National Notifiable Disease Reporting System Research Articles

Incidence of anogenital warts in Liuzhou, south China: a comparison of data from a prospective study and from the national surveillance system

To determine the incidence of anogenital warts (AGWs) in the Chinese general population, we compared the data from a prospective study and from the National Notifiable Disease Report System (NNDRS). A cohort study including 2378 women and 2309 men aged 18–55 years old enrolled from Liuzhou, China, was conducted with three scheduled visits at 6-month intervals from May 2014 to March 2016. And, a questionnaire survey was performed to collect the diagnosis history of AGWs at the enrollment visit. The data on reported AGW cases of Liuzhou in the NNDRS from 2006 to 2015 were also analyzed. Overall, the incidence rates of AGWs in the prospective study, in the self-reported diagnosis during past 12 months and in the NNDRS were 1.26 per 1000 person-years (95% confidence interval (CI): 0.16–2.37), 2.35 (95% CI: 1.17–4.20) and 0.183 (95% CI: 0.178–0.187), respectively. Human papillomavirus 6 or 11 were found in all the AGW biopsy samples (10/10). The onset time of AGWs in women was earlier, and the cumulative risk increased more quickly at a young age along with each subsequent younger birth cohort (P<0.0001), whereas slight differences were observed in the different male birth cohorts (P=0.0785). The sexual behavior of individuals and their sexual partners had a strong relationship with self-reported AGWs. Our study indicates that the incidence of AGWs in China is as high as that in developed countries, and the data based on the national surveillance system seriously underestimate the real disease burden of AGWs.

Epidemiologic Features of Enterovirus 71-Associated Hand-Foot-and-Mouth Disease from 2009 to 2013 in Zhejiang, China.

Enterovirus 71 (EV71) usually causes hand-foot-and-mouth disease (HFMD) with severe clinical symptoms and even deaths in China. There is no efficient antiviral drug to protect against severe EV71-associated HFMD, making the development of EV71 vaccines therefore a priority. However, the potential target subject population(s) to be immunized with EV71 vaccine are not well understood. In this study, we characterized the epidemiology regarding EV71-associated HFMD on the basis of provincial-level surveillance. We extracted data on EV71-associated HFMD from the National Notifiable Disease Reporting System in Zhejiang Province, China between 1 January 2009 and 31 December 2013 (n = 7650). The higher incidence rate of EV71 cases occurred in those children aged 12–23 months, with boys being predominant. Interestingly, different peaks activities of EV71 infection was observed in different calendar year, with one peak in 2009 and 2013 and two peaks in 2010–2012. However, EV71 infection seemed to predominately occur in warm season and a distinguished cyclic peak that seemed to be of about 12 months. Children aged 12–23 months are thus identified as an important target population for public health intervention, for example, it is recommended that these key subjects immunized with EV71 vaccine. In addition, an enhanced surveillance system for EV71-associated with HFMD needs to focus on generic and phylogenetic analysis.

Risk factors of acute hepatitis B virus through blood and sexual contact transmission in Beijing

Objective To investigate the risk factors of acute hepatitis B virus through blood and sexual contact transmission in Beijing. Methods A population-based 1∶2 matched case-control study was used in our survey. Three hundred and one acute hepatitis B cases living in Beijing more than one year reported in National Notifiable Disease Reporting System from January 2013 to December 2014 were recruited as cases. Six hundred and two sex-, age- and resident-matched individuals were selected as controls. All cases and controls were interviewed by questionnaires. Categorical variables were compared using chi-square test between groups. Risk factors for acute hepatitis B virus through blood and sexual contact transmission were calculated by Logistic regression model. Results Univariate factor analysis showed that history of drug injection in hospital more than half a year (χ2=5.45, P=0.03), surgery (χ2=6.94, P=0.01), supragingival scaling (χ2=4.21, P=0.05), component blood donation (χ2=4.43, P=0.04), close household contact (χ2=8.19, P=0.01), pedicure (χ2=4.41, P=0.04), scraping (χ2=6.94, P=0.01) and cupping (χ2=8.94, P=0.00) were the risk factors for acute hepatitis B virus through blood and sexual contact transmission. Multivariate Logistic analysis enrolled risk factors with significance into equation and showed that history of drug injection in hospital more than half a year (OR=3.44, 95%CI: 1.31-9.01), surgery (OR=4.03, 95%CI: 1.44-11.30), close household contact (OR=3.17, 95%CI: 1.32-7.65) and cupping (OR=1.87, 95%CI: 1.03-3.40) were the risk factors for acute hepatitis B virus through blood and sexual contact transmission. Multivariate Logistic analysis enrolled all risk factors into equation and showed that history of surgery (OR=1.45, 95%CI: 1.45-26.84), traumatic medical cosmetology (OR=6.83, 95%CI: 1.06-44.16) were the risk factors for acute hepatitis B virus through blood and sexual contact transmission. Conclusion History of drug injection in hospital more than half a year, surgery, close household contact, cupping and traumatic medical cosmetology are the risk factors for acute hepatitis B virus through blood and sexual contact transmission in Beijing. Key words: Hepatitis B; Acute; Blood; Sexual behavior; Risk factors; Case-control studies

Analysis on duplicate reporting of hepatitis B in national notifiable communicable disease report system in China, 2011-2013

Objective: To analyze the duplicated reporting of hepatitis B in the national notifiable communicable disease report system (NNDRS) in China during 2011-2013. Methods: The data of hepatitis B reported from January 1, 2011 to December 31, 2013 were collected from NNDRS, the duplicated reporting were searched with software SAS 9.1.3 according to the cases'ID number, name, gender, birth data and current address code. Results: During 2011-2013, a total of 3 389 374 hepatitis B cases were reported through NNDRS, but the duplicated reporting rate was 7.35% (249 047). According to 6 protocols, the duplicated reporting rate ranged from 0.88% to 6.38%. If using the data in 2011 as the baseline, the duplicated reporting rate in the three years was 2.91%, 8.11% and 11.72%, respectively. In the duplicated repeating, 33.04% (71 709) occurred in the same year, and 66.96% (145 329) occurred in other year. Without the duplicated repeating, the hepatitis B incidence in Xinjiang and Qinghai provinces in 2013 could decreased by 30.80/100 000 and 26.26/100 000, respectively. Conclusions: The analysis indicated that the duplicated repeating rate of hepatitis B was 7.36% in NNDRS during 2011-2013, and the duplicated reporting mainly occurred in other years. The duplicated reporting of hepatitis B in NNDRS had greatly affected the accuracy of surveillance data in some provinces, such as Xinjiang and Qinghai.

Epidemiological characteristics and vertification analysis for acute hepatitis B in Beijing, 2005-2014

Objective: To analyze epidemiological characteristics of acute hepatitis B(aHPB)in Beijing and to recheck epidemiology and laboratory results of aHPB cases in the sampling area. Methods: We analyzed epidemiological characteristics of aHPB cases reported in National Notifiable Disease Reporting System(NNDRS)from 2005 to 2014 in Beijing, using a stratified cluster sampling method and based on the average reported incidence of hepatitis B from 2005 to 2011 in NNDRS, we projected 430 aHPB cases in the sampling area from 2012 to 2014, for which 307 received blood sample retesting. Inclusion criteria of aHPB cases were those living in Beijing more than 1 year, using name, sex, age, or identity card number as key fields to verify that they had not been previously reported in the database. Accuracy and adjusted aHPB incidence rate for 2005- 2014 in Beijing was analyzed by rechecking aHPB cases. Results: Epidemiological survey showed that aHPB coincidence rate was 89.5%(385/430)in NNDRS from 2012 to 2014 in Beijing. Laboratory tests showed that the aHPB coincidence rate was 92.2%(283/307). The total coincidence rate was 82.54%. The aHPB adjustment incidence rate dropped from 5.05/100 thousand in 2005 to 0.98/100 thousand in 2014 in Beijing. The aHPB adjustment incidence rate among residents younger than 15 years dropped to 0/100 thousand. Conclusion: The incidence of aHPB in Beijing dropped to a low level from 2005 to 2014. There were no aHPB cases in residents younger than 15 years.

The coverage of hepatitis A vaccine among 2-29 year olds and the reporting incidence of hepatitis A in China, 2014

To evaluate the hepatitis A vaccine coverage among 2-29 year olds and the reported incidence rates of hepatitis A, in China. Based on data from the national sero-survey on hepatitis B in 2014, information on hepatitis A vaccine immunization was collected and the coverage of hepatitis A vaccine was analyzed with SAS software (Version 9.4). Incidence data on hepatitis A was also collected from the National Notifiable Disease Reporting System between 2004 and 2014, and analyzed using the micro-software Excel 2007. Totally, data involving 29 058 people aged 2-29 years were available for analysis and the overall hepatitis A vaccine coverage was 44.6%. The younger the age, the higher the coverage appeared. Among the 2-6 year and the 7-14 year olds, rates of hepatitis A vaccine coverage were 91.2% and 76.0% respectively. From 2004 to 2014, the incidence rates of hepatitis A in the whole population were declining, annually. The incidence rates showed continuously declining as 82.5%, 90.6%, 72.1% among children at the age groups of 2-6 years, 7-14 years and in the whole population, from 2007 to 2013. After the inclusion of hepatitis A vaccine into the Expanded Programe on Immunization (EPI), the coverage of hepatitis A vaccine among the 2-6 year olds increased to over 90%, with no obvious difference between the urban and rural areas. Incidence of hepatitis A in the 2-6 year olds showed a more rapid decline than that in the whole population.

Association between the incidence of varicella and meteorological conditions in Jinan, Eastern China, 2012-2014.

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

Changing Epidemiological Characteristics of Hepatitis A in Zhejiang Province, China: Increased Susceptibility in Adults.

BackgroundHepatitis A is a common acute hepatitis caused by hepatitis A virus (HAV). Annually, it affects 1.4 million people worldwide. Between 1991 and 1994, HAV infections were highly endemic in Zhejiang Province (China), with 78,720 reported HAV infections per year. Hepatitis A vaccine came on the market in 1995 and was implemented for voluntary immunization. Since 2008, hepatitis A vaccine has been integrated into the national childhood routine immunization program.ObjectiveTo understand the current epidemiological profile of hepatitis A in Zhejiang Province since hepatitis A vaccine has been available for nearly two decades.MethodsThis study used the 2005–2014 National Notifiable Diseases Reporting System data to evaluate the incidence rate of notified hepatitis A cases in Zhejiang Province.ResultsThe overall trend of incidence rate of notified hepatitis A cases significantly decreased from 2005 to 2014 (P< 0.001). During the study period, the reported incidence rate in individuals aged ≤19 years declined to the historically lowest record in 2014. Compared with individuals aged ≤19 years, those aged ≥20 years showed the highest incidence rate (P< 0.001). Majority of HAV infected cases were Laborers, accounting for approximately 70% of reported cases.ConclusionsChildhood immunization strategy with hepatitis A vaccine seemed to be effective in decreasing notified hepatitis A incidence rate in individuals aged ≤19 years. Those aged ≥20 years were observed to be the most susceptible population. The vast majority of hepatitis A cases were notified among Laborers. Therefore, we strongly suggest that future preventive and control measures should focus more on adults, particularly Laborers, in addition to the current childhood hepatitis A vaccination programme.

Short term effect of weather patterns on the incidence of hand foot and mouth disease aged ≤5 years old in Jinan city

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

Rubella outbreak in Poland in 2013 – an analysis of surveillance data at the national and province level

Abstract Introduction. Poland is a member of the WHO European Region where a complete eradication of measles and rubella is planned to be finished by 2015. Poland accounted for 99% of all reported rubella cases in 27 EU/EEA countries in 2013. It is a good time to evaluate whether the established Polish vaccination strategy was sufficient to reach the goal of rubella elimination in the near future. Aim. The aim of this study was to analyze the epidemiology of rubella in Poland when the disease outbreak took place in 2013, to determine the reasons of that situation and to find the solution for future rubella elimination strategies. Material and methods. To analyze the epidemiology of rubella in Poland during the disease outbreak in 2013 the authors used rubella surveillance data collected by the Provincial and National Notifiable Disease Reporting System in 2004-2013. The information at the provincial level derived from one of the 16 provinces (Malopolska). The data on MMR vaccination coverage in 2003-2012 derived from the National Surveillance System. The percentages of rubella cases and vaccine coverage between Poland with Malopolska province were compared. Results. The outbreak started in late 2012 and continued through 2013, when 38548 rubella cases (incidence rate 100.1/ 100 000) were notified. Geographically, rubella cases were reported from the entire country, with the highest incidence rate in Malopolska province (254.9/100 000). Only 5 cases from Malopolska and 120 in whole country were laboratory confirmed, the remaining 99.7% were reported solely on the basis of clinical signs. The vaccination coverage was not sufficient to protect the population against rubella outbreak in Poland, especially among adolescents and young adult males. Conclusions. The strengthening of routine immunization program and implementation of some additional vaccination campaigns in young adults as well as laboratory confirmation of all suspected cases are the challenges that will have to be met to eliminate rubella in Poland

Trends of acute hepatitis B notification rates in eastern China from 2005 to 2013.

Zhejiang Province was a high endemicity for hepatitis B disease in the 1990's. A number of measures implemented since then have begun to control and prevent hepatitis B. In 1992, hepatitis B vaccine came on the market. In 2002, hepatitis B vaccine was included in the national Expanded Programme on Immunization (EPI). Between 2007 and 2010, catch-up vaccination was implemented for children under 15. Since 2010, vaccination guidelines for high-risk groups have also been adopted. This study evaluated the impact of these control and prevention strategies on acute hepatitis B notification rates from 2005 through 2013. Data from the National Notifiable Disease Reporting System (NNDRS) revealed a steady downward trend in notification rates of acute hepatitis B. The most dramatic decline occurred among pre-adults, highlighting the benefits of EPI's policy of universal vaccination for children. However, the highest notification rates occurred among young adults of lower socio-economic status. These findings indicate the strong need to vaccinate young adults at risk for HBV infection as well as to collect risk-factor information in the NNDRS for monitoring and following up persons with acute hepatitis B.

Cost-effectiveness analysis of a hepatitis B vaccination catch-up program among children in Shandong Province, China

Objective: The aim of the study was to estimate long-term cost‑effectiveness of a hepatitis B vaccination catch-up program among children born between 1994 and 2001 (when they were 8‑15 y old) in Shandong province, China, to provide information for nationwide evaluation and future policy making.Methods: We determined the cost-effectiveness of the catch-up program compared with the status quo (no catch-up program). We combined a Decision Tree model and a Markov model to simulate vaccination and clinical progression after hepatitis B virus (HBV) infection. Parameters in the models were from the literature, a field survey, program files, and the National Notifiable Disease Reporting System (NNDRS). The incremental cost‑effectiveness ratio (ICER) was used to compare the 2 alternative strategies. One-way sensitivity analysis, 2-way sensitivity analysis, and probability sensitivity analysis were used to assess parameter uncertainties.Results: The catch-up program was dominant compared with the status quo. Using a total of 5.53 million doses of vaccines, the catch-up program could prevent 21,865 cases of symptomatic acute hepatitis B, 3,088 carrier states with positive hepatitis B surface antigen (HBsAg), and 812 deaths due to HBV infection. The catch-up program could add 28,888 quality-adjusted life years (QALYs) and save $192.01 million in the targeted population in the future. The models were robust, considering parameter uncertainties.Conclusion: The catch-up program in Shandong province among children born between 1994 and 2001 was ‘very cost-saving.’ It could save life years and reduce total future costs. Our study supported the desirability and impact of such a catch-up program throughout China.

Meteorological factors and risk of scrub typhus in Guangzhou, southern China, 2006-2012.

BackgroundScrub typhus is becoming the most common vector born disease in Guangzhou, southern China. In this study, we aimed to examine the effect of weather patterns on the incidence of Scrub typhus in the subtropical city of Guangzhou for the period 2006–2012, and assist public health prevention and control measures.MethodsScrub typhus reported cases during the period of 2006–2012 in Guangzhou were obtained from National Notifiable Disease Report System (NNDRS). Simultaneous meteorological data including temperature, relative humidity, atmospheric pressure, sunshine, and rainfall were obtained from the documentation of the Guangzhou Meteorological Bureau. A negative binomial regression was used to identify the relationship between meteorological variables and scrub typhus.ResultsAnnual incidence rates of scrub typhus from 2006 to 2012 were 3.25, 2.67, 3.81, 4.22, 4.41, 5.12, and 9.75 (per 100 000) respectively. Each 1°C rise in temperature corresponded to an increase of 14.98% (95% CI 13.65% to 16.33%) in the monthly number of scrub typhus cases, while a 1 hPa rise in atmospheric pressure corresponded to a decrease in the number of cases by 8.03% (95% CI −8.75% to −7.31%). Similarly, a 1 hour rise in sunshine corresponded to an increase of 0.17% or 0.54%, and a 1 millimeter rise in rainfall corresponded to an increase of 0.05% or 0.10%, in the monthly number of scrub typhus cases, depending on the variables considered in the model.ConclusionOur study provided evidence that climatic factors were associated with occurrence of scrub typhus in Guangzhou city, China. Temperature, duration of sunshine, and rainfall were positively associated with scrub typhus incidence, while atmospheric pressure was inversely associated with scrub typhus incidence. These findings should be considered in the prediction of future patterns of scrub typhus transmission.

The method and efficacy for screening neonatal tetanus in high risk areas in China

To establish a method for screening neonatal tetanus (NT) in high risk areas in China using multi-sources data. We adopted six NT-related indicators from National Notifiable Disease Report System (NNDRS) and National Maternal and Child Health Annual Report System, to calculate weighted high-risk score at prefecture level in 2010 and 2011. And we selected the top 30 high risk cities, and compared the scores with the actual NT incidence ranking and WHO scoring. The highest areas distributed in the Southwest of China with poor and minority population, and the Southeast part with high density of migrants. In the leading 30 prefectures with high score between the methods of weighted high-risk scoring and reported NT incidence ranking, there were 8 different. In comparison of the results of the methods of weighed high-risk scoring and WHO scoring, 276 prefectures in 340 distributed were divided into the same ranking groups, with Kappa coefficient 0.56 (P < 0.01). The Chi-Square association coefficient was 0.74 (P < 0.01), which showed a high correlation. But there were 10 different prefectures in the leading 36 prefectures between the two methods. The weighted scoring method included several possible factors influencing NT incidence and took their weights into consideration. Thereby, compared with WHO scoring method, this method could be more appropriate for the reality in China.

Epidemic situation and surveillance on SFTS in China, 2011-2012

To analyze the data of surveillance on severe fever with thrombocytopenia syndrome (SFTS), from 2011 to 2012 in China. Descriptive methods were conducted to analyze the surveillance data from 2011 to 2012 which were collected from the internet-based National Notifiable Disease Reporting System. From 2011 to 2012, a total of 1229 SFTS cases and 107 deaths were reported in China with the average annual incidence rate of 0. 046/100 000 and case fatality rate of 8.7%. Compared to 2011, morbidity of 2012 has increased by 23.5% and mortality has decreased by 32%. 16 provinces reported SFTS cases. More cases occurred in spring and summer seasons,with the peak in May to July, during this period, 69% of the total cases were reported. The ages of the patients ranged from 1 to 85 years, 44.2% of total case was 55 to 70 years old, there were no differences in sex. Of all the cases 86. 8% was farmer. Severe fever with thrombocytopenia syndrome in widely distributed in China, especially in the central and eastern regions, the incidence has obvious seasonal. Surveillance and immigration quarantine should be strengthened.

Epidemiological Characteristics of Japanese Encephalitis in Guizhou Province, China, 1971–2009

ObjectiveThe aim of the study was to establish the contemporary epidemiological characteristics of Japanese encephalitis (JE) in Guizhou Province. MethodsA retrospective study of National Notifiable Disease Reporting System (NNDRS) data from 1971 through 2009, was conducted to ascertain the geographical, seasonal, and age distributions of JE incidence in Guizhou Province, China. ResultsA total of 68 425 JE cases were reported in Guizhou from 1971–2009. The JE cases occurred sporadically in all 9 prefectures of Guizhou, mostly among residents of rural areas. Seasonal distribution of JE remained consistent over the period from 1971–2009 with the main transmission season starting from June to September and peaking in August. JE occurred mainly in children under the age of 15 years with peak incidence in the 0–6-year age group. Pearson's correlation analysis showed that JE vaccine distribution had a negative correlation with JE incidence rates during 1971–2009 (coefficient of correlation=−0.475, P<0.01). ConclusionOver the period of 1971–2009, the JE incidence rate had declined dramatically in terms of geographical and age distributions due to JE vaccination to children at risk.

The current epidemic situation and surveillance regarding hemorrhagic fever with renal syndrome in China, 2010

To analyze the surveillance data on hemorrhagic fever with renal syndrome (HFRS) including the epidemiological characteristics and trend of the disease, in 2010. Descriptive methods were conducted to analyze the surveillance data in 2010 which were collected from the internet-based National Notifiable Disease Reporting System and 40 HFRS sentinels in China. There were 9526 cases of HFRS reported in 2010 in the country with an annual morbidity of 0.71/10(5), which was higher than that reported in 2009. And the case fatality rate in 2010 was 1.24%. During the year 2010, most cases were reported in spring and autumn-winter season, with November as the peak month. The proportion of cases reported in autumn-winter season was higher than that in spring. The number of cases reported in males was higher than that in females among all the age groups, and similar pattern of mortality could be seen in most of the age groups. The percentage of cases over 60 years old had increased in recent years. Farmers were still under the highest risk. Density and the virus-carrying rate of animal hosts, as well as the infection rate were relatively stable and similar to the previous findings. As to the prevailing species, Apodemus agrarius and Rattus norvegicus were still the most common and leading animal hosts. However, the dominant species in sentinel of Yunnan were Rattus flavipectus and Eothenomys miletus respectively, and a new hantavirus called LUXV was found, namely Eothenomys miletus. HFRS cases were widely distributed in most provinces of China, but cases mainly focus on certain areas and present the nature of aggregation. The risk of outbreak could not be ruled out for variety of factors. Population characteristics and seasonal fluctuation had been changing.

Genetic characterization of wild-type measles viruses isolated in China, 2006-2007.

Molecular characterization of wild-type measles viruses in China during 1995-2004 demonstrated that genotype H1 was endemic and widely distributed throughout the country. H1-associated cases and outbreaks caused a resurgence of measles beginning in 2005. A total of 210,094 measles cases and 101 deaths were reported by National Notifiable Diseases Reporting System (NNDRS) and Chinese Measles Laboratory Network (LabNet) from 2006 to 2007, and the incidences of measles were 6.8/100,000 population and 7.2/100,000 population in 2006 and 2007, respectively. Five hundred and sixty-five wild-type measles viruses were isolated from 24 of 31 provinces in mainland China during 2006 and 2007, and all of the wild type virus isolates belonged to cluster 1 of genotype H1. These results indicated that H1-cluster 1 viruses were the predominant viruses circulating in China from 2006 to 2007. This study contributes to previous efforts to generate critical baseline data about circulating wild-type measles viruses in China that will allow molecular epidemiologic studies to help measure the progress made toward China's goal of measles elimination by 2012.

Measles Resurgence Associated with Continued Circulation of Genotype H1 Viruses in China, 2005

Measles morbidity and mortality decreased significantly after measles vaccine was introduced into China in 1965. From 1995 to 2004, average annual measles incidence decreased to 5.6 cases per 100,000 population following the establishment of a national two-dose regimen. Molecular characterization of wild-type measles viruses demonstrated that genotype H1 was endemic and widely distributed throughout the country in China during 1995-2004. A total of 124,865 cases and 55 deaths were reported from the National Notifiable Diseases Reporting System (NNDRS) in 2005, which represented a 69.05% increase compared with 2004. Over 16,000 serum samples obtained from 914 measles outbreaks and the measles IgM positive rate was 81%. 213 wild-type measles viruses were isolated from 18 of 31 provinces in China during 2005, and all of the isolates belonged to genotype H1. The ranges of the nucleotide sequence and predicted amino acid sequence homologies of the 213 genotype H1 strains were 93.4%-100% and 90.0%-100%, respectively. H1-associated cases and outbreaks caused the measles resurgence in China in 2005. H1 genotype has the most inner variation within genotype, it could be divided into 2 clusters, and cluster 1 viruses were predominant in China throughout 2005.

Hepatitis A Surveillance and Vaccine Use in China From 1990 Through 2007

BackgroundHepatitis A vaccines have been highly effective in preventing hepatitis A. To investigate the epidemiology of hepatitis A in China after hepatitis A vaccine became available, we reviewed reported cases of hepatitis A and the use of hepatitis A vaccine in China during the period from 1990 through 2007.MethodsData from the National Notifiable Disease Reporting System from 1990 to 2007 and the Emergency Events Reporting System from 2004 to 2007 were reviewed and epidemiologic characteristics analyzed. Hepatitis A vaccine distribution between 1992 and 2007 was also reviewed.ResultsThe incidence of hepatitis A has declined by 90% since 1990, from 56 to 5.9 per 105/year. Declines in age-specific incidence were seen in all age groups, most dramatically among children younger than 10 years. Disease incidence still varies substantially: poorer western provinces have had the highest incidences since 2000. In high-incidence provinces, children younger than 10 years continue to have a high disease incidence. Only 50% of cases were laboratory-confirmed, and only 3% occurred in reported local outbreaks. Over 156 million doses of hepatitis A vaccine have been distributed since 1992, and use has continued to increase since 2003.ConclusionsIncidence of hepatitis A has decreased in all age groups, likely due to changing socioeconomic conditions and increasing hepatitis A vaccine use. Nevertheless, western populations remain at high risk, with transmission predominantly occurring among children. The epidemiology of hepatitis A transmission is not well understood. Improved surveillance with better laboratory confirmation is needed to monitor the impact of universal hepatitis A vaccination of young children; this strategy began to be implemented in 2008.