Chen Li, Wang Liping, Xing Yi, Xie Junqing, Su Binbin, Geng Mengjie, Ren Xiang, Zhang Yi, Liu Jieyu, Ma Tao, Chen Manman, Ma Qi, Jiang Jianuo, Cui Mengjie, Guo Tongjun, Yuan Wen, Song Yi, Dong Yanhui, Ma Jun
Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China.
Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
Lancet Reg Health West Pac. 2023 Jun 7;38:100811. doi: 10.1016/j.lanwpc.2023.100811. eCollection 2023 Sep.
An accelerated epidemiological transition, economic development and urbanization have brought rapid reductions but a potential disparity in infectious diseases burdens in-school and out-of-school children, adolescents, and youths in China. This paper assesses the disparity in spectrum of infectious diseases between two groups, and described disparity's variation by age, year and province, and determined the priority diseases.
A total of 7,912,274 new incident cases (6,159,021 in school and 1,753,253 out of school) aged 6-21 years across 43 notifiable infectious diseases have been collected based on China's Notifiable Infectious Disease Surveillance System from 2013 to 2021. All infectious diseases are categorized into seven categories: vaccine preventable, bacteria, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. We used the index of incidence rate ratio (IRR) of by specific disease, category, year, and age to assess the disparity between those out-of-school and in-school, and determine their separate priority diseases.
From 2013 to 2021, a small disparity of notifiable infectious diseases existed with higher average yearly incidence for out-of-school children, adolescents, and youth than that in-school (327.601 v.s. 319.677 per 100,000, IRR = 1.025, 95%CI: 1.023-1.027, standardized IRR = 1.169, 95%CI: 1.155-1.183), and it gradually narrowed by surveillance years with IRR from 1.351 in 2013 to 1.015 in 2021 due to large decreased disparity in compulsory education stage group. Such disparity was mainly driven by sexually transmitted and bloodborne diseases, bacteria diseases, vectorborne diseases, quarantinable diseases and zoonotic diseases. However, vaccine preventable diseases, gastrointestinal and enterovirus diseases showed higher incidence of infectious diseases for those in-school than that out-of-school, particularly for seasonal influenza, mumps and hand-foot-and-mouth disease. Meanwhile, such disparity is obvious in most of ages and in eastern and coastal regions of China, and the narrowing trend is attributed to six categories diseases, except for sexually transmitted and bloodborne diseases with gradually widened disparity between two groups with surveillance years with IRR from 22.939 in 2013 to 23.291 in 2021 due to large disparity for those who have completed compulsory education.
A huge achievement has been achieved in reducing the burden and disparity of infectious diseases between out-of-school and in-school children, adolescents, and youths in China, particularly for the compulsory education stage population. The priorities for the coming decades will be to extend successful strategies to a broad scope and promote education, particularly for the investment of social health resources and the improvement of personal health literacy in the non-compulsory education stage. This should involve extending the years of compulsory school, improving sex health education, strengthening monitoring, expanding immunization programs coverage and prioritizing the prevention and control of sexually transmitted diseases and tuberculosis among out-of-school population.
National Natural Science Foundation of China and Beijing Natural Science Foundation.
加速的流行病学转变、经济发展和城市化使中国在校和校外儿童、青少年及青年的传染病负担迅速减轻，但可能存在差距。本文评估了两组人群传染病谱的差异，描述了按年龄、年份和省份划分的差异变化，并确定了重点疾病。
基于中国法定传染病监测系统，收集了2013年至2021年期间43种法定传染病的7912274例新发病例（在校6159021例，校外1753253例），年龄在6至21岁之间。所有传染病分为七类：疫苗可预防疾病、细菌感染性疾病、胃肠道和肠道病毒感染性疾病、性传播和血源传播疾病、媒介传播疾病、人畜共患疾病以及检疫传染病。我们使用特定疾病、类别、年份和年龄的发病率比（IRR）指数来评估校外和在校人群之间的差异，并确定各自的重点疾病。
2013年至2021年期间，法定传染病存在较小差异，校外儿童、青少年及青年的年平均发病率高于在校人群（每10万人中分别为327.601例和319.677例，IRR = 1.025，95%CI：1.023 - 1.027，标准化IRR = 1.169，95%CI：1.155 - 1.183），且随着监测年份的增加逐渐缩小，由于义务教育阶段人群的差异大幅下降，IRR从2013年的1.351降至2021年的1.015。这种差异主要由性传播和血源传播疾病、细菌感染性疾病、媒介传播疾病、检疫传染病和人畜共患疾病导致。然而，疫苗可预防疾病、胃肠道和肠道病毒感染性疾病在校人群中的传染病发病率高于校外人群，特别是季节性流感、腮腺炎和手足口病。同时，这种差异在大多数年龄段以及中国东部和沿海地区较为明显，缩小趋势归因于六类疾病，除性传播和血源传播疾病外，两组之间的差异随着监测年份逐渐扩大，IRR从2013年的22.939增至到2021年的23.291，这是由于完成义务教育人群的差异较大。
中国在校和校外儿童、青少年及青年在减轻传染病负担和缩小差异方面取得了巨大成就，特别是义务教育阶段人群。未来几十年的重点将是把成功策略推广到更广泛范围，并促进教育，特别是在非义务教育阶段投入社会卫生资源和提高个人健康素养。这应包括延长义务教育年限、改善性健康教育、加强监测、扩大免疫规划覆盖范围以及优先防控校外人群中的性传播疾病和结核病。
中国国家自然科学基金和北京市自然科学基金。
