中国疾病预防控制中心

Background:The global macroeconomic impact of Tuberculosis (TB) lacks comprehensive quantification using standardized economic frameworks. Methods:This analysis utilized data from the Global Burden of Disease (GBD) 2021 to assess the economic burden of TB through the lens of the Value of a Statistical Life Year (VSLY) framework, integrating willingness-to-pay-based economic measures. The study monetized the total disability-adjusted life years (DALYs) associated with TB to estimate overall welfare losses. Country-specific gross domestic product (GDP) data, adjusted for purchasing power parity (PPP), were sourced from the World Bank and integrated with DALY estimates to calculate the Value of Lost Welfare (VLW). Results:In 2021, the global economic cost of TB, expressed as VLW, was estimated at US$1.98 trillion (95% uncertainty interval [UI]: 1.62, 2.45), representing 1.29% (95% UI: 1.05, 1.60) of global GDP. The economic impact of TB was disproportionately distributed across regions, with countries of low Socio-Demographic Index (SDI) facing the most severe burden, where VLW represented 7.83% (95% UI: 5.70, 11.20) of GDP. Lower-middle SDI regions experienced a VLW impact of 5.28% (95% UI: 4.30, 6.58). Sub-Saharan Africa (US$406.2 billion; 8.40% of GDP) and South Asia (US$822.5 billion; 5.70% of GDP) were identified as the most economically affected super-regions. India bore the highest absolute economic burden (US$477.5 billion). In contrast, high-SDI countries demonstrated a VLW-to-GDP ratio of just 0.10% (95% UI: 0.09, 0.12). Conclusions:Prioritizing TB control in economic policy is urgently needed. Equitable resource allocation to high-burden regions is vital to alleviate the disease's economic consequences and improve global health.

Background Due to insufficient routine surveillance, the nationwide disease burden of hand, foot and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6), an emerging serotype, in China remains unclear. This study aimed to estimate the incidence of CVA6-associated HFMD across the Chinese mainland. Methods CVA6 positive data from 511 locations across the Chinese mainland during 2008-2022 were integrated from the national pathogen surveillance system and literature, and reported HFMD cases during the same period were obtained from the national infectious disease surveillance system. The predicted positivity rate and incidence of CVA6-associated HFMD in children under five years of age across the Chinese mainland were estimated using a Bayesian geostatistical Gaussian model based on positivity data, reported cases, and environmental, socioeconomic, demographic, and vaccination factors. Results The model estimated that the average positivity rate of CVA6 in the Chinese mainland from 2008 to 2022 was 24.1%, with a 95% Bayesian credible interval (BCI) of 11.9-43.3%. The corresponding average annual incidence of CVA6-associated HFMD in children under five years of age was 506 (95% BCI: 272-805) per 100,000. The yearly incidence of CVA6-associated HFMD in children under five years of age peaked in 2018 (873 per 100,000; 95% BCI: 513-1309) before a subsequent decline after 2020. The incidence was highest in South China (1571 per 100,000; 95% BCI: 890-2420) and lowest in Northeast China (208 per 100,000; 95% BCI: 106-340). The estimated CVA6-associated HFMD incidence showed a consistent upward trend across different economic level groups before 2020, and tended to be higher in high-gross domestic product (GDP) per capita regions than in medium- and low-GDP regions. Conclusions Model-based estimates indicate a potentially high incidence of CVA6-associated HFMD on the Chinese mainland, particularly in South China, highlighting the need for enhanced surveillance of CVA6 and targeted control efforts in high-incidence regions.

The effect of heavy metals on male hormonal regulation-particularly the hypothalamic-pituitary-testicular (HPT) axis-remains poorly characterized. We aim to investigate associations between heavy metal exposure and HPT axis-related hormones. We analyzed data, including male participants aged 3-80 years, from a nationally representative survey. Five metals and twelve sex hormones were measured. We used multivariate linear regression and restricted cubic splines to assess associations and dose-response relationships. Mixture effects were quantified using quantile-based g computation. The modifying effects of vitamin D and folate were examined. The underlying mechanisms were explored through a narrative review and integrative bioinformatics analysis. A total of 6547 males were included. Metal exposure was predominantly associated with hormonal perturbations in adolescents and older adults. Specifically, metal mixture was associated with hormones in adolescent males [effect range: -5.10% (95% CI: -9.24, -0.76) to 18.12% (95% CI: 9.80, 27.07)] and older males [effect range: 3.17% (95% CI: 0.07, 6.37) to 10.94% (95% CI: 4.82, 17.43)]. Effect modifications were observed for vitamin D in children and adolescents, and for folate across all age groups. The PI3K-Akt signaling pathway was identified as a potential mechanism. Our findings provide novel insights into the association and potential pathway between heavy metals and male hormonal disturbance.

Objective:To determine the proportions of drug-resistant tuberculosis (TB), its trends, and the drug resistance-conferring mutations among patients with pulmonary TB aged 10-24 years in China. Methods:The data of patients with pulmonary TB were retrieved from a national drug-resistant TB survey for analysis. Joinpoint regression software was used to analyze time trends. We also used whole genome sequencing to analyze the lineages and drug resistance-conferring mutations of 621 isolates. Results:Among 4,235 patients with pulmonary TB, the proportion of new cases of multidrug-resistant tuberculosis (MDR-TB) was 3.18% (95% confidence interval [ CI]: 2.37-4.15) for adolescents and 3.76% (95% CI: 3.03-4.60) for young adults; for previously treated patients, MDR-TB accounted for 11.25% (95% CI: 5.28-20.28) of adolescents and 11.05% (95% CI: 6.88-16.55) of young adults. The proportion of patients with MDR-TB remained stable among both new and previously treated patients aged 10-24 years during the study period. Through whole genome sequencing, we found that the most common mutations in the MDR-TB strains were Ser315Thr in the katG gene (71.74%) and Ser450Leu in the rpoB gene (50.00%). Conclusion:This study revealed a high proportion of MDR-TB among adolescents and young adults, indicating that urgent and comprehensive measures are needed to reduce the emergence and transmission of drug-resistant TB among this population in China.

Background Although female smoking prevalence in China remains low, emerging evidence suggests that social acceptance may be increasing, with tobacco marketing increasingly targeting women. This study explored women’s smoking behaviours, motivations and societal perceptions toward this in urban China.Methods Between May and October 2019, 28 semistructured focus groups were conducted in Beijing, Changsha and Shenzhen with 288 participants: 12 groups of female smokers, 6 of female former smokers, 6 of female never-smokers and 4 of men. Participants were recruited both online and offline, and smoking status was verified with a carbon monoxide monitor. Discussions were transcribed verbatim and analysed thematically using dual coding.Results Four themes emerged. First, while stigma against female smoking persisted, social acceptance is growing, especially among younger generation. Second, three initiation stages were identified: adolescence, early career and post-retirement, often triggered by peer influence, occupational stress and life transitions. Third, many female smokers concealed their behaviour, reflecting tension between shifting descriptive norms and enduring injunctive norms, which may contribute to underreporting in surveillance data. Fourth, misconceptions about smoking harms and quitting were common, with most women who smoke relying on willpower and showing limited interest in cessation support; pregnancy was one of the few strong motivators for quitting.Conclusions Findings suggest gradual normalisation of female smoking in urban China, driven by evolving gender roles and targeted marketing. Public health responses should prioritise gender-specific health education, strengthen promotion of cessation services and tighten restrictions on tobacco marketing towards women to prevent future increases in female smoking.