epidemiological changes
Although the overall incidence of infectious diseases in China showed an upward trend from 2004 to 2018, fortunately, this trend stabilized after 2010. Overall mortality from infectious diseases has increased significantly, with HIV/AIDS replacing tuberculosis and rabies as the leading cause of death since 2008. Incidence rates for most vaccine-preventable diseases have remained low, with the exception of seasonal influenza, mumps, whooping cough, and rubella. Seasonal changes suggest that these diseases, particularly pertussis and seasonal influenza (whose incidence has increased rapidly over 15 years), should continue to be public health priorities. Among quarantine diseases, classic infectious diseases such as cholera and plague have almost disappeared. Except for dengue fever and scarlet fever, the incidence of insect-borne infectious diseases and bacterial infectious diseases is on a downward trend. Over the past 15 years, dengue fever and scarlet fever cases have increased 20.7-fold and 4.2-fold respectively.It is worth noting that through regional and inter-departmental cooperation, such as the joint malaria prevention and control plan of the five central and three southern provinces, the improvement of the malaria diagnostic reference laboratory system, and the implementation of the “1 “3-7” malaria surveillance and response strategy, China in 2021 It is certified as the 40th malaria-free country by the World Health Organization. However, the continued increase in imported cases is a current challenge (7,8,9). Contrary to the sharp decline in local cases, imported malaria cases have shown an explosive increase, accounting for increased from 16.2% in 2004 to 99.9% in 2017 (10). It is also worth noting that due to the wide distribution Anopheles sinensis In China, the possibility of a resurgence of malaria remains, especially ask. vivax malaria. Therefore, China still needs to remain vigilant against the resurgence of malaria. It is necessary to improve the monitoring and response system, focus on hot spots and high-risk groups, promptly detect imported cases, and report quickly to prevent the continued spread of the epidemic. In addition, epidemiological and entomological surveillance are necessary (10). Increases in the incidence of hepatitis C, syphilis, and especially HIV/AIDS indicate that sexually transmitted diseases have become an important new focus. Although the incidence of dysentery and typhoid/paratyphoid fever continues to decrease, the prevalence of other gastrointestinal or enterovirus-borne diseases remains relatively high. The geographical distribution of infectious diseases is obvious. In the western region, bacterial infections and zoonotic diseases occur more frequently and the health burden is excessive.
The incidence of hepatitis B and mumps dominates among vaccine-preventable diseases. Although the incidence of hepatitis B has declined since 2007, it has remained one of the most common infectious diseases in China for 15 years. With the implementation of the national immunization program and the improvement of health conditions, the incidence of hepatitis A and B among Chinese adolescents and children has decreased significantly, while the incidence of hepatitis A and B among Chinese adults has increased (11, 12). Mumps incidence began to decline in 2012 due to the Expanded Immunization Program, but has increased since 2015 and is now the most common infection among children aged 3–10 years (13). It is worth noting that diseases such as whooping cough and seasonal influenza have experienced an unexplained resurgence around the world in the past decade, raising concerns about vaccine effectiveness and coverage (14).
Tuberculosis is one of the top ten causes of death globally, and its death toll in China is second only to HIV/AIDS. From 2004 to 2018, the tuberculosis incidence rate dropped from 1st to 4th, and dropped significantly from 74.64 cases per 100,000 people to 59.27 cases (APC=-3.1%, ask< 0.001). The introduction of the National Tuberculosis Control Program in 1991 may be the main reason for the decline (15). Currently, drug-resistant tuberculosis is the main threat to the control and elimination of tuberculosis in my country (16). In 2017, approximately 14% of TB patients worldwide died from MDR-TB (17).
The incidence of scarlet fever is increasing worldwide. Since 2008, outbreaks have occurred in Vietnam (18 cases), Hong Kong (19 cases) and the United Kingdom (20 cases). The relaxation of family planning policies and the increase in susceptible populations have led to the resurgence of scarlet fever (21, 22). This prompted public health departments to establish school-based surveillance and emergency response systems. Similar measures can help prevent hand, foot and mouth disease, infectious diarrhea, and other susceptible childhood diseases, but their effectiveness is unclear (23). Scarlet fever mainly affects children aged 1 to 9 years old in the western and northern regions of my country, while tuberculosis mainly affects people aged 0 and 9 years and above in the southern region. The regional heterogeneity of incidence rates indicates that prevention and control of infectious diseases should be carried out in different regions according to their respective epidemiological characteristics.
During the study period, AIDS incidence and deaths continued to increase in China, especially among men, and infections among younger people were on the rise ( 11 ). High-risk sexual behaviors appear to be one of the reasons for the increased incidence of HIV/AIDS (24). As of the end of September 2018, there were 850,000 reported HIV infections and 262,000 deaths, with sexual behavior being the main route of transmission. In 2017, heterosexual transmission accounted for 69.6% of reported infections, and male homosexual transmission accounted for 25.5% (25). Inadequate sex education, the pursuit of casual sex, and social media hype appear to be factors in the increased incidence. Although the government has introduced response policies, the implementation of the policies still urgently requires a series of measures, including publicity activities, attention from the education department, sex education at home and school, and purification of the online environment (24).
Overall morbidity and mortality from infectious diseases in China have declined significantly in recent decades, thanks to public health interventions and mass vaccination programs. However, after the SARS outbreak in 2003, the overall incidence rate in China showed a gradual upward trend, which was confirmed in our study of 44 major infectious diseases (1). Fortunately, this trend changed after 2010. Several factors may explain this growing trend. The first is to improve the timeliness of reporting. Many emerging infectious diseases have an acute onset, high case fatality rate, difficulty in early detection and diagnosis, and lack of targeted prevention and control measures. Thanks to improvements in surveillance systems and medical diagnosis, more hidden cases have been discovered. In addition, developments in medical care, such as the widespread use of polymerase chain reaction (PCR), have made the diagnosis of diseases more convenient. In fact, when some fast, convenient, and highly specific technologies are developed and used for medical applications, we often see a significant increase in disease diagnosis (26). Second, large-scale population movements make prevention and control more difficult, making vaccination and other measures difficult to implement. Frequent international business contacts increase the risk of cross-border spread of infectious diseases, and unsafe sexual behavior increases the risk of sexually transmitted diseases. Third, the environment and existing production and lifestyle promote the spread of infectious diseases. The environmental sanitation situation in urban and rural areas in some areas is worrying, and traditional production and lifestyles have led to the constant occurrence of zoonotic diseases. Overall, my country’s prevention and control work currently faces dual pressures from traditional infectious diseases and emerging infectious diseases. Prominent problems include backward infrastructure, weak monitoring and testing capabilities, insufficient funds, and a serious shortage of professional talents. It is necessary to further strengthen the implementation of relevant provisions of the Infectious Disease Prevention and Control Law, lay a solid foundation, and make up for shortcomings. Pay more attention to the construction of talent teams and improvement of professional capabilities, and increase investment in equipment, facilities and other hardware.
health promotion advice
Over the past few decades, China has adopted targeted strategies to prevent the spread of infectious diseases. Some measures have proven effective and can provide insights and important lessons for other developing countries. First, improve the legal, regulatory and policy system. Disease prevention and control work should be legalized, institutionalized, standardized and normalized. Secondly, build a strict public health monitoring network. The national health security informatization project, the National Disease Control Information System, has been put into operation, and the world’s largest horizontal and vertical disease and health risk factor monitoring network has been built. The monitoring network for key endemic diseases and drinking water quality covers all towns and villages across the country, focusing on common diseases and diseases among students nearby. The health hazard monitoring and intervention system is increasingly improving. For example, improved sanitation and water supply facilities, improved blood collection safety, and large-scale vector control can contribute to successful prevention of infectious diseases.
Strength and Limitations
Several limitations of our study should be noted. First, the effectiveness of surveillance systems and diagnostic accuracy based on data from reporting systems may be overestimated. Second, incidence rates may be underestimated due to self-selection bias, as people with a particular infectious disease are more likely to avoid screening than those without the infection. In addition, potential biases may affect morbidity and mortality reporting due to differences in the level of medical care, hospital diagnostic levels, or inclusion/exclusion criteria across regions.