The following background information on HCV in China is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2] Primary references are available on request.

PREVALENCE SURVEYS (ANTIBODY AND / OR VIRAL RNA):

GENERAL POPULATION:
Hepatitis C accounts for 8% of acute hepatitis Cases in Nanchong (2004 publication) to 18.1% of acute hepatitis in the Beijing area (1995 to 2000)
4.07% of the general population in 1997; 3.0% in 1999 (estimates)
0.58% nationwide (six regions, 2009 publication)
0.15% of adults in Liangshan Prefecture, Sichuan Province (2011 publication)
8.2% of rural adults in Shanxi – 27.7% of former commercial blood / plasma donors (2003)
0.9% of persons in Anyang (2006 to 2008)
0.5% of normal subjects (and 5.0% of liver disease patients) in Nanjing (1997 publication)
31.0% of persons in central Tibet (2001)
1.1% to 2.7% of the general population of Beijing
9.6% of elderly adults in Linxian (rural Henan) (2000)

BLOOD DONORS:
8.68% of blood donors – 12.87% prior to 1998 (15.78% during 1994 to 1995) , and 1.71% after 1998 (analysis of 265 studies, 2011 publication)
0% to 1.1% of volunteer blood donors (1997)
29.19% of non-remunerated blood donors in Shaoxing (2007 publication)
30% of professional blood donors in Hebei and Inner Mongolia
1.5% to 3% in professional blood donors from Liaoning and Anhui (1993 publication)
0.49% of blood donors in Chongqing (2008 publication)
0.53% of blood donors in Chengdu (2006 to 2007)
0.335% of voluntary blood donors in Guangzhou (2004 to 2007)
12.7% of former commercial blood / plasma donors in rural Shanxi Province (2004)

INJECTING DRUG USERS (IDU): As of 2011, an estimated 10 million injecting drug users worldwide are seropositive toward Hepatitis C virus – including 1.6 million in China.
32.35% of IDU (15 cities, 2011 publication)
4.0% of IDU (2010 publication)
66.97% of IDU (range 11.43% in Shaanxi to 90.77% in Hubei) vs. 18.37% of non-injecting drug users (literature review, 2009)
61.4% of IDU in China, with highest rates in Hubei, Yunnan, Guangxi, Hunan and Xinjiang (2008 publication)
71.0% of IDU in Sichuan (2002); 67.49% in Guangzhou
69.7% of IDU in Wuhan (2006 publication)
63.2% of IDU in Dongguan, Guangdong (2008)
71.6% of IDU in Guangdong (2010 publication)
94.3% of IDU on methadone maintenance, in Wuhan (2008 publication)
69.0% of Chinese and 48.1% of Burmese IDU in the China-Burma border region (2011 publication)
56.9% of HIV-positive IDU (2003 publication)

HIV-POSITIVE PATIENTS:
78.6% of HIV-positive former blood donors (Hubei, 2008 publication)
76.4% of HIV-positive patients vs. 2.5% of HIV-negative individuals (Shanxi Province, 2010 publication)
41.83% of HIV-positive patients (2007 to 2008)
59.0% of HIV-positive patients (Shanxi, Zhejiang, Yunnan and Xinjiang, 2011 publication)
9.6% of HIV-positive children receiving ART (2009 publication)
19.4% of HIV-positive patients receiving AART (Beijing, 2005 to 2007)

83.6% of AIDS patients were found to be co-infected with hepatitis C, 2.3% singly co infected with hepatitis B, and 5.5% co infected with HIV/HCV/HBV; 8.6% were infected with HIV only. (Zhengzhou, publication 2006)

MEN WHO HAVE SEX WITH MEN (MSM)
0.4% of MSM in 2004; 5.2% in 2006 (Beijing)
0.8% of MSM in Beijing (2005 to 2006)
0.4% of MSM in Beijing (2008 publication)
0.7% of MSM in Jiangsu (2006 to 2007)
0% of MSM in Taizhou city, Zhejiang province (2008 publication)

COMMERCIAL SEX WORKERS (CSW) / CLIENTS:
6.8% of CSW in Kunming, Yunnan (2008 publication)
8.7% of male clients of CSW in Sichuan (2010 publication)

PATIENTS WITH HEPATITIS / LIVER DISEASE:
14% to 27% of patients with chronic hepatitis
16% of hepatitis B carriers
43% of patients with cirrhosis
39% of patients with hepatocellular carcinoma

HEMODIALYSIS PATIENTS:
54% of hemodialysis patients and 6% of commercial blood donors – rates somewhat higher among carriers of Hepatitis GB-C. (Beijing, 1996)
41% of hemodialysis patients (meta-analysis, 2009 publication)
17.2% of hemodialysis patients in Zhejiang (2009 publication)

OTHER:
1.72% of patients with oral lichen planus (2010 publication)
1.30% of subjects with thyroid autoantibodies vs. 0.53% of a control group (2011 publication)

Primary liver cancer, one of the principal sequelae of Hepatitis C, is the second most common malignancy in China, responsible for 360,000 incident cases, and 350,000 deaths per year. Mortality rates of liver cancer were 17.6 and 7.3 per 100,000 for males and females during 1973 to 1975, 29.0 and 11.2 per 100,000 during 1990 to 1992, and 37.55 and 14.45 per 100,000 during 2004 to 2005.

References:
1. Berger SA. Infectious Diseases of China, 2011. 635 pp, 253 graphs, 3049 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-china/
2. Berger SA. Hepatitis C: Global Status, 2011. 164 pp, 160 graphs, 1500 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/hepatitis-c-global-status/

Note featured on ProMED

Anaplasmosis has been documented in both humans and animals in China. [1,2] The following background data are abstracted from GIDEON (primary reference available on request).

Time and Place:
– Seropositive ruminants have been documented in Xinjiang Uygur Autonomous Region area.
– Seropositive rodents have been documented in Jilin Province: Japanese field mouse (Apodemus peninsulae), Black-striped field mouse (A. agrarius) and Siberian chipmunk (Tamias sibirica).
– Ehrlichial DNA (Anaplasma phagocytophilum) has been detected in Ixodes persulcatus ticks from the Northeastern (ie, Lyme disease) region – Inner Mongolia and Heilongjiang Province.
– Infected rodents, sheep and ticks (I. persulcatus and Dermacentor silvarum) have been detected in Jilin Province.

Prevalence surveys:
8.82% of forest rodents in Jilin Province, 1.64% in Helongjiang Province and 0% in Inner Mongolia autonomous region (2007 publication)
14.1% of rodents captured from a mountainous area in southeastern China (Zhejiang Province, 2008 publication)
5.5% of rodents from Heilongjiang Province, Inner Mongolia Autonomous Region, Jilin Province, Zhejiang Province, Guizhou Province, and Xinjiang Autonomous Region (2004 to 2006)
1.9% of rabbits captured in southeastern China (2009 publication)
4.6% to 6.8% of I. persulcatus in Jilin Province (2003 to 2005 publications)
7.34% of small mammals in the forest area of Hengduan Mountains, southwestern China (2009 publication)
6.7% of livestock and 14.5% of small rodents (2010 publication)

Seroprevalence surveys:
8.8% of farm workers near Tianjin (2006)
19.8% of persons with animal or tick exposure in central and southeastern China (2007)

Notable outbreaks:
2006 – An outbreak (9 cases) of transmission through blood or secretions was reported in Anhui Province among hospital staff who had treated an index patient.
2008 – An outbreak (5 cases, 3 fatal) was reported in Wanjiakou village in Shandong Province.

References:
1. Berger SA. Infectious Diseases of China, 614 pp. Gideon e-books, 2010. http://www.gideononline.com/ebooks/country/infectious-diseases-of-china/
2. Berger SA. Anaplasmosis: Global Status, 23 pp. Gideon e-books, 2010. http://www.gideononline.com/ebooks/disease/anaplasmosis-global-status/

Update: Quoted in ProMED

Time and Place:
Trichinosis was first documented in China in 1918.
- Disease prevalence in Beijing was estimated at 0.3% in 1918 and 0.16% in 1919.
- The principal foci of trichinosis are located in the southeast, center and northeast.
- As of 1999, 17 or the country’s provinces and autonomous regions report the disease.
- 4,033 cases (73 fatal) were reported during 1964 to 1979; 5,558 in 1983; 15,599 (141 fatal) during 1980 to 1989; 5,529 (26 fatal) during 1990 to 2002.
- 88.6% of clinical cases and 99.6% of fatal cases during 1964 to 2002 were reported from Yunnan, Guangxi and Tibet.

Prevalence surveys:
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GIDEON was quoted in a recent ProMED post related to a case of unknown hemorrhagic disease in China:

Background information on HGA in China is available on the Global Infectious Disease and Epidemiology Network (GIDEON) website.

Seropositive ruminants have been documented in Xinjiang Uygur Autonomous Region area. (see ref 1 below)
- Seropositive rodents have been documented in Jilin Province: Japanese field mouse (_Apodemus peninsulae_), Black-striped field mouse (_A. agrarius_) and Siberian chipmunk (_Tamias sibiricu_). (see
ref 2 below)
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In an undiagnosed case of hemorrhagic disease in China, Marjorie Pollack, a ProMED editor, used GIDEON to help figure out the differential diagnosis. From the ProMED note:

Using the database of the Global Infectious Disease and Epidemiology Network (GIDEON ) to see possible etiologies for a hemorrhagic fever syndrome in China, the most likely diagnosis would be Old World hantavirus infection (57 percent probability), followed by _Streptococcus suis_ infection (40 percent), leptospirosis (1.8 percent) and Crimean-Congo hemorrhagic fever (CCHF — less than one percent probability).

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