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Peak timing for strong epidemics were correctly predicted on day 91 with a 95% credible interval of [104.42 105.08].
The methods both surpassed 95% accuracy by day 63, which was approximately two weeks before the mean peak day of 98 for strong epidemics.
Both methods achieved significantly higher accuracy in the classification of catastrophic, severe and strong epidemics compared to moderate, mild and milder epidemics.
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M. pneumoniae infections showed a strong epidemic peak, but Chlamydia spp. were consistently detected throughout the year.
In summary, we confirmed a strong epidemic peak of M. pneumoniae positive respiratory samples among adult patients with confirmed CAP in Germany during 2011 2012.
Quarterly rates of M. pneumoniae positive samples ranged from 1.5%too 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year.
Combined with Rule 1, we adopted a four-color gauge for visualizing the HFMD epidemic monitoring process, indicating the degree of severity of the epidemic, in which yellow represents an activation signal, while orange, red and purple stand for alerts of mild, moderate and strong epidemic trends in the coming month, respectively.
Although we did not include serologic testing to provide further information for the differentiation of colonization of patient from infection, the results of our study confirm a strong epidemic peak of M. pneumoniae positive respiratory samples among adult patients with suspected CAP in Germany during 2011 2012.
The spread of a disease can be deeply affected by heterogeneities in infectiousness, with high viral charge 'superspreader' individuals triggering stronger epidemic events [1].
We may expect most of the discrepancy between influenza and measles to be due to the effects of natural selection, as both infections represent acute viral infections displaying strong seasonal epidemics.
Both methodologies show support for the common occurrence of strong seasonal epidemics followed by deep troughs limiting viral diversity, for the existence of multiple viral introductions during a season, and for the lack of sustained viral persistence between epidemics [ 8, 13- 17].
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