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Benjawan Roudreo 1 Article
Alleviation of PM2.5-associated Risk of Daily Influenza Hospitalization by COVID-19 Lockdown Measures: A Time-series Study in Northeastern Thailand
Benjawan Roudreo, Sitthichok Puangthongthub
J Prev Med Public Health. 2024;57(2):108-119.   Published online January 19, 2024
DOI: https://doi.org/10.3961/jpmph.23.349
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AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Abrupt changes in air pollution levels associated with the coronavirus disease 2019 (COVID-19) outbreak present a unique opportunity to evaluate the effects of air pollution on influenza risk, at a time when emission sources were less active and personal hygiene practices were more rigorous.
Methods
This time-series study examined the relationship between influenza cases (n=22 874) and air pollutant concentrations from 2018 to 2021, comparing the timeframes before and during the COVID-19 pandemic in and around Thailand’s Khon Kaen province. Poisson generalized additive modeling was employed to estimate the relative risk of hospitalization for influenza associated with air pollutant levels.
Results
Before the COVID-19 outbreak, both the average daily number of influenza hospitalizations and particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) concentration exceeded those later observed during the pandemic (p<0.001). In single-pollutant models, a 10 μg/m3 increase in PM2.5 before COVID-19 was significantly associated with increased influenza risk upon exposure to cumulative-day lags, specifically lags 0-5 and 0-6 (p<0.01). After adjustment for co-pollutants, PM2.5 demonstrated the strongest effects at lags 0 and 4, with elevated risk found across all cumulative-day lags (0-1, 0-2, 0-3, 0-4, 0-5, and 0-6) and significantly greater risk in the winter and summer at lag 0-5 (p<0.01). However, the PM2.5 level was not significantly associated with influenza risk during the COVID-19 outbreak.
Conclusions
Lockdown measures implemented during the COVID-19 pandemic could mitigate the risk of PM2.5-induced influenza. Effective regulatory actions in the context of COVID-19 may decrease PM2.5 emissions and improve hygiene practices, thereby reducing influenza hospitalizations.
Summary
Key Message
In the present research, both single- and multi-pollutant models indicated that the level of PM2.5 was significantly related to the daily number of influenza cases in Khon Kaen, Thailand, prior to the COVID-19 outbreak. Additionally, a significant risk difference was observed between the pre-outbreak and the pandemic periods due to the reduction in air pollutant concentrations because of lockdown measures to control the spread of COVID-19. These findings could be useful for developing environmental policies and strategies accordingly to mitigate respiratory health issues.

JPMPH : Journal of Preventive Medicine and Public Health