Macrolide resistance rates of Mycoplasma pneumoniae in the Beijing population were as high as 68.9%, 90.0%, 98.4%, 95.4%, and 97.0% in the years 2008 to 2012, respectively. Common macrolide-resistant mobile genetic elements were not detected with any isolate. These macrolide-resistant isolates came from multiple clones rather than the same clone. No massive aggregation of a particular clone was found in a specific period. Mycoplasma pneumoniae is one of the important pathogens causing human respiratory tract infection, especially in community-acquired pneumonia (1, 2). The major clinical treatment for M. pneumoniae infection is the use of macrolide antibiotics (ML). With the widespread use of the drug, ML-resistant isolates have been reported worldwide (3-5). The resistance mechanism has been identified as a point mutation in the 23S rRNA gene. Other mechanisms of macrolide resistance cannot be excluded and have not been identified. In recent years, ML-resistant M. pneumoniae has become very serious in Asia (6, 7) and has attracted the attention of scientists. Studies on ML-resistant M. pneumoniae in China have only recently been conducted, and the limited reports have been mainly ML resistance analyses of a small number of strains isolated during a few months and from specific populations, such as children or adults (8-11). These reports are lacking continuous full-population surveillance data of M. pneumoniae drug resistance. In view of the above-mentioned information, we have studied drug resistance of 309 M. pneumoniae isolates from a whole population of strains isolated from people with respiratory infections in Beijing, China, from 2008 to 2012, a study which will help us to understand the status of drug-resistant M. pneumoniae in Beijing in recent years.M. pneumoniae strains. A total of 309 M. pneumoniae strains were isolated from 1,183 respiratory infection specimens from Beijing Chao-Yang Hospital, Beijing Children's Hospital, and Beijing Centers for Diseases Control and Prevention. One hundred fifty-six isolates were from 388 pediatric specimens of patients Ͻ14 years of age, and the remaining 153 isolates were collected from 795 adolescent and adult specimens. All 309 isolates were purified, cultured, and identified with a real-time PCR method (12).Detection of macrolide resistance at the gene level. Genomic DNA of 309 M. pneumoniae isolates was extracted using the QIAamp DNA minikit (Qiagen). The extracts were distributed into aliquots and saved at Ϫ20°C. The domain V region of the 23S rRNA gene was amplified by PCR methods described previously (6). The amplification products were sequenced by the Beijing Genomics Institute (BGI). The results showed that there were existing point mutations in domain V of the 23S rRNA gene region of 280 strains in the 309 M. pneumoniae isolates. In 272 of the 280 isolates (97.1%), the mutation was identified as A2063G. Seven of the 280 isolates (2.5%) had the A2064G mutation, one of the 280 isolates (0.4%) had an A2063T mutation, and the remaining 29 isolates did not h...

Background Hepatitis B virus (HBV) infection is a major public health problem in China. Over a decade has passed since the last National Hepatitis Seroepidemiological Survey was conducted in 2006. The lack of updated data on hepatitis B in China makes assessing the current prevalence and burden of the disease inadequate. In response to the above situation, a systematic review and meta-analysis was conducted to provide a better understanding of hepatitis B epidemiology in the general population of China. Methods A systematic search was conducted in international databases (Medline through PubMed, EMBASE, Cochrane, Web of Science) and national databases (CBM, CNKI, WanFang Data) to retrieve primary studies published between January 1, 2013 and December 31, 2017. The pooled prevalence of HBV infection and 95% confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also performed. Results Of the 27 studies included in the meta-analysis, the pooled estimated prevalence of HBV infection in the general population of China from 2013 to 2017 was 6.89% (95% CI:5.84–7.95%), which could be extrapolated to an estimated population of 84 million living with HBsAg in 2018. The prevalence of HBV infection in males was higher than that in females (5.88% vs 5.05%), and rural areas had a higher prevalence than urban areas (5.86% vs 3.29%). The highest prevalence of HBV infection was reported in Western provinces (8.92, 95% CI: 7.19–10.64%). In adults older than 20 years, the prevalence of HBV infection was approximately 7%, which was higher than that in children. Conclusion The prevalence of HBV infection in the general population of China was classified as higher intermediate prevalence (5–7.99%), of which more than 90% of the HBV infection population included adults older than 20 years. The blocking of mother-to-infant hepatitis B transmission and plans involving timely birth dose of hepatitis B vaccine within 24 h should be implemented. Additionally, improving the quality of life and survival rate of the infected population through antiviral therapy and high-risk adult vaccination will be the priority of our future work. Moreover, various control measures should be implemented in different provinces across China.

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This system enabled detection of the onset and peak of an epidemic.

MICs of eight antibiotics were detected with 40 Chinese Mycoplasma pneumoniae isolates. Thirty-eight isolates (95%) were macrolide resistant. Each macrolide-resistant isolate harbored an A2063G or A2064G point mutation in the 23S rRNA gene. All 40 isolates (100%) were type I strains, but they might have originated from different clones. Mycoplasma pneumoniae is a common pathogen causing community-acquired pneumonia (CAP) (4, 9, 12). Macrolides are the drugs of primary choice for the treatment of M. pneumoniae infections. Macrolide resistance rates of M. pneumoniae have increased rapidly in recent years, especially in Asia (3, 10, 11). In 2009, studies from China found that 83% (44/53) and 92% (46/50) of M. pneumoniae strains isolated from pediatric patients in Shanghai (6) and Beijing (14) were resistant to macrolides, respectively. In 2010, the macrolide resistance rate of M. pneumoniae isolated from ambulatory adult patients was 69% (46/67) in Beijing (1).In this study, 40 M. pneumoniae isolates were collected from CAP patients in Beijing, China. The antibiotic resistance patterns of this pathogen were surveyed with eight agents, and the mechanisms of resistance for macrolide-resistant isolates were investigated with 23S rRNA gene analysis.M. pneumoniae strains. Forty M. pneumoniae isolates were obtained from 182 CAP patients in the Beijing, Dongcheng, and Xicheng Centers for Disease Control and Prevention from January 2011 to June 2011. The clonalities of all M. pneumoniae isolates were determined by the filtration-cloning technique and identified by colony morphology and real-time PCR assays (2).Antimicrobial susceptibility testing of isolates. The MICs of eight antibiotics were determined by broth microdilution methods with SP4 broth (Remel). M. pneumoniae reference strain M129 (ATCC 29342) was tested as an antibiotic-sensitive control. Thirty-eight (95%) isolates were macrolide resistant. The MIC 50 values of isolates for erythromycin, clarithromycin, azithromycin, and josamycin were greater than 256 g/ml, 256 g/ml, 32 g/ml, and 4 g/ml, respectively. The MIC 90 values of the isolates with the four macrolides above were greater than 256 g/ml, 256 g/ ml, 32 g/ml, and 8 g/ml, respectively. All M. pneumoniae isolates were susceptible to tetracycline and fluoroquinolones (Table 1). Gatifloxacin was more active than ciprofloxacin and levofloxacin. The MIC 90 of gatifloxacin (0.064 g/ml) was much lower than those of ciprofloxacin (1 g/ml) and levofloxacin (1 g/ml).Sequencing analysis of the 23S rRNA gene. Genomic DNA of each isolate was extracted with the QIAamp DNA minikit (Qiagen). Domains II and V of the 23S rRNA gene were amplified by methods described previously (8). All the amplicons were sequenced by the Beijing Genomics Institute (BGI). Thirty-seven isolates harbored an A2063G mutation in domain V of the 23S rRNA gene, while one isolate harbored an A2064G mutation in domain V of the 23S rRNA gene. No mutations were found in domain II (Table 1).Typing of the p1 gene. All 40 M. pneumoniae isolates from CAP...

A total of 201 Mycoplasma pneumoniae clinical isolates from Beijing, China, isolated from 2008 to 2011, were clustered into 16 multiple-locus variable-number tandem-repeat analysis (MLVA) types, of which 6 new MLVA types have never been reported previously. Type 1 isolates based on p1 gene genotyping were mainly MLVA types E, J, P, U, and X. There was no correlation between macrolideresistant Mycoplasma pneumoniae and their MLVA type. Mycoplasma pneumoniae is an important pathogen for human respiratory tract infection, especially for communityacquired pneumonia (CAP), of which M. pneumoniae infection accounts for a ratio of 10% to 30% (1, 2). The genotyping of clinical isolates is an important means for understanding the epidemiology of M. pneumoniae and the analysis of its breakout. Except for fewer adhesion-related protein-coding genes, the genomic sequences of M. pneumoniae are highly homogeneous, so the previously reported genotyping target site of M. pneumoniae is mainly a p1 adhesion protein gene. Commonly used PCR-restriction fragment length polymorphism (PCR-RFLP) technology primarily classified M. pneumoniae into type 1 and type 2 (3, 4). With the in-depth study of the RepMp2/3 and RepMp4 repeat sequence within the p1 gene, more variants of type 1 and 2 isolates were found by molecular subtyping and sequencing (5-8). However, the methods mentioned above have limited ability for understanding the M. pneumoniae epidemiological investigations. (14). Bacterial DNA from cultivated M. pneumoniae isolates was extracted using the QIAamp DNA minikit (Qiagen), and the aliquots were placed in a refrigerator at Ϫ20°C. p1 gene-based genotyping of M. pneumoniae. Sixty of 201 M. pneumoniae clinical isolates were genotyped by full-length sequencing of the p1 gene in our previous report (8); the other 141 isolates were genotyped by a previously reported method (15, 16). Results indicated that 184 (91.5%) isolates were type 1, 2 (1.0%) isolates were variant 2a, 15 (7.5%) isolates were variant 2c, and no type 2 isolates were detected.Sequencing analysis of the 23S rRNA gene. The domain V of 23S rRNA, related to M. pneumoniae macrolide resistance, was detected using a previously reported method (17). Results indicated that 24 (11.9%) isolates were macrolide sensitive without mutation and 177 (88.1%) isolates were macrolide resistant with mutation within the domain V of 23S rRNA, of which the numbers of A2063G, A2064G, and A2064T mutant isolates were 171, 5, and 1, respectively. M. pneumoniae MLVA genotyping. A total of 201 M. pneumoniae clinical isolates were analyzed using the MLVA assay (9), with M129 as a reference strain. Using nonfluorescent primers, PCR amplification against 5 VNTRs from 10 randomly selected isolates was performed to validate the creditability of MLVA genotyping. All data were analyzed using BioNumerics (version 6.5) software. Results indicated that 201 M. pneumoniae clinical isolates were divided into 16 MLVA types, of which 10 types were reported previously, and the other 6 types were new MLVA typ...

A double-blind, randomized, controlled trial involving 706 adults was conducted to evaluate the immunogenicity and safety of different dosages of whole-virion or split-virion H1N1 influenza vaccines with or without aluminum adjuvant. A rapid and strong immune response was induced at day 14 after the first injection. The seroprotection rates ranged from 72.7% (95% confidence interval [CI], 62.7%-81.1%) for 5-microg whole-virion aluminum formulation to 97.0% (95% CI, 90.9%-99.7%) for 30-microg split-virion nonaluminum formulation. All formulations were well tolerated. The incidences of mild, moderate, and severe reactions were 71 (10.1%), 15 (2.1%), and 1 (0.1%) of 706 reactions, respectively. The 15-microg split-virion formulation had the best immunogenicity and safety.

BackgroundInfluenza continues to have a major impact on vulnerable populations worldwide, particularly among the elderly (≥60 years of age). Vaccination for targeted groups is recommended by the WHO as the most effective way to control influenza infections. Since 2009, the Beijing municipal government has provided influenza vaccination to the elderly at no out-of-pocket cost to reduce influenza threats and improve related health equality. The study aims to evaluate the equality of the policy, and to analyze factors that bring influences to equality.MethodsBased on data from a household survey, concentration index (CI) was calculated to measure the socioeconomic inequality in influenza vaccination. A Logit regression model was used to decompose CI, in which the contribution of each determinant was calculated and the percentages of these contribution were obtained.ResultsFree influenza vaccination at point of use shows significant pro-poor distribution among the elderly in Beijing (CI = −0.115). After the decomposition of CI, the elderly with lower income, higher education, and living in rural areas were more likely to get the influenza vaccination, in which place of residence (contribution percentage = 57 %) held the most contribution of variance.ConclusionsBeijing’s free influenza vaccination strategy at point of use could provide the poor elderly with equal opportunities to receive preventive health service, showing a significant pro-poor distribution. The poor elderly, who live in rural areas with high education, benefit most from the policy. Further policy interventions should target the population living in urban areas in order to improve the utilization of public health services and health equality.