Abstract Since May 2022, laboratory-confirmed cases of monkeypox have been reported in more than 40 non-endemic countries and the epidemic may spread to other countries through human-to-human transmission. This study aims to introduce the characteristics of monkeypox virus and analyze the epidemic situation and the risk of imported cases in Zhejiang Province. Multiple recommendations are proposed to prevent monkeypox epidemics in Zhejiang Province including strengthening entry personnel quarantine, establishing monkeypox monitoring system, carrying out monkeypox-related health education, and making risk assessment and preparation.

Objective: To investigate the epidemiological characteristics of hand, foot and mouth disease ( HFMD ) in Zhejiang Province, so as to provide insights into HFMD control. Methods: The incidence of HFMD in Zhejiang Province from 2016 to 2019 was collected from National Notifiable Disease Reporting System. The temporal distribution, human distribution, regional distribution and pathogenic typing of HFMD were descriptively analyzed in Zhejiang Province from 2016 to 2019. Results: Totally 642 305 cases with HFMD were reported in Zhejiang Province from 2016 to 2019, including 121 severe cases and 9 fatal cases. The annual incidence of HFMD was 335.88/105, 147.76/105, 435.63/105 and 221.77/105, respectively. The incidence of HFMD peaked from May to July each year, and the three highest annual incidence included Ningbo, Jinhua and Wenzhou cities, while the lowest annual incidence was seen in Zhoushan City. The HFMD cases were predominantly found in children at ages of 1 to 5 years ( 537 738 cases, 83.72% ), and in children living at home ( 419 408 cases, 65.30% ). The average annual incidence of HFMD was higher in males than in females ( 328.23/105 vs. 239.99/105; P<0.05). The dominant pathogens gradually shifted from enterovirus 71 ( EV71 ) to Coxsachievirus A16 ( CA16 ), and other enteroviruses remained as the main pathogenic subtypes. Conclusions The incidence HFMD was high in summer and autumn in Zhejiang Province from 2016 to 2019. Children living at home are at a high risk of HFMD, and CA16 type gradually became the dominant pathogen of HFMD.

Objective: To investigate the willingness to receive a COVID-19 vaccination and its influencing factors among individuals that missed the second dose of the inactivated COVID-19 vaccine in Zhejiang Province, so as to provide the evidence for improving the strategy for COVID-19 vaccination. Methods: Individuals that did not receive the second dose of the inactivated COVID-19 vaccine after 56 days of getting the first dose (missed individuals) from March and May, 2021, were randomly sampled from Zhejiang Provincial SaaS Vaccination Information System. Their basic information, status of getting the inactivated COVID-19 vaccine and willingness to receive the second dose of the inactivated COVID-19 vaccine were collected through telephone interviews. The factors affecting the willingness to receive the second dose of the inactivated COVID-19 vaccine were identified among the missed individuals using a multivariable logistic regression model. Results: Totally 562 individuals were investigated, and there were 292 (51.96%) valid respondents. There were 54 actual missed individuals, with a mean age of (40.91±16.75) years, which included 39 men (72.22%) and 15 women (27.78%). Of all missed individuals, 23 had an educational level of junior high school and below (42.59%). The mean duration from the time of investigation to the time of getting the first dose of the inactivated COVID-19 vaccine was (137±28) days. A half of the missed individuals were willing to receive the second dose of the inactivated COVID-19 vaccine. Multivariable logistic regression analysis showed high willingness to receive the second dose of the inactivated COVID-19 vaccine among the missed individuals with requirements of vaccination in the workplace (OR=5.393, 95%CI: 1.112-26.152) and low willingness among the missed individuals that felt physical discomfort after receiving the first dose (OR=0.168, 95%CI: 0.035-0.806). Conclusions The willingness to receive the second dose of the inactivated COVID-19 vaccine was low among the missed individuals, and high willingness is seen among the missed individuals with requirements of vaccination in the workplace and without physical discomfort after receiving the first dose of the inactivated COVID-19 vaccine.

Objective: To investigate the prevalence and influencing factors of depressive symptoms among grassroots healthcare workers in Zhejiang Province, so as to provide insights into improving their mental health. Methods: Grassroots healthcare workers of community health service centers and township health centers were sampled from one county (city, district) in each of 11 cities in Zhejiang Province using a convenience sampling method from December 2022 to January 2023. Participants' gender, age, educational level and average daily sleep duration in the past week were collected through questionnaires, and depression symptoms was investigated according to Self-rating Depression Scale. Factors affecting the depressive symptoms were identified using a multivariable logistic regression model. Results: A total of 1 946 questionnaires were distributed, and 1 945 valid questionnaires were recovered, with an effective response rate of 99.95%. There were 444 boys, accounting for 22.83%, and 1 501 girls, accounting for 77.17%. The median age was was 36 (interquartile range, 44) years. There were 786 healthcare workers detected with depressive symptoms, with a prevalence rate of 40.41%, and the prevalence rates of mild, moderate and severe depressive symptoms were 26.94%, 10.49% and 2.98%, respectively. Multivariable logistic regression analysis identified age (50 years and older, OR=0.572, 95%CI: 0.386-0.846), annual income (100 000 to 149 999 Yuan, OR=0.780, 95%CI: 0.635-0.958; 150 000 to 199 999 Yuan, OR=0.463, 95%CI: 0.282-0.760; 200 000 Yuan and above, OR=0.303, 95%CI: 0.098-0.937), vocation (nurse, OR=1.593, 95%CI: 1.252-2.027) and sleep duration (less than 7 hours, OR=2.164, 95%CI: 1.768-2.648) as factors affecting depressive symptoms among grassroots healthcare workers in Zhejiang Province. Conclusions The prevalence of depressive symptoms among grassroots healthcare workers in Zhejiang Province is 40.41%. Age, annual income, job and sleep duration may affect the development of depressive symptoms among grassroots healthcare workers.

Objective To observe the curative effect of auricular point sticking on menstrual distending pains of breasts. Methods Sixty-two patients with hyperplasia of mammary glands were randomized evenly into experiment group and control group:the former were managed with auricular point sticking and the latter with oral administration of Xiaoyao Pills for three treatment courses, each menstrual cycle as a course.The two groups were compared in terms of menstrual distending pains of breasts.Results The experiment group was significantly better than the control group in terms relieves of pains as well as the curative effect after the trial (P<0.01 for both).Conclusions Auricular point sticking is effective in relieving the menstrual distending pains of breasts.It is simple for manipulation and thus worth clinical spreading.

Objective:To study the influence of triptolide on neutrophils asthmatic mice of WBC and EOS in bronchoalveolar lavage fluid.Methods:Using ovalbumin ( OVA) combined with lipopolysaccharide ( LPS) method to establish sensitized asthmatic mice,BALB/c mice were randomly divided into 32 neutrophilic asthma group ( NA group ) , neutrophil triptolide intervention group (TLN group),neutrophil dexamethasone group (DXN group) and normal control group (NC group),n=8,hemocytometer calculated for each group of mice bronchoalveolar lavage fluid ( BALF) of the total number of WBC and EOS;smears stained Switzerland View in-flammatory cell infiltration.Results: In bronchioalveolar lavage fluid, numbers and infiltrations of WBC and EOS were significantly decreased in the DXN,TLN group than those in the NA group(P<0.05);but were significantly higher than the NC group (P<0.05), the DXN group above parameters were significantly higher than the TLN group ( all P<0.05 ) .Conclusion: Triptolide can reduce the total number of BALF WBC and EOS,inhibit lung WBC,EOS infiltration,ease neutrophilic airway inflammation.

Objective: To establish a prediction model of herpangina epidemic trend based on Baidu index and hand, foot and mouth disease, so as to provide insights into analyses of communicable disease epidemics with limited or missing surveillance data. Methods: The incidence of hand, foot and mouth disease in Zhejiang Province during the period from the first week of 2015 through the 39th week of 2021 was retrieved from the China Information System for Disease Control and Prevention, and the Baidu index of hand, foot and mouth disease and herpangina was collected via the Baidu search engine during the same period. The correlation between the Baidu index and time series of hand, foot and mouth disease was examined using wavelet analysis. In addition, a random forest training model was created based on the Baidu index and incidence of hand, foot and mouth disease, and the fitting effectiveness was evaluated using the mean percentage error, while the Baidu index of herpangina was included in the model to predict the epidemic trend of herpangina during the study period. Results: The Baidu index of herpangina and hand, foot and mouth disease, and the Baidu index and incidence of hand, foot and mouth disease all appeared two peaks at the 26th and 52th week. The phase difference was less than 0.1 week between the Baidu index and time series of hand, foot and mouth disease, and the mean percentage error of the training model was 13.07%, with high concordance between the predicted number and actual report number of cases with hand, foot and mouth disease. The numbers of herpangina cases were predicted to be 28 822, 27 341, 28 422, 51 782, 52 457 and 5 691 from 2015 to 2020, and there were totally 48 702 herpangina cases reported until the 39th week of 2021. Like hand, foot and mouth disease, the incidence of herpangina peaked between May and July. Conclusion The random forest training model based on the Baidu index and incidence of hand, foot and mouth disease is feasible to predict the epidemic trend of herpangina.

Objective: To investigate the factors affecting cataract among the elderly, so as to provide insights into cataract control. Methods: Based on the major public health monitoring project of Zhejiang Province, residents at ages of 60 years and older were selected from 7 districts (counties) using a multi-stage stratified cluster random sampling method, and were followed up every other year from 2014 to 2020. Demographics, lifestyle, dietary habits and cataract incidence were collected, and factors affecting the incidence of cataract were identified using a multivariable Cox proportional hazard regression model. Results: Totally 9 642 residents were investigated, with a mean age of (68.89±7.39) years, and including 4 635 males (48.07%). There were 828 incident cataract cases, with an incidence rate of 20.946/1 000 person-years. Multivariable Cox proportional hazard regression analysis showed that women (HR=1.695, 95%CI: 1.377-2.088), age of 65 years and older (HR=1.707-5.044, 95%CI: 1.400-7.327), overweight/obesity (HR=1.313, 95%CI: 1.131-1.524), educational level (primary school, HR=1.642, 95%CI: 1.400, 1.926; junior high school, HR=1.553, 95%CI: 1.148-2.102), annual family income (10 000 to 50 000 Yuan, HR=1.353, 95%CI: 1.155-1.585; 50 000 to 100 000 Yuan, HR=0.663, 95%CI: 0.500-0.881; 100 000 to 150 000 Yuan, HR=0.340, 95%CI: 0.204-0.565), smoking (HR=0.649, 95%CI: 0.494-0.853), frequency of vegetable intake of >3 days/week (HR=0.693, 95%CI: 0.527-0.912), frequency of fruit intake of >3 days/ week (HR=0.833, 95%CI: 0.694-0.899), frequency of egg intake of >3 days/week (HR=0.579, 95%CI: 0.450-0.745), frequency of soy products intake of >3 days/week (HR=0.706, 95%CI: 0.588-0.849), frequency of dairy products intake of >3 days/week (HR=1.510, 95%CI: 1.199-1.901) and frequency of nut intake of >3 days/week (HR=1.733, 95%CI: 1.162-2.586) were statistically associated with the development of cataract among the elderly. Conclusion Gender, age, body mass index, educational level, income, smoking, and frequency of vegetables, fruits, eggs, soy products, dairy products and nuts intake are associated with the development of cataracts.

Objective: To examine the effect of dietary behaviors on handgrip strength loss among the elderly, so as to provide insights into the prevention of handgrip strength loss. Methods : Based on the health surveillance cohort among the elderly in Zhejiang Province, two villages or communities were randomly sampled from each of Shaoxing and Zhoushan cities using a multi-stage cluster sampling method, and all residents that had lived in local areas for one year and longer and had an age of 60 years and older were enrolled. Participants' demographics, dietary behaviors, smoking, drinking, and exercise were collected through questionnaire surveys, and the height, body weight and handgrip strength were measured. The handgrip strength loss was diagnosed according the 2019 Consensus Update on Sarcopenia Diagnosis and Treatment proposed by Asian Working Group for Sarcopenia, and the effect of dietary behaviors on handgrip strength loss was examined using a multivariable logistic regression model. Results: A total of 1 265 residents were enrolled, with a mean age of (70.67±7.30) years, and including 565 men (44.66%) and 700 women (55.34%). The overall prevalence of handgrip strength loss was 42.85% among the participants, and the prevalence was 40.35% in men and 44.86% in women, respectively. Multivariable logistic regression analysis showed that nut intake for 1 to 3 times a week (OR=0.180, 95%CI: 0.088-0.367) and for 4 to 6 times a week (OR=0.241, 95%CI: 0.113-0.514) led to a reduced risk of handgrip strength loss among the elderly, and intake of sugary drinks for 4 to 6 times a week led to an increased risk of handgrip strength loss among the elderly (OR=2.298, 95%CI: 1.120-4.714) after adjustment for age, body mass index, educational level and exercise. Conclusion Intake of nuts and sugary drinks may affect the development of handgrip strength loss among the elderly.

Objective: To analyze the epidemiological characteristics of overseas imported cases with coronavirus disease 2019 (COVID-19) in Zhejiang Province, so as to provide insights into containment of overseas imported COVID-19. Methods: The pertaining to overseas imported COVID-19 cases in Zhejiang Province during the period between January 1, 2020 and May 31, 2022 were captured from the Chinese Disease Prevention and Control Information System. The temporal, spatial and population distributions, the duration from entry to the first time of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test, and COVID-19 vaccination of overseas imported COVID-19 cases were analyzed using a descriptive epidemiological method. Results: A total of 1 535 overseas imported COVID-19 cases were reported in Zhejiang Province during the period between January 1, 2020 and May 31, 2022, including 596 confirmed cases and 939 asymptomatic infections, and all reported cases were imported from 102 countries and territories. Overseas imported COVID-19 cases were reported in each month during the period between March 2020 and May 2022 except May 2020, and the mean monthly number of reported overseas imported COVID-19 cases was 125 during the period between December 2021 and May 2022. Overseas imported COVID-19 cases were reported across 11 cities of Zhejiang Province, with the largest numbers reported in Hangzhou (978 cases) and Jiaxing cities (177 cases), and imported cases were reported in 76.09% of counties (districts) in Zhejiang Province. The overseas imported COVID-19 cases were predominantly identified among individuals with Chinese nationality (88.79%), at ages of 20 to 39 years (59.09%), and students (21.82%), workers (17.20%) and business servants (17.00%) were predominant occupations among the overseas imported COVID-19 cases. The median duration from entry to the first time of positive SARS-CoV-2 nucleic acid test was 3.98 (7.06) d during the period between January 1, 2020 and May 31, 2022, and was 3.23 (4.97) d during the period between December 1, 2021 and May 31, 2022, which was significantly shorter than that during the period between January 1, 2020 and November 30, 2021 (P<0.001). The proportion of normal and more severe types of COVID-19 was 15.69% among cases without COVID-19 vaccination, which was significantly higher than that (7.77%) among those receiving booster vaccination (χ2=5.345, P=0.021), but was not significantly different from that (12.65%) among those receiving full-dose vaccination (χ2=0.971, P=0.324). Conclusions Students with Chinese nationality, workers and business servants were predominant among overseas imported COVID-19 cases in Zhejiang Province until May 31, 2022. The duration from entry after December 1, 2021 to identification of overseas imported COVID-19 cases shortened, and booster COVID-19 vaccination facilitated the alleviation of severity of clinical symptoms. There is a long-term risk of overseas importation of COVID-19 in Zhejiang Province, and the containment of imported COVID-19 requires to be sustainably implemented among entry personnel.