中国疾病预防控制中心周报最新文献

Introduction: Cycloplegic refraction is the gold standard for assessing refractive error in children. However, logistical constraints hinder its implementation in large-scale surveys.

Methods: Data obtained from a nationwide ocular health survey conducted in ten provincial-level administrative divisions in China were analyzed (2020-2024). Participants aged 5-18 years underwent standardized non-cycloplegic and cycloplegic autorefraction, axial length (AL), corneal radius (CR), and AL/CR measurements. Random forest and XGBoost models were trained to predict the cycloplegic spherical equivalent (SE) using non-cycloplegic SE, uncorrected visual acuity (UCVA), and biometric parameters. Performance was evaluated using R², root mean square error (RMSE), and Bland-Altman analysis.

Results: Both models exhibited strong predictive performance. In the test set, random forest achieved R²=0.88 and RMSE=0.55 diopter (D), whereas XGBoost achieved R²=0.89 and RMSE=0.54 D. Non-cycloplegic SE, AL/CR ratio, AL, and UCVA were consistently the top predictors. The predicted SE exhibited strong agreement with the cycloplegic SE, with minimal residual bias.

Conclusion: Machine learning models incorporating noncycloplegic SE and ocular biometrics accurately estimate cycloplegic SE in children and adolescents, providing a practical alternative for large-scale refractive-error surveillance when cycloplegia is impractical.

What is already known about this topic?: Myopia prevalence among Chinese students remains persistently high, with axial length and the axial length-to-corneal radius ratio demonstrating significant associations with refractive status in children and adolescents.

What is added by this report?: This investigation employed cycloplegic optometry to assess refractive errors across children and adolescents in 10 provincial-level administrative divisions, utilizing axial length (AL) and axial length-to-corneal radius ratio (AL/CR) as predictive indicators of refractive status.

What are the implications for public health practice?: The AL/CR ratio demonstrates superior predictive accuracy for myopia compared to AL alone and can effectively identify at-risk children during early developmental stages. Incorporating routine monitoring of AL and AL/CR into school health programs can enhance early detection capabilities and support targeted myopia management strategies.

What is already known about this topic?: China exhibits a high prevalence of myopia; however, comprehensive national data based on cycloplegic refraction to assess the current status of hyperopic reserve in children and adolescents remains unavailable.

What is added by this report?: This study describes different percentiles of spherical equivalent (SE) after cycloplegic refraction for children and adolescents aged 5-18 years across 10 provincial-level administrative divisions (PLADs) and cities in China. SE values declined progressively with age in both males and females, with females demonstrating significantly lower median SE values than males beginning at age 10.

What are the implications for public health practice?: Hyperopic reserve requires systematic monitoring, particularly among females approaching puberty and younger children. Early surveillance by relevant departments is strongly recommended to support comprehensive myopia prevention and control strategies.

What is already known about this topic?: Insufficient hyperopic reserve serves as a preclinical indicator of myopia development and is influenced by socioeconomic factors and behavioral patterns. However, region-specific risk profiles remain inadequately characterized.

What is added by this report?: This nationwide investigation demonstrates substantial regional heterogeneity in myopia risk factors. Children residing in low-gross domestic product (GDP) regions exhibit significantly stronger associations between screen time usage and poor screen habits with insufficient hyperopic reserve. This relationship is most pronounced among girls in low-GDP areas.

What are the implications for public health practice?: Public health interventions should prioritize targeted screen use guidance for children, particularly girls in socioeconomically disadvantaged regions, to effectively protect visual health and prevent myopia progression.

Post-exposure prophylaxis (PEP) represents the critical intervention for preventing rabies and comprises three essential components: thorough wound cleansing, vaccination, and administration of rabies immunoglobulin (RIG) or monoclonal antibodies (mAbs) for category III exposures. The World Health Organization (WHO) endorses the use of mAb cocktails as an effective replacement for RIG in PEP protocols. Since 2016, four anti-rabies monoclonal antibodies (RmAbs) have received clinical approval for use in India and China. This article provides an overview of the current research status of RmAb. By reviewing clinical studies related to RmAb, it highlights the clinical advantages of RmAb over HRIG in terms of efficacy, accessibility, safety, acceptability, and clinical application in special populations. Additionally, it explores the future clinical prospects of RmAb, including their use in extremely high-risk cases, their impact on circulating antibodies, and their potential role in rabies treatment.

Introduction: Rabies is a zoonotic disease caused by rabies viruses(RABV). China is a high-risk country for rabies. To address China's rabies situation, the Chinese Ministry of Agriculture and Rural Affairs issued the National Animal Disease Surveillance and Epidemiological Investigation Plan. This study systematically summarized animal rabies surveillance data from the past two decades based on the Program.

Methods: Suspected rabies cases collected through the Program between 2004 and 2024 underwent confirmatory diagnosis at the National Reference Laboratory (NRL) for animal rabies using national standard protocols: direct fluorescent antibody testing (FAT) and real-time RT-PCR. Epidemiological data from confirmed cases were analyzed using Geographic Information System (GIS) mapping and statistical evaluation methods.

Results: Laboratory diagnosis confirmed 331 of 433 suspected cases (76.44%) as rabies-positive. These confirmed cases originated from 15 provincial-level administrative divisions (PLADs) and revealed two distinct transmission patterns: a) dog-mediated rabies, accounting for 47.13% of cases and predominantly endemic in southern PLADs, where it poses ongoing human exposure risks; and b) wildlife-mediated rabies in livestock, comprising 52.87% of cases and primarily transmitted by foxes in northern PLADs, with the Inner Mongolia Autonomous Region (IMAR) experiencing the highest burden.

Conclusions: This nationwide surveillance has elucidated current rabies transmission dynamics across China, revealing persistent threats from dog rabies to human health in southern PLADs and emerging threats from wildlife-mediated rabies to livestock in northern border regions. These findings underscore the critical need for enhanced surveillance systems and targeted vaccination strategies addressing both domestic dog populations and wildlife reservoirs to achieve effective rabies control.

What is already known about this topic?: Human rabies remains nearly universally fatal despite medical advances. Diagnosis is frequently delayed when patients present with atypical symptoms, and the failure to receive postexposure prophylaxis (PEP) continues to be a major contributor to mortality worldwide.

What is added by this report?: This represents the first confirmed human rabies case in Guangxi caused by the JSTZ190314 strain, successfully identified through metagenomic next-generation sequencing (mNGS). The patient initially presented with urinary symptoms that led to a misdiagnosis before characteristic neurological manifestations developed, ultimately progressing to brain death 28 days after neurological onset (34 days from initial urinary symptoms).

What are the implications for public health practice?: This case demonstrates the critical importance of mNGS in diagnosing atypical rabies presentations and emphasizes the urgent need for enhanced early clinical recognition, standardized PEP administration protocols, and strengthened regional viral surveillance systems.

What is already known about this topic?: Both the 4-dose (Zagreb) and 5-dose (Essen) rabies vaccination regimens demonstrate comparable immunogenicity and safety profiles in clinical trials and are approved for use in China.

What is added by this report?: This study pioneers active safety surveillance via a mobile application, identifying an adverse reaction rate of 2.10% for the Zagreb regimen and 2.70% for the Essen regimen. The Zagreb regimen had a lower out-of-window administration rate of 8.41% compared to 16.38%. Compliance was influenced by age, marital status, and exposure level, while the Essen regimen involved additional factors, including education level and perceived convenience.

What are the implications for public health practice?: This study supports broader adoption of the 4-dose regimen to reduce logistical challenges and enhance compliance. Mobile application-based active surveillance presents a novel approach to enhancing real-world monitoring quality.