BACKGROUND:Long-term transmission of multidrug-resistant tuberculosis (MDR-TB) challenges TB control by generating new cases and enabling the emergence of extensively resistant strains. We investigated its epidemiologic and bacterial drivers in Shanghai, China. METHODS:We conducted a retrospective study of Mycobacterium tuberculosis isolates and associated epidemiological data from individuals diagnosed with rifampicin-resistant TB in Shanghai over 14 years (2004-2018). Using whole-genome sequencing, Bayesian reconstruction of transmission trees, and multivariable regression analysis to identify epidemiological and bacterial factors associated with the transmission of MDR-TB. RESULTS:Between 2004 and 2018, 1456 individuals in Shanghai were diagnosed with MDR or rifampicin-resistant TB, with whole-genome sequences available for 1100 isolates. The overall genomic clustering rate was 55.3%, with large clusters (those containing ≥5 cases) accounting for 39.9% of the clustered strains. Risk factors for clustered MDR-TB transmission included local residents (adjusted odds ratio [aOR] 2.28, 95% confidence interval [CI]: 1.67-3.11), diagnostic delays ≥2 months (aOR 1.75, 95% CI: 1.24-2.47), specific M. tuberculosis sublineages (L2.3.3-L2.3.6), and the rpoB S450L mutation with compensatory mutations (aOR 2.14, 95% CI: 1.64-2.78). Large MDR-TB clusters were significantly associated with long-term transmission (>5 years, P < .001). Long-term transmission clusters correlated with same-street residence, local residents, and MDR-TB strains carrying katG315T, rpoBS450L and compensatory mutations. CONCLUSIONS:Despite ample healthcare resources, MDR-TB persists in urban areas due to both epidemiological and bacterial factors. The rpoB S450L mutation with compensatory mutations enhances transmission even in the absence of clear epidemiologic links. Effective control measures must address both epidemiological and bacterial factors.

With the scaling up of WHO-recommended diagnostics, 40

Pasteurella multocida serotype A (PmCQ2), a Gram-negative zoonotic pathogen, causes severe respiratory disease in a variety of domestic and wild animals, leading to high morbidity and mortality and substantial agricultural economic losses. Pyroptosis, a gasdermin-mediated programmed cell death mechanism, facilitates pathogen clearance but exacerbates tissue damage through inflammatory cytokine release. While our prior work established PmCQ2-driven NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome activation, the role of pyroptosis in pulmonary pathology during infection remains unresolved. Here, we demonstrate that PmCQ2 induces macrophage pyroptosis via gasdermin D (GSDMD) cleavage, evidenced by lactate dehydrogenase (LDH) release, membrane pore formation under transmission electron microscopy (TEM), and proteolytic generation of GSDMD-N termini. Pharmacological inhibition of NLRP3 (MCC950) and genetic ablation of caspase-11 significantly attenuated GSDMD activation, IL-1β secretion, and pyroptotic cell death, implicating both canonical (NLRP3/caspase-1) and noncanonical (caspase-11) pathways. Crucially, GSDMD knockout mice exhibited markedly reduced lung injury, evidenced by diminished inflammatory infiltration and preserved alveolar architecture, compared to wild-type (WT) counterparts following PmCQ2 challenge. This study provides the first evidence that PmCQ2 triggers GSDMD-dependent pyroptosis through dual signaling axes, directly linking this inflammatory cell death pathway to pathogen-induced pulmonary damage. Our findings position GSDMD as a central therapeutic target to mitigate tissue injury during P. multocida infection, offering a framework for novel interventions that balance antimicrobial defense and inflammation control in zoonotic pathogens.

Hepatitis E virus (HEV) remains a major public health concern in China, with a significant increase in notified incidence over the last two decades. We aimed to examine trends and potential contributing factors associated with hepatitis E incidence and infection in Shanghai, a highly developed metropolis. Hepatitis E notified incidence data were retrieved from the National Notifiable Infectious Disease Reporting System (2004–2024). Six cross-sectional community-based serological surveys were conducted between 2001 and 2024, involving a total of 6,305 participants. Pathogen surveillance was annually conducted in confirmed cases, swine bile, and shellfish between 2018 and 2024. HEV was genotyped via amplification of a 150-nt fragment within ORF2 and phylogenetically analyzed. A total of 14,071 hepatitis E cases were notified in Shanghai during 2004–2024, with a Joinpoint detected in 2012 and an increasing trend thereafter (annual percentage change 5.03

Mycobacterium tuberculosis/human immunodeficiency virus (TB/HIV) co-infection remains a significant global public health challenge. In areas with a lower incidence of TB and HIV, how to elevate screening efficiency while maintaining cost-effectiveness worth further exploration. This study aimed to explore a suitable algorithm for TB prevention and intervention among people who live with HIV (PLHIV) in Shanghai based on a cohort study. A prospective cohort study was conducted in Jing’an and Baoshan Districts, Shanghai, from May 2019 to December 2024. Participants underwent baseline and annual follow-up assessments using interferon-gamma release assays (IGRA) and standardized questionnaires. Firth’s penalized maximum likelihood logistic regression was employed for both univariable and multivariable analyses to address potential complete separation. Among 963 enrolled participants, 857 completed baseline assessments. The baseline TBI prevalence was 6.8

With population aging, the burden of tuberculosis (TB) among the elderly is rising. Older adults are at high risk of TB but susceptible to poor TB care. In this study, we enrolled TB patients aged over 60 years registered in Shanghai during 2019-2021. A seven-step care cascade from estimated TB burden in the community to treatment outcomes was constructed to quantify retention and attrition at each step of TB health service. Patient pathway analysis was carried out in two districts of Shanghai to describe patients' care-seeking behaviors, service coverage, and diagnosis delays. Across the care cascade, the largest gaps occurred from symptom onset to care seeking (11.3%) and from treatment initiation to completion (10.7%). Male sex, older age, and mycobacterium tuberculosis positivity were associated with treatment discontinuation and unfavorable outcomes. The patient pathway analysis revealed that first contact at lower-level or non-TB-designated hospitals was associated with more complex pathways and may contribute to diagnostic delays. These findings highlight the need to promote proactive care seeking upon symptoms, strengthen targeted adherence support for older people, and improve diagnostic capacity and referral efficiency at lower-level health facilities.

Life expectancy is one of the most widely used indicators for the measurement of overall health of a population. We conducted a retrospective cohort study to analyze temporal trends in life expectancy among people with HIV (PWH) in Shanghai from 2012 to 2023, stratified by sex, and to evaluated the evolving gap compared with the general population, using data from the national epidemiology database and abridged life tables. A total of 24,848 PWH were included in the analysis, with 91.2% (22,669) being male and 8.8% (2179) being female. Life expectancy at age 20 among all PWH increased from 36.8 (95% confidence interval [CI]: 35.1-38.5) years in 2012-2014 to 53.2 (95% CI: 51.7-54.6) years in 2021-2023. Increases were observed among both males (from 36.7 [95% CI: 35.0-38.4] to 52.6 [95% CI: 51.1-54.1] years) and females (from 35.6 [95% CI: 31.7-39.4] years in 2012-2017 to 56.9 [95% CI: 51.8-62.1] years in 2021-2023). The corresponding gap compared with the Shanghai general population narrowed from 26.8 in 2012-2014 to 12.8 in 2021-2023. Life expectancy at age 20 among PWH in Shanghai increased substantially between 2012 and 2023, with greater improvement among females. The survival gap relative to the general population narrowed but remained.

Background: Isoniazid (INH) remains a cornerstone of tuberculosis (TB) prevention and treatment, administered either as monotherapy or in combination with rifamycin-containing regimens. In this study, the preventive regimens analyzed included 6 months of daily INH monotherapy (6H), 3 months of daily INH plus rifampicin (3HR), and 3 months of twice-weekly INH plus rifapentine (3H2P2). Despite the adoption of shorter-course regimens, substantial inter-individual variability (IIV) in INH exposure persists, potentially impacting both therapeutic efficacy and toxicity. A quantitative, regimen-specific characterization of INH pharmacokinetics is therefore critical to support model-informed dosing strategies. Methods: Population pharmacokinetic models were developed separately for INH administered as 6H, 3HR, and 3H2P2. The models characterized absorption, clearance, and IIV of INH, while accounting for co-administered rifamycin. The effects of N-acetyltransferase 2 (NAT2) acetylator phenotype and relevant clinical covariates were systematically evaluated. Model performance was assessed using goodness-of-fit diagnostics, posterior predictive checks, and visual predictive checks. Population pharmacokinetic models were developed using a Bayesian nonlinear mixed-effects framework implemented in Stan through CmdStanR version 0.9.0, with additional data processing, statistical summaries, and visualization performed using R version 4.2.3. Results: INH pharmacokinetics were adequately described by regimen-specific models, revealing distinct differences in absorption and variability across regimens. Typical INH apparent oral clearance (CL/F) estimates were 21.83 L/h for 6H, 26.32 L/h for 3HR, and 25.98 L/h for 3H2P2. NAT2 phenotype was a major determinant of INH clearance across regimens: compared with intermediate acetylators, slow acetylators showed 35.4% lower CL/F, whereas fast acetylators showed 48.4% higher CL/F, indicating higher INH exposure in slow acetylators and lower exposure in fast acetylators. Body weight also influenced INH pharmacokinetics. Co-administration with rifampicin or rifapentine influenced INH pharmacokinetics in a manner consistent with reduced exposure in rifamycin-containing regimens, particularly among fast acetylators. Conclusions: Regimen-specific population pharmacokinetic modeling elucidated clinically relevant differences in INH exposure across commonly used preventive and treatment regimens. These findings highlight the importance of accounting for regimen- and genotype-specific effects when optimizing INH dosing and provide a quantitative framework for future model-informed precision dosing approaches in TB care.

To analyze the status of patient delay (PD) and diagnosis delay (DD) and explore factors associated with delays among migrant tuberculosis (TB) patients in suburban Shanghai from 2015 to 2024, aiming to provide a scientific basis for targeted TB control strategies. A retrospective surveillance-based study was conducted using pulmonary tuberculosis (PTB) case data from Fengxian District, Shanghai, obtained from the Tuberculosis Information Management System. Statistical analyses, including the Mann–Whitney U test, chi-square test, multivariable logistic regression, and generalized least squares (GLS) analysis, were performed to examine factors associated with delays. Joinpoint regression was used to analyze temporal trends. A total of 3,178 PTB cases (1,573 locals and 1,605 migrants) were included. Compared with locals, migrants exhibited a significantly shorter median PD (8 vs. 11 days; P < 0.001) but a longer median DD (9 vs. 7 days; P < 0.001). Regarding PD, a significant upward trend was observed among migrants from 2017 to 2024 (Annual Percentage Change [APC] = 5.28

Objective The relationship between periodontitis and diabetes is well-established, yet the underlying mechanisms are incompletely understood. This study aimed to investigate the role of Klebsiella pneumoniae (Kp94), isolated from the salivary microbiota of periodontitis patients, in exacerbating diabetes by disrupting intestinal immunity and metabolic homeostasis. Design Following the induction of periodontitis by ligation and oral gavage of Kp94, the systemic metabolic status of the mice was assessed through the Disease Activity Index (DAI), intraperitoneal glucose tolerance test (IPGTT), and measurements of serum total cholesterol (TC) and glycated hemoglobin (HbA1c). To investigate the underlying mechanisms, transcriptomic analysis of intestinal tissues and 16S rRNA sequencing of intestinal contents were performed. Furthermore, intestinal immunity was evaluated by immunohistochemistry/immunofluorescence, and the proportion of ILC3s was analyzed by flow cytometry. Results Kp94 induced gut microbiota dysbiosis and systemic glucose intolerance. Mechanistically, Kp94 suppressed the intestinal ILC3/IL-22 pathway, which impaired mucosal immunity by reducing antimicrobial peptide (BD3, LCN2) expression, disrupting the mucus barrier, and increasing intestinal permeability. Concomitantly, this suppression inhibited endocrine function, notably GLP-1 production. Crucially, IL-22 administration rescued these defects by alleviating endoplasmic reticulum stress, thereby restoring barrier and endocrine integrity, and improving metabolic parameters, including HbA1c. Conclusion Our findings suggest that the intestinal ILC3/IL-22 pathway may serve as a potential mechanistic link and therapeutic target for the metabolic and pancreatic damage associated with Kp94 in periodontitis-related diabetes.

BACKGROUND:Bacterial meningitis (BM) represents a severe infectious disease characterized by high mortality and neurological sequelae. The increasing prevalence of antimicrobial resistance has compromised antibiotic therapies, emphasizing an urgent need for alternative treatments. Taxifolin (TAX), a naturally occurring flavonoid, exhibits multiple bioactivities, yet its role in BM remains unknown. PURPOSE:This study investigated the therapeutic effects of TAX in BM and explored its underlying molecular mechanisms. STUDY DESIGN AND METHODS:Using both in vitro and in vivo approaches, we established BM models with extraintestinal pathogenic Escherichia coli and Streptococcus suis. The therapeutic efficacy of TAX was assessed through comprehensive analyses of pathological changes and inflammatory responses. Molecular mechanisms were investigated using multiple approaches, including network pharmacology, Western blotting, drug affinity-responsive target stability assay, and cellular thermal shift assay. RESULTS:TAX significantly inhibited bacteria-induced cell death in microglia and brain endothelial cells, reduced microglial inflammatory responses, and protected endothelial tight junction proteins in vitro. In mice, TAX markedly reduced mortality, alleviated tissue damage, and suppressed inflammatory responses. The protective effects of TAX were associated with the inhibition of PI3K/AKT and MAPK pathways, with AKT identified as its direct target. CONCLUSIONS:Our findings identify TAX as a potential therapeutic agent for BM treatment, with its protective effects associated with the inhibition of PI3K/AKT and MAPK pathways. These results provide a foundation for the further development of TAX-based interventions against BM.

Objective:To assess the independent and combined effects of air pollutants, meteorological factors, and greenspace exposure on new tuberculosis (TB) cases. Methods:TB case data from Shanghai (2013-2018) were obtained from the Shanghai Center for Disease Control and Prevention. Environmental data on air pollutants, meteorological variables, and greenspace exposure were obtained from the National Tibetan Plateau Data Center. We employed a distributed-lag nonlinear model to assess the effects of these environmental factors on TB cases. Results:Increased TB risk was linked to PM 2.5, PM 10, and rainfall, whereas NO 2, SO 2, and air pressure were associated with a reduced risk. Specifically, the strongest cumulative effects occurred at various lags: PM 2.5 ( RR = 1.166, 95% CI: 1.026-1.325) at 0-19 weeks; PM 10 ( RR = 1.167, 95% CI: 1.028-1.324) at 0-18 weeks; NO 2 ( RR = 0.968, 95% CI: 0.938-0.999) at 0-1 weeks; SO 2 ( RR = 0.945, 95% CI: 0.894-0.999) at 0-2 weeks; air pressure ( RR = 0.604, 95% CI: 0.447-0.816) at 0-8 weeks; and rainfall ( RR = 1.404, 95% CI: 1.076-1.833) at 0-22 weeks. Green space exposure did not significantly impact TB cases. Additionally, low temperatures amplified the effect of PM 2.5 on TB. Conclusion:Exposure to PM 2.5, PM 10, and rainfall increased the risk of TB, highlighting the need to address air pollutants for the prevention of TB in Shanghai.

Introduction Treatment compliance is considered significant for curing tuberculosis (TB). Digital adherence technologies (DATs) have been recommended for improving treatment compliance and outcomes of patients with TB. Whereas the effectiveness of DATs on TB treatment remains indefinite, we estimated whether a mobile application has an effect on treatment adherence and outcomes among patients with TB in an urban area in China.Methods We conducted a multicentre, two-arm, open-label, equivalent, stratified block randomisation trial from 7 districts involving 4670 eligible new patients with TB in Shanghai, China. Patients in the intervention group were instructed to get access to the app through WeChat. In the control group, patients were treated with standard of care. The primary outcome of this study was a composite outcome, which included death, treatment failure, loss to follow-up and relapse. The secondary outcomes were mainly described as overall poor treatment adherence and monthly poor treatment adherence. A generalised estimating equation is used to estimate the correlation between the two groups’ outcomes after adjusting for concomitant variables.Results Between 1 March 2021 and 31 December 2022, 741 patients (371 in the intervention group and 370 in the control group) were included in the intention-to-treat population, 430 (58%) were male and the median age was 33 years (IQR 27–49). 80 (22%) patients in the intervention group and 104 (28%) patients in the control group had a primary composite outcome event. The adjusted risk difference for the intervention versus control was −7.04 percentage points (95% CI −13.25 to −1.14, p=0.025); secondary outcome included overall poor treatment adherence with an adjusted risk difference −16.39 percentage points (95% CI −22.13 to −9.62, p<0.001).Conclusions The mobile health application improved TB treatment adherence and outcomes significantly, especially for loss to follow-up. Future research should be focused on implementation problems in various settings and the improvement of patient-centred management strategies.Trial registration number ChiCTR2000037575.

OBJECTIVES:Fluoroquinolones (FQ) are one of the most prescribed broad-spectrum antibiotics and a cornerstone of tuberculosis (TB) treatment. TB patients may have had FQ resistance before treatment initiation. However, the association between pre-diagnostic FQ exposure and acquired FQ-resistant TB remains unclear. METHODS:A case-control study was conducted among all pulmonary TB patients in Shanghai during 2022-2023. Cases were TB patients who had possible acquired FQ resistance identified through whole-genome sequencing (WGS), while controls were FQ susceptible patients. Pre-diagnostic FQ prescriptions were extracted from the Shanghai Electronic Health Record (EHR) platform. RESULTS:Among 3496 patients, 7.4% had FQ-resistant TB, with 93.5% (243/260) phylogenetically inferred as possible acquired resistance. Multivariate analysis revealed FQ exposure was the strongest predictor of possible acquired FQ resistance with an aOR of 4.31 for a single prescription and 13.18 for multiple prescriptions. A nonlinear dose-response relationship between resistance probability and prescription number was found. Most prescriptions to cases were from non-TB-designated tertiary hospitals for non-TB respiratory diseases, with an exposure interval of ≥61 days prior to TB diagnosis. CONCLUSION:Acquired resistance dominates FQ resistance in Shanghai TB patients. The dose-response relationship between pre-diagnostic FQ exposure and possible acquired resistance underscores the need for judicious FQ use.

BACKGROUND: Students represent a key demographic for tuberculosis (TB) control in China. This study utilizes a dynamic Markov model to forecast the epidemiological trends of active tuberculosis (ATB) among students in Shanghai through 2035 and evaluate the effectiveness of different control strategies. METHODS: A Markov model incorporating six distinct states of TB transmission was utilized to simulate disease dynamics within a hypothetical cohort of 100,000 individuals. The model assessed the prevalence of latent tuberculosis infection (LTBI) and ATB, categorizing the cases based on whether they received the recommended treatment regimen. RESULTS: Under the current measures without any additional interventions, the model projected a marginal decline in ATB prevalence. Specifically, ATB prevalence is predicted to decrease to 14.80 per 100,000 by 2035. With an increase in tuberculosis preventive treatment (TPT) coverage to 20%, 50%, or 80%, the reductions in ATB prevalence were modest. When the detection rate of LTBI was fixed at 12% and combined with TPT coverage levels of 20%, 50%, and 80%, the reductions in ATB prevalence were 17.01%, 36.56%, and 50.68% respectively. Increasing the detection rate of LTBI to 35% alongside TPT coverages of 20%, 50%, and 80% led to more pronounced declines in ATB prevalence, at 40.95%, 69.36%, and 80.46% respectively. CONCLUSIONS: Under the current TB control measures, the prevalence of ATB among students would result in only marginal decline trajectories through 2035, falling substantially short of achieving the strategic goal of ending TB. Enhanced strategies that simultaneously increase detection rates and coverage of TPT are likely to significantly reduce ATB prevalence in this population.

ObjectiveTo describe the epidemiological characteristics and trend of pulmonary tuberculosis among the elderly in Shanghai from 2014 to 2023, to estimate the incidence between 2024‒2025, so as to provide references for optimizing the prevention and control strategies of pulmonary tuberculosis for elderly in Shanghai.MethodsData of pulmonary tuberculosis patients aged ≥60 years in Shanghai registered in the Tuberculosis Registration and Management System of Chinese Center for Disease Control and Prevention from 2014 to 2023 was derived to describe the demographic characteristics of the elderly patients with pulmonary tuberculosis, and to calculate the reported incidence rate and annual percentage change (APC) of pulmonary tuberculosis. The autoregressive integrated moving average (ARIMA) model was constructed using monthly reported incidence data from January 2014 to June 2023, and data from July to December in 2023 were used to validate the model and predict the reported incidence rate of pulmonary tuberculosis among elderly in 2024 and 2025.ResultsA total of 19 208 elderly pulmonary tuberculosis patients were registered and reported in Shanghai from 2014 to 2023, with an average annual reported incidence rate of 35.04/100 000. The reported incidence rate of pulmonary tuberculosis in elderly showed an overall decreasing trend, APC=-3.34% (t=-3.360, P=0.010). While, the proportion of elderly pulmonary tuberculosis patients showed a yearly increasing trend among the total registered and reported cases, APC=5.65% (t=10.820, P<0.001). The difference in the average annual reported incidence rate of pulmonary tuberculosis in elderly was statistically significant in different regions (χ2=31.762, P=0.007), with the central urban areas(33.23/100 000) being lower than that in suburban areas (36.46/100 000), and the annual decreasing rate was faster in central urban area, APC=-4.88% (t=-4.838, P<0.001) and -2.76% (t=-2.811, P=0.023), respectively. The incidence rate was significantly higher in males than that in females (χ2=514.395, P<0.001). Additionally, the difference in reported incidence rate was statistically significant among different age groups(χ2=119.751,P<0.001), among which patients aged ≥80 years had the highest average annual incidence rate (59.69/100 000), and those aged ≤60 years had the lowest average annual incidence rate (28.57/100 000). Compared with the non-residential permanent elderly population (47.68/100 000), the average annual incidence rate of pulmonary tuberculosis among the elderly with household registration in Shanghai was lower (33.82/100 000) (χ2=24.295, P<0.001). The ARIMA (0,0,1) (0,1,1) 12 model was used to predict the incidence rate of pulmonary tuberculosis among the elderly in Shanghai in 2024 and 2025, and which was predicted to be 37.41/100 000 and 35.92/100 000, respectively.ConclusionThe reported incidence rate of pulmonary tuberculosis among the elderly in Shanghai showed an overall yearly downward trend from 2014 to 2023, but its proportion in the total number of reported pulmonary tuberculosis cases increased year by year. Prevention and control efforts should still not be slackened and emphasis should be placed on male, suburban and non-residential permanent elderly populations.

INTRODUCTION:Tuberculosis preventive treatment (TPT) has been initiated systematically in Shanghai supported by a public health project. This study aimed to evaluate the acceptance of TPT, identify the factors related to its refusal, and find an optimal way to promote TPT among student tuberculosis (TB) contacts. METHODS:We screened contacts of the TB index case from a TB outbreak on campus. A two-step approach of first conducting a lecture of TB health literacy, followed by one-on-one TPT consultations was used to mobilise TPT among students with latent TB infection (LTBI). A semistructured questionnaire was designed between the lecture and the one-on-one TPT consultations, covering general demographic information, awareness of core TB knowledge and willingness to accept TPT, along with the reasons for refusal. Logistic regression analysis was used to identify the risk factors for refusing TPT. RESULTS:A total of 52 contacts were identified with LTBI. After the lecture on TB health literacy, their scores on the core TB knowledge was 14.0±2.3. Students had a poor awareness rate of TB knowledge in the part of TB treatment and policy (70.2%) and Mycobacterium tuberculosis infection preventive measures and LTBI (67.3%) compared with the average rate (84.3%). The acceptance rate of TPT reached 42.3% at the end of the two-step promotion. The main reasons for refusing TPT included: (1) the duration for TPT was too long and follow-up management was too cumbersome; (2) the confidence in their own immunity and belief in their low risk of TB and (3) the fear of side effects of TPT. CONCLUSIONS:The two-step approach of first conducting a lecture of TB health literacy, followed by one-on-one TPT consultations, is effective for mobilising TPT. To further implement TPT, we recommend making the scientific popularisation for LTBI in a more easy-to-understand way and optimising the management of TPT.

What is already known about this topic?:Current strategies for chronic viral hepatitis prevention and control include immunization, prevention of mother-to-child transmission, expanded testing, antiviral therapy, and national drug price negotiations. To advance high-quality, integrated prevention and treatment services, a decentralized service delivery approach may be beneficial. What is added by this report?:The chronic viral hepatitis community-based healthcare management program in Shanghai delivered comprehensive service packages across 4 categories encompassing 10 distinct interventions, including epidemiological investigation, health education, free testing, community dispensing services, and immunization to family caregivers. The enrolled patients increased substantially from baseline, and antiviral treatment utilization rates reached 64.5% and 58.2% in 2019 and 2023 from 24.5% in 2012. Concurrently, abnormality rates for hepatitis B virus deoxyribonucleic acid (HBV DNA), alanine aminotransferase (ALT), total bilirubin (TBIL), and hepatic fibrosis indices decreased significantly. The 2023 aMAP score demonstrated a significant reduction in hepatocellular carcinoma risk among patients under management. Additionally, community dispensing services were accessed by 14.1% (2019) and 18.2% (2023) of enrolled patients. What are the implications for public health practice?:The community-based healthcare management program could effectively decentralize hepatitis-related testing and treatment services, and create a favorable environment for the viral hepatitis elimination efforts.

The number and proportion of people aged 65 and above in Shanghai are increasing, posing challenges to tuberculosis (TB) control. This study aims to assess the impact of this demographic change on the TB epidemic in Shanghai. Data were obtained from the TB Information Management System, with case counts and notification rates calculated by gender, age, and year. TB notification rates and trends were analyzed under two demographic scenarios: a constant aging scenario and an increasing aging scenario. Grey models (GM (1,1)) and age-period-cohort (APC) models were employed to forecast changes in the elderly population as well as age-specific TB notification rates. The estimated annual percentage change (EAPC) quantified trends over time. From 2015 to 2023, a total of 29,694 TB cases were reported, with males accounting for 69.79

Tuberculosis (TB), particularly extremely drug-resistant TB (EDR-TB), remains a significant public health concern worldwide. Understanding the transmission patterns and epidemiological characteristics of EDR-TB is vital for effective disease control. Between 1 January 2006 and 31 December 2018, we collected clinical M. tuberculosis strains in Shanghai, with whole-genome sequencing performed on 58 identified clinical EDR-TB strains. We analyzed EDR-related genetic mutations, conducted phylogenetic analyses, and examined bacterial and epidemiological factors that influence their transmission. Among these 58 EDR patients, 43.1% (25/58) were aged 45-64 years, with a median age of 51 years (interquartile range, IQR, 29-59 years). About two-thirds of the EDR-TB patients were residents. We observed a clustering rate of 44.8% (26/58) among EDR strains. Logistic regression analysis indicated a higher risk of recent EDR-TB transmission among the strains with the drug-resistant compensatory mutations. The primary mode of EDR-TB transmission in the study setting was recent, direct person-to-person spread of drug-resistant strains, as evidenced by high clustering rates and the presence of identical resistance mutations among clustered cases.