Background: This study aimed to determine the disease burden and strain distribution of rotavirus in children with diarrhea <5 years old in Suzhou, China. Methods: The study was conducted among children with diarrhea <5 years old at Suzhou University Affiliated Children's Hospital from 2013 to 2019. Rotavirus antigen was detected in clinical laboratory and then sent to Suzhou Centers for Disease Control and Prevention for further molecular analysis. Group A rotavirus (RVA) was detected through enzyme-linked immunosorbent assays, and G-genotype and P-genotype of RVA were tested using reverse transcription-polymerase chain reaction. Results: Of a total of 198,130 children with diarrhea, 70,813 (35.7%) were positive for RVA; RVA-related diarrhea was detected in 7798 (20.7%, n = 7798/37,710) inpatients and 63,015 (39.3%, n = 63,015/160,420) outpatients. Most children (92.0%, n = 65,171/70,813) positive for RVA were found as children <3 years old. Children 12-35 months old were reported as the highest prevalence among all age groups. The seasonal peak of RVA was in the autumn and winter. Among all 673 RVA strains genotyped, the G9P[8] strain was reported to be persistently predominant in the pediatric population from 2013 to 2019. Conclusions: The burden of diarrhea disease due to rotavirus infection remains high in Suzhou.
Background: There is a limited amount of data in China on the disease burden of respiratory syncytial virus-(RSV) associated acute lower respiratory infection (ALRI) among young children. This study aimed to estimate the hospitalization rate of RSVassociated ALRI (RSV-ALRI) among children aged 0-59 months in Suzhou, China. Methods: All cases from children hospitalized with ALRI who were aged 0-59 months in Suzhou University Affiliated Children's Hospital during January 2010 to December 2014 were retrospectively identified. Detailed diagnosis and treatment data were collected by reviewing each individual's medical chart. In accordance with the World Health Organization (WHO) influenza disease burden estimation, the hospitalization rate of RSV-ALRI among children aged 0-59 months in Suzhou, China, was then estimated.Results: Out of the 28,209 ALRI cases, 19,317 (68.5%) were tested for RSV, of which the RSV positive proportion was 21.3% (4107/19,317). The average hospitalization rate of RSV-ALRI for children aged 0-59 months was 14 (95% confidence interval[CI]:14-14)/1000 children years, and that for children aged 0-5, 6-11, 12-23, and 24-59 months were 70 (95% CI: 67-73), 31 (95% CI: 29-33), 11 (95% CI: 10-12), and 3 (95% CI: 3-3)/1000 children years, respectively. Conclusion:A considerable degree of RSV-ALRI hospitalization exists among children aged 0-59 months, particularly in those under 1 year of age. Therefore, an effective monoclonal antibody or vaccine is urgently needed to address the substantial hospitalization burden of RSV infection.
Currently, the classical, counterfactual, and structural confounding definitions, are simultaneously used in teaching or practice context of epidemiology. Despite the resemblance, the three definitions are different in many aspects. A unified theory of confounding and confounding control has not been established. At the same time, the distinction between several confounding-related concepts is not clear-cut. Inspired by the structural causal model, this paper puts forwards an improved confounding definition to unify previous confounding definitions. The improved definition defines confounding as the association between exposure and the risk factor for the outcome, which cannot be interpreted by the causal effect of exposure on the risk factor. In so doing, confounding control methods is derived naturally, and several confusing confounding-related concepts is distinguished clearly.
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