This article provides an overview of the severe acute respiratory syndrome (SARS) epidemics in mainland China and of what we have learned since the outbreak.The epidemics spanned a large geographical extent but clustered in two regions:first in Guangdong Province,and about 3 months later in Beijing and its surrounding areas.The resulting case fatality ratio of 6.4％ was less than half of that in other SARS-affected countries and regions,partly due to younger-aged patients and a higher proportion of community-acquired infections.Strong political commitment and a centrally coordinated response were most important for controlling SARS.The long-term economic consequence of the epidemic was limited.Many recovered patients suffered from avascular osteonecrosis,as a consequence of corticosteroid usage during their infection.The SARS epidemic provided valuable experience and lessons relevant in controlling outbreaks of emerging infectious diseases,and has led to fundamental reforms of the Chinese health system.Additionally,the epidemic has substantially improved infrastructures,surveillance systems,and capacity to response to health emergencies.In particular,a comprehensive nationwide internet-based disease reporting system was established.

For the past several decades, the infectious disease profile in China has been shifting with rapid developments in social and economic aspects, environment, quality of food, water, housing, and public health infrastructure. Notably, 5 notifiable infectious diseases have been almost eradicated, and the incidence of 18 additional notifiable infectious diseases has been significantly reduced. Unexpectedly, the incidence of over 10 notifiable infectious diseases, including HIV, brucellosis, syphilis, and dengue fever, has been increasing. Nevertheless, frequent infectious disease outbreaks/events have been reported almost every year, and imported infectious diseases have increased since 2015. New pathogens and over 100 new genotypes or serotypes of known pathogens have been identified. Some infectious diseases seem to be exacerbated by various factors, including rapid urbanization, large numbers of migrant workers, changes in climate, ecology, and policies, such as returning farmland to forests. This review summarizes the current experiences and lessons from China in managing emerging and re-emerging infectious diseases, especially the effects of ecology, climate, and behavior, which should have merits in helping other countries to control and prevent infectious diseases.
Behavior ; China ; epidemiology ; Climate ; Communicable Diseases ; classification ; epidemiology ; Communicable Diseases, Emerging ; epidemiology ; Disease Outbreaks ; Ecology ; Forecasting ; Humans ; Incidence

Infectious disease surveillance have played an important role in the national diseases prevention and control strategies.In line with the reporting system,infectious disease surveillance has been greatly improved and played pivotal role in preventing epidemics since 1949 in China.To date,surveillance remains an effective approach to infectious disease control and prevention because of the global serious situation.In this column "infectious disease surveillance",we have involved articles as systematic analysis of surveillance data and solid evidence related to the development of strategies and measures for infectious diseases control and prevention.

Objective To investigate the spatiotemporal expansion and risk factors of scrub typhus (ST) in Shandong,Jiangsu and Anhui provinces.Methods Based on the reported cases in Shandong and Jiangsu from 2006 to 2013,and Anhui from 2008 to 2013 epidemiological characteristics of ST and associated environmental factors were analyzed,using the panel negative binomial regression model.Results A total of 2 968,2 331 and 3 447 ST cases were respectively reported in Shandong,Jiangsu and Anhui during 2006-2013,with the average annual incidence rates as 0.39,0.38 and 0.94 per 100 000 population.Uptrend in Shandong and Jiangsu,but a slight rollback seen in Anhui were observed.Expansion of natural foci was found in the 3 provinces,with affected counties accounted for 38.0％,48.2％ and 46.5％ in Shandong,Jiangsu and Anhui,respectively in 2013.Cases were clustered in autumn but with a peak of single epidemic appeared in October or November,in all the 3 provinces.More female and elderly patients were seen,than in the other age groups,in all the 3 provinces.Majority of the cases were farmers,with an increasing trend in incidence,in all these provinces,followed by housekeepers in Shandong and preschool children in Anhui.The risk factors of transmission in all the 3 provinces were negatively associated with the monthly precipitation,and showing an "inverted-U" pattern in association with monthly temperature.A positive relationship between the risk of transmission and monthly relative humidity was found in Shandong and Jiangsu provinces.However,an "inverted-U" pattern between the risk of transmission and the monthly sunshine hour,appeared in Shandong and Anhui provinces.The incidence of Scrub typhus in Shandong was also positively related to the coverage of forest.Conclusion Surveillance programs and health education measures should focus on the warm and moist areas in all the 3 provinces,and also on forestry areas in Shandong.Health education and prevention on mite-bite should be targeted,especially on high-risk populations as the elderly and farmers,in the 3 provinces.Housekeepers in Shandong and children in Anhui should also be under special concern.

Objective To understand the impact of meteorological factors on the incidence of hand,foot and mouth disease (HFMD) and the epidemiological characteristics of HFMD in China.Methods Bayesian hierarchical model[Besag,York,and Mollie' (BYM) model] was used to fit the data.The fitting effects of uncorrelated heterogeneity (UH) model,correlated heterogeneity (CH) model and spatial and temporal interaction model were compared and the best model was selected to analyze the meteorological factors influencing the incidence of HFMD.Results The UH +CH model with spatial and temporal interaction had best fitting effect (DIC=35 507.2).Rainfall(RR=1.051 7,95％ CI:1.050 4-1.052 5),average temperature (RR=1.089 6,95％ CI:1.078 1-1.106 9),average relative humidity (RR=l.089 0,95％CI:1.082 1-1.091 2),average air pressure (RR=l.076 4,95％ CI:1.074 8-1.077 9) and hours of sunshine (RR=1.0851,95％ CI:1.0798-1.0875) were the meteorological factors influencing the incidence of HFMD.Conclusion The incidence of HFMD had spatial and temporal clustering characteristics.The meteorological factors were closely related with the incidence of HFMD.

objective To identify the three strains of pink-pigmented bacteria isolated from ticks.Methads 16S rDNA sequence analysis,16S rDNA similarity searching,bacterial morphological,physiological and biochemical tests and fatty acids analysis were used.Results The bacterial strains were pinkpigment,gram negative,strictly aerobic coccobacillus.They grow optimally at 37℃,while not in the presence of≥5% NaCl.The tests showed positive result for urease,D-glucose,citrate,UV absorption,and catalase.The predominant fatty acids were C16:0,C17:0,C18:1 ωgc and C19:0 cyc.Comparative 16S rDNA sequences analysis revealed that the strains were closely related to Roseomonas cervicalis and could reach up to 99.1% identity.Conclusion Based on phenotypic,biochemical and phylogenetic data,we propose these three isolates represent distinct species in genus Roseomonas,of which ticks may serve as a potential vector.

Beijing has been one of the epicenters attacked most severely by the SARS-CoV (severe acute respiratory syndrome-associated coronavirus) since the first patient was diagnosed in one of the city's hospitals. We now report complete genome sequences of the BJ Group, including four isolates (Isolates BJ01, BJ02, BJ03, and BJ04) of the SARS-CoV. It is remarkable that all members of the BJ Group share a common haplotype, consisting of seven loci that differentiate the group from other isolates published to date. Among 42 substitutions uniquely identified from the BJ group, 32 are non-synonymous changes at the amino acid level. Rooted phylogenetic trees, proposed on the basis of haplotypes and other sequence variations of SARS-CoV isolates from Canada, USA, Singapore, and China, gave rise to different paradigms but positioned the BJ Group, together with the newly discovered GD01 (GD-Ins29) in the same clade, followed by the H-U Group (from Hong Kong to USA) and the H-T Group (from Hong Kong to Toronto), leaving the SP Group (Singapore) more distant. This result appears to suggest a possible transmission path from Guangdong to Beijing/Hong Kong, then to other countries and regions.
Genome, Viral ; Haplotypes ; Humans ; Mutation ; Open Reading Frames ; Phylogeny ; SARS Virus ; genetics

We report a complete genomic sequence of rare isolates (minor genotype) of the SARS-CoV from SARS patients in Guangdong, China, where the first few cases emerged. The most striking discovery from the isolate is an extra 29-nucleotide sequence located at the nucleotide positions between 27,863 and 27,864 (referred to the complete sequence of BJ01) within an overlapped region composed of BGI-PUP5 (BGI-postulated uncharacterized protein 5) and BGI-PUP6 upstream of the N (nucleocapsid) protein. The discovery of this minor genotype, GD-Ins29, suggests a significant genetic event and differentiates it from the previously reported genotype, the dominant form among all sequenced SARS-CoV isolates. A 17-nt segment of this extra sequence is identical to a segment of the same size in two human mRNA sequences that may interfere with viral replication and transcription in the cytosol of the infected cells. It provides a new avenue for the exploration of the virus-host interaction in viral evolution, host pathogenesis, and vaccine development.
Base Sequence ; China ; Cluster Analysis ; Gene Components ; Genetic Variation ; Genome, Viral ; Genotype ; Molecular Sequence Data ; Phylogeny ; Reverse Transcriptase Polymerase Chain Reaction ; SARS Virus ; genetics ; Sequence Analysis, DNA ; Severe Acute Respiratory Syndrome ; genetics

Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; therapy