Objective To analyze the characteristics of viral load variations and their influencing factors among patients during the chikungunya fever outbreak in Guangdong Province in 2025, providing a scientific basis for precise assessment and the formulation of intervention and management measures. Methods Data of Chikungunya fever cases in Guangdong Province from July 18 to November 5, 2025, were extracted from the China Disease Control and Prevention Information System and the Guangdong Provincial Field Epidemiological Investigation System. The cycle threshold (Ct value) obtained from real-time fluorescence quantitative RT-PCR testing of chikungunya virus nucleic acid in case samples was analyzed to examine its variation characteristics over the course of the disease and the influencing factors. Results A total of 4 409 patients were included in the analysis, with age of 39.41±19.98 years and Ct value of 25.06±5.52. The distribution of Ct values showed an inverted U-shaped pattern across different age groups. In the multivariate analysis, elderly individuals (≥65 years) had lower Ct values than those aged 18-<65 years, and the difference was statistically significant (P<0.001). Children (<6 years) also had lower Ct values compared with the 118-<65 age group, but the difference was not statistically significant (P=0.093). Ct values gradually increased over time after disease onset, with a more gradual increasing trend in elderly and pediatric populations. Multivariate regression analysis indicated that elderly patients (≥65 years) had lower Ct values (β=-3.21, 95%CI: -3.68 to -2.73), while those from the eastern Guangdong (β=0.82, 95%CI: 0.37 to 1.28) and those with a longer interval from disease onset to detection (β=1.14, 95%CI: 1.05 to 1.24) had higher Ct values. After adjusting for basic characteristics, fever (β=-3.06, 95%CI: -4.09 to -2.04) and arthralgia (β=-2.64, 95%CI: -3.60 to -1.69) were associated with lower Ct values, while rash (β=1.60, 95%CI: 0.78 to 2.41) was associated with higher Ct values. Conclusion The viral load of Chikungunya patients in Guangdong Province in 2025 varied across different disease courses, age groups, and symptomatic populations, which can be integrated into infection risk assessments. Special attention should be given to elderly and pediatric patients, and timely intervention should be provided for patients presenting with fever and arthralgia.
Objective To establish a universal real-time reverse transcription polymerase chain reaction (RT-PCR) method for rapid and specific detection of all lineages of the Chikungunya virus (CHIKV). Methods Specific primers and TaqMan probes were designed and synthesized targeting the major CHIKV lineages, including the Asian genotype, the East-Central-South African (ECSA) genotype-Central African clade, the ECSA genotype-Indian Ocean lineage, and the West African genotype. A real-time RT-PCR detection system was subsequently established. The specificity, repeatability, reproducibility, and limit of detection (LOD) of the method were systematically evaluated and validated. Finally, the developed assay was applied to clinical samples for validation. Results A pan-lineage real-time RT-PCR assay for CHIKV detection was successfully developed. The sensitivity of the assay reached 200 copies/mL for all three major CHIKV lineages. The coefficients of variation for repeatability were 1.51%, 0.95%, 0.97%, and 0.69%, and those for reproducibility were 0.76%, 1.57%, 1.07%, and 1.08%, demonstrating excellent repeatability and reproducibility. Specificity testing showed no cross-reactivity with dengue virus (serotypes 1-4), Zika virus, or yellow fever virus genes, confirming good specificity. In a prospective clinical evaluation of 1 740 samples, the assay correctly identified all 24 CHIKV-positive samples, with a detection rate of 100% (24/24) and Ct values ranging from 18 to 35. Notably, no false positives were detected in the remaining 1 716 CHIKV-negative samples, which comprised a challenging panel of 64 dengue virus-positive cases, 76 malaria-positive cases, and 1 576 other negative controls. This demonstrates the method's excellent clinical sensitivity and specificity. Conclusion The real-time RT-PCR method established in this study enables rapid, sensitive, and specific detection of CHIKV, and is suitable for early clinical diagnosis of CHIKV infection.
Objective To analyze the epidemiological characteristics of confirmed chikungunya fever cases reported in Sichuan Province in 2025, with a focus on the epidemiological features and emergency response to the first local outbreak in a county of Sichuan Province in October, and to provide a scientific basis for the surveillance, early warning, prevention, and control of mosquito-borne infectious diseases. Methods Case data were derived from individual records of confirmed chikungunya fever cases with current residence in Sichuan Province reported in 2025 through the National Notifiable Infectious Disease Reporting Information Management System, as well as epidemiological investigation reports of cases involved in the outbreak. Data collation and statistical analysis were performed using Excel 2016 software. Results In 2025, a total of 363 confirmed cases of Chikungunya fever were reported in Sichuan Province, of which 341 (93.94%) were locally acquired. The incidence peaked in October, accounting for 326 cases (89.81%). Nanchong City reported the highest number of cases (302, 83.20%), exhibiting a unimodal outbreak pattern. The county-level outbreak documented 282 confirmed cases, with a male-to-female ratio of 0.71∶1 and a mean age of (46.03±25.07) years. Farmers accounted for the largest occupational group (49.65%). Cases were mostly localized in the county's urban area, accounting for 271 cases (96.10%). The epidemic persisted for 12 days, demonstrating a fast onset and prompt remission. The predominant clinical manifestation was arthralgia (85.11%), followed by fever (64.54%) and rash (30.50%); only 17.02% of cases presented with the classic triad of symptoms simultaneously. Through a four-tier coordinated command system, grid-based management, and expedited mosquito vector treatment, the Breteau Index (BI) and net trap index (NTI) declined rapidly to safe levels, facilitating prompt containment of the epidemic. All cases received timely treatment, with no severe cases or deaths. Conclusion The 2025 chikungunya fever epidemic in Sichuan Province exhibited a distinct seasonal peak and pronounced local clustering. The epidemic signifies that chikungunya fever has established local transmission in Category Ⅱ inland regions of China, marked by rapid onset and unusual clinical presentations. Enhancing early monitoring throughout the epidemic season, improving clinical recognition capacity, and establishing an efficient emergency response system and precise mosquito vector control framework are essential for controlling mosquito-borne infectious illnesses.
Objective To evaluate the repellent efficacy of Atractylodes lancea essential oil against Aedes albopictus and to analyze its active constituents, so as to provide a reference for the further development and application of botanical repellents. Methods A. albopictus was used as the subject, a three-part tube screening assay was employed to test the repellent effect of the essential oil. The repellent performance and persistence on both fabric and human skin were assessed, according to the industry standard and the national standard. Gas chromatography-electroantennographic detection (GC-EAD) and gas chromatography-mass spectrometry (GC-MS) were utilized to screen and identify the active components in the essential oil that elicit electrophysiological responses in mosquitoes. Results Behavioral assays demonstrated Atractylodes lancea essential oil had significant repellent efficacy, with a repellency rate of 95.35% at a 4.0% concentration. Human skin tests revealed that the mean complete protection times of essential oil solutions for 10.0% and 20.0% were 8.4 hours and 8.6 hours, respectively. Fabric repellent tests revealed that 10.0% and 20.0% of essential oil solution did not achieve the standard for complete protection. GC-EAD recordings indicated that the essential oil elicited electrophysiological responses in mosquitoes. Through GC-EAD screening combined with GC-MS analysis, 15 potential active constituents, including β-eudesmol, cyperotundone, and atractylodin, were identified. Conclusion Atractylodes lancea essential oil is an efficient natural repellent that exhibits excellent repellent activity even at relatively low concentrations. Its mechanism of action may involve interference with the mosquito olfactory system by its volatile components.
Objective To analyze epidemiological and clinical characteristics of chikungunya fever cases in Hubei Province in 2025, and to provide a scientific basis for epidemic prevention and control strategies. Methods Data on all chikungunya fever cases reported in Hubei Province in 2025 were collected from the Infectious Disease Surveillance and Reporting System of the China Disease Control and Prevention Information System. Descriptive epidemiological methods were used to analyze the temporal, spatial, and population distribution, as well as clinical characteristics. Non-parametric tests were employed to analyze the impact of healthcare-seeking behaviors on the interval from first consultation to diagnosis. Results A total of 74 chikungunya fever cases were reported in Hubei Province in 2025, including 71 confirmed cases and 3 asymptomatic infections, with an incidence rate of 0.124 4/100 000, and no severe or fatal cases were reported. Among these, 48 cases (64.86%) were imported from other provinces, mainly from Guangdong Province (95.83%), and 26 cases (35.14%) were local cases, predominantly distributed in Wuhan City (19 cases). The reported cases were concentrated from August to October (68/74, 91.89%), with a peak in October (53 cases). The majority of cases (57/74, 77.03%) were aged 18 to <60 years. The top three occupational groups were housework/unemployed/retired personnel (21/74, 28.38%), farmers/migrant workers (18/74, 24.32%), and students/children (14/74, 18.92%). The main clinical manifestations included fever (63/74, 85.14%), arthralgia (51/74, 68.92%), and rash (44.59%). Arthralgia most commonly involved the wrists, knees, and ankles. The Ct value of viral nucleic acid was 27.02±5.68, with no statistically significant differences across age groups or occupations (P>0.05). However, Ct values differed significantly among different sampling time groups (H=9.203, P<0.05), with the viral load was higher in the early stage (≤3 days) of the disease. Healthcare-seeking behavior analysis showed that 52.70% of cases first visited primary healthcare facilities, and the interval from first visit to laboratory confirmation was significantly longer than those who first visited tertiary medical institutions (U=331.50, P<0.05). Two or more visits (U=276.50, P<0.05) and the need for upward referral (U=247.50, P<0.05) were also associated with significantly prolonged diagnosis time. Conclusion Chikungunya fever cases were predominantly imported in Hubei Province in 2025, with distinct seasonality. The occupations were mainly unemployed/retired people and farmers/migrant workers. The majority of cases were mild. However, insufficient diagnostic capacity and recognition of chikungunya fever at primary healthcare facilities led to delays in laboratory confirmation. It is recommended to strengthen training for primary healthcare staff, optimize referral mechanisms, and improve early recognition and rapid response capabilities to prevent local transmission triggered by imported cases.
Objective To investigate changes in resistance of Aedes albopictus to insecticides in core areas before and after the emergency response to dengue and chikungunya outbreaks in Hainan Province in 2025, and to explore rational insecticide application strategies for short-term outbreak recurrence. Methods In 2025, Aedes albopictus larvae were collected from the core areas of dengue fever and chikungunya fever outbreaks in Haikou, Wuzhishan, and Sanya before and after emergency response and disposal. The collected larvae were reared under laboratory conditions to the first-filial-generation adults. Insecticide resistance was assessed by the adult contact diagnostic dose method, with adult mortality used to evaluate resistance changes following outbreak disposal. The χ2 test was employed to analyze changes in Aedes albopictus mortality to insecticides, and Pearson correlation analysis was performed to examine inter-insecticide associations. Results Prior to emergency response and disposal, Aedes albopictus populations from Haikou, Sanya and Wuzhishan cities demonstrated suspected resistance to propoxur, with 97.53%, 96.67% and 95.35% mortality; populations from Haikou and Wuzhishan cities showed resistance to fenitrothion, with mortality rates of 75.32% and 70.37%; the Sanya population demonstrated susceptibility to fenitrothion, with a mortality rate of 98.78%; populations from Haikou, Sanya and Wuzhishan cities demonstrated resistance to deltamethrin, permethrin and lambda-cyhalothrin. Following emergency response and disposal, resistance-associated mortality further declined across populations. In Haikou City, mortality to propoxur decreased to 53.49%. Mortality to fenitrothion showed a significant decrease (χ2=4.32, P<0.05), while mortality to deltamethrin, permethrin, and lambda-cyhalothrin remained unchanged. In Wuzhishan City, mortality to all tested insecticides declined, with significant decreases observed for propoxur and permethrin (χ2=5.65 and 29.6, respectively; P<0.05 for both). In Sanya City, the resistance level to fenitrothion increased, with mortality rising to 95.29%; mortality to propoxur, deltamethrin, permethrin, and lambda-cyhalothrin declined, with significant decreases observed for propoxur, deltamethrin, and permethrin (χ2=7.61, 21.90, and 54.70, respectively; P<0.05 for all). A very strong positive correlation was observed between mortality to deltamethrin and fenitrothion (r=0.789, 0.05<P=0.062<0.1). No significant correlations were observed among mortality rates to the other insecticides (P>0.1). Conclusion Large-scale insecticide application during the epidemic response exacerbated the resistance of Aedes albopictus to insecticides. It is recommended that, during short-term outbreak recurrence, insecticide application be guided by resistance profiles, environmental management measures such as breeding site elimination be strengthened, and insecticide use be strategically reduced to slow the development of resistance.
Objective To analyze the epidemiological characteristics of chikungunya fever and mosquito vector emergency surveillance data in Heshan, Guangdong Province, from September to October 2025, evaluate the effectiveness of the implemented vector control measures, summarize the experience of epidemic control and prevention, and provide evidence for the early warning and precise prevention of similar mosquito-borne infectious diseases in the future. Methods Case report data of chikungunya fever and mosquito vector emergency surveillance data from epidemic sites were collected in Heshan City from September to October 2025. Descriptive epidemiological methods were used to analyze the temporal, spatial, and population distribution characteristics of the outbreak to clarify the epidemic features. The dynamic trends of the Breteau index (BI) and adult density index (ADI) were assessed during different phases of the outbreak. Spearman rank correlation analysis was employed to evaluate the correlation between daily new case numbers and mosquito density indices. Results From September to October 2025, a total of 2 302 cases of chikungunya fever were reported in Heshan, from September to October 2025, with the peak incidence concentrated between September 15 and October 3. The spatial distribution was highly concentrated, with 1 563 cases reported in Shaping Street, accounting for 67.90% (1 563/2 302) of the total reported cases. The affected population was primarily aged 45-64 years. Mosquito surveillance indicated that BI and ADI were high in the early stage of the outbreak, but decreased to safe thresholds (BI<5, ADI<2) within approximately one week after intervention. Correlation analysis showed a significant positive correlation between daily case numbers with both BI and ADI (rs=0.96, 0.93; P<0.001), suggesting that vector density was a critical driver of transmission. It took about 23 days from the time mosquito indices reached safe levels to a low-level sporadic phase. The chikungunya outbreak exhibited distinct spatiotemporal and population clustering characteristics, with case occurrence highly correlated with mosquito density. Conclusion Early and intensive mosquito control measures effectively interrupted the transmission chain. However, the subsidence of the outbreak featured a "plateau phase" and a "trailing phase", indicating that sustained case surveillance and refined vector management remain necessary even after mosquito density reaches safe levels, to prevent resurgence of the outbreak.
Objective To analyze the epidemiological characteristics and risk factors for local transmission of chikungunya cases in Shenzhen City in 2025, providing scientific evidence for precise prevention and control of mosquito-borne diseases in megacities. Methods The socio-demographic and spatio-temporal distribution of cases were analyzed; Spearman's cross-correlation and negative binomial regression were used to examine the lagged association between incidence and population inflow. Global and local spatial autocorrelation analyses together with hotspot shift analysis were conducted to explore spatial clustering and evolutionary characteristics. Logistic regression models were used to identify risk factors for local transmission of imported cases. Results In 2025, a total of 818 chikungunya fever cases were reported in Shenzhen, comprising 313 imported cases and 505 local cases. Imported cases were mainly from Foshan and Guangzhou in Guangdong (125 cases, accounting for 39.94%), and Guangxi was the predominant source outside Guangdong (59 cases, 18.85%). The male-to-female ratio was 1∶0.6, with cases predominantly at working-aged 20-<50 years (537 cases, 65.6%). By occupation, workers accounted for 28.1%(230 cases) of all cases. The epidemic curve showing a unimodal distribution, with the incidence peak on October 11 (54 cases, accounting for 6.6%). There was a 6-day lag association with the incidence and population inflow (Spearman r=0.164, P=0.039). For every 10 000 increase in population inflow, the daily number of cases increased by 4.2% (IRR=1.042, 95%CI: 1.026-1.060) after 6 days. There was a significant spatial clustering of cases(global Moran's I of imported cases =0.332 9, Z=4.94, P<0.001; Moran's I of local cases =0.253 4, Z=3.59, P<0.001). Over time, the epidemic hotspots in the city shifted from the peripheral areas toward the central urban area. Residence in urban villages was an independent risk factor for local transmission (OR=4.472, 95%CI: 1.928-11.739), while arthralgia symptoms (OR=0.459, 95%CI: 0.224-0.940) and self-medication (OR = 0.262, 95% CI: 0.041-0.931, likelihood ratio test P=0.037) were protective factors. Conclusion The chikungunya fever epidemic in Shenzhen was driven by population inflow from the Pearl River Delta region, forming high-risk clusters in central urban areas. Residence in urban villages significantly increases the risk of local transmission and should be prioritized for prevention and control. Arthralgia and self-medication reduce transmission, but mild cases pose a higher occult risk, necessitating enhanced health education and surveillance. It is recommended to establish cross-regional collaborative surveillance, focus on vector control in urban villages, and strictly implement mosquito prevention and isolation measures for mild cases.
Objective To analyze the epidemiological characteristics and influencing factors of chikungunya fever in Nanhai District, Foshan City, Guangdong Province in 2025, and to provide a reference for the development of local prevention and control measures. Methods A descriptive epidemiological analysis was conducted on 1 274 local cases. Chi-square tests, non-parametric tests, correlation and regression analyses were employed to examine the temporal, spatial, and demographic distribution, urban-rural disparities, the impact of population density, and the timeliness of case diagnosis. Results The epidemic lasted for 130 days, peaking in July. It affected 199 villages/communities across 7 towns/subdistricts, with Guicheng accounting for 46.94% of cases. The proportion of affected villages/communities was significantly higher in urban communities (92.96%) than in rural communities (61.01%) (P<0.001). Local transmission predominated (94.8%), yet the urban-rural distribution differed: locally acquired cases were more prevalent in rural communities (59.4%), whereas imported cases were concentrated in urban communities (66.7%) (P<0.001). Case count and density both correlated strongly with population density (r=0.860 and 0.865, P<0.05); for every 1000 people/km² increase in population density, an estimated 54 additional cases occurred. Cluster outbreaks (90 events, 73.55% of cases) were more common in urban settings (P<0.001). Cases were predominantly male (53.38%) and aged 30-<40 years. Occupationally, homemakers, the unemployed, and retirees constituted the largest groups. The mean time from onset to diagnosis was (2.17±1.31) days. Diagnosis delay was associated with infection acquired outside the district, diagnosis rendered outside the district, case reporting from primary-level medical institutions, and a healthcare-seeking distance of ≥20 km (P<0.05). Mosquito vector surveillance indicated that the density of Aedes albopictus had already exceeded the transmission risk threshold during the early phase of the epidemic (June-July). Conclusion The epidemic showed significant spatial clustering and pronounced urban-rural disparities. High population density was the key risk factor driving epidemic spread. Urban communities faced a higher incidence risk and a greater frequency of cluster outbreaks, and served as the main gateway for imported cases; rural communities, by contrast, were the principal zone of local transmission. Diagnostic delays highlighted deficiencies in cross-regional coordination, primary-care diagnostic capacity, and healthcare accessibility. Differentiated prevention and control strategies are recommended, along with strengthened regional joint-prevention mechanisms and primary-level capacity building.
Objective To analyze clinical characteristics of patients with chikungunya fever across different age groups in Nanning, Guangxi, in 2025, so as to provide evidence for the development of localized control and prevention strategies and clinical management. Methods A retrospective analysis was conducted on the clinical data of 197 confirmed chikungunya fever patients admitted to Nanning Fourth People's Hospital from August 12 to September 30, 2025. Patients were categorized by age into minors group (<18 years), youth group (18-<40 years), middle-aged group (40-<65 years), and elderly group (≥65 years). Clinical symptoms, signs, and laboratory findings were compared across groups. Results All 197 patients were of mild condition. Fever (84.77%), rash (86.80%), and arthralgia (88.32%) were the three typical core symptoms. The proportion of typical triad was 67.00%, predominantly in the minors (74.20%) and youth (75.00%) groups. The triad was the initial symptom in 27.92% of cases, followed by arthralgia (21.83%). The triad was the main initial symptoms in the minors and youth groups, whereas arthralgia was the predominant in middle-aged and elderly groups. Fever occurred in 85.27% of patients, with the highest incidence in the youth group (93.06%), 15.48% of the patients had a second fever. The time to fever onset was significantly earlier in the minors group compared to the elderly group, and the difference was statistically significant (P<0.05). Rash was primarily maculopapular, with the highest incidence in the youth group (94.44%). Pretibial erythema/edema was more common in the elderly group (37.04%). Secondary rash occurred in 39.18% of patients with rash. The incidence of arthralgia was highest in the middle-aged group (98.24%), and lowest in the minors group (77.42%), with a statistically significant difference (P<0.05). The elderly group experienced more severe arthralgia, with significantly higher proportions of moderate-to-severe pain, joint swelling, stiffness, and limited mobility compared to other groups (P<0.001). Superficial lymphadenopathy was observed in 20.30% of patients, with significantly higher incidence in the minors and youth groups compared to the elderly group (P<0.05). Laboratory results showed the highest C-reactive protein levels in the elderly group. The nucleic acid negative conversion rate was only 21.83% by day 7 of the disease course. Conclusion Clinical manifestations of chikungunya fever patients show significant age-related differences in the Nanning area. Adolescents and young adults predominantly present with rash and fever, while middle-aged and elderly patients exhibit more prominent and severe joint symptoms. The prolonged viral clearance time suggests the need for enhanced pre-discharge assessment and targeted health management.
Objective To analyze the epidemiological characteristics and control effectiveness of a local chikungunya fever outbreak in Quanzhou City, Fujian Province, in 2025, providing empirical evidence to continuously improve the investigation and response to locally acquired chikungunya fever outbreaks. Methods Field epidemiological investigation methods were employed to collect case information and emergency monitoring data on mosquito vector density from a local chikungunya fever outbreak in Fujian Province in 2025. Descriptive epidemiological methods were used to analyze the epidemic features. WPS Office software was utilized for statistical analysis of indicators including the epidemiological distribution of cases (time, place, and person), symptom profiles, and mosquito vector density. Results From August 24 to September 10, 2025, a local chikungunya fever outbreak occurred in Quanzhou City, Fujian Province, with a total of 164 confirmed cases. The median interval from onset to diagnosis was 1 (1, 2) days. This outbreak exhibited a typical unimodal distribution pattern, characterized by the coexistence of high clustering and sporadic cases. The virus demonstrated effective transmissibility across different populations and age groups. All 164 cases were mild, with no severe or fatal cases; 23 cases (14.02%) concurrently presented with fever, rash, and arthralgia. Following the activation of the emergency response and the implementation of comprehensive adult mosquito control measures in risk areas, both the Breteau Index and adult mosquito density fell below the safety threshold within 3 days, and the outbreak was effectively contained within 4 weeks. Conclusion Chikungunya fever spreads rapidly. Establishing a more sensitive surveillance case definition is crucial for achieving early case detection. A prompt response at the initial stage of the outbreak, together with organizing coordinated and efficient mosquito control operations in risk areas, are core measures for successfully interrupting the transmission chain of mosquito-borne diseases such as chikungunya fever and dengue fever.
Chikungunya fever is a viral infectious disease transmitted by the bite of Aedes aegypti and Ae. albopictus mosquitoes. It is widely prevalent in tropical and subtropical regions. The disease first broke out in Tanzania in 1952, and between 1952 and 2003, it was only endemc in Africa, Southeast and South Asia, however, since the outbreak of the disease in the Indian Ocean region in 2004, the epidemic has spread to Africa, Asia, Americas, Oceania, and Europe. As of the end of 2024, indigenous epidemics of chikungunya fever had occurred in 119 countries and regions around the world, and about three-quarters of the global population is at risk of infection by chikungunya virus (CHIKV). It has evolved into a globally rampant vector-borne infectious disease. The continuous expansion of the distribution areas of Ae. aegypti and Ae. albopictus, along with the enhanced adability of CHIKV to these mosquito vectors, and increased transmission efficiency, are the main causes of the pandemic of the disease. Since the beginning of 2025, outbreaks of the disease have resurfaced and shown a trend of diffusion in the Indian Ocean region, Central and South America, and Southeast Asia. Indigenous outbreak of the disease were occurred in Guangdong Province, China, 2025. Recently, the World Health Organization has an alert, urging member countries to strengthen their preparedness to deal with the epidemic. In this context, mastering the global epidemic situation of chikungunya fever, CHIKV genotypes, and factors influencing transmission, and further strengthening surveillance of imported cases and vector Aedes mosquitoes, prevention of cross-border transmission, and local outbreaks are important tasks currently facing China. This paper provides a review of the relevant research progress.
Chikungunya fever, as an important arthropod-borne infectious disease, is intrinsically linked to cross-border transmission and population mobility. This article systematically reviews research progress in China on the association between overseas labor export and the risk of chikungunya virus importation. It is found that China's overseas labor export shows a significant regional concentration feature, with Asia (especially Southeast Asia) and Africa being the main destinations, jointly accounting for approximately 80% of the total. Guangdong Province, as the main entry point for returning laborers, shows high concentration of laborers returning from Asia and Africa. Based on the global chikungunya fever epidemic data from 2020 to 2024 and traceability results from a 2025 outbreak in Guangdong Province, it is suggested that the return of overseas laborers is a key route for virus importation. Due to high exposure risk, delayed detection during entry quarantine, and delayed medical treatment upon returning home, laborers from chikungunya fever-endemic areas such as Southeast Asia and Africa have become a critical vulnerable link in the importation and transmission chain of arthropod-borne diseases in China, especially in Guangdong Province. In the future, it is necessary to strengthen multi-departmental collaboration and multi-source data integration, enhance the quarantine and epidemiological research on overseas laborers at ports of entry, and establish an arthropod-borne infectious disease importation risk assessment system based on the domestic and overseas mobility patterns, thereby providing scientific support for the effective prevention and control of local outbreaks of arthropod-borne infectious diseases.
Objective To analyze the investigation and disposal process of the first local chikungunya fever(CHIK) case in Shanghai, and to provide reference for the diagnosis, treatment and prevention of CHIK. Methods Epidemiological investigation was adopted for the case survey. Viral nucleic acid was detected by multiplex real-time fluorescent quantitative PCR. Risk areas of the epidemic foci were demarcated, and Aedes density monitoring was conducted using Breteau index method, double net trap method and BG-Trap method. Results The case presented symptoms such as fever, arthralgia, conjunctival hyperemia and rash; blood routine showed decreased white blood cell count and increased C-reactive protein. Laboratory test indicated that the Chikungunya virus nucleic acid was positive (Ct value: 21.92), and gene sequencing results showed that the virus strain was consistent with that of the imported case in the same community, both belonging to the East/Central/South African genotype. From October 10th, 2025 to the end of the epidemic, the mosquito vector density reached the safe level [Breteau index<5, tent trapping index<0.9 mosquitoes/(tent⋅hour)] in both the core area and the warning area of the epidemic site. The epidemic was finally ended on October 31st. Conclusion The case is the first local CHIK case in Shanghai. Early detection and isolation of the case, efficient implementation of mosquito vector monitoring and disinfection, and multi-department joint prevention and control are the keys to effectively curbing the local epidemic of CHIK.
Objective To obtain near-full-length HIV sequences using near-full-length gene amplification combined with next-generation sequencing, and to identify their recombination forms. Methods From two newly reported HIV-1 infected individuals in Liaoning Province in 2023 harboring potential URFs, near-full-length viral genomes were amplified from target samples using semi-genomic amplification technology. Near-full-length HIV genome sequences were acquired by next-generation sequencing (NGS), and the recombination analysis was performed using SimPlot and BootScan. Recombination fragments were validated through segmented phylogenetic trees. Results Two full-length sequences were ultimately obtained with lengths of 8 795 bp and 8 833 bp, respectively, covering all HIV structural genes. Phylogenetic and recombination analyses revealed that both sequences (LNJZ230022 and LNDL230042) possessed an HIV-1 subtype B backbone. LNJZ230022 sequence incorporated CRF07_BC and CRF01_AE gene fragments, with recombinations in gag and env regions and breakpoints at positions 803, 1147, 2120, 6323, 7758, and 9274 (HXB2). LNDL230042 was inserted by CRF07_BC gene fragments, with recombination regions in vpr and env and breakpoints at 779, 5608, 5870, 6745, 7541, and 9073 (HXB2). Sample LNDL230042 exhibited an N88T mutation at position 88 in the PR region, classified as moderate resistance, and an F53L mutation at position 53, indicating low-level resistance. Sample LNJZ230022 exhibited no resistance mutations. Conclusion By employing NGS to assemble full-length HIV genomes, we successfully identified two URFs from HIV-infected individuals in Liaoning and conducted detailed characterization of their recombination patterns. This approach captured large-scale recombination events in the env gp120 region, providing a critical molecular foundation for understanding recombination and immune escape in locally circulating strains. This study not only expands our understanding of HIV-1 genetic diversity and recombination trends in Liaoning Province but also demonstrates the feasibility and importance of using NGS to obtain near-full-length sequences for precise monitoring of novel circulating recombinant HIV-1 strains.
Objective To deeply analyze the epidemiological characteristics and trends of hepatitis E among the elderly population in eastern China, providing scientific data support for developing regional hepatitis E prevention and control strategies. Methods Incidence data on hepatitis E among individuals aged 60 years and above in eastern China from 2008 to 2022 were retrieved from China Disease Control and Prevention Information System. Descriptive methods were used to analyze the epidemiological distribution of the disease. Joinpoint regression analysis was performed to examine the temporal trends in reported incidence and age-standardized incidence rates. An age-period-cohort model was conducted to assess the independent effects of age, period, and birth cohort. Results The average annual age-standardized reported incidence rate (ASRIR) of hepatitis E among the elderly population was 5.42/100 000 in eastern China, which was higher in males (7.81/ 100 000) than in females (3.17/100 000). From 2008 to 2022, the ASRIR of hepatitis E in the elderly showed a downward trend in eastern China, with an average annual percentage change (AAPC) of -3.33% (-5.22% to -1.41%, P=0.003), and -4.19% (-6.01% to -2.33%, P<0.001) for males and -1.50% (-4.56%~1.67%, P=0.351) for females, respectively. The age-period-cohort analysis showed that the risk of hepatitis E decreased with age in the elderly in eastern China, with RR declining from 1.28 (95%CI: 1.17-1.41) in the 60-<65 years old group to 0.45 (95%CI: 0.38-0.53) in the ≥85 years old group. The period effect showed incidence of hepatitis E in the elderly showed a continuous downward trend from 2008 to 2022, with RR decreasing from 1.06 (95%CI: 0.99-1.13) in 2008-2012 to 0.70 (95%CI: 0.65-0.75) in 2018-2022. The cohort effect demonstrated the later the birth cohort, the lower the risk, with the higest RR in the 1923-1927 birth cohort (RR=2.88, 95%CI: 2.01-4.13) and the lowest in the 1953-1957 cohort (RR=0.63, 95%CI: 0.55-0.72). Conclusion From 2008 to 2022, the ASRIR of hepatitis E among the elderly population showed a declining trend in eastern China. It is necessary to strengthen the monitoring of the changing trend of hepatitis E in the elderly male, and take targeted prevention and control measures to actively respond to the epidemic of hepatitis E in the elderly.
Objective To investigate the clinical characteristics and molecular epidemiological features of Cryptococcus isolates in HIV-positive and HIV-negative patients with cryptococcal meningitis (CM), and to provide a reference for early recognition, diagnosis, and treatment of CM. Methods A retrospective comparative analysis was conducted on the clinical characteristics and cryptococcal genotypes of HIV-positive and HIV-negative CM patients admitted to a tertiary hospital in Guangzhou between March 2015 and February 2024. Antifungal susceptibility testing was performed using the ATB FUNGUS 3 system, and strain genotypes were determined by mass spectrometry and multilocus sequence typing (MLST). Results A total of 121 patients with CM were included, comprising 102 HIV-positive patients and 19 HIV-negative patients. Compared with the HIV-negative group, the HIV-positive group had a higher proportion of male patients (80.4% vs 47.4%, χ2=7.680, P<0.01), had a shorter interval from symptom onset to diagnosis (17 vs 45 days, U=-3.794,P<0.01）). Laboratory findings showed that, in the HIV-positive group, the CD4+ T-cell count, CD4+/CD8+ ratio, cerebrospinal fluid white blood cell count, cerebrospinal fluid protein level, and cerebrospinal fluid glucose level were 12 (5, 34) cells/μL, 0.04 (0.02, 0.08), 28 (15, 61) ×106/L, 489 (306, 833) g/L, and 2.3 (1.9, 3.1) mmol/L, respectively; all of these parameters differed significantly from those of the HIV-negative group (U=-4.852, -5.363, -2.052, -3.552, and -3.376, respectively; all P<0.01). The 4-week and 24-week mortality rates in the HIV-positive group were 14.7% and 28.4%, respectively, both higher than those in the HIV-negative group (5.3% and 15.8%, respectively), though the differences were not statistically significant (both P>0.05). Molecular typing showed that Cryptococcus neoformans VNI was the predominant molecular type in both groups (98.0% vs 100.0%, P=0.332), with ST5 as the predominant sequence type (81.4% vs 94.7%). In addition, two Cryptococcus gattii (VG) isolates were identified in the HIV-positive group, and three isolates of a novel sequence type, ST685, were detected for the first time; one patient harboring this sequence type died at the 24-week follow-up. Conclusion Compared with HIV-negative CM patients, HIV-positive CM patients exhibited a weaker cerebrospinal fluid inflammatory response and a relatively poorer prognosis. Particular attention should be paid to infection with the newly identified ST685 sequence type detected in the HIV-positive group.
Objective To investigate protective effects and mechanisms of metformin against lymphocyte death in heat stroke (HS), and to provide new insights into strategies for prevention and treatment of immune dysregulation in HS. Methods Male C57BL/6 mice were randomly assigned to three groups: normothermic control group (Control), heat stroke+ saline treatment group (HS+Sal), and heat stroke+metformin treatment group (HS+Met). The HS+Met group was intraperitoneally injected with metformin (200 mg/kg) daily, while the Control and HS+Sal groups were given the same volume of normal saline. After 14 days of pretreatment regimen, a classic heat stroke model was established via thermal exposure. The survival status of mice was observed within 72 h after the cessation of heat exposure, or hepatic and renal function indicators and blood routine tests were detected at 24 h after cessation of heat exposure. Spleen weight, spleen index (spleen weight/body weight), and splenic lymphocyte counts were assessed, along with histopathological and transmission electron microscopy observations. To further investigate the protective mechanisms of metformin, an in vitro heat stress model was established using the Jurkat lymphocyte cell line. The impact of metformin on cell viability under heat stress was determined using the CCK-8 assay. Additionally, adenosine 5'-monophosphate-activated protein kinase (AMPK) phosphorylation was detected by Western blotting. Furthermore, interventions with an autophagy inhibitor were performed to clarify the critical role of the autophagy. Results Compared with HS+Sal group, HS+Met group exhibited a significantly higher survival rate (χ2=4.11, P<0.05), attenuated hepatic and renal injury, and elevated platelet counts. HS+Met group also showed a relatively larger spleen volume and higher spleen weight. Both splenic and peripheral blood lymphocyte counts in HS+Met group were significantly higher than those in HS+Sal group. Histopathological staining and electron microscopy results indicated that metformin mitigated heat stroke-induced lymphocyte damage and cell death. In vitro experiments revealed that metformin pretreatment facilitated AMPK phosphorylation, thereby augmenting autophagy levels in heat-stressed lymphocytes and mitigating lymphocyte death. Furthermore, blocking autophagy with an autophagy inhibitor reversed the protective effect of metformin against hyperthermia-induced lymphocyte death. Conclusion Metformin ameliorates the severity of heat stroke and reduces lymphocyte death during heat stroke by enhancing autophagy, suggesting its potential clinical application in heat stroke prevention.
Objective To investigate the diversity of species, distribution characteristics, and genetic evolutionary relationships of mosquitoes in Guizhou Province, a mosquito population survey and phylogenetic analysis were conducted across multiple regions, aiming to provide a scientific basis for the prevention and control of mosquito-borne infectious diseases in the area. Methods Female mosquitoes were collected using methods such as ultraviolet light traps, BG-Trap COI mosquito traps, and the human landing catch method. Specimens were morphologically identified, and representative samples, as well as individuals difficult to identify, were selected for tissue DNA extraction. A fragment of the mitochondrial cytochrome c oxidase subunit I (COI) gene was amplified by PCR and sequenced. Multiple sequence alignment was performed using BioEdit 7.0 software, and a phylogenetic tree was constructed using MEGA 12.0 software to analyze the genetic relationships and geographical origins of different mosquito species. Results A total of 20 739 female mosquitoes were collected, primarily from cattle sheds (12 980) and pigsties (6 785). Combined morphological and molecular identification revealed 10 species belonging to 4 genera. Armigeres subalbatus (43.7%), Anopheles sinensis (29.4%), and Culex tritaeniorhynchus (21.7%) were the dominant species across the province. Geographically, Anopheles sinensis, Culex quinquefasciatus, and Armigeres subalbatus were widespread throughout the province, while Culex tritaeniorhynchus was distributed in all regions except Liupanshui. The remaining species (For example, Lutzia vorax and Culex bhutanensis were collected in Anshun City, while Anopheles minimus and Culex murrelli were collected in Qiannan Prefecture. Aedes vexans npponii was recorded in both Anshun City and Qiannan Prefecture.) were only collected in specific areas. Phylogenetic analysis indicated that the COI sequences of Anopheles sinensis, Armigeres subalbatus, Aedes albopictus, Culex quinquefasciatus, and Culex murrelli clustered with reference strains from China, suggesting that these species have formed stable populations in Guizhou Province and other domestic regions. Lutzia vorax and Anopheles minimus not only clustered with domestic strains but also fell within the same clade as foreign strains. In contrast, Aedes vexans npponii and Culex bhutanensis clustered with geographical strains from countries such as Japan, South Korea, Vietnam, and Bhutan, respectively, indicating their presence and formation of small local populations, which may suggest a risk of introduction from abroad. Conclusion Mosquito species in Guizhou Province are relatively diverse and widely distributed, with clearly defined dominant species. Lutzia vorax is a newly recorded species in Guizhou Province, and Culex bhutanensis is a newly recorded species in China. The potential introduction of certain species from abroad may increase the transmission risk of mosquito-borne diseases.
Objective To analyze the etiology, drug resistance and genome evolution of three cases of meningococcal meningitis(MM), and to provide scientific basis for improving prevention and control strategy of Neisseria meningitidis (Nm). Methods Three samples of cerebrospinal fluid from patients with suspected Nm infection in Zunyi City in 2024 were detected by macrogene sequencing and real-time PCR, and 143 throat swabs from close contacts were detected by real-time PCR, and strains were isolated. Biochemical identification, serotyping, E-test and genome analysis were performed on the isolates. Results The results of real-time PCR showed that Nm was detected in 3 cases of cerebrospinal fluid and 18 samples of close contacts, and typical gram-negative diplococcus was detected under microscope. No pathogen was isolated from the case samples, and 6 Nm strains were isolated from close contacts. Serotype distribution showed that cases 1, 2 and 15 close contacts were of group B, and case 3 was mixed infection of group B and group Y. Phenotypic resistance results showed that 6 strains were sensitive to ceftriaxone, meropenem, minocycline, chloramphenicol and rifampin, and all were intermediate resistant to ampicillin, resistant to penicillin and co-trimoxazole; 5 strains were resistant to levofloxacin and ciprofloxacin; and 2 strains were not sensitive to cefotaxime. cgMLST typing results showed that the capsular type of the 5 strains were all type B. The ST typing results showed that 2 strains were ST-7962, 1 strain was ST-5664, and 2 strains were not classified. Phylogenetic analysis showed that strains P171 and P173 clustered with strains 116953, 116959, 116962, and 116960, while strains P175 and P176 clustered with strains 116951, 87062, 131547, 131546, 131548, 116948, and 133566. These two clusters showed significant differences from P174. Conclusion There is a risk of transmission of Neisseria meningitidis group B and Y in Zunyi City in 2024. Nm strains exhibit multidrug resistance and carry multiple virulence genes, suggesting potential trans-temporal and trans-spatial transmission across the country. It is suggested to strengthen pathogen monitoring and drug sensitivity detection, guide clinical accurate drug use, and contain the spread of epidemic situation.
Objective To evaluate the diagnostic value of nanopore targeted next-generation sequencing (tNGS) of tissue specimens combined with pathological testing for paucibacillary tuberculosis. Methods A total of 81 patients with suspected peripheral pulmonary tuberculosis and extrapulmonary tuberculosis who visited Hebei Chest Hospital from August 2021 to May 2025 were enrolled. Using the final definitive diagnosis as the standard, the positive rates of tNGS, pathology, GeneXpert, TB-DNA, Mycobacterium tuberculosis culture, and acid-fast staining were compared; the diagnostic efficacies of tNGS, histopathology, and the combined detection were evaluated. Results Among the 81 cases, 67 were ultimately confirmed as active tuberculosis. Based on definitive diagnosis and regarding two categories of tuberculosis pathological diagnosis as positive indicators, the positive rates of tNGS, pathology, GeneXpert, TB-DNA, Mycobacterium tuberculosis culture, and acid-fast staining were 85.07%(57/67), 70.15%(47/67), 36.67%(22/60), 21.88%(7/32), 8.89%(4/45), and 7.14%(3/42), respectively. The differences between tNGS and other methods were statistically significant (P<0.05). The combination of tNGS and pathology showed a higher diagnostic value compared to individual methods, with an area under the curve of 0.899, sensitivity of 94.03%, specificity of 85.71%, and Kappa value of 0.755. An increase in tNGS read count was significantly associated with a higher proportion of tuberculosis diagnoses, and the final diagnostic composition varied significantly across different read count ranges (χ2=22.352, P=0.000 4). As the number of detected Mycobacterium tuberculosis sequences increased in the pathological tissues, the proportions of necrotic lesions and hyperplasia gradually rose; necrotic changes were most prominent in the group with sequence reads ≥10 000 reads, showing statistically significant differences (χ2=15.338, P=0.009 0). Conclusion When detecting Mycobacterium tuberculosis in tissue lesions, tNGS demonstrates higher sensitivity than traditional methods. The combination of tNGS and pathology exhibits superior diagnostic efficacy. The read count of tNGS serves as a promising trend indicator for supporting tuberculosis diagnosis.
Objective To investigate the distribution characteristics and antimicrobial resistance patterns of Klebsiella pneumoniae on hospital environmental surfaces, as well as on the hands and in the nasal cavities of healthcare workers, aiming to provide data support for disinfection and protection guidelines. Methods From June 2024 to June 2025, 2 836 samples were collected from environmental surfaces, healthcare workers' hands, and nasal cavities across 10 hospitals in Shanghai. K. pneumoniae strains were isolated through culture and biochemical identification. Antibiotic susceptibility testing was performed using a broth microdilution method. Whole-genome sequence of the target bacteria was obtained using next-generation sequencing technology, followed by bioinformatics analysis. Results The detection rates of K. pneumoniae from highest to lowest were: healthcare workers' nasal cavities (2.74%, 12/438), environmental surfaces (1.13%, 22/1 944), and healthcare workers' hands (0.66%, 3/454). Environmental surface-derived isolates exhibited a multidrug resistance rate of 66.67% (10/15). All three isolates from healthcare workers' hands were resistant only to ampicillin, while nasal isolates showed a multidrug resistance rate of 40.00% (4/10). Genomic sequencing was performed on 28 isolates, identifying 70 antimicrobial resistance genes, 30 virulence genes, and 27 distinct sequence types (ST). Carbapenemase genes were detected in four environmental surface-derived isolates. Two nasal isolates (ST23-KL1 and ST65-KL2) carried six classes of virulence genes simultaneously. The three hand-derived isolates harbored only aminoglycoside resistance genes. Notably, one ST15-KL19 strain isolated from pillow and bedding surfaces demonstrated potential for high virulence and high resistance. A total of 98 plasmids were identified across the 28 strains, predominantly carrying IncF replicons. Plasmid host prediction indicated K. pneumoniae as the primary host. Conjugative plasmids were present in 57.14% (16/28) of isolates. One environmental surface-derived strain simultaneously carried both antimicrobial resistance and virulence plasmids. Conclusion K. pneumoniae isolates from all three sources exhibited diversity in ST types and plasmid profiles. The detection rate on healthcare workers' hands was the lowest, and these isolates did not exhibit high-level resistance or hypervirulence. Strains from environmental surfaces showed significant multi-drug resistance, with carbapenemase genes being predominant. K. pneumoniae was most frequently detected in the nasal cavities of healthcare workers. Although the overall resistance level was relatively low, the presence of hypervirulent clones indicates a potential transmission risk, highlighting the need for reinforced isolation precautions in clinical practice.
Objective To verify the diagnostic efficacy of Mycobacterium tuberculosis nucleic acid colloidal gold technology (PCR colloidal gold assay) for detecting Mycobacterium tuberculosis in sputum samples of clinical pulmonary tuberculosis patients, to evaluate the diagnostic value of PCR colloidal gold assay for tuberculosis. Methods Sputum samples from 239 active pulmonary tuberculosis patients registered in four designated tuberculosis medical institutions were collected in Nantong City between July 1, 2024, and May 31, 2025. The same sputum samples were tested for Mycobacterium tuberculosis using sputum smear microscopy, GeneXpert, and PCR colloidal gold assay. The differences in positive rates were compared among the three methods for different types of patients, the diagnostic efficacy of PCR colloidal gold assay was evaluated, with GeneXpert results and clinical comprehensive diagnosis as reference standards. Results Among the 239 pulmonary tuberculosis patients, 111 cases (46.44%) were diagnosed with pulmonary tuberculosis (pathogen-positive), and 128 cases (53.56%) were clinically diagnosed (pathogen-negative). The positive rate was 30.96% (74/239) of sputum smear microscopy, was 43.93% (105/239) of GeneXpert method, and was 51.05% (122/239) of PCR colloidal gold assay. There was a statistically significant difference in positive detection rates of Mycobacterium tuberculosis among at least two methods(P<0.001). Further analysis revealed that in the overall patients, positive detection rates for Mycobacterium tuberculosis by GeneXpert method and PCR colloidal gold assay were higher than that by sputum smear microscopy, with statistically significant differences, but no statistically significant difference was observed between the GeneXpert method and PCR colloidal gold assay. Using GeneXpert detection as the standard, the sensitivity of the PCR colloidal gold assay and smear microscopy were 96.19%(95%CI: 90.53%-98.95%) and 66.67%(95%CI:56.80%-75.57%), respectively; the specificity were 84.33%(95%CI:77.05%-90.03%) and 97.01%(95%CI:92.53%-99.18%), respectively; the positive predictive values were 82.79%(95%CI:75.07%-88.93%) and 94.59%(95%CI:86.76%-98.51%), respectively; and the negative predictive values were 96.58%(95%CI:91.56%-99.06%) and 78.79%(95%CI:71.89%-84.70%), respectively. The overall consistency between PCR colloidal gold assay and GeneXpert was good (Kappa=0.791), significantly higher than that of smear microscopy (Kappa=0.658). With clinical diagnosis results as the reference standard, the sensitivity of the PCR colloidal gold asasay was 95.50%(95%CI：89.97%-98.54%), the specificity was 87.50%(95%CI：80.50%-92.73%), the concordance was 91.21%(95%CI：86.77%-94.61%), and the Kappa value was 0.825(95%CI：0.758-0.892). Conclusion The PCR colloidal gold assay showed high consistency with clinical diagnosis, and equivalent comparable diagnostic efficacy to GeneXpert, which can improve the positive detection rate of sputum samples from suspected pulmonary tuberculosis patients. The method offers convenience, visual readout, low cost, simple in steps, and have low requirements for laboratory conditions, making it suitable for widespread application in primary medical institutions as an early clinical pulmonary tuberculosis diagnostic method.
Transmission routes are critical to the prevention and control of infectious diseases. In addition to respiratory, fecal - oral, and sexual transmission, indirect transmission of pathogens through contaminated surfaces is emerging as a potential new mode of transmission. With the continuous development of international trade, the interaction between international trade and infectious disease outbreaks is becoming increasingly close. The cross-border transmission of epidemics through contaminated goods has become a new challenge for port epidemic prevention and control. Understanding the survival time of pathogens on inanimate surfaces is of great significance for port disinfection and epidemic prevention and control.Numerous studies have described the mechanism of pathogen transmission through contaminated surfaces, and some studies have even pointed out that some infectious disease outbreaks were caused by contaminated objects. However, there has been no systematic and in-depth study on the survival of different pathogens on the surface of different subjects. In this paper, we systematically review studies on the persistence of different DNA viruses such as Adenoviridae, Papillomaviridae, Herpesviridae, and Poxviridae, as well as RNA viruses such as Reoviridae, Picornaviridae, Caliciviridae, Flaviviridae, Orthomyxoviridae, Paramyxoviridae, Filoviridae, Coronaviridae, Retroviridae, and Hepadnaviridae on the surface of objects, and explore the possibility of cross-border transmission through international goods, providing a reference for pandemic prevention and control at ports.
The Expert Consensus on the Construction Standards of Heat Stroke Medical Rescue Systems (2025) represents the first guiding document in China to systematically construct a full-process rescue system for heat stroke. In the context of increasing risks of heat stroke under global warming, this consensus aims to "reduce incidence rate, improve treatment success rates, and enhance long-term prognosis" by proposing an integrated prevention and control strategy covering "prevention-pre-hospital emergency care-in-hospital treatment-rehabilitation-chronic disease management." Its core components focus on four key dimensions: promoting the shift of the prevention threshold forward to "heat not causing illness"; strengthening pre-hospital emergency care with "golden half-hour" rapid cooling; establishing a multidisciplinary in-hospital treatment system; and incorporating rehabilitation and chronic disease management into the standardized pathway for the first time. The consensus further clarifies standardized construction requirements, including a four-tier rescue network structure, the setup of dedicated rescue units, and the establishment of heat tolerance testing laboratories, with the goal of achieving systematic, standardized, and homogeneous heat stroke prevention and treatment. The implementation of this consensus provides critical guidance for addressing health threats posed by extreme climate events and enhancing national public health emergency response capabilities.
