Impact of interventions on the incidence of natural focal diseases during the outbreak of COVID-19 in Jiangsu Province, China
Authors: Cheng Xiaoqing , Hu Jianli , Luo Li , Zhao Zeyu , Zhang Nan , Hannah Mikah Ngwanguong , Rui Jia , Lin Shengnan , Zhu Yuanzhao , Wang Yao , Yang Meng , Xu Jingwen , Liu Xingchun , Yang Tianlong , Liu Weikang , Li Peihua , Deng Bin , Li Zhuoyang , Liu Chan , Huang Jiefeng , Peng Zhihang , Bao Changjun , Chen Tianmu 
Published: September 2021

Abstract
Background
During the period of the coronavirus disease 2019 (COVID-19) outbreak, strong intervention measures, such as lockdown, travel restriction, and suspension of work and production, may have curbed the spread of other infectious diseases, including natural focal diseases. In this study, we aimed to study the impact of COVID-19 prevention and control measures on the reported incidence of natural focal diseases (brucellosis, malaria, hemorrhagic fever with renal syndrome [HFRS], dengue, severe fever with thrombocytopenia syndrome [SFTS], rabies, tsutsugamushi and Japanese encephalitis [JE]).

Methods
The data on daily COVID-19 confirmed cases and natural focal disease cases were collected from Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial CDC). We described and compared the difference between the incidence in 2020 and the incidence in 2015–2019 in four aspects: trend in reported incidence, age, sex, and urban and rural distribution. An autoregressive integrated moving average (ARIMA) (p, d, q) × (P, D, Q)s model was adopted for natural focal diseases, malaria and severe fever with thrombocytopenia syndrome (SFTS), and an ARIMA (p, d, q) model was adopted for dengue. Nonparametric tests were used to compare the reported and the predicted incidence in 2020, the incidence in 2020 and the previous 4 years, and the difference between the duration from illness onset date to diagnosed date (DID) in 2020 and in the previous 4 years. The determination coefficient (R2) was used to evaluate the goodness of fit of the model simulation.

Results
Natural focal diseases in Jiangsu Province showed a long-term seasonal trend. The reported incidence of natural focal diseases, malaria and dengue in 2020 was lower than the predicted incidence, and the difference was statistically significant (P < 0.05). The reported incidence of brucellosis in July, August, October and November 2020, and SFTS in May to November 2020 was higher than that in the same period in the previous 4 years (P < 0.05). The reported incidence of malaria in April to December 2020, HFRS in March, May and December 2020, and dengue in July to November 2020 was lower than that in the same period in the previous 4 years (P < 0.05). In males, the reported incidence of malaria in 2020 was lower than that in the previous 4 years, and the reported incidence of dengue in 2020 was lower than that in 2017–2019. The reported incidence of malaria in the 20–60-year age group was lower than that in the previous 4 years; the reported incidence of dengue in the 40–60-year age group was lower than that in 2016–2018. The reported cases of malaria in both urban and rural areas were lower than in the previous 4 years. The DID of brucellosis and SFTS in 2020 was shorter than that in 2015–2018; the DID of tsutsugamushi in 2020 was shorter than that in the previous 4 years.

Conclusions
Interventions for COVID-19 may help control the epidemics of natural focal diseases in Jiangsu Province. The reported incidence of natural focal diseases, especially malaria and dengue, decreased during the outbreak of COVID-19 in 2020. COVID-19 prevention and control measures had the greatest impact on the reported incidence of natural focal diseases in males and people in the 20–60-year age group.

Graphical Abstract