Although the incidence of tuberculosis (TB) in most parts of China are well under control now, in less developed areas such as Qinghai, TB still remains a major public health problem. This study aims to reveal the spatio-temporal patterns of TB in the Qinghai province, which could be helpful in the planning and implementing key preventative measures. We extracted data of reported TB cases in the Qinghai province from the China Information System for Disease Control and Prevention (CISDCP) during January 2009 to December 2016. The Kulldorff’s retrospective space-time scan statistics, calculated by using the discrete Poisson probability model, was used to identify the temporal, spatial, and spatio-temporal clusters of TB at the county level in Qinghai. A total of 48,274 TB cases were reported from 2009 to 2016 in Qinghai. Results of the Kulldorff’s scan revealed that the TB cases in Qinghai were significantly clustered in spatial, temporal, and spatio-temporal distribution. The most likely spatio-temporal cluster (LLR = 2547.64, RR = 4.21, P < 0.001) was mainly concentrated in the southwest of Qinghai, covering seven counties and clustered in the time frame from September 2014 to December 2016. This study identified eight significant space-time clusters of TB in Qinghai from 2009 to 2016, which could be helpful in prioritizing resource assignment in high-risk areas for TB control and elimination in the future.

Human adenoviruses (HAdVs) are prevalent in patients with respiratory infections, in which recombination has important implications for viral detection and pathogenicity. However, less HAdVs recombination was reported in Qinghai plateau. In this study, we obtained an HAdV-C strain (QH-1665/2018) isolated from an infant aged one month with influenza-like illness in Qinghai Province in 2018. The whole genome sequence was generated by next-generation sequencing, and compared with that of other HAdV-C strains available in public. The strain QH-1665/2018 genome is comprised of 36,014 nucleotides and encoded 36 putative proteins. Phylogenetic analysis of complete HAdV genomes and 3 major antigen genes (penton, hexon and fiber) showed that strain QH-1665/2018 was clustered into HAdV-1 [P1H1F1]. Recombination analysis based on the RDP4 package and SimPlot software showed that QH-1665/2018 was a recombinant involving HAdV-1, HAdV-2 and HAdV-5, which was then re-confirmed by phylogenetic analysis. Our results suggest that HAdV-C recombination is highly complex, should be focused on, and the epidemiological and virological surveillance should be strengthened in Qinghai Province.

Multistage stratified random sampling was used to explore the relationship of health literacy with novel coronavirus disease 2019 (COVID-19) prevention and control knowledge, attitude and practice (KAP) in residents aged 15–69 years old in Shanxi Province. The questionnaire, which was issued by the Chinese Center for Health Education, consisted of a health literacy questionnaire and a COVID-19 prevention and control KAP questionnaire. According to the national unified scoring method, the participants were divided into two groups: those who with adequate health literacy and those who with inadequate health literacy. The results of the answer to each KAP question were compared between the two groups by Chi-square test or Wilcoxon rank sum test. Binary logistic regression was used to control confounding effects of socio-demographic characteristics to draw relatively reliable conclusions. A total of 2700 questionnaires were distributed, and 2686 valid questionnaires were returned, with an efficiency rate of 99.5%. Health literacy qualified was identified for 18.32% (492/2686) in Shanxi Province. Compared with the inadequate health literacy group, people with adequate health literacy had a higher corrected answer rate in 11 knowledge-related questions (all P < 0.001); showed more positive answer to each attitude-related question in the three aspects, namely, responsibility for the prevention and control of infectious disease transmission, evaluation for COVID-19-related information release and reporting, and evaluation for the government’s COVID-19 prevention and control results (all P < 0.001); and acted more actively in the practice concerning appropriate self-prevention and control behaviors during the COVID-19 outbreak (all P < 0.001). Logistic regression analyses confirmed that with adequate health literacy played a positive role in each of the contents of COVID-19 prevention and control KAP (ORs were between 1.475 and 4.862, all P < 0.001). Health literacy is closely related to COVID-19 prevention and control KAP in the general population of Shanxi Province. People with high score of health literacy were generally better able to grasp COVID-19 prevention and control knowledge, have more positive attitudes toward prevention and control, and perform better prevention and control behaviors. Promoting residents’ health literacy by targeted health education can play an important and positive role in dealing with the threat of major infectious diseases outbreaks.

The aim of this study was to investigate the occurrence and molecular characteristics of Bartonella infections in small rodents in the Shangdang Basin, China. Small rodents were captured using snap traps, and their liver, spleen, and kidney tissues were harvested for Bartonella detection and identification using a combination of real-time PCR of the ssrA gene (296 bp) and conventional PCR and sequencing of the gltA gene (379 bp). Results showed that 55 of 147 small rodents to be positive for Bartonella, with a positivity rate of 37.41%, and 95% confidence interval of 29.50%- 45.33%. While the positivity rate across genders (42.62% in males and 33.72% in females, χ² = 1.208, P = 0.272) and tissues (28.57% in liver, 33.59% in spleen, and 36.76% in kidney, χ² = 2.197, P = 0.333) of small rodents was not statistically different, that in different habitats (5.13% in villages, 84.44% in forests, and 54.17% in farmlands, χ² = 80.105, P<0.001) was statistically different. There were 42 Bartonella sequences identified in six species, including 30 B. grahamii, three B. phoceensis, two B. japonica, two B. queenslandensis, one B. fuyuanensis and four unknown Bartonella species from Niviventer confucianus, Apodemus agrarius and Tscherskia triton. In addition to habitat, Bartonella species infection could be affected by the rodent species as well. Among the Bartonella species detected in this area, B. grahamii was the dominant epidemic species (accounting for 71.43%). B. grahamii exhibited four distinct clusters, and showed a certain host specificity. In addition, 11 haplotypes of B. grahamii were observed using DNASP 6.12.03, among which nine haplotypes were novel. Overall, high occurrence and genetic diversity of Bartonella were observed among small rodents in the Shangdang Basin; this information could potentially help the prevention and control of rodent-Bartonella species in this area.

Hand, Foot, and Mouth Disease (HFMD) is most frequently caused by Enterovirus71 (EV-A71) or Coxsackie virus A16 (CV-A16), infants and young children are at greatest risk. Describing the epidemiology of HFMD can help develop and better target interventions, including the use of pediatric EV-A71 vaccination. We obtained data from the national surveillance system for HFMD cases with onset dates from 2009 to 2015. We defined probable cases as patient with skin papular or vesicular rashes on the hands, feet, mouth, or buttocks and confirmed cases as patients with the above symptoms along with laboratory-based enterovirus detection. We generated overall and age-specific annual incidence rates and described the temporal variability and seasonality of HFMD in Qinghai Province. We identified spatial clustering of HFMD incidence at the county level using the Local Indicator of Spatial Associationand an alpha level of 0.05. During the study period, 14,480 HFMD probable or confirmed cases were reported in Qinghai Province. Of the 2158 (14.9%) with laboratory confirmation, 924 (42.6%) were caused by CV-A16 and 830 (38.2%) were caused by EV-A71. The majority (89%) of all case-patients were ≤ 5 years of age and male (61.5%). The overall mean annual HFMD incidence rate was 36.4 cases per 100,000 populations, while the incidence rate for children ≤5 years of age was 379.5 cases per 100,000. Case reports peaked during the months of May through July. HFMD was predominantly caused by EV-A71, except in 2010 and 2014 when CV-A16 was the predominant causative agent. High incidence rates of HFMD were clustered (Moran’s I = 0.59, P < 0.05) in the eastern region of the province. HFMD remains an important cause of childhood disease in Qinghai Province, occurring in an acyclical pattern of increased incidence, primarily due to CV-A16 circulation every three years. Incidence is also seasonal and tends to spatially cluster in the eastern region of the province. Since approximately 40% of confirmed HFMD cases were due to EV-A71, EV-A71 vaccination is likely to have a positive impact on the HFMD disease burden. Routine analysis of local surveillance data is crucial for describing disease occurrence and changes in etiology.

In this study, we aimed to investigate the prevalence and molecular characteristics of Bartonella infections in small mammals from the central region of the Qinghai-Tibetan Plateau. Toward this, small mammals were captured using snap traps in Yushu City and Nangqian County, West China, and the spleen tissue was used for Bartonella culture. The suspected positive colonies were evaluated using polymerase chain reaction (PCR) amplification and by sequencing the citrate synthase (gltA) gene. We discovered that 31 out of the 103 small mammals tested positive for Bartonella, with an infection rate of 30.10%. Sex differences between the mammals did not result in a significant difference in infection rate (χ² = 0.018, P = 0.892). However, there was a significant difference in infection rates in different small mammals (Fisher’s exact probability method, P = 0.017) and habitats (χ² = 7.157, P = 0.028). Additionally, 31 Bartonella strains belonging to three species were identified, including B. grahamii (25), B. japonica (4) and B. heixiaziensis (2), among which B. grahamii was the dominant epidemic strain (accounting for 80.65%). Phylogenetic analyses showed that most of the B. grahamii isolates identified in this study may be closely related to the strains isolated from Japan and China. Genetic diversity analyses revealed that B. grahamii strains had high genetic diversity, which showed a certain host and geographical specificity. The results of Tajima’s test suggested that the B. grahamii followed the progressions simulated by a neutral evolutionary model in the process of evolution. Overall, a high prevalence and genetic diversity of Bartonella infection were observed in small mammals in the central region of the Qinghai-Tibetan Plateau. B. grahamii as the dominant epidemic strain may cause diseases in humans, and the corresponding prevention and control measures should be taken into consideration in this area.