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Climate change may lead to emerging and re-emerging infectious diseases and pose public health challenges to human health and the already overloaded healthcare system. It is therefore important to review current knowledge and identify further directions in China, the largest developing country in the world. A comprehensive literature review was conducted to examine the relationship between climate variability and infectious disease transmission in China in the new millennium. Literature was identified using the following MeSH terms and keywords: climatic variables [temperature, precipitation, rainfall, humidity, etc.] and infectious disease [viral, bacterial and parasitic diseases]. Fifty-eight articles published from January 1, 2000 to May 30, 2018 were included in the final analysis, including bacterial diarrhea, dengue, malaria, Japanese encephalitis, HFRS, HFMD, Schistosomiasis. Each 1 °C rise may lead to 3.6%–14.8% increase in the incidence of bacillary dysentery disease in south China. A 1 °C rise was corresponded to an increase of 1.8%–5.9% in the weekly notified HFMD cases in west China. Each 1 °C rise of temperature, 1％ rise in relative humidity and one hour rise in sunshine led to an increase of 0.90%, 3.99% and 0.68% in the monthly malaria cases, respectively. Climate change with the increased temperature and irregular patterns of rainfall may affect the pathogen reproduction rate, their spread and geographical distribution, change human behavior and influence the ecology of vectors, and increase the rate of disease transmission in different regions of China. Exploring relevant adaptation strategies and the health burden of climate change will assist public health authorities to develop an early warning system and protect China's population health, especially in the new 1.5 °C scenario of the newly released IPCC special report. • Many infectious diseases such as malaria and dengue fever are mostly affected by climate variability and climate change. • The impact of climate change on infectious disease transmission may be more prevalent in southern cities of China. • More infectious studies with multiple-locations and a long study period as well as adaptation strategies are required. [ABSTRACT FROM AUTHOR]

There is limited evidence of effects and seasonal variation of temperature change on emergency department visits (EDVs). To investigate the association between diurnal temperature range (DTR), temperature change between neighboring days (TCN) and a comprehensive collection of cause-specific EDVs in China. We collected EDVs, weather, and air pollution data in 20 sites in China from 2014 to 2018. We applied a quasi–Poisson regression with distributed lag nonlinear model to evaluate DTR- and TCN-EDVs association. We used meta-analysis to pool site-specific estimates. We also conducted seasonal analysis and assess effects of modifiers. A 1 °C increase of DTR and TCN was associated with 0.29% [95% confidence interval (CI): 0.07%, 0.51%)] and 1.44% (95% CI: 0.93%, 1.96%) increase of total EDVs, respectively. People aged 18–44 were sensitive to DTR and TCN, while the elderly population was sensitive to TCN only in spring and autumn. In seasonal analysis, effects of temperature change on total EDVs were lower in summer. TCN increased risks of genitourinary diseases in summer, respiratory diseases in winter, injury in autumn, and mental diseases in spring. DTR increased the risk of respiratory diseases in autumn. Exposure to DTR and TCN was associated with elevated risk of EDVs but with great seasonal variations. Our results provided potential time and target populations for adaptive strategies and preventive measures. • Temperature change increased risks of visiting the emergency department. • Male and people aged 18–44 were sensitive to DTR and TCN. • The elderly population was vulnerable to TCN in spring and autumn. • Effects of DTR and TCN on total EDVs were lower in summer. • Seasonal variation exists in effects of DTR and TCN by age and disease. [ABSTRACT FROM AUTHOR]

Abstract: Background: Devastating health effects from recent heat waves in China have highlighted the importance of understanding health consequences from extreme heat stress. Despite the increasing mortality from extreme heat, very limited studies have quantified the effects of summer extreme temperature on heat-related illnesses in China. Methods: The associations between extreme heat and daily heat-related illnesses that occurred in the summers of 2011–2013 in Ningbo, China, have been examined, using a distributed lag non-linear model (DLNM) based on 3862 cases. The excess morbidities of heat-related illness during each heat wave have been calculated separately and the cumulative heat wave effects on age-, sex-, and cause-specific illnesses in each year along lags have been estimated as well. Results: After controlling the effect of relative humidity, it is found that maximum temperature, rather than heat index, was a better predictor of heat-related illnesses in summers. A positive association between maximum temperatures and occurrence of heat-related diseases was apparent, especially at short lag effects. Six heat waves during the period of 2011–2013 were identified and all associated with excess heat-related illnesses. Relative to the average values for the corresponding periods in 2011 and 2012, a total estimated 679 extra heat-related illnesses occurred during three heat waves in 2013. The significant prolonged heat wave effects on total heat-related illnesses during heat waves in three study years have also been identified. The strongest cumulative effect of heat waves was on severe heat diseases in 2013, with a 10-fold increased risk. More males than females, individuals with more severe forms of illness, were more affected by the heat. However, all age groups were vulnerable. Conclusions: Recent heat waves had a substantial and delayed effect on heat illnesses in Ningbo. Relevant active well-organized public health initiatives should be implemented to reduce the adverse effects of heat extremes on the illnesses. [Copyright &y& Elsevier]

Evidence is limited regarding the association between temperatures and health costs. We tried to investigate the association between temperatures and emergency department visits (EDVs) costs in China. Daily data on EDVs costs, weather, air pollution were collected from 17 sites in China during 2014–2018. A quasi–Poisson generalized additive regression with distributed lag nonlinear model was applied to assess the temperature–EDVs cost association. Random-effect meta-analysis was used to pool the estimates from each site. Attributable fractions and national attributable EDVs costs due to heat and cold were calculated. Relative risk (RR) due to extreme heat over 0–7 lag days was 1.14 [95% confidence intervals (CI): 1.08–1.19] and 1.11 (95% CI: 1.07–1.16) for EDVs examination (including treatment) and medicine cost, respectively. People aged 18–44 and those with genitourinary diseases were at higher risk from heat. 0.72% of examination cost and 0.57% of medicine cost were attributed to extreme heat, costing 274 million Chinese Yuan annually. Moderate heat had lower RR but higher attributable fraction of EDVs costs. Exposure to extreme cold over 0–21 lag days increased the risk of medicine cost for people aged 18–44 [RR: 1.30 (95% CI: 1.10–1.55)] and those with respiratory diseases [RR: 1.56 (95% CI: 1.14–2.14)], but had non-statistically significant attributable fraction of the total EDVs cost. Exposure to heat and cold resulted in remarkable health costs. More resources and preparedness are needed to tackle such a challenge as our climate is rapidly changing. • Exposure to heat and cold result in remarkable health costs of patients. • Heat annually attributed 1.21 billion CNY (0.18 billion USD) of costs on EDVs. • People aged 18–44 and with genitourinary diseases were at higher cost risk from heat. • Cold increased EDVs costs risk for people aged 18–44 and with respiratory diseases. [ABSTRACT FROM AUTHOR]