tetano
Editor, Senior Moderator
Front Public Health
. 2026 Mar 17:14:1780983.
doi: 10.3389/fpubh.2026.1780983. eCollection 2026.
Epidemiological characteristics of imported influenza viruses at Shanghai entry-exit ports from 2017 to 2024
Xinyi Ma[SUP] 1 [/SUP], Ye Lu[SUP] 2 [/SUP], Shiwei Yu[SUP] 2 [/SUP], Zaijiong Yi[SUP] 2 [/SUP], Chunli Hu[SUP] 2 [/SUP], Liming Xue[SUP] 2 [/SUP], Zilong Zhang[SUP] 2 [/SUP], Zhengan Tian[SUP] 2 [/SUP], Shenwei Li[SUP] 1 2 [/SUP]
Affiliations
Objectives: To characterize long-term epidemiological patterns of imported influenza at Shanghai entry-exit ports from 2017 to 2024 and to compare changes before and after the COVID-19 pandemic, thereby providing a basis for optimizing cross-border surveillance strategies.
Methods: Surveillance data were collected from febrile inbound travelers identified by infrared temperature screening (≥37.3 °C) at major Shanghai ports during 2017-2019 and 2023-2024. Throat swabs were tested using real-time RT-qPCR for influenza A and B viruses. Positivity rates, seasonality, demographic characteristics, geographic origins, and viral type distributions were compared between pre- and post-COVID-19 periods using appropriate statistical tests.
Results: Among 33,118 febrile inbound travelers screened, 6,163 influenza cases were confirmed, yielding an overall positivity rate of 18.61%. No significant difference was observed between the pre- and post-COVID-19 periods (18.94% vs. 18.52%, p = 0.34), despite a marked increase in case numbers following travel resumption. Imported influenza exhibited a persistent bimodal seasonal pattern, with winter-spring peaks largely associated with Northern Hemisphere sources and summer peaks primarily driven by Southern Hemisphere imports. The geographic origin of cases shifted significantly, with the Western Pacific Region accounting for 66.2% of cases in 2024, while contributions from the Americas declined (p < 0.05). Adults aged 25-59 years increasingly predominated, and the proportion of travelers aged ≥60 years rose over time. Influenza A viruses remained dominant throughout the study period, accounting for 93.3% of cases in 2023, while influenza B showed a partial rebound in 2024.
Conclusion: Imported influenza at Shanghai entry-exit ports rebounded rapidly after COVID-19, with stable transmission intensity but notable shifts in geographic origin, age composition, and viral distribution. The persistence of bimodal seasonality and increasing concentration of cases from the Western Pacific Region highlight the need to transition from fixed seasonal screening toward dynamic, risk-based port surveillance with emphasis on high-traffic routes and adult travelers.
Keywords: epidemiological characteristics; imported influenza virus; lineage change; port surveillance; post-COVID-19 recovery.
. 2026 Mar 17:14:1780983.
doi: 10.3389/fpubh.2026.1780983. eCollection 2026.
Epidemiological characteristics of imported influenza viruses at Shanghai entry-exit ports from 2017 to 2024
Xinyi Ma[SUP] 1 [/SUP], Ye Lu[SUP] 2 [/SUP], Shiwei Yu[SUP] 2 [/SUP], Zaijiong Yi[SUP] 2 [/SUP], Chunli Hu[SUP] 2 [/SUP], Liming Xue[SUP] 2 [/SUP], Zilong Zhang[SUP] 2 [/SUP], Zhengan Tian[SUP] 2 [/SUP], Shenwei Li[SUP] 1 2 [/SUP]
Affiliations
- PMID: 41923765
- PMCID: PMC13036154
- DOI: 10.3389/fpubh.2026.1780983
Objectives: To characterize long-term epidemiological patterns of imported influenza at Shanghai entry-exit ports from 2017 to 2024 and to compare changes before and after the COVID-19 pandemic, thereby providing a basis for optimizing cross-border surveillance strategies.
Methods: Surveillance data were collected from febrile inbound travelers identified by infrared temperature screening (≥37.3 °C) at major Shanghai ports during 2017-2019 and 2023-2024. Throat swabs were tested using real-time RT-qPCR for influenza A and B viruses. Positivity rates, seasonality, demographic characteristics, geographic origins, and viral type distributions were compared between pre- and post-COVID-19 periods using appropriate statistical tests.
Results: Among 33,118 febrile inbound travelers screened, 6,163 influenza cases were confirmed, yielding an overall positivity rate of 18.61%. No significant difference was observed between the pre- and post-COVID-19 periods (18.94% vs. 18.52%, p = 0.34), despite a marked increase in case numbers following travel resumption. Imported influenza exhibited a persistent bimodal seasonal pattern, with winter-spring peaks largely associated with Northern Hemisphere sources and summer peaks primarily driven by Southern Hemisphere imports. The geographic origin of cases shifted significantly, with the Western Pacific Region accounting for 66.2% of cases in 2024, while contributions from the Americas declined (p < 0.05). Adults aged 25-59 years increasingly predominated, and the proportion of travelers aged ≥60 years rose over time. Influenza A viruses remained dominant throughout the study period, accounting for 93.3% of cases in 2023, while influenza B showed a partial rebound in 2024.
Conclusion: Imported influenza at Shanghai entry-exit ports rebounded rapidly after COVID-19, with stable transmission intensity but notable shifts in geographic origin, age composition, and viral distribution. The persistence of bimodal seasonality and increasing concentration of cases from the Western Pacific Region highlight the need to transition from fixed seasonal screening toward dynamic, risk-based port surveillance with emphasis on high-traffic routes and adult travelers.
Keywords: epidemiological characteristics; imported influenza virus; lineage change; port surveillance; post-COVID-19 recovery.