Scenario analysis of COVID-19 dynamical variations by different social environmental factors: a case study in Xinjiang.

Background: With the rapid advancement of the One Health approach, the transmission of human infectious diseases is generally related to environmental and animal health. Coronavirus disease (COVID-19) has been largely impacted by environmental factors regionally and globally and has significantly disrupted human society, especially in low-income regions that border many countries. However, few research studies have explored the impact of environmental factors on disease transmission in these regions. Methods: We used the Xinjiang Uygur Autonomous Region as the study area to investigate the impact of environmental factors on COVID-19 variation using a dynamic disease model. Given the special control and prevention strategies against COVID-19 in Xinjiang, the focus was on social and environmental factors, including population mobility, quarantine rates, and return rates. The model performance was evaluated using the statistical metrics of correlation coefficient (CC), normalized absolute error (NAE), root mean square error (RMSE), and distance between the simulation and observation (DISO) indices. Scenario analyses of COVID-19 in Xinjiang encompassed three aspects: different population mobilities, quarantine rates, and return rates. Results: The results suggest that the established dynamic disease model can accurately simulate and predict COVID-19 variations with high accuracy. This model had a CC value of 0.96 and a DISO value of less than 0.35. According to the scenario analysis results, population mobilities have a large impact on COVID-19 variations, with quarantine rates having a stronger impact than return rates. Conclusion: These results provide scientific insight into the control and prevention of COVID-19 in Xinjiang, considering the influence of social and environmental factors on COVID-19 variation. The control and prevention strategies for COVID-19 examined in this study may also be useful for the control of other infectious diseases, especially in low-income regions that are bordered by many countries.

Effectiveness and Determinants of Implementing the "Xinjiang Model" for Tuberculosis Prevention and Control: A Quantitative Study.

Objective: To analyze the effectiveness of the "Xinjiang Model" for tuberculosis prevention and control in Kashgar Prefecture, Xinjiang, and to explore the determinants of the policy implementation effect. Methods: The registration data of pulmonary tuberculosis (PTB) patients in Kashgar Prefecture from 2012 to 2021 were collected to describe the temporal trend of registered incidence. A questionnaire survey was conducted among PTB patients registered and treated in the tuberculosis management information system in Zepu and Shache Counties from January 2022 to July 2023 to collect and analyze "Xinjiang model" determinants of effectiveness. Results: The PTB registered incidence in Kashgar Prefecture showed a significant increasing trend from 2012 to 2018 (APC=18.7%) and a significant decreasing trend from 2018-2021 (APC=-28.8%). Among the Kashgar Prefecture, compared with average registered incidence in 2012-2017, registered incidence in 2021 in Shufu, Maigaiti, and Zepu Counties had a greater decline rate of 58.68%, 57.16%, and 54.02%, respectively, while the registered incidence in 2021 in Shache County increased by 6.32%. According to the comprehensive analysis of the factors affecting the effect of policy implementation, the proportion of PTB patients in Zepu County whose health status has now significantly improved compared with that before treatment was significantly greater than that in Shache County (P<0.05); patients in Shache County were significantly less aware than those in Zepu County of how to take tuberculosis drugs, precautions, adverse reactions, and regular reviews during treatment; the factors that accounted for the greater proportion of heavy treatment burden in both Shache and Zepu Counties were discomfort caused by taking or injecting drugs, accounting for 12.8% and 8.7%, respectively. Conclusion: The "Xinjiang model" can effectively control the epidemic situation of tuberculosis in Kashgar, and the knowledge of tuberculosis treatment, adverse reactions to tuberculosis drugs, and treatment costs were the determinants of the effectiveness of policy implementation.

Intervention Effect of New Tuberculosis Control Model on Tuberculosis Incidence in Xinjiang.

Objective: To quantitatively evaluate the intervention effect of the "Xinjiang model" policy on pulmonary tuberculosis (PTB) incidence in Xinjiang, and to compare the difference of policy effect between areas with different tuberculosis burdens. Methods: We retrospectively collected data on the registered incidence of PTB patients in 14 prefectures of Xinjiang from January 2012 to December 2021 and used Joinpoint model to describe the time trend of registered incidence, single-group interrupted time series (ITS) model to analyze the dynamics of registered incidence before and after the policy intervention, and controlled interrupted time series (CITS) model to compare the differences in the effects of the policy in different tuberculosis burdened areas. Results: The areas with high registered incidence of PTB in Xinjiang were mainly located in the four prefectures of southern Xinjiang. The time trend of registered incidence of PTB in Xinjiang from 2012 to 2021 showed a general downward trend (AAPC=-3.4%), an upward trend from 2012 to 2018 (APC=12.1%), and a rapid downward trend from 2018 to 2021 (APC=-28.3%). Single-group ITS results showed that registered incidence in Xinjiang increased by 13.806/100,000 one month after policy was implemented (P<0.001); the long-term effect of policy was a downward trend in registered incidence (ß3<0, P<0.001), decreasing by 0.690/100,000 per month. In high-, medium-, and low-burden areas of PTB, the long-term effect of policy was a monthly decrease in registered incidence of 1.460/100,000, 0.227/100,000, and 0.064/100,000, respectively. The long-term effects of policy interventions in high- and medium-burden areas showed a faster decline in registered incidence than in low-burden areas (ß7 was -1.548 and -0.194, respectively, P<0.001). Conclusion: A dynamic causal relationship exists between "Xinjiang model" policy and registered incidence, and its continued implementation is effective in controlling the spread of tuberculosis.

A Tuberculosis Outbreak at a School - Xinjiang Uygur Autonomous Region, China, 2019.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Worldwide, tuberculosis (TB) continues to be the most important cause of death from a single infectious agent, and China has a high TB burden. Although the reported incidence of TB in students is lower than that in general population, TB outbreaks in schools have continuously been reported in the past years, suggesting that schools are a high-risk setting for TB transmission. WHAT IS ADDED BY THIS REPORT?: In total, 31 TB patients were founded in students. Epidemiological linkage among all TB cases could not be determined due to absence of genome sequencing. However, based on the analysis of screening results, the index case was probably the source of transmission. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: The preventative measurements should be implemented in schools. Adding TB examinations into entrance examinations and strengthening health education could find TB cases early, and improving ventilation could decrease the risk of TB transmission in schools.