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1.  Ebola Virus Outbreak Investigation, Sierra Leone, September 28–November 11, 2014  
Emerging Infectious Diseases  2015;21(11):1921-1927.
Knowledge of epidemiologic, clinical, and viral features of the outbreak is critical for optimizing control and treatment measures.
During 2014–2015, an outbreak of Ebola virus disease (EVD) swept across parts of West Africa. The China Mobile Laboratory Testing Team was dispatched to support response efforts; during September 28–November 11, 2014, they conducted PCR testing on samples from 1,635 suspected EVD patients. Of those patients, 50.4% were positive, of whom 84.6% lived within a 3-km zone along main roads connecting rural towns and densely populated cities. The median time from symptom onset to testing was 5 days. At testing, 75.7% of the confirmed patients had fever, and 94.1% reported at least 1 gastrointestinal symptom; all symptoms, except rash and hemorrhage, were more frequent in confirmed than nonconfirmed patients. Virus loads were significantly higher in EVD patients with fever, diarrhea, fatigue, or headache. The case-fatality rate was lower among patients 15–44 years of age and with virus loads of <100,000 RNA copies/mL. These findings are key for optimizing EVD control and treatment measures.
doi:10.3201/eid2111.150582
PMCID: PMC4622249  PMID: 26485317
Ebola virus disease; Ebola virus; Sierra Leone; western Africa; epidemiologic characteristics; clinical features; virus load; transmission; viruses; laboratory testing; investigation; epidemiology; epidemic; outbreak; control measures; treatment
2.  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.
doi:10.1128/JB.01863-12
PMCID: PMC3510575  PMID: 23209254
3.  Emerging tick-borne infections in mainland China: an increasing public health threat 
The Lancet. Infectious diseases  2015;15(12):1467-1479.
Since the beginning of the 1980s, 33 emerging tick-borne agents have been identified in mainland China, including eight species of spotted fever group rickettsiae, seven species in the family Anaplasmataceae, six genospecies in the complex Borrelia burgdorferi sensu lato, 11 species of Babesia, and the virus causing severe fever with thrombocytopenia syndrome. In this Review we have mapped the geographical distributions of human cases of infection. 15 of the 33 emerging tick-borne agents have been reported to cause human disease, and their clinical characteristics have been described. The non-specific clinical manifestations caused by tick-borne pathogens present a major diagnostic challenge and most physicians are unfamiliar with the many tick-borne diseases that present with non-specific symptoms in the early stages of the illness. Advances in and application of modern molecular techniques should help with identification of emerging tick-borne pathogens and improve laboratory diagnosis of human infections. We expect that more novel tick-borne infections in ticks and animals will be identified and additional emerging tick-borne diseases in human beings will be discovered.
doi:10.1016/S1473-3099(15)00177-2
PMCID: PMC4870934  PMID: 26453241
4.  Nosocomial transmission of avian influenza A (H7N9) virus in China: epidemiological investigation 
The BMJ  2015;351:h5765.
Study question Can avian influenza A (H7N9) virus be transmitted between unrelated individuals in a hospital setting?
Methods An epidemiological investigation looked at two patients who shared a hospital ward in February 2015, in Quzhou, Zhejiang Province, China. Samples from the patients, close contacts, and local environments were examined by real time reverse transcriptase (rRT) polymerase chain reaction (PCR) and viral culture. Haemagglutination inhibition and microneutralisation assays were used to detect specific antibodies to the viruses. Primary outcomes were clinical data, infection source tracing, phylogenetic tree analysis, and serological results.
Study answer and limitations A 49 year old man (index patient) became ill seven days after visiting a live poultry market. A 57 year old man (second patient), with a history of chronic obstructive pulmonary disease, developed influenza-like symptoms after sharing the same hospital ward as the index patient for five days. The second patient had not visited any poultry markets nor had any contact with poultry or birds within 15 days before the onset of illness. H7N9 virus was identified in the two patients, who both later died. Genome sequences of the virus isolated from both patients were nearly identical, and genetically similar to the virus isolated from the live poultry market. No specific antibodies were detected among 38 close contacts. Transmission between the patients remains unclear, owing to the lack of samples collected from their shared hospital ward. Although several environmental swabs were positive for H7N9 by rRT-PCR, no virus was cultured. Owing to delayed diagnosis and frequent hospital transfers, no serum samples were collected from the patients, and antibodies to H7N9 viruses could not be tested.
What this study adds Nosocomial H7N9 transmission might be possible between two unrelated individuals. Surveillance on patients with influenza-like illness in hospitals as well as chickens in live poultry markets should be enhanced to monitor transmissibility and pathogenicity of the virus.
Funding, competing interests, data sharing Funding support from the Program of International Science and Technology Cooperation of China (2013DFA30800), Basic Work on Special Program for Science and Technology Research (2013FY114600), National Natural Science Foundation of China (81402730), Special Program for Prevention and Control of Infectious Diseases in China (2013ZX10004218), US National Institutes of Health (1R01-AI108993), Zhejiang Province Major Science and Technology Program (2014C03039), and Quzhou Science and Technology Program (20111084). The authors declare no other interests and have no additional data.
doi:10.1136/bmj.h5765
PMCID: PMC4652199  PMID: 26586515
5.  Occurrence and Reassortment of Avian Influenza A (H7N9) Viruses Derived from Coinfected Birds in China 
Journal of Virology  2014;88(22):13344-13351.
ABSTRACT
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.
doi:10.1128/JVI.01777-14
PMCID: PMC4249101  PMID: 25210174
6.  Babesia venatorum Infection in Child, China 
Emerging Infectious Diseases  2014;20(5):896-897.
doi:10.3201/eid2005.121034
PMCID: PMC4012784  PMID: 24751126
Babesia venatorum; parasites; protozoa; human infection; child; ticks; zoonoses; China
7.  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.
doi:10.3201/eid2005.130995
PMCID: PMC4012798  PMID: 24750663
Rickettsia raoultii; rickettsia; human infections; ticks; Dermacentor silvarum; vector-borne infections; China
8.  Factors affecting quantity of pollen dispersal of spray cut chrysanthemum (Chrysanthemum morifolium) 
BMC Plant Biology  2014;14:5.
Background
Spray cut chrysanthemum is a vital flower with high ornamental value and popularity in the world. However, the excessive quantity of pollen dispersal of most spray cut chrysanthemum is an adverse factor during its flowering stage, and can significantly reduce its ornamental value and quickly shorten its vase life. More seriously, excessive pollen grains in the air are usually harmful to people, especially for those with pollen allergies. Therefore, in order to obtain some valuable information for developing spray cut chrysanthemum with less-dispersed or non-dispersed pollen in the future breeding programs, we here investigated the factors affecting quantity of pollen dispersal of spray cut chrysanthemum with four cultivars, i.e. ‘Qx-097’, ‘Noa’, ‘Qx-115’, and ‘Kingfisher’, that have different quantity of pollen dispersal.
Results
‘Qx-097’ with high quantity of pollen dispersal has 819 pollen grains per anther, 196.4 disk florets per inflorescence and over 800,000 pollen grains per inflorescence. The corresponding data for ‘Noa’ with low quantity of pollen dispersal are 406, 175.4 and over 350,000, respectively; and 219, 144.2 and nearly 160,000 for ‘Qx-115’ without pollen dispersal, respectively. ‘Kingfisher’ without pollen dispersal has 202.8 disk florets per inflorescence, but its anther has no pollen grains. In addition, ‘Qx-097’ has a very high degree of anther cracking that nearly causes a complete dispersal of pollen grains from its anthers. ‘Noa’ has a moderate degree of anther cracking, and pollen grains in its anthers are not completely dispersed. However, the anthers of ‘Qx-115’ and ‘Kingfisher’ do not crack at all. Furthermore, microsporogenesis and pollen development are normal in ‘Qx-097’, whereas many microspores or pollen degenerate in ‘Noa’, most of them abort in ‘Qx-115’, and all of them degrade in ‘Kingfisher’.
Conclusions
These results suggest that quantity of pollen dispersal in spray cut chrysanthemum are mainly determined by pollen quantity per anther, and capacity of pollen dispersal. Abnormality during microsporogenesis and pollen development significantly affects pollen quantity per anther. Capacity of pollen dispersal is closely related to the degree of anther dehiscence. The entire degeneration of microspore or pollen, or the complete failure of anther dehiscence can cause the complete failure of pollen dispersal.
doi:10.1186/1471-2229-14-5
PMCID: PMC3890635  PMID: 24393236
9.  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.
doi:10.3201/eid1810.120594
PMCID: PMC3471638  PMID: 23017728
Candidatus Neoehrlichia mikurensis; bacteria; human infection; ticks; rodents; vector-borne infections; China
10.  Anaplasma phagocytophilum Infection in Ticks, China–Russia Border 
Emerging Infectious Diseases  2011;17(5):932-934.
doi:10.3201/eid1705.101630
PMCID: PMC3321783  PMID: 21529418
Anaplasma phagocytophilum; ticks; bacteria; China; Russia; border; letter
11.  Geo-spatial Hotspots of Hemorrhagic Fever with Renal Syndrome and Genetic Characterization of Seoul Variants in Beijing, China 
Background
Hemorrhagic fever with renal syndrome (HFRS) is highly endemic in mainland China, and has extended from rural areas to cities recently. Beijing metropolis is a novel affected region, where the HFRS incidence seems to be diverse from place to place.
Methodology/Principal Findings
The spatial scan analysis based on geographical information system (GIS) identified three geo-spatial “hotspots” of HFRS in Beijing when the passive surveillance data from 2004 to 2006 were used. The Relative Risk (RR) of the three “hotspots” was 5.45, 3.57 and 3.30, respectively. The Phylogenetic analysis based on entire coding region sequence of S segment and partial L segment sequence of Seoul virus (SEOV) revealed that the SEOV strains circulating in Beijing could be classified into at least three lineages regardless of their host origins. Two potential recombination events that happened in lineage #1 were detected and supported by comparative phylogenetic analysis. The SEOV strains in different lineages and strains with distinct special amino acid substitutions for N protein were partially associated with different spatial clustered areas of HFRS.
Conclusion/Significance
Hotspots of HFRS were found in Beijing, a novel endemic region, where intervention should be enhanced. Our data suggested that the genetic variation and recombination of SEOV strains was related to the high risk areas of HFRS, which merited further investigation.
Author Summary
Hemorrhagic fever with renal syndrome (HFRS) is caused by Hantaviruses, the enzootic viruses with a worldwide distribution. In China, HFRS is a significant public health problem with more than 10,000 human cases reported annually and the endemic areas of the disease have extended from rural to urban areas and even to central cities in recent years. The HFRS incidence has increased recently and the morbidity seemed to be considerably diverse in different areas in Beijing, the capital of China. With the aim of gaining more information to control this disease, we carried out a spatial analysis of HFRS based on the data from human cases during 2004–2006 and investigated the genetic features of complete S and partial L segment sequences of Seoul virus from natural infected rodent hosts and patients. We found three geo-spatial clusters, i.e., “hotspots” of HFRS in Beijing, where intervention should be enhanced. Our data indicated that the genetic variation and recombination of SEOV might be related to the high risk areas of HFRS in Beijing, which was worthy of further investigation.
doi:10.1371/journal.pntd.0000945
PMCID: PMC3019113  PMID: 21264354
12.  Human Brucellosis, Inner Mongolia, China 
Emerging Infectious Diseases  2010;16(12):2001-2003.
doi:10.3201/eid1612.091081
PMCID: PMC3294567  PMID: 21122244
Brucellosis; Brucella spp.; China; bacteria; zoonoses; letter
13.  Climate Variability and Hemorrhagic Fever with Renal Syndrome Transmission in Northeastern China 
Environmental Health Perspectives  2010;118(7):915-920.
Background
The transmission of hemorrhagic fever with renal syndrome (HFRS) is influenced by climatic variables. However, few studies have examined the quantitative relationship between climate variation and HFRS transmission.
Objective
We examined the potential impact of climate variability on HFRS transmission and developed climate-based forecasting models for HFRS in northeastern China.
Methods
We obtained data on monthly counts of reported HFRS cases in Elunchun and Molidawahaner counties for 1997–2007 from the Inner Mongolia Center for Disease Control and Prevention and climate data from the Chinese Bureau of Meteorology. Cross-correlations assessed crude associations between climate variables, including rainfall, land surface temperature (LST), relative humidity (RH), and the multivariate El Niño Southern Oscillation (ENSO) index (MEI) and monthly HFRS cases over a range of lags. We used time-series Poisson regression models to examine the independent contribution of climatic variables to HFRS transmission.
Results
Cross-correlation analyses showed that rainfall, LST, RH, and MEI were significantly associated with monthly HFRS cases with lags of 3–5 months in both study areas. The results of Poisson regression indicated that after controlling for the autocorrelation, seasonality, and long-term trend, rainfall, LST, RH, and MEI with lags of 3–5 months were associated with HFRS in both study areas. The final model had good accuracy in forecasting the occurrence of HFRS.
Conclusions
Climate variability plays a significant role in HFRS transmission in northeastern China. The model developed in this study has implications for HFRS control and prevention.
doi:10.1289/ehp.0901504
PMCID: PMC2920909  PMID: 20142167
China; cross-correlation; forecast; hemorrhagic fever with renal syndrome; risk factors; time-series Poisson regression
14.  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.
doi:10.3201/eid1605.091293
PMCID: PMC2953994  PMID: 20409364
Anaplasma phagocytophilum; isolation; rodents; sheep; China; rickettsia; research

Results 1-14 (14)