Xincai Xiao

Emergence of dengue virus 4 genotype II in Guangzhou, China, 2010: Survey and molecular epidemiology of one community outbreak

BackgroundThe re-emergence of dengue virus 4 (DENV-4) has become a public health concern in South America, Southeast Asia and South Asia. However, it has not been known to have caused a local outbreak in China for the past 20 years. The purpose of this study was to elucidate the epidemiology of one local community outbreak caused by DENV-4 in Guangzhou city, China, in 2010; and to determine the molecular characteristics of the genotype II virus involved.Case presentationsDuring September and October of 2010, one imported case, a Guangzhou resident who travelled back from Thailand, resulted in 18 secondary autochthonous cases in Guangzhou City, with an incidence rate of 5.53 per 10,000 residents. In indigenous cases, 14 serum samples tested positive for IgM against DENV and 7 for IgG from a total of 15 submitted serum samples, accompanied by 5 DENV-4 isolates. With identical envelope gene nucleotide sequences, the two isolates (D10168-GZ from the imported index case and Guangzhou 10660 from the first isolate in the autochthonous cases) were grouped into DENV-4 genotype II after comparison to 32 previous DENV-4 isolates from GenBank that originated from different areas.ConclusionsBased on epidemiological and phylogenetic analyses, the outbreak, which was absent for 20 years after the DENV-4 genotype I outbreak in 1990, was confirmed as DENV-4 genotype II and initially traced to the imported index case, a Guangzhou resident who travelled back from Thailand.

Detection of avian influenza A(H7N9) virus from live poultry markets in Guangzhou, China: a surveillance report.

Purpose A virologic surveillance program for A(H7N9) virus was conducted from April 15, 2013 to February 14, 2014 in Guangzhou, aiming to clarify the geographical distribution of A(H7N9) viruses among live poultry markets (LPMs) and poultry farms in Guangzhou. Virological and serological surveys of poultry workers were also conducted to evaluate the risk of poultry-to-human transmission of the A(H7N9) virus. Methods 36 retail LPMs, 6 wholesale LPMs and 8 poultry farms were involved in our surveillance program. About 20 live poultry and environmental samples were obtained from each surveillance site at every sampling time. Different environmental samples were collected to represent different poultry-related work activities. RT-PCR and virus culture were performed to identify the A(H7N9) virus. Hemagglutinin inhibition assay and RT-PCR were conducted to detect possible A(H7N9) infection among poultry workers. Results A total of 8900 live poultry and environmental samples were collected, of which 131(1.5%) were tested positive for A(H7N9) virus. 44.4% (16/36) of retail LPMs and 50.0% (3/6) of wholesale LPMs were confirmed to be contaminated. No positive samples was detected from poultry farms. A significant higher positive sample rate was found in environmental samples related to poultry selling (2.6%) and slaughtering (2.4%), compared to poultry holding (0.9%). Correspondingly, A(H7N9) viruses were isolated most frequently from slaughter zone. In addition, 316 poultry workers associated with the 19 contaminated-LPMs were recruited and a low seroprevalence (1.6%) of antibody against A(H7N9) virus was detected. An asymptomatic A(H7N9) infection was also identified by RT-PCR. Conclusions Our study highlights the importance of conducting effective surveillance for A(H7N9) virus and provides evidence to support the assumption that slaughtering is the key process for the propagation of A(H7N9) virus in retail LPMs. Moreover, the ability of A(H7N9) virus to cross species barrier is proved to be still limited.

Rapid increase of scrub typhus: an epidemiology and spatial-temporal cluster analysis in Guangzhou City, Southern China, 2006-2012.

Background Scrub typhus has been increasingly reported in Southern China, and public health authorities are concerned about its increased incidence. Additionally, little evidence is available on the epidemiology of scrub typhus in Southern China. This study aims to analyze the epidemiological and geographic features of ST in Guangzhou City, Southern China, to guide the future prevention efforts. Methods Scrub typhus surveillance data in Guangzhou City during 2006–2012 were obtained from the Chinese National Communicable Disease Surveillance Network. We first conducted a descriptive analysis to analyze the epidemiological features of scrub typhus. Then we used space-time scan statistic based on a discrete Poisson model to detect and evaluate high-risk spatial-temporal clusters of scrub typhus. Results There were 4,001 cases of scrub typhus in Guangzhou City during the study period. The incidence of scrub typhus increased from 3.29 per 100,000 in 2006 to 9.85 per 100,000 in 2012. A summer peak was observed in June and July with a second peak in September and October except year 2009 and 2011. The majority of the cases (71.4%) were among persons aged ≥40 years, and female incidence was higher than male incidence in persons ≥50 years. In the space-time analysis, high-risk clusters were concentrated in rural areas in Guangzhou City. Over the past 7 years, Haizhu District, an urban area, was found to be a high-risk cluster for the first time in 2012. Conclusion The resurgence of scrub typhus epidemics in Guangzhou population in 2012 necessitates more effective measures for minimizing future epidemics. Consideration of high-risk population and historical spatial-temporal clusters may help prevent scrub typhus. The risk of scrub typhus in urban areas should not be neglected and needs more attention from public health authorities.

Transmission of avian influenza A(H7N9) virus from father to child: a report of limited person-to-person transmission, Guangzhou, China, January 2014.

We investigated a possible person-to-person transmission within a family cluster of two confirmed influenza A(H7N9) patients in Guangzhou, China. The index case, a man in his late twenties, worked in a wet market that was confirmed to be contaminated by the influenza A(H7N9) virus. He developed a consistent fever and severe pneumonia after 4 January 2014. In contrast, the second case, his five-year-old child, who only developed a mild disease 10 days after disease onset of the index case, did not have any contact with poultry and birds but had unprotected and very close contact with the index case. The sequences of the haemagglutinin (HA) genes of the virus stains isolated from the two cases were 100% identical. These findings strongly suggest that the second case might have acquired the infection via transmission of the virus from the sick father. Fortunately, all 40 close contacts, including the other four family members who also had unprotected and very close contact with the cases, did not acquire influenza A(H7N9) virus infection, indicating that the person-to-person transmissibility of the virus remained limited. Our finding underlines the importance of carefully, thoroughly and punctually following-up close contacts of influenza A(H7N9) cases to allow detection of any secondary cases, as these may constitute an early warning signal of the viruss increasing ability to transmit from person-to-person.

Asymptomatic, Mild, and Severe Influenza A(H7N9) Virus Infection in Humans, Guangzhou, China

Targeted surveillance for influenza A(H7N9) identified 24 cases of infection with this virus in Guangzhou, China, during April 1, 2013-March 7, 2014. The spectrum of illness ranged from severe pneumonia to asymptomatic infection. Epidemiologic findings for 2 family clusters of infection highlight the importance of rigorous close contact monitoring.

Influenza associated mortality in Southern China, 2010-2012.

OBJECTIVE Influenza caused substantial morbidity and mortality worldwide. The mortality burden caused by influenza has been under evaluation; however, data assessing this burden have been relatively sparse in tropical or subtropical regions. We estimated influenza-associated mortality in Guangzhou, China and assessed the excess mortality due to different influenza virus subtypes. METHODS We estimated influenza-associated excess mortality due to all-cause, pneumonia and influenza, cardiorespiratory disease and other influenza-associated diagnoses from weekly numbers of deaths and influenza surveillance data through negative binomial regression model during 2010-2012. RESULTS Estimates derived from the model indicated that influenza resulted in 14.72 (95% confidence interval (CI), 12.12-17.31) deaths per 100,000 population per year from all-cause death among all ages group. Most deaths (84.2%) occurred among people aged ≥65 years. B virus caused 5.84 (95%CI, 4.10-7.58) deaths per 100,000 population for all-cause death, which was higher than A (H3N2) (4.89, 95%CI, 3.19-6.59) or A(H1N1)pdm09 (3.99, 95%CI, 2.32-5.66). CONCLUSIONS Influenza is responsible for a substantial mortality especially among people aged ≥65 years and influenza B virus caused the highest influenza-associated mortality. The results highlight the need for seasonal influenza vaccination programs in subtropical areas to decrease excess mortality.

A city park as a potential epidemic site of scrub typhus: a case–control study of an outbreak in Guangzhou, China

BackgroundScrub typhus is an important public health problem in China, especially in Guangzhou city. Typical outbreaks of scrub typhus have been previously reported in rural areas, affecting mainly farmers. We describe an atypical outbreak of the disease with case fatalities, from a park in Haizhu District, Guangzhou, that could turn out to be a potential scrub typhus epidemic site.MethodsFrom May 2012 to June 2012, a case–control study was conducted to identify source and risk factors of this outbreak. Reported cases of scrub typhus in Xiaogang Park were confirmed by Weil–Felix test or a nested polymerase chain reaction (NPCR). Controls were matched with their neighbors by gender and age. Multivariate conditional logistic regression was used to identify risk factors and protective factors.ResultsA total of 29 cases were confirmed by Weil–Felix test, including 4 deaths by both Weil–Felix test and NPCR. All patients presented with fever (100%), while 28 (96.6%) cases had eschars, 10 (34.5%) headache, 10 (34.5%) chills, 6 (20.7%) lymphadenopathy, 5 (17.2%) rash, 2 (6.9%) vomiting and 1 (3.5%) presented with conjunctival congestion. The proportion of cases with activity history in Xiaogang Park was much higher than the control group (72.4% vs 24.1%, P < 0.001), and morning exercise in park or field was also as a risk factor for scrub typhus (adjusted OR = 3.0, 95% CI: 1.1 - 8.2). Four factors were significantly associated with the risk of developing scrub typhus: sitting on the lawn (adjusted OR = 8.0, 95% CI: 1.4 - 44.5), close contact with rats (adjusted OR = 3.3, 95% CI: 1.2 -9.6), sitting near the rat holes (OR = 6.8, 95% CI: 1.2 - 38.1) and wearing long-sleeved clothing when outside (adjusted OR = 0.3, 95% CI: 0.1 - 0.7).ConclusionsWe confirmed an atypical outbreak of scrub typhus in a park in Guangzhou city, which has the potential to develop into an important epidemic site. This public health risk should not be neglected and requires more attention from authorities.

Identification of Aedes albopictus larval index thresholds in the transmission of dengue in Guangzhou, China.

ABSTRACT: Entomological indices have been used to quantitatively express vector density, but the threshold of larval indices of Aedes albopictus in dengue epidemics is still undefined. We conducted a case-control study to identify the thresholds of Aedes albopictus larval indices in dengue epidemics. Two unit levels of analysis were used: district and street. The discriminative power of the indices was assessed by receiver operating characteristic (ROC) curves. The association between the entomologic indices and dengue transmission was further explored by a logistic regression model. At the district level, there was no significant difference in the Breteau index (BI) between districts that reported cases and those did not (t=0.164, p>0.05), but the Container index (CI) did show a significant difference (t=2.028, p<0.01). The AUC (Area Under the Curve) of BI, CI, and prediction value were 0.540, 0.630, and 0.533, respectively. Predicting at the street level, the AUC of BI, CI, and prediction values were 0.684, 0.660, and 0.685, respectively, and 0.861, 0.827, and 0.867 for outbreaks. BI=5.1, CI=5.4, or prediction value =0.491were suggested to control the epidemic efficiently with the fewest resources, where BI=4.0, CI=5.1, or PRE =0.483 were suggested to achieve effectiveness.

Clinical and epidemiological characteristics of a patient infected with H5N6 avian influenza A virus

• We reported the case of the first patient worldwide to survive an infection with influenza A (H5N6) virus.

Evolutionary and phylodynamic analyses of Dengue virus serotype I in Guangdong Province, China, between 1985 and 2015

To determine the evolutionary and phylodynamic history of DENV-1 in Guangdong, the strains detected between 1985 and 2015 were determined with phylogenetic and Bayesian analyses of the E gene. Three DENV-1 genotypes (I, V, and VI) were circulating in Guangdong, and genotype I was detected most frequently. The evolutionary rate of DENV-1 was estimated to be 1.03 × 10-3 nucleotide substitutions/site/year. The most recent ancestor of the viruses existed approximately 141 years ago. The observed epidemiological dynamics correlated with similar fluctuations in diversity, and the epidemiological dynamics of DENV-1 transmission reflect dramatic changes in the viral population sizes. Two recombination events were identified in those strains. The selection pressures were estimated and revealed an abundance of negatively selected sites but few positively selected sites. These data improve our understanding of the evolution and molecular epidemiology of DENV-1 and provide insights that will facilitate the surveillance and control of DENV-1.