The Evolving Industrial Landscape in Occupational Chronic Benzene Poisoning — 6 PLADs, China, 2020–2023

Yan Zhang^1,2; Jin Zhou¹; Lei Han³; Qiang Jia⁴; Lili Du⁵; Jin Li⁶; Wenjie Li¹; Qiang Zeng⁷; Lifang Zhou⁸; Tongying Kang¹; Yiting Gu¹; Xiurong Cheng¹; Caihong Xing^1,2,9,#

1.State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China;

2.State Key Laboratory of Trauma, Burn and Combined Injury, Third Military Medical University, Chongqing, China;

3.Jiangsu Provincial Center for Disease Control and Prevention, Nanjing City, Jiangsu Province, China;

4.Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan City, Shandong Province, China;

5.Sichuan Center for Disease Control and Prevention, Chengdu City, Sichuan Province, China;

6.Fujian Center for Prevention and Control of Occupational Diseases and Chemical Poisoning, Fuzhou City, Fujian Province, China;

7.Tianjin Centers for Disease Control and Prevention, Tianjin, China;

8.Zhejiang Center for Disease Control and Prevention, Hangzhou City, Zhejiang Province, China;

9.Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Caihong Xing, xingch@niohp.chinacdc.cn.

As a major producer and consumer of benzene, China has long confronted the challenge of occupational chronic benzene poisoning (OCBP). Between 2005 and 2019, OCBP in China primarily occurred in private enterprises, small- and medium-sized enterprises, and the general/special-purpose equipment manufacturing industry. However, with the continuous strengthening of national supervision and restrictions on the use of benzene-containing materials, the industrial distribution of OCBP may have changed from 2020 to 2023. A total of 6 provincial-level administrative divisions (PLADs) with concentrated benzene-related industries — Jiangsu, Zhejiang, Shandong, Sichuan, Fujian, and Tianjin — were selected for analysis. We collected data on 162 newly reported OCBP cases from 2020 to 2023. Based on the National Economic Industry Classification standards, we analyzed these cases according to enterprise size, economic type, and industry classification. The number of OCBP cases in China decreased significantly, reaching a historical low of 56 cases in 2023 [accounting for 15.3% of chronic occupational poisoning (COP)], compared to an average of 256 cases annually from 2005 to 2019 (26.7% of COP). From 2020 to 2023, OCBP continued to occur predominantly in manufacturing, private, and small- and medium-sized enterprises. However, the primary industry associated with OCBP shifted to chemical raw materials and chemical products manufacturing, followed by petroleum, coal, and other fuel processing industries. OCBP remains a major component of COP in China. While continuing to regulate the manufacturing industry, especially small- and medium-sized enterprises, supervision should be strengthened in the evolving industries where benzene poisoning now predominantly occurs.

职业性慢性苯中毒的产业格局演变 — 6省份，中国，2020–2023年

张岩^1,2；周瑾¹；韩磊³；贾强⁴；杜利利⁵；李津⁶；李文捷¹；曾强⁷；周莉芳⁸；康同影¹；顾轶婷¹；程秀荣¹；邢彩虹^1,2,9,#

1. 创伤与化学中毒全国重点实验室，中国疾病预防控制中心职业卫生与中毒控制所，北京，中国；

2. 中国人民解放军第三军医大学创伤、烧伤与复合伤国家重点实验室，重庆，中国；

3. 江苏省疾病预防控制中心，南京市，江苏省，中国；

4. 职业卫生与职业病防治研究院，山东第一医科大学（山东省医学科学院），济南市，山东省，中国；

5. 四川省疾病预防控制中心，成都市，四川省，中国；

6. 福建省职业病与化学中毒预防控制中心，福州市，福建省，中国；

7. 天津市疾病预防控制中心，天津，中国；

8. 浙江省疾病预防控制中心，杭州市，浙江省，中国；

9. 中国疾病预防控制中心化学污染与健康安全重点实验室，中国疾病预防控制中心职业卫生与中毒控制所，北京，中国。

^# 通信作者: 邢彩虹，xingch@niohp.chinacdc.cn。

作为苯的主要生产国和消费国，中国长期面临职业性慢性苯中毒（OCBP）的防控挑战。2005至2019年间，我国OCBP病例主要集中于私营企业、中小型企业以及通用/专用设备制造业。然而，随着国家持续加强监管力度并严格限制含苯材料使用，2020至2023年间OCBP的行业分布可能已发生改变。本研究选取苯相关产业集中的6个省级行政区（江苏、浙江、山东、四川、福建和天津），收集2020-2023年新报告的162例OCBP病例。根据《国民经济行业分类》标准，从企业规模、经济类型和行业分类三个维度进行分析。2020-2023年间，我国OCBP病例数明显下降，2023年达到历史最低水平（56例，占慢性职业中毒病例的15.3%），而2005-2019年OCBP每年的平均病例数为256例（占慢性职业中毒病例的26.7%）。2020年至2023年间，职业性慢性苯中毒（OCBP）事件仍主要发生在制造业、私营及中小型企业领域。然而，与OCBP关联的首要产业已转变为化学原料和化学制品制造业，其次为石油、煤炭等燃料加工工业。OCBP仍是我国慢性职业中毒的主要构成类型。在持续加强制造业（特别是中小企业）监管的同时，还需加强对苯中毒发生行业的监督管理。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.152

Characterization of Temporal and Spatial Changes of Endemic Fluorosis Due to Coal-Burning Pollution — China, 2009–2023

Jian Wang^1,2; Lijun Zhao^1,2; Zhe Li³; Wei Wei^1,2; Hongna Sun^1,2; Lihua Wang^1,2; Lin Gao^1,2; Xiaohong Ji^1,2; Wei Wang^1,2; Qiaoshi Zhao^1,2; Mang Li^1,2; Cheng Li^1,2; Junrui Pei^1,2,#

1. Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention; Harbin Medical University, Harbin City, Heilongjiang Province, China;

2.  NHC Key Laboratory of Etiology and Epidemiology; Harbin Medical University, Harbin City, Heilongjiang Province, China;

3. Shaanxi Center for Disease Control and Prevention, Xi’an City, Shaanxi Province, China.

^# Corresponding author: Junrui Pei, peijunrui@ems.hrbmu.edu.cn.

Coal-burning pollution type of endemic fluorosis remains a significant public health threat in certain rural areas of China. This study aimed to analyze the long-term trends in dental fluorosis prevalence in coal-burning fluorosis areas in China from 2009 to 2023. We collected and analyzed dental fluorosis detection rates among children aged 8–12 in 12 coal-burning fluorosis provincial-level administrative divisions (PLADs) of China (2009–2023). The optimal Autoregressive Integrated Moving Average with Exogenous Inputs (ARIMAX) time series model was used to predict dental fluorosis detection rates in children from 2019 to 2023. The GeoDa (version 1.20.0; GeoDa Institute) software was employed for spatial analysis, while the SaTScan (version 10.1; GeoDa Institute) was used to analyze spatial-temporal aggregation patterns. From 2009 to 2023, the dental fluorosis detection rates in children aged 8–12 years in coal-burning fluorosis areas showed a decreasing trend, declining from 49.51% to 1.56%. After 2016, achieving the elimination standard (<15%). There was a good agreement between the observed detection rates and expected values, with a relative risk (RR) of 0.98. Global analysis shows that the detection rate of dental fluorosis is randomly dispersed. The Moran's I index for dental fluorosis detection rates was positive in 2009, 2011, and 2013, while the negative in other years, Z-values were ranging from -1.53 to 0.99. Local analysis indicates that Yunnan Province has continuously presented a low-high aggregation pattern from 2011 to 2013. Space-time analysis identified 9 PLADs as low-prevalence clusters, while only Yunnan was classified as a high-prevalence cluster in 2022–2023 [odds ratio (OR)=1.07, Log likelihood ratio (LLR)=30.45, P<0.05]. China has achieved remarkable success in the prevention and control of coal-burning fluorosis.These findings provide critical reference value to support targeted prevention strategies for coal-burning fluorosis.

燃煤污染型地方性氟中毒时空变化特征 — 中国，2009–2023年

王健^1,2；赵丽军^1,2；李哲³；魏玮^1,2；孙洪娜^1,2；王丽华^1,2；高琳^1,2；纪晓红^1,2；王伟^1,2；赵巧湜^1,2；郦芒^1,2；李城^1,2；裴俊瑞^1,2,#

1. 地方病控制中心，中国疾病预防控制中心；哈尔滨医科大学，哈尔滨市，黑龙江省，中国；

2. 病因流行病学重点实验室，国家卫生健康委；哈尔滨医科大学，哈尔滨市，黑龙江省，中国；

3. 陕西省疾病预防控制中心，西安市，陕西省，中国。

^# 通信作者：裴俊瑞，peijunrui@ems.hrbmu.edu.cn。

燃煤污染型地方性氟中毒在我国部分农村地区仍是一项不容忽视的健康威胁。本研究旨在分析2009–2023年中国燃煤污染型氟中毒地区氟斑牙患病率的长期趋势。我们收集整理了中国12个燃煤污染型氟中毒地区8–12岁儿童氟斑牙检出率（2009–2023年）。采用最优ARIMAX模型预测2019–2023年儿童氟斑牙检出率，并运用GeoDa (1.20.0)软件进行空间分析。通过SaTScan (10.1)进行时空聚集性分析。2009–2023年，燃煤污染型氟中毒地区8–12岁儿童氟斑牙检出率呈下降趋势，从49.51%下降到1.56%。在2016年后达到消灭标准（<15%），检出率与期望值吻合较好，相对危险度（RR）为0.98。全球分析显示，氟斑牙检出率呈随机分布。Moran's I指数在2009年、2011年和2013年为正，其他年份的为负，Z值范围为-1.53–0.99。局部分析表明，2011至2013年期间，云南省持续呈现低-高值聚集模式。时空分析显示共有9个省级行政区划被划分为低流行集群，只有2022–2023年云南被划分为高流行集群，(OR=1.07，LLR=30.45, P<0.05)。我国燃煤污染型氟中毒的防控工作成效显著，这些发现为支持有针对性的燃煤氟中毒预防策略提供了重要的参考价值。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.153

Prevalence of Elevated Blood Pressure in Children and Adolescents Aged 7–17 Years Old and Its Association with Dietary Approaches to Stop Hypertension — China, 2021

Wenshuo You¹; Qiya Guo^1,2; Wei Cao^1,2; Titi Yang¹; Peipei Xu¹; Qian Gan¹; Hui Pan¹; Xiaoning Wang¹; Zhenyu Yang^1,2,3; Qian Zhang^1,2; Wenhua Zhao¹; Juan Xu^1,#

1. National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China;

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

3. Key Laboratory of Human Milk Science, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Juan Xu, xujuan@ninh.chinacdc.cn.

To investigate the prevalence of elevated blood pressure (EBP) and its association with Dietary Approaches to Stop Hypertension (DASH) adherence among Chinese children and adolescents, providing evidence for dietary interventions targeting pediatric hypertension. Data were derived from the "National Survey on Nutrition and Health of Children Aged 0–18 Years," a key project under China's 13th Five-Year Plan for National Science and Technology Infrastructure. DASH scores were calculated using standardized criteria, and multivariable logistic regression models were employed to evaluate associations between EBP and DASH adherence. The prevalence of EBP in 7–17-year-olds was 15.4%. The median DASH score was 24 points, with the highest adherence tertile (T3) exhibiting a lower prevalence of EBP (14.9%) compared to T1 (16.2%) and T2 (15.2%). In the fully adjusted model (Model 2), adolescents aged 13–17 years in the T3 DASH adherence group showed reduced risk of EBP [odds ratio (OR)=0.78, 95% confidence interval (CI)=0.60, 0.98] relative to T1. Higher DASH adherence is associated with reduced EBP risk in adolescents aged 13–17 years, emphasizing the protective role of DASH-recommended foods in promoting cardiovascular health.

7–17岁儿童青少年血压偏高与DASH之间的关联 — 中国，2021年

由文烁¹；郭齐雅^1,2；曹薇^1,2；杨媞媞¹；徐培培¹；甘倩¹；潘慧¹；王晓宁¹；杨振宇^1,2,3；张倩^1,2；赵文华¹；许娟^1,#

1. 营养与健康所，中国疾病预防控制中心，北京，中国;

2. 国家卫生健康委公共营养与健康重点实验室，营养与健康所，中国疾病预防控制中心，北京，中国;

3. 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：许娟，xujuan@ninh.chinacdc.cn。

了解我国儿童青少年血压偏高状况及其与防治高血压饮食法（DASH）之间的关联关系，为儿童青少年高血压的饮食干预提供参考。本研究数据来源于十三五国家科技基础资源调查专项"中国0-18岁儿童营养与健康系统调查与应用项目"。采用评分法计算DASH评分，并用多因素Logistic回归模型分析其血压偏高与DASH之间的关联。我国7—17岁儿童青少年血压偏高的检出率为15.4%。DASH评分中位数为24分，DASH依从性最高的T3组血压偏高检出率为14.9%，低于T1（16.2%）和T2（15.2%）组。在完全调整模型（模型2）中，与T1组相比，13—17岁青少年DASH评分T3组（OR=0.78, 95% CI=0.60—0.98）能减少儿童青少年血压偏高的风险。DASH是13—17岁青少年血压偏高的保护因素，增加DASH中提倡食用的食物摄入有助于促进血压健康。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.154

Investigation of a Thunderstorm Asthma Event — Chongqing Municipality, China, April 2024

Guangzhao Yi^1,&,#; Lin Yang^2,&; Guilin Hu³; Yu Xiong²; Zhongjie Wang¹; Qianqian Zeng¹; Li Qi²; Jiang Long^2,#

1. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China;

2. Chongqing Center for Disease Control and Prevention, Chongqing, China;

3. Chongqing Yuzhong District Center for Disease Control and Prevention, Chongqing, China.

^& Joint first authors.

^# Corresponding authors: Jiang Long, cfs@cqcdc.org; Guangzhao Yi, 202774@hospital.cqmu.edu.cn. 

On April 1, 2024, a severe thunderstorm occurred in Chongqing, followed by a surge in patients with suspected asthma presenting to the Emergency Department of the First Affiliated Hospital of Chongqing Medical University. A retrospective investigation was conducted to identify the causes and risk factors of this incident, aiming to guide the prevention and control of similar events. A questionnaire was designed for telephone follow-up to collect basic information, disease onset characteristics, and residential environment data from patients and their cohabitants. Descriptive analysis and a retrospective case-control study were employed to analyze epidemiological features and risk factors. Meteorological data and environmental indices were concurrently collected. Ninety suspected thunderstorm asthma cases were identified, with disease onset predominantly clustered between 21:00 on April 1 and 03:00 on April 2. The epidemic curve suggested a point-source exposure or short-term continuous exposure pattern. Among 57 clinically diagnosed thunderstorm asthma cases and 111 controls, multivariate analysis revealed allergic rhinitis as an independent risk factor for thunderstorm asthma (OR =13.129, 95% CI: 2.782, 61.960). Based on epidemiological investigation, environmental assessment, and laboratory testing results, this incident was classified as a thunderstorm asthma event (TAE), with allergic rhinitis identified as an independent risk factor.

一起雷暴哮喘事件调查 — 重庆直辖市，中国， 2024年4月

易光兆^1,&,#；杨琳^2,&；胡桂林³；熊宇²；王忠杰¹；曾倩倩¹；漆莉²；龙江^2,#

1.重庆医科大学附属第一医院，重庆，中国；

2.重庆市疾病预防控制中心传染病防制所，重庆，中国；

3.重庆市渝中区疾病预防控制中心，重庆，中国。

^# 通信作者：龙江，cfs@cqcdc.org；易光兆，202774@hospital.cqmu.edu.cn。

在2024年4月1日，重庆发生了雷暴强对流天气，随后重庆医科大学附属第一医院急诊科接诊了大量疑似哮喘的病人。为了解事件发生的原因和危险因素，为类似事件的防控提供参考进行了回顾性调查。设计调查问卷电话回访收集就诊人员和其同住人员基础信息、发病情况、居住环境等信息；采用描述分析和回顾性病例对照研究分析病例流行特征和影响因素。同时收集了气象因素和环境指数等数据。发现疑似雷暴哮喘病例90例，发病时间集中在4月1日21时–2日3时，流行曲线提示为点源暴露或短期持续性暴露。临床诊断雷暴哮喘病例57例，对照组111例，多因素分析结果提示过敏性鼻炎是人群罹患雷暴哮喘的独立危险因素(OR=13.129，95% Cl：2.782, 61.960)。根据流行病学调查、环境学调查和病原学调查，本起群体性事件为一起雷暴哮喘事件，过敏性鼻炎为人群罹患雷暴哮喘的独立危险因素。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.155

An Occupational Trichloromethane-Induced Hepatotoxicity Outbreak — Shenzhen City, Guangdong Province, China, October 2024

Ye Li¹; Weile Huang¹; Wenting Feng²; Haihua Bin^1,#

1. Baoan District Public Health Service Center, Shenzhen City, Guangdong Province, China;

2. Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen City, Guangdong Province, China.

^# Corresponding author: Haihua Bin, liye@baoan.gov.cn.

To investigate an occupational trichloromethane-induced hepatotoxicity incident at a Shenzhen printing enterprise, identify its root causes, evaluate intervention effectiveness, and provide evidence for occupational health regulation and corporate solvent management. Routine occupational health examinations in October 2024 identified 34 workers with elevated alanine aminotransferase (ALT) levels. This finding, combined with four hospital-reported cases of abnormal liver function, triggered a comprehensive multisectoral investigation. Thirty-nine solvents and nine air samples were collected for gas chromatography-mass spectrometry (GC-MS) analysis. A case-control study was conducted (18 cases vs. 49 job-matched controls), and multisectoral coordination was implemented throughout the response. Forty-three cases of occupational liver injury were confirmed (83.7% asymptomatic; 10 requiring medical intervention). Both "eco-friendly adhesive-tape cleaner" (57.65% trichloromethane) and "adhesive-tape cleaning restorer" (66.59% trichloromethane) exceeded the 20% concentration limit mandated by GB 38508-2020. The peak airborne trichloromethane concentration in the printing workshop reached 110.3 mg/m³ (5.5-fold above the GBZ 2.1-2019 occupational exposure limit). Solvent exposure was the primary risk factor [cleaner: odds ratio (OR)=32, 95% confidence interval (CI): 13.89–73.46; restorer: OR=23, 95% CI: 18.23–56.93]. No new cases emerged following intervention implementation. The incident originated from the enterprise's solvent reformulation to meet environmental standards without addressing occupational health risks. Occupational health examinations and multisectoral coordination were pivotal for containment. This study recommend: 1) including trichloromethane in priority volatile organic compound (VOC) control lists; 2) strengthening corporate solvent verification; 3) enforcing ventilation management.

一起三氯甲烷职业性肝中毒事件 — 深圳市，广东省，中国，2024年10月

李烨¹；黄伟乐¹；冯文艇²；宾海华^1,#

1. 宝安区公共卫生服务中心，深圳市，广东省，中国； 

2. 深圳市职业病防治院，深圳市，广东省，中国。

^# 通信作者：宾海华，liye@baoan.gov.cn。

调查深圳市某印刷企业发生的职业性三氯甲烷肝中毒事件，查明事件的根本原因，评估干预措施的效果，为职业卫生监管和企业溶剂管理提供依据。2024年10月例行职业健康检查发现34名员工丙氨酸氨基转移酶（ALT）水平异常，结合医院上报的4例肝功能异常病例，启动多部门调查。采集39种溶剂及9份空气样本进行气相色谱-质谱（GC-MS）分析；开展病例对照研究（18例患者 vs. 49例同岗位对照）；实施多部门协同响应。确诊43例职业性肝损伤（83.7%无症状，10例需医疗干预）；"环保胶带清洁剂"（三氯甲烷57.65%）与"胶带清洁修复剂"（三氯甲烷66.59%）均超出GB 38508-2020规定的20%浓度限值；印刷车间空气中三氯甲烷峰值浓度达110.3 mg/m³（超标GBZ 2.1-2019职业接触限值5.5倍）；溶剂暴露为主要风险因素（清洁剂：OR=32，95% CI：13.89，73.46；修复剂：OR=23，95% CI：18.23，56.93）；实施干预措施后未出现新增病例。事件根源是企业为满足环保标准调整溶剂配方却忽视职业健康风险；职业健康检查与多部门协同对防控至关重要。建议：1）将三氯甲烷纳入挥发性有机化合物（VOC）重点管控清单；2）强化企业溶剂成分验证；3）加强通风管理。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.156