Cadmium, a toxic heavy metal, is widely present in food. It has been reported that chronic cadmium exposure is associated with kidney disease, osteoporosis, cardiovascular disease and cancer. The aim of this study was to assess the dietary cadmium exposure and potential health risk in different age-sex groups of the Chinese population (children aged 4–11 years, young people aged 12–17 years and adults aged over 18 years), and in the southern and northern population using a semi-probabilistic method. Cadmium was detected in 228,687 food samples from 32 food categrories by graphite furnace atomic absorption spectrometry. The dietary cadmium exposures were estimated by combining the cadmium concentration data with food consumption data derived from the China National Nutrient and Health Survey 2002, and evaluated against the Provisional Tolerable Monthly Intake (PTMI) of 25 μg/kg BW/month established by the Joint FAO/WHO expert committee on food additives (JECFA). The mean dietary cadmium exposure of the general Chinese population (15.3 μg/kg BW/month) was below the PTMI. The high consumer exposures (95th percentile, P95) for the general population and different sub-groups were higher than the PTMI. The dietary cadmium exposure of the southern population was apparently higher than that of the northern population. Rice was the most important contributor to cadmium exposure for Chinese people, especially those living in the southern areas of China. These findings indicated that the health risk from dietary cadmium exposure of the general Chinese people was low, but the health risk of cadmium exposure of certain sub-groups should be of concern.

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Human-to-human transmissions of severe fever with thrombocytopenia syndrome virus in Anhui province, 2010e2017 Dear Sir, Severe fever with thrombocytopenia syndrome virus (SFTSV) is a novel virus that belongs to the genus phlebovirus in the Bunyaviridae family. It was first isolated from the blood of Chinese patients in 2010 [1]. According to the China Information System for Diseases Control and Prevention (CISDCP), 23 provinces have reported cases of severe fever with thrombocytopenia syndrome (SFTS) from the year 2010 to 2016. There has been an upward trend in reported cases, mainly distributed in northeastern , eastern and central China [2]. Human-to-human transmission has been reported to occur via contact with blood, body fluids, and vomitus in hospitals and at funerals [3e5]. Of the 1506 cases of SFTS reported in Anhui province since January 2010, human-to-human transmission has been involved in 24 (http://www.cdpc.chinacdc.cn). As of 31 December, 2017, seven index patients of SFTSV resulted in the secondary infection of 17 patients. Those seven human-to-human transmissions were distributed across six counties: two in Jinzhai and one each in Huaining, Guangde, Quanjiao, Chaohu, and Zongyang. The seven index patients (three men and four women, median age 63 years, range 46e68 years) were all farmers who lived in hilly or mountainous areas. After coming into contact with these patients, 17 secondary patients were infected, including 10 men and seven women. The median age of secondary patients was 45 years, with a range between 22 and 69 years (see Fig. 1). Of the 24 SFTS patients involved in human-to-human transmission, 18 (seven index patients and 11 secondary patients) experienced signs and symptoms of SFTSV infection, and eight (seven index patients and one secondary patient) died on the median day of Day 11 of the disease. Location at which human-to-human transmissions occurred included the funeral of three, in hospital of two, and two both in hospital and at funeral. Of the 17 secondary patients, five had a history of blood contact with an index patient, 11 had a history of blood and body fluid contact with an index patient, and one had a history of probable aerosol contact. The median incubation period for 12 patients (one index patient and 11 symptomatic secondary patients) was 9 days, ranging from 4 to 14 days. Close contact monitoring showed that six close contacts tested positive for immunoglobulin M (IgM) and immunoglobulin G Center for Disease Control and Prevention, and the Zongyang Center for Disease Control and Prevention. Contents lists available at ScienceDirect Clinical Microbiology and Infection j o u r n a l h o m e p a g e : w w w. c l i n i c a l m i c r o b i o l o g y a n d i n f e c t i o n. c o m

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is a severe viral disease caused by SFTSV. It is important to estimate the rate of missed SFTS diagnosis and to further understand the actual incidence in high endemic areas in China.MethodsThis study was conducted in two high SFTS endemic provinces in 2015. Patients hospitalized in 2014 or within 1 year before investigation were selected after considering their clinical manifestations, specifically, fever, platelet, and white blood cell. During retrospective investigation, sera were collected to detect SFTSV antibodies to assess SFTSV infection. To further understand SFTSV infection, acute phase sera were detected; SFTSV infection rate among a healthy population was also investigated to determine the basic infection level.ResultsIn total, 246 hospitalized cases were included, including 83 cases (33.7%) with fever, thrombocytopenia and leukopenia, 38 cases (15.4%) with fever and thrombocytopenia but without leukopenia, and 125 cases (50.8%) without fever but with thrombocytopenia and leukopenia. In total, 13 patients (5.3%) were SFTSV IgM antibody-positive, 48 (19.5%) were IgG-positive. Of the 13 IgM-positive cases, 11 (84.6%) were IgG-positive (9 with titres ≥1:400). Seropositive rates of antibodies were high (8.4% for IgM and 30.1% for IgG) in patients with fever, thrombocytopenia and leukopenia. Furthermore, among IgG-positive cases in this group, 76% (19/25) of patients’ IgG antibody titres were ≥1:400. Additionally, 28 of 246 cases were initially diagnosed with suspected SFTS and were then excluded, and 218 patients were never diagnosed with SFTS; the seropositive rates of IgM and IgG in these two groups were 25% and 67.9% and 2.8% and 13.3%, respectively. These rates were 64.3% and 21.4% in 14 sera collected during acute phase of the 28 cases mentioned above. Seropositive rate of SFTSV IgG was only 1.3% in the patient-matched healthy group, and no IgM antibody was detected. A preliminary estimate of 8.3% of SFTS cases were missed in SFTS high endemic provinces.ConclusionsThe actual SFTS incidence was underestimated. Effective measures such as adding a new SFTS case category - “SFTS clinical diagnosis cases” or using serological detection methods during acute phase should be considered to avoid missed diagnoses.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-2970-7) contains supplementary material, which is available to authorized users.

What is already known about this topic?The genus Anaplasma contains seven recognized bacterial species, mainly transmitted by tick bites. The two species, A. phagocytophilum and A. capra, are known commonly to cause diseases in humans. What is added by this report?Anaplasma bovis was initially thought to be only an animal agent until the first patient case was reported in 2019. This study investigated another two patients who became sick within one month in the same township and were infected with A. bovis in Anhui Province. What are the implications for public health practice?This study suggested that more A. bovis-infected patients may exist in this area and that patients with anaplasmosis require an early and specific diagnosis.

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The overall seroprevalence of SFTSV is higher in the western region of Anhui, possibly due to latent infection, with the main risk factors being living in areas of uncontrolled vegetation growth, long-term residents of the locality and tick bites. Further investigations are warranted to clarify the modes of SFTS virus transmission, while vector management, education on tick bite prevention and personal hygiene management should be implemented for high risk groups in endemic areas.