The Concept and Scope of Resilience Against Infectious Disease Outbreaks

Shiyao Xu¹; Hongyuan Wang²; Fei Li¹; Bin He³; Kaiju Liao⁴; Qun Li⁴; Xiaoye Wang^4,#; Zhifeng Wang^1,#

1 Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China;

2 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China;

3 Haidian District Center for Disease Control and Prevention, Beijing, China;

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

^# Corresponding authors: Zhifeng Wang, wangzhifeng@bjmu.edu.cn; Xiaoye Wang, wangxy2@chinacdc.cn.

Resilience is widely discussed and applied across multiple disciplines, with its concept having evolved in the field of hazards and disasters over recent decades. However, there remains a lack of a resilience concept specifically applicable to infectious disease outbreaks, which can lead to misidentification of key issues in outbreak prevention and control, hindering the effective application of this concept. This study aims to provide a clear definition of resilience against infectious disease outbreaks. Building on the fundamental meaning of resilience and its application to hazards and disasters, the research has identified and developed several essential elements for resilience against infectious disease outbreaks by comparing infectious diseases with other types of natural hazards. This study then proposes that resilience against infectious disease outbreaks is the capacity to effectively prevent, detect, respond to, and control outbreaks without seriously affecting essential functions of health and social systems, which could be measured by the intensity of infectious diseases that an area can effectively manage. The concept and scope of resilience proposed in this study provides a valuable framework for improving regional capacity to better prepare for potential epidemic and pandemic threats in the future.

传染病疫情防控的韧性概念界定

许诗瑶¹；王洪源²；李斐¹；何斌³；廖凯举⁴；李群⁴；王霄晔^{4, #}；王志锋^1,#

1 卫生政策与管理学系，公共卫生学院，北京大学，北京，中国；

2 流行病与卫生统计学系，公共卫生学院，北京大学，北京，中国；

3 北京市海淀区疾病预防控制中心，北京，中国；

4 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：王志锋，wangzhifeng@bjmu.edu.cn；王霄晔，wangxy2@chinacdc.cn。

如今，韧性一词已被广泛讨论并被多个学科领域应用。近几十年来，灾害领域引入并发展了韧性概念。然而，目前仍缺乏适用于传染病的韧性概念，容易导致传染病领域难以利用这一概念发现疫情防控的关键问题，阻碍了这一概念在传染病防控中的有效应用。本研究旨在界定传染病疫情防控的韧性概念。通过比较传染病与不同类型自然灾害的特征，本研究基于韧性及抗灾韧性的基本含义，分析了传染病疫情防控的韧性所需关注和强调的要点，进而提出，传染病疫情防控的韧性是指某地区有效预防、发现、应对和控制疫情冲击而不会严重影响当地社会经济与卫生系统基本功能的承压能力，可以通过某地区防控能力可应对的最大程度疫情冲击来衡量。本研究形成的传染病疫情防控的韧性概念可为提升不同地区传染病疫情防控能力提供针对性视角，有助于各地区充分准备和应对未来可能发生的传染病大流行。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.132

An Increasing Prevalence of Non-GII.4 Genotypes Causing Norovirus Gastroenteritis Outbreaks — Beijing Municipality, China, 2017–2024

Hongbo Jing¹; Yanhui Yang²; Mu He¹; Yanbo Wang¹; Yu Zhao¹; Zhan Li¹; He Zhang¹; Nan Jia¹; Yanmeng Gao¹; Shengtian Liu¹; Tao Peng^1#; Miao Jin^2#

1. Shunyi District Center for Disease Control and Prevention, Beijing, China;

2. National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Tao Peng, pt16@tsinghua.org.cn; Miao Jin, jinmiao@ivdc.chinacdc.cn.

Since 2014, non-GII.4 norovirus genotypes have increasingly challenged the predominance of GII.4, particularly in Asia. This study analyzed the epidemiological and genetic characteristics of norovirus outbreaks from January 2017 to June 2024 in a district of Beijing, China. We tested 2,016 stool samples collected from 309 acute gastroenteritis outbreaks for norovirus using real-time RT-PCR. Partial polymerase and capsid sequences of norovirus-positive samples were amplified and sequenced for phylogenetic analysis. Additionally, we performed genome amplification and sequence analysis on seven GII.7[P7] strains. Between January 2017 and June 2024, 150 norovirus outbreaks were reported, with GII norovirus causing 83.3% of these outbreaks. We identified 16 distinct genotypes. Among the 102 GII genotype outbreaks, non-GII.4 norovirus outbreaks (81.4%) significantly outnumbered GII.4 norovirus outbreaks (18.6%). The three most prevalent genotypes during the study period were GII.2[P16] (46.1%, 47/102), GII.3[P12] (14.7%, 15/102), and GII.4 Sydney[P16] (12.7%, 13/102). GII.2[P16] predominated in 2017, 2018, and 2020, while GII.3[P12] was the dominant genotype in 2022. Multiple genotypes emerged in 2023. In the first half of 2024, GII.4 Sydney[P16] became predominant (36.9%), while a novel GII.7[P7] variant emerged, accounting for 26.3% of outbreaks. All seven GII.7[P7] genome sequences formed an independent branch in both VP1 and polymerase regions. Our findings demonstrate that non-GII.4 noroviruses play an increasingly important role in outbreaks in Beijing. Continuous surveillance is needed to better understand and control norovirus outbreaks in future epidemic seasons.

非GII.4型诺如病毒引起的胃肠炎疫情持续升高 — 北京市，中国，2017–2024年

荆红波¹；杨艳辉²；何牧¹；王彦波¹；赵宇¹；李湛¹；张赫¹；贾楠¹；高雅萌¹；刘盛田¹；彭涛^1,#；靳淼^2,#

1. 北京市顺义区疾病预防控制中心，北京，中国；

2. 病毒病预防控制所，中国疾病预防控制中心，北京，中国。

^# 通信作者：彭涛，pt16@tsinghua.org.cn；靳淼，jinmiao@ivdc.chinacdc.cn。

自2014年以来，非GII.4型诺如病毒逐渐取代了GII.4型的流行优势，尤其是在亚洲地区。本研究主要了解2017年1月-2024年6月北京市某区诺如病毒疫情的流行病学和病原特征。使用荧光定量PCR方法对收集的309起急性胃肠炎疫情中2016份粪便标本进行诺如病毒的核酸检测，对诺如病毒核酸阳性标本进行部分聚合酶和衣壳区扩增和测序。同时对7株GII.7[P7]进行了全基因组扩增和序列分析。2017年1月-2024月6月，共报告了150起诺如病毒疫情，83.3% (102/150)的疫情为GII型。150起疫情共鉴定出16种基因型,非GII.4 NoV (81.4%)远高于GII.4 NoV (18.6%)，其中前三种主要基因型是GII.2[P16] (46.1%，47/102)、GII.3[P12] (14.7%，15/102)和GII.4 Sydney[P16]，占12.7%，13/102)。GII.2[P16]是2017年、2018年和2020年的主要基因型。GII.3[P12]是2022年的主要基因型。2023年出现了多种基因型。2024年上半年GII.4 Sydney[P16]为主要基因型 (36.9%)，同时出现了一种新的基因型GII.7[P7]，占26.3%。7个GII.7[P7]全基因组序列分析显示在VP1和聚合酶区域都形成了一个独立的分支。非GII.4 NoVs在北京的疫情中明显增多，应对其进行持续监测，进一步了解和预测诺如病毒的流行特征。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.129

Prevalence of Micronutrient Deficiencies in Children and Adolescents Aged 3–17 Years — 14 PLADs, China, 2019–2021

Xuehong Pang¹; Zhenyu Yang^1,#; Shan Jiang¹; Ye Bi¹; Mingjia Luo¹; Yu Zhou¹; Jing Zhang¹; Qian Zhang¹; Wenhua Zhao¹

1. National Institute for Nutrition and Health; Key Laboratory of Public Nutrition and Health, National Health Commission of the People's Republic of China; Key Laboratory of Human Milk Science, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Zhenyu Yang, yangzy@ninh.chinacdc.cn.

Micronutrient deficiencies in children remains a significant global health challenge. This study presents the recent prevalence of micronutrient deficiencies among children and adolescents aged 3-17 years in China. Using data from the National Nutrition and Health Systematic Survey for children aged 0-18 years in China (2019-2021), we analyzed the prevalence of six micronutrient deficiencies (vitamin A, vitamin D, iron, zinc, selenium, and copper) in children aged 3–17 years. A total of 9,121 children were included. The prevalence across age groups (3–5, 6–8, 9–11, 12–14, and 15–17 years) was 0.6%, 0.6%, 0.3%, 0.3%, and 0.1% for vitamin A deficiency; 18.8%, 22.2%, 13.9%, 7.8%, and 4.4% for marginal vitamin A deficiency; 4.5%, 9.8%, 17.6%, 36.3%, and 35.6% for vitamin D deficiency; 26.8%, 39.8%, 44.1%, 44.4%, and 40.9% for vitamin D insufficiency; 4.4%, 4.2%, 5.2%, 17.0%, and 18.3% for iron deficiency; 3.0%, 1.5%, 2.6%, 4.7%, and 4.4% for zinc deficiency; 5.7%, 5.7%, 7.7%, 9.0%, and 6.6% for low selenium status; and 1.1%, 1.6%, 1.9%, 1.2%, and 1.7% for copper deficiency, respectively. Among children aged 3–17 years in China, vitamin D deficiency and iron deficiency emerge as the most prevalent micronutrient deficiencies.

在3-17岁儿童青少年人群中微量营养素缺乏状况研究 — 14省份，中国，2019–2021年

庞学红¹；杨振宇^1,#；姜珊¹；毕烨¹；骆明佳¹；周钰¹；张晶¹；张倩¹；赵文华¹

1. 营养与健康所；国家卫生健康委公共营养与健康重点实验室；母乳科学研究重点实验室，中国疾病预防控制中心，北京，中国。

^# 通信作者: 杨振宇，yangzy@ninh.chinacdc.cn。

本文分析了中国3–17岁儿童青少年微量营养素缺乏状况。本研究资料来源于中国0–18岁儿童营养与健康系统调查与应用项目数据，分析2019–2021年中国3–17岁儿童青少年维生素 A、维生素 D、铁、锌、硒、铜的缺乏率。在9121名调查对象中，3–5岁、6–8岁、9–11岁、12–14岁和15–17岁儿童维生素A的缺乏率分别为0.6%、0.6%、0.3%、0.3%和0.1%，边缘性维生素A缺乏率分别为18.8%、22.2%、13.9%、7.8%和4.4%，维生素D缺乏率分别为4.5%、9.8%、17.6%、36.3%和35.6%，维生素D不足率分别为 26.8%、39.8%、44.1%、44.4%和40.9%，铁缺乏率分别为4.4%、4.2%、5.2%、17.0%和18.3%，锌缺乏率分别为3.0%、1.5%、2.6%、4.7%和4.4%，低硒率分别为5.7%、5.7%、7.7%、9.0%和6.6%，铜缺乏率分别为1.1%、1.6%、1.9%、1.2%和1.7%。中国3–17岁儿童青少年中，微量营养素缺乏最为普遍的问题是维生素D缺乏和铁缺乏。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.130

HPV Genotypes and Associated Disease Prevalence in Males with Confirmed HPV Exposure — Shenzhen City, Guangdong Province, China, 2018–2022

Heng Li^1,2,&,#; Nini Li^3,&; Feifei Huang³; Liping Ding¹; Xiaoping Hong¹; Dongzhou Liu^1,4,#

1. Department of Rheumatology and Immunology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, Guangdong Province, China;

2. Integrated Chinese and Western Medicine Postdoctoral research station, Jinan University, Guangzhou City, Guangdong Province, China;

3. Department of Pathology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen City, Guangdong Province, China;

4. Department of Geriatrics, Geriatric Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen City, Guangdong Province, China.

^& Joint first authors.

^# Corresponding author: Heng Li, liheng@jnu.edu.cn; Dongzhou Liu, liu.dongzhou@szhospital.com.

Human papillomavirus (HPV) is a globally prevalent infection, with multiple genotypes strongly associated with cancers and other diseases. While epidemiological studies in females are extensive, research on HPV genotype distribution in males remains limited. We conducted a retrospective study by collecting and analyzing clinical and laboratory data from male patients with confirmed HPV infection at Shenzhen People's Hospital. The distribution of HPV genotypes and their associations with specific disease types were evaluated. A total of 2,037 male participants were included, with an overall HPV infection rate of 45%. Low-risk genotypes predominated, with HPV 6 and HPV 11 accounting for 25% and 12% of cases, respectively. High-risk genotypes such as HPV 16 and HPV 52 showed low prevalence (<3%) but exhibited a slight upward trend in 2022. No significant age distribution differences were observed between HPV-positive and HPV-negative groups. The frequency of multiple HPV genotype infections increased slightly with age. Specific HPV genotypes showed unique associations with acne (HPV 56), allergic dermatitis (HPV 59), and amyloidosis (HPV 58). Low-risk HPV genotypes predominate in males with confirmed exposure. Older males appear more susceptible to multiple infections, and specific genotypes are associated with distinct diseases, supporting the need for male-targeted HPV vaccination and surveillance programs.

男性HPV感染者基因型及相关疾病流行特征分析 — 深圳市，广东省，中国，2018–2022年

李恒^1,2,&,#；李妮妮^3,&；黄斐斐³；丁利平¹；洪小平¹；刘冬舟^1,4,#

1. 风湿免疫科，深圳市人民医院（暨暨南大学第二临床医学院、南方科技大学第一附属医院），深圳市，广东省，中国；

2. 中西医结合博士后流动站，暨南大学，广州市，广东省，中国；

3. 病理科，暨南大学第二临床医学院（深圳市人民医院），深圳市，广东省，中国；

4. 老年病科，老年医学中心，深圳市人民医院（暨暨南大学第二临床医学院、南方科技大学第一附属医院），深圳市，广东省，中国。

^& 共同第一作者

^# 通信作者：李恒，liheng@jnu.edu.cn；刘冬舟，liu.dongzhou@szhospital.com。

人乳头瘤病毒（HPV）在全球广泛流行，多个基因型与癌症及其他疾病密切相关。目前，在女性中的流行病学研究较多，但对于男性，特别是HPV基因型分布的研究仍然有限。采用回顾性研究方法，收集并整理深圳市人民医院确诊HPV感染男性患者的临床及实验室数据，分析各型HPV感染情况及其与疾病类型的关联性。研究结果显示，在男性感染者中低危型HPV基因型更为常见，部分疾病与特定HPV基因型存在独特关联。此外，年龄较大的男性更容易发生多重基因型共感染。本研究强调了将男性纳入HPV疫苗接种计划的重要性。结合早期筛查及健康教育，有望减少性别间HPV传播，降低相关疾病总体负担。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.131

A Foodborne Disease Outbreak Caused by Salmonella — Guiyang City, Guizhou Province, China, September 2024

Peipei Zuo^1,&; Hua Dai^2,&; Qianqian Zhou¹; Jiajun Jiang²; Fei Yuan²; Yanxia Zhou³; Anzhong Wu¹; Yiya Liu¹; Hua Guo^1,#

1. Guizhou Center for Disease Control and Prevention, Guyang City, Guizhou Province, China;

2. Guiyang Center for Disease Control and Prevention, Guyang City, Guizhou Province, China;

3. Baiyun Center for Disease Control and Prevention, Guyang City, Guizhou Province, China.

^& Joint first authors.

^# Corresponding author: Hua Guo, guohua_cqy@163.com.

On September 11, 2024, a foodborne disease outbreak occurred at a middle school. Upon receiving the report, investigators promptly arrived at the scene to verify the incident, identify suspicious food items and risk factors that contributed to the outbreak, providing a reference for the prevention and investigation of similar incidents in the future. Epidemiological methods were employed to characterize the clinical and epidemiological features of cases. A case-control study was conducted to identify suspicious meals and food items. Samples from cases, food products, and environmental sources were collected for laboratory testing. A total of 112 cases met the case definition, with an attack rate of 3.20%. The predominant clinical manifestations included fever (100.00%), diarrhea (92.86%), and vomiting (34.82%). The case-control study indicated that egg cakes and soybean milk sold at window 17 of the Second canteen were the suspicious food items. By September 12, 252 samples had been collected, with laboratory testing detecting Salmonella Newport in 26 samples. Based on epidemiological investigation, hygienic assessment, and laboratory testing results, this incident is classified as an outbreak of foodborne disease caused by Salmonella Newport contamination. The health and well-being of students is paramount, necessitating strengthened food hygiene supervision in schools, regular food safety knowledge training, and comprehensive measures to reduce the risk of foodborne disease in educational settings.

一起纽波特沙门氏菌引起的学校食源性疾病暴发调查分析 — 贵阳市，贵州省，中国， 2024年9月

左佩佩^1,&；代华^2,&；周倩倩¹；蒋家俊²；袁飞²；周艳霞³；吴安忠¹；刘怡娅¹；郭华^1,#

1. 贵州省疾病预防控制中心，贵阳市，贵州省，中国；

2. 贵阳市疾病预防控制中心，贵阳市，贵州省，中国；

3. 白云区疾病预防控制中心，贵阳市，贵州省，中国。

^& 共同第一作者。

^# 通信作者：郭华，guohua_cqy@163.com。

学校是人群高度集中的场所，一旦发生群体性食源性疾病暴发，会扰乱学校正常的教学秩序，造成不良的社会影响。2024年9月11日，某中学发生一起食源性聚集性事件。接到报告后，调查人员迅速赶到现场核实事件情况，查明引起某中学食源性疾病暴发的可疑食品、致病因子和危险因素，为今后类似事件的防控和调查提供参考依据。通过描述性流行病学方法描述病例的临床特征、流行病学特征及相关危险因素，开展病例对照研究，分析可疑餐次及食物，采集病例和食堂工作人员肛拭子、留样食物及环境样本进行实验室检测。符合病例定义的病例共112例，罹患率为3.20%，其中男生60人，女生52人，男女比例为1.15:1。临床症状主要为发热（100.00%）、腹泻（92.86%）、呕吐（34.82%）等。病例对照研究结果显示在第二食堂17窗口售卖的鸡蛋饼和豆浆为可疑食物。采集病例生物样本、食物及环境样本共252份，通过实验室检测，其中26份样本分离培养出纽波特沙门氏菌。结合流行病学调查，卫生学调查，实验室检测的结果考虑本次事件为一起由纽波特沙门氏菌感染的食源性疾病暴发事件。学生的健康成长非常重要，应加强学校等集体单位的食品卫生监管工作，定期进行食品安全知识培训，降低学校食源性疾病的发生风险。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.098