ArticleInfectious diseases of poverty2024
Molecular epidemiology and phylogenetic analysis of influenza viruses A (H3N2) and B/Victoria during the COVID-19 pandemic in Guangdong, China.
Article in Infectious diseases of poverty, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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8 citing papers in PubMed.
- Pre-pandemic contraction, phase-specific rate variation, and site-specific antigenic adaptation shape influenza A(H3N2) evolutionary dynamics in Hubei, China.Journal of virology · 2026Article
- Molecular and antigenic characteristics of the influenza B virus in Guangzhou, 2022-2023.Virology journal · 2026Article
- Epidemiological characteristics of imported influenza viruses at Shanghai entry-exit ports from 2017 to 2024.Frontiers in public health · 2026Article
- Molecular epidemiology and genetic characteristics of influenza viruses in a local pediatric population of eastern China, 2024.Frontiers in microbiology · 2026Article
- Changes in the epidemic patterns of respiratory pathogens of children in guangzhou, China during the COVID-19 pandemic.BMC infectious diseases · 2025Article
- Shifting respiratory pathogens: Post-COVID-19 trends in community-acquired infections in underserved communities.PloS one · 2025Article
- Genetic characterization of the respiratory tract viruses in Jilin, Northeast China, 2023.Frontiers in public health · 2025Article
- Global, regional, and national burden of upper respiratory infections, 1990-2021: Findings from the Global Burden of Disease study 2021.Science in One Health · 2024Article
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Abstract
backgroundNon-pharmaceutical measures and travel restrictions have halted the spread of coronavirus disease 2019 (COVID-19) and influenza. Nonetheless, with COVID-19 restrictions lifted, an unanticipated outbreak of the influenza B/Victoria virus in late 2021 and another influenza H3N2 outbreak in mid-2022 occurred in Guangdong, southern China. The mechanism underlying this phenomenon remains unknown. To better prepare for potential influenza outbreaks during COVID-19 pandemic, we studied the molecular epidemiology and phylogenetics of influenza A(H3N2) and B/Victoria that circulated during the COVID-19 pandemic in this region.
methodsFrom January 1, 2018 to December 31, 2022, we collected throat swabs from 173,401 patients in Guangdong who had acute respiratory tract infections. Influenza viruses in the samples were tested using reverse transcription-polymerase chain reaction, followed by subtype identification and sequencing of hemagglutinin (HA) and neuraminidase (NA) genes. Phylogenetic and genetic diversity analyses were performed on both genes from 403 samples. A rigorous molecular clock was aligned with the phylogenetic tree to measure the rate of viral evolution and the root-to-tip distance within strains in different years was assessed using regression curve models to determine the correlation.
resultsDuring the early period of COVID-19 control, various influenza viruses were nearly undetectable in respiratory specimens. When control measures were relaxed in January 2020, the influenza infection rate peaked at 4.94% (39/789) in December 2021, with the influenza B/Victoria accounting for 87.18% (34/39) of the total influenza cases. Six months later, the influenza infection rate again increased and peaked at 11.34% (255/2248) in June 2022; influenza A/H3N2 accounted for 94.51% (241/255) of the total influenza cases in autumn 2022. The diverse geographic distribution of HA genes of B/Victoria and A/H3N2 had drastically reduced, and most strains originated from China. The rate of B/Victoria HA evolution (3.11 × 10
conclusionsDespite the extraordinarily low detection rate of influenza infection, concealed influenza transmission may occur between individuals during strict COVID-19 control. This ultimately leads to the accumulation of viral mutations and accelerated evolution of H3N2 and B/Victoria viruses. Monitoring the evolution of influenza may provide insights and alerts regarding potential epidemics in the future.
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