Dysentery in Mainland China, 2004–2020: Spatiotemporal Dynamics and the impact of COVID-19 public health interventions

Dysentery in Mainland China, 2004–2020: Spatiotemporal Dynamics and the impact of COVID-19 public health interventions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dysentery in Mainland China, 2004–2020: Spatiotemporal Dynamics and the impact of COVID-19 public health interventions Hongwei Ma, Dongliang Ke, Mengen Xu, Xudong Zhou, Zhihao Lei, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9233265/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 16 You are reading this latest preprint version Abstract Background Dysentery remains a significant enteric disease globally, causing substantial morbidity and economic burden. Dysentery incidence in China has declined over the past two decades, but the seasonal pattern, spatial clustering, and interprovincial heterogeneity of this decline have not been fully characterised at the national level. The effect of COVID-19 NPIs on dysentery transmission in 2020 also remains unclear. Methods We analysed CISDCP surveillance data from January 2004 to December 2020 across 31 provinces. Joinpoint regression identified long-term trends; time-series decomposition quantified seasonal components; Global Moran's I and LISA assessed spatial autocorrelation and local clusters. Six forecasting models were evaluated per province using a composite standardised index (neural network, ETS, SARIMA, hybrid, BSTS, Prophet). Province-specific models trained on 2004–2019 data generated counterfactual incidence estimates for 2020, which were compared with observed values. Results A total of 3,971,083 cases and 661 deaths were reported. Incidence declined throughout, with an accelerated fall after 2017 (APC: −11.47% for 2004–2017; −18.85% for 2017–2020). Seasonal patterns were stable year to year, though peak amplitude decreased over time. Spatial clustering was significant during 2005–2018 (P < 0.01) but absent in 2020. Beijing and Tianjin had the highest bacillary dysentery incidence; southwest provinces showed a relatively higher amoebic dysentery burden. Infants aged 0–1 years had the largest case share. In 2020, observed national incidence was ~ 18.1% below counterfactual estimates, with wide provincial variation (Guangdong − 34.9%, Chongqing − 35.6%; Qinghai and Hainan showing smaller gaps). Conclusions Dysentery burden in mainland China fell steadily from 2004 to 2020, but seasonality, spatial clustering, and provincial disparities persisted. Infants remained the primary high-risk group. The 2020 decline exceeded pre-pandemic projections by ~ 18%, consistent with collateral benefits from COVID-19 NPIs, though changes in healthcare-seeking behaviour may also contribute. These findings support hotspot-targeted control, priority actions for infants and childcare settings, and province-level early warning. Dysentery Time-series analysis Spatiotemporal analysis COVID-19 Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 07 May, 2026 Reviews received at journal 05 May, 2026 Reviews received at journal 05 May, 2026 Reviews received at journal 04 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviews received at journal 10 Apr, 2026 Reviewers agreed at journal 03 Apr, 2026 Reviewers agreed at journal 03 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 30 Mar, 2026 Submission checks completed at journal 30 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9233265","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619005307,"identity":"67320057-9dd1-4228-9b13-c01510fa0ade","order_by":0,"name":"Hongwei Ma","email":"","orcid":"","institution":"Huazhong Agricultural University","correspondingAuthor":false,"prefix":"","firstName":"Hongwei","middleName":"","lastName":"Ma","suffix":""},{"id":619005308,"identity":"15f5c42f-e061-4f09-9a43-ae3dfcb34491","order_by":1,"name":"Dongliang Ke","email":"","orcid":"","institution":"Wuhan University of 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interventions","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dysentery, Time-series analysis, Spatiotemporal analysis, COVID-19","lastPublishedDoi":"10.21203/rs.3.rs-9233265/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9233265/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDysentery remains a significant enteric disease globally, causing substantial morbidity and economic burden. Dysentery incidence in China has declined over the past two decades, but the seasonal pattern, spatial clustering, and interprovincial heterogeneity of this decline have not been fully characterised at the national level. The effect of COVID-19 NPIs on dysentery transmission in 2020 also remains unclear.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe analysed CISDCP surveillance data from January 2004 to December 2020 across 31 provinces. Joinpoint regression identified long-term trends; time-series decomposition quantified seasonal components; Global Moran's I and LISA assessed spatial autocorrelation and local clusters. Six forecasting models were evaluated per province using a composite standardised index (neural network, ETS, SARIMA, hybrid, BSTS, Prophet). Province-specific models trained on 2004\u0026ndash;2019 data generated counterfactual incidence estimates for 2020, which were compared with observed values.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 3,971,083 cases and 661 deaths were reported. Incidence declined throughout, with an accelerated fall after 2017 (APC: \u0026minus;11.47% for 2004\u0026ndash;2017; \u0026minus;18.85% for 2017\u0026ndash;2020). Seasonal patterns were stable year to year, though peak amplitude decreased over time. Spatial clustering was significant during 2005\u0026ndash;2018 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) but absent in 2020. Beijing and Tianjin had the highest bacillary dysentery incidence; southwest provinces showed a relatively higher amoebic dysentery burden. Infants aged 0\u0026ndash;1 years had the largest case share. In 2020, observed national incidence was ~\u0026thinsp;18.1% below counterfactual estimates, with wide provincial variation (Guangdong\u0026thinsp;\u0026minus;\u0026thinsp;34.9%, Chongqing\u0026thinsp;\u0026minus;\u0026thinsp;35.6%; Qinghai and Hainan showing smaller gaps).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDysentery burden in mainland China fell steadily from 2004 to 2020, but seasonality, spatial clustering, and provincial disparities persisted. Infants remained the primary high-risk group. The 2020 decline exceeded pre-pandemic projections by ~\u0026thinsp;18%, consistent with collateral benefits from COVID-19 NPIs, though changes in healthcare-seeking behaviour may also contribute. These findings support hotspot-targeted control, priority actions for infants and childcare settings, and province-level early warning.\u003c/p\u003e","manuscriptTitle":"Dysentery in Mainland China, 2004–2020: Spatiotemporal Dynamics and the impact of COVID-19 public health interventions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 20:15:09","doi":"10.21203/rs.3.rs-9233265/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T10:15:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T00:26:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T19:44:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T23:51:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254522227835909005765489236760486320620","date":"2026-05-04T18:03:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325264596860670859337018025005207441568","date":"2026-04-17T05:03:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333873718159040382289326900133062718909","date":"2026-04-16T19:10:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73903169787392918558336908469585933822","date":"2026-04-15T20:55:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T08:55:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188842453824204607398312096570652152911","date":"2026-04-03T08:02:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31318317129833525623664419080224208672","date":"2026-04-03T05:54:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-02T22:02:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T10:43:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T08:03:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-30T08:03:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-03-26T11:00:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e6573624-c814-405b-a2b5-7a40c12b9fad","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T10:15:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T00:26:54+00:00","index":126,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T19:44:11+00:00","index":125,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T23:51:57+00:00","index":121,"fulltext":""},{"type":"reviewerAgreed","content":"254522227835909005765489236760486320620","date":"2026-05-04T18:03:17+00:00","index":120,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T10:26:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 20:15:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9233265","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9233265","identity":"rs-9233265","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}