Epidemiology of scarlet fever in Victoria, Australia, 2007-2017.

In the last 10-15 years, there has been a global resurgence of scarlet fever, an infection historically associated with significant morbidity and mortality. It is unknown whether scarlet fever incidence has increased in Australia. We aimed to examine the incidence, predictors and severity of scarlet fever in the state of Victoria, Australia from 2007 to 2017, analyzing scarlet fever emergency department (ED) presentations, hospitalizations and deaths. Of the 1 578 scarlet fever cases during the study period, most occurred in children aged <10 years (1 344, 85%), in males (882, 56%), and during winter and spring months (918, 57%). There were no deaths with scarlet fever, however, 374 cases (24%) were admitted to hospital. The annual incidence of scarlet fever was stable during the study period (mean, 2.5; range, 1.9-3.1 cases per 100 000). Annual incidence was highest in children aged <5 years (19.3 per 100 000), and was 21% higher in males than females, adjusting for age and year (incidence rate ratio, 1.21, 95%CI 1.09-1.34). Whilst scarlet fever ED presentations and hospitalizations were stable in Victoria from 2007 to 2017, the recent identification of a Streptococcus pyogenes variant in Australia associated with epidemic scarlet fever overseas highlights the risk of future outbreaks.

Maud L. Menten: Pioneering Physician and Biochemist.

Dr. Maud Leanora Menten, an esteemed Canadian physician, biochemist, and organic chemist, conducted a wide range of valuable biochemistry research for over 40 years, making groundbreaking discoveries about cancer treatments, enzyme kinematics, anesthesia medicine, bacterial toxins, vitamin deficiencies, hematology, and histochemistry. Menten demonstrated intense perseverance and tenacity in her education, defying societal norms to not only become one of the first Canadian women to earn a research-intensive Doctor of Medicine (MD) degree, but to also be one of the first to earn a PhD. Although she was restricted in her work in Canada, she moved to the U.S. and published an estimated 100 research studies over her career. She is most well known for her work with Dr. Leonor Michaelis, with whom she created the Michaelis-Menten equation for the relationship between reaction rate and enzyme-substrate concentration. However, she conducted many other noteworthy research projects, such as using radium bromide for cancer treatment in rats and using electrophoretic mobility to study human hemoglobin, which allowed for a more advanced protein analysis. Her research in hemoglobin preceded the findings of Linus Pauling by several years, however, he is often the only one credited for this work. After her death, the extent and depth of her work was better understood and appreciated by many, and she was recognized by her alma mater, the University of Toronto, and her former workplace, the University of Pittsburgh. She was also posthumously inducted into the Canadian Medical Hall of Fame.

Epidemiological changes of scarlet fever before, during and after the COVID-19 pandemic in Chongqing, China: a 19-year surveillance and prediction study.

BACKGROUND: This study aimed to investigate the epidemiological changes in scarlet fever before, during and after the COVID-19 pandemic (2005-2023) and predict the incidence of the disease in 2024 and 2025 in Chongqing Municipality, Southwest China. METHODS: Descriptive analysis was used to summarize the characteristics of the scarlet fever epidemic. Spatial autocorrelation analysis was utilized to explore the distribution pattern of the disease, and the seasonal autoregressive integrated moving average (SARIMA) model was constructed to predict its incidence in 2024 and 2025. RESULTS: Between 2005 and 2023, 9,593 scarlet fever cases were reported in Chongqing, which resulted in an annual average incidence of 1.6694 per 100,000 people. Children aged 3-7 were the primary victims of this disease, with the highest average incidence found among children aged 6 (5.0002 per 100,000 people). Kindergarten children were the dominant infected population, accounting for as much as 54.32% of cases, followed by students (34.09%). The incidence for the male was 1.51 times greater than that for the female. The monthly distribution of the incidence showed a bimodal pattern, with one peak occurring between April and June and another in November or December. The spatial autocorrelation analysis revealed that scarlet fever cases were markedly clustered; the areas with higher incidence were mainly concentrated in Chongqing's urban areas and its adjacent districts, and gradually spreading to remote areas after 2020. The incidence of scarlet fever increased by 106.54% and 39.33% in the post-upsurge period (2015-2019) and the dynamic zero-COVID period (2020-2022), respectively, compared to the pre-upsurge period (2005-2014) (P < 0.001). During the dynamic zero-COVID period, the incidence of scarlet fever decreased by 68.61%, 25.66%, and 10.59% (P < 0.001) in 2020, 2021, and 2022, respectively, compared to the predicted incidence. In 2023, after the dynamic zero-COVID period, the reported cases decreased to 1.5168 per 100,000 people unexpectedly instead of increasing. The cases of scarlet fever are predicted to increase in 2024 (675 cases) and 2025 (705 cases). CONCLUSIONS: Children aged 3-7 years are the most affected population, particularly males, and kindergartens and primary schools serving as transmission hotspots. It is predicted that the high incidence of scarlet fever in Chongqing will persist in 2024 and 2025, and the outer districts (counties) beyond urban zone would bear the brunt of the impact. Therefore, imminent public health planning and resource allocation should be focused within those areas.

A rapid molecular detection tool for toxigenic M1UK Streptococcus pyogenes.

BACKGROUND: The gradual replacement of the Streptococcus pyogenes M1global genotype by a newly emergent M1UK variant is a global public health threat warranting increased surveillance. M1UK differs from progenitor M1global genotype by 27 single nucleotide polymorphisms (SNPs) and is characterised by increased speA superantigen expression in vitro. METHODS: An allele-specific real-time PCR assay was developed for the rapid detection of M1UK strains. The assay was used in combination with whole-genome sequencing to determine emm (sub)type distribution for 51 invasive (n = 9) and non-invasive (n = 42) S. pyogenes clinical isolates. RESULTS: Emm1 was the most prevalent S. pyogenes emm serotype (n = 11) in this set of clinical isolates, with M1UK being the dominant emm1 genotype (4/5 invasive, 3/6 non-invasive isolates). The assay accurately detected M1UK strains. Whole genome sequencing revealed continued presence of Australian M1UK sub-lineages associated with epidemic scarlet fever-causing S. pyogenes in Asia. CONCLUSIONS: Our study establishes a suitable target for detection of the toxigenic M1UK, and confirms the maintenance of M1UK strains in Queensland, Australia. This assay can be deployed in laboratories and provides a valuable, cost-effective tool to enhance surveillance of the expanding M1UK clone.

Invasive Streptococcal Infection in Children: An Italian Case Series.

Since October 2022, alerts have spread from several countries about the increase in invasive group A streptococcal (iGAS) and scarlet fever cases affecting young children. We aim to analyze the epidemiology of GAS infections in the last 12 years in our hospital and identify the clinical features of invasive cases observed in 2023. We conducted a retrospective study enrolling children and adolescents hospitalized at our pediatric clinic from January to December 2023 for a definitive diagnosis of iGAS infection. Clinical, laboratory, and imaging data were collected and analyzed. Comparing 2016 and 2023, we observed a similar number of GAS infections (65 vs. 60 cases). Five children with iGAS infection were hospitalized between March and April 2023. The median age was five years. At admission, all patients showed tachycardia disproportionate to their body temperature. Vomiting was a recurrent symptom (80%). Laboratory tests mostly showed lymphopenia, hyponatremia, and high inflammatory markers. The number of pediatric iGAS cases significantly increased in 2023. Clinical (pre-school-aged children with high fever, unexplained tachycardia, and vomiting) and laboratory parameters (high procalcitonin levels, hyponatremia, and lymphopenia) could help identify and suspect a potential iGAS infection.

Scaling features in high-concentrations PM2.5 evolution: the Ignored factor affecting scarlet fever incidence.

As an acute respiratory disease, scarlet fever has great harm to public health. Some evidence indicates that the time distribution pattern of heavy PM2.5 pollution occurrence may have an impact on health risks. This study aims to reveal the relation between scaling features in high-concentrations PM2.5 (HC-PM2.5) evolution and scarlet fever incidence (SFI). Based on the data of Hong Kong from 2012 to 2019, fractal box-counting dimension (D) is introduced to capture the scaling features of HC-PM2.5. It has been found that index D can quantify the time distribution of HC-PM2.5, and lower D values indicate more cluster distribution of HC-PM2.5. Moreover, scale-invariance in HC-PM2.5 at different time scales has been discovered, which indicates that HC-PM2.5 occurrence is not random but follows a typical power-law distribution. Next, the exposure-response relationship between SFI and scale-invariance in HC-PM2.5 is explored by Distributed lag non-linear model, in conjunction with meteorological factors. It has been discovered that scale-invariance in HC-PM2.5 has a nonlinear effect on SFI. Low and moderate D values of HC-PM2.5 are identified as risk factors for SFI at small time-scale. Moreover, relative risk shows a decreasing trend with the increase of exposure time. These results suggest that exposure to short-term clustered HC-PM2.5 makes individual more prone to SFI than exposure to long-term uniform HC-PM2.5. This means that individuals in slightly-polluted regions may face a greater risk of SFI, once the PM2.5 concentration keeps rising. In the future, it is expected that the relative risk of scarlet fever for a specific region can be estimated based on the quantitative analysis of scaling features in high-concentrations PM2.5 evolution.

Retrospective analysis of an outbreak of scarlet fever in United Arab Emirates.

Background: Scarlet fever is an infectious disease caused by Streptococcus pyogenes. However, there is limited data regarding the disease in the Arab World, including the United Arab Emirates. Objective: To analyse a scarlet fever outbreak in United Arab Emirates. Methods: This retrospective cross-sectional study included scarlet fever cases diagnosed at the Kanad Hospital, Al Ain, United Arab Emirates in 2022 and 2023. Data were retrieved from the hospital records and analysed using SPSS version 23.0. Chi-Square, Mann-Whitney, and Monte Carlo tests were applied. Results: Two hundred and twenty-two cases (13.5% in 2022 and 86.5% in 2023) were confirmed (P<0.001). Majority (67.1%) of the patients were aged 3-6 years, with a mean age of 4.56 ± 1.99 years. Rash, fever and sore throat were observed in 100%, 99.1%, and 82.0% of cases, respectively. The majority (85.1%) were managed as outpatients and 77.0% responded to oral penicillin. Patients' age was not significantly associated with nonresponse to penicillin and in-hospital admission. The outbreak had winter and summer peaks, with the highest incidence occurring during January and February 2023. Conclusion: This study serves as a valuable reference for other studies, which should include antimicrobial susceptibility testing and the prevailing genetic variance of Streptococcus pyogenes.

The association between the scarlet fever and meteorological factors, air pollutants and their interactions in children in northwest China.

Scarlet fever (SF) is an acute respiratory transmitted disease that primarily affects children. The influence of meteorological factors and air pollutants on SF in children has been proved, but the relevant evidence in Northwest China is still lacking. Based on the weekly reported cases of SF in children in Lanzhou, northwest China, from 2014 to 2018, we used geographical detectors, distributed lag nonlinear models (DLNM), and bivariate response models to explore the influence of meteorological factors and air pollutants with SF. It was found that ozone (O3), carbon monoxide (CO), sulfur dioxide (SO2), temperature, pressure, water vapor pressure and wind speed were significantly correlated with SF based on geographical detectors. With the median as reference, the influence of high temperature, low pressure and high pressure on SF has a risk effect (relative risk (RR) > 1), and under extreme conditions, the dangerous effect was still significant. High O3 had the strongest effect at a 6-week delay, with an RR of 5.43 (95%CI: 1.74,16.96). The risk effect of high SO2 was strongest in the week of exposure, and the maximum risk effect was 1.37 (95%CI: 1.08,1.73). The interactions showed synergistic effects between high temperatures and O3, high pressure and high SO2, high nitrogen dioxide (NO2) and high particulate matter with diameter of less than 10 µm (PM10), respectively. In conclusion, high temperature, pressure, high O3 and SO2 were the most important factors affecting the occurrence of SF in children, which will provide theoretical support for follow-up research and disease prevention policy formulation.

Infodemiology and infoveillance: framework for contagious exanthematous diseases, of childhood in Italy.

BACKGROUND: Contagious exanthematous diseases are becoming a major public health problem. The purpose of this study was to evaluate the potential epidemiological trend of four infectious exanthematous diseases in Italy through the searches on the internet. METHODS: We used the following Italian search term: 'Sesta malattia' (Sixth Disease, in English), 'Eritema Infettivo' (also knows 'Quinta malattia' in Italian; Fifth Disease in English), 'Quarta malattia' (Fourth Disease in English) and 'Scarlattina' (Scarlet fever in English). We overlapped Google Trends and Wikipedia data to perform a linear regression and correlation analysis. Statistical analyses were performed using the Spearman's rank correlation coefficient (rho). The study period is between July 2015 and December 2022. RESULTS: The diseases considered have a seasonal trend and the search peaks between GT and Wikipedia overlap. A temporal correlation was observed between GT and Wikipedia search trends. Google Trends Internet search data showed strong correlation with Wikipedia with a rho statistically significant for Fifth disease (rho = 0.78), Fourth disease (rho = 0.76) and Scarlet-fever (rho = 0.77), moderate correlation for Sixth disease (rho = 0.32). CONCLUSIONS: Infectious disease searches using Google and Wikipedia can be useful for public health surveillance and help policy makers implement prevention and information programs for the population, in addition to the fact that increases in searches could represent an early warning in the detection of outbreaks.

Detection of toxigenic M1UK lineage group A Streptococcus clones in Taiwan.

BACKGROUND: A new sublineage of emm1 group A Streptococcus (GAS), M1UK, has emerged in Europe, North America, and Australia. Notably, a significant portion of emm1 isolates in Asia, particularly in Hong Kong and mainland China, acquired scarlet fever-associated prophages following the 2011 Hong Kong scarlet fever outbreak. However, the presence of the M1UK sublineage has not yet been detected in Asia. METHODS: This study included 181 GAS isolates (2011-2021). The emm type of these isolates were determined, and 21 emm1 isolates from blood or pleural fluid (2011-2021) and 10 emm1 isolates from throat swabs (2016-2018) underwent analysis. The presence of the scarlet fever-associated prophages and the specific single nucleotide polymorphisms of the M1UK clone were determined by polymerase chain reaction and the genome sequencing. RESULTS: The M1UK lineage strains from throat swab and blood samples were identified. One of the M1UK strain in Taiwan carried the scarlet fever-associated prophage and therefore acquired the ssa, speC, and spd1 toxin repertoire. Nonetheless, the increase of M1UK was not observed until 2021, and there was a reduction in the diversity of emm types in 2020-2021, possibly due to the COVID-19 pandemic restriction policies in Taiwan. CONCLUSIONS: Our results suggested that the M1UK lineage clone has introduced in Taiwan. In Taiwan, the COVID-19 restrictions were officially released in March 2023; therefore, it would be crucial to continuously monitor the M1UK expansion and its related diseases in the post COVID-19 era.

Medical aspects of the tour by Martin Martin (c 1660-1719) of the Western and Northern Islands of Scotland, Circa 1695.

This review is based investigations on the Western Isles, Scotland, by Martin Martin, a notable Scottish Highlander, academic and medical doctor, of the 17th-18th century. His extensive observations of the geography and peoples of these Isles were recorded in his books, "On the Description of the Western Islands of Scotland Circa 1695" and "A Late Voyage to St Kilda". In these books and subsequent papers there were some noteworthy observations on the occurrence (and as he says non-occurrence) of "epidemical" diseases and conditions afflicting the peoples of The Isle of Skye and the Western Isles of Scotland in this period, and these are discussed in this review. Martin also gives details of a wide variety of remedies that were observed or reported by inhabitants around that time. Some of these remedies are interesting for their relevance to the period but others are of doubtful merit. These are reviewed here more for their significance in the understanding of the diseases and conditions of humans and even in some cases animals at that time. Introductions by Charles Withers and R.W. Munro, 11 and re-assessments of the contributions of Martin and colleagues of that time have given insight into the health and condition of peoples of the Western Isles of Scotland(the Occidental) (Martin 1695; Martin 1716).

Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence.

INTRODUCTION: Group A Streptococcus (GAS) causes mild diseases, and unfrequently invasive infections (iGAS). Following the December 2022 alert from the United Kingdom regarding the unusual increase in GAS and iGAS infections, we analyzed the incidence of GAS infections in 2018-2022 in our hospital. METHODS: We conducted a retrospective study of patients seen in a pediatric emergency department (ED) diagnosed with streptococcal pharyngitis and scarlet fever and patients admitted for iGAS during last 5 years. RESULTS: The incidence of GAS infections was 6.43 and 12.38/1000 ED visits in 2018 and 2019, respectively. During the COVID-19 pandemic the figures were 5.33 and 2.14/1000 ED visits in 2020 and 2021, respectively, and increased to 10.2/1000 ED visits in 2022. The differences observed were not statistically significant (p=0.352). CONCLUSIONS: In our series, as in other countries, GAS infections decreased during the COVID-19 pandemic, and mild and severe cases increased considerably in 2022, but did not reach similar levels to those detected in other countries.

Characterization of the RofA regulon in the pandemic M1global and emergent M1UK lineages of Streptococcus pyogenes.

The standalone regulator RofA is a positive regulator of the pilus locus in Streptococcus pyogenes. Found in only certain emm genotypes, RofA has been reported to regulate other virulence factors, although its role in the globally dominant emm1 S. pyogenes is unclear. Given the recent emergence of a new emm1 (M1UK) toxigenic lineage that is distinguished by three non-synonymous SNPs in rofA, we characterized the rofA regulon in six emm1 strains that are representative of the two contemporary major emm1 lineages (M1global and M1UK) using RNAseq analysis, and then determined the specific role of the M1UK-specific rofA SNPs. Deletion of rofA in three M1global strains led to altered expression of 14 genes, including six non-pilus locus genes. In M1UK strains, deletion of rofA led to altered expression of 16 genes, including nine genes that were unique to M1UK. Only the pilus locus genes were common to the RofA regulons of both lineages, while transcriptomic changes varied between strains even within the same lineage. Although introduction of the three SNPs into rofA did not impact gene expression in an M1global strain, reversal of three SNPs in an M1UK strain led to an unexpected number of transcriptomic changes that in part recapitulated transcriptomic changes seen when deleting RofA in the same strain. Computational analysis predicted that interactions with a key histidine residue in the PRD domain of RofA would differ between M1UK and M1global. RofA is a positive regulator of the pilus locus in all emm1 strains but effects on other genes are strain- and lineage-specific, with no clear, common DNA binding motif. The SNPs in rofA that characterize M1UK may impact regulation of RofA; whether they alter phosphorylation of the RofA PRD domain requires further investigation.

Stevens-Johnson syndrome: a case report of possible cephalosporin-induced cutaneous adverse reaction.

A severe medical condition known as Stevens-Johnson syndrome (SJS) is marked by a cutaneous and mucosal reaction from the use of specific medications. The prodromal illness is followed by severe mucocutaneous symptoms in this immune-mediated disease. We describe the clinical history of a 55-year-old Caucasian woman who was exposed to cephalosporins. In resource-constrained countries and hospitals where cutaneous biopsy is not readily available, it is not easy to diagnose Steven Johnson Syndrome. This is particularly true in countries where the incidence of infectious diseases such as scarlet fever and measles is high and the early symptoms of SJS can be mistaken for these conditions. We used the Naronjo scale to confirm the probable association of the drug with the syndrome. Physicians while writing prescriptions for their patients need to warn them of potential side effects and they should keep in mind conditions like Stevens-Johnson syndrome. This case report highlights the need for improved knowledge and understanding of SJS among healthcare practitioners in resource-limited communities where the prevalence of infectious diseases is high.

Regional differences in historical diphtheria and scarlet fever notification rates in The Netherlands, 1905-1925: a spatial-temporal analysis.

BACKGROUND: We describe how rates of two frequently occurring notifiable diseases-diphtheria and scarlet fever-varied between regions of The Netherlands in the early twentieth century, and identify potential factors underlying this variation. METHODS: Digitized weekly mandatory notification data for 1905-1925, municipality level, were aggregated into 27 'spatial units' defined by unique combinations of province and population density category (high: more than 4500; mid : 1250-4500; low: less than 1250 inhabitants km-2). Generalized additive regression models were fitted to estimate the associations between notification rates and population density, infant mortality rate and household income, while adjusting for temporal trends per spatial unit. RESULTS: Annual per capita notification rates for both diphtheria and scarlet fever tended to rise from the beginning of the period 1905-1925 until peaking around 1918/1919. Adjusted diphtheria notification rates were higher for high- and mid- compared with low-density municipalities (by 71.6 cases per 100 000, 95% confidence interval (CI) : 52.7-90.5; 39.0/100 k, 95% CI : 24.7-53.3, respectively). Scarlet fever showed similar associations with population density (35.7 cases per 100 000, 95% CI : 9.4-62.0; 21.4/100 k, 95% CI: 1.5-41.3). CONCLUSIONS: There was considerable spatial variation in notification rates for both diseases in early twentieth century Netherlands, which could partly be explained by factors capturing variation in living conditions and socio-economic circumstances. These findings aid understanding of contemporary respiratory infection transmission.

Streptococcus pyogenes Lineage ST62/emm87: The International Spread of This Potentially Invasive Lineage.

Streptococcus pyogenes is known to be associated with a variety of infections, from pharyngitis to necrotizing fasciitis (flesh-eating disease). S. pyogenes of the ST62/emm87 lineage is recognized as one of the most frequently isolated lineages of invasive infections caused by this bacterium, which may be involved in hospital outbreaks and cluster infections. Despite this, comparative genomic and phylogenomic studies have not yet been carried out for this lineage. Thus, its virulence and antimicrobial susceptibility profiles are mostly unknown, as are the genetic relationships and evolutionary traits involving this lineage. Previously, a strain of S. pyogenes ST62/emm87 (37-97) was characterized in our lab for its ability to generate antibiotic-persistent cells, and therapeutic failure in severe invasive infections caused by this bacterial species is well-reported in the scientific literature. In this work, we analyzed genomic and phylogenomic characteristics and evaluated the virulence and resistance profiles of ST62/emm87 S. pyogenes from Brazil and international sources. Here we show that strains that form this lineage (ST62/emm87) are internationally spread, involved in invasive outbreaks, and share important virulence profiles with the most common emm types of S. pyogenes, such as emm1, emm3, emm12, and emm69, which are associated with most invasive infections caused by this bacterial species in the USA and Europe. Accordingly, the continued increase of ST62/emm87 in severe S. pyogenes diseases should not be underestimated.

Early Warning and Prediction of Scarlet Fever in China Using the Baidu Search Index and Autoregressive Integrated Moving Average With Explanatory Variable (ARIMAX) Model: Time Series Analysis.

BACKGROUND: Internet-derived data and the autoregressive integrated moving average (ARIMA) and ARIMA with explanatory variable (ARIMAX) models are extensively used for infectious disease surveillance. However, the effectiveness of the Baidu search index (BSI) in predicting the incidence of scarlet fever remains uncertain. OBJECTIVE: Our objective was to investigate whether a low-cost BSI monitoring system could potentially function as a valuable complement to traditional scarlet fever surveillance in China. METHODS: ARIMA and ARIMAX models were developed to predict the incidence of scarlet fever in China using data from the National Health Commission of the People's Republic of China between January 2011 and August 2022. The procedures included establishing a keyword database, keyword selection and filtering through Spearman rank correlation and cross-correlation analyses, construction of the scarlet fever comprehensive search index (CSI), modeling with the training sets, predicting with the testing sets, and comparing the prediction performances. RESULTS: The average monthly incidence of scarlet fever was 4462.17 (SD 3011.75) cases, and annual incidence exhibited an upward trend until 2019. The keyword database contained 52 keywords, but only 6 highly relevant ones were selected for modeling. A high Spearman rank correlation was observed between the scarlet fever reported cases and the scarlet fever CSI (rs=0.881). We developed the ARIMA(4,0,0)(0,1,2)(12) model, and the ARIMA(4,0,0)(0,1,2)(12) + CSI (Lag=0) and ARIMAX(1,0,2)(2,0,0)(12) models were combined with the BSI. The 3 models had a good fit and passed the residuals Ljung-Box test. The ARIMA(4,0,0)(0,1,2)(12), ARIMA(4,0,0)(0,1,2)(12) + CSI (Lag=0), and ARIMAX(1,0,2)(2,0,0)(12) models demonstrated favorable predictive capabilities, with mean absolute errors of 1692.16 (95% CI 584.88-2799.44), 1067.89 (95% CI 402.02-1733.76), and 639.75 (95% CI 188.12-1091.38), respectively; root mean squared errors of 2036.92 (95% CI 929.64-3144.20), 1224.92 (95% CI 559.04-1890.79), and 830.80 (95% CI 379.17-1282.43), respectively; and mean absolute percentage errors of 4.33% (95% CI 0.54%-8.13%), 3.36% (95% CI -0.24% to 6.96%), and 2.16% (95% CI -0.69% to 5.00%), respectively. The ARIMAX models outperformed the ARIMA models and had better prediction performances with smaller values. CONCLUSIONS: This study demonstrated that the BSI can be used for the early warning and prediction of scarlet fever, serving as a valuable supplement to traditional surveillance systems.

Patterns in the Incidence of Scarlet Fever Among Children Aged 0-9 Years - China, 2010-2019.

Introduction: This study investigates the patterns of scarlet fever among Chinese children aged 0-9 years from 2010 to 2019. The objective is to provide insights that may inform potential adjustments to China's current prevention and control tactics for this illness. Methods: The present study utilized data on the occurrence of scarlet fever in children from 2010 to 2019, sourced from the National Notifiable Disease Reporting System database, managed by the Chinese Center for Disease Control and Prevention. This research implemented SAS9.4 software to construct trajectory models representing the temporal incidence of scarlet fever, accounting for key variables such as sex, geographic region, urban versus rural dwellings, and various age brackets. Results: From 2010 to 2019, a total of 554,695 scarlet fever cases were reported among children aged 0-9 years in the 31 mainland Chinese provincial-level administrative divisions, signifying a rate of 35.36 per 100,000 individuals. An inconsistent yet generally rising trend was observed, evidenced by a 3.17-fold increase in reported cases and a 3.02-fold escalation in incidence rate over this period. Examination of these trends revealed three distinctive developmental patterns for both males and females, with the lowest prevalence in the first trajectory and the highest in the third. The incidence was consistently higher among males than females in all trajectories. The urban and northern regions displayed equal or greater trajectory rates than their rural and southern counterparts, respectively. In terms of age groups, the lowest incidence was observed in the 0-1-year age group, while the highest was recorded in the 4-5 and 6-7-year age groups. Conclusions: Between 2010 and 2019, there was a marked increase in the incidence of scarlet fever among children in China. The disease predominantly impacts urban-dwelling children, ranging from 4 to 7 years old, in the northern regions of the country. The incidence is reported to be higher among boys compared to girls.

Epidemiological characteristics of common respiratory infectious diseases in children before and during the COVID-19 epidemic.

Background: Since the outbreak of coronavirus disease 2019 (COVID-19), public's awareness of infection prevention and control has increased overall, and various prevention and control measures have been adopted. These measures may also have a certain impact on the occurrence of other infectious diseases. Therefore, we collected information on children with several respiratory infectious diseases in Jinan Children's Hospital in China from 2016 to 2022 and analyzed their changes. Method: We collected data on age, sex and number of cases of pertussis, measles, scarlet fever, pulmonary tuberculosis, mumps and influenza, which were diagnosed by clinical and laboratory criteria, from 1 January 2016 to 31 December 2022 in Jinan Children's Hospital in Jinan, Shandong Province, China. Data on the number of people affected by these diseases in China from the Chinese Center for Disease Control and Prevention were compared. Then, we processed the data by using WPS Excel 2019 and SPSS. Results: A total of 12,225 cases were included in this study in Jinan Children's Hospital, which consisted of 3,688 cases of pertussis (2,200 cases before COVID-19 and 1,488 during COVID-19), 680 cases of measles (650 cases before COVID-19 and 30 during COVID-19), 4,688 cases of scarlet fever (4,001 cases before COVID-19 and 687 during COVID-19), 114 cases of tuberculosis (86 cases before COVID-19 and 28 during COVID-19), 449 cases of mumps (340 cases before COVID-19 and 109 during COVID-19) and 2,606 cases of influenza (1,051 cases before COVID-19 and 1,555 during COVID-19). The numbers of children in the hospital with pertussis, measles, scarlet fever, mumps and influenza decreased substantially during COVID-19 in 2020-2022 compared with numbers in 2016-2019, while numbers of patients in China with all six respiratory infectious diseases, including pulmonary tuberculosis, declined during the pandemic. A rebound of pertussis, scarlet fever and influenza was observed in 2021 and 2022. Conclusions: The study found that viral pathogens such as those causing measles, mumps and influenza all decreased during the pandemic, after which influenza rebounded. Infection diseases caused by bacteria such as scarlet fever and pertussis also decreased during COVID-19, and then a rebound occurred. However, tuberculosis stayed relatively constant.

Epidemiological characteristics and spatiotemporal clustering of scarlet fever in Liaoning Province, China, 2010-2019.

BACKGROUND: To explore the epidemiological characteristics and spatiotemporal distribution of scarlet fever in Liaoning Province, which could provide scientific evidence for the formulation and improvement of prevention and control strategies and measures. METHODS: Data on scarlet fever cases and population were obtained from the China Information System for Disease Control and Prevention in Liaoning Province between 2010 and 2019. We examined the spatial and spatiotemporal clusters of scarlet fever across Liaoning Province using the Moran's I, local indicators of spatial association, local Gi* hotspot statistics, and Kulldorff's retrospective space-time scan statistical analysis. RESULTS: Between 1st January 2010 and 31st December 2019, 46,652 cases of scarlet fever were reported in Liaoning Province, with an annual average incidence of 10.67 per 100,000. The incidence of scarlet fever had obvious seasonality with high incidence in early summer June and early winter December. The male-to-female ratio was 1.53:1. The highest incidence of cases occurred in 3-9 year old children. The most likely spatiotemporal cluster and the secondary clusters were detected in urban regions of Shenyang and Dalian, Liaoning Province. CONCLUSIONS: The incidence of scarlet fever has obvious spatiotemporal clustering, with the high-risk areas mainly concentrated in urban area of Shenyang and Dalian, Liaoning Province. Control strategies need to focus on high-risk season, high-risk areas and high-risk populations in order to reduce the incidence of scarlet fever.