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Roudreo B, Puangthongthub S. Alleviation of PM2.5-associated Risk of Daily Influenza Hospitalization by COVID-19 Lockdown Measures: A Time-series Study in Northeastern Thailand. J Prev Med Public Health 2024; 57:108-119. [PMID: 38374709 PMCID: PMC10999304 DOI: 10.3961/jpmph.23.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Abrupt changes in air pollution levels associated with the coronavirus disease 2019 (COVID-19) outbreak present a unique opportunity to evaluate the effects of air pollution on influenza risk, at a time when emission sources were less active and personal hygiene practices were more rigorous. METHODS This time-series study examined the relationship between influenza cases (n=22 874) and air pollutant concentrations from 2018 to 2021, comparing the timeframes before and during the COVID-19 pandemic in and around Thailand's Khon Kaen province. Poisson generalized additive modeling was employed to estimate the relative risk of hospitalization for influenza associated with air pollutant levels. RESULTS Before the COVID-19 outbreak, both the average daily number of influenza hospitalizations and particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) concentration exceeded those later observed during the pandemic (p<0.001). In single-pollutant models, a 10 μg/m3 increase in PM2.5 before COVID-19 was significantly associated with increased influenza risk upon exposure to cumulative-day lags, specifically lags 0-5 and 0-6 (p<0.01). After adjustment for co-pollutants, PM2.5 demonstrated the strongest effects at lags 0 and 4, with elevated risk found across all cumulative-day lags (0-1, 0-2, 0-3, 0-4, 0-5, and 0-6) and significantly greater risk in the winter and summer at lag 0-5 (p<0.01). However, the PM2.5 level was not significantly associated with influenza risk during the COVID-19 outbreak. CONCLUSIONS Lockdown measures implemented during the COVID-19 pandemic could mitigate the risk of PM2.5-induced influenza. Effective regulatory actions in the context of COVID-19 may decrease PM2.5 emissions and improve hygiene practices, thereby reducing influenza hospitalizations.
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Affiliation(s)
- Benjawan Roudreo
- Industrial Toxicology and Risk Assessment Graduate Program, Department of Environmental Science, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Sitthichok Puangthongthub
- Industrial Toxicology and Risk Assessment Graduate Program, Department of Environmental Science, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
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2
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Wang Y, Zhang R, Yang F, Yang L, Li Q, Guo J, Liu X, Song J, Zhang G, Li J, An Z, Alexis NE, Jaspers I, Wu W. Potential mechanisms mediating PM 2.5-induced alterations of H3N2 influenza virus infection and cytokine production in human bronchial epithelial cells. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 259:115069. [PMID: 37244199 DOI: 10.1016/j.ecoenv.2023.115069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023]
Abstract
Exposure to particulate matter (PM) has been associated with increased hospital admissions for influenza. Airway epithelial cells are a primary target for inhaled environmental insults including fine PM (PM2.5) and influenza viruses. The potentiation of PM2.5 exposure on the effects of influenza virus on airway epithelial cells has not been adequately elucidated. In this study, the effects of PM2.5 exposure on influenza virus (H3N2) infection and downstream modulation of inflammation and antiviral immune response were investigated using a human bronchial epithelial cell line, BEAS-2B. The results showed that PM2.5 exposure alone increased the production of pro-inflammatory cytokines including interleukin-6 (IL-6) and IL-8 but decreased the production of the antiviral cytokine interferon-β (IFN-β) in BEAS-2B cells while H3N2 exposure alone increased the production of IL-6, IL-8, and IFN-β. Importantly, prior exposure to PM2.5 enhanced subsequent H3N2 infectivity, expression of viral hemagglutinin protein, as well as upregulation of IL-6 and IL-8, but reduced H3N2-induced IFN-β production. Pre-treatment with a pharmacological inhibitor of nuclear factor-κB (NF-κB) suppressed pro-inflammatory cytokine production induced by PM2.5, H3N2, as well as PM2.5-primed H3N2 infection. Moreover, antibody-mediated neutralization of Toll-like receptor 4 (TLR4) blocked cytokine production triggered by PM2.5 or PM2.5-primed H3N2 infection, but not H3N2 alone. Taken together, exposure to PM2.5 alters H3N2-induced cytokine production and markers of replication in BEAS-2B cells, which in turn are regulated by NF-κB and TLR4.
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Affiliation(s)
- Yinbiao Wang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Rui Zhang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Fuyun Yang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Lin Yang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Qingmei Li
- Henan Provincial Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou 450002, PR China
| | - Junqing Guo
- Henan Provincial Key Laboratory of Animal Immunology, Henan Academy of Agricultural Sciences, Zhengzhou 450002, PR China
| | - Xiao Liu
- School of Laboratory Medicine, Henan Medical College, Zhengzhou 451191, PR China
| | - Jie Song
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Guofu Zhang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Juan Li
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Zhen An
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilona Jaspers
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, PR China.
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Ma P, Zhou N, Wang X, Zhang Y, Tang X, Yang Y, Ma X, Wang S. Stronger susceptibilities to air pollutants of influenza A than B were identified in subtropical Shenzhen, China. ENVIRONMENTAL RESEARCH 2023; 219:115100. [PMID: 36565842 DOI: 10.1016/j.envres.2022.115100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Air pollution was indicated to be a key factor contributing to the aggressive spread of influenza viruses, whereas uncertainty still exists regarding to whether distinctions exist between influenza subtypes. Our study quantified the impact of five air pollutants on influenza subtype outbreaks in Shenzhen, China, a densely populated and highly urbanized megacity. Daily influenza outbreak data of laboratory-confirmed positive cases were obtained from the Shenzhen CDC, from May 1, 2013 to Dec 31, 2015. Concentrations of nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matters ≤2.5 μm (PM2.5), particulate matters ≤10 μm (PM10), and ozone (O3), were retrieved from the 18 national monitoring stations. The generalized additive model (GAM) and distributed lag non-linear model (DLNM) were used to calculate the concentration-response relationships between environmental inducers and outbreak epidemics, respectively for influenza A (Flu-A) and B (Flu-B). There were 1687 positive specimens were confirmed during the study period. The cold season was restricted from Nov. 4th to Apr. 20th, covering all seasons other than the long-lasting summer. Relatively heavy fine particle matter (PM2.5) and NO2 pollution was observed in cold months, with mean concentrations of 46.06 μg/m3 and 40.03 μg/m3, respectively. Time-series analysis indicated that high concentrations of NO2, PM2.5, PM10, and O3 were associated with more influenza outbreaks at short lag periods (0-5 d). Although more Flu-B (679 cases) epidemics occurred than Flu-A (382 cases) in the cold season, Flu-A generally showed higher susceptibility to air pollutants. A 10 μg/m3 increment in concentrations of PM2.5, PM10, and O3 at lag 04, was associated with a 2.103 (95%CI: 1.528-2.893), 1.618 (95%CI: 1.311-1.996), and 1.569 (95%CI: 1.214-2.028) of the relative risk (RR) of Flu-A, respectively. A 5 μg/m3 increase in NO2 was associated with higher risk of Flu-A at lag 03 (RR = 1.646, 95%CI: 1.295-2.092) and of Flu-B at lag 04 (RR = 1.319, 95%CI: 1.095-1.588). Nevertheless, barely significant effect of particulate matters (PM2.5, PM10) on Flu-B and SO2 on both subtypes was detected. Further, the effect estimates of NO2 increased for both subtypes when coexisting with other pollutants. This study provides evidence that declining concentrations of main pollutants including NO2, O3, and particulate matters, could substantially decrease influenza risk in subtropical Shenzhen, especially for influenza A.
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Affiliation(s)
- Pan Ma
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China; Chengdu Plain Urban Meteorology and Environment Scientific Observation and Research Station of Sichuan Province, Chengdu, 610225, Sichuan, China.
| | - Ning Zhou
- The First People's Hospital of Lanzhou, Lanzhou, 730050, Gansu, China.
| | - Xinzi Wang
- Meteorological Bureau of Jinnan District, Tianjin, 300350, China.
| | - Ying Zhang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China; Chengdu Plain Urban Meteorology and Environment Scientific Observation and Research Station of Sichuan Province, Chengdu, 610225, Sichuan, China.
| | - Xiaoxin Tang
- Shenzhen National Climate Observatory, Shenzhen, 518000, China.
| | - Yang Yang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China.
| | - Xiaolu Ma
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China.
| | - Shigong Wang
- Plateau Atmosphere and Environment Key Laboratory of Sichuan Province, College of Atmospheric Science, Chengdu University of Information Technology, Chengdu, 610225, Sichuan, China.
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Lian XY, Xi L, Zhang ZS, Yang LL, Du J, Cui Y, Li HJ, Zhang WX, Wang C, Liu B, Yang YN, Cui F, Lu QB. Impact of air pollutants on influenza-like illness outpatient visits under COVID-19 pandemic in the subcenter of Beijing, China. J Med Virol 2023; 95:e28514. [PMID: 36661040 DOI: 10.1002/jmv.28514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
This study aimed to explore the association between air pollutants and outpatient visits for influenza-like illnesses (ILI) under the coronavirus disease 2019 (COVID-19) stage in the subcenter of Beijing. The data on ILI in the subcenter of Beijing from January 1, 2018 to December 31, 2020 were obtained from the Beijing Influenza Surveillance Network. A generalized additive Poisson model was applied to examine the associations between the concentrations of air pollutants and daily outpatient visits for ILI when controlling meteorological factors and temporal trend. A total of 171 943 ILI patients were included. In the pre-coronavirus disease 2019 (COVID-19) stage, an increased risk of ILI outpatient visits was associated to a high air quality index (AQI) and the high concentrations of particulate matter less than 2.5 (PM2.5 ), particulate matter 10 (PM10 ), sulphur dioxide (SO2 ), nitrogen dioxide (NO2 ), and carbon monoxide (CO), and a low concentration of ozone (O3 ) on lag0 day and lag1 day, while a higher increased risk of ILI outpatient visits was observed by the air pollutants in the COVID-19 stage on lag0 day. Except for PM10 , the concentrations of other air pollutants on lag1 day were not significantly associated with an increased risk of ILI outpatient visits during the COVID-19 stage. The findings that air pollutants had enhanced immediate effects and diminished lag-effects on the risk of ILI outpatient visits during the COVID-19 pandemic, which is important for the development of public health and environmental governance strategies.
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Affiliation(s)
- Xin Yao Lian
- Department of Laboratorial Science and Technology, Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Lu Xi
- Beijing Tongzhou Center for Diseases Prevention and Control, Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing, People's Republic of China
| | - Zhong Song Zhang
- Department of Laboratorial Science and Technology, Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Li Li Yang
- Beijing Tongzhou Center for Diseases Prevention and Control, Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing, People's Republic of China
| | - Juan Du
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
| | - Yan Cui
- Beijing Tongzhou Center for Diseases Prevention and Control, Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing, People's Republic of China
| | - Hong Jun Li
- Beijing Tongzhou Center for Diseases Prevention and Control, Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing, People's Republic of China
| | - Wan Xue Zhang
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
| | - Chao Wang
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
| | - Bei Liu
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
| | - Yan Na Yang
- Center for Disease Control and Prevention of Beijing Economic and Technological Development Area, Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing, People's Republic of China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology, Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China.,Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
| | - Qing Bin Lu
- Department of Laboratorial Science and Technology, Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China.,Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, People's Republic of China
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5
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Wang X, Cai J, Liu X, Wang B, Yan L, Liu R, Nie Y, Wang Y, Zhang X, Zhang X. Impact of PM 2.5 and ozone on incidence of influenza in Shijiazhuang, China: a time-series study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:10426-10443. [PMID: 36076137 PMCID: PMC9458314 DOI: 10.1007/s11356-022-22814-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/27/2022] [Indexed: 05/03/2023]
Abstract
Most of the studies are focused on influenza and meteorological factors for influenza. There are still few studies focused on the relationship between pollution factors and influenza, and the results are not consistent. This study conducted distributed lag nonlinear model and attributable risk on the relationship between influenza and pollution factors, aiming to quantify the association and provide a basis for the prevention of influenza and the formulation of relevant policies. Environmental data in Shijiazhuang from 2014 to 2019, as well as the data on hospital-confirmed influenza, were collected. When the concentration of PM2.5 was the highest (621 μg/m3), the relative risk was the highest (RR: 2.39, 95% CI: 1.10-5.17). For extremely high concentration PM2.5 (348 μg/m3), analysis of cumulative lag effect showed statistical significance from cumulative lag0-1 to lag0-6 day, and the minimum cumulative lag effect appeared in lag0-2 (RR: 0.760, 95% CI: 0.655-0.882). In terms of ozone, the RR value was 2.28(1.19,4.38), when O3 concentration was 310 μg/m3, and the RR was 1.65(1.26,2.15), when O3 concentration was 0 μg/m3. The RR of this lag effect increased with the increase of lag days, and reached the maximum at lag0-7 days, RR and 95% CI of slightly low concentration and extremely high concentration were 1.217(1.108,1.337) and 1.440(1.012,2.047), respectively. Stratified analysis showed that there was little difference in gender, but in different age groups, the cumulative lag effect of these two pollutants on influenza was significantly different. Our study found a non-linear relationship between two pollutants and influenza; slightly low concentrations were more associated with contaminant-related influenza. Health workers should encourage patients to get the influenza vaccine and wear masks when going out during flu seasons.
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Affiliation(s)
- Xue Wang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Jianning Cai
- The Department of Epidemic Treating and Preventing, Center for Disease Prevention and Control of Shijiazhuang City, Shijiazhuang, China
| | - Xuehui Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Binhao Wang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Lina Yan
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Ran Liu
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Yaxiong Nie
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Yameng Wang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Xinzhu Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Hebei Province Key Laboratory of Environment and Human Health, 361 Zhongshan East Road, Shijiazhuang, 050017, China.
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Yang J, Yang Z, Qi L, Li M, Liu D, Liu X, Tong S, Sun Q, Feng L, Ou CQ, Liu Q. Influence of air pollution on influenza-like illness in China: a nationwide time-series analysis. EBioMedicine 2022; 87:104421. [PMID: 36563486 PMCID: PMC9800295 DOI: 10.1016/j.ebiom.2022.104421] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence concerning effects of air pollution on influenza-like illness (ILI) from multi-center is limited and little is known about how regional factors might modify this relationship. METHODS In this ecological study, ILI cases defined as outpatients with temperature ≥38 °C, accompanied by cough or sore throat, were collected from National Influenza Surveillance Network in China. We adopted generalized additive model with quasi-Poisson to estimate province-specific association between air pollution and ILI in 30 Chinese provinces during 2015-2019, after adjusting for time trend and meteorological factors. We then pooled province-specific association by using random-effect meta-analysis. Potential effect modifications of season and regional characteristics were explored. FINDINGS A total of 26, 004, 853 ILI cases and 777, 223, 877 hospital outpatients were collected. In general, effects of air pollutants were acute. An inter-quartile range increase of PM2.5, SO2, PM10, NO2 and CO at lag0, and O3 at lag0-2 was associated with 3.08% (95% CI: 1.91%, 4.27%), 3.00% (1.86%, 4.16%), 6.46% (4.71%, 8.25%), 7.21% (5.73%, 8.71%), 4.37% (3.05%, 5.70%), and -9.26% (-11.32%, -7.14%) change of ILI at national level, respectively. Associations between air pollutants and ILI varied by season and regions, with higher effect estimates in cold season, eastern and central regions and provinces with more humid condition and larger population. INTERPRETATION This study indicated that most air pollutants increased the risk of ILI in China. Our findings might provide implications for the development of policies to protect public health from air pollution and influenza. FUNDING National Natural Science Foundation of China and Chongqing Health Commission Program.
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Affiliation(s)
- Jun Yang
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China,Corresponding author.
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Mengmeng Li
- Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Di Liu
- School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
| | - Xiaobo Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Shilu Tong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Qinghua Sun
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China,Corresponding author.
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China,Corresponding author.
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Zhang R, Lai KY, Liu W, Liu Y, Lu J, Tian L, Webster C, Luo L, Sarkar C. Community-level ambient fine particulate matter and seasonal influenza among children in Guangzhou, China: A Bayesian spatiotemporal analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 826:154135. [PMID: 35227720 DOI: 10.1016/j.scitotenv.2022.154135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Influenza is a major preventable infectious respiratory disease. However, there is little detailed long-term evidence of its associations with PM2.5 among children. We examined the community-level associations between exposure to ambient PM2.5 and incident influenza in Guangzhou, China. METHODS We used data from the city-wide influenza surveillance system collected by Guangzhou Centre for Disease Control and Prevention (GZCDC) over the period 2013 and 2019. Incident influenza was defined as daily new influenza (both clinically diagnosed and laboratory confirmed) cases as per standard diagnostic criteria. A 200-meter city-wide grid of daily ambient PM2.5 exposure was generated using a random forest model. We developed spatiotemporal Bayesian hierarchical models to examine the community-level associations between PM2.5 and the influenza adjusting for meteorological and socioeconomic variables and accounting for spatial autocorrelation. We also calculated community-wide influenza cases attributable to PM2.5 levels exceeding the China Grade 1 and World Health Organization (WHO) regulatory thresholds. RESULTS Our study comprised N = 191,846 children from Guangzhou aged ≤19 years and diagnosed with influenza between January 1, 2013 and December 31, 2019. Each 10 μg/m3 increment in community-level PM2.5 measured on the day of case confirmation (lag 0) and over a 6-day moving average (lag 0-5 days) was associated with higher risks of influenza (RR = 1.05, 95% CI: 1.05-1.06 for lag 0 and RR = 1.15, 95% CI: 1.14-1.16 for lag 05). We estimated that 8.10% (95%CI: 7.23%-8.57%) and 20.11% (95%CI: 17.64%-21.48%) influenza cases respectively were attributable to daily PM2.5 exposure exceeding the China Grade I (35 μg/m3) and the WHO limits (25 μg/m3). The risks associated with PM2.5 exposures were more pronounced among children of the age-group 10-14 compared to other age groups. CONCLUSIONS More targeted non-pharmaceutical interventions aimed at reducing PM2.5 exposures at home, school and during commutes among children may constitute additional influenza prevention and control polices.
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Affiliation(s)
- Rong Zhang
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Wenhui Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Yanhui Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Jianyun Lu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Linwei Tian
- School of Public Health, The University of Hong Kong, Patrick Mason Building, Sassoon Road, Pokfulam, Hong Kong, China
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Lei Luo
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong, China.
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Jones RP, Ponomarenko A. Trends in Excess Winter Mortality (EWM) from 1900/01 to 2019/20-Evidence for a Complex System of Multiple Long-Term Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063407. [PMID: 35329098 PMCID: PMC8953800 DOI: 10.3390/ijerph19063407] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
Trends in excess winter mortality (EWM) were investigated from the winter of 1900/01 to 2019/20. During the 1918–1919 Spanish flu epidemic a maximum EWM of 100% was observed in both Denmark and the USA, and 131% in Sweden. During the Spanish flu epidemic in the USA 70% of excess winter deaths were coded to influenza. EWM steadily declined from the Spanish flu peak to a minimum around the 1960s to 1980s. This decline was accompanied by a shift in deaths away from the winter and spring, and the EWM calculation shifted from a maximum around April to June in the early 1900s to around March since the late 1960s. EWM has a good correlation with the number of estimated influenza deaths, but in this context influenza pandemics after the Spanish flu only had an EWM equivalent to that for seasonal influenza. This was confirmed for a large sample of world countries for the three pandemics occurring after 1960. Using data from 1980 onward the effect of influenza vaccination on EWM were examined using a large international dataset. No effect of increasing influenza vaccination could be discerned; however, there are multiple competing forces influencing EWM which will obscure any underlying trend, e.g., increasing age at death, multimorbidity, dementia, polypharmacy, diabetes, and obesity—all of which either interfere with vaccine effectiveness or are risk factors for influenza death. After adjusting the trend in EWM in the USA influenza vaccination can be seen to be masking higher winter deaths among a high morbidity US population. Adjusting for the effect of increasing obesity counteracted some of the observed increase in EWM seen in the USA. Winter deaths are clearly the outcome of a complex system of competing long-term trends.
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Affiliation(s)
- Rodney P. Jones
- Healthcare Analysis & Forecasting, Wantage OX12 0NE, UK
- Correspondence:
| | - Andriy Ponomarenko
- Department of Biophysics, Informatics and Medical Instrumentation, Odessa National Medical University, Valikhovsky Lane 2, 65082 Odessa, Ukraine;
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Hsiao TC, Cheng PC, Chi KH, Wang HY, Pan SY, Kao C, Lee YL, Kuo HP, Chung KF, Chuang HC. Interactions of chemical components in ambient PM 2.5 with influenza viruses. JOURNAL OF HAZARDOUS MATERIALS 2022; 423:127243. [PMID: 34844361 DOI: 10.1016/j.jhazmat.2021.127243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 05/28/2023]
Abstract
The significance of this work is that ambient PM2.5 is a direct transmission mode for influenza virus infection to the human alveolar epithelium. The concentration of PM2.5 was 11.7 ± 5.5 μg/m3 in Taipei during 24 December 2019-13 January 2020. Approximately 79% of inhaled PM2.5 is able to reach the upper-to-lower airway, and 47% of PM2.5 is able to reach the alveolar epithelium for influenza virus infection. Influenza A and B viruses were detected in PM2.5 on 9 days, and the influenza A/H5 virus was detected on 15 days during the study period. FL and Pyr were negatively correlated with the influenza A virus. D(ah)P and Acp were positively correlated with the influenza B and A/H5 viruses, respectively. Cd, V, and Zn were positively correlated with the influenza A, B, and A/H5 viruses, respectively. Next, influenza A, B, and A/H5 viral plasmids interacted with carbon black, H2O2, DEPs, and UD. We observed that H2O2 significantly decreased levels of complementary DNA of the three influenza viruses. DEPs and UD significantly decreased influenza A and A/H5 viral levels. In conclusion, chemicals in PM2.5 may play vital roles in terms of viable influenza virus in the atmosphere.
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Affiliation(s)
- Ta-Chih Hsiao
- Graduate Institute of Environmental Engineering, National Taiwan University, Taipei, Taiwan.
| | - Po-Ching Cheng
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for International Tropical Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Kai Hsien Chi
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chao Tung University, Taipei, Taiwan.
| | - Hung-Yang Wang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for International Tropical Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Shih-Yu Pan
- Institute of Environmental and Occupational Health Sciences, National Yang Ming Chao Tung University, Taipei, Taiwan.
| | - Ching Kao
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yueh-Lun Lee
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Han-Pin Kuo
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Loaiza-Ceballos MC, Marin-Palma D, Zapata W, Hernandez JC. Viral respiratory infections and air pollutants. AIR QUALITY, ATMOSPHERE, & HEALTH 2021; 15:105-114. [PMID: 34539932 PMCID: PMC8441953 DOI: 10.1007/s11869-021-01088-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 09/01/2021] [Indexed: 05/17/2023]
Abstract
Air pollution is a public health issue of global importance and a risk factor for developing cardiorespiratory diseases. These contaminants induce reactive oxygen species (ROS) and increased pro-inflammatory cytokines such as IL-1β, IL-6, and IL-8, triggering the inflammatory response that alters cell and tissue homeostasis and facilitates the development of diseases. The effects of air pollutants such as ozone, particulate matter (PM10, PM2.5, and PM0.1), and indoor air pollutants on respiratory health have been widely reported. For instance, epidemiological and experimental studies have shown associations between hospital admissions for individual diseases and increased air pollutant levels. This review describes the association and relationships between exposure to air pollutants and respiratory viral infections, especially those caused by the respiratory syncytial virus and influenza virus. The evidence suggests that exposure to air contaminants induces inflammatory states, modulates the immune system, and increases molecules' expression that favors respiratory viruses' pathogenesis and affects the respiratory system. However, the mechanisms underlying these interactions have not yet been fully elucidated, so it is necessary to develop new studies to obtain information that will allow health and policy decisions to be made for the adequate control of respiratory infections, especially in the most vulnerable population, during periods of maximum air pollution.
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Affiliation(s)
| | - Damariz Marin-Palma
- Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellin, Colombia
- Grupo Inmunovirologia, Facultad de Medicina, Universidad de Antioquia, UdeA, Medellin, Colombia
| | - Wildeman Zapata
- Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellin, Colombia
- Grupo Inmunovirologia, Facultad de Medicina, Universidad de Antioquia, UdeA, Medellin, Colombia
| | - Juan C. Hernandez
- Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellin, Colombia
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Li X, Xu J, Wang W, Liang JJ, Deng ZH, Du J, Xie MZ, Wang XR, Liu Y, Cui F, Lu QB. Air pollutants and outpatient visits for influenza-like illness in Beijing, China. PeerJ 2021; 9:e11397. [PMID: 34141466 PMCID: PMC8179240 DOI: 10.7717/peerj.11397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background Air pollution leads to many adverse health conditions, mainly manifested by respiratory or cardiac symptoms. Previous studies are limited as to whether air pollutants were associated to influenza-like illness (ILI). This study aimed to explore the association between air pollutants and outpatient visits for ILI, especially during an outbreak of influenza. Methods Daily counts of hospital visits for ILI were obtained from Peking University Third Hospital between January 1, 2015, and March 31, 2018. A generalized additive Poisson model was applied to examine the associations between air pollutants concentrations and daily outpatient visits for ILI when adjusted for the meteorological parameters. Results There were 35862 outpatient visits at the fever clinic for ILI cases. Air quality index (AQI), PM2.5, PM10, CO and O3 on lag0 days, as well as nitrogen dioxide (NO2) and sulfur dioxide (SO2) on lag1 days, were significantly associated with an increased risk of outpatient visits for ILI from January 2015 to November 2017. From December 2017 to March 2018, on lag0 days, air pollutants PM2.5 [risk ratio (RR) = 0.971, 95% CI: 0.963-0.979], SO2 (RR = 0.892, 95% CI: 0.840–0.948) and CO (RR = 0.306, 95% CI: 0.153–0.612) were significantly associated with a decreased risk of outpatient visits for ILI. Interestingly, on the lag2 days, all the pollutants were significantly associated with a reduced risk of outpatient visits for ILI except for O3. We did not observe the linear correlations between the outpatient visits for ILI and any of air pollutants, which were instead associated via a curvilinear relationship. Conclusions We found that the air pollutants may be associated with an increased risk of outpatient visits for ILI during the non-outbreak period and with a decreased risk during the outbreak period, which may be linked with the use of disposable face masks and the change of outdoor activities. These findings expand the current knowledge of ILI outpatient visits correlated with air pollutants during an influenza pandemic.
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Affiliation(s)
- Xiaoguang Li
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Jie Xu
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Wei Wang
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Jing-Jin Liang
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Zhong-Hua Deng
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Juan Du
- Department of Laboratorial of Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Ming-Zhu Xie
- Department of Laboratorial of Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Xin-Rui Wang
- Department of Laboratorial of Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial of Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Fuqiang Cui
- Department of Laboratorial of Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Qing-Bin Lu
- Department of Laboratorial of Science and Technology, School of Public Health, Peking University, Beijing, China
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Zhang R, Meng Y, Song H, Niu R, Wang Y, Li Y, Wang S. The modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo, China. Respir Res 2021; 22:153. [PMID: 34016093 PMCID: PMC8138986 DOI: 10.1186/s12931-021-01744-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background Although exposure to air pollution has been linked to many health issues, few studies have quantified the modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo, China. Methods The data of daily incidence of influenza and the relevant meteorological data and air pollution data in Ningbo from 2014 to 2017 were retrieved. Low, medium and high temperature layers were stratified by the daily mean temperature with 25th and 75th percentiles. The potential modification effect of temperature on the relationship between air pollutants and daily incidence of influenza in Ningbo was investigated through analyzing the effects of air pollutants stratified by temperature stratum using distributed lag non-linear model (DLNM). Stratified analysis by sex and age were also conducted. Results Overall, a 10 μg/m3 increment of O3, PM2.5, PM10 and NO2 could increase the incidence risk of influenza with the cumulative relative risk of 1.028 (95% CI 1.007, 1.050), 1.061 (95% CI 1.004, 1.122), 1.043 (95% CI 1.003, 1.085), and 1.118 (95% CI 1.028, 1.216), respectively. Male and aged 7–17 years were more sensitive to air pollutants. Through the temperature stratification analysis, we found that temperature could modify the impacts of air pollution on daily incidence of influenza with high temperature exacerbating the impact of air pollutants. At high temperature layer, male and the groups aged 0–6 years and 18–64 years were more sensitive to air pollution. Conclusion Temperature modified the relationship between air pollution and daily incidence of influenza and high temperature would exacerbate the effects of air pollutants in Ningbo. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01744-6.
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Affiliation(s)
- Rui Zhang
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Yujie Meng
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Hejia Song
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No 7. Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Ran Niu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Yu Wang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No 7. Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yonghong Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No 7. Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Songwang Wang
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
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