Changes in Influenza Activities Impacted by NPI Based on 4-Year Surveillance in China: Epidemic Patterns and Trends

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Abstract

Background

Since the Non-pharmaceutical Intervention (NPI) by COVID-19 emerged, influenza activity has been somewhat altered.

Objectives

The aim of this study was to explore changes in influenza activities in the context of COVID-19 based on the sentinel hospitals/units in Guangdong, southern China.

Methods

The surveillance data in influenza-like illness (ILI) were collected from 21 cities in Guangdong between September 2017 and August 2021, while 43 hospitals/units were selected to analyze the predominant types of influenza, population characteristics, and seasonal features by three methods (the concentration ratio, the seasonal index, and the circulation distribution), based on a descriptive epidemiological approach.

Results

During the four consecutive influenza seasons, a total of 157345 ILIs were tested, of which 9.05% were positive for influenza virus (n = 14238), with the highest positive rates for both IAV (13.20%) and IBV (5.41%) in the 2018–2019 season. After the emergence of COVID-19, influenza cases decreased near to zero from March 2020 till March 2021, and the dominant type of influenza virus changed from IAV to IBV. The highest positive rate of influenza existed in the age-group of 5 ~ < 15 years in each season for IAV ( P < 0.001), which was consistent with that for IBV ( P < 0.001). The highest annual positive rates for IBV emerged in eastern Guangdong, while the highest annual positive rates of IAV in different seasons existed in different regions. Furthermore, compared with the epidemic period (ranged from December to June) during 2017–2019, the period ended three months early (March 2020) in 2019–2020, and started by five months behind (April 2021) during 2020–2021.

Conclusion

The highest positive rates in 5 ~ < 15 age-group suggested the susceptible in this age-group mostly had infected with infected B/Victoria. Influenced by the emergence of COVID-19 and NPI responses, the epidemic patterns and trends of influenza activities have changed in Guangdong, 2017–2021.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44197-023-00134-z.

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Most cited references 23

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Estimates of global seasonal influenza-associated respiratory mortality: a modelling study

A. Iuliano, Katherine M Roguski, Howard H. Chang … (2018)

Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000-500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999-2015.

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Impact of COVID-19 outbreaks and interventions on influenza in China and the United States

Luzhao Feng, Ting Zhang, Qing Wang … (2021)

Coronavirus disease 2019 (COVID-19) was detected in China during the 2019–2020 seasonal influenza epidemic. Non-pharmaceutical interventions (NPIs) and behavioral changes to mitigate COVID-19 could have affected transmission dynamics of influenza and other respiratory diseases. By comparing 2019–2020 seasonal influenza activity through March 29, 2020 with the 2011–2019 seasons, we found that COVID-19 outbreaks and related NPIs may have reduced influenza in Southern and Northern China and the United States by 79.2% (lower and upper bounds: 48.8%–87.2%), 79.4% (44.9%–87.4%) and 67.2% (11.5%–80.5%). Decreases in influenza virus infection were also associated with the timing of NPIs. Without COVID-19 NPIs, influenza activity in China and the United States would likely have remained high during the 2019–2020 season. Our findings provide evidence that NPIs can partially mitigate seasonal and, potentially, pandemic influenza. Non-pharmaceutical interventions (NPIs) implemented to interrupt COVID-19 transmission may also impact the spread of other infectious diseases. Here, the authors estimate that influenza activity in China and the United States reduced by up to 80% when NPIs were in place in the 2019–2020 season.

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The impact of the COVID-19 pandemic on influenza, respiratory syncytial virus, and other seasonal respiratory virus circulation in Canada: A population-based study

Helen E. Groves, Pierre-Philippe Piché-Renaud, Adriana Peci … (2021)

Background The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in implementation of public health measures worldwide to mitigate disease spread, including; travel restrictions, lockdowns, messaging on handwashing, use of face coverings and physical distancing. As the pandemic progresses, exceptional decreases in seasonal respiratory viruses are increasingly reported. We aimed to evaluate the impact of the pandemic on laboratory confirmed detection of seasonal non-SARS-CoV-2 respiratory viruses in Canada. Methods Epidemiologic data were obtained from the Canadian Respiratory Virus Detection Surveillance System. Weekly data from the week ending 30 th August 2014 until the week ending the 13 th March 2021 were analysed. We compared trends in laboratory detection and test volumes during the 2020/2021 season with pre-pandemic seasons from 2014 to 2019. Findings We observed a dramatically lower percentage of tests positive for all seasonal respiratory viruses during 2020-2021 compared to pre-pandemic seasons. For influenza A and B the percent positive decreased to 0•0015 and 0•0028 times that of pre-pandemic levels respectively and for RSV, the percent positive dropped to 0•0169 times that of pre-pandemic levels. Ongoing detection of enterovirus/rhinovirus occurred, with regional variation in the epidemic patterns and intensity. Interpretation We report an effective absence of the annual seasonal epidemic of most seasonal respiratory viruses in 2020/2021. This dramatic decrease is likely related to implementation of multi-layered public health measures during the pandemic. The impact of such measures may have relevance for public health practice in mitigating seasonal respiratory virus epidemics and for informing responses to future respiratory virus pandemics. Funding No additional funding source was required for this study.

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Author and article information

Contributors

Ping Huang: pphuang1@163.com

Journal

Journal ID (nlm-ta): J Epidemiol Glob Health

Journal ID (iso-abbrev): J Epidemiol Glob Health

Title: Journal of Epidemiology and Global Health

Publisher: Springer Netherlands (Dordrecht )

ISSN (Print): 2210-6006

ISSN (Electronic): 2210-6014

Publication date (Electronic): 3 August 2023

Publication date PMC-release: 3 August 2023

Publication date Collection: September 2023

Volume: 13

Issue: 3

Pages: 539-546

Affiliations

[1 ]a. Guangdong Key Laboratory of Pathogen Detection for Emerging Infectious Disease Response, b. Workstation for Emerging Infectious Disease Control and Prevention, Guangdong Center for Disease Control and Prevention, Guangzhou, 511430 China

[2 ]GRID grid.284723.8, ISNI 0000 0000 8877 7471, School of Public Health, , Southern Medical University, ; Guangzhou, 510515 China

[3 ]GRID grid.12981.33, ISNI 0000 0001 2360 039X, Sun Yat-Sen Memorial Hospital, , Sun Yat-Sen University, ; Guangzhou, 510120 China

Article

Publisher ID: 134

DOI: 10.1007/s44197-023-00134-z

PMC ID: 10468473

PubMed ID: 37535238

SO-VID: 347dbcc6-6c95-4348-b8eb-871d6266d3bc

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 11 April 2023

Date accepted : 14 June 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003453, Natural Science Foundation of Guangdong Province;

Award ID: 2016A030313775

Award Recipient : Ping Huang

Funded by: Science and Technology Planning Project of Guangzhou, Guangdong Province

Award ID: 201904010286

Award Recipient : Ping Huang

Funded by: Administration of Traditional Chinese Medicine of Guangdong Province

Award ID: 20202024

Award Recipient : Ping Huang

Funded by: Medical Science and Technology Research Foundation of Guangdong Province

Award ID: C2022012

Award Recipient : Lijun Liang

Custom metadata

Keywords: influenza,seasonal characteristics,concentration ratio,seasonal index,circular distribution,non-pharmaceutical intervention (npi)

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Keywords: influenza, seasonal characteristics, concentration ratio, seasonal index, circular distribution, non-pharmaceutical intervention (npi)

Changes in Influenza Activities Impacted by NPI Based on 4-Year Surveillance in China: Epidemic Patterns and Trends

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Abstract

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Results

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Supplementary Information

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Novel Coronavirus Disease COVID-19

Most cited references 23

Estimates of global seasonal influenza-associated respiratory mortality: a modelling study

Impact of COVID-19 outbreaks and interventions on influenza in China and the United States

The impact of the COVID-19 pandemic on influenza, respiratory syncytial virus, and other seasonal respiratory virus circulation in Canada: A population-based study

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