Independent and interactive effects of ambient temperature and absolute humidity on the risks of avian influenza A(H7N9) infection in China.

The emergence of avian influenza A(H7N9) virus poses a pandemic threat to human beings. It was proposed that meteorological factors might be important environmental factors favoring the occurrence of H7N9 infection, but evidence is still inadequate. In this study, we aimed to investigate the independent and interactive effects of ambient temperature (TM) and absolute humidity (AH) on H7N9 infection risks in China. The individual information of all reported H7N9 cases and daily meteorological data in five provinces/municipality (Zhejiang, Jiangsu, Shanghai, Fujian, and Guangdong) in China during 2013-2016 were collected. We employed a case-crossover study design, in which the 7-10days before the onset date of each H7N9 case was defined as the hazard period, and 4weeks before the hazard period was taken as the control period. The average levels of meteorological factors were calculated during the hazard and control periods. A Cox regression model was used to estimate the independent and interactive effects of TM and vapor pressure (VP), an indicator of AH, on H7N9 infection risks. A total of 738 H7N9 cases were included in the present study. Significantly nonlinear negative associations of TM and VP with H7N9 infection risks were observed in all cases, and in cases from northern and southern regions. There were significant interactive effects between TM and VP on H7N9 infection risks, and the risks of H7N9 infection were higher in cold-dry days than other days. We further observed different risky windows of H7N9 infection in the northern (TM: 0-18°C, VP: 313mb) and southern areas (TM: 7-21°C, VP: 3-17mb). We concluded that ambient temperature and absolute humidity had significant independent and interactive effects on H7N9 infection risks in China, and the risks of H7N9 infection were higher in cold-dry days. The risky windows of H7N9 infection were different in the northern and southern areas.