ObjectiveThis study aimed to evaluate the impact of nonpharmaceutical interventions (NPIs) taken to combat COVID-19 on the prevalence of respiratory viruses (RVs) of acute respiratory infections (ARIs) in Shanghai.MethodsSamples from ARI patients were collected and screened for 17 respiratory viral pathogens using TagMan low density microfluidic chip technology in Shanghai from January 2019 to December 2020. Pathogen data were analyzed to assess changes in acute respiratory infections between 2019 and 2020.ResultsA total of 2,744 patients were enrolled, including 1,710 and 1,034 in 2019 and 2020, respectively. The total detection rate of RVs decreased by 149.74% in 2020. However, detection rates for human respiratory syncytial virus B (RSVB), human coronavirus 229E (HCoV229E), human coronavirus NL63 (HCoVNL63), and human parainfluenza virus 3 (HPIV3) increased by 91.89, 58.33, 44.68 and 24.29%, in 2020. The increased positive rates of RSVB, HPIV3, resulted in more outpatients in 2020 than in 2019. IFV detection rates declined dramatically across gender, age groups, and seasons in 2020.ConclusionNPIs taken to eliminate COVID-19 had an impact on the prevalence of respiratory viral pathogens, especially the IFVs in the early phases of the pandemic. Partial respiratory viruses resurged with the lifting of NPIs, leading to an increase in ARIs infection.

ObjectiveTo investigate the impact of acute respiratory infections in children under 12 years old in Pudong New Area， Shanghai from 2019 to 2023.MethodsAcute respiratory infection samples of children under 12 years old from three sentinel hospitals in Pudong New Area， Shanghai from 2019 to 2023 were collected， and 42 respiratory infection pathogens， including influenza virus， adenovirus， parainfluenza virus， respiratory syncytial virus， human enterovirus/rhinovirus， human pulmonary virus， human bokavirus， coronavirus （229E， HKU1， NL63 and OC43）， and novel coronavirus， were detected with microfluidic chips. The situation of acute respiratory infections among outpatient and inpatient children in this area was analyzed for the before the implementation of non pharmacological intervention measures （2019.12‒2020.1）， during the period of non pharmacological intervention measures （2020.2‒2022.12）， and after non pharmacological intervention measures （2023.1‒2023.6）.ResultsFrom 2019 to 2023， a total of 1 770 samples were collected， and 445 pathogens were detected， with a detection rate of 25.14% （445/1 770）. The main pathogens detected during the study period were influenza virus： 8.70% （154/1 770）， respiratory syncytial virus： 4.41% （78/1 770）， human enterovirus/rhinovirus： 2.66% （47/1 770）， human adenovirus： 2.49% （44/1 770）， and parainfluenza virus： 2.20% （39/1 770）. Before the implementation of non pharmacological intervention measures， outpatients were primarily infected with influenza， parainfluenza virus， and respiratory syncytial virus， with detection rates of 8.09%， 4.49%， and 4.04%， respectively； inpatients were mainly infected with influenza， respiratory syncytial virus， and parainfluenza virus， with detection rates of 4.49%， 3.82%， and 3.15%， respectively. During the period of non pharmacological intervention measures， influenza， rhinovirus and respiratory syncytial virus were the main viruses detected in the samples of outpatient children， with detection rates of 4.04%， 3.60%， and 2.47%， respectively； inpatient samples mainly detected respiratory syncytial virus， rhinovirus， and influenza virus， with detection rates of 3.60%， 2.02%， and 1.80%， respectively. After non pharmacological intervention measures， influenza， rhinovirus and respiratory syncytial virus were the main pathogens detected in the outpatients， with detection rates of 9.89%， 2.92% and 2.02%， respectively； influenza， respiratory syncytial virus， and rhinovirus were the main pathogens detected in inpatient children， with detection rates of 6.29%， 1.57%， and 1.35%， respectively.ConclusionThe prevalence of pathogens related to acute respiratory infections in children is influenced by non pharmacological preventive measures.

ObjectiveTo analyze the epidemic characteristics of measles and rubella in Pudong New Area of Shanghai from 2013 to 2022， and to provide data support for the elimination of measles and rubella.MethodsEnzyme linked immunosorbent assay was used to detect IgM antibodies in serum samples. The sequence of 630 nucleotides at the C-terminal of N gene of measles virus was amplified by reverse transcription-polymerase chain reaction and the phylogenic tree was constructed.ResultsA total of 1 529 suspected cases of measles were detected from 2013 to 2022， among which the positive rate of measles IgM antibody was 33.55% （513/1 529）. The highest positive rate （20.73%） was from March to May ， and the positive rate of rubella IgM antibody was 6.80% （104/1 529）. The positive rate of both IgM was higher in males than that in females （P<0.05）. The IgM against measles was mainly detected in 0‒ years old （63.16%， 96/152） and 20‒ years old （45.61%， 161/353）. The IgM against rubella was mainly detected in 10‒20 years old （27.27%， 18/66）. The IgM antibody could be detected more easily from 4 to 28 days after eruption， and the IgM antibody positive rate of measles/rubella from 2020 to 2022 was significantly lower than previous years （2013‒2019）. There were 2 D8 genotype strains， and the rest were H1a gene subtypes.ConclusionThe positive rate of IgM antibodies against measles/rubella in Pudong New Area of Shanghai decreased significantly. People aged 0‒ years and 20‒ years old are more susceptible to measles， and rubella is concentrated in 10‒ years old. It is necessary to strengthen the vaccination of school-age children， in order to achieve the goal of eliminating measles. The age group with high risk of exposure should be checked for vaccination status to ensure the enhanced immunization， and the surveillance of imported measles cases should be strengthened.

目的 对上海市浦东新区一起食物中毒事件进行病原检测和溯源分析,为此类事件的处置和判定提供依据.方法 对病例和从业人员肛拭子以及留样食品样品进行病原分离和鉴定;对分离株进行肠毒素检测、药物敏感性试验、脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)分子分型和溯源.结果 从9份病例肛拭子、1份从业人员肛拭子及3份留样食品样品中分离到13株金黄色葡萄球菌.10株人源分离株产A型和E型肠毒素,3株食源分离株产A型、D型和E型肠毒素.13株分离株均对青霉素耐药,PFGE条带相似度为100％,MLST分型均为ST6型.结论 本起事件是由金黄色葡萄球菌污染引起的食物中毒事件,需要进一步加强对食品加工企业、食堂等的宣传教育和管理,防止类似事件的发生.

ObjectiveTo understand the serotype distribution and drug resistance of salmonella contaminated in commercially available food.MethodsSalmonella detection， including the serotypes， was conducted in food products sold in Pudong New Area from 2020 to 2022. The antimicrobial susceptibility test of 15 antibiotics was conducted by the broth microassay.ResultsA total of 118 salmonella strains were detected in 2 497 pieces of food， with a total detection rate of 4.7%. The dominant detection categories were poultry meat， livestock meat and aquatic products. The 118 salmonella strains could be divided into 24 serotypes， Salmonella enteritidis （26.4%）， Salmonella Typhimurium （16.2%） and Salmonella delpy （14.4%） were the main dominant types. Salmonella had the highest resistance rate to ampicillin （63.6%）， followed by tetracycline， chloramphenicol， cotrimoxazole and nalidixic acid. Among the three dominant serotypes， the multidrug resistance rate of Salmonella typhimurium was the highest （89.5%）， followed by Salmonella delpy （70.6%） and Salmonella enteritidis （61.3%）.ConclusionLivestock， poultry meat， and aquatic products are seriously contaminated by salmonella with diverse serotypes. The livestock meat is mainly contaminated by Salmonella typhimurium and Salmonella delpy， and the poultry meat is mainly contaminated by Salmonella enteritidis. The drug resistance spectrum is wide and the multi-drug resistance rate is high. Different from the livestock and aquatic isolates， poultry meat-derived strains have high tolerance to ampicillin， nalidixic acid and polymyxin， and carry certain potential food safety risks.

Objectives To evaluate the efficiency of detecting six virulence genes of enteroaggregative Escherichia coli(E.coli),abbreviated to EAEC,for diagnosis of EAEC infection among diarrhea patients.Methods Isolation and identification of E.coli strains were conducted for fecal samples collected from 2 366 diarrhea patients during January 2015 to December 2019 at 12 medical facilities in Pudong New Area of Shanghai municipality.The detection of six virulence genes(aggR,astA,pic,aaiA,aatA,and aaiG)of EAEC and HEp-2 cell adhesion test-the gold standard assay of EAEC were performed on the isolated E.coli strains.The EAEC positivity is determined according to following five positive result combinations of the six virulence genes detection:(1st)both uidA and aggR;(2nd)uidA and any one of aggR/astA/pic;(3rd)uidA and any one of aggR/aatA/aaiG/aaiA;(4th)uidA and any one of aggR/astA/aaiA;and(5th)uidA and any one of aggR/astA/pic/aaiA/aatA/aaiG.Taking the result of HEp-2 cell adhesion test as the gold standard assay,the sensitivity and specificity of the detections of the six virulence genes and their combinations were evaluated using Kappa value,and area under receiver operation curve(AUC).Results For a total of 1 390 E.coli strains isolated from all the samples,266(19.14％)were of AA adhesion phenotype and the positivity rate of astA(21.87％,n=304)was the highest among the six virulence genes detected.According to the standard of HEp-2 cell adhesion test,the detected rate(number)of EAEC positive among the samples from the 2 366 diarrhea patients were 11.24％(266),2.37％(56),14.84％(351),9.68％(229),5.26％(361)and 16.48％(390/2 366)based on the results of the 1st,2nd,3rd,4th,and 5th combination of the six virulence genes detections,respectively,with the highest specificity of 99.86％(2 097/2 100)and the lowest sensitivity of 19.92％(53/266)for the detection of the 1st combination of the six virulence genes.Moderate consistency was observed between the detection results of the standard assay and the 3rd/4th/5th combination of the six virulence genes detection,with the range of Kappa values of 0.58-0.65 and the AUC was from 0.806 to 0.882 for the 2nd/3rd/4th/5th combination of the six virulence genes detection,indicating a high efficiency of the detections for the diagnosis of EAEC infection in diarrhea patients.Conclusion The results of the study suggest that the detection of the six EAEC virulence genes could not substitute HEp-2 cell adhesion test for diagnosing EAEC infection among diarrhea patients.

目的 研究小柴胡汤含药血清对流感病毒A(H1N1)pdm09、H3N2、BV、BY 4种亚型株感染狗肾细胞(MDCK)的抗病毒作用.方法 采用噻唑蓝(MTT)法结合细胞病变效应(CPE)法,以磷酸奥司他韦作为对照药物,观察不同质量浓度小柴胡汤含药血清对流感病毒A(H1N1)pdm09、H3N2、BV、BY 4种亚型株感染MDCK的抗病毒作用,计算细胞存活率、病毒抑制率、半数毒性浓度(TC50)和半数有效浓度(EC50),并以治疗指数(TI)作为评价指标.结果 小柴胡汤含药血清对MDCK的TC50为3 533.59μg/mL.对流感病毒A(H1N1)pdm09、H3N2、BV、BY 4 种亚型株感染 MDCK 的 EC50 分别为 288.12、173.90、1 037.85、1 107.27 μg/mL,其 TI 分别为 12.26、20.32、3.40、3.19.结论 小柴胡汤含药血清对流感病毒A(H1N1)pdm09、H3N2、BV、BY 4种亚型株感染MDCK均有抑制作用.

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by 2019 novel Coronavirus (2019-nCoV). At present, the most used method to diagnose 2019-nCoV is nucleic acid test. Suspected cases underwent real-time fluorescent RT-PCR examination, and those who were 2019-nCoV nucleic acid positive were confirmed cases. However, in the process of nucleic acid test, factors such as specimen quality, specimen transportation and storage conditions, detection reagents and methods may cause false negative or false positive results. This article reviews the factors that may affect the results of 2019-nCoV nucleic acid test, and provides a basis for the diagnosis of suspected COVID-19 cases.

ObjectiveAn epidemiological investigation and analysis of a food poisoning incident at a school in Pudong New Area was conducted to identify the pathogenic factors, pathogenic food and the source of contamination, and to taken effective control measures and provided reference for the disposal of similar incidents in future.MethodsA descriptive epidemiological method was used to analyze the epidemiological characteristics of the incident; a case-control study was used to analyze the suspicious food; interview and on-the-spot investigation were used to conduct food hygiene investigation to understand the process of food production, transportation, storage and raw material sources; samples of anal swabs, food, processing links and drinking water were collected for laboratory testing.ResultsFifty-one suspected cases were found, and the clinical manifestations were mainly diarrhea, fever, abdominal pain, headache, nausea and vomiting. The incubation period of onset ranged from 2.5 to 5.1 h, with a median of 20 h. The case-control analysis found that the sandwich at breakfast on September 4th, 2018 was the suspect high-risk food. Salmonella was detected in the samples of anal swab from 7 cases. Molecular typing analysis of the positive strains of Salmonella by pulsed field gel electrophoresis indicated that they were from the same source of infection, and there was a situation of simultaneous infection of multiple types of Salmonella.ConclusionThis was an incident of food poisoning caused by Salmonella, and the suspect food was sandwich. It is suggested that school catering units should strengthen the examination of food supply, strictly implement the sample retention system and implement various food safety measures.

目的 了解2012-2019年上海市浦东新区常见呼吸道感染冠状病毒(HCoV)的分子流行特征.方法 2012年1月-2019年12月,对区内11家医疗机构采集的呼吸道样本使用多重PCR方法检测冠状病毒及其他7种呼吸道病毒,并分析其流行病学特点.结果 2012-2019年,共采集9 872例呼吸道样本,检出呼吸道病毒阳性标本4 000例(40.52％),流感病毒(17.27％,1 705/9 872)、鼻病毒(5.69％,562/9 872)和副流感病毒(4.18％,413/9 872)是检出的主要呼吸道病毒.冠状病毒共检出406例(4.11％,406/9 872),4种冠状病毒的构成比分别为32.76％(OC43,133/406)、33.00％(NL63,134/406)、27.34％(229E,111/406)和 6.40％(HKU1,26/406).冠状病毒感染以＜10及≥50岁人群为主.冠状病毒检出率随人口密集程度呈沿江、中部和沿海3个片区依次递减的趋势.冠状病毒呈低全年散发状态,春夏出现流行高峰,气温与HCoV的流行呈弱相关(r=0.21,P＜0.05).结论 冠状病毒是上海市浦东新区发热呼吸道感染人群中主要病毒性病原,应强化重点人群的防控知识宣传教育,减少人群聚集,避免因冠状病毒引起的聚集性疫情发生.

目的 了解2017年-2019年上海市浦东新区单核细胞增生李斯特菌(Listeriamonocytogenes,LM)的分子流行特征.方法 监测上海市浦东新区的生禽肉、生畜肉、畜内脏、熟肉制品、即食食品和蔬菜水果类,按照GB 4789.30-2016对单核细胞增生李斯特菌进行分离、鉴定,并分析血清型、耐药性、毒力基因型、MLST分子型别.结果 浦东新区市售食品中单核细胞增生李斯特菌的检出率为5.29％(81/1531),血清型以1/2a(51.85％)为主.98.76％(80/81)的菌株携带多种毒力基因.分离株对四环素耐药率最高(16.05％),共归属于15种同源复合体,归属ST9同源复合体菌株最多(33.3％).结论 2017年-2019年监测的上海市浦东新区6类市售食品中,单核细胞增生李斯特菌污染比较严重,优势血清型为1/2a,对四环素耐药率最高,多数为产毒株,MLST分型以ST9(1/2c)为主,临床上常见的ST3、ST8、ST87、ST121型菌株均有检出,应加强监测与管理,以防食源性疾病的产生.

目的 了解2015-2016年上海市浦东新区病毒性腹泻感染中腺病毒感染的分子流行病学特征.方法 采集浦东新区14家二、三级医疗机构肠道门诊中的腹泻患者粪便标本和信息,通过实时荧光聚合酶链式反应(real-time PCR)方法对样本中的腺病毒等5种腹泻类病毒进行初筛;对腺病毒初筛阳性标本,通过人喉癌上皮细胞(Hep-2细胞系)分离腺病毒毒株;通过PCR,扩增腺病毒六邻体蛋白(Hexon蛋白)部分片段并测序,测序结果使用BioEdit软件进行整理,MEGA软件构建腺病毒系统进化树,BEAST软件对腺病毒核苷酸替换率进行分析.结果 2015-2016年,浦东新区疾病预防控制中心共采集腹泻病例样本4 089份,在1 595份腹泻病毒初筛阳性样本中,有腺病毒阳性146份,腺病毒的检出率为3.57％(146/4089),腺病毒在腹泻病毒中的构成比为9.15％(146/1 595).腺病毒感染的男女比为1.56:1,0～9岁是所有年龄组中最易感染腺病毒腹泻的年龄组.腺病毒感染没有明显的季节分布.分离到的58株毒株共有11个腺病毒血清型,以腺病毒41型(22株)和3型(18株)血清型为主.腺病毒的核苷酸变异率为3.53×10-6核苷酸替换/位点/年.结论 腺病毒41和3型是本地区腺病毒腹泻的主要病毒基因型,存在腺病毒核苷酸替换,需要加强腺病毒感染腹泻的研究与防控,避免因腺病毒感染导致的聚集性疫情的发生.

目的 了解在上海市浦东新区引起急性出血性结膜炎的腺病毒分子流行病学特征.方法 采集急性出血性结膜炎病例的眼分泌物标本,用实时荧光PCR法检测肠道病毒70型、柯萨奇病毒A组24型变种以及腺病毒核酸.通过Hep-2细胞分离腺病毒毒株,扩增毒株的Hexon基因,测序并分析.结果 2014-2016年,共采集和检测333份样本,有68份样本检出病毒阳性,其中,检出柯萨奇病毒A组24型变种1份,检出率为0.30％,检出腺病毒67份,检出率为20.12％,未检出肠道病毒70型.腺病毒引起的急性出血性结膜炎感染主要集中在6～11月,感染者的年龄以20～39岁为主.分离到腺病毒毒株42株,通过对Hexon基因测序分析,核酸序列的同源性在80％～100％,7个基因型分属于腺病毒血清型的B、D和E3个血清型组.结论 腺病毒是上海市浦东新区急性出血性结膜炎的主要致病病原,需要加强对腺病毒的监测,防止因腺病毒感染所导致的急性出血性结膜炎聚集性疫情的暴发和流行.

目的 了解2013-2016年上海市浦东新区腺病毒感染的分子流行病学特征.方法 通过对区内7家医疗机构呼吸道样本使用多重PCR方法检测呼吸道病毒,对腺病毒阳性样本使用Hep-2细胞进行毒株分离,分离到的毒株通过Hexon蛋白基因进行PCR扩增和产物测序和分析.结果 2013-2016年,共检测3 446份呼吸道样本,检出呼吸道病毒阳性标本1 428份,检出率为41.44％,其中腺病毒阳性104份,检出率为3.02％.腺病毒感染的症状温和,以＜5岁婴幼儿感染为主,5-6月是感染的主要高峰期.分离到的33株腺病毒毒株以腺病毒3型和7型为主,主要集中于B、C和E3血清型上.结论 腺病毒是上海市浦东新区呼吸道感染的主要病毒之一,需要对腺病毒的变异进行进一步的检测,防止聚集性疫情的发生.

BACKGROUND:Norovirus (NoV), a member of the Caliciviridae, is now recognized as the leading cause of acute gastroenteritis (AGE) worldwide. Globally, the GII.4 Sydney_2012 variant has predominated in NoV-related AGE since 2012, although the novel variant GII.17 has also been reported as responsible for gastroenteritis outbreaks in East Asia since 2014. This study aimed to disclose the recent genotype patterns of NoV genogroup II (GII) presenting in AGE patients in Pudong New Area of Shanghai through a laboratory-based syndromic surveillance system. The study further aimed to delineate the predominant strains circulating in the population.METHODS:Pudong New Area is located in eastern Shanghai and covers 20.89% of the Shanghai population. The laboratory-based syndromic surveillance system is composed of 12 sentinel hospitals among the 68 general hospitals in this area. AGE patients who sought medical care were sampled following an AGE surveillance protocol. Stool samples were collected from participating patients, and a standardized questionnaire was given to each patient by trained nurses to gain information on the disease profiles and demographics of the patients. Real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to screen the GI nd GII NoV and RT-PCR was used to amplify NoV GII partial capsid protein open reading frame 2 (ORF2). NoV Genotyping Tool (version 1.0, RIVM, MA Bilthoven, Netherlands) was used for genotyping, and a phylogenetic analysis was conducted by MEGA 7.0.RESULTS:During 2014-2016, among the 2069 virus-infected AGE cases, 65.88% were caused by NoV. NoV-AGE occurred most frequently in the periods from October to March. The patients with more severe diarrheal symptoms and vomiting were more likely to be infected by NoV. The main genotypes were GII.17 (44.69%) and GII.4 (39.26%), which dominated the NoV-AGE epidemics jointly or in turn, whereas a slight increase in GII.2 was observed beginning in May 2016. The GII.17 strains tended to cluster more with the Hu/JP/2014/GII.P17_GII.17/Kawasaki323 variants, representing novel prevalent strains. Among the GII.4 strains, the GII.4 Sydney_2012 variant was still the predominant strain.CONCLUSIONS:NoV GII has become the main cause of virus-infected AGE in Pudong New Area, Shanghai. The predominant genotypes of NoV GII were GII.17 and GII.4. Comprehensive laboratory-based surveillance is important for clinical diagnosis and treatment. Identification of emerging new genotypes is also crucial for the prevention and control of NoV-infected AGE.

Sixty norovirus outbreaks that occurred in Pudong District, Shanghai in 2017 and affected 959 people were summarised. Of the outbreaks, 29 (48.3%), 27 (45.0%), and 4 (6.7%) occurred in kindergartens, primary schools, and middle schools, respectively. Although the total number of outbreaks peaked in March (13/60, 21.7%), outbreaks in kindergartens and primary schools peaked in April (6/29, 20.7%) and March (8/27, 29.6%), respectively. Primary schools had the highest median number of cases per outbreak (19) and the highest proportion of cases (54.6%). The male-to-female case ratio differed among school classifications, with the highest male case ratio (69.2%) occurring in middle schools. Primary symptoms also differed across the school classifications. Molecular virology analysis showed that a single viral strain caused each outbreak at each school. In turn, 50.6, 28.8, and 20.6% of cases were infected by GII.4, GII.2, and GII.17, respectively. Vomiting was seen in 98.2, 97.3, and 88.6% of the subjects infected with noroviruses GII.17, GII.4, and GII.2, respectively, and nausea in 73.6, 43.9, and 39.0%. In conclusion, noroviruses mainly affect primary school and kindergarten students. GII.4, GII.2, and GII.17 are the main epidemic strains in the local area, and the primary symptoms differed by age and genotype.

目的 了解2015-2016年上海市浦东新区禽流感病毒在涉禽场所中的阳性情况,为人禽流感防控工作提供依据.方法 采集2015-2016年上海市浦东新区规模禽类养殖场、家庭禽类养殖户和活禽交易市场活禽鸡的禽类样本(喉/泄殖腔拭子)及外环境样本(禽类粪便、物体表面擦拭样本、水体样本),运用实时荧光定量逆转录聚合酶链反应(RTPCR)方法检测禽流感病毒.结果 2015-2016年共检测标本2 820份,检出甲型流感病毒阳性530份,阳性率为18.79％.H5、H7和H9亚型均有检出,以H9为主,阳性率为10.92％.3类涉禽场所中,以活禽交易市场的禽流感病毒检出阳性率最高为37.69％,涉禽场所8种类型样本中,案板表面擦拭标本、笼具污水的阳性率高于禽喉试子、笼具表面擦拭标本、禽粪便、地表面擦拭物、禽饮用水及禽泄殖腔拭子.全年进行监测,其中1、6-7和10-12月检出阳性率高于2-5和8-9月.结论 2015-2016年浦东新区活禽交易市场、禽贩卖及屠宰环节和冬季禽流感病毒检出率较高,今后应加强监测监管,做好消毒、适时关闭活禽交易市场等防控措施,降低人禽流感发生风险.

[Objective] To carry out the analysis on molecular epidemiological characteristics of enteroviruses that cause clustered hand,foot and mouth disease in Pudong New Area of Shanghai from 2011-2016,understand the virus epidemic law of hand,foot and mouth disease,and provide laboratory basis for the prevention and control of hand,foot and mouth disease in Pudong New Area.[Methods] During 2011-2016,1 489 of cluster or outbreak cases were detected for viral nucleic acid typing by the Realtime Fluorescence Quantitative PCR,and positive samples were isolated and cultured.Then the results were compared from different aspects of gender,age and temporal distribution.DNA sequencing and phylogenetic tree were performed to analyze VP1 gene sequences.[Results] 736 of 1 489 samples were positive for enterovirus nucleic acid,including 232 (15.58％) cases of EV71,290 (19.48％) cases of CA16,100 (6.72％) cases of CA6,5 (0.34％) cases of CA10,and 109 (7.32％) unidentified cases.EV71 was the dominant pathogen in 2011,accounting for 67.42％.CA16 was the dominant pathogen in 2012,2015 and 2016,which respectively accounted for 50.40％,49.61％ and 70.00％.In 2013 and 2014,each type accounted for more than 17％ except CA10.The composition of CA6 rose rapidly from 9.30％ in 2012 to 22.48％ in 2015.The male-to-female ratio of positive cases was 1.59∶1.Most of cases were children under 5 yaers old,accounting for 84.65％.The peak season of EV71 and CA16 infection appeared April to June in summer,and that of CA6 infection emerged in September to December in winter.VP1 gene sequencing analysis results showed that all EV71 strains belonged to C4a,CA16 strains belonged to B1,and CA6 belonged to third group.[Conclusion] The epidemic of cluster hand,foot and mouth disease from 2011-2016 is mainly caused by EV71 and CA16,followed by CA6.The incidence rate in males is higher than that in females,children below 5 years old are the major population,and peak season of EV71 and CA16 infection appears April to June in summer.All of the isolates of EV71 and CA16 subtype are similar with the isolates in China,and CA6 epidemic shows a rising trend since 2012.

Objective To understand the epidemiological characteristics of norovirus detection based on the diarrhea syndromic surveillance in Pudong ,Shanghai .Methods Diarrhea syndromic surveillance program was conducted in outpatient and emergency departments of 12 sentinel hospitals during 2012 -2016 .The clinical and epidemiological data of diarrheal patients were collected .The fecal specimens were also sampled . The detections for norovirus by polymerase chain reaction and gene sequencing were performed .Chi-square test or Fisher exact probability test was used to compare the detection rate .Binary logistic regression was used to explore the impact factors of norovirus infection among diarrheal patients . Results The detective rate of norovirus among diarrheal patients was 21 .59％ ,peaking from October to next March .Among all the age groups ,the detection rate was highest among patients with 25 - 64 years old .The patients with more severe diarrhea symptoms (> 5 times a day) were more likely to be infected with norovirus than those with diarrhea 3 - 5 times a day (χ2 = 21 .167 ,P< 0 .01) .Vomiting was also an indicator of norovirus infection .Patients presented with vomiting had a higher norovirus detection rate (χ2 = 198 .543 , P < 0 .01) . Norovirus G Ⅱ was the predominant genotype .Conclusions The recent epidemic of norovirus infection in diarrheal patients in Pudong new district has an apparent seasonality peaked from October to next March .Adult ,patients with vomiting and more severe diarrhea symptoms are at risk of norovirus infection .The long-term surveillance is critical for the norovirus infection control .

More than 30 residents and nursing assistants in a geriatric nursing hospital developed acute gastroenteritis from December 7th to December 18th, 2014 in Shanghai, China. An immediate epidemiological investigation was conducted to identify the etiological agent of the outbreak, mode of transmission and the risk factors. Cases were investigated according to an epidemiological questionnaire. Samples from cases, highly transmissible environmental surfaces and drinking water were collected for pathogens detection. A retrospective cohort study was conducted to explore the transmission mode. A total of 34 cases were affected in this acute gastroenteritis outbreak, including 23 residents, 9 nursing assistants and 2 doctors. 13 out of 30 samples were positive for GII.17 norovirus, no other pathogen was detected. Nursing assistants who developed gastroenteritis symptoms had a higher attack rate in residents they cared than those who did not develop any gastroenteritis symptoms (p < 0.001). The acute gastroenteritis outbreak was caused by GII.17 norovirus. Person-to-person close contact and contaminated environmental surfaces were the probable transmission route. Nursing assistants were considered to play an important role in the secondary spread of norovirus. The poor medical skill and personal hygiene habits of nursing assistants in China should be paid attention and improved urgently which is critically important to prevent hospital infections.