A 23-year-old male died of severe pneumonia and respiratory failure in a tertiary hospital in Beijing, and 4 out of 55 close contacts developed fever. Molecular analysis confirmed human adenovirus type 7 (HAdV7) as the causative agent. We highlight the importance of early diagnosis and treatment and proper transmission control of HAdV7. CASE REPORT Human adenovirus type 7 (HAdV7) infection is associated with acute respiratory disease syndrome, pharyngoconjunctival fever, pneumonia, and central nervous system disease (1-4). According to the last global survey, approximately one-fifth of all HAdV infections reported to the World Health Organization (WHO) were attributed to HAdV7 (5). HAdV7 outbreaks generally occur in settings with close living conditions, such as military barracks, hospital wards, and chronic care facilities (1,(6)(7)(8). In hospitals, HAdV has emerged as a nosocomial pathogen, and nosocomial outbreaks caused by HAdV7 with fatal cases have been reported worldwide (8-10). Although some prevention measurements have been carried out to control nosocomial transmission, questions regarding the efficacy of these programs persist, and the contribution of HAdV7 (and adenoviruses in general) to nosocomial infection is likely to be underestimated. Here, we report a case of HAdV7 infection associated with severe pneumonia and fatal acute lower respiratory disease and nosocomial transmission.The index case, a 23-year-old male in Wuhan City, Hubei Province, China, presented with a fever of approximately 39°C on 18 January 2014, but discontinuous treatment did not alleviate his symptoms. On 26 January, he was admitted to the emergency department of a tertiary hospital in Beijing. A routine blood test showed high neutrophil levels (71.4%) and elevated plasma C reactive protein (19 mg/ml), and chest radiographs revealed an increase of right lung markings. However, the use of cefoxitin sodium by injection did not prevent his condition from worsening, with symptoms including severe fever, cough, and phlegm. He was diagnosed with pneumonia and transferred to the respiratory department on 28 January. Six days later, he was transferred to an intensive care unit (ICU) because of lung consolidation, and he passed away on 5 February 2014.During his hospitalization, 4 of 55 close contacts developed fevers higher than 38.0°C, including a family member, a bedside clinician, and two patients in the same ward (Table 1 and Fig. 1). The initial secondary case (patient 1) was his cousin, a 19-year-old girl who visited the index case on 26 January for 30 min in the emergency department and on 2 February for 5 min in the respiration department. The distance between them was more than 2 meters, but neither wore a mask. She experienced a fever of 38.5°C on 3 February. Patient 2, a 29-year-old male with acute pancreatitis and a fatty liver, was admitted to the same ward of the emergency department on 27 January. He developed a fever on 3 February, and a chest X-ray showed pulmonary shadows. Patient 3, a bedside clinician of the inde...
BackgroundMalaria incidence in China's Hainan province has dropped significantly, since Malaria Programme of China Global Fund Round 1 was launched. To lay a foundation for further studies to evaluate the efficacy of Malaria Programme and to help with public health planning and resource allocation in the future, the temporal and spatial variations of malaria epidemic are analysed and areas and seasons with a higher risk are identified at a fine geographic scale within a malaria endemic county in Hainan.MethodsMalaria cases among the residents in each of 37 villages within hyper-endemic areas of Wanning county in southeast Hainan from 2005 to 2009 were geo-coded at village level based on residence once the patients were diagnosed. Based on data so obtained, purely temporal, purely spatial and space-time scan statistics and geographic information systems (GIS) were employed to identify clusters of time, space and space-time with elevated proportions of malaria cases.ResultsPurely temporal scan statistics suggested clusters in 2005,2006 and 2007 and no cluster in 2008 and 2009. Purely spatial clustering analyses pinpointed the most likely cluster as including three villages in 2005 and 2006 respectively, sixteen villages in 2007, nine villages in 2008, and five villages in 2009, and the south area of Nanqiao town as the most likely to have a significantly high occurrence of malaria. The space-time clustering analysis found the most likely cluster as including three villages in the south of Nanqiao town with a time frame from January 2005 to May 2007.ConclusionsEven in a small traditional malaria endemic area, malaria incidence has a significant spatial and temporal heterogeneity on the finer spatial and temporal scales. The scan statistics enable the description of this spatiotemporal heterogeneity, helping with clarifying the epidemiology of malaria and prioritizing the resource assignment and investigation of malaria on a finer geographical scale in endemic areas.
Vitrification is increasingly used in assisted reproductive technology (ART) laboratories worldwide, and potential vitrification‐induced risks require further exploration. The effect of vitrification on changes in DNA methylation and imprinting disorders was investigated in E9.5 mouse fetuses and placentas. Fetus and placental tissues were collected from the natural mating (nautural conception [NC]) group, in vitro culture (IVC) group and vitrified embryo transfer (VET) group. The fetal crown‐rump length at E9.5 in both the IVC (0.210 ± 0.059 mm) and VET (0.205 ± 0.048 mm) groups was significantly reduced compared with the NC group (0.288 ± 0.083 mm). The global methylation levels of fetuses were decreased in the IVC group compared with the NC group and it was increased after vitrification compared with IVC (p < 0.05), similar to what was observed in the NC group (p > 0.05). The changes could be attributed to the disorders of DNA methyltransferases and ten‐eleven translocations. In the IVC and VET fetuses, a majority of maternally expressed genes were upregulated, which repressed fetal growth. Furthermore, vitrification led to a change in the methylation level of KvDMR1, which resulted in the disturbance of gene imprinting. According to our results, vitrification could contribute to increased methylation compared with IVC and contributes to a gene imprinting disorder rather than recovery. Despite the routine use of embryo vitrification in clinical settings, the effect that this procedure may have on genomic imprinting deserves much greater attention.
Quarantine Methods and Secondary Outbreak Prevention
Traffic congestion is one of the most vexing city problems and involves numerous factors which cannot be addressed without a holistic approach. Congestion cannot be narrowly tackled at the cost of a city's quality of life. Focusing on transport and land use planning, this paper examines transport policies and practices on both the supply and demand sides and finds that indirect travel demand management might be the most desirable solution to this chronic traffic ailment. The concept of absorption of traffic demand through the renaissance of streets as a way for traffic relief is introduced from two perspectives, with some examples from dense Asian urban contexts to demonstrate this. Firstly, jobs-housing balance suggests the return of production activities to residential areas and sufficient provision of diverse space/housing options to deal with work-related traffic. The second approach is to promote the street as a multi-activity destination rather than a thoroughfare to access dispersed daily needs, and to advocate more street life to diminish non-commuting traffic. Based on this, suggestions for better transport planning policies are put forward.
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