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China is now facing trade-offs between economic growth and the resulting environmental and social burdens. In the 14th Five-Year Plan and the 2035 long-term goal, China put forward in-depth sustainable development strategies. To examine sustainability, a metric reflecting social and environmental costs is necessary, such as the Genuine Progress Indicator (GPI). However, data quality has become an important factor affecting the credibility of the included items in GPI. Hence, we conducted the first China Genuine Progress indicator Survey (CGPiS) at the micro-household level containing 42,000 samples. Based on this, we improved the GPI framework covering 23 subitems and measured China's national-level and provincial-level GPI in 2016. The results indicate that a region with a higher GDP usually has a higher GPI, while the gaps of sustainable economic welfare measured by GPI between regions are larger than the GDP gaps. Environmental accounts in all measured provinces are negative. Housework and volunteer service in the social account have great potential contributions to the future growth of GPI. Our findings are essential for driving changes in China's economic governance to realize sustainable development and promoting the GPI application in pilot cities.

Although widely recognized as the key to climate goals, coal "phase down" has long been argued for its side effects on energy security and social development. Retrofitting coal power units with biomass and coal co-firing with a carbon capture and storage approach provides an alternative way to avoid these side effects and make deep carbon dioxide emission cuts or even achieve negative emission. However, there is a lack of clear answers to how much the maximum emission reduction potential this approach can unlock, which is the key information to promote this technology on a large scale. Here, we focus on helping China's 4536 coal power units make differentiated retrofit choices based on unit-level heterogeneity information and resource spatial matching results. We found that China's coal power units have the potential to achieve 0.4 Gt of negative CO

Respiratory syncytial virus (RSV) is one of the main causes of acute respiratory infections (ARI) leading to a heavy disease burden. Reports on RSV in China are limited, especially in Fujian Province, and RSV whole-genome sequences in Fujian Province are not reported. This study aimed to explore the genomic characteristics of RSV to provide evidence for the development of vaccines and medicines.Reverse transcription-polymerase chain reaction (RT-PCR) was used to amplify and obtain the attachment (G) gene and whole-genome fragments from the positive samples. Genetic evolution as well as nucleotide and amino acid homology analyses of the virus sequences were conducted to identify any amino acid mutations.A total of 72 RSV-positive cases were collected, and 53 G gene sequences were obtained using polymerase chain reaction (PCR) amplification. The ON1 and BA11 genotypes were found to be dominant using the Basic Local Alignment Search Tool (BLAST) on the NCBI website. The 40 genotype ON1 sequences had high nucleotide identity (95.3%-99.8%) and amino acid similarity (92.5%-100%), whereas the 13 BA11 genotype sequenceshad 97.3% - 99.6% nucleotide identity and 94.8% - 99.7% amino acid similarity. Compared to the ON1 prototype (JN257693) and BA11 prototype (AY333364), the obtained sequences had no nucleotide insertions or deletions, indicating high similarity among the samples. A total of 17 RSV whole genome sequences were obtained, 10 of which were genotype ON1 and seven were genotype BA11. Certain amino acid mutations were found in the antigen site and epitope of the fusion (F) protein but not in the G protein. Glycosylation analyses of specific RSV genes revealed high positive selection rates for the gene, and the N- and O-linked glycosylation sequences in the F gene were relatively conserved.From July 2018 to January 2020, ON1 and BA11 were the most prevalent RSV genotypes in Fujian Province. A high nucleotide identity and amino acid similarity were observed between the reference strain and the obtained strains, as well as among the sequences of the obtained isotypes. Certain amino acid mutations occur at the antigen site and the epitope of the F protein.

Summary Background The announcement of China's 2060 carbon neutrality goal has drawn the world's attention to the specific technology pathway needed to achieve this pledge. We aimed to evaluate the health co-benefits of carbon neutrality under different technology pathways, which could help China to achieve the carbon neutrality goal, air quality goal, and Healthy China goal in a synergetic manner that includes health in the decision-making process. Methods In this modelling study, we used Shared Socioeconomic Pathway 2 with no climate policy as the reference scenario, and two representative carbon neutrality scenarios with identical emission trajectories and different technology pathways—one was led by renewable energies and the other was led by negative emission technologies. We had three modules to analyse health co-benefits and mitigation costs for each policy scenario. First, we used a computable general equilibrium model that captures the operation of the whole economic system to investigate the carbon mitigation costs and air pollutant emission pathways of different technology portfolios. Second, we used a reduced complexity air quality model to estimate the concentrations of particulate matter in the atmosphere from the air pollutant emission pathways. Finally, we used a health impact evaluation model to estimate premature deaths, morbidity, and the resulting loss of life expectancy, then these health impacts were monetised according to value of a statistical life and cost of illness. We compared the monetised health co-benefits against the corresponding mitigation costs to explore the cost-effectiveness of different technology portfolios. A series of uncertainties embodied in carbon neutrality pathways and models were considered. Findings In our models, sole dependence on improving end-of-pipe air pollution control measures is not sufficient for all Chinese provinces to meet the 2005 WHO PM2·5 standards (10 μg/m3) by 2060. Only a combination of strong climate and air pollution control policies can lead to substantial improvement of air quality across China. If the carbon neutrality pathway led by developing renewable energies was followed, the air quality of all provinces could meet the WHO guideline by 2060. With the realisation of carbon neutrality goals, the total discounted mitigation costs (discount rate 5%) from 2020–60 would range from 40–125 trillion Chinese yuan (CNY), and 22–50 million cumulative premature deaths could be avoided. China has the potential to increase the associated life expectancy by 0·88–2·80 years per person in 2060 versus the reference scenario. The health benefits are higher in the renewable energies-led scenarios, whereas the mitigation costs are smaller in the negative emission technologies-led scenarios. If the value of a statistical life is set higher than 12·5 million CNY (39% of the Organisation for Economic Co-operation and Development value), the health co-benefits will be higher than mitigation costs, even when considering all included uncertainties, implying the cost-effectiveness of China's carbon neutrality goal. Interpretation The life expectancy increase from the realisation of China's 2060 carbon neutrality goal could be equivalent to the past 5–10 years of life expectancy growth in China. Choosing an appropriate carbon neutrality pathway affects the health of China's population both today and in the future. Our findings suggest that, if China incorporates health co-benefits into climate policy making and puts a high value on people's health, it should choose a carbon neutrality pathway that relies more on developing renewable energies and avoid over-reliance on negative emission technologies. Funding National Key R&D Program of China, National Natural Science Foundation of China, Tsinghua-Toyota Joint Research Fund, Tsinghua-Rio Tinto Joint Research Centre for Resources, and Global Energy Interconnection Group. Translation For the Chinese translation of the abstract see Supplementary Materials section.

Background Highly pathogenic avian influenza (HPAI) A(H7N9) virus emerged and caused human infections during the 2016‐2017 epidemic wave of influenza A(H7N9) viruses in China. We report a human infection with HPAI H7N9 virus and six environmental isolates in Fujian Province, China. Methods Environmental surveillance was conducted in live poultry markets and poultry farms in Fujian, China. Clinical and epidemiologic data and samples were collected. Real‐time RT‐PCRs were conducted for each sample, and H7‐positive samples were isolated using embryonated chicken eggs. Full genomes of the isolates were obtained by next‐generation sequencing. Phylogenetic analysis and antigenic analysis were conducted. Results A 59‐year‐old man who raised about 1000 ducks was identified as HPAI H7N9 infection. Six HPAI H7 viruses were isolated from environmental samples, including five H7N9 viruses and one H7N6 virus. Phylogenetic results showed the human and environmental viruses are highly genetically diverse and containing significantly different gene constellation from that of other HPAI H7N9 previously reported. The internal genes derived from H7N9/H9N2, H5N6, and the Eurasian wild‐bird gene pool, indicating waterfowl‐originated genotypes, have emerged in HPAI H7N9/N6 viruses and caused human infection. Conclusion The new genotypes raise the concern that these HPAI H7 viruses might transmit back into migratory birds and spread to other countries as the HPAI H5Nx viruses. Considering their capability of causing severe infections in both human and poultry, the HPAI H7 viruses in this study pose a risk to public health and the poultry industry and highlight the importance of sustained surveillance of these viruses.

Biofuel plays an important role in the transition to low-carbon energy systems. However, the large-scale expansion of biofuels may cause drastic land use change (LUC) due to feedstock cultivation and further result in other sustainability impacts (e.g., food supply), which are the key concerns for policy makers when designing bioenergy policies. However, biophysical models omit the indirect LUC from interactions of economic agents, whereas economic models lack the depiction of heterogeneous land use types. Thus, through either technique, it has formidable challenges to simulate land conversions among alternative uses driven by socioeconomic activities, especially policy mandates. To bridge the gap between these models by simultaneously considering land heterogeneity and market mechanisms and to gain better insights into specific national/regional cases to supplement previous global biofuel and LUC analyses, in this study, we develop a national computable general equilibrium (CGE) model augmented with an explicit land allocation module and design a scenario approach to simulate different patterns of land use management. Food grains and dedicated energy crops are considered feedstock sources and marginal land is incorporated as a potential land supply. Using this model, the case study of China quantifies the direct and indirect LUC driven by the bioethanol (one of the main biofuels) expansion of the new nationwide E10 mandate (gasoline containing 10% ethanol) in 2020, as well as the further impacts on food security. The results show that a slight land reallocation occurs with decreases in the land supply for rice (−0.016%), other non-feedstock grains and crops, as well as forest and grassland (−0.023%). The land competition among existing croplands would be intense in the non-deforestation scenario. If marginal land is reclaimed for feedstock cultivation, the cropland competition could be softened. The results of sensitivity analysis indicate that the total LUC scale would be 4.0–5.9% with no corn stockpile serving as feedstock. Additionally, the bioethanol expansion would trigger higher food prices (around +0.1%). To alleviate the negative impacts on land resources and food security, planting energy crops on marginal land could increase non-grain feedstocks by 10% and save 0.217% of croplands; therefore, it may be one of the promising pathways for sustainable biofuel development in China. This study can lay a common foundation for further integrated impact assessments of biofuel expansion.

Usually, previous studies on the future development pathway of coal power are based on the economic models to provide the administrative pathways, or the coal-fired power plants dataset to provide bottom-up pathways with the multi-scenario hypothesis. However, these two methods above are difficult to be combined: there is a gap between the comprehensive consideration of economic, policy, and environmental factors, with the high spatial resolution of technology and space. This study narrows the gap between regional projection and unit data, and also considers the uncertainty of the operating units with the Monte Carlo Method. Firstly, we evaluate the score of each unit according to its technical parameters and other attribute information, which is based on a sufficient dataset of coal-fired power units with their geographical spatial coordinates. And next, the probability distribution function is built according to the scores of the candidate units. Then, we do sampling from the candidate units until the total capacity reaches the regional projection of the coal power development goal. Based on this method, we could identify the spatial distribution probability of coal-fired power units in the future, and therefore it can help us explore the environmental impacts in high-resolution space.•The method calculates the probability of operating status of candidate units using technical and attribute information-base scores with Monte Carlo method.•This paper describes the uncertainties in determining the spatial distribution of future power plants, and verifies the robustness of the results.•This method narrows the scale gap between regional projection and unit-level data., Graphical abstract Image, graphical abstract

Coronavirus disease 2019 (COVID-19) has become a pandemic with increasing numbers of cases worldwide. SARS-CoV-2, the causative virus of COVID-19, is mainly transmitted through respiratory droplets or through direct and indirect contact with an infected person. The possibility of potential faecal-oral transmission was investigated in this study. We collected 258 faecal specimens from nine provinces in China and detected the nucleic acid of SARS-CoV-2 using real-time RT–PCR. Vero cells were used to isolate the virus from SARS-CoV-2 nucleic acid positive samples, after which sequencing of Spike gene in eight samples was performed. In all, 93 of 258 (36%) stool samples were positive for SARS-CoV-2 RNA. The positive rates of critical, severe, moderate, and mild patients were 54.4%, 56.1%, 30.8%, and 33.3%, respectively. The content of nucleic acid increased within 2 weeks after the onset of the disease. From the perspective of clinical typing, the nucleic acid can be detected in the faeces of critical patients within two weeks and until four to five weeks in the faeces of severe and mild patients. SARS-CoV-2 was isolated from stool specimens of two severe patients. Four non-synonymous mutations in Spike gene were newly detected in three stool samples. A small number of patients had strong faecal detoxification ability. The live virus in faeces could be an important source of contamination, which may lead to infection and further spread in areas with poor sanitary conditions. The findings of this study have public health significance and they should be considered when formulating disease control strategies.

Almost all global scenarios under ambitious climate targets rely on the deployment of negative emission technologies (NETs). Bioenergy with carbon capture and storage (BECCS) and afforestation are two promising NET options. However, their roles in most countries’ deep decarbonization pathways and the potential economic and environmental implications have not been fully investigated. Besides, broad economic interactions and complex technical information of NETs bring challenges for traditional top-down or bottom-up models. To address the methodological issues, we integrate energy technology details into a macroeconomic framework and develop a national hybrid computable general equilibrium (CGE) model for China. Based on this, insights are provided into the deployment scale of BECCS and afforestation in China’s mitigation pathways towards carbon neutrality by 2060, as well as the induced macroeconomic and land-use consequences. The results indicate that NETs are necessary for realizing carbon neutrality. BECCS would enter the market around 2030 and the share of negative emissions provided by it would reach about 79% in 2060. The carbon removals in 2060 would be 2,118 MtCO2yr−1, 170 MtCO2yr−1, and 617 MtCO2yr−1 from bioelectricity with CCS, biofuel with CCS, and afforestation, respectively. When only BECCS is deployed as NET, more fossil energy needs to be phased out and renewable energy would take larger market shares. In 2060, most biomass would consist of cellulosic crops (43–47%) and residues (49–52%). Cropland would decrease by 6.9–8.3% due to land competition caused by NET deployment. GDP loss would be 6.4% in 2060 to reach near-zero without NETs. If BECCS and afforestation are both adopted, GDP loss would be alleviated to 4.8%. This study supplements the existing global literature to identify the local feasibility and trade-offs of NET expansion.

Coal power production is the second largest source of water demand in China. However, as coal power would undergo significant changes under ambitious climate goals (2℃ or 1.5℃), it’s not clear how the low-carbon transition of the power sector made at the provincial level would affect the catchment-level water resources in the future. With a power system model (MESEIC) and a unit-level coal-fired power unit dataset, this study explores different power sector transition pathways from 2020 to 2050, and maps out the catchment-level water stress risk of China’s coal power with Monte Carlo method. Results show that the future power supply mix varies much under the shared socio-economic pathways (SSPs) and carbon emission targets. Without carbon emission targets, coal power would continue to dominate the power supply mix advantage and would cause severe risk of water stress. Under SSP1-5, the national water withdrawal from coal power in 2050 would be 12.2–176.2 billion m3 under the reference scenario, but would decline to 10.7–59.2 billion m3 with 2℃ target and 0.11–35.5 billion m3 with 1.5℃ target. Compared with the 2℃ target, the catchment-level water stress risk generated by coal-fired power plants in north China would be significantly reduced under the stricter target of 1.5℃. However, the benefits would be reduced under SSP5 because of the application of carbon capture and storage. This study reveals the strong synergies between reducing carbon emissions and alleviating water stress risk in China’s power sector, but regional risk should be noted while achieving the carbon reduction targets.

BACKGROUND Hand, foot, and mouth disease (HFMD) is a common contagious disease in infants; it is caused by multiple serotypes of human enterovirus (EV), which belongs to the enterovirus genus of the picornavirus family. According to sentinel surveillance, infection with EVs other than EV71 and CVA 16 have become increasingly common in recent years among HFMD patients, posing new challenges for HFMD control. This study aimed to explore the spectrum of serotypes in the other EVs (non-EV71 and non-CVA16) in Fujian province in southeastern China. MATERIAL AND METHODS We investigated 562 samples from EVs-infected HFMD patients with diagnosis confirmed by real-time RT-PCR with other EVs infection between 2011 and 2015. Nucleotide acid detection and the serotyping of the enteroviruses were also performed. The complete VP1 gene was amplified and sequenced. VP1-based phylogenetic analyses of CVA6, CVA10, CVA4, and CVA2 were also performed. RESULTS Among the samples, 22 serotypes of the other EVs, which belong to 4 species of human enterovirus A-D, were identified. Of the 22 serotypes, CVA6 (57.8%) and CVA10 (21.0%) were most common, followed by CVA4 (6.8%) and CVA2 (2.7%). The other 18 serotypes accounted for 11.7% of samples, none of which exceeded 2%. Among 47 (8.4%) samples from patients with severe HFMD, 10 serotypes were identified and most samples belonged to CVA6 (20/47), followed by CVA10 (11/47). Entire VP1 comparison revealed that overall genetic identities were 96.7%, 96.3%, 94.4%, and 94.9% among strains within CVA6, CVA10, CVA4, and CVA2, respectively. CONCLUSIONS VP1-based phylogenetic analysis for the 4 predominant serotypes indicated various clades or sub-clades, which suggests the complex transmissions of other enteroviruses in Fujian.

This study aimed to investigate the epidemiological, clinical, and virologic characteristics of avian influenza A (H7N9) confirmed cases from two family clusters in Southeast China. Epidemiological data of the H7N9 confirmed cases and their close contacts were obtained through interviews and reviews of medical records. Of the four patients in these two family clusters, two cases had mild symptoms, one had severe symptoms, and one died. Three of the four patients had a history of exposure to live poultry or contaminated environments. The complete genome sequences of the H7N9 viruses from the same family cluster were highly homologous, and the four isolated viruses from the two family clusters exhibited the virologic features of the H7N9 virus, in terms of transmissibility, pathogenicity, host adaptation, and antiviral drug resistance. In addition, our findings indicated that the A/Fujian/18/2015 viral strain contained an additional hemagglutinin G225D substitution, which preferentially binds α2,6-linked sialic acids. The results of this study demonstrate that one family cluster was infected through common exposure to live poultry or contaminated environments, and the other was more likely to be infected through the human-to-human route.

Background Avian influenza A (H5N6) virus poses a great threat to the human health since it is capable to cross the species barrier and infect humans. Although human infections are believed to largely originate from poultry contaminations, the transmissibility is unclear and only limited information was available on poultry environment contaminations, especially in Fujian Province. Methods A total of 4901 environmental samples were collected and tested for Avian Influenza Virus (AIV) from six cities in Fujian Province through the Fujian Influenza Surveillance System from 2013 to 2017. Two patient-related samples were taken from Fujian’s first confirmed H5N6 human case and his backyard chicken feces in 2017. Chi-square test or Fisher’s exact probability test was used to compare the AIV and the viral subtype positive rates among samples from different Surveillance cities, surveillance sites, sample types, and seasons. Phylogenetic tree analysis and molecular analysis were conducted to track the viral transmission route of the human infection and to map out the evolutions of H5N6 in Fujian. Results The overall positive rate of the H5 subtype AIVs was 4.24% (208/4903). There were distinctive differences (p

Dengue fever (DF) is a vector-borne disease and a tremendous socioeconomic burden on tropical and subtropical countries worldwide. To explore the characteristics of DF epidemic in the Fujian province, information of DF cases in Fujian during 2004-2014 was collected and analyzed. The complete E genes of 48 viral isolates were amplified and sequenced for phylogenetic analysis. A total of 733 cases was reported, of which 612 (83.5%) occurred during the peak period from August to October. Additionally, 76% (190/250) of imported cases originated from Southeast Asia countries, by the epidemiological investigation. Phylogenetic analysis of the 48 viral isolates revealed that three genotypes (I, IV, V) of DENV1, and one genotype each of DENV2 (cosmopolitan) and DENV3 (I) circulated in Fujian during 2004-2014. Similar to the results of the epidemiological investigations, the source of most of the viral isolates, including imported and indigenous cases, may be Southeast Asia countries; however, importation from adjacent provinces was also observed in recent years. Overall, DF is considered an imported epidemic disease in Fujian. Increasing diversity of the viral source and geographic expansion of the area affected by DF in recent years highlights the necessity for strengthening surveillance of the DF epidemic and developing strategies for DF prevention and control in Fujian.

Millions of cases of hand, foot, and mouth disease (HFMD) have been reported annually in mainland China since 2008. In this study, we investigated the epidemiology and etiology of an HFMD epidemic in Fujian province, which is located in subtropical southeastern China. Our study found similar epidemiological features of HFMD in southern areas of China, including seasonality and demographic distribution, as well as correlation between severity of illness and serotype. At least 22 serotypes of other enterovirus co-circulating with enterovirus 71 were found to belong to clade C4a, and those circulating with coxsackievirus A16 were associated with clades B1a and B1b.

Background Enterovirus 71 (EV71) is a causative agent of hand, foot and mouth disease (HFMD), which can spread its infection to central nervous and other systems with severe consequence. A key factor in the replication of EV71 is its 3C proteinase (3C pro ), a significant drug target. Peptidomimetics were employed as inhibitors of this enzyme for developing antivirals. However, the peptide bonds in these peptidomimetics are a source of low bioavailability due to their susceptibility to protease digestion. To produce non-peptidomimetic inhibitors by replacing these peptide bonds, it would be important to gain better understanding on the contribution of each component to the interaction and potency. Methods A series of compounds of different lengths targeting 3C pro and having an α,β-unsaturated ester as the warhead were synthesized and their interactions with the enzyme were evaluated by complex structure analyses and potency assays for a better understanding on the relationship between potency and evolution of interaction. Results The P2 moiety of the compound would need to be oriented to interact in the S2 site in the substrate binding cleft and the P3–P4 moieties were required to generate sufficient potency. A hydrophobic terminal group will benefit the cellular uptake and improve the activity in vivo . Conclusions and general significance The data presented here provide a basis for designing a new generation of non-peptidomimetics to target EV71 3C pro .

Actions to reduce carbon emissions often entail co-benefits for environmental protection, like air pollutants reduction. Previous studies made contributions to estimate these co-benefits, but few considered the feedbacks from the socioeconomic system and the natural system. This paper extends the Dynamic Integrated model of Climate and the Economy (DICE) model, a classical Integrated Assessment model (IAM), into the Dynamic Integrated model of Climate, Air pollution and the Economy (DICAE) model. Through the hard link between a new air pollution module and the other modules in the original DICE, this paper quantifies the co-benefits of mitigating CO2 emissions for NOX emission reduction, and compares the predicted climate change, economic output and social utility under seven mixed policy scenarios. In addition, uncertainty analysis based on Monte Carlo simulation is carried out to verify the robustness of the DICAE model. The results indicate that the NOX emissions co-emitted with CO2 emissions would be over 0.6 Gt/year in a no-policy scenario. In policy scenarios, mitigating CO2 emissions can simultaneously reduce at least 15% of the NOX emissions, and the more severe the climate mitigation target is, the more obvious co-benefits for NOX emission reduction. Although these co-benefits can offset some mitigation costs, it will not be cost-effective when NOX emission reduction is achieved completely depending on ambitious carbon mitigation, so the end-of-pipe technology for NOX emission is also indispensable. For policymakers, they should recognize the co-benefits of climate policies, actively taking mitigation actions. Moreover, they are encouraged to combine CO2 mitigation with NOX emission reduction and coordinate their policy intensities to make wise use of the co-benefits.

A Dengue outbreak was reported in Dongfen town Jianou county, Fujian province on September 19, 2014. The goal of this project was to explore the role of syndromic surveillance program in the practice of early detection on disease outbreak through the case mentioned above.The authors retrospectively collected data related to Outpatient log and Pharmacy drug use in Dongfen township hospital through the electronic information system of the hospital from August to November, 2014. All the abnormal events were recorded, according to related data on fever and drug use. Description of fever, syndromic characteristics, correlation and Linear regression analyses were conducted, using the surveillance data on fever syndrome and drug use from the pharmacy.A total of 1 102 cases with fever and 2 437 fever-related clinic visits were reported which showing an increased number of 19.6, 10.2 times respectively, when compared to the same period of the previous year in which men accounted for 45.3% (499/1 102) and female accounted for 54.7% (603/1 102). Age groups presented an atypical type " M" type. 5 and 10 year olds groups formed the largest proportion, accounted for 11.5% (127/1 102) of the total number os the patients. The correlation coefficient ranged from 0.85 to 0.97 (P0.05). Data from the syndromic surveillance program showed an " outbreak" was occured in August 23, 2014.Compared to routine surveillance program, the syndromic surveillance program could detect the appearence of an outbreak, a month or even more earlier. The role of syndromic surveillance program needs to be further explored.

To study the molecular epidemiology of hand-foot-mounth disease (HFMD) associated Coxsackievirus A10 (Cox A10) identified in Fujian province.A total of 1 525 specimens from non-EV71 non-Cox A16 HFMD patients were collected during 2011-2014. Isolated virus strains were identified and sub-typed. Full-length coding regions for the VP1 gene of the predominant serotype Cox A10 isolates were amplified and sequenced.Among the 407 non-EV71 non-Cox A16 HFMD cases confirmed by virus isolation and molecular subtyping, 103 (25.3%) were caused by Cox A10, accounting for 11.0%, 6.0%, 18.4% and 9.2% among the HFMD-associated entero-viruses identified in 2011, 2012, 2013 and 2014, respectively, in Fujian province. Compared to the general features observed in the HFMD epidemics, no differences on the Cox A10-specificity rates were observed among factors as geographical origins, gender or age groups, but all with high rates of severity. Data from the nucleotide sequence analyses on VP1 genes showed low homology levels of 76.0%-77.1% among Cox A10 strains from Fujian province, in contrast to the prototype Cox A10 strain, but with high levels of homology in the amino acid sequences (91.9%-93.6%). RESULTS from the Phylogenetic analysis also indicated that Cox A10 isolates from Fujian province were distinct from the prototype strain or other isolates from other countries but was homologous to domestic strains, but the Fujian isolates clustered into multiple branches.Cox A10 remained one of the predominant serotypes of HFMD in Fujian province. Cox A10 isolates identified in Fujian province were co-circulating and co-evolving with other domestic strains.

To investigate clinical and epidemiological characteristics of hospitalized severe acute respiratory illnesses (SARI) patients under 15 years old registered by sentinel hospitals at 10 cities and risk factors analysis of severe illness.The objects of this study were 2 937 SARI patients under 15 years old registered by sentinel surveillance in internal wards, pediatrics wards and intensive care units (ICU) of 10 sentinel hospitals in 10 cities during the period from December 2009 to June 2014. We also collected case report form (CRF) of them and their throat swabs for influenza testing. The inclusion criteria was hospitalized patients who were admitted by surveillance departments, registered by SARI surveillance system, under 15 years old, meeting SARI case definition and with complete CRF. Rank-sum test was used to compare the difference of age, the duration including from onset to admission, hospital stay and from onset to discharging/death between mild illness and severe illness. Chi-square test was used to compare the difference of demographic characteristics, influenza psoitive rate, vaccination rate of influenza, chronic medical conditions and clinical characteristics between mild illness and severe illness. Logistic regression was used to analysis risk factors associated with severe illness by two stratifications from SARI surveillance protocol (2 years old and ≥ 2 years old).Among 2 937 SARI patients under 15 years old, 97.7% (2 872/2 937) was mild illnesses, and 2.3% (65/2 937) was severe illnesses. 78.8% (2 315/2 937) was under 5 years old. The median ages of severe illness and mild illness were 0.4 and 2.0 years old (U = -6.23, P0.001). The proportions of severe illness and mild illness with at least one chronic medical condition were 32.3% (21/65) and 8.4% (240/2 872) (χ² = 45.03, P0.001). The positive rate of influenza virus was 6.5% (190/2 937), which was 6.5% (186/2 858) for mild illness and 6.2% (4/65) for severe illness (χ² = 0.08, P = 0.961). The proportion of seasonal influenza vaccination was 1.5% (42/2 853), which was 1.5% (42/2 788) for mild illness and higher than that for severe illness (0) (χ² = 6.09, P = 0.048). For under 2 years old patients, age11 months and with at least one chronic medical condition were risk factors for severe SARI illness, and the risk for SARI patients who was 12-23 months and without medical condition was 14.71 (5.35-40.44) and 5.61 (2.96-10.63). For ≥ 2 years old patients, age, with at least one chronic medical condition and seasonal influenza vaccination history have no association with severe illness, OR (95% CI) was 0.92 (0.80-1.05), 0.67 (0.09-5.05) and 0.85 (0.31-2.35), respectively.Most of SARI patients registered by 10 urban sentinel hospitals were patients under 5 years old. Age11 months and with at least chronic medical conditions were possible risk factors of severe illness of SARI patients.

To identify clinical characteristics of hospitalized laboratory-confirmed influenza cases of children under 15 years old, and their risk factors of influenza infection.Analyzing the reports of hospitalized laboratory-confirmed influenza cases of children under 15 years old who were detected by the sentinel surveillance systems in 10 provinces from December 2009 to June 2014. Such data as their demographic, medical history, clinical symptoms and signs, treatment and outcome were collected using questionnaires, with their clinical characteristics and their risk factors of influenza infection described.Of the 2 937 severe acute respiratory infection inpatients, 190 (6.5%) were laboratory-confirmed influenza cases. 123 (64.7%) of such confirmed cases were male, and 139 (73.2%) were children under 5 years old, with age median of 3.0 years (IQR: 1.0-5.0 years). 20 (10.5%) of them had at least one chronic medical condition, mostly chronic cardiovascular disease (3.2%), immunosuppressive disease (3.2%), and cancer/tumor (2.6%). Most common clinical symptoms of the cases were fever (92.6%) and cough (88.8%), of which abnormal pulmonary auscultation (51.1%) and abnormal chest X-ray performance (36.1%) were the most common clinical signs. 29 cases (15.8%) had complications, of which pneumonia (15.3%) was most common. 16 cases (8.6%) used antiviral drugs, and 4 cases (2.2%) were admitted into ICU. Risk factor analysis suggested that age6 months (OR = 0.406, 95% CI: 0.203-0.815) was a protective factor against influenza infection; and age 5-9 years old (OR = 2.535, 95% CI: 1.059-6.066) was a risk factor for influenza infection.Hospitalized laboratory-confirmed influenza cases were found mostly in children under 5 years old. Risk exposure for influenza infection varied among age groups.

Using heteroduplex mobility assay (HMA) to subtype human immunodeficiency virus type 1 (HIV-1) for the purpose of understanding HIV-1 subtype epidemic in Fujian province.DNA fragments of HIV-1 env gene were amplified from peripheral blood mononuclear cell (PBMC) cocultures of HIV-1 infected individuals by nested polymerase chain reaction (PCR). Heteroduplexs were formed through hybridizing PCR products from the samples and reference plasmid. According to the mobility of heteroduplexs in polyacrylamide gel electrophoresis, HIV-1 subtype from that sample was characterized and further confirmed by nucleotide sequencing analysis.Thirteen of 15 (86.67%) samples were successfully subtyped by HMA, except 2 failures. Subtype E and B took up 80% (12/15) and 6.67% (1/15) respectively. Results indicated a high concordance between HMA and nucleotide sequencing analysis and concordance rate was 86.67% (13/15).Subtype E appeared to be the major epidemic strain of HIV-1 in Fujian. HMA showed the characteristics of fastness, easiness, economic and with high specificity, and can be used in the surviellance for the epidemic strain of HIV-1.