The Lancet Regional Health - Western Pacific

Aim: To assess temporal trends in incidence and mortality and project the future burden of five major gastrointestinal cancers in Jiangsu Province, China. Methods: Population-based cancer registry data from Jiangsu Province between 2010 and 2021 were used to analyze the burden of esophageal, gastric, colon, rectal, and liver cancers. Age-standardized incidence and mortality rates were calculated and compared by cancer type, sex, and urban-rural residence. Joinpoint regression was used to estimate annual percentage changes (APC) and average annual percentage changes (AAPC). The APC from the most recent Joinpoint segment was used to project incidence and mortality rates to 2030. Results: In 2021, gastric cancer had the highest age-standardized incidence and mortality among the five cancers. Incidence and mortality were consistently higher in males than in females and increased markedly after 50 years of age. From 2010 to 2021, age-standardized incidence and mortality declined for esophageal, gastric, and liver cancer, but increased for colon and rectal cancer. Colon cancer showed the steepest increase in both incidence and mortality. Rural areas experienced faster increases in colon and rectal cancer burden than urban areas. Projections to 2030 suggest continued declines in esophageal, gastric, and liver cancer, while colon cancer incidence and mortality are expected to rise further. Conclusion: Jiangsu Province is experiencing a transition in gastrointestinal cancer burden, with continued declines in esophageal, gastric, and liver cancers but an emerging and growing burden of colorectal cancer, especially colon cancer. Prevention strategies should focus on expanding colorectal cancer screening and early diagnosis, particularly in rural areas, while sustaining control of esophageal, gastric, and liver cancers.

Against accelerating global urbanization, we analyzed regional cancer health disparities in Japan using nationwide cancer incidence and mortality data. This cross-sectional ecological study included 1889 Japanese municipalities, categorized as urban, suburban, and rural. Using 2015 Census data, we estimated the normalized Areal Deprivation Index (normADI) and, using 2016-2018 cancer registry and vital statistics data, estimated standardized incidence and mortality ratios with a fully Bayesian hierarchical spatial model (FBSIR/FBSMR). We examined their association by urbanicity, analyzing 3,056,535 incident cases and 1,140,250 deaths. Higher normADI was associated with increased FBSMR for all cancers, particularly in urban areas (risk ratio 1.18 for males; 1.12 for females). Mortality of stomach, colorectal, lung, and liver cancers increased with increasing deprivation in urban areas, with stronger effects for male colorectal, liver, and lung cancers as urbanicity increased. Sensitivity analyses using alternative modeling formulations, both spatial and non-spatial, yielded broadly similar results. The greater impact of ADI on cancer mortality in urban areas underscores the need for poverty-focused cancer prevention strategies with growing urban populations.

AimThe dietary pattern in the downstream Yangtze River region of Eastern China has garnered widespread attention for its potential health benefits but lacks empirical evidence. This study aimed to identify and characterize this dietary pattern, develop a dietary pattern index, and evaluate its associations with adiposity, cardiometabolic diseases (CMDs), mortality, and gut microbiota. MethodsThis study used data from 8665 participants aged 18-80 years in the WELL-China cohort (2016-2019, Hangzhou, Eastern China) as the discovery cohort. K-means clustering identified an "Eastern Diet" (EastDiet) pattern and an adherence index based on the 12 food groups and flavor preferences were developed. Adiposity was measured using dual-energy X-ray absorptiometry. Incident CMDs and mortality were tracked through June 2024. Validation involved two external cohorts. ResultsThe EastDiet pattern was identified characterizing by high plant-based and aquatic food consumption, low refined grains and red meat intake, and a high preference for light-flavored. EastDiet index was favorably associated with lower adiposity. Comparing the highest to the lowest adherence tertiles, hazard ratios (HRs) for CMDs, type 2 diabetes, and cardiovascular diseases were 0.75 (95% CI: 0.62-0.90), 0.76 (0.60-0.96), and 0.71 (0.53-0.94), respectively. All-cause mortality was similarly reduced. Gut microbiota profiles associated with higher EastDiet adherence were linked to improved adiposity and reduced CMDs risk. Validation cohorts replicated these findings. ConclusionThis study identified and characterized the EastDiet pattern from Eastern China and determined its health benefits. Our findings highlighted the potential of the EastDiet as a healthful dietary pattern for Chinese population.

IntroductionHeat waves are increasingly frequent and linked to higher mortality risks in Hong Kong. However, estimates of total excess mortality associated with heat waves remain unavailable. This study quantifies excess deaths associated with heat waves in Hong Kong from 2014 to 2023. MethodsDaily age- and sex-specific mortality rates and population data were obtained from the Hong Kong Life Tables and Census and Statistics Department. Temperature data came from the Hong Kong Observatory, and relative risks were derived from local research. A Monte Carlo simulation was used to estimate heat-attributable deaths under different heat wave definitions, calculating total excess deaths and annualized death rates per 100,000 population. ResultsBetween 2014 and 2023, heat exposure resulted in an estimated 1,455 (95% CI: 1,098-1,812) to 3,238 (95% CI: 3,234-3,242) excess deaths. In 2023, annualized excess death rates ranged from 2.95 (95% CI: 2.41-3.50) to 5.09 (95% CI: 5.07-5.12) per 100,000 people. Males and individuals aged 65 or older were disproportionately affected. ConclusionOver the 10-year study period, 1,455 to 3,238 excess deaths in Hong Kong were attributed to extreme heat. Heat waves now rank among the top ten causes of death in Hong Kong, with mortality rates comparable to diabetes. These findings underscore the need for urgent public health interventions to mitigate the impact of extreme heat. Author SummaryO_ST_ABSWhy was this study done?C_ST_ABSO_LIHong Kong has experienced increasingly frequent and intense heatwaves in recent years, yet the health impacts of extreme heat have not been comprehensively quantified. C_LIO_LIThere is a lack of localized evidence on the mortality burden attributable to extreme heat, particularly across different demographic groups, to inform public health responses in subtropical urban settings. C_LI What did the researchers do and find?O_LIThis study modelled the association between extreme heat and all-cause mortality in Hong Kong from 2014 to 2023, applying multiple heatwave definitions. C_LIO_LIThe results estimate that over 1,400 excess deaths could have been preventable during the study period, with elevated vulnerability observed among males and individuals aged 65 years and older. C_LIO_LIExtreme heat was identified as an independent risk factor for mortality, with a health burden comparable to that of chronic diseases such as diabetes. C_LI What do these findings mean?O_LIThe findings underscore the urgent need for Hong Kong to develop and implement comprehensive Heat Action Plans (HAPs) to reduce excess mortality during extreme heat events. C_LIO_LIWith climate change expected to increase the frequency and severity of heatwaves--and an aging population--HAPs must prioritize the protection of high-risk groups. C_LIO_LIThese results provide critical evidence for public health planning, emphasizing the importance of tailored, data-driven interventions to enhance climate resilience in urban populations. C_LI

Background: Rectal cancer (RC) is traditionally grouped within colorectal cancer (CRC), despite growing evidence of distinct epidemiologic features. However, global comparative assessments of lifetime risks of RC relative to CRC remain limited. We aimed to estimate lifetime risks of developing and dying from RC and CRC worldwide and to examine geographic, socioeconomic, and temporal variations in the proportional contribution of RC within CRC. Methods: Age-specific incidence and mortality estimates for RC and CRC across 185 countries were obtained from GLOBOCAN 2022, together with population and all-cause mortality data from the United Nations. Lifetime risks of incidence (LRI) and mortality (LRM) were calculated using the adjusted-for-multiple-primaries (AMP) method by sex, country, region, and Human Development Index (HDI). The RC-to-CRC lifetime risk ratio quantified the proportional contribution of RC. Temporal trends were assessed in 42 countries using Cancer Incidence in Five Continents Plus (CI5plus) data and average annual percent change (AAPC). Results: In 2022, the global lifetime risk of developing RC was 1.61% and dying from RC was 0.95%, accounting for approximately 35% of the corresponding CRC lifetime burden (4.61% and 2.68%). Absolute lifetime risks of both RC and CRC increased with HDI. In contrast, the proportional contribution of RC varied markedly, peaking at 41%-43% in Central and South-Eastern Asia but falling below 20% in the Caribbean and Central America, and showed a negative association with HDI. The LRI/LRM ratio increased with socioeconomic development. Temporal analyses showed increasing LRI trends in 17 of 42 countries for CRC versus 9 for RC, while declines occurred in 14 countries for RC and 11 for CRC. Conclusions: RC constitutes a substantial yet epidemiologically distinct component of the global CRC burden. Its proportional contribution varies across regions and does not parallel absolute risk patterns, supporting the need for subsite-specific surveillance and prevention strategies.

Understanding the complex relationship between diet and cancer remains a critical challenge in global health research. Traditional studies have often examined isolated dietary components or focused on region-specific dietary patterns, limiting the ability to identify broader, population-level associations. In this study, a comprehensive global-scale analysis was conducted to investigate the associations between 16 dietary components and the incidence of total and subtype-specific cancers across 155 countries or regions. By integrating harmonized dietary exposure data and epidemiological records, and applying a network-based analytical framework, the study reveals both established and underexplored associations, such as the positive relationships between red meat and alcohol intake with overall cancer risk, and the inverse correlations between pulses and multiple cancer subtypes. Beyond individual associations, this study identifies interdependent dietary interaction patterns, highlighting synergistic and antagonistic effects that are often masked in conventional univariate models. The work also exemplifies how macro association (MA) networks can be constructed and dissected at a small scale to extract interpretable modules, offering a methodological foundation for broader, multi-domain MA network development. The resulting findings provide a translational basis for targeted dietary guidance and illustrate the potential of network-based approaches in advancing nutritional oncology research. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=153 SRC="FIGDIR/small/25337797v1_ufig1.gif" ALT="Figure 1"> View larger version (56K): org.highwire.dtl.DTLVardef@19104edorg.highwire.dtl.DTLVardef@1da801borg.highwire.dtl.DTLVardef@1075c5org.highwire.dtl.DTLVardef@a3e8f5_HPS_FORMAT_FIGEXP M_FIG C_FIG

ObjectivesTo estimate the global, regional, and national burden and trends of Guillain-Barre Syndrome (GBS), and to explore the impact of the COVID-19 pandemic and related public health measures on the GBS burden. DesignObservational study. Setting204 countries and territories. Data sourcesGlobal Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 and Our World in Data. Main outcome measuresAll-cause and COVID-19-specific age-standardized years lived with disability (YLD) rates and estimated annual percentage change (EAPC). ResultsGlobally, the burden of GBS significantly increased during the COVID-19 pandemic, age-standardized YLD rates were 0.86 (95% uncertainty interval (UI): 0.56 to 1.24) per 100,000 people in 2020, rising to 1.75 (95% UI: 1.12 to 2.54) per 100,000 people in 2021, reflecting an EAPC of 70.35% (95% UI: 38.73 to 109.06) from 2019 to 2021. Regionally, the highest age-standardized YLD rates in 2020 and 2021 were observed in the high-income Asia Pacific and central Latin America, respectively, while the lowest rates were found in East Asia for both years. Age-standardized YLD rates rose 3.7 times faster in countries with a low socio-demographic index (SDI) versus countries with a high SDI (103.21% per year (95% UI: 71.10 to 141.35%) vs 28.02% per year (11.46 to 47.03)). Males generally had higher YLD rates across all age groups, with the highest disparity in those aged 80 and above. During the first two years of the pandemic, the increase in YLD rates was more pronounced in females and younger populations aged 15-29 years. A statistically negative correlation was observed between COVID-19 vaccination coverage and the GBS burden, with increases in full vaccination coverage per 100 people leading to decreases in all-cause YLD rates by 0.0070 and COVID-19-specific YLD rates by 0.0128 per 100,000 people. ConclusionPredominantly driven by the surge of COVID-19 cases, the burden of GBS significantly increased during the first two years of the pandemic, especially in those countries with lower SDI levels. Greater increases in the GBS burden were observed in females and younger populations (15-29 years). Importantly, the benefits of vaccination outweighed the risks in controlling the post-COVID-19 GBS burden, although significant disparities in vaccination coverage existed between countries. These findings offer robust evidence facilitating public education and transparent communication on COVID-19 vaccination and highlight the urgency for targeted control measures to manage the burden of post-infection complications, such as GBS, during future COVID-19 waves or other potential pandemics. WHAT IS ALREADY KNOWN ON THIS TOPICGuillain-Barre syndrome (GBS) is an autoimmune disease, and respiratory and gastrointestinal infections are the major triggering factors. From 1990 to 2019, the burden of GBS was relatively low, with negligible changes observed in most countries and territories. The impact of the COVID-19 pandemic and vaccination on the burden of GBS remains not fully understood. WHAT THIS STUDY ADDSDuring the COVID-19 pandemic, the global age-standardized years lived with disability (YLD) related to GBS increased by 70.30% annually, and low socio-demographic index (SDI) regions experienced the most rapid GBS burden increment (103.21%). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was the primary factor contributing to the increased burden of GBS during the COVID-19 pandemic. Improving vaccination coverage was the most effective measure to reduce the post-COVID-19 burden of GBS, and each additional fully vaccinated person (per hundred people) decreased the COVID-19-specific age-standardized YLD of GBS by 0.0128 per 100,000 population.

IMPORTANCEMM was an incurable clonal plasma cell malignancy with substantial prevalence and incidence, which had resulted in a significant burden of disease. Our study aimed to evaluate the global, regional and national burden of MM by sex, age, and SDI from 1990 to 2021, along with associated risk factors and predicted temporal trends. OBJECTIVETo assess the global burden, epidemiological trends, and risk factors of MM and project its incidence rate by 2050. DesignThis is a systematic analysis of the global burden of MM from 1990 to 2021. SettingThe study primarily analyzed the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of MM from Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2021, by region, age, sex, and SDI. ParticipantsThe study builds on findings from the GBD 2021. ExposureMultiple myeloma. Main Outcomes and MeasuresThe Joinpoint regression was used to describe the trends. Two-sample Mendelian randomization (MR) analysis was conducted to identify the causal relationship between weight-related risk factors and MM. The Bayesian age-period-cohort (BAPC) model was used to predict the future trend. ResultsIn 2021, the age-standardized prevalence rate (ASPR) of MM was 4.65 (95% UI: 4.21 to 5.01) per 100,000 people, and the age-standardized mortality rate (ASMR) was 1.40 (95% UI: 1.24 to 1.52) per 100,000 people globally. The burden of MM was the highest in the high SDI region, with Monaco and Bahamas reporting the highest age-standardized incidence rate (ASIR), age-standardized DALY rate (ASDR), and ASMR in 2021. Simultaneously, ASRs peaked in the elderly population and were higher in males than in females. GBD 2021 reported high body mass index (BMI) as a risk factor for MM which was further confirmed by two-sample MR analysis. Additionally, BMI, waist circumference, obesity class 1, obesity class 2, overweight and hip circumference were also risk factors for MM. By 2050, the global incidence rate was predicted to decrease slightly but increase within the age group of 20-69. Conclusions and RelevanceThis study found that MM remained a significant public health issue, particularly in high SDI regions and among the elderly. A causal relationship exists between MM and body weight, indicating the need for targeted prevention and intervention strategies in high-risk regions and populations.

BackgroundIn September 2021, the U.S. Centers for Disease Control and Prevention (CDC) implemented the Traveler-based Genomic Surveillance (TGS) program, a surveillance system that leverages genomic sequencing of samples from international air travelers and aviation wastewater for early detection of infectious threats. MethodsDuring September 2021-August 2024, nasal samples were collected anonymously from volunteer international travelers arriving at eight U.S. airports. During February 2023- August 2024, aviation wastewater samples were collected from arriving flights. Nasal samples were pooled and sent to a laboratory for RT-PCR testing. Genomic sequencing was conducted for SARS-CoV-2 and respiratory, gastrointestinal (wastewater), and other pathogens of public health importance. FindingsNasal samples from 694,798 travelers were grouped into 67,308 pools and tested; 13,990 (20.8%) were positive for SARS-CoV-2. Over 80% (400/495) of airplane and 96{middle dot}6% (422/437) triturator (a wastewater collection point from multiple airplanes) samples were positive for SARS-CoV-2. Sequence results were made publicly available a median of 11 days (IQR 10- 13 days) after sample collection. Predominant SARS-CoV-2 variants changed over time. Positive tests for influenza virus and respiratory syncytial virus were high in December/January, and gastrointestinal viruses were detected in wastewater during all months. Monitoring was scaled in response to reported outbreaks of COVID-19 and Mycoplasma pneumoniae in China and clade 1 monkeypox virus in central Africa. InterpretationTraveler nasal and aviation wastewater sampling can provide critical early detection of infectious pathogens before widespread U.S. community transmission. The TGS program provides a model for integrated traveler-based genomic surveillance. FundingCDC Research in ContextO_ST_ABSEvidence before this projectC_ST_ABSWe searched PubMed for relevant studies published during December 1, 2020-August 31, 2024, using the terms "traveler surveillance", "wastewater monitoring", "SARS-CoV-2 genomics", and "airport-based surveillance", without language restrictions. Previous reports have shown the feasibility of using travelers as sentinel populations for disease surveillance. Modeling studies have proposed integrating genomic data into international travel surveillance systems to enhance early pathogen detection, and evidence from Australia, Canada, and the UK suggests such programs could be scalable and effective. Early pandemic-era wastewater surveillance, particularly aviation wastewater, demonstrated that air travel hubs can be used to monitor pathogen importation. Prior efforts largely focused on SARS-CoV-2, with limited integration of multi-pathogen surveillance or side-by-side comparisons of nasal and wastewater surveillance modalities. A limited number of public health reviews have examined the broader implications of airport-based surveillance, including novel methods like airplane wastewater testing. However, empirical data on sustained, large-scale implementation of these models especially outside of regulatory or mandatory testing frameworks have been sparse. Added value of this projectThis is the first real-world implementation and scale-up of an anonymized, multi-pathogen traveler-based surveillance system across multiple U.S. international airports. We developed a scalable framework that integrated nasal swab testing, airplane and airport wastewater sampling, with genomic sequencing into a unified pathogen surveillance platform. Unlike prior efforts which primarily focused on SARS-CoV-2, this program captured respiratory and gastrointestinal viruses simultaneously and tracked genomic variation in near-real time. The program transitioned from a pilot to a multi-modality national surveillance system in under four years, engaging nearly 700,000 international travelers, and nearly 1000 aviation wastewater samples. Our findings demonstrate the feasibility of rapidly adapting this infrastructure for emerging threats and underscores the importance of sentinel surveillance in addressing global sequencing blind spots. Implications of all the available evidenceThe successful scale-up and real-time application of the TGS program illustrates that traveler-based surveillance can serve as a critical global early warning tool. Data generated from this program have filled gaps in global pathogen tracking, informed public health responses to outbreaks, and demonstrated that surveillance of international travelers can be achieved without mandatory testing. The scalability, speed, and adaptability of the program offer a viable model for global replication, especially as routine surveillance capacities decline. Our findings suggest that integration of multi-modal, voluntary traveler surveillance including sequencing and wastewater-based epidemiology should be considered a core component of pandemic preparedness and response frameworks worldwide.

BackgroundWhile the incidence of inflammatory bowel disease (IBD) has stabilized in Western countries since 1990, it is experiencing an upward trend in newly industrializing countries. The Asian region encompasses a multitude of developing countries at varying stages of IBD progression. Therefore, comprehending the current epidemiological characteristics of the disease in this region becomes imperative, enabling countries and locales in Asia to proactively address the evolving IBD burden in the upcoming several decades. MethodsWe analyze variation trends in the burden of IBD in Asia from 1990 to 2019, employing data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), and provide projections for future changes in IBD incidence in Asia over the next 20 years. ResultsIn 2019, the number of incidence cases of IBD in Asia was 145,561 (95% UI 124,960-170,895), the total number of prevalence cases reached nearly 2 million (95% UI 1.71-2.32), and 13,957 (95% UI 11,898-16,021) patients died of IBD. Meanwhile, the total years lived with disability (YLDs) attributed to IBD amounted to 299,663 (95% UI 198,365-418,635), while the total disability-adjusted life-years (DALYs) rose to 649,760 (95% UI 530,395-783,181). The total number of incidence cases in Asia is projected to reach 179,756 in 2040, with an age-standardized incidence rate of 2.92 per 100,000 population. ConclusionsThe increase in the overall burden of IBD in Asia is primarily driven by population growth and aging, with both incidence and DALYs continuing to rise in most countries. It is imperative for each country to adapt its measures to local conditions, improve prevailing healthcare service patterns, and draw insights from the frontier countries to respond to the evolving epidemic characteristics of IBD.

Key FeaturesO_LIThe Northwest China Real-World and Population-based cohort is an ongoing prospective cohort with more than 25 million population, covering almost all residents across approximately 1.66 million square kilometers in northwest China C_LIO_LIThe cohort integrates data from various sources, including health profiles, examination records, electronic health records, mortality records, statistical yearbooks, and environmental datasets, covering comprehensive health-related factors such as demographics, lifestyle factors, family medical history, living conditions, enrollment in national public health services, physical examinations, blood assay tests, diagnostic assessments, disease outcomes, and cause-specific mortality. C_LIO_LIThis real-world dataset can evaluate clinical treatment effectiveness and prognosis, assess impact of health policy, and investigate the health effects of multiple risk factors . C_LIO_LIFrom January 2019 to December 2023, the cohort has included 13,634,481 participants, accumulating 47,050,707 person-years of follow-up, with 13,598,407 medical diagnosis records and 881,114 recorded deaths. C_LIO_LICohort data are available upon request. De-identified and anonymized data are stored on local servers and accessed through a data-sharing platform, enabling users to utilize the data without direct access to the raw information. A description of the proposed research can be sent to Yining Yang & Qian Di. C_LI

BackgroundThe global rise in obesity has led to an increasing burden of hepatocellular carcinoma (HCC) associated with high BMI, alongside viral hepatitis. This study evaluates the global burden of HCC due to high BMI, using the Global Burden of Disease (GBD) framework. MethodsData from GBD 2021 were analyzed to compare age-standardized death rates (ASDR) and disability-adjusted life-years (ASR) of DALYs for high BMI-associated HCC from 1990 to 2021. The Estimated Annual Percentage Change (EAPC) was calculated using linear regression, and the Nordpred model was applied for projections from 2022 to 2040. ResultsFrom 1990 to 2021, both ASDR and ASR of DALYs for high BMI-associated HCC showed significant increases. The burden was higher in males, older age groups (especially 80+), and regions with intermediate SDI values. Projections suggest that the global burden will continue rising until 2040 but at a slower rate, potentially stabilizing by then. ConclusionThe global burden of high BMI-associated HCC is increasing, especially in males and the elderly. Tailored prevention and treatment strategies are crucial to address regional trends and mitigate the growing disease burden.

IntroductionModeling when influenza epidemics typically occur can help countries optimize surveillance, time clinical and public health interventions, and reduce the burden of influenza. MethodsWe used influenza virus detections reported during 2011-2024 by 180 countries to the Global Influenza Surveillance and Response System, excluding COVID-19 pandemic impacted years (2020-2023). We analyzed data by calendar year (week 1-52) or shifted year (week 30-29) time windows, based on when most influenza detections occurred in each country. For countries with sufficient data, we computed generalized additive models (GAMs) of each countrys weekly influenza-positive tests to smooth and impute time series distributions. From these GAMs, we calculated each countrys normalized weekly influenza burden. Country-specific normalized time series were grouped using hierarchical k-means clustering reducing the Euclidean distance between time series within clusters. We calculated cluster-specific GAMs to estimate average seasonal timing. Countries without sufficient data were assigned to a cluster based on population-weighted latitudinal distance to a clusters mean latitude. ResultsWe identified five clusters, or epidemic zones, from 111 countries with sufficient data. The influenza burden in epidemic zones A and B was consistent with a northern hemisphere pattern, with most influenza detections occurring during October-April (A) and September-March (B), while epidemic zones D and E were characterized by southern hemisphere-like seasonal timing, with most influenza burden occurring during May-November. Epidemic zone C had most influenza burden occurring during September-March; most countries assigned to this cluster were in the tropics. ConclusionEpidemic zones may serve as a useful tool to strengthen and optimize influenza surveillance for global health decision-making (e.g., during vaccine strain composition discussions) and to guide country preparedness efforts for seasonal influenza epidemics, including the timing of enhanced surveillance, as well as the procurement and delivery of vaccines and antivirals. What is already known on this topicPrevious initiatives to provide a framework for describing global influenza patterns and to support national and regional prevention and control strategies have classified countries into influenza transmission zones, based primarily on geographic proximity. Many countries have improved their surveillance systems for respiratory viruses, providing an opportunity to re-assess patterns of influenza dynamics using analytic approaches focused on influenza detection data and maximizing global coverage. What this study addsOptimal clustering of influenza surveillance data from 111 countries and proximal assignment by latitude of countries lacking sufficient data grouped countries into five epidemic zones. How this study might affect research, practice or policyBy providing improved resolution on the temporal and geographical dynamics of influenza activity, this study offers an evidence base to aid national and global decision-making on enhanced surveillance strategies, vaccine strain selection, seasonal epidemic preparedness, and resource allocation, thereby strengthening efforts to prevent and control influenza worldwide. This data-driven framework for characterizing global patterns of influenza virus circulation can be leveraged to reexamine patterns as new data become available.

BackgroundMaternal hypertensive disorder (MHD) is a significant global health concern, affecting 5% to 10% of pregnant women. We aimed to systematically estimate the global, regional, and national burden and temporal trends of MHD from 1990 to 2021. MethodsData including the incidence, deaths, and disability-adjusted life years (DALYs), along with their age-standardized rates (ASRs) of MHD were obtained from the Global Burden of Disease Study 2021 and stratified by age and the sociodemographic index (SDI). An age-period cohort (APC) model was employed to clarify the impacts of age, period, and cohort. Decomposition and frontier analyses were used to assess the influencing factors and disease disparities, respectively. ResultsIn 2021, there were 18,050,085 (95% uncertainty interval [UI]: 15,356,124 to 21,519,204) incident cases, 38,147 (95% UI: 31,879 to 46,096) deaths and 2,469,637 (95% UI: 2,083,398 to 2,958,213) DALYs cases globally. The ASRs of incidence, deaths, and DALYs significantly decreased from 1990 to 2021. The burden of MHD was negatively correlated with SDI. Age-specific analysis revealed the highest burden in the 20-34 age group, with increasing trends in the 35-54 age group in high SDI regions. The APC model highlighted significant period and cohort effects, with improvements in high-middle SDI regions. ConclusionsAlthough the global burden of MHD has decreased, significant disparities persist, particularly in low SDI regions, requiring targeted interventions such as strengthening healthcare infrastructure and international cooperation to address the burden. In high SDI regions, managing lifestyle risk factors is also crucial in pregnant women with advanced age.

BackgroundRising concerns over waning immunity and reduction in neutralizing activity against variants of concern (VOCs) have contributed to deploying booster doses by different strategies to tackle the COVID-19 pandemic. Preliminary findings from Phase I and II have shown that V-01, a recombinant fusion protein vaccine against COVID-19, exhibited favorable safety and immunogenicity profiles in 1060 adult participants of both younger and senior age. Herein, we aimed to assess the immunogenicity and safety for a booster dose in participants previously primed with a two-dose 10g V-01 regimen (day 0, 21) from phase I trial, providing reassuring data for necessity and feasibility of a homogenous booster dose. MethodsWe conducted a single-arm, open-label trial at the Guangdong Provincial Center for Disease Control and Prevention (Gaozhou, China). Forty-three eligible participants who were previously primed 4-5 months earlier with two-dose 10g V-01 regimen from phase I trial received booster vaccination. We primarily assessed the immunogenicity post-booster vaccination, measured by RBD-binding antibodies using ELISA and neutralizing activity against wild-type SARS-CoV-2 and emerging variants of concern (VOCs) using neutralization assays. We secondarily assessed the safety and reactogenicity of the booster vaccination. ResultsThe third dose of V-01 exhibited significant boosting effects of humoral immune response in participants primed with two-dose 10g V-01 regimen regarding both wild-type SARS-CoV-2 and VOCs. We observed a 60.4-folds increase in neutralizing titres against SARS-CoV-2 of younger adults, with GMTs of 17 (95%CI: 12-23) prior to booster vaccination in comparison to 1017 (95%CI: 732-1413) at day 14 post booster vaccination; and a 53.6-folds increase in that of older adults, with GMTs of 14 (95%CI: 9-20) before booster vaccination in comparison to 729(95%CI: 397-1339) at day 14 post-booster vaccination. The neutralizing titres against SARS-CoV-2 Delta strain also demonstrated a sharp increase from the day of pre booster vaccination to day 14 post booster vaccination, with GMTs of 11 (95%CI:8-15) versus 383 (95%CI:277-531) in younger adults (35.4-folds increase), and 6.5(95%CI: 5-8) versus 300(95%CI:142-631) in older adults (46.0-folds increase), respectively. We also observed a considerable and consistent increase of pseudovirus neutralizing titres against emerging VOCs from day 28 post second vaccination to day 14 post booster vaccination, with GMTs of 206 (95%CI:163-259) versus 607 (95%CI: 478-771) for Alpha strain, 54 (95%CI:38-77) versus 329 (95%CI: 255-425) for Beta strain, 219 (95%CI:157-306) versus 647 (95%CI: 484-865) for Delta strain. Our preliminary findings indicate a homogenous booster dose of V-01 was safe and well-tolerated, with overall adverse reactions being absent or mild-to-moderate in severity, and no grade 3 or worse AEs were related to booster vaccination. ConclusionsA homogenous booster immunization in participants receiving a primary series of two-dose V-01 elicited a substantial humoral immune response against wild-type SARS-CoV-2 and emerging VOCs, along with a favorable safety and reactogenicity profile. Our study provided promising data for a homogenous prime-boost strategy using recombinant protein vaccine to tackle the ongoing pandemic, potentially providing broad protection against emerging VOCs and overcoming waning immunity.

BackgroundChina is a country with a very heavy burden of liver cancer disease, and understanding the epidemiological characteristics and trends of liver cancer in China can help develop targeted public health strategies. MethodsThe data were retrieved from the Global Burden of Disease (GBD) Study 2021. The age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) were used to estimate the trends in the incidence of and deaths from liver cancer by sex, region, country, and etiology between 1990 and 2021. Additionally, the attributable risk factors for deaths and disability adjusted life years (DALYs) were assessed. Finally, the Bayesian age-period-cohort model was used to predict the ASIR and ASDR of liver cancer from 2022 to 2035. ResultsIn China, from 1990 to 2021, the incidence of liver cancer increased from 96.43 thousand (95% UI: 80.97, 113.76) to 196.63 thousand (95% UI: 158.27, 243.55), and the number of deaths increased from 94.93 thousand (95% UI: 79.88, 111.52) to 172.06 thousand (95% UI: 139.62, 212.49). Moreover, the ASIR was 10.58 (95% UI: 8.94, 12.43) per 100,000 population in 1990 and 9.52 (95% UI: 7.72, 11.78) per 100,000 population in 2021, and the ASDR was 10.75 (95% UI: 9.12, 12.61) per 100,000 population in 1990 and 8.35 (95% UI: 6.80, 10.29) per 100,000 population in 2021. The peak number of liver cancer cases was concentrated in the population aged 65-69 years, but the incidence rate showed an obvious trend of increasing with age. Liver cancer due to hepatitis B was the most common type of cancer. Tobacco ranked first among risk factors, with rapidly increasing risk factors being drug use and high body mass index. In the next 15 years, the ASIR and ASDR will not decrease among people aged 60 and over. ConclusionWith the aging of the population in China, liver cancer remains an important disease burden. Therefore, measures should be taken to target risk factors and high-risk groups.

Before January 22, 2020, only one pediatric case of COVID-19 was reported in mainland China1,2. However, a retrospective surveillance study3 identified six children who had been hospitalized for COVID-19 in one of three central Wuhan hospitals between January 7th and January 15th. Given that Wuhan has over 395 other hospitals, there may have been far more severe pediatric cases than reported.

BackgroundWith economic development and lifestyle transitions, obesity prevalence has increased, and kidney cancer is significantly influenced by high body mass index (BMI), particularly among middle-aged males. This study analyzes the burden and trends of kidney cancer attributable to high BMI among middle-aged males in East and Southeast Asia, and projects future trends. MethodsBased on the Global Burden of Disease (GBD) 2021 study, we assessed the burden of kidney cancer attributable to high BMI among middle-aged males in East and Southeast Asia from 1990 to 2021, specifically comparing deaths, disability-adjusted life years (DALYs), age-standardized DALY rates (ASDR), and age-standardized mortality rates (ASMR). Furthermore, we analyzed spatiotemporal trends of kidney cancer at multiple levels. Additionally, the Bayesian Age-Period-Cohort (BAPC) model was employed to predict future burden trends through 2040. ResultsFrom 1990 to 2021, DALYs and deaths attributable to high BMI-induced kidney cancer among middle-aged males in East Asia increased dramatically by 530.73% and 517.28%, respectively, while corresponding increases in Southeast Asia reached 478.68% and 478.70%. These growth rates significantly exceeded the global average. In 2021, the ASDR in East Asia was 15.63 per 100,000, and the ASMR was 0.40 per 100,000. For Southeast Asia, the ASDR and ASMR were 9.40 per 100,000 and 0.25 per 100,000, respectively, highlighting substantial regional disparities. Both regions exhibited a positive correlation between Socio-demographic Index (SDI) and ASDR/ASMR, with a disproportionately higher burden observed in the 55-59-year age group. Projections indicate that the burden in these regions will continue to rise through 2040. ConclusionThe increasing burden of kidney cancer attributable to high BMI among middle-aged males in East and Southeast Asia has become a serious public health challenge. Developing and implementing targeted interventions to address the escalating obesity epidemic and its impact on kidney cancer have become critically urgent.

Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe first searched PubMed for articles published until November 2023 with the keywords "("HPV") AND ("Vaccine" or "Vaccination") AND ("Social Media")". We identified about 390 studies, most of which were discussions on the potentials or feasibility of social media in HPV vaccination advocacy or research, or manual coding-driven analyses on text (eg., tweets) about HPV vaccines emerged on social media platforms. When we added keyword "Machine Learning", we identified only 12 studies, with several of them using AI-driven approach, such as deep learning, machine learning, and natural language process, to analyze extensive text data about public perceptions of HPV vaccination and perform monitor on social media platforms, X (Twitter) and Reddit. All these studies are from English-language social media platforms in developed countries. No study to date has monitored public perceptions of HPV vaccination on social media platforms from the developing countries including China. Added value of this studyThis is the first deep-learning study monitoring public perceptions of HPV vaccination expressed on Chinese social media platforms (Weibo in our case), revealing key temporal and geographic variations. We found a sustained high level of positive attitude towards HPV vaccination and exposure to social norms facilitating HPV vaccination among Weibo users, with a lower national prevalence of negative attitude, perceived barriers to accepting vaccination, misinformation about HPV or HPV vaccination, indicating the achievement of relevant health communication. High prevalence practical barriers to HPV vaccination expressed on Weibo was associated with relatively insufficient of HPV vaccine accessibility in China, suggesting the health systems should prioritize on addressing issues about vaccine supply. Lower positive perception of HPV vaccination among male users, higher vaccine hesitancy towards 2-valent vaccine, and provincial-level spatial cluster of higher negative attitude towards HPV vaccination indicate that tailored strategies need to be formed targeting specific population, areas, and vaccine type. Our monitor practice on public perceptions of HPV vaccine from Weibo shows the feasibility of realizing public health surveillance potential of social media listening in Chinese context. Leveraging recent advances in deep learning, our approach could be a cost-effective supplement to existing surveillance techniques. Implications of all the available evidenceThis national surveillance study highlights the value of deep learning-driven social media listening as a convenient and effective approach for identifying emerging trends in public perceptions of HPV vaccination to inform interventions. As a supplement to existing public health surveillance techniques, it is particularly helpful to inform tailored and timely strategies in health communication and resource allocation at multiple levels. Key stakeholders and officials should maintain focus on health education highlighting the risks and consequences of HPV infections, and benefits and safety of all types of HPV vaccines; health systems should aim to resolve issues of vaccine accessibility. A proposed research area is the further development of deep learning models to monitor public perceptions of vaccines and analyzing misinformation about and barriers to HPV vaccination expressed on Chinese social media platforms. BackgroundHPV vaccination rate is low in China. Understanding the multidimensional barriers and impetuses perceived by individuals to vaccination is essential. We aim to assess the public perceptions, perceived barriers, and facilitators towards HPV vaccination expressed on Chinese social media platform Weibo. MethodsWe collected Weibo posts regarding HPV vaccines between 2018 to 2023. We annotated 6,600 posts manually according to behavior change theories, and subsequently fine-tuned deep learning models to annotate all posts collected. Based on the annotated results of deep learning models, temporal and geographic analyses were conducted for public attitudes towards HPV vaccination and its determinants. FindingsTotally 1,972,495 Weibo posts were identified as relevant to HPV vaccines. Deep learning models reached predictive accuracy of 0.78 to 0.96 in classifying posts. During 2018 to 2023, 1,314,510 (66.6%) posts were classified as positive attitudes. And 224,130 posts (11.4%) were classified as misinformation, 328,442 posts (16.7%) as perceived barriers to accepting vaccines, and 580,590 posts (29.4%) as practical barriers to vaccination. The prevalence of positive attitude increased from 15.8% in March 2018 to 79.1% in mid-2023 (p < 0.001), and misinformation declined from 36.6% in mid-2018 to 10.7% in mid-2023 (P < .001). Central regions exhibited higher prevalence of positive attitudes and social norms, whereas Shanghai, Beijing megacities and northeastern regions showed higher prevalence of negative attitudes and misinformation. Positive attitudes were significantly lower for 2-valent vaccines (65.7%), than 4-valent or 9-valent vaccines (79.6% and 74.1%). InterpretationSocial media listening represents a promising surveillance approach for monitoring public perceptions on health issues and can enable the development of health communication strategies.

ObjectivesTwo kinds of epidemic surveillance models are presented for containing the spread of SARS-CoV-2 variants so as to avert and stamp out a community-acquired outbreak (CAO) with non-pharmaceutical interventions (NPIs), tests, and vaccination. DesignThe surveillance of domestic cluster infections transmitted from imported cases with one-week time lag assessed by the Poisson model and the surveillance of whether, how and when NPIs and test contained the CAO with the SEIR model. SettingsBorder and Community of Taiwan. Main Outcome MeasurementsThe expected number and the upper bound of the 95% credible interval (CrI) of weekly covid-19 cases compared with the observed number for assessing the threshold of a CAO; effective reproductive number (Rt) and the effectiveness of NPIs for containing a CAO. ResultsFor the period of January-September 2020 when the wild type and the D614G period were prevailing, an increase in one imported case prior to one week would lead to 9.54% (95% CrI 6.44% to 12.59%) higher risk of domestic cluster infection that provides a one-week prior alert signal for more stringent NPIs and active testing locally. Accordingly, there was an absence of CAO until the Alpha VOC period of February 2021. However, given level one of NPI alert the risk of domestic cluster infections was gradually elevated to 14.14% (95% CrI 5.41% to 25.10%), leading to the Alpha VOC CAOs of six hotspots around mid-May 2021. It took two-and-half months for containing this CAO mainly with level three of NPI alert and rapid test and partially by the rolling out of vaccination. By applying the SEIR model, the Rt decreased from 4.0 at beginning to 0.7 on 31 July 2021 in parallel with the escalating NPIs from 30% to 90%. Containing a small outbreak of Delta VOC during this CAO period was also evaluated and demonstrated. After controlling the CAO, it again returned to imported-domestic transmission for Delta VOC from July until September 2021, giving an estimate of 10.16% (95% CrI: 7.01% to 13.59%) for the risk of several small cluster infections. However, there was an absence of CAO that resulted from the effectiveness of NPIs and tests, and the rapid expansion of vaccination. ConclusionsAverting and containing CAOs of SARS-CoV-2 variants are demonstrated by two kinds of epidemic surveillance models that have been applied to Taiwan scenario. These two models can be accommodated to monitor the epidemic of forthcoming emerging SARS-CoV-2 VOCs with various circumstances of vaccine coverage, NPIs, and tests in countries worldwide.