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1.  Occurrence and Reassortment of Avian Influenza A (H7N9) Viruses Derived from Coinfected Birds in China 
Journal of Virology  2014;88(22):13344-13351.
Over the course of two waves of infection, H7N9 avian influenza A virus has caused 436 human infections and claimed 170 lives in China as of July 2014. To investigate the prevalence and genetic diversity of H7N9, we surveyed avian influenza viruses in poultry in Jiangsu province within the outbreak epicenter. We found frequent occurrence of H7N9/H9N2 coinfection in chickens. Molecular clock phylogenetic analysis confirms coinfection by H7N9/H9N2 viruses and also reveals that the identity of the H7N9 outbreak lineage is confounded by ongoing reassortment between outbreak viruses and diverse H9N2 viruses in domestic birds. Experimental inoculation of a coinfected sample in cell culture yielded two reassortant H7N9 strains with polymerase segments from the original H9N2 strain. Ongoing reassortment between the H7N9 outbreak lineage and diverse H9N2 viruses may generate new strains with the potential to infect humans, highlighting the need for continued viral surveillance in poultry and humans.
IMPORTANCE We found frequent occurrence of H7N9/H9N2 coinfection in chickens. The H7N9 outbreak lineage is confounded by ongoing reassortment between H7N9 and H9N2 viruses. The importance of H9N2 viruses as the source of novel avian influenza virus infections in humans requires continuous attention.
PMCID: PMC4249101  PMID: 25210174
2.  Avian Influenza A(H7N9) Virus Antibodies in Close Contacts of Infected Persons, China, 2013–2014 
Emerging Infectious Diseases  2015;21(4):709-711.
PMCID: PMC4378467  PMID: 25811885
subtype H7N9 virus; influenza A(H7N9) virus; H7N9; influenza; avian influenza; viruses; human-to-human transmission; human; close contacts; seroepidemiology; China
3.  Babesia venatorum Infection in Child, China 
Emerging Infectious Diseases  2014;20(5):896-897.
PMCID: PMC4012784  PMID: 24751126
Babesia venatorum; parasites; protozoa; human infection; child; ticks; zoonoses; China
4.  Human Infections with Rickettsia raoultii, China 
Emerging Infectious Diseases  2014;20(5):866-868.
We used molecular methods to identify Rickettsia raoultii infections in 2 persons in China. These persons had localized rashes around sites of tick bites. R. raoultii DNA was detected in 4% of Dermacentor silvarum ticks collected in the same area of China and in 1 feeding tick detached from 1 patient.
PMCID: PMC4012798  PMID: 24750663
Rickettsia raoultii; rickettsia; human infections; ticks; Dermacentor silvarum; vector-borne infections; China
5.  Epidemiology of human adenovirus and molecular characterization of human adenovirus 55 in China, 2009–2012 
Human adenovirus 55 (HAdV-55) has caused recent outbreaks of acute respiratory disease (ARD) among adults and military trainees. The active surveillance for HAdV infections was sparse in China, and current knowledge on the HAdV-type distributions and its molecular evolution is lacking.
To acquire better understanding on the prevalence and molecular evolution of HAdV-55 strains in China, for an informed strategy for disease control and prevention.
Nasopharyngeal aspirates were collected from hospitalized children with ARTI in Chongqing during 2009–2012. The genotype of HAdV isolates were determined by sequencing the partial hexon and fiber genes. Whole genome sequences of HAdV-55 were obtained for molecular evolution analysis.
About 191 (8·55%) HAdV were detected in 2234 children, including 92 (48·2%) with HAdV-7, 72 (37·7%) with HAdV-3, 6 (3·1%) with HAdV-55, 5 (2·6%) with HAdV-5, 4 (2·1%) with HAdV-1, 1 (0·5%) with HAdV-2, and 11(5·8%) with untyped HAdV. Four of these children developed pneumonia, two of whom were diagnosed with severe pneumonia and/or encephalopathy. HAdV-55 isolates clustered with HAdV-11 sequences based on the hexon gene and clustered with HAdV-14 sequences based on the fiber gene and the whole genome. The overall evolutionary rates of hexon gene, fiber gene, and whole genome of HAdV-55 were estimated at 6·2 × 10−5 s/s/y, 8·0 × 10−5 s/s/y, and 1·7 × 10−5 s/s/y, respectively.
This study suggested HAdV-55 as an emerging infectious disease pathogen has conserved genetic structure and is closely related to each other. Further molecular investigation based on HAdV-55 of wider origin might facilitate understanding its diversity, dissemination, and transmission in China.
PMCID: PMC4181478  PMID: 24467816
Acute respiratory disease; children; China; human adenovirus
6.  Genome Sequence of Borrelia afzelii Strain HLJ01, Isolated from a Patient in China 
Journal of Bacteriology  2012;194(24):7014-7015.
We report here the genome sequence of Borrelia afzelii strain HLJ01, isolated from a patient with Lyme disease in China. It is the first report of the whole genome of a B. burgdorferi sensu lato isolate from a human in China.
PMCID: PMC3510575  PMID: 23209254
7.  Transmission and Maintenance Cycle of Bartonella quintana among Rhesus Macaques, China 
Emerging Infectious Diseases  2013;19(2):297-300.
We detected Bartonella quintana in 48.6% of captive rhesus macaques from an animal facility in Beijing, China. Prevalence of infection increased over the period of observation. Our findings suggest that macaques may serve as reservoir hosts for B. quintana and that Pedicinus obtusus lice might act as efficient vectors.
PMCID: PMC3563275  PMID: 23347418
Bartonella quintana; rhesus macaques; reservoir host; lice; transmission; China; vector-borne infections; Bartonella
8.  Human Infection with Candidatus Neoehrlichia mikurensis, China 
Emerging Infectious Diseases  2012;18(10):1636-1639.
To identify Candidatus Neoehrlichia mikurensis infection in northeastern China, we tested blood samples from 622 febrile patients. We identified in 7 infected patients and natural foci for this bacterium. Field surveys showed that 1.6% of ticks and 3.8% of rodents collected from residences of patients were also infected.
PMCID: PMC3471638  PMID: 23017728
Candidatus Neoehrlichia mikurensis; bacteria; human infection; ticks; rodents; vector-borne infections; China
9.  Distribution and Risk Factors of 2009 Pandemic Influenza A (H1N1) in Mainland China 
American Journal of Epidemiology  2012;175(9):890-897.
Data from all reported cases of 2009 pandemic influenza A (H1N1) were obtained from the China Information System for Disease Control and Prevention. The spatiotemporal distribution patterns of cases were characterized through spatial analysis. The impact of travel-related risk factors on invasion of the disease was analyzed using survival analysis, and climatic factors related to local transmission were identified using multilevel Poisson regression, both at the county level. The results showed that the epidemic spanned a large geographic area, with the most affected areas being in western China. Significant differences in incidence were found among age groups, with incidences peaking in school-age children. Overall, the epidemic spread from southeast to northwest. Proximity to airports and being intersected by national highways or freeways but not railways were variables associated with the presence of the disease in a county. Lower temperature and lower relative humidity were the climatic factors facilitating local transmission after correction for the effects of school summer vacation and public holidays, as well as population density and the density of medical facilities. These findings indicate that interventions focused on domestic travel, population density, and climatic factors could play a role in mitigating the public health impact of future influenza pandemics.
PMCID: PMC3339311  PMID: 22491083
China; disease outbreaks; disease transmission, infectious; influenza, human; invasion process; pandemics
10.  Using Geographic Information System-based Ecologic Niche Models to Forecast the Risk of Hantavirus Infection in Shandong Province, China 
Hemorrhagic fever with renal syndrome (HFRS) is an important public health problem in Shandong Province, China. In this study, we combined ecologic niche modeling with geographic information systems (GIS) and remote sensing techniques to identify the risk factors and affected areas of hantavirus infections in rodent hosts. Land cover and elevation were found to be closely associated with the presence of hantavirus-infected rodent hosts. The averaged area under the receiver operating characteristic curve was 0.864, implying good performance. The predicted risk maps based on the model were validated both by the hantavirus-infected rodents' distribution and HFRS human case localities with a good fit. These findings have the applications for targeting control and prevention efforts.
PMCID: PMC3042829  PMID: 21363991
11.  Anaplasma phagocytophilum Infection in Ticks, China–Russia Border 
Emerging Infectious Diseases  2011;17(5):932-934.
PMCID: PMC3321783  PMID: 21529418
Anaplasma phagocytophilum; ticks; bacteria; China; Russia; border; letter
12.  Identification of Norovirus as the Top Enteric Viruses Detected in Adult Cases with Acute Gastroenteritis 
To elucidate the importance of the norovirus and other enteric viruses, and the difference of the genetic relatedness on norovirus between the outbreak and sporadic cases, a total of 557 stool samples, consisting of 503 sporadic cases and 54 samples of 4 outbreaks were collected and tested for norovirus and other enteric viruses in Beijing, China, July 2007–June 2008. The data showed norovirus, rotavirus, astrovirus, and sapovirus, were detected in 26.6%, 6.1%, 1.8%, and 0.5%, respectively. Norovirus was detected almost throughout the surveillance period, norovirus co-infecting with rotavirus, astrovirus, and sapovirus, respectively, were identified both in outbreak and the sporadic cases. GII.4/2006 was identified as the predominant strain circulating both in outbreak and sporadic cases. The results showed that norovirus was rather the important agent than other enteric viruses affected adults with acute gastroenteritis; no significant genetic relatedness of the dominant strains was found between the outbreak and sporadic cases.
PMCID: PMC2844560  PMID: 20348525
13.  Human Brucellosis, Inner Mongolia, China 
Emerging Infectious Diseases  2010;16(12):2001-2003.
PMCID: PMC3294567  PMID: 21122244
Brucellosis; Brucella spp.; China; bacteria; zoonoses; letter
14.  Roseomonas sp. Isolated from Ticks, China 
Emerging Infectious Diseases  2010;16(7):1177-1178.
PMCID: PMC3321887  PMID: 20587203
Roseomonas; bacteria; ticks; Dermacentor nuttalli; China; letter
15.  Anaplasma phagocytophilum from Rodents and Sheep, China 
Emerging Infectious Diseases  2010;16(5):764-768.
Three strains were isolated and characterized.
To characterize the strains of Anaplasma phagocytophilum in wild and domestic animals in China, we isolated the organism from rodents and sheep in northeastern China. We isolated 3 strains (2 from rodents and 1 from sick sheep) through propagation in BALB/c mice and then cell culture in HL60 cells. The 3 isolates were identified by Wright-Giemsa staining, immunofluorescence, and electronic microscopy and were characterized by sequence analyses of the 16S rRNA gene, partial citrate synthase gene, major surface protein 4 gene, and heat shock protein gene. The multiple sequences of the 3 isolates were identical to each other but different from all known strains from other countries. The public health and veterinary relevance of the isolates deserves further investigation.
PMCID: PMC2953994  PMID: 20409364
Anaplasma phagocytophilum; isolation; rodents; sheep; China; rickettsia; research
16.  Dual Seasonal Patterns for Influenza, China 
Emerging Infectious Diseases  2010;16(4):725-726.
PMCID: PMC3321959  PMID: 20350403
Influenza; seasonal pattern; surveillance; viruses; letter
17.  Tick-borne Agents in Rodents, China, 2004–2006 
Emerging Infectious Diseases  2009;15(12):1904-1908.
Many rodent species may be involved in the enzootic maintenance of these agents.
A total of 705 rodents from 6 provinces and autonomous regions of mainland People’s Republic of China were tested by PCRs for tick-borne agents (Anaplasma phagocytophilum, Borrelia burgdorferi sensu lato, spotted fever group rickettsiae, and Francisella tularensis). Infection rates were 5.5%, 6.7%, 9.1% and 5.0%, respectively. Eighteen (2.6%) rodents of 10 species were positive for 2 or 3 agents. Sequence analysis of PCR products confirmed the presence and genotypes of detected agents. These findings demonstrate that these tick-borne agents cocirculate and that a variety of rodent species may be involved in their enzootic maintenance.
PMCID: PMC3044509  PMID: 19961668
Anaplasma phagocytophilum; Borrelia burgdorferi sensu lato; spotted fever group rickettsiae; Francisella tularensis; rodents; coexistence; China; research
18.  Spatial Analysis of Tuberculosis Cases in Migrants and Permanent Residents, Beijing, 2000–2006 
Emerging Infectious Diseases  2008;14(9):1413-1419.
Population fluctuation is a risk factor for TB in Beijing.
To determine the role of the migrant population in the transmission of tuberculosis (TB), we investigated the distribution and magnitude of TB in permanent residents and migrant populations of Beijing, People’s Republic of China, from 2000 through 2006. An exploratory spatial data analysis was applied to detect the “hot spots” of TB among the 2 populations. Results, using the data obtained from 2004–2006, showed that people who migrated from the western, middle, and eastern zones of China had a significantly higher risk of having TB than did permanent residents. These findings indicate that population fluctuations have affected the rate of TB prevalence in Beijing, and interventions to control TB should include the migrant population.
PMCID: PMC2603090  PMID: 18760008
pulmonary tuberculosis; migrant population; spatial analysis; Extra Poisson model; research
19.  Landscape Elements and Hantaan Virus–related Hemorrhagic Fever with Renal Syndrome, People’s Republic of China 
Emerging Infectious Diseases  2007;13(9):1301-1306.
Hemorrhagic fever with renal syndrome (HFRS) is an important public health problem in the People’s Republic of China, accounting for 90% of human cases reported globally. In this study, a landscape epidemiologic approach, combined with geographic information system and remote sensing techniques, was applied to increase our understanding of HFRS due to Hantaan virus and its relationship with landscape elements in China. The landscape elements considered were elevation, normalized difference vegetation index (NDVI), precipitation, annual cumulative air temperature, land surface temperature, soil type, and land use. Multivariate logistic regression analysis showed that HFRS incidence was remarkably associated with elevation, NDVI, precipitation, annual cumulative air temperature, semihydromorphic soils, timber forests, and orchards. These findings have important applications for targeting HFRS interventions in mainland China.
PMCID: PMC2857277  PMID: 18252099
Landscape elements; hemorrhagic fever with renal syndrome (Apodemus type); remote sensing; GIS; research
20.  Orientia tsutsugamushi in Eschars from Scrub Typhus Patients 
Emerging Infectious Diseases  2006;12(7):1109-1112.
Eschars can be used for genetic characterization of O. tsutsugamushi during the convalescent phase.
To verify the value of eschars for the diagnosis of scrub typhus and to characterize genotypes of Orientia tsutsugamushi in patients, we examined eschars and blood specimens of 7 patients from Shandong Province, People's Republic of China, for O. tsutsugamushi by polymerase chain reaction targeting the Sta56 gene. All 7 eschars and acute-phase blood samples were positive, while no specific DNA amplicons were obtained from the 7 convalescent-phase blood samples collected after antimicrobial drug therapy. The findings indicate that patients' eschars can be used for detection and genetic characterization of O. tsutsugamushi during the convalescent phase.
PMCID: PMC3375733  PMID: 16836828
Scrub typhus; eschar; Orientia tsutsugamushi
21.  Francisella tularensis in Rodents, China 
Emerging Infectious Diseases  2006;12(6):994-996.
A total of 420 rodents in China were examined for Francisella tularensis by polymerase chain reaction. The infection rates were 4.76% in total, and 11.65%, 10.00%, 6.56%, 1.77%, and 0% in Jilin, Xinjiang, Heilongjiang, Inner Mongolia, and Zhejiang, respectively. Sequence analysis showed that all the detected agents belonged to F. tularensis subsp. holarctica.
PMCID: PMC3373048  PMID: 16707060
Francisella tularensis; tularemia; PCR; rodents; China; dispatch
22.  Pulmonary Tuberculosis and SARS, China 
Emerging Infectious Diseases  2006;12(4):707-709.
PMCID: PMC3294680  PMID: 16715587
SARS; People’s Republic of China; pulmonary tuberculosis; letter
23.  Molecular Epidemiology of SARS-associated Coronavirus, Beijing 
Emerging Infectious Diseases  2005;11(9):1420-1424.
Viral adaptation to the host may be occurring under selective immune pressure.
Single nucleotide variations (SNVs) at 5 loci (17564, 21721, 22222, 23823, and 27827) were used to define the molecular epidemiologic characteristics of severe acute respiratory syndrome–associated coronavirus (SARS-CoV) from Beijing patients. Five fragments targeted at the SNV loci were amplified directly from clinical samples by using reverse transcription–polymerase chain reaction (RT-PCR), before sequencing the amplified products. Analyses of 45 sequences obtained from 29 patients showed that the GGCTC motif dominated among samples collected from March to early April 2003; the TGTTT motif predominanted afterwards. The switch from GGCTC to TGTTT was observed among patients belonging to the same cluster, which ruled out the possibility of the coincidental superposition of 2 epidemics running in parallel in Beijing. The Beijing isolates underwent the same change pattern reported from Guangdong Province. The same series of mutations occurring in separate geographic locations and at different times suggests a dominant process of viral adaptation to the host.
PMCID: PMC3310602  PMID: 16229772
severe acute respiratory syndrome; molecular epidemiology; single nucleotide variation; RT-PCR, research
24.  Long-term SARS Coronavirus Excretion from Patient Cohort, China 
Emerging Infectious Diseases  2004;10(10):1841-1843.
This study investigated the long-term excretion of severe acute respiratory syndrome–associated coronavirus in sputum and stool specimens from 56 infected patients. The median (range) duration of virus excretion in sputa and stools was 21 (14–52) and 27 (16–126) days, respectively. Coexisting illness or conditions were associated with longer viral excretion in stools.
PMCID: PMC3323244  PMID: 15504274
Dispatch; Severe acute respiratory syndrome; epidemiology; cohort; transmission; diagnosis; RT-PCR
The Journal of infection  2014;69(2):174-181.
The rapid emergence, spread, and disease severity of avian influenza A(H7N9) in China has prompted concerns about a possible pandemic and regional spread in the coming months. The objective of this study was to predict the risk of future human infections with H7N9 in China and neighboring countries by assessing the association between H7N9 cases at sentinel hospitals and putative agricultural, climatic, and demographic risk factors.
This cross-sectional study used the locations of H7N9 cases and negative cases from China’s influenza-like illness surveillance network. After identifying H7N9 risk factors with logistic regression, we used Geographic Information Systems (GIS) to construct predictive maps of H7N9 risk across Asia.
Live bird market density was associated with human H7N9 infections reported in China from March-May 2013. Based on these cases, our model accurately predicted the virus’ spread into Guangxi autonomous region in February 2014. Outside China, we find there is a high risk that the virus will spread to northern Vietnam, due to the import of poultry from China.
Our risk map can focus efforts to improve surveillance in poultry and humans, which may facilitate early identification and treatment of human cases.
PMCID: PMC4077931  PMID: 24642206
chickens; influenza in birds; influenza A virus – H7N9 subtype; international health problems; surveillance

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