Scrub typhus in mainland China, 2006–2012 : the need for targeted public health interventions

Scrub typhus is a vector-borne disease carried by the chigger mite. The aetiological agent is the rickettsia Orientia tsutsugamushi, which is endemic to several countries in the Asia-Pacific region, including China [1]. It is also a travel-associated disease [2] and of great importance among military personnel [3], [4]. During the Second World War, scrub typhus was associated with a higher case fatality ratio than any other infectious disease in the China-Burma-India theatre of operations 1,3. Clinical presentation in patients varies from asymptomatic to life-threatening disease [5], including acute hearing loss and multiple organ failure [6], [7]. To date, there is still no effective and reliable human vaccine against scrub typhus and no point-of-care diagnostics available [1].

Impact of climate variability on Plasmodium vivax and Plasmodium falciparum malaria in Yunnan Province, China

BACKGROUND Malaria remains a public health problem in the remote and poor area of Yunnan Province, China. Yunnan faces an increasing risk of imported malaria infections from Mekong river neighboring countries. This study aimed to identify the high risk area of malaria transmission in Yunnan Province, and to estimate the effects of climatic variability on the transmission of Plasmodium vivax and Plasmodium falciparum in the identified area. METHODS We identified spatial clusters of malaria cases using spatial cluster analysis at a county level in Yunnan Province, 2005-2010, and estimated the weekly effects of climatic factors on P. vivax and P. falciparum based on a dataset of daily malaria cases and climatic variables. A distributed lag nonlinear model was used to estimate the impact of temperature, relative humidity and rainfall up to 10-week lags on both types of malaria parasite after adjusting for seasonal and long-term effects. RESULTS The primary cluster area was identified along the China-Myanmar border in western Yunnan. A 1°C increase in minimum temperature was associated with a lag 4 to 9 weeks relative risk (RR), with the highest effect at lag 7 weeks for P. vivax (RR = 1.03; 95% CI, 1.01, 1.05) and 6 weeks for P. falciparum (RR = 1.07; 95% CI, 1.04, 1.11); a 10-mm increment in rainfall was associated with RRs of lags 2-4 weeks and 9-10 weeks, with the highest effect at 3 weeks for both P. vivax (RR = 1.03; 95% CI, 1.01, 1.04) and P. falciparum (RR = 1.04; 95% CI, 1.01, 1.06); and the RRs with a 10% rise in relative humidity were significant from lag 3 to 8 weeks with the highest RR of 1.24 (95% CI, 1.10, 1.41) for P. vivax at 5-week lag. CONCLUSIONS Our findings suggest that the China-Myanmar border is a high risk area for malaria transmission. Climatic factors appeared to be among major determinants of malaria transmission in this area. The estimated lag effects for the association between temperature and malaria are consistent with the life cycles of both mosquito vector and malaria parasite. These findings will be useful for malaria surveillance-response systems in the Mekong river region.

Spatiotemporal patterns of Japanese Encephalitis in China, 2002–2010

OBJECTIVE The aim of the study is to examine the spatiotemporal pattern of Japanese Encephalitis (JE) in mainland China during 2002-2010. Specific objectives of the study were to quantify the temporal variation in incidence of JE cases, to determine if clustering of JE cases exists, to detect high risk spatiotemporal clusters of JE cases and to provide evidence-based preventive suggestions to relevant stakeholders. METHODS Monthly JE cases at the county level in mainland China during 2002-2010 were obtained from the China Information System for Diseases Control and Prevention (CISDCP). For the purpose of the analysis, JE case counts for nine years were aggregated into four temporal periods (2002; 2003-2005; 2006; and 2007-2010). Local Indicators of Spatial Association and spatial scan statistics were performed to detect and evaluate local high risk space-time clusters. RESULTS JE incidence showed a decreasing trend from 2002 to 2005 but peaked in 2006, then fluctuated over the study period. Spatial cluster analysis detected high value clusters, mainly located in Southwestern China. Similarly, we identified a primary spatiotemporal cluster of JE in Southwestern China between July and August, with the geographical range of JE transmission increasing over the past years. CONCLUSION JE in China is geographically clustered and its spatial extent dynamically changed during the last nine years in mainland China. This indicates that risk factors for JE infection are likely to be spatially heterogeneous. The results may assist national and local health authorities in the development/refinement of a better preventive strategy and increase the effectiveness of public health interventions against JE transmission.

Epidemiologic characteristics of cases for influenza A(H7N9) virus infections in China

China's National Health and Family Planning Commission announced 3 deaths caused by avian-origin influenza A(H7N9) virus in March, which was the first time that the H7N9 strain has been found in humans [1]. This is of major public health significance and raises urgent questions and global concerns [2, 3]. To explore epidemic characteristics of human infections with H7N9 virus, data on individual cases from 19 February 2013 (onset date of first case) to 14 April 2013 were collected from the China Information System for Disease Control and Prevention, which included information about sex; age; occupation; residential address; and day of symptom onset, diagnosis, and outcome for each case. The definition of an unconfirmed probable H7N9 case is a patient with epidemiologic evidence of contact …

Epidemiologic features of severe fever with Thrombocytopenia Syndrome in China, 2011-2012

Severe fever with thrombocytopenia syndrome (SFTS), an emerging vector-borne disease, is caused by a novel bunyavirus belonging to the genus Phlebovirus [1, 2]. SFTS infections can be life-threatening and are characterized by sudden onset of fever, thrombocytopenia, gastrointestinal symptoms, and leukocytopenia. The tick Haemaphysalis longicornis is generally considered to be the vector of SFTS, which is widely distributed in China [2]. Person-to-person transmission through direct contact with contaminated blood has also been reported as a possible means of SFTS transmission [3–5]. Currently, there is no specific treatment other than supportive care [6]...

Spatial Patterns of Malaria Reported Deaths in Yunnan Province, China

Malaria has been a heavy social and health burden in the remote and poor areas in southern China. Analyses of malaria epidemic patterns can uncover important features of malaria transmission. This study identified spatial clusters, seasonal patterns, and geographic variations of malaria deaths at a county level in Yunnan, China, during 1991–2010. A discrete Poisson model was used to identify purely spatial clusters of malaria deaths. Logistic regression analysis was performed to detect changes in geographic patterns. The results show that malaria mortality had declined in Yunnan over the study period and the most likely spatial clusters (relative risk [RR] = 23.03–32.06, P < 0.001) of malaria deaths were identified in western Yunnan along the China–Myanmar border. The highest risk of malaria deaths occurred in autumn (RR = 58.91, P < 0.001) and summer (RR = 31.91, P < 0.001). The results suggested that the geographic distribution of malaria deaths was significantly changed with longitude, which indicated there was decreased mortality of malaria in eastern areas over the last two decades, although there was no significant change in latitude during the same period. Public health interventions should target populations in western Yunnan along border areas, especially focusing on floating populations crossing international borders.

Development route of the wind power industry in China

Wind power is one of the world's major renewable energy sources, and its utilization provides an important contribution in helping solve the energy problems of many countries. After nearly 40 years of development, China's wind power industry now not only manufactures its own massive six MW turbines but also has the largest capacity in the world with a national output of 50 million MW•h in 2010 and set to rise by eight times of that amount by 2020. This paper investigates this development route by analyzing relevant academic literature, statistics, laws and regulations, policies and research and industry reports. The main drivers of the development in the industry are identified as technologies, turbines, wind farm construction, pricing mechanism and government support systems, each of which is also divided into different stages with distinctive features. A systematic review of these aspects provides academics and practitioners with a better understanding of the history of the wind power industry in China and reasons for its rapid development with a view to enhancing progress in wind power development both in China and the world generally.

Global characteristics of school transformation in China

In many ways, China’s education system is quite different from systems of education in the West. Rich descriptions of school transformation, however, have revealed that the factors that fuelled transformation in schools in China are also evident in schools in Australia, England, Finland, Wales and the United States. This paper draws on an international project that examined how secondary schools from six countries achieved success by developing and drawing on their resources, referred to as four forms of capital: financial, intellectual, social and spiritual. It describes how five secondary schools in Chongqing, Western China, viewed each form of capital and how the four forms of capital were strengthened and aligned through outstanding governance to support the success of all students. The case is made that, although some aspects of the forms of capital found in schools in China may be viewed differently, the approaches adopted by these schools share a number of common elements with approaches to school transformation identified in Western schools. It is argued that these common elements from a range of international settings constitute a rich evidence base for understanding school transformation and for new insights in governance and leadership.

Predicting freeway pavement construction cost using a back-propagation neural network : a case study in Henan, China

The objective of this research was to develop a model to estimate future freeway pavement construction costs in Henan Province, China. A comprehensive set of factors contributing to the cost of freeway pavement construction were included in the model formulation. These factors comprehensively reflect the characteristics of region and topography and altitude variation, the cost of labour, material, and equipment, and time-related variables such as index numbers of labour prices, material prices and equipment prices. An Artificial Neural Network model using the Back-Propagation learning algorithm was developed to estimate the cost of freeway pavement construction. A total of 88 valid freeway cases were obtained from freeway construction projects let by the Henan Transportation Department during the period 1994−2007. Data from a random selection of 81 freeway cases were used to train the Neural Network model and the remaining data were used to test the performance of the Neural Network model. The tested model was used to predict freeway pavement construction costs in 2010 based on predictions of input values. In addition, this paper provides a suggested correction for the prediction of the value for the future freeway pavement construction costs. Since the change in future freeway pavement construction cost is affected by many factors, the predictions obtained by the proposed method, and therefore the model, will need to be tested once actual data are obtained.

Beyond online preprints : formalization of open initiatives in China

A growing number of online journals and academic platforms are adopting light peer review or 'publish then filter' models of scholarly communication. These approaches have the advantage of enabling instant exchanges of knowledge between academics and are part of a wider search for alternatives to traditional peer review and certification processes in scholarly publishing. However, establishing credibility and identifying the correct balance between communication and scholarly rigour remains an important challenge for digital communication platforms targeting academic communities. This paper looks at a highly influential, government-backed, open publishing platform in China: Science Paper Online, which is using transparent post-publication peer-review processes to encourage innovation and address systemic problems in China's traditional academic publishing system. There can be little doubt that the Chinese academic publishing landscape differs in important ways from counterparts in the United States and Western Europe. However, this article suggests that developments in China also provide important lessons about the potential of digital technology and government policy to facilitate a large-scale shift towards more open and networked models of scholarly communication.

Exposure to ambient heat and urolithiasis among outdoor workers in Guangzhou, China

Objectives: To assess the impact of exposure to ambient heat on urolithiasis among outdoor workers in a subtropical city of China. Methods: The 2003–2010 health check data of a shipbuilding company in Guangzhou, China were acquired. 190 cases and 760 matched controls were involved in this study. We assessed the relationship between exposure to ambient heat and urolithiasis for different occupations using conditional logistic regression. Results: Spray painters were most likely to develop urolithiasis (OR = 4.4; 95% CI: 1.7, 11.4), followed by smelter workers (OR = 4.0; 95% CI: 1.8, 9.2), welders (OR = 3.7; 95% CI: 1.9, 7.2), production security and quality inspectors (OR = 2.7; 95% CI: 1.4, 3.0), and assemblers (OR = 2.2; 95% CI: 1.1, 4.3). Overall, outdoor workers were more likely to present with urolithiasis compared with indoor employees (p b 0.05). In addition, workers with longer cumulative exposure time (OR = 1.5; 95% CI: 1.2, 1.8) and abnormal blood pressure (OR = 1.6; 95% CI: 1.0, 2.5) had higher risk for urolithiasis. Conclusions: Our findings demonstrate a significant association between exposure to ambient heat and urolithiasis among outdoor working populations. Public health intervention strategies should be developed to specifically target outdoor occupations.

Geographic co-distribution of influenza virus subtypes H7N9 and H5N1 in humans, China

Human infection with a novel low pathogenicity influenza A(H7N9) virus in eastern China has recently raised global public health concerns (1). The geographic sources of infection have yet to be fully clarified, and confirmed human cases from 1 province have not been linked to those from other provinces. While some studies have identified epidemiologic characteristics of subtype H7N9 cases and clinical differences between these cases and cases of highly pathogenic influenza A(H5N1), another avian influenza affecting parts of China (2–4), the spatial epidemiology of human infection with influenza subtypes H7N9 and H5N1 in China has yet to be elucidated. To test the hypothesis of co-distribution of high-risk clusters of both types of infection, we used all available data on human cases in mainland China and investigated the geospatial epidemiologic features...