China Hands Research Articles

Statistical monitoring of the hand, foot and mouth disease in China.

In a period starting around 2007, the Hand, Foot, and Mouth Disease (HFMD) became wide-spreading in China, and the Chinese public health was seriously threatened. To prevent the outbreak of infectious diseases like HFMD, effective disease surveillance systems would be especially helpful to give signals of disease outbreaks as early as possible. Statistical process control (SPC) charts provide a major statistical tool in industrial quality control for detecting product defectives in a timely manner. In recent years, SPC charts have been used for disease surveillance. However, disease surveillance data often have much more complicated structures, compared to the data collected from industrial production lines. Major challenges, including lack of in-control data, complex seasonal effects, and spatio-temporal correlations, make the surveillance data difficult to handle. In this article, we propose a three-step procedure for analyzing disease surveillance data, and our procedure is demonstrated using the HFMD data collected during 2008-2009 in China. Our method uses nonparametric longitudinal data and time series analysis methods to eliminate the possible impact of seasonality and temporal correlation before the disease incidence data are sequentially monitored by a SPC chart. At both national and provincial levels, our proposed method can effectively detect the increasing trend of disease incidence rate before the disease becomes wide-spreading.

Comparative epidemiology and virology of fatal and nonfatal cases of hand, foot and mouth disease in mainland China from 2008 to 2014.

This study aimed to analyze the epidemiology and virology of fatal and nonfatal hand, foot, and mouth disease (HFMD) cases in Mainland China. A total of 10,714,237 survivors and 3046 deaths were reported from 2008 to 2014 June, with a case fatality rate of 0.03%. The morbidity of the survivors increased from 37.6/100,000 in 2008 to 139.6/100,000 in 2013 and peaked in 2012 at 166.8/100,000. However, the mortality varied around 0.03-0.04/100,000 across the time. Most of the survivors were distributed in the southern and eastern China, predominantly in the Guangxi and Hainan Province, whereas deaths were dominant in southern (Guangxi) and southwestern (Guizhou) China. The two groups showed similar seasonal fluctuations from 2008 to 2014, peaking in spring and early summer. Of the total cases, 93.97% were children less than 5 years of age, with those ≤ 2 years old accounting for 60.08% versus 84.02% in the survivor and death groups, respectively. Boys were at higher risk of infection than girls in both groups. Five years of virological surveillance showed that 43.73%, 22.04%, and 34.22% of HFMD cases were due to EV71, CoxA16 and other enteroviruses, respectively. EV71 was encountered in most deaths, with no substantial effect of age, gender, month, and year on incidence. Subgenotype C4a was the prevalent EV71 strain in Mainland China, with no significant difference in the VP1 gene related to virulence between the two groups. In conclusion, based on the largest population study, fatal and nonfatal HFMD cases, mainly caused by C4a of EV71, are circulating in Mainland China with a low-cause fatality rate.

A real-time RT-PCR assay for rapid detection of coxsackievirus A10.

Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) have been the primary causative agents of hand, foot, and mouth disease (HFMD) outbreaks in mainland China in the past. Hence, the surveillance of HFMD has mostly focused on these viruses. However, in recent years, coxsackievirus A10 (CA10) has also been associated with the increasing sporadic HFMD cases and outbreaks. Therefore, a sensitive assay for rapid detection of the CA10 RNA is necessary for disease control. Here, we have developed a specific TaqMan real-time RT-PCR assay by analyzing VP1 gene sequences of CA10 strains from different locations. The assay has been shown to be specific, sensitive, and robust through detection of other related viruses, standard curves, and clinical samples, respectively. This is the first report on development of a VP1 gene-based TaqMan real-time RT-PCR assay for rapid diagnosis of CA10 virus.

Aid Refugee Chinese Intellectuals, Inc. and the Political Uses of Humanitarian Relief, 1952-1962 援助中国知识人士协会与难民援助的政治作用, 1952-1962

This paper examines the operations of Aid Refugee Chinese Intellectuals (arci). It argues that arci’s project failed in ways that illuminate the politicized, symbolic operations of refugee relief and the difficulties of manipulating mid-twentieth century migration flows, particularly of Asians. arci’s challenges included registering too many, poorly qualified refugees for assistance rather than a useful “leadership” class; the limited willingness of the Nationalist regime to accept even well-educated new residents into the struggling economy of its tightly controlled political base; dependence on the State Department for funding and the imposition of its priorities onto arci’s programs; and the preferences and capacities of arci registrants in forging their own paths. These problems illuminate the complicated, codependency of the “special relationship” between American “China hands” and the China Lobby and the Christian leader of the Nationalists, as well as the politicized and perhaps intractably irreconcilable messiness of managing refugee flows.

Risk Factors for Critical Disease and Death from Hand, Foot and Mouth Disease

There has been a high mortality and morbidity rate of critical and fatal patients from hand, foot and mouth disease (HFMD) in China in recent. Causes for development of critical and fatal disease remain unclear. We performed a case-control study to assess the association between use of drugs and development of critical disease and death from HFMD. We found that glucocorticoids treatment was associated with a greater incidence of severe HFMD, whereas andrographolides treatment was associated with a protective effect when they are used for treatment within 48 hours after onset or before being diagnosed as critical. We recommend that glucocorticoids should not be used for mild HFMD and andrographolides should undergo clinical trials for treatment of enterovirus 71 infections.

Will the explosive growth of China continue?

The role of China in the world economy is constantly growing. In particular we observe that it plays more and more important role in the support of the world economic growth (as well as high prices of certain very important commodities). In the meantime the perspectives of the Chinese economy (as well as possible fates of the Chinese society) remain unclear, whereas respective forecasts look rather contradictory. That is why the search for new aspects and modes of analysis of possible development of China turns out to be rather important for the forecasting of global futures. This article employs a combination of scientific methods that imply (a) the analysis at the level of Chinese economic model; (b) the analysis at regional level (at this level the Chinese economic model is compared with the regional East Asian model); (c) the analysis at the global level that relies on the modified world-system approach that allows to answer the question whether China will replace the USA as the global leader. It is important that the analysis is conducted simultaneously in economic, social, demographic, and political dimensions.As regards the analysis of specific features of the Chinese model as an especial type of the East Asian model (that is based on the export orientation, capital & technology importation, as well as cheap labor force), we note as organic features of the Chinese model the totalitarian power of the Communist Party and the immenseness of resources. As regards special features of the Chinese model, we note (in addition to “cheap ecology” and cheap labor force) and emphasize that China has a multilevel (in a way unique) system of growth driving forces, where, as opposed to developed states, the dominant role belongs not to native private capital, but to state corporations, local authorities and foreign business. This explains the peculiarities of the Chinese investment (or rather overinvestment), which determines high growth rate up to a very significant degree. A unique feature of the Chinese model is the competition of provinces and territories for investments and high growth indicators.As regards perspectives of the global hegemony of China, we intend to demonstrate that, on the one hand, economic and political positions of China will strengthen in the forthcoming decades, but, on the other hand, China, assuming all possible future success, will be unable to take the USA position in the World System. We believe that in a direct connection with the development of globalization processes the hegemony cycle pattern is likely to come to its end, which will lead to the World System reconfiguration and the emergence of its new structure that will allow the World System to continue its further development without a hegemon.Finally, the article describes some possible scenarios of the development of China. We demonstrate that China could hardly avoid serious difficulties and critical situations (including those connected with demographic problems); however, there could be different scenarios of how China will deal with the forthcoming crisis. We also come to the conclusion that it would be better for China to achieve a slowdown to moderate growth rates (that would allow China to go through the forthcoming complex transition period with less losses) than to try to return at any cost to explosive growth rates attested in the 2000s.

Hand, foot and mouth disease in China: evaluating an automated system for the detection of outbreaks

ObjectiveTo evaluate the performance of China’s infectious disease automated alert and response system in the detection of outbreaks of hand, foot and mouth (HFM) disease.MethodsWe estimated size, duration and delay in reporting HFM disease outbreaks from cases notified between 1 May 2008 and 30 April 2010 and between 1 May 2010 and 30 April 2012, before and after automatic alert and response included HFM disease. Sensitivity, specificity and timeliness of detection of aberrations in the incidence of HFM disease outbreaks were estimated by comparing automated detections to observations of public health staff.FindingsThe alert and response system recorded 106 005 aberrations in the incidence of HFM disease between 1 May 2010 and 30 April 2012 – a mean of 5.6 aberrations per 100 days in each county that reported HFM disease. The response system had a sensitivity of 92.7% and a specificity of 95.0%. The mean delay between the reporting of the first case of an outbreak and detection of that outbreak by the response system was 2.1 days. Between the first and second study periods, the mean size of an HFM disease outbreak decreased from 19.4 to 15.8 cases and the mean interval between the onset and initial reporting of such an outbreak to the public health emergency reporting system decreased from 10.0 to 9.1 days.ConclusionThe automated alert and response system shows good sensitivity in the detection of HFM disease outbreaks and appears to be relatively rapid. Continued use of this system should allow more effective prevention and limitation of such outbreaks in China.

The Population-Based Health Effect of Hand, Foot and Mouth Disease in Children in Shanghai

An effective enterovirus 71 (EV71) vaccine is needed to control the annual outbreaks of hand, foot and mouth disease (HFMD) in China. Adequate epidemiologic data relating to HFMD are needed to make decisions about appropriate public health interventions and implementation of the new EV71 vaccine. We analyzed the population-based epidemiologic characteristics, clinical outcome and laboratory investigation of the 2011 HFMD outbreak in children based on the citywide surveillance system in Shanghai. The incidence rate of HFMD was 25.8 per 1000 in children <10 years of age in Shanghai in 2011, ranging from 2.5 per 1000 in the age group 7 to 9.9 years to 48.4 per 1000 in the age group 3 to 3.9 years. Children 1 to 1.9 years were at the highest risk of developing severe complications and most susceptible to HFMD. Boys and migrant children had significantly increased risks of contracting HFMD and developing severe disease. More institutional clusters/outbreaks occurred in the winter peak months than in the summer peak months. Migrant young children played a central role in the spread of HFMD in the community. EV71 was identified in 39.7% of mild HFMD outpatients, 47.4% of hospitalized patients, 92.1% of severe inpatients with complications, 50% of outbreaks and 38.8% of clusters in institutions. HFMD and EV71 infections have a significant health effect on Shanghai children.

Co-circulation and genomic recombination of coxsackievirus A16 and enterovirus 71 during a large outbreak of hand, foot, and mouth disease in Central China.

A total of 1844 patients with hand, foot, and mouth disease (HFMD), most of them were children of age 1–3-year-old, in Central China were hospitalized from 2011 to 2012. Among them, 422 were infected with coxsackievirus A16 (CVA16), 334 were infected with enterovirus 71 (EV71), 38 were co-infected with EV71 and CVA16, and 35 were infected with other enteroviruses. Molecular epidemiology analysis revealed that EV71 and CVA16 were detected year-round, but EV71 circulated mainly in July and CVA16 circulated predominantly in November, and incidence of HFMD was reduced in January and February and increased in March. Clinical data showed that hyperglycemia and neurologic complications were significantly higher in EV71-infected patients, while upper respiratory tract infection and C-reactive protein were significantly higher in CVA16-associated patients. 124 EV71 and 80 CVA16 strains were isolated, among them 56 and 68 EV71 strains were C4a and C4b, while 25 and 55 CVA16 strains were B1a and B1b, respectively. Similarity plots and bootscan analyses based on entire genomic sequences revealed that the three C4a sub-genotype EV71 strains were recombinant with C4b sub-genotype EV71 in 2B–2C region, and the three CVA16 strains were recombinant with EV71 in 2A–2B region. Thus, CVA16 and EV71 were the major causative agents in a large HFMD outbreak in Central China. HFMD incidence was high for children among household contact and was detected year-round, but outbreak was seasonal dependent. CVA16 B1b and EV71 C4b reemerged and caused a large epidemic in China after a quiet period of many years. Moreover, EV71 and CVA16 were co-circulated during the outbreak, which may have contributed to the genomic recombination between the pathogens. It should gain more attention as there may be an upward trend in co-circulation of the two pathogens globally and the new role recombination plays in the emergence of new enterovirus variants.

Phylodynamics of Human Coxsackievirus B5

ABSTRACT: Aim: Coxsackievirus B5 is recognized as an important pathogen in aseptic meningitis and hand, foot and mouth disease of children. A new distinctive sublineage of Coxsackievirus B5 associated with outbreak of neurological hand, foot and mouth disease in China was recently reported. Materials &amp; methods: We employed a molecular evolution method to study the genetic variation and evolutionary history of Coxsackievirus B5 in China. Coxsackievirus B5 isolates from China can be divided into four major groups with obvious temporal evolution routes. Results: A 'mutation box' covering amino acids 75, 85, 90 and 95 of VP1 protein was observed to be unique in the isolates group from Henan and Shandong province. The temporal evolution routes of the amino acids changes in the 'mutation box' were studied. Conclusion: Our results provide primary insight into the relationship between genetic variation and epidemic behavior of Coxsackievirus B5.

Modeling and Preventive Measures of Hand, Foot and Mouth Disease (HFMD) in China

This paper concentrates on the HFMD data of China from March 2009 to December 2012. We set up a mathematical model to fit those data with the goodness of fit and obtain the optimal parameter values of the model. By the Chi-square test of statistical inference, the optimal parameter values of the model are reasonable. We obtained the basic reproductive number of the disease for each year, and it is larger than 1. Thus, we conclude that HFMD will persist in China under the current conditions, so we investigate the preventive measures to control the HFMD. If the preventive measures proposed in our paper were implemented, HFMD would be controlled quickly and the number of infections would decline rapidly over a period of time.

Identification of Health Risks of Hand, Foot and Mouth Disease in China Using the Geographical Detector Technique

Hand, foot and mouth disease (HFMD) is a common infectious disease, causing thousands of deaths among children in China over the past two decades. Environmental risk factors such as meteorological factors, population factors and economic factors may affect the incidence of HFMD. In the current paper, we used a novel model—geographical detector technique to analyze the effect of these factors on the incidence of HFMD in China. We collected HFMD cases from 2,309 counties during May 2008 in China. The monthly cumulative incidence of HFMD was calculated for children aged 0–9 years. Potential risk factors included meteorological factors, economic factors, and population density factors. Four geographical detectors (risk detector, factor detector, ecological detector, and interaction detector) were used to analyze the effects of some potential risk factors on the incidence of HFMD in China. We found that tertiary industry and children exert more influence than first industry and middle school students on the incidence of HFMD. The interactive effect of any two risk factors increases the hazard for HFMD transmission.

Hand, foot, and mouth disease in China, 2008–12: an epidemiological study

Hand, foot, and mouth disease is a common childhood illness caused by enteroviruses. Increasingly, the disease has a substantial burden throughout east and southeast Asia. To better inform vaccine and other interventions, we characterised the epidemiology of hand, foot, and mouth disease in China on the basis of enhanced surveillance. We extracted epidemiological, clinical, and laboratory data from cases of hand, foot, and mouth disease reported to the Chinese Center for Disease Control and Prevention between Jan 1, 2008, and Dec 31, 2012. We then compiled climatic, geographical, and demographic information. All analyses were stratified by age, disease severity, laboratory confirmation status, and enterovirus serotype. The surveillance registry included 7,200,092 probable cases of hand, foot, and mouth disease (annual incidence, 1·2 per 1000 person-years from 2010-12), of which 267,942 (3·7%) were laboratory confirmed and 2457 (0·03%) were fatal. Incidence and mortality were highest in children aged 12-23 months (38·2 cases per 1000 person-years and 1·5 deaths per 100,000 person-years in 2012). Median duration from onset to diagnosis was 1·5 days (IQR 0·5-2·5) and median duration from onset to death was 3·5 days (2·5-4·5). The absolute number of patients with cardiopulmonary or neurological complications was 82,486 (case-severity rate 1·1%), and 2457 of 82486 patients with severe disease died (fatality rate 3·0%); 1617 of 1737 laboratory confirmed deaths (93%) were associated with enterovirus 71. Every year in June, hand, foot, and mouth disease peaked in north China, whereas southern China had semiannual outbreaks in May and September-October. Geographical differences in seasonal patterns were weakly associated with climate and demographic factors (variance explained 8-23% and 3-19%, respectively). This is the largest population-based study up to now of the epidemiology of hand, foot, and mouth disease. Future mitigation policies should take into account the heterogeneities of disease burden identified. Additional epidemiological and serological studies are warranted to elucidate the dynamics and immunity patterns of local hand, foot, and mouth disease and to optimise interventions. China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases, WHO, The Li Ka Shing Oxford Global Health Programme and Wellcome Trust, Harvard Center for Communicable Disease Dynamics, and Health and Medical Research Fund, Government of Hong Kong Special Administrative Region.

Surveillance of hand, foot, and mouth disease for a vaccine

Hand, foot, and mouth disease is a common and self-limiting illness that mainly affects young children. 1 Solomon T Lewthwaite P Perera D Cardosa MJ McMinn P Ooi MH Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis. 2010; 10: 778-790 Summary Full Text Full Text PDF PubMed Scopus (963) Google Scholar The major causative agents of hand, foot, and mouth disease are enteroviruses (species Enterovirus A) such as enterovirus 71 (EV71), Coxsackie A virus 16 (CV-A16), and Coxsackie A virus 6 (CV-A6). 2 International Committee on Taxonomy of VirusesPicornaviridae Study Group. http://www.picornastudygroup.com Google Scholar , 3 Nishimura Y Shimizu H Cellular receptors for human enterovirus species A. Front Microbiol. 2012; 3: 105 Crossref PubMed Scopus (28) Google Scholar CV-A16 is usually associated with mild hand, foot, and mouth disease. A growing epidemic of atypical but self-limiting disease caused by CV-A6 has been reported worldwide. 4 Feder Jr., HM Bennett N Modlin JF Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6. Lancet Infect Dis. 2014; 14: 83-86 Summary Full Text Full Text PDF PubMed Scopus (107) Google Scholar However, an EV71 infection might cause severe neurological manifestations including polio-like paralysis, brainstem encephalitis, and fatal cardiopulmonary complications with or without hand, foot, and mouth disease. 1 Solomon T Lewthwaite P Perera D Cardosa MJ McMinn P Ooi MH Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis. 2010; 10: 778-790 Summary Full Text Full Text PDF PubMed Scopus (963) Google Scholar Outbreaks of the disease due to EV71 have been reported worldwide since initial identification of the disease in 1969. During large outbreaks of hand, foot, and mouth disease, several fatal cases of disease with cardiopulmonary failure were reported in Sarawak, Malaysia in 1997, and in Taiwan in 1998. Thereafter, EV71 infections have caused thousands of deaths in young children, especially in the Asia–Pacific region, including Malaysia, Taiwan, Vietnam, Cambodia, and China, posing a serious threat to public health in these regions. 1 Solomon T Lewthwaite P Perera D Cardosa MJ McMinn P Ooi MH Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis. 2010; 10: 778-790 Summary Full Text Full Text PDF PubMed Scopus (963) Google Scholar Certain Asia–Pacific countries have intensified or established disease and infectious agent surveillance systems to monitor national and regional epidemics and other severe EV71-associated diseases. 5 WHO Western Pacific RegionHand, foot, and mouth disease (HFMD). http://www.wpro.who.int/emerging_diseases/HFMD/en/ Google Scholar Hand, foot, and mouth disease in China, 2008–12: an epidemiological studyThis is the largest population-based study up to now of the epidemiology of hand, foot, and mouth disease. Future mitigation policies should take into account the heterogeneities of disease burden identified. Additional epidemiological and serological studies are warranted to elucidate the dynamics and immunity patterns of local hand, foot, and mouth disease and to optimise interventions. Full-Text PDF

Study on Risk Factors for Severe Hand, Foot and Mouth Disease in China

BackgroundEpidemics of HFMD are elevated every year globally, especially in mainland China. The disease now presents as an increasing threat to public health worldwide.MethodsFive hundred and seventy-one EV71-infected HFMD patients in Beijing You'an Hospital were grouped by disease severity: Mild (no severe complication) (n = 221), and Severe group (complicated with brainstem encephalitis (BE), and/or pulmonary edema (PE) (n = 350)). Clinical and laboratory findings and levels of 7 serum cytokines were analyzed.ResultsUnivariate analysis showed that (RR)>26/min (p<0.001), age<4 yo (p = 0.001), GLU>8.3 mmol/L (p = 0.008), CL<98 mmol/L (p = 0.026), and WBC>1.2×109/L (p = 0.040) were associated with severe cases. Results of multivariate analysis indicated five independent risk factors (RR>26/min (p<0.001), Age<4 yo (p<0.001), GLU>8.3 mmol/L (p = 0.011), LYM>40% (p = 0.010), and ALT>40 U/L (p = 0.045)). In addition to single-factor analysis, we further analyzed the use of different combinations of risk factors. “GLU>8.3 and CL<98 and RR>26” (confidence ration (CR) = 100%) is the top indicator, followed by “ALT>40 and LYM>40% and RR>26 and Age<4 yo” (CR = 92.9%).Serum levels of IL-2, IL-4, IL-10, IFNγ, GM-CSF, and TNFα were higher in severe cases than in mild cases. A new evaluation scoring system by scoring each risk factor 1 and independent risk factor 2 was developed for early identification of severe HFMD cases.ConclusionsFive independent risk factors, along with indicative combinations of risk factors, for severe cases were identified, and a scoring system was created to facilitate the use of indicators for early medical intervention.

Molecular Epidemiology of Coxsackievirus A16: Intratype and Prevalent Intertype Recombination Identified

Coxsackievirus A16 (CVA16) is responsible for nearly 50% of all the confirmed hand, foot, and mouth disease (HFMD) cases in mainland China, sometimes it could also cause severe complications, and even death. To clarify the genetic characteristics and the epidemic patterns of CVA16 in mainland China, comprehensive bioinfomatics analyses were performed by using 35 CVA16 whole genome sequences from 1998 to 2011, 593 complete CVA16 VP1 sequences from 1981 to 2011, and prototype strains of human enterovirus species A (EV-A). Analysis on complete VP1 sequences revealed that subgenotypes B1a and B1b were prevalent strains and have been co-circulating in many Asian countries since 2000, especially in mainland China for at least 13 years. While the prevalence of subgenotype B1c (totally 20 strains) was much limited, only found in Malaysia from 2005 to 2007 and in France in 2010. Genotype B2 only caused epidemic in Japan and Malaysia from 1981 to 2000. Both subgenotypes B1a and B1b were potential recombinant viruses containing sequences from other EV-A donors in the 5’-untranslated region and P2, P3 non-structural protein encoding regions.

Western Visions of the Far East in a Transpacific Age, 1522–1657

Contents: Introduction: Europe's encounter of Asia in early modernity Part 1 Imagining the Far East from Europe: 'The Indies of the West' or, the tale of how an imaginary geography circumnavigated the globe, Ricardo PadrA^3n Imagining China in a golden age Spanish epic, Christina H. Lee. Part 2 Discovering the Far East: The first China hands: the forgotten Iberian origins of Sinology, Liam Matthew Brockey Matteo Ricci on China via Samuel Purchas: faithful re-presentation, Nicholas Koss Representations of China and Europe in the writings of Diego de Pantoja: accommodating the East or privileging the West? Robert Richmond Ellis Women in the eyes of a Jesuit between the East Indies, New Spain, and early modern Europe, Haruko Natawa Ward. Part 3 Sightings of the Far East in Europe: Chinos in 16th-century Spain, Juan Gil Native vassals: Chinos, indigenous identity, and legal protection in early modern Spain, Tatiana Seijas Travelers from afar through civic spaces: the Tensho embassy in Renaissance Italy, Marco Musillo The Borghese papacy's reception of a samurai delegation and its fresco-image at Palazzo del Quirinale, Rome, Mayu Fujikawa Bibliography Index.

Prevalence of enteroviruses in children with and without hand, foot, and mouth disease in China

BackgroundTo determine the prevalence of human enteroviruses (HEVs) among healthy children, their parents, and children with hand, foot, and mouth disease (HFMD).MethodsWe conducted a case–control study that included throat samples from 579 children with HFMD and from 254 healthy controls. Throat samples from 49 households (98 parents and 53 healthy children) were also analyzed. Phylogenetic analysis was carried out to study genetic relationships of EV71 strains.ResultsThe HEV positive rate in HFMD patients was significantly higher than that in healthy controls (76.0% vs. 23.2%, P < 0.001). The EV71 (43.7% vs. 15.0%, P < 0.001), CVA16 (18.0% vs. 2.8%, P < 0.001), and CVA10 (5.7% vs. 0.8%, P = 0.001) serotypes were significantly overrepresented in HFMD patients in comparison to healthy children. Other HEV serotypes were detected with comparable frequency in cases and controls. The HEV positive rate in severe HFMD patients was significantly higher than that in mild group (82.1% vs. 73.8%, P = 0.04). The EV71 (55.0% vs. 39.7%, P = 0.001) and CVA16 (11. 9% vs. 20.0%, P = 0.024) positive rate differed significantly between severe and mild HFMD patients. Other HEV serotypes were detected with comparable frequency between severe and mild HFMD patients. Among 49 households, 22 households (44.9%) had at least 1 family member positive for HEV. Children had significantly higher HEV positive rate than adult (28.3% vs. 14.3%, P = 0.037). The HEV positive rate was similar between mothers and fathers (12.24% vs. 16.32%, P = 0.56). The VP1 sequences of EV71 from HFMD patients and healthy children were nearly identical and all were clustered in the same clade, C4a.ConclusionsOur study demonstrated the co-circulation of multiple HEV serotypes in children with and without HFMD during epidemic. Our study deserves the attention on HFMD control.

LT. COL. WALTER GORDON HARMON, ‘AN OLD CHINA HAND’

Gordon Harmon was born in China in 1900 and after the First World War served in the Salt Revenue Guards for a number of years. After the outbreak of WWII he was posted in a liaison role to the centre of Chinese government in Chungking. There he worked with Chiang Kai Shek's Nationalist Intelligence Service. But he also had quite close links with Chou En-Lai, who was also in Chungking at that time. The extent of his more general relationship with the Communists is unclear, but he seems to have reported fairly extensively on their plans and intentions. Harmon has left a very detailed record of a conversation with Mao Tse-tung in 1946 which seems to suggest that he had met Mao a few times before.. It was Mao who apparently said to Harmon “I am not interested in Hongkong and I will certainly not allow it to become a bone of contention between your country and mine”

An early warning and response system for hand, foot and mouth Disease in China, 2011-2012

Background: A China Infectious Disease Automated-alert and Response System (CIDARS) has been increasingly utilized nationwide for early outbreak detection and rapid response for infectious diseases...