Abstract

Nationwide prospective surveillance of all-age patients with acute respiratory infections was conducted in China between 2009‒2019. Here we report the etiological and epidemiological features of the 231,107 eligible patients enrolled in this analysis. Children <5 years old and school-age children have the highest viral positivity rate (46.9%) and bacterial positivity rate (30.9%). Influenza virus, respiratory syncytial virus and human rhinovirus are the three leading viral pathogens with proportions of 28.5%, 16.8% and 16.7%, and Streptococcus pneumoniae, Mycoplasma pneumoniae and Klebsiella pneumoniae are the three leading bacterial pathogens (29.9%, 18.6% and 15.8%). Negative interactions between viruses and positive interactions between viral and bacterial pathogens are common. A Join-Point analysis reveals the age-specific positivity rate and how this varied for individual pathogens. These data indicate that differential priorities for diagnosis, prevention and control should be highlighted in terms of acute respiratory tract infection patients’ demography, geographic locations and season of illness in China.

China operates a national surveillance program for acute respiratory infections and sampled over 200,000 patients between 2009–2019. Here, the authors present results from this program and describe patterns by age, pathogen type, presence of pneumonia, and season.

Details

Title
Etiological and epidemiological features of acute respiratory infections in China
Author
Zhong-Jie, Li 1 ; Hai-Yang, Zhang 2 ; Li-Li, Ren 3 ; Qing-Bin, Lu 4   VIAFID ORCID Logo  ; Ren Xiang 1 ; Cui-Hong, Zhang 1 ; Yi-Fei, Wang 1 ; Sheng-Hong, Lin 1 ; Xiao-Ai, Zhang 2 ; Li, Jun 5 ; Shi-Wen, Zhao 6 ; Zhi-Gang, Yi 7   VIAFID ORCID Logo  ; Chen, Xiao 8 ; Zuo-Sen, Yang 9 ; Meng Lei 10 ; Wang, Xin-Hua 10 ; Ying-Le, Liu 11 ; Wang, Xin 12 ; Ai-Li, Cui 13 ; Sheng-Jie, Lai 14 ; Jiang, Tao 2   VIAFID ORCID Logo  ; Yang, Yuan 2 ; Lu-Sha, Shi 1 ; Meng-Yang, Liu 2 ; Yu-Liang, Zhu 1 ; An-Ran, Zhang 2 ; Zhang Zhi-Jie 15 ; Yang, Yang 16   VIAFID ORCID Logo  ; Ward, Michael P 17   VIAFID ORCID Logo  ; Lu-Zhao, Feng 1 ; Huai-Qi, Jing 12 ; Liu-Yu, Huang 18 ; Wen-Bo, Xu 13 ; Chen, Yu 8 ; Jian-Guo, Wu 11 ; Zheng-Hong, Yuan 19 ; Meng-Feng, Li 5   VIAFID ORCID Logo  ; Wang, Yu 20 ; Li-Ping, Wang 1 ; Li-Qun, Fang 2   VIAFID ORCID Logo  ; Liu, Wei 2   VIAFID ORCID Logo  ; Hay, Simon I 21   VIAFID ORCID Logo  ; Gao, George F 20   VIAFID ORCID Logo  ; Wei-Zhong, Yang 20 ; Meng-Jie, Geng 1 ; Yu-Juan, Shen 22 ; Yan-Yan, Jiang 22 ; Sun, Qiao 23 ; Li-Peng, Hao 23 ; Chu-Chu, Ye 23 ; Wang, Yong 18 ; Wen-Yi, Zhang 18 ; Zhang, Qi 11 ; Wei-Yong, Liu 24 ; Zi-Yong, Sun 24 ; Fa-Xian, Zhan 25 ; Xiong, Ying 26 ; De-Shan, Yu 10 ; Chun-Xiang, Wang 27 ; Sheng-Cang, Zhao 27 ; Wen-Rui, Wang 28 ; Xia, Lei 28 ; Juan-Sheng, Li 29 ; Yu-Hong, Wang 30 ; Zhang, Yan 30 ; Jun-Peng, Yang 31 ; Yan-Bo, Wang 31 ; Fu-Cai, Quan 32 ; Zhi-Jun, Xiong 32 ; Li-Ping, Liang 33 ; Quan-E, Chang 33 ; Wang, Yun 34 ; Wang, Ping 34 ; Ling-Ling, Mao 35 ; Jia-Meng, Li 36 ; Li-Kun, Lv 36 ; Xu, Jun 37 ; Chang, Shu 37 ; Yan-Jun, Zhang 38 ; Cui Lun-Biao 39 ; Kui-Cheng, Zheng 40 ; Xing-Guo, Zhang 41 ; Zhang, Xi 42 ; Li-Hong, Tu 42 ; Wang, Wei 7 ; Xiao-Fang, Zhou 6 ; Xiao-Fang, Pei 43 ; Tian-Li, Zheng 43 ; Xiao-Ni, Zhong 44 ; Li, Qin 45 ; Ling, Hua 45 ; Ding-Ming, Wang 46 ; Shi-Jun, Li 46 ; Shu-Sen, He 47 ; Zhu, Xun 5 ; Chang-Wen, Ke 48 ; Xiao, Hong 48 ; Di Biao 49 ; Zhang, Ying 49 ; Hong-Wei, Zhou 50 ; Yu, Nan 50 ; Hong-Jian, Li 51 ; Yang, Fang 51 ; Fu-Xiang, Wang 52 ; Wang, Jun 52 

1  Chinese Center for Disease Control and Prevention, Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Beijing, China (GRID:grid.198530.6) (ISNI:0000 0000 8803 2373) 
2  Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China (GRID:grid.410740.6) (ISNI:0000 0004 1803 4911) 
3  Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Pathogen Biology, Beijing, China (GRID:grid.506261.6) (ISNI:0000 0001 0706 7839) 
4  Peking University, Department of Laboratorial Science and Technology, School of Public Health, Beijing, China (GRID:grid.11135.37) (ISNI:0000 0001 2256 9319) 
5  Sun Yat-sen University, Guangzhou, China (GRID:grid.12981.33) (ISNI:0000 0001 2360 039X) 
6  Yunnan Center for Disease Control and Prevention, Kunming, China (GRID:grid.508395.2) 
7  Shanghai Public Health Clinical Center, Shanghai, China (GRID:grid.470110.3) (ISNI:0000 0004 1770 0943) 
8  Zhejiang University, Hangzhou, China (GRID:grid.13402.34) (ISNI:0000 0004 1759 700X) 
9  Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China (GRID:grid.13402.34) 
10  Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China (GRID:grid.508057.f) 
11  Wuhan University, Wuhan, China (GRID:grid.49470.3e) (ISNI:0000 0001 2331 6153) 
12  National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China (GRID:grid.508381.7) (ISNI:0000 0004 0647 272X) 
13  Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Beijing, China (GRID:grid.198530.6) (ISNI:0000 0000 8803 2373) 
14  Chinese Center for Disease Control and Prevention, Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Beijing, China (GRID:grid.198530.6) (ISNI:0000 0000 8803 2373); University of Southampton, School of Geography and Environmental Science, Southampton, UK (GRID:grid.5491.9) (ISNI:0000 0004 1936 9297); Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Shanghai, China (GRID:grid.8547.e) (ISNI:0000 0001 0125 2443) 
15  School of Public Health, Fudan University, Department of Epidemiology and Health Statistics, Shanghai, China (GRID:grid.8547.e) (ISNI:0000 0001 0125 2443) 
16  University of Florida, Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, Gainesville, USA (GRID:grid.15276.37) (ISNI:0000 0004 1936 8091) 
17  The University of Sydney, Sydney School of Veterinary Science, Camden, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X) 
18  The Institute for Disease Prevention and Control of PLA, Beijing, China (GRID:grid.488137.1) (ISNI:0000 0001 2267 2324) 
19  Fudan University, Shanghai, China (GRID:grid.8547.e) (ISNI:0000 0001 0125 2443) 
20  Chinese Centre for Disease Control and Prevention, Beijing, China (GRID:grid.198530.6) (ISNI:0000 0000 8803 2373) 
21  Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA (GRID:grid.34477.33) (ISNI:0000000122986657); Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA (GRID:grid.34477.33) (ISNI:0000000122986657) 
22  Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, China (GRID:grid.198530.6) (ISNI:0000 0000 8803 2373) 
23  Center of Disease Prevention and Control in Pudong New Area of Shanghai, Shanghai, China (GRID:grid.198530.6) 
24  Huazhong University of Science and Technology, Tongji Hospital, Tongji Medical College, Wuhan, China (GRID:grid.33199.31) (ISNI:0000 0004 0368 7223) 
25  Hubei Provincial Center for Disease Control and Prevention, Wuhan, China (GRID:grid.508373.a) (ISNI:0000 0004 6055 4363) 
26  Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, China (GRID:grid.508373.a) 
27  Qinghai Provincial Center for Disease Control and Prevention, Xining, China (GRID:grid.508057.f) 
28  Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Hohhot, China (GRID:grid.508390.7) 
29  Lanzhou University, Lanzhou, China (GRID:grid.32566.34) (ISNI:0000 0000 8571 0482) 
30  Lanzhou Center for Disease Control and Prevention, Lanzhou, China (GRID:grid.32566.34) 
31  Baiyin Center for Disease Control and Prevention, Baiyin, China (GRID:grid.32566.34) 
32  Tianshui Center for Disease Control and Prevention, Tianshui, China (GRID:grid.32566.34) 
33  Wuwei Center for Disease Prevention and Control, Wuwei, China (GRID:grid.32566.34) 
34  Qingyang Center for Disease Control and Prevention, Qingyang, China (GRID:grid.32566.34) 
35  Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China (GRID:grid.32566.34) 
36  Tianjin Center for Disease Control and Prevention, Tianjin, China (GRID:grid.464467.3) 
37  Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China (GRID:grid.464467.3) 
38  Zhejiang Center for Disease Control and Prevention, Hangzhou, China (GRID:grid.433871.a) 
39  Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China (GRID:grid.410734.5) 
40  Fujian Center for Disease Control and Prevention, Fuzhou, China (GRID:grid.410734.5) 
41  Beilun People’s Hospital, Ningbo, China (GRID:grid.410734.5) 
42  Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China (GRID:grid.430328.e) 
43  Sichuan University, Chengdu, China (GRID:grid.13291.38) (ISNI:0000 0001 0807 1581) 
44  Chongqing Medical University, Chongqing, China (GRID:grid.203458.8) (ISNI:0000 0000 8653 0555) 
45  Chongqing Center for Disease Control and Prevention, Chongqing, China (GRID:grid.203458.8) 
46  Guizhou Center for Disease Control and Prevention, Guiyang, China (GRID:grid.496805.6) 
47  Sichuan Province Center for Disease Control and Prevention, Chengdu, China (GRID:grid.496805.6) 
48  Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (GRID:grid.508326.a) 
49  Guangzhou Municipal Center for Disease Control and Prevention, Guangzhou, China (GRID:grid.508326.a) 
50  Zhujiang Hospital, Southern Medical University, Guangzhou, China (GRID:grid.417404.2) (ISNI:0000 0004 1771 3058) 
51  Jinan University, Guangzhou, China (GRID:grid.258164.c) (ISNI:0000 0004 1790 3548) 
52  The Third People’s Hospital of Shenzhen, Shenzhen, China (GRID:grid.410741.7) 
Publication year
2021
Publication date
2021
Publisher
Nature Publishing Group
e-ISSN
20411723
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41467-021-25120-6
ProQuest document ID
2562363301
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.