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According to the website of National Health Commission on the 13th, the comprehensive group of joint prevention and control mechanism for novel coronavirus epidemic in the State Council recently issued the Notice on Further Strengthening the Quality Management of nucleic acid sampling in Covid-19. In order to further strengthen the quality management of nucleic acid sampling in Covid-19, improve the standardization and accuracy of nucleic acid sampling, and provide safe and high-quality nucleic acid sampling services for the people, the relevant requirements are hereby notified as follows:

First, fully understand the importance of nucleic acid sampling

Nucleic acid sampling is an important part of nucleic acid detection in Covid-19. The standardized operation, personnel training and organization management of sampling are directly related to the accuracy and reliability of the test results and the personal feelings of the people. Improper management of nucleic acid sampling may not only lead to inaccurate test results, but also cross-infection among people, which will adversely affect epidemic prevention and control. All localities should attach great importance to the management of nucleic acid sampling, take problem-oriented measures, pay close attention to implementation, standardize the management of sampling links, and continuously improve the quality of nucleic acid sampling.

Second, ensure that the sampling personnel are qualified.

All localities should strictly manage the qualification of nucleic acid sampling personnel, and on the basis of existing medical personnel, personnel with health-related professional and technical qualifications in private hospitals, retail pharmacies, school clinics and enterprises and institutions should be included in the sampling personnel team, and they can engage in nucleic acid sampling only after they have been organized and standardized by the health administrative department and passed the examination. The deployment and use of sampling personnel should try not to crowd out normal medical resources to ensure the people’s demand for medical treatment.

Three, standardize the training of nucleic acid sampling

The local health administrative departments should standardize the organization, training and assessment of nucleic acid sampling in accordance with the Handbook of Nucleic Acid Detection in Medical Institutions in novel coronavirus (Trial Second Edition) and the Training Program for Nucleic Acid Sampling in Covid-19 (see Annex). By making training videos and organizing practical training, sampling personnel can master commonly used collection methods such as oropharyngeal swab and nasopharyngeal swab, correctly put on and use personal protective equipment, and implement various infection control measures. Video training is not allowed to replace practical training.

Fourth, strengthen the quality control of nucleic acid sampling

All localities should earnestly strengthen the quality control of nucleic acid sampling, and ensure the scientific operation and behavior of sampling personnel in accordance with the principle of "no training and no post, and no post if the training is unqualified". At the same time, the nucleic acid detection institutions should further improve the indoor quality control, and monitor whether the cells are collected by the sampling swab by analyzing the internal reference data of the detection reagents, so as to reflect and improve the sampling quality. The administrative department of health should organize to carry out spot checks on nucleic acid sampling, find problems in time, and put forward suggestions for improvement.

Five, do a good job in the organization and management of nucleic acid sampling

All localities should further strengthen the organization and management of nucleic acid sampling points, guide each sampling point to be equipped with enough sampling personnel, auxiliary personnel or volunteers, reasonably arrange the sampling personnel to shift and rest, provide corresponding logistics services, implement the relevant requirements of caring for medical personnel, and provide high-quality and efficient nucleic acid sampling services for the masses.

Covid-19 nucleic acid sampling training program  

In order to guide all localities to do a good job in training nucleic acid sampling personnel, standardize the sampling process, ensure the sampling quality and prevent possible cross-infection, this scheme is formulated.

I. Training organization

Local health administrative departments or their entrusted professional institutions are responsible for formulating training courseware and training course arrangement, and organizing nucleic acid sampling assessment. Those who pass the examination shall obtain the sampling training certificate issued by the health administrative department or its entrusted professional organization.

Second, the training content

The training contents mainly include the collection methods of oropharyngeal swabs and nasopharyngeal swabs, personal protection and infection control. The training time is at least one day, including theoretical training and practical training.

(a) oropharyngeal and nasopharyngeal swab sampling.

1. Collection method of oropharyngeal swab. The subjects adopt a posture with their heads slightly tilted and their mouths wide open, exposing their pharyngeal tonsils on both sides. The key point of oropharyngeal swab sampling is to pass the swab over the base of tongue, wipe it back and forth at least 3 times with a little force on both sides of pharyngeal tonsils, and then wipe it up and down the posterior pharyngeal wall at least 3 times. After sampling, put the swab head into the collection tube containing virus preservation solution, with the swab breaking point at the nozzle, break it slightly to make the swab head fall into the liquid in the collection tube, discard the broken swab rod, tighten the tube cover, and put the collection tube on a stable shelf. After each case is collected, the sampling personnel shall carry out hand disinfection.

2. Nasopharyngeal swab collection method. The sampler holds a swab and sticks it to the nostril to enter, and slowly goes back and forth along the bottom of the lower nasal passage. Because the nasal passage is arc-shaped, do not use too much force to avoid traumatic bleeding. When the tip of the swab reaches the back wall of nasopharyngeal cavity, gently rotate it for one week (in case of reflex cough, it should be stop for a minute), then slowly take out the swab and immerse the swab head in a tube containing 2 ~ 3 ml virus preservation solution.

In case of multi-person mixed mining, we should also pay attention to the standard operation of mixed swab. Taking 10-in-1 mixed sampling as an example, the remaining 9 swabs were collected in turn according to the above collection method, and the collected swabs were placed in the same collection tube, with gentle movements to avoid aerosol generation. After continuously collecting 10 swabs, tighten the tube cover to prevent spillage. If there are less than 10 swabs in the collection tube, special marks should be made and recorded.

(2) Personal protection of sampling personnel. Personal protection includes putting on and off personal protective equipment (including: medical protective mask, latex gloves, protective screen or goggles, isolation gown or protective clothing and working cap) correctly, and standardizing hand hygiene.

Personal protective equipment should be worn in the following order: medical protective mask and working cap, isolation gown or protective clothing, protective screen or goggles, and gloves. After wearing a mask, the tightness test of the mask should be carried out to ensure good tightness. If the mask is polluted or wet during use, gloves and protective clothing should be replaced in time if they are polluted or damaged.

Before taking off personal protective equipment, it is necessary to carry out hand hygiene, then take off protective screen or goggles in turn, take off isolation gown or protective clothing, gloves, hat and medical protective mask. In the process of taking off, the contaminated surface should not touch the internal clothes. Hand hygiene should be done before and after each step, and hands should not touch the contaminated surface.

(3) Infection control.

1. The sampling point is partitioned. The sampling point should be an open and well-ventilated site, which is divided into waiting area, collection area, buffer area, temporary isolation area and temporary storage area of medical waste, so as to effectively disperse the density of people to be inspected. (1) Waiting area. Set pedestrian passage, at the same time set a safe distance to ensure the protection and safety of waiting personnel. According to the weather conditions, it is equipped with facilities such as heat preservation, cooling, sun protection and rain protection. (2) Acquisition area. According to climatic conditions, tents, cold/warm fans and appropriate tables and chairs are provided. Equipped with disinfection supplies, swabs and virus collection tubes for collection, and paper towels, vomit bags and masks should be prepared for the collected personnel. If the specimen cannot be transported to the laboratory in time, a 4℃ refrigerator or low-temperature storage box should be prepared for temporary storage. (3) Buffer area. The space should be relatively closed for sampling personnel to change personal protective equipment, place protective equipment, disinfection supplies for collection, swabs, collection tubes and outdoor disinfection equipment that match the scale of sampling points. (4) Temporary isolation zone. Used to temporarily isolate suspected patients or high-risk groups found in the collection process. (5) Temporary storage area for medical wastes. Used for temporary storage of medical waste, and do a good job of collection, packaging, harmless treatment, handover and so on.

2. Do a good job of cleaning and disinfection. When collecting specimens, hand hygiene should be strictly implemented, and one hand should be disinfected, that is, after the specimen collection of the previous person is completed, hand disinfection must be carried out before the next collection operation can be carried out. Attention should be paid to the prevention and control of infection in the sampling process, and other parts should not touch the mined personnel except the swab to prevent cross-infection. After the sampling site work, medical instruments, articles and surfaces should be cleaned and disinfected. Clean the environmental surface thoroughly with clean water and detergent, and use effective disinfectants to disinfect the surface of environmental objects, especially the high-frequency contact parts. Standardize the treatment of patients’ respiratory secretions, excreta and vomit.

3. Avoid crowds. Clear guiding signs should be set up at sampling points to ensure one-way flow of personnel, and the sampling process and matters needing attention should be defined. Do a good job in the fine organization and management of the sampling site. While maintaining the work order by staff and volunteers, we encourage physical means to strictly implement the requirements of safe distance interval.

Third, the assessment

The assessment contents include sampling operation, personal protection and theoretical knowledge of sensing control. The main assessment of practical operation, when necessary, can arrange a simple theoretical examination. It mainly covers the following contents:

1. Whether you can wear a mask correctly and how well you know the potential risks.

2. Whether you can correctly grasp the procedures of putting on and taking off isolation gown or protective clothing, and understand the potential risks.

3. Whether the oropharyngeal and nasal swab collection operation can be standardized, and the degree of understanding that irregular operation may affect the test results.

4. Whether hand hygiene can be carried out correctly, and the degree of understanding of infection control methods such as environmental ventilation, cleaning and disinfection, and standardized disposal of medical wastes.

General Secretary of the Supreme Leader put forward in his important speech on July 26th that "China’s development has reached a new historical starting point and Socialism with Chinese characteristics has entered a new stage of development". We should strive to achieve socialist modernization, that is, the second century goal, after winning the decisive battle to build a well-off society in an all-round way. China has gone from poverty to poverty, from everything to prosperity, to entering and building a well-off society in an all-round way, and to modernization. The changes in China have attracted worldwide attention. Although we still have many problems to solve, every Chinese has a deep sense of gain.

Does China’s experience mean anything to the world? I think it is meaningful, especially for developing countries. As General Secretary of the Supreme Leader pointed out in his important speech on "July 26th", "Socialism with Chinese characteristics has expanded the way for developing countries to modernize, contributed China wisdom and provided China’s plan for solving human problems". China is the largest developing country in the world, and the road of China is different from that of the west. In the past, the west always vilified and even slandered us, saying that we were autocratic and that we had no freedom, human rights and so on. Facts speak plainer than words. Isn’t the significance of China’s experience and China’s road obvious to developing countries?

I remember there was a sensational news on the Internet last year that a Shanghai girl responded to the color revolution. One of her teachers in the United States asked her, why don’t you have a color revolution with so many young people in China? She found two pictures of Pudong in Shanghai for her teacher, what Pudong was like in the past and what Pudong is like now. She said, why should we make any color revolution to change it when we are living so well? This China girl has Chinese’s self-confidence. What self-confidence is there? It is our road confidence, theoretical confidence, institutional confidence and cultural confidence. Others have to consider: in such a poor country, great changes have taken place in such a short time, and the people are so confident. Is this road useful to us? Therefore, the concept of China Road is a great inspiration to developing countries. Specifically, there are at least several aspects:

First, China has both long-term planning and concrete measures to implement the planning in its development. This is a great inspiration to some developing countries, because many developing countries and even western developed countries lack long-term planning. A politician in a western country said that we are all politicians, but politicians in China can make long-term plans, but we can’t. It’s useless for us to make them. Politicians in China can do things for the people, and we consider running for office every day, so we can’t do practical things. Planning and doing things are our advantages, doesn’t this inspire developing countries? Therefore, one of the most important connotations of China Road is that there are both long-term plans and concrete measures to implement these plans.

Second, develop the socialist market economy. Other developing countries have also developed market economy, which is not as successful as ours, and some even developed into polarization in the end. Why? Because China combined the invisible hand with the visible hand. The invisible hand is the market, and the visible hand is the macro-control of the government. If we just engage in a laissez-faire market economy without considering the adjustment of supply and demand in the market, it is likely that resources will be wasted a lot, and in the end, all products will be surplus, which will not be enjoyed by ordinary people and the economy will still be in a state of collapse. What we have is a market economy system under the macro-control of the state, which is called socialist market economy. Many developing countries are considering this experience, that is to say, we can’t simply engage in a laissez-faire market economy, but we must also have macro-control by the government.

Third, not only enliven the rich, but also help the poor out of poverty. At the beginning, our poverty alleviation was to help the poor in rural areas and the low-income people in cities. Later, we engaged in development-oriented poverty alleviation so that the poor could master skills and really get rid of poverty. Since the 18th National Congress, General Secretary of the Supreme Leader has put forward a big project: precision poverty alleviation. Millions of team members went to villages and households to register their cards, find out the base number and solve the poverty problem. Recently, the General Secretary of the Supreme Leader proposed to help the poor in depth and use some new measures to solve the problem of poverty alleviation for the deeply poor. We have announced that by 2020, when a well-off society is built in an all-round way, the rural poor will be lifted out of poverty according to the current standards, all poverty-stricken counties in the country will be stripped of their hats, and the problem of regional poverty will be solved well. Invigorating and getting rich and helping the poor out of poverty are the fundamental purposes of our party to serve the people. Although there is still a gap between ordinary people, it will not lead to polarization and confrontation. The United Nations has also affirmed China’s great contribution to achieving its Millennium poverty reduction goal, which is also very enlightening to developed countries.

Fourth, reform, development and stability are organically unified. Reform is the driving force and development is the goal. Develop in reform and be stable at the same time. We are soberly aware that there are many contradictions in a developing country. If the society is unstable or even the political situation is unstable, all reform measures will not be implemented and all development goals will be ruined. Many countries develop Western-style democracy and freedom, with unstable society and political situation. All development is empty talk, and all reforms cannot be promoted. The Communist Party of China (CPC) combines reform, development and stability, and organically unifies the strength of reform, the speed of development and the affordability of the people. This experience is unparalleled in the world. Some people make irresponsible remarks about our stability, and have no idea why we can succeed or the characteristics of China society. The organic unity of reform, development, stability is a great highlight of China road.

Fifth, combine electoral democracy with deliberative democracy. Our choice of democratic system is not to engage in the western election system, but to combine the two forms of electoral democracy and deliberative democracy. By exercising the right to vote, ordinary people can choose their favorite leading cadres who can lead the rich, have the spirit of reform and innovation, and are law-abiding, honest and clean. More importantly, we also have a consultation system. No matter who is a cadre, we must go through consultation before making major decisions. Our consultations include political parties, big consultations, government consultations, CPPCC consultations, people’s organizations consultations, grassroots social consultations, and social organizations consultations. The whole democratic system is different from the West. General Secretary of the Supreme Leader said that the democracy that people were awakened when they voted was formalism. Our democracy is that you vote when you vote and continue to participate in democracy after you vote. Our major decisions seek the opinions of the people, which is not available in western developed and developing countries.

Therefore, China Road, China Wisdom and China Plan are of great significance to developing countries. What Chinese did was written in two histories, the first was written in the history of the great rejuvenation of the Chinese nation, and the second was written in the history of the progress of the people of the world. We must have this spirit, and we can also have this spirit; We have this pursuit, and we can achieve it.

(The author is the former vice president of the Central Party School)

China CDC Weekly recently released a survey on hand-foot-mouth disease virus, and Coxsackie virus A6 has become the main pathogen leading to severe cases of hand-foot-mouth disease in China. At present, Coxsackie virus A6 associated with severe hand, foot and mouth disease is evolving, and there is a risk of outbreak.

According to the research team, hand, foot and mouth disease is an infectious disease mainly caused by a variety of enteroviruses, which mainly affects infants and children. The symptoms are usually fever, oral ulcers and rashes, and the symptoms are generally mild and relieved within 7 to 10 days. However, some severe cases may have life-threatening neurological, respiratory or circulatory complications. Previously, enterovirus A71 was the main pathogen causing severe cases of hand, foot and mouth disease.

In 2016, inactivated enterovirus A71 vaccine was widely used, which significantly reduced the incidence of hand, foot and mouth disease caused by the virus. However, due to the lack of cross-protection between different enterovirus serotypes, the diversity of pathogens of severe hand, foot and mouth disease has changed.

According to the national laboratory monitoring network of hand, foot and mouth disease pathogens, the research team investigated the severe cases of hand, foot and mouth disease in China from 2012 to 2023, and obtained 74 strains of coxsackie virus A6 for analysis, and concluded that coxsackie virus A6 has become the main pathogen leading to severe cases of hand, foot and mouth disease in China. In addition, the virus related to severe hand, foot and mouth disease is evolving and there is a risk of outbreak. Therefore, it is necessary to strengthen the monitoring of severe hand, foot and mouth disease.

Among 74 severe cases of hand, foot and mouth disease related to coxsackie virus A6, 48 cases were male and 26 cases were female. The average age is about 2 years old, including 25 children under 1 year old, 26 children between 1 and 5 years old and 3 children over 5 years old. The research team said that the immune system of severe cases of hand, foot and mouth disease under 5 years old is immature, and if it cannot be diagnosed and treated in time, it may increase susceptibility and lead to serious complications and potentially fatal consequences. Therefore, the development of coxsackie virus A6 vaccine is very important to prevent severe hand, foot and mouth disease in susceptible children.

A little more news.

How is hand, foot and mouth disease spread?

Patients and recessive infected people are the sources of infection of hand, foot and mouth disease, and the proportion of recessive infection is large. Patients are contagious before onset, usually within 1 week after onset.

The route of transmission is diverse and easy to realize. The main mode of transmission is close contact, and infection is caused by direct contact with patients’ feces, herpes fluid, nasopharyngeal secretions and saliva, and contact with contaminated hands, towels, handkerchiefs, toothcups, toys, tableware, bottles, bedding and other items or environment. It can also spread through respiratory droplets, such as coughing and sneezing; Drinking or eating water and food contaminated by virus can also be infected.

How to prevent hand, foot and mouth disease?

(1) Avoid contact with children. Try not to hug, share toys, share tableware, toiletries, etc. with children to prevent cross infection.

(2) Maintain hand hygiene. Good hand hygiene is an effective measure to prevent hand, foot and mouth disease. Children should clean their hands after touching public goods, after going out to play, before eating, after going to the toilet, and after parents and caregivers go home, before processing food, after changing diapers or handling items contaminated by feces. Usually, you can wash your hands with soapy water or hand sanitizer. After contacting patients and pollutants, you should choose a chlorine-containing disinfectant with appropriate concentration to wash your hands.

(3) reduce aggregation. Crowd gathering and frequent contact are easy to spread hand, foot and mouth disease. It is suggested that children should not be taken to public places with crowded people and poor air circulation during the epidemic period of hand, foot and mouth disease.

(4) The environment is ventilated. Closed public places and rooms should be ventilated frequently to maintain air circulation.

(5) Cleaning and disinfection. Regular cleaning and disinfection of frequent contact parts, daily necessities and children’s toys; Milk utensils, tableware, etc. should be boiled and disinfected; Clothes and bedding are often dried in the sun or disinfected by ultraviolet light.

(6) vaccination. Although EV-A71 vaccine can not prevent other enterovirus infections, it can effectively prevent hand, foot and mouth disease and other related diseases caused by EV-A71 infection, and reduce the occurrence of severe hand, foot and mouth disease and death. In order to play a protective role as early as possible, children are encouraged to complete the whole vaccination before the age of 12 months. Vaccination is not recommended for children over 5 years old.

Editor | Gu Ying

Comprehensive | Beijing Daily Tianjin CDC China CDC

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Original title: "Vigilance | Early warning of disease control: there is an outbreak risk of this virus! 》

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