Public Health Measures During the COVID-19 Pandemic Reduce the Spread of Other Respiratory Infectious Diseases

Sharp rise in high-virulence Bordetella pertussis with macrolides resistance in Northern China

OBJECTIVE

To elucidate the evolution of antigen genotype and antimicrobial resistance distribution of Bordetella pertussis (B. pertussis) from 2019 to 2023 in northern China.

METHODS

Polymerase chain reaction (PCR) amplification and sequencing were utilized to identify the seven antigen genotypes (ptxA, ptxC, ptxP, prn, fim2, fim3, tcfA). E-test and Kirby-Bauer (K-B) disc diffusion were employed to determine the minimum inhibitory concentration (MIC) and zone of inhibition for B. pertussis against antimicrobial agents. Subsequently, 50 isolates were chosen for multi-locus variable-number tandem-repeat analysis (MLVA) typing and whole-genome sequencing.

RESULTS

A total of 442 B. pertussis isolates were determined. The strains with high virulence harbouring ptxP3 allele surged from 13.5% (21/155) in 2019-2021 to 93.0% (267/287) in 2022-2023. Concurrently, the erythromycin resistance B. pertussis (ERBP) in ptxP3 isolates markedly rose from 42.9% (9/21) in 2019-2021 to 100% (267/267) in 2022-2023. The majority of ptxP3 isolates (76.0%,219/288) exhibited the ptxA1/ptxC1/prn2/fim2-1/fim3A/tcfA-2 genotype. Among the 442 confirmed patients, the children aged 3-14 years escalated rapidly from 13.5% in 2019 to 45.6% in 2023. The MT28 strains were responsible for 66.0% (33/50) of the tested ones, in which ERBP was prevalent at 87.9% (29/33). All the present sequenced ptxP3-ERBP strains (31/31) were clustered into the sub-lineage IVd.

CONCLUSIONS

These results suggested the clonal spread of the ptxP3-ERBP lineage of B. pertussis with high virulence and macrolides resistance could be an important cause of the recent pertussis resurgence in China. Furthermore, the increased cases among pre-school and school-aged children underscore the importance of booster vaccination in this population.

Epidemiological Trends and Public Health Implications of Dengue Fever in Zhejiang Province, China: A Decadal Analysis from National to Cangnan Perspectives

Objective

To analyze dengue fever outbreaks in China, Zhejiang Province, and a local region to provide a scientific basis for early warning surveillance and the prevention and control of dengue epidemics.

Methods

This retrospective study examines dengue fever data from China and Zhejiang Province over the past decade, including incidence, mortality, seasonal distribution, age characteristics, and regional distribution. Local data from the past decade were also analyzed.

Results

Over the last ten years, the average annual incidence rate of dengue fever in China has been 0.7764 per 100,000 individuals, with a mortality rate of 0.000945 per 100,000. In the same period, the incidence rate in Zhejiang Province was 0.4546 per 100,000, with no fatalities reported. Dengue fever cases in both China and Zhejiang Province are primarily seen during the summer and autumn seasons. Between 2014 and 2020, cases were documented across all age groups in China, demonstrating an age-specific pattern in the annual average incidence rate, with rates initially increasing to peak in young adults and subsequently declining with advancing age. The highest rates were noted in the 20-29.9 and 30-39.9 age brackets. With the exception of Tibet, all regions in China have recorded cases, with Guangdong, Yunnan, Fujian and Zhejiang in the southern part of the country being the main high-incidence areas. In Cangnan County, 30 cases of dengue fever were reported over the past decade, predominantly affecting imported cases, males, and young to middle-aged adults.

Conclusion

Dengue fever cases are rising in China, particularly in southern regions. 15 to 50 years old people are most affected. There is a pressing need for region-specific strategies to mitigate the impact of dengue fever, particularly in high-incidence areas.

Hospitalization dynamics during COVID-19: Insights into disease trends and patient outcomes

OBJECTIVES

To find the pattern of hospitalization pattern change in COVID-19 pandemic, we aimed to compare the admission and mortality rate of each disease in all wards before and during the pandemic.

METHODS

Data for all ICD-10 disease categories were collected from 17 shahrivar hospital database for 14922 patients before (23 July 2017-23 January 2020 (and 10941 patients during the pandemic (20 February 2020- 20 September 2022). We compared the age, sex, duration of hospitalization, the frequency of readmission and outcome of patients in these two periords. Also the number of patients in each ICD-10 category and in each ward was compared.

RESULTS

Comparing the two periods revealed a decrease in overall admission frequency (14,922 vs. 10,941 patients). During the pandemic, patients experienced significantly shorter hospital stays (P < 0.001). There was no significant difference in the number of patients entering remission or experiencing mortality (P = 0.063). Notably, admissions for neoplasms, blood disorders, nervous system conditions, eye disorders, circulatory and digestive system issues, genitourinary system disorders, congenital malformations, and poisoning significantly increased during the pandemic, while admissions for other conditions decreased. Admissions varied significantly across departments, with notable increases in the NICU, PICU, emergency, neonatal, and hematology departments during the pandemic (P < 0.001).

CONCLUSIONS

In conclusion, our findings highlight the impact of the COVID-19 pandemic on hospitalization patterns, equipping healthcare managers to improve resource allocation and readiness for future health challenges.

Targeted prevention strategy: Exploring the interaction effect of environmental and social factors on infectious diseases

Human disease and health issues are globally significant and closely related to environmental and social factors. However, the interaction effects of such factors on diseases are unclear, which has resulted in a lack of targeted prevention strategies. By taking infectious diseases in China as an example, this study uses an interpretable machine learning method to analyze the impact of environmental and social factors on disease, including industrial SO2 emissions, sanitary toilet coverage rate, and sunshine duration. The modeling results confirm the existence of a nonlinear relationship between infectious diseases incidence and each of the potential factors. That is, increased SO2 emissions can increase infectious diseases incidence, whereas broad sanitary toilet coverage can reduce such risk. This study examines the interaction of the driving factors and reveals that variation in the sunshine duration can affect the impact of SO2 emissions on infectious diseases incidence. This study proposes the use of multilevel risk trigger points (RTPs) to develop early warning and targeted regulation measures and classifies the points as primary, secondary, and tertiary. For example, for Henan Province, the RTPs of SO2 emissions are 291,031, 897,579, and 1,381,342 tons, whereas those for Shandong are 362,802, 1,177,650, and 1,658,118 tons. At the tertiary RTP level, SO2 emissions can significantly increase infectious disease incidence, which has prompted policymakers to implement pollution reduction and disease prevention measures. This study clarifies the role and interaction effects of environmental and social factors on infectious diseases to aid in precise disease prevention and environmental health management.

Synthesis of Urchin-Like Au@TiO2 Nano-Carriers as a Drug-Loading System Toward Cancer Treatment

In recent years, improving the pharmaceutical properties of drug delivery for anti-cancer treatment has become increasingly important. This is necessary to address challenges related to absorption, distribution, and stability. One potential approach solution is to attach the drug to a carrier system, such as functional noble nanomaterials, in order to improve the control of drug release and stability. Core-satellite nanoparticles (CSN) with an anisotropic morphology have enormous potential for targeted drug delivery and cancer treatment because of their large surface area, exceptional stability, and biocompatibility. We used a simple seed-mediated approach to synthesize urchin-like gold nanoparticles (ULGNPs) with a high aspect ratio and a dense network of 49 nm-sized branches, using seed solution, silver nitrate, and ascorbic acid. The ULGNPs were synthesized without a surfactant and then encapsulated with thin layers of amorphous TiO2 (ULGNPs@TiO2), resulting in an average overall size of 136±15 nm with a 27.5 nm TiO2 layer. Doxorubicin (Dox) was chosen as a model drug to assess the distribution carrier ability of ULGNPs@TiO2 core-satellite nanoparticles. The results showed 86.5 % Dox loading and 72.3 % release capacity at pH 5. The anti-cancer ability of ULGNPs@TiO2-Dox was meticulously assessed using breast cancer MCF-7 cells in the WST-1 assay. The results revealed that ULGNPs@TiO2-Dox exhibited approximately 92 % toxicity in MCF-7 cells compared to the free Dox of 89.6 % at low concentrations (5 ppm). Based on the simulation results for loading ULGNPs@TiO2 with Dox, it was observed that a structure containing five layers of Au (111) with three fixed bottom layers and two relaxed top layers, in addition to six TiO2 (100) layers, was analyzed using Grimme's DFT-D3 dispersion corrections (Scheme 1). The density functional theory (DFT) adsorption energy (Eads) shows that the amorphous TiO2 increases the Dox loading activity of ULGNPs, with Eads=-3.85 eV, negatively higher than isolated ULGNPs (Eads=-2.87 eV) and TiO2 alone (Eads=-3.61 eV). This drug carrier design has the potential to revolutionize anti-cancer treatment.

Epidemiology of Pertussis and the Screening Value of WBC and Lymphocyte Percentage

Objective

Pertussis is a highly contagious respiratory disease, and early diagnosis and timely treatment are crucial for reducing complications and transmission. In this study, we analyzed the prevalence of pertussis and assessed the value of the WBC and lymphocyte percentage in its screening.

Methods

A retrospective analysis was conducted on global pertussis data from the past decade. Patients who recently underwent pertussis nucleic acid detection and complete blood count (CBC) in our hospital were selected. Based on the results, 538 patients were classified into the pertussis group, and 595 into the control group. White blood count (WBC) and lymphocyte percentages were compared, diagnostic efficacy was calculated, and evaluate their application value in the diagnosis of pertussis.

Results

In the past decade, the global incidence of pertussis first decreased, then increased. In China and Zhejiang province, it fluctuated but showed an upward trend recently. In Zhejiang Province, pertussis was more prevalent in summer and winter and rose last year. Between 2018 and 2020, most pertussis cases in China were infants under 1 year old. Last year, only 1.12% of patients in our hospital were infants, with more patients over 5 years old. WBC, lymphocyte percentage, and platelet count (PLT) was higher in the pertussis group (P < 0.05). Logistic regression showed that WBC, lymphocyte percentage, and PLT were correlated with pertussis infection. Sequential analysis showed that the WBC, lymphocyte percentage, and Youden's index for both combined were 0.124, 0.082, and 0.044, respectively.

Conclusion

The global incidence of pertussis is rising, with significant increases among adolescents and adults. Improved prevention and control strategies are needed. WBC and lymphocyte percentage serve as auxiliary diagnostic indicators, but their efficacy is limited.

Trend of hand, foot and mouth disease before, during, and after China's COVID control policies in Zhejiang, China

Objective

To describe the trends in the incidence of hand, foot and mouth disease (HFMD) before, during, and after China's Coronavirus Disease (COVID) control policies, and to interpret the influence on HFMD incidence at different control stages in Zhejiang Province.

Methods

We collected data on HFMD cases in Zhejiang between 2014 and 2023. We compared the constituent ratios of cases at different COVID control stages by sex, age, child groups, and pathogens and weekly seasonal indices to observe seasonal variations in the incidence of HFMD. An interrupted time-series segmented regression analysis was applied to estimate the influence on HFMD incidence at different control stages. Stratified and sensitivity analyses were conducted to validate the findings.

Results

A considerable proportion of cases occurred among children living separately. The proportions of children in kindergartens or nurseries and children aged 2-4 years were relatively low at the strict control stage compared to the other three stages. Enteroviruses other than enterovirus 71 and coxsackie virus A16 were the dominant HFMD pathogens, and the proportion showed an increasing trend. The usual spring-summer peak in HMFD incidence did not occur in 2020, and the periodicity of the biennial peak was disrupted for a year. The summer peak in 2023 was higher than that in the other years, and was delayed by 3 weeks. The trend changes in weekly HFMD cases during the strict control and regular control stages were - 15% (IRR: 0.85, 95% CI: 0.81-0.89) and 17% (IRR: 1.17, 95% CI: 1.12-1.23), respectively. However, the change was not statistically significant during the reopening stage (IRR: 1.41, 95% CI: 0.34-5.88). The expected number of cases increased by 1.12 times (95% CI: 243.17, 53.45%) during the reopening stage compared to what would have occurred if the zero-COVID policy had continued in 2023.

Conclusion

Non-pharmaceutical interventions (NPIs) for COVID-19 control can mitigate HFMD. However, after the dynamic zero-COVID policy ended, the HFMD incidence returned to historical levels. Strict NPIs such as traffic restrictions and kindergarten closures cannot be sustained long-term. NPIs such as improving personal hygiene for routine prevention are highly recommended.

Underestimated Incidence Rate of Pertussis in the Community: Results from Active Population-Based Surveillance in Yiwu, China

BACKGROUND

The resurgence of pertussis in China underscores the urgency of active surveillance to complement the passive surveillance system.

METHODS

Active surveillance for pertussis was conducted from 1 June 2021 to 31 May 2022, at Yiwu, Zhejiang province of China. Patients with suspected pertussis were further confirmed as pertussis cases by PCR and culture. The incidence rate of pertussis in the community was estimated.

RESULTS

The overall estimated incidence of pertussis was 108.3 per 100,000 (95% CrI: 91.7-126.4). Children aged 4-5 years had the highest incidence (1154.3 per 100,000 [95% CrI: 817.4-1553.5]), followed by infants aged 1 year (836.1 per 100,000 [95% CrI: 434.0-1308.8]). Infants aged 0-4 months had the highest hospitalization rate among the pertussis patients (>50.0%). Although the incidence was low in elderly aged ≥ 60 years, the hospitalization rate was rather high (6.7%).

CONCLUSION

Active surveillance in this study revealed a higher burden of pertussis in Yiwu, China, compared to passive surveillance. Children aged 4-5 years are the dominant population group at risk of pertussis. Infants aged ≤ 4 months are the most vulnerable pertussis patients that require hospitalization treatment. Our results highlight the urgency of large-scale active surveillance of pertussis in China.

Epidemiological characteristics of influenza outbreaks in schools in Jiangsu Province, China, 2020-2023 post-COVID-19 pandemic

BACKGROUND

This study aimed to analyze the epidemic characteristics and influencing factors of school influenza outbreaks in Jiangsu Province, China from 2020 to 2023,following the COVID-19 pandemic, to inform prevention and control strategies.

METHODS

Data on influenza-like illness(ILI) outbreaks from the Chinese Influenza Surveillance Information System and national-level influenza surveillance sentinel hospitals were analyzed. The temporal distribution, school type, virus strains, and outbreak scales were examined using descriptive statistics.

RESULTS

From 2020 to 2023, 1142 influenza outbreaks occurred in schools, with primary schools(ages 6 to 12) accounting for 71.80%. Most large outbreaks were caused by A(H1N1) and A(H3N2), responsible for 8.99% of total outbreaks. Outbreaks were predominantly reported in the pre-peak periods of B(Victoria) and A(H1N1) circulation, accounting for 86.31% and 92.32% of their respective total outbreaks. No concurrent influenza and COVID-19 outbreaks were observed during the study period.

CONCLUSION

Primary and secondary schools are high-risk settings for influenza outbreaks. A(H3N2) shows higher adaptability and is more likely to co-circulate with other subtypes/lineages, especially A(H1N1), leading to larger outbreaks. B(Victoria)-caused outbreaks are more frequent but smaller in scale. School influenza outbreaks are more likely to occur during the early stages of seasonal peaks, particularly for B(Victoria) and A(H1N1). This suggests that influenza outbreaks in schools may play a crucial role in seeding and accelerating the spread of the virus within the broader community.

Changes in Infectious Disease-Specific Health Literacy in the Post-COVID-19 Pandemic Period: Two-Round Cross-Sectional Survey Study

Background

Infectious disease-specific health literacy (IDSHL) is a crucial factor in the development of infectious diseases. It plays a significant role not only in mitigating the resurgence of infectious diseases but also in effectively averting the emergence of novel infections such as COVID-19. During the 3 years of the COVID-19 pandemic, China primarily adopted nonpharmaceutical interventions, advocating for people to avoid crowded places and wear masks to prevent the spread of COVID-19. Consequently, there has been a dearth of research concerning IDSHL and its corresponding focal points for health education.

Objective

This study aimed to (1) evaluate the changes in IDSHL scores between 2019 (before the COVID-19 pandemic) and 2022 (the postepidemic period of COVID-19) and (2) explore the risk factors affecting IDSHL using a multivariate logistic regression analysis.

Methods

This study used 2-round cross-sectional surveys, conducted in 2019 and 2022, respectively, in 30 counties in Zhejiang Province, China. Multiple-stage stratified random sampling was used to select households, and a Kish grid was used to identify participants. An identical standardized questionnaire consisting of 12 closed-ended questions was used to measure IDSHL scores before and after the COVID-19 pandemic (2019 and 2022). Standard descriptive statistics, chi-square tests, t tests, and multivariate logistic regression analyses were used to analyze the data.

Results

The 2-round cross-sectional surveys conducted in 2019 and 2022 yielded, out of 19,366 and 19,221 total questionnaires, 19,257 (99.44% response rate) and 18,857 (98.11% response rate) valid questionnaires, respectively. The correct response rate for the respiratory infectious diseases question "When coughing or sneezing, which of the following is correct?" increased from 29.10% in 2019 to 37.92% in 2022 (χ²1=332.625; P<.001). The correct response rate for the nonrespiratory infectious diseases question "In which of the following ways can hepatitis B be transmitted to others?" decreased from 64.28% to 59.67% (χ²1=86.059; P<.001). In terms of IDSHL scores, a comparison between 2022 and 2019 revealed notable statistical differences in the overall scores (t1=10.829; P<.001) and across the 3 dimensions of knowledge (t1=8.840; P<.001), behavior (t1=16.170; P<.001), and skills (t1=9.115; P<.001). With regard to the questions, all but 4 exhibited statistical differences (P<.001). Multivariate logistic regression analyses indicated that the 2022 year group had a higher likelihood of possessing acquired IDSHL than the 2019 group (odds ratio 1.323, 95% CI 1.264-1.385; P<.001).

Conclusions

When conducting health education, it is imperative to enhance efforts in nonrespiratory infectious disease health education, as well as respiratory infectious diseases such as COVID-19. Health education interventions should prioritize ethnic minority populations with a poor self-health status and low education.

Forecasting and analyzing influenza activity in Hebei Province, China, using a CNN-LSTM hybrid model

BACKGROUND

Influenza, an acute infectious respiratory disease, presents a significant global health challenge. Accurate prediction of influenza activity is crucial for reducing its impact. Therefore, this study seeks to develop a hybrid Convolution Neural Network-Long Short Term Memory neural network (CNN-LSTM) model to forecast the percentage of influenza-like-illness (ILI) rate in Hebei Province, China. The aim is to provide more precise guidance for influenza prevention and control measures.

METHODS

Using ILI% data from 28 national sentinel hospitals in the Hebei Province, spanning from 2010 to 2022, we employed the Python deep learning framework PyTorch to develop the CNN-LSTM model. Additionally, we utilized R and Python to develop four other models commonly used for predicting infectious diseases. After constructing the models, we employed these models to make retrospective predictions, and compared each model's prediction performance using mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE), and other evaluation metrics.

RESULTS

Based on historical ILI% data from 28 national sentinel hospitals in Hebei Province, the Seasonal Auto-Regressive Indagate Moving Average (SARIMA), Extreme Gradient Boosting (XGBoost), Convolution Neural Network (CNN), Long Short Term Memory neural network (LSTM) models were constructed. On the testing set, all models effectively predicted the ILI% trends. Subsequently, these models were used to forecast over different time spans. Across various forecasting periods, the CNN-LSTM model demonstrated the best predictive performance, followed by the XGBoost model, LSTM model, CNN model, and SARIMA model, which exhibited the least favorable performance.

CONCLUSION

The hybrid CNN-LSTM model had better prediction performances than the SARIMA model, CNN model, LSTM model, and XGBoost model. This hybrid model could provide more accurate influenza activity projections in the Hebei Province.

Post-COVID-19 pandemic changes in pertussis incidence among patients with acute respiratory tract infections in Zhejiang, China

Background

Previous studies have compared the incidence of pertussis before and during the COVID-19 pandemic, finding that public health measures related to COVID-19 contributed to a temporary decline in reported pertussis cases during the pandemic. However, the post-pandemic period has seen a resurgence in respiratory infections, influenced by relaxed health measures and decreased public vigilance. This study investigates the epidemiological dynamics of pertussis among patients with acute respiratory tract infections (ARTI) in Zhejiang Province, China, providing essential reference information for ongoing public health strategies.

Methods

This study analyzed multicenter data from January 2023 to May 2024, involving 8,560 patients with ARTI from three hospitals in Zhejiang Province. Inclusion criteria included patients who presented with cough symptoms and were clinically diagnosed with either acute upper respiratory tract infections (URTI) or acute lower respiratory tract infections (LRTI), and who had undergone at least one Bordetella pertussis DNA test. The study analyzed the epidemiological changes of pertussis positivity rates and their associations with time, age, gender, and diagnosis types (URTI and LRTI).

Results

From January 2023 to May 2024, the positivity rate and testing number for pertussis among patients with ARTI generally showed a gradual increasing pattern. In March 2024, the positivity rate reached its peak at 31.58%, followed by a weekly decline. The overall positivity rate was 23.59%, with no significant differences observed between genders. Pertussis incidence was higher in patients with LRTI (24.49%) compared to those with URTI (18.63%, OR = 1.40, 95% CI: 1.20-1.63, p < 0.001) and in outpatients (25.32%) compared to inpatients (6.09%, OR = 4.17, 95% CI: 3.07-5.64, p < 0.001). According to a generalized additive model analysis, there was a wave-shaped, non-linear relationship between age and pertussis incidence, with a relatively high rate observed in the 5 to 17 age group, peaking at age 10 (33.85%). Additionally, the impact of age, patient type, and diagnosis type on the pertussis infection rate varied across different age groups.

Conclusion

After the COVID-19 pandemic, the positivity rate of pertussis in Zhejiang Province peaked in early 2024 and then showed a declining pattern. Children and adolescents were particularly affected, emphasizing the need for enhanced vaccination and public health interventions in this population.

Pandemics: past, present, and future: multitasking challenges in need of cross-disciplinary, transdisciplinary, and multidisciplinary collaborative solutions

The extensive history of pandemics has spanned many centuries, profoundly impacting societies, economies, and public health, and thereby shaping the course of history in various ways. Advances in medicine, science, and public health practices have played a pivotal role in mitigating the effects of pandemics over time. This review explores the scientific landscape of contemporary pandemics, examining their diverse and complex nature. It goes beyond the biological aspects of pandemics to consider socioeconomic, environmental, and technological factors. Through a scientific lens, this study aims to understand the complexities of pandemics and contribute to the expanding knowledge base that helps humanity strengthen its defenses against global health threats. By elucidating the enigmas of pandemics, the study hopes to foster a more resilient and prepared global health environment. Highlighting the importance of a multidisciplinary, cross-disciplinary, and transdisciplinary approach, this exploration emphasizes the critical need to integrate biological, socioeconomic, environmental, and technological domains to develop more robust defenses against these global health challenges.

Detection of Bordetella spp. in children with pertussis-like illness from 2018 to 2024 in China

OBJECTIVE

To evaluate the role of Bordetella pertussis (B. pertussis), B. parapertussis, B. holmesii, and B. bronchiseptica on pertussis resurgence in China, particularly the sharp rise since the latest winter.

METHODS

Nasopharyngeal swabs collected from children with pertussis-like illness from January 2018 to March 2024 were cultured to detect B. pertussis, B. parapertussis, B. holmesii, and B. bronchiseptica, and tested for all of these except for B. bronchiseptica using a pooled real-time polymerase chain reaction (PCR) kit targeting insertion sequences ptxS1, IS481, IS1001, and hIS1001.

RESULTS

Out of the collected 7732 nasopharyngeal swabs, 1531 cases tested positive for B. pertussis (19.8%, 1531/7732), and 10 cases were positive for B. parapertussis (0.1%, 10/7732). B. holmesii and B.bronchiseptica were not detected. The number of specimens and the detection rate of B. pertussis were 1709 and 26.9% (459/1709) in 2018, 1936 and 20.7% (400/1936) in 2019, which sharply declined to 308 and 11.4% (35/308) in 2020, 306 and 4.2% (13/306) in 2021, and then notably increased to 754 and 17.6% (133/754) in 2022, 1842 and 16.0% (295/1842) in 2023, 877 and 22.3% (196/877) in the first quarter of 2024. The proportion of children aged 3 to less than 6 years (preschool age) and 6 to 16 years (school age) in pertussis cases increased significantly during the study period, especially the proportion of school-aged children increased from 2.0% (9/459) in 2018 to 40.8% (80/196) in 2024.

CONCLUSIONS

B. pertussis was the predominant pathogen among children with pertussis-like illness in China, with sporadic detection of B. parapertussis and no detection of B. holmesii or B.bronchiseptica. The preschool and school-age children are increasingly prevalent in B. pertussis infection cases, which may be associated with the latest rapid escalation of pertussis outbreak.

Ethical implications of COVID-19 management-is freedom a desired aim, or a desired means to an end?

Most developed societies managed, due to their prosperity and resource abundance, to structure relationships among free individuals in such a way to leave them fundamentally unstructured, according to the free market principle. As the pandemic illustrated well, this lack of structure when facing collective threats makes it impossible to collectively and proportionately assess and manage its implications and consequences. This may be particularly precarious when introducing comprehensive, monitoring and tracking, surveillance systems dependent on the vaccination status of the individual. If our previously shared aims were successfully and collectively enacted with the greatest of costs, is it permissible that the degree of personal freedom is a commodity, and everyone is a compulsory participant? The need to control one's COVID-19 status allows the individual to become legally free from excessive enactment of sovereignty of the state. Should these rights be regulated by the free market?

Evaluating the Effectiveness of Public Health Measures During Infectious Disease Outbreaks: A Systematic Review

Over the previous three decades, the incidence of infectious disease outbreaks has considerably increased and the trend is expected to increase further. Public health measures are essential for controlling and preventing emerging outbreaks of infectious illnesses. This study is aimed at evaluating the effectiveness of public health measures during infectious disease outbreaks by summarizing the outcomes from the available evidence in the literature. A systematic review was carried out through a detailed search strategy using specific keywords applied across different electronic databases, including the Science Direct, PubMed, and EMBASE databases. Studies published between 2015 and 2024 were included with a focus on cohorts, clinical trials, longitudinal studies, case-control, and quasi-experimental studies. Low-quality studies and those published before 2015 along with incorrect findings or measures were excluded. A standardized form was used for data extraction. The quality of included studies and the risk of bias were assessed through relevant techniques. The obtained data was narrative synthesized and findings were organized systematically. The reviewed studies revealed that public health measures are considerably effective against infectious disease outbreaks. The success of various measures such as social isolation, confinement measures, and public education on hygiene against different outbreaks of respiratory infectious diseases has been well-established in the literature. Moreover, the timing of intervention application plays a vital role in their success. The implementation in the early phase of an outbreak is highly effective, as it protects more people from infection and controls the overall burden of the disease. The systematic review provided valuable insights into the efficiency of public health measures in monitoring outbreaks of infectious illnesses. The main findings suggest that appropriate public health interventions are effective in controlling the incidence of contagious disease outbreaks. Ongoing research strives to investigate measures that are most effective from the perspective of public health against various transmittable diseases to prevent future outbreaks.

Wearing masks to prevent one epidemic may mask another

Background

With attempts at lifting most COVID-19 pandemic-related restrictions, other common respiratory viruses have caused more health concern than in earlier seasons in pediatric populations.

Objective

To explore the role of non-pharmaceutical interventions (NPIs) in a rebound in other respiratory viral pathogens, especially in light of general vaccination fatigue, COVID-19 boosters, and operational challenges in the healthcare system.

Methods

A research-based commentary supported with recent literature review.

Findings

Pandemic-related lockdowns in Europe, Australia, and New Zealand have created a significant population of susceptible young children without preexisting immunity due to lack of exposure during the colder months. Relying on NPIs for a prolonged period due to low vaccination rates may lead to increased respiratory infection susceptibility, especially among young children less than 5 years old. The key public health question is whether NPIs should be implemented in the long run and what are the long-term implications on the dynamics of endemic infections and population immunity.

Discussion

Prevention cannot be the only cure for any infectious disease, and long-term impact of NPIs depends on the dynamics of population susceptibility. The SARS-CoV-2 pandemic has reinforced the importance of vaccination and the knowledge on vaccine use combined with NPIs will be of great value in controlling other known and unknown respiratory pathogens. Combining NPIs and vaccination is paramount in disease control, and the discussion on how to prevent collateral damage to sensitive populations while relaxing NPI-related measures should also merit attention.

The effects of the COVID-19 pandemic on dengue cases in Malaysia

Background

Globally, the COVID-19 pandemic has affected the transmission dynamics and distribution of dengue. Therefore, this study aims to describe the impact of the COVID-19 pandemic on the geographic and demographic distribution of dengue incidence in Malaysia.

Methods

This study analyzed dengue cases from January 2014 to December 2021 and COVID-19 confirmed cases from January 2020 to December 2021 which was divided into the pre (2014 to 2019) and during COVID-19 pandemic (2020 to 2021) phases. The average annual dengue case incidence for geographical and demographic subgroups were calculated and compared between the pre and during the COVID-19 pandemic phases. In addition, Spearman rank correlation was performed to determine the correlation between weekly dengue and COVID-19 cases during the COVID-19 pandemic phase.

Results

Dengue trends in Malaysia showed a 4-year cyclical trend with dengue case incidence peaking in 2015 and 2019 and subsequently decreasing in the following years. Reductions of 44.0% in average dengue cases during the COVID-19 pandemic compared to the pre-pandemic phase was observed at the national level. Higher dengue cases were reported among males, individuals aged 20-34 years, and Malaysians across both phases. Weekly dengue cases were significantly correlated (ρ = -0.901) with COVID-19 cases during the COVID-19 pandemic.

Conclusion

There was a reduction in dengue incidence during the COVID-19 pandemic compared to the pre-pandemic phase. Significant reductions were observed across all demographic groups except for the older population (>75 years) across the two phases.

Epidemiological characteristics of common respiratory infectious diseases in children before and during the COVID-19 epidemic

Background

Since the outbreak of coronavirus disease 2019 (COVID-19), public's awareness of infection prevention and control has increased overall, and various prevention and control measures have been adopted. These measures may also have a certain impact on the occurrence of other infectious diseases. Therefore, we collected information on children with several respiratory infectious diseases in Jinan Children's Hospital in China from 2016 to 2022 and analyzed their changes.

Method

We collected data on age, sex and number of cases of pertussis, measles, scarlet fever, pulmonary tuberculosis, mumps and influenza, which were diagnosed by clinical and laboratory criteria, from 1 January 2016 to 31 December 2022 in Jinan Children's Hospital in Jinan, Shandong Province, China. Data on the number of people affected by these diseases in China from the Chinese Center for Disease Control and Prevention were compared. Then, we processed the data by using WPS Excel 2019 and SPSS.

Results

A total of 12,225 cases were included in this study in Jinan Children's Hospital, which consisted of 3,688 cases of pertussis (2,200 cases before COVID-19 and 1,488 during COVID-19), 680 cases of measles (650 cases before COVID-19 and 30 during COVID-19), 4,688 cases of scarlet fever (4,001 cases before COVID-19 and 687 during COVID-19), 114 cases of tuberculosis (86 cases before COVID-19 and 28 during COVID-19), 449 cases of mumps (340 cases before COVID-19 and 109 during COVID-19) and 2,606 cases of influenza (1,051 cases before COVID-19 and 1,555 during COVID-19). The numbers of children in the hospital with pertussis, measles, scarlet fever, mumps and influenza decreased substantially during COVID-19 in 2020-2022 compared with numbers in 2016-2019, while numbers of patients in China with all six respiratory infectious diseases, including pulmonary tuberculosis, declined during the pandemic. A rebound of pertussis, scarlet fever and influenza was observed in 2021 and 2022.

Conclusions

The study found that viral pathogens such as those causing measles, mumps and influenza all decreased during the pandemic, after which influenza rebounded. Infection diseases caused by bacteria such as scarlet fever and pertussis also decreased during COVID-19, and then a rebound occurred. However, tuberculosis stayed relatively constant.

The indirect impacts of nonpharmacological COVID-19 control measures on other infectious diseases in Yinchuan, Northwest China: a time series study

BACKGROUND

Various nonpharmaceutical interventions (NPIs) against COVID-19 continue to have an impact on socioeconomic and population behaviour patterns. However, the effect of NPIs on notifiable infectious diseases remains inconclusive due to the variability of the disease spectrum, high-incidence endemic diseases and environmental factors across different geographical regions. Thus, it is of public health interest to explore the influence of NPIs on notifiable infectious diseases in Yinchuan, Northwest China.

METHODS

Based on data on notifiable infectious diseases (NIDs), air pollutants, meteorological data, and the number of health institutional personnel in Yinchuan, we first fitted dynamic regression time series models to the incidence of NIDs from 2013 to 2019 and then estimated the incidence for 2020. Then, we compared the projected time series data with the observed incidence of NIDs in 2020. We calculated the relative reduction in NIDs at different emergency response levels in 2020 to identify the impacts of NIPs on NIDs in Yinchuan.

RESULTS

A total of 15,711 cases of NIDs were reported in Yinchuan in 2020, which was 42.59% lower than the average annual number of cases from 2013 to 2019. Natural focal diseases and vector-borne infectious diseases showed an increasing trend, as the observed incidence in 2020 was 46.86% higher than the estimated cases. The observed number of cases changed in respiratory infectious diseases, intestinal infectious diseases and sexually transmitted or bloodborne diseases were 65.27%, 58.45% and 35.01% higher than the expected number, respectively. The NIDs with the highest reductions in each subgroup were hand, foot, and mouth disease (5854 cases), infectious diarrhoea (2157 cases) and scarlet fever (832 cases), respectively. In addition, it was also found that the expected relative reduction in NIDs in 2020 showed a decline across different emergency response levels, as the relative reduction dropped from 65.65% (95% CI: -65.86%, 80.84%) during the level 1 response to 52.72% (95% CI: 20.84%, 66.30%) during the level 3 response.

CONCLUSIONS

The widespread implementation of NPIs in 2020 may have had significant inhibitory effects on the incidence of respiratory infectious diseases, intestinal infectious diseases and sexually transmitted or bloodborne diseases. The relative reduction in NIDs during different emergency response levels in 2020 showed a declining trend as the response level changed from level 1 to level 3. These results can serve as essential guidance for policy-makers and stakeholders to take specific actions to control infectious diseases and protect vulnerable populations in the future.

[Paying attention to the epidemic of group A Streptococcus infections in multiple European and American countries]

At the end of 2022, the World Health Organization reported an increase in group A Streptococcus (GAS) infections, such as scarlet fever, in multiple countries. The outbreak primarily affected children under 10 years old, and the number of deaths was higher than anticipated, causing international concern. This paper reviews the current state of the GAS disease outbreak, its causes, and response measures. The authors aim to draw attention from clinical workers in China and increase their awareness and vigilance regarding this epidemic. Healthcare workers should be aware of the potential epidemiological changes in infectious diseases that may arise after the optimization of control measures for coronavirus disease 2019 to ensure children's health.

Association between Compliance with COVID-19 Restrictions and the Risk of SARS-CoV-2 Infection in Poland

During the coronavirus disease 19 (COVID-19) pandemic it has become very important to comply with preventive measures. We aimed to assess compliance with applicable restrictions and to explore the links between the level of compliance and the risk of COVID-19. This cross-sectional study included Polish adults who were asked to complete a validated questionnaire. The study period was from 1 November 2020 to 31 January 2021 and a computer-assisted web interview method was chosen to perform the survey. The study involved 562 women and 539 men. COVID-19 was reported in 11.26% of participants. A good level of compliance with the sanitary restrictions was reported for 38.87% of participants, an average level of compliance for 47.96%, and a low level of compliance for 13.17%. A reduced risk of COVID-19 was associated with the following preventive measures: regular use of protective masks, social and physical distancing in public places, regular use of hand sanitizers with high ethanol content, and the use of disposable gloves in public places. Our survey revealed satisfactory public compliance with the pandemic restrictions. Sanitary and epidemiologic measures to prevent the pandemic were shown to be adequate and effective.

Aggressive behavior, boredom, and protective factors among college students during closed-off management of the COVID-19 pandemic in China

Background

Chinese colleges have implemented strict closed-off management in response to the outbreak of a new variant of the new coronavirus, Omicron. But such management measures may lead to more aggressive behavior. The study aimed to determine the associations between boredom and aggressive behavior with aggression and to examine the impact of boredom on aggression through the moderating role of cognitive flexibility.

Methods

The Multidimensional State Boredom Scale, the Reactive-Proactive Aggression Questionnaire, and the Cognitive Flexibility Inventory were applied to a sample of 719 college students who were in a closed-off management environment.

Results

For individuals with high cognitive flexibility, the relationship between state boredom and proactive aggression was not significant. The relationship between state boredom and proactive aggression was significantly positively correlated for individuals with low cognitive flexibility, especially low substitutability. Cognitive flexibility has no significant moderating effect on the relationship between state boredom and reactive aggression.

Conclusion

The findings highlighted the importance of boredom as a potential risk factor for aggression, while cognitive flexibility appears as a potential protective factor.

Epidemiological characteristics of community-acquired pneumonia and effects from the COVID-19 pandemic in Shenzhen of China

OBJECTIVE

This study aimed to observe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of non-COVID-19 community-acquired pneumonia (CAP) in Shenzhen of China, offering new ideas for evaluating the effects of non-pharmaceutical interventions.

METHODS

A retrospective analysis was conducted of inpatients with pneumonia from 2017 to 2021. Epidemiological characteristics of CAP and effects from the COVID-19 pandemic were analyzed by the basic characteristics, time distribution, etiology and disease burden.

RESULTS

There were a total of 5746 CAP inpatient cases included from 2017 to 2021. The number of CAP hospitalizations decreased during the pandemic from 2020 to 2021, with seasonal variations of being higher in spring and winter and lower in summer and autumn, whereas it was prevalent throughout the year prior to the pandemic. The children group decreased significantly during the pandemic, with a 15% decrease in the share of CAP inpatients. The detection rates of bacteria and mycoplasma decreased in CAP patients, while the detection rate of the virus increased, and the number of moderate and severe cases reduced more than that of the mild.

CONCLUSION

Non-pharmaceutical interventions from COVID-19 have led to a decrease in the number of CAP inpatients, especially for children, with a specific seasonal prevalence in spring and winter, when the prevention interventions should be strengthened further for adults during the pandemic.

Seroepidemiology of pertussis in the east of China: Estimates of incidence of infection in adolescents and adults pre- and post-COVID-19

Introduction

The dramatic decrease in the number of reported cases of pertussis during COVID-19 pandemic has been underestimated. The objective was to compare the estimated incidence rate of pertussis in populations pre- and post-COVID-19 pandemic by analyzing the anti-pertussis toxin (anti-PT) IgG and anti-filamentous hemagglutininant (anti-FHA) IgG antibodies in healthy Chinese population from 2018 to 2021.

Methods

All serum samples (N = 1,000) were collected from healthy population (aged ≥ 15 years) who attended an annual monitoring project of antibody levels in Jiangsu province in 2018-2021 were measured by ELISA.

Results

The positive rates of anti-PT IgG and anti-FHA IgG antibodies were 11.4% (114/1,000) and 20.2% (202/1,000) (≥40 IU/ml), the GMC were 17.25 (95% CI: 15.49-19.03) IU/mL and 24.94 (95% CI: 22.73-27.16) IU/mL in the study population, respectively. The percentage of participants with anti-PT IgG antibodies higher than 40 IU/mL was 5.20% (11/212) in 2018, 5.5% (19/348) in 2019, 21.2% (46/217) in 2020 and 17.0% (38/223) in 2021, respectively. The non-detectable rate (<5 IU/mL) of anti-PT IgG antibodies was 16.9, 17.7, 28.1, and 37.3% in 2018, 2019, 2020, and 2021, respectively. We assumed that the infection occurred within 58.6 days, and based on the overall proportion (2.9%) of individuals with anti-PT IgG antibody ≥100 IU/ml, the incidence rate (/100) was estimated by the formula to be 18.08 (95% CI: 12.40-26.11). In addition, the estimated incidence of Post-COVID-19 was higher than that of Pre-COVID-19 (36.33/100 vs. 12.84/100), and the difference was statistically significant (p < 0.05).

Conclusions

Our results suggest a high rate of under-reporting of pertussis in Jiangsu Province both pre- and post-COVID-19 pandemic, and there are a large number of adults of childbearing age who are susceptible to pertussis. It seems imperative that vaccination of adolescents and adults should be considered for inclusion in vaccination programs.

Coadministration of seasonal influenza and COVID-19 vaccines: A systematic review of clinical studies

The lifting of non-pharmaceutical measures preventing transmission of SARS-CoV-2 (and other viruses, including influenza viruses) raises concerns about healthcare resources and fears of an increased number of cases of influenza and COVID-19. For the 2021-2022 influenza season, the WHO and >20 European countries promoted coadministration of influenza and COVID-19 vaccines. Recently, the French Health Authority recommended coupling the COVID-19 vaccination with the 2022-2023 influenza vaccination campaign for healthcare professionals and people at risk of severe COVID-19. The present systematic review examines published data on the safety, immunogenicity, efficacy/effectiveness, and acceptability/acceptance of coadministration of influenza and COVID-19 vaccines. No safety concerns or immune interferences were found whatever the vaccines or the age of vaccinated subjects (65- or 65+). No efficacy/effectiveness data were available. The results should reassure vaccinees and vaccinators in case of coadministration and increase vaccine coverage. Healthcare systems promoting coupled campaigns must provide the necessary means for successful coadministration.

Analysis of the epidemiological characteristics between 2004 and 2017 and prediction of the changing pattern of other infectious diarrhea (OID) under COVID-19 in China

The study describes epidemiological features and transmission of other infectious diarrhea (OID) before and during the epidemic of COVID-19 in China, which lays a foundation for OID prevention and control. Incidence rate and mortality data of OID containing detailed epidemiological information such as date, age and region from 2004 to 2017, and total OID case number from 2018 to 2020 were obtained from the Data Center of China's Public Health Science and the National Bureau of Statistics' statistical yearbook. The Joinpoint regression model and Z test was used to analyze, while R language and ArcGIS 10.5 for drawing. The autoregressive integrated moving average model was used to predict the influence of COVID-19 on OID. The OID incidence rate increased from 31.69/10 million in 2004 to 92.42/10 million in 2017, and the mortality rate decreased from 1.82/10,000 to 0.14/10,000. The male to female incidence ratio was 1.39:1 (P < .001). The patients' age showed a decreased trend with age (P < .001). The scattered children devoted the most OID incidence rate. The bimodal distribution of OID incidence was summer peak in northern China, 2 apparent peaks in central and eastern, and winter peak in southern. The autoregressive integrated moving average model predicted 1,406,557 in 2020, comparing the actual OID cases in 2020 to 1,062,277. Affected by the epidemic control measures of COVID-19, the number of OID cases declined by 32.4% (Absolute percentage error = 32.4%). The OID incidence rate in China continuously increased and showed a bimodal distribution in summer and winter with inconspicuous regional characteristics, gender and age susceptibility differences, and occupational differences. Meanwhile, COVID-19 significantly reduced OID incidence in 2020. The discoveries might bring a beneficial effect on OID prevention and control policies.

Collateral Impact of COVID-19 Prevention Measures on Re-Emergence of Scarlet Fever and Pertussis in Mainland China and Hong Kong China

The incidence of scarlet fever and pertussis has increased significantly in China in recent years. During the COVID-19 pandemic, stringent non-pharmaceutical intervention measures were widely adopted to contain the spread of the virus, which may also have essential collateral impacts on other infectious diseases, such as scarlet fever and pertussis. We compared the incidence data of scarlet fever and pertussis in Mainland China and Hong Kong from 2004 to 2021 before and after the COVID-19 pandemic. The results show that the incidence of both diseases decreased significantly in 2020-2021 compared to the after-re-emergence stage in these two locations. Specifically, in 2020, scarlet fever decreased by 73.13% and pertussis by 76.63% in Mainland China, and 83.70% and 76.10%, respectively, in Hong Kong. In the absence of COVID-19, the predicted incidence of both diseases was much higher than the actual incidence in Mainland China and Hong Kong in 2020-2021. This study demonstrates that non-pharmaceutical measures implemented during the COVID-19 pandemic can partially reduce scarlet fever and pertussis re-emergence in Mainland China and Hong Kong.

[The investigation on the acute, severe hepatitis of unknown origin in children]

In April 2022, the United Kingdom notified the World Health Organization (WHO) of an unexpected increase of acute hepatitis of unknown origin in children. Subsequent investigations have found more than 400 cases in more than 20 countries and regions around the world. Although the potential role of adenovirus type 41 in the pathogenesis of these cases is one hypothesis, but it is probably not the only pathogenic factor, and other infectious and non-infectious causes cannot be completely ruled out. For hepatitis caused by non-hepatitis A, B, C, D and E viruses, there is a lack of systematic monitoring and research, and many unknowns still exist. According to the current etiology speculation and epidemiological characteristics of adenovirus in China, cases of acute hepatitis with unknown origin may be found in China in the future. There is also a risk of imported cases. This article systematically sorts out the reports and studies on child acute hepatitis of unknown origin, hoping to attract the attention of pediatric clinicians in China, raise awareness and vigilance, and calmly prepare for possible abnormal situations.

Seroprevalence of Pertussis in Adults at Childbearing Age Pre- and Post- COVID-19 in Beijing, China

The number of reported pertussis cases has significantly decreased during the coronavirus disease 2019 (COVID-19) pandemic under the influence of strict public health measures in many countries including China. This study evaluated the prevalence of serum anti-pertussis toxin (anti-PT) IgG antibodies in adults at childbearing age pre- and post- COVID-19 in Beijing, China. Altogether, 2021 serum samples collected from individuals aged 20 to 39 years who attended an annual health examination at the Sixth Medical Center of PLA General Hospital, Beijing, in 2018~2020 were measured by ELISA. The median concentration of anti-PT IgG antibodies among participants in 2020 (2.96 IU/mL) was significantly lower than that in 2018 (3.27 IU/mL) (p = 0.011) and in 2019 (3.24 IU/mL) (p = 0.014). The percentage of participants with anti-PT IgG antibodies higher than 40 IU/mL (indicating a pertussis infection within the past few years) was 1.79% (9/503) in 2018, 2.04% (15/735) in 2019 and 1.66% (13/783) in 2020, respectively. The corresponding numbers of the non-detectable (<5 IU/mL) rate of anti-PT IgG antibodies were 66.60%, 65.99% and 70.24%. Our results showed that there was a significant difference between true and reported incidence rates even during the COVID-19 pandemic. The proportion of adults at childbearing age without pertussis-specific antibodies is high, suggesting that booster vaccinations in adults should be considered in this country.

The secondary outcome of public health measures amidst the COVID-19 pandemic in the spread of other respiratory infectious diseases in Thailand

The coronavirus disease 2019 (COVID-19) has promoted stringent public health measures such as hand hygiene, face mask wearing, and physical distancing to contain the spread of the viral infection. In this retrospective study, the secondary outcomes of those public health measures on containing other respiratory infections among the Thai population were investigated. Hospitalization data spanning from 2016 to 2021 of six respiratory infectious diseases, namely influenza, measles, pertussis, pneumonia, scarlet fever, and tuberculosis (TB), were examined. First, the expected respiratory infectious cases where no public health measures are in place are estimated using the seasonal autoregressive integrated moving average (SARIMA) model. Then the expected number of cases and the observed cases were compared. The results showed a significant drop in the incidence of respiratory infectious diseases by an average of 61%. The reduction in hospitalization is significant for influenza, measles, pertussis, pneumonia, and scarlet fever (p < 0.05), while insignificant for TB (p = 0.54). The notable decrease in the incidence of cases is ascribed to the implementation of public health measures that minimized the opportunity for spread of disease. This decline in cases following relaxation of pandemic countermeasure is contingent on its scope and nature, and it is proof that selective physical distancing, hand hygiene, and use of face masks in public places is a viable route for mitigating respiratory morbidities.

Clinical and biological consequences of respiratory syncytial virus genetic diversity

Respiratory syncytial virus (RSV) is one of the most common etiological agents of global acute respiratory tract infections with a disproportionate burden among infants, individuals over the age of 65, and immunocompromised populations. The two major subtypes of RSV (A and B) co-circulate with a predominance of either group during different epidemic seasons, with frequently emerging genotypes due to RSV's high genetic variability. Global surveillance systems have improved our understanding of seasonality, disease burden, and genomic evolution of RSV through genotyping by sequencing of attachment (G) glycoprotein. However, the integration of these systems into international infrastructures is in its infancy, resulting in a relatively low number (~2200) of publicly available RSV genomes. These limitations in surveillance hinder our ability to contextualize RSV evolution past current canonical attachment glycoprotein (G)-oriented understanding, thus resulting in gaps in understanding of how genetic diversity can play a role in clinical outcome, therapeutic efficacy, and the host immune response. Furthermore, utilizing emerging RSV genotype information from surveillance and testing the impact of viral evolution using molecular techniques allows us to establish causation between the clinical and biological consequences of arising genotypes, which subsequently aids in informed vaccine design and future vaccination strategy. In this review, we aim to discuss the findings from current molecular surveillance efforts and the gaps in knowledge surrounding the consequence of RSV genetic diversity on disease severity, therapeutic efficacy, and RSV-host interactions.