| Introduction:Respiratory system infectious diseases are one of the main causes of death and disability worldwide,causing about 4 million deaths worldwide every year,and imposing a huge burden on the social economy and health system in terms of direct medical expenses and indirect productivity losses.In addition,emerging respiratory viruses in recent years,such as the H5N1 avian influenza virus,the new H1N1 virus that caused the 2009 influenza pandemic,and the SARS-Co V-2 virus that emerged in 2019,all pose a serious threat to global health and sanitation security.Influenza is an acute infectious respiratory disease caused by influenza virus.Globally,influenza virus infection is the main cause of respiratory diseases and is related to 14%of acute lower respiratory diseases.Every year,5-10%of adults and 20-30%of children are infected with influenza,resulting in 3-5 million severe cases worldwide and approximately 1 million deaths.Although there are currently vaccines and effective antiviral drugs for influenza viruses,due to multiple comprehensive factors such as virus mutations,influenza virus infections will still have a significant impact on global morbidity and mortality every year.The seasonality of influenza indicates that meteorological factors may have an impact on its spread.As the world’s largest developing country,China has about3.4 million influenza-related outpatients and 88,000 influenza-related respiratory diseases every year.China has a vast territory and diverse climate types.According to the distribution of accumulated temperature,the whole country is divided into 5temperature zones and 1 special Qinghai-Tibet Plateau area.Understanding the trend characteristics of influenza epidemics distributed in provinces in various temperature zones of China is helpful for grasping the dynamic distribution of influenza epidemics throughout the year at the national level and deploying public health protection measures in advance.Meteorological factors not only directly affect the survival and spread of infectious diseases in the respiratory system,but more and more studies have shown that meteorological factors also directly or indirectly affect the formation and distribution of air pollutants.Pneumonia,a respiratory infectious disease,is the most infectious cause of death among children in the world.In 2017,pneumonia caused the death of more than 800,000 children under 5 years of age worldwide,accounting for 15%of all deaths of children under 5 years of age.Studies have pointed out that the level of childhood pneumonia infection is not only related to pathogens and genetic factors,but meteorological and air pollutants are also one of the main causes of childhood pneumonia.Children’s air intake per unit body weight is greater than that of adults,and given that children’s immune systems and various organs are still in the developmental stage,children have become more sensitive to exposure to risk factors.According to the World Health Organization report,children’s current exposure to air pollution has not been experienced by previous generations.It is predicted that this generation will suffer from an unprecedented level of chronic respiratory diseases in the later stages of life,and the burden of disease caused by pneumonia can and should be affected.Therefore,exploring the impact of meteorological factors and air pollutants on children’s pneumonia infection in China is of relatively important value for strengthening personal protection of the population and for the government to formulate corresponding policies and measures.During the COVID-19 epidemic prevention and control period,strict non-pharmaceutical interventions（NPIs）were implemented globally,including city closures,closed schools,close contact tracking,isolation,wearing masks,hand hygiene,and disinfection in public places,Maintain social distancing,etc.Since COVID-19 is the same as influenza,the main route of virus infection is considered to be respiratory droplets.The purpose of various NPIs is to greatly reduce the contact rate of the population,thereby slowing down the spread of the virus.Therefore,these NPIs for the prevention of COVID-19 have the same effect on the spread of other respiratory infectious diseases.During the COVID-19epidemic prevention and control period,do China,the United Kingdom,Germany,France,the United States,Canada,Italy,Japan,and South Korea,which are in the northern temperate zone,still show similar seasonal characteristics in the influenza epidemic pattern?Or does it show a similar trend of change?Under the influence of the relatively influential international and domestic NPIs,how has the development trend of COVID-19 cases in the above countries changed?In addition,since NPIs measures are also an effective way to prevent and control the spread of other infectious diseases,under these measures,which statutory reported infectious diseases in China have changed during the epidemic prevention and control period,what changes have occurred,whether they have dropped,where is the peak,and how much is worthy of deep studying.Among respiratory infectious diseases,influenza and COVID-19 can both trigger a global pandemic.Because of its wide-scale impact and large populations,it has triggered extensive research by scholars around the world.In order to fully understand the relevant progress in the research field of this subject,we first apply bibliometrics methods to comprehensively sort out the published literature in this field,so as to provide a detailed bibliographic basis for the research of this topic.Objective:（1）Through bibliometric analysis,we can fully understand the relevant research progress of the impact of meteorological factors and NPIs on influenza and COVID-19epidemic,and then provide detailed and objective bibliographic support for the design and development of this research.By combing through information about the country,author,research topic,and literature citations in this research field,and objectively analyzing the characteristics of the literature,we can fully grasp the research progress,current situation and hot issues in this field,and the findings will provide guidance and reference for the following research design of this study.Carry out to provide guidance and reference.（2）By carrying out research on influenza epidemic patterns at the provincial level and the correlation between influenza epidemics and meteorological factors,we can understand the trend characteristics of influenza epidemics distributed in provinces in various temperature zones in China,and make a comprehensive view of the annual influenza epidemic at the national level.The dynamic distribution of the epidemic and the advance deployment of public health protection measures are of certain reference significance.By analyzing the impact of NPIs measures on the trend of COVID-19 and influenza in northern temperate countries,distinguishing the seasonal characteristics and trend of influenza epidemics in China,the United Kingdom,Germany,France,the United States,Canada,Italy,Japan,and South Korea,which are in the northern temperate zone,could give certain support for normalized prevention and control of the COVID-19 and influenza at the same time in the future.（3）To understand the impact of meteorological factors and air quality monitoring indicators on the incidence of pneumonia in children in Shenyang,China,Generalized additive modeling analysis are used to explore the correlation between the short-term effects of air pollutants and meteorological factors and the daily visits of children with pneumonia.（4）By comparing the incidence of notifiable infectious diseases in China from 2009to 2020,time series analysis is carried out to study the changes in the incidence of these relevant diseases in 2020,exploring the effect of NPIs on infectious diseases of different transmission routes and its strength.Material and methods:The first part of this research jointly applied Cite Space and R software,based on bibliometric analysis to present and visualize the scientific knowledge of published literature in the joint research field of meteorological factors and NPIs with influenza and COVID-19.Based on the bibliometric analysis results,we can analyze the trend of publication of meteorological factors and NPIs that jointly research with influenza and COVID-19 respectively,the evolution trend of themes,and current research hotspots could give us a guide for the research direction of other parts of the whole research.In the second part of the study,the monthly average annual percentage（MAAP）is used as an indicator to evaluate the influenza virus prevalence level,and the minimum months where the sum of MAAP reaches 75%during the year are defined as the influenza epidemic period of the current year to draw the Map of the distribution characteristics of meteorological and influenza epidemics in various provinces of China through 2005 to 2016.Calculate the correlation between the meteorological factors of each province and MAAP by SPSS software.According to the bibliometric results of the first part,the meteorological indicators include temperature,relative humidity,pressure and precipitation,and then use R software to map the national monthly influenza epidemic distribution map and the trend map of influenza MAAP and meteorological factors in each province.Nine countries located in the northern temperate zone were selected as representative research objects,calculate the incidence of influenza in each country based on population density,and use descriptive epidemiological research methods to show the overall and subtype of influenza cases in the 2015/16 to 2019/20influenza season in each country,to present the epidemic trend of changes in the incidence of influenza cases and COVID-19 cases among different countries under the influence of WHO and representative health events and NPIs in every country since January 2020.Combining major public health events and NPIs measures to map the development and change trends of the COVID-19 epidemic in each country.The COVID-19 incidence data is stored and pre-processed through Microsoft Excel software,R packages including ggplot2 and ggpubr were applied for illustrations.On the basis of bibliometrics and the research results of the second part,the third part of the study selected Shenyang,a city in northern China that has a strong correlation with meteorological factors,as the research site,and explored environmental meteorological factors by constructing a generalized additive model based on Poisson distribution to identify its impact on the incidence of pneumonia in children in Shenyang.After controlling the day effect,holiday effect and weekend effect,the optimal model is selected through the model’s AIC（Akaike Information Criterion）value,and the single-pollutant model and the multi-pollutant model are constructed.Bibliometric analysis shows that the modeling research on NPIs measures is currently a research hotspot in this field.The fourth part is to build a time series model to study the changes in the incidence of notifiable infectious diseases in China in 2020,and to explore the effect of prevention and control measures on the effect of infectious diseases with different transmission ways.It is assumed that the monthly incidence data of infectious diseases has a certain seasonal,periodic and trending time series pattern.Fit the optimal time series model through the monthly historical incidence of infectious diseases and predict the incidence of infectious diseases in the next year.To examine the accuracy of the model,candidate models include exponential smoothing and SARIMA models.Results:Bibliometrics shows that the number of publications of joint research on meteorological factors and influenza has shown an overall upward trend year by year,while research on the correlation between NPIs and influenza and the COVID-19 did not show a significant upward trend before 2020,but related literature in2020 The number of publications has shown explosive growth.Temperature and humidity are the main meteorological factors in the study of the correlation between meteorological factors and respiratory infectious diseases represented by influenza.In China,with the increase of latitude,the annual concentration trend of influenza epidemics in each region becomes more obvious,and the epidemic period is relatively shortened.The epidemic months are mainly concentrated in winter and spring.In high latitude areas,the correlation between influenza epidemic intensity and meteorological factors is more significant than that in the areas in the relative low latitude.Among the four meteorological indicators,namely temperature,air pressure,relative humidity and precipitation,air pressure is positively correlated with the intensity of influenza epidemics in various regions.With the exception of several provinces in southern China,temperature,relative humidity,and precipitation are negatively correlated with influenza epidemics in most regions of China.The influenza prevalence curves of the countries in the northern temperate zone have shown a typical single-peak pattern over the years,and they are all concentrated in the winter and spring.The number of influenza cases after population density adjustment shows that the influenza epidemic situation in the United States and Canada over the years is more severe than other countries.Affected by NPIs,the monitoring data of China’s 2019/20 influenza season began to decline rapidly from the 2nd week,and the influenza season ended early around the 9th week.The influenza epidemic trend of this season in most other countries is also presented a downward trend near the 10th week.With a series of strict NPIs and the high degree of cooperation from the whole people,China controlled the progress of the COVID-19 epidemic in early March.The development of the COVID-19 epidemic in other countries showed varying degrees of downward trends from early April to mid-April.Except for China,the incidence of COVID-19 in other countries has subsequently increased to varying degrees.Due to the lack of detailed data on the development and implementation of NPIs in each country,the relationship between the representative public health policies and the release time points of important epidemic prevention and control events selected by us and the incidence trend of COVID-19 in each country is not obvious.Through modeling and analysis of the incidence of pneumonia among children in Shenyang and environmental and meteorological factors,we found that in the single pollutant model,O3 has the strongest explanatory power to the model,followed by PM2.5 and SO2.According to the Akaike Information Criterion（AIC）,O3,average temperature,PM10,average air pressure,wind speed and daily average relative humidity are included as variables into the final multi-pollutant model.Within a certain numerical range,the effect of O3 on the outpatient number of children with pneumonia weakens as its concentration rises.The average air pressure and average daily relative humidity have little effect on the outpatient number of children with pneumonia.When the wind speed reaches about 3.5 m/s,The impact on outpatient number is the most significant,and PM10 reaches its maximum effect at a concentration of 125μg/m3.Through time series analysis of the incidence of notifiable infectious diseases in China,we found that the time series model has a relatively good fitting effect on the incidence of most diseases.During the prevention and control of the COVID-19 epidemic in 2020,compared with the predicted value of the time series,the actual incidence of infectious diseases with droplets as the main mode of transmission has shown a significant downward trend,followed by blood-borne and sexually transmitted infectious diseases,and again by the digestive tract.Disease,which has the least effect on insect-borne and natural foci-borne diseases.Conclusion:（1）Temperature and humidity are the main meteorological factors in the joint study of meteorology and respiratory infectious diseases represented by influenza.There are not many joint studies on NPIs and influenza in the past.Relevant studies increased rapidly in 2020,and the topics in the field will be further refined,such as hand hygiene,contact tracking,etc.In addition,modeling research on NPIs and respiratory infectious diseases may continue its research enthusiasm.（2）As far as we know,this research is the first to integrate the quantitative analysis of flu cases and meteorological data for more than ten years in China on the provincial basis.Through MAAP conversion of case data,the epidemic pattern of influenza in various regions of China is made clearer.This method can also be helpful for confirming the epidemic period of other seasonal respiratory infectious diseases.The selected nine countries in the northern temperate zone showed a single-peak epidemic pattern over the years,and they were concentrated in the winter and spring.Affected by the effects of international and domestic NPIs,the 2019/20influenza season in northern temperate countries all ended early.（3）The generalized additive model can simulate the incidence of pneumonia among children in Shenyang under different environmental and meteorological factors.O3,average temperature,PM10,average air pressure,wind speed,daily average relative humidity,PM2.5 and SO2 are indicators that have a relatively robust impact on the incidence of pneumonia in children.（4）Most infectious diseases are suitable for analysis through time series models.Except for natural foci and vector-borne infectious diseases,measures taken in response to COVID-19 are also effective on diseases transmitted through respiratory tract,digestive tract,blood source and sexual.The measures have the greatest effect on respiratory infectious diseases,followed by blood-borne and sexually transmitted infectious diseases,and again for digestive tract infectious diseases,and have the least effect on insect-borne and natural foci-borne diseases. |
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