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Effects of Long-Term Exposure to Air Pollution on the Resurgence of Scarlet Fever in China: A 15-Year Surveillance Study

49 Pages Posted: 24 Sep 2019

See all articles by Yonghong Liu

Yonghong Liu

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Hui Ding

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Shu-ting Chang

Academia Sinica - Research Center for Humanities and Social Science

Hui Zhong Zhong

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Na Zhao

Chinese Academy of Sciences (CAS) - CAS Key Laboratory of Pathogenic Microbiology and Immunology

Yiming Bao

Chinese Academy of Sciences (CAS)

Liwei Yap

Academia Sinica - Research Center for Humanities and Social Science

Weijia Xu

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Minyi Wang

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Yuan Li

Baoan District Centre for Disease Control and Prevention

Shuwen Qin

Zhejiang Provincial Center for Disease Control and Prevention - Department of Infectious Diseases

Zhao Yu

Zhejiang Provincial Center for Disease Control and Prevention - Department of Infectious Diseases

Xingyi Geng

Jinan Centre for Disease Control and Prevention

Supen Wang

Chinese Academy of Sciences (CAS)

Zhi Yu

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Ta-Chien Chan

Academia Sinica - Research Center for Humanities and Social Science

Shelan Liu

Zhejiang Provincial Center for Disease Control and Prevention - Department of Infectious Diseases

More...

Abstract

Background: Aimed to investigate the association between the resurgence of scarlet fever and long-term exposure to air pollutants and weather conditions in China.

Methods: Data on scarlet fever were from the National Notifiable Disease Reporting System. Air pollutants were from the National Environmental Protection Department, and weather conditions were from the National Meteorological Information Center. A lag non-linear model (DLNM) was used to estimate the excess risk of scarlet fever associated with air pollutants and weather conditions.

Findings: 655,039 scarlet fever cases were reported during 2004-18. It started to surge in 2011 (4.7638 per 100 000), and peaked in 2018 (5.6736 per 100 000). The average incidence in 2011-18 was twice that in 2004-10 (rate ratio=2.302; 95% CI: 2.289-2.314; p<0.001]. There was a lowmoderate correlation between scarlet fever and monthly NO2 concentration (r=0.21), sunlight (r=0.28), and wind speed (r=0.24), but the others were weak [PM10 (r=0.13), ozone (r=0.11), and PM2.5 (r=0.05)]. By contrast, it was inversely correlated with monthly relative humidity (RH, r=-0.37), precipitation (r=-0.24) and mean temperature (r=-0.2). A one-unit increment of NO₂ concentration was associated with scarlet fever increased (RR=1.5, 95% CI: 1.35-1.66). The RR was recorded at lag 0 at 42 μg/m3 NO2 concentration (RR=1.15). NO2 pooled estimates varied substantially across China (RR=1.02~4.16), but were higher in northern parts.

Interpretation: Long-term exposure to ambient NOâ‚‚ was associated with scarlet fever resurgence, triggered by low RH, temperature, precipitation, and high wind speed and sunshine. Further interventions to reduce NO2 emissions might suppress the resurgence of scarlet fever.

Funding Statement: National Science and Technology Major Project of China (Grant no. 2016YFC0202005) and the National Natural Science Foundation of China (Grant no. 41975165, Grant no. 31700320), key epidemiological disciplines of Zhejiang Provincial Health of China, and Shenzhen Science and Technology Innovation Committee (Grant no. JCYJ20160427155352873).

Declaration of Interests: The authors declared that they did not have a conflict of interest.

Ethics Approval Statement: This study was done according to the principles and guidelines of the Declaration of Helsinki, and was approved by the Research Ethics Committee of the Zhejiang Provincial Center for Disease Control and Prevention. All initial information identifying patients was anonymized in this study.

Suggested Citation

Liu, Yonghong and Ding, Hui and Chang, Shu-ting and Zhong, Hui Zhong and Zhao, Na and Bao, Yiming and Yap, Liwei and Xu, Weijia and Wang, Minyi and Li, Yuan and Qin, Shuwen and Yu, Zhao and Geng, Xingyi and Wang, Supen and Yu, Zhi and Chan, Ta-Chien and Liu, Shelan, Effects of Long-Term Exposure to Air Pollution on the Resurgence of Scarlet Fever in China: A 15-Year Surveillance Study (September 20, 2019). Available at SSRN: https://ssrn.com/abstract=3457437 or http://dx.doi.org/10.2139/ssrn.3457437

Yonghong Liu

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Guangzhou, 510275
China

Hui Ding

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Guangzhou, 510275
China

Shu-ting Chang

Academia Sinica - Research Center for Humanities and Social Science

128 Academia Road
Taipei
Taiwan

Hui Zhong Zhong

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Guangzhou, 510275
China

Na Zhao

Chinese Academy of Sciences (CAS) - CAS Key Laboratory of Pathogenic Microbiology and Immunology

52 Sanlihe Rd.
Datun Road, Anwai
Beijing, Xicheng District 100864
China

Yiming Bao

Chinese Academy of Sciences (CAS)

52 Sanlihe Rd.
Datun Road, Anwai
Beijing, Xicheng District 100864
China

Liwei Yap

Academia Sinica - Research Center for Humanities and Social Science

128 Academia Road
Taipei
Taiwan

Weijia Xu

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Guangzhou, 510275
China

Minyi Wang

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering

Guangzhou, 510275
China

Yuan Li

Baoan District Centre for Disease Control and Prevention

Shenzhen
China

Shuwen Qin

Zhejiang Provincial Center for Disease Control and Prevention - Department of Infectious Diseases

Hangzhou
China

Zhao Yu

Zhejiang Provincial Center for Disease Control and Prevention - Department of Infectious Diseases

Hangzhou
China

Xingyi Geng

Jinan Centre for Disease Control and Prevention

Jinan
China

Supen Wang

Chinese Academy of Sciences (CAS)

52 Sanlihe Rd.
Datun Road, Anwai
Beijing, Xicheng District 100864
China

Zhi Yu

Sun Yat-sen University (SYSU) - School of Intelligent Systems Engineering ( email )

Guangzhou, 510275
China

Ta-Chien Chan

Academia Sinica - Research Center for Humanities and Social Science ( email )

128 Academia Road
Taipei
Taiwan

Shelan Liu (Contact Author)

Zhejiang Provincial Center for Disease Control and Prevention - Department of Infectious Diseases ( email )

Hangzhou
China