Post-exposure prophylaxis plays an important role in the continued decline of rabies epidemic in China. In the new era, significant progress has been made in the professional construction of rabies post-exposure prophylaxis; the theoretical and practical basis of subject setting has become mature gradually; related medical and biotechnology industries are developing rapidly; innovative research is synchronized with the international level and gradually approaching the leading level; the international and domestic influence is expanding day by day; the series of humanized service measures under standardized management meets the health needs of the people. The rabies post-exposure prophylaxis in China is stepping into the new situation.

Rabies is one of the important zoonotic infectious diseases, with a mortality rate of almost 100%. Rabies is a vaccine preventable disease, and proper rabies exposure prophylaxis can effectively prevent the occurrence of human rabies. In recent years, there has been significant progress in clinical research on the rabies exposure prophylaxis both domestically and internationally. World Health Organization (WHO) released the Rabies Vaccine: WHO Position Paper-April 2018. In order to guide medical institutions of all levels in rabies exposure prophylaxis, the National Administration of Disease Prevention and Control, in conjunction with the National Health Commission of the People's Republic of China, organized the Rabies Vaccine Working Group of the National Immunization Program Technical Working Group and invited experts to revise and issue the National Regulation for the Rabies Exposure Prophylaxis (2023 Edition). This article compares the National Regulation for the Rabies Exposure Prophylaxis (2009 Edition) and interprets the updated key points and supporting basis of the new version of the guidelines to guide clinical application and implementation.

Objective To investigate the ability in diagnosing and reporting brucellosis of primary medical personnel in Suide County of Shaanxi Province,and provide scientific basis for making prevention and control strategies.Methods Convenience sampling method was adopted in October 2016.A questionnaire survey was conducted among the county hospitals,township hospitals,village clinics and individual clinics in Suide County to collect information on the ability in diagnosing and reporting brucellosis of primary medical personnel.The specific content includes the basic information,the awareness of brucellosis diagnosis and reporting capabilities,the situation of brucellosis training,and the views about the diagnosis of brucellosis.SPSS 18.0 software was used to carry out descriptive statistical analysis.Results A total of 77 primary healthcare workers were surveyed.Their average age was (38 ± 9) years old,57.1％ (44/77) workers were undergraduates,and 53.2％ (41/77) were working in county hospitals.9.1％ (7/77) were completely aware of the major infectious diseases,29.9％ (23/77) were fully aware of the transmission mute,28.6％ (22/77) and 66.2％ (51/77) known the high risk population and the epidemiological history of brucellosis.Twenty-six percent (20/77) of the medical staff were thoroughly aware of the main clinical manifestations,68.8％ (53/77) were clearly aware of the clinical stage of brucellosis;24.7％ (19/77) could understand the specificity of the laboratory tests of brucellosis;44.2％ (34/77) had a strong ability in reporting brucellosis.71.4％ (55/77) of the medical staff received the training about the knowledge of brucellosis;49.4％ (38/77) thought that the clinical manifestation was the most difficult to grasp in the criteria about diagnosis of brucellosis.Conclusions The ability of diagnosis and reporting of brucellosis is weak in primary healthcare workers in Suide County,the epidemiology and clinical knowledge of brucellosis are not comprehensive.It is suggested to strengthen the understanding of brucellosis among medical staff,especially in primary healthcare workers.We should carry out the training of disease epidemiology and clinical knowledge of brucellosis and standardize patient management.

Objective To learn the diagnosis and treatment of brucellosis patients in Suide County of Shaanxi Province in 2015,and to provide a scientific basis for making accurate prevention and control measures.Methods All the cases diagnosed as brucellosis in Suide County from January 1 to December 31 in 2015 and lived in this county were retrospectively investigated by case questionnaire survey,including basic information,medical procedures,and epidemiological contacts.Descriptive statistical analysis was performed using SPSS 18.0 software.Results In 2015,75 cases of brucellosis were diagnosed in Suide County,75 questionnaires were distributed,with 53 completed questionnaires returned.The average age of respondents was (49 ± 14) years old,of which 84.9％ (45/53) were male and 94.3％ (50/53) were farmers,except one case was actively monitored by Suide County Centre for Disease Control and Prevention then treated,the rest of the patients were treated after the onset of the disease.Of the 52 patients,one patient was diagnosed after one visit,accounting for 25.0％ (13/52);one patient was diagnosed after at least 4 visits,accounting for 3.8％ (2/52).The cumulative diagnosis rate at provincial-level hospitals was 1/3 and that at disease prevention and control institutions was 92.7％ (51/55),there were no confirmed cases in municipal hospitals,county hospitals,township hospitals,village clinics and individual clinics.For the first reason to see a doctor,65.4％ (34/52) of the patients were fever or accompanied by sweating,fatigue,arthralgia and waist and leg pain.The medians from onset to treatment between the first diagnosis,and 2,3,4 visits were 15,18,27,45 days,respectively;the median from onset to diagnosis was 21 days,ranging from 2 to 182 days.Totally 84.9％ (45/53) patients had a history of exposure to animals,of which 97.8％ (44/45) had contacted the sheep.Conclusions The cases in Suide County are mainly adult male farmers,and the diagnosis rate at hospitals below municipal level is low.It is recommended to strengthen the health intervention of high-risk groups and improve the level of diagnosis and treatment of primary medical staff.

The purified Vero cell rabies vaccine (PVRV) has been used in rabies prevention for more than 40 years. A comprehensive review of the relevant researches on PVRV in rabies prevention at local and overseas in recent years shows that in the simplified Zagreb immunization program, PVRV has the similar immunogenicity and safety as in the standard Essen program. PVRV, purified chicken embryo cell rabies vaccine (PCECV) and human diploid cell rabies vaccine (HDCV) have similar immunogenicity and safety. PVRV also has good immunogenicity and safety in special populations such as those with diseases. The combined vaccination of PVRV and acellular diphtheria, tetanus, pertussis and inactivated poliomyelitis combined vaccine (DTP-IPV) or others did not find immune interference, which provided feasibility for children to vaccinate against rabies at the same time of vaccinating with planned vaccines. The combination of PVRV and equine rabies immunoglobulin can also achieve better prevention effect. PVRV plays an important role in the prevention of rabies, and its wide application will make a positive contribution to achieving the goal of eliminating rabies transmitted from dogs to humans by 2030 proposed by World Health Organization (WHO).

Non-neonatal tetanus is an acute, specific, toxic disease in patients over 28 days of age, characterized by continuous rigidity and paroxysmal spasms of the skeletal muscles throughout the body caused by the intrusion of Clostridium tetani through skin or mucosal membrane into the body and reproducing in anaerobic environments to produce exotoxins. The mortality rate of severe patients is close to 100% without medical intervention. Even with aggressive comprehensive treatment, the global mortality rate remains at 30%-50%, making it a potentially fatal disease. In order to standardize the diagnosis, treatment and prevention of non-neonatal tetanus, based on "Regulation for Diagnosis and Treatment of Non-neonatal Tetanus (2019 Edition)", experts have revised this regulation according to clinical practice and recent research progress in this field to guide medical institutions in the prevention and control of non-neonatal tetanus. This article interprets the key points and basis for updating the 2024 edition regulation to guide clinical implementation and application.

Objective To analyze epidemiological characteristics and trends of rabies and explore control and prevention measures based on the rabies surveillance data of 2012 in China.Methods Data of 2012 from China' s infectious disease surveillance reporting and management system and sentinel surveillance systems in 6 provinces were used,for a retrospective analysis in descriptive epidemiological methods.Results 1 425 cases were reported in 731 counties of 27 provinces in 2012 and 1 361 deaths were reported due to rabies,with the rabies incidence rate and mortality rate of 0.11/100 000 and 0.10/100 000 respectively,decreasing by 26.0％ and 27.9％ respectively from 2011.Rabies epidemic was mainly found in southern regions,followed by middle and eastern regions in China.49.6％ of total rabies cases were found in Guangxi,Guangdong,Hunan,Guizhou,and Henan province,which were the top five provinces.The rabies cases were mainly peasants,students and scattered children,accounting for 70.9％,8.3％ and 5.8％ of total cases respectively.The male-female ratio in rabies cases was 2.6:1.In 2012,294 epidemiological questionnaires were collected,revealing that 92.1％ of the exposure was caused by dogs and 6.8％ by cats.The median of latent period was 70 days.62.4％ of the cases were exposed in upper limb,and only 6.9％ of such cases were vaccinated after exposure while the proportion of passive immunity biological vaccination was 2.9％ for cases with exposure of category Ⅲ.Surveillance data from PEP (post-exposure prophylaxis) clinics showed that 81.7％ of the visitors were hurt by dogs and the exposure categories Ⅰ,Ⅱ and Ⅲ accounted for 7.0％,50.5％ and 42.5％ respectively.The proportion of of the exposure categories varied by PEP surveillance clinics.Conclusion Despite continuing decrease of rabies cases in China in 2012,the number of counties (districts) affected failed relatively slow,with a tendency of rabies spreading to the western and northern regions in China.There were more rabies cases in rural areas than urban ones,and children and elderly people constitute the high-risk population.Animal reservoir of rabies was still dogs as before.Poor PEP and insufficient use of vaccination and passive immunity preparations were main causes for onset of human rabies.

Objective To analyze the epidemiological features and surveillance management programs on severe fever with thrombocytopenia syndrome (SFTS) in China from 2011 to 2014.Methods The analysis of epidemiological characteristics and surveillance management programs was based on the annual reporting data collected from the National Disease Reporting Information System while the description of cluster incidents was based on those reports collected from the Public Health Emergency Information Management System (PHEIMS).Association between age groups and fatality rate was tested under the Cochran-Armitage Trend Test.The difference of fatality rates between differing groups was analyzed,using the chi-square test,with statistical significance on α=0.05.Results Between 2011 and 2014,5 352 suspected,probable and lab-confirmed cases of SFTS were reported in 23 provinces,of which 16 provinces reported 2 750 lab-confirmed cases with a fatality of 7.9％,accounting for 51.4％ of all the cases,nation-wide.Henan,Shandong,Hubei,Anhui,Liaoning,Zhejiang and Jiangsu reported 99.3％ of those lab-confirmed cases.The period between April and October appeared the epidemic season,with its peak from May to July.Most cases were farmers,accounted for 88.3％ of the lab-confirmed cases.People at the age between 50-74 occupied 67.6％ of all the cases.Fatality of the disease continually increased from 3.7％ in the age group 40-44 to 13.5％ in the age group older than 80.Fatality rates appeared statistically different between the groups with or without misdiagnosis,with OR as 3.06 (95％CI:1.61-5.90).Secondary cases of the cluster incidents were most likely to result from contacting the blood of the index cases.Conclusion Number of reported SFTS cases showed a rising trend in China.Henan,Hubei,Anhui,Shandong and Liaoning provinces appeared at high risk of the disease.Geographical distribution of the SFTS cases' seemed highly sporadic,with May to July being the peak season.Farmers and elderly were considered as high risk population.Occasionally,cluster incidents might be seen,as the result of contacting the blood of cases or corpses.Being at older age and misdiagnosis seemed to be risk factors for fatality.

Objective To analyze the epidemiological characteristics of human brucellosis in northern and southern areas of China,and to develop national strategies for brucellosis prevention and control.Methods Individual data on human brucellosis was collected from the National Notifiable Infectious Disease Reporting Information System to describe the situation of brucellosis in China during 2015-2016.Epidemiological features of the disease in northem and southern areas of China were analyzed.Results A total of 104 125 cases were reported in mainland China during 2015-2016,with an average incidence rate as 3.81/100 000.The overall incidence rate from the northem provinces was 7.77/100 000 in 2016,a 18.6％ decrease from 2015 (9.55/100 000),whereas the incidence rate in the southern provinces was 0.27/100 000 in 2016,with an increase of 28.6％ than 0.21/100 000 in 2015.90.0％ of the newly infected counties mainly distributed in southern China.As for the locations of reporting cases,most of them were in the same counties in the northern areas (52.3％) while most cases in the southern areas (59.6％) were imported from other counties.The median age of the cases was 48 (IQR:38-58) years,with male-to-female ratios as 2.7 ∶ 1 in the north and 2.2 ∶ 1 in the south.Majority of the cases were occupation-related,from both the northern (86.8％) and southern (62.7％) areas.Human brucellosis occurred every month throughout the year but with an obvious seasonal increase between March and July.Conclusions Different epidemiological features of human brucellosis appeared in both northern and southern areas of China.The disease was seen endemic in the northem and dispersal in the southem provinces.Appropriate strategies for brucellosis prevention and control should be developed,according to the different epidemiological characteristics in the northcm or southcm areas.

Rabies is a zoonotic infectious disease caused by lyssavirus and characterized by central nervous system symptoms. The fatality rate of rabies is almost 100%. About 59 000 cases die of rabies worldwide every year, mainly in Asia and Africa. China is an epidemic country of rabies. Grade II and III exposures are the main types of rabies exposures in China. Standardized post?exposure prophylaxis (PEP) can prevent rabies almost 100%. Human Rabies Vaccine Technical Working Group, National Immunization Advisory Committee and invited experts reached an expert consensus on PEP by referring to the World Health Organization′s position paper on rabies vaccine in 2018 and related research progress in recent.