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Showing papers by "Chinese Center for Disease Control and Prevention published in 2017"


Journal ArticleDOI
TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.

10,401 citations


Journal ArticleDOI
TL;DR: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence‐based interventions to address this problem.
Abstract: BACKGROUND Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHOD ...

4,519 citations


Journal ArticleDOI
TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors (GBD) study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions as discussed by the authors.
Abstract: Summary Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions. In this systematic analysis, we quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level. Methods We estimated global and country-specific prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for various neurological disorders that in the GBD classification have been previously spread across multiple disease groupings. The more inclusive grouping of neurological disorders included stroke, meningitis, encephalitis, tetanus, Alzheimer's disease and other dementias, Parkinson's disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, medication overuse headache, brain and nervous system cancers, and a residual category of other neurological disorders. We also analysed results based on the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility, to identify patterns associated with development and how countries fare against expected outcomes relative to their level of development. Findings Neurological disorders ranked as the leading cause group of DALYs in 2015 (250·7 [95% uncertainty interval (UI) 229·1 to 274·7] million, comprising 10·2% of global DALYs) and the second-leading cause group of deaths (9·4 [9·1 to 9·7] million], comprising 16·8% of global deaths). The most prevalent neurological disorders were tension-type headache (1505·9 [UI 1337·3 to 1681·6 million cases]), migraine (958·8 [872·1 to 1055·6] million), medication overuse headache (58·5 [50·8 to 67·4 million]), and Alzheimer's disease and other dementias (46·0 [40·2 to 52·7 million]). Between 1990 and 2015, the number of deaths from neurological disorders increased by 36·7%, and the number of DALYs by 7·4%. These increases occurred despite decreases in age-standardised rates of death and DALYs of 26·1% and 29·7%, respectively; stroke and communicable neurological disorders were responsible for most of these decreases. Communicable neurological disorders were the largest cause of DALYs in countries with low SDI. Stroke rates were highest at middle levels of SDI and lowest at the highest SDI. Most of the changes in DALY rates of neurological disorders with development were driven by changes in YLLs. Interpretation Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, despite substantial decreases in mortality rates from stroke and communicable neurological disorders. The number of patients who will need care by clinicians with expertise in neurological conditions will continue to grow in coming decades. Policy makers and health-care providers should be aware of these trends to provide adequate services. Funding Bill & Melinda Gates Foundation.

2,995 citations


Proceedings ArticleDOI
21 Jul 2017
TL;DR: A unified implementation of the Faster R-CNN, R-FCN and SSD systems is presented and the speed/accuracy trade-off curve created by using alternative feature extractors and varying other critical parameters such as image size within each of these meta-architectures is traced out.
Abstract: The goal of this paper is to serve as a guide for selecting a detection architecture that achieves the right speed/memory/accuracy balance for a given application and platform. To this end, we investigate various ways to trade accuracy for speed and memory usage in modern convolutional object detection systems. A number of successful systems have been proposed in recent years, but apples-toapples comparisons are difficult due to different base feature extractors (e.g., VGG, Residual Networks), different default image resolutions, as well as different hardware and software platforms. We present a unified implementation of the Faster R-CNN [30], R-FCN [6] and SSD [25] systems, which we view as meta-architectures and trace out the speed/accuracy trade-off curve created by using alternative feature extractors and varying other critical parameters such as image size within each of these meta-architectures. On one extreme end of this spectrum where speed and memory are critical, we present a detector that achieves real time speeds and can be deployed on a mobile device. On the opposite end in which accuracy is critical, we present a detector that achieves state-of-the-art performance measured on the COCO detection task.

2,484 citations


Journal ArticleDOI
TL;DR: This poster presents a poster presenting a poster presented at the 2016 International Conference of the Association for the Study of Viral Influenza and its Disruption in China, where it was presented for the first time.
Abstract: Yuelong Shu1, John McCauley2 1. WHO Collaborating Center for Reference and Research on Influenza, Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China 2. WHO Collaborating Centre for Reference and Research on Influenza, Crick Worldwide Influenza Centre, the Francis Crick Institute, London, United Kingdom

2,306 citations


Journal ArticleDOI
A. Danielle Iuliano1, Katherine Roguski1, Howard H. Chang2, David Muscatello3, Rakhee Palekar4, Stefano Tempia1, Cheryl Cohen5, Jon Michael Gran6, Jon Michael Gran7, Dena L. Schanzer, Benjamin J. Cowling8, Peng Wu8, Jan Kynčl, Li Wei Ang9, Minah Park8, Monika Redlberger-Fritz10, Hongjie Yu11, Laura Espenhain12, Anand Krishnan13, Gideon O. Emukule1, Liselotte van Asten, Susana Silva, Suchunya Aungkulanon14, Udo Buchholz15, Marc-Alain Widdowson1, Joseph S. Bresee1, Eduardo Azziz-Baumgartner, Po-Yung Cheng, Fatimah S. Dawood, Ivo M. Foppa, Sonja J. Olsen, Michael Haber, Caprichia Jeffers, C. Raina MacIntyre, Anthony T. Newall, James G. Wood, Michael Kundi, Therese Popow-Kraupp, Makhdum Ahmed, Mahmudur Rahman, Fatima Marinho, C Viviana Sotomayor Proschle, Natalia Vergara Mallegas, Feng Luzhao, Li Sa, Juliana Barbosa-Ramírez, Diana Malo Sanchez, Leandra Abarca Gomez, Xiomara Badilla Vargas, aBetsy Acosta Herrera, María Josefa Llanés, Thea Kølsen Fischer, Tyra Grove Krause, Kåre Mølbak, Jens Nielsen, Ramona Trebbien, Alfredo Bruno, Jenny Ojeda, Hector Ramos, Matthias an der Heiden, Leticia del Carmen Castillo Signor, Carlos Enrique Serrano, Rohit Bhardwaj, Mandeep S. Chadha, Venkatesh Vinayak Narayan, Soewarta Kosen, Michal Bromberg, Aharona Glatman-Freedman, Zalman Kaufman, Yuzo Arima, Kazunori Oishi, Sandra S. Chaves, Bryan O. Nyawanda, Reem Abdullah Al-Jarallah, Pablo A Kuri-Morales, Cuitláhuac Ruiz Matus, Maria Eugenia Jimenez Corona, Alexander Burmaa, Oyungerel Darmaa, Majdouline Obtel, Imad Cherkaoui, Cees C van den Wijngaard, Wim van der Hoek, Michael G Baker, Don Bandaranayake, Ange Bissielo, Sue Huang, Liza Lopez, Claire Newbern, Elmira Flem, Gry M Grøneng, Siri Hauge, Federico G de Cosío, Yadira De Molto, Lourdes Moreno Castillo, María Agueda Cabello, Marta Von Horoch, José L. Medina Osis, Ausenda Machado, Baltazar Nunes, Ana Paula Rodrigues, Emanuel Rodrigues, Cristian Calomfirescu, Emilia Lupulescu, Rodica Popescu, Odette Popovici, Dragan Bogdanovic, Marina Kostic, Konstansa Lazarevic, Zoran Milosevic, Branislav Tiodorovic, Mark I-Cheng Chen, Jeffery Cutter, Vernon J. Lee, Raymond T. P. Lin, Stefan Ma, Adam L. Cohen, Florette K. Treurnicht, Woo Joo Kim, Concha Delgado-Sanz, Salvador de mateo Ontañón, Amparo Larrauri, Inmaculada León, Fernando Vallejo, Rita Born, Christoph Junker, Daniel Koch, Jen-Hsiang Chuang, Wan-Ting Huang, Hung-Wei Kuo, Yi-Chen Tsai, Kanitta Bundhamcharoen, Malinee Chittaganpitch, Helen K. Green, Richard Pebody, Natalia Goñi, Hector Chiparelli, Lynnette Brammer, Desiree Mustaquim 
TL;DR: These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden.

1,658 citations


Journal ArticleDOI
Bin Zhou1, James Bentham1, Mariachiara Di Cesare2, Honor Bixby1  +787 moreInstitutions (231)
TL;DR: The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries, and the contributions of changes in prevalence versus population growth and ageing to the increase.

1,573 citations


Journal ArticleDOI
Ting Shi1, David A. McAllister2, Katherine L. O'Brien3, Eric A. F. Simões4, Shabir A. Madhi5, Bradford D. Gessner, Fernando P. Polack, Evelyn Balsells1, Sozinho Acácio6, Claudia Aguayo, Issifou Alassani, Asad Ali7, Martin Antonio8, Shally Awasthi9, Juliet O. Awori10, Eduardo Azziz-Baumgartner11, Eduardo Azziz-Baumgartner12, Henry C. Baggett12, Vicky L. Baillie5, Angel Balmaseda, Alfredo Barahona, Sudha Basnet13, Sudha Basnet14, Quique Bassat15, Quique Bassat6, Wilma Basualdo, Godfrey Bigogo10, Louis Bont16, Robert F. Breiman17, W. Abdullah Brooks11, W. Abdullah Brooks3, Shobha Broor18, Nigel Bruce19, Dana Bruden12, Philippe Buchy20, Stuart Campbell1, Phyllis Carosone-Link20, Mandeep S. Chadha21, James Chipeta22, Monidarin Chou23, Wilfrido Clara12, Cheryl Cohen24, Cheryl Cohen5, Elizabeth de Cuellar, Duc Anh Dang, Budragchaagiin Dash-Yandag, Maria Deloria-Knoll3, Mukesh Dherani19, Tekchheng Eap, Bernard E. Ebruke8, Marcela Echavarria, Carla Cecília de Freitas Lázaro Emediato, Rodrigo Fasce, Daniel R. Feikin12, Luzhao Feng25, Angela Gentile26, Aubree Gordon27, Doli Goswami3, Doli Goswami11, Sophie Goyet20, Michelle J. Groome5, Natasha B. Halasa28, Siddhivinayak Hirve, Nusrat Homaira11, Nusrat Homaira29, Stephen R. C. Howie30, Stephen R. C. Howie31, Stephen R. C. Howie8, Jorge Jara32, Imane Jroundi15, Cissy B. Kartasasmita, Najwa Khuri-Bulos33, Karen L. Kotloff34, Anand Krishnan18, Romina Libster35, Romina Libster28, Olga Lopez, Marilla G. Lucero36, Florencia Lución26, Socorro Lupisan36, Debora N. Marcone, John P. McCracken32, Mario Mejia, Jennifer C. Moïsi, Joel M. Montgomery12, David P. Moore5, Cinta Moraleda15, Jocelyn Moyes5, Jocelyn Moyes24, Patrick K. Munywoki37, Patrick K. Munywoki10, Kuswandewi Mutyara, Mark P. Nicol38, D. James Nokes10, D. James Nokes39, Pagbajabyn Nymadawa40, Maria Tereza da Costa Oliveira, Histoshi Oshitani41, Nitin Pandey9, Gláucia Paranhos-Baccalà42, Lia Neu Phillips17, Valentina Picot42, Mustafizur Rahman11, Mala Rakoto-Andrianarivelo, Zeba A Rasmussen43, Barbara Rath44, Annick Robinson, Candice Romero, Graciela Russomando45, Vahid Salimi46, Pongpun Sawatwong12, Nienke M Scheltema16, Brunhilde Schweiger47, J. Anthony G. Scott48, J. Anthony G. Scott10, Phil Seidenberg49, Kunling Shen50, Rosalyn J. Singleton51, Rosalyn J. Singleton12, Viviana Sotomayor, Tor A. Strand14, Tor A. Strand52, Agustinus Sutanto, Mariam Sylla, Milagritos D. Tapia34, Somsak Thamthitiwat12, Elizabeth Thomas43, Rafal Tokarz53, Claudia Turner54, Marietjie Venter55, Sunthareeya Waicharoen56, Jianwei Wang57, Wanitda Watthanaworawit54, Lay-Myint Yoshida58, Hongjie Yu25, Heather J. Zar38, Harry Campbell1, Harish Nair59, Harish Nair1 
University of Edinburgh1, University of Glasgow2, Johns Hopkins University3, University of Colorado Boulder4, University of the Witwatersrand5, International Military Sports Council6, Aga Khan University7, Medical Research Council8, King George's Medical University9, Kenya Medical Research Institute10, International Centre for Diarrhoeal Disease Research, Bangladesh11, Centers for Disease Control and Prevention12, Tribhuvan University13, University of Bergen14, University of Barcelona15, Utrecht University16, Emory University17, All India Institute of Medical Sciences18, University of Liverpool19, Boston Children's Hospital20, National Institute of Virology21, University of Zambia22, University of Health Sciences Antigua23, National Health Laboratory Service24, Chinese Center for Disease Control and Prevention25, Austral University26, University of Michigan27, Vanderbilt University28, University of New South Wales29, University of Auckland30, University of Otago31, Universidad del Valle de Guatemala32, University of Jordan33, University of Maryland, Baltimore34, National Scientific and Technical Research Council35, Research Institute for Tropical Medicine36, Pwani University College37, University of Cape Town38, University of Warwick39, Academy of Medical Sciences, United Kingdom40, Tohoku University41, École normale supérieure de Lyon42, John E. Fogarty International Center43, Charité44, Universidad Nacional de Asunción45, Tehran University of Medical Sciences46, Robert Koch Institute47, University of London48, University of New Mexico49, Capital Medical University50, Alaska Native Tribal Health Consortium51, Innlandet Hospital Trust52, Columbia University53, Mahidol University54, University of Pretoria55, Thailand Ministry of Public Health56, Peking Union Medical College57, Nagasaki University58, Public Health Foundation of India59
TL;DR: In this paper, the authors estimated the incidence and hospital admission rate of RSV-associated acute lower respiratory infection (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions.

1,470 citations


Journal ArticleDOI
27 Jun 2017-JAMA
TL;DR: To estimate the recent prevalence and to investigate the ethnic variation of diabetes and prediabetes in the Chinese adult population, a nationally representative cross-sectional survey in 2013 in mainland China was conducted.
Abstract: Importance Previous studies have shown increasing prevalence of diabetes in China, which now has the world’s largest diabetes epidemic. Objectives To estimate the recent prevalence and to investigate the ethnic variation of diabetes and prediabetes in the Chinese adult population. Design, Setting, and Participants A nationally representative cross-sectional survey in 2013 in mainland China, which consisted of 170 287 participants. Exposures Fasting plasma glucose and hemoglobin A 1c levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes. Main Outcomes and Measures Primary outcomes were total diabetes and prediabetes defined according to the 2010 American Diabetes Association criteria. Awareness and treatment were also evaluated. Hemoglobin A 1c concentration of less than 7.0% among treated diabetes patients was considered adequate glycemic control. Minority ethnic groups in China with at least 1000 participants (Tibetan, Zhuang, Manchu, Uyghur, and Muslim) were compared with Han participants. Results Among the Chinese adult population, the estimated standardized prevalence of total diagnosed and undiagnosed diabetes was 10.9% (95% CI, 10.4%-11.5%); that of diagnosed diabetes, 4.0% (95% CI, 3.6%-4.3%); and that of prediabetes, 35.7% (95% CI, 34.1%-37.4%). Among persons with diabetes, 36.5% (95% CI, 34.3%-38.6%) were aware of their diagnosis and 32.2% (95% CI, 30.1%-34.2%) were treated; 49.2% (95% CI, 46.9%-51.5%) of patients treated had adequate glycemic control. Tibetan and Muslim Chinese had significantly lower crude prevalence of diabetes than Han participants (14.7% [95% CI, 14.6%-14.9%] for Han, 4.3% [95% CI, 3.5%-5.0%] for Tibetan, and 10.6% [95% CI, 9.3%-11.9%] for Muslim; P Conclusions and Relevance Among adults in China, the estimated overall prevalence of diabetes was 10.9%, and that for prediabetes was 35.7%. Differences from previous estimates for 2010 may be due to an alternate method of measuring hemoglobin A 1c .

1,261 citations


Journal ArticleDOI
TL;DR: Stroke burden in China has increased over the past 30 years, and remains particularly high in rural areas, with the greatest stroke burden observed in the northern and central regions.
Abstract: Background:China bears the biggest stroke burden in the world. However, little is known about the current prevalence, incidence, and mortality of stroke at the national level, and the trend in the ...

1,222 citations


Journal ArticleDOI
TL;DR: This nationwide investigation provided robust evidence of the associations between short‐term exposure to PM2.5 and increased mortality from various cardiopulmonary diseases in China.
Abstract: Rationale: Evidence concerning the acute health effects of air pollution caused by fine particulate matter (PM2.5) in developing countries is quite limited.Objectives: To evaluate short-term associations between PM2.5 and daily cause-specific mortality in China.Methods: A nationwide time-series analysis was performed in 272 representative Chinese cities from 2013 to 2015. Two-stage Bayesian hierarchical models were applied to estimate regional- and national-average associations between PM2.5 concentrations and daily cause-specific mortality. City-specific effects of PM2.5 were estimated using the overdispersed generalized additive models after adjusting for time trends, day of the week, and weather conditions. Exposure–response relationship curves and potential effect modifiers were also evaluated.Measurements and Main Results: The average of annual mean PM2.5 concentration in each city was 56 μg/m3 (minimum, 18 μg/m3; maximum, 127 μg/m3). Each 10-μg/m3 increase in 2-day moving average of PM2.5 concentrat...

Journal ArticleDOI
Ryan M Barber1, Nancy Fullman1, Reed J D Sorensen1, Thomas J. Bollyky  +757 moreInstitutions (314)
TL;DR: In this paper, the authors use the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

Journal ArticleDOI
Gytis Dudas1, Gytis Dudas2, Luiz Max Carvalho1, Trevor Bedford2, Andrew J. Tatem3, Guy Baele4, Nuno R. Faria5, Daniel J. Park6, Jason T. Ladner7, Armando Arias8, Armando Arias9, Danny Asogun, Filip Bielejec4, Sarah L Caddy8, Matthew Cotten10, Matthew Cotten11, Jonathan D'ambrozio7, Simon Dellicour4, Antonino Di Caro, Joseph W. Diclaro, Sophie Duraffour12, Michael J. Elmore13, Lawrence Fakoli, Ousmane Faye14, Merle L. Gilbert7, Sahr M. Gevao15, Stephen K. Gire6, Stephen K. Gire16, Adrianne Gladden-Young6, Andreas Gnirke6, Augustine Goba, Donald S. Grant, Bart L. Haagmans11, Julian A. Hiscox17, Umaru Jah18, Jeffrey R. Kugelman7, Di Liu, Jia Lu8, Christine M. Malboeuf6, Suzanne Mate7, David A. Matthews19, Christian B. Matranga6, Luke W. Meredith18, Luke W. Meredith8, James Qu6, Joshua Quick20, Susan D. Pas11, My V. T. Phan10, My V. T. Phan11, Georgios Pollakis17, Chantal B.E.M. Reusken11, Mariano Sanchez-Lockhart7, Stephen F. Schaffner6, John S. Schieffelin, Rachel Sealfon6, Rachel Sealfon21, Etienne Simon-Loriere14, Etienne Simon-Loriere22, Saskia L. Smits11, Kilian Stoecker, Lucy Thorne8, Ekaete Alice Tobin, Mohamed A. Vandi, Simon J. Watson10, Kendra West6, Shannon L.M. Whitmer, Michael R. Wiley7, Sarah M. Winnicki23, Sarah M. Winnicki6, Shirlee Wohl6, Shirlee Wohl16, Roman Wölfel, Nathan L. Yozwiak16, Nathan L. Yozwiak6, Kristian G. Andersen24, Kristian G. Andersen25, Sylvia O. Blyden, Fatorma K. Bolay, Miles W. Carroll, Bernice Dahn, Boubacar Diallo26, Pierre Formenty26, Christophe Fraser5, George F. Gao27, Robert F. Garry, Ian Goodfellow18, Ian Goodfellow8, Stephan Günther12, Christian T. Happi, Edward C. Holmes28, Brima Kargbo, Sakoba Keita, Paul Kellam10, Paul Kellam29, Marion Koopmans11, Jens H. Kuhn30, Nicholas J. Loman20, N’Faly Magassouba, Dhamari Naidoo26, Stuart T. Nichol31, Tolbert Nyenswah, Gustavo Palacios7, Oliver G. Pybus5, Pardis C. Sabeti16, Pardis C. Sabeti6, Amadou A. Sall14, Ute Ströher31, Isatta Wurie15, Marc A. Suchard32, Philippe Lemey4, Andrew Rambaut1 
20 Apr 2017-Nature
TL;DR: It is revealed that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity, which will help to inform interventions in future epidemics.
Abstract: The 2013-2016 West African epidemic caused by the Ebola virus was of unprecedented magnitude, duration and impact. Here we reconstruct the dispersal, proliferation and decline of Ebola virus throughout the region by analysing 1,610 Ebola virus genomes, which represent over 5% of the known cases. We test the association of geography, climate and demography with viral movement among administrative regions, inferring a classic 'gravity' model, with intense dispersal between larger and closer populations. Despite attenuation of international dispersal after border closures, cross-border transmission had already sown the seeds for an international epidemic, rendering these measures ineffective at curbing the epidemic. We address why the epidemic did not spread into neighbouring countries, showing that these countries were susceptible to substantial outbreaks but at lower risk of introductions. Finally, we reveal that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity. These insights will help to inform interventions in future epidemics.

Journal ArticleDOI
TL;DR: These data showed the long‐term presence of Ebola virus RNA in semen and declining persistence with increasing time after ETU discharge, as well as the risk of sexual transmission of EVD.
Abstract: BACKGROUND Ebola virus has been detected in the semen of men after their recovery from Ebola virus disease (EVD), but little information is available about its prevalence or the duration of its persistence. We report the initial findings of a pilot study involving survivors of EVD in Sierra Leone. METHODS We enrolled a convenience sample of 100 male survivors of EVD in Sierra Leone, at different times after their recovery from EVD, and recorded self-reported information about sociodemographic characteristics, the EVD episode, and health status. Semen specimens obtained at baseline were tested by means of a quantitative reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay with the use of the target-gene sequences of NP and VP40. RESULTS A total of 93 participants provided an initial semen specimen for analysis, of whom 46 (49%) had positive results on quantitative RT-PCR. Ebola virus RNA was detected in the semen of all 9 men who had a specimen obtained 2 to 3 months after the onset of EVD, in the semen of 26 of 40 (65%) who had a specimen obtained 4 to 6 months after onset, and in the semen of 11 of 43 (26%) who had a specimen obtained 7 to 9 months after onset; the results for 1 participant who had a specimen obtained at 10 months were indeterminate. The median cycle-threshold values (for which higher values indicate lower RNA levels) were 32.0 with the NP gene target and 31.1 with the VP40 gene target for specimens obtained at 2 to 3 months, 34.5 and 32.3, respectively, for specimens obtained at 4 to 6 months, and 37.0 and 35.6, respectively, for specimens obtained at 7 to 9 months. CONCLUSIONS These data showed the persistence of Ebola virus RNA in semen and declining persistence with increasing months since the onset of EVD. We do not yet have data on the extent to which positivity on RT-PCR is associated with virus infectivity. Although cases of suspected sexual transmission of Ebola have been reported, they are rare; hence the risk of sexual transmission of the Ebola virus is being investigated. (Funded by the World Health Organization and others.)

Journal ArticleDOI
TL;DR: T-cell immunological studies of SARS-CoV are summarized and the potential cross-reactivity of the SARV-specific immunity against MERS- coV is discussed, which may provide useful recommendations for the development of broad-spectrum vaccines against coronavirus infections.

Journal ArticleDOI
TL;DR: Wang et al. as mentioned in this paper employed a spatial Durbin model (SDM) to investigate the impacts of both air pollution and its spatial spillover effect on public health in 116 cities of China over 2006-2012.

Journal ArticleDOI
Nicholas J Kassebaum1, Hmwe H Kyu1, Leo Zoeckler1, Helen E Olsen1  +256 moreInstitutions (120)
TL;DR: Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden.
Abstract: Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

Journal ArticleDOI
TL;DR: Long-term exposure to PM2.5 was associated with nonaccidental, CVD, lung cancer, and COPD mortality in China and the HR estimate from this cohort was consistently higher than IER predictions.
Abstract: Background: Cohort studies in North America and western Europe have reported increased risk of mortality associated with long-term exposure to fine particles (PM2.5), but to date, no such studies h...

Journal ArticleDOI
TL;DR: This epidemiological study aimed to describe the epidemiological characteristics, clinical severity, and time-to-event distributions of patients infected with A H7N9 in the 2016-17 epidemic compared with previous epidemics.
Abstract: Summary Background The avian influenza A H7N9 virus has caused infections in human beings in China since 2013 A large epidemic in 2016–17 prompted concerns that the epidemiology of the virus might have changed, increasing the threat of a pandemic We aimed to describe the epidemiological characteristics, clinical severity, and time-to-event distributions of patients infected with A H7N9 in the 2016–17 epidemic compared with previous epidemics Methods In this epidemiological study, we obtained information about all laboratory-confirmed human cases of A H7N9 virus infection reported in mainland China as of Feb 23, 2017, from an integrated electronic database managed by the China Center for Disease Control and Prevention (CDC) and provincial CDCs Every identified human case of A H7N9 virus infection was required to be reported to China CDC within 24 h via a national surveillance system for notifiable infectious diseases We described the epidemiological characteristics across epidemics, and estimated the risk of death, mechanical ventilation, and admission to the intensive care unit for patients admitted to hospital for routine clinical practice rather than for isolation purpose We estimated the incubation periods, and time delays from illness onset to hospital admission, illness onset to initiation of antiviral treatment, and hospital admission to death or discharge using survival analysis techniques Findings Between Feb 19, 2013, and Feb 23, 2017, 1220 laboratory-confirmed human infections with A H7N9 virus were reported in mainland China, with 134 cases reported in the spring of 2013, 306 in 2013–14, 219 in 2014–15, 114 in 2015–16, and 447 in 2016–17 The 2016–17 A H7N9 epidemic began earlier, spread to more districts and counties in affected provinces, and had more confirmed cases than previous epidemics The proportion of cases in middle-aged adults increased steadily from 41% (55 of 134) to 57% (254 of 447) from the first epidemic to the 2016–17 epidemic Proportions of cases in semi-urban and rural residents in the 2015–16 and 2016–17 epidemics (63% [72 of 114] and 61% [274 of 447], respectively) were higher than those in the first three epidemics (39% [52 of 134], 55% [169 of 306], and 56% [122 of 219], respectively) The clinical severity of individuals admitted to hospital in the 2016–17 epidemic was similar to that in the previous epidemics Interpretation Age distribution and case sources have changed gradually across epidemics since 2013, while clinical severity has not changed substantially Continued vigilance and sustained intensive control efforts are needed to minimise the risk of human infection with A H7N9 virus Funding The National Science Fund for Distinguished Young Scholars

Journal ArticleDOI
TL;DR: A systematic review and meta-analysis to summarize information regarding the epidemiology, clinical characteristics, and serotype distribution and risk factors for global dengue outbreaks occurring from 1990 to 2015 found Fever, malaise, headache, and asthenia were the most frequently reported clinical symptoms and signs among d Dengue patients.
Abstract: Dengue is an arthropod-borne infectious disease caused by dengue virus (DENV) infection and transmitted by Aedes mosquitoes. Approximately 50-100 million people are infected with DENV each year, resulting in a high economic burden on both governments and individuals. Here, we conducted a systematic review and meta-analysis to summarize information regarding the epidemiology, clinical characteristics, and serotype distribution and risk factors for global dengue outbreaks occurring from 1990 to 2015. We searched the PubMed, Embase and Web of Science databases through December 2016 using the term “dengue outbreak”. In total, 3853 studies were identified, of which 243 studies describing 262 dengue outbreaks met our inclusion criteria. The majority of outbreak-associated dengue cases were reported in the Western Pacific Region, particularly after the year 2010; these cases were primarily identified in China, Singapore and Malaysia. The pooled mean age of dengue-infected individuals was 30.1 years; of the included patients, 54.5% were male, 23.2% had DHF, 62.0% had secondary infections, and 1.3% died. The mean age of dengue patients reported after 2010 was older than that of patients reported before 2010 (34.0 vs 27.2 yrs); however, the proportions of patients who had DHF, had secondary infections and died significantly decreased after 2010. Fever, malaise and asthenia were the most frequently reported clinical symptoms and signs among dengue patients. In addition, among the identified clinical symptoms and signs, positive tourniquet test (OR = 4.86), ascites (OR = 13.91) and shock (OR = 308.09) were identified as the best predictors of dengue infection, DHF and mortality, respectively (both P < 0.05). The main risk factors for dengue infection, DHF and mortality were living with uncovered water container (OR = 1.65), suffering from hypotension (OR = 6.18) and suffering from diabetes mellitus (OR = 2.53), respectively (all P < 0.05). The serotype distribution varied with time and across WHO regions. Overall, co-infections were reported in 46.8% of the evaluated outbreaks, and the highest pooled mortality rate (2.0%) was identified in DENV-2 dominated outbreaks. Our study emphasizes the necessity of implementing programs focused on targeted prevention, early identification, and effective treatment.

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TL;DR: The sources and formation of haze are described, the mitigation measures in force, the relationship between haze pollution and public health is reviewed, the potential policy options for prevention, the need for wider public dialogue and the implications for scientific research are discussed.

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TL;DR: Robust evidence of higher nonaccidental and cardiovascular mortality in association with short-term exposure to ambient ozone in China is provided, and associations between ozone and daily cause-specific mortality were positive but imprecise and nonsignificant.
Abstract: Background: Few large multicity studies have been conducted in developing countries to address the acute health effects of atmospheric ozone pollution. Objective: We explored the associations betwe...

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TL;DR: This research highlights the need to understand more fully the role of “spatially aggregated immune checkpoints” in the development of central nervous systems.
Abstract: Drug resistance surveillance is crucial for control of drug-resistant tuberculosis (TB). However, limited data exists on the burden of drug-resistant TB in children. The goal of this work was to generate prevalence data regarding rifampicin- (RIF-) resistant childhood TB in northern China and to test the feasibility of Xpert for surveying pediatric TB drug resistance prevalence. We enrolled 362 clinically diagnosed childhood TB patients and collected sputum, gastric lavage aspirate (GLA), bronchoalveolar lavage fluid (BALF), and cerebral spinal fluid (CSF) samples. Xpert and solid culture were utilized to detect RIF resistance. The detection rate of Xpert-positive TB among new clinically diagnosed TB cases was 38.4% (139/362), significantly higher than that of solid culture-positive TB (16.3%, 59/362, P < 0.01). Notably, Xpert-positive rates differed significantly by sample type, with the highest positive rate for GLA (51.2%). The unit testing costs per RIF-resistant TB patient were $828.41 for solid culture and $761.86 for Xpert. Our data demonstrate that the prevalence of RIF resistance among childhood TB cases in our study (6.9%) is comparable to the national RIF resistance prevalence level of new cases (6.7%). In addition, Xpert is superior to the solid culture for RIF resistance survey in the childhood TB patients.

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TL;DR: The prevalence of smoking remained extremely high in men, but low and falling in Chinese women, and stronger and more efficient tobacco control is urgently needed.
Abstract: Background China consumes about 40% of the world9s cigarettes, predominantly by men, following a large increase in recent decades. We assess sex-specific prevalence and changing patterns of smoking in Chinese adults in the current decade. Methods A nationally representative survey of smoking was conducted in 2010 among 100 000 Chinese adults aged ≥18 years, using a multistage stratified cluster sampling method. Information on smoking frequency, type, amount, age started and quitting was collected. Sex-specific standardised prevalence and means were analysed and compared with estimates in the 1996 national survey. Results In Chinese men aged ≥18, 62.4% were ever-smokers in 2010, including 54.0% current smokers and 8.4% ex-smokers. The smoking prevalence was higher in rural than in urban men (63.9% vs 58.4%). In younger men, the age to start smoking was earlier and exclusive cigarette use was much higher. Among current smokers, only 17.3% intended to quit. Compared with a similar survey in 1996 among adults aged 30–69, more smokers had quit in 2010 than in 1996 (11.0% vs 4.2%), but the number of cigarettes smoked per current smoker was higher (17.9 vs 15.2). In Chinese women, only 3.4% ever smoked and there has been a large intergenerational decrease in smoking uptake rates. In 2010, there were 318 million current smokers in China, consuming an estimated 1740 billion cigarettes. Conclusions The prevalence of smoking remained extremely high in men, but low and falling in Chinese women. Tobacco smoking remains an important public health issue in China, and stronger and more efficient tobacco control is urgently needed.

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TL;DR: Although the health risk levels from exposure to individual metals in dusts were low, the non-carcinogenic risks from multiple metals to local children exceeded the acceptable level (1.0), suggesting that the overall risk from Exposure to multiple metals in Dust is concerning.

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TL;DR: Recent transmission of MDR tuberculosis strains, with increasing drug-resistance, drives the M DR tuberculosis epidemic in Shanghai, China.
Abstract: Summary Background Multidrug-resistance is a substantial threat to global elimination of tuberculosis. Understanding transmission patterns is crucial for control of the disease. We used a genomic and epidemiological approach to assess recent transmission of multidrug-resistant (MDR) tuberculosis and identify potential risk factors for transmission. Methods We did a population-based, retrospective study of patients who tested positive for tuberculosis between Jan 1, 2009, and Dec 31, 2012, in Shanghai, China. We did variable-number-of-tandem-repeat genotyping and whole-genome sequencing of isolates. We measured strain diversity within and between genomically clustered isolates. Genomic and epidemiological data were combined to construct transmission networks. Findings 367 (5%) of 7982 patients with tuberculosis had MDR tuberculosis and 324 (88%) of these had isolates available for genomic analysis. 103 (32%) of the 324 MDR strains were in 38 genomic clusters that differed by 12 or fewer single nucleotide polymorphisms (SNPs), indicating recent transmission of MDR strains. Patients who had delayed diagnosis or were older than 45 years had high risk of recent transmission. 235 (73%) patients with MDR tuberculosis probably had transmission of MDR strains. Transmission network analysis showed that 33 (87%) of the 38 clusters accumulated additional drug-resistance mutations through emergence or fixation of mutations during transmission. 68 (66%) of 103 clustered MDR strains had compensatory mutations of rifampicin resistance. Interpretation Recent transmission of MDR tuberculosis strains, with increasing drug-resistance, drives the MDR tuberculosis epidemic in Shanghai, China. Whole-genome sequencing can measure of the heterogeneity of drug-resistant mutations within and between hosts and help to determine the transmission patterns of MDR tuberculosis. Funding National Science and Technology Major Project, National Natural Science Foundation of China, and US National Insitutes of Health.

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TL;DR: The different waves of H7N9 regarding their epidemiology, pathogenesis, evolution, and characteristic features are summarized and compared, and factors behind the recent increase in the number of human cases and sudden outbreaks in chickens are speculated on.

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TL;DR: The complex structure of nivolumab withPD-1 is reported and the effects of PD-1 N-glycosylation on the interactions with nivlumab are evaluated to provide the basis for the design of future inhibitory molecules targeting PD- 1.
Abstract: Cancer immunotherapy by targeting of immune checkpoint molecules has been a research 'hot-spot' in recent years. Nivolumab, a human monoclonal antibody targeting PD-1, has been widely used clinically since 2014. However, the binding mechanism of nivolumab to PD-1 has not yet been shown, despite a recent report describing the complex structure of pembrolizumab/PD-1. It has previously been speculated that PD-1 glycosylation is involved in nivolumab recognition. Here we report the complex structure of nivolumab with PD-1 and evaluate the effects of PD-1 N-glycosylation on the interactions with nivolumab. Structural and functional analyses unexpectedly reveal an N-terminal loop outside the IgV domain of PD-1. This loop is not involved in recognition of PD-L1 but dominates binding to nivolumab, whereas N-glycosylation is not involved in binding at all. Nivolumab binds to a completely different area than pembrolizumab. These results provide the basis for the design of future inhibitory molecules targeting PD-1.

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TL;DR: A CRISPR/Cas9 mediated CCR5 ablating system in long-term HSCs is established, which confers HIV-1 resistance in vivo, and evidence for translating C CR5 gene-edited HSC transplantation for an HIV cure to the clinic is provided.

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TL;DR: Prevalence of hypertension in Chinese adults in 2013-14 was 27.8%, with the adjusted prevalence higher in men than in women and increasing steeply with rising age, foreshadowing substantial unnecessary disease burden.