An increasing number of regional governments have begun to pay, partially or fully, for influenza vaccination for selected groups. However, this small-scale policy approach has failed to increase national uptake. A free, nationwide vaccination program would require a substantial annual investment. A cost-effectiveness analysis is needed to identify the most efficient methods to improve coverage.

Hospitalization with H7N9 virus infection is associated with older age and chronic heart disease, and patients have a longer duration of hospitalization than patients with H5N1 or pH1N1. This suggests that host factors are an important contributor to H7N9 severity.

[1] Tropospheric ozone (O 3 ) enhancements have been continuously observed over Hong Kong. We studied the O 3 enhancement events and assessed their relation to the springtime O 3 maximum in the lower troposphere over Hong Kong using a 6-year (1993 to 1999) ozonesonde data set. We identified the source regions of biomass burning emission, and established the chemical and transport characteristics of O 3 -rich air masses in the enhanced O 3 profiles using satellite imagery, air trajectory and trace gas data measured on board the DC-8 aircraft during the PEM-West-B experiment. We identified a total of 39 O 3 enhancement events, among which 35 events (90%) occurred from late February to May and 30 events (77%) had O 3 enhancement within the 2.0-6.0 km altitude. The excess O 3 in the O 3 -rich layers adds an additional 12% of O 3 into the tropospheric O 3 column and results in an overall springtime O 3 maximum in the lower troposphere. Forward trajectory analysis suggests that the O 3 -rich air masses over Hong Kong can reach central Pacific and the western coast of North America within 10 days. Back air trajectories show that the O 3 -rich air masses in the enhanced profiles pass over the Southeast (SE) Asia subcontinent, where active biomass burning occurs in the O 3 enhancement period. We identified the Indo-Burma region containing Burma, Laos and northern Thailand, and the Indian-Nepal region containing northern India and Nepal as the two most active regions of biomass burning emissions in the SE Asia subcontinent. Ozone and trace gas measurement on board the DC-8 aircraft revealed that O 3 -rich air masses are found over many parts of the tropical SE Asia and subtropical western Pacific regions and they have similar chemical characteristics. The accompanying trace gas measurements suggest that the O 3 -rich air masses are rich in biomass burning tracer, CH 3 Cl, but not the general urban emission tracers. We thus believe that the springtime O 3 enhancement over Hong Kong is as a result of transport of photochemical O 3 produced from biomass burning emissions from the upwind SE Asian continent. The large-scale enhancements of O 3 in tropical SE Asia and the subtropical western Pacific rim that result from SE Asian biomass burning activities such as presented here thus are of atmospheric importance and deserve further research efforts.

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Background Historically, malaria had been a widespread disease in China. A national plan was launched in China in 2010, aiming to eliminate malaria by 2020. In 2017, no indigenous cases of malaria were detected in China for the first time. To provide evidence for precise surveillance and response to achieve elimination goal, a comprehensive study is needed to determine the changing epidemiology of malaria and the challenges towards elimination. Methods Using malaria surveillance data from 2011 to 2016, an integrated series of analyses was conducted to elucidate the changing epidemiological features of autochthonous and imported malaria, and the spatiotemporal patterns of malaria importation from endemic countries. Results From 2011 to 2016, a total of 21,062 malaria cases with 138 deaths were reported, including 91% were imported and 9% were autochthonous. The geographic distribution of local transmission have shrunk dramatically, but there were still more than 10 counties reporting autochthonous cases in 2013–2016, particularly in counties bordering with countries in South-East Asia. The importation from 68 origins countries had an increasing annual trend from Africa but decreasing importation from Southeast Asia. Four distinct communities have been identified in the importation networks with the destinations in China varied by origin and species. Conclusions China is on the verge of malaria elimination, but the residual transmission in border regions and the threats of importation from Africa and Southeast Asia are the key challenges to achieve and maintain malaria elimination. Efforts from China are also needed to help malaria control in origin countries and reduce the risk of introduced transmission. Electronic supplementary material The online version of this article (10.1186/s12936-019-2736-8) contains supplementary material, which is available to authorized users.

BackgroundThe seasonal influenza vaccine coverage rate in China is only 1.9 %. There is no information available on the economic burden of influenza-associated outpatient visits and hospitalizations at the national level, even though this kind of information is important for informing national-level immunization policy decision-making.MethodsA retrospective telephone survey was conducted in 2013/14 to estimate the direct and indirect costs of seasonal influenza-associated outpatient visits and hospitalizations from a societal perspective. Study participants were laboratory-confirmed cases registered in the National Influenza-like Illness Surveillance Network and Severe Acute Respiratory Infections Sentinel Surveillance Network in China in 2013. Patient-reported costs from the survey were validated by a review of hospital accounts for a small sample of the inpatients.ResultsThe study enrolled 529 outpatients (median age: eight years; interquartile range [IQR]: five to 20 years) and 254 inpatients (median age: four years; IQR: two to seven years). Among the outpatients, 22.1 % (117/529) had underlying diseases and among the inpatients, 52.8 % (134/254) had underlying diseases. The average total costs related to influenza-associated outpatient visits and inpatient visits were US$ 155 (standard deviation, SD US$ 122) and US$ 1,511 (SD US$ 1,465), respectively. Direct medical costs accounted for 45 and 69 % of the total costs related to influenza-associated outpatient and inpatient visits, respectively. For influenza outpatients, the mean cost per episode in children aged below five years (US$ 196) was higher than that in other age groups (US$ 129–153). For influenza inpatients, the mean cost per episode in adults aged over 60 years (US$ 2,735) was much higher than that in those aged below 60 years (US$ 1,417–1,621). Patients with underlying medical conditions had higher costs per episode than patients without underlying medical conditions (outpatients: US$ 186 vs. US$ 146; inpatients: US$ 1,800 vs. US$ 1,189). In the baseline analysis, inpatients reported costs were 18 % higher than those found in the accounts review (n = 38).ConclusionThe economic burden of influenza-associated outpatient and inpatient visits in China is substantial, particularly for young children, the elderly, and patients with underlying medical conditions. More widespread influenza vaccination would likely alleviate the economic burden of patients. The actual impact and cost-effectiveness analysis of the influenza immunization program in China merits further investigation.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0077-6) contains supplementary material, which is available to authorized users.

BackgroundVaccine regulation in China meets World Health Organization standards, but China’s vaccine industry and immunization program have some characteristics that differ from other countries. We described the history, classification, supply and prices of vaccines available and used in China, compared with high-and middle-incomes countries to illustrate the development of Chinese vaccine industry and immunization program.MethodsImmunization policy documents were obtained from the State Council and the National Health and Family Planning Commission (NHFPC). Numbers of doses of vaccines released in China were obtained from the Biologicals Lot Release Program of the National Institutes for Food and Drug Control (NIFDC). Vaccine prices were obtained from Chinese Central Government Procurement (CCGP). International data were collected from US CDC, Public Health England, European CDC, WHO, and UNICEF.ResultsBetween 2007 and 2015, the annual supply of vaccines in China ranged between 666 million and 1,190 million doses, with most doses produced domestically. The government’s Expanded Program on Immunization (EPI) prevents 12 vaccine preventable diseases (VPD) through routine immunization. China produces vaccines that are in common use globally; however, the number of routinely-prevented diseases is fewer than in high- and middle-income countries. Contract prices for program (EPI) vaccines ranged from 0.1 to 5.7 US dollars per dose - similar to UNICEF prices. Contract prices for private-market vaccines ranged from 2.4 to 102.9 US dollars per dose - often higher than prices for comparable US, European, and UNICEF vaccines.ConclusionChina is a well-regulated producer of vaccines, but some vaccines that are important globally are not included in China’s EPI system in China. Sustained and coordinated effort will be required to bring Chinese vaccine industry and EPI into an era of global leadership.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3422-0) contains supplementary material, which is available to authorized users.

The burden of diarrhea attributed to rotavirus is high in China, highlighting the potential value of vaccination. The rapid shift of RVA strains highlights the importance of conducting rotavirus surveillance to ensure that currently marketed vaccines provide protective efficacy against the circulating strains.