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Chong KC, Chan PKS, Lee TC, Lau SYF, Wu P, Lai CKC, Fung KSC, Tse CWS, Leung SY, Kwok KL, Li C, Jiang X, Wei Y. Determining meteorologically-favorable zones for seasonal influenza activity in Hong Kong. Int J Biometeorol 2023; 67:609-619. [PMID: 36847884 DOI: 10.1007/s00484-023-02439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Investigations of simple and accurate meteorology classification systems for influenza epidemics, particularly in subtropical regions, are limited. To assist in preparing for potential upsurges in the demand on healthcare facilities during influenza seasons, our study aims to develop a set of meteorologically-favorable zones for epidemics of influenza A and B, defined as the intervals of meteorological variables with prediction performance optimized. We collected weekly detection rates of laboratory-confirmed influenza cases from four local major hospitals in Hong Kong between 2004 and 2019. Meteorological and air quality records for hospitals were collected from their closest monitoring stations. We employed classification and regression trees to identify zones that optimize the prediction performance of meteorological data in influenza epidemics, defined as a weekly rate > 50th percentile over a year. According to the results, a combination of temperature > 25.1℃ and relative humidity > 79% was favorable to epidemics in hot seasons, whereas either temperature < 16.4℃ or a combination of < 20.4℃ and relative humidity > 76% was favorable to epidemics in cold seasons. The area under the receiver operating characteristic curve (AUC) in model training achieved 0.80 (95% confidence interval [CI], 0.76-0.83) and was kept at 0.71 (95%CI, 0.65-0.77) in validation. The meteorologically-favorable zones for predicting influenza A or A and B epidemics together were similar, but the AUC for predicting influenza B epidemics was comparatively lower. In conclusion, we established meteorologically-favorable zones for influenza A and B epidemics with a satisfactory prediction performance, even though the influenza seasonality in this subtropical setting was weak and type-specific.
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Affiliation(s)
- Ka Chun Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tsz Cheung Lee
- Hong Kong Observatory, Hong Kong Special Administrative Region, China
| | - Steven Y F Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Christopher K C Lai
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kitty S C Fung
- Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Cindy W S Tse
- Department of Pathology, Kwong Wah Hospital, Hong Kong Special Administrative Region, China
| | - Shuk Yu Leung
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong Special Administrative Region, China
| | - Ka Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong Special Administrative Region, China
| | - Conglu Li
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiaoting Jiang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuchen Wei
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Chong KC, Chan E, Lee TC, Kwok KL, Lau SYF, Wang P, Lam HCY, Goggins W, Mohammad K, Leung SY, Chan PKS. 91Is rainfall associated with paediatric acute gastroenteritis in an affluent setting? A 21-Year Retrospective Investigation. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although many literatures demonstrated heavy rainfall was associated with an increased risk of acute gastroenteritis via contaminated food and water, we hypothesized there is no association between rainfall and paediatric acute gastroenteritis in a setting with high-standard food and water hygiene.
Methods
Intestinal infection-related hospital admissions data during 1998-2018 for children under 5 years of age in Hong Kong were collected. Meteorological data were collected from the Hong Kong Observatory. A distributed lag nonlinear model was employed to examine the associations between meteorological factors and the risk of hospital admissions due to acute gastroenteritis.
Results
Rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to acute gastroenteritis but low temperature, low and high relative humidity did. The risk was 6.3% higher (95% confidence interval: 0.3% to 12.6%) when temperature was at 15.1oC (i.e. the 5th percentile). The adjusted relative risk was statistically significantly higher when relative humidity was ≤73.0% or ≥ 84.0%.
Conclusions
Text: We suggest rainfall playing a minor role in disease transmission via contaminated food and water in affluent societies like Hong Kong. Instead, we speculate low temperature and humidity extremes have greater impact on transmission through increased stability and infectivity of enteric viruses.
Key messages
Weather plays a minor role in food and water contamination in affluent societies.
Low temperature and humidity extremes might improve survival of enteric viruses.
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Affiliation(s)
- Ka Chun Chong
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, Shenzhen, China
| | - Emily Chan
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - TC Lee
- Hong Kong Observatory, Hong Kong
| | - KL Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
| | - SYF Lau
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - P Wang
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - HCY Lam
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - W Goggins
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - K Mohammad
- School of Public Health and Primary Care, The Chinese University Of Hong Kong, Hong Kong
| | - SY Leung
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
| | - PKS Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong
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Chong KC, Lee TC, Bialasiewicz S, Chen J, Smith DW, Choy WSC, Krajden M, Jalal H, Jennings L, Alexander B, Lee HK, Fraaij P, Levy A, Yeung ACM, Tozer S, Lau SYF, Jia KM, Tang JWT, Hui DSC, Chan PKS. Association between meteorological variations and activities of influenza A and B across different climate zones: a multi-region modelling analysis across the globe. J Infect 2019; 80:84-98. [PMID: 31580867 DOI: 10.1016/j.jinf.2019.09.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/03/2019] [Accepted: 09/25/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To elucidate the effects of meteorological variations on the activity of influenza A and B in 11 sites across different climate regions. METHODS Daily numbers of laboratory-confirmed influenza A and B cases from 2011-2015 were collected from study sites where the corresponding daily mean temperature, relative humidity, wind speed and daily precipitation amount were used for boosted regression trees analysis on the marginal associations and the interaction effects. RESULTS Cold temperature was a major determinant that favored both influenza A and B in temperate and subtropical sites. Temperature-to-influenza A, but not influenza B, exhibited a U-shape association in subtropical and tropical sites. High relative humidity was also associated with influenza activities but was less consistent with influenza B activity. Compared with relative humidity, absolute humidity had a stronger association - it was negatively associated with influenza B activity in temperate zones, but was positively associated with both influenza A and B in subtropical and tropical zones. CONCLUSION The association between meteorological factors and with influenza activity is virus type specific and climate dependent. The heavy influence of temperature on influenza activity across climate zones implies that global warming is likely to have an impact on the influenza burden.
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Affiliation(s)
- Ka Chun Chong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tsz Cheung Lee
- Hong Kong Observatory, Government of The Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Seweryn Bialasiewicz
- Child Health Research Centre, The University of Queensland, Brisbane, Australia; Centre for Children's Health Research, Brisbane, Australia
| | - Jian Chen
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - David W Smith
- Faculty of Medicine and Health Sciences, University of Western Australia, Perth, Australia; Department of Microbiology, PathWest QEII Medical Centre, Perth, Australia
| | - Wisely S C Choy
- Hong Kong Observatory, Government of The Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Mel Krajden
- British Columbia Centre for Disease Prevention and Control, Vancouver, BC, Canada
| | - Hamid Jalal
- Clinical Microbiology and Public Health Laboratory, Health Protection Agency, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Lance Jennings
- Pathology Department, University of Otago, Christchurch, New Zealand
| | - Burmaa Alexander
- National Influenza Center, National Center of Communicable Diseases, Ministry of Health, Mongolia
| | - Hong Kai Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | | | - Avram Levy
- Faculty of Medicine and Health Sciences, University of Western Australia, Perth, Australia; Department of Microbiology, PathWest QEII Medical Centre, Perth, Australia
| | - Apple C M Yeung
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sarah Tozer
- Child Health Research Centre, The University of Queensland, Brisbane, Australia; Centre for Children's Health Research, Brisbane, Australia
| | - Steven Y F Lau
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Katherine M Jia
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Julian W T Tang
- University Hospitals Leicester, University of Leicester, Leicester, United Kingdom
| | - David S C Hui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Paul K S Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Chen E, Wang MH, He F, Sun R, Cheng W, Zee BCY, Lau SYF, Wang X, Chong KC. An increasing trend of rural infections of human influenza A (H7N9) from 2013 to 2017: A retrospective analysis of patient exposure histories in Zhejiang province, China. PLoS One 2018; 13:e0193052. [PMID: 29447278 PMCID: PMC5814046 DOI: 10.1371/journal.pone.0193052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although investigations have shown that closing live poultry markets (LPMs) is highly effective in controlling human influenza A (H7N9) infections, many of the urban LPMs were shut down, but rural LPMs remained open. This study aimed to compare the proportional changes between urban and rural infections in the Zhejiang province from 2013 to 2017 by analyzing the exposure histories of human cases. METHODS All laboratory-confirmed cases of H7N9 from 2013 (the first wave) to 2017 (the fifth wave) in the Zhejiang province of China were analyzed. Urban and rural infections were defined based on the locations of poultry exposure (direct and indirect) in urban areas (central towns) and rural areas (towns and villages on the outskirts of cities). A Chi-square trend test was used to compare the proportional trend between urban and rural infections over time and logistic regression was used to obtain the odds ratio by years. RESULTS From 2013 to 2017, a statistically significant trend in rural infections was observed (p <0.01). The incremental odds ratio by years of rural infections was 1.59 with 95% confidence intervals of 1.34 to 1.86. Each year, significant increases in the proportion of live poultry transactions in LPMS and poultry processing plants were detected in conjunction with an increased proportion of urban and rural infections. CONCLUSION The empirical evidence indicated a need for heightened infection control measures in rural areas, such as serving rural farms and backyards as active surveillance points for the H7N9 virus. Other potential interventions such as the vaccination of poultry and extending the closure of LPMs to the provincial level require further careful investigations.
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Affiliation(s)
- Enfu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Binjiang District, Hangzhou, Zhejiang, China
| | - Maggie H. Wang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Fan He
- Zhejiang Provincial Center for Disease Control and Prevention, Binjiang District, Hangzhou, Zhejiang, China
| | - Riyang Sun
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Cheng
- Zhejiang Provincial Center for Disease Control and Prevention, Binjiang District, Hangzhou, Zhejiang, China
| | - Benny C. Y. Zee
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Steven Y. F. Lau
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaoxiao Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Binjiang District, Hangzhou, Zhejiang, China
- * E-mail: (KCC); (XW)
| | - Ka Chun Chong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- * E-mail: (KCC); (XW)
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