Changing Seasonality of Infectious Diarrhea in the Sichuan Province of China from 2005 to 2017 Open Access

Abstract

Many diseases, including infectious diarrhea, follow both secular and seasonal trends in incidence. These trends are crucial to understand for public health interventions, allowing professionals to understand the effectiveness of current techniques and tailor new responses to fit the dynamics of disease. Little is known about the temporal pattern of infectious diarrhea in the Sichuan Province of China. We used data from the National Infectious Disease Reporting System (NIDRS) to evaluate the seasonal and secular trends of infectious diarrhea, categorized as Bacillary Dysentery (BD) and Other Infectious Diarrhea (OID) from 2005 to 2017. Individual case reports were aggregated by month and used to generate time series plots, perform wavelet analyses, and fit negative binomial regression models. The seasonality of OID in Sichuan shifted from a 12-month periodicity with a summer peak from 2005-2013 to a 6-month periodicity with summer and winter peaks from 2013-2017. For BD, there was a nearly 80% decrease in median monthly reported cases from 2,305 in 2005 to 484 in 2017. As the median monthly reported BD cases decreased, the seasonal pattern shifted towards the winter months, potentially indicating a baseline endemicity underneath the seasonality. Firstly, our study concluded that the incidence of BD has greatly reduced, possibly due to recent efforts to improve water and sanitation health in the region. Secondly, we hypothesize the shift in OID seasonality indicates that there has been a change in the makeup of pathogens within the disease categorization.

Table of Contents

Background………………………………………………………………………………..1

Methods……………………………………………………………………………………4

Results……………………………………………………………………………………..6

Discussion…………………………………………………………………………………8

References………………………………………………………………………………..13

Tables

    Table 1…………………………………………………………………………..........16

    Table 2………………………………………………………………………...……...17

Figures

    Figure 1……………………………………………………………………………….18

    Figure 2……………………………………………………………………………….19

    Figure 3a……………………………………………..……………………………….20

    Figure 3b……………………………………………..……………………………….21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Epidemiology China Seasonality Wavelet Analysis Infectious Diarrhea Disease Dynamics
Committee Chair / Thesis Advisor	Benjamin Lopman, PhD, Emory University
Committee Members	Xintong Li, PhD, Emory University

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