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2026 Volume 42 Issue 2  Published: 2026-02-10
    Special Report—Strengthening the Public Health Workforce
  • Mile LIN , Chongyi WANG , Wuqi QIU , Ayan MAO , Shaoqiong LI , Yujie YANG
    doi: 10.11847/zgggws1147301
    Objective

    To analyze the current status and equity of human resource allocation in centers for disease control and prevention (CDCs) at the county level in China, thereby providing reference for promoting the high-quality development of county-level CDCs.

    Methods

    The data were collected from the National Disease Prevention and Control Integrated Management System and the 2019–2023 Statistical Yearbooks. The Gini coefficient, Theil index, and health resource density index were adopted to analyze the current status and equity of human resource allocation in China′s county-level CDCs in the dimensions of population, geography, and economy.

    Results

    In 2023, the staff size and ratio in China′s county-level CDCs reached 162 836 and 1.16 per 10 000, respectively, both demonstrating consistent year-on-year growth. The Gini coefficient of all regions was less than 0.2 according to population distribution, less than 0.3 according to economic level distribution, less than 0.4 in eastern and central China and close to 0.6 in western China according to geographical area distribution. The Theil index across regions was approximately 0.36 in the geographical dimension, and 0.02 and 0.07 in the population and economic dimensions, respectively. For population and geographical dimensions, the intra-regional contribution exceeded that between regions, while the opposite pattern held for the economic dimension. The national and regional health resource density index showed an increasing trend year by year.

    Conclusions

    The staff size in China′s county-level CDCs has shown sustained growth. Their distribution remains relatively equitable across population and economic dimensions, but exhibits weaker equity in the geographical dimension. Efforts should focus on promoting intra-regional coordination and integration of human resources to reduce disparities within regions.

  • Special Report—Strengthening the Public Health Workforce
  • Xiaoxu WANG , Mengmeng HU , Yiwen MA , Yaoguang ZHANG
    doi: 10.11847/zgggws1148000
    Objective

    To analyze the distribution situation and turnover of primary health care (PHC) physicians and its impact on equity of distribution in China from 2011 to 2021, thereby providing empirical evidence for optimizing the allocation and workforce development of PHC physicians.

    Methods

    We used the basic information of health human resources collected by the National Health Commission Statistical Information Center. Individual-level data collected by April 2022 were longitudinally linked to construct a retrospective cohort for analysis of the turnover pattern of PHC physicians. The Gini coefficient and Theil index were calculated to measure the equity of distribution. We performed counterfactual analysis to evaluate the impact of turnover on distribution equity.

    Results

    The number of PHC physicians and the number per thousand population in China increased from 644 858 and 0.48 in 2011 to 1 102 532 and 0.78 in 2021, respectively. Among the 3 696 434 PHC physicians enrolled in the cohort study from 2011 to 2021, a total of 384 364 turnover events were related to PHC institutions, primarily occurring between PHC institutions [173 051 (45.0%)]. The net turnover rate of PHC physicians increased from 0.22% to 0.46% with fluctuations. The factual Gini coefficient and Theil index decreased from 0.142 and 0.033 in 2011 to 0.123 and 0.025 in 2021, respectively, while the counterfactual Gini coefficient and Theil index declined from 0.146 and 0.035 in 2012 to 0.121 and 0.024 in 2021, respectively, which suggested improved equity in the distribution of PHC physicians. From 2012 to 2021, the annual "counterfactual minus factual" results were persistently negative with absolute values ranging from 0.000 2 to 0.004 4, suggesting that physician turnover had a minimal impact on the equity of physician distribution.

    Conclusions

    The development of PHC physicians in China shows a positive trend. Continuous efforts should be made to strengthen the dynamic monitoring and guide the rational turnover of PHC human resources.

  • Special Report—Strengthening the Public Health Workforce
  • Qingsong YANG , Jinzhong JIA , Jing LI , Zhiqiang WANG , Mengting ZHANG
    doi: 10.11847/zgggws1148034
    Objective

    To investigate the determinants of starting salaries among master of public health (MPH) graduates, thereby giving insights for enhancing career outcomes.

    Methods

    The data from the National Survey of Educational Satisfaction among Medical Graduates (June–July 2022) were used to analyze the starting salaries of 495 employed MPH graduates from 54 colleges and universities across China. Unpaired binary logistic regression was adopted to identify the factors influencing starting salaries, while Shapley value decomposition was employed to quantify the relative contribution of each variable.

    Results

    Geographic location of employment, employer type, annual household income per capita, and gender were primary determinants of starting salaries. Compared with the graduates employed in eastern China, those in central China had 0.17 times the odds of securing higher starting salaries (95%CI: 0.09–0.33), while those in western China had 0.33 times the odds (95%CI: 0.21–0.52). Graduates employed at centers for disease control and prevention (CDCs) had 0.34 times the odds of securing higher starting salaries relative to those at comprehensive hospitals (95%CI: 0.21–0.55). Graduates from high-income households exhibited 1.68 times the odds of securing higher starting salaries than those from low-income households (95%CI: 1.12–2.54). Male graduates had 1.67 times the odds of securing higher starting salaries compared with female graduates (95%CI: 1.06–2.66). Shapley value decomposition revealed that structural factors of the labor market accounted for 83.50% of starting salary disparities. The contribution of employer type (42.75%) exceeded that of geographic location of employment (40.75%).

    Conclusions

    Structural factors of the labor market predominantly influence the starting salaries of MPH graduates, with employer type exerting a stronger effect than geographic location of employment. Annual household income per capita and gender also significantly impact starting salaries.

  • Special Report—Strengthening the Public Health Workforce
  • Xiaobin LIU , Shuangfeng FAN , Wei SUN , Juan LI , Wenzhi HUANG , Chunlin WU , Qidi PANG , Yu LÜ
    doi: 10.11847/zgggws1146527
    Objective

    To understand the settings, staffing, and performance of public health management departments in Sichuan province, thus providing a basis for exploring the scope, evaluation criteria, and compensation mechanisms of the public health work in medical institutions.

    Methods

    In July 2024, according to the Sichuan Province Medical Institutions Public Health Responsibility List (2023 Edition), a survey form was designed by the Sichuan Preventive Medicine Association for the survey of 261 medical institutions and 648 full-time and part-time public health management practitioners across 21 cities and prefectures in Sichuan province.

    Results

    In the surveyed medical institutions, there were 178 tertiary hospitals and 83 secondary hospitals. More than 80% of hospitals had independent public health department, while the proportion of hospitals where the public health department was co-located with the healthcare-asscoiated infection department exceeded 80%. The proportion of designated/sentinel settings in tertiary hospitals was 56.74%, which was higher than that (34.94%) in secondary hospitals (χ2 = 10.762, P = 0.001). In addition, tertiary hospitals outperformed secondary hospitals in the establishment of public health departments (76.97% vs. 60.24%), emergency management departments (91.01% vs. 80.72%), allocation of public health administrators in clinical departments (80.90% vs. 61.45%), and infectious disease information level (92.70% vs. 83.13%). The staffing structure of public health management departments in hospitals was predominantly composed of nurses (56.02%), with a more severe imbalance in secondary hospitals. Although the overall implementation of public health management work was generally consistent between hospitals of different levels, tertiary hospitals had higher proportions in staff health care (47.19% vs. 31.33%), foodborne disease surveillance and reporting (83.71% vs. 69.88%), and myopia prevention and control (14.61% vs. 4.82%) than secondary hospitals. In contrast, secondary hospitals had a higher proportion in hospital infection prevention and control than tertiary hospitals (60.24% vs. 44.38%).

    Conclusions

    Although the public health management in Sichuan province has developed rapidly, there are insufficient resource allocation and uneven service levels. In the future, it is necessary to optimize the organizational framework, adjust the staffing structure, explore compensation mechanisms, and build an evaluation system to improve the overall quality and efficiency of hospital public health services.

  • Special Report—Strengthening the Public Health Workforce
  • Weiyong CHEN , Haiting FENG , Wei WANG , Xin ZHOU , Junming LIN , Yu HU , Qiaoqin MA
    doi: 10.11847/zgggws1147536

    The pilot initiative of deploying disease control supervisors in healthcare institutions represents an institutional innovation aimed at deepening the integration of medical treatment and disease prevention. Emerging from the mandate for healthcare institutions to fulfill disease prevention responsibilities, this initiative serves as a critical measure to advance the high-quality development of disease control systems. This article reviews the current status of pilot program for disease control supervisors in healthcare institutions in Zhejiang province. Applying a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, we comprehensively evaluated the initiative by constructing a SWOT matrix and proposed recommendations for the development and optimization of prevention and control strategies. To foster the healthy progression of this pilot effort, future work should align with national strategies for building a high-quality disease prevention system and the modern development of the Healthy Zhejiang initiative. Key priorities include strengthening institutional safeguards and workforce development, leveraging digital intelligence tools, enhancing collaboration between full-time and part-time supervisors, and improving the capacity of healthcare institutions for early detection, reporting, and responses to infectious disease outbreaks.

  • Special Report—Strengthening the Public Health Workforce
  • Lin ZHU , Wenting LI , Yimeng CHEN , Guoliang MA
    doi: 10.11847/zgggws1146626
    Objective

    To establish an evaluation index system for public health responsibilities in secondary and tertiary medical institutions, thus strengthening the public health functions of medical institutions and enhancing the collaboration between regional medical and public health institutions.

    Methods

    In 2023, in line with China's national and Jiangsu provincial policies and decisions on strengthening the implementation of public health responsibilities in medical institutions, a framework for the evaluation index system was initially developed through interviews, expert discussion, and policy-literature analysis. The Delphi method was then applied with 20 experts across relevant fields over two consultation rounds to establish the evaluation index system for the public health responsibilities in secondary and tertiary medical institutions. The analytic hierarchy process (AHP) was employed to determine the weight of each index.

    Results

    The recovery rates of questionnaires reached 100% in both rounds, with an expert authority coefficient of 0.88 and the coefficient of concordance meeting the criteria (P<0.001). The evaluation index system consisted of 8 first-level indexes, 23 second-level indexes, and 72 third-level indexes. The mean importance scores, appropriateness scores, and total scores for all levels of indexes were not less than 4.00, with a coefficient of variation below 20%. The AHP results revealed that public health safety management (0.194), infectious disease prevention and control (0.147), and immunization services (0.136) are key areas of public health responsibilities for medical institutions.

    Conclusions

    The evaluation index system for public health responsibilities of secondary and tertiary hospitals helps medical institutions clarify key points of public health responsibilities, strengthen the public health responsibilities, optimize the integration paths of medical services and prevention, and enhance the systems and mechanisms for public health services and disease prevention and control.

  • Epidemiological Research
  • Zeyu HUANG , Junjia JIANG , Shitong YANG , Junling GAO
    doi: 10.11847/zgggws1145858
    Objective

    To explore the association between self-efficacy and subjective well-being (SWB) among older adults, thus providing a scientific basis for developing measures to improve the SWB of older adults.

    Methods

    A questionnaire survey was conducted from December 2018 to December 2023 among 27 352 older adults aged 65 and above, selected via a two-stage sampling method from 146 communities in 10 cities across China. The Chinese version of the General Self-Efficacy Scale (GSES) was adopted to assess self-efficacy, and the Chinese version of the Personal Wellbeing Index for Adults (PWI-A) was used to assess SWB. A generalized linear regression model was employed to analyze the association between self-efficacy and SWB.

    Results

    The 27 352 older adults showed the average SWB score of 52.76 ± 11.85 and the average self-efficacy score of 2.65 ± 0.72. The generalized linear regression model showed that without controlling for other factors, older adults with self-efficacy scores in the second (Q2), third (Q3), and fourth quartiles (Q4) had SWB scores 3.8 (95%CI: 3.4–4.2), 6.0 (95%CI: 5.6–6.3), and 11.0 (95%CI: 10.6–11.4) higher, respectively, than those with self-efficacy scores in the first quartile (Q1). After controlling for covariates, such as sex, age, and prevalence of chronic diseases, older adults with self-efficacy scores in Q2, Q3, and Q4 had SWB scores 2.5 (95%CI: 2.1–2.8), 4.0 (95%CI: 3.6–4.3), and 8.2 (95%CI: 7.8–8.6) higher than those with self-efficacy scores in Q1.

    Conclusions

    There is a positive correlation between self-efficacy and SWB scores in older adults. Providing learning environments, psychological interventions, and improving physical health conditions can enhance the self-efficacy and SWB of older adults.

  • Epidemiological Research
  • Chengli TANG , Mengru WU , Wenjing QIANG , Rui WU , Yongkang LIU , Houlin ZHANG , Beibei ZHU , Fangbiao TAO
    doi: 10.11847/zgggws1148113
    Objective

    To investigate the prevalence of depressive symptoms in pregnant couples in Anhui province and analyze the dose-response relationships of insufficient sleep and late bedtime with depressive symptoms, thus providing evidence for family-centered perinatal health interventions.

    Methods

    This multicenter cross-sectional study was conducted from November 2023 to June 2024. Through convenience sampling, 2 460 pregnant couples were recruited from five regions across southern, central, and northern Anhui province. Depressive symptoms in both partners were assessed via the Edinburgh Postnatal Depression Scale (EPDS). A self-designed questionnaire was employed to collect sociodemographic information, sleep duration, and bedtime. Generalized additive models (GAMs) were adopted to explore the associations between sleep and depression, while multivariable logistic regression was performed to examine the independent and interactive effects of sleep duration and bedtime on depression risk.

    Results

    Depressive symptoms were detected in 16.4% of pregnant women and 14.6% of husbands, with a 3.3% co-occurrence rate. The symptom prevalence followed a U-shaped trend across trimesters, peaking at 19.4% in women during the third trimester. GAMs revealed nonlinear dose-response relationships of sleep duration and bedtime with depression. Insufficient sleep (<7 h) and late bedtime (>23:00) were independent risk factors for both wives (OR = 1.72, 95%CI: 1.35–2.16; OR = 2.46, 95%CI: 1.75–3.46) and husbands (OR = 1.69, 95%CI: 1.33–2.14; OR = 1.41, 95%CI: 1.27–2.24). Combined insufficient sleep and late bedtime further increased the risk (wives: OR = 3.75, 95%CI: 2.29–6.14; husbands: OR = 1.63, 95%CI: 1.09–2.43). A statistically significant interactive effect between partners′ sleep duration was observed on maternal depressive symptoms (OR = 1.38, 95%CI: 1.10–1.77).

    Conclusions

    Pregnant women exhibit higher depression prevalence than spouses, particularly during late pregnancy. Insufficient sleep and late bedtime are critical risk factors. Family-centered interventions targeting couple-based sleep health are recommended for perinatal depression prevention.

  • Experimental Study
  • Xinmiao WANG , Yiran SHANG , Yanhua FANG , Zongxing ZHANG , Ying YI , Jinhui WU
    doi: 10.11847/zgggws1146353
    Objective

    To design a local negative pressure isolation protection system on sickbed for infectious patients and conduct experimental research on its performance to analyze and evaluate the reliability and safety of its isolation protection against biological aerosol.

    Methods

    A local negative pressure isolation protection system on sickbed was designed with consideration to the structural type and materials. Then, the system was tested in terms of subjects′ experience, static and dynamic pressure difference, and noise. Particularly, the isolation protection performance of this system against biological aerosol in micro-circumstance airtight cabin was tested.

    Results

    The local negative pressure isolation protection system on sickbed quickly established a stable local negative pressure difference within 1 min, with a maximum fluctuation error of 4.6%. The average noise under the maximum air volume was 64.2 dB(A). When Serratia marcescens aerosol with a maximum concentration of 1.4 × 1011 CFU/mL was atomized inside the isolation hood, the aerosol leakage rate outside the hood was 0, which showed that the local negative pressure isolation protection system on sickbed could effectively cut off the transmission of pathogenic microorganisms in the air. Moreover, the subjects had a good subjective experience.

    Conclusions

    The designed local negative pressure isolation protection system on sickbed is comfortable, lightweight, and portable, which can be used to reduce the risk of microbial spread among respiratory patients.

  • Survey and Report
  • Hao YANG , Bowang CHEN , Jiapeng LU , Yang YANG
    doi: 10.11847/zgggws1148182
    Objective

    To understand the use and its influencing factors of secondary prevention drugs among patients with cardiovascular and cerebrovascular diseases (CVDs) in East China from 2014 to 2019, thus providing a basis for the improving medication adherence of secondary prevention drugs among these patients.

    Methods

    Data were collected from 19 992 patients with CVDs who aged 35–75 years and used secondary prevention drugs in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (China PEACE MPP) from September 2014 to November 2019 across 57 counties/districts in seven provincial-level administrative regions (Shanghai, Jiangsu, Zhejiang, Anhui, Fujian, Jiangxi, and Shandong) in East China. Multivariate mixed models were employed with community-specific random intercepts to analyze the associations of individual characteristics with the reported use of secondary prevention drugs.

    Results

    Among the 19 992 patients with CVDs reported in East China from 2014 to 2019, 4 435 (22.18%) patients used antiplatelets or statins. Among them, 3 671 (18.36%) and 2 181 (10.91%) patients used antiplatelets and statins, respectively, and 1 417 cases (7.09%) used both types of drugs. The results of the multivariate mixed model analysis showed that the patients with CVDs who had educational background of junior high school or above, hypertension history, dyslipidemia history, overweight or obesity were more likely to report taking secondary prevention drugs. Female patients, current smokers, and those diagnosed with CVDs for more than 7 years were less likely to report taking secondary prevention drugs.

    Conclusions

    The use of secondary prevention drugs among the patients with CVDs was suboptimal in East China from 2014 to 2019. Gender, educational background, history of hypertension and dyslipidemia, current smoking status, body mass index, and time from diagnosis of CVDs are the main influencing factors for the use of secondary prevention drugs among the patients in East China.

  • Survey and Report
  • Kaige DU , Yanru CHEN , Shuopeng YANG , Shaoxia SONG , Xiujun MA , Ti LIU
    doi: 10.11847/zgggws1148516
    Objective

    To understand the epidemic trend of SARS-CoV-2 and explore the practical significance of sewage monitoring in the assessment and prevention of COVID-19 epidemic by analyzing the monitoring data of SARS-CoV-2 in sewage in Shandong province.

    Methods

    In 2024, a total of 9 464 sewage samples from the main urban sewage treatment plants in 16 cities of Shandong province were collected weekly. The positive rate and the weighted average concentration of SARS-CoV-2 in the samples were continuously monitored. Correlation analysis was conducted between the weekly positive rates and weighted average concentrations across the province. On the basis of the data such as the weighted average concentration, the weekly number of SARS-CoV-2 infections was estimated. Correlation analysis was then performed between the estimated infection number and the reported cases of SARS-CoV-2 infection in Shandong province.

    Results

    In 2024, a total of 9 464 sewage samples were monitored in Shandong province. The average positive rate of SARS-CoV-2 in the wastewater throughout the year was 46.91%, and the average weighted average concentration was 11.69 copies/mL. The positive rate and weighted average concentration of SARS-CoV-2 in the sewage samples in Shandong province showed two peaks. The first peak occurred from the 1st week to the 24th week (January to June), with the highest positive rate of 77.72% and the highest weighted average concentration of 42.27 copies/mL. The second peak occurred from the 29th week to the 46th week (July to November), with the highest positive rate of 67.36% and the highest weighted average concentration of 19.7 copies/mL. The positive rate and weighted average concentration throughout the province had a high correlation (r = 0.888 7, P < 0.001, 95%CI: 0.812 9–0.934 9). The positive rates varied among different cities (χ2 = 2 233, P < 0.001), ranging from 14.58% to 89.58%. The weighted average concentrations ranged from 0.81 to 46.76 copies/mL. The number of reported SARS-CoV-2 infection cases in Shandong province ranged from 117 to 5 864, and the trend of increase or decrease in the number of reported cases over time was consistent with the changes in positive rate and weighted average concentration of SARS-CoV-2 in sewage. The estimated number of infections throughout the year ranged from 52 to 2 277, and there was a correlation between the estimated infection number and the number of reported cases (r = 0.769 9, P < 0.001, 95%CI: 0.629 2–0.861 8).

    Conclusions

    The positive rate and concentration changes of SARS-CoV-2 in sewage in Shandong province, 2024 are basically consistent with the variations in the number of reported cases. There is a certain correlation between the estimated infection number and the number of reported cases. The monitoring results of sewage can to some extent reflect the infection situation of the population.

  • Survey and Report
  • Chuangduan CHEN , Shu XIAO , Jianpeng XIAO , Ruipeng LU , Zuhua RONG , Weilin ZENG , Jianguo ZHAO , Dexin GONG
    doi: 10.11847/zgggws1147047

    This study proposes a method for automated report generation in disease control agencies using R Markdown and demonstrates the entire workflow from data collection, analysis, and visualization to report generation through a case study on mosquito surveillance data. By integrating text, code, and output results, R Markdown significantly reduces manual operations and improves report accuracy and reproducibility. This study represents the first application of R Markdown in the automated report generation of mosquito surveillance, offering an efficient and reusable solution for public health. The findings highlight the method ability to enhance data processing efficiency, report flexibility, and real-time decision-making support.

  • Survey and Report
  • Tian WANG , Wanting YANG , Tao WANG , Hongbin CAO , Yang LIU
    doi: 10.11847/zgggws1148133
    Objective

    To investigate the impact of activity frequency on the self-care ability of older adults in China, providing a reference for developing active aging strategies aligned with their activity patterns.

    Methods

    Data were drawn from the 2021 Chinese Longitudinal Healthy Longevity Survey (CLHLS) covering 14 022 older adults aged ≥ 65 years in 27 provinces (autonomous regions and municipalities). Multivariate ordinal logistic regression models were employed to analyze the associations between activity frequency and two functional outcomes: activities of daily living (ADL) and instrumental activities of daily living (IADL).

    Results

    Among the 14 022 participants, 9 474 (67.6%), 1 037 (7.4%), and 3 511 (25.0%) showed the ADL status of full independence, requiring partial assistance, and full dependence, respectively; 3 803 (27.1%), 2 104 (15.0%), and 8 115 (57.9%) exhibited the IADL status of full independence, requiring partial assistance, and full dependence, respectively. The activity frequency was low, moderate, and high in 2 830 (20.2%), 143 (1.0%), and 11 049 (78.8%) participants, respectively. After adjustment for sex, age, children′s financial support, marital status, residence, income adequacy, and pension insurance, multivariate ordinal logistic regression analysis revealed that compared with the low-frequency group, the moderate-frequency group had reduced risks of ADL impairment (OR = 0.309, 95%CI: 0.218–0.437) and IADL impairment (OR = 0.175, 95%CI: 0.110–0.280). Furthermore, compared with the low-frequency group, the high-frequency group had decreased risks of ADL impairment (OR = 0.142, 95%CI: 0.129–0.156) and IADL impairment (OR = 0.082, 95%CI: 0.067–0.100).

    Conclusions

    Increased activity frequency is associated with a reduced risk of ADL and IADL impairment among older adults in China, promoting greater independence.

  • Survey and Report
  • Zongnan CHANG , Yifei FANG , Sheng YANG , Geyu LIANG
    doi: 10.11847/zgggws1147448
    Objective

    To investigate the phase-specific impacts of non-pharmaceutical interventions (NPIs) during the coronavirus disease 2019 (COVID-19) pandemic on the transmission of hand, foot and mouth disease (HFMD) and evaluate the applicability and dynamic responsiveness of different prediction models in an intervention context.

    Methods

    Monthly HFMD incidence data from 2014 to 2023 in Fengyang county, Anhui province, China were analyzed. Theil–Sen robust regression was employed to estimate the annual percent change (APC) and the average annual percent change (AAPC) before and after COVID-19. Baseline scheme (counterfactual stress test): the model was trained on the data from January 2014 to December 2019 and validated on the data from January 2020 to December 2023, without incorporating any pandemic intervention variables. Intervention scheme (adaptive prediction): the model was trained on the data from January 2014 to November 2022, incorporating phase-specific intervention dummy variables, and validated on the data from December 2022 to December 2023. The prediction performance of seasonal autoregressive integrated moving average model with exogenous regressors (SARIMAX), Prophet (a time-series decomposable additive model), and long short-term memory (LSTM) was compared based on mean absolute percentage error (MAPE), root mean square error (RMSE), and mean absolute error (MAE). Two novel indices, the phase sensitivity index (PSI) and the resilience coefficient (REC), were proposed to assess model adaptability in terms of dynamic responsiveness and resistance to perturbations.

    Results

    In the pre-pandemic period from 2014 to 2019, HFMD incidence declined (APC = −15.97%, 95%CI: −22.06% to −6.80%, P = 0.004). In the post-pandemic period from 2020 to 2023, it increased (APC = 36.17%, 95%CI: 8.84% to 54.72%, P = 0.002). Over the full period from 2014 to 2023, the overall trend still decreased (AAPC = −12.28%, 95%CI: −16.49% to −7.37%, P < 0.001). During the relaxation period from December 2022 to December 2023, the intervention scheme outperformed the baseline scheme in out-of-sample prediction: the MAPE of SARIMAX decreased from 73.77% to 44.54% (a reduction of 29.23 percentage points); the MAPE of LSTM decreased from 46.18% to 41.85%; whereas the MAPE of Prophet remained high at 69.73%. The PSI/REC indicated that the SARIMAX and Prophet intervention models were more sensitive to the transition from routine control to relaxation, with PSI greater than 1 and recovery within 1 month (REC equal to 1); LSTM showed a PSI close to 1 but slower recovery (REC equal to 0.33) in about 3 months.

    Conclusions

    Non-pharmaceutical interventions exert phase-specific effects on HFMD transmission with a risk of rebound. Statistical models and deep learning models are complementary for surveillance under intervention scenarios. Statistical models are sensitive to exogenous shocks and recover quickly, whereas deep learning models excel in short-term fitting but require enhanced generalization and adaptive updating after relaxation of control measures. Integrating multiple models is recommended to optimize infectious disease early warning systems under complex dynamics in the presence of interventions.

  • Survey and Report
  • Lingli WANG , Hao JIANG , Xiao XIAO , Liming HUANG , Hong XU
    doi: 10.11847/zgggws1146910
    Objective

    To estimate the risk of Vibrio parahaemolyticus-caused illness associated with the consumption of seafood in Hangzhou, and identify the key points for risk control, thereby providing evidence for adopting effective risk management measures.

    Methods

    The surveillance data of V. parahaemolyticus concentration in seafood in Hangzhou from 2011 to 2022 and Hangzhou residents′ seafood consumption data in 2015 were extracted. According to the growth model of V. parahaemolyticus and related parameters from scientific literature, the Monte Carlo simulation method was employed to analyze the change of V. parahaemolyticus concentration in seafood from market to table and quantify the exposure of V. parahaemolyticus in the residents by consuming seafood in Hangzhou. Finally, a dose-response model was adopted to assess the risk of gastroenteritis caused by V. parahaemolyticus.

    Results

    The positive rate of V. parahaemolyticus in retail seafood in Hangzhou was 31.78% (90%CI: 28.38%–35.42%), with an initial contamination level of –0.20 (90%CI: –0.82 to 2.04) lg CFU/g. The average daily incidence risk of gastroenteritis caused by V. parahaemolyticus in seafood among residents was 1.93 × 10–5 in Hangzhou. The number of people infected with V. parahaemolyticus per million residents per year due to seafood consumption was 7 044. The sensitivity analysis showed that the risk was mainly and positively correlated with the initial contamination level of V. parahaemolyticus in seafood and the transportation and storage temperature and time of seafood.

    Conclusions

    There is certain health risk due to the consumption of seafood in Hangzhou. The risk could be effectively reduced by controlling the contamination level of V. parahaemolyticus in retail seafood and strictly controlling the storage and transportation temperature and time of seafood.

  • Survey and Report
  • Mingrui CHEN , Yingying HAN , Xinling MAO , Yueping MI , Ling LIN , Bo CAI , Quanyong XIANG
    doi: 10.11847/zgggws1148252
    Objective

    To analyze the incidence trends of female breast cancer in the cancer registration areas of Nantong city, Jiangsu province from 2013 to 2022, thus providing a basis for developing prevention and control strategies for female breast cancer in this region.

    Methods

    Data of female breast cancer cases registered in Nantong city from 2013 to 2022 were collected from the tumor follow-up database. The urban/rural area-specific crude incidence rate, the age-standardized incidence rate by Chinese standard population (ASIRC), and age-standardized incidence rate by world standard population (ASIRW) of female breast cancer were calculated. The crude incidence rate of female breast cancer in each age group was calculated. The Joinpoint model was used to estimate the annual average percentage change (AAPC) in these indicators for revealing the incidence trends of female breast cancer in selected areas with cancer registration in the city during this period.

    Results

    In the cancer registration areas of Nantong city from 2013 to 2022, the crude incidence rate, ASIRC, and ASIRW (per 100 000) of female breast cancer were 53.83 (50.08 for urban population and 55.31 for rural population), 30.72 (28.97 for urban population and 31.43 for rural population), and 28.73 (27.20 for urban population and 29.33 rural population), respectively. The crude incidence rate, ASIRC, and ASIRW of female breast cancer in the total population and urban and rural areas showed upward trends (AAPC: 3.79%–5.96%, all P < 0.01), and the incidence rate of female breast cancer in rural areas showed a more significant upward trend. The incidence rates of female breast cancer in the age groups of 30–39 years, 40–49 years, 50–59 years, 60–69 years, and 70–79 years in the cancer registration areas all showed upward trends (AAPC: 3.44%–5.37%, all P < 0.01).

    Conclusions

    The incidence rate of female breast cancer in the cancer registration areas of Nantong city from 2013 to 2022 showed an upward trend. Special attention should be paid to the prevention and control of female breast cancer in rural areas. Women aged 30–79 years are the key population for breast cancer prevention and control in this region.

  • Survey and Report
  • Wenmin LIU , Cuiping ZHOU , Dandan YANG , Laibao YANG
    doi: 10.11847/zgggws1146675
    Objective

    To examine the vaccination status of herpes zoster vaccine (HZV) and adverse events following immunization (AEFIs), thus providing evidence for the vaccination of HZV.

    Methods

    Two sets of data relevant to HZV vaccination in Pudong New Area of Shanghai from August 1, 2020 to July 31, 2024 were collected for statistical analysis, including information on HZV vaccination from the Pudong Immunization Program Integrated Management Cloud Platform and on AEFIs registered in the China Information System for Disease Control and Prevention.

    Results

    During the study period, 37 103 doses of HZV were totally vaccinated and 1 107 AEFIs were registered, with a reported AEFI incidence of 298.36/10 000 doses, 99.73% of which were common adverse reactions. The reported AEFI incidence of recombinant zoster vaccine (RZV) was 315.56/10 000 doses, which was higher than that (27.11/10 000 doses) of zoster vaccine live (ZVL). Among the receivers of RZV, females had higher reported AEFI incidence than males (348.58/10 000 doses vs. 254.05 /10 000 doses; χ2 = 23.412, P < 0.001). The individuals of 50–59 years old had higher reported AEFI incidence than those of 60–69 years old and 70 years old (342.86 /10 000 doses vs. 304.07 /10 000 doses and 259.53 /10 000 doses, respectively; χ2 = 9.574, P = 0.008). In addition, the reported AEFI incidence of the first dose was higher than that of the second dose (483.26/10 000 doses vs. 123.25/10 000 doses; χ2 = 369.000, P < 0.001).

    Conclusions

    The reported HZV-related AEFIs were mainly common adverse reactions in Pudong New area, with no serious adverse reaction reported, which suggest good safety of HZV.

  • Review
  • Hao WU , Jiaxuan BIAN , Shaofu DU , Huiqun JIA , Hui WANG , Ligui WANG , Xiaoying LI , Hongbin SONG
    doi: 10.11847/zgggws1148334

    This study explores and summarizes existing analytical methods for tracing the origins of dengue fever, including the techniques based on epidemiology, genomics, molecular phylogeny of the dengue virus, and Geographic Information Systems (GIS). These approaches reveal the transmission routes, mutations, and host adaptation of the dengue virus from different perspectives. This paper introduces the applicability of these methods across different geographical regions and temporal scales and analyzes the advantages and disadvantages of these methods in practical applications to provide insights for the development of novel tracing technologies in the future. The aim is to enhance the understanding about the transmission mechanisms of dengue fever and offer technical support for the tracing, prediction, and control of dengue fever outbreaks.

  • Review
  • Yijing LIU , Jingqi ZHANG
    doi: 10.11847/zgggws1147786

    Data annotation is the foundation for the application of artificial intelligence (AI). This paper reviews the real-world applications of data annotation in public health and clinical medicine, with the aim of providing reference for promoting the construction of China′s smart medical system and the modernization of public health governance. The Chinese and English articles on the applications of data annotation in public health and clinical medicine were retrieved from the China National Knowledge Infrastructure (CNKI) and the Web of Science Core Collection with the time interval from January 1, 2020 to April 20, 2025. Data annotation demonstrates significant application potential in smart healthcare management and services, diagnostic assistance, disease surveillance, pharmacovigilance and new drug development, as well as chronic disease management. It substantially enhances the accuracy of medical AI models, optimizes clinical workflows, and advances precision medicine. Currently, medical data annotation shows the development trends of automation, multi-center collaboration, and dynamization, while still facing challenges such as inconsistent standards and privacy protection. In the future, it is necessary to build a standardized and intelligent annotation ecosystem to fully release the potential of AI in the medical field and help achieve the Healthy China initiative.