ObjectiveTo analyze the composition of respiratory virus pathogen spectrum and epidemiological characteristics among adult influenza-like illness (ILI) cases in Putuo District of Shanghai from 2015 to 2024, to summarize the epidemic patterns of respiratory viruses across different time periods and populations, and to provide scientific evidence for the prevention and control of adult respiratory virus infections in Putuo District of Shanghai.MethodsSurveillance data of 2 273 adult ILI cases from sentinel hospitals under the comprehensive surveillance system for acute respiratory infections in Putuo District of Shanghai from 2015 to 2024 were retrospectively collected. Descriptive epidemiological methods were adopted to analyze the temporal and population distribution characteristics of respiratory viruses, including influenza virus (IFV), respiratory syncytial virus (RSV), adenovirus (ADV), and human metapneumovirus (HMPV). The mixed infection status among different age groups was compared, and the distribution of influenza virus subtypes was described. SPSS 22.0 and WPS Office software were used for statistical analyses.ResultsThe overall detection rate of respiratory viruses in 2 273 adult ILI cases was 43.51%. The detection rate in females (45.48%) was significantly higher than that in males (41.25%), with statistical significance (χ2=4.113, P=0.043). Individuals aged 60 years old and above had the highest detection rate (47.41%) (χ2=8.430, P=0.014). The detection rates in winter (50.41%) and summer (48.42%) were higher than those in other seasons (χ2=47.028, P<0.001). The overall viral detection rate decreased after 2020 (χ2=208.411, P<0.001). Detection rates of various viruses varied by year, with IFV and ADV showing high rates from 2015 to 2019 (all P<0.001), while human coronavirus (HCoV) and rhinovirus/enterovirus (HRV/EV) exhibited higher rates from 2020 to 2022 (all P<0.001). Co-infection with IFV and HCoV was the most common, followed by co-infection with IFV and ADV, together accounting for 50.00% of all mixed infections. During the surveillance period, the detection rate of IFV was significantly higher than that of other respiratory viruses. Influenza B/Victoria lineage predominated in 2021, followed by successive predominance of influenza A(H1N1), A(H3N2), and the co-circulation of the two subtypes from 2022 to 2023. Influenza A(H1N1) re-emerged as the predominant subtype in the first half of 2024.ConclusionFrom 2015 to 2024, respiratory virus infections in adults prevailed in winter and summer, and people aged 60 years old and above were the key high-risk population. The detection rates of respiratory viruses declined after 2020. IFV was the predominant pathogen detected, and different influenza virus subtypes circulated alternately each year.

BackgroundHypoxic hepatitis (HH) after on-pump coronary artery bypass grafting (CABG) is associated with poor outcomes, but dedicated prediction tools are lacking. We developed and internally validated a parsimonious model for severe postoperative aminotransferase elevation compatible with HH.MethodsThis retrospective single-center study included 626 consecutive adults who underwent CABG with cardiopulmonary bypass at Beijing Anzhen Hospital between June 2020 and June 2023. The outcome was peak postoperative alanine aminotransferase or aspartate aminotransferase ≥800 U/L after exclusion of alternative causes of acute liver injury during data extraction. Missing predictor data were addressed with random-forest multiple imputation (20 datasets). Prespecified predictors were screened with LASSO penalized logistic regression in each imputed dataset using 10-fold cross-validation; stably selected variables entered the final logistic model. Internal validation used bootstrap optimism correction, with temporal split and complete-case analyses as secondary analyses.ResultsThe outcome occurred in 57/626 patients (9.1%) and was associated with higher in-hospital mortality (49.1% vs. 4.6%; P < 0.001). Final predictors were total sternotomy count (OR 3.533, 95% CI 1.724–7.241), cardiopulmonary bypass duration (OR 1.047 per minute, 95% CI 1.035–1.059), and peak intraoperative lactate (OR 1.403 per mmol/L, 95% CI 1.251–1.574). Apparent and optimism-corrected AUCs were 0.907 and 0.903; temporal validation AUC was 0.955.ConclusionA three-predictor model estimated the risk of severe postoperative aminotransferase elevation compatible with HH after on-pump CABG and may support intraoperative or early postoperative risk awareness. External validation is required before routine use.

RATIONALE AND OBJECTIVES:Medical imaging integrated with artificial intelligence (AI) has demonstrated considerable potential in predicting the tumor immune microenvironment (TIME). However, the robustness of methodologies and predictive performance remains debated. This study systematically reviews and performs a meta-analysis to evaluate the advancements in AI-driven medical imaging for predicting the TIME in thoracic tumors, with a specific focus on Programmed Death-Ligand 1 (PD-L1) expression and CD8+ tumor-infiltrating lymphocytes (TILs). We hypothesize that medical imaging-based AI models can effectively predict key components of the tumor immune microenvironment in thoracic cancers, specifically PD-L1 expression and CD8+ TILs. METHODS:Following PRISMA guidelines, we systematically searched PubMed, Cochrane, Embase, and Web of Science for studies published up to July 01, 2025. Studies evaluating AI-driven medical imaging for predicting thoracic tumor TIME were included. Diagnostic accuracy data were extracted, and a meta-analysis was conducted using a random-effects model to assess the predictive performance of AI models for PD-L1 expression and CD8+ TILs. Heterogeneity analysis and publication bias assessment were also performed. RESULTS:A total of 68 studies were included, of which 25 were eligible for meta-analysis. The pooled area under the curve (AUC) for AI-driven medical imaging prediction of PD-L1 expression was 0.81 (95% CI: 0.78-0.85), with a sensitivity of 0.77 (95% CI: 0.74-0.80) and a specificity of 0.73 (95% CI: 0.71-0.76). For CD8+ TIL prediction, the pooled AUC was 0.86 (95% CI: 0.82-0.89), with a sensitivity of 0.81 (95% CI: 0.72-0.87) and a specificity of 0.81 (95% CI: 0.76-0.84). Subgroup analysis indicated that integrating multimodal imaging and deep learning models improved predictive performance. Nevertheless, considerable heterogeneity was observed among studies (I² > 75%). CONCLUSION:AI-driven medical imaging exhibits strong predictive capability for thoracic tumor TIME, particularly in PD-L1 expression and CD8+ TIL prediction. However, significant interstudy heterogeneity limits the generalizability of current models. Future studies should prioritize multicenter, large-scale research, standardization of imaging feature extraction, and integration of biological mechanisms to improve the clinical applicability of AI models.

ObjectiveThe study analyzed the impact of urbanization on epidemiological characteristics of respiratory infectious disease in Tongzhou District, Beijing during 2014−2022 to provide reference for prevention and control priorities of respiratory infectious diseases during the innovative urbanization process in China.MethodsThe incidence data of notifiable respiratory infectious diseases (NRIDs) in Tongzhou Beijing during 2014−2022 were summarized. The trend of incidence rate was analyzed by Joinpoint regression model, and entropy method was performed to construct the comprehensive index of urbanization (CIU) and generalized linear model was used to analyze the influence of CIU on the incidence rate of respiratory infectious diseases.ResultsTotally 72616 NRIDs cases were reported in Tongzhou District during 2014−2022, and the incidence rate of NRIDs was higher during 2017-2019 (153/100 000) than during 2014-2016 (930/100 000) and during 2020-2022 (371/100 000), respectively (both P<0.001). The CIU constantly increased with slight fluctuation in 2016 and 2018, respectively. The incidence rate of NRIDs showed an increase along with the CIU during 2014−2019 (r=0.95, P=0.004), while the incidence rate’s tendency was interrupted by COVID-19 during 2020 with slight decrease in 2020 to 2021 and rebounded in 2022. For the patients aged <15 years, the incidence rate of NRIDs revealed a very sharp rise at the urbanization period without COVID-19 pandemic compared with that under pre-urbanization period (RR=7.93, 95% CI 7.63−8.24), and dropped off to the similar level as of pre-urbanization period when COVID-19 pandemic spread.ConclusionsUrbanization process may increase the incidence of NRIDs but constrained by COVID-19. Certain measures should be taken to prevent and control the effects by urbanization process, such as good natural environment with less population density, ecological environment with good air quality, promoted hand hygiene, mask wearing, keeping interpersonal distance, vaccination, media publicity for NRIDs’ prevention and control.

A thorough and precise comprehension understanding of the HIV epidemic is crucial for effective HIV prevention and control. This study aimed to update the estimates of the overall HIV burden in China in 2018 and to assess the trends of HIV prevalence, incidence, and mortality from 1985 to 2018. The Estimation and Projection Package (EPP)/Spectrum software was utilized for estimation, a method highly recommended by UNAIDS. Data were collected from more than 1800 HIV sentinel surveillance sites, population-based seroprevalence surveys, and HIV screening of antenatal clinics and pre-marital medical check-ups across the country. Assumptions about age and sex were used to adapt the parameters of disease progression, including CD4 progression rates and mortality rates for individuals on and off antiretroviral therapy (ART). Joinpoint (version 4.7.0.0) was used to analyze the trends of prevalence, incidence, mortality, and fatality rates from 1985 to 2018. In 2018, the total number of people living with HIV (PLWH) adults in China was estimated to be 1.23 million, corresponding to approximately 106.5/100 000 in the country. A total of 71.8% of adult PLWH were men. Over half of PLWH (58.6%) were infected through heterosexual contact, about one-third (30.2%) through male-to-male transmission, 9.0% through IDU, and 2.3% due to former plasma donation. HIV incidence in adults reached its first small peak in 1992 with 52 400 new infections (95% confidence interval: 2700-920 000). After a brief period of rapid decline between 1992 and 1994, the annual number of new infections among adults increased again and remained relatively stable at 81 000 (95% uncertainty interval [UI]: 60 000-105 000) in 2018. In recent years, the number of new infections through blood donation has been eliminated, and the number of infections through injecting drug use has been kept low. Sexual contact became the predominant transmission route, while casual sexual contact became increasingly common. Overall, HIV mortality has been steadily increasing and has recently begun to decline during the period of 2012-2018. The number of deaths from HIV/AIDS in 2018 was approximately 35 000 (95% UI: 30 000-41 000). The number of estimated PLWH in China has exceeded one million, due to the ongoing occurrence of new infections and longer survival rates. HIV transmission through blood products has been eradicated. Casual sex has become a significant mode of transmission. It is recommended to enhance the implementation of strategies and measures for sexual communication in the general population and to bolster multidisciplinary research.

Objective This study aimed to examine the characteristics of Group A Streptococcus (GAS) infection and identify the emm genotypes and the superantigen gene of GAS strains isolated from children from 2011 to 2019 in Tongzhou District, Beijing. Methods Pharyngeal swab samples from children with scarlet fever or pharyngeal infection were collected and tested for GAS. In GAS isolates, emm genotypes and superantigen genes were identified. Logistic regression models were used to explore the correlations between demographic characteristics, clinical manifestations, and GAS infection. Results In total, 172/1,214 (14.2%) GAS were isolated. The GAS infection rate in children with scarlet fever was 47.5%, higher than 8.5% in children with pharyngeal infection (p < 0.001). The risk of GAS infection was associated with oral mucosal congestion in children with scarlet fever, and older age, tonsillitis, and rash in children with pharyngeal infection. Seven emm genotypes were detected in 164 GAS isolated strains, of which emm12 and emm1 accounted for 47.0 and 46.3%, respectively. Among 112 GAS isolates, the top 5 detection rates of superantigen genes were speF 100.0%, speG 100.0%, speB 98.2%, speC 94.6%, and smeZ 82.1%. Higher proportions of speA, speJ, and speK were detected in emm1 isolates, while speH and speI were more common in emm12 isolates (p < 0.001). Conclusion The changing predominant type expanded the knowledge of the circulating emm types, which should be considered in future vaccine development.

Background This study aimed to describe the temporal trends in the age and sex burdens of lower respiratory infections (LRIs) in China and globally from 1990 to 2021 and to analyze their epidemiological characteristics to formulate corresponding strategies to control LRIs.Methods This study utilized open data from the Global Burden of Disease (GBD) database from 1990 to 2021 to assess the burden of disease based on the prevalence, incidence, mortality, years lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of LRIs in China and globally. Moreover, a comprehensive comparative analysis of the epidemiological characteristics of LRIs in China and globally was conducted via the Joinpoint regression model, age-period-cohort model (APC model), and stratified analysis of the study method from multiple dimensions, such as age, sex, and period. Finally, we used an autoregressive integrated moving average (ARIMA) model to predict the disease burden in LRIs over the next 15 years.Results From 1990 to 2021, China's age-standardized incidence, deaths, and disability-adjusted life year (DALY) rates per 100,000 people decreased from 5,481.13 (95% CI: 5,149.05, 5,836.35) to 2,853.81 (95% CI: 2,663.94, 3,067.55), from 60.65 (95% CI. 52.96, 66.66) to 14.03 (95% CI: 11.68, 17) and from 3,128.39 (95% CI: 2,724.11, 3,579.57) to 347.67 (95% CI: 301.28, 402.94). The global age-standardized incidence, deaths, and DALY rates per 100,000 people, on the other hand, decreased from 6,373.17 (95% CI: 5,993.51, 6,746.04) to 4,283.61 (95% CI: 4,057.03, 4,524.89) and from 61.81 (95% CI: 56.66, 66.74) to 28.67 (95% CI: 25.92, 31.07) and from 3,472.9 (95% CI: 3,090.71, 3,872.11) to 1,168.8 (95% CI: 1,016.96, 1,336.95). The decline in the aforementioned indicators is greater in the female population than in the male population, and the decrease in China is more pronounced than the global trend. In China, the age-standardized incidence and mortality rates of LRIs showed an annual average percentage change (AAPC) of -2.12 (95% CI: -2.20, -2.03) and -4.77 (95% CI: -5.14, -4.39), respectively. Globally, the age-standardized incidence and mortality rates for LRIs decreased by -1.28 (95% CI: -1.37, -1.18) and -2.47 (95% CI: -2.61, -2.32). By 2036, the incidence of lower respiratory infections (LRI) among men and women in China is projected to decrease by 36.55 and 46.87%, respectively, while the mortality rates are expected to decline to 12.67% for men and increase by 71.85% for women. In comparison, the global decline in LRI incidence is lower than that observed in China, yet the reduction in mortality rates is greater globally than in China.Conclusions Age-standardized incidence, mortality and disability-adjusted life years (DALYs) decreased more in China than at the global level between 1990 and 2021. Compared with the previous period, the COVID-19 pandemic has led to a significant decrease in the disease burden of LRIs. As the population continues to age, the disease burden of LRIs in the old adult population will become a major new public health challenge.

In this study, we analyzed the dynamic molecular epidemiology of herpangina based on pharyngeal swabs and demographic data collected from children with herpangina monitored in Tongzhou district in China from January 2021 to December 2022. A total of 1022 herpangina cases were diagnosed. Out of 225 samples collected, 56.4% (127/225) were positive for non-polio enterovirus, with seven genotypes identified: coxsackievirus A4 (CV-A4), CV-A6, CV-A10, CV-A2, CV-A16, CV-B3, and CV-A8. The predominant genotypes associated with herpangina changed during and after the COVID-19 pandemic, with the predominant genotypes being CV-A4 and CV-A6 in 2021 and CV-A10 and CV-A6 in 2022.

This study aimed to explore the association between air pollutants and outpatient visits for influenza-like illnesses (ILI) under the coronavirus disease 2019 (COVID-19) stage in the subcenter of Beijing. The data on ILI in the subcenter of Beijing from January 1, 2018 to December 31, 2020 were obtained from the Beijing Influenza Surveillance Network. A generalized additive Poisson model was applied to examine the associations between the concentrations of air pollutants and daily outpatient visits for ILI when controlling meteorological factors and temporal trend. A total of 171 943 ILI patients were included. In the pre-coronavirus disease 2019 (COVID-19) stage, an increased risk of ILI outpatient visits was associated to a high air quality index (AQI) and the high concentrations of particulate matter less than 2.5 (PM2.5 ), particulate matter 10 (PM10 ), sulphur dioxide (SO2 ), nitrogen dioxide (NO2 ), and carbon monoxide (CO), and a low concentration of ozone (O3 ) on lag0 day and lag1 day, while a higher increased risk of ILI outpatient visits was observed by the air pollutants in the COVID-19 stage on lag0 day. Except for PM10 , the concentrations of other air pollutants on lag1 day were not significantly associated with an increased risk of ILI outpatient visits during the COVID-19 stage. The findings that air pollutants had enhanced immediate effects and diminished lag-effects on the risk of ILI outpatient visits during the COVID-19 pandemic, which is important for the development of public health and environmental governance strategies.

Air pollutants can cause serious harm to human health and a variety of respiratory diseases. This study aimed to explore the associations between air pollutants and outpatient visits for influenza-like illness (ILI) under urbanization process in the sub-center of Beijing. The data of ILI in sub-center of Beijing from April 1, 2014 to December 31, 2020 were obtained from Beijing Influenza Surveillance Network. A generalized additive Poisson model was applied to examine the associations between the concentrations of air pollutants and daily outpatient visits for ILI when controlling meteorological factors and holidays. A total of 322,559 patients with ILI were included. The results showed that in the early urbanization period, the effects of PM2.5, PM10, SO2, O3, and CO on lag0 day, and PM2.5, PM10, O3, and CO on lag1 day were not significant. In the later urbanization period, AQI and the concentrations of PM2.5, PM10, SO2, NO2 and CO on lag1 day were all significantly associated with an increased risk of outpatient visits for ILI, which increased by 0.34% (95%CI 0.23%, 0.45%), 0.42% (95%CI 0.29%, 0.56%), 0.44% (95%CI 0.33%, 0.55%), 0.36% (95%CI 0.24%, 0.49%), 0.91% (95%CI 0.62%, 1.21%) and 0.38% (95%CI 0.26%, 0.49%). The concentration of O3 on lag1 day was significantly associated with a decreased risk of outpatient visits for ILI, which decreased by 0.21% (95%CI 0.04%, 0.39%). We found that the urbanization process had significantly aggravated the impact of air pollutants on ILI outpatient visits. These findings expand the current knowledge of ILI outpatient visits correlated with air pollutants under urbanization process.

Background:The changing pattern of pathogen spectrum causing herpangina in the time of coronavirus disease 2019 (COVID-19) pandemic was unknown. The purpose of this study was to investigate the changes on the molecular epidemiology of herpangina children during 2019-2020 in Tongzhou district, Beijing, China.Method:From January 2019 to December 2020, children diagnosed with herpangina were recruited by the staff from Tongzhou Center for Disease Control and Prevention (CDC) in Beijing. Viral RNA extraction from pharyngeal swabs was used for enterovirus (EV) detection and the complete VP1 gene was sequenced. The phylogenetic analysis was performed based on all VP1 sequences for EV genotypes.Result:A total of 1,331 herpangina children were identified during 2019-2020 with 1,121 in 2019 and 210 in 2020, respectively. The predominant epidemic peak of herpangina children was in summer and autumn of 2019, but not observed in 2020. Compared to the number of herpangina children reported in 2019, it decreased sharply in 2020. Among 129 samples tested in 2019, 61 (47.3%) children were detected with EV, while 22.5% (20/89) were positive in 2020. The positive rate for EV increased since June 2019, peaked at August 2019, and decreased continuously until February 2020. No cases were observed from February to July in 2020, and the positive rate of EV rebounded to previous level since August 2020. Four genotypes, including coxsackievirus A6 (CV-A6, 9.3%), CV-A4 (7.8%), CV-A10 (2.3%) and CV-A16 (10.1%), were identified in 2019, and only three genotypes, including CV-A6 (9.0%), CV-A10 (6.7%) and CV-A16 (1.1%), were identified in 2020. The phylogenetic analysis showed that all CV-A6 strains from Tongzhou located in Group C, and the predominant strains mainly located in C2-C4 subgroups during 2016-2018 and changed into C1 subgroup during 2018-2020. CV-A16 strains mainly located in Group B, which consisting of strains widely distributed around the world.Conclusions:The predominant genotypes gradually shifted from CV-A16, CV-A4 and CV-A6 in 2019 to CV-A6 in 2020 under COVID-19 pandemic. Genotype-based surveillance will provide robust evidence and facilitate the development of public health measures.

BackgroundThis study aimed to evaluate HIV incidence, factors associated with HIV incidence and transmitted drug resistance (TDR) among newly infected men who have sex with men (MSM) in Harbin, P.R. China. MethodsA cohort study was conducted among MSM in Harbin during 2013 and 2018, with a follow-up frequency of every 6 months. Blood samples from MSM were tested for HIV antibodies, RNA was extracted from plasma, and the pol gene was sequenced, and genotypic drug-resistance analyses were performed. ResultsFrom 2013 to 2018, the overall rate of HIV incidence was 3.55/100 PY. Syphilis infection, unprotected sex with men in the past 6 months, and unawareness of HIV/AIDS knowledge were risk factors for HIV seroconversion. The distribution of HIV genotypes was as follows: CRF01_AE, 57.1%; CRF07_BC, 28.5%; CRF55_01B, 2.0%; B, 8.2%. The prevalence of transmitted drug resistance was 4.08%. ConclusionHIV incidence in MSM in Harbin is moderately high, and transmitted drug resistance exists in the population.

Influenza-like illness (ILI) varies in intensity year by year, generally keeping a stable pattern except for great changes of its epidemic pattern. Of the most impacting factors, urbanization has been suggested as shaping the intensity of influenza epidemics. Besides, growing evidence indicates the nonpharmaceutical interventions (NPIs) to severe acute respiratory syndrome coronavirus 2 offer great advantages in controlling infectious diseases. The present study aimed to evaluate the impact of urbanization and NPIs on the dynamic of ILI in Tongzhou, Beijing, during January 2013 to March 2021. ILI epidemiological surveillance data in Tongzhou district were obtained from Beijing Influenza Surveillance Network and separated into three periods of urbanization and four intervals of coronavirus disease 2019 pandemic. Standardized average incidence rates of ILI in each separate stages were calculated and compared by using Wilson method and time series model of seasonal ARIMA. Influenza seasonal outbreaks showed similar epidemic size and intensity before urbanization during 2013-2016. Increased ILI activity was found during the process of Tongzhou's urbanization during 2017-2019, with the rate difference of 2.48 (95% confidence interva [CI]: 2.44, 2.52) and the rate ratio of 1.75 (95% CI: 1.74, 1.76) of ILI incidence between preurbanization and urbanization periods. ILI activity abruptly decreased from the beginning of 2020 and kept at the bottom level almost in every epidemic interval. The top decrease in ILI activity by NPIs was shown in 5-14 years group in 2020-2021 influenza season, as 92.2% (95% CI: 78.3%, 95.2%). The results indicated that both urbanization and NPIs interrupted the epidemic pattern of ILI. We should pay more attention to public health when facing increasing population density, human contact, population mobility, and migration in the process of urbanization. NPIs and influenza vaccination should be implemented as necessary measures to protect people from common infectious diseases like ILI.

Hand, foot, and mouth disease (HFMD) is an infectious disease that usually occurs in children under 5 years and is caused by a group of enteroviruses. This study aimed to investigate the epidemiological characteristics of HFMD clusters from 2016 to 2020 in Tongzhou, Beijing, and explored the genetic evolution of CV-A6. The HFMD case information came from the Information System of China Center for Disease Control and Prevention (CDC), as well as the clusters information verification and on-site investigation by Tongzhou CDC. ARIMA model was applied to forecast HFMD clusters in 2020. Totally 440 HFMD clusters were reported during 2016-2020. The large peak of the clusters occurred in April-July, followed by a smaller peak in October-November during 2016-2019. However, in 2020, the two peaks disappeared. The main site of HFMD clusters was childcare facilities (65.0%) and mostly occurred in urban areas (46.1%). The detection rate of CV-A6 was the highest (36.1%), and cases with CV-A6 infection had the highest proportion of fever. The phylogenetic analysis based on CV-A6 VP1 gene showed that the predominant strains mainly located in Group F during 2016-2017, while changed into Group A during 2018-2020. HFMD clusters presented seasonality, mainly located in childcare facilities and urban areas, and CV-A6 was the major causative agent. Targeted prevention and control measures should be taken to reduce HFMD clusters.

BACKGROUND:Little is known about suicide mortality among people with HIV in low-income and middle-income countries. This study aimed to assess suicide mortality and its temporal change among people with HIV after diagnosis, then describe potential risk factors. METHODS:This nationwide, population-based cohort study used data from the China Information System for Disease Control and Prevention (CISDCP), which continually enrolled people diagnosed with HIV in mainland China. We included all people with HIV diagnosed between Jan 1, 2012, and Dec 31, 2018, who were aged 15 years or older at diagnosis. Follow-up started from the date of HIV diagnosis to the date of death, date of last follow-up visit, or Dec 31, 2018, whichever came first. Crude suicide mortality was calculated as the number of suicide deaths divided by person-years at risk in 2012-18 and compared by time after HIV diagnosis. Standardised mortality ratios (SMRs) were used to compare the relative risk of suicide deaths in people with HIV with the general population. We compared the trends of suicide mortality across three diagnosis year groups (2012-13, 2014-15, and 2016-18) using cumulative incidence curve of suicide. Competing-risk models were used to explore the potential risk factors of suicide. FINDINGS:770 656 people diagnosed with HIV were included in the CISDCP database, 763 287 of whom were aged 15 years or older at diagnosis and had follow-up information available. During follow-up, 2825 (2·0%) of 144 729 all-cause deaths were due to suicide, with a mortality of 142·8 deaths by suicide per 100 000 person-years (95% CI 137·7-148·2). People with HIV were at an increased risk of suicide compared with the general population (SMR 20·9 [95% CI 20·2-21·7]). The greatest risk was during the first 3 months after diagnosis (SMR 98·1 [93·1-103·4]), which then decreased but was still elevated after the first year (SMR 9·2 [8·5-9·8]). Late diagnosis and never on antiretroviral therapy were independent risk factors for suicide. INTERPRETATION:Suicide mortality decreased during the study period, which coincided with improvement in access to care and treatment coverage. This study suggests the importance of targeted suicide prevention for people with HIV throughout the course of diagnosis and that the focus of efforts should be concentrated on the first 3 months after diagnosis. Our findings highlight the urgent need to integrate suicide screening and prevention in HIV care. FUNDING:Young Scholar Scientific Research Foundation of National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention. TRANSLATION:For the Chinese translation of the abstract see Supplementary Materials section.

What is already known about this topic?The annual rates of newly diagnosed cases of human immunodeficiency virus (HIV) are increasing in China, yet the annual number of newly diagnosed cases of HIV infected through injection drug use (IDU) is decreasing.What is added by this report?Newly diagnosed cases of HIV infected through IDU in China from 2012 to 2019 show decreases year over year, but the risk of new infections through injecting drugs still exists.What are the implications for public health practice?This study highlighted that new HIV infections through IDU continue to be at a low level. However, individuals that are newly diagnosed as HIV-positive through IDU need to have their baseline CD4 T+ lymphocytes (CD4) cell counts monitored and have their sources of infections traced.

An ongoing outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread in the world, whereas asymptomatic carriers may also play a critical role in the pandemic. We report a familial cluster of COVID-19 caused by one family member before his onset of illness, indicating that it seems to be potentially infectious during the incubation period, even earlier than we expected. Close contact, especially in a small enclosed space, might be the cause of familial transmission. The unsynchronized changes in the clinical symptoms and COVID-19 nucleic acid were found in this case, so consecutive nucleic acid detection of pretty suspected cases was recommended. Family members, especially of whom the confirmed cases contacted with since one incubation period before onset rather than 2 days before onset, should be regarded as close contact and centrally isolated in case of asymptomatic infection already existed in the family.

We report three clusters related with potential pre-symptomatic transmission of coronavirus disease (COVID-19) between January and February 2020 in Shanghai, China. Investigators interviewed suspected COVID-19 cases to collect epidemiological information, including demographic characteristics, illness onset, hospital visits, close contacts, activities' trajectories between 14 days before illness onset and isolation, and exposure histories. Respiratory specimens of suspected cases were collected and tested for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) assay. The interval between the onset of illness in the primary case and the last contact of the secondary case with the primary case in our report was 1 to 7 days. In Cluster 1 (five cases), illness onset in the five secondary cases was 2 to 5 days after the last contact with the primary case. In Cluster 2 (five cases) and Cluster 3 (four cases), the illness onset in secondary cases occurred prior to or on the same day as the onset in the primary cases. The study provides empirical evidence for transmission of COVID-19 during the incubation period and indicates that pre-symptomatic person-to-person transmission can occur following sufficient exposure to confirmed COVID-19 cases. The potential pre-symptomatic person-to-person transmission puts forward higher requirements for prevention and control measures.

Background Herpangina is a highly infectious disease, which is usually prevalent in preschool children. Methods This study analyzed the clinical and pathogenic characteristics of herpangina children to demonstrate the epidemiology of herpangina. Clinical manifestations, laboratory indicators and pharyngeal swabs were collected from children with herpangina who were monitored by Tongzhou Center for Disease Control and Prevention in Beijing, 2008. Utilizing pharyngeal swabs, virus extraction and amplification were performed for nucleotide identification and sequencing. The phylogenetic analysis was conducted based on all sequences amplified in this study and strains retrieved from GenBank. Results Among 190 children with herpangina, 69.0% (131/190) were positive for enterovirus. Eight genotypes were identified, mainly including CV-A6 (39/131), CV-A4 (25/131), CV-A10 (24/131). The phylogenetic analysis showed one CV-A6 strain of Tongzhou was imported from Japan. CV-A10 strains were clustered into five groups (A-E). The dominant cluster of CV-A10 was Group E6 between 2009 and 2013, and converted to Group E5 after 2013. CV-A6 was the predominant pathogen causing herpangina in Tongzhou in 2018, followed by CV-A4 and CV-A10. Conclusions The circulation of coxsackievirus had spatiotemporal cluster. In controlling the transmission of herpangina, the surveillance and reporting system should be enhanced.