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Peer-reviewedCC BY 4.0Frontiers in Public Health

Multi-source COVID-19 surveillance in Fujian, China: epidemiological features of two epidemic waves and public health implications

  • Jiawei Lin1,2
  • Senshuang Zheng1
  • Zhifang Zhang1
  • Jingjing Cai1
  • Cailin Chen1
  • Yuedong Lin3,4
  • Jianming Ou1,2
  • Hansong Zhu1,2
  • Wenjing Ye1,2
  • Shenggen Wu1,2
4 affiliations
  1. 1Fujian Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research
  2. 2School of Public Health, Fujian Medical University
  3. 3Xiamen Center for Disease Control and Prevention
  4. 4Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine
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Abstract

Objective: Using Fujian’s multi-source Coronavirus Disease 2019 (COVID-19) surveillance system, this study compared epidemiological features and indicator associations of two successive epidemic waves to optimize epidemic surveillance and prevention strategies.

Methods: Multi-source surveillance data were collected from week 49 of 2022 (the week of December 7, 2022, when the 10 optimization measures were issued) to week 29 of 2023 (July 17–23, 2023) in Fujian Province, including reported COVID-19 cases, fever clinic visits, population nucleic acid testing, sentinel hospital surveillance, hospitalized severe cases, and viral variants. Descriptive epidemiology, Spearman correlation, and lagged cross-correlation analyses were adopted for data evaluation.

Results: The first wave showed a sharp peak pattern, with most indicators peaking around weeks 51–52/2022 and reported cases peaking at week 1/2023; the second wave exhibited a gradual peak at week 21/2023. Peak levels of the second wave were 10.7–99.9% lower across indicators, although the markedly reduced nucleic acid testing volume and changed surveillance conditions warrant cautious interpretation of cross-wave comparisons. The interval between the two epidemic peaks was about 5 months, and severe cases consistently lagged infection peaks by approximately 2 weeks. Indicators were strongly correlated, with the highest correlation between sentinel and nucleic acid positivity rates (rs = 0.92, p < 0.001); lagged cross-correlation analysis indicated that these two indicators moved essentially in synchrony. The XBB variant took approximately 4 weeks from initial local detection to predominance alongside the second epidemic peak.

Conclusion: The two observed epidemic peaks were approximately 5 months apart, and multi-source surveillance indicators showed high temporal concordance. However, lagged cross-correlation indicated that the indicators moved essentially in synchrony, so sentinel surveillance should be regarded as a complementary monitoring tool rather than a proven early-warning measure. The XBB variant reached predominance approximately 4 weeks after initial local detection in this episode, a descriptive observation that cannot be generalized as a validated predictive tool. These findings facilitate multi-wave epidemic preparedness and surveillance improvement.

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Cite

BibTeXRIS
BibTeX
@article{lin2026multisource,
  title = {{Multi-source COVID-19 surveillance in Fujian, China: epidemiological features of two epidemic waves and public health implications}},
  author = {Jiawei Lin and Senshuang Zheng and Zhifang Zhang and Jingjing Cai and Cailin Chen and Yuedong Lin and Jianming Ou and Hansong Zhu and Wenjing Ye and Shenggen Wu},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1857657},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1857657/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Multi-source COVID-19 surveillance in Fujian, China: epidemiological features of two epidemic waves and public health implications
AU  - Jiawei Lin
AU  - Senshuang Zheng
AU  - Zhifang Zhang
AU  - Jingjing Cai
AU  - Cailin Chen
AU  - Yuedong Lin
AU  - Jianming Ou
AU  - Hansong Zhu
AU  - Wenjing Ye
AU  - Shenggen Wu
PY  - 2026
DA  - 2026/10/29
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1857657
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1857657/full
AB  - Objective: Using Fujian’s multi-source Coronavirus Disease 2019 (COVID-19) surveillance system, this study compared epidemiological features and indicator associations of two successive epidemic waves to optimize epidemic surveillance and prevention strategies.  Methods: Multi-source surveillance data were collected from week 49 of 2022 (the week of December 7, 2022, when the 10 optimization measures were issued) to week 29 of 2023 (July 17–23, 2023) in Fujian Province, including reported COVID-19 cases, fever clinic visits, population nucleic acid testing, sentinel hospital surveillance, hospitalized severe cases, and viral variants. Descriptive epidemiology, Spearman correlation, and lagged cross-correlation analyses were adopted for data evaluation.  Results: The first wave showed a sharp peak pattern, with most indicators peaking around weeks 51–52/2022 and reported cases peaking at week 1/2023; the second wave exhibited a gradual peak at week 21/2023. Peak levels of the second wave were 10.7–99.9% lower across indicators, although the markedly reduced nucleic acid testing volume and changed surveillance conditions warrant cautious interpretation of cross-wave comparisons. The interval between the two epidemic peaks was about 5 months, and severe cases consistently lagged infection peaks by approximately 2 weeks. Indicators were strongly correlated, with the highest correlation between sentinel and nucleic acid positivity rates (rs = 0.92, p < 0.001); lagged cross-correlation analysis indicated that these two indicators moved essentially in synchrony. The XBB variant took approximately 4 weeks from initial local detection to predominance alongside the second epidemic peak.  Conclusion: The two observed epidemic peaks were approximately 5 months apart, and multi-source surveillance indicators showed high temporal concordance. However, lagged cross-correlation indicated that the indicators moved essentially in synchrony, so sentinel surveillance should be regarded as a complementary monitoring tool rather than a proven early-warning measure. The XBB variant reached predominance approximately 4 weeks after initial local detection in this episode, a descriptive observation that cannot be generalized as a validated predictive tool. These findings facilitate multi-wave epidemic preparedness and surveillance improvement.
SN  - 2296-2565
ER  -