The association between weekly mean temperature and the epidemic of influenza across 122 countries/regions,2014-2019
Xiaoxiao Cao
Wenhao Zhu
Zhenghan Luo
Ran He
Yihao Li
Shirong Hui
Sheng Yang
Rongbin Yu
Peng Huang
Abstract：The study examined the association between weekly mean temperature and influenza cases across 122 countries/regions (2014-2019) using a distributed lag non-linear model. We analyzed 3,145,206 cases of overall influenza (Flu-All), with influenza A (Flu-A) and influenza B (Flu-B) accounting for 73.49% and 26.51%, respectively. Within a lag of two weeks, Flu-All incidence demonstrated a bimodal temperature relationship, with peak relative risks (RR) of 6.02 (95% confidence interval [CI]: 1.92-20.77) at -8°C and 3.08 (95% CI: 1.27-7.49) at 22°C. Flu-A exhibited a similar bimodal pattern, with RRs of 3.76 (95% CI: 2.39-5.91) at -8°C and 2.08 (95% CI: 1.55-2.80) at 22°C. Flu-B demonstrated a single risk peak at 1°C (RR=4.48, 95% CI: 1.74-11.55). Subgroup analyses of climate zones revealed variations: tropical zones peaked at 12°C (RR=1.37, 95% CI: 1.08-1.74), while dry and temperate zones exhibited the highest risks at -5°C, with RRs of 4.49 (95% CI: 2.46-7.15) and 5.23 (95% CI: 3.17-8.64), respectively. Cold zones peaked at 1°C (RR=5.96, 95% CI: 3.76-9.43). Subgroup analyses of influenza transmission zones revealed variations: Africa showed a higher risk between 6°C and 14°C, Asia showed a higher risk below 3°C, and Europe exhibited distinct risks of influenza peaks at -1°C (Eastern Europe), 1°C (Southwestern Europe), and -20°C (Northern Europe). Elevated risks above 11°C were identified in the Americas and Oceania. These findings establish a predictive framework for influenza outbreak preparedness by integrating regional temperature patterns with global climate variability.
Keywords：influenzainfluenza subtypetemperatureclimatic zonesinfluenza transmission zones
Publication Date：2025-11-30
Online Publishing Date：2026-01-15(First online date of this platform, not the publication date of the document)
Pages：10( 601-610 )