Spatial Heterogeneity and Influencing Factors of HFRS Epidemics in Rural and Urban Areas:A Study in Guanzhong Plain of Shaanxi Province,China

Objective The Guanzhong Plain of Shaanxi Province is a severely afflicted hemorrhagic fever with renal syndrome(HFRS)epidemic area,while HFRS prevalence has decreased in most epidemic areas in China.Little information is available regarding the leading fine-scale influencing factors in this highly HFRSconcentrated area and the roles of natural environmental and socioeconomic factors.To investigate this,two regions in the Guanzhong Plain,that is,the Chang’an District and Hu County,with similar geographical environments,different levels of economic development,and high epidemic prevalence,were chosen as representative areas of the HFRS epidemic.Methods Maximum entropy models were constructed based on HFRS cases and fine-scale influencing factors,including meteorological,natural environmental,and socioeconomic factors,from 2014 to 2016.Results More than 95% of the HFRS cases in the study area were located in the northern plains,which has an altitude of less than 800 m,with topography contributed 84.1% of the impact on the spatial differentiation of the HFRS epidemic.In the northern plains,precipitation and population density jointly affected the spatial differentiation of the HFRS epidemic,with contribution rates of 60.7% and 28.0%,respectively.By comparing the influencing factors of the northern plains of Chang’an District and Hu County,we found that precipitation and the normalized difference vegetation index(NDVI)dominated the HFRS epidemic in the relatively developed Chang’an District,while land-use type,temperature,precipitation and population density dominated the HFRS epidemic in the relatively undeveloped Hu County.Conclusion Topography was the primary key factor for HFRS prevalence in the Chang’an District and Hu County,and the spatial differentiation of HFRS was dominated by precipitation and population density in the northern plains.Compared with the influencing factors of the relatively developed Chang’an District,the developing Hu County was more affected by socioeconomic factors.When formulating targeted HFRS epidemic prevention and control strategies in the targeted areas,it is crucial to consider the local economic development state and combine natural environmental factors,including the meteorological environment and vegetation coverage.

3-to 24-month Follow-up on COVID-19 with Pulmonary Tuberculosis Survivors after Discharge:Results from a Prospective,Multicenter Study

Objective Coronavirus disease 2019(COVID-19)and tuberculosis(TB)are major public health and social issues worldwide.The long-term follow-up of COVID-19 with pulmonary TB(PTB)survivors after discharge is unclear.This study aimed to comprehensively describe clinical outcomes,including sequela and recurrence at 3,12,and 24 months after discharge,among COVID-19 with PTB survivors.Methods From January 22,2020 to May 6,2022,with a follow-up by August 26,2022,a prospective,multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China.Clinical outcomes,including sequela,recurrence of COVID-19,and PTB survivors,were collected via telephone and face-to-face interviews at 3,12,and 24 months after discharge.Results Thirty-two COVID-19 with PTB survivors were included.The median age was 52(45,59)years,and 23(71.9%)were men.Among them,nearly two-thirds(62.5%)of the survivors were moderate,three(9.4%)were severe,and more than half(59.4%)had at least one comorbidity(PTB excluded).The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6%at 3 months to 15.8%at 24 months,with anxiety having a higher proportion over a follow-up.Cough and amnesia recovered at the 12-month follow-up,while anxiety,fatigue,and trouble sleeping remained after 24months.Additionally,one(3.1%)case presented two recurrences of PTB and no re-positive COVID-19during the follow-up period.Conclusion The proportion of long symptoms in COVID-19 with PTB survivors decreased over time,while nearly one in six still experience persistent symptoms with a higher proportion of anxiety.The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.