Please wait a minute...
Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2018, Vol. 12 Issue (1) : 76-83    https://doi.org/10.1007/s11684-017-0609-5
REVIEW |
Recent transmission of Mycobacterium tuberculosis in China: the implication of molecular epidemiology for tuberculosis control
Chongguang Yang1,2, Qian Gao1()
1. Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science, Fudan University, Shanghai 200032, China
2. Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
 Download: PDF(138 KB)   HTML
 Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks
Abstract

Tuberculosis (TB) has remained an ongoing concern in China. The national scale-up of the Directly Observed Treatment, Short Course (DOTS) program has accelerated the fight against TB in China. Nevertheless, many challenges still remain, including the spread of drug-resistant strains, high disease burden in rural areas, and enormous rural-to-urban migrations. Whether incident active TB represents recent transmission or endogenous reactivation has helped to prioritize the strategies for TB control. Evidence from molecular epidemiology studies has delineated the recent transmission of Mycobacterium tuberculosis (M. tuberculosis) strains in many settings. However, the transmission patterns of TB in most areas of China are still not clear. Studies carried out to date could not capture the real burden of recent transmission of the disease in China because of the retrospective study design, incomplete sampling, and use of low-resolution genotyping methods. We reviewed the implementations of molecular epidemiology of TB in China, the estimated disease burden due to recent transmission of M. tuberculosis strains, the primary transmission of drug-resistant TB, and the evaluation of a feasible genotyping method of M. tuberculosis strains in circulation.

Keywords tuberculosis      recent transmission      molecular epidemiology      China     
Corresponding Authors: Qian Gao   
Just Accepted Date: 30 November 2017   Online First Date: 11 January 2018    Issue Date: 06 February 2018
 Cite this article:   
Chongguang Yang,Qian Gao. Recent transmission of Mycobacterium tuberculosis in China: the implication of molecular epidemiology for tuberculosis control[J]. Front. Med., 2018, 12(1): 76-83.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0609-5
http://academic.hep.com.cn/fmd/EN/Y2018/V12/I1/76
Publications Duration of sampling Sampling strategy Settings No. of cases Genotyping method Clustering rate* Proportion of Beijing strain Risk factors
Li et al., 2016 [35] 1 year ND Hebei Province 1017 Spoligotyping+ 15-VNTR 25% 90% ND
Hu et al., 2015 [31] 3 years Population based Four rural counties from multiple provinces 1332 Spoligotyping+ 24-VNTR+ 4 highly variable loci 14% 75% ND
Yang et al., 2015 [28] 3 years Population based Five provincial counties across China 2274 VNTR (9+ 3), including 4 highly variable loci 31% 72% Beijing family, MDR strains
Lu et al., 2014 [33] 3 months Enrolled consecutively 30 counties in Jiangsu Province 497 Spoligotyping+ 15-VNTR (new) 27% 81% ND
Wang et al., 2014 [32] 18 months Population based Six cities in Eastern China 1222 7-VNTR
+ RFLP-61110
15% ND MDR strains
Tian et al., 2012 [34] 3 years ND Gansu Province in Northwest China 218 12-MIRU-VNTR 55% 86% ND
Yang et al., 2012 [29] 2 years Population based Six provincial counties across China 1375 16-VNTR 28% 75% ND
Hu et al., 2009 [30] 1 year Cross-sectional Two counties in Eastern China 351 12-MIRU-VNTR+ RFLP-6110 23% 69% ND
Tab.1  General characteristics of the molecular epidemiology studies
1 Wang L, Zhang  H, Ruan Y,  Chin DP,  Xia Y, Cheng  S, Chen M,  Zhao Y, Jiang  S, Du X,  He G, Li  J, Wang S,  Chen W, Xu  C, Huang F,  Liu X, Wang  Y. Tuberculosis prevalence in China, 1990–2010; a longitudinal analysis of national survey data. Lancet 2014; 383(9934): 2057–2064
https://doi.org/10.1016/S0140-6736(13)62639-2 pmid: 24650955
2 WHO. Global tuberculosis report 2015. Geneva: World Health Organization, 2015. 
3 Zhao Y, Xu  S, Wang L,  Chin DP,  Wang S, Jiang  G, Xia H,  Zhou Y, Li  Q, Ou X,  Pang Y, Song  Y, Zhao B,  Zhang H,  He G, Guo  J, Wang Y. National survey of drug-resistant tuberculosis in China. N Engl J Med 2012; 366(23): 2161–2170
https://doi.org/10.1056/NEJMoa1108789 pmid: 22670902
4 Tang S, Ping  H. New features and controlling strategies of tuberculosis in the new century in China. Chin J Pract Intern Med (Zhongguo Shi Yong Nei Ke Za Zhi) 2011; 6:403–5 (in Chinese)
5 Lin HH, Wang  L, Zhang H,  Ruan Y, Chin  DP, Dye C. Tuberculosis control in China: use of modelling to develop targets and policies. Bull World Health Organ 2015; 93(11): 790–798
https://doi.org/10.2471/BLT.15.154492 pmid: 26549907
6 Small PM, Hopewell  PC, Singh SP,  Paz A, Parsonnet  J, Ruston DC,  Schecter GF,  Daley CL,  Schoolnik GK. The epidemiology of tuberculosis in San Francisco. A population-based study using conventional and molecular methods. N Engl J Med 1994; 330(24): 1703–1709
https://doi.org/10.1056/NEJM199406163302402 pmid: 7910661
7 Alland D, Kalkut  GE, Moss AR,  McAdam RA,  Hahn JA,  Bosworth W,  Drucker E,  Bloom BR. Transmission of tuberculosis in New York City. An analysis by DNA fingerprinting and conventional epidemiologic methods. N Engl J Med 1994; 330(24): 1710–1716
https://doi.org/10.1056/NEJM199406163302403 pmid: 7993412
8 Clark CM, Driver  CR, Munsiff SS,  Driscoll JR,  Kreiswirth BN,  Zhao B, Ebrahimzadeh  A, Salfinger M,  Piatek AS,  Abdelwahab J. Universal genotyping in tuberculosis control program, New York City, 2001–2003. Emerg Infect Dis 2006; 12(5): 719–724
https://doi.org/10.3201/eid1205.050446 pmid: 16704826
9 Glynn JR, Crampin  AC, Yates MD,  Traore H,  Mwaungulu FD,  Ngwira BM,  Ndlovu R,  Drobniewski F,  Fine PE. The importance of recent infection with Mycobacterium tuberculosis in an area with high HIV prevalence: a long-term molecular epidemiological study in Northern Malawi. J Infect Dis 2005; 192(3): 480–487
https://doi.org/10.1086/431517 pmid: 15995962
10 Jasmer RM, Hahn  JA, Small PM,  Daley CL,  Behr MA,  Moss AR,  Creasman JM,  Schecter GF,  Paz EA, Hopewell  PC. A molecular epidemiologic analysis of tuberculosis trends in San Francisco, 1991–1997. Ann Intern Med 1999; 130(12): 971–978
https://doi.org/10.7326/0003-4819-130-12-199906150-00004 pmid: 10383367
11 Barnes PF, Cave  MD. Molecular epidemiology of tuberculosis. N Engl J Med 2003; 349(12): 1149–1156
https://doi.org/10.1056/NEJMra021964 pmid: 13679530
12 Supply P, Allix  C, Lesjean S,  Cardoso-Oelemann M,  Rüsch-Gerdes S,  Willery E,  Savine E,  de Haas P,  van Deutekom H,  Roring S,  Bifani P,  Kurepina N,  Kreiswirth B,  Sola C, Rastogi  N, Vatin V,  Gutierrez MC,  Fauville M,  Niemann S,  Skuce R,  Kremer K,  Locht C,  van Soolingen D. Proposal for standardization of optimized mycobacterial interspersed repetitive unit-variable-number tandem repeat typing of Mycobacterium tuberculosis. J Clin Microbiol 2006; 44(12): 4498–4510
https://doi.org/10.1128/JCM.01392-06 pmid: 17005759
13 Luo T, Yang  C, Pang Y,  Zhao Y, Mei  J, Gao Q. Development of a hierarchical variable-number tandem repeat typing scheme for Mycobacterium tuberculosis in China. PLoS One 2014; 9(2): e89726
https://doi.org/10.1371/journal.pone.0089726 pmid: 24586989
14 Allix-Béguec C,  Wahl C, Hanekom  M, Nikolayevskyy V,  Drobniewski F,  Maeda S,  Campos-Herrero I,  Mokrousov I,  Niemann S,  Kontsevaya I,  Rastogi N,  Samper S,  Sng LH, Warren  RM, Supply P. Proposal of a consensus set of hypervariable mycobacterial interspersed repetitive-unit-variable-number tandem-repeat loci for subtyping of Mycobacterium tuberculosis Beijing isolates. J Clin Microbiol 2014; 52(1): 164–172
https://doi.org/10.1128/JCM.02519-13 pmid: 24172154
15 Liu M, Luo  T, Yang C,  Liu Q, Gao  Q. Evaluation of different sets of variable number of tandem repeats loci for genotyping Mycobacterium tuberculosis isolates in China. Chin J Tuberc Respir Dis (Zhonghua Jie He He Hu Xi Za Zhi)  2015; 38(10): 746–750 (in Chinese)
pmid: 26703941
16 Lu B, Pourcel  C, Liu JH,  Dong HY,  Zhang YY,  Jiang Y,  Liu ZG, Zhao  XQ, Wan KL. Establishment of the standard operation program on multiple loci variable numbers tandem repeats analysis typing on Mycobacterium tuberculosis. Chin J Epidemiol  (Zhong-hua Liu Xing Bing Xue Za Zhi)  2008; 29(9): 919–924 (in Chinese)
pmid: 19173859
17 Chen HX, Cai  C, Liu JY,  Zhang ZG,  Yuan M, Jia  JN, Sun ZG,  Huang HR,  Gao JM, Li  WM. Discriminatory power of variable number on tandem repeats loci for genotyping Mycobacterium tuberculosis strains in China. Chin J Epidemiol (Zhonghua Liu Xing Bing Xue Za Zhi)  2017; 38(6): 794–799 (in Chinese)
pmid: 28647985
18 Shi L, Dong  H. BA Sang,  Xi Luo, Suo  L, Zhao X,  Wan K. Evaluation and analysis on genetic diversity of clinical Mycobacterium tuberculos isisolates from Tibetan patients by variable-number tandem repeats of mycobacterial interspersed repetitive units. Chin J Ioonoses (Zhongguo Ren Shou Gong Huan Bing Xue Bao) 2014; 30: 4 (in Chinese)
19 Zhang L, Chen  J, Shen X,  Gui X, Mei  J, Deriemer K,  Gao Q. Highly polymorphic variable-number tandem repeats loci for differentiating Beijing genotype strains of Mycobacterium tuberculosis in Shanghai, China. FEMS Microbiol Lett 2008; 282(1): 22–31
https://doi.org/10.1111/j.1574-6968.2008.01081.x pmid: 18336551
20 Gardy JL, Johnston  JC, Ho Sui SJ,  Cook VJ,  Shah L, Brodkin  E, Rempel S,  Moore R,  Zhao Y, Holt  R, Varhol R,  Birol I,  Lem M, Sharma  MK, Elwood K,  Jones SJ,  Brinkman FS,  Brunham RC,  Tang P. Whole-genome sequencing and social-network analysis of a tuberculosis outbreak. N Engl J Med 2011; 364(8): 730–739
https://doi.org/10.1056/NEJMoa1003176 pmid: 21345102
21 Walker TM, Ip  CL, Harrell RH,  Evans JT,  Kapatai G,  Dedicoat MJ,  Eyre DW,  Wilson DJ,  Hawkey PM,  Crook DW,  Parkhill J,  Harris D,  Walker AS,  Bowden R,  Monk P, Smith  EG, Peto TE. Whole-genome sequencing to delineate Mycobacterium tuberculosis outbreaks: a retrospective observational study. Lancet Infect Dis 2013; 13(2): 137–146
https://doi.org/10.1016/S1473-3099(12)70277-3 pmid: 23158499
22 Luo T, Yang  C, Peng Y,  Lu L, Sun  G, Wu J,  Jin X, Hong  J, Li F,  Mei J, DeRiemer  K, Gao Q. Whole-genome sequencing to detect recent transmission of Mycobacterium tuberculosis in settings with a high burden of tuberculosis. Tuberculosis (Edinb) 2014; 94(4): 434–440
https://doi.org/10.1016/j.tube.2014.04.005 pmid: 24888866
23 Yang C, Luo  T, Shen X,  Wu J, Gan  M, Xu P,  Wu Z, Lin  S, Tian J,  Liu Q, Yuan  Z, Mei J,  DeRiemer K,  Gao Q. Transmission of multidrug-resistant Mycobacterium tuberculosis in Shanghai, China: a retrospective observational study using whole-genome sequencing and epidemiological investigation. Lancet Infect Dis 2017; 17(3): 275–284
https://doi.org/10.1016/S1473-3099(16)30418-2 pmid: 27919643
24 Nikolayevskyy V, Kranzer  K, Niemann S,  Drobniewski F. Whole genome sequencing of Mycobacterium tuberculosis for detection of recent transmission and tracing outbreaks: a systematic review. Tuberculosis (Edinb) 2016; 98: 77–85
https://doi.org/10.1016/j.tube.2016.02.009 pmid: 27156621
25 Walker TM, Kohl  TA, Omar SV,  Hedge J,  Del Ojo Elias C,  Bradley P,  Iqbal Z,  Feuerriegel S,  Niehaus KE,  Wilson DJ,  Clifton DA,  Kapatai G,  Ip CL, Bowden  R, Drobniewski FA,  Allix-Béguec C,  Gaudin C,  Parkhill J,  Diel R, Supply  P, Crook DW,  Smith EG,  Walker AS,  Ismail N,  Niemann S,  Peto TE; Modernizing Medical Microbiology (MMM) Informatics Group. Whole-genome sequencing for prediction of Mycobacterium tuberculosis drug susceptibility and resistance: a retrospective cohort study. Lancet Infect Dis 2015; 15(10): 1193–1202
https://doi.org/10.1016/S1473-3099(15)00062-6 pmid: 26116186
26 Luo T, Comas  I, Luo D,  Lu B, Wu  J, Wei L,  Yang C, Liu  Q, Gan M,  Sun G, Shen  X, Liu F,  Gagneux S,  Mei J, Lan  R, Wan K,  Gao Q. Southern East Asian origin and coexpansion of Mycobacterium tuberculosis Beijing family with Han Chinese. Proc Natl Acad Sci USA 2015; 112(26): 8136–8141
https://doi.org/10.1073/pnas.1424063112 pmid: 26080405
27 Glynn JR, Vynnycky  E, Fine PEM. Influence of sampling on estimates of clustering and recent transmission of Mycobacterium tuberculosis derived from DNA fingerprinting techniques. Am J Epidemiol 1999; 149(4): 366–371
https://doi.org/10.1093/oxfordjournals.aje.a009822 pmid: 10025480
28 Yang C, Shen  X, Peng Y,  Lan R, Zhao  Y, Long B,  Luo T, Sun  G, Li X,  Qiao K, Gui  X, Wu J,  Xu J, Li  F, Li D,  Liu F, Shen  M, Hong J,  Mei J, DeRiemer  K, Gao Q. Transmission of Mycobacterium tuberculosis in China: a population-based molecular epidemiologic study. Clin Infect Dis 2015; 61(2): 219–227
https://doi.org/10.1093/cid/civ255 pmid: 25829000
29 Yang C, Luo  T, Sun G,  Qiao K, Sun  G, DeRiemer K,  Mei J, Gao  Q. Mycobacterium tuberculosis Beijing strains favor transmission but not drug resistance in China. Clin Infect Dis 2012; 55(9): 1179–1187
https://doi.org/10.1093/cid/cis670 pmid: 22865872
30 Hu Y, Jiang  WL, Zhao Q,  Wang WB,  Xu B. The combined application of multiple genotyping methods in identifying genotypes of Mycobacterium tuberculosis strain circulating in rural China. Chin J Tuberc Respir Dis (Zhonghua Jie He He Hu Xi Za Zhi) 2009; 32(8): 576–580 (in Chinese)
pmid: 19958674
31 Hu Y, Mathema  B, Zhao Q,  Chen L, Lu  W, Wang W,  Kreiswirth B,  Xu B. Acquisition of second-line drug resistance and extensive drug resistance during recent transmission of Mycobacterium tuberculosis in rural China. Clin Microbiol Infect 2015; 21(12): 1093 e9–e18
32 Wang W, Mathema  B, Hu Y,  Zhao Q, Jiang  W, Xu B. Role of casual contacts in the recent transmission of tuberculosis in settings with high disease burden. Clin Microbiol Infect 2014; 20(11): 1140–1145
https://doi.org/10.1111/1469-0691.12726 pmid: 24941878
33 Lu W, Lu  B, Liu Q,  Dong H, Shao  Y, Jiang Y,  Song H, Chen  C, Li G,  Xu W, Zhao  X, Wan K,  Zhu L. Genotypes of Mycobacterium tuberculosis isolates in rural China: using MIRU-VNTR and spoligotyping methods. Scand J Infect Dis 2014; 46(2): 98–106
https://doi.org/10.3109/00365548.2013.858182 pmid: 24359517
34 Tian LL, Si  HY, Mu TJ,  Fan WB, Wang  J, Jiang WM,  Li Q, Yang  B, Zhang Y,  Zhu BD. Molecular epidemiology of Mycobacterium tuberculosis in Gansu Province of China. Chin Med J (Engl) 2012; 125(19): 3458–3464
pmid: 23044306
35 Li Y, Cao  X, Li S,  Wang H, Wei  J, Liu P,  Wang J, Zhang  Z, Gao H,  Li M, Wan  K, Dai E. Characterization of Mycobacterium tuberculosis isolates from Hebei, China: genotypes and drug susceptibility phenotypes. BMC Infect Dis 2016; 16(1): 107
https://doi.org/10.1186/s12879-016-1441-2 pmid: 26939531
36 Huang Y, Zhong  J, Zhang Y,  Chen S, Wang  X. Outbreak of tuberculosis in a high school in Zhejiang, China. Chin J Epidemiol (Zhonghua Liu Xing Bing Xue Za Zhi) 2015; 36(2): 172–175 (in Chinese)
pmid: 25907730
37 Ma MJ, Yang  Y, Wang HB,  Zhu YF, Fang  LQ, An XP,  Wan KL, Whalen  CC, Yang XX,  Lauzardo M,  Zhang ZY,  Cao JF, Tong  YG, Dai EH,  Cao WC. Transmissibility of tuberculosis among school contacts: an outbreak investigation in a boarding middle school, China. Infect Genet Evol 2015; 32: 148–155
https://doi.org/10.1016/j.meegid.2015.03.001 pmid: 25757905
38 Chen W, Xia  Y, Li X,  Zhou L, Li  C, Wan K,  Cheng S. A tuberculosis outbreak among senior high school students in China in 2011. J Int Med Res 2012; 40(5): 1830–1839
https://doi.org/10.1177/030006051204000521 pmid: 23206464
39 Nardell E, Churchyard  G. What is thwarting tuberculosis prevention in high-burden settings? N Engl J Med 2011; 365(1): 79–81
https://doi.org/10.1056/NEJMe1105555 pmid: 21732840
40 Shen X, Yang  C, Wu J,  Lin S, Gao  X, Wu Z,  Tian J, Gan  M, Luo T,  Wang L, Yu  C, Mei J,  Pan Q, DeRiemer  K, Yuan Z,  Gao Q. Recurrent tuberculosis in an urban area in China: relapse or exogenous reinfection? Tuberculosis (Edinb) 2017; 103: 97–104
https://doi.org/10.1016/j.tube.2017.01.007 pmid: 28237039
41 Shen G, Xue  Z, Shen X,  Sun B, Gui  X, Shen M,  Mei J, Gao  Q. The study recurrent tuberculosis and exogenous reinfection, Shanghai, China. Emerg Infect Dis 2006; 12(11): 1776–1778
https://doi.org/10.3201/eid1211.051207 pmid: 17283636
42 Kan X, Wang  K, Yang JA,  Liu Z, Chen  G, Zhang Y,  Wang J, Liu  X, Wang Q. Molecular epidemiology study on relapse after cure of smear positive cases. Anhui Med J (Anhui Yi Xue) 2011; 32(1): 89–91 (in Chinese)
43 Li X, Zhang  Y, Shen X,  Shen G, Gui  X, Sun B,  Mei J, Deriemer  K, Small PM,  Gao Q. Transmission of drug-resistant tuberculosis among treated patients in Shanghai, China. J Infect Dis 2007; 195(6): 864–869
https://doi.org/10.1086/511985 pmid: 17299717
44 Nsofor CA, Jiang  Q, Wu J,  Gan MY, Liu  QY, Zuo TY,  Zhu GF, Gao Q. Transmission is a noticeable cause of resistance among treated tuberculosis patients in Shanghai, China. Sci Rep 2017; 7(1): 7691
https://doi.org/10.1038/s41598-017-08061-3 pmid: 28794425
45 Xue He G, van den Hof  S, van der Werf MJ, Guo H,  Hu YL, Fan  JH, Zhang WM,  Tostado CP,  Borgdorff MW. Inappropriate tuberculosis treatment regimens in Chinese tuberculosis hospitals. Clin Infect Dis 2011; 52(7): e153–e156
https://doi.org/10.1093/cid/cir075 pmid: 21427388
46 Liu Q, Via  LE, Luo T,  Liang L,  Liu X, Wu  S, Shen Q,  Wei W, Ruan  X, Yuan X,  Zhang G,  Barry CE 3rd,  Gao Q. Within patient microevolution of Mycobacterium tuberculosis correlates with heterogeneous responses to treatment. Sci Rep 2015; 5(1): 17507
https://doi.org/10.1038/srep17507 pmid: 26620446
47 Sun G, Luo  T, Yang C,  Dong X, Li  J, Zhu Y,  Zheng H,  Tian W, Wang  S, Barry CE 3rd,  Mei J, Gao  Q. Dynamic population changes in Mycobacterium tuberculosis during acquisition and fixation of drug resistance in patients. J Infect Dis 2012; 206(11): 1724–1733
https://doi.org/10.1093/infdis/jis601 pmid: 22984115
48 Gao Q, Li  X. Transmission of MDR tuberculosis. Drug Discov Today Dis Mech 2010; 7(1): e61–e65
https://doi.org/10.1016/j.ddmec.2010.09.006
49 Hu Y, Hoffner  S, Jiang W,  Wang W, Xu  B. Extensive transmission of isoniazid resistant M. tuberculosis and its association with increased multidrug-resistant TB in two rural counties of eastern China: a molecular epidemiological study. BMC Infect Dis 2010; 10(1): 43
https://doi.org/10.1186/1471-2334-10-43 pmid: 20187977
50 Mehra M, Cossrow  N, Kambili C,  Underwood R,  Makkar R,  Potluri R. Assessment of tuberculosis burden in China using a dynamic disease simulation model. Int J Tuberc Lung Dis 2013; 17(9): 1186–1194
https://doi.org/10.5588/ijtld.12.0959 pmid: 23827732
51 Liao P, Guo  M, Tang F,  Wang G, Siyuan  LI, Yang Z,  Cao B. Analysis of patients from active case finding in rural areas of Wusheng, Sichuan. Chin J Antituberculosis (Zhongguo Fang Lao Za Zhi) 2016; 38(7): 576–581 (in Chinese)
[1] FMD-17094-OF-GQ_suppl_1 Download
[1] Min Chen, Yuan Xu, Nan Hong, Yali Yang, Wenzhi Lei, Lin Du, Jingjun Zhao, Xia Lei, Lin Xiong, Langqi Cai, Hui Xu, Weihua Pan, Wanqing Liao. Epidemiology of fungal infections in China[J]. Front. Med., 2018, 12(1): 58-75.
[2] Jikai Liu, Li Bai, Weiwei Li, Haihong Han, Ping Fu, Xiaochen Ma, Zhenwang Bi, Xiaorong Yang, Xiuli Zhang, Shiqi Zhen, Xiaoling Deng, Xiumei Liu, Yunchang Guo. Trends of foodborne diseases in China: lessons from laboratory-based surveillance since 2011[J]. Front. Med., 2018, 12(1): 48-57.
[3] Chun Chen,Zhihong Cheng,Ping Jiang,Mei Sun,Qi Zhang,Jun Lv. Effect of the new maternity insurance scheme on medical expenditures for caesarean delivery in Wuxi, China: a retrospective pre/post-reform case study[J]. Front. Med., 2016, 10(4): 473-480.
[4] Huiqin Zhong,Ya Shao,Ling Fan,Tangshen Zhong,Lu Ren,Yan Wang. Perceived resource support for chronic illnesses among diabetics in north-western China[J]. Front. Med., 2016, 10(2): 219-227.
[5] Xijin Xu,Xiang Zeng,H. Marike Boezen,Xia Huo. E-waste environmental contamination and harm to public health in China[J]. Front. Med., 2015, 9(2): 220-228.
[6] Hui Li,Ran Li,Jiuxin Qu,Xiaomin Yu,Zhixin Cao,Yingmei Liu,Bin Cao. Ventricular tachycardia in a disseminated MDR-TB patient: a case report and brief review of literature[J]. Front. Med., 2014, 8(2): 259-263.
[7] Lizhe Ai, Yaqin Yu, Xiaoli Liu, Chong Wang, Jieping Shi, Hui Sun, Qiong Yu. Are the SNPs of NKX2-1 associated with papillary thyroid carcinoma in the Han population of Northern China?[J]. Front Med, 2014, 8(1): 113-117.
[8] Xiangwei Li, Yu Yang, Jianmin Liu, Feng Zhou, Wei Cui, Ling Guan, Fei Shen, Cong Gao, Mufei Li, Qi Jin, Lei Gao. Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis[J]. Front Med, 2013, 7(3): 354-366.
[9] Wei Li, Shan Lu, Zhigang Cui, Jinghua Cui, Haijian Zhou, Yiqing Wang, Zhujun Shao, Changyun Ye, Biao Kan, Jianguo Xu. PulseNet China, a model for future laboratory-based bacterial infectious disease surveillance in China[J]. Front Med, 2012, 6(4): 366-375.
[10] Kai Gao, Junzhi Wang. The biopharmaceutical industry in China: history and future perspectives[J]. Front Med, 2012, 6(2): 101-111.
[11] Zhiping Yang, Qiong Wu, Kaichun Wu, Daiming Fan. Scientific publications on systematic review and meta-analysis from Chinese authors: a 10-year survey of the English literature[J]. Front Med, 2012, 6(1): 94-99.
[12] Min ZHANG, Hong SHANG, Zhe WANG, Wei-Guo CUI, Qing-Hai HU. Natural history of HIV infection in former plasma donors in rural China[J]. Front Med Chin, 2010, 4(3): 346-350.
[13] Xu-Ming BIAN, Qi GUO, Qing-Wei QI. Current situation and development of prenatal diagnosis in China[J]. Front Med Chin, 2010, 4(3): 271-274.
[14] Li-Guang TIAN MPH, Jia-Xu CHEN PhD, Yu-Chun CAI BM, Jian GUO MPH, Xiao-Mei TONG, Qin LIU DVM, Xiao-Nong ZHOU PhD, Tian-Ping WANG PhD, Xiao-Mei YIN, Wei-Duo WU, Li ZHOU, Feng-Feng WANG, Zhen-Li WANG MSc, Guo-Jin CHENG, Peter STEINMANN PhD, Lan-Hua LI MSc, . Co-infection of HIV and parasites in China: Results from an epidemiological survey in rural areas of Fuyang city, Anhui province, China[J]. Front. Med., 2010, 4(2): 192-198.
[15] Shi-Ming CHENG MD, Yu-Ji LAI MS, Er-Yong LIU MS, Lin ZHOU MD, Xue-Jing WANG MS, Qiu-Lan CHEN MS, Dong-Ming LI MS, Ning WANG MD, . Study on factors affecting TB/HIV co-infection in four counties of China[J]. Front. Med., 2010, 4(2): 185-191.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed