Objective To investigate the prevalence of thyroid disease in early pregnancy women of Hangzhou,and further to discuss the necessity of screening thyroid function in early pregnant women.Methods From March to October 2013,1 165 cases of women in the center of community health service (or health) for routine prenatal care during early pregnancy were used as research subjects.Household salt,fasting morning urine and serum samples were collected.The salt iodine level was measured by direct titration of sodium thiosulfate.The urinary iodine level was measured by arsenic-cerium contact process method.The levels of serum TSH,FT4,and thyroid peroxidase antibody (TPOAb) were measured by chemiluminescence method.Results The median of urinary iodine of the early pregnancy women was 135.2 μg/L,and only 26.7％ of early pregnancy women' s iodine-nutrition status were optimal.These were no significant difference in median urinary iodine as well as the frequency distribution between urban and suburban(P＞0.05).The abnormal rates of TSH and FT4 in early pregnancy women with negative TPOAb were 6.8％ (71/1 039) and 8.9％ (92/1 039),and the abnormal rates of TSH and FT4 in suburban areas were higher than those in urban areas(P=0.035,P =0.001).The prevalences of hypothyroidism,subclinical hypothyroidism,and hypothyroxinemia in early pregnant women of Hangzhou were 0.3％ (3/1 165),2.0％ (23/1 165),and 4.8％ (56/1 165) respectively,and the prevalence of hypothyroxinemia in suburban areas was significantly higher than that in urban areas (6.1％ vs 3.5％,P =0.040).The positive rate of TPOAb was 9.9％ (114/1 153).The early pregnant women with positive TPOAb have an increased risk of thyroid dysfunction,the ratio of TSH over the reference values was significantly higher than that in the negative group and more prone to subclinical hypothyroidism (OR =3.34,95％ CI 1.29-8.65).Conclusion The early pregnant women in rural areas or with positive TPOAb have an increased risk of abnormal thyroid function,thyroid function and iodine nutrition screening or monitoring should be highlighted.

Objective To explore the impact of iodine nutrition on 8-10 years old children after adjusting the iodine content in iodized salt in Hangzhou.Methods Twelve counties (areas,cities) were divided into urban,suburban and rural areas in Hangzhou.By population proportion survey (PPS),every county(area,city) was divided into east,west,south,north and middle districts; one school was selected in each district; forty children (half male and half female) aged 8-10 years old in each school were selected; family salt and urine samples of each student were collected.The levels of salt and urinary iodine were measured by picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer method (WS/T 107-2006),respectively.Results Two thousand seven hundred and twenty-five household salt samples were collected.The median of salt iodine,the iodized salt coverage rate,the qualification rate of iodized salt and the consumption rate of qualified iodized salt were 24.00 mg/kg,4.35％(2 571/2 725),91.02％(2 340/2 571) and 85.87％(2 340/2 725),respectively.The medians of salt iodine in urban,suburb and rural areas were 24.10,22.12,24.30 mg/kg,respectively.A total of 2 664 children urine samples were collected.The median of urinary iodine (MUI) of the children was 177.24 μg/L.The MUIs in urban,suburb and rural areas were 175.00,178.55,178.00 μg/L,respectively; in male was 183.00 μg/L and female was 170.50 μg/L.When non-iodized and unqualified iodized salt were taken,the differences of urinary iodine within groups were statistically significant in urban,suburb and rural areas(x2 =18.652,14.686,all P ＜ 0.05).In rural area,the difference of urinary iodine of 8-10 years old children who ingested different types of iodized salt was statistically significant(x2 =39.07,P ＜ 0.05).Conclusion After adjusting the iodine content of salt in Hangzhou,the iodine-nutritional status of 8-10 years old students is at a appropriatelevel.

Objectives In order to develop a rapid microsatellite genotyping assay for inter-strain differentiation of Candida albicans isolates and understand the transmission characteristics of the infections. Methods DNA was extracted from C. albicans isolates from genitals, anal canals and oral cavities of 39 women and 27 men with genital candidiasis. The microsatellite sequences in stabel genes(CDC3, EF3 and HIS3) were amplified by a fluorescence labeled PCR. Fluorescent signals were read with an automatic se- quencer, and the data were collected with GeneScan software followed by genotyping with Genotyper soft- ware to analyze polymorphic microsatellite loci. Results Combined analysis of the 3 microsatellite markers showed 18 gene allele associations in C. albicans from genital sites of all men and women, including 10 in women, 11 in men and 3 in both. The allele associations of dominant pathogenetic strains for both sexes were 116:124, 122:131,160:200, which covered 50% of pathogenetic infection. Three common allele associations for both sexes covered 71% of all infections. Genitals and anal canals shared strains of same allele associations in 80% of women and in only 3.8% of men. The strains of same allele associations were identified in both genitals and mouth in 2.7% of women but in none of men. In their genital sites 71% of couples shared the same allele strains, of which 80% were the dominant pathogenetic strains identified in both sexes. Conclusions The improved microsatellite genotyping assay is useful for rapid differentiation, identification of infective source, and contact tracing of C. albicans infection. There are pathogenetic C. albi- cans strains with predominant allele associations in genital infections.

Objective To explore the impact of iodine nutrition on pregnant women after adjusting the iodine content in iodized salt in Hangzhou and provide a scientific basis for supplementation of iodine to pregnant women.Methods After adjusting the iodine content of salt from 2012 to 2014,proportional probability sampling method was used to select 300 families and 100 pregnant women from every county (area,city) of Hangzhou City,and the household salt and urine samples were collected to detect iodine.Results Totally 3 904,3 900 and 3 900 samples of household salts were collected with the medians of salt iodine concentration of 23.77,22.75 and 23.30 mg/kg of each year from 2012 to 2014,respectively.The qualified rate of iodized-salt was 95.87％ (3 550/3 703),97.04％ (3 510/3 617) and 96.53％ (3 564/3 692) and the consuming rate of qualified iodized salt was 90.92％ (3 550/3 904),90.01％ (3 510/3 900) and 91.38％ (3 564/3 900),respectively,from the year 2012 to 2014.Totally 1 300,1 217 and 1 315 urine samples of pregnant women were collected and the median of urinary iodine (MUI) of each year from 2012 to 2014 was 119.90,136.40 and 124.00 μg/L,respectively.Conclusion After adjusting the iodine content of salt in Hangzhou,the salt iodine consumption levels of pregnant women's family are stable,but the level of urinary iodine is low,which should be pay attention to.

Objective To explore the impact of iodine nutrition on pregnant women before and after adjusting the iodine content in iodine salt.Methods Twelve counties (areas,cities) in Hangzhou were divided into urban,suburban and rural areas before and after adjusting the iodine content of salt.One survey spot was selected in each district and one hundred pregnant women were selected;family salt and urinary samples of each pregnant woman were collected.The levels of salt and urinary iodine were measured by the methods of picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer (WS/T 107-2006),respectively.Results One thousand two hundred and thirty-nine and one thousand two hundred and thirty-three household salt samples were collected before and after adjusting the iodine content in iodine salt.The median of salt iodine of pregnant women (23.30 mg/kg) before adjusting the iodine content in iodine salt was lower than that after adjusting the iodine content in iodine salt (30.09 mg/kg,x2 =-4.71,P ＜ 0.01).The iodine salt coverage rate and the consumption rate of qualified iodized salt after adjusting the iodine content in iodine salt [93.92％ (1 158/1 233),93.84％ (1 157/1 233)] were higher than those before adjusting the iodine content in iodine salt [91.85％ (1 138/1 239),91.37％ (1 132/1 239),x2 =4.01,5.51,all P ＜ 0.05].The iodine salt coverage rate and the consumption rate of qualified iodized salt in urban and suburb areas after adjusting the iodine content in iodine salt [99.42％ (510/513),100.00％ (203/203),97.86％ (5021513),100.00％ (203/203)] were higher than those before adjusting the iodine content in iodine salt [86.71％ (450/519),98.00％ (196/200),77.26％ (401/519),85.00％ (170/200)],but the iodine salt coverage rate and the consumption rate of qualified iodized salt in rural area before adjusting the iodine content in iodine salt [94.62％ (492/520),86.92％ (452/520)] were higher than those after adjusting the iodine content in iodine salt [85.69％(443/517),76.98％ (398/517),x2=64.22,2.32,100.02,32.90,23.31,17.33,all P ＜ 0.05].One thousand two hundred and thirty-four and one thousand two hundred and thirty-one household urine samples were collected before and after adjusting the iodine content in iodine salt.The median of urinary iodine (MUI,114.80 μg/L) of pregnant women after adjusting the iodine content in iodine salt was lower than that before adjusting the iodine content in iodine salt (168.60 μg/L,x2 =36.92,P ＜ 0.01).The MUIs of pregnant women in urban,suburban,and rural areas (171.30,170.20 and 162.40 μg/L) before adjusting the iodine content in iodine salt were higher than those after adjusting the iodine content in iodine salt (101.00,149.48 and 119.90 μg/L,x2 =-7.78,-2.63,-6.28,all P ＜ 0.01).The differences of urinary iodine between groups were statistically significant in urban,suburban and rural areas after adjusting the iodine content in iodine salt (x2 =32.86,P ＜ 0.01),the MUI of pregnant women in urban areas was lower than those in the suburban and rural areas (x2 =6.70,8.13,all P ＜ 0.05).Conclusions After adjusting the iodine content of salt in Hangzhou,the iodine-nutrition level of pregnant women is decreased.But the consumption rates of qualified iodized salt and the MUIs in urban,suburb,rural areas are different,so the coverage of iodized salt at household level needs to be enhanced and the health education should be highlighted.

Objective To explore the impact of iodine nutrition on children in areas with different iodized-salt covering rate after adjusting the iodine content in iodized salt in Hangzhou.Methods After adjusting the iodine content of salt,every county (area,city) of Hangzhou was divided into east,west,south,north and middle districts;one school was selected in each district,40 children aged 8-10 years old in each school were selected.The goiter rates of 8-10 years old students were examined (WS 276-2007).The family salt and urine samples of each student were collected.The levels of salt and urinary iodine were measured by picric sodium thiosulfate titrimetric (GB 13025.7-2012) and spectrophotometer method (WS/T 107-2006),respectively.Areas were classified according to the coverage rate of iodized salt ＜95％ and ≥95％,and their urinary iodine levels were compared.Results A total of 2 395 samples were collected with a median salt iodine concentration of 23.50 mg/kg and a urinary iodine level of 167.45 μg/L.The goiter rate of children 8-10 years old was 1.75％ (42/2 395).The total iodized-salt covering rate was 93.15％ (2 231/2 395) and the difference was statistically significant between different districts and towns (x2 =153.13,P ＜0.01),but the level was less than 95％ in 6 areas.The urinary median iodine was 151.00 μg/L in the areas where the iodized-salt covering rate was less than 95％,lower than 173.50 μg/L in the areas where the iodized-salt covering rate was more than or equal to 95％ (x2 =-5.28,P ＜0.01).Conclusions After adjusting the iodine content of salt in Hangzhou,the iodine-nutrition status of 8 to 10 years old students is optimal.But the urinary iodine levels are different in areas with different iodized-salt covering rates,so the coverage of iodized salt at household level need to be enhanced and the health education should be strengthen.

Objective: To investigate the epidemiological characteristics of malaria in Hangzhou City from 2004 to 2021, so as to provide the evidence for formulating the post-elimination control strategy for malaria in Hangzhou City. Methods: The epidemic situation of malaria in Hangzhou City from 2004 to 2021 were collected from the National Information System for Disease Control and Prevention in China, and the temporal, spatial and human distributions of malaria cases and the source of malaria infections were analyzed in Hangzhou City during the pre-elimination stage (2004 to 2009), the elimination stage (2010 to 2015) and the post-elimination stage (2016 to 2021). Results: Totally 602 malaria cases were reported in Hangzhou City from 2004 to 2021,and the annual mean incidence of malaria was 0.22/105, 0.20/105 and 0.18/105 during the pre-elimination, elimination and post-elimination stages, appearing a tendency towards a decline. Men accounted for 63.96%, 85.07% and 93.75% of all malaria cases and there were 67.86%, 82.84% and 80.00% of cases at ages of 18 to 50 years during the pre-elimination, elimination and post-elimination stages, both appearing a tendency towards a decline (χ2trend=56.748, P<0.001; χ2trend=39.971, P<0.001). The predominant occupation of malaria cases shifted from farmers or migrant workers to multiple occupations, and the proportion of commercial servants increased from 4.87% during the pre-elimination stage to 24.38% during the post-elimination stage (χ2trend=73.308, P<0.001). The proportion of Plasmodium vivax malaria cases reduced from 96.43% during the pre-elimination stage to 7.50% during the post-elimination stage, and the proportion of P. falciparum malaria cases increased from 3.57% to 71.25%, while P. ovale, P. malariae and mixed infections were identified since 2010. There was a significant season-specific incidence of P. vivax malaria during the pre-elimination stage, and the period between May and October was an epidemic season; however, there was no season-specific incidence of P. vivax malaria during the elimination and post-elimination stages. The regional distribution of malaria cases presented a tendency towards a shift from suburb and rural areas to urban areas (χ2trend=74.229, P<0.001). No local cases were detected in Hangzhou City since 2010, and 94.22% of malaria cases were overseas imported cases after malaria elimination, including 90.61% from Africa. Conclusions oung and middle-aged men were high-risk populations for malaria in Hangzhou City from 2004 to 2021, and overseas commercial servants gradually became the predominant source of malaria infections, with malaria parasite species tending to be diverse. Improving the management of overseas imported cases and timely identification and treatment of cases are major interventions to consolidate malaria elimination achievements in Hangzhou City.

Objective:To investigate the situation of salt sales and education on prevention and treatment of iodine deficiency disorders in salt sales outlets in Hangzhou after the reform of salt industry system, and provide a basis for promotion of scientific iodine supplementation for the public.Methods:In 2020, 4 townships (towns, streets) were selected from 13 districts (counties, cities) of Hangzhou by stratified sampling method. Each township (town, street) delimited 5 survey areas according to the directions of east, west, south, north and middle, and a salt sales place was selected as the survey site in each investigation area. A face-to-face questionnaire was used to investigate the sales of salt in sales outlets and the publicity and education of iodine deficiency disorders prevention and treatment.Results:A total of 238 edible salt sales outlets were effectively investigated, including 113 urban outlets, 78 suburban outlets, and 47 rural outlets; 55.9% (133/238) of the outlets sold non-iodized salt. A total of 68 072 bags of small packaged salt were sold every month, the overall sales of iodized salt was significantly higher than that of non-iodized salt ( Z = - 2.865, P < 0.05), and the sales of iodized salt in urban and suburban sales outlets were higher than that of non-iodized salt ( Z = - 2.313, - 2.237, P < 0.05). The sales of salt in urban and suburban sales outlets were the highest with the price of 2-5 yuan of salt, accounting for 78.6% (33 562/42 705) and 82.3% (13 970/16 979), respectively; in rural sales outlets, with the price of 1-2 yuan of salt was the highest, accounting for 72.8% (6 110/8 388). Among the 238 salt sales outlets, 29.4% (70/238) of the outlets had set up a prevention and treatment of iodine deficiency disorders sign, and 39.9% (95/238) of the outlets salt sales staff known "recommended salt for pregnant women", 31.1% (74/238) of the outlets whose salt sales staff had actively informed salt buyers about the prevention and treatment of iodine deficiency disorders. The total monthly sales of salt and the sales of iodized salt at outlets where the prevention and treatment of iodine deficiency disorders signs were set up and the salt sales staff were aware of the "recommended salt for pregnant women" were higher than outlets where no signs were set up and the sales staff were not aware ( Z = - 3.733, - 3.722, - 2.109, - 2.324, P < 0.05). Conclusions:After the reform of salt industry system, the iodized salt supply of salt sales outlets in Hangzhou is sufficient. With the increase of non-iodized salt supply channels, we should strengthen the active publicity and education on prevention and treatment of iodine deficiency disorders in the sales section.

Objective:To study the impact of "Five Water Governance" policy on iodine in drinking water of residents in the external environment in Hangzhou City, and to provide scientific basis for iodine supplementation in accordance with local conditions.Methods:In May 2017, in the process of implementing the "Five Water Governance" program in Hangzhou City, water samples were collected in 13 districts (counties and cities) with towns as units according to different water supply methods. The "Method for Iodine Detection in Iodine-deficient and High-iodine Areas" recommended by the National Iodine Deficiency Disorders Reference Laboratory was adopted for water iodine detection. According to the water source (tap water, well water, spring water) and geographical location (urban area, suburb area, rural area), the distribution of water iodine was analyzed.Results:A total of 722 water samples were tested in the city, the median water iodine was 1.1 μg/L, ranged from 0.3 to 105.0 μg/L, the median water iodine of all districts (counties, cities) was < 10 μg/L. There were 182 townships in the city, with 94 townships providing centralized water supply, 3 townships decentralized water supply, and 85 townships mixed water supply. The median water iodine levels in tap water, well water, and spring water were 1.3, 0.9, and 1.6 μg/L, respectively, and the median iodine levels in urban, suburban, and rural water were 3.6, 1.2, and 1.0 μg/L, respectively.Conclusions:The iodine content in the drinking water of residents in the external environment of Hangzhou City is relatively low, and it still belongs to iodine deficiency areas. The strategy of salt iodization for prevention and treatment of iodine deficiency disorders should be continued while the measures of "Five Water Governance" are carried out.

Objective To establish a normal reference range of thyroid-related indicators of early pregnant women in Hangzhou,and investigate the prevalence of thyroid disease among them after the implementation of a new standard of salt iodine content, in order to provide reference for monitoring of thyroid disease in pregnant women.Methods A total of 582 women in early pregnancy(0 - 13 weeks of gestation) in Hangzhou were selected via the stratified random sampling method as the subjects of the study and for detection of serology thyroid function. The levels of serum thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody (TgAb) were measured by chemiluminescence method. According to the standard American Academy of Clinical Biochemistry (NACB), 359 women in early pregnancy were strictly screened to establish the normal reference value of TSH, FT4, and the reference range using the 95% confidence interval (95%CI). At the same time, the newly establish reference interval was used to evaluate the thyroid function of 582 early pregnant women. Results The reference interval of TSH in early pregnant women of Hangzhou was 0.048 -3.354 mU/L.The reference interval of FT4was(13.023 ± 3.316) pmol/L, and the tenth percentile of FT4was 11.030 pmol/L. Eighty-four persons' thyroid function was abnormal in 582 and the rate of abnormal was 14.4% (84/582), in which the rates of abnormal in clinical hypothyroidism, subclinical hypothyroidism, subclinical hyperthyroidism and hypothyroxinemia were 0.2% (1/582), 3.4% (20/582), 1.9% (11/582) and 8.9% (52/582), respectively. The case with clinical hyperthyroidism was not detected. The positive rate of TPOAb and TgAb were 10.8% (63/582) and 11.7%(68/582). The abnormal rate of hypothyroxinemia and the positive rate of TPOAb in early pregnant women in the city(11.4%,13.5%)were significantly higher than that in the rural areas(6.3%,8.1%,χ2=4.708,4.309, P < 0.05). Conclusions The normal reference value of thyroid hormones in early pregnant women in Hangzhou is established, and it is found that the incidence of thyroid disease is higher in pregnant women in Hangzhou after the implementation of the new standard of salt iodine content, therefore, it is imperative to carry out monitoring (or screening)of thyroid function in early pregnant women.