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Characterization of regional influenza seasonality patterns in China and implications for vaccination strategies: spatio-temporal modeling of surveillance data

Yu, Hongjie ; Alonso, Wladimir J ; Feng, Luzhao ; Tan, Yi ; Shu, Yuelong ; Yang, Weizhong ; Viboud, Cécile Riley, Steven

PLoS medicine, 2013-11, Vol.10 (11), p.e1001552-e1001552 [Periódico revisado por pares]

United States: Public Library of Science

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  • Título:
    Characterization of regional influenza seasonality patterns in China and implications for vaccination strategies: spatio-temporal modeling of surveillance data
  • Autor: Yu, Hongjie ; Alonso, Wladimir J ; Feng, Luzhao ; Tan, Yi ; Shu, Yuelong ; Yang, Weizhong ; Viboud, Cécile
  • Riley, Steven
  • Assuntos: Bayes Theorem ; China - epidemiology ; Climate ; Distribution ; Epidemics ; Geographic Mapping ; Hospitals ; Humans ; Incidence ; Influenza ; Influenza A virus ; Influenza B virus ; Influenza vaccines ; Influenza virus ; Influenza, Human - epidemiology ; Influenza, Human - prevention & control ; Influenza, Human - transmission ; Influenza, Human - virology ; Linear Models ; Management ; Models, Biological ; Population Surveillance ; Prevention ; Provinces ; Regression analysis ; Seasonal variations (Diseases) ; Seasons ; Socioeconomic Factors ; Studies ; Temperature ; Time series ; Vaccination
  • É parte de: PLoS medicine, 2013-11, Vol.10 (11), p.e1001552-e1001552
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    ObjectType-Article-2
    ObjectType-Feature-1
    Conceived and designed the experiments: HY WA CV. Performed the experiments: WA CV. Analyzed the data: LF YT WA CV. Contributed reagents/materials/analysis tools: YS WY. Wrote the first draft of the manuscript: CV. Contributed to the writing of the manuscript: HY WA YT LF YS WY CV. ICMJE criteria for authorship read and met: HY WA YT LF YS WY CV. Agree with manuscript results and conclusions: HY WA YT LF YS WY CV.
    The authors have declared that no competing interests exist.
  • Descrição: The complexity of influenza seasonal patterns in the inter-tropical zone impedes the establishment of effective routine immunization programs. China is a climatologically and economically diverse country, which has yet to establish a national influenza vaccination program. Here we characterize the diversity of influenza seasonality in China and make recommendations to guide future vaccination programs. We compiled weekly reports of laboratory-confirmed influenza A and B infections from sentinel hospitals in cities representing 30 Chinese provinces, 2005-2011, and data on population demographics, mobility patterns, socio-economic, and climate factors. We applied linear regression models with harmonic terms to estimate influenza seasonal characteristics, including the amplitude of annual and semi-annual periodicities, their ratio, and peak timing. Hierarchical Bayesian modeling and hierarchical clustering were used to identify predictors of influenza seasonal characteristics and define epidemiologically-relevant regions. The annual periodicity of influenza A epidemics increased with latitude (mean amplitude of annual cycle standardized by mean incidence, 140% [95% CI 128%-151%] in the north versus 37% [95% CI 27%-47%] in the south, p<0.0001). Epidemics peaked in January-February in Northern China (latitude ≥33°N) and April-June in southernmost regions (latitude <27°N). Provinces at intermediate latitudes experienced dominant semi-annual influenza A periodicity with peaks in January-February and June-August (periodicity ratio >0.6 in provinces located within 27.4°N-31.3°N, slope of latitudinal gradient with latitude -0.016 [95% CI -0.025 to -0.008], p<0.001). In contrast, influenza B activity predominated in colder months throughout most of China. Climate factors were the strongest predictors of influenza seasonality, including minimum temperature, hours of sunshine, and maximum rainfall. Our main study limitations include a short surveillance period and sparse influenza sampling in some of the southern provinces. Regional-specific influenza vaccination strategies would be optimal in China; in particular, annual campaigns should be initiated 4-6 months apart in Northern and Southern China. Influenza surveillance should be strengthened in mid-latitude provinces, given the complexity of seasonal patterns in this region. More broadly, our findings are consistent with the role of climatic factors on influenza transmission dynamics. Please see later in the article for the Editors' Summary.
  • Editor: United States: Public Library of Science
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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