Following the first human infection with the influenza A (H10N8) virus in Nanchang, China in December 2013, we identified two additional patients on January 19 and February 9, 2014. The epidemiologic, clinical, and virological data from the patients and the environmental specimen collected from 23 local live poultry markets (LPMs) were analyzed. The three H10N8 cases had a history of poultry exposure and presented with high fever (>38°C), rapidly progressive pneumonia and lymphopenia. Substantial high levels of cytokines and chemokines were observed. The sequences from an isolate (A/Environment/Jiangxi/03489/2013 [H10N8]) in an epidemiologically linked LPM showed highly identity with human H10N8 virus, evidencing LPM as the source of human infection. The HA and NA of human and environmental H10N8 isolates showed high identity (99.1–99.9%) while six genotypes with internal genes derived from H9N2, H7N3 and H7N9 subtype viruses were detected in environmental H10N8 isolates. The genotype of the virus causing human infection, Jiangxi/346, possessed a whole internal gene set of the A/Environment/Jiangxi/10618/2014(H9N2)-like virus. Thus, our findings support the notion that LPMs can act as both a gene pool for the generation of novel reassortants and a source for human infection, and intensive surveillance and management should therefore be conducted.

After the first national-scale outbreak of Hand, foot, and mouth disease (HFMD) in China, a national surveillance network was established. Here we described the epidemiology and pathogenic profile of HFMD and the impact of EV-A71 vaccination on pathogen spectrum of enteroviruses in the southeastern Chinese city of Nanchang during 2010–2019. A total of 7,951 HFMD cases from sentinel hospitals were included, of which 4,800 EV-positive cases (60.4%) were identified by real-time RT-PCR. During 2010–2012, enterovirus 71 (EV-A71) was the main causative agent of HFMD, causing 63.1% of cases, followed by 19.3% cases associated with coxsackievirus A16 (CV-A16). Since 2013, the proportion of other enteroviruses has increased dramatically, with the sub genotype D3 strain of Coxsackievirus A6 (CV-A6) replacing the dominance of EV-A71. These genetically diverse native strains of CV-A6 have co-transmitted and co-evolved in Nanchang. Unlike EV-A71 and CV-A16, most CV-A6 infections were concentrated in autumn and winter. The incidence of EV-A71 infection negatively correlated with EV-A71 vaccination (r = −0.990, p = 0.01). And severe cases sharply declined as the promotion of EV-A71 vaccines. After 2-year implementation of EV-A71 vaccination, EV-A71 is no longer detected from the reported HFMD cases in Nanchang. In conclusion, EV-A71 vaccination changed the pattern of HFMD epidemic, and CV-A6 replaced the dominance of EV-A71 over time.

An outbreak of hand, foot, and mouth disease was reported through hospital-based surveillance in Nanchang, China in 2014. A total of 244 cases were reported, 176 (72.1%) cases were tested positive for enteroviruses by direct reverse transcription-polymerase chain reaction, in which enterovirus A71 (EV-A71), coxsackievirus A16 (CV-A16), and untyped enteroviruses (UEV) accounted for 84.1%, 3.4%, and 12.5%, respectively. In this outbreak, children under 5 years old constituted more than 98% of the positive cases, and the ratio of male to female cases was 2.6 to 1 (P < 0.01). Phylogenetic analysis indicated that the Nanchang EV-A71 strains belonged to subgenotype C4a undergoing continuously evolutionary changes.

Historically, Jiangxi province has had the largest HfRS burden in china. However, thus far, the comprehensive understanding of the spatiotemporal distributions of HfRS is limited in Jiangxi. in this study, seasonal decomposition analysis, spatial autocorrelation analysis, and space-time scan statistic analyses were performed to detect the spatiotemporal dynamics distribution of HfRS cases from 2005 to 2018 in Jiangxi at the county scale. The epidemic of HFRS showed the characteristic of bi-peak seasonality, the primary peak in winter (November to January) and the second peak in early summer (May to June), and the amplitude and the magnitude of HFRS outbreaks have been increasing. The results of global and local spatial autocorrelation analysis showed that the HfRS epidemic exhibited the characteristic of highly spatially heterogeneous, and Anyi, fengxin, Yifeng, Shanggao, Jing'an and Gao'an county were hot spots areas. A most likely cluster, and two secondary likely clusters were detected in 14-years duration. The higher risk areas of the HFRS outbreak were mainly located in Jiangxi northern hilly state, spreading to Wuyi mountain hilly state as time advanced. this study provided valuable information for local public health authorities to design and implement effective measures for the control and prevention of HfRS. Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne infectious disease caused by hantaviruses in the Bunyaviridae family 1. Transmission of hantavirus to humans occurs via inhalation of aerosolized viral particles present in the urine, feces, and saliva excreted into the environment by rodents infected with it 2. In China, the major causative agents of HFRS are Hantaan virus (HTNV) and Seoul virus (SEOV), whose natural rodents hosts are respectively striped field mice (A. agrarius) and Norway rats (R. norvegicus) 3,4. So far, China remains the most endemic country, and there were more than 11,000 HFRS cases reported annually from 2016 to 2018 5. Jiangxi province, which is located in the southern bank of the middle and lower reaches of the Yangzi River, is one of the most serious HFRS endemic areas of China. Since the first case of HFRS was reported in Pengze county in 1961, the HFRS epidemic has rapidly spread to 6 counties in the 1960s, 39 counties in the 1970s, 65 counties in the 1980s, and 88 counties in the 1990s. The number of HFRS cases has also risen sharply, and reached a peak in 1985, with an incidence of 21/100,000 persons. The epidemic of HFRS has expanded throughout the central and northern Jiangxi and reached Ningdu county, Ganzhou city, in the south 6. Jiangxi currently remains one of the provinces with the highest HFRS incidence during recent years according to the national HFRS surveillance data 7. The susceptible population of HFRS is heterogeneous in space, socioeconomic status, and the geographical difference between different regions 8. Furthermore, infectious disease outbreaks can occur in very short time periods and infect a large number of individuals 9,10. As a resu...

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