Hepatitis B, TB common as infectious diseases rise in China

Although SARS infection rates in China steadied after the 2003 outbreak, researchers reported in The Lancet Infectious Diseases that the country needs improved measures to control diseases such as hepatitis B, tuberculosis and hand, foot and mouth disease.

“The SARS tragedy in 2003 greatly afflicted China and revealed the shortcomings of China’s infectious disease prevention system, propelling the Chinese government to accelerate reforms,” Shigui Yang, PhD, of the First Affiliated Hospital, Zhejiang University, Hangzhou, China, and colleagues wrote. “Understanding the epidemiological distribution of infectious diseases is the most important task for controlling infectious diseases. However, the specific geographic patterns and temporal trends of major infectious diseases in the post-SARS era have been researched rarely.”

The researchers evaluated the incidence and mortality of 45 different infectious diseases from January 2004 to December 2013 using a Chinese public health database that covered 31 provinces in mainland China. Yang and colleagues used joinpoint regression to estimate the annual percentage chance in the incidence of each disease.

Across all 45 infections included in the study, the researchers identified a total of 54,984,661 cases for a mean yearly incidence of 417.98 cases per 100,000 population, according to Yang and colleagues. Hand, foot and mouth disease was the most common infection (114.48 per 100,000), followed by hepatitis B (81.57 per 100,000) and tuberculosis (80.33 per 100,000). A total of 132,681 deaths were reported. The average yearly mortality rate was 1.01 deaths per 100,000 population, whereas the average case mortality rate was 2.4 per 1,000 population.

Yang and colleagues wrote that the overall incidence of infectious disease each year was greater in men than in women, with the highest incidence occurring in children aged younger than 10 years. In patients aged older than 20 years, men showed a greater yearly mortality than women. Overall, mortality was greatest in patients aged older than 80 years.

The annual mean incidence of infectious disease rose from 300.5 cases per 100,000 population in 2004 to 483.6 cases per 100,000 population in 2013, the researchers wrote. Hydatid disease (24%), hepatitis C (19.2%), syphilis (16.3%) and HIV (16.3%) showed the fastest annual growth rates.

Despite this increase, Yang and colleagues reported that the increase slowed overtime, dropping from an annual 6.2% increase from 2004 to 2008 to a 2.3% annual increase from 2009 onward.

“The epidemiology and comparative burden of communicable disease determines which diseases warrant public health resources and intervention,” Katherine Gibney, of the Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Australia, and Robert Hall, MPH, FRACMA, FAFPHM, FPHAA, senior lecturer in

the department of epidemiology and preventive medicine at Monash University, Melbourne, wrote in an accompanying editorial. “In a country as large as China, identification of the communicable disease causing the greatest burden and the population groups most affected by specific diseases is a massive, and very important, undertaking. The findings should be used by public health decision makers — both provincial and national — to prioritize diseases and populations for public health action.” – by Andy Polhamus

Disclosure: Gibney reports salary support from the National Health and Medical Research Council of Australia. Hall reports no relevant financial disclosures. The researchers report no relevant financial disclosures.