Objective To analyze the epidemiological characteristics of coxsackievirus A16 (CVA16)-associated hand, foot and mouth disease (HFMD) in China for evidences to inform targeted prevention and control strategies and measures. Methods Virological surveillance data on HFMD were retrieved from 31 provincial-level administrative divisions (provinces, autonomous regions, and municipalities) in China between 2010 and 2022. Descriptive epidemiology was used to analyze the epidemiological characteristics of CVA16-associated HFMD cases identified through the national surveillance network. Results From 2010 to 2022, virological surveillance of HFMD in China recorded 1 150 953 cases, in whom 755 660 were laboratory-confirmed positives, with an overall positivity rate being 65.66%. There were 71 748 severe (including fatal) cases, among which 54 304 were positive, with a positive detection rate of 75.69%. No significant trend was observed in the annual proportion of CVA16 among positive cases (χ²_trend=0.01, P>0.05). In contrast, EV-A71 showed a significant decline (χ²_trend=113 262.42, P<0.01), whereas other enteroviruses exhibited an upward trend (χ²_trend=81 714.46, P<0.01). The overall CVA16 detection rate was 17.05% (196 273/1 150 953), in which positive detection rate was 6.03% (4 324/71 748) for severe cases (including deaths). The positive rate of CVA16 was the lowest (4.47% on average yearly) in 2010-2015 in severe cases (including deaths), and increased to 11.56% on average between 2016 and 2022. By temporal distribution, CVA16-associated HFMD displayed a unimodal seasonal pattern, peaking annually from March to July, with southern regions experiencing earlier outbreaks than northern areas. By population distribution, males and females accounted for 61.21% (120 129/196 273) and 38.79% (76 144/196 273) of the CVA16 cases, with detection rates of 17.20% and 16.82%, respectively (χ²=29.29, P<0.01). The infection was dominated in children aged 0-5 years (91.63%, 179 837/196 273). Provincial variation in CVA16 detection was minimal among mild cases but substantial for severe/fatal cases. Conclusion In China, the proportional contribution of CVA16 and its overall positive detection rate among HFMD cases remained stable. However, a significant increase in positive detection rates was observed specifically in severe cases. These findings highlight the necessity for sustained virological surveillance of HFMD pathogens, continuous monitoring of CVA16 transmission dynamics, strengthened prevention and control measures in high-incidence regions and high-risk populations, and expedited development of multivalent vaccines incorporating CVA16.

Objective To characterize the epidemiological features of recurrent hand, foot and mouth disease (HFMD) cases in Yunnan Province and identify risk factors of reinfection for scientific evidence in prevention and control of HFMD reinfection. Methods The case data on HFMD reported in Yunnan Province between 2020 and 2024 were retrieved via the Chinese Disease Prevention and Control Information System. Epidemiological characteristics of the reinfection cases were analyzed using descriptive epidemiology. Kaplan-Meier plotter was used to estimate the cumulative risk of HFMD reinfection, and Cox proportional hazards regression models were applied to analyze the risk factors for reinfection. Results A total of 12 191 HFMD reinfection cases were reported in Yunnan Province from 2020 to 2024, with a reinfection rate of 5.69%. The incidence peaked in June-July and October-November. By subgroups, higher reinfection rates were observed in males (5.96%), children aged <3 years (8.00%), home-based children (7.49%), laboratory-confirmed cases (6.19%), cases infected with other enteroviruses (7.12%), and cases with severe initial infections (9.87%). The median interval between infections was 14 (9-23) months. Kaplan-Meier curves indicated a rapid increase in reinfection risk within 20 months after the initial infection. Cox regression analysis revealed that the reinfection risks were higher for males [HR=1.149, 95%CI:(1.108, 1.191)], children aged <3 years [HR = 1.665, 95%CI:(1.570, 1.766)], urban residents [HR=1.064, 95% CI:(1.027, 1.103)], home-based children and childcare attendees [HR=5.251, 95%CI:(4.410, 6.251); HR=4.326, 95%CI:(3.653, 5.123)], laboratory-confirmed cases [HR=1.276, 95%CI:(1.209, 1.346)], and cases with severe initial infections [HR=1.502, 95%CI:(1.050, 2.149)]. Conclusion HFMD reinfection in Yunnan Province peaks in summer and autumn. Higher reinfection risks are associated with males, urban residents, young children, and severe initial infections, for which targeted interventions for these high-risk groups before epidemic peaks are recommended to reduce HFMD reinfection rates.

Objective To analyze the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) in Sichuan Province for evidences for scientific prevention and control of this infection. Methods The case data of HFMD in Sichuan Province registered in the Chinese Disease Prevention and Control Information System were retrieved from 2020 to 2024, and the pathological testing results of HFMD samples were collected from local Centers for Disease Control and Prevention (CDCs) in Sichuan. Descriptive epidemiology was used to analyze the epidemiological characteristics, and the seasonal distribution patterns were examined via seasonal index analysis. Results From 2020 to 2024, a cumulative total of 351 617 HFMD cases were reported in Sichuan Province, with an average annual incidence rate of 84.01/100 000. Of the reported cases, there were 161 severe cases and one death. Male and female cases numbered 201 178 and 150 439, respectively, with a sex ratio of 1.34∶1. The incidence rates for men and women were 95.23 and 72.55 per 100 000 population, respectively. Children under five years old constituted the majority of cases (299 509 cases, 85.18%), with the highest incidence rate observed in one-year-olds (2 891.03/100 000). Most cases occurred among children in home-based care (191 123 cases, 54.36%), though the proportion of student cases increased annually, reaching 12.02% by 2024. Seasonal analysis indicated bimodal incidence peaks in 2021 and 2023 and unimodal peaks in other years, with overall seasonal indices indicating elevated transmission from May to July and October to November. Geographically, annual incidence rates across prefectures ranged from 22.11 to 124.69 per 100 000 population, with the highest rates in Chengdu City (124.69/100 000), Panzhihua City (110.54/100 000), and Ya’an City (108.62/100 000). Pathogen distribution showed dominance by other enteroviruses in all years except 2024, when coxsackievirus A16 (CVA16) prevailed. Severe cases (including fatal) were most seen in children under three years old (135 cases, 83.33%), for which other enteroviruses were responsible (84.17%, 101/120). Conclusion HFMD in Sichuan Province peaks during summer and autumn, predominantly affecting infants and young children, with other enteroviruses as the leading pathogens. Our findings suggest that targeted prevention and control measures should prioritize high-risk populations during the peak seasons.

Objective To understand the epidemiological characteristics and pathogen spectrum of hand, foot and mouth disease (HFMD) in Jilin Province for evidence in scientific prevention and control of this infection. Methods The data associated with HFMD cases and pathogen spectrum reported in Jilin Province from 2017 to 2023 were collected through the Chinese Disease Prevention and Control Information System, and descriptive epidemiological methods were used to analyze the temporal, population and regional distribution of the epidemic. Results In total, 38 393 cases of HFMD were reported in Jilin Province between 2017 and 2023. The average annual reported incidence rate was 21.36 per 100 000 population. Of the reported cases, 12 were severe infection, and no deaths. The epidemic seasons were in July and October, during which a cumulative 31 659 cases (82.46 percent) were reported. The number of reported cases (22 887 cases) and the average annual reported incidence rate (25.33/100 000) were higher for males than for females (15 506 cases, 17.35/100 000). The age of onset of the disease was mainly between 0 and 5 years (27 739 cases, 72.25%). The occupational distribution was dominated by children living at home (15 535 cases, 40.46%), children in nursery and kindergarten (13 693 cases, 35.67%) and students (8 533 cases, 22.23%). Cases of HFMD were reported in every city (prefecture) throughout the province. The top three cities (prefecture) by the number of cases reported were Changchun (10 994 cases, 28.64%), Jilin (7 996 cases, 20.83%) and Yanbian Korean Autonomous Prefecture (7 112 cases, 18.52%). Laboratory studies indicated that EV-A71, CVA16 and other enteroviruses accounted for 11.88%, 20.84%, 67.28%, respectively. The proportion of EV-A71 and CVA16 showed a decreasing trend, while the composition of other enteroviruses was increasing trend. Conclusion Comprehensive prevention and control measures should be carried out in Jilin Province for the key population and key areas during high-incidence seasons of HFMD to reduce its prevalence in the population. Other enteroviruses are gradually becoming dominant serotypes and need close monitoring.

Objective To analyze the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) as well as the influencing factors for severe HFMD cases in Kunming area for scientific evidences in formulating surveillance and prevention strategies. Methods The case data of HFMD reported from Kunming area between January 1, 2010 and December 31, 2024 were initially retrieved via the Chinese Disease Prevention and Control Information System, and then analyzed regarding the temporal, geographic and demographic distribution, etiological characteristics, and the influencing factors associated with severe HFMD. Results In total, 247 275 cases of HFMD were reported in Kunming area from 2010 to 2024, with an average annual incidence rate of 231.64/100 000. OF the cases, 5 718 were severe, and 30 deaths were reported. The average annual severe rate and mortality rate were 5.36/100 000 and 0.03/100 000, respectively. The reported incidence rate, severe rate, and mortality rate showed a trend of decline (Z=-113.14, -52.95, -7.29, all P < 0.05). The incidence presented with bimodal distribution, and peaked from April to July (138 233 cases, 55.90%) and October to December (59 306 cases, 23.98%). The top three counties (cities, districts) with the highest incidence were Songming County (358.67/100 000), Guandu District (316.82/100 000), and Shilin Yi Autonomous County (300.93/100 000). The incidence was dominated by children aged 0 to 5 years (227 675 cases, 92.07%), and children living at home (132 412 cases, 53.55%). Among the laboratory-confirmed cases, 10 064 cases (32.07%) were EV-A71 type, 10 519 cases (33.52%) were CVA16 type, and 10 799 cases (34.41%) were other enteroviruses. The dominant serotypes of HFMD cases reported in Kunming area between 2010 and 2015 were EV-A71 (7 546 cases, 46.11%) and CVA16 (7 155 cases, 43.73%). In 2016, the proportion of other enteroviruses was basically equal to that of EV-A71 type. From 2017 to 2024, other enteroviruses became the dominant serotype of HFMD in Kunming City (7 272 cases, 69.86%). Multivariate logistic regression analysis showed that children under 3 years old, male cases, children living at home, and population living in suburban area were risk factors for developing into severe HFMD, yet the treatment within 3 days after the onset was a protective factor. Conclusion Overall, the incidence of HFMD in Kunming area tends to decline over time, and dominant enterovirus serotypes causing HFMD in current stage are other enteroviruses. We suggest that timely medical treatment of high-risk groups is the key to prevent severe diseases.

Objective To analyze the epidemiological and spatiotemporal distribution characteristics of hand, foot and mouth disease (HFMD) in Chengdu area so as to provide evidence for targeted prevention and control of this infection. Methods The data on HFMD cases and pathogen surveillance in Chengdu from 2014 to 2023 were retrieved from the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the characteristics of temporal, population and regional distribution. Spatial autocorrelation analysis and spatiotemporal scan statistics were used to analyze the clustering of HFMD in time and space. Results A total of 337 633 HFMD cases were reported in Chengdu area from 2014 through 2023, during which the incidence reported ranged from 83.53/100 000 to 383.86/100 000, with an annual incidence being 195.82/100 000 on average. The prevalence peaked in April-July and November-December in general. Cases were predominant in population ≤6 years old (96.44%), and most involved in children living at home (59.35%). The annual incidence rate was 224.52/100 000 for males and 166.81/100 000 for females. Global spatial autocorrelation analysis revealed a positive spatial correlation in 2015 (Moran's I = 0.19, Z=2.03, P < 0.05). Local spatial autocorrelation identified “high-high” clusters in peripheral urban districts (e.g., Xindu, Pidu) and “low-low” clusters in core urban districts (e.g., Gaoxin, Qingyang). Spatiotemporal scan analysis indicated primary clusters in peripheral districts (e.g., Chongzhou, Dayi, Longquanyi) during May-August and October-November. Other enteroviruses (untyped) were dominated from 2017 to 2020, whereas CVA6 became predominant from 2021 to 2023. Conclusion HFMD in Chengdu area exhibited spatiotemporal clustering, primarily affecting children ≤6 years old, with CVA6 as dominant pathogen in past years. Our findings suggest that prevention efforts should focus on high-risk seasons, key areas, and vulnerable populations.

Objective To understand the survival status and the influencing factors in patients infected with human immunodeficiency virus (HIV) /acquired immune deficiency syndrome (AIDS) in Hefei area for theoretical basis in formulating intervention measures. Methods The routine data, follow-up data and treatment status of HIV/AIDS victims in Hefei area were retrieved from 1997 to 2023 via the National Comprehensive HIV/AIDS Information Management System. The survival rate of HIV/AIDS sufferers was calculated by life table method, and the average survival time was estimated by Kaplan-Meier plotter. Cox regression model was used to analyze the factors affecting the survival in HIV/AIDs victims and those receiving antiretroviral therapy. Results A total of 4 305 patients infected with HIV/AIDS were reported in Hefei area from 1997 to 2023, in which there were 371 deaths. The all-cause mortality rate was 1.56/100 person-years, and the average survival time was 18.89 years. The average survival time was significantly longer in patients who received antiretroviral therapy than in the untreated patients (19.63 years versus 3.49 years, χ²=2 304.81, P<0.01). Multivariate Cox regression analysis showed that lower age [15-24 years (HR=0.20), 25-34 years (HR=0.36), 35-44 years (HR=0.47)] was a protective factor for the survival of HIV/AIDS victims. Being unmarried (HR=1.52), divorced or widowed (HR=1.33), primary school or below (HR=2.11), junior high school (HR=1.53), high school or technical secondary school (HR=1.54), heterosexually transmitted infection (HR=1.30), lower first CD4⁺ T lymphocyte count [0-49 (HR=5.32), 50-199 (HR=2.62) and 200-349 (HR=2.43)] and absence of antiretroviral therapy (HR=29.61) were risk factors for the survival. In addition, lower age [15-24 years (HR=0.12), 25-34 years (HR=0.21) and 35-44 years (HR=0.36)] was a protective factor for death in patients undergone antiretroviral therapy. BMI<18.5 kg/m² before treatment (HR=2.22), unmarried (HR=2.76), divorced or widowed (HR=1.91), primary school or below (HR=3.02), junior high school (HR=1.95), heterosexually transmitted infection (HR=1.46), lower CD4⁺T lymphocyte count at initial measurement [0-49 (HR=2.91) and 50-199 (HR=2.03)], clinical stage Ⅳ by WHO before treatment (HR=1.75), and initial second-line treatment plan (HR=1.56) were risk factors for the death in patients who received antiretroviral therapy. Conclusion Antiretroviral therapy is a key factor affecting the survival time of infected with HIV/AIDS victims. Age at diagnosis, BMI before treatment and CD₄⁺T lymphocyte count at the first laboratory test are the main factors affecting death in patients who had received treatment. Early detection, diagnosis and treatment can reduce the risk of death in the HIV/AIDS victims.

Objective To investigate the effects of Toxoplasma gondii infection on the expression of microRNA-155 (miR-155) in microglia and the role of miR-155 in the microglial activation. Methods BV-2 murine microglial cells were divided into four groups, namely, PRU infection group (infected with T. gondii PRU strain tachyzoites), miR-155 mimics group (transfected with miR-155 mimics), PRU + miR-155 inhibitor group (infection followed by miR-155 inhibitor transfection), and control group (transfection reagent only). Cellular miR-155, IL-1β, IL-12, and inducible nitric oxide synthase (iNOS) mRNA levels were detected by qPCR. Protein levels of IL-1β, IL-12, and nitric oxide (NO) in supernatants were measured by ELISA. Western blotting was performed to analyze the suppressor of cytokine signaling 1 (SOCS1) protein expression. Flow cytometry was used to assess the apoptosis in N2a neuronal cells cultured with conditioned medium prepared from each group′s supernatants. Results Compared with control group and PRU + miR-155 inhibitor group, both PRU-infected and miR-155 mimics groups showed significantly upregulated miR-155 expression, accompanied by increased IL-1β, IL-12, iNOS mRNA levels, and elevated NO production, whereas protein SOCS1 expression was markedly downregulated (all P < 0.05). Neuronal apoptosis rates in PRU-infected (22.37%±1.88%) and miR-155 mimics groups (29.87%± 0.67%) were significantly higher than those in the control group (9.84%±0.57%), yet the PRU + inhibitor group (10.91%±2.01%) showed similar apoptosis rates to the controls. Conclusion Toxoplasma gondii infection may result in upregulated miR-155 expression in the microglia, which further suppresses SOCS1 protein expression and subsequently promotes release of proinflammatory cytokines IL-1β, IL-12 and iNOS, ultimately inducing neuronal apoptosis.

Objective To summarize the clinical features and treatment experience in the moderate to severe angiostrongyliasis cantonensis in children for improving the understanding of this infection. Methods The clinical data, including the general information, findings of laboratory studies, imaging and neuroelectrophysiological examinations as well as treatment and prognosis, were retrospectively analyzed in the patients of pediatric angiostrongyliasis admitted to the Women and Children′s Medical Center Affiliated to Guangzhou Medical University between September 1, 2018 and March 30, 2024. Results A total of 18 cases were included, including 11 males and 7 females, with a median age of 2.2 (1.3, 4.4) years. The 18 children had fever and neurological symptoms, in whom 5 were accompanied by respiratory symptoms such as cough and expectoration. Fundus examination failed to reveal any larvae of Angiostrongylus cantonensis. Elevated count and percentage of eosinophil in peripheral blood were found in all children, with a median count of eosinophils being 22.7 (14.7, 36.0)×10⁹/L and the median percentage of eosinophils being 2.3 (0.9, 4.0)%, respectively. Cerebrospinal fluid pressure and white blood cell count in the cerebrospinal fluid were elevated. The median cerebrospinal fluid pressure arrived at 220.0 (205.0, 272.5) mm H₂O, and the median white blood cell count in the cerebrospinal fluid was 404.0 (230.0, 841.5)×10⁶/L. Twelve of the 14 children undergone detection of the serum antibody were positive for Angiostrongylus cantonensis, and 5 were positive for Angiostrongylus cantonensis in the 11 cases undergone antibody test of the cerebrospinal fluid. Fifteen children received metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid, positive results were seen in 14. Four children underwent blood mNGS, positive findings were found in 2. Abnormalities were found in 16 of the 18 children undergone cranial MRI examination. Twelve children underwent chest CT examination, and their results were all abnormal. After definitive diagnosis, all the 18 children received deworming with albendazole, 16 were treated with combined use of glucocorticoids. One child died of pulmonary haemorrhage, and another one was complicated with bilateral ocular cohesion and limited abduction. The remaining 16 cases were cured, without sequelae during 1 and 15 months of follow-up. Conclusion For pediatric patients with fever and neurological symptoms, peripheral blood eosinophilia, abnormalites indicated by cranial MRI or chest CT, anti-parasitic antibody detection and cerebrospinal fluid mNGS should be done as soon as possible. Early diagnosis and treatment of Angiostrongyliasis cantonensis can effectively improve the neurological symptoms and prognosis of patients.

Objective To understand the status of awareness of knowledge about tuberculosis (TB) prevention and control and the ways to acquire this knowledge among the elderly population in Anhui Province for scientific basis to optimize the related prevention and control strategies and measures. Methods By stratified random sampling, we conducted a survey on the elderly population living in the 36 committees (administrative villages) in the southern, central, and northern Anhui Province from October to December 2022. The subjects at each site consisted of three age groups, namely, 60-69 years, 70-79 years, and ≥80 years. Then 32, 26 and 22 individuals were randomly included from each age group, respectively, and underwent face-to-face questionnaire response. The survey centered on understanding the respondents′ awareness of core information concerning TB prevention and control, along with the avenues through which they accessed this information. Results A total of 2 810 elderly individuals were surveyed, including 1 414 males and 1 396 females, with an average age of (72.89±7.84) years. The overall awareness rate of five core items towards pulmonary TB information was 49.17% (6 908/14 050), while the full awareness rate of all core information was 10.39% (292/2 810). By awareness of single core information, the rate was the highest in “persistent coughing, expectoration, or blood-tinged sputum should be suspected of pulmonary TB infection” (68.68%, 1 930/2 810), whereas the awareness rate was the lowest in “washing hands frequently, ensuring ventilation, strengthening physical fitness can prevent pulmonary TB, and covering the mouth and nose when coughing and no spitting indiscriminately may reduce transmission” (34.98%, 983/2 810). Education level, occupation, and annual household income were influencing factors for full awareness rates. The full awareness rates were relatively higher in individuals with higher education levels and household incomes, as well as those who were workers or retirees. Publicity from the health workers was the most important source of knowledge towards pulmonary TB prevention and treatment (43.02%, 1 209/2 810), whereas the radio, TV programs and films were the most preferred sources to acquire such knowledge (59.40%, 1 669/2 810). Conclusion The overall awareness rate of the knowledge on the core pulmonary TB prevention and treatment appears relatively lower in the elderly population in Anhui Province, and they are particularly poor in awareness of the preventive measures, for which it is recommended to boost the pulmonary TB prevention and treatment knowledge in the elderly population through publicity by the radio, TV programs and film as well as health workers.

Objective To analyze the investigation and management of a Chlamydia psittaci infection case for evidence in following prevention and control of similar infection. Methods A field epidemiological investigation was conducted for a confirmed psittacosis case that occurred in Chengdu City in April 2023. The investigation consisted of field survey on the living environment, collection of the pharyngeal swabs from co-exposed individuals, anal swabs from the suspected animals, and environmental samples (including pigeon loft and ventilation shafts). Then all samples were subjected to nucleic acid detection of Chlamydia psittaci. Results The patient presented with fever, chills and productive cough. After treatment failure by self-medication, the patient was admitted to a hospital, and confirmed with psittacosis by metagenomic next-generation sequencing. The investigation demonstrated that the patient was living on the 18th floor, where carrier pigeons were intensively bred on the 19th floor rooftop. The ventilation duct beneath the pigeon loft was found damaged, and the environmental samples revealed positive results from pigeon feces swabs and indeterminate positivity from ventilation duct defects. No suspected cases were identified. Conclusion The event in this report was suspected to be caused by carrier pigeons raised on the roof of residents and transmitted through the ventilation system. Recommendations include enhanced regulation of informal poultry breeding facilities in residential areas to mitigate zoonotic transmission risks of Chlamydia psittaci.

The variant surface antigens (VSAs) present on Plasmodium falciparum-infected erythrocytes are implicated in the pathogenesis of severe malaria, and can serve as a potential target for protective immunity. The subtelomeric variant open reading frame (STEVOR) is a significant member of the VSAs family, which mediates the invasion of uninfected erythrocytes by merozoites and binding to glycophorin C (GPC) receptors on the erythrocyte surface and plays a crucial role in rosetting formation. Antibodies targeting the semiconserved (SC) region of STEVOR have been shown to inhibit both merozoite invasion and rosette formation. This article aims at systematically summarizing the structure and function of STEVOR, investigating the action mechanism of STEVOR in severe malaria and reviewing its progress in related vaccine development, with an attempt to provide a reference for the prevention and control of severe malaria.