Surveillance, Epidemiology and Impact of EV-A71 Vaccination on Hand, Foot, and Mouth Disease in Nanchang, China, 2010–2019

After the first national-scale outbreak of Hand, foot, and mouth disease (HFMD) in China, a national surveillance network was established. Here we described the epidemiology and pathogenic profile of HFMD and the impact of EV-A71 vaccination on pathogen spectrum of enteroviruses in the southeastern Chinese city of Nanchang during 2010–2019. A total of 7,951 HFMD cases from sentinel hospitals were included, of which 4,800 EV-positive cases (60.4%) were identified by real-time RT-PCR. During 2010–2012, enterovirus 71 (EV-A71) was the main causative agent of HFMD, causing 63.1% of cases, followed by 19.3% cases associated with coxsackievirus A16 (CV-A16). Since 2013, the proportion of other enteroviruses has increased dramatically, with the sub genotype D3 strain of Coxsackievirus A6 (CV-A6) replacing the dominance of EV-A71. These genetically diverse native strains of CV-A6 have co-transmitted and co-evolved in Nanchang. Unlike EV-A71 and CV-A16, most CV-A6 infections were concentrated in autumn and winter. The incidence of EV-A71 infection negatively correlated with EV-A71 vaccination (r = −0.990, p = 0.01). And severe cases sharply declined as the promotion of EV-A71 vaccines. After 2-year implementation of EV-A71 vaccination, EV-A71 is no longer detected from the reported HFMD cases in Nanchang. In conclusion, EV-A71 vaccination changed the pattern of HFMD epidemic, and CV-A6 replaced the dominance of EV-A71 over time.

The Profile of Microbiological Pathogens in Diabetic Foot Ulcers

Diabetic foot, a main complication of diabetes mellitus, renders the foot susceptible to infection, and may eventually lead to non-traumatic limb amputation due to the deterioration of diabetic foot ulcers (DFUs). Characterizing the pathogen spectrum and antibiotic susceptibility is critical for the effective treatment of DFUs. In the current study, the characteristics and antibiotic susceptibility of the pathogen spectrum were analyzed. Secretions from the DFUs of 102 patients were cultured, and dominant pathogens were identified by using test cards. Antibiotic susceptibility of dominant pathogens was assayed by the Kirby–Bauer assay. We found that the dominant pathogens varied with age, duration of diabetes, blood sugar control, and the initial cause of ulcers. Moreover, the dominant pathogens were susceptible to at least one antibiotic. However, the antibacterial efficacy of several commonly used antibiotics decreased from 2016 to 2019. Our study indicates that the identification of dominant pathogens and antibiotic susceptibility testing is essential for the treatment of DFUs with effective antibiotics, while the abuse of antibiotics should be strictly restrained to reduce the generation of antibiotic-resistant strains.

Risk Factors and Distribution of Pathogens for Pulmonary Infection in Patients with Severe Acute Pancreatitis

Objective: To investigate risk factors and distribution of pathogens for pulmonary infection in patients with severe acute pancreatitis. Methods: The clinical data of 285 patients with severe acute pancreatitis were retrospectively analyzed. Sputum specimens of patients with lung infections were studied. Univariate analysis and logistic regression were performed to screening the factors correlating to lung infections. Results: Gram-negative bacilli were the principal microorganisms isolated from those lung infections, and these bacterial pathogens demonstrated a marked pattern of antibiotic resistance. It was identified that age (OR 1.05, 95% CI 1.01-1.09, p=0.01), Ranson scores (OR 3.01 , 95% CI 1.13-8.03, p = 0.03) and surgical treatment (OR4.27, 95% CI 1.03-17.65, p = 0.04)were independent risk factors of lung infections in patients with severe acute pancreatitis. Conclusion: Analysis of pathogen spectrum and drug sensitivity will contribute to choosing antibiotics empirically. And preventive measures aimed at risk factors could help reduce the incidence of lung infections in patients with severe acute pancreatitis.

Climate-Driven Trends in Pathogen Spectrum of HFMD

Background: Pathogen spectrum is vital during infectious disease epidemics. However, the role of pathogen spectrum during hand, foot, and mouth disease (HFMD) epidemics and the major contributing factors remains unknown.Methods: HFMD cases from 2016 to 2018 in Guangzhou, China were collected. The relationship between HFMD cases and pathogen spectrum, as well as the association between pathogen spectrum and climate factors were studied using general linear models. We transformed the pathogen spectrum to the isometric log-ratio (ILR) components included in the model. Additionlly, vaccination rates were adjusted in the climate driven models.Results: We observed seasonal trends in HFMD cases, pathogen spectrum, and climate factors. The model regressing case numbers on pathogen spectrum revealed negative associations with both the ILRs of CAV16 (RR = 0.725, P<0.001) and EV71 (RR = 0.421, P<0.001). The model regressing pathogen spectrum on driven factors showed that the trends for EV71 proportions were inversely related to vaccination rate (%, β = -0.152, P=0.098) and temperature (°C , β = -0.065, P=0.004). Additionally, the trends for CVA16 proportions were inversely related to vaccination rate (%, β = -0.461, P=0.004) and temperature (°C , β = -0.068, P=0.031). The overall trends for pathogen spectrum showed that EV71 decreased significantly, while the trends for CVA16 increased annually.Conclusions: Our findings suggest a potential pathway for climate factors - pathogen spectrum - HFMD cases. Our study is practical and useful for targeted prevention and control, as well as provides environmental-based evidence.

The Presence of Periodontal Pathogens in Gastric Cancer

BackgroundThe microbiome is thought to play a role in the development of gastric cancer (GC). Several studies have put forward putatively carcinogenic species in addition to Helicobacter pylori, but are not in perfect alignment, possibly due to variable parameters in the experiments, including downstream processing. Meta-analyses have not been published so far, so there is lack in clinical guidance beyond H. pylori eradication therapy.MethodsHere, we analysed gastric mucosa samples from nine public data sets, including GC samples. Using both unsupervised and supervised learning, we defined fine grain bacterial networks of gastric mucosa and identified species associated with tumor status of samples.ResultsWe found anatomic locations and cohort regions among the possible factors leading to the observation of study specific gastric microbiomes. Despite this variability, the periodontal species Fusobacterium nucleatum, Parvimonas micra and Peptostreptococcus stomatis were found in association with tumor status in several datasets. The three species were predicted to be in interaction by ecological network analysis and also formed the intersection of tumor associated species between four GC data sets and five colorectal cancer (CRC) data sets we reanalyzed. We formulated a probiotic composition putatively competing with the GC pathogen spectrum, from correlation analysis in a large superset of gut samples (n=17,800) from clinical- and crowd-sourced studies.ImplicationsThe overlapping bacterial pathogen spectrum between two gastrointestinal tumor types, GC and CRC, has implications for etiology, treatment and prevention. In vitro testing results reported in literature suggest H. pylori eradication treatment should be efficient against the GC pathogen spectrum, yet the existence of an upstream periodontal reservoir is of concern. To address this, we propose longer term use of the formulated probiotics composition.