A study of the relationship between #human #infection with #avian #influenza A #H5N6 and environmental avian influenza viruses in #Fujian, #China (BMC Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Infect Dis. 2019 Sep 2;19(1):762. doi: 10.1186/s12879-019-4145-6.

A study of the relationship between human infection with avian influenza a (H5N6) and environmental avian influenza viruses in Fujian, China.

Chen P1, Xie JF1,2, Lin Q2, Zhao L2, Zhang YH2, Chen HB2, Weng YW1,2, Huang Z2, Zheng KC3,4.

Author information: 1 College of Public Health, Fujian Medical University, No. 88, Jiaotong Road, Taijiang District, Fuzhou, 350000, China. 2 Fujian Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, 350001, China. 3 College of Public Health, Fujian Medical University, No. 88, Jiaotong Road, Taijiang District, Fuzhou, 350000, China. kingdadi9909@126.com. 4 Fujian Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, Fuzhou, 350001, China. kingdadi9909@126.com.




Avian influenza A (H5N6) virus poses a great threat to the human health since it is capable to cross the species barrier and infect humans. Although human infections are believed to largely originate from poultry contaminations, the transmissibility is unclear and only limited information was available on poultry environment contaminations, especially in Fujian Province.


A total of 4901 environmental samples were collected and tested for Avian Influenza Virus (AIV) from six cities in Fujian Province through the Fujian Influenza Surveillance System from 2013 to 2017. Two patient-related samples were taken from Fujian’s first confirmed H5N6 human case and his backyard chicken feces in 2017. Chi-square test or Fisher’s exact probability test was used to compare the AIV and the viral subtype positive rates among samples from different Surveillance cities, surveillance sites, sample types, and seasons. Phylogenetic tree analysis and molecular analysis were conducted to track the viral transmission route of the human infection and to map out the evolutions of H5N6 in Fujian.


The overall positive rate of the H5 subtype AIVs was 4.24% (208/4903). There were distinctive differences (p < 0.05) in the positive rates in samples from different cities, sample sites, sample types and seasons. The viruses from the patient and his backyard chicken feces shared high homologies (99.9-100%) in all the eight gene segments. Phylogenetic trees also showed that these two H5N6 viruses were closely related to each other, and were classified into the same genetic clade with another six H5N6 isolates from the environmental samples. The patient’s H5N6 virus carried genes from H6N6, H5N8 and H5N6 viruses originated from different areas. The R294K or N294S substitution was not detected in the neuraminidase (NA). The S31 N substitution in the matrix2 (M2) gene was detected but only in one strain from the environmental samples.


The H5 subtype of AIVs has started circulating in the poultry environments in Fujian Province. The patient’s viral strain originated from the chicken feces in his backyard. Genetic reassortment in H5N6 viruses in Fujian Province was indicated. The H5N6 viruses currently circulating in Fujian Province were still commonly sensitive to Oseltamivir and Zanamivir, but the resistance against Amantadine has emerged.

KEYWORDS: Avian influenza a (H5N6) virus; Environmental contamination; Phylogenetic analysis

PMID: 31477028 PMCID: PMC6719373 DOI: 10.1186/s12879-019-4145-6 [Indexed for MEDLINE] Free PMC Article

Keywords: Avian Influenza; H5N6; H5N8; H6N6; Reassortant strain; Human; Poultry; Fujian; China.


Association between #particulate matter #air #pollution and #lung #cancer (Thorax, abstract)

[Source: Thorax, full page: (LINK). Abstract, edited.]

Association between particulate matter air pollution and lung cancer

Zhenyu Zhang 1, Dawei Zhu 2, Bin Cui 3, Ruoxi Ding 4, Xuefeng Shi 5, Ping He 2

Author affiliations: 1 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; 2 China Center for Health Development Studies, Peking University, Beijing, China; 3 School of Public Health, Peking University, Beijing, China; 4 Institute of Population Research, Peking University, Beijing, China; 5 School of Management, Beijing University of Chinese Medicine, Beijing, China

Correspondence to Professor Ping He, China Center for Health Development Studies, Peking University, Beijing 100191, China; phe@pku.edu.cn; Professor Xuefeng Shi; shixuefeng981206@163.com



Long-term exposure to particulate matter 2.5 μm (PM2.5) air pollution is associated with an increased risk of lung cancer. However, the evidence is limited in low-income and middle-income countries. We estimated the association between the incidence of lung cancer and PM2.5 air pollution exposure in the Urban Employee Basic Medical Insurance (UEBMI) beneficiaries in China. A total of 16 483 new lung cancer cases diagnosed from 12 966 137 UEBMI beneficiaries from 36 cities between 2013 and 2016. The relative risk for lung cancer associated with a 10 µg/m3 increase in 3-year PM2.5 exposure was 1.12 (95% CI 1.00 to 1.26). The population attributable risk estimated for a reduction in PM2.5 concentration to 35 µg/m3 corresponded to a decrease of 14% in cases of lung cancer. Reducing PM2.5 air pollution has a significant public health benefit.


DOI: http://dx.doi.org/10.1136/thoraxjnl-2019-213722



XS and PH are joint senior authors.

ZZ and DZ contributed equally.


This work was supported by the Peking University’s Start-up Fund (BMU2018YJ004)

Competing interests 

None declared.

Patient consent for publication 

Not required.

Ethics approval 

The study was deemed as exempt from ethical approval by the institutional review board of the Beijing University of Chinese medicine (No.2019BZHYLL0201).

Provenance and peer review 

Not commissioned; externally peer reviewed.

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Keywords: Environmental pollution; Cancer; China.


Comparative #Pathogenicity and #Transmissibility of the #H7N9 Highly Pathogenic #Avian #Influenza Virus and the H7N9 LPAI Virus in #Chickens (Viruses, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Viruses. 2019 Nov 10;11(11). pii: E1047. doi: 10.3390/v11111047.

Comparative Pathogenicity and Transmissibility of the H7N9 Highly Pathogenic Avian Influenza Virus and the H7N9 Low Pathogenic Avian Influenza Virus in Chickens.

Yu H1, Zhang K1, Ye X1, Wang W1, Wu W1, Wang X1, Guan Y1, He Z1, Wang Y2, Jiao P1.

Author information: 1 College of Veterinary Medicine, South China Agricultural University, 483 Wushan Road, Tianhe District, Guangzhou 510642, China. 2 Department of Epidemiology, Public Health College, Harbin Medical University, Harbin 150081, China.



There were five outbreaks of H7N9 influenza virus in humans in China since it emerged in 2013, infecting >1000 people. The H7N9 low pathogenic influenza virus was inserted into four amino acids in the HA protein cleavage site to mutate into the H7N9 highly pathogenic virus. This emerging virus caused 15 outbreaks in chickens from the end of 2016 to date. Two H7N9 avian influenza virus (AIV) strains, A/chicken/Guangdong/A46/2013 (LPAIV) and A/chicken/Guangdong/Q29/2017 (HPAIV), were selected to compare the pathogenicity and transmissibility between H7N9 LPAIVs and HPAIVs in chickens. We inoculated 3- to 4-week-old specific-pathogen-free (SPF) chickens with 6 log10EID50/0.1 mL viruses via the ocular-nasal route and co-housed four chickens in each group. The inoculated chicken mortality rate in the A46 and Q29 groups was 1/5 and 5/5, respectively. Q29 virus replication was more efficient compared to the A46 virus in inoculated chickens. Infected chickens initiated viral shedding to naïve contact chickens through respiratory and digestive routes. Both viruses transmitted between chickens by naïve contact, but the Q29 virus had a higher pathogenicity in contact chickens than the A46 virus. Compared with early H7N9 LPAIVs, the pathogenicity and transmissibility of the emerging H7N9 HPAIV was stronger in chickens, indicating that H7N9 influenza virus may continue to threaten human and poultry health.

KEYWORDS: H7N9; avian influenza virus; chickens; pathogenicity; transmissibility

PMID: 31717632 DOI: 10.3390/v11111047

Keywords: Avian Influenza; H7N9; Poultry.


#Genetic, Molecular, and #Pathogenic Characterization of the #H9N2 #Avian #Influenza Viruses Currently Circulating in South #China (Viruses, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Viruses. 2019 Nov 8;11(11). pii: E1040. doi: 10.3390/v11111040.

Genetic, Molecular, and Pathogenic Characterization of the H9N2 Avian Influenza Viruses Currently Circulating in South China.

Sun H1, Lin J1, Liu Z1, Yu Y1, Wu M1, Li S1, Liu Y1, Feng Y1, Wu Y1, Li M1, Jiao P1, Luo K1, Liao M1.

Author information: 1 College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China.



The prevalence and variation of the H9N2 avian influenza virus (AIV) pose a threat to public health. A total of eight viruses isolated from farmed poultry in South China during 2017-2018 were selected as representative strains for further systematic study. Phylogenetic analyses indicated that these prevalent viruses belong to the Y280-like lineage and that the internal genes are highly similar to those of recently circulating human H7N9 viruses. The receptor-binding assay showed that most of the H9N2 isolates preferentially bound to the human-like receptor, increasing the risk of them crossing the species barrier and causing human infection. Our in vitro, multi-step growth curve results indicate these viruses can effectively replicate in mammalian cells. Infection in mice showed that three viruses effectively replicated in the lung of mice. Infection in swine revealed that the viruses readily replicated in the upper respiratory tract of pig and effectively induced viral shedding. Our findings suggested that the H9N2 AIVs circulating in poultry recently acquired an enhanced ability to transmit from avian to mammalians, including humans. Based on our findings, we propose that it is essential to strengthen the efforts to surveil and test the pathogenicity of H9N2 AIVs.

KEYWORDS: H9N2; influenza A virus; pathogenicity; pigs; receptor; replication

PMID: 31717393 DOI: 10.3390/v11111040

Keywords: Avian Influenza; H9N2; Poultry.


#Evolution of #hypervirulence in #carbapenem-resistant #Klebsiella pneumoniae in #China: a multicentre, molecular epidemiological analysis (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Evolution of hypervirulence in carbapenem-resistant Klebsiella pneumoniae in China: a multicentre, molecular epidemiological analysis

Yawei Zhang, Longyang Jin, Pengwen Ouyang, Qi Wang, Ruobing Wang, Juan Wang, Hua Gao, Xiaojuan Wang, Hui Wang on behalf of the China Carbapenem-Resistant Enterobacteriaceae (CRE) Network

Journal of Antimicrobial Chemotherapy, dkz446, https://doi.org/10.1093/jac/dkz446

Published: 12 November 2019




Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) have been increasingly reported in China. Here, a multicentre, longitudinal surveillance study on CR-hvKP is described.


We retrospectively investigated carbapenem-resistant K. pneumoniae (CRKP) in 56 centres across China during 2015–17 and screened the virulence genes (iucA, iroN, rmpA and rmpA2) for the presence of virulence plasmids. Hypermucoviscosity, serum killing and Galleria mellonella lethality experiments were conducted to identify CR-hvKP among strains with all four virulence genes. Capsule typing, fitness and plasmid features of CR-hvKP were also investigated.


A total of 1052 CRKP were collected. Among these, 34.2% (360/1052) carried virulence genes and 72 of them had all four of the virulence genes tested. Fifty-five (76.4%) were considered to be CR-hvKP using the G. mellonella infection model, with KPC-2-producing K64-ST11 being the most common type (80%, 44/55). Prevalence of CR-hvKP differed greatly between regions, with the highest in Henan (25.4%, 17/67) and Shandong (25.8%, 25/97). A significant increase in CR-hvKP among KPC-2-producing ST11 strains was observed, from 2.1% (3/141) in 2015 to 7.0% (23/329) in 2017 (P = 0.045). Alarmingly, compared with classic CRKP, no difference in growth was found among CR-hvKP (P = 0.7028), suggesting a potential risk for dissemination. The hybrid virulence and resistance-encoding plasmid evolved from pLVPK and the resistance plasmid harbouring blaKPC-2, indicating evolution existed between the hypervirulence and hyper-resistance plasmid.


CR-hvKP were more frequently detected than previously assumed, especially among KPC-2-producing ST11. Dissemination of hypervirulence could be extremely rapid due to limited fitness cost. Also, the evolution of resistance genes into hypervirulence plasmids was identified, presenting significant challenges for public health and infection control.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; Plasmids; China.


Analysis of #drug #resistance of #ESBL-producing #Escherichia coli and #Klebsiella pneumoniae in #children with #UTI (Saudi Med J., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Saudi Med J. 2019 Nov;40(11):1111-1115. doi: 10.15537/smj.2019.11.24547.

Analysis of drug resistance of extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae in children with urinary tract infection.

Keshi L1, Weiwei X, Shoulin L, Xiadong L, Hao W, Junhai J, Xiangwei W, Rui W, Pei Z.

Author information: 1 Department of Urology, Shenzhen Children’s Hospital,Shenzhen,Guangdong Province, China. E-mail. keshilu@szu.edu.cn.




To investigate the drug resistance of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli ) and Klebsiella pneumoniae (K. pneumoniae) in children with urinary tract infection  (UTI) and to provide the rationale for clinical use of antibiotics.


This is a retrospective analysis of drug susceptibility in children with E. coli or K. pneumoniae-positive urine culture between August 2013 and August 2017,  Shenzhen Children’s Hospital, Shenzhen, China. Drug resistance was statistically assessed using Fisher exact test and χ2 test.


A total of 698 cases of E. coli, 426 of which were confirmed ESBL-producing strains, and 217 cases of K. pneumoniae, including 111 ESBL-producing strains, were detected, and the difference in proportion of positive ESBL-producing strains (61.03% versus 51.15%) was statistically significant (p=0.010). The average drug resistance rates of E. coli and K. pneumoniae to piperacillin/tazobactam, meropenem, ertapenem, imipenem, and amikacin were less than 15%. The average resistance rates of ESBL-producing E. coli and K. pneumoniae to cefpodoxime, cefixime, cefazolin, and ceftriaxone was less than 98%, while average resistance rates for non-ESBL-producing bacteria to the above 4 drugs was less than 20%.


In southern China, the proportion of ESBL-producing strains and the drug resistance rates of E. coli and K. pneumoniae in UTI in children was high, but their resistance rates to carbapenems and β-lactamase inhibitor complexes containing tazobactam were low. Carbapenems are the most effective antibacterial drugs for the treatment of ESBL-producing bacteria.

PMID: 31707407 DOI: 10.15537/smj.2019.11.24547

Keywords: Antibiotics; Drugs Resistance; Beta-lactams; Carbapenem; E. Coli; Klebsiella pneumoniae; UTI; China; Pediatrics.


A 7-year #surveillance of the #drug #resistance in #Klebsiella pneumoniae from a primary #healthcare center (Ann Clin Microbiol Antimicrob., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Ann Clin Microbiol Antimicrob. 2019 Nov 9;18(1):34. doi: 10.1186/s12941-019-0335-8.

A 7-year surveillance of the drug resistance in Klebsiella pneumoniae from a primary health care center.

Li G1, Zhao S1, Wang S1, Sun Y1, Zhou Y1, Pan X2.

Author information: 1 Department of Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China. 2 Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuningxi Road, Dongyang, Zhejiang, China. panfengyuwuzu@163.com.




The increased prevalence of Klebsiella pneumoniae infections and resistance rates are a current cause for concern. However, data for resistance rates in K. pneumoniae strains from primary hospitals and the resistance distribution among the different isolate sample sources are scarce.


All the K. pneumoniae strains were isolated from patients who visited a primary health care center located in Central Zhejiang Province from January 2011 to December 2017. The specimens included blood, sputum, cervical secretions and urine. The species were identified by the Vitek 2 Compact Bacterial Identification and Monitoring System or VITEK-MS and the extended spectrum β-lactamase (ESBL) and drug resistance profiles were identified using the AST-GN13 Gram negative susceptibility card (VITEK-2). The genotype of strains from urine sources was analyzed by detecting TEM and SHV genes. Finally, the drug resistance rates among the isolates from different sample sources were analyzed using the Chi square test with SPSS software.


A total of 5319 K. pneumoniae strains were isolated in this study. Among the 20 antimicrobial drugs studied, the resistance rates of K. pneumoniae strains varied from 1.4% (ertapenem) to 23.1% (nitrofurantoin). The antibiotic resistance rates varied significantly among the isolate samples sources for all, with the highest rates for all antibiotics except for nitrofurantoin found in urine samples. In addition, the ESBL-positive rate in urine samples was 27.1%, significantly higher than that of cervical secretions (20.2%), blood (16.5%) and sputum (15.2%). Compared to the ESBL-negative strains, higher resistance rates were detected in the ESBL-positive strains. The most common genotype of isolates from urine was SHV (28%, 23/82), following by TEM (14.6%, 12/82).


The highest resistance rates of K. pneumoniae strains to most antibiotics found in urine samples are partly due to the ESBLs, indicating that a special attention should be paid in the treatment of urinary tract infection.

KEYWORDS: Drug resistance; ESBL; Klebsiella pneumoniae; Urine

PMID: 31706307 DOI: 10.1186/s12941-019-0335-8

Keywords: Antibiotics; Drugs Resistance; UTI; China; Nosocomial outbreaks.