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\begin{document}

\title{Impact of Ambient Air Pollutants on Influenza-like illness, Influenza A
and Influenza B: A Nationwide Time-Series Study in China}



\author[1]{shenglan xiao}%
\author[1]{Dina Wang}%
\author[1]{Yadi Wu}%
\author[1]{Xi Huang}%
\author[1]{Qing Zhang}%
\author[2]{Dayan Wang}%
\author[1]{Yuelong Shu}%
\affil[1]{Sun Yat-Sen University School of Public Health Shenzhen}%
\affil[2]{Chinese Center for Disease Control and Prevention}%


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  \date{May 30, 2024}


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\begin{abstract}
Influenza constitutes a critical respiratory infection that imposes
significant public health burdens. The precise influence of these
pollutants on influenza activity remains unclear. This study aimed to
investigate the effects of different air pollutants on the incidence of
influenza-like illness (ILI), influenza A (Flu A), and influenza B (Flu
B) in China based on nationwide data on air pollution and the influenza
data from 554 sentinel hospitals across 30 provinces and municipalities
from 2014 to 2017. Distributed Lag Nonlinear Model (DLNM) was employed
to discern the lagged effects amid the concentrations of six distinct
air pollutants, namely PM2.5, PM10, O \textsubscript{3}, CO, SO
\textsubscript{2}, and NO \textsubscript{2}, and the incidence of ILI,
Flu A, as well as Flu B. Our analysis indicated that there was generally
no distinction in the effects of air pollutants on the incidence of ILI,
Flu A, and Flu B, although variations existed in terms of the specific
level of risk associated with each of these categories. Specifically,
elevated levels of PM2.5, PM10, CO, SO \textsubscript{2}, and NO
\textsubscript{2} were predominantly associated with an increased risk
of influenza. In contrast, the effect of O \textsubscript{3}
concentration on influenza was bidirectional whereby it promoted
influenza outbreaks at low and high levels.%
\end{abstract}%



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