Climate change is reshaping the global landscape and transmission of infectious diseases, posing a profound threat to public health systems. Despite a growing body of evidence on expanding transmission of infectious diseases due to climate change, translating this evidence into effective actions to reduce infectious disease burden remains insufficient. To address these challenges, we organized this special issue Climate Change and Infectious Diseases and synthesized new evidence on climate-sensitive infectious diseases and response frameworks. To bridge the implementation gap, we propose a core framework of four evidence-based strategies to mitigate impacts of climate change on infectious diseases, including strengthening health adaptation actions, applying innovative and comprehensive control measures, building climate-resilient and low-carbon health systems, and improving global governance and equity. We advocate for translating evidence into action to reduce infectious disease burdens in the context of global climate change, and policymakers, researchers, and clinical practitioners need to work together to achieve this important goal.

Tuberculosis (TB) remains a serious challenge to China’s public health, and timely detection and diagnosis of play key roles in preventing disease spread and deterioration. The aim of this study was to understand the delay in consultation for TB patients in Shenyang City, Liaoning Province, and to determine the factors that influence this delay. Delay in consultation was analysed retrospectively in Shenyang City, Liaoning Province. Basic information on TB patients from January 1, 2015, to December 31, 2024, was extracted from the China Tuberculosis Information Management System (TBIMS). The median and interquartile spacing were used for statistical description, and the chi-square test and binary logistic regression model were used to analyse the influencing factors. A total of 38,928 TB patients were included. The median duration of delay in consultation was 18 (6,36) days, and 22,051 (56.65

Norovirus is the leading cause of acute gastroenteritis outbreaks worldwide. A total of 1859 norovirus outbreaks were reported from 2016 to 2022 in Beijing, China. GII.2[P16] was the predominant genotype during 2016-2021, and GII.3[P12] during 2021-2022. In the early stage of the COVID-19 epidemic (January to June of 2020), strict prevention and control measures were implemented, and only eight norovirus outbreaks were reported. Most norovirus outbreaks occurred in schools (95.6%, 1778). As the level of schooling rises, the scale of norovirus outbreaks also increases (median case numbers: 8 for kindergarten, 10 for primary school, 11 for secondary school, and 14 for college; p trend < 0.001), while the attack rate decreases (median attack rates were correspondingly 25.8%, 17.5%, 10.0%, and 8.8%; p trend < 0.001). Compared to outbreaks caused by person-to-person transmission, foodborne and waterborne outbreaks are larger in scale. Delayed outbreak response is also a risk factor for larger-scale outbreaks. Norovirus outbreaks have emerged as a significant concern for public health in Beijing. Persistent genotyping efforts are essential to facilitate early warning. Outbreaks in different locations or through different transmission routes require specific prevention and control measures.

Background:Sudden infant death syndrome (SIDS) remains a leading cause of infant mortality. The neonatal period, as a distinct stage within infancy, has been a focus due to its associated mortality burden. We evaluated the global mortality burden and temporal trends of neonatal SIDS attributable to each risk factor from 1990 to 2021, assessed socioeconomic inequalities across these risk factors, and projected these trends through 2035. Methods:Data on neonatal SIDS deaths and the proportions attributable to risk factors were obtained from the Global Burden of Disease (GBD) 2021 study. Temporal trends in mortality rates were assessed using the average annual percent change (AAPC), socioeconomic inequalities were evaluated using the slope index of inequality (SII) and the concentration index, and future mortality burden through 2035 was projected using autoregressive integrated moving average (ARIMA) models. Results:Behavioral risks, child and maternal malnutrition, and low birth weight and short gestation were the leading contributors to neonatal SIDS mortality, with the burden concentrated in lower sociodemographic index (SDI) regions. Between 1990 and 2021, mortality attributable to these risk factors declined globally but remained unevenly distributed across socioeconomic groups. Inequality analyses indicated a persistent concentration of deaths in disadvantaged settings. Projections to 2035 suggest continued declines for most risk factors, although environmental risks may decrease more slowly. Conclusions:SIDS in the neonatal period remains a major global health challenge, particularly in low-SDI regions. Interventions targeting behavioral risks, child and maternal malnutrition, and low birth weight and short gestation are urgently needed.

The disease-related burden of atmospheric contamination is a major global health concern. The air quality index (AQI) assesses air quality based mainly on the concentration of an individual pollutant (chief pollutant). However, this traditional evaluation method has limited applicability to multi-pollutant pollution. Based on the health impacts of multiple contaminants, the air-quality health index offers a thorough method for quantifying air pollution, and is more applicable for the overall assessment of acute health effects. We established a time-series database by collecting and summarizing environmental and mortality data for thirteen cities within the Beijing–Tianjin–Hebei region (2018–2020). Based on models such as the generalized additive model and meta-analyses, we successfully constructed a regional air quality health index for the Beijing–Tianjin–Hebei region. Subgroup analyses of the predisposing factors highlighted the presence of vulnerable populations and seasonal patterns. Older adults (≥75 years), females, people with low educational backgrounds, and people with underlying conditions may have been susceptible to effects of atmospheric contaminants, increased emissions from anthropogenic sources during the cold season, and air pollution induced by unfavorable meteorological conditions, contributing to seasonal health effects. These findings have consequences for the evaluation of pollutants’ health risks and public health behaviors and are essential for the creation of suitable environmental standards and management strategies to safeguard public health.

While global warming is generally associated with fewer extremely cold days, prolonged cold spells continue to pose important public health concern. However, recent evidence on their spatiotemporal distribution and mortality burden in China is lacking. We conducted a nationwide county-level assessment of prolonged cold spells and their attributable mortality across China from 2020 to 2023. Daily meteorological data were retrieved from the NOAA database, and mortality data from 26 representative cities were analyzed using a time-stratified case-crossover design. Cold spells were defined as ≥ 5 consecutive days with mean temperature below the 5th percentile of the local distribution. Excess deaths were estimated by integrating relative risks with county-level population and crude death rates. During the study period, 11,737 cold spell events were identified nationwide, totaling 94,815 days. The frequency and geographic extent of prolonged cold spells showed notable year-to-year variation, with substantial spatial heterogeneity in their impacts. Overall, 41,614 excess deaths were attributable to prolonged cold spells, and the annual mortality burden fluctuated across the four years, reaching the highest level (16,914 deaths) in 2023. Northern provinces exhibited elevated mortality risks, yet southern provinces such as Chongqing, Sichuan and Guangdong also bore substantial burdens due to large exposed populations. Temporally, excess deaths clustered in December and January, consistent with periods of most severe cold spells. Health risks unequally affected vulnerable groups, particularly women and older adults. Under the background of global warming, prolonged cold spells in China exhibited considerable interannual variability while continuing to impose substantial health burdens nationwide. These findings highlight the need to consider spatiotemporal dynamics in climate change adaptation planning and emphasize regionally tailored public health strategies to mitigate cold related risks.

The carcinogenic mechanism of benzo[a]pyrene (BaP) is not fully understood. Our previous studies unexpectedly revealed that A-kinase anchoring protein 12 (AKAP12), a recognized tumor suppressor frequently downregulated in malignancies, is markedly upregulated in BaP-transformed 16HBE cells (THBEc1). This paradoxical upregulation prompted us to investigate its functional consequence and regulatory mechanism. Using CRISPR/Cas9-mediated genome editing, we serendipitously obtained a cell line harboring a homozygous 18-bp deletion at positions 61 to 78 in exon 3 of AKAP12, resulting in loss of six amino acids and sustained upregulation of mutant protein; this line was named THBEc1-ΔAKAP12-c4. These cells exhibited decreased in vitro colony growth and migration, and decreased in vivo experimental lung metastasis, without affecting subcutaneous tumor growth, revealing selective suppression of metastatic phenotypes. Furthermore, we identified forkhead box A1 (FOXA1), a transcription factor with an established oncogenic role in BaP-induced carcinogenesis, as a key upstream regulator: knockout of FOXA1 downregulated AKAP12. These findings outline a dual role for FOXA1 in driving oncogenic processes while upregulating AKAP12 as a compensatory brake on metastasis. Our study supports the tumor/metastasis suppressor role of AKAP12 in BaP-induced carcinogenesis, and the mutant AKAP12 provides a tool for dissecting the functional domains of this protein.

Workplace violence (WPV) against healthcare workers has become a growing problem, which seriously affects the medical service market and is the focus of global concern. This study aimed to evaluate the prevalence of WPV among doctors in tertiary general hospitals in Northeast China, and to analyze the influencing factors of WPV, so as to provide a reference for the development of targeted and effective prevention strategies and measures of WPV. A cross-sectional survey was conducted at two tertiary general hospitals in Dalian, Liaoning Province, Northeast China, from February to March 2024. Data were collected using a structured questionnaire covering WPV situations, sociodemographic characteristics, work situations, and psychosocial factors. A binary logistic regression model was employed to assess the independent influencing factors of WPV. A total of 503 doctors were included in this study, of whom 31.8

Klebsiella pneumoniae liver abscess (KLA) is an emerging public health concern in Asia. Involvement of the caudate lobe with concurrent inferior vena cava thrombosis is exceedingly rare but life-threatening. Timely diagnosis and management are critical but challenging. Multimodal ultrasound can play a pivotal role in both diagnosis and treatment guidance. A 66-year-old woman with diabetes presented with 10 days of fever and chills. Imaging revealed a caudate lobe liver abscess containing gas with extension to the inferior vena cava (IVC) and associated septic thrombosis. Contrast-enhanced ultrasound and CT confirmed a Klebsiella pneumoniae liver abscess. Ultrasound-guided percutaneous drainage was performed, and cultures identified an ESBL-producing Klebsiella pneumoniae. The patient was treated with broad-spectrum antibiotics, therapeutic anticoagulation, and catheter drainage. Despite an episode of septic shock during hospitalization, she gradually improved, and follow-up imaging showed near-complete resolution of the abscess and complete disappearance of the IVC thrombus. The caudate lobe KLA complicated by IVC thrombosis, particularly gas-containing septic thrombosis, is rare but life-threatening. Multimodal ultrasound plays an important role in the early diagnosis and interventional management of KLA complicated by IVC thrombosis. Timely ultrasound-guided drainage with targeted antimicrobial therapy and individualized anticoagulation can achieve effective source control and favorable outcomes without open surgery.

Abstract Although the link between seasonal influenza and environment has been established, the heterogeneous impacts of climate extreme events with their interactions remain poorly understood. Based on 630,120 influenza-positive cases from hospitals in 335 Chinese cities (2005–2019), this case-crossover study adopted distributed lag nonlinear models to quantify exposure-lag-response relationships between environmental exposures and influenza, applied machine learning to rank dominant variables, and performed a Long Short-Term Memory (LSTM) model using Beijing as proof of concept to test the forecasting utility of extreme events. Meteorological variables, air pollution, and extreme events are significantly associated with influenza risk. Machine learning models indicate that atmospheric temperature, humidity, and particulate matter may be the primary contributors. Co-exposure to extreme events showed a higher joint risk than single exposure, with a significant submultiplicative interaction on the multiplicative scale and no evidence of additive interaction. Based on the Beijing-specific LSTM proof-of-concept framework, integrating extreme events significantly enhanced daily influenza forecasting performance. Climate factors, air pollution, and extreme events potentially shape influenza risk, with heterogeneous effects across subtypes, demographics, and geography. These findings underscore the potential benefits of integrating extreme climate events into influenza forecasting and precise public health responses in the era of climate change.

The number of patients with skin diseases visiting hospitals in China has been increasing over the past few decades. Hospital-based analysis of outpatient populations may provide insights into the epidemiology of skin diseases. To explore the epidemiology of skin diseases at the hospital level, this study conducted a cross-sectional analysis by extracting and comparing medical information from 863,466 outpatient visits in 2018 and 1,250,032 in 2023 at the dermatology clinic of Huashan Hospital. Both years of data showed that atopic dermatitis (AD) and acne were the most frequently recorded diseases, followed by vitiligo, infectious skin diseases, psoriasis, urticaria, alopecia, and seborrheic dermatitis. The female-to-male patient ratio was 1.12. The prevalence of dermatological conditions also varied across different age groups. Infectious skin diseases, photosensitivity, and vitiligo were most frequently observed during the summer months, whereas alopecia tended to increase in the fall. Approximately 30.7

ObjectiveTo investigate the correlation between adverse outcomes and the Geriatric Nutritional Risk Index(GNRI) in elderly patients with bacterial pneumonia.MethodsBased on the MIMIC⁃Ⅳ 2.2 database,a total of 2 903 elderly patients with bacterial pneumonia were selected as the study subjects. Nutritional risk was classified into four grades according to GNRI.The relationship between 28⁃day mortality and GNRI in elderly patients with bacterial pneumonia was elucidated using restricted cubic splines(RCS),Kaplan⁃Meier regression analysis,Cox proportional hazards regression models,and subgroup analysis.The Boruta algorithm was employed to rank the importance of predictors for 28⁃day mortality.ResultsA non⁃linear negative correlation was observed between 28⁃day mortality and GNRI in elderly patients with bacterial pneumonia(P<0.001).GNRI value of 90.281 was identified as the critical point for clinical intervention.An elevated GNRI was associated with reduced mortality.The results of the Cox proportional hazards regression model indicated that GNRI was a significant predictor of 28⁃day mortality(P<0.001).Subgroup analysis revealed that factors such as demographic characteristics and comorbidities did not have statistically significant impact on the relationship between 28⁃day mortality and GNRI(P>0.05).GNRI was identified as one of the key influencing factors for 28⁃day mortality.ConclusionsGNRI has demonstrated predictive value for short⁃term mortality in elderly patients with bacterial pneumonia.Nutritional support for elderly patients with bacterial pneumonia during treatment may reduce their mortality.

Introduction:With the advent of more sensitive HIV-1 viral load (VL) testing systems, a greater number of low VL samples can be identified. However, for some patients who were previously virally suppressed, the new testing system may yield discordant results, posing challenges for clinical decision-making. This study systematically evaluated and compared the performance of the cobas 5800/6800 testing systems and the cobas AmpliPrep/cobas TaqMan (CAP/CTM) testing systems. Methods:The performance of the cobas 5800/6800 and CAP/CTM systems was assessed in terms of quantitative accuracy, precision, limits of detection, linearity, and clinical performance. A multi-center evaluation involving 18 sub-centers was conducted, and correlation and agreement analyses were performed on the quantitative results between the systems. The VL distribution among 1,486 patients in Yunnan Province was also analyzed to evaluate the impact of switching to the cobas 6800 system. Results:All the systems achieved a quantitative bias within 0.25 log and intra-run CV% below 5% at 10,000 and 1,000 IU/mL, while CAP/CTM demonstrated a CV% slightly exceeding 5% at 100 IU/mL. The limits of detection (cobas 5800/6800: 24 IU/mL; CAP/CTM: 30 IU/mL) matched manufacturer specifications, with all systems showing excellent linearity (R²=0.9965-0.9990) and subtype coverage. Correlation analysis showed strong associations (R²>0.90), yet the quantitative results of cobas 5800 and cobas 6800 showed a modestly higher, but consistent bias compared to CAP/CTM. Analysis of the VL distribution showed that switching to the cobas 6800 testing system significantly increased the proportion of VL between 20-200 copies/mL; however, no significant difference was observed after calculation using the correlation coefficient obtained from the multi-center evaluation. Conclusion:In summary, both the legacy and new testing systems exhibited excellent performance in detecting HIV-1 subtypes prevalent in China. This study provides reliable data to enable more accurate assessment of viral suppression efficacy during the transition period.

Objective To investigate the outcomes of the ESAT6-CFP10 skin test (EC-ST) among close contacts of pulmonary tuberculosis (PTB) patients in school settings and to identify factors associated with positive EC-ST results, and to provide a theoretical basis for PTB prevention and control strategies in schools.Methods From January 2024 to March 2025, EC-ST screening and a questionnaire survey were conducted among close contacts of school-diagnosed PTB patients in Jiangning District, Nanjing City. Univariate and multivariate generalized estimating equations (GEE) models were employed to explore potential factors associated with positive EC-ST results among school-based close contacts.Results Based on 40 confirmed PTB cases, a total of 1,860 close contacts within schools who had been exposed to these cases were screened. EC-ST results identified 55 individuals with positive reactions, resulting in a positivity rate of 2.96%. The positivity rates varied significantly among different age groups, occupations, and screening frequencies (P < 0.05). Multivariate GEE analysis revealed that obesity was a protective factor for positive EC-ST result among close contacts in school settings [OR=0.74, 95%CI (0.56, 0.98),P=0.037], absence of Bacillus Calmette-Guérin (BCG) vaccination scar [OR=1.29, 95%CI (1.12, 1.49),P< 0.001], and no previous history of tuberculosis/latent tuberculosis infection [OR=1.48, 95%CI (1.09, 2.01),P=0.012] were risk factors for positive EC-ST result among close contacts in school settings.Conclusion Schools should enhance the monitoring and management of PTB infection by implementing timely screening measures for close contacts of confirmed cases. Particular attention should be given to high-risk groups, including individuals with underweight and absence of BCG vaccination scar. Early detection ofMycobacterium tuberculosis infections and active PTB cases is essential for effective prevention of transmission within schools.

This study evaluated the impact of Particulate Matter 2.5 (PM 2.5) and its components on lung function. In total, 2,045 participants aged 40-89 years were recruited for this multi-center cross-sectional study. Lung function measurements were performed. Real-time PM 2.5 and its component data were obtained from atmospheric monitoring sites. Linear mixed-effects (LME) models were used to assess the relationships between PM 2.5, its components, and lung function. Weighted quantile sum regression, quantile g-computation, and Bayesian kernel machine regression were applied to assess the joint effects of PM 2.5 components on lung function. The mean PM 2.5 concentration during the study period was 71.92 μg/m 3. Among PM 2.5 components, nitrate had the highest mean concentration (16.82 μg/m 3), followed by organic carbon and sulfate. In the LME models, PM 2.5 exposure at a 1-day lag, scaled to its interquartile range, was significantly related to decreased lung function. Specifically, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1), one-second rate (FEV 1/FVC), peak expiratory flow (PEF), and forced expiratory flow at 25% FVC (FEF 25%) decreased by 3.75%, 6.56%, 2.89%, 10.48%, and 8.71%, respectively. An age-stratified analysis showed stronger negative associations among participants aged ≥ 60 years compared with middle-aged adults. In mixed-exposure models, the PM 2.5 mixture was significantly linked to a decline in lung function. Zinc (Zn) and magnesium ion (Mg 2+) were significantly linked to reduced FVC and ammonium ion (NH 4 +) was identified as a key contributor to reduced FEV 1, PEF, and FEF 75%. Lung function declined with increasing PM 2.5 and its components. Zn, Mg 2+, and NH 4 + were identified as key components.

Background: Tuberculosis remains a major respiratory infectious disease requiring prioritized pfrevention and control in China. Currently, domestic research predominantly focuses on national or provincial-level macrolevel studies and long-term epidemiological analyses of cities in Northeast China are lacking. Additionally, quantitative evaluations of fluctuations in the disease incidence before and after outbreaks are limited, and applicable predictive models have not been developed. Therefore, we conducted an analysis of epidemiological trends of tuberculosis in the city of Shenyang. Objective: This study aims to systematically elucidate the temporal, population-based, and regional epidemiological patterns of tuberculosis in Shenyang from 2015 to 2024; quantitatively analyse the characteristics of fluctuations in tuberculosis cases before and after the COVID-19 pandemic; and establish a time series prediction model. These findings will provide a scientific basis for developing targeted tuberculosis prevention and control strategies tailored to specific populations and regions. Methods: Surveillance data on pulmonary tuberculosis in Shenyang city from 2015 to 2024 were collected. Epidemiological descriptive methods were employed to analyse temporal trends, demographic characteristics, and spatial distribution patterns. Time series models were used to fit the incidence trends and obtain short-term predictions. The results of this study revealed significant sex, age, and occupational and regional disparities in the distribution of tuberculosis (TB) cases in Shenyang. Compared with that in 2019, the incidence rate in 2020 decreased by 15.46%, representing the greatest decline during the study period. From 2021 to 2024, the number of TB cases fluctuated and tended to increase. The time series model displayed an excellent fit and predictive performance for local TB epidemic trends. Conclusions: This study accurately delineates the evolutionary pattern of tuberculosis incidence in Shenyang, which is characterized by an initial decrease followed by an increase. It supplements empirical epidemiological data on tuberculosis in northeastern Chinese cities and provides a theoretical foundation for conducting a tuberculosis epidemiological analysis and trend forecasting in Shenyang and other similar cities in the region.

Objective:City-specific tools for assessing and warning about respiratory disease risks are underdeveloped, limiting effective public health response. This study aimed to develop and validate a novel city-specific prediction framework (WHA air-LSTM) for forecasting daily respiratory outpatient visits by integrating a composite air pollution health index. Methods:Based on over 223.7 million hospital visits across multiple megacities, we constructed and validated a five-level morbidity-driven composite air pollution index (WHA air) for each city using city-specific exposure-response relationships. An LSTM model was built using WHA air, temperature, humidity, and historical visit data to predict next-day visits. The proposed modeling framework was developed with city-level data, and it was externally validated using datasets from other cities. Results:Higher WHA air levels were significantly associated with increased outpatient visits. The model demonstrated excellent predictive performance (Beijing: R 2 = 0.963, RMSE = 53.5) and effectively captured visit surges. Excluding WHA air degraded model accuracy (ΔRMSE = +44.1%). The framework maintained robust performance in external validation, confirming its transferability. Conclusion:The WHA air-LSTM framework provides a scalable and practical tool for city-level respiratory disease early warning by bridging environmental monitoring with clinical practice.

The cryosphere, encompassing glaciers, ice sheets, permafrost, and snow, plays a critical role in regulating climate and sustaining human wellbeing. However, climate change is driving widespread cryosphere degradation, intensifying geophysical and climate-related hazards that pose escalating risks to the public health and safety. The resulting decline in both the quantity and quality of cryosphere services also has severe consequences, particularly for populations in polar regions, high-altitude mountains, and their downstream areas. Furthermore, teleconnected climate systems can even extend cryosphere change impacts beyond these regions. It has been seen that increasing cryosphere-related hazards, such as glacial lake outburst floods and extreme winter events, heighten public health risks. Disrupted meltwater supply and ecosystem shifts inflict water and food insecurity in arid and semiarid regions, exacerbating malnutrition and disease burdens. Additionally, thawing permafrost may release ancient pathogens and toxic substances, increasing the risks of infectious disease outbreaks and severe environmental contamination. Addressing these cascading risks requires urgent interdisciplinary research, public awareness, and investment in adaptive strategies to strengthen societal resilience amid a rapidly changing cryosphere and safeguard public well-being.