Influencing factors for severe cases with 2009 influenza A (H1N1) by logistic regression.

▾<p>Bad psychological health refers to score of psychological health lower than 3.</p>▴<p>Timely anti-viral therapy is defined as initiating anti-viral therapy in 2 days after the onset of influenza A (H1N1).</p

Comparison of demographic and clinical characteristics between severe cases and mild cases with 2009 influenza A (H1N1).

▾<p>Median (upper quartile, lower quartile);</p>▴<p><i>Z</i> value;</p>⧫<p>Mean (standard deviation);</p>★<p><i>t</i> value;</p>△<p>Obesity refers to BMI≥30;</p>▽<p>Psychological health scores range from 1 to 5 (the higher the score is, the better the psychological health is).</p

Replication capacity and adaptability of a severe fever with thrombocytopenia syndrome virus at different temperatures

<div><p>Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease caused by the SFTS virus (SFTSV). Although fever and thrombocytopenia are the typical manifestations of SFTS, a specific SFTS case with no fever was observed in Zhejiang, China. In this report, we aimed to explore the probable reason for the absence of fever by analyzing the genetic characteristics and temperature sensitivity (ts) of the SFTSV strain ZJ2013-06, which was isolated from the specific case. Phylogenetically, different clusters of SFTSV strains circulated in Zhejiang. ZJ2013-06 was farthest from ZJ2014-02, an isolate belonging to a Chinese dominant cluster, and nearest to the coastal strain NB24/CHN/2013. Ts tests, performed on Vero cells at 37°C and 39°C, indicated that ZJ2013-06 had restricted replication at 39°C. Its viral loads were substantially reduced at 39°C compared with that at 37°C (approximately 100-fold reduction) and were significantly lower than that of ZJ2014-02 at 39°C (<i>P</i> < 0.01). By adaptive culture at 39°C, the induced strain ZJ2013-06-P7 was obtained. Owing to a reverse mutation (S1616), ZJ2013-06-P7 lost the ts of the original strain, displaying similar replication processes with NB24/CHN/2013. The results indicated that the amino acid residue 1616 was related to the ts characteristics of ZJ2013-06. Our study revealed that ZJ2013-06 was temperature-sensitive and may be related to the absence of fever in our case.</p></div

Temperature sensitivity of NB24/CHN/2013 and ZJ2013-06-P7.

<p>Temperature sensitivity of NB24/CHN/2013 and ZJ2013-06-P7.</p

Database of the monthly distribution of HFMD cases in Zhejiang Province.

(XLSX)</p

Proliferation curves of ZJ2013-06 and ZJ2014-02 in Vero cells at different temperatures.

<p>Proliferation curves of ZJ2013-06 and ZJ2014-02 in Vero cells at different temperatures.</p

Spatial characteristics and the epidemiology of human infections with avian influenza A(H7N9) virus in five waves from 2013 to 2017 in Zhejiang Province, China

<div><p>Background</p><p>The five-wave epidemic of H7N9 in China emerged in the second half of 2016. This study aimed to compare the epidemiological characteristics among the five waves, estimating the possible infected cases and inferring the extent of the possible epidemic in the areas that have not reported cases before.</p><p>Methods</p><p>The data for the H7N9 cases from Zhejiang Province between 2013 and 2017 was obtained from the China Information Network System of Disease Prevention and Control. The start date of each wave was 16 March 2013, 1 July 2013, 1 July 2014, 1 July 2015 and 1 July 2016. The <i>F</i> test or Pearson’s chi-square test were used to compare the characteristics of the five waves. Global and local autocorrelation analysis was carried out to identify spatial autocorrelations. Ordinary kriging interpolation was analyzed to estimate the number of human infections with H7N9 virus and to infer the extent of infections in the areas with no cases reported before.</p><p>Result</p><p>There were 45, 94, 45, 34 and 80 cases identified from the first wave to the fifth, respectively. The death rate was significantly different among the five waves of epidemics (<i>χ</i>² = 10.784, <i>P</i> = 0.029). The age distribution (<i>F</i> = 0.903, <i>P</i> = 0.462), gender (<i>χ</i>² = 2.674, <i>P</i> = 0.614) and occupation(<i>χ</i>² = 19.764, <i>P</i> = 0.407) were similar in each period. Most of the cases were males and farmers. A significant trend (<i>χ</i>² = 70.328, <i>P</i><0.001) was identified that showed a growing proportion of rural cases. There were 31 high-high clusters and 3 high-low clusters at the county level among the five waves and 12, 8, 2, 9 and 3 clusters in each wave, respectively. The total cases infected with the H7N9 virus were far more than those that have been reported now, and the affected areas continue to expand. The epidemic in the north of Zhejiang Province persisted in all five waves. Since the second wave, the virus spread to the south areas and central areas. There was an obvious decline in the infected cases in the urban areas, and the epidemics mostly occurred in the rural areas after the fourth wave. The epidemic was relatively dispersed since the third wave had fewer than two cases in most of the areas and showed a reinforcing trend again in the fifth wave.</p><p>Conclusions</p><p>The study revealed that there were few differences in the epidemiologic characteristics among the five waves of the epidemic. However, the areas where the possible epidemic circulated was larger than reported. The epidemic cross-regional expansion continued and mostly occurred in rural areas. Continuous closure of the live poultry market (LPM) is strongly recommended in both rural and urban areas. Illegal and scattered live poultry trading, especially in rural areas, must be forbidden. It is suggested too that a more rigorous management be performed on live poultry trade and wholesale across the area. Health education, surveillance of cases and pathogenicity should also be strengthened.</p></div

Trend of the incidence of EV71 cases between 2016 and 2021 shown by joinpoint regression.

The red squares denote the observed values of the incidence, and the blue line is the slope of the APC. The APC was the annual percent change.</p

Replication capacities of ZJ2013-06 at different temperatures.

<p>Replication capacities of ZJ2013-06 at different temperatures.</p

Seasonal distribution trends of EV71, Cox A16 and other enterovirus cases.

Seasonal distribution trends of EV71, Cox A16 and other enterovirus cases.</p