Age and Gender Adjusted Comparison of Clinical Features between Severe Cases Infected with H7N9 and H1N1pdm Influenza A in Jiangsu Province, China

<div><p>Background</p><p>Influenza H7N9 and H1N1pdm can cause severe human infections. It is important to investigate the distinguishing clinical features between these two diseases. Several studies have compared the differences in general, however, age and gender adjusted comparisons may be more useful and informative to the health professionals.</p><p>Methods</p><p>A total of 184 severe H1N1pdm patients and 37 severe H7N9 patients from Jiangsu Province were included in this analysis to perform age and gender adjusted comparison of clinical features.</p><p>Results</p><p>After adjusting age and gender, no significant differences in chronic medical conditions or treatment were found between severely ill patients with H7N9 and H1N1pdm. Severely ill patients with H7N9 had significantly longer interval from onset of illness to neuraminidase inhibitor treatment and to death. They were more likely to have complications such as acute respiratory distress syndrome (ARDS), liver and renal dysfunctions, and had a significantly higher risk of death.</p><p>Conclusion</p><p>Our results suggests that age and gender should be adjusted as important confounding factors when comparing the clinical features between severe H7N9 and H1N1pdm patients to avoid any misunderstanding regarding the differences between these two diseases particularly in terms of clinical severity and prognosis.</p></div

Distribution of selected variables between severe H7N9 and H1N1pdm patients.

<p>^a Patients with missing data were excluded for each variable.</p><p>^b Pearson chi-square test was used for comparing proportions and continuity correction or Fisher’s Exact Test was used if appropriate. Mann-Whitney U test was used for comparing medians.</p><p>^c Age and gender were adjusted using General Linear Model (for BMI) or Cox proportional hazards model (for selected time durations) for continuous variables and Logistic regression model for categorical variables.</p><p>^d Interquartile range (IQR), Frequency (FREQ), Body mass index (BMI)</p><p>Distribution of selected variables between severe H7N9 and H1N1pdm patients.</p

Age distribution of severe patients infected with influenza H7N9 and H1N1pdm in Jiangsu Province, China.

<p>Age distribution of severe patients infected with influenza H7N9 and H1N1pdm in Jiangsu Province, China.</p

Table_2_Analysis of the spatial-temporal distribution characteristics of hepatitis E in Jiangsu province from 2005 to 2020.DOC

ObjectiveThis study attempts to analyze the spatial clustering and spatial-temporal distribution characteristics of hepatitis E (HE) at the county (city and district) level in Jiangsu province to provide a scientific basis for the prevention and control of HE.MethodThe information on HE cases reported in the Chinese Center for Disease Control and Prevention Information System from 2005 to 2020 was collected for spatial autocorrelation analysis and spatial-temporal clustering analysis.ResultFrom 2005 to 2020, 48,456 HE cases were reported in Jiangsu province, with an average annual incidence rate of 3.87/100,000. Male cases outnumbered female cases (2.46:1), and the incidence was highest in the 30–70 years of age group (80.50%). Farmers accounted for more than half of all cases (59.86%), and in terms of the average annual incidence, the top three cities were all in Zhenjiang city. Spatial autocorrelation analysis showed that Global Moran's I of HE incidence varied from 0.232 to 0.513 for the years. From 2005 to 2020, 31 counties (cities and districts) had high and statistically significant HE incidence, and two clustering areas were detected by spatial-temporal scanning.ConclusionHE incidence in Jiangsu province from 2005 to 2020 was stable, with age and gender differences, regional clustering, and spatial-temporal clustering. Further investigation of HE clustering areas is necessary to formulate corresponding targeted prevention and control measures.</p

Table_1_Emergence of mcr-1-Harboring Salmonella enterica Serovar Sinstorf Type ST155 Isolated From Patients With Diarrhea in Jiangsu, China.DOCX

Background: This study analyzed the antimicrobial resistance phenotypes and mechanisms of quinolone, cephalosporins, and colistin resistance in nontyphoidal Salmonella from patients with diarrhea in Jiangsu, China.Methods: A total of 741 nontyphoidal Salmonella isolates were collected from hospitals in major cities of Jiangsu Province, China between 2016 and 2017. Their susceptibility to commonly used antibiotics was evaluated by broth micro-dilution and sequencing analysis of resistance genes screened by a PCR method. For mcr-1 positive isolates, genetic relationship study was carried out by pulsed-field gel electrophoresis and multiloci sequence typing analysis. The transferability of these plasmids was measured with conjugation experiments and the genetic locations of mcr-1 were analyzed by pulsed-field gel electrophoresis profiles of S1-digested genomic DNA and subsequent Southern blot hybridization.Results: Among 741 nontyphoidal Salmonella isolates, the most common serotypes identified were S. Typhimurium (n=257, 34.7%) and S. Enteritidis (n=127, 17.1%), and the isolates showed 21.7, 20.6, and 5.0% resistance to cephalosporins, ciprofloxacin, and colistin, respectively. Among the 335 nalidixic acid-resistant Salmonella, 213 (63.6%) and 45 (13.4%) had at least one mutation in gyrA and parC. Among the plasmid-borne resistance, qnrS1 (85; 41.9%) and aac(6')-Ib-cr4 (75; 36.9%) were the most common quinolone resistance (PMQR) genes, while blaCTX-M-14 (n=35) and blaCTX-M-55 (n=46) were found to be dominant extended-spectrum beta-lactamase (ESBL) genes in nontyphoidal Salmonella. In addition, eight mcr-1-harboring strains were detected since 2016 and they were predominate in children under the age of 7years. Conjugation assays showed the donor Salmonella strain has functional and transferable colistin resistance and Southern blot hybridization revealed that mcr-1 was located in a high molecular weight plasmid.Conclusion: In nontyphoidal Salmonella, there is a rapidly increasing trend of colistin resistance and this is the first report of patients harboring mcr-1-positive Salmonella with a new ST type ST155 and new serotype S. Sinstorf. These findings demonstrate the necessity for cautious use and the continuous monitoring of colistin in clinical applications.</p

Table_1_Analysis of the spatial-temporal distribution characteristics of hepatitis E in Jiangsu province from 2005 to 2020.DOC

ObjectiveThis study attempts to analyze the spatial clustering and spatial-temporal distribution characteristics of hepatitis E (HE) at the county (city and district) level in Jiangsu province to provide a scientific basis for the prevention and control of HE.MethodThe information on HE cases reported in the Chinese Center for Disease Control and Prevention Information System from 2005 to 2020 was collected for spatial autocorrelation analysis and spatial-temporal clustering analysis.ResultFrom 2005 to 2020, 48,456 HE cases were reported in Jiangsu province, with an average annual incidence rate of 3.87/100,000. Male cases outnumbered female cases (2.46:1), and the incidence was highest in the 30–70 years of age group (80.50%). Farmers accounted for more than half of all cases (59.86%), and in terms of the average annual incidence, the top three cities were all in Zhenjiang city. Spatial autocorrelation analysis showed that Global Moran's I of HE incidence varied from 0.232 to 0.513 for the years. From 2005 to 2020, 31 counties (cities and districts) had high and statistically significant HE incidence, and two clustering areas were detected by spatial-temporal scanning.ConclusionHE incidence in Jiangsu province from 2005 to 2020 was stable, with age and gender differences, regional clustering, and spatial-temporal clustering. Further investigation of HE clustering areas is necessary to formulate corresponding targeted prevention and control measures.</p

Susceptibility of spotted doves to SFTSV infection is dependent on challenge dose.

Susceptibility of spotted doves to SFTSV infection is dependent on challenge dose.</p

Change in body mass of the spotted doves following SFTSV challenge.

Mean changes in body mass and standard error bars are plotted at daily intervals following challenge of the spotted doves. Changes in body mass following SFTSV challenge showed a dose and strain dependent response. Birds challenged with 107 plaque-forming units (PFU) of SFTSV strain JS2014 had earlier and greater losses of body mass than did birds challenged with 105 or 103 PFU of the same SFTSV strain. Birds challenged with SFTSV strain JS2014 had greater losses of body mass than the birds challenged with same dose level of SFTSV strain JS2010.</p

Experimental infection of spotted doves with two SFTSV strains.

Error bars represent standard error of the mean log10 PFU/mL of serum. The horizontal dashed line indicates a limit of detection of 101.8 PFU/mL. A: Spotted Doves inoculated with 107 plaque forming units (PFU) of SFTSV strain JS2014 (solid line) had higher mean viral loads that peaked earlier than did birds inoculated with 105 (dashed line) or 103 PFU (fine dashed line) of virus. B: Spotted doves inoculated with 107 plaque forming units (PFU) of SFTSV strain JS2010 (solid line) had higher mean viral loads that peaked earlier than did those birds inoculated with 105 (dashed line) or 103 PFU (fine dashed line) of virus.</p

Viral distribution, as determined by RNA copy numbers, in organs from birds experimentally infected with 10⁵ PFU of two SFTSV strains.

Viral titers are represented as geometric mean±SD. A detection limit of 0.95 log10RNA copies g-1 was determined. Spotted doves inoculated with 105 PFU of SFTSV strain JS2014 (A) had higher and earlier mean viral loads than birds inoculated with 105 PFU of SFTSV strain JS2010 (B).</p