tetano
Editor, Senior Moderator
BMC Infect Dis
. 2025 Jul 18;25(1):925.
doi: 10.1186/s12879-025-11279-6. Impact of COVID-19 control measures on influenza positivity among patients with acute respiratory infections, 2018-2023: an interrupted time series analysis
Wei Chen[SUP] #[/SUP][SUP] 1 [/SUP], Huabin Wang[SUP] #[/SUP][SUP] 2 [/SUP], Xianlin Ten[SUP] 3 [/SUP], Miao Fu[SUP] 2 [/SUP], Meili Lin[SUP] 2 [/SUP], Xiaoping Xu[SUP] 2 [/SUP], Yongjun Ma[SUP] 2 [/SUP]
Affiliations
Background: After experiencing the global COVID-19 pandemic, whether there have been new changes in the epidemiological characteristics of influenza has become a topic of great concern. This study aims to investigate the impact of implementation and lifting of COVID-19 control measures on influenza positivity among patients with acute respiratory infections (ARI) from 2018 to 2023.
Methods: The data were collected from January 2018 to December 2023 in two designated sentinel hospitals in Jinhua. We performed an interrupted time series analysis (ITSA) using a beta regression model and a generalized additive model (GAM), adopting a two-model cross-validation strategy to assess the effect of two major interventions on influenza positivity: the COVID-19 control measures implemented in early 2020 and lifted at the end of 2022. We also analyzed influenza epidemiological characteristics and seasonality before, during, and after the pandemic.
Results: A total of 98,244 cases were included in this study, and the overall influenza positivity rate was 39.34%. Females and the 6-17-year age group had higher positivity rates. Before the pandemic, influenza primarily showed a winter peak pattern, whereas during the pandemic, the positivity rate declined significantly with no distinct peak. After the pandemic ended, an unusual dual-peak pattern emerged. The interrupted time series analysis revealed that, following the implementation of non-pharmaceutical interventions (NPIs) in early 2020, influenza positivity immediately decreased significantly in the beta regression model (β = -1.75, p = 0.003). After the lifting of measures in late 2022, a marginally lagged increasing trend was observed in the beta regression model (β = 0.14, p = 0.096) and a significant increasing trend was found in the GAM model (edf = 7.00, p < 0.001). Seasonal effects differed between the models: the beta regression model exhibited significant annual seasonal fluctuations (sin12 = 0.67, p < 0.001), while the GAM model did not exhibit a significant association independent of the time trend.
Conclusion: COVID-19 and its control measures substantially reduced influenza positivity rates; however, once these measures were lifted, influenza activity resurged, and its seasonal epidemic pattern changed. The intensity of influenza appeared to exceed pre-pandemic levels, underscoring the importance of NPIs in controlling respiratory infectious diseases. Strengthened surveillance and optimized strategies remain necessary to mitigate the threat of influenza in the post-pandemic era.
Keywords: Influenza epidemiology; Interrupted time series analysis; Non-pharmaceutical interventions; Post-pandemic era.
. 2025 Jul 18;25(1):925.
doi: 10.1186/s12879-025-11279-6. Impact of COVID-19 control measures on influenza positivity among patients with acute respiratory infections, 2018-2023: an interrupted time series analysis
Wei Chen[SUP] #[/SUP][SUP] 1 [/SUP], Huabin Wang[SUP] #[/SUP][SUP] 2 [/SUP], Xianlin Ten[SUP] 3 [/SUP], Miao Fu[SUP] 2 [/SUP], Meili Lin[SUP] 2 [/SUP], Xiaoping Xu[SUP] 2 [/SUP], Yongjun Ma[SUP] 2 [/SUP]
Affiliations
- PMID: 40682030
- PMCID: PMC12275363
- DOI: 10.1186/s12879-025-11279-6
Background: After experiencing the global COVID-19 pandemic, whether there have been new changes in the epidemiological characteristics of influenza has become a topic of great concern. This study aims to investigate the impact of implementation and lifting of COVID-19 control measures on influenza positivity among patients with acute respiratory infections (ARI) from 2018 to 2023.
Methods: The data were collected from January 2018 to December 2023 in two designated sentinel hospitals in Jinhua. We performed an interrupted time series analysis (ITSA) using a beta regression model and a generalized additive model (GAM), adopting a two-model cross-validation strategy to assess the effect of two major interventions on influenza positivity: the COVID-19 control measures implemented in early 2020 and lifted at the end of 2022. We also analyzed influenza epidemiological characteristics and seasonality before, during, and after the pandemic.
Results: A total of 98,244 cases were included in this study, and the overall influenza positivity rate was 39.34%. Females and the 6-17-year age group had higher positivity rates. Before the pandemic, influenza primarily showed a winter peak pattern, whereas during the pandemic, the positivity rate declined significantly with no distinct peak. After the pandemic ended, an unusual dual-peak pattern emerged. The interrupted time series analysis revealed that, following the implementation of non-pharmaceutical interventions (NPIs) in early 2020, influenza positivity immediately decreased significantly in the beta regression model (β = -1.75, p = 0.003). After the lifting of measures in late 2022, a marginally lagged increasing trend was observed in the beta regression model (β = 0.14, p = 0.096) and a significant increasing trend was found in the GAM model (edf = 7.00, p < 0.001). Seasonal effects differed between the models: the beta regression model exhibited significant annual seasonal fluctuations (sin12 = 0.67, p < 0.001), while the GAM model did not exhibit a significant association independent of the time trend.
Conclusion: COVID-19 and its control measures substantially reduced influenza positivity rates; however, once these measures were lifted, influenza activity resurged, and its seasonal epidemic pattern changed. The intensity of influenza appeared to exceed pre-pandemic levels, underscoring the importance of NPIs in controlling respiratory infectious diseases. Strengthened surveillance and optimized strategies remain necessary to mitigate the threat of influenza in the post-pandemic era.
Keywords: Influenza epidemiology; Interrupted time series analysis; Non-pharmaceutical interventions; Post-pandemic era.