Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study

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Summary

Background

The model of infectious disease prevention and control changed significantly in China after the outbreak in 2003 of severe acute respiratory syndrome (SARS), but trends and epidemiological features of infectious diseases are rarely studied. In this study, we aimed to assess specific incidence and mortality trends of 45 notifiable infectious diseases from 2004 to 2013 in China and to investigate the overall effectiveness of current prevention and control strategies.

Methods

Incidence and mortality data for 45 notifiable infectious diseases were extracted from a WChinese public health science data centre from 2004 to 2013, which covers 31 provinces in mainland China. We estimated the annual percentage change in incidence of each infectious disease using joinpoint regression.

Findings

Between January, 2004, and December, 2013, 54 984 661 cases of 45 infectious diseases were reported (average yearly incidence 417·98 per 100 000). The infectious diseases with the highest yearly incidence were hand, foot, and mouth disease (114·48 per 100 000), hepatitis B (81·57 per 100 000), and tuberculosis (80·33 per 100 000). 132 681 deaths were reported among the 54 984 661 cases (average yearly mortality 1·01 deaths per 100 000; average case fatality 2·4 per 1000). Overall yearly incidence of infectious disease was higher among males than females and was highest among children younger than 10 years. Overall yearly mortality was higher among males than females older than 20 years and highest among individuals older than 80 years. Average yearly incidence rose from 300·54 per 100 000 in 2004 to 483·63 per 100 000 in 2013 (annual percentage change 5·9%); hydatid disease (echinococcosis), hepatitis C, and syphilis showed the fastest growth. The overall increasing trend changed after 2009, and the annual percentage change in incidence of infectious disease in 2009–13 (2·3%) was significantly lower than in 2004–08 (6·2%).

Interpretation

Although the overall incidence of infectious diseases was increasing from 2004, the rate levelled off after 2009. Effective prevention and control strategies are needed for diseases with the highest incidence—including hand, foot, and mouth disease, hepatitis B, and tuberculosis—and those with the fastest rates of increase (including hydatid disease, hepatitis C, and syphilis).

Funding

Chinese Ministry of Science and Technology, National Natural Science Foundation (China).

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Most cited references 13

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Permutation tests for joinpoint regression with applications to cancer rates.

H. Kim, M P Fay, E. J. Feuer … (2000)

The identification of changes in the recent trend is an important issue in the analysis of cancer mortality and incidence data. We apply a joinpoint regression model to describe such continuous changes and use the grid-search method to fit the regression function with unknown joinpoints assuming constant variance and uncorrelated errors. We find the number of significant joinpoints by performing several permutation tests, each of which has a correct significance level asymptotically. Each p-value is found using Monte Carlo methods, and the overall asymptotic significance level is maintained through a Bonferroni correction. These tests are extended to the situation with non-constant variance to handle rates with Poisson variation and possibly autocorrelated errors. The performance of these tests are studied via simulations and the tests are applied to U.S. prostate cancer incidence and mortality rates. Copyright 2000 John Wiley & Sons, Ltd.

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Dual Seasonal Patterns for Influenza, China

Yue-Long Shu, Li-Qun Fang, Sake de Vlas … (2010)

To the Editor: Since 2000, the People’s Republic of China has had a nationwide surveillance network for influenza, which as of 2005 has been reported on the Chinese Center for Disease Control and Prevention website (www.cnic.org.cn/ch/). This surveillance has shown a remarkable dual pattern of seasonal influenza on mainland China. Whereas a regular winter pattern is noted for northern China (similar to that in most parts of the Northern Hemisphere), the pattern in southern China differs. In southern China, influenza is prevalent throughout the year; it has a clear peak in the summer and a less pronounced peak in the winter. Because this dual seasonal pattern of influenza has not been reported outside China and is relevant to pandemic (H1N1) 2009, we describe surveillance data for rates of consultation for influenza-like illness (ILI) and influenza subtypes in patients with ILI. We emphasize the spread of influenza from southern to northern China. Before it was extended in June 2009, the National Influenza Surveillance Network had been composed of 63 influenza laboratories and 197 sentinel hospitals across 31 provinces of mainland China. In 13 of 16 northern provinces, surveillance began from the week including October 1 and ended in the week including March 31 of the following year. In the 3 northern provincial areas of Liaoning, Tianjin, and Gansu and in all southern provinces, surveillance was conducted throughout the year. Data consisted of information about ILI cases and virus subtypes. The sentinel hospitals defined ILI cases according to World Health Organization criteria: sudden onset of fever >38°C, cough or sore throat, and absence of other diagnoses ( 1 ). The number of ILI cases and the total number of outpatients at the sites (ILI consultation rate) were recorded each day and reported to the National Influenza Surveillance Information System each week. Sentinel hospitals were required to collect 5–15 nasopharyngeal swabs each week from ILI patients who had not taken antiviral drugs and who had fever (>38°C) for no longer than 3 days. The swabs were sent to the corresponding influenza laboratories for virus isolation and identification; results were reported to the National Influenza Surveillance Information System within 24 hours. From the National Influenza Surveillance Network, a database of surveillance information from April 2006 to March 2009 was established. For influenza surveillance purposes, mainland China was divided into northern and southern parts, basically following the Qinling Mountain range in the west and the Huai River in the east. The prominent influenza peaks in the winter in the north and summer in the south were clear for adults and for children (Figure, panel A); the level of ILI was 3–5× for children. The influenza subtypes causing the 3 peaks in the north were preceded by a peak of the same subtypes in the south. During winter 2006–07, the influenza subtype was seasonal H1N1 and to a lesser extent H3N2. In winter 2007–08, the virus was B/Yamagata; and in 2008–09, it was again seasonal influenza A (H1N1), which was almost absent in the south during April–December 2007. Antigenic characteristics of the influenza virus from the north were similar to those from the south in the same epidemic episode ( 2 ). Furthermore, influenza A (H3N2) was in southern China throughout the year, whereas in northern China, this subtype only showed a clear peak in the first 2 winters of the study period. Subtype B/Victoria and B (unsubtyped) were both in northern and southern China in irregular and low numbers. Data from the 3 northern provincial areas with year-round surveillance confirmed that influenza cases during April–September were negligible (data not shown). Figure Epidemic patterns, by month, from the surveillance data of the influenza-like illness (ILI) consulting rate and influenza subtypes in ILI patients in mainland China, per month, April 2006–March 2009. A) ILI percentages for northern (dashed lines) and southern (solid lines) mainland China, by age group. B) Average temperature and relative humidity. The influenza subtypes of seasonal influenza A (H1N1) and B/Yamagata that have caused the past 3 summer peaks in southern China were followed by an epidemic of the same subtypes in northern China during the subsequent winter. This finding may indicate that these peaks are regular epidemic phenomena for seasonal influenza in China. Another possible explanation is that other subtypes were cocirculating with the predominant subtype at the time of epidemics. The dual pattern of seasonal peaks for influenza is well-known for the Northern and Southern Hemispheres, but apparently it is also possible on 1 side of the equator. China is a large country with climatic differences between north and south. Although most of southern China is above the Tropic of Cancer, it is warmer and more humid than northern China (Figure, panel B), which may explain the different seasonal patterns within mainland China ( 3 ). Knowledge of the dual patterns of influenza in China is relevant for determining effective control measures, and knowledge of the underlying mechanisms of such patterns is relevant to understanding the epidemiology of influenza in general.

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Modeling seasonality in space-time infectious disease surveillance data.

Steven M. Paul, Leonhard Held (2012)

Infectious disease data from surveillance systems are typically available as multivariate times series of disease counts in specific administrative geographical regions. Such databases are useful resources to infer temporal and spatiotemporal transmission parameters to better understand and predict disease spread. However, seasonal variation in disease notification is a common feature of surveillance data and needs to be taken into account appropriately. In this paper, we extend a time series model for spatiotemporal surveillance counts to incorporate seasonal variation in three distinct components. A simulation study confirms that the different types of seasonality are identifiable and that a predictive approach suggested for model selection performs well. Application to surveillance data on influenza in Southern Germany reveals a better model fit and improved one-step-ahead predictions if all three components allow for seasonal variation. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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Author and article information

Contributors

Lanjuan Li

Journal

Journal ID (nlm-ta): Lancet Infect Dis

Journal ID (iso-abbrev): Lancet Infect Dis

Title: The Lancet. Infectious Diseases

Publisher: Elsevier Ltd.

ISSN (Print): 1473-3099

ISSN (Electronic): 1474-4457

Publication date PMC-release: 12 April 2017

Publication date (Print): July 2017

Publication date (Electronic): 12 April 2017

Volume: 17

Issue: 7

Pages: 716-725

Affiliations

[a ]State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

[b ]Zhejiang Institute of Medical-care Information Technology, Hangzhou, China

Author notes

[* ]Correspondence to: Prof Lanjuan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China ljli@ 123456zju.edu.cn

Article

Publisher ID: S1473-3099(17)30227-X

DOI: 10.1016/S1473-3099(17)30227-X

PMC ID: 7164789

PubMed ID: 28412150

SO-VID: ca84ffbc-a091-40e3-a30e-8b3863966c5a

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Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study

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Point-of-Care Testing for Infectious Diseases Super Collection

Most cited references 13

Permutation tests for joinpoint regression with applications to cancer rates.

Dual Seasonal Patterns for Influenza, China

Modeling seasonality in space-time infectious disease surveillance data.

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