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    Special Issue on "Spatio-temporal Dynamics Analysis, Risk Assessment and Emergency Management for COVID-19 Epidemic"
    Lifestyle medicine
    Xin MA
    Journal of Shandong University (Health Sciences). 2020, 58(10):  1-6, 12.  doi:10.6040/j.issn.1671-7554.0.2020.1151
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    Lifestyle medicine (LM), an emerging new medical discipline, uses evidence-based lifestyle therapeutic approaches (non-drug, non-surgery modalities) to prevent, treat and oftentimes reverse lifestyle-related chronic disea- ses. Board Certification of LM was first initiated by American Society of Lifestyle Medicine in 2017 and followed by countries in Europe and Asia. LM has been considered a global movement and the future of healthcare reform. "Healthy China 2030 Plan" and " Healthy China Action Plan" issued by China government in 2016 and 2019 respectively have emphasized the importance of "people?s healthy lifestyle" and "everyone as the first responder of his/her own health". The establishment and development of LM in China will play a significant role in the "Healthy China 2030 Plan" and be an indispensable component of "Healthy China Action Plan".

    Climate change may increase the risk of emerging infectious diseases
    Cunrui HUANG,Shizhou DENG
    Journal of Shandong University (Health Sciences). 2020, 58(10):  7-12.  doi:10.6040/j.issn.1671-7554.0.2020.0737
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    The frequent occurrences of emerging infectious diseases in recent years have caused huge burdens on the global economy and society. Climate-driven changes in the natural environment disrupt the ecosystem balance, destroy the habitat of wild animals, affect the survival, transmission and distribution of pathogens and their vectors and intermediate hosts, which contribute to increased risks of infectious diseases. Due to the complex links among climate change, human activity, nature environment, wildlife and pathogens, the challenge of emerging infectious diseases should be addressed with multidisciplinary and multi-sectoral collaboration in the future.

    Application of geographic information system in the control of COVID-19 epidemic
    Xiujun LI,Xinlou LI,Kun LIU,Xiaobo ZHAO,Meng MA,Bo SUN
    Journal of Shandong University (Health Sciences). 2020, 58(10):  13-19.  doi:10.6040/j.issn.1671-7554.0.2020.0891
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    Since the outbreak of coronavirus disease 2019 (COVID-19) epidemic, the geographic information system (GIS) has played an important role in explaining the epidemic distribution, characteristics of regional transmission, risk assessment, and early prediction and warning, which greatly helped the disease control and prevention. In this study, the application of GIS in COVID-19 prevention and control was reviewed, hoping to provide reference for future improvement in the prevention and control measures.

    Construction of SEIQCR epidemic model and its application in the evaluation of public health interventions on COVID-19 in Guangzhou
    XU Lijun, LIU Wenhui, LIU Yuan, LI Meixia, LUO Lei, OU Chunquan
    Journal of Shandong University (Health Sciences). 2020, 58(10):  20-24.  doi:10.6040/j.issn.1671-7554.0.2020.0775
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    Objective To develop a dynamic model of susceptible(S), exposed people in the latent period(E), infective(I), quarantined(Q), confirmed(C), and recovered(R)(SEIQCR)to evaluate the role of interventions and control the coronavirus disease 2019(COVID-19)epidemic in Guangzhou. Methods Based on the SEIR propagation dynamics model, the modules of “quarantined” and “confirmed” cases were added to establish a new SEIQCR model. The epidemic data in Guangzhou from Jan. 13 to Mar. 17, 2020 were fitted to obtain the parameters of SEIQCR model. Results The number of predicted cases based on these parameters was highly consistent with the actual incidence(R2=0.93). Time-dependent reproduction number declined rapidly with the implementation of first level response to COVID-19, indicating that local transmission was effectively controlled. Conclusion The preventative and control measures were effective. Local government should continue strictly implementing the isolation system and cut off the transmission channels to curb the transmission of COVID-19. The SEIQCR model can provide methodological reference for intervention assessment in other regions.
    A dynamic modeling study on the effects of Wuhan traffic control and centralized quarantine measures on COVID-19 epidemic
    JIN Xinye, LU Zhenzhen, DING Zhongxing, CHEN Feng, PENG Zhihang
    Journal of Shandong University (Health Sciences). 2020, 58(10):  25-31.  doi:10.6040/j.issn.1671-7554.0.2020.0712
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    Objective To quantitatively evaluate the effects of traffic control and centralized quarantine measures on COVID-19 epidemic in Wuhan, so as to provide scientific basis for epidemic prevention and control. Methods The SEIAHR model was established based on SEIR dynamic model, which took into account the characteristics of asymptomatic carriers and unconfirmed quarantined patients. Based on the timing of prevention measures, the epidemic was divided into three stages, the parameters were fitted, the basic reproduction numbers of different stages were calculated, and the development trend of epidemic was predicted. Results The R0 decreased dramatically. The R0 of the three stages were 3.684 1(95%CI: 3.106 1-4.048 0), 2.178 8(95%CI: 1.725 8-3.577 6)and 0.362 5(95%CI: 0.349 9-0.367 6), respectively. Due to the traffic control travel and centralized quarantine, the peak of the disease moved forward from April 19 to March 14, 2020. The scale of the epidemic had also been reduced by prevention and control measures. Conclusion The traffic control and centralized quarantine measures implemented in Wuhan were effective for the epidemic control, which can provide reference for other countries.
    Reproduction number estimation and epidemic analysis of coronavirus disease 2019 in Shandong Province based on Poisson process
    ZHU Yuchen, LI Chunyu, QI Chang, WANG Ying, LIU Lili, ZHANG Dandan, WANG Xu, KANG Dianmin, LI Xiujun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  32-37.  doi:10.6040/j.issn.1671-7554.0.2020.0683
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    Objective To explore the epidemic dynamics of coronavirus disease 2019(COVID-19)in Shandong Province, and to provide a scientific basis for the future prevention and control of new outbreaks of COVID-19 and other emerging infectious diseases. Methods After collecting the information of 559 confirmed cases with COVID-19 reported by the Shandong Provincial Health Commission and determining the infection date of the cases, a propagation model was established based on the Poisson process and the basic reproduction number and instantaneous reproduction number were calculated during the COVID-19 epidemic in Shandong Province. The results obtained by calculating the instantaneous reproduction numbers based on sequential Bayesian and time-dependent methods were compared. Results The difference between the date of onset of a confirmed case and the date when it was reported generally followed the Weibull distribution. When the COVID-19 outbreak started in Shandong Province, the basic reproduction number(R0)was 2.64(95%CI:1.37-4.51), and the instantaneous reproduction number showed a gradually downward trend with time. Three calculation methods all showed the same trend. Conclusion After the intervention of prevention and control measures, the local epidemic of COVID-19 in Shandong Province has basically ended, but the constant vigilance is necessary in order to prevent the second outbreak of the epidemic.
    Epidemic dynamics of COVID-19 in Xinyang City, Henan Province
    LI Chunyu, ZHU Yuchen, QI Chang, LIU Lili, ZHANG Dandan, WANG Xu, XU Xueli, LI Xiujun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  38-43.  doi:10.6040/j.issn.1671-7554.0.2020.0642
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    Objective To explore epidemic dynamics of coronavirus disease 2019(COVID-19)in Xinyang City so as to provide scientific basis for optimizing the prevention and control strategies and evaluating the effects of intervention. Methods The epidemic data of official report was collected. The date of infection was determined to estimate the incubation period. At the same time, the infectious disease dynamic model of SEIR was constructed to analyze the development of disease and the dynamic changes of epidemic situations when the time of implementing prevention and control policies was changed. Results A total of 274 cases were reported in Xinyang City, with the incidence rate of 3.72 out of 100 000. The median incubation period was 6.00(4.00, 7.25)days. Model analysis showed that the basic reproductive number(R0)was 2.86 and the effective reproductive number decreased to 0.29 after the prevention and control measures were taken. If prevention and control measures were taken three days in advance, the number of cases would reduce by 50.5%, while three days later, the number of cases would double. Conclusion The epidemic spread rapidly in Xinyang City, but was quickly controlled under the strong prevention and control measures of the state.
    Epidemiological characteristics and incubation period of coronavirus disease 2019 in Anhui Province
    SHE Kaili, ZHANG Dandan, QI Chang, LIU Tingxuan, JIA Yan, ZHU Yuchen, LI Chunyu, LIU Lili, WANG Xu, SU Hong, LI Xiujun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  44-52.  doi:10.6040/j.issn.1671-7554.0.2020.0744
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    Objective To analyze the epidemiological characteristics and incubation of coronavirus disease 2019(COVID-19)from Jan. 22 to Mar. 8, 2020 in Anhui Province, in order to provide the basis for further understanding of the transmission pattern of COVID-19 and formulating regional control measures. Methods Based on the data released by the provincial and municipal health committees, global and local aggregation analyses were performed with spatial autocorrelation statistical method to reveal the epidemiological characteristics of COVID-19 in Anhui. The distribution of COVID-19 incubation was estimated with reference to the exposure and onset time. Results A total of 990 confirmed cases of COVID-19 and 6 deaths were reported in Anhui. The crude mortality rate was 0.61%. Since the first case was confirmed, the number of cases increased rapidly, with a maximum of 74 in a single day on Feb. 6, and then gradually declined. The patients aged 8 months to 91 years, and the majority(65.19%)were 31 to 60 years old. The male to female ratio was 1.16∶1, and there were many cluster cases. From Jan. 22 to 29, 75% of the cases had exposure history to Hubei and then the proportion decreased significantly. By Mar. 8, there were confirmed cases in 16 cities, among which Hefei, Fuyang and Bengbu were mostly affected by the epidemic. There was obvious spatial autocorrelation of the cases. Before Jan. 31, most cases were imported from Hubei while local cases were sporadic, and then local contact spread the infection. The Gamma distribution fitted well, indicating the median incubation of COVID-19 was 5.64(95%CI: 5.11-6.22)days. Conclusion The epidemiological characteristics of COVID-19 in Anhui Province are similar to those in other provinces. Early prevention and control measures have achieved phased results. With the resumption of work and production in various areas, the prevention and control efforts need to be consolidated to prevent the epidemic from rebounding.
    Influence factors of COVID-19 in Shandong Province based on geographically weighted generalized linear model
    QI Chang, ZHU Yuchen, LI Chunyu, LIU Lili, ZHANG Dandan, WANG Xu, SHE Kaili, CHEN Ming, KANG Dianmin, LI Xiujun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  53-59.  doi:10.6040/j.issn.1671-7554.0.2020.0694
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    Objective To explore the related influence factors of coronavirus diseases 2019(COVID-19)in Shandong Province and understand the regional distribution characteristics of the epidemic situation, and to provide a scientific basis for guiding prevention and control strategies. Methods The number of confirmed cases of COVID-19 and related influence factors in Shandong Province from January 21 to March 1, 2020 were collected. The geographic weighted generalized linear model(GWGLM)was used to analyze the number of confirmed cases and the spatial heterogeneity among various influence factors. Results We analyzed spatial distribution of 558 confirmed cases. The results of GLM analysis showed that the population density, per capita disposable income, public budget expenditure, the proportion of Hubei immigrations and the spatial distance from Wuhan were statistically significant. The denser the population, the higher the per capita disposable income, and the higher the public budget expenditure, the greater the number of confirmed cases; the size of the Hubei immigrants and the spatial distance from Wuhan were inversely related to the number of confirmed cases in most counties and districts. In this study, the R2 of GWGLM was 0.363, and the model could explain 36.3% of the total variation of COVID-19 confirmed cases. Conclusion GWGLM reveals the spatial heterogeneity of COVID-19 and its influence factors, and helps the local area to apply the policy precisely; the hierarchical prevention and control measures of different regions should be developed according to the spatial distribution characteristics of each factor and its local relationship with the number of confirmed cases.
    Risk factors of severe and critical patients with COVID-19 in Hubei, China
    LIU Jun, LI Huan, ZHANG Shiyu, ZHANG Peng, AI Siqi, TIAN Fei, LIN Hualiang
    Journal of Shandong University (Health Sciences). 2020, 58(10):  60-65.  doi:10.6040/j.issn.1671-7554.0.2020.0690
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    Objective To investigate the risk factors of severe and critical patients with coronavirus disease 2019(COVID-19)in Hubei, China. Methods All patients with COVID-19 registered in the National Legal Infectious Disease Reporting System of Hubei Provincial Center for Disease Control and Prevention, as of March 18, 2020, were recruited. According to the symptoms, the patients were divided into two groups: mild/moderate patients and severe/critical patients. Their general characteristics were described, and the risk factors of severe and critical patients with COVID-19 were explored by using a Logistic regression model. Results A total of 48 814 cases were included, of which 38 730 were mild/moderate patients and 10 084 were severe/critical patients. The median age was 54(41, 65)years. Multivariate analysis showed that the elderly, male, home workers, people in Wuhan City, migrants, longer interval between onset and diagnosis, low temperature, higher concentrations of PM2.5/PM10/SO2/O3 increased the risk of severe/critical diagnosis in patients with COVID-19. Conclusion The elderly, male, home workers, people in Wuhan City, migrants, longer interval between onset and diagnosis, low temperature, and air pollution exposure are risk factors for severe/critical COVID-19 patients. More attention should be paid to people with these characteristics.
    Epidemic characteristics and spatial analysis of COVID-19 in Zhejiang Province
    JIA Yan, LI Chunyu, LIU Lili, SHE Kaili, LIU Tingxuan, ZHU Yuchen, QI Chang, ZHANG Dandan, WANG Xu, CHEN Enfu, LI Xiujun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  66-73.  doi:10.6040/j.issn.1671-7554.0.2020.0746
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    Objective To explore the temporal and spatial distribution characteristics of confirmed cases of coronavirus disease(COVID-19)in Zhejiang Province and to determine the correlation between number of confirmed cases and geographical demographic factors, so as to provide theoretical basis for the prevention and control of COVID-19. Methods Data of COVID-19 cases confirmed during Jan. 21 and Feb. 19, 2020 in Zhejiang Province were collected. The demographic, temporal and spatial distribution characteristics and exposure history were descriptively analyzed. With county as a unit, the spatial autocorrelation was analyzed, and 11 cities were classified with hierarchical clustering. The correlation between number of confirmed cases and geographical demographic factors was determined with Spearman rank correlation analysis. Results 71.44%(848 cases)of the patients were aged 18-60 years, and there was no statistically significant difference between the sexes(P=0.742). The number of daily confirmed new cases reached the peak around Jan. 29 in various cities. After Jan. 30, The majority of daily confirmed new cases had exposure history of other areas. The confirmed cases in various counties and districts of Zhejiang Province showed characteristic of spatial clustering, and the clustering hotspots were some counties of Wenzhou and Taizhou City. The 11 cities were classified into 4 categories: Wenzhou; Ningbo; Hangzhou and Taizhou; other cities. Population size moving in from Wuhan was positively correlated with the number of cases(rs=0.93, P<0.001). Conclusion In the early stage of COVID-19 epidemic, the majority of cases had exposure history of Hubei; in the later stage, reported cases were mainly secondary cases. Clustering hotspots were some counties of Wenzhou and Taizhou City. Currently, the prevention and control of the epidemic in Zhejiang Province has been effective. It is necessary to continue implementing control measures to prevent the outbreak from rebounding in high-risk areas, and to actively respond to the epidemic risk caused by return to work and school. In addition, people from high-risk areas should be strictly monitored and managed.
    Epidemiological characteristics and spatial-temporal clustering of COVID-19 in Hebei Province
    LIU Tingxuan, QI Chang, SHE Kaili, JIA Yan, ZHU Yuchen, LI Chunyu, LIU Lili, WANG Xu, ZHANG Zhihua, LI Xiujun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  74-81.  doi:10.6040/j.issn.1671-7554.0.2020.0745
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    Objective To analyze the epidemiological characteristics and spatial-temporal clustering of coronavirus disease 2019(COVID-19)in Hebei Province in order to provide scientific basis for the formulation of prevention and control measures. Methods Data of COVID-19 epidemic in Hebei Province from Jan. 22 to Feb. 27, 2020 were collected to analyze the epidemic characteristics. The clustering of epidemic was analyzed with spatial-temporal scanning. Results On Jan. 22, the first confirmed case of COVID-19 was reported in Shijiazhuang City. As of Feb. 27, a total of 318 cases were reported in the whole province, including 80 imported cases(25.16%)from Hubei(including Wuhan), and 69 imported cases(21.70%)from Wuhan. The ratio of males to females was 1.06∶1. Patients aged 30 to 69 years accounted for 70.76% of the total. The peak period of epidemic outbreak was Feb. 5 to Feb. 10, with a maximum of 24 cases reported in a single day on Feb. 7, and then the number of cases gradually decreased. As of Mar. 12, there had been no new confirmed cases for 14 consecutive days. COVID-19 epidemic was found in 11 prefectures and cities in Hebei Province, including 82 districts/counties(82/175, 46.86%), of which the most severely affected was Qianan City(30 cases). A total of 239 clustering outbreaks were reported in all 11 prefectures and cities, 110(46.03%)of which were caused by family clusters. Qianxi County of Tangshan City, Zunhua City and Qianan City had the highest spatial-temporal clustering, and the clustering time was from Feb. 5 to 15(RR=15.69, LLR=61.75, P<0.01). Conclusion The entire population is susceptible to COVID-19. The early cases were mainly imported from other provinces, and in the later stage, cases were mainly local. Clustering outbreaks accounted for 2/3 of the total. No medical staff were infected. When the state initiated a first-level response, the epidemic had been effectively controlled. However, with the resumption of work and school and the increase of imported cases from abroad and asymptomatic infections, it is still necessary to strengthen regular epidemic prevention and control and maintain the favorable situation.
    Clustering distribution of COVID-19 in Wenzhou from January to March 2020 based on spatiotemporal analysis
    LIU Lili, JIA Yan, QI Chang, ZHU Yuchen, LI Chunyu, SHE Kaili, LIU Tingxuan, LI Xiujun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  82-88.  doi:10.6040/j.issn.1671-7554.0.2020.0735
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    Objective To explore the spatiotemporal distribution of COVID-19 in Wenzhou and to provide theoretical basis for the formulation of preventive and control measures. Methods The epidemic data of COVID-19 cases returning from Wuhan and local secondary cases who contacted with the confirmed cases from 21 January 2020 to 1 March 2020 were collected and analyzed. ArcGIS 10.5 was used to produce a map of the number of cases. Spatiotemporal clustering analysis was performed with SaTScan 9.6 to explore the epidemic characteristics of returning and local cases and to investigate the causes of local cases. Results As of 1 March 2020, the cumulative number of COVID-19 cases was 504, with an incidence of 6.08/100 000. The cumulative number of discharged cases was 447. Of all cases, 168 returned from Wuhan and 221 local secondary cases contacted with the confirmed cases. The spatial-temporal cluster analysis of the two types of cases showed obvious clustering, and the clustering results were basically consistent. Clusters occurred mainly in Yueqing City, Ruian City and Yongjia County. Conclusion There is a spatialtemporal aggregation of COVID-19 in Wenzhou. Counties with more COVID-19 cases returning from Wuhan had more local secondary cases. Prevention and control measures should be taken especially in regions where a large number of people migrated to reduce the risk of COVID-19.
    Epidemiological characteristics of COVID-19 in Xi’an city
    ZHANG Hui, SONG Shuxuan, LIU Jifeng, HE Zhen, SHAO Zhongjun, LIU Kun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  89-94.  doi:10.6040/j.issn.1671-7554.0.2020.0674
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    Objective To analyze the epidemiological characteristics of confirmed cases of coronavirus disease 2019(COVID-19)in Xian, so as to provide scientific basis for the prevention and control measures. Methods Data of COVID-19 cases were collected from the official website of Xian Health Commission and Shaanxi Province Health Commission, and analyzed with descriptive epidemiological analysis, Wilcoxon rank sum test and Kruskal-Wallis H test. Results Totally 125 cases(67 male and 58 female)were reported as of March 31. The average age of patients was(48.23±15.94, range 13-89)years, and those aged 35-54 years accounted for 44.00%(55/125). There were 52 imported cases and 73 local secondary cases, 117 of which had clear sources of infection while 8 cases had not. Death occurred in 3 cases. Altogether 23 cluster outbreaks were reported, involving 89 cases, among which 13(56.52%)were family clusters involving 38 cases(42.70%). The top three districts with reported cases were Yanta(29 cases), Xincheng(20 cases)and Lianhu(16 cases). Epidemic curve showed two peaks on Jan. 28(11 cases)and Jan. 31(10 cases), 2020. The median days were 1.0(0.5, 3.0)d from onset to the first visit, 4.0(3.0,6.5)d from the first visit to diagnosis, and 7.0(4.0,10.0)d from onset to diagnosis. There were significant differences in the days from the first visit to diagnosis between imported cases and local secondary cases(Z=-2.107, P=0.035), and in the days from onset to diagnosis between the cases who took medications and who did not take medications before the first visit(Z=-2.690, P=0.007). Conclusion The epidemic curve of COVID-19 in Xian could be divided into 3 phases: imported cases from other provinces, local secondary cases and imported cases from abroad. Family cluster was an important characteristic of COVID-19 in Xian. Imported cases could be diagnosed earlier than local secondary cases. Self-treatment before the first visit could affect the laboratory confirmation of COVID-19. Preventing imported cases from abroad is still the focus of future efforts.
    Investigation of a family cluster outbreak of coronavirus disease 2019 in Xian
    BAI Yao, CHEN Zhijun, SONG Shuxuan, HE Zhen, CHEN Baozhong, SHAO Zhongjun, LIU Kun
    Journal of Shandong University (Health Sciences). 2020, 58(10):  95-99.  doi:10.6040/j.issn.1671-7554.0.2020.0677
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    Objective To investigate the transmission characteristics of a family cluster outbreak of coronavirus disease 2019(COVID-19)in Xian, in order to provide reference for prevention and control efforts. Methods Epidemiological investigations on the confirmed cases, asymptomatic carriers and their close contacts were carried out, the transmission chain was analyzed, and the pharyngeal swabs for nucleic acid tests of SARS-CoV-2 were collected. Results A total of 4 mild cases, 1 severe case and 2 asymptomatic carriers were tracked. The severe case finally died. The first case(A)had onset on Jan. 31, 2020, and the other cases(B, C as well as D, E)had onset 1-13 days later, who were second, third, and fourth generation cases. Conclusion The prevention and control of COVID-19 should focus on family cluster outbreak. Early detection of the source of infection and screening and isolation of close contacts are important to prevent the spread of the epidemic.
    Investigation and analysis of the characteristics of a family cluster of coronavirus disease 2019 in Zibo
    WANG Ling, CAO Haixia, ZHANG Ling, ZHANG Wenna, PAN Yanping, SHI Ying, ZHANG Wei, CUI Feng
    Journal of Shandong University (Health Sciences). 2020, 58(10):  100-104.  doi:10.6040/j.issn.1671-7554.0.2020.0640
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    Objective To investigate a family cluster of coronavirus disease 2019(COVID-19)in Zibo, so as to analyze the characteristics of the epidemic. Methods The cases and close contacts were investigated with field epidemiological method, and the data collected were analyzed with descriptive epidemiological method. Results The first case had onset on Jan. 10, 2020, who was a migrant worker returning home from Hangzhou. The last case had onset on Feb.14. A total of 244 people were involved, among whom 14 were confirmed and 2 were asymptomatic carriers, including 11 males and 5 females, aged 23 to 84 years(median 50). The incidence was 6.56%(16/244). The epidemic affected 2 districts, 4 towns, 4 villages and 8 families. The maximum incubation period was 10 days, the minimum was 3 days, and the median was 4 days. Before centralized isolation measures were taken, 11 people had onset, 9 of whom sought treatment in small clinics or took medicine by themselves. The median from onset to diagnosis was 15 days, and the longest time was 31 days. The epidemic had 3-4 generations of transmission. Conclusion This family cluster was caused by an imported case untreated in time who visited family members and relatives during the Spring Festival, indicating that the prevention and control of infectious diseases in rural areas should be strengthened. The function of health monitoring and management of key groups in communities and villages should be given full play.
    Preliminary discussion on hospital service areas distribution and the setting of isolation points under the COVID-19 epidemic
    HUANG Jiaqi, XIAO Shuang, ZHANG Jun, ZHANG Zhijie
    Journal of Shandong University (Health Sciences). 2020, 58(10):  105-111.  doi:10.6040/j.issn.1671-7554.0.2020.0795
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    Objective To explore the distributions of hospital service areas under epidemic situation and the methods of setting centralized isolation points based on service areas from the perspective of space facility layout optimization. Methods A Huff model was applied to analyze the distributions of service areas of tertiary hospitals in Shanghai. Candidate locations were set to achieve maximizing coverage, and a location-allocation model was applied to predict the optimal hospital location. Results Among the tertiary hospitals that can admit COVID-19 cases in Shanghai, the central area had a high density of hospitals. The distributions of service areas in urban and rural hospitals were obviously different, and the service areas of rural hospitals were large. It was recommended to optimize the allocation of a new hospital in the center region of Songjiang District and an appropriate number of hospitals in the central area of Pudong New District. Conclusion Considering the distribution of hospital service areas, isolation points can be set in the communities close to the affiliated hospitals, and the hospitals corresponding to each isolation point should be clearly identified when a case occurs. It is recommended to optimize the configuration to add tertiary hospitals in Songjiang District and Pudong New District.
    Comparison of the clinical characteristics between 37 adults and 10 children with COVID-19
    WANG Bin, BU Xuehui, KONG Xianggen, ZHANG Zhaohua, WU Anzhao, XIAO Di, JIANG Xuemei
    Journal of Shandong University (Health Sciences). 2020, 58(10):  112-116.  doi:10.6040/j.issn.1671-7554.0.2020.0740
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    Objective To explore the differences in clinical characteristics between children and adults with COVID-19. Methods The epidemiological characteristics, clinical symptoms, laboratory results, imaging results and treatment regimens of 37 adult and 10 children cases of COVID-19 were analyzed. Results Family clusters were more common in the adult group, while all children cases were caused by intra-family transmission. The adult group had a significantly higher incidence of symptoms such as fever, cough, pharyngeal pain(pharyngeal itch)and fatigue(muscle soreness)than the children group(P<0.05), while there is no difference in symptoms like chest tightness and chest pain. The children group had a higher rate of non-changing pulmonary imaging than the adult group(P<0.05). The children group had higher increase of myocardial enzyme than the adult group(P<0.05), while there were no differences in the increases of liver enzyme, myoglobin and troponin. The children group had lower increase of CRP, IL-6 and SAA than the adult group(P<0.05), while there were no significant differences in the increase of PCT and decreases of leukocyte and lymphocyte counts. The treatment regimen for the children group was simpler than that for the adults. Conclusion Intra-family transmission is the main way for children to catch COVID-19. Compared with adults, children have milder clinical symptoms, milder CT lesions, no obvious liver and myocardial damage, and no significant changes in inflammatory indicators.
    Development and clinical value evaluation of IgM-IgG antibody detection kit for SARS-CoV-2 infection in 15 cases
    LI Huanjie, OU Lanxiang, CHEN Hong, CHEN Jian, GENG Jun, GAO Zhipeng, WANG Yan, DING Xinglong, CHEN Zhen, ZHU Zhiwei, LIU Lunqin, Wang Yunshan
    Journal of Shandong University (Health Sciences). 2020, 58(10):  120-126.  doi:10.6040/j.issn.1671-7554.0.2020.0741
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    Objective To develop a colloidal gold kit for rapid detection of IgM-IgG antibodies of SARS-CoV-2, optimize the development and application strategy, and investigate the diagnostic value of SARS-CoV-2 IgM-IgG antibodies by detecting serum of clinically confirmed patients. Methods The RBD and NTD domains of S protein from SARS-CoV-2 virus were expressed and purified to prepare IgM-IgG antibody colloidal gold detection kit by coating antigen and polyclonal antibody with preparation technique of colloidal gold, then the clinical efficacy was validated. The blood samples collected from 15 PCR confirmed COVID-19 patients were detected and the positive rate was calculated to analyze the response progress of SARS-CoV-2 antibody IgM-IgG on virus. Results The overall positive rate of IgM-IgG antibody assay test was 73.33%, which was higher that single IgM(positive rate: 53.33%)or IgG(positive rate: 60.00%)test. Three cases were positive out of five aliens. The epidemiology analyses showed that 7 positive cases had infected with SARS-CoV-2 virus for more than one week. The sensitivity of the antibody detection kit was 73.33% and the specificity was 95.00%. Conclusion The IgM-IgG combined test method is rapid, convenient and easy to operate, and can be used to carry on the primary screening for the suspected patients, especially the aliens and asymptomatic patients. On the other hand, the IgM-IgG detection result can be used as the basis to infer the virus-infected progress. The rapid dection results of IgM-IgG antibody may be helpful for the diagnosis and treatment on COVID-19.
    Optimization, validation and analysis of a 2019-nCoV nucleic acid detection kit
    ZHOU Yunying, ZHANG Tong, ZHAO Qianqian, WANG Haiyan, WANG Yunshan
    Journal of Shandong University (Health Sciences). 2020, 58(10):  127-133.  doi:10.6040/j.issn.1671-7554.0.2020.0923
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    Objective To optimize the sensitivity and specificity of a 2019-nCoV nucleic acid detection kit, so as to improve the positive detection rate and provide guidance for clinical use by comparison with different kits. Methods From January to March 2020, 88 confirmed and 572 negative specimens of 2019-nCoV were recruited from 6 2019-nCOV nucleic acid testing centers including Jinan Central Hospital Affiliated to Shandong University. By sequence analysis of the whole genome of 2019-nCoV, a more sensitive primer and probe were designed to optimize the buffer ratio and amplification process. The sensitivity was evaluated with cross-reactive experiment and endogenous substances interference test. The optimized kit and 3 other commercial kits were compared with gradient dilution tests. Results The optimized ORF1ab and N gene had higher sensitivity to the RNA targets of 2019-nCoV. When the concentration of virus was 1, the virus could be detected, and the amplification curve was better than the commercial kits. The sensitivity of ORF1ab was increased by 2 times(1∶10 vs 1∶5)compared with WHO or other self-designed kits, and the sensitivity of N gene was increased by 8 times(1∶80 vs 1∶10)and 2 times(1∶80 vs 1∶40)compared with CDC and WHO kits respectively. The results of cross-reactive test and endogenous substances interference test showed that the accuracy of nasopharyngeal swabs was 100%, there was no cross-reaction with other pathogens with similar infection symptoms, and the accuracy and specificity of the kit were 100%. Conclusion The optimized 2019-nCoV nucleic acid detection kit has higher sensitivity and specificity, which is helpful to solve the false negative nucleic acid detection and increase the positive rate, and is significant to formulate discharge criteria of low viral load patients.