Objective: Routine immunization coverage in Papua New Guinea has decreased in the past 5 years. This persistently low routine immunization coverage has resulted in low population immunity and frequent outbreaks of vaccine-preventable disease across the country. We describe the use of a catch-up programme to improve routine immunization during the coronavirus disease pandemic in Papua New Guinea during 2020–2022. Methods: In June 2020, 13 provinces of Papua New Guinea were selected to undergo a vaccination catch-up programme, with technical support from the World Health Organization (WHO) and the United Nations Children’s Fund. Twelve provinces received financial and logistic support through the Accelerated Immunization and Health Systems Strengthening programme, and one received support from WHO. All stakeholders were involved in planning and implementing the catch-up programme. Results: Between July 2020 and June 2022, about 340 health facilities conducted catch-up activities. The highest number of children aged under 1 year were vaccinated in 2022 (n = 33 652 for third dose of pentavalent vaccine). The national coverage of routine immunization (including the catch-up vaccinations) increased between 2019 and 2020 – by 5% for the third dose of pentavalent vaccine, 11% for the measles-rubella vaccine and 16% for the inactivated poliovirus vaccine. The coverage declined slightly in 2021 before increasing again in 2022. Discussion: The catch-up programme was an instrumental tool to improve routine immunization coverage between 2020 and 2022 and during the pandemic in Papua New Guinea. With appropriate technical and logistic support, including financial and human resources, catch-up programmes can strengthen routine immunization coverage across the country.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Objective:To establish the biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

Objective:To systematically analyze and evaluate the IgG antibody levels of varicella-zoster virus (VZV) in healthy population in China.Methods:CNKI, Wanfang, CBM and PubMed databases were used for the retrieval of literatures about VZV IgG antibody levels in healthy people in China from January 1, 2000 to November 3, 2020. The quality of the included papers was evaluated by the critical appraisal tools for cross sectional study from Joanna Briggs Institute (JBL). The stratified analysis on the IgG antibody levels in populations in different age groups, provinces, regions, gender groups, and years was performed by using software Stata 14.0.Results:A total of 59 papers were included that met the inclusion criteria, including 51 papers in Chinese and 8 papers in English. There were 22 papers with quality score of 8, 16 papers with quality score of 7, 15 papers with quality score of 6, and 6 papers with quality score of 5. Meta-analysis showed that the positive rate of VZV IgG antibody in healthy population in China was 64% (95% CI:60%-67%, I 2 =98.7%), and the IgG antibody levels were reported in the papers for 22 provinces of China. The positive rate of VZV IgG antibody was highest in Yunnan (79%, 95% CI: 64%-93%, I 2 =94.7%) and lowest in Inner Mongolia (50%, 95% CI: 46%-54%); the positive rate of VZV IgG antibody was highest in Northeastern China (71%, 95% CI: 69%-73%) and lowest in Eastern China (62%, 95% CI: 57%-67%); the positive rate of VZV IgG antibody in urban population was higher than that in rural population ( RR=1.08, 95% CI: 1.04-1.11). The positive rate of VZV IgG antibody in women was higher than that in men ( RR=1.10, 95% CI: 1.08-1.11); the positive rate of VZV IgG antibody in the population increased with age; and the positive rate of VZV IgG antibody increased with the change of sampling time. Conclusion:The positive rate of VZV IgG antibody in healthy population in China was relatively low; the coverage of varicella vaccine should be improved for the outbreak control and incidence reduction of varicella in China.

Objective:To explore the application effect of health management in extended nursing for patients with hemorrhagic stroke.Methods:Using the convenient sampling method, a total of 120 patients with hemorrhagic stroke who were admitted to the First People's Hospital of Lianyungang in Jiangsu Province from August 2018 to August 2019 were selected as the research objects. According to the random number table method, they were divided into the control groups and the observation group, with 60 cases in each group. The control group and the observation group were respectively given traditional family follow-up nursing and extended nursing based on health management. The mastery degree of knowledge about hemorrhagic stroke disease, self-health management ability, medication compliance and psychological status of patients with hemorrhagic stroke were observed in the two groups.Results:After the implementation of extended nursing based on health management, the total scores of mastery degree of knowledge about nursing for hemorrhagic stroke and self-health management ability in the observation group were respectively (90.38±2.13) and (149.65±4.65) , which were higher than (59.07±2.45) and (115.79±5.34) of the control group, and the differences were statistically significant ( P<0.01) . The total compliance rate of patients in the observation group was 86.67% (52/60) , which was higher than 43.33% (26/60) in the control group, and the difference was statistically significant ( P<0.01) . After the intervention, scores of SDS and SAS of the observation group were (41.87±8.23) and (40.68±7.34) , which were lower than (54.23±7.45) and (52.02±9.86) of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The extended nursing based on health management is well applied in the family follow-up work of patients with hemorrhagic stroke. Mastery degree of knowledge of patients, self-health management ability, and treatment compliance are improved and levels of depression and anxiety are reduced.

The aim of this paper is to explore the practical measures of integrating “ideological and political course” into “Psychiatry”. “Ideological and political course” is a key measure to foster character and civic virtue in colleges and universities， and a crucial link of “three -full education”. Based on the characteristics of the course “Psychiatry” and the practical experience of the course “ideological and political work” in the faculty of mental health， North Sichuan Medical College， this paper puts forward the strategies of implementing “ideological and political course” from four aspects： improving teachers’ understanding and practical ability of “ideological and political course”， constructing the integration point of ideological and political course in “Psychiatry”， choosing the teaching methods of “ideological and political course” and evaluating the teaching effect， thus providing references for the implementation of “ideological and political course” in the follow-up professional courses.

Objective To investigate the clinical features,diagnosis and treatment of infantile diabetes.Methods The clinical data of 27 infants with type 1 diabetes (T1DM) admitted to our hospital from Apr.2014 to Jun.2016 were retrospectively analyzed.SPSS16.0 statistical software was used to carry out t test and chisquare test on relevant data.Results The onset age of diabetes in infants and young children was 1 year to 3 years and 7 months.There were 15 males and 12 females.The onset season was mainly in winter and spring.The fasting blood glucose in cesarean section was significantly higher than that in natural production group (P＜0.05).12 cases(44.44％) were complicated with respiratory infections before the onset of the disease,including 6 cases of pathogenic detection of viruses,mainly Coxsackie virus.Among them,14 cases were admitted to hospital with polydipsia and polyuria,6 cases had fever,cough and mental retardation,7 cases had elevated blood glucose,16 cases (62.50％) and 6 cases of women with diabetic ketoacidosis (37.50％).The incidence of diabetic ketoacidosis in male diabetic patients was higher than that in females (62.50％ vs 37.50％,x2=6.49,P＜0.05).With abnormal liver function and dyslipidemia in 2 cases;myocardial enzyme abnormality in 7 cases;abnormal thyroid function in 10 cases;26 cases of electrolyte abnormality,mainly hyponatremia;2 cases of positive anti-insulin antibody and 5 cases of positive glutamic acid decarboxylase antibody.Before admission,13 (35.14％) cases were misdiagnosed,6 cases were misdiagnosed as bronchopneumonia,3 cases were misdiagnosed as central nervous system infection,3 cases were sepsis and 1 case was myocarditis.All patients were treated with insulin.After 7 to 10 days of treatment,the patient's condition improved and continued to be treated at home.Conclusions The clinical manifestations of infantile T1DM onset are not typical,and it is easy to be associated with ketoacidosis.Infection may be one of the important causes of diabetic ketoacidosis.When the child has an infection and the blood sugar level is high,attention should be paid to the occurrence of diabetic ketoacidosis,to avoid misdiagnosis.

Abstract Since the first confirmed human infection with avian influenza A(H5N1) virus was reported in Hong Kong SAR (China) in 1997, sporadic zoonotic avian influenza viruses causing human illness have been identified globally with the World Health Organization (WHO) Western Pacific Region as a hotspot. A resurgence of A(H5N1) occurred in humans and animals in November 2003. Between November 2003 and September 2017, WHO received reports of 1838 human infections with avian influenza viruses A(H5N1), A(H5N6), A(H6N1), A(H7N9), A(H9N2) and A(H10N8) in the Western Pacific Region. Most of the infections were with A(H7N9) (n = 1562, 85%) and A(H5N1) (n = 238, 13%) viruses, and most (n = 1583, 86%) were reported from December through April. In poultry and wild birds, A(H5N1) and A(H5N6) subtypes were the most widely distributed, with outbreaks reported from 10 and eight countries and areas, respectively. Regional analyses of human infections with avian influenza subtypes revealed distinct epidemiologic patterns that varied across countries, age and time. Such epidemiologic patterns may not be apparent from aggregated global summaries or country reports; regional assessment can offer additional insight that can inform risk assessment and response efforts. As infected animals and contaminated environments are the primary source of human infections, regional analyses that bring together human and animal surveillance data are an important basis for exposure and transmission risk assessment and public health action. Combining sustained event-based surveillance with enhanced collaboration between public health, veterinary (domestic and wildlife) and environmental sectors will provide a basis to inform joint risk assessment and coordinated response activities.

OBJECTIVE: To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014.

METHODS: An outbreak investigation with a case control study was conducted. A case was defined as an inpatient in one hospital in Western Province, Solomon Islands with high fever (> 38.5 °C) and a negative malaria microscopy test admitted between 1 and 31 May 2014. Asymptomatic controls matched with the cases residentially were recruited in a ratio of 1:2. Serum samples from the subjects were tested for rickettsial infections using indirect micro-immunofluorescence assay.

RESULTS: Nine cases met the outbreak case definition. All cases were male. An eschar was noted in five cases (55%), and one developed pneumonitis. We did not identify any environmental factors associated with illness. Serum samples of all five follow-up cases (100%) had strong-positive IgG responses to scrub typhus. All but one control (10%) had a moderate response against scrub typhus. Four controls had low levels of antibodies against spotted fever group rickettsia, and only one had a low-level response to typhus group rickettsia.

DISCUSSION: This outbreak represents the first laboratory-confirmed outbreak of scrub typhus in the Western Province of Solomon Islands. The results suggest that rickettsial infections are more common than currently recognized as a cause of an acute febrile illness. A revised clinical case definition for rickettsial infections and treatment guidelines were developed and shared with provincial health staff for better surveillance and response to future outbreaks of a similar kind.

Diarrhoeal disease is the second leading cause of death in children under age 5 worldwide, with rotavirus being the main etiology. In the Lao People's Democratic Republic, acute watery diarrhoea (AWD) was introduced as one of the national notifiable diseases in 2004. We retrospectively reviewed the aggregate (n = 117 277) and case-based (n = 67 755) AWD surveillance data from 2009 to 2013 reported weekly from 1115 health facilities nationwide. Rotavirus rapid test data from all eight sentinel sites in Vientiane Capital in 2013 were also collected for analysis. The incidence of AWD ranged between 215 and 476 cases per 100 000 population and increased from 2009 to 2012 when it levelled off. The most affected age group was children under 5 who were about seven to nine times more likely to have AWD than the rest of the population (P < 0.0001). In children under 5, 74.8% of the cases were aged 0-24 months and AWD was 1.28 times more common in males (P < 0.0001). Among the 230 stool specimens tested in children under 5 in 2013, 109 (47.4%) tested positive for rotavirus. The increased AWD incidence over the study period may reflect a true increase in AWD or an improved sensitivity of the system. We recommend new mothers breastfeed up to two years after birth, which is known to reduce AWD morbidity and mortality in young children. We also recommend conducting rotavirus disease burden and cost-effectiveness studies to explore the benefits of introduction of rotavirus vaccine.