China has an extremely low overall IDDM incidence rate. China also has the greatest geographic and ethnic variation seen for any country.

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A large nationwide outbreak occurred in 1989-1990 in China, in which nearly 10,000 poliomyelitis cases were reported. After two rounds of oral poliovirus vaccine (OPV) supplemental activity in nearly every province in the 1992-1993 winter season, no wild poliovirus was detected in 1993 in 22 provinces in the middle of China that contained 86% of the population. During the first national immunization days (NIDs) conducted in December 1993 and January 1994, 83 million children 0-47 months of age were immunized. In 1994, wild poliovirus was identified in only 6 of 2397 children with stool specimens tested. After a second NID in December 1994 and January 1995, no wild poliovirus was detected in 1995 despite a very high level of virus surveillance. In summary, double-round mass supplemental OPV immunizations in children 0-3 years old in two consecutive winters eliminated wild poliovirus from 23% of the world's population (1.2 billion people).

A case-based virus surveillance system for wild poliovirus in China was developed. By 1993, all 30 provincial immunization units and, by 1994, all 29 provincial laboratories were sending computerized data to the national level. In 1993, a county-level, computerized map was operationalized that permitted visual monitoring of the progress of the polio eradication program every month by county. In 1993, wild poliovirus type 1 was detected in 8 provinces. Wild poliovirus mainly caused clusters of polio cases identified by a surveillance system that detected primarily clinical polio in children <5 years old (1 stool sample was collected on approximately 50% of reported cases). By 1995, the surveillance system had reached certification-like levels (80% of acute flaccid paralysis [AFP] patients with 2 stool specimens and AFP case rate of 1/100,000 children <15 years old). No indigenous wild poliovirus was detected in 1995. This general case-based model can be applied to measles and other important diseases, and may then lead to a more rapid decrease in adverse health outcomes.

China is the epicenter of the global tobacco epidemic. China grows more tobacco, produces more cigarettes, makes more profits from tobacco and has more smokers than any other nation in the world. Approximately one million smokers in China die annually from diseases caused by smoking, and this estimate is expected to reach over two million by 2020. China cities have a unique opportunity and role to play in leading the tobacco control charge from the “bottom up”. The Emory Global Health Institute—China Tobacco Control Partnership supported 17 cities to establish tobacco control programs aimed at changing social norms for tobacco use. Program assessments showed the Tobacco Free Cities grantees’ progress in establishing tobacco control policies and raising public awareness through policies, programs and education activities have varied from modest to substantial. Lessons learned included the need for training and tailored technical support to build staff capacity and the importance of government and organizational support for tobacco control. Tobacco control, particularly in China, is complex, but the potential for significant public health impact is unparalleled. Cities have a critical role to play in changing social norms of tobacco use, and may be the driving force for social norm change related to tobacco use in China.

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The World Health Organization recommends conducting supplemental immunization activities to eradicate poliomyelitis by the year 2000. Although effective in eliminating poliomyelitis from the Americas, supplemental campaigns require substantial resources. To assess differential campaign effectiveness in eliminating this disease, poliomyelitis occurrence was compared in counties in China that targeted children <3 versus <4 years of age. Counties that targeted children <3 years of age reported poliomyelitis more frequently after the campaigns. This association was observed even after accounting for the effects of previous poliomyelitis occurrence, urban versus rural setting, and population density. While several limitations emphasize the preliminary nature of these findings, these data support targeting the widest possible age group of susceptible children to ensure maximum effectiveness in eliminating poliomyelitis. Thus, while reducing the target age of these activities may result in considerable resource savings, such campaigns may not be as effective in eliminating poliomyelitis.

A retrospective study on the incidence of insulin-dependent diabetes mellitus (IDDM) among children aged 0-14 years was carried out from 1989-1993 in urban Shanghai, China. The average annual population at risk (0-14 yr) consisted of 1,401,664 children. All the cases were collected from the hospitals (primary source) and from primary and middle schools and kindergartens (second source) with independent validation of case ascertainment. There were 53 IDDM cases from the primary source, 23 from the secondary source, with a total of 58. The ascertainment corrected total number of IDDM cases was 67 by the capture-recapture method. The average crude annual incidence rate was 0.83 [95% confidence interval (CI) 0.61-1.04] and ascertainment corrected incidence rate 0.96 (95% CI 0.80-1.12) per 100,000. Peak incidence fell in 1992 and in the 9 year-old group. The incidence of childhood IDDM in the urban districts of Shanghai was reconfirmed to be the lowest in the world but by comparing the results of former investigations a trend was found of increasing incidence of IDDM.