Respiratory syncytial virus (RSV) causes recurrent infections throughout life. Yet, the form and durability of antibody-mediated protection induced by infection remained poorly understood. We conducted a longitudinal cohort study in Taizhou City, China. Participant age distribution approximately reflected the age structure of population in Taizhou. Blood samples were collected at baseline (March 12, 2023) and four follow-up visits (May 7–26, 2023, August 13–23, 2023, November 12, 2023, and June 2–3, 2024). Serum-specific RSV pre-fusion F (PreF) protein antibody titres were measured for all samples, and neutralising antibodies against RSV strain A2 and RSV strain B were assessed in a subset. Using a Bayesian inference framework and reversible-jump Markov Chain Monte Carlo, we recovered individual infection histories, estimated population-level RSV incidence, and characterised antibody dynamics from longitudinal PreF titres. We also estimated the correlates of protection (COP) by quantifying the relationship between PreF antibody titres and infection risk. A total of 508 individuals were included. Over the study period, two RSV epidemic waves were observed: the first wave between May and November 2023 and the second from February to May 2024. We estimated seasonal RSV infection rates of 4–7

Aim This study aimed to develop an efficient and cost-saving diagnostic approach using natural language processing and explainable machine learning models. Subject and Methods 11,863 Influenza-like illness cases from Huzhou City, China for four common respiratory viruses were collected: SARS-CoV-2, influenza, respiratory syncytial virus, and adenovirus. Natural language processing techniques were employed to extract and normalize symptom features from unstructured clinical text. Five machine learning algorithms were evaluated using AUC, accuracy, sensitivity, and specificity to select the best-performing model. Subgroup analyses by age, sex, and fever status assessed model robustness, and SHAP values were calculated for interpretability. Results Compared with existing diagnostic tools, our model demonstrated higher accuracy and better predictive performance, with AUCs of 0.856 (95% CI: 0.830–0.881) for SARS-CoV-2, 0.737 (95% CI: 0.713–0.760) for Influenza, 0.801 (95% CI: 0.744–0.857) for RSV, and 0.782 (95% CI: 0.748–0.816) for adenovirus, showing particularly high capability for SARS-CoV-2 and RSV. Subgroup analyses showed particularly excellent discriminative accuracy in pediatric or afebrile patients. Conclusions This study demonstrates the feasibility of integrating natural language processing and machine learning techniques for identification of respiratory viruses based solely on symptoms, and offers a low-cost and efficient alternative to PCR testing, which can reduce reliance on resource-intensive testing and enhance early detection in clinical practice. This approach can support early screening and resource allocation in both clinical and public health settings.

Background Rotavirus is a principal etiological agent of severe acute gastroenteritis in young children, for which vaccination constitutes the cornerstone of prophylactic intervention. However, to our knowledge, few studies have comprehensively assessed the differential population impacts of alternative rotavirus vaccination strategies within China. This study was therefore conducted to quantify the effect of vaccination on the epidemiological dynamics of rotavirus-associated gastroenteritis in Shanghai. Methods An age-structured Susceptible-Infected-Recovered-Susceptible (SIRS-type) compartmental model incorporating the effects of vaccine interventions was developed. Epidemiological data on reported cases were sourced from the infectious disease surveillance system. Scenario-based simulations were employed to evaluate vaccine efficacy and the prospective outcomes of strategic adjustments to the vaccination program. Results The model demonstrated a high degree of fit with observed epidemiological data over the calibration period from July 2015 to April 2024 (R2 = 0.747, RMSE = 58.55 cases/month; LOO R2 = 0.423). The implementation of the RotaTeq vaccination program resulted in an estimated cumulative reduction of 20.0% (95% CI: 18.9–21.6%) in the whole population and 24.6% (95% CI: 23.0–26.5%) among children under 5 years, relative to a no-RotaTeq counterfactual. Simulations indicated that optimizing the vaccination schedule of the Lanzhou lamb rotavirus vaccine (LLR) and augmenting coverage rates are effective strategies for outbreak mitigation. The introduction of Lanzhou lamb reassortant rotavirus vaccine, live, oral, trivalent (LLR3) and oral hexavalent reassortant rotavirus vaccine (WH-HRV) would further reduce the disease burden across all age groups, potentially controlling the epidemic to a minimal endemic level post-2029. Conclusions The incidence of rotavirus-associated gastroenteritis in Shanghai exhibited a discernible downward trend between 2015 and 2024, a decline associated with substantial contribution from the introduction of the RotaTeq vaccine. The optimization of existing vaccination protocols, in conjunction with the deployment of novel vaccines, is anticipated to be crucial for achieving more comprehensive and sustained control of rotavirus transmission in Shanghai.

Abstract Background Public health initiatives increasingly target multiple overlapping high-risk groups to maximize impact. However, a common challenge in modelling these initiatives is to capture these overlapping risk factors, leading to potential misallocation of resources and biased effectiveness estimates. Using China’s tuberculosis (TB) control program as an example, this study explores different possible frameworks to account for population heterogeneity and risk overlap. Methods We examined four risk allocation frameworks: ( i ) Direct Summation (DS), a simple additive benchmark; ( ii ) Probabilistic Union Deduplication (PUD), using inclusion-exclusion principles; ( iii ) Risk population combination (RPC), modeling interaction effects; and (iv) Agent-Based Framework (ABF), a granular microsimulation. To show how these frameworks could be used in epidemiological modelling, we embedded each within a deterministic transmission model of TB epidemiology in China, to simulate the impact of China’s National Tuberculosis Strategic Plan (NTSP). We explored each framework when implemented in both static and dynamic versions. We compared them using methodological principles and indicators of intervention cost (screening volume) and benefits (cases/deaths averted). Results Under the static version, the detection yield of active cases followed a consistent hierarchy: DS > PUD > RPC ≈ ABF. The DS method systematically overestimated yields by double-counting overlapping populations, while PUD corrected for overlap but ignored interaction. The RPC and ABF methods provided the most granular estimates by incorporating Risk population combinations. Additionally, comparing static versus dynamic versions revealed that for the same multi-risk screening framework, mortality reductions remained stable and incidence reductions varied significantly. Conclusion This study presents potential screening frameworks for overlapping risk populations. The RPC method offers optimal balance of real-world plausibility and computational efficiency. We propose the dynamic RPC method as the preferred tool for routine analysis where multimorbidity and intersectional risks exist, providing a robust evidence base for optimizing resource allocation in heterogeneous populations.

Background: In settings with high antibiotic pressure, pneumococcal conjugate vaccines (PCVs) offer an underutilized strategy for antimicrobial resistance mitigation. In China, PCVs remain excluded from the National Immunization Program (NIP), providing a unique epidemiological context to evaluate the impact of suboptimal vaccine coverage on the carriage and transmission of resistant Streptococcus pneumoniae. Methods: In the multicenter HAPEC study, we collected nasopharyngeal swabs from 1,695 children under five years with clinically diagnosed pneumonia and 1,467 healthy community children across Hainan Province between April 2023 and November 2024, and characterized pneumococci by multiplex PCR, culture, serotyping and antimicrobial susceptibility testing. Findings: Pneumococcus was detected in 41.8% of pneumonia cases and 33.1% of community children, despite widespread pre-sampling antibiotic exposure. PCV13-type serotypes accounted for 53.5% and 42.3% of carriage, respectively, and were more frequently resistant than non-PCV13 serotypes to one or more (67.5% vs 54.7%; p=0.01) and two or more (21.6% vs 12.4%; p=0.02) clinically used antibiotics. Only 10–20% of children had received any PCV. Receipt of two or more doses, but not a single dose, was associated with lower PCV13-type carriage (aOR=0.44, p<0.01). Interpretation: Broader PCV13 coverage with full-schedule completion and government-supported access could reduce antibiotic-resistant pneumococcal carriage and transmission in both hospital and community settings.

PURPOSE:This prospective community-based cohort study (Acute Respiratory Infection Epidemiological Characteristics Assessment Study (ARI-ECAS)) aims to systematically monitor acute respiratory infection (ARI) incidence, characterise multiple pathogen coinfection patterns and explore microbial landscape dynamics in Shanghai's general population. By integrating syndromic surveillance, molecular diagnostics and metagenomic sequencing, the study seeks to enhance understanding of ARI epidemiology, seasonal variation and host-pathogen interactions to inform predictive modelling and optimise public health interventions in high-density urban environments. PARTICIPANTS:The study enrolled 15 199 permanent residents from all 16 districts of Shanghai, with baseline oropharyngeal swab samples across five representative districts (Xuhui, Jing'an, Jiading, Songjiang and Fengxian). Inclusion criteria required residency ≥6 months and consent for weekly follow-ups. Exclusion criteria addressed mobility limitations (planned relocation >6 months) and recent ARI history. Participants provided demographic, behavioural and clinical data via the Shanghai Health Cloud platform, with baseline and symptomatic-phase biological samples collected for analysis. FINDINGS TO DATE:During the initial 8-month surveillance period (May 2024-January 2025), the ARI-ECAS cohort demonstrated critical insights into the epidemiology of acute respiratory infections in Shanghai's urban communities. Among 15 199 participants, 10.96% reported symptomatic episodes, of whom 21.43% experienced recurrent infections. Pathogen detection using targeted next-generation sequencing (tNGS) identified microbial aetiologies in 53.52% of symptomatic cases, revealing a high prevalence of coinfections: 27.96% involved dual pathogens, while 33.01% showed polymicrobial interactions (≥3 pathogens). Notably, 85.09% of symptomatic episodes were self-managed, underscoring a low healthcare-seeking rate (14.91%) consistent with patterns observed in urban China during postpandemic transitions. FUTURE PLANS:The current phase of data collection will conclude in June 2025; however, syndromic surveillance and tNGS protocols will be sustained to capture multiyear seasonal transmission patterns. To enhance comparative rigour, future protocols will aim to collect samples from participants during asymptomatic periods in the subsequent year to serve as seasonal baseline controls. Building on this foundation, the study will integrate contact behaviour and mobility surveys to quantify parameters critical for understanding pathogen transmission dynamics (eg, household contacts and public transportation usage). Furthermore, pathogen detection and metagenomic data will be combined with transcriptomic and metabolomic profiling in selected cases to model multipathogen interaction networks and delineate host immune response pathways, thereby advancing mechanistic insights into polymicrobial cocirculation.

Mycobacterium tuberculosis (Mtb) lineage 4 (L4) remains as a crucial component of the pathogen. Genetic factors potentiate the spread of Mtb, while the genomic feature and epidemic success at individual level of L4 strains have not been fully illustrated, especially in China. Therefore, the current study aimed to obtain additional understanding on the pan-genome architecture and transmission of the pathogen. The results first revealed a low proportion of soft-core genes (28.66

BACKGROUND:Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infections (ALRIs) in children. To guide policymaking on controlling RSV-associated ALRIs (RSV-ALRIs) in China, we estimated the national, regional, and provincial burdens of RSV-ALRIs and associated hospitalizations for children under 5 years old. METHODS:We systematically identified publications about RSV-ALRIs in China with epidemiological data before 2020. We compared seasonality data from this period with data during the COVID-19 epidemic. We built a dataset to assess RSV-ALRI burden by age and region, using a generalized linear mixed-effects model and a conceptual proportionality framework to assess hospitalization rates. A risk factor-based model were used to estimate regional and provincial RSV-ALRI incidence. FINDINGS:Children aged 0 to 12 months had the highest risk of RSV-ALRI and associated hospitalization. Provincial variations existed, with some southern provinces exhibiting higher incidence and some western provinces higher hospitalization rates. The COVID-19 epidemic shifted RSV hospitalization peaks to early autumn (Guangdong, Shanghai), whereas Hubei and Shandong demonstrated delayed peak onset compared with the pre-pandemic period. INTERPRETATION:Our study of the burden RSV-ALRIs in China identified obvious heterogeneity by age and region. These findings highlight the need for targeted RSV vaccination strategies and resource allocation prioritizing high-risk groups and areas. FUNDING:This work was supported by the Shanghai Municipal Science and Technology Major Project (Grant No. ZD2021CY001), the National Natural Science Foundation of China (Grant No. 82073612), and Shanghai New Three-year Action Plan for Public Health (GWVI-1, GWVI-11.1-03 and GWVI-11.1-01).

Influenza-like illness (ILI) and severe acute respiratory infection (SARI) remain significant public health burdens, particularly among older adults and in resource-limited settings. However, long-term epidemiologic trends across different pandemic phases remain poorly understood, especially for vulnerable populations. Surveillance and hospital records collected between 2017 and 2024 from two sentinel hospitals in Shanghai, China, were analyzed. Interrupted time-series (ITS) models were used to evaluate temporal changes in ILI and SARI incidence. Large-scale data processing techniques were applied to extract structured information from unstructured medical records, enabling comprehensive analysis of clinical characteristics and outcomes. Both ILI and SARI cases declined sharply during the COVID-19 pandemic but rebounded thereafter. Older adults (≥60 years) experienced disproportionately greater increases in these cases, along with higher risks of ILI-to-SARI progression and ICU admission. Although clinical recovery rates improved in the post-pandemic period, the demand for oxygen therapy and hospital-based care remained elevated. These findings highlight the long-term impact of the COVID-19 pandemic on respiratory infection dynamics and underscore the need for targeted interventions for older adults. Despite highest susceptibility and baseline risk for severe illness, older adults demonstrated improved post-pandemic clinical outcomes due to enhanced clinical prioritization. Strengthening vaccination programs, improving health education, and enhancing resource preparedness are crucial to reduce the post-pandemic disease burden, particularly in settings with limited healthcare capacity. These findings provide important evidence to strengthen post-pandemic respiratory surveillance and improve protection strategies for older adults in China.

A significant reduction in hand-foot-mouth disease (HFMD) cases has occurred across the country, since EV-A71 vaccine was licensed for use in China in 2016. We compared the epidemiology and virological characteristics before and after the implementation of EV-A71 vaccination over a 15-y period in Minhang district, Shanghai, and conducted a test-negative design to estimate the vaccine effectiveness (VE) of EV-A71 vaccine against HFMD. A total of 73,160 HFMD cases, 361 severe cases, and 3 fatalities were reported in the Minhang district, Shanghai during 2009-2023. After the implementation of EV-A71 vaccine program, the incidence rate, case-severity rate, and fatality rate of HFMD showed a significant decline by 56.7%, 95.2%, and 100.0%, respectively. The proportion of age group 6-10 y increased by 105.7%. The predominance of EV-A71 and CV-A16 was replaced by CV-A6 and CV-A10 in the post-2017 period. Full-dose immunization coverage rate maintained 50% during 2019-2023. The overall VE against EV-A71-associated HFMD and herpangina was 89.9% (95% CI: 74.5-96.0) for two-dose series and 67.9% (95% CI: 2.6-89.6) for one-dose vaccination. The VE for two-dose vaccination was 92.2%, 88.1%, and 100% against EV-A71-associated outpatient visit, non-severe hospitalization, and severe complications, respectively. There was no cross-protective effect of EV-A71 vaccination against non-EV-A71 serotype infection. EV-A71 vaccination program substantially reduced HFMD burden in Shanghai, with two-dose series providing robust protection against EV-A71-associated HFMD and herpangina. The shift of non-EV-A71 serotypes warrants an effort to develop multivalent vaccines to control HFMD epidemics.

Tuberculosis (TB) remains the leading cause of death from a single infectious agent worldwide. This study was conducted in Huzhou City, a low-TB-incidence areas, to investigate the prevalence of tuberculosis infection (TBI) and its associated risk factors among rural elderly population. The findings aim to inform TB elimination strategies in similar low-incidence settings. A cross-sectional study was conducted from May to August 2023 among 1,258 rural residents aged ≥ 65 years in Changxing County, Huzhou City. Data were collected through health examinations, structured questionnaires, and interferon-gamma release assay (IGRA) testing using the QuantiFERON-TB Gold kit (ELISA). Chi-square tests, t-tests, and Fisher’s exact tests were used to compare TBI prevalence across subgroups. Variables with P < 0.05 in univariate analyses were entered into a multivariate logistic regression model. A multi-model strategy was applied to evaluate the association between abnormal imaging findings and TBI. Restricted cubic splines (RCS) were used to examine the dose-response relationship between blood glucose levels and TBI. Among the 1,032 enrolled permanent residents aged ≥ 65 years, the IGRA-positive was 9.79

BACKGROUND:This study aimed to investigate the prevalence and temporal patterns of five major sexually transmitted infections (STIs) among individuals with HIV in Jiading, Shanghai, China, from 2009 to 2024. METHODS:Data on HIV and the five targeted STIs, including Treponema pallidum, Neisseria gonorrhoeae, condyloma acuminatum (HPV), genital herpes (HSV) and genital Chlamydia trachomatis infection, were extracted from the China Information System for Disease Control and Prevention. Descriptive analyses and logistic regression models were used to describe temporal patterns and identify associated factors. RESULTS:Among 1337 individuals with HIV, 24.8% (n = 367) had at least one STI diagnosis. T. pallidum was the most prevalent (63.5%), followed by HPV (20.4%), N. gonorrhoeae (9.3%), C. trachomatis (4.9%) and HSV (1.9%). Simultaneous HIV and STI diagnoses accounted for 41.1% of cases, and STI before HIV accounted for 39.8%. In multivariable analysis, homosexual transmission was associated with higher odds of STI diagnosis compared with heterosexual transmission (aOR 1.55; 95% CI: 1.11-2.17). Individuals diagnosed in hospitals also had higher odds of STI detection than those diagnosed in voluntary counseling and testing clinics (aOR 2.00; 95% CI: 1.49-2.68). CONCLUSIONS:Syphilis and HPV are highly prevalent among individuals with HIV, and frequently occur before or concurrently with HIV diagnosis. Low detection rates of N. gonorrhoeae, C. trachomatis and HSV likely reflect asymptomatic infections and underscreening. These findings underscore the need for routine and integrated HIV and STI screening, as well as targeted prevention strategies to reduce the syndemic burden of HIV and STIs.

Quantifying transmission distance helps to understand infectious disease spread patterns, but few studies have assessed this for (re-)emerging respiratory infectious diseases. The COVID-19 pandemic's extensive surveillance and high-quality data in China offer a strong model for studying the spread pattern of respiratory infections. We collected COVID-19 outbreak data from June 2020 to December 2022 in mainland China to estimate transmission distances, examine the association between urban characteristics and transmission distance, and explore its implications in outbreak response. The mean transmission distance of all outbreaks was 18.94 km. This distance varied by SARS-CoV-2 variants, with wild-type outbreaks showing shortest transmission distance (3.08 km) and Omicron outbreaks showing longest transmission distance (20.17 km). Transmission distance was positively associated with city size and total length of roads. Potential transmission areas identified as areas within transmission distance of the first 100 cases contained 63.84–99.61% of cases. Providing testing services to residents in these areas helped to control the outbreak. Our results suggest that transmission distances can help predict where emerging respiratory infectious diseases may spread next spatially and guide the implementation of targeted interventions.

Although systemic exposure to anti-tuberculosis agents is critical for therapeutic efficacy, substantial inter-individual variability of drug exposure persists despite standardized dosing. Emerging studies suggest that the gut microbiota may influence drug metabolism and host pharmacokinetics, yet the role of the gut microbiota in driving pharmacokinetic variability in the context of multidrug-resistant tuberculosis (MDR-TB) remains unclear. In this prospective cohort study, we aimed to examine whether pre-treatment gut microbial composition and functional capacity shape drug exposure in patients with MDR-TB. We enrolled patients with MDR-TB at designated TB medical institutions in Suzhou, Jiangsu Province. Fecal samples were collected prior to anti-tuberculosis treatment for metagenomic sequencing, and blood samples were obtained after two weeks of treatment to estimate the drug exposure levels of levofloxacin, linezolid, bedaquiline, clofazimine, and cycloserine. The relationship between gut microbiota features and drug exposure was assessed using MaAsLin2 to identify microbial species, metabolic pathways, and enzymes associated with drug metabolism. Pronounced dysbiosis, characterized by reduced alpha diversity and a decrease in anaerobic bacteria abundance accompanied by an increase in facultative anaerobes, was associated with lower plasma exposure to levofloxacin, linezolid, bedaquiline, clofazimine, and cycloserine. Metagenomic functional profiling indicated that biosynthesis pathways for amino acid and peptidoglycan were enriched in individuals with higher drug exposure, while degradation pathways for these compounds were more prevalent in those with lower exposure. Specific species positively associated with drug exposure encoded genes for the enzymes involved in the biosynthesis pathways for amino acid and peptidoglycan. Analyses demonstrate that pre-treatment dysbiosis is associated with lower systemic exposure to anti-TB drugs. These findings suggest a potential link between gut microbiota composition and drug exposure variability, though causality remains to be established. Further research is needed to determine whether microbiota-targeted strategies could influence pharmacokinetics and improve MDR-TB treatment outcomes.

Background Pneumonia is the leading cause of death in children, yet its etiology in tropical China remains poorly characterized. Using the framework from Pneumonia Etiology Research for Child Health (PERCH), we characterized etiologic spectrum of pneumonia in children under 10 years in Hainan Province. Methods We conducted a multi-center case-control study in Hainan Province (March 2023–2024). Children with clinical pneumonia who attended pre-specified centers were consecutively enrolled as cases, alongside healthy controls from vaccination clinics . Nasopharyngeal swabs (NP) were collected, and 22 pathogens were detected by multiplex PCR. The PERCH Integrated Analysis (PIA) used Bayesian partial latent class analysis to estimate the etiologic fractions (EF) and 95% credible intervals of pathogens at the individual and population levels. Results Among 2,111 cases and 1,505 controls, the most common virus detected was respiratory syncytial virus (RSV) (20.3%), which had the strongest positive association with case status (odds ratio [OR] = 92.7) and the highest EF (31.1%). Human metapneumovirus (HMPV), parainfluenza virus, and Mycoplasma pneumoniae each contributed ≥5% of the etiological fraction, although the relative contributions of most pathogens varied by age group. Generally, individual pneumonia cases were mainly caused by viral pathogens (76.0%), rather than bacterial pathogens (10.5%). Conclusions This study highlights that a small subset of pathogens causes the majority of childhood pneumonia. Whose findings challenge the prevailing reliance on empirical antibiotics and highlight RSV immunoprophylaxis as an urgent public health priority. Targeted, geographically specific prevention strategies are essential to reduce the childhood pneumonia burden in this region.

Background:Acute respiratory infections (ARIs) remain a major global health concern. Although long-term air pollution exposure has been linked to ARIs, prospective evidence from community-based populations remains limited. Objective:This study aimed to quantify the burden of ARIs in the community and examine the associations between long-term exposure to particulate matter 2.5 (PM2.5) and ozone (O3) and the risks of ARIs, with additional analyses using influenza-like illness (ILI) as a more specific outcome. Methods:We conducted a prospective cohort study including 3617 residents in Shanghai, China, who were followed weekly for 1 year. Individual-level exposure to PM2.5 and O3 concentrations was estimated using high-resolution datasets. Cox proportional hazards models with shared frailty were applied to assess associations with ARIs. Exposure windows of 3, 6, 9, and 12 months were evaluated, and the optimal window was selected based on the Akaike information criterion. Effect estimates were reported per IQR increase. Dose-response relationships, subgroup analyses, and multiple sensitivity analyses were performed. Results:During 3217 person-years of follow-up, 885 ARI events were documented (0.27 per person-year). In the fully adjusted model using the 12-month exposure window, each IQR increase in PM2.5 was associated with higher risks of ARIs (hazard ratio [HR] 1.594, 95% CI 1.340-1.897), with stronger associations observed for ILI (HR 1.948, 95% CI 1.484-2.557). For O3, the corresponding HRs were 1.510 (95% CI 1.135-2.007) for ARIs, with stronger associations for ILI (HR 2.229, 95% CI 1.385-3.588). PM2.5 showed a nonlinear association with ARIs, whereas linear relationships were observed for PM2.5 with ILI and O3 with both outcomes. Evidence of effect modification was observed by age, residence, and season for PM2.5 and by season for O3. Results were robust across multiple sensitivity analyses. Conclusions:Long-term exposure to PM2.5 and O3 is associated with increased risk of ARIs, with similar associations observed for ILI. These findings highlight the importance of long-term air pollution control and targeted interventions for susceptible populations, particularly during cold seasons.

Objectives The number of post-marketing studies assessing the vaccine effectiveness (VE) of the Lanzhou lamb rotavirus vaccine (LLR, licensed in 2000 exclusively in China) and the oral human attenuated pentavalent rotavirus vaccine (RotaTeq, licensed in China in 2018) in China is limited. Methods A test-negative case-control study based on prospective surveillance was conducted among diarrhea patients aged 5 years and younger at five hospitals in Shanghai, China. Cases and controls were defined based on the results of real-time fluorescent quantitative reverse transcription polymerase chain reaction (rRT-PCR) of fecal samples for rotavirus. Both matched and unmatched case-control study designs were employed using logistic regression models, with adjustments for age at onset age and the rotavirus epidemic season. Results In the LLR-specific analysis (247 cases, 2191 controls), the VE of partial LLR vaccination (2 doses) was 49.09 % (95 % CI: 1.69 % ∼ 73.64 %) in multivariate analyses. In the RotaTeq-specific analysis (42 cases and 523 controls), the VE of complete RotaTeq vaccination was 87.13 % (95 % CI: 45.87 % ∼ 96.94 %), 89.46 % (95 % CI: 55.03 % ∼ 97.53 %), and 85.69 % (95 % CI: 33.43 % ∼ 96.93 %) respectively in univariate, multivariate, and matched analyses, respectively. The vaccination coverage for any dose among 2893 patients with rotavirus-negative diarrhea born between 2011 and 2022 was 49.78 %. Following the licensure of RotaTeq in 2018, this coverage increased from 45.02 % to 61.77 %. Conclusions RotaTeq demonstrates a robust protective effectiveness, while LLR provides a certain level of protection against mild to moderate rotavirus diarrhea in children in Shanghai. For privately purchased (non-NIP) vaccines, we estimate that the coverage for rotavirus vaccines among children in Shanghai is high. Complete rotavirus vaccination is recommended for age-eligible children. Further post-marketing research on rotavirus vaccines is necessary to inform decision-making regarding the introduction of rotavirus vaccination in China.

BACKGROUND:The implementation of concurrent vaccination strategies presents a promising approach to simplify complex immunization schedules while maintaining vaccine safety and efficacy. This study evaluates both the safety profile and economic impact of co-administering 13-valent pneumococcal conjugate vaccine (PCV13) and rotavirus vaccines in Shanghai, China. METHODS:The study focuses on infants under 2 years old. The safety of concurrent PCV13 and rotavirus vaccination was assessed across urban and suburban clinics, with adverse events monitored on the day of vaccination and via 7-day follow-up. The economic evaluation, conducted from a societal perspective, accounted for direct medical, non-medical, and indirect costs. Costs were calculated per dose and per fully immunized child. Economic analyses utilized cost-minimization analysis (CMA) and budgetary impact analysis (BIA), with sensitivity analyses to ensure robustness. FINDINGS:The incidence of systemic adverse effects was 4.82 % for PCV13 alone, 4.35 % for rotavirus vaccine alone, and 4.11 % for simultaneous vaccination, with no statistically significant differences between the three patterns of vaccination. Partial-dose concurrent vaccination is cost-effective, with total costs reduced by 2.29 %, 2.20 %, and 1.07 % for co-administering 1, 2, and 3 doses, respectively, compared to the current separate administration schedule. Cost savings are predominantly achieved in direct non-medical costs and indirect costs, with potential savings exceeding 40 %. INTERPRETATION:Compared to separate administration of RV and PCV13, concurrent administration optimizes resource utilization in immunization programs, reduces costs to families by reducing clinic visits, and has a favorable safety profile. This strategy is especially valuable for enhancing the efficiency and sustainability of immunization programs in densely populated urban settings.

Antimicrobial resistance (AMR) is a global health challenge. Recently, overwhelming evidence suggests a possible association between fine particulate matter (PM2.5) and bacterial AMR. However, the PM2.5-AMR association was poorly understood. In this global analysis, we aim to provide an in-depth and comprehensive insight into the PM2.5-AMR association. Based on multiple global databases, two Bayesian multivariable models (negative binomial regression model and logistic regression model) with different lag time were used to estimate the association, quantify the lag-response effects, and identify potential effect modifiers. A total of 114,488 isolates with genome data, collected between 2000 and 2022 from 139 countries and regions, were examined. For every 10 μg/m3 increase in PM2.5 exposure over the past 12 months, there was a corresponding 11.2 % increase (95 % CI: 10.6 %, 11.7 %) in the percentage of total resistance genes per isolate and an odds ratio of 1.18 (95 % CI: 1.17, 1.20) for carrying at least one resistance gene. There was a dose-response relationship between PM2.5 level and AMR. The PM2.5-AMR association might be highest at cumulative exposure during the past 12 months, and modified by bacterial species, sample sources, environmental factors, and other national-level economic, medical, and social factors. To summarize, we found significant associations between PM2.5 exposure and AMR. Further studies are needed in phenotypic resistance data and possible intervention experiments in animals or humans to confirm these findings.