The epidemiological trends of 45 national notifiable infectious diseases in China: An analysis of national surveillance data from 2013 to 2022
Authors: Zhou Hongrang , Wang Xiaoling , Li Guifu , Zhou Zhe , Wang Xiaoming , Hu Jingfei , Wang Yufeng , Chen Muxin , Ye Kaiyou , Xiao Ning , Ai Lin 
Published: January 2024

Abstract
Objective
To conduct an in-depth analysis of the epidemiological characteristics of 45 notifiable infectious diseases in mainland China the past decade, in order to comprehensively understand and grasp the epidemic situation, as well as to provide references and foundations for the development of effective prevention and control strategies and measures.
Method
Based on the monthly analysis report of the National Infectious Disease Surveillance System (NIDSS), data on reportable infectious diseases in China from 2013 to 2022 were obtained. The data were processed using IBM SPSS 22.0 and Excel 2010 software, and a joint-point regression model was used to analyze incidence and case-fatality ratios trends from 2013 to 2022.
Results
From 2013 to 2022, a total of 76,874,318 cases of notifiable infectious diseases were reported in mainland China, with an average annualized incidence rate of 551.26/100,000, and 207,216 deaths from notifiable infectious diseases, corresponding to an average annualized case-fatality rate of 2.70 /1,000. Throughout this period, the overall incidence rate showed a downward trend, with an average annual percentage changes (AAPC) of -0.14% (95% CI: -3.75–3.51%), while the overall case-fatality rate showed an upward trend, with an AAPC of 5.41% (95% CI: 2.29–8.61%). In this decade, HFMD, hepatitis B, infectious diarrhea, tuberculosis, and influenza were the prevalent infectious diseases in terms of morbidity among 45 notifiable infectious diseases, while acquired immune deficiency syndrome (AIDS), tuberculosis, rabies, infectious diarrhea, and COVID-19 were the diseases with high numbers of deaths. According to the classification of A, B and C, the incidence of notifiable infectious diseases in mainland China from 2013 to 2022 was primarily dominated by C infectious diseases, accounting for 54.50%. Based on different transmission routes, intestinal infectious diseases were the most prevalent, accounting for 40.64% of the total morbidity. The overall monthly incidence trend of notifiable infectious diseases in mainland China exhibited a "W" distribution, while the monthly case-fatality ratios trend shows a "M" distribution. During the COVID-19 epidemic period (2020–2022), compared with the pre-epidemic period (2017–2019), the incidence rate of 6 infectious diseases increased and the incidence rate of 34 infectious diseases decreased; the case-fatality ratios of 18 diseases increased and 14 diseases decreased.
Conclusion
It is very crucial to continuously reinforce the prevention and control of key infectious diseases, including AIDS, tuberculosis and viral hepatitis as well as highly prevalent infectious diseases, such as hand-foot-mouth disease, influenza and infectious diarrhoeal diseases. Concurrently, we should enhance our surveillance and response to emerging infectious diseases to safeguard public health and safety.