China's answer to Ebola: a lethal haemorrhagic fever that kills 20,000 people a year

by Michael Woodhead

Like many other countries, China has gone into a hysterical spin about the threat posed by Ebola virus disease.

Authorities have dusted off the useless thermal scanners last used in the avian flu outbreaks, and have started screening passengers arriving at from Africa at Chinese airports. And despite the World Health Organization saying that China does not need to be overly concerned about the disease, authorities have been issuing stern warnings to health workers about being vigilant for Ebola and also looking with suspicion on the African expats living in cities such as Guangzhou. The irony is that China has seen its own counterpart of Ebola virus disease, a killer disease that has been increasing dramatically in the last two years.

But first some background: Ebola is a haemorrhagic fever, caused by the Ebola virus, which belongs to the  Filoviridae family of RNA viruses. The virus comes from apes and bats and is only transmitted between humans by body fluids such as blood and saliva - in Africa it has been spread by hunters cutting up meat from infected animals, and spread to healthcare workers and close relatives to touch the dead bodies of Ebola victims at traditional African funerals. In the latest outbreak there have been 1323 confirmed and suspected cases of Ebola reported, and 729 deaths. That's a mortality rate of 55% according to my calculator.

What to make then of China's recent little remarked but lethal cases of haemorrhagic fever? In April, Dr Du Hong and colleagues from the Center for Infectious Diseases, Tangdu Hospital, Xian, described the horrific symptoms of some of the 356 patients who had been treated at their hospital for  "hemorrhagic fever with renal syndrome" (HFRS),  a disease caused by Hantavirus that is spread by rats (or more specifically in their droppings, which may become aerosolised and spread to anyone working near where rats have been active).

The symptoms are similar to Ebola: fever, circulatory collapse with hypotension, hemorrhage, but also with acute kidney failure (hence the name renal syndrome). The difference between Ebola and HFRS is that the Hantavirus disease has a death rate of 'only' 40%. For China, which has had about 50,000 cases of HFRS annually, that means about there have been, at a conservative estimate, 20,000 deaths from Hanta virus every year. Makes the 730 Ebola deaths in Africa look fairly insignificant doesn't it? And as with Ebola, there is no treatment or vaccine for Hantavirus, only supportive care.

And that's not all. China has other types of haemorrhagic fever. This month The Lancet carries a report of the emergence of one, known as "severe haemorrhagic fever with thrombocytopenia". This is a viral disease spread by ticks, caused by the SFTS phlebovirus in the Bunyaviridae family. According to Dr Liu Quan and colleagues from the State Key Laboratory of Veterinary Etiological Biology, Lanzhou, SFTS was first reported in 2010 and has since been found in 11 provinces of China, with about 2500 reported cases, and an average case-fatality rate of 7%. That's about 175 deaths. As the study authors say with some understatement: "The disease has become a substantial risk to public health".

China is the epicentre for Hantavirus haemorrhagic fever in the world, but it is not the only country affected. The disease is also seen in Europe and the US - a Denver man died of the infection just this week. But with tens of thousands of Chinese people dying every year from this terrible haemorrhagic disease, perhaps China ought to worry more about curbing Hantavirus - and the rats that carry it - rather than panicking over the threat from an African outbreak of Ebola.

Public health workers unprepared for emergencies

Public health workers in north east China are poorly prepared for emergency situations, a study has found.

A survey of 368 public health inspectors from 17 public health areas in Heilongjiang found that most staff believed they had adequate skills and compensation to manage in a crisis. However the study also found that competency and preparedness were lacking. Lack of explicit national job requirements, overlapping responsibilities and poor collaboration among agencies, together with poor knowledge and skills level of personnel, led to an ambiguity of responsibility, and hindered the preparedness competency of public health staff, according to the study in BMJ Open.

Chinese experts call for more focus on tobacco control

As health is the people's top priority, the Chinese government should do more to control tobacco, experts say.

At a three-day seminar on tobacco control that ended on Thursday in Beijing, Hu Angang, director of the Research Center for Contemporary China at Tsinghua University, said tobacco is the biggest killer in China, and it is not just a public health issue, but involves the sustainable development of the whole nation.

While the government works on economic renewal, transformation of tobacco industry must be addressed and the tobacco supply reduced, Hu said.

China is the world's largest cigarette producer and consumer. The number of smokers exceeds 300 million, with at least 740 million nonsmokers regularly exposed to secondhand smoke.

Zhi Xiuyi, head of the Lung Cancer Diagnosis and Treatment Center of the Capital Medical University, said the top four killers in China, namely cardiovascular disorders, malignant tumors, respiratory disorders and heart disease, are all related to tobacco.

In 2003, China signed the WHO Framework Convention on Tobacco Control (FCTC) and it became effective in January 2006. The FCTC requires a reduction in tobacco supply as well as consumption. The 12th Five-Year plan (2011-2015) promised to ban smoking in public places.

Experts are widely critical of the current government effort, describing it as lagging far behind the FCTC standard, and no national law is yet in place banning smoking in indoor public places.

Wang Qingbin, associate professor with the China University of Political Science and Law, believes that although local rules were established in 2007 in Shanghai, Guangzhou, Harbin, and other cities,enforcement has been far from satisfactory.

"There are no clear punishment clauses in most of the regulations, and even in cities with punitive stipulations, only a few fines were issued. The responsible departments simply turn a blind eye because they don't have enough money to hire special staff," he said.

Last December, the Ministry of Industry and Information Technology (MIIT), the Ministry of Health and six other government departments  released the China Tobacco Control Program (2012-2015), to reduce tobacco use and reduce tobacco planting. The program is the first at state level  on tobacco control, and marked a new phase for comprehensive tobacco control.

Angela Pratt, a technical officer with the Tobacco Free Initiative of the WHO Representative Office in China, called for more government effort on banning tobacco advertising, graphic warnings on cigarette packs, and raising taxes.

"These measures are included in the FCTC, have proved effective in other countries and helped saved millions of lives," she said.

Source: China Daily

Chinese Center for Disease Control and Prevention (CDC) works with US counterpart

by Dr Tom Frieden, CDC Director
 For more than 30 years, the US CDC has worked with China on public health issues that have benefited people of all nations.
Together our nations proved the benefits of folic acid which saved children around the world from birth defects. We are exploring novel approaches to HIV prevention, testing and treatment. We are researching risk factors for cardiovascular disease – one of the world’s leading causes of death. Along with other nations, China and the US are working together on influenza surveillance to better protect the world.
This week, I had an opportunity to discuss these achievements with my colleague Dr. WANG Yu, Director of the Chinese Center for Disease Control and Prevention (China CDC). The US CDC and China CDC Directors meet annually to decide our mutual priorities, explore ways to share what we’ve learned with other nations and expand upon our collaborative successes. This was the tenth anniversary of the US-China CDC Directors meeting which allowed for reflection on a few key 10-year benchmarks.
China has made great strides in public health over the past decade. In 2003, the world was in the grip of SARS which began in China and resulted in sweeping changes to global public health response. In 2013, China is actively strengthening its domestic public health detection and response system. Ten years ago, US CDC began to work in China on its growing HIV/AIDS pandemic. Now, Chinese HIV/AIDS clinics are testing innovative point-of-care technologies that will be distributed globally to use in other nations in their fight against AIDS. In 2001, US CDC’s Field Epidemiology Training Program began helping China CDC to build a force of disease detectives to identify and control domestic disease outbreaks.
Ten years later, China expanded its contribution to the global effort to eradicate polio by joining the Stop the Transmission of Polio (STOP) vaccination teams. Ten years ago, China had only eight sentinel hospitals conducting virologic influenza surveillance and a single national laboratory. Throughout the next decade, US CDC supported its partners in China CDC to improve the quantity and quality of its surveillance sites. In 2013, China’s influenza network spans 554 sentinel hospitals and 409 laboratories and is one of only five WHO Collaborating Centres for Influenza Reference and Research in the world.
US CDC congratulates China and its public health professionals for making a world of difference. Collaborating with China provides US CDC unprecedented opportunities to work with the largest population in the world on public health approaches that benefit the people of China, the US and the world.
Source: CDC Blog

Children of rural migrants get NGO health checks in Beijing

by Simone Cote
A number of private organizations such as NGOs and individuals are helping migrant workers' children to get medical check ups.
As more and more migrant workers are flocking to big Chinese cities like Beijing to find work, they often bring their children with them hoping to provide them with a better life.
Simone Cote has more:
Recently a group of 46 migrant school children between the ages of 8 and 10 years old all had the opportunity to have their first ever annual health check ups at the Global Care Hospital in Beijing
Founded in 2009 by Helen Boyle, the Migrant Children's Foundation also known as MCF is a non profit organization that works with migrant communities in Beijing, China.
Helen says that for almost every child that has received a health care check up, it is their first time to visit the doctor.
"They don't have a check up at all in fact a lot of them if they have health issues, the parents they can't afford to actually, to actually seek treatment. So this is something for them for the parents to be sure that the child is ok, but also you know like what I said if there is an issue, they actually can tackle it from you know an early phase."
For most of the children, they say when they are sick they still have to attend school because their parents have to go to work.
The Director of the Health Management Centre for the Global Care Hospital, Wei Changhong says that while generally most of the migrant children are healthy, there are some common problems she has seen in the recent health check ups for the children:
"According to my experience, one common problem is about nutrition. The other is about development, such as whether their bones are healthy enough and whether they are tall enough. We use instruments, such as the weighing-machine to do a comprehensive assessment for children, and then we can see their health conditions".
And while there are still many more migrant children on the list to receive health care check ups in the coming year, Helen says that the MCF in collaboration with the support of the Australian Chamber of Commerce and the Global Care Hospital hundreds of more children will receive free health care check ups in the coming year.
Source: CRI

SARS was a watershed for China public health domestically but not globally

by Chan Lai-Ha
In 2002, SARS not only exposed a fundamental shortcoming of China's public health surveillance system as well as its single-minded pursuit of economic growth since the late 1970s, but also forced China to realise that, in the era of globalisation, public health is no longer a domestic, social issue that can be isolated from foreign-policy concern.
Its ailing health care system, its aspiration to be seen as a “responsible state,” and international demands for health cooperation have compelled China to be more proactive in the global health domain. There are signs that China is now using public health as a means to strengthen its diplomatic relations with the developing world, in particular the African continent. While China has embraced multilateral cooperation in a wide array of global health issues, its engagement remains “state centric” and therefore leaders attach primary significance to intergovernmental organisations, particularly the UN agencies.
Following the Chinese government's acknowledgement of a SARS outbreak in the country, it began to acknowledge the importance of public health to national development and to accordingly strengthen its multilateral cooperation in combating contagious diseases inside and beyond its borders. For example, in the midst of the recent global economic downturn, the Chinese government announced in 2009 an injection of 850 billion yuan (US$125 billion) into its health care system to improve its operation. Since the SARS outbreak, it has not only deepened its engagement with other nations and international organisations, and cooperated with a variety of actors in dealing with its own fledgling health care system including the problem of HIV/AIDS, but China has also developed a vision for global health diplomacy. A ground-breaking implication of the SARS outbreak for China is that it was struck to realise that public health is not simply a domestic, social issue that can be isolated from foreign-policy and security concerns. In a globalising world, the Chinese government appears to have learned that its health policy will be scrutinised by the world, and hence, it has become more open to and actively participates in global health governance. The government is now learning from such European countries as the UK, France, and Switzerland in the provision of the global public goods for health. Its substantial health assistance to sub-Saharan Africa in building hospitals and training health practitioners forms part of its health diplomacy and contribution to global health governance. It has also been proactively engaging with both regional and global health institutions since 2003 and set up different health surveillance networks with its ASEAN partners as well as other intergovernmental organisations, such as the Asia-Pacific Economic Cooperation (APEC) forum .
Despite its increasing engagement with global health governance since the SARS outbreak, China's approach remains, however, fundamentally state-centric, contrary to the essence of global health diplomacy and governance. With grave concern about the loss of national sovereignty to external or nongovernmental actors, Chinese senior leaders have therefore attached primary significance to intergovernmental organisations, particularly the UN agencies. In evaluating the impact of SARS, Andrew Price-Smith has put the same point succinctly: “while the SARS epidemic may have generated moderate institutional change at the domestic level …, it resulted in only ephemeral change at the level of global governance”. In other words, national sovereignty is still of paramount importance for the Chinese leadership. Because of its sensitivity to foreign interference into its internal affairs, the Chinese government has not yet formally or officially endorsed the notion of “human security.” Under the umbrella concept of national security, “human safety,” instead of “human security,” is discussed throughout all of China's five white papers on national defence since 2000 (i.e., 2000, 2002, 2004, 2006, and 2008). Taiwan's participation in the World Health Assembly is predicated on the condition that it is considered part of China, not an independent entity. Having no tolerance in ceding its supreme authority, the central government has adopted a multi-faceted attitude towards its civil society organisations. While Beijing shows its willingness to cooperate with a wide array of actors inside China, it refuses to let its domestic NGOs and activists establish direct links with their counterparts overseas.
It is still uncertain whether this sovereign concern will trump the provision of global public good for health. Nevertheless, in a highly globalizing world, infectious diseases know no border. While China is seeking to adhere as much as possible to the underlying norms and rules of global health governance (and sometimes even applies them to their extremes), as evidenced by its handling of the recent swine flu outbreak, the major step forward is perhaps to reframe health as a global public good that is available to each and every individual of the world, rather than merely as an issue of concern to nation-states.
Source: PLOS Medicine

One in six Chinese people have food poisoning every year

New food safety regulations are in place in China, but the problem lies in enforcing them

by Dr Yongning Wu, Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing

Food safety  has become one of the most challenging social issues in China that needs to be addressed.
Domestic issues concerning food safety occur more frequently in China than in other countries; there are loopholes in all the aspects of the food chain—from the farm to the table; public concerns over food safety are growing. A severe scandal related to food safety was recently exposed with regards to the production and extensive use of banned cooking oil which shows that China faces a grave situation in ensuring food safety. In contrast with the different major food safety issues in developed countries, China is dealing with recurrent instances of foodborne diseases, not due to micro-organisms or environmental pollutants, but due to the illegal use of pesticides and veterinary drugs as well as adulterated materials.

In October 2011, the China National Center for Food Safety Risk Assessment was established; it is responsible for risk surveillance, risk assessment, early warning and risk communication, as well as scientific support for national food safety standards. This is the first professional body that aims to offer national-level risk assessment to policy makers and the public, and is one of the few interdepartmental centres in the world, indicating an important step by the Chinese government to strengthen food safety capability building. In June 2012, the State Council issued the 12th Five Year Plan for the National Food Safety Regulation System, highlighting the Chinese government's efforts towards food safety. The plan pointed out that the government needed to comprehensively promote the development of the system in 10 areas: regulations and standards, monitoring and assessment, inspection, process control, supervision of the import and export, food safety, emergency management, comprehensive coordination, science and technology support for research and development, food safety information integrity and missionary training. Key projects will be built that aim to address the urgent outstanding issues with the weak link of the food safety regulatory system need, including food safety risk assessment, the traceability system and the national food safety information exchange platform. In future, China will still need to strengthen development and application of new technologies such as the exposome characterisation of hazards occurring in Chinese food, and particularly risk-benefit techniques for exposure assessment and translational toxicology, to provide technological support for the food safety basic research programme.
As in other countries, although the main problem lies in enforcing food-safety regulations, the largest food safety issues in China are still foodborne diseases, most of which are characterised by acute gastrointestinal illness (AGI). There is a lack of practical means to ensure the implementation of foodborne disease surveillance system improvement. Since only a few cases with AGI seek medical care or submit a specimen for laboratory testing which is then not routinely cultured for pathogens, the true burden of foodborne diseases in China is not clear. During 2010 and 2011, the Center for Food Safety Risk Assessment launched the foodborne diseases active surveillance pilot work in some provinces in China, and the results highlight the substantial burden of AGI cases. It is estimated that there were 202 million cases of foodborne disease in China in 1 year, which means that about 1 in 6.6 people experienced at least one episode of foodborne disease annually (unpublished data). China also needs to establish a foodborne disease active surveillance and traceability system from patients about food-originated pathogens by laboratory-based PULSENET (ChinaFoodNet). One objective is to enhance the ability to deal with emergencies like the outbreak of Escherichia coli O104:H4 in Germany. The rapid expansion of swine production and its potential role as a source of plasmid-mediated quinolone resistance (PMQR) genes in the environment highlights the importance of international co-operation to promote the prudent use of antibiotics in medical therapy, agriculture and animal hus­bandry, and supports the need for effective treatment of husbandry wastewater before its release into the environment. Our results imply that the corre­lation of PMQR genes between wastewater and paired farm soil is a valuable first step in the environmental risk assessment of PMQR genes, but further research is needed to better understand transfer mechanisms. We also recommend the establishment of programmes to monitor antibiotic resistance genes in the envi­ronment on a global scale in order to clarify the extent of potential risks to public health.
The common challenges faced by the world, such as environmental degradation and global foodborne disease outbreaks, together with the food safety issues manifested at the particular social stage of development, constitute the theme of food safety in China. Besides those listed above, there are many reasons for concern about food safety in China and for informing the public that the government is actively addressing these issues. There is still a lot of work to be done to solve the food safety problems in China and to address people's concerns.
Read the full article (subscription only): Journal of Epidemiology and Community Health

Health officials urge flu vaccination

Only about 2% of Chinese people have flu vaccinations each year

Public health specialists have urged more people to get flu shots this winter, as the killer virus continues to sweep the country.
Although influenza cases are "well within the normal range compared with last year", China's top health specialist Shu Yuelong warned that the number of people receiving vaccinations is still far lower than international levels, potentially putting lives at risk.
"Only about 2 percent of people on the Chinese mainland get flu shots each year," the director of the National Influenza Center, under
the Center for Disease Control and Prevention, said on Tuesday.
A total of 360 cases of H1N1 flu were reported between Dec 1 and Jan 6, including two people in Beijing who died. Another person also perished from a different strain.
Shu warned that outbreaks will last into March, "which might mean more deaths, particularly among children and the elderly," the most vulnerable groups.
H1N1 and H3N2, the two most prominent flu strains this season, may have even claimed more lives, he said.
Due to the current system of reporting casualties, as well as limited laboratory facilities at many health institutions, "a number of fatal flu cases may have gone undetected and instead been attributed to secondary complications, such as heart failure," Shu added.
Wang Lin, director of healthcare and disease prevention at the China-Japan Friendship Hospital in Beijing, said the number of people making appointments for shots had increased slightly.
The situation was different at the hospital's international medical unit, though, according to its director, Zhu Yuqing.
"We get about two or three foreigners coming for flu shots each day, similar to past years," she said.
And according to He Xiong, deputy director of the Beijing Center for Disease Control and Prevention, many clinics offering the vaccine in the capital had stopped giving shots due to a lack of demand.
He said about 1.7 million residents had received flu shots this winter, mostly elderly people and students.
Deng Haihua, spokesman for the Ministry of Health, said the flu virus had not mutated and "vaccines provide good protection from H1N1, H3N2 and the influenza B strain".
Source: China Daily

China shows east-west divide in public health funding

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by Tang Shenlang
One of the key objectives of China’s new health system reform is to improve equality and effectiveness of public health functions and services.
Since health reform was launched in 2009, the central and local governments have allocated RMB 15 Yuan per person to support public health programs. That level of funding has now increased to RMB 25 Yuan in 2012. One slogan used in China’s health sector is “Equalization of public health functions and services among different places of China.” Has such an objective been achieved or is it at least on the right track?
From my point of view, under the current fiscal decentralization system it would be formidably difficult to improve equity in public health between the developed and developing regions of China. Although the central government has developed policies to ensure that central and western parts of China receive a minimum of RMB 25 per capita from both the central and local governments, the gap between eastern coastal areas and western inland has continued to increase. For example, the Shanghai Municipal Government has allocated RMB 70-80 Yuan per person for public health services in recent years. Therefore, it is not surprising to see that the public health services offered there are significantly improved and much better than that provided at central and western parts of China.
Another challenge in the implementation of China’s public health reform is the lack of detailed guidelines on the effective use of funds to implement public health interventions. RMB 25 per person per year is not a lot of money for a district or county in China. The Ministry of Health has developed a long list of public health functions and services that local health authorities and/or the CDC can do with the funds allocated to them.
Several years ago, I worked on a DFID-funded health policy project in Weifang City in Shandong Province, and visited several community health centers. These community health centers, often responsible for a catchment area of as many as 2,000 individuals, received RMB 10 Yuan per capita for public health interventions. The local health authorities required these community health centers to offer up to 56 interventions, including non-communicable disease case management (e.g. hypertension, diabetes), infectious disease control (e.g. TB), health promotion and education, etc. It was nearly impossible for these community health centers to implement all these interventions, given such modest financial resources and lack of qualified personnel. A recent article published by the Bulletin of WHO also reported that village doctors did not find the financial subsides for the provision of public health services to be sufficient remuneration for their efforts.
My advice to China’s Ministry of Health is to work with different regions to prioritize the public health interventions based on their cost-effectiveness and the growing burden of disease. In addition, the central government should increase the financial resources provided to the poor regions to support effective public health programs. Otherwise, I cannot see how equity in public health functions and services in China can be improved.
Source: Duke University

Salt substitution reduces hypertension in Chinese people

Blood pressure was lowered by 4mm after replacing some sodium chloride with potassium chloride

by Michael Woodhead
Replacing regular salt with a potassium chloride-based  alternative may be an effective additional way to lower blood pressure for Chinese hypertensive patients, a study has shown.
Professor Zhou Beufan and colleagues from Beijing assessed the potential efficacy of replacing sodium chloride with potassium chloride for preventing hypertension in patients with hypertension and also in normotensive family member controls.
They conducted a double-blind, randomized controlled trial among 200 families in rural China to establish the two-year effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulfate) compared with normal salt (100% sodium chloride) on blood pressure.
Of the 372 people who completed the study, the mean overall difference in blood pressure between the two groups at the 24-month follow-up was 2 mm Hg for systolic BP and  and 2 mm Hg for diastolic BP. For the people with hypertension, there was a 4mm Hg overall decrease in systolic blood pressure, but diastolic blood pressure was not affected by salt use in the hypertensive group.
The researchers conclude that salt substitution lowers systolic blood pressure in hypertensive patients and lowers both systolic and diastolic blood pressure in normotensive controls.
"Salt substitution, therefore, may be an effective adjuvant therapy for hypertensive patients and [has] potential efficacy in preventing hypertension in normotensive individuals," they say.
Source: Journal of Human Hypertension

Immunisation halts Xinjiang polio outbreak

Immunisation has helped curb an outbreak of polio that affected 21 people and caused one death

WHO has confirmed that the Xinjiang region is clear of disease after last year's outbreak
China's disease control authorities will continue supporting the Xinjiang Uygur autonomous region to keep the region polio-free, a senior official has said.
Wang Yu, who heads the Chinese Center for Disease Control and Prevention, made the promise at a media event on Tuesday in Beijing to mark Xinjiang's continued polio-free status, which was confirmed by the World Health Organization at the end of last month.
Last year, there was an outbreak of polio in Xinjiang that entered the region from abroad. The 21 cases detected between August and October 2011 resulted in one death, and 17 people, including eight children, were paralyzed, according to the Ministry of Health.
Polio, or poliomyelitis, is a virus that infects the brain and spinal cord, mostly in children younger than 5 years old. One in every 200 cases leads to paralysis, usually of the legs.
"We've learned a lesson and will expand routine vaccinations in the area to avert future outbreaks," Wang said.
He said previous Chinese CDC studies showed that only 60 to 70 percent of Xinjiang residents had been vaccinated against polio, but 85 percent should be vaccinated to ward off an outbreak.
"In some areas the rate could be as low as 50 percent," he said.
In response, "the central government has allocated 160 million yuan ($25.7 million) to improve local public health services", Wang said.
Vaccination agencies will all be equipped with appliances to store vaccines at the necessary low temperatures, he said.
A suspected-case reporting system will be established at local hospitals to detect possible infections as soon as possible, he added.
In addition, border surveillance will be beefed up to prevent polio from entering China from abroad, he said.
According to Luo Huiming, deputy director of the National Immunization Program under the Chinese CDC, the outbreak last year was the first to come from abroad since 2000.
Because Xinjiang borders Pakistan and Afghanistan, where polio is endemic, "it's still at risk of infections, which know no boundaries", Luo said.
"We have to ensure comprehensive polio vaccination in the area to protect people from the disease," he said, adding that greater efforts should be made to raise vaccination awareness, particularly among ethnic groups.
"Thanks to assistance from the WHO and UNICEF, we launched a massive polio vaccination program in Xinjiang and regained the polio-free status within a short time," he said.
Five large-scale vaccination campaigns have been carried out in Xinjiang between September 2011 and April 2012, and at least 43 million doses of polio vaccine were given to children and adults.
According to the WHO, Chinese governments at all levels spent more than 340 million yuan for the response effort.
Michael O'Leary, the WHO representative in China, said that the 2011 polio outbreak showed that no place was safe until the crippling and lethal infection is eradicated worldwide.
With vaccination being the only means of prevention, it's crucial to strive for and maintain high immunization coverage, he added.
Luo Huiming agreed and recalled some difficulties during the massive vaccination campaigns.
Some local people refused at first to get vaccinated because of ethnic traditions, he said.
"Some even confused vaccination with family planning — the two sound similar in Chinese," he said.
"But with great patience we informed them of the importance of vaccination, and most finally said yes," he said, adding that the vaccination programs were free and voluntary.
A 33-year-old Uygur resident of Kashgar, Xinjiang, who gave his name as Parhat, was vaccinated during the campaigns.
"People younger than 40 in southern Xinjiang were advised to get the polio vaccine, so I did. I took the 'sugar pill' vaccine twice for free at the community center since last September," he said.
"Before taking the vaccine, I read and signed the notice about possible side effects after taking the pill. I had a fever after taking the vaccine, but the day after I was fine," he said.
Source: China Daily

China launches national anti-smoking plan

Anti-smoking plan aims to cut China's smoking rate to 25% of population by 2015

China has published a plan to reduce the world’s largest population of smokers as part of a 2005 treaty, without implementing recommendations such as warning labels that include photos of rotten teeth and diseased lungs.
China plans to cut the number of smokers to 25 percent of the population by 2015 from 28.1 percent in 2010, according to the plan published by the Ministry of Industry and Information Technology yesterday, seven years after the country signed the treaty that recommends the graphic warning labels.
The government will “comprehensively” prohibit smoking in public places and ban ads, promotion and sponsorship by tobacco companies, according to the plan. There is no mention of tax rates in the plan.
China has more than 300 million smokers, including half the adult male population, and about 740 million people are exposed to second-hand smoke risks, the ministry said. The tobacco industry accounts for 20 million jobs and contributed 6 percent of fiscal revenues in 2010, the ministry said.
“The plan carries a heavy smell of cigarettes,” Wu Yiqun, a director at the Beijing-based ThinkTank Research Center for Health Development. “It’s a compromise result between the tobacco industry and the Health Ministry, and it seems the tobacco side has the upper hand.” The State Tobacco Monopoly Administration was involved in the plan’s preparation.
Wu, a former deputy director at the Chinese Center for Disease Control and Prevention, singled out the lack of graphic photos as a weakness. Australia, Canada and most European Union members have introduced such warnings or have agreed to do so, according to the World Health Organization website.
“It means China’s tobacco control efforts will be weak compared to mainstream international practices,” Wu said. The lack of any plan to increase taxes on tobacco is another weakness, she said.
The WHO recommended in March that China should almost triple excise taxes on tobacco products to 70 percent from 26 percent, to dissuade young people from taking up the habit. Half of the country’s smokers spend 5 yuan (80 cents) or less for a packet of 20 cigarettes, the WHO said.
Smoking, which is linked to 1 million deaths a year in China, is endangering the labor force, Health Minister Chen Zhu said in April.
Using cigarettes as gifts or gestures of friendship is still a popular practice in the country, and many poor regions rely on the industry to generate jobs and fiscal revenue, the industry ministry said.
Cigarette production and consumption in China both increased by 3 percent last year, according to data from Bloomberg Industries. China’s share of world cigarette consumption increased to 40 percent last year from 35 percent in 2006. Consumption in the rest of the world has declined steadily since 2000.
The brother of Chinese Vice Premier Li Keqiang should be removed from his post as a top official in China’s state-owned tobacco monopoly to avoid conflicts of interest, according to a report published by the Washington-based Brookings Institution in October. Li last month took the No.2 position in China’s new leadership and is now oversees public health.
China’s new tobacco plan was jointly prepared by the ministries of industry, health, finance and foreign affairs; and the general administrations of tobacco, customs, safety and industry and commerce.
Source: Bloomberg

PM2.5 pollution from coal burning kills 9000 a year and costs $1 billion

Report shows the high health costs of fine particle pollution in four Chinese cities

An estimated 8,572 premature deaths occurred in four major Chinese cities in 2012, due to high levels of PM2.5 pollution, a joint study by Greenpeace East Asia and Peking University’s School of Public Health has concluded.
The report also estimates PM2.5 pollution caused the cities of Shanghai, Guangzhou, Xi’an and Beijing to suffer a combined total of US$1.08 billion in economic losses over the past year. Greenpeace is calling for an urgent policy adjustment, including capping regional coal consumption, De-NOx retrofiting for existing coal-fired power plants, and shutting down inefficient coal-fired industrial boilers.
The report “PM2.5: Measuring the human health and economic impacts on China's largest cities” states that if these cities can effectively lower their PM2.5 levels to meet the World Health Organization’s Air Quality Guidelines (WHO AQG), such deaths would be reduced by at least 81%, and the economic losses for these four cities could be reduced by $US868 million. Unfortunately no cities currently have a timeline to meet WHO AQG.
“PM2.5 is putting public health at high risk every day, but worse still, if we follow the current official plans we would need to wait 20 years to get to the national standard, which is still risky compared to the WHO guidelines,” said Greenpeace campaigner Zhou Rong. “Who can afford the wait?” Greenpeace is calling for a concrete and ambitious timetable to tackle PM2.5 pollution, thus improving the air quality to reach the health standard set out by WHO AQG.
For the report, researchers from Greenpeace and Peking University’s School of Public Health studied the impact of PM2.5 in Beijing, Shanghai, Guangzhou and Xi’an, which represented major urban centres in China’s north, east, south and west respectively.
“Besides saving a lot of human lives, combating PM2.5 can also significantly reduce the national cost on health care,” said Zhou Rong. Taking Beijing as an example, the report found the Chinese capital experienced a loss of US$328 million in 2012 because of PM2.5 pollution. But had it reached WHO AQG, US$283 million could have been saved. (For details please refer to the media briefing paper section three).
Recent statistics from China’s Ministry of Environmental Protection (MEP) show cities in China’s Yangtze River Delta, Pearl River Delta, and Beijing-Tianjin-Hebei region suffered over 100 hazy days a year with PM2.5 concentration two to four times above World Health Organization guidelines. The effects of PM2.5-related air pollution extend beyond hazy days, also leading to systematic damage to human health.
PM2.5 is small in particle size but as pollution can reach a large surface area. It is more prone to carrying a variety of toxic heavy metals, acid oxides, organic pollutants and other chemicals, as well as microorganisms such as bacteria and viruses in the air. When inhaled, it can enter a person’s blood stream. Exposure to PM2.5 can contribute to cardiovascular, cerebrovascular and respiratory diseases, as well as greater cancer risks, all leading to a significantly higher mortality rate.
Studies have shown PM2.5 is most prevalant in the combustion of coal. Since the majority of China’s energy comes from coal plants, Greenpeace is urging regional governments to cap coal consumption.
Greenpeace is also calling on the local governments in key regions to go beyond requirements raised by recent MEP plans, and to take ambitious steps to set up specific air quality improvement plans, including detailed PM2.5 pollution reduction timelines.
Source: Greenpeace

Guangzhou gong for Brum doc

Prof KK Cheng of Birmingham University

The government of Guangzhou has named University of Birmingham public health researcher Professor KK Cheng as an honorary citizen.
The prestigious honour was bestowed by Mr Wan Qingliang, Party Secretary of the CPC Guangzhou and Mr Chen Jianhua, Mayor of Guangzhou at an official ceremony in the city last week.
Professor Cheng has a longstanding and active relationship with Guangzhou and has led the University’s academic interests in its most significant engagement in China to date - The University of Birmingham Guangzhou Centre, a landmark partnership between the University and the Guangzhou Municipal Government.
For over 10 years, Professor Cheng has been at the forefront of a pioneering public health project in Guangzhou. The Guangzhou Biobank Cohort Study (GBCS) is a collaborative research project between the Guangzhou Number 12 People's Hospital and the Universities of Birmingham and Hong Kong, which is following up 30,000 men and women over 50 in Guangzhou.
This project is recognised internationally as an important platform that supports research on the role of genetic, lifestyle, occupational, environmental and life course factors in common chronic diseases.
Since 2006, the study has produced over 80 papers and has made important contributions to policy making in China and beyond. The main long-term aim of the study is to examine the effects of genetic and environmental influences on health and chronic disease development (particularly circulatory disease, chronic respiratory disease, cancer and dementia).  In addition to being a fruitful scientific study, it has provided a strong launch pad for the University's development in Guangzhou.
Source: Birmingham University

Beijing mums and babies have severe vitamin D deficiency

More than 50% of pregnant women had vitamin D deficiency

by Michael Woodhead
Pregnant women living in Beijing are at high risk of vitamin D deficiency, and many babies are born underweight because their mothers lack of the vitamin, Chinese researchers have shown
Clinicians from the Department of Pathology and Experimental Medicine at the 306 Hospital of PLA, Beijing measured vitamin D levels [25-hydroxyvitamin D (25(OH)D] in seventy pregnant woman and also analysed the health of their babies
They found severe vitamin D deficiency  (levels below 25 nmol/l) in 55 % of mothers and 47 % of newborns. Neither mothers nor newborns had vitamin D concentrations that reached the normal level (over 75 nmol/l). In addition the levels of vitamin D in mothers was positively correlated with that in the unborn (i.e. in placental cord blood). The research show that newborns of mothers with severe vitamin D deficiency had lower birth length and birth weight. The baby's head circumference and birth weight were lower in vitamin D-deficient newborns.
"[Our] study indicates that pregnant women and neonates residing in Beijing are at high risk of vitamin D deficiency.  [Vitamin D] concentrations are dependently related to maternal 25(OH)D levels. Maternal and neonatal vitamin D status influences newborn size," the researchers conclude.
Read more: Public Health Nutrition

Avian flu risk spikes at Chinese New Year due to busy poultry markets

Poultry markets promote spread of avian flu during the Spring Festival

by Michael Woodhead
The live poultry trade in Southern China has been linked to increased transmission of life-threatening avian H5N1 inlfuenza infection around the time of Chinese New Year Festivities.
According to researchers from the UN Food and Agriculture Organization H5N1 Programme in Beijing, sporadic avian flu infections in poultry and humans are still occurring in China. The researchers therefore investigated seasonal patterns in links between the movement of live poultry originating from southern China and HPAIV H5N1 infection in four wholesale live bird markets (LBMs) in Hunan and Guangxi provinces of South China. They found that seasonal differences in the live poultry trade in Southern China around the Chinese New Year festivities were associated with higher HPAIV H5N1 infection risk in humans and poultry.
The researchers found that the geographical extent of poultry trade was greater during February compared to other months surveyed "indicating that the marketing chain of poultry products originating in south China can reach wider geographical coverage during this month. These widespread poultry trading patterns at Chinese New year "are likely to pose considerable challenges for the containment of HPAIV H5N1, they say.
"Taken together, these results highlight the role of live bird markets in South China in facilitating the seasonal movement of live poultry between southern and northern provinces of China, probably due to the high demand during and shortly after the Chinese New Year festivities."
Read more: PLOS One

Vitamin D deficiency is common among Shanghai residents

Shanghai is located on the eastern coast of China, with a subtropical latitude of 31°N, where vitamin D deficiency is assumed not to be a clinical problem due to the abundant sunshine. However, the results of a new study challenge this assumption. Research by clinicians from Shanghai Jiao Tong University Affiliated Sixth People's Hospital has shown there here is a high prevalence of vitamin D insufficiency and/or deficiency among healthy adults living in Shanghai during the winter season.
The study involved 649 men and 1939 women aged 20–89 years who were randomly sampled in Shanghai.  During the winter season, the prevalence of vitamin D insufficiency (defined as a level below 30 ng/mL) was 84% in males and 89% in females. The prevalence of vitamin D deficiency (defined as below 20 ng/mL) was 30% in males and 46% in females.
The results of the study confirm the observation that vitamin D deficiency and/or insufficiency is endemic in urban Chinese.
Read more: PLOS One

Urban Chinese: 15% are obese and 19% are overweight

Obesity and overweight have become epidemic in urban populations in China; and associations of risk factors with obesity differ between men and women.
A sample of 25,196 urban adults aged 18 to 74 years in Northeast China was selected and measurements of height, weight and waist circumference were taken from 2009-2010. Definitions of overweight and obesity by the WHO were used. The overall prevalence rates of general obesity and overweight classified by BMI were 15.0% (15.7% for men and 14.3% for women) and 19.2% (20.8% for men and 17.7% for women), respectively, and the overall prevalence rate of abdominal obesity was 37.6% (31.1% for men and women 43.9% for women). The elderly and those who had a history of parental obesity, alcohol drinking, or former cigarette smoking were at high risk of obesity classified by BMI or waist circumference, whereas those with a higher level of education, higher family income, or a healthy and balanced diet were at low risk of obesity. Men with a higher level education level, a white-collar job, a cadre job, or higher family income were the high risk group, and women with a higher level of education or higher family income were the low risk group.

Read more: BMC Public Health

Ma Zhengzhou: An AIDS Relief Practitioner on the Frontlines

As part of her series on NGOs in Anhui, CDB Senior Staff Writer, Guo Ting, tells the bittersweet story of an AIDS relief practitioner’s ultimately successful efforts to set up a Chi Heng Foundation office in Anhui province, register it as a NGO and deliver financial assistance to HIV-infected families in the area. Ma Zhengzhou’s story reveals the difficulties faced by NGO practitioners in China yet also illustrates how they can overcome those difficulties by persisting through adversity and rejection, and building good relations with local GONGOs.
At the end of 2011, I received an anonymous reader’s letter.  The letter in fact consisted of only a single line, "please pay attention to the tragic fate of rural HIV-infected people," while the body was completely empty, without a name or contact details.  Curious, I wrote back to seek an understanding of the writer: He was Xiao Dai, a young man from rural northern Anhui, whose parents contracted HIV through blood transfusions in the 1990’s, bringing further hardship to this already poor family.  He had to study hard to secure a place at a university, and yet he arrived  carrying his bedroll, unable to pay his tuition, and prepared to be rejected and head south to do manual work.  He avoided this fate thanks to the generosity of the Chi Heng Foundation (智行基金会), an organization that provides financial aid to children affected by AIDS and which, having learned of his situation, provided tuition fees and living expenses.  Today Xiao Dai has graduated and is married with children.
Read more: China Development Brief

Doctors say face masks have no proven health benefits

Doctors say consumers should be wary of claims that masks filter out tiny PM2.5 particles as China so far has no regulations governing the masks and some may cause respiratory problems.
Many different masks are available, such as medical masks, activated carbon masks and industrial masks, in drugstores, supermarkets and online for "PM2.5 protection."
In a Shanghai drugstore on Jiangning Road, a medical mask with activated carbon costs 10 yuan (US$16). A sales clerk said she didn't know whether the mask can stop PM2.5 particles.
In some online stores, however, vendors boast that masks costing from 3 to 20 yuan stop PM2.5 particles. None, however, have the certificates that could help prove their claims.
"Right now there is no quality standard or guideline on PM2.5 protection masks and most so-called protection masks just use ordinary materials without proof of their effects," said Zhao Danqing from Shanghai Sinotextiles Co, which makes masks.
"With the public awareness of air pollution, making masks is such a profitable business. The government must issue a quality guideline to regulate the market and ensure public health," said Zhao.
Activated carbon masks and ordinary medical masks can't stop PM2.5 particles, while activated carbon itself produces particles, doctors warned.
Some industrial masks can block PM2.5, but they are not for daily use.
They may cause adverse reactions in people with heart disease or respiratory illness because they can limit air intake, experts said.

Read more: Shanghai Daily