Association between ozone and influenza transmissibility in China

Background Common air pollutants such as ozone (O 3 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and particulate matter play significant roles as influential factors in influenza-like illness (ILI). However, evidence regarding the impact of O 3 on influenza transmissibility in multi-subtropical regions is limited, and our understanding of the effects of O 3 on influenza transmissibility in temperate regions remain unknown. Methods We studied the transmissibility of influenza in eight provinces across both temperate and subtropical regions in China based on 2013 to 2018 provincial-level surveillance data on influenza-like illness (ILI) incidence and viral activity. We estimated influenza transmissibility by using the instantaneous reproduction number ( R_t ) and examined the relationships between transmissibility and daily O 3 concentrations, air temperature, humidity, and school holidays. We developed a multivariable regression model for R_t to quantify the contribution of O 3 to variations in transmissibility. Results Our findings revealed a significant association between O 3 and influenza transmissibility. In Beijing, Tianjin, Shanghai and Jiangsu, the association exhibited a U-shaped trend. In Liaoning, Gansu, Hunan, and Guangdong, the association was L-shaped. When aggregating data across all eight provinces, a U-shaped association was emerged. O 3 was able to accounted for up to 13