Volume 05 · Issue 06 · 2023

In June 2023, the 2022 global mpox (monkeypox) outbreak began to affect Guangdong Province, one of the first regions in mainland China to report mpox cases. By July 10, 2023, 93 mpox cases had been reported in Guangdong Province. This study describes the epidemiological characteristics of these patients by collecting and analyzing data on demographics, sexual behavior, medical history, travel history, clinical symptoms, and diagnostic pathways and processes. The 93 mpox cases were all men aged 20-48 years, 95.70 % were men who have sex with men (MSM), and 48.39 % were HIV-positive. A few cases were married (to women) or living with children. The rash was present in almost all cases (98.91 %), with the most common sites being the genital and perianal areas (70.33 %). Intimate sexual contact was suspected to be the main route of infection, with a median incubation period of 8.5 days (IQR 5.0–11.8). The number of cases increased rapidly, and most patients had no history of international travel, suggesting sustained community transmission within the MSM population in Guangdong Province. In addition, 93.55 % of cases were detected by medical institutions, and more than half of these patients had two or more hospital visits before being diagnosed as an mpox case, indicating that clinicians need further training to increase their sensitivity to mpox. Targeted interventions should prioritize MSM while remaining vigilant for transmission to other populations, such as women and children.

To develop a national reference panel for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen detection kit and establish a quality standard. The cultures of SARS-CoV-2 and other pathogens were collected to establish a national reference panel for SARS-CoV-2 antigen detection. The stability and homogeneity of the reference panel were evaluated. Based on World Health Organization (WHO) guidance and nucleic acid quantitative results, a quality standard reference panel was established. Currently, three generations of SARS-CoV-2 antigen national reference materials with batch numbers 370095–202001, 370095–202202, and 370095–202203 have been successfully established. These national reference panels comprised 8 positive samples, 20 negative samples, 1 repetitive sample, and 1 lower detection limit sample. The stability and homogeneity of the reference panel meet the requirements. The quality standards are as follows: the positive and negative coincidence rates are 8/8 and 20/20, respectively. The 10 test results of the medium and low-concentration repetitive reference materials should be positive, and the color rendering should be uniform (or the coefficient of variance should not be higher than 20.0%). The lower detection limit should be at least 5 × 10⁵ U/mL (equivalent to copies/mL), and higher concentrations above the lower detection limit must be positive. A national reference panel for the SARS-CoV-2 antigen detection kit has been established. As the standard of SARS-CoV-2 antigen reagents, the reference panel has played a crucial role in the pre-marketing quality evaluation and post-marketing quality supervision in China.

Hand, foot, and mouth disease (HFMD) is a contagious disease mainly occurring in young children, and outbreaks commonly occur among young children in the Asia–Pacific region including Thailand. Moreover, the World Health Organization (WHO) monitors HFMD in the Western Pacific region to detect outbreaks and other significant events by the Regional Event Based Surveillance System. HFMD is mainly caused by a group of enteroviruses (EVs) transmitted through direct contact (person to person) and indirect contact with contaminated objects (surface-to-hand). However, few studies have examined the surface stability of EVs. In this study, we investigated the stability of enterovirus A71 (EV-A71) and coxsackievirus A16 (CVA16) on three different dry surfaces (wood, plastic, and stainless steel) using the endpoint titration using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) staining of viable cells and real-time polymerase chain reaction (viral genome detection). The results revealed that virus infectivity dramatically decreased within a few hours on dry surfaces. However, viral RNA could be detected on dry surfaces for up to 28 days. Concerning heat inactivation, both EV-A71 and CVA16 were inactivated after exposure to 60°C for 15 min. Information on virus stability on different dry surfaces will provide useful information for HFMD transmission control.

In October 2017, a small outbreak of echovirus 30 (E30) associated with aseptic meningitis in nine cases occurred at a primary school in the Ningxia Hui Autonomous Region. That year, we observed a significant increase in E30 levels in an acute flaccid paralysis (AFP) case surveillance system. To investigate their phylogenetic relationships, we determined the whole genomic sequences of 12 strains isolated from aseptic meningitis cases, AFP cases, and healthy children. We found that the E30 strains circulating in Ningxia belong to two lineages (H and J). The strains isolated in 2010, 2012, and 2016 belonged to the H lineage. In 2017, a new lineage, J, emerged as the dominant lineage. Phylogenetic trees were constructed based on the whole genome and P1, P2, and P3 regions; clustering with other types of enterovirus species B was found, suggesting that recombination events had occurred. The recombination sites were mainly in regions 2B, 2C, and 3D. This study confirmed that the E30 strains in Ningxia in 2010, 2012, and 2016 had different recombination patterns and were recombined with different enteroviruses. The 2017 epidemic E30 originated from another new lineage with a complex recombination pattern and formed an independent transmission chain in Ningxia.

Understanding how human leukocyte antigen (HLA) polymorphism affects both the susceptibility and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection will help to identify individuals at higher risk to better manage and prioritize vaccination at the clinical level and explain the differences in epidemic trends in different regions at the epidemiological level. This study compared the frequencies of HLA class I alleles (HLA-A, B) in 214 coronavirus disease 2019 (COVID-19) patients with different disease severity and 35 healthy controls and analyzed the correlations between specific HLA alleles and disease severity and T cell memory. The results showed no significant difference in HLA allele frequencies between COVID-19 patients and healthy controls (P > 0.05). The allele HLA-B*13:02 was significantly correlated with the disease severity of COVID-19 patients (P = 0.006). After adjustment for age and disease severity, the T cell responses of COVID-19 convalescents with the allele HLA-B*40:01 may be lower at six months (P = 0.044) and 12 months (P = 0.069). Moreover, these results may be due to their rare peptide anchors by analyzing the binding peptide motifs of these HLA alleles. The study may be valuable for investigating the potential association of specific HLA alleles with SARS-CoV-2 infection.

Enteroviruses (EVs) are human pathogens commonly observed in children aged 0–5 years and adults. EV infections usually cause the common cold and hand-foot-and-mouth disease; however, more severe infections can result in multiorgan complications, such as polio, aseptic meningitis, and myocarditis. The molecular mechanisms by which enteroviruses cause these diseases are still poorly understood, but accumulating evidence points to two enterovirus proteases, 2A^pro and 3C^pro, as the key players in pathogenesis. The 2A^pro performs post-translational proteolytic processing of viral polyproteins and cleaves several host factors to evade antiviral immune responses and promote viral replication. It was also discovered that coxsackievirus-induced cardiomyopathy was caused by 2A^pro-mediated cleavage of dystrophin in cardiomyocytes, indicating that cellular protein proteolysis may play a key role in enterovirus-associated diseases. Therefore, studies of 2A^pro could reveal additional substrates that may be associated with specific diseases. Here, we discuss the genetic and structural properties of 2A^pro and review how the protease antagonizes innate immune responses to promote viral replication, as well as novel substrates and mechanisms for 2A^pro. We also summarize the current approaches for identifying the substrates of 2A^pro to discover novel mechanisms relating to certain diseases.

Antimicrobial resistance (AMR) is a growing global threat, especially in low- and middle-income countries (LMICs), causing prolonged illnesses, heightened antimicrobial use, increased healthcare expenses, and avoidable deaths. If not tackled, AMR could force 24 million people into severe poverty by 2030 and hinder progress on Sustainable Development Goals (SDGs). AMR spreads through interconnected ecosystems, with humans, animals, and the environment serving as reservoirs. Pharmaceutical wastewater, loaded with antibiotics and resistance genes, poses a significant environmental risk, mainly due to inadequate treatment and irresponsible disposal. The pharmaceutical industry is a notable contributor to environmental antibiotic pollution, with varying effluent management practices. Contaminated pharmaceutical wastewater discharge harms water sources and ecosystems. Urgent collaborative efforts are needed across policymakers, regulators, manufacturers, researchers, civil society, and communities, adopting a One Health approach to curb AMR's spread. Developing global standards for pharmaceutical effluent antibiotic residues, effective treatment methods, and improved diagnostics are vital in addressing AMR's environmental impact while safeguarding public health and the environment. National action plans should encompass comprehensive strategies to combat AMR. Preserving antibiotic efficacy and ensuring sustainable production require a united front from all stakeholders.

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