BackgroundRabies continues to pose a significant public health challenge in China. To offer a scientific foundation for formulating rabies prevention and control strategies, this study conducted a national survey to comprehend the current status of rabies post-exposure prophylaxis (PEP) clinics construction and the surveillance of rabies-exposed individuals in China.MethodsThe Chinese Center for Disease Control and Prevention (CCDC) developed a national rabies prevention and control questionnaire, and conducted a survey across 31 provinces in Mainland China. The questionnaire was completed by the person in charge of rabies prevention and control in each provincial disease prevention and control institution.ResultsBy the end of 2022, 24,304 PEP clinics were reported in Mainland China. The number of PEP clinics per capita in China is 1.75 per 100,000. Nationwide, 47% of PEP clinics were capable of handling category III exposures. A total of 10,770,543 PEP clinic visits were reported. East China reported the highest number of rabies exposures (4,022,265). Among category III exposures, only 35% reported using rabies immunoglobulin (RIG). 97% of rabies exposures were attacked by dogs or cats. In South China, exposures caused by cats were nearly as frequent as those caused by dogs (47% and 48% respectively).ConclusionsThe distribution of PEP clinics across China is uneven. This pattern appears broadly consistent with the historical geographic distribution of rabies risk, which may reflect a risk-informed allocation of resources. We recommended implementing tiered prevention and control strategies, with emphasis on enhancing the stockpile of RIG, dogs and cats population management, and health education in regions with higher rabies exposure risks. In provinces with a high incidence of rabies outbreaks, it is essential to actively advocate for the inclusion of rabies vaccines and RIG in the reimbursement scope of the New Rural Cooperative Medical Insurance Scheme, and raise the reimbursement rate and limit. The "One Health" approach should be adopted, including mandatory immunization and surveillance management systems for dogs and cats.

Rabies is a fatal zoonotic infectious disease primarily caused by the rabies virus. Anti-rabies monoclonal antibody (mAb) is developed using modern genetic engineering technology. However, no bibliometric assessment has been conducted to evaluate the scientific progress in this area. A search of articles in the Web of Science (WoS) from January 1, 1991, to November 17, 2024, yielded 455 papers that were analyzed using various online analysis tools. The cumulative publications from 1991 to 2023 followed a linear distribution. The United States and China led this research initiative. Keywords were divided into two clusters, including “monoclonal-antibody” and “post-exposure prophylaxis.” This systematic bibliometric analysis of the literature on anti-rabies monoclonal antibodies will help to reveal the internal relationship of the whole research and development network and promote the perfection of related research and development work to a considerable extent. This study not only delineates the historical trajectory and current status of mAb research but also provides valuable insights and concrete recommendations for future directions.

BACKGROUND:Rabies continues to pose a significant public health challenge in China. Here we reported the risk factors associated with the failure to initiate post-exposure prophylaxis (PEP) vaccination in China for period 2016-2020. It is essential for identifying strategies to decrease the incidence of these preventable fatalities. METHODS:We analyzed data from 1,733 case investigations in China between 2016 and 2020. Chi-squared tests and logistic regression analyses were utilized to identify factors associated with the failure to initiate PEP vaccination. RESULTS:A majority of the incidents (n = 1,295; 84.3%) involved animal bites, with dog wounds constituting 94.0% of these cases (n = 1,437). Domestic animals from the victims' own residences accounted for 48.5% (n = 690) of human rabies cases, followed by free-roaming animals at 34.4% (n = 489). Among the domesticated animals, 95.7% (n = 779) had not been vaccinated against rabies. Category III wounds were present in 66.1% (n = 952) of all cases. In the multivariable model, factors occupation, exposure category, and source of attacking animal were significantly associated with failure to initiate PEP vaccination. However, only 4.3% (n = 41) received rabies immunoglobulin (RIG), and a mere 1.2% (n = 11) underwent complete PEP vaccination in addition to RIG administration. The median incubation period for rabies was recorded at 72 days, with an interquartile range (IQR) of 35.0-173.0 days. CONCLUSIONS:The majority of individuals affected by rabies did not pursue PEP vaccination, especially those with category II wounds or those bitten by domestic animals from their own households. To decrease mortality from rabies, it is imperative to launch prevention campaigns directed at these groups. Furthermore, enhancing the regular vaccination of domestic dogs is crucial for long-term control of the disease.

Introduction:Rabies remains a significant zoonotic disease in China. Following comprehensive control measures implemented since 2006, annual human cases declined steadily from 2008 through 2023. However, 2024 witnessed a 36.9% increase in cases compared with 2023, indicating possible changes in transmission dynamics or control effectiveness. This study analyzes the epidemiological characteristics and spatiotemporal patterns of rabies from 2005 to 2024 to inform targeted prevention strategies. Methods:We employed descriptive epidemiological methods to analyze the spatiotemporal distribution and demographic characteristics of rabies cases in China. Spatial clustering was assessed using global and local Moran's I statistics (P<0.05). Retrospective space-time scan analysis (2005-2024) was performed using SaTScan software to identify significant disease clusters. We conducted spatial frequency analysis by calculating the number of years each county reported at least one case during the study period; counties reporting cases in ≥10 years were classified as high-frequency areas. Results:Following a peak of 3,300 cases in 2007, rabies incidence declined continuously for 16 years before resurging in 2024 (167 cases, representing a 36.9% increase compared with 2023). Cases remained geographically concentrated, with 76.0% occurring in six central and southern provincial-level administrative divisions. The majority of affected counties (74%) reported only a single case. Males (70.0%), farmers (68.6%), and individuals aged 41-70 years (53.8%) comprised the highest-risk populations. Spatial analysis revealed that High-High clusters decreased in number over time. These clusters also shifted geographically: from widespread distribution across southwestern provincial-level administrative divisions (PLADs) during 2005-2014 to concentration in central agricultural zones during 2020-2024, particularly along the border regions of Henan, Hunan, Hubei, and Anhui PLADs. We identified 352 high-frequency counties. Spatiotemporal scan statistics detected seven significant clusters during 2005-2024, all located in central and southwestern regions. Outbreaks within these clusters peaked during summer and autumn months (July-November) from 2006 to 2013, with no new clusters emerging after 2014. Conclusions:Our findings demonstrate that China's rabies control efforts have successfully transitioned the epidemic from widespread endemic transmission to sporadic occurrence with localized clustering. The 2024 resurgence occurred predominantly in historically endemic hotspots identified through spatial analysis. Sustaining these control achievements will require implementing precision prevention strategies specifically targeted at these persistent high-risk counties.

Post-exposure prophylaxis (PEP) represents the critical intervention for preventing rabies and comprises three essential components: thorough wound cleansing, vaccination, and administration of rabies immunoglobulin (RIG) or monoclonal antibodies (mAbs) for category III exposures. The World Health Organization (WHO) endorses the use of mAb cocktails as an effective replacement for RIG in PEP protocols. Since 2016, four anti-rabies monoclonal antibodies (RmAbs) have received clinical approval for use in India and China. This article provides an overview of the current research status of RmAb. By reviewing clinical studies related to RmAb, it highlights the clinical advantages of RmAb over HRIG in terms of efficacy, accessibility, safety, acceptability, and clinical application in special populations. Additionally, it explores the future clinical prospects of RmAb, including their use in extremely high-risk cases, their impact on circulating antibodies, and their potential role in rabies treatment.

Background: Since the introduction of Pasteur’s rabies vaccine in 1885, rabies prophylaxis and post-exposure prophylaxis (PEP) have been widely administered globally under the recommendation of the World Health Organization (WHO). However, 124 documented cases of PEP failure had been reported worldwide between 1980 and 2023. Additionally, sporadic media reports from China showed occasional PEP failures between 2017 and 2024. Rabies remains a serious public health problem in over 150 countries and regions. Methods: In this review, we summarize PEP procedures recommended by the Advisory Committee on Immunization Practices (ACIP) and the WHO. We also analyze potential contributing factors to PEP failure, propose a concept of circulating antibodies, and discuss their roles in PEP. Furthermore, we summarize key guidelines for clinical trial design from the U.S. Food and Drug Administration (FDA) and China’s Center for Drug Evaluation (CDE), as well as the latest developments in monoclonal antibody (cocktail) therapies. Results: Adherence to core PEP practices, such as wound cleansing, infiltration of wounds with immunoglobulin (mAbs), and administration of vaccines, and broader societal involvement are crucial for preventing rabies infection in most cases. For high-risk exposures or immunocompromised individuals, the provision of circulating antibodies through high-dose human rabies immune globulin (HRIG) or mAbs is of utmost importance for preventing PEP failure. Conclusions: Early, high-concentration circulating antibodies are important for preventing PEP failure. Addressing the global issue of rabies requires involvement of the entire society. Only through collective efforts can we tackle this neglected disease and achieve WHO’s goal of “zero by 30”.

Background: The 4-dose Essen intramuscular (IM) regimen for rabies post-exposure prophylaxis (PEP) has been recommended by Advisory Committee on Immunization Practices (ACIP) and World Health Organization (WHO), but the large-sample clinical evidence is still limited. Method: Rabies virus neutralizing antibodies of 11,752 patients were detected from 409 rabies prevention clinics in 27 provinces in China. Patients with serum collected before or no later than 1 h after injection on the day of the fifth dose (day 28) of 5-dose Essen regimen were included in Group A to observe the immune efficacy of 4dose Essen IM regimen, and patients with serum collected 14-28 days after injection of the fifth dose were included in Group B to observe the immune efficacy of 5-dose Essen IM regimen. Results: Finally, 2351 cases met the inclusion and exclusion criteria, including 2244 cases in Group A and 107 cases in Group B. The antibody titer of Group A was higher than that of Group B [12.21 (4.15, 32.10) IU/ml vs. 9.41 (3.87, 27.38) IU/ml] (P= 0.002). In Group A, the median antibody titers were 4.01IU/ml, 11.63IU/ml and 29.46IU/ml in patients vaccinated with purified hamster kidney cell vaccine (PHKCV), purified Vero cell vaccine (PVRV), and human diploid cell rabies vaccine (HDCV), respectively, with statistical significance (P< 0.001). Conclusions: The 4-dose Essen IM regimen could provide satisfactory immune effect, and HDCV induced higher antibody titer than PHKCV or PVRV.

Background Brucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients. Methods A multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation. Results A total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5-58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906-8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176-2.384), arthralgia (OR = 3.197, 95% CI 1.986-5.148), eye bulging pain (OR = 3.482, 95% CI 1.349-8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310-2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145-2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%). Conclusions More than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

BackgroundNon-pharmaceutical interventions (NPIs) have been implemented worldwide to suppress the spread of coronavirus disease 2019 (COVID-19). However, few studies have evaluated the effect of NPIs on other infectious diseases and none has assessed the avoided disease burden associated with NPIs. We aimed to assess the effect of NPIs on the incidence of infectious diseases during the COVID-19 pandemic in 2020 and evaluate the health economic benefits related to the reduction in the incidence of infectious diseases.MethodsData on 10 notifiable infectious diseases across China during 2010-2020 were extracted from the China Information System for Disease Control and Prevention. A two-stage controlled interrupted time-series design with a quasi-Poisson regression model was used to examine the impact of NPIs on the incidence of infectious diseases. The analysis was first performed at the provincial-level administrative divisions (PLADs) level in China, then the PLAD-specific estimates were pooled using a random-effect meta-analysis.ResultsA total of 61,393,737 cases of 10 infectious diseases were identified. The implementation of NPIs was associated with 5.13 million (95% confidence interval [CI] 3.45-7.42) avoided cases and USD 1.77 billion (95% CI 1.18-2.57) avoided hospital expenditures in 2020. There were 4.52 million (95% CI 3.00-6.63) avoided cases for children and adolescents, corresponding to 88.2% of total avoided cases. The top leading cause of avoided burden attributable to NPIs was influenza [avoided percentage (AP): 89.3%; 95% CI 84.5-92.6]. Socioeconomic status and population density were effect modifiers.ConclusionsNPIs for COVID-19 could effectively control the prevalence of infectious diseases, with patterns of risk varying by socioeconomic status. These findings have important implications for informing targeted strategies to prevent infectious diseases.

BACKGROUND:Hemorrhagic fever with renal syndrome (HFRS) is a significant zoonotic disease mainly transmitted by rodents. However, the determinants of its spatiotemporal patterns in Northeast China remain unclear. OBJECTIVE:This study aimed to investigate the spatiotemporal dynamics and epidemiological characteristics of HFRS and detect the meteorological effect of the HFRS epidemic in Northeastern China. METHODS:The HFRS cases of Northeastern China were collected from the Chinese Center for Disease Control and Prevention, and meteorological data were collected from the National Basic Geographic Information Center. Times series analyses, wavelet analysis, Geodetector model, and SARIMA model were performed to identify the epidemiological characteristics, periodical fluctuation, and meteorological effect of HFRS in Northeastern China. RESULTS:A total of 52,655 HFRS cases were reported in Northeastern China from 2006 to 2020, and most patients with HFRS (n=36,558, 69.43%) were aged between 30-59 years. HFRS occurred most frequently in June and November and had a significant 4- to 6-month periodicity. The explanatory power of the meteorological factors to HFRS varies from 0.15 ≤ q ≤ 0.01. In Heilongjiang province, mean temperature with a 4-month lag, mean ground temperature with a 4-month lag, and mean pressure with a 5-month lag had the most explanatory power on HFRS. In Liaoning province, mean temperature with a 1-month lag, mean ground temperature with a 1-month lag, and mean wind speed with a 4-month lag were found to have an effect on HFRS, but in Jilin province, the most important meteorological factors for HFRS were precipitation with a 6-month lag and maximum evaporation with a 5-month lag. The interaction analysis of meteorological factors mostly showed nonlinear enhancement. The SARIMA model predicted that 8,343 cases of HFRS are expected to occur in Northeastern China. CONCLUSIONS:HFRS showed significant inequality in epidemic and meteorological effects in Northeastern China, and eastern prefecture-level cities presented a high risk of epidemic. This study quantifies the hysteresis effects of different meteorological factors and prompts us to focus on the influence of ground temperature and precipitation on HFRS transmission in future studies, which could assist local health authorities in developing HFRS-climate surveillance, prevention, and control strategies targeting high-risk populations in China.

Introduction: Analyze the recent epidemiological and temporal-spatial characteristics of human brucellosis in China and provide information for adjusting strategies for brucellosis control.Methods: Human brucellosis data were obtained from the National Notifiable Disease Reporting System (NNDRS). A geographical information system (GIS) was used to visualize high-risk areas with annual incidence based on county (district) polygons. The space-time scan statistic (STSS) was applied to detect the space-time clusters of human brucellosis.Results: A total of 69,767 cases were reported from 2,083 counties in the mainland of China in 2021, a 47.7% increase from 2020 (47,425). About 95.5% of the total cases were centralized in northern China and 31.8% in Inner Mongolia (IM). The number of counties with an incidence exceeding 100 per 100,000 was 34 in 2020 and 65 in 2021. From 2020 to 2021, 24 space-time clusters were detected. The two primary clusters were located northeast of IM, including 109 counties. The secondary clusters affected 208 counties in 2020 and spread to 297 counties in 2021, the majority of which were located in the middle of IM, exhibiting a trend spreading west from IM to neighboring provincial-level administrative divisions (PLADs). Conclusions: From 2020 to 2021, the incidence of human brucellosis nationwide was exponential, demonstrating distinct spatiotemporal characteristics. Space-time clusters were located in IM and neighboring areas. Therefore, considerable efforts are required to curb this momentum.

The purified Vero cell rabies vaccine (PVRV) has been used in rabies prevention for more than 40 years. A comprehensive review of the relevant researches on PVRV in rabies prevention at local and overseas in recent years shows that in the simplified Zagreb immunization program, PVRV has the similar immunogenicity and safety as in the standard Essen program. PVRV, purified chicken embryo cell rabies vaccine (PCECV) and human diploid cell rabies vaccine (HDCV) have similar immunogenicity and safety. PVRV also has good immunogenicity and safety in special populations such as those with diseases. The combined vaccination of PVRV and acellular diphtheria, tetanus, pertussis and inactivated poliomyelitis combined vaccine (DTP-IPV) or others did not find immune interference, which provided feasibility for children to vaccinate against rabies at the same time of vaccinating with planned vaccines. The combination of PVRV and equine rabies immunoglobulin can also achieve better prevention effect. PVRV plays an important role in the prevention of rabies, and its wide application will make a positive contribution to achieving the goal of eliminating rabies transmitted from dogs to humans by 2030 proposed by World Health Organization (WHO).

Background Despite the increasing number of cases of scrub typhus and its expanding geographical distribution in China, its potential distribution in Fujian Province, which is endemic for the disease, has yet to be investigated. Methods A negative binomial regression model for panel data mainly comprising meteorological, socioeconomic and land cover variables was used to determine the risk factors for the occurrence of scrub typhus. Maximum entropy modeling was used to identify the key predictive variables of scrub typhus and their ranges, map the suitability of different environments for the disease, and estimate the proportion of the population at different levels of infection risk. Results The final multivariate negative binomial regression model for panel data showed that the annual mean normalized difference vegetation index had the strongest correlation with the number of scrub typhus cases. With each 0.1% rise in shrubland and 1% rise in barren land there was a 75.0% and 37.0% increase in monthly scrub typhus cases, respectively. In contrast, each unit rise in mean wind speed in the previous 2 months and each 1% increase in water bodies corresponded to a decrease of 40.0% and 4.0% in monthly scrub typhus cases, respectively. The predictions of the maximum entropy model were robust, and the average area under the curve value was as high as 0.864. The best predictive variables for scrub typhus occurrence were population density, annual mean normalized difference vegetation index, and land cover types. The projected potentially most suitable areas for scrub typhus were widely distributed across the eastern coastal area of Fujian Province, with highly suitable and moderately suitable areas accounting for 16.14% and 9.42%, respectively. Of the total human population of the province, 81.63% reside in highly suitable areas for scrub typhus. Conclusions These findings could help deepen our understanding of the risk factors of scrub typhus, and provide information for public health authorities in Fujian Province to develop more effective surveillance and control strategies in identified high risk areas in Fujian Province.

Epidemiological characteristics of human rabies in mainland China, 2005–2020 were analyzed to evaluate the effect of rabies control in China in recent years. A total of 24,319 human rabies cases were recorded in 2097 counties in 321 cities of 31 provinces in mainland China. Only 202 cases, located in 143 counties, were recorded in 2020, compared with 3305 cases in 992 counties in 2007; however, rabies was still relatively severe in Hunan Province even in 2020. Peak periods occurred in July–November; August was often the month with the most cases. Guizhou, Hunan, Guangdong, and Guangxi Provinces, in the central and southern regions, accounted for 50.0% of the cases in 2005–2020. Cases occurred almost exclusively in rural areas with 96.7% versus 3.3% in urban areas. A paradoxical relative expansion from southern, eastern, and central towards southwestern, northwestern, northern, and northeastern regions was observed along with the overall reduction of cases. Some regions witnessed complete elimination. The male-to-female ratio was 2.33:1; 66.8% of all cases were reported in the 0–10 (13.8%) and 41–70 (53.0%) age groups. Farmers (68.3%), followed by students (12.2), and diaspora children (6.5%) were most frequently involved. Our results provide objective information for the improvement of rabies prevention and control efforts. This will aid policymakers in China and elsewhere achieve the “Zero human deaths from dog-mediated rabies by 2030” global goal.

This study aims to describe the epidemiological characteristics of scrub typhus, detect the spatio-temporal patterns of scrub typhus at county level, and explore the associations between the environmental variables and scrub typhus cases in Anhui Province. Time-series analysis, spatial autocorrelation analysis, and space–time scan statistics were used to explore the characteristics and spatiotemporal patterns of the scrub typhus in Anhui Province. Negative binomial regression analysis was used to explore the association between scrub typhus and environmental variables. A total of 16,568 clinically diagnosed and laboratory-confirmed cases were reported from 104 counties of 16 prefecture-level cities. The number of female cases was higher than male cases, with a proportion of 1.32:1. And the proportion of cases over 65 years old was the highest, accounting for 33.8% of the total cases. Two primary and five secondary high-risk clusters were detected in the northwestern, northeastern, and central-eastern parts of Anhui Province. The number of cases in primary and secondary high-risk clusters accounted for 60.27% and 3.00%, respectively. Scrub typhus incidence in Anhui Province was positively correlated with the population density, normalized difference vegetation index, and several meteorological variables. The mean monthly sunshine duration with 3 lags (SSD_lag3), mean monthly ground surface temperature with 1 lag (GST_lag1), and mean monthly relative humidity with 3 lags (RHU_lag3) had the most significant association with increased cases of scrub typhus. Our findings indicate that public health interventions need to be focused on the elderly farmers in north of the Huai River in Anhui Province.

Background A global plan has been set to end human deaths from dog-mediated rabies by 2030 ("Zero-by-30"), but whether it could be achieved in some countries, such as China, remains unclear. Although elimination strategies through post-exposure prophylaxis (PEP) use, dog vaccination, and patient risk assessments with integrated bite case management (IBCM) were proposed to be cost-effective, evidence is still lacking in China. We aim to evaluate the future burdens of dog-mediated human rabies deaths in the next decade and provide quantitative evidence on the cost-effectiveness of different rabies-control strategies in China. Methods Based on data from China's national human rabies surveillance system, we used decision-analytic modelling to estimate dog-mediated human rabies death trends in China till 2035. We simulated and compared the expected consequences and costs of different combination strategies of the status quo, improved access to PEP, mass dog vaccination, and use of IBCM. Results The predicted human rabies deaths in 2030 in China will be 308 (95%UI: 214–411) and remain stable in the next decade under the status quo. The strategy of improved PEP access alone could only decrease deaths to 212 (95%UI: 147–284) in 2028, remaining unchanged till 2035. In contrast, scaling up dog vaccination to coverage of 70% could eliminate rabies deaths by 2033 and prevent approximately 3,265 (95%UI: 2,477–3,687) extra deaths compared to the status quo during 2024–2035. Moreover, with the addition of IBCM, the "One Health" approach through mass dog vaccination could avoid unnecessary PEP use and substantially reduce total cost from 12.53 (95%UI: 11.71–13.34) to 8.73 (95%UI: 8.09–9.85) billion US dollars. Even if increasing the total costs of IBCM from 100 thousand to 652.10 million US dollars during 2024–2035, the combined strategy of mass dog vaccination and use of IBCM will still dominate, suggesting the robustness of our results. Conclusions The combined strategy of mass dog vaccination and IBCM requires collaboration between health and livestock/veterinary sectors, and it could eliminate Chinese rabies deaths as early as 2033, with more deaths averted and less cost, indicating that adding IBCM could reduce unnecessary use of PEP and make the "One Health" rabies-control strategy most cost-effective.

目的 分析2017-2021年全国内脏利什曼病流行特点,为今后内脏利什曼病的防治提供科学依据.方法 收集2017-2021年国家传染病报告信息管理系统报告的内脏利什曼病病例信息,使用描述流行病学方法,用Excel 2016、ARCGIS和SPSS 22.0软件分析内脏利什曼病病例的发病季节、波及县(区)、人群年龄和职业特点等流行病学特征.结果 2017-2021年,全国23个省(直辖市、自治区)103个市278个县(区)共报告内脏利什曼病1 019例,死亡1例.男女比例为2.1∶1.山西省(347例,34.1％)、甘肃省(238例,23.4％)、陕西省(158例,15.5％)、新疆维吾尔自治区(76例,7.5％)、四川省(74例,7.3％)和河南省(46例,4.5％)报告病例数居前6位,报告病例数合计占全国报告发病总数的92.1％.全国累计报告内脏利什曼病超过30例的县(区)共7个,波及山西省阳泉市(平定县、郊区、矿区),甘肃省甘南藏族自治州(舟曲县)、陇南市(武都区、宕昌县),陕西省韩城市共3省4市.2017-2021年,全国内脏利什曼病报告病例数先降后升,病例数在164～239例间变化.其中,山西、陕西、河南省病例数呈明显上升趋势.各年龄组均有病例报告,主要分布在0～5岁和61岁以上组人群,其报告病例数分别占全部病例数的29.5％(301/1019)和15.8％(161/1019).全国内脏利什曼病没有明显的发病季节高峰,以4-6月发病人数相对较多.病例以农民、散居儿童为主,分别占到40.8％(416/1019)、27.5％(280/1 019).6个重点省不同年龄组的发病差异有统计学意义(x2=174.061,P＜0.001).6个重点省不同职业人群发病差异有统计学意义(x2=236.042,P＜0.001).结论 2017-2021年全国内脏利什曼病总体处于低水平地方流行状态,病例呈散在分布,局部地区出现了聚集性疫情;波及地区既有持续传播的疫源地,又有新的输入与扩散.中西部局部地区山丘型内脏利什曼病病例快速显著上升.我国内脏利什曼病疫情仍不容忽视,控制乃至消除任重道远.

Background: Hemorrhagic fever with renal syndrome (HFRS) occurs widely in Northeastern China, but the mechanism and interactions of meteorological and socio-economic factors on the transmission of HFRS are still largely unknown. Objective: We explored the effects of socioeconomic-environmental factors on the spatio-temporal variation of HFRS incidence from 2001 to 2019 in Northeastern China. Specifically, the relative importance and contribution rates (CR) of determinants of HFRS were identified by boosted regression tree and variance partitioning analysis, respectively. Structural equation models (SEMs) were used to explain the roles of climatic and socio-economic factors in the transmission of HFRS. And a negative binomial regression was used to identify the risk effect between monthly meteorological variables and HFRS with 0-6 months lags in Northeastern China. Results: Over the past decades, the high-risk areas of HFRS were mainly concentrated in the northern and eastern areas of Northeastern China. Additionally, HFRS mainly presented a decreasing trend from 2001 to 2019 in most areas of Northeastern China, but slightly increased in the cities of Daqing, Songyuan, Baicheng, and Tonghua. The temporal dynamics of the incidence of HFRS were primarily explained by the variations in population density (CR = 27.30%), climate (CR = 13.30%), and economic condition(CR = 1.90%). The spatial variations of HFRS were medicated by the climate (CR = 16.95%) and population density (CR = 9.45%) and medical health care (CR = 2.25%). The SEM models indicated that humid and warm climates were conducive to the incidence and increase of HFRS, but the improvement in education and an increase in population density reduced the transmission of HFRS. Conclusion: Climate and population density appeared to mediate the spatio-temporal variation of HFRS in Northeastern China. These findings may provide valuable empirical evidence for the management of HFRS in endemic areas.

目的 随着世界卫生组织推行新的狂犬病疫苗接种程序,寻找更新我国狂犬病疫苗接种程序的临床数据支持.方法 本项目在多中心原则下招募健康受试者,采集国产细胞培养纯化的狂犬病疫苗接种第4针和第5针2周后的血清,使用快速荧光灶抑制实验测定狂犬病病毒中和抗体滴度,并分析接种不同剂次后狂犬病病毒中和抗体滴度的差异.结果 接种第4针后的所有样本中和抗体滴度100％阳转,高于0.5 IU/mL.接种第4针后的中和抗体平均值为29.59 IU/mL,中和抗体滴度分布1.17～162.73I U/mL,中位数为22.51 IU/mL;接种第5针后中和抗体平均值为24.64 IU/mL,中和抗体滴度分布4.62～89.77 IU/mL,中位数为21.09 IU/mL.统计分析显示,两组数据差异无统计学意义(P>0.05).结论 我国细胞培养纯化的狂犬病疫苗接种第4针后中和抗体滴度已经高于保护水平抗体滴度,此次临床研究数据支持推行"简化4针法"的免疫程序.