Background: Human papillomavirus (HPV) vaccine has been proven a safe, necessary, and effective measure against HPV infection. However, HPV vaccine uptake remains limited among university students in China. This study investigated HPV vaccine intent among university freshmen in the largest university town in China. Methods: A cross-sectional online survey was conducted among unvaccinated female and male freshmen attending seven universities in Songjiang University Town, Shanghai, during 2024–2025. The questionnaire collected sociodemographic characteristics, HPV and HPV-vaccine-related knowledge, awareness, and vaccine intent. Factors associated with HPV vaccine intent were determined. Results: A total of 3397 valid questionnaires were collected, including female (60.02%) and male (39.98%) university freshmen. Overall, 76.12% were aware of HPV, 80.98% were aware of the HPV vaccine, and 84.31% expressed vaccine intent, with significantly higher rates among females than males (each p < 0.001). Socioeconomics, knowledge, awareness, sexual behavior, and HPV testing history were significantly associated with vaccine intent (each p < 0.05). The most common reason for no intent was perceived low risk of HPV-related diseases (40.53%). The most expected improvement measures were regulatory confirmation of vaccine safety and effectiveness (37.71%) and healthcare professionals’ recommendations (37.71%), with no gender difference (each p > 0.05). Notably, 4.00% refused HPV vaccination, regardless of improvement measures. Additionally, most respondents preferred financial supporting policies, regardless of gender or vaccine intent (each p > 0.05). Conclusions: University freshmen showed the disparity between high awareness/intent and low knowledge. Financial considerations may influence HPV vaccination decisions. Thus, improving knowledge, particularly among males, and providing financial support may enhance HPV vaccine intent.

BACKGROUND:Varicella is a common vaccine-preventable disease in China, with frequent outbreaks in schools and communities. In late 2018, Wuxi implemented a free two-dose varicella vaccination policy. This study evaluated its epidemiological impact. RESEARCH DESIGN AND METHODS:We analyzed outbreak data from Wuxi during 2014-2024. Main outcomes included outbreaks, cases, and outbreak duration. Interrupted time series and ARIMA models were used to evaluate temporal trends. Fixed-effects regression examined the association between vaccination coverage and outbreak indicators. Spatial analysis identified clustering patterns before and after policy. RESULTS:After policy implementation (2019-2024), outbreaks decreased by about 56% and cases decreased by about 60%. Annual percent change shifted from strongly positive before the policy (APC > 140%, p < 0.05) to negative after the policy (APC < -30%, p < 0.05). Each 1% increase in two-dose coverage was associated with reductions of 0.82 outbreaks (p < 0.001), 21.67 cases (p < 0.001), and 2.55 days in duration (p < 0.05). Spatial clustering weakened over time. CONCLUSION:The free two-dose vaccination policy was associated with substantial reductions in varicella outbreaks in Wuxi. Sustaining high two-dose coverage remains important. Interpretation should consider the ecological design, lack of individual-level vaccination data, and potential COVID-19-related confounding.

Human papillomavirus (HPV) vaccine uptake remains suboptimal among adolescent girls in China. In November 2025, bivalent HPV vaccine was included in China's National Immunization Program for girls aged 13. This study examined girls' vaccination scenario and parental willingness to pay (WTP) for HPV vaccine. A cross-sectional survey was conducted among parents of girls aged 9-14 in the Yangtze River Delta, one of the socioeconomically developed regions in China, between March and August 2025. The survey investigated HPV vaccination scenarios among mothers and their daughters. Contingent valuation method was used to estimate parental WTP. A total of 4,595 parents participated. Overall, 62.6% intended to vaccinate their daughters (39.9% for themselves or their wives), and 8.1% had completed/scheduled HPV vaccination in daughters (35.5% in mothers). It remained inconsistent between mothers and daughters (Kappa = 0.38). Daughters receiving influenza vaccine, parents being informed through schools or community health centers, and greater HPV knowledge were associated with both HPV vaccine intent and uptake (each P < .05). HPV vaccine uptake in daughters was associated with parents endorsing teacher engagement (P = .004). The average WTP was CNY 2,373 for daughters; it was higher among higher-income parents and those with daughters who received influenza vaccine, but lower among parents expecting governmental funding or unwilling to vaccinate daughters (each P < .05). School-based settings are key drivers of HPV vaccine intent and uptake among girls in the Yangtze River Delta. Multi-channel communication and stakeholder engagement may enhance parental decision-making. Improving vaccine financing strategies may promote health equity as China expands HPV vaccination.

Background: Adult susceptibility to diphtheria and tetanus may increase as vaccine-induced immunity wanes, yet repeated population-based serosurveillance data in China are limited. Methods: We analyzed annual serosurveys conducted in Pudong New Area, Shanghai, China, from 2017 to 2025 among healthy adults aged 20–49 years. Diphtheria and tetanus IgG concentrations were measured by ELISA. Seroprotection was defined as antibody concentration ≥0.1 IU/mL. Antibody concentrations were further categorized as <0.01, 0.01–<0.1, 0.1–<1.0, and ≥1.0 IU/mL, and geometric mean concentrations (GMCs) were calculated. Multivariable logistic regression models were fitted to assess factors associated with non-protection, including survey year, age group, and household registration. Sensitivity analyses excluding the 2018 survey year were conducted. Results: A total of 2376 serum samples were included. Overall seroprotection was 21.46% for diphtheria and 13.80% for tetanus. The proportion protected against both antigens was 9.05%, while 73.78% showed concurrent non-protection against both antigens. The overall GMC was 0.032 IU/mL (95% CI: 0.030–0.034) for diphtheria and 0.018 IU/mL (95% CI: 0.017–0.019) for tetanus. Concentrations ≥1.0 IU/mL were uncommon for both antigens. Adults aged 40–49 years had higher odds of non-protection than those aged 20–29 years for diphtheria (OR: 2.43, 95% CI: 1.85–3.21) and tetanus (OR: 2.94, 95% CI: 2.11–4.13). Non-local residents also had higher odds of non-protection than local residents for diphtheria (OR: 1.55, 95% CI: 1.24–1.93) and tetanus (OR: 2.81, 95% CI: 2.15–3.69). Seroprotection varied across survey years, with a marked nadir in 2018. Sensitivity analyses excluding 2018 attenuated most year-specific associations, whereas age- and residence-related differences persisted. Conclusions: Healthy adults aged 20–49 years in Pudong showed low seroprotection and low GMCs against both diphtheria and tetanus, with a high proportion concurrently non-protected against both antigens. These findings highlight a persistent adult immunity gap and support further evaluation of adult booster strategies and enhanced serosurveillance.

BACKGROUND:Leptospirosis is a globally distributed zoonotic disease that remains a significant public health concern, yet integrated evidence linking human infection, animal reservoirs, and Leptospira serogroups remains limited. Pan'an County, a rural sentinel site in eastern China, provides a suitable setting for investigating leptospirosis transmission within a One Health framework. This study aimed to characterize epidemiological patterns in humans and associated animal infections, providing evidence for understanding leptospirosis transmission. METHODS:A retrospective and field-based surveillance study was conducted from 2007 to 2025. Descriptive methods were used to analyze temporal, spatial, and demographic characteristics of human leptospirosis cases. Animal surveillance was conducted across multiple host species to assess infection status and Leptospira serogroup distribution. Correlation analysis was performed to evaluate associations between rodent density, infection status, and human leptospirosis cases. RESULTS:A total of 53 human leptospirosis cases were reported, with a marked peak in 2007 and no fatalities. Cases were concentrated in late summer and primarily affected middle-aged farmers, with no significant spatial clustering observed. Animal surveillance identified 5630 samples with an overall positivity rate of 2.58%. Infections were detected in rodents, frogs, and ducks, while pigs and cattle were negative. Rodents and frogs were exclusively associated with Icterohaemorrhagiae, whereas ducks exhibited multiple serogroups. Rodent density was positively correlated with human cases, while no association was observed between infection positivity rates and human incidence. CONCLUSION:Leptospirosis in Pan'an is characterized by a stable Icterohaemorrhagiae-dominated transmission system primarily maintained by rodent reservoirs, with human infection occurring through occupational and environmental exposure in agricultural settings. Aquatic-associated animals such as frogs and ducks likely function as environmental interface hosts within a One Health transmission framework. These findings suggest a rodent-associated transmission cycle and support the value of integrated human-animal-environment surveillance for leptospirosis control in rural endemic regions.

Background Rodent-borne pathogens pose important global health risks, yet national-scale assessments linking host-pathogen ecology with disease dynamics remain limited, particularly in China. Methods We compiled global (>29,000 records) and China-specific (2235 records; 1950–2023) rodent-pathogen datasets to characterize host-pathogen networks, identify hyperreservoirs, and quantify prevalence heterogeneity using hierarchical meta-regression. We applied a two-layer framework integrating 1-km host suitability surfaces (stacking ensemble of boosted regression trees and random forest models) with province-level disease inference using generalized linear models for hemorrhagic fever with renal syndrome (HFRS), leptospirosis, and plague. Human exposure was estimated by overlaying suitability with gridded population data. Results Globally, 116 pathogens of concern were identified across 206 host species, including 30 spillover-risk viruses and 34 hyperreservoirs. Meta-regression identified sample source as the only consistently robust moderator of prevalence heterogeneity; other moderators (e.g., rodent family, region, and habitat type) showed inconsistent or non-robust associations. Host suitability was positively associated with HFRS incidence (incidence rate ratio = 1.36, P < 0.01) but negatively or not significantly associated with leptospirosis and plague. In China, the three diseases showed contrasting suitability patterns, with approximately 404 million people (29.3%) residing in areas with high suitability for at least one disease. Conclusions Our analysis elucidates disease-specific ecological drivers and identifies spatial priorities to inform targeted One Health surveillance and integrated interventions.

Background: Parents serve as the primary decision-makers for childhood vaccination while also making decisions regarding their own vaccination, yet vaccination decision drivers are typically studied separately by vaccine type or target population. Methods: This study investigated parental decision-making processes for two self-paid and non-National Immunization Program vaccines in China, childhood rotavirus vaccine and adult influenza vaccine, by utilizing a structured survey grounded in the World Health Organization Behavioral and Social Drivers of Vaccination framework. Spearman’s rank correlation coefficients were used to assess the consistency of parental attitudes toward the two vaccines across behavioral and social driver domains. Structural equation models were conducted separately for childhood and adult vaccines to examine decision-making pathways. Results: The findings indicated that parental drivers related to awareness, social processes, and practical issues showed a high consistency across adult and childhood vaccination decisions (r > 0.7), whereas the consistency in vaccination behaviors remained low (r = 0.21). Compared with adult vaccination, childhood vaccination decisions were more strongly influenced by vaccine safety concerns and healthcare practitioners’ recommendations, which emerged as key drivers. Furthermore, family norms emerged as an effectively shared driver of vaccination decisions for both adult and childhood vaccines (adult: β = 0.784; childhood: β = 0.970). Conclusions: By jointly synthesizing adult and childhood vaccination decisions from a parental perspective, this study provides crucial evidence to support the development of integrated, family-centered strategies to improve vaccine uptake.

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

In China, human papillomavirus (HPV) vaccination for girls has been included in the National Immunization Program (NIP), providing free 2-valent HPV vaccine (2vHPV) for 13-year-old girls. This study assessed the public health impact and cost-effectiveness of routine 2vHPV/9vHPV for girls aged 13 years, with/without a catch-up strategy for females aged ≤ 26 years, in six cities with free 2vHPV programs but differing socioeconomic development across China (Wuxi, Suzhou, Guangzhou, Yuxi, Chengdu, and Shijiazhuang). A discrete-time Markov model was developed from the healthcare system perspective over a 100-year horizon. Routine (aged 13 years) and catch-up (aged ≤ 26 years) vaccination coverages were assumed at 90

Background:SFTS is a tick-borne infectious disease with a high case fatality ratio with geographic expansion. While there have been some studies exploring the link between environmental and climatic factors on SFTS, we further test a hypothesis that social factors may play a role in the increasing burden. Methods:Using data from Zhejiang Province, China (2011-2023), we estimated the effects of environmental, climatic, and social factors on SFTS incidence using a Bayesian negative binomial regression model. Rigorous model selection processes, including variations of functional formats among independent variables and model validation, were followed. Influences of each covariate were assessed using block cross-validation experiments. We predicted the implications of the associations derived until 2028 based on climate projections. Findings:Environmental, climatic, and social factors were all selected in the final model. Higher risk areas included mountainous and cropland regions, with moderate temperatures, high precipitation, and longer sunlight exposure. Urbanization is negatively associated with SFTS risks, while human mobility is positively associated with SFTS risks. Spatial random effects do not significantly improve model performance after including human mobility measures and were thus excluded from the final model. By 2028, we are expecting a 23% increase in SFTS incidence; 9% more counties are likely going to report their first case. An SFTS season is expected to expand from March to October to year-round. Conclusions:This study provides a comprehensive investigation of the associations between environmental, climatic, and social factors and SFTS risks using a data-driven approach. Our findings underscore the growing role of social dynamics, particularly mobility, in shaping SFTS risk. SFTS in Zhejiang is expected to spread wider and last longer, calling for timely adaptation of public health strategies.

Dengue, a mosquito-borne tropical disease caused by the dengue virus, has seen a significant increase in global incidence in recent decades. China has experienced a rapid rise in dengue cases since 2013, posing a serious threat to population health and increasing economic burden. This study aimed to evaluate the knowledge of, and attitudes toward, dengue fever and dengue vaccination among healthcare practitioners in China. A cross-sectional study was conducted using an online questionnaire survey targeting medical professionals in Zhejiang, Yunnan, and Hainan provinces, which are endemic areas for dengue virus infection in China. The questionnaire assessed participants' understanding of dengue virus transmission, high-risk groups, symptoms, and knowledge of and attitudes toward dengue vaccines. Results showed that 98.6% of participants reported having prior knowledge of dengue virus. Knowledge of at-risk populations was strongly associated with actual dengue knowledge and vaccine attitudes, which may drive vaccine acceptance. Most respondents (71.0%) held neutral attitudes toward dengue vaccination, followed by 20.8% who held positive attitudes and 8.2% who held negative attitudes. Individuals with neutral attitudes were the most critical in determining vaccine acceptance. Among those who accepted vaccination, 56.1% held neutral attitudes, and among those who refused vaccination, 84.3% held neutral attitudes. Whilst most respondents (87.6%) reported that they would vaccinate susceptible populations against dengue, only 7.5% were aware that approved dengue vaccines exist. This study provides valuable insights into current knowledge of, and attitudes toward, dengue fever and vaccination among healthcare practitioners in China. Associations between specific knowledge domains, vaccine attitudes, and vaccine acceptance highlight directions for educational campaigns and vaccine promotion.

Background: In China, the human papillomavirus (HPV) vaccine has not yet been included in the national immunization program (NIP). Nevertheless, several provinces and municipalities have launched pilot HPV vaccination programs targeting female adolescents in secondary schools since 2021. This study aimed to explore the roles of key stakeholders in the decision-making process regarding HPV vaccination and to provide recommendations for future promotional strategies. Methods: Semi-structured interviews were conducted with stakeholders from Shanghai, Jiangsu, Zhejiang, and Anhui, including public health professionals, school teachers, and parents of adolescent girls. The interview framework comprised both fixed-choice and open-ended questions. Key topics addressed included: (1) the support for prioritizing HPV vaccination within NIP, (2) the influence of stakeholders on vaccination decisions, and (3) suggestions for enhancing vaccination promotion. Results: Eighty-three people participated in the study. Only 30 % of respondents believed HPV vaccination should be prioritized in the NIP, citing concerns about public perception, cultural values, and financial feasibility. Health and class teachers were found to have a substantial impact on the vaccination choices of parents and their daughters. To boost vaccination uptake, a comprehensive approach that includes stakeholder collaboration, educational campaigns, digital technology, and improved access to immunization services was proposed. Conclusion: This research provides valuable insights into the decision-making processes surrounding HPV vaccination and advocacy efforts aimed at girls aged 9-14 years. The findings serve as important references for future initiatives aimed at promoting awareness and uptake of the vaccine.

In 2024 herpangina surveillance in Yuhuan City, China, two Coxsackievirus B4 strains (Z168, Z296) were identified. Full-length genome sequencing revealed that both strains belonged to genotype D that was first documented in eastern China. The two strains showed the highest nucleotide similarity to Coxsackievirus B4 strains isolated in the UK (2017). In the recombination events, both major parental strains were identified as Coxsackievirus B4 strains isolated in France (2015 and 2017). Echovirus 11 and Coxsackievirus B5 were detected as minor parental strains, indicating intertypic recombination. Phylogenetically, Z168 and Z296 clustered closely with European genotype D strains (2013-2024) but were distant from previously reported Chinese genotype D strains (Yunnan 2013-2016; Tianjin 2019). Bayesian phylogeographic reconstruction suggested a complex global transmission history of Coxsackievirus B4 with increasing cross-border transmission in recent decades, including genotypes A, D and E transmitting among North America, Europe and Asia. Both strains possessed a unique amino acid substitution within a putative neutralizing epitope, suggesting potential antigenic evolution. These findings indicate that the Z168 and Z296 strains likely represent a recent European introduction, forming a lineage distinct from earlier Chinese genotype D isolates. This highlights the need for molecular surveillance to track Coxsackievirus B4 emergence and evolution.

BackgroundRespiratory tract infections are common infectious diseases, with microbial dysbiosis closely linked to clinical outcomes in the host. As key regulators of bacteria, phages can influence the structure and stability of microbial communities by infecting host bacteria. Metagenomic next-generation sequencing (mNGS) enables comprehensive analysis of phage community characteristics in clinical samples.MethodsThis study included 6,404 clinical samples, comprising 4,837 bronchoalveolar lavage fluids (BALF) and 1,567 sputum samples, for metagenomic next-generation sequencing (mNGS), while collecting patient demographics, sample types, mNGS results, and clinical outcomes. Host-derived sequences were removed post-sequencing and aligned against viral reference databases. Phage community structures across sample types were assessed using alpha and beta diversity metrics. Spearman correlation analysis explored associations between phages and bacteria. Further bioinformatics analysis was performed on 194 samples, including viral sequence assembly and identification using SPAdes, VirSorter2, and PhaMer; CD-HIT clustering and redundancy removal; CheckV quality assessment; PhaTYP lifestyle prediction; Prodigal protein gene annotation; and BLASTP alignment against the CARD database to screen for phage resistance genes.ResultsThe sputum and BALF groups exhibited comparable richness, diversity, and evenness, yet their community structures differed significantly. Intensive Care Unit (ICU) admission status was closely associated with reduced phage community diversity and significant alterations in community structure, and the abundance distribution of several phage families (Peduoviridae, Autoscriptoviridae, Casjensviridae, Demerecviridae) also changed significantly. Additionally, the phage community structure in sputum samples was significantly associated with patient clinical outcomes. Correlation analysis demonstrated that the Aliceevansviridae family in sputum samples had extensive positive associations with various bacteria. After assembly, 69.5% of pOTUs were predicted to be temperate phages, and 28.9% were predicted to be virulent phages; moreover, the vast majority (99.2%) of phage sequences showed low similarity to antibiotic resistance genes.ConclusionThis study identifies distinct phage community characteristics across respiratory sample types and reveals that ICU patients exhibit reduced phage diversity and markedly altered community structures. Furthermore, the phage composition in upper respiratory tract samples shows a clear relationship with patient prognosis, providing new insights into respiratory infection microecology.

BACKGROUND:Meningococcal serogroup distribution evolves globally. In China, meningococcal polysaccharide vaccine (MPSV)-A is included in the National Expanded Program on Immunization (EPI) for infants at 6 months of age, while meningococcal polysaccharide conjugate vaccines (MPCV)-AC/ACYW are classified as non-EPI (self-paid) vaccines administered starting at 3 months of age. This study aimed to investigate the knowledge, perception, and practice of meningococcal vaccines among healthcare practitioners (HCPs) at points of vaccination (POVs) and caregivers of infants aged 3-7 months. METHODS:A cross-sectional survey was conducted between January 2023 and December 2024 across 29 provinces in China. A total of 5069 HCPs at POVs and 148,269 caregivers of infants aged 3-7 months were enrolled. Structured questionnaires were distributed to collect data on vaccine knowledge, perception, preferences, and vaccination practice. FINDINGS:Most HCPs (91·9 %) acknowledged the substantial burden of meningococcal disease. However, 99·4 % of HCPs reported uncertainty in meningococcal disease prevention, primarily due to insufficient public awareness (85·3 %). When selecting self-paid meningococcal vaccines, HCPs prioritized protective efficacy (73·1 %) and serogroup coverage (70·5 %), aligning with the priorities of caregivers choosing MPCV-ACYW (78·2 %). Conversely, caregivers choosing MPSV-A or MPCV-AC prioritized safety (42·2 % and 50·6 %, respectively) and cost-effectiveness (52·6 % and 42·7 %, respectively). Moreover, caregivers reported infants receiving the MPCV-ACYW experienced milder irritability and crying, and exhibited better overall safety and tolerability, compared to MPCV-AC (each p < 0·001). Additionally, 35·4 % of infants received simultaneous administration of their first-dose meningococcal vaccine and other vaccines. Simultaneous administration patterns of meningococcal vaccines and other vaccines differed by age and vaccine type. INTERPRETATION:This study is the first to systematically determine the perceptions and practices of meningococcal vaccination from both HCPs and caregivers across provinces in China. Most HCPs acknowledged the necessity of early meningococcal vaccination and MPCV-ACYW effectiveness. The findings indicate a need to strengthen public awareness of meningococcal disease, implement tailored health advocacy, and promote multivalent meningococcal vaccines.

Hepatitis E virus (HEV) is endemic in China, with swine as the most common reservoir. It poses a zoonotic public health risk to swine workers. This study evaluated the cost-effectiveness of hepatitis E vaccination for this high-risk group in China. A decision tree-Markov model was utilized to evaluate the cost-effectiveness of two hepatitis E vaccination strategies, without or following screening, for swine workers aged 16-60 in China from societal perspectives, compared to no vaccination. We calculated HEV-related cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of GDP per capita. A sensitivity analysis was conducted. Additionally, we stimulated the scenarios of fully receiving 3-dose schedule, partially receiving 3-dose schedule, and fully receiving 2-dose schedule. Both hepatitis E vaccination strategies significantly reduced HEV-related cases and deaths compared to no vaccination. ICERs were estimated to be USD 11,428.16 and 9830.71/QALY averted for vaccination without and following screening, respectively, both lower than GDP per capita (USD 12,325.24, 2023). Furthermore, one-way sensitivity analysis identified the discount rate, utility in asymptomatic cases, and probability of symptomatic infection as crucial factors affecting ICER. Probabilistic sensitivity analysis (PSA) showed a 47.5% cost-effectiveness probability for hepatitis E vaccination following screening, compared to 52.5% for no vaccination. Notably, vaccination following screening was cost-ineffective after age 40 and at a price of USD 138.0/dose. Additionally, fully receiving 2-dose and partially 3-dose schedules were cost-effective, regardless of hepatitis E vaccination without or following screening strategies, while fully receiving 3-dose schedule was cost-ineffective with the vaccination without screening strategy. Hepatitis E vaccination following screening would be optimal for swine workers in China. Vaccination starting at an earlier age and lower vaccine prices can improve the cost-effectiveness. Additionally, 2-dose schedule may be recommended during a hepatitis E outbreak to achieve cost-effectiveness.

Background:Since varicella is already known to be a globally distributed disease, the focus should be more on its transmissibility or disease burden. The incidence of varicella is affected by natural and socio-economic factors. However, it is unclear how these factors synergetically impact the dynamics of varicella transmission and control. Methods:We conducted a retrospective analysis of varicella cases in children aged 0-17 years from 2013 to 2022 in Jiading District, Shanghai, China. First, we evaluated demographic characteristics, epidemiological trends of varicella. And then, we explored the impact of two-dose varicella vaccine (VarV) program on varicella incidence using interrupted time-series analyses, and assessed the influence of natural and socio-economic factors using principal component analysis and multivariate regression. Spatial analysis was conducted to compare varicella epidemiology. Results:Our analysis includes 6,482 reported varicella cases, with a higher incidence observed among males (58.67%). Regional differences were noted, with the highest incidence in the western region and the lowest in the central region. Before the implementation of the two-dose VarV program, varicella incidence increased by 0.28 cases per 100,000 per month. Following the two-dose VarV program's introduction, the incidence rate decreased by 0.49 cases per 100,000 per month, with an impressive 79.10% reduction in the annual average incidence among children aged 4-6 years. By analyzing the impact of demographic characteristics, healthcare capacity, economic level, air pollutants, and meteorological factors on the incidence of varicella, we found that the child population ratio and VarV program were most strongly associated with varicella incidence. Conclusion:The study underscores the importance of sustained monitoring of child population ratio and VarV program to reduce varicella transmission and protect vulnerable groups.

Human papillomavirus (HPV) causes multiple diseases in both sexes. This study evaluates the cost-effectiveness and epidemiological impact - defined as reductions in HPV-related disease cases - of a gender-neutral vaccination (GNV) strategy in China's economically developed metropolises: Beijing, Shanghai, and Guangzhou. A discrete-time Markov model simulated no vaccination, female-only vaccination (FOV), and GNV strategies among 12-year-olds. The cost matrix included vaccine procurement, administration, and treatment costs from Chinese data and literature. The case matrix translated model-estimated reductions in HPV infections into decreases in disease incidence by applying baseline incidence rates adjusted for HPV genotype attribution, relative risk reductions, and disease-specific lag times. Outcomes assessed were costs (2023 USD), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and cases averted. Compared to FOV, the ICERs for GNV were USD 323,134/QALY (Beijing), USD 305,816/QALY (Shanghai), and USD 251,853/QALY (Guangzhou), exceeding local willingness-to-pay thresholds, indicating cost-ineffectiveness. The GNV strategy averted 3.9%, 4.7%, and 3.9% more HPV-related cases over 30 years in Beijing, Shanghai, and Guangzhou, respectively. Sensitivity analyses showed that GNV became cost-effective when the 9vHPV uptake rate was below 20% in girls (Shanghai) or below 10% in girls (Beijing and Guangzhou), regardless of the uptake rate (≤80%) in boys. It was also cost-effective if vaccine price dropped to USD 21.4 (Shanghai), USD 18.9 (Beijing), or USD 19.1 (Guangzhou). Price thresholds rose substantially with decreasing female uptake but changed little with male uptake variation. The GNV strategy may be cost-effective when the 9vHPV uptake rate remains low in girls or the vaccine price significantly decreases.

Porcine reproductive and respiratory syndrome virus (PRRSV) has imposed significant economic burdens on the global swine industry. The majority of PRRSV strains can induce high fever at various stages of pig development. However, the PRRSV strain that triggers the biphasic temperature phenomenon remains relatively rare. In this study, a novel PRRSV variant, designated SJ0107, was isolated from local pig farms in Tianjin, Northern China, in 2024. Recombination analysis reveals that SJ0107 is a recombinant PRRSV strain resulting from the interaction between lineage 1.8 and lineage 8.3, with four potential recombination breakpoints located in Nsp2 (nt 766/1997), Nsp4 (nt 5413), and Nsp9 (nt 7750). Animal challenge experiments conducted on four-week-old piglets demonstrated that SJ0107 can induce rare initial hypothermia symptoms within 5 days post-inoculation (dpi). Subsequently, the body temperature returned to normal, and high-grade fever symptoms emerged at 11 dpi, lasting for one week before normalizing again. Meanwhile, severe histopathological lung lesions were also detected in the pathological sections. In conclusion, the findings reveal that the SJ0107 strain undergoes a dual-phase temperature alteration, which not only complicates traditional diagnostic criteria reliant on persistent fever but also heightens the risk of misdiagnosis in the initial phases of infection. These insights underscore the necessity of revising surveillance protocols for emerging PRRSV variants that exhibit atypical pathogenic characteristics.