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Qiao M, Zhu F, Chen J, Li Y, Wang X. Effects of scheduled school breaks on the circulation of influenza in children, school-aged population, and adults in China: A spatio-temporal analysis. Int J Infect Dis 2024; 140:78-85. [PMID: 38218380 DOI: 10.1016/j.ijid.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVES To investigate the effect of scheduled school break on the circulation of influenza in young children, school-aged population, and adults. METHODS In a spatial-temporal analysis using influenza activity, school break dates, and meteorological covariates across mainland China during 2015-2018, we estimated age-specific, province-specific, and overall relative risk (RR) and effectiveness of school break on influenza. RESULTS We included data in 24, 25, and 17 provinces for individuals aged 0-4 years, 5-19 years and 20+ years. We estimated a RR meta-estimate of 0.34 (95% confidence interval 0.29-0.40) and an effectiveness of 66% for school break in those aged 5-19 years. School break showed a lagged and smaller mitigation effect in those aged 0-4 years (RR meta-estimate: 0.73, 0.68-0.79) and 20+ years (RR meta-estimate: 0.89, 0.78-1.01) versus those aged 5-19 years. CONCLUSION The results show heterogeneous effects of school break between population subgroups, a pattern likely to hold for other respiratory infectious diseases. Our study highlights the importance of anticipating age-specific effects of implementing school closure interventions and provides evidence for rational use of school closure interventions in future epidemics.
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Affiliation(s)
- Mengling Qiao
- Department of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fuyu Zhu
- Department of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junru Chen
- Department of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - You Li
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Xin Wang
- Department of Biostatistics, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom.
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2
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N Naumova E. Forecasting Seasonal Acute Malnutrition: Setting the Framework. Food Nutr Bull 2023; 44:S83-S93. [PMID: 37850923 DOI: 10.1177/03795721231202238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Malnutrition is an umbrella term that refers to an impairment in nutrition indicative of subsequently compromised human well-being. The term covers the full spectrum of nutritional impairments from a small yet detectable departure from a "norm" to a terminal stage when severe malnutrition could result in death. This broad spectrum of nutritional departures from "the optimum" dictates the need for an ensemble of metrics to capture the complexity of involved mechanisms, risk factors, precipitating events, short-term, and long-term consequences. Ideally, these metrics should be universally applicable to vulnerable populations, settings, ages, and times when people are most susceptible to malnutrition. We should be able to characterize and intervene to minimize the risk of malnutrition, especially child acute malnutrition that could be assessed by anthropometric measurements. OBJECTIVES The main challenge in reaching such an ambitious goal is the complexity of measuring, characterizing, explaining, predicting, and preventing malnutrition at any dimension: temporal or spatial and at any scale: a person or a group. The expansive body of literature has been accumulated on many temporal aspects of malnutrition and seasonal changes in nutritional (anthropometric) status. The research community is now shifting their attention to predictive modeling of child malnutrition and its importance for clinical and public health interventions. This communication aims to provide an overview of challenges for understanding child malnutrition from a perspective of predictive modeling focusing on well-documented seasonal variations in nutritional outcomes and exploring "the systems approach" to tackle underlining conceptual and practical complexities to forecast seasonal malnutrition in an accurate and timely manner. This generalized approach to forecasting seasonal malnutrition is then applied specifically to child acute malnutrition.
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Affiliation(s)
- Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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3
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Servadio JL, Thai PQ, Choisy M, Boni MF. Repeatability and timing of tropical influenza epidemics. PLoS Comput Biol 2023; 19:e1011317. [PMID: 37467254 PMCID: PMC10389745 DOI: 10.1371/journal.pcbi.1011317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/29/2023] [Indexed: 07/21/2023] Open
Abstract
Much of the world experiences influenza in yearly recurring seasons, particularly in temperate areas. These patterns can be considered repeatable if they occur predictably and consistently at the same time of year. In tropical areas, including southeast Asia, timing of influenza epidemics is less consistent, leading to a lack of consensus regarding whether influenza is repeatable. This study aimed to assess repeatability of influenza in Vietnam, with repeatability defined as seasonality that occurs at a consistent time of year with low variation. We developed a mathematical model incorporating parameters to represent periods of increased transmission and then fitted the model to data collected from sentinel hospitals throughout Vietnam as well as four temperate locations. We fitted the model for individual (sub)types of influenza as well as all combined influenza throughout northern, central, and southern Vietnam. Repeatability was evaluated through the variance of the timings of peak transmission. Model fits from Vietnam show high variance (sd = 64-179 days) in peak transmission timing, with peaks occurring at irregular intervals and throughout different times of year. Fits from temperate locations showed regular, annual epidemics in winter months, with low variance in peak timings (sd = 32-57 days). This suggests that influenza patterns are not repeatable or seasonal in Vietnam. Influenza prevention in Vietnam therefore cannot rely on anticipation of regularly occurring outbreaks.
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Affiliation(s)
- Joseph L Servadio
- Center for Infectious Disease Dynamics and Department of Biology, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School of Preventative Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Marc Choisy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Maciej F Boni
- Center for Infectious Disease Dynamics and Department of Biology, Pennsylvania State University, University Park, Pennsylvania, United States of America
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Lofgren E, Naumova EN, Gorski J, Naumov Y, Fefferman NH. How Drivers of Seasonality in Respiratory Infections May Impact Vaccine Strategy: A Case Study in How Coronavirus Disease 2019 (COVID-19) May Help Us Solve One of Influenza's Biggest Challenges. Clin Infect Dis 2022; 75:S121-S129. [PMID: 35607766 PMCID: PMC9213832 DOI: 10.1093/cid/ciac400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Vaccines against seasonal infections like influenza offer a recurring testbed, encompassing challenges in design, implementation, and uptake to combat a both familiar and ever-shifting threat. One of the pervading mysteries of influenza epidemiology is what causes the distinctive seasonal outbreak pattern. Proposed theories each suggest different paths forward in being able to tailor precision vaccines and/or deploy them most effectively. One of the greatest challenges in contrasting and supporting these theories is, of course, that there is no means by which to actually test them. In this communication we revisit theories and explore how the ongoing coronavirus disease 2019 (COVID-19) pandemic might provide a unique opportunity to better understand the global circulation of respiratory infections. We discuss how vaccine strategies may be targeted and improved by both isolating drivers and understanding the immunological consequences of seasonality, and how these insights about influenza vaccines may generalize to vaccines for other seasonal respiratory infections.
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Affiliation(s)
- Eric Lofgren
- WSU Paul G. Allen School for Global Health Allen Center PO Box 647090 240 SE Ott Road Pullman, WA 99164, USA
| | - Elena N. Naumova
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy Jaharis Family Center for Biomedical and Nutrition Sciences Tufts University 150 Harrison Avenue Boston, MA 02111, USA
| | - Jack Gorski
- Blood Research Institute Versiti Milwaukee WI, 53226, USA
| | - Yuri Naumov
- Chief Science Officer Back Bay Group 10 Post Office Square – Suite 1300N Boston, MA 02109, USA
| | - Nina H. Fefferman
- Ecology and Evolutionary Biology National Institute for Mathematical and Biological Synthesis University of Tennessee 447 Hesler Biology Building Knoxville, TN, 37966, USA,Corresponding Author: Nina H. Fefferman
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Simpson RB, Lauren BN, Schipper KH, McCann JC, Tarnas MC, Naumova EN. Critical Periods, Critical Time Points and Day-of-the-Week Effects in COVID-19 Surveillance Data: An Example in Middlesex County, Massachusetts, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031321. [PMID: 35162344 PMCID: PMC8835321 DOI: 10.3390/ijerph19031321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 01/14/2023]
Abstract
Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major waves of the novel coronavirus 2019 pandemic (COVID-19). We examined DoW effects by non-pharmaceutical intervention phases adjusting for wave-specific signatures using the John Hopkins University’s (JHU’s) Center for Systems Science and Engineering (CSSE) COVID-19 data repository from 2 March 2020 through 7 November 2021 in Middlesex County, Massachusetts, USA. We cross-referenced JHU’s data with Massachusetts Department of Public Health (MDPH) COVID-19 records to reconcile inconsistent reporting. We created a calendar of statewide non-pharmaceutical intervention phases and defined the critical periods and timepoints of outbreak signatures for reported tests, cases, and deaths using Kolmogorov-Zurbenko adaptive filters. We determined that daily death counts had no DoW effects; tests were twice as likely to be reported on weekdays than weekends with decreasing effect sizes across intervention phases. Cases were also twice as likely to be reported on Tuesdays-Fridays (RR = 1.90–2.69 [95%CI: 1.38–4.08]) in the most stringent phases and half as likely to be reported on Mondays and Tuesdays (RR = 0.51–0.93 [0.44, 0.97]) in less stringent phases compared to Sundays; indicating temporal changes in laboratory testing practices and use of healthcare facilities. Understanding the DoW effects in daily surveillance records is valuable to better anticipate fluctuations in SARS-CoV-2 testing and manage appropriate workflow. We encourage health authorities to establish standardized reporting protocols.
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Concordance between the Clinical Diagnosis of Influenza in Primary Care and Epidemiological Surveillance Systems (PREVIGrip Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031263. [PMID: 35162284 PMCID: PMC8835369 DOI: 10.3390/ijerph19031263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
Introduction: Health authorities use different systems of influenza surveillance. Sentinel networks, which are recommended by the World Health Organization, provide information on weekly influenza incidence in a monitored population, based on laboratory-confirmed cases. In Catalonia there is a public website, DiagnostiCat, that publishes the number of weekly clinical diagnoses at the end of each week of disease registration, while the sentinel network publishes its reports later. The objective of this study was to determine whether there is concordance between the number of cases of clinical diagnoses and the number of confirmed cases of influenza, in order to evaluate the predictive potential of a clinical diagnosis-based system. Methods: Population-based ecological time series study in Catalonia. The period runs from the 2010–2011 to the 2018–2019 season. The concordance between the clinical diagnostic cases and the confirmed cases was evaluated. The degree of agreement and the concordance were analysed using Bland–Altman graphs and intraclass correlation coefficients. Results: There was greater concordance between the clinical diagnoses and the sum of the cases confirmed outside and within the sentinel network than between the diagnoses and the confirmed sentinel cases. The degree of agreement was higher when influenza rates were low. Conclusions: There is concordance between the clinical diagnosis and the confirmed cases of influenza. Registered clinical diagnostic cases could provide a good alternative to traditional surveillance, based on case confirmation. Cases of clinical diagnosis of influenza may have the potential to predict the onset of annual influenza epidemics.
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Mangrum D, Niekamp P. JUE Insight: College student travel contributed to local COVID-19 spread. JOURNAL OF URBAN ECONOMICS 2022; 127:103311. [PMID: 33746308 PMCID: PMC7962882 DOI: 10.1016/j.jue.2020.103311] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/17/2020] [Indexed: 05/21/2023]
Abstract
Due to the suspension of in-person classes in response to the COVID-19 pandemic, students at universities with earlier spring breaks traveled and returned to campus while those with later spring breaks largely did not. We use variation in academic calendars to study how travel affected the evolution of COVID-19 cases and mortality. Estimates imply that counties with more early spring break students had a higher growth rate of cases than counties with fewer early spring break students. The increase in case growth rates peaked two weeks after spring break. Effects are larger for universities with students more likely to travel through airports, to New York City, and to popular Florida destinations. Consistent with secondary spread to more vulnerable populations, we find a delayed increase in mortality growth rates. Lastly, we present evidence that viral infection transmission due to college student travel also occurred prior to the COVID-19 pandemic.
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Affiliation(s)
- Daniel Mangrum
- Research and Statistics Group, Federal Reserve Bank of New York, 33 Liberty Street, New York, NY, 10045, United States
| | - Paul Niekamp
- Department of Economics, Ball State University, 2000 N McKinley Ave, Muncie, IN, 47306
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Simpson RB, Babool S, Tarnas MC, Kaminski PM, Hartwick MA, Naumova EN. Signatures of Cholera Outbreak during the Yemeni Civil War, 2016-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010378. [PMID: 35010649 PMCID: PMC8744546 DOI: 10.3390/ijerph19010378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
The Global Task Force on Cholera Control (GTFCC) created a strategy for early outbreak detection, hotspot identification, and resource mobilization coordination in response to the Yemeni cholera epidemic. This strategy requires a systematic approach for defining and classifying outbreak signatures, or the profile of an epidemic curve and its features. We used publicly available data to quantify outbreak features of the ongoing cholera epidemic in Yemen and clustered governorates using an adaptive time series methodology. We characterized outbreak signatures and identified clusters using a weekly time series of cholera rates in 20 Yemeni governorates and nationally from 4 September 2016 through 29 December 2019 as reported by the World Health Organization (WHO). We quantified critical points and periods using Kolmogorov–Zurbenko adaptive filter methodology. We assigned governorates into six clusters sharing similar outbreak signatures, according to similarities in critical points, critical periods, and the magnitude of peak rates. We identified four national outbreak waves beginning on 12 September 2016, 6 March 2017, 28 May 2018, and 28 January 2019. Among six identified clusters, we classified a core regional hotspot in Sana’a, Sana’a City, and Al-Hudaydah—the expected origin of the national outbreak. The five additional clusters differed in Wave 2 and Wave 3 peak frequency, timing, magnitude, and geographic location. As of 29 December 2019, no governorates had returned to pre-Wave 1 levels. The detected similarity in outbreak signatures suggests potentially shared environmental and human-made drivers of infection; the heterogeneity in outbreak signatures implies the potential traveling waves outwards from the core regional hotspot that could be governed by factors that deserve further investigation.
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Affiliation(s)
- Ryan B. Simpson
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
- Correspondence: (R.B.S.); (E.N.N.); Tel.: +1-978-697-1037 (R.B.S.); +1-617-636-2927 (E.N.N.)
| | - Sofia Babool
- Department of Neuroscience, The University of Texas at Dallas, 800 W Campbell Road, Richardson, TX 75080, USA;
| | - Maia C. Tarnas
- Department of Community Health, School of Arts and Sciences, Tufts University, 574 Boston Avenue, Medford, MA 02155, USA;
| | - Paulina M. Kaminski
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
| | - Meghan A. Hartwick
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
| | - Elena N. Naumova
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; (P.M.K.); (M.A.H.)
- Correspondence: (R.B.S.); (E.N.N.); Tel.: +1-978-697-1037 (R.B.S.); +1-617-636-2927 (E.N.N.)
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He Y, Zhao Y, Chen Y, Yuan H, Tsui K. Nowcasting influenza‐like illness (ILI) via a deep learning approach using google search data: An empirical study on Taiwan ILI. INT J INTELL SYST 2021. [DOI: 10.1002/int.22788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuxin He
- College of Urban Transportation and Logistics Shenzhen Technology University Shenzhen China
| | - Yang Zhao
- School of Public Health (Shenzhen) Sun Yat‐Sen University Guangzhou China
| | - Yupeng Chen
- Trial Retail Engineering (T. R. E. China) Yantai China
| | - Hsiang‐Yu Yuan
- Department of Biomedical Sciences City University of Hong Kong Hong Kong China
| | - Kwok‐Leung Tsui
- Department of Industrial and Systems Engineering Virginia Polytechnic Institute and State University Blacksburg Virginia USA
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10
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Simpson RB, Zhou B, Alarcon Falconi TM, Naumova EN. An analecta of visualizations for foodborne illness trends and seasonality. Sci Data 2020; 7:346. [PMID: 33051470 PMCID: PMC7553952 DOI: 10.1038/s41597-020-00677-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022] Open
Abstract
Disease surveillance systems worldwide face increasing pressure to maintain and distribute data in usable formats supplemented with effective visualizations to enable actionable policy and programming responses. Annual reports and interactive portals provide access to surveillance data and visualizations depicting temporal trends and seasonal patterns of diseases. Analyses and visuals are typically limited to reporting the annual time series and the month with the highest number of cases per year. Yet, detecting potential disease outbreaks and supporting public health interventions requires detailed spatiotemporal comparisons to characterize spatiotemporal patterns of illness across diseases and locations. The Centers for Disease Control and Prevention's (CDC) FoodNet Fast provides population-based foodborne-disease surveillance records and visualizations for select counties across the US. We offer suggestions on how current FoodNet Fast data organization and visual analytics can be improved to facilitate data interpretation, decision-making, and communication of features related to trend and seasonality. The resulting compilation, or analecta, of 436 visualizations of records and codes are openly available online.
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Affiliation(s)
- Ryan B Simpson
- Tufts University Friedman School of Nutrition Science and Policy, Boston, USA
| | - Bingjie Zhou
- Tufts University Friedman School of Nutrition Science and Policy, Boston, USA
| | | | - Elena N Naumova
- Tufts University Friedman School of Nutrition Science and Policy, Boston, USA.
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Effects of Data Aggregation on Time Series Analysis of Seasonal Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165887. [PMID: 32823719 PMCID: PMC7460497 DOI: 10.3390/ijerph17165887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/03/2023]
Abstract
Time series analysis in epidemiological studies is typically conducted on aggregated counts, although data tend to be collected at finer temporal resolutions. The decision to aggregate data is rarely discussed in epidemiological literature although it has been shown to impact model results. We present a critical thinking process for making decisions about data aggregation in time series analysis of seasonal infections. We systematically build a harmonic regression model to characterize peak timing and amplitude of three respiratory and enteric infections that have different seasonal patterns and incidence. We show that irregularities introduced when aggregating data must be controlled during modeling to prevent erroneous results. Aggregation irregularities had a minimal impact on the estimates of trend, amplitude, and peak timing for daily and weekly data regardless of the disease. However, estimates of peak timing of the more common infections changed by as much as 2.5 months when controlling for monthly data irregularities. Building a systematic model that controls for data irregularities is essential to accurately characterize temporal patterns of infections. With the urgent need to characterize temporal patterns of novel infections, such as COVID-19, this tutorial is timely and highly valuable for experts in many disciplines.
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