Seesaw Effect Between COVID-19 and Influenza From 2020 to 2023 in World Health Organization Regions: Correlation Analysis.

BACKGROUND: Seasonal influenza activity showed a sharp decline in activity at the beginning of the emergence of COVID-19. Whether there is an epidemiological correlation between the dynamic of these 2 respiratory infectious diseases and their future trends needs to be explored. OBJECTIVE: We aimed to assess the correlation between COVID-19 and influenza activity and estimate later epidemiological trends. METHODS: We retrospectively described the dynamics of COVID-19 and influenza in 6 World Health Organization (WHO) regions from January 2020 to March 2023 and used the long short-term memory machine learning model to learn potential patterns in previously observed activity and predict trends for the following 16 weeks. Finally, we used Spearman correlation coefficients to assess the past and future epidemiological correlation between these 2 respiratory infectious diseases. RESULTS: With the emergence of the original strain of SARS-CoV-2 and other variants, influenza activity stayed below 10% for more than 1 year in the 6 WHO regions. Subsequently, it gradually rose as Delta activity dropped, but still peaked below Delta. During the Omicron pandemic and the following period, the activity of each disease increased as the other decreased, alternating in dominance more than once, with each alternation lasting for 3 to 4 months. Correlation analysis showed that COVID-19 and influenza activity presented a predominantly negative correlation, with coefficients above -0.3 in WHO regions, especially during the Omicron pandemic and the following estimated period. The diseases had a transient positive correlation in the European region of the WHO and the Western Pacific region of the WHO when multiple dominant strains created a mixed pandemic. CONCLUSIONS: Influenza activity and past seasonal epidemiological patterns were shaken by the COVID-19 pandemic. The activity of these diseases was moderately or greater than moderately inversely correlated, and they suppressed and competed with each other, showing a seesaw effect. In the postpandemic era, this seesaw trend may be more prominent, suggesting the possibility of using one disease as an early warning signal for the other when making future estimates and conducting optimized annual vaccine campaigns.

One-year temporal changes in long COVID prevalence and characteristics: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to explore the 1-year temporal change in prevalence, variety, and potential risk factors of long COVID symptoms, and to further predict the prognostic trends of long COVID. METHODS: We searched electronic databases for related studies published from January 2020 to February 2022, and conducted one group meta-analysis and locally weighted regression explore the monthly temporal change in the prevalence of each long COVID symptom in 1-year follow-up period. RESULTS: A total of 137 studies were included in meta-analysis, including 134,093 participants. The temporal change of any long COVID symptom showed a steep decrease initially (from 92% at acute phase to 55% at 1-month follow-up), followed by stabilization at approximately 50% during 1-year follow-up. Six months or more after the acute phase, the odds ratio (OR) of population characteristic factors increased, such as female gender (from 1.62 to 1.82), while the OR value of acute phase-related factors (severe/critical and hospitalization) decreased. As for specific symptoms, about two-thirds of the symptoms did not significantly reduce during the 1-year follow-up, and the neuropsychiatric symptoms showed a higher long-term prevalence (approximately 25%) and longer persistence than physical-symptoms. CONCLUSIONS: The temporal changes in the prevalence and characteristics speculate that long COVID may persist longer than expected. In particular, we should pay more attention to neuropsychiatric symptoms and other symptoms for which there is no significant downward trend in prevalence. The influence of acute phase-related factors for long COVID gradually decreases over time, while the influence of population characteristic-related gradually increases.

COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study.

BACKGROUND: Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy. OBJECTIVE: The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors. METHODS: A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy. RESULTS: Among the 1422 participants, 538 (37.8%) were not vaccinated against COVID-19. The COVID-19-recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95% CI 1.09-1.19). "Self-needs" was the main reason for patients to receive the COVID-19 vaccine, whereas "already have antibodies and do not need vaccination" was the main reason for patients to not receive the COVID-19 vaccine. CONCLUSIONS: Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19-recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19-recovered patients could foster trust and promote their uptake of vaccination.

Incidence, hospitalization, and mortality in children aged 5 years and younger with respiratory syncytial virus-related diseases: A systematic review and meta-analysis.

Objectives: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in young children. We aimed to analyze the factors affecting the estimation of RSV-related disease burden, and to provide evidence to help establish a surveillance system. Methods: We searched the English- and Chinese-language databases for articles published between January 1, 2010 and June 2, 2022. The quality of the included articles was assessed using the Agency for Healthcare Research and Quality scale. Random-effects models were used for data synthesis and subgroup analyses. This review was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42022372972). Results: We included 44 studies (149,321,171 participants), all of which were of medium or high quality. The pooled RSV-related disease incidence, hospitalization rate, in-hospital mortality, and overall mortality rates in children aged 5 years and younger were 9.0 per 100 children per year (95% confidence interval [CI]: 7.0-11.0), 1.7 per 100 children per year (95% CI: 1.3-2.1), 0.5 per 100 children per year (95% CI: 0.4-0.5), and 0.05 per 100 children per year (95% CI: 0.04-0.06), respectively. Age, economics, surveillance types, case definition, and data source were all recognized as influencing factors. Conclusions: A standardized and unified RSV surveillance system is required. Case definition and surveillance types should be fully considered for surveillance of different age groups.

Driving more WHO-recommended vaccines in the National Immunization Program: Issues and challenges in China.

WHO-recommended vaccines substantially prevent and control vaccine-preventable diseases (VPDs), but their inclusion differs among countries and regions. We reviewed the application for WHO-recommended vaccines in China and described the concerns and obstacles in driving the inclusion of more vaccines into China's NIP, including immunization strategies, financial barriers, vaccination services, and behavioral and social supply-side and demand-side factors. China has made significant efforts, however, they may not be sufficient until the inclusion of more WHO-recommended vaccines in the National Immunization Program (NIP), ensuring that the vaccination encompasses the whole life course of individuals, establishment of more trustworthy vaccination finance and procurement, increasing vaccine development, optimizing vaccine demand forecasts, improving the accessibility and equity of vaccination services, capturing the key points of behavioral and social drivers of vaccination on the demand side, and establishing holistic prevention and control from a public health perspective.

Perceived stigma among discharged patients of COVID-19 in Wuhan, China: A latent profile analysis.

Background: Perceived stigma has greatly influenced the life quality of the COVID-19 patients who recovered and were discharged (RD hereafter). It is essential to understand COVID-19 stigma of RD and its related risk factors. The current study aims to identify the characteristics of perceived COVID-19 stigma in RD using latent profile analysis (LPA), to explore its psycho-social influencing factors, and to determine the cut-off point of the stigma scale using receiver operating characteristic (ROC) analysis. Methods: A cross-sectional study was conducted among COVID-19 RD in 13 communities in Jianghan District, Wuhan City, Hubei Province, China from June 10 to July 25, 2021, enrolling total 1,297 participants. Data were collected on demographic characteristics, COVID-19 perceived stigma, post-traumatic stress disorder (PTSD), anxiety, depression, sleep disorder, fatigue, resilience, social support, and peace of mind. LPA was performed to identify different profiles of perceived COVID-19 stigma level. Univariate analysis and multinominal logistic regression analysis were conducted to explore the influencing factors in different profiles. ROC analyses was carried out to identify the cut-off value of perceived stigma. Results: Among the participants, three profiles of perceived stigma were identified: "low perceived COVID-19 stigma" (12.8%), "moderate perceived COVID-19 stigma" (51.1%), and "severe perceived COVID-19 stigma" (36.1%). Multinominal logistic regression analysis revealed that older age, living with other people, anxiety, and sleep disorder were positively associated with moderate perceived COVID-19 stigma, while higher educational level was negatively associated with moderate perceived COVID-19 stigma. Female, older age, living with other people, anxiety, and sleep disorder were positively associated with severe perceived COVID-19 stigma, while higher educational level, social support, and peace of mind were negatively associated with severe perceived COVID-19 stigma. ROC curve of the Short Version of COVID-19 Stigma Scale (CSS-S) for screening perceived COVID-19 stigma showed that the optimal cut-off value was ≥ 20. Conclusion: The study focuses on the issue of perceived COVID-19 stigma and its psycho-socio influencing factors. It provides evidence for implementing relevant psychological interventions to COVID-19 RD.

Mediating role of resilience in the relationship between COVID-19 related stigma and mental health among COVID-19 survivors: a cross-sectional study.

BACKGROUND: The global coronavirus disease 2019 (COVID-19) has caused many negative effects on physical and mental health of patients who have survived COVID-19. Apart from some long-lasting physical sequelae, those COVID-19 survivors are also suffering stigma and discrimination at different levels around the world. The current study aims to assess the role resilience played in stigma and mental disorders among COVID-19 survivors. METHODS: The cross-sectional study was carried out among former COVID-19 patients in Jianghan District (Wuhan, China) from June 10 to July 25, 2021. The demographic questions, the Impact of Events Scale-Revised, the Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Resilience Style Questionnaire and the Short Version of COVID-19 Stigma Scale of 12 items were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis and Structural Equation Modeling were used to make data description and analysis. RESULTS: A total of 1541 out of 1601 COVID-19 survivors (887 females and 654 males) were included in the analysis. Perceived stigma of those COVID-19 survivors correlates significantly with anxiety (r = 0.335, P < 0.001), depression (r = 0.325, P < 0.001) and post-traumatic stress disorder (PTSD) (r = 0.384, P < 0.001). It has a direct effect on COVID-19 survivors' anxiety (ß = 0.326, P < 0.001), depression (ß = 0.314, P < 0.001), PTSD (ß = 0.385, P < 0.001) and their resilience (ß = - 0.114, P < 0.01). Resilience partially mediated the association between perceived stigma and anxiety (ß = 0.020, P < 0.01), depression (ß = 0.020, P < 0.01), and PTSD (ß = 0.014, P < 0.01) among COVID-19 survivors. CONCLUSION: Stigma has a significant negative impact on mental health, while resilience plays a mediator role in the relationship between stigma and mental health among COVID-19 survivors. Based on our study, we suggested that when designing psychological interventions for COVID-19 survivors, consideration should be taken into account to reduce stigma and improve resilience.

Quantitative Analysis of the Effectiveness of Antigen- and Polymerase Chain Reaction-Based Combination Strategies for Containing COVID-19 Transmission in a Simulated Community

The number of coronavirus disease 2019 (COVID-19) cases continues to surge, overwhelming healthcare systems and causing excess mortality in many countries. Testing of infectious populations remains a key strategy to contain the COVID-19 outbreak, delay the exponential spread of the disease, and flatten the epidemic curve. Using the Omicron variant outbreak as a background, this study aimed to evaluate the effectiveness of testing strategies with different test combinations and frequencies, analyze the factors associated with testing effectiveness, and optimize testing strategies based on these influencing factors. We developed a stochastic, agent-based, discrete-time susceptible–latent–infectious–recovered model simulating a community to estimate the association between three levels of testing strategies and COVID-19 transmission. Antigen testing and its combination strategies were more efficient than polymerase chain reaction (PCR)-related strategies. Antigen testing also showed better performance in reducing the demand for hospital beds and intensive care unit beds. The delay in the turnaround time of test results had a more significant impact on the efficiency of the testing strategy compared to the detection limit of viral load and detection-related contacts. The main advantage of antigen testing strategies is the short turnaround time, which is also a critical factor to be optimized to improve PCR strategies. After modifying the turnaround time, the strategies with less frequent testing were comparable to daily testing. The choice of testing strategy requires consideration of containment goals, test efficacy, community prevalence, and economic factors. This study provides evidence for the selection and optimization of testing strategies in the post-pandemic era and provides guidance for optimizing healthcare resources.

Quantitative Analysis of the Effectiveness of Antigen- and Polymerase Chain Reaction-Based Combination Strategies for Containing COVID-19 Transmission in a Simulated Community.

The number of coronavirus disease 2019 (COVID-19) cases continues to surge, overwhelming healthcare systems and causing excess mortality in many countries. Testing of infectious populations remains a key strategy to contain the COVID-19 outbreak, delay the exponential spread of the disease, and flatten the epidemic curve. Using the Omicron variant outbreak as a background, this study aimed to evaluate the effectiveness of testing strategies with different test combinations and frequencies, analyze the factors associated with testing effectiveness, and optimize testing strategies based on these influencing factors. We developed a stochastic, agent-based, discrete-time susceptible-latent-infectious-recovered model simulating a community to estimate the association between three levels of testing strategies and COVID-19 transmission. Antigen testing and its combination strategies were more efficient than polymerase chain reaction (PCR)-related strategies. Antigen testing also showed better performance in reducing the demand for hospital beds and intensive care unit beds. The delay in the turnaround time of test results had a more significant impact on the efficiency of the testing strategy compared to the detection limit of viral load and detection-related contacts. The main advantage of antigen testing strategies is the short turnaround time, which is also a critical factor to be optimized to improve PCR strategies. After modifying the turnaround time, the strategies with less frequent testing were comparable to daily testing. The choice of testing strategy requires consideration of containment goals, test efficacy, community prevalence, and economic factors. This study provides evidence for the selection and optimization of testing strategies in the post-pandemic era and provides guidance for optimizing healthcare resources.

Willingness to accept herpes zoster vaccines and the influencing factors in China.

BACKGROUND: Herpes zoster increases the burden on the elderly in an aging society. Although an effective vaccine licensed by China Food and Drug Administration in 2019 was introduced into the market in June 2020, the willingness and influencing factors of herpes zoster vaccines in Chinese adults ≥ 50-years-old during coronavirus disease-2019 pandemic are yet to be elucidated. METHODS: An online questionnaire survey was conducted using a simple random sampling method in October 2021 for viewers of the broadcast program. A binary logistic regression and multiple response analysis were conducted for herpes zoster vaccine and vaccination willingness. Pareto's graphs were plotted to present the multiple-choice questions of influencing factors. RESULTS: A total of 3838 eligible participants were included in this study. Among them, 43.02% intended to be vaccinated, including 10.34% self-reported about receiving at least one shot of shingles vaccine, 30.22% declined, and 26.76% were hesitant. This population comprised a large proportion of middle-aged and older people (≥ 50-years-old) who have not experienced an episode of herpes zoster (54.98%) or are unaware of the virus (33.22%). The strongest determinants of vaccine hesitancy among older people were education background of Master's degree or above compared to senior high or equivalent and below, personal monthly income < 3000 RMB compared to 3000-5999 RMB, and living in a rural area. CONCLUSIONS: The willingness to get shingles vaccines can be improved further. Professional education and credible recommendation might prompt the elderly to improve their willingness and reassure them of the safety and efficacy of the vaccine. Also, accessibility and affordability should also be improved in the future.

Long-term outcomes in COVID-19 patients who recovered from the first wave of the pandemic.

This cross-sectional study evaluated the long-term health effects of coronavirus disease 2019 (COVID-19) in Jianghan District (Wuhan, China). The results showed that 61.4% of COVID-19 patients reported at least one symptom and 8.8% had depressive symptoms at the 17-month follow-up. The proportion of patients with chest radiographic abnormalities in Fangcang shelter hospitals and designated COVID-19 hospitals was 31.6% and 41.1%, respectively, and the proportion of patients with impaired pulmonary diffusion capacity in these hospitals was 52.8% and 60.9%, respectively. Female sex (odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.16-1.88), severe disease (OR = 1.46, 95% CI: 1.01-2.10) and a higher number of initial symptoms (OR = 1.31, 95% CI: 1.23-1.40) were associated with the development of sequelae symptoms at 17 months. This study involving community-dwelling COVID-19 adults may help determine the long-term effects of COVID-19 during the first pandemic wave. Nonetheless, larger follow-up studies are needed to characterize the post-COVID-19 condition.

Influencing factors of anxiety and depression of discharged COVID-19 patients in Wuhan, China.

OBJECTIVES: This study is intended to assess the prevalence of depression and anxiety in individuals who had recovered from COVID-19 and been discharged from hospital (RD hereafter) in Wuhan, China, and to explore the factors associated with these mental disorders. METHODS: Participants of this study were the RD who were infected at the beginning of the outbreak from 13 communities in Jianghan District of Wuhan City, Hubei Province, China by convenience sampling in mid-2021. The Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, the Resilience Style Questionnaire, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis, and logistic regression analysis were used to describe and analyze the data and to examine the factors associated with the mental health status of this population. RESULTS: In total, we recruited 1601 participants from 3059 COVID-19 patients, and 1541 participants completed the questionnaire survey, with a response rate of 96.25%. Finally, 1297 participants met the inclusion and exclusion criteria in this study, of whom 28.8% and 37.9% reported mild to severe levels of anxiety and depression symptoms. Perceived better mental health status during hospitalization, higher frequency of alcohol use per week, peace of mind, higher education level, and resilience were negatively associated with anxiety, while stigma and history of psychological or emotional counseling before infection was positively associated with anxiety. More severe clinical classification of COVID-19 and stigma (AOR = 1.057, P<0.001) were both positively associated with depression, while perceived better mental health status during hospitalization (AOR = 0.564, P<0.001), higher frequency of alcohol use per week (AOR = 0.462, P = 0.004), peace of mind (AOR = 0.857, P<0.001), and social support (AOR = 0.972, P = 0.034) were negatively associated with depression. CONCLUSIONS: Tailored interventions on reducing stigma, enhancing mindfulness and social support should be taken into account to alleviate anxiety and depression among RD.

Association between influenza vaccination and SARS-CoV-2 infection and its outcomes: systematic review and meta-analysis.

BACKGROUND: World Health Organization recommends that influenza vaccines should benefit as much of the population as possible, especially where resources are limited. Corona virus disease 2019 (COVID-19) has become one of the greatest threats to health systems worldwide. The present study aimed to extend the evidence of the association between influenza vaccination and COVID-19 to promote the former. METHODS: In this systematic review, four electronic databases, including the Cochrane Library, PubMed, Embase, and Web of Science, were searched for related studies published up to May 2022. All odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by meta-analysis. RESULTS: A total of 36 studies, encompassing 55,996,841 subjects, were included in this study. The meta-analysis for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection provided an OR of 0.80 (95% CI: 0.73-0.87). The statistically significant estimates for clinical outcomes were 0.83 (95% CI: 0.72-0.96) for intensive care unit admission, 0.69 (95% CI: 0.57-0.84) for ventilator support, and 0.69 (95% CI: 0.52-0.93) for fatal infection, while no effect seen in hospitalization with an OR of 0.87 (95% CI: 0.68-1.10). CONCLUSION: Influenza vaccination helps limit SARS-CoV-2 infection and severe outcomes, but further studies are needed. REGISTRATION: PROSPERO, CRD 42022333747.

Exploring meteorological impacts based on Köppen-Geiger climate classification after reviewing China's response to COVID-19.

More than 30 months into the novel coronavirus 2019 (COVID-19) pandemic, efforts to bring this prevalence under control have achieved tentative achievements in China. However, the continuing increase in confirmed cases worldwide and the novel variants imply a severe risk of imported viruses. High-intensity non-pharmaceutical interventions (NPIs) are the mainly used measures of China's early response to COVID-19, which enabled effective control in the first wave of the epidemic. However, their efficiency is relatively low across China at the current stage. Therefore, this study focuses on whether measurable meteorological variables be found through global data to learn more about COVID-19 and explore flexible controls. This study first examines the control measures, such as NPIs and vaccination, on COVID-19 transmission across 189 countries, especially in China. Subsequently, we estimate the association between meteorological factors and time-varying reproduction numbers based on the global data by meta-population epidemic model, eliminating the aforementioned anthropogenic factors. According to this study, we find that the basic reproduction number of COVID-19 transmission varied wildly among Köppen-Geiger climate classifications, which is of great significance for the flexible adjustment of China's control protocols. We obtain that in southeast China, Köppen-Geiger climate sub-classifications, Cwb, Cfa, and Cfb, are more likely to spread COVID-19. In August, the RSIM of Cwb climate subclassification is about three times that of Dwc in April, which implies that the intensity of control efforts in different sub-regions may differ three times under the same imported risk. However, BSk and BWk, the most widely distributed in northwest China, have smaller basic reproduction numbers than Cfa, distributed in southeast coastal areas. It indicates that northwest China's control intensity could be appropriately weaker than southeast China under the same prevention objectives.

Awareness, knowledge and attitude toward influenza vaccination in several population groups in China: A cross-sectional study.

Background: We aimed to comprehensively analyze awareness, knowledge and attitude toward influenza vaccine and the factors associated to vaccine acceptance among the young and middle-aged general population, healthcare workers, and health-related administrators in China. The factors influencing the promotion of influenza vaccination were also evaluated among healthcare workers and administrators. Methods: This is a multicenter, cross-sectional study. General population adults, healthcare workers (HCWs), and health administrators were enrolled in seven regions across China during the 2020-2021 flu season. Data were collected via an online questionnaire, which included information request as to awareness, knowledge, and attitude toward influenza vaccination. Statistical significance set at p-values < 0.05. Results: A total of 3,239 individuals were included in our analyses. There were gaps in consciousness to action, especially between awareness (87.1%) and knowledge (57.7%), and between willingness (57.3%) and vaccination (22.3%). The downward trends were similar in all three groups. HCW group and the health administrator group showed more positive propensity to accept influenza vaccines than the general population group. For the general population group, those with a lower educational level (lower than a bachelor's degree) were less likely to be vaccinated (aOR = 0.66, 95% CI: 0.45-0.96). For the HCW group, practitioners older than 45 years were more reluctant to be vaccinated than those under 25 years (aOR = 0.41, 95% CI: 0.19-0.86). For the health administrator group, personnel aged 26 years and above were less inclined to be vaccinated (aORs = 0.17-0.20). In all groups, people who had received influenza vaccines in the past 5 years (aOR = 1.72, 95% CI: 1.31-2.26 in general population group, 13.05, 95% CI: 7.71-22.10 in HCW group, and 19.30, 95% CI: 9.66-42.63 in health administrator group) were more likely to be vaccinated in future seasons. People who were not covered by the free program or those without awareness of the related programs were less likely to be vaccinated (aORs < 0.63). Most (70.8%) of HCWs showed intention to recommend the influenza vaccine. Clinical doctors, those who had flu shots themselves, and those who had more knowledge, were more like to make recommendations. Health administrators stated that insufficient budget resources and workforce, and low public awareness are main difficulties in the promotion of influenza vaccine. Conclusion: The influencing factors of the attitude toward influenza vaccination vary across populations. Governments need to carry out focused vaccination promotion programs, especially for healthcare workers, to improve the coverage of influenza vaccination.

Exploring meteorological impacts based on Köppen-Geiger climate classification after reviewing China's response to COVID-19

More than 30 months into the novel coronavirus 2019 (COVID-19) pandemic, efforts to bring this prevalence under control have achieved tentative achievements in China. However, the continuing increase in confirmed cases worldwide and the novel variants imply a severe risk of imported viruses. High-intensity non-pharmaceutical interventions (NPIs) are the mainly used measures of China's early response to COVID-19, which enabled effective control in the first wave of the epidemic. However, their efficiency is relatively low across China at the current stage. Therefore, this study focuses on whether measurable meteorological variables be found through global data to learn more about COVID-19 and explore flexible controls. This study first examines the control measures, such as NPIs and vaccination, on COVID-19 transmission across 189 countries, especially in China. Subsequently, we estimate the association between meteorological factors and time-varying reproduction numbers based on the global data by meta-population epidemic model, eliminating the aforementioned anthropogenic factors. According to this study, we find that the basic reproduction number of COVID-19 transmission varied wildly among Köppen-Geiger climate classifications, which is of great significance for the flexible adjustment of China's control protocols. We obtain that in southeast China, Köppen-Geiger climate sub-classifications, Cwb, Cfa, and Cfb, are more likely to spread COVID-19. In August, the RSIM of Cwb climate subclassification is about three times that of Dwc in April, which implies that the intensity of control efforts in different sub-regions may differ three times under the same imported risk. However, BSk and BWk, the most widely distributed in northwest China, have smaller basic reproduction numbers than Cfa, distributed in southeast coastal areas. It indicates that northwest China's control intensity could be appropriately weaker than southeast China under the same prevention objectives.

The association of mindfulness and psychological well-being among individuals who have recovered from COVID-19 in Jianghan District, Wuhan, China: A cross-sectional study.

BACKGROUND: In the global pandemic of the coronavirus disease 2019 (COVID-19), depression and post-traumatic stress disorder (PTSD) have commonly occurred among COVID-19 patients, whose experiences of infection and subsequent treatment might develop negative consequences on their mental well-being even after recovery. Despite the general recognition of efficacy of mindfulness-based interventions in reducing psychological distress among various populations, there were insufficient studies on the relationship between mindfulness and mental health among individuals who have recovered from COVID-19. OBJECTIVE: The current study aims to identify the prevalence of common mental health challenges among recovered COVID-19 patients in Jianghan District, Wuhan, China and to explore the potential mechanism through which mindfulness alleviate depression and PTSD. METHODS: A cross-sectional survey on mental health was conducted among a convenience sample of adults recovered from COVID-19 in Jianghan District, Wuhan, China. The study participants completed questionnaires under the assistance of trained investigators. The questionnaire included Chinese version of Five Facets of Mindfulness Questionnaire-Short Form (FFMQ-SF), Generalized Anxiety Disorder Questionnaire (GAD-7), Resilience Style Questionnaire (RSQ), Impact of Events Scale-Revised (IES-R), and Patient Health Questionnaire (PHQ-9) to measure mindfulness, anxiety, resilience, PTSD, and depression respectively. Structural equation modeling was used to explore the relationship between mindfulness and mental health outcomes of this population. RESULTS: 1541 respondents (654 [42.4 %] men and 887 [57.6 %] women) completed the questionnaire between June 10 and July 25, 2021, of whom 36.2 % and 27.1 % had mild and severe levels of depressive and anxiety symptoms respectively, and 15.2 % was indicated with PTSD. The average score of mindfulness of the study participants was (3.100 ± 0.387), and that of resilience was (3.560 ± 0.877). The structural equation model fit the data well, demonstrating that mindfulness was negatively associated with depressive symptoms directly (ß = -0.031, P = 0.021) or indirectly through the mediation effect of resilience (ß = -0.019, P = 0.009) and anxiety symptoms (ß = -0.208, P < 0.001), and was negatively associated with PTSD through the mediation effect of anxiety symptoms (ß = -0.142, P < 0.001). CONCLUSION: Individuals who have recovered from COVID-19 commonly experienced psychological distress. Mindfulness is associated with alleviation of depressive and PTSD symptoms directly or indirectly. Interventions based on mindfulness are suggested to improve the mental well-being of this population.

Humoral responses after inactivated COVID-19 vaccination in individuals with and without prior SARS-CoV-2 infection: A prospective cohort study.

We evaluated and compared humoral immune responses after inactivated coronavirus disease 2019 (COVID-19) vaccination among naïve individuals, asymptomatically infected individuals, and recovered patients with varying severity. In this multicenter, prospective cohort study, blood samples from 666 participants were collected before and after 2 doses of inactivated COVID-19 vaccination. Among 392 severe acute respiratory syndrome coronavirus 2-naïve individuals, the seroconversion rate increased significantly from 51.8% (median antispike protein pan-immunoglobulins [S-Igs] titer: 0.8 U/ml) after the first dose to 96% (median S-Igs titer: 79.5 U/ml) after the second dose. Thirty-two percent of naïve individuals had detectable neutralizing antibodies (NAbs) against the original strain but all of them lost neutralizing activity against the Omicron variant. In 274 individuals with natural infection, humoral immunity was significantly improved after a single vaccine dose, with median S-Igs titers of 596.7, 1176, 1086.5, and 1828 U/ml for asymptomatic infections, mild cases, moderate cases, and severe/critical cases, respectively. NAb titers also improved significantly. However, the second dose did not substantially increase antibody levels. Although a booster dose is needed for those without infection, our findings indicate that recovered patients should receive only a single dose of the vaccine, regardless of the clinical severity, until there is sufficient evidence to confirm the benefits of a second dose.

Seroprevalence and dynamics of anti-SARS-CoV-2 antibodies: a longitudinal study based on patients with underlying diseases in Wuhan.

BACKGROUND: Assessing the humoral immunity of patients with underlying diseases after being infected with SARS-CoV-2 is essential for adopting effective prevention and control strategies. The purpose of this study is to analyze the seroprevalence of people with underlying diseases and the dynamic change features of anti-SARS-CoV-2 antibodies. METHODS: We selected 100 communities in Wuhan using the probability-proportional-to-size sampling method. From these 100 communities, we randomly selected households according to a list provided by the local government. Individuals who have lived in Wuhan for at least 14 days since December 2019 and were ≥ 40 years old were included. From April 9-13, 2020, community staff invited all selected individuals to the community healthcare center in batches by going door-to-door or telephone. All participants completed a standardized electronic questionnaire simultaneously. Finally, 5 ml of venous blood was collected from all participants. Blood samples were tested for the presence of pan-immunoglobulins, IgM, IgA, and IgG antibodies against SARS-CoV-2 nucleocapsid protein and neutralising antibodies were assessed. During the period June 11-13, 2020 and October 9-December 5, 2020, all family members of a positive family and matched negative families were followed up twice. RESULTS: The seroprevalence of anti-SARS-CoV-2 antibodies in people with underlying diseases was 6.30% (95% CI [5.09-7.52]), and that of people without underlying diseases was 6.12% (95% CI [5.33-6.91]). A total of 313 people were positive for total antibodies at baseline, of which 97 had underlying disease. At the first follow-up, a total of 212 people were positive for total antibodies, of which 66 had underlying disease. At the second follow-up, a total of 238 people were positive for total antibodies, of which 68 had underlying disease. A total of 219 participants had three consecutive serum samples with positive total antibodies at baseline. The IgG titers decreased significantly with or without underlying diseases (P < 0.05) within the 9 months at least, while the neutralizing antibody titer remained stable. The titer of asymptomatic patients was lower than that of symptomatic patients (baseline, P = 0.032, second follow-up, P = 0.018) in the underlying diseases group. CONCLUSION: Our research focused on the serological changes of people with and without underlying diseases in a state of single natural infection. Regardless of the underlying diseases, the IgG titer decreased significantly over time, while there was no significant difference in the decline rate of IgG between with and without underlying diseases. Moreover, the neutralizing antibody titer remained relatively stable within the 9 months at least.

COVID-19 vaccination in Chinese children: a cross-sectional study on the cognition, psychological anxiety state and the willingness toward vaccination.

It is important to understand the cognition, willingness, and psychological anxiety state of Chinese guardians toward COVID-19 vaccination for their children to predict the future vaccination rate and to help the design of policies that aim to expand the population with immunity against COVID-19. This study collected data with a professional vaccination registration platform for children named "Xiao Dou Miao" in February 2021. The psychological anxiety state of the guardians was self-evaluated using the psychological anxiety scale. Factors that might influence the willingness of guardians to vaccinate their children were identified using logistic regression analysis. This study included 12,872 questionnaires with 70.9% of guardians showing willingness to vaccinate their children. Guardians who were male, aged 40-49 and from rural area were more willing to vaccinate their children. Fathers, guardians with higher education and income, whose children have a history of adverse vaccine reactions and allergies were less willing to vaccinate their children (p < .001). More than 80% of the guardians expressed a high level of trust for vaccine information released by official and health-related agencies. Guardians who were not vaccinated were more anxious than those who were vaccinated (χ2 = 27.99, p < .001). To protect children from COVID-19, vaccine coverage in children should be expanded rapidly and public awareness on vaccine safety and effectiveness should be improved.