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We aim to examine the associations of six ambient pollutants with influenza transmissibility in China and assess the effect of the depletion of susceptibles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Provincial\u2010level surveillance data on weekly influenza\u2010like illness (ILI) incidence and viral activity were utilized to estimate the instantaneous reproduction number (R<jats:sub>t<\/jats:sub>) using spline functions. Log\u2010linear regression and the distributed lag non\u2010linear model (DLNM) were employed to investigate the effects of ambient pollutants\u2014ozone (O<jats:sub>3<\/jats:sub>), particulate matter \u22642.5\u00a0\u03bcm (PM<jats:sub>2.5<\/jats:sub>), particulate matter \u226410\u00a0\u03bcm (PM<jats:sub>10<\/jats:sub>), nitrogen dioxide (NO<jats:sub>2<\/jats:sub>), sulfur dioxide (SO<jats:sub>2<\/jats:sub>), and carbon monoxide (CO)\u2014on influenza transmissibility across 30 Chinese provinces from 2014 to 2019. Additionally, the potential effects of the depletion of susceptibles and regional characteristics were explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There is a significantly positive correlation between influenza transmissibility and five distinct ambient pollutants: PM<jats:sub>2.5<\/jats:sub>, PM<jats:sub>10<\/jats:sub>, SO<jats:sub>2<\/jats:sub>, CO, and NO<jats:sub>2<\/jats:sub>. On average, these ambient pollutants explained percentages of the variance in R<jats:sub>t<\/jats:sub>: 0.8%, 0.8%, 1.9%, 1.3%, and 1.4%, respectively. Conversely, O<jats:sub>3<\/jats:sub> was found to be negatively associated with R<jats:sub>t<\/jats:sub>, explaining 1.5% of the variance in R<jats:sub>t<\/jats:sub>. When controlling for the effect of susceptibles depletion, the effects of all pollutants were more pronounced. The effects of PM<jats:sub>2.5<\/jats:sub>, PM<jats:sub>10<\/jats:sub>, CO, and SO<jats:sub>2<\/jats:sub> were higher in the eastern and southern regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most ambient pollutants may potentially contribute to the facilitation of human\u2010to\u2010human influenza virus transmission in China. This observed association was maintained even after adjusting for variation in the susceptible population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/irv.13177","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T02:39:37Z","timestamp":1690166377000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The association between ambient pollutants and influenza transmissibility: A nationwide study involving 30 provinces in China"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0064-272X","authenticated-orcid":false,"given":"Jiao","family":"Yang","sequence":"first","affiliation":[{"name":"School of Population Medicine and Public Health Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guohui","family":"Fan","sequence":"additional","affiliation":[{"name":"School of Population Medicine and Public Health Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"},{"name":"National Center for Respiratory Medicine National Clinical Research Center for Respiratory Diseases, China\u2010Japan Friendship Hospital  Beijing China"},{"name":"Institute of Respiratory Medicine Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"},{"name":"Department of Clinical Research and Data management Center of Respiratory Medicine, China\u2010Japan Friendship Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Life Course and Population Sciences King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Population Medicine and Public Health Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunshao","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Population Medicine and Public Health Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luzhao","family":"Feng","sequence":"additional","affiliation":[{"name":"School of Population Medicine and Public Health Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weizhong","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Population Medicine and Public Health Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(17)33293\u20102"},{"key":"e_1_2_10_3_1","volume-title":"Seasonal Influenza Factsheet","author":"WHO","year":"2018"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/v14112563"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0806852106"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sste.2021.100432"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467\u2010021\u201023440\u20101"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2013.06.022"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0169\u20105347(02)02502\u20108"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2022.104421"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11356\u2010022\u201022814\u20102"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12940\u2010016\u20100115\u20102"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1476\u2010069X\u201013\u2010102"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwt132"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0407293101"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00369\u20102018"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","unstructured":"Van SeventerJM HochbergNS.Principles of Infectious Diseases: Transmission Diagnosis Prevention. 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