Liu Zhou Center for Disease Prevention and Control

Background/Objectives: Varicella is a highly contagious childhood disease that may cause severe complications in susceptible populations. The SV-1 cell line-based varicella vaccine (VarV [SV-1]) has been increasingly used in routine immunization; however, safety and reporting patterns during the transition from partial use to full Expanded Program on Immunization (EPI) implementation remain poorly characterized. This study aimed to evaluate the safety profile and reporting dynamics of VarV (SV-1) before and after its incorporation into the Expanded Program on Immunization in Jiangsu Province, China. Methods: A retrospective observational study was conducted using data from the Jiangsu Provincial Immunization Integrated Service Management Information System and the Chinese National Adverse Event Following Immunization (AEFI) Information System (CNAEFIS), including all reported AEFI following VarV (SV-1) vaccination among children under 6 years of age during 2021-2023. Temporal trends, distribution characteristics, and factors associated with AEFI reporting were assessed using descriptive analyses, negative binomial (NB) regression models, and interrupted time series (ITS) analysis. Results: A total of 1,208,500 doses of VarV (SV-1) were administered, and 634 AEFI cases were reported, corresponding to an overall reporting rate of 52.46 per 100,000 doses. Most reported events were mild, self-limiting common reactions, predominantly pyrexia and injection-site reactions. No serious adverse events were identified. Although no immediate level change was observed at EPI implementation, a significant increasing post-EPI trend was detected, consistent with enhanced surveillance sensitivity rather than a change in intrinsic vaccine safety. Abnormal reactions were rare and resolved without sequelae. Conclusions: AEFI reporting rates following VarV (SV-1) vaccination in Jiangsu Province were within expected ranges, predominantly mild and reversible. Findings support the favorable safety profile of the VarV (SV-1) in routine childhood immunization programs and provide real-world evidence to support continued implementation of the two-dose varicella vaccination strategy within the EPI.

ObjectiveTo evaluate the diagnostic and prognostic predictive value of the pan-immune-inflammation value (PIV) and triglyceride-glucose (TyG) index in premature coronary artery disease (PCAD).MethodsThis study analyzed data from 26,883 patients admitted with chest pain at Liuzhou People's Hospital (January 2014 to December 2020), with 5,653 patients included after screening. Multiple machine learning algorithms, including Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Lasso regression, Random Forest (RF), and logistic regression, were applied to identify PCAD-related variables, which were integrated into a decision tree model. Propensity score matching (PSM) ensured cohort comparability. The Mime1 package facilitated ensemble feature selection and visualization, while optimal PIV and TyG cutoff values were determined via Receiver Operating Characteristic (ROC) analysis for 36-month survival subgroup analysis.ResultsLogistic regression identified PIV [odds ratio [OR] 2.651, 95% CI [to be specified], P < 0.001] and TyG [OR 1.003, 95% CI (to be specified), P < 0.001] as PCAD risk factors. The decision tree model, incorporating PIV, TyG, and white blood cell count (WBC), achieved an accuracy of 0.88 and an area under the ROC curve (AUC) of 0.86 for PCAD diagnosis. Survival analysis over 36 months revealed that low PIV and TyG levels were associated with reduced all-cause mortality, whereas elevated levels correlated with poorer prognosis (P < 0.001), with TyG showing a pronounced effect.ConclusionThe combined evaluation of PIV, TyG, and WBC offers robust diagnostic and prognostic value for PCAD, with elevated PIV and TyG levels indicating a poor prognosis, underscoring their potential as clinical biomarkers.

Depression is a significant focus in mental health research, emerging as a pressing public health concern globally. The Planetary Health Diet Index (PHDI), recently proposed by The Lancet to balance health and environmental sustainability, remains unclear in its role in preventing depression-our study aims to investigate this association and seeks to optimize this dietary index. A cross-sectional analysis was conducted using 2005-2018 NHANES data from 27,868 participants. Dietary quality was measured using PHDI-US, and depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9; score ≥10 indicating depressive symptoms). Associations between dietary indices and depressive symptoms were analyzed using multivariable logistic regression and restricted cubic splines. Machine learning identified key PHDI-US components, leading to the recalibration of PHDI-US to create PHDI-Fruits. Except for the Dietary Inflammatory Index (DII), the PHDI-US, HEI-2020, AHEI, and MEDI all demonstrated protective effects against depression. However, the benefits of PHDI-US were weaker compared to the other indices, particularly among participants with high adherence. Among the components of PHDI-US, fruits had the most significant impact. After recalibrating the PHDI-Fruits component, its ability to reduce depression incidence improved substantially, surpassing that of the other dietary indices. Optimizing the preventive effect of PHDI on depression, the recalibrated PHDI-Fruits significantly enhances its ability to prevent depression, effectively improving the applicability of PHDI in populations affected by depression.

Background: Monitoring bone mineral density (BMD) in adults is critical for early detection of osteoporosis and prevention of fracture, for which quantitative ultrasound (QUS) is a good non-invasive tool. We examined the associations of QUS measures, including stiffness index (SI) and T-score, with socio-demographic, lifestyle, and anthropometric correlates and risk of subsequent fracture. Methods: Calcaneal QUS was performed using GE's Lunar Achilles EXPII among 24,651 adults (mean age 59.5 years, 61.7% women) from the China Kadoorie Biobank study. Socio-demographic and lifestyle information was collected using an interviewer-administered electronic questionnaire, and anthropometrics were measured following standard protocols. Incidence of fracture and osteoporosis was recorded via linkage with nationwide health insurance database. Linear and Cox regression analyses were conducted, adjusting for potential confounders. Results: On average, men had higher SI (92.8 vs. 86.0) but lower T-score (-0.85 vs. -0.64) than women. In both men and women, advanced age and smoking were inversely associated with SI and T-score, while physical activity and tea drinking were positively so (p < 0.0001 for all). Except for height, all other anthropometric measures were significantly and positively associated with both BMD measures. With each SD lower SI, the risk of subsequent fracture was 26% (95% confidence interval: 10-44%) and 40% (25-57%) higher in men and women, and the corresponding associations of T-score were identical. Conclusions: Among Chinese adults, the SI and T-score provided by Achilles EXPII had similar patterns and predictive values for subsequent fracture, despite the T-score for men and women not being directly comparable because of gender-specific references used. Future studies are needed to confirm or refute the causality of relationship between lifestyle and anthropometric factors and BMD.

(1) Background: We aimed to analyze the epidemiological characteristics of hemorrhagic fever with renal syndrome (HFRS) in Longyou County and to provide a basis for the future response to this disease. (2) Methods: Data on hemorrhagic fever and host animals were collected from 2011 to 2023. Descriptive methods were used to analyze the epidemic. The R4.4.1 software was used to show how the host density relates to the virus levels, temperature, and rainfall and to predict the host density. (3) Results: We observed 58 cases of hemorrhagic fever, the majority of which occurred in farmers. There were two incidence peaks each year during the spring and winter seasons, accounting for 22.41% and 43.10% of the total cases, respectively. The outdoor rodent population density was significantly and positively correlated with the outdoor rodent virus prevalence (R2 = 0.9411), serving as a robust predictor of the outdoor rodent virus prevalence. Additionally, the density of outdoor rodents exhibited a strong nonlinear relationship with the temperature and precipitation. (4) Conclusions: After hemorrhagic fever vaccination, rodent population density control, and rodent carrier rodent control from 1995 to 2000, the hemorrhagic fever epidemic was generally stable, and the epidemiological characteristics remained stable. In the future, we should continue to take active and effective comprehensive measures to intervene, further realize the effective control of HFRS, and prevent the recurrence of hemorrhagic fever epidemics.

PurposeTo investigate the predictive value of leukocyte subsets and C-reactive protein (CRP) in coronary artery disease (CAD).MethodsWe conducted a Mendelian randomization analysis (MR) on leukocyte subsets, C-reactive protein (CRP) and CAD, incorporating data from 68,624 patients who underwent coronary angiography from 2010 to 2022. After initial screening, clinical data from 46,664 patients were analyzed. Techniques employed included propensity score matching (PSM), logistic regression, lasso regression, and random forest algorithms (RF). Risk factors were assessed, and the sensitivity and specificity of the models were evaluated using receiver operating characteristic (ROC) curves. Additionally, survival analysis was conducted based on a 36-month follow-up period.ResultsThe inverse variance weight (IVW) analysis showed that basophil count (OR 0.92, 95% CI: 0.84–1.00, P = 0.048), CRP levels (OR 0.87, 95% CI: 0.73–1.00, P = 0.040), and lymphocyte count (OR 1.10, 95% CI: 1.04–1.16, P = 0.001) are significant risk factors for CAD. Using LASSO regression, logistic regression, and RF analysis, both CRP and lymphocyte counts were consistently identified as risk factors for CAD, prior to and following PSM. The ROC curve analysis indicated that the combination of lymphocyte and CRP levels after PSM achieves a higher diagnostic value (0.85). Survival analysis revealed that high lymphocyte counts and low CRP levels are associated with a decreased risk of Major Adverse Cardiovascular Events (MACE) (P < 0.001). Conversely, a higher CRP level combined with lymphocyte counts correlates with a poorer prognosis.ConclusionThere is a causal relationship between lymphocytes, CRP and CAD. The combined assessment of CRP and lymphocytes offers diagnostic value for CAD. Furthermore, high CRP levels coupled with low lymphocyte counts are associated with a poor prognosis.

Trivalent oral poliovirus vaccine (tOPV) has been withdrawn and instead an inactivated poliovirus vaccine (IPV) and bivalent type 1 and type 3 OPV (bOPV) sequential immunization schedule has been implemented since 2016, but no immune persistence data are available for this polio vaccination strategy. This study aimed to assess immune persistence following different polio sequential immunization schedules. Venous blood was collected at 24, 36, and 48 months of age from participants who had completed sequential schedules of combined IPV and OPV in phase III clinical trials. The serum neutralizing antibody titers against poliovirus were determined, and the poliovirus-specific antibody-positive rates were evaluated. A total of 1104 participants were enrolled in this study. The positive rates of poliovirus type 1- and type 3-specific antibodies among the sequential immunization groups showed no significant difference at 24, 36, or 48 months of age. The positive rates of poliovirus type 2-specific antibody in the IPV-IPV-tOPV group at all time points were nearly 100%, which was significantly higher than the corresponding rates in other immunization groups (IPV-bOPV-bOPV and IPV-IPV-bOPV). Immunization schedules involving one or two doses of IPV followed by bOPV failed to maintain a high positive rate for poliovirus type 2-specific antibody.

This study attempts to analyze the spatial clustering and spatial-temporal distribution characteristics of hepatitis E (HE) at the county (city and district) level in Jiangsu province to provide a scientific basis for the prevention and control of HE. The information on HE cases reported in the Chinese Center for Disease Control and Prevention Information System from 2005 to 2020 was collected for spatial autocorrelation analysis and spatial-temporal clustering analysis. From 2005 to 2020, 48,456 HE cases were reported in Jiangsu province, with an average annual incidence rate of 3.87/100,000. Male cases outnumbered female cases (2.46:1), and the incidence was highest in the 30-70 years of age group (80.50%). Farmers accounted for more than half of all cases (59.86%), and in terms of the average annual incidence, the top three cities were all in Zhenjiang city. Spatial autocorrelation analysis showed that Global Moran's I of HE incidence varied from 0.232 to 0.513 for the years. From 2005 to 2020, 31 counties (cities and districts) had high and statistically significant HE incidence, and two clustering areas were detected by spatial-temporal scanning. HE incidence in Jiangsu province from 2005 to 2020 was stable, with age and gender differences, regional clustering, and spatial-temporal clustering. Further investigation of HE clustering areas is necessary to formulate corresponding targeted prevention and control measures.