Patient Delay in the Diagnosis of Pulmonary Tuberculosis in the Elderly — China, 2015–2023

Yushu Liu¹; Mingkuan Fan²; Yuhong Li^1,3; Jiaojie Kang¹; Ybryim A¹; Tianxin Yan^1,3; Jun Cheng^1,3; Hui Zhang^1,3#

1 National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China.

2 Medical College of Xiangyang Polytechnic, Xiangyang City, Hubei Province, China.

3 National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Hui Zhang, zhanghui@chinacdc.cn.

Pulmonary tuberculosis (PTB) remains a critical global health challenge, with a disproportionate burden on elderly populations. The study aims to investigate patient delay among the elderly in China from 2015 to 2023. Data on PTB patients aged 65 and older were extracted from the Tuberculosis Information Management System (TBIMS) within the Chinese Center for Disease Control and Prevention Information System. Patient delay was defined as more than two weeks from symptom onset to the first medical consultation. Elderly patients with PTB in China experience notable patient delays, with a slight decrease observed from 2015 to 2023. The median interquartile range (IQR) of total delay was 22 (8–49) days. Patients who were farmers, herders, or fishermen, and those who visited non-designated TB institutes experienced longer delays. Additionally, patients in western China experienced longer delays than those in the eastern and central regions. Patients identified through active case-finding (ACF) demonstrated shorter intervals before seeking medical care than those detected through passive case-finding (PCF). However, despite being identified through ACF, a significant proportion of patients still experienced substantial delays before receiving necessary medical attention. Delayed consultations among elderly PTB patients in China remain a significant concern. Targeted strategies, such as active screening, are imperative, especially in regions with notable delays.

老年肺结核患者就诊延迟情况 — 中国，2015–2023年

刘玉舒¹；范明宽²；李玉红^1,3；康娇洁¹；阿依奴尔¹；严天心^1,3；成君^1,3；张慧^1,3#

1 中国疾病预防控制中心结核病预防控制中心，北京，中国；

2 襄阳职业技术学院医学院，襄阳市，湖北省，中国；

3 传染病溯源预警与智能决策全国重点实验室，中国疾病预防控制中心，北京，中国。

^# 通信作者：张慧，zhanghui@chinacdc.cn。

肺结核仍然是全球重大公共卫生问题，老年群体的肺结核负担更重。本研究旨在分析2015-2023年中国老年肺结核患者的患者延迟情况。数据来自中国疾病预防控制中心结核病信息管理系统（TBIMS），研究对象为全国65岁及以上肺结核患者。患者延迟定义为从出现肺结核相关症状到首次就诊的时间间隔超过两周。研究发现，2015至2023年间，中国老年肺结核患者的就诊延迟比例有所下降。患者延迟的中位数（四分位距）为22（8–49）天。农、牧、渔民以及到结核病非定点医疗机构就诊的患者延迟时间较长，且西部地区患者的延迟显著高于东部和中部地区。通过主动筛查（ACF）发现的患者就医时间明显短于被动筛查（PCF）发现的患者，但即便是主动发现的患者中，仍有相当比例在接受治疗前经历了较长的延迟。中国老年肺结核患者的就诊延迟问题依然严峻，尤其在延迟时间较长的地区，亟需采取如主动筛查等更加针对性的干预措施。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.221

Characterization of a New HIV-1 Circulating Recombinant Form CRF142_BC — Yunnan, China, 2015 and 2021

Min Chen¹*; Huichao Chen²*; Shouxiong Lei³*; Jie Dai⁴; Yanling Ma²; Manhong Jia^4#

1. Yunnan Provincial Key Laboratory of Public Health and Biosafety & Health Laboratory Center, Yunnan Center for Disease Control and Prevention, Kunming City, Yunnan Province, China

2. Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming City, Yunnan Province, China.

3. Division for STD/AIDS Control and Prevention, Zhaotong Center for Disease Control and Prevention, Zhaotong City, Yunnan Province, China.

4. Yunnan Provincial Key Laboratory of Public Health and Biosafety, Yunnan Center for Disease Control and Prevention, Kunming City, Yunnan Province, China.

^* Joint first authors.

^# Corresponding authors: Manhong Jia, jiamanhong@hotmail.com.

Human immunodeficiency virus 1 (HIV-1) is known for its frequent mutation and recombination, which contribute to the genetic diversity of the virus. Recombination between subtypes of HIV-1 generates unique recombinant forms (URFs) in individuals, some of which become circulating recombinant forms (CRFs) once they circulate in the population. Yunnan Province was the first location in China where the main HIV-1 strains were found. Due to the long-term HIV-1 epidemic, various recombinant forms were generated, including the predominant HIV-1 CRFs currently circulating in China (2). In a previous study, this study’s authors found five samples that differed from known subtypes/CRFs. To determine whether they were potential CRFs and how they arose, the authors amplified and sequenced the near-full-length genome (NFLG) sequences and performed phylogenetic, recombination, and evolutionary analyses. Phylogenetic analysis revealed that these five sequences clustered in a distinct monophyletic clade distantly related to all known HIV-1 CRFs. Recombination analysis revealed that they shared a subtype C backbone with four subtype B insertions, forming nine subregions. Phylogenetic analyses of the subregions confirmed the parental lineage of each subregion. According to the naming criteria, the strains were named CRF142_BC. Bayesian evolutionary analysis revealed that the time of origin of CRF142_BC was approximately 1990–1997. The identification of new CRFs will provide a basis for the molecular tracing of HIV-1 in China, as well as for the study of HIV mutations and vaccines.

一种新型HIV-1流行重组形式CRF142_BC的鉴定 — 中国云南省，2015 和2021年

陈敏^1*；陈会超^2*；雷寿雄^3*；戴洁⁴；马艳玲²；贾曼红^4#

1. 云南省公共卫生与生物安全重点实验室&卫生检验中心，云南省疾病预防控制中心，昆明市，云南省，中国；

2. 性病艾滋病防制所，云南省疾病预防控制中心，昆明市，云南省，中国；

3. 性病艾滋病防治科，昭通市疾病预防控制中心，昭通市，云南省，中国；

4. 云南省公共卫生与生物安全重点实验室，云南省疾病预防控制中心，昆明市，云南省，中国。

^* 共同第一作者。

^# 通信作者：贾曼红, jiamanhong@hotmail.com。

人体免疫缺陷病毒 1（Human immunodeficiency virus 1, HIV-1）经常发生变异和重组，导致了病毒基因的多样性。HIV-1 亚型之间的重组会在个体中产生独特重组形式（unique recombinant forms, URF），其中一些重组形式一旦在人群中流行就会成为流行重组形式（circulating recombinant forms, CRF）。云南省是中国最早发现主要 HIV-1 毒株的地区。由于 HIV-1 的长期流行，产生了多种重组型，包括目前在中国流行的主要CRFs。在之前的研究中，本研究的作者发现了5个不同于已知亚型/CRF 的样本。为了确定它们是否是潜在的 CRFs 以及它们是如何产生的，作者扩增并测序了近全长基因组（near-full-length genome, NFLG）序列，并进行了系统发育、重组和进化分析。系统进化分析表明，这5个序列聚集在一个独立的簇中，与所有已知的 CRF相对远离。重组分析表明，它们共享1个 C 亚型骨架和4个 B 亚型的插入片段，形成9个亚区。各亚区的系统进化分析证实了每个亚区的来源。根据命名标准，这些毒株被命名为 CRF142_BC。贝叶斯进化分析表明，CRF142_BC的起源时间约为1990-1997年。新CRF的鉴定将为中国HIV-1的分子追踪、HIV变异和疫苗研究提供依据。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.222

Psychoactive Substance Use and the Impact on the AIDS Epidemic Among the MSM Population: a Meta-Analysis — Worldwide, 2014–2023

Donghang Luo¹; Jie Xu¹; Wei Luo^1#

1 National Center for AIDS/STD Control & Prevention,Chinese Center for Diseases Control and Prevention, Beijing, China.

^# Corresponding author: Wei Luo, luowei@chinaaids.cn.

This study aimed to evaluate psychoactive substance use and its impact on HIV prevalence among men who have sex with men (MSM) in China through a systematic meta-analysis. This study searched Chinese and English databases, including CNKI, Wanfang, Wipro, CBM, PubMed, Cochrane Library, EMBASE, and Web of Science, for literature published between January 1, 2014, and December 31, 2023. Statistical analyses, including forest plots, heterogeneity testing, and publication bias assessment, were conducted using Stata 17.0. A total of 31 studies involving 88,181 samples, including 8,437 HIV-positive cases, were analyzed. The meta-analysis indicated a 17% prevalence (95% CI: 14%, 20%) of psychoactive substance use in MSM. Within China, rush poppers were used by 47.26% of MSM, while amphetamine derivatives were used by 9.97%. In other regions, prevalence rates were 12.86% for amphetamine derivatives, 3.62% for rush poppers, and 3.34% for GHB. Subgroup analysis revealed an odds ratio (OR) for HIV risk of 1.57 (95% CI: 1.42, 1.74) for MSM in China and 2.16 (95% CI: 1.72, 2.71) elsewhere. The OR for amphetamine derivative users was 3.06 (95% CI: 2.38, 3.93), suggesting increased susceptibility to HIV. Psychoactive substance use among MSM is significantly associated with higher HIV risk, particularly for amphetamine derivatives. These findings underscore the need for targeted prevention strategies based on substance type and region and highlight areas for future research.

男男性行为者群体中精神活性物质使用情况及其对艾滋病流行的影响：Meta分析 — 世界范围，2014–2023年

罗董杭¹；徐杰¹；罗巍^1#

1. 中国疾病预防控制中心性病艾滋病预防控制中心，北京，中国。

^# 通信作者：罗巍，luowei@chinaaids.cn。

本研究旨在通过系统的Meta分析，评估中国男男性行为者（MSM）群体中精神活性物质的使用情况及其对HIV流行的影响。本研究检索了2014年1月1日至2023年12月31日间包括CNKI、万方、维普、CBM、PubMed、The Cochrane Library、EMBASE和Web of Science在内的中英文数据库，筛选出符合条件的文献。使用统计学软件Stata 17.0进行森林图绘制、异质性检验以及发表偏倚的评估。最终纳入31项研究，涵盖88,181个样本，其中HIV阳性患者8,437例。Meta分析显示，MSM群体中精神活性物质的使用率为17%（95% CI：14%，20%）。中国境内MSM群体中Rush Poppers的使用率高达47.26%，而安非他命衍生物的使用率为9.97%。在其他国家和地区，安非他命衍生物的使用率为12.86%，Rush Poppers为3.62%，GHB为3.34%。亚组分析揭示，中国MSM群体使用精神活性物质与HIV感染的风险比（OR）为1.57（95% CI：1.42，1.74），而在其他国家和地区，这一风险比为2.16（95% CI：1.72，2.71）。此外，安非他命衍生物组的风险比为3.06（95% CI：2.38，3.93），表明这类物质可能使个体更易感染HIV。MSM群体中精神活性物质的使用与HIV感染风险的增加显著相关，特别是在使用安非他命衍生物的MSM群体中。研究结果强调了针对特定地区和精神活性物质类型的预防策略的重要性，并指出了未来研究需要进一步探讨的方向。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.223

Assessment of the Potential for Cross-Border Transmission of Infectious Diseases via Commercial Air Travel — Shanghai Municipality, China, 2019–2023

Weimin Hao^1,2; JieyanGu³; YujueWang²; Li Wang²; LiguangHou²; Ting Wang⁴; Wei Zhang⁵; Yi Zhang⁵; Na He^1,6#; Zhengan Tian^7#

¹ Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China;

² Division of Health Quarantine, Shanghai Customs District, Shanghai, China;

³ Division of Enterprise Management, Shanghai Customs District, Shanghai, China;

⁴ Hongqiao Airport Customs House, Shanghai Customs District, Shanghai, China;

⁵ Pudong International Airport Customs House, Shanghai Customs District, Shanghai, China;

⁶ Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China;

⁷ Shanghai International Travel Healthcare Center, Shanghai, China;

^# Corresponding authors: Na He, nhe@fudan.edu.cn; Zhengan Tian, tianzhenganciq@163.com.

As one of the major means of transport in today’s world, air transport facilitates more convenient international travel and trade with its rapid development, and at the same time, brings about a series of public health issues as well, especially the risk of cross-border transmission of infectious diseases. PHEICs (Public Health Emergency of International Concern) represented by COVID-19 foreground the need for stricter quarantine measures of inbound conveyances and travelers to control importation of infectious diseases. We analyzed epidemiological surveillance data of inbound travelers of Shanghai Pudong International Airport and Shanghai Hongqiao International Airport before and after the pandemic (2019–2023) and compared the distributions and contributing factors of these diseases in 2019 (pre-pandemic) and 2023 (post-pandemic). Our study found that the overall incidence of imported infectious diseases at Shanghai’s airports in 2023 reached 5.2 per 10,000 travelers, a 2.5-fold increase from the pre-pandemic level (2019). Further analysis of inbound travelers’ general information and histories of travel and contact indicated that, with certain special circumstances excluded, the pattern of changes in the positive detection rate of arrivals was basically in line with the disease incidence in countries from which travel was initiated. Hence, risk assessment implemented based upon big data models can precisely target travelers of high risks, effectively improve the performance of front-line quarantine, and build a stronger defense of frontier health quarantine against importation of infectious diseases.

航空口岸输入性传染病跨境传播风险研究 — 中国上海，2019–2023年

郝为民^1,2；顾洁妍³；王玉珏²；王俐²；侯立光²；王霆⁴；张炜⁵；张奕⁵；何纳^1,6；田桢干⁷

1 复旦大学公共卫生学院流行病学系，复旦大学，上海，中国；

2 上海海关卫生检疫处，上海，中国；

3 上海海关企业管理处，上海，中国；

4 上海虹桥机场海关，上海，中国；

5 上海浦东国际机场海关，上海，中国；

6 复旦大学上海市重大传染病和生物安全研究院，复旦大学，上海，中国；

7 上海国际旅行卫生保健中心，上海，中国。

^* 共同第一作者

^# 通信作者：何纳，nhe@fudan.edu.cn；田桢干，tianzhenganciq@163.com。

航空业，作为全球最重要的交通方式之一，其快速发展为交通运输和国际贸易提供了极大的便利，但同时也带来了一系列公共卫生问题，尤其是传染病的跨境传播风险。以新冠为代表的国际关注突发公共卫生事件（PHEIC），进一步凸显了通过加强交通工具和入境人员预防控制措施以控制传染病境外传入的重要性。本文以新冠疫情前后（2019年和2023年）上海浦东和虹桥国际机场入境旅客流行病学监测数据为基础，对比分析了航空口岸输入性传染病跨境传播的主要特征及其影响因素。研究发现，新冠疫情后的2023年，上海航空口岸对输入性传染病监测中每万人感染率为5.2，准确率相较2019年增长了2.5倍。进一步分析入境旅客的基本情况、旅行史和接触史等因素发现，在排除一些特殊要素后，不同国家入境旅客受其来源国家或地区的疾病发病率的影响显著。因此，在出入境口岸基于大数据模型开展风险评估，精准识别高风险旅客，可以有效提升口岸一线卫生检疫效率，严防跨境传染病输入，更严密筑牢口岸检疫防线。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.224

Risk Assessments for Type 1 Wild Poliovirus and Type 2 Vaccine-Derived Poliovirus Importation and Transmission — China, 2023

Wei Kang^1,2; Chunxiang Fan^1,2; Yifan Song^1,2; Zhaonan Zhang^1,2; Xiaoqi Wang^1,2; Miao Wang^1,2; Jing Ma³; Mulei Chen³; Yuzhen Yang^1,2; Yi Wen^1,2; Lei Cao^1,2; Lance Rodewald^1,2; Ping Zhang⁴; Fuzhen Wang^1,2; Zundong Yin^1,2; Ning Wen^1,2; Hong Yang^1,2*

1. National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China;

2. National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China;

3. Education and Training of Chinese Center for Disease Control and Prevention, Beijing, China;

4. Taiyuan Center for Disease Control and Prevention, Taiyuan City, Shanxi Province, China.

^# Corresponding author: Hong Yang, yanghong@chinacdc.cn.

A study assessing China's risk of poliovirus importation and transmission in 2023 identified high-risk PLADs for both wild poliovirus type 1 (WPV1) and circulating vaccine derived poliovirus type 2 (cVDPV2). Xizang, Qinghai, and Xinjiang were deemed high-risk for WPV1, while Xizang, Hainan, and Shaanxi faced the highest risk for cVDPV2. The assessment utilized two independent tools, evaluating factors such as population immunity, surveillance quality, and importation risk. Despite no recent poliovirus importations, the study emphasized the ongoing threat from neighboring countries. Researchers noted inadequate inactivated poliovirus vaccine (IPV) coverage in some regions, potentially leaving populations vulnerable to type 2 poliovirus. The study recommended targeted preventive measures, including catch-up IPV vaccinations and enhanced surveillance, particularly in high-risk areas. This research underscores the importance of maintaining vigilance and strengthening polio prevention strategies, even in polio-free countries like China.

脊髓灰质炎野病毒和Ⅱ型疫苗衍生脊髓灰质炎病毒输入传播风险评估 — 中国，2023年

康伟^1,2；樊春祥^1,2；宋祎凡^1,2；张肇南^1,2；王晓琪^1,2；王淼^1,2；马静³；陈慕磊³；杨玉珍^1,2；文艺^1,2；曹雷^1,2；Lance Rodewald^1,2；王富珍^1,2；尹遵栋^1,2；温宁^1,2；杨宏^1,2*

1.传染病溯源预警与智能决策全国重点实验室，中国疾病预防控制中心，北京，中国；

2.中国疾病预防控制中心免疫规划中心，北京，中国；

3.中国疾病预防控制中心教育培训处，北京，中国。

# 通信作者: 杨宏，yanghong@chinacdc.cn。

评估中国各省（自治区、直辖市，下同）2023年Ⅰ型脊髓灰质炎（脊灰）野病毒（Wild poliovirus，WPV1）和Ⅱ型疫苗衍生脊灰病毒（Vaccine-deprived poliovirus，VDPV）输入传播的风险。应用先前建立的中国WPV1和Ⅱ型VDPV输入传播风险评估工具，风险因素为人群免疫情况、脊灰病毒监测情况和输入传播风险，各省根据风险得分判定风险级别。西藏、青海和新疆为WPV1输入传播高风险省份，西藏、海南和陕西为Ⅱ型VDPV输入传播高风险省份。由于中国周边国家如巴基斯坦和阿富汗仍有WPV1疫情发生，且中国灭活脊灰疫苗（Inactivated Poliovirus vaccine, IPV）接种率不足，建议不同省份特别是高风险省份根据继续开展预防措施，例如IPV疫苗补充免疫和加强监测，以维持中国无脊灰状态。。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.225