiencies was seen in Myanmar (47.1%) and the lowest decline was seen in Thailand (10.5%). The highest decline in the age standardized mortality rate of chronic diseases was in Russia (21.5%), and the lowest decline was in Indonesia (2.9%). Russia had the highest decrease (33.0%) in age standardized mortality rate for injury, and the lowest decrease was seen in Turkey (4.7%). Compared with those in 2009, among the 13 major countries along the “Belt and Road” in 2019, Iran had the highest increase in the mortality rate of residents aged 70 and older (5.5%), and Bangladesh had the highest decrease (13.4%). In 2009 and 2019, the proportion of causes of death from infectious diseases, maternal and infant diseases, and nutritional deficiencies were the lowest in Russia (4.3%) and in China (3.3%), and the highest were both in Pakistan (47.5% and 39.0%); for chronic diseases, the proportion was the lowest in Pakistan (46.8% and 55.3%), and the highest was in Turkey (88.1%) and in China (90.1%); the lowest proportion of deaths caused by injury was seen in Turkey (5.0% and 4.9%), and the highest was in Iran (14.9% and 10.5%). There were differences in the ranking of causes of death among different populations and countries. Stroke and ischemic heart disease were the leading two causes in 10 major countries along the “Belt and Road” in 2009 and 2019 except for in Egypt, India, and Pakistan.   Conclusion  The life expectancy and mortality varied substantially for residents in 13 major countries along the “Belt and Road”. Health cooperation should be strengthened among the countries.
Screening, early diagnosis and treatment of liver cancer in Zherong county of Fujian province: 2012 – 2019
LIN Yong-tian, WEI Qing-song, YANG Sheng-yun,
2022, 38(8): 1054-1057. doi: 10.11847/zgggws1135840
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Abstract:
  Objective  To examine outcomes of screening, early diagnosis and treatment of liver cancer in Fujian province and to provide evidences for the evaluation on population-based liver cancer screening.   Methods   Zherong county in a mountainous rural region of the province was selected with cluster sampling for the analysis. Serum hepatitis B virus surface antigen (HBsAg) was tested among all male residents aged 35 – 64 years and female residents aged 45 – 64 years in diagnostic screenings on liver cancer carried out from July 2012. Then serum alpha-fetoprotein (AFP) detection and B-mode ultrasonography (BU) of liver were performed in all HBsAg-positive residents every 6 months after the screening. All diagnosed liver cancer patients were followed up till April 30th, 2021 and observed survival of the patients were calculated with life table method. The efficiency of the screening, early diagnosis and treatment were assessed using rate of task completion, detection, early diagnosis, and early treatment.   Results  Of 51 486 residents having HBsAg screening from July 2012 through December 2019, 4 412 (8.72%) were positive. Among the HBsAg-positive participants, 10 653 person-times of AFP detection and BU of liver were carried out, with an overall task completion rate of 94.16%, and totally 49 liver cancer cases were detected, with the detection rate of 0.32%. For all the diagnosed liver cancer cases, the rate of early detection was 40.81% and that of early treatment was 79.59%. The calculated 1-, 3-, 5-year survival of the liver cancer cases were 75.51%, 43.28%, and 34.96% and the survivals were significantly higher than those of 36.18%, 16.56%, and 11.60% for the liver cancer patients registered from 2012 through 2014 in Fujian Provincial Cancer Registry System (P < 0.05 for all).   Conclusion  The study findings suggest that semiannual serum AFP detection and BU of liver could detect liver cancer cases more effectively in HBsAg-positive population and the survival of the detected liver cases may be increased due to early diagnosis and treatment.
Changes in erythrocyte methylmercury among women during pregnancy: a monocentric survey and comparison study
CHEN Xing, LUO Jia-yao, CHEN Huan, CHEN Xi,
2022, 38(8): 1058-1061. doi: 10.11847/zgggws1136158
Abstract:
  Objective   To investigate changes in peripheral erythrocyte methylmercury among pregnant women during different gestational periods and the methylmercury in neonatal umbilical cord blood erythrocyte.   Methods  Totally 79 pregnant women having prenatal examination were recruited at a women′s and children′s health care center in Wuhan city during January – April, 2019. The women′s peripheral blood samples were collected at the first trimester (12 ± 2 weeks of gestation) and the third trimester (37 ± 2 weeks of gestation) and neonatal umbilical cord blood samples were also collected. Red blood cells of the samples were separated and concentrations of methylmercury in the cells were detected with high performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICP-MS).   Results   The geometric means of erythrocyte methylmercury of all the women were 0.322 μg/g (interquartile range [IRQ]: 0.188 – 0.728 μg/g) for the samples of first trimester, 0.238 μg/g (IRQ: 0.120 – 0.549 μg/g ) for those of third trimester, and 0.515 μg/g (IRQ: 0.322 – 1.099 μg/g) for neonatal umbilical cord samples. The erythrocyte methylmercury of the first trimester samples was significantly higher than that of the third trimester samples (P < 0.05); while, the erythrocyte methylmercury of both the first trimester and the third trimester samples were significantly lower than that of neonatal umbilical cord samples (both P < 0.05). The erythrocyte methylmercury of the umbilical cord blood samples, the first trimester samples and the third trimester samples were closely correlated with each other, with the correlation coefficients of 0.763, 0.866, and 0.854, respectively.   Conclusion   The erythrocyte methylmercury of pregnant women during first and third trimester and that of neonatal umbilical cord blood are significantly correlated with each other. Higher erythrocyte methylmercury of neonatal umbilical cord blood than that of women during pregnancy suggests a possible enrichment of methyl mercury.
Rapid pathogen detection and molecular tracing: a laboratory analysis on a cholera epidemic
XIONG Chang-hui, YANG Meng, XU Xiao-qian,
2022, 38(8): 1062-1065. doi: 10.11847/zgggws1136896
Abstract:
  Objective  To report rapid pathogen isolation and identification, virulence gene detection and pathogen tracing for a suspected cholera epidemic.   Methods  Four stool and four anal swab specimens were collected from 8 diarrhea patients in an overseas tour group and 13 anal swab specimens were also collected from 13 other members of the tour group on October 21, 2018. Rapid detections of the specimens were conducted with Filmarray system and real-time PCR rapid identification and culture methods were used, respectively, for the specimens. VITEK-2 automatic microbial identification instrument and pulsed field gel electrophoresis (PFGE) typing were used for bio-identification of the isolated strains. Virulence genes were analyzed with real-time PCR.   Results  Vibrio parahemolyticus (VP) was isolated from 11 of the specimens. Molecular typing of PFGE showed that the 11 VP stains were highly homologous, indicating that the epidemic was resulted from the infection of a same VP strain.   Conclusion  Combined utilization of multiple laboratory detections is of important value for rapid diagnosis, pathogen identification and tracing in epidemiological investigation on cholera epidemics.
Evidence-Based Medicine
Lipid level and risk of Alzheimer′s disease: a systematic review and meta-analysis
LÜ Xuan-rui, XU Jing, LIN Xiao-nan, SONG Jing,
2022, 38(8): 1066-1069. doi: 10.11847/zgggws1138716
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Abstract:
  Objective  To systematically evaluate the role of blood lipid level in predicting the risk of Alzheimer′s disease (AD).   Methods  We searched Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database for Chinese Technical Periodicals (VIP), Pubmed, Web of Science, Springer, and Cocharne Library for literatures on the correlation between AD incidence and blood lipid level published in Chinese or English till June 2021 and supplementary manual tracing for some of the references was also conducted. Newcastle-Ottawa-Scale literature quality evaluation scale was adopted to evaluate the quality of the included studies. Statistical analyses were performed with RevMan5.3 software.   Results  A total of 15 eligible studies were selected according to the inclusion and exclusion criteria, and the data on blood lipid level were collected from 1 435 healthy elderly people and 2 162 elderly people with AD. Meta-analysis showed that there was no significant difference in total cholesterol (TC) and triglyceride (TG) level between the AD sufferers and the healthy controls; low-density lipoprotein cholesterol (LDL-C) was significantly higher in the AD sufferers than that in the healthy controls (mean difference [MD] = 3.59, 95% confidence interval [95% CI]: 0.98 – 6.21); while, high-density lipoprotein cholesterol (HDL-C) was significantly lower in the AD sufferers than that in the healthy controls (MD = – 3.47, 95% CI: – 5.94 – – 0.99).   Conclusion  Higher LDL-C level but lower HDL-C level may indicate a higher risk of AD in older adults.
Overview
Salt reduction in the world – intervention strategies and measures: a progress review
FAN Fang, LI Ying-hua
2022, 38(8): 1070-1078. doi: 10.11847/zgggws1137783
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Abstract:
Non-communicable diseases (NCDs) is the main cause of deaths around the world and salt reduction is considered as one of the most cost-effective priority actions to reduce the risk of NCDs. In order to reduce salt intake among residents, many countries in the world have implemented a series of salt reduction strategies and measures, such as establishing salt reduction policies, enhancing consumer health education, improving food formulations in the food industry, and implementing front-of-package labeling programs. This paper summarizes researches on source of salt, salt and health, as well as the strategies, measures and achievements of salt reduction intervention in some countries and regions, in order to provide references for carrying out relevant salt reduction actions in China.
Progress in researches on health risk types in designated drivers
ZHANG Meng, WANG Qi-qi, YAO Hong-yan, , LIU Jian-jun
2022, 38(8): 1079-1081. doi: 10.11847/zgggws1135792
Abstract:
Designated driving service provides new ideas for reducing drunk driving. As the core of designated driving industry, the health status of designated drivers is closely related to the safety of driving. Current researches are mainly about the utility evaluation of the designated driving service, and few about the designated drivers. This study summarizes the definition of designated drivers, the types, research methods and intervention measures of health risks, and provides references for exploring the health risk management measures for designated drivers.
Long-term effects of pregnancy exposure to natural disasters on physical health: a review
ZHAO Yi-hao, HU Xi-yuan, GUO Chao
2022, 38(8): 1082-1087. doi: 10.11847/zgggws1136302
Abstract:
Based on the theory of developmental origins of health and disease (DOhaD), adult diseases are related to adverse factors experienced in early life. In this study, we reviewed relevant literatures and studied the effects of pregnancy exposure to disasters such as earthquakes, floods, famines, hurricanes, tropical cyclone, and ice storms on physical health of infants, children, adolescents, and adults. Published researches demonstrated that exposure to catastrophic events during fetus period could exert adverse effects on physical health from newborn to adulthood, and the exposure at different periods could have different effects on physical health. At present, there are a few studies on the long - term effects of fetal exposure to catastrophic events on physical health in China, and it is necessary to establish a long - term monitoring cohort of exposed people. In addition, further study is needed to explore the impact of catastrophic exposure at different stages of fetal period on physiological health in order to provide evidences for developing effective intervention programs.
Development of group B meningococcal vaccine: a progress review
ZHAO Wei, BAI Shuang, KANG Yan-li,
2022, 38(8): 1088-1092. doi: 10.11847/zgggws1137414
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Abstract:
Epidemic cerebrospinal meningitis is a respiratory infectious disease caused by Neisseria meningitidis, most commonly manifesting as meningitis and septicaemia. Due to the lack of effective prevention measures, serogroup B Neisseria meningitidis (MenB) has become one of dominant epidemic bacterial groups. In recent years, the emergence of reverse vaccinology has greatly promoted the research on serogroup B meningococcal vaccine, and researches on the vaccine have also made a breakthrough. In order to develop a more effective meningococcal vaccine, this article reviews the research progress on new protein antigen vaccine, outer membrane vesicle vaccine and recombinant protein vaccine in the field of MenB vaccine.
Public Health Forum
Social attributes and social prevention and control of disease: a comment
WANG Chao, LU Zu-xun
2022, 38(8): 1093-1096. doi: 10.11847/zgggws1138138
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Abstract:
The social attribute of people determines that illness is not only a medical problem, but also a social disease. The illness has a wide range of social attributes from its occurrence and development, diagnosis and treatment to its social impacts. The prevention and control of disease require a full participation of the whole society, including the government, medical institutions, social organizations, and individuals. However, a healthy social environment urgently requires further innovations in disease prevention and control concepts and strategies to strengthen social foundations against to various diseases.