The changing pattern of enteric pathogen infections in China during the COVID-19 pandemic: a nation-wide observational study

Li-Ping Wang; Jia-Yi Han; Shi-Xia Zhou; Lin-Jie Yu; Qing-Bin Lu; Xiao-Ai Zhang; Hai-Yang Zhang; Xiang Ren; Cui-Hong Zhang; Yi-Fei Wang; Sheng-Hong Lin; Qiang Xu; Bao-Gui Jiang; Chen-Long Lv; Jin-Jin Chen; Chang-Jun Li; Zhong-Jie Li; Yang Yang; Wei Liu; Li-Qun Fang; Simon I. Hay; George F. Gao; Wei-Zhong Yang

The Lancet Regional Health. Western Pacific (Nov 2021)

The changing pattern of enteric pathogen infections in China during the COVID-19 pandemic: a nation-wide observational study

Li-Ping Wang,
Jia-Yi Han,
Shi-Xia Zhou,
Lin-Jie Yu,
Qing-Bin Lu,
Xiao-Ai Zhang,
Hai-Yang Zhang,
Xiang Ren,
Cui-Hong Zhang,
Yi-Fei Wang,
Sheng-Hong Lin,
Qiang Xu,
Bao-Gui Jiang,
Chen-Long Lv,
Jin-Jin Chen,
Chang-Jun Li,
Zhong-Jie Li,
Yang Yang,
Wei Liu,
Li-Qun Fang,
Simon I. Hay,
George F. Gao,
Wei-Zhong Yang

Affiliations

Li-Ping Wang: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
Jia-Yi Han: School of Mathematical Sciences, Ocean University of China, Qingdao, China
Shi-Xia Zhou: Anhui Medical University, Hefei, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Lin-Jie Yu: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Qing-Bin Lu: Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, P. R. China
Xiao-Ai Zhang: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Hai-Yang Zhang: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Xiang Ren: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
Cui-Hong Zhang: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
Yi-Fei Wang: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
Sheng-Hong Lin: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
Qiang Xu: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Bao-Gui Jiang: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Chen-Long Lv: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Jin-Jin Chen: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China
Chang-Jun Li: School of Mathematical Sciences, Ocean University of China, Qingdao, China
Zhong-Jie Li: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; Corresponding author at: Chinese Centre for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing 102206, People's Republic of China.
Yang Yang: Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, U. S. A; Corresponding author at: Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
Wei Liu: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China; Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, P. R. China; Corresponding author at: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing 100071, P. R. China.
Li-Qun Fang: Anhui Medical University, Hefei, China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China; Corresponding author at: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing 100071, P. R. China.
Simon I. Hay: Department of Health Metrics Sciences, School of Medicine, University of Washington; Institute for Health Metrics and Evaluation, University of Washington
George F. Gao: Chinese Centre for Disease Control and Prevention, Beijing, China
Wei-Zhong Yang: Chinese Centre for Disease Control and Prevention, Beijing, China

Journal volume & issue: Vol. 16
p. 100268

Abstract

Read online

Background: Non pharmaceutical interventions (NPI) including hand washing directives were implemented in China and worldwide to combat the COVID-19 pandemic, which are likely to have had impacted a broad spectrum of enteric pathogen infections. Methods: Etiologically diagnostic data from 45 937 and 67 395 patients with acute diarrhea between 2012 and 2020, who were tested for seven viral pathogens and 13 bacteria respectively, were analyzed to assess the changes of enteric pathogen infections in China during the first COVID-19 pandemic year compared to pre-pandemic years. Findings: Test positive rates of all enteric viruses decreased during 2020, compared to the average levels during 2012−2019, with a relative decrease of 71•75% for adenovirus, 58•76% for norovirus, 53•50% for rotavirus A, and 72•07% for the combination of other four uncommon viruses. In general, a larger reduction of positive rate in viruses was seen among adults than pediatric patients. A rebound of rotavirus A was seen after September 2020 in North China rather than South China. Test positive rates of bacteria decreased during 2020, compared to the average levels during 2012−2019, excepting for nontyphoidal Salmonella and Campylobacter coli with 66•53% and 90•48% increase respectively. This increase was larger for pediatric patients than for adult patients. Interpretation: The activity of enteric pathogens changed profoundly alongside the NPIs implemented during the COVID-19 pandemic in China. Greater reductions of the test positive rates were found for almost all enteric viruses than for bacteria among acute diarrhea patients, with further large differences by age and geography. Lifting of NPIs will lead to resurgence of enteric pathogen infections, particularly in children whose immunity may not have been developed and/or waned. Funding: China Mega-Project on Infectious Disease Prevention; National Natural Science Funds.

Published in The Lancet Regional Health. Western Pacific

ISSN: 2666-6065 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanwpc/home

About the journal

Abstract

Keywords