The study aimed to establish a three-dimensional risk matrix model as a simplified, practical semi-quantitative risk assessment tool for primary-level pathogenic microorganism laboratories, and to verify the model using actual laboratory activity data from district Centers for Disease Prevention and Control (CDCs) in Beijing. Three core dimensions of laboratory biosafety risk—pathogen hazard (H), laboratory activity type (A), and annual operation frequency (F) mapped to the likelihood of event occurrence (L[F])—were quantitatively defined. A novel risk calculation formula, R = H × A × L[F], and a hierarchical risk matrix were established. Based on the calculated R values, definitive risk levels and targeted control measures were formulated. Laboratory activity data from 16 district CDCs in Beijing in 2024 were collected and analyzed to validate the model. The 16 CDCs conducted 130 tests for pathogenic microorganisms in 2024, of which 88 % involved Category III pathogens. Laboratory utilization intensity varied significantly across CDCs, with only two reporting a daily workload of ≥ 5 tests per Biosafety Level 2 (BSL-2) room. One laboratory activity was determined to pose an unacceptable level of risk. The proportion of acceptable risks reached 100 % for inactivated and non-infectious materials, 89 %–100 % for uncultured infectious materials, and 52 %–100 % for viable pathogen cultures. A total of 62 laboratory activities were classified as hazard zones, primarily involving Category II pathogens (47 %) and viable pathogen cultures (61 %). Our findings demonstrate that the three-dimensional risk matrix model establishes a standardized semi-quantitative risk assessment framework for primary-level laboratories handling pathogenic microorganisms. It further provides a robust quantitative basis to inform evidence-based risk management and resource allocation. Notably, procedures involving viable pathogen cultures emerge as critical control points, warranting prioritized intervention in risk prevention and mitigation strategies.

Enterovirus (EV) exhibits high evolutionary activity and is associated with a wide spectrum of human diseases. Environmental surveillance employing next-generation sequencing (NGS) is an effective approach for elucidating EV type diversity and genetic variation; however, similar studies in China are limited. Sewage samples were collected monthly in Jinan, China, from January to December 2024 and subsequently concentrated. EV isolation was conducted using cell culture, followed by VP1 amplification and Sanger sequencing. Concurrently, VP1 amplicons directly obtained from sewage concentrates were subjected to NGS. Similarity and phylogenetic analysis were performed. A total of 104 EV strains representing nine serotypes were isolated via cell culture, with echovirus 11 (E11) and E3 being the most prevalent, accounting for 34.62% (36/104) and 27.88% (29/104) of the total isolates, respectively. NGS technology identified 31 EV types, with CVB4 and CVA16 exhibiting the highest read counts. Additionally, uncommon types such as D68, A71, A76, B88, A90, and C99 and 11 rhinovirus types were detected in the sewage samples. Phylogenetic analysis revealed that CVA16 and D68 sequences from sewage had close genetic relationship with recent Chinese strains, and multiple branches of B88 and C99 were observed. This study represents the first detection of D68 and B88 in sewage in China, demonstrating co-circulation of diverse enteroviruses with significant genetic variability in the region. These findings underscore the utility of environmental surveillance for tracking EV epidemiology and evolution.IMPORTANCEEnteroviruses are significant human pathogens associated with frequent epidemics and outbreaks. Although numerous types exist, some exhibit low prevalence and are rarely detected. By implementing next-generation sequencing (NGS) in wastewater surveillance, this study comprehensively characterized enterovirus diversity, revealing multiple uncommon types of interest. Notably, we detected EV-D68-an emerging agent linked to acute flaccid myelitis-in sewage, underscoring its public health relevance. Additionally, we identified multiple rhinovirus types. These data demonstrate the local circulation of diverse viruses with substantial public health implications and provide a critical foundation for disease monitoring and early warning systems.

BACKGROUND: While the live attenuated measles virus vaccine is generally safe and highly effective, it has been associated with a significant number of vaccine-associated rash illnesses (VARIs). Some VARIs had been identified through the measles case-based surveillance system in Shandong province. METHODS: In our study, we comprehensively examined the epidemiological characteristics of VARIs using a cross-sectional study design with comparative subgroup analysis. Additionally, we conducted a detailed analysis of the genetic properties of VARIs. RESULTS: Among the 189 cases of VARIs, 90.47% (171 cases) were children aged 8 to 18 months who had received a single dose of measles-containing vaccine (MCV). Additionally, 16.40% (31/189) of these VARIs exhibited at least one symptom such as cough, coryza, or conjunctivitis. A significant linear correlation was observed between measles morbidity and the incidence of VARIs (R = 0.76, p = 0.03). Of the 189 VARIs, 109 cases were sampled throat swabs and 47.09% cases (89/189) were sampled within 5 days after the onset of rash, and only 30.28% (33/109) of these were successfully genotyped. Among the successfully genotyped sequences, 90.91% (30 sequences) were 100% consistent with the Shanghai-191 strain, with nucleotide identities ranging from 99.7% to 100%. Selective pressure analysis revealed no evidence of positive selection within the genotype A sequences from Shandong. CONCLUSION: Our data demonstrate that VARI cases predominantly occur in children after single-dose MCV vaccination. Genotyping remains essential to prevent misdiagnosis and ensure accurate surveillance. This highlights the urgent requirement for either improved genotyping efficiency or vaccine-strain-specific rapid tests. CLINICAL TRIAL: Not applicable.

BACKGROUND:Human noroviruses are the major cause of acute gastroenteritis and exhibit considerable genetic diversity. Next generation sequencing (NGS) analysis based on environmental surveillance has been proved to be an effective method in norovirus surveillance. METHODS:Between January 2019 and December 2021, 36 sewage samples were collected and analyzed using real-time quantitative PCR to detect noroviruses. Partial VP1 region was amplified and subjected to NGS analysis to assess the abundance and genetic characterization of various norovirus genotypes across different samples. RESULTS:A total of 23 norovirus genotypes were identified, including 9 genotypes of GI, 13 genotypes of GII and 1 genotype of GIX. The most frequently detected genotypes were GI.5 (86.11%), GII.2 (86.11%), GII.4 (63.89%), GII.17 (58.33%), and GII.13 (55.56%). Additionally, some rare genotypes, such as GI.7, GII.5, GII.9, and GII.16, which had not been previously reported in Shandong, were identified. No significant differences were observed in genotypic diversity or viral copy numbers in sewage samples when comparing pre- and post-COVID-19 periods. A total of 379 partial VP1 sequences were obtained, with the means sequence identity within a genotype of Shandong sequences ranging from 92.69 to 98.37% and a coefficient of variation ranging from 1.46 to 6.73%. Phylogenetic analysis indicated that local noroviruses within each genotype comprised multiple co-circulating lineages. CONCLUSIONS:Our data demonstrate that sewage contains noroviruses with considerable high diversities. NGS based environmental surveillance greatly improves the understanding of norovirus circulation and should be encouraged.

Aichi virus (AiV) infection is associated with gastroenteritis symptoms, and sewage surveillance has emerged as an effective approach for assessing AiV prevalence. However, a comprehensive understanding of its epidemiology and genetic diversity remains limited, particularly in China. In this study, monthly sewage samples were collected from Jinan, China, between 2019 and 2022. The AiV genome was quantitatively analyzed, and the VP1 region was amplified from sewage concentrates for subsequent next-generation sequencing (NGS). The results revealed a remarkably high detection rate of 95.83% (46/48) over the 4-year study period. Quantitative analysis showed AiV genome concentrations ranging from 1.4 × 103 to 2.7 × 105 genomic copies per liter in sewage, with distinct seasonal patterns and peak occurrences during summer and autumn. Phylogenetic analysis of the VP1 region revealed that Jinan sequences clustered into three groups within genotypes A and B, with an average p-distance of 0.091. Genotype A was detected in all sewage samples (100.00%), while genotype B was found in 52.50% of samples. In terms of relative abundance, they constituted 86.06% and 13.94% of the total clean reads, respectively. This study represents the first application of amplicon NGS for AiV detection in sewage samples in China, revealing the continuous co-circulation of multiple transmission lineages and significant genetic diversity of AiV in wastewater systems. The findings demonstrate that NGS technology significantly enhances detection sensitivity and provides substantially more comprehensive data for the molecular epidemiology of AiV.

There are challenges in selecting SARS-CoV-2 vaccine compositions, primarily due to divergent infection or vaccination history and immunological biases toward previous strains. In this study, we evaluated humoral immune responses induced by variant-based monovalent vaccines as booster shots in mice previously vaccinated with an ancestral strain-based vaccine with or without Omicron BA.5 exposure. Our data suggest that immunological biases toward earlier variants attenuated the potency of variant-based vaccines as a booster dose against subsequent variants, whereas a second booster dose mitigated this effect. Furthermore, in the context of vaccine-induced immunity, prior exposure to Omicron sublineages (e.g., BA.5) attenuated the effect of immunological biases toward earlier variants on the neutralizing potency against Omicron subvariants. In addition, the interval between vaccine doses should also be considered, as an immunologic plateau might occur after repeated vaccination. Furthermore, the XBB.1 monovalent vaccine and a tetravalent vaccine (SCTV01E-2) composed of pre-Omicron variant (Beta) and Omicron subvariants (BA.1, BQ.1.1, and XBB.1) showed comparable neutralizing potency against several Omicron sublineages (BA.1, BA.5, BQ.1.1, XBB.1, XBB.1.5, XBB.1.16, and EG.5) under divergent vaccination history, implicating that multivalent platforms could be explored as a flexible strategy if future strains diverge significantly from current variants.IMPORTANCEContinuous evolution of SARS-CoV-2 variants has raised the need to optimize immunization regimens and update vaccine compositions to protect against the newly emerging variants in the context of repeated vaccination. The significance of this research is briefly summarized as follows:1) Immunological biases toward earlier variants attenuated the potency of variant-based vaccines as a booster dose against subsequent variants, which can be mitigated by a second booster dose.2) In the context of vaccine-induced immunity, a previous exposure to Omicron sublineages, such as BA.5, attenuated the influence of immunological biases toward earlier variants on the neutralizing potency against Omicron subvariants.3) The interval between vaccine doses should be taken into account since an immunologic plateau might occur after repeated vaccination.4) Multivalent vaccines, with epitope diversity, may theoretically enhance the magnitude and breadth of cross-neutralization responses, thereby providing a buffer for unpredictable future variants.

Since molecular typing method of enterovirus was introduced, many new types have been discovered. However, due to the low epidemic potential, the information on newer enteroviruses remains limited globally. This study aims to investigate the diversity and phylogeny of newer enterovirus types through environmental surveillance utilizing next-generation sequencing (NGS) technology. Sixty-six wastewater samples were collected from two cities in eastern China between 2019 and 2021 and concentrated 100-fold using a negatively charged membrane method. After cell culture, 388 enterovirus isolates representing 14 serotypes were recovered, including Sabin-like poliovirus type 1 (n = 22) and type 3 (n = 57). Concurrently, RNA extraction was performed on all 66 sewage concentrates, and VP1 semi-nested RT-PCR yielded 56 amplicons, which were subsequently subjected to NGS. The NGS analysis identified a total of 33 serotypes, with echovirus 11, coxsackievirus A10, echovirus 18, coxsackievirus B4, and coxsackievirus B5 being the most prevalent, accounting for 29.11

Objectives: To evaluate the neutralizing antibody (NAb) levels against the SARS-CoV-2 Omicron variants BF.7, BQ.1, BQ.1.1, XBB.1, and XBB.1.5 after vaccination and natural infection. Methods: The NAbs against the different viral strains of 490 individuals with SARS-CoV-2 and 187 without SARS-CoV-2 in the Beijing COVID-19 outbreak during December 2022 to January 2023 were analyzed. Results: In uninfected individuals, limited levels of NAbs were produced against the prototype and variant strains after two doses vaccine but significantly increased after three or four doses of the vaccine. The infected individuals had high NAbs levels against the BF.7, BQ.1, and BQ.1.1 variants and moderate NAbs levels against the XBB.1 and XBB.1.5 variants. The highest NAbs levels were observed after two inoculation doses. The third and fourth doses vaccine did not result in a significant increase the NAbs levels. After the last dose of vaccination, the NAbs levels peaked at 12 months for the prototype and BF.7 and between 6 to 12 months for the BQ.1, BQ.1.1, XBB.1, and XBB.1.5 variants. Conclusions: The immune response decreases as the virus mutates. If booster vaccination is considered necessary, it is suggested for at least 6 months after infection.

Human astroviruses (HAstVs) are a significant etiological agent of acute gastroenteritis in children. In order to investigate the circulation of HAstVs during the COVID-19 pandemic, a 2-year environmental surveillance was conducted in Jinan between 2020 and 2021. A total of 24 sewage samples were collected and concentrated. Real-time PCR indicated a positive rate of 83.3

In 1992, Hepatitis B vaccine was first recommended for routine neonatal immunization in China. This study aimed to estimate the prevalence of hepatitis B virus (HBV) infection in Shandong Province, eastern China (updating our previous study in 2014), and to help guide the efforts of hepatitis B elimination. We determined prevalence of HBV infection from the remaining serum samples collected through a population-based survey, which was originally intended for a seroepidemiological survey of anti-SARS-CoV-2 antibodies conducted in 2023. The samples (n = 5000) were obtained from individuals all-aged over 1 year residing in ten counties of Shandong Province. The chemiluminescence microparticle immunoassay was used to detect serological markers of HBV. In total, 4999 samples were eligible for the test of hepatitis B. The overall prevalence of HBsAg, anti-HBs, and anti-HBc in the 2023 survey was 2.25

What is already known about this topic?:The impact of air temperature on varicella has been studied, but there is limited research exploring its effect on varicella by gender and age group.What is added by this report?:We conducted a time series analysis to examine the differential effects of air temperature on varicella infection across different demographic groups. Our findings indicate that lower temperatures have a more pronounced influence on varicella incidence among males and children compared to females and adults.What are the implications for public health practice?:These findings can assist in identifying populations that are vulnerable to temperature-related varicella and in guiding the implementation of effective measures for varicella control.

ABSTRACT Mosquitoes carry a large number of known and unknown viruses, some of which could cause serious diseases in humans or animals. Metagenomic sequencing for mosquito viromes is crucial for understanding the evolutionary history of viruses and preventing emerging mosquito-borne diseases. We collected 1,598 mosquitoes belonging to four species from five counties in Shandong Province, China in 2021. They were grouped by species and sampling locations and subjected to metagenomic next-generation sequencing for the analysis of the viromes. A total of 233,317,352 sequencing reads were classified into 30 viral families and an unclassified group. Comparative analysis showed that mosquitoes in Shandong Province generally possessed host-specific virome. We detected mosquito-borne viruses including Japanese encephalitis virus, Getah virus, and Kadipiro virus in Culex tritaeniorhynchus and Anopheles sinensis samples. Phylogenetic analysis showed that these pathogenic viruses may have existed in mosquitoes in Shandong Province for a long time. Meanwhile, we identified 22 novel viruses belonging to seven families and the genus Negevirus . Our study comprehensively described the viromes of several common mosquito species in Shandong Province, China, and demonstrated the major role of host species in shaping mosquito viromes. Furthermore, the metagenomic data provided valuable epidemiological information on multiple mosquito-borne viruses, highlighting the potential risk of infection transmission. IMPORTANCE Mosquitoes are known as the source of various pathogens for humans and animals. Culex tritaeniorhynchus , Armigeres subalbatus , and Anopheles sinensis have been found to transmit the Getah virus, which has recently caused increasing infections in China. Cx. tritaeniorhynchus and Culex pipiens are the main vectors of Japanese encephalitis virus and have caused epidemics of Japanese encephalitis in China in past decades. These mosquitoes are widely present in Shandong Province, China, leading to a great threat to public health and the breeding industry. This study provided a comprehensive insight into the viromes of several common mosquito species in Shandong Province, China. The metagenomic sequencing data revealed the risks of multiple pathogenic mosquito-borne viruses, including Japanese encephalitis virus, Getah virus, and Kadipiro virus, which are of great importance for preventing emerging viral epidemics.

Measles incidence reached a historic low in 2020-2021, and virological surveillance data showed that transmission of the domestic H1 genotype as well as multiple imported genotypes had been interrupted. This evidence confirms that China is currently approaching measles elimination. Background To provide useful insights into measles elimination progress in China, measles surveillance data were reviewed, and the transmission patterns of measles viruses circulating in China during 1993-2021 were analyzed. Methods Measles incidence data from the National Notifiable Disease Reporting System of the China Center for Disease Control and Prevention were analyzed. A total of 17 570 strains were obtained from 30 of 31 provinces in mainland China during 1993-2021. The recommended genotyping window was amplified. Genotyping analysis was conducted for comparison with the reference strains. Phylogenetic analyses were performed to identify genetic relationships among different lineages within the genotypes. Results With high coverage of routine immunization and intensive supplementary immunization activities, measles incidence has shown a downward trend since 1993, despite 2 resurgences, reaching a historic low level in 2020-2021 (average 0.5 per million). During 1993-2021, 9 genotypes including domestic genotype H1; imported genotypes B3, D4, D8, D9, D11, G3, and H2; and vaccine-associated genotype A were identified. Among them, the genotype H1 strain circulated endemically in China for more than 25 years; the last strain was detected in Yunnan Province in September 2019. Multiple imported genotypes have been identified since 2009 showing different transmission patterns. Since April 2020, no imported strains have been detected, while vaccine-associated genotype A continues to be detected. Conclusions The evidence of low incidence during 2020-2021 and virological surveillance data in this study confirm that China is currently approaching measles elimination.

We previously developed a polysaccharide-–RBD-conjugated nanoparticle vaccine which induced protective efficacy against SARS-CoV-2 in a mouse model. Here, we newly developed a vaccine, SCTV01A, by chemically conjugating recombinant SARS-CoV-2 RBD-Fc and PPS14 (Streptococcus pneumoniae serotype type 14 capsular polysaccharide). The immunogenicity and toxicity of SCTV01A were evaluated in animal models. The PPS14 conjugation enhanced the immunogenicity of RBD-Fc in C57BL/6 mice whether formulated with SCT-VA02B or Alum adjuvant. SCTV01A also induced high opsonophagocytic activity (OPA) against S. pneumoniae serotype 14. In addition, SCTV01A stimulated potent neutralizing titers in rhesus macaques and effectively reduced lung inflammation after SARS-CoV-2 infection with neither antibody-dependent enhancement (ADE) nor vaccine-enhanced diseases (VED) phenomenon. Importantly, the long-term toxicity study of SCTV01A in rhesus macaques did not cause any abnormal toxicity and was tolerated at the highest tested dose (120 μg). The existing immunogenicity and toxicological evaluation results have demonstrated the safety and efficacy of SCTV01A, which will be a promising and feasible vaccine to protect against SARS-CoV-2 infection.

Neutralizing antibody is an important indicator of vaccine efficacy, of which IgG is the main component. IgG can be divided into four subclasses. Up to now, studies analysing the humoral response to SARS-CoV-2 vaccination have mostly focused on measuring total IgG, and the contribution of specific IgG subclasses remains elusive. The aim of this study is to investigate the kinetics of neutralizing antibodies and IgG subclasses, and to explore their relationships in people vaccinated with inactivated COVID-19 vaccine. We conducted a prospective cohort study in 174 healthy adults aged 18–59 years old who were administrated 2 doses of CoronaVac 14 days apart and a booster dose 1 year after the primary immunization, and followed up for 15 months. Blood samples were collected at various time points after primary and booster immunization. We used live SARS-CoV-2 virus neutralizing assay to determine neutralizing ability against the wild-type strain and 4 variants (Beta, Gamma, Delta and Omicron) and ELISA to quantify SARS-CoV-2 RBD-specific IgG subclasses. The results showed that the 2-dose primary immunization only achieved low neutralizing ability, while a booster shot can significantly enhance neutralizing ability against the wild-type strain, Beta, Gamma, Delta and Omicron variants. IgG1 and IgG3 were the most abundant serum antibodies, and IgG2 and IgG4 were hardly detected at any time. The ratio of IgG1/IgG3 was positively associated with the neutralization ability. The underlying mechanism requires further exploration.

Objectives: To determine the status of immune responses after primary and booster immunization for SARS-CoV-2 variants and evaluate the differences in disease resistance based upon titers of neutralizing antibodies (NAbs) against the variants. Methods: Participants aged 18–59 years received 2 doses of inactivated COVID-19 vaccine, 14 days apart, and a booster dose after 12 months. Blood samples were collected before vaccination (baseline), 1 and 6 months after primary immunization, and at multiple instances within 21 days of the booster dose. NAbs against the spike protein of Wuhan-Hu-1 and 3 variants were measured using pseudovirus neutralization assays. Results: Of 400 enrolled participants, 387 completed visits scheduled within 6 months of the second dose and 346 participants received the booster dose in the follow-up research. After 1 month of primary immunization, geometric mean titers (GMTs) of NAbs peaked for Wuhan-Hu-1, whereas GMTs of other variants were <30. After 6 months of primary immunization, GMTs of NAbs against all strains were <30. After 3 days of booster immunization, GMTs were unaltered, seroconversion rates reached approximately 50% after 7 days, and GMTs of NAbs against all strains peaked at 14 days. Conclusion: Two-dose of inactivated COVID-19 vaccine induced the formation of NAbs and memory-associated immune responses, and high titers of NAbs against the variants obtained after booster immunization may further improve the effectiveness of the vaccine.

Abstract Background Measles caused by measles virus (MeV) is a highly contagious viral disease which has also been associated with complications including pneumonia, myocarditis, encephalitis, and subacute sclerosing panencephalitis. The current study isolated 33 strains belonging to 2 groups, outbreak and sporadic strains, in 13 cities of Shandong province, China from 2013 to 2019. Comparison of genetic characterization among 15 outbreak strains and 18 sporadic strains was performed by analyzing nucleotide sequences of the C-terminal region of N protein gene (N-450). Results All 33 stains belonged to genotype H1. The outbreak strains and sporadic strains distributed crossly in phylogenetic tree. Sequences alignment revealed some interesting G to A transversion which changed the amino acids on genomic sites 1317, 1422, and 1543. The nucleotide and amino acid similarities among outbreak isolates were 98–100% (0–10 nucleotide variations) and 97.7–100%, respectively; They were 97.3–100% and 96.6–100%, respectively for sporadic isolates. Evolutionary genetics analysis revealed that the mean evolution rates of outbreak and sporadic isolates were 1.26 N 10− 3 and 1.48 N 10− 3 substitutions per site per year separately, which were similar with corresponding data before 2012. Local transmission analysis suggested that there were three transmission chains in this study, two of them originated from Japan. Outbreak cases and sporadic cases emerged alternatively and were reciprocal causation on the transmission chains. Conclusions Our study investigated the phylogeny and evolutional genetics of MeV during a 7-year surveillance, and compared epidemic and genetic characteristics of outbreak strains and sporadic strains. These results underscore the importance of evolutionary study alongside with sporadic cases in discovering and tracing possible outbreaks, especially in the stage of measles elimination.

目的 分析2014-2021年北京市麻疹风疹实验室网络运转状况,综合各项指标评价网络运行质量.方法 汇总2014-2021年北京市麻疹风疹实验室网络病例诊断、病原学分析、病毒基因型、职能考核等结果数据,综合网络运转情况进行统计分析.结果 网络共包括21家实验室,其中市级疾病预防控制中心1家、区级疾病预防控制中心16家、医疗机构4家,各级实验室按职责和检测时限有序分工.2014-2021年网络实验室共检测疑似麻疹或风疹病例血清样本12 229份,麻疹阳性率19.32％,风疹阳性率7.10％;核酸样本8 100份,麻疹阳性率23.72％,风疹阳性率8.63％.麻疹病毒基因型测序1 705株,分型发现H1a基因型1 687株、D8基因型11株、B3基因型2株、疫苗株5株;风疹病毒基因型测序37株,其中1E基因型13株、2B基因型24株.网络每年开展质量控制和技术培训,各实验室职能考核成绩良好.结论 北京市麻疹风疹实验室网络运转良好,并通过持续技术提升提高了实验室诊断敏感性和监测能力,同时通过严格的质量控制保证了实验室数据准确高效,为北京市麻疹消除和风疹防控提供有力的技术保障.

To better understand the importation and circulation patterns of rubella virus lineages 1E-L2 and 2B-L2c circulating in China since 2018, 3,312 viral strains collected from 27 out of 31 provinces in China between 2018 and 2021 were sequenced and analyzed with the representative international strains of lineages 1E-L2 and 2B-L2c based on genotyping region. Time-scale phylogenetic analysis revealed that the global lineages 1E-L2 and 2B-L2c presented distinct evolutionary patterns. Lineage 1E-L2 circulated in relatively limited geographical areas (mainly Asia) and showed geographical and temporal clustering, while lineage 2B-L2c strains circulated widely throughout the world and exhibited a complicated topology with several independently evolved branches. Furthermore, both lineages showed extensive international transmission activities, and phylogeographic inference provided evidence that lineage 1E-L2 strains circulating in China possibly originated from Japan, while the source of lineage 2B-L2c isolated since 2018 is still unclear. After importation into China in 2018, the spread of lineage 1E-L2 presented a three-stage transmission pattern from southern to northern China, whereas lineage 2B-L2c spread from a single point in western China to all the other four regions. These two transmission patterns allowed both imported lineages to spread rapidly across China during the 2018-9 rubella epidemic and eventually established endemic circulations. This study provides critical scientific data for rubella control and elimination in China and worldwide.