中国疾病预防控制中心周报最新文献

Introduction: Common methods for assessing and responding to outbreaks of emerging infectious diseases (EIDs) are usually applied in isolation and have limitations. This study aimed to integrate the risk matrix and Borda count methods to assess the importation risk of EIDs to China, using Lassa fever (LF) as an example.

Methods: This study used a mixed-methods approach combining multi-source data with an integrated risk matrix and Borda count method. Data were obtained from the World Health Organization, the Concise Statistics of International Students dataset, the United Nations World Tourism Organization, and the Statistical Yearbook. Importation risk was assessed across two dimensions: possibility and severity. Total importation risk was then categorized into 4 levels (low, moderate, high, and extremely high), corresponding to green, yellow, orange, and red zones, respectively, in the risk matrix assessment index. The Borda count method was used to rank the risks.

Results: The importation risk for 9 countries that experienced LF outbreaks from 1996 to 2023 was scored and ranked by importation possibility and severity to derive overall importation risks. This study determined that Nigeria posed the highest LF importation risk to China, ranking first among West African countries with the highest Borda points. Countries with moderate importation risk included Sierra Leone, Burkina Faso, and Ghana.

Discussion: An integrated risk matrix and Borda count method presented in this study may serve as a significant supplement to other risk assessment methods and enrich the current toolbox of public health countermeasures and inform future risk management of the importation of EIDs.

What is already known about this topic?: Pregnancy is associated with increased risk for severe illness and complications attributable to influenza infection. Information about the incidence of influenza hospitalization among pregnant and early postpartum women in China is limited.

What is added by this report?: Population-based data from a large city in southern China estimated the annual influenza hospitalization rate to be 2.1 per 1,000 live births. Among hospitalized pregnant and postpartum women with influenza, 86% were admitted to obstetrics rather than respiratory medicine wards; fewer than one third received antiviral treatment. Influenza vaccination coverage among hospitalized pregnant and postpartum women with influenza was <0.1%.

What are the implications for public health practice?: Increasing vaccination coverage among pregnant women can reduce influenza-associated morbidity. Raising awareness about early detection, treatment, and infection control of influenza in obstetrics wards is needed to reduce the adverse impact of influenza on pregnant women.

What is already known about this topic?: The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults, but the risk factors for this age group were unclear.

What is added by this report?: The prevalence was estimated at 12.8% and 5.7% for males and females over 50 in 2020-2021, with confirmed risk factors of cigarette smoking, a family history of respiratory diseases, respiratory symptoms, and a history of cough or respiratory diseases during childhood.

What are the implications for public health practice?: The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner.

Introduction: China faces a growing burden of chronic obstructive pulmonary disease (COPD). Previous mortality estimations were primarily based on the underlying cause of death. This study analyzed COPD-associated death and its comorbidities using all COPD cases listed on the chain of events on death certificates.

Methods: A retrospective analysis of the National Mortality Surveillance System (NMSS) was conducted to estimate COPD-associated mortality from 2014 to 2021. Age-standardized mortality rates (ASMRs) were calculated stratified by sex, region, and residence. Joinpoint regression was used to estimate the average annual percentage change (AAPC) during the study period.

Results: From 2014 to 2021, the ASMR of COPD decreased from 91.85 to 45.90 per 100,000 population. Significant but uneven decreases in COPD mortality were observed across gender [females: AAPC: -11.2%, 95% confidence interval (CI): -11.9 to -10.4%; males: AAPC: -8.0%, 95% CI: -9.2 to -6.8%], regions (eastern: AAPC: -10.7%, 95% CI: -11.5 to -9.9%; central: AAPC: -9.9%, 95% CI: -10.9 to -8.9%; western: AAPC: -7.7%, 95% CI: -10.6 to -4.7%), and residential areas (urban: AAPC: -10.9%, 95% CI: -12.3 to -9.5%; rural: AAPC: -8.3%, 95% CI: -9.1 to -7.4%). Other than COPD, cardiovascular diseases and respiratory conditions were the major underlying causes of death in COPD-associated mortality.

Conclusions: COPD is a significant comorbidity of other disorders in China. Although COPD-associated mortality substantially decreased from 2014 to 2021, the burden remained high in underdeveloped regions.

Introduction: Solid fuel combustion is a significant source of household air pollution and an important risk factor for chronic obstructive pulmonary disease (COPD). This study presents the rates and change in the use of solid fuels for cooking and heating in China.

Methods: Based on data from the Chinese Chronic Obstructive Pulmonary Disease Surveillance, the research estimated the rates and change of solid fuels usage for cooking and heating from 2014-2015 to 2019-2020 and the rate of primary cooking solid fuels usage in 2019-2020, and analyzed the association between solid fuels usage and COPD.

Results: The rates of solid fuels usage for cooking and heating significantly decreased, dropping from 45.3% to 28.0% and from 33.5% to 23.2%, respectively. Usage rates were higher among rural residents, with 47.2% using it for cooking and 37.7% for heating in 2019-2020. The usage of solid fuels for cooking is associated with increased risk of COPD. Among rural residents, combined usage of biomass and coal for cooking (OR=1.29, 95% CI: 1.12, 1.48) and using coal as primary fuel for cooking (OR=1.18, 95% CI: 1.00, 1.38) are associated with higher risk of COPD. The usage of biomass for cooking is associated with an increased risk of COPD in urban residents (OR=1.17, 95% CI: 1.03, 1.32).

Conclusions: The study demonstrates a significant decline in the use of household solid fuels. Nevertheless, high utilization rates persist among individuals in rural settings and those from lower socioeconomic backgrounds. It is of great public health importance to propose targeted fuel substitution measures for various solid fuels in different regions to reduce the risk of COPD.

What is already known about this topic?: China has the world's most significant public health and economic burden of chronic respiratory disease. However, the association between preserved ratio impaired spirometry (PRISm) and mortality risk is unknown.

What is added by this report?: The PRISm group exhibited a 37% higher risk of all-cause mortality than the normal group, and the risks of death from cardiovascular diseases, neoplasms, respiratory diseases, and infectious and parasitic diseases were also increased in PRISm. Moreover, the presence of respiratory symptoms or disease was associated with an increased risk of mortality in PRISm.

What are the implications for public health practice?: It is imperative to enhance public awareness of PRISm and to implement measures to facilitate the regression of PRISm toward normal lung function.

High-quality infectious disease surveillance systems are foundational to infectious disease prevention and control. Current major infectious disease surveillance systems globally can be categorized as either indicator-based, which are more specific, or event-based, which are more timely. Modern surveillance systems commonly utilize multi-source data, strengthened information sharing, advanced technology, and improved early warning accuracy and sensitivity. International experience may provide valuable insights for China. China's existing infectious disease surveillance systems require urgent enhancements to monitor emerging infectious diseases and improve the integration and learning capabilities of early warning models. Methods such as establishing multi-stage surveillance systems, promoting cross-sectoral and cross-provincial data sharing, applying advanced technologies like artificial intelligence, and cultivating professional talent should be adopted to enhance the development of intelligent and multipoint-triggered infectious disease surveillance systems in China.

Introduction: Many measures implemented to control the coronavirus disease 2019 (COVID-19) pandemic have reshaped the epidemic patterns of other infectious diseases. This study estimated the impact of the COVID-19 pandemic on respiratory and intestinal infectious diseases and potential changes following reopening.

Methods: The optimal intervention and counterfactual models were selected from the seasonal autoregressive integrated moving average (SARIMA), neural network autoregression (NNAR), and hybrid models based on the minimum mean absolute percentage error (MAPE) in the test set. The relative change rate between the actual notification rate and that predicted by the optimal model was calculated for the entire COVID-19 epidemic prevention period and the "reopening" period.

Results: Compared with the predicted notification rate based on the counterfactual model, the total relative change rates for the 9 infectious diseases were -44.24%, respiratory infections (-55.41%), and intestinal infections (-26.59%) during 2020-2022. Compared with the predicted notification rate based on the intervention model, the total relative change rates were +247.98%, respiratory infections (+389.59%), and intestinal infections (+50.46%) in 2023. Among them, the relative increases in influenza (+499.98%) and hand-foot-mouth disease (HFMD) (+70.97%) were significant.

Conclusions: Measures taken in Jiangsu Province in response to COVID-19 effectively constrained the spread of respiratory and intestinal infectious diseases. Influenza and HFMD rebounded significantly after the lifting of COVID-19 intervention restrictions.

What is already known about this topic?: Analyzing the characteristics of epidemic development after the emergence of the severe acute respiratory syndrome virus 2 Omicron variants with its subvariants and the impact of income level inequalities on the coronavirus disease 2019 (COVID-19) case-fatality ratio helps to better understand the spread of novel coronavirus infections.

What is added by this report?: The median time interval between the first and second waves of Omicron sub-variants was 70 days (interquartile spacing: 43.75-91), and between the second and third waves was 87.5 days (interquartile spacing: 49-119), which obeyed a lognormal distribution. The case-fatality ratio of the first wave was significantly higher than that of the second and third waves. During the initial epidemic period, there was no significant geographic differences in the case-fatality ratio of the first wave, while the case-fatality ratio in countries with high income levels was significantly lower than in countries with other income levels.

What are the implications for public health practice?: We still need to pay attention to the COVID-19 pandemic, as inequalities in income levels have an impact on the case-fatality ratio during the early stages of Omicron epidemics. In most countries, strains of the virus are likely to move from low to high population prevalence after 2-4 months.