Abstract
Few studies have estimated the nonlinear association of ambient temperature with the risk of influenza. We therefore applied a time-series analysis to explore the short-term effect of ambient temperature on the incidence of influenza in Wuhan, China. Daily influenza cases were collected from Hubei Provincial Center for Disease Control and Prevention (Hubei CDC) from January 1, 2014, to December 31, 2017. The meteorological and daily pollutant data was obtained from the Hubei Meteorological Service Center and National Air Quality Monitoring Stations, respectively. We used a generalized additive model (GAM) coupled with the distributed lag nonlinear model (DLNM) to explore the exposure-lag-response relationship between the short-term risk of influenza and daily average ambient temperature. Analyses were also performed to assess the extreme cold and hot temperature effects. We observed that the ambient temperature was statistically significant, and the exposure-response curve is approximately S-shaped, with a peak observed at 23.57 ℃. The single-day lag curve showed that extreme hot and cold temperatures were both significantly associated with influenza. The extreme hot temperature has an acute effect on influenza, with the most significant effect observed at lag 0-1. The extreme cold temperature has a relatively smaller effect but lasts longer, with the effect exerted continuously during a lag of 2-4days. Our study found significant nonlinear and delayed associations between ambient temperature and the incidence of influenza. Our finding contributes to the establishment of an early warning system for airborne infectious diseases.
Highlights
Influenza virus is a single-stranded ribonucleic acid (RNA) virus with segmented negative sense which belongs to the family Orthomyxoviridae (Belser et al, 2010, Alexander, 2007, Pica et al, 2012)
The extreme hot temperature has an acute effect on influenza, with the most significant effect observed at lag 0-1
Influenza viruses are categorized into four types: A, B, C, and D, and the seasonal influenza epidemics are mainly caused by types A and B (Mostafa et al, 2018)
Summary
Influenza virus is a single-stranded ribonucleic acid (RNA) virus with segmented negative sense which belongs to the family Orthomyxoviridae (Belser et al, 2010, Alexander, 2007, Pica et al, 2012). As an acute respiratory infectious disease, influenza can be spread through direct contact, large droplets in short distance, and small droplets in long distance (Weber and Stilianakis, 2008, Tellier, 2009). The incubation period of influenza varies from 1 to 7 days, with an average period of two days. The main symptoms of influenza is characterized by a sudden onset of fever, cough, headache, muscle and joint pain, severe malaise (feeling unwell), sore throat, and a runny nose (WHO, 2018). The periodic emergence of new strains makes it difficult to effectively prevent and control influenza. The periodic emergence of new strains makes it difficult to effectively prevent and control influenza. (Kamradt-Scott, 2012, Magee et al, 2015)
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