The study drew on monthly and annual reported case counts from China’s Public Health Science Data Center, covering 192 consecutive monthly observations for each virus from January 2005 to December 2020. Reported incidence was calculated as cases per 100,000 permanent residents, using year-end population figures from the Hainan Provincial Bureau of Statistics as the denominator. To place the provincial data in context, the team also extracted national Global Burden of Disease (GBD) estimates for China spanning 1990 to 2023, and they obtained annual tourist visit statistics from the provincial tourism department. No missing or duplicate observations were identified, and no study years were excluded, giving the analysis a complete and unbroken record.

Joinpoint regression, a technique that identifies inflection points in a time series and estimates the annual percent change (APC) within each segment, revealed a distinctly phased pattern for reported hepatitis B incidence in Hainan. Rates fell from 2005 to 2008 with an APC of −9.10 percent per year, rose from 2008 to 2018 with an APC of +10.50 percent per year, and then showed a non-significant decline through 2020. Across the full sixteen years, the average annual percent change (AAPC) was +3.37 percent, a statistically significant overall increase. Reported hepatitis C followed a different course: it climbed continuously from 2005 to 2015 at a striking +32.10 percent per year, then declined at −10.90 percent per year through 2020, yielding an overall AAPC of +14.54 percent. By contrast, the national GBD estimates showed overall AAPCs of −0.54 percent for hepatitis B and −1.52 percent for hepatitis C, both modestly downward over their respective periods.

The divergence between provincial reported data and national modeled estimates is a central finding. The authors caution that the two data sources differ in definition and origin, so national GBD trends serve only as contextual references. Still, the mid-period rise in reported hepatitis B in Hainan is unlikely to reflect a simple failure of vaccination strategy. China added hepatitis B vaccination to its childhood immunization program decades ago, and studies from Guangzhou and Xiamen have documented declining reported incidence in those cities. The Hainan increase may instead reflect expanded screening, greater detection of previously acquired chronic infections, repeated healthcare encounters, rising healthcare accessibility, and changes in reporting-system sensitivity, layered on top of genuine transmission dynamics and increasing vaccine-derived protection in younger birth cohorts. China continues to carry a large reservoir of chronic hepatitis B infection, and insufficient diagnosis, treatment, and follow-up remain major barriers to elimination.

For hepatitis C, the pre-2015 surge in reported incidence plausibly mirrors improvements in testing capacity, strengthening of the reporting infrastructure, and increased screening that uncovered previously undiagnosed infections. The post-2015 decline coincided with broader gains in blood safety, awareness, screening, and access to antiviral therapy, including the transformative arrival of direct-acting antivirals (DAAs), which can cure chronic hepatitis C infection in most treated patients. Yet the authors note that Hainan-specific information on testing and treatment coverage was unavailable, so the analysis cannot determine whether these factors caused the observed decline. A large pool of undiagnosed infections may continue to limit progress, since DAAs alone cannot reach patients who are never screened or linked to care.

Seasonality, often a signature of environmentally driven pathogens, was conspicuously absent for both viruses. The team applied seasonal-trend decomposition using Loess (STL), an additive method that splits each monthly series into trend, seasonal, and remainder components with a twelve-month seasonal period. Kruskal–Wallis tests comparing the distributions of the STL seasonal components across calendar months found no statistically significant differences for hepatitis B (H = 11.10, P = 0.435) or hepatitis C (H = 2.81, P = 0.993). Descriptive seasonality indices were highest in July for hepatitis B (107.8) and April for hepatitis C (107.4), and lowest in February for both (78.3 and 73.9, respectively). The February trough may relate to reduced healthcare seeking and delayed testing during the Spring Festival holiday, but the authors stress that these fluctuations likely reflect reporting variation rather than seasonal transmission, and that long-term trends and population-structure changes carry greater public health relevance than isolated monthly peaks.

To project future trajectories, the researchers fitted seasonal autoregressive integrated moving average (SARIMA) models to the monthly series. For hepatitis B, the selected model was SARIMA (0,1,2) × (2,1,0) with a twelve-month seasonal cycle, which had the lowest Akaike information criterion among candidates and passed the Ljung–Box residual autocorrelation test at lag 12 (Q = 10.771, P = 0.549). For hepatitis C, SARIMA (1,1,1) × (0,0,1) was chosen because an alternative with slightly lower information criteria retained significant residual autocorrelation; the selected model showed acceptable diagnostics at lag 24 (Q = 31.162, P = 0.074). Forecasting to 2030, the annualized projected reported hepatitis B incidence was 12.00 per 100,000 population, with a 95 percent prediction interval spanning roughly 0.00 to 121.20, numerically close to the study-defined reference value of 12.20. The hepatitis C projection was 22.54 per 100,000 (approximately 0.00 to 39.10), about 6.4 times the study-defined reference value of 3.55. The reference values were defined as 10 percent of the corresponding 2015 reported incidence rates, echoing the WHO framework of a 90 percent reduction in new infections by 2030, but the authors insist they are not equivalent to WHO elimination targets.

The wide prediction intervals, generated from 10,000 simulated forecast paths, signal substantial long-term uncertainty, and the authors repeatedly warn that the projections are conditional extrapolations of historical reporting patterns. A declining trend, they note, does not necessarily imply proximity to elimination. Hepatitis B control depends on sustained immunization coverage, prevention of mother-to-child transmission, adult diagnosis and treatment, and management of chronic infection, whereas hepatitis C elimination hinges on active screening, rapid linkage to treatment after diagnosis, and improved treatment coverage. Insufficient screening, incomplete linkage to care, declining treatment uptake, and ongoing transmission in high-risk populations may all weaken control efforts even in the DAA era.

Sensitivity analyses highlighted the disruptive fingerprint of the COVID-19 pandemic year. When Joinpoint models were refitted excluding 2020, the overall AAPC rose from 3.37 to 4.96 percent per year for hepatitis B and from 14.54 to 16.43 percent per year for hepatitis C, indicating that the 2020 observations deviated from prior reporting patterns and pulled the long-term trend estimates downward. Out-of-sample SARIMA forecasts built on 2005–2019 data predicted a mean monthly reported hepatitis B incidence of 15.11 per 100,000 for 2020, but the observed value was 10.98, some 27.3 percent lower; for hepatitis C, the forecast of 1.92 exceeded the observed 1.74 by 9.5 percent. Reduced healthcare seeking, testing, and reporting during pandemic-control measures, consistent with findings from China, Spain, and Italy, likely explain these shortfalls rather than any sudden improvement in prevention.

Finally, the study explored ecological associations between annual tourist visits, which grew from roughly 17 million in 2005 to about 83 million in 2019 before falling to approximately 56 million in 2020, and reported hepatitis incidence. In raw annual analyses, tourist visits correlated strongly with both reported hepatitis B (r = 0.871) and hepatitis C (r = 0.879), both P < 0.001, and the associations persisted after excluding 2020. However, because both series shared pronounced long-term trends, the team repeated the correlations on first-differenced and linearly detrended data. Only the hepatitis B association survived (r = 0.567 after differencing, P = 0.028; r = 0.691 after detrending, P = 0.003), while the hepatitis C association vanished (r = 0.070, P = 0.804 after differencing). The authors interpret this cautiously: tourism volume may reflect concurrent changes in population mobility, healthcare use, screening activity, socioeconomic development, and reporting capacity rather than any direct causal effect on transmission. The analyses were aggregated and exploratory, lacking individual-level data on age, sex, vaccination status, transmission route, testing, and treatment. The authors conclude that Hainan should maintain hepatitis B immunization and screening while prioritizing hepatitis C screening, diagnosis, and linkage to treatment, supported by continued surveillance among mobile and key populations as the province’s free trade port development accelerates population mobility.

Subject of Research: Infectious Disease Epidemiology

Article Title: Trends and forecasting of reported hepatitis B and hepatitis C incidence in Hainan Province, China, 2005–2020

Article References: Wang, J., Li, S., Fu, C., Su, Y., Fu, H., Tian, Y., & Lan, C. (2026). Trends and forecasting of reported hepatitis B and hepatitis C incidence in Hainan Province, China, 2005–2020. Frontiers in Epidemiology, 6, Article 1899759. https://doi.org/10.3389/fepid.2026.1899759

Image Credits: AI Generated

DOI: 10.3389/fepid.2026.1899759

Keywords: hepatitis B, hepatitis C, Hainan Province, time-series analysis, SARIMA forecasting, viral hepatitis surveillance, China, Trends, forecasting, reported, hepatitis, incidence

Fusarium is no ordinary genus. Established more than two centuries ago by Link in 1809, it encompasses fungi defined by their elongated, fusoid, multiseptate, falcate macroconidia — the distinctive banana-shaped spores that give the group its name. Its members occupy wildly different ecological roles: some live as harmless saprobes recycling dead plant matter, others as endophytes tucked inside healthy tissues, and still others as devastating pathogens of crops, and even of humans and animals. Many produce mycotoxins, making accurate species identification a matter of global food security as well as pure taxonomy.

Yet identifying Fusarium species is notoriously difficult. Overlapping spore morphology and inconsistent taxonomic frameworks have long muddied the waters, which is why modern mycologists increasingly rely on multi-locus phylogenetic analyses — comparing DNA sequences from several genes at once — to draw species boundaries. The genus currently comprises 20 recognized species complexes plus three undefined groupings, and the two new Hainan species each slot into a different one of these evolutionary lineages.

The first newcomer, isolated from Mallotus japonicus, belongs to the Fusarium lateritium species complex, or FLSC. This group carries historical weight: the name Fusarium lateritium was proposed by Nees in 1817 from a collection on Fagus twigs, and in 1917 Wollenweber established Section Lateritium for species with pale to rose-colored cultures, blue erumpent sclerotia, intercalary chlamydospores, and relatively straight macroconidia with a curved, often beaked apical cell and a pedicellate foot-cell. When O’Donnell and colleagues delimited the FLSC in 2013 using multi-locus phylogeny, it contained just three species — F. lateritium, F. stilboides, and F. sarcochroum. Today the complex has grown to 29 accepted phylogenetic species, many recovered from woody plants, a trajectory that strongly suggests its true richness remains underestimated, particularly in understudied regions and hosts.

The new species has been named Fusarium malloti, honoring its host genus. In phylogenetic trees built from concatenated sequences of four genes — tef1, tub2, rpb2, and CaM — the isolate formed a well-supported clade, with maximum likelihood bootstrap support of 100 percent and Bayesian posterior probability of 1.0, sitting sister to F. lateritium itself. The analysis included 134 Fusarium isolates across 32 species, with the alignment spanning 3,102 nucleotide positions, of which 206 were parsimony-informative. Morphologically, F. malloti can be distinguished from its closest relative by the septation of its sporodochial conidia — 1 to 6 septa with 2-septate conidia absent, compared with 3 to 6, occasionally up to 9, in F. lateritium — and by the smaller size of its 6-septate conidia, which measure 47.7 to 51.2 by 3.9 to 5.3 micrometers versus roughly 75.3 to 78.9 by 5.0 to 6.5 micrometers in the older species. Sequence differences reinforce the split: 8 base pair differences in tef1, 14 in rpb2, and 2 in tub2.

The second discovery came from Castanopsis, a genus of Fagaceae oaks and chestnuts, and landed in a very different corner of the Fusarium tree: the Fusarium torreyae species complex, or FtorSC. This complex was established through comparative studies of canker pathogens attacking Torreya taxifolia in Florida and Zanthoxylum bungeanum in China, and originally comprised three core species — F. torreyae, F. zanthoxyli, and F. continuum. Only recently, with the discovery of F. verae from soil in New South Wales, Australia, did the complex grow to four species. The Hainan isolate, now described as Fusarium castanopsidicola, resolved as a distinct lineage sister to F. verae, supported by five genetic markers: ITS, LSU, rpb1, rpb2, and tef1. Its addition extends the known host range of the FtorSC to a new woody host family.

The phylogenetic evidence for F. castanopsidicola is equally robust. In a tree containing 14 isolates, with F. venenatum as the outgroup, the new species formed a clade with 100 percent bootstrap support and a posterior probability of 1.0. The concatenated alignment stretched across 5,084 nucleotide bases, with 488 parsimony-informative characters. Genetic distances from its nearest relative are clear: 6 differences out of 286 base pairs in tef1 and 24 out of 1,744 in rpb2. Morphologically, the fungus produces cinnamon-colored sporodochia on carnation leaves, densely branched conidiophores, and falcate, dorsiventrally curved conidia with 1 to 5 septa; no chlamydospores were observed. Its closest relative, F. verae, lacks a published morphological description, making the genetic distinction all the more important.

Both species were recovered using standard but meticulous methods. Infected leaf fragments measuring five by five millimeters were excised from lesion margins, surface-sterilized through sequential immersion in 75 percent ethanol, sterile water, and 5 percent sodium hypochlorite, then plated on potato dextrose agar and incubated at 25 degrees Celsius in the dark. Pure cultures were characterized after seven days, with colony morphology, pigmentation, and growth rates documented, and microscopic structures measured under differential interference contrast optics. DNA was extracted using the CTAB method, amplified with locus-specific primers, and sequenced, with all new sequences deposited in GenBank. Voucher specimens are preserved at Shandong Agricultural University, and ex-type cultures are held in both the SAUCC and CGMCC collections, ensuring the names are permanently anchored to physical material.

Why does this matter beyond the catalog of names? Fusarium species are among the most economically consequential fungi on Earth, and knowing exactly which species is where is the foundation of disease diagnosis and management. The FLSC in particular holds biological intrigue: while information on secondary metabolite production by its members remains scarce, genome sequences of F. sarcochroum have revealed gene clusters potentially linked to sphinganine-analog mycotoxins, and a recent study showed that an F-box protein in endophytic F. lateritium acts as a molecular switch between symbiosis and pathogenesis by disrupting auxin homeostasis through beta-carboline chemistry. Whether F. malloti harbors similar biosynthetic machinery is an open question that future genomic and metabolomic work could answer, potentially unlocking biotechnological applications.

For now, the authors caution that only limited strains were obtained for each species, and further sampling is needed to clarify the ecological roles these fungi play in Asian forest ecosystems. But the message of the study is unmistakable: even in a genus as intensively studied as Fusarium, tropical hotspots like Hainan continue to yield surprises. With more than 1,907 species epithets already listed in Index Fungorum and species complexes still expanding, the intersection of careful morphology and multi-locus DNA analysis is proving the indispensable toolkit for mapping the true diversity of a genus that shapes agriculture, medicine, and forest ecology alike.

Subject of Research: Discovery and phylogenetic characterization of two new Fusarium species from Hainan Province, China

Article Title: Morphological and phylogenetic analyses reveal new species of the Fusarium lateritium species complex and Fusarium torreyae species complex ( Nectriaceae , Hypocreales ) from Hainan Province, China

Article References: Zhang, J., Wang, Y., Yuan, J., & Zhang, X. (2026). Morphological and phylogenetic analyses reveal new species of the Fusarium lateritium species complex and Fusarium torreyae species complex (Nectriaceae, Hypocreales) from Hainan Province, China. MycoKeys, 141, 45-62. https://doi.org/10.3897/mycokeys.141.209463

Image Credits: AI Generated

DOI: 10.3897/mycokeys.141.209463

Keywords: Fusarium, Fusarium lateritium species complex, Fusarium torreyae species complex, Hainan Province, fungal taxonomy, phylogenetics, multi-locus analysis, Nectriaceae, Hypocreales, Castanopsis, Mallotus japonicus, new species

The research team, led by Shiye Deng and corresponding author Lei Qiu of Hainan Medical University, recruited 1,294 women seeking treatment at two tertiary reproductive care centers in Hainan Province, a tropical island region where cultural expectations around childbearing remain strong. Every participant completed a battery of validated psychometric instruments: the Infertility Stigma Scale, which captures both externally imposed public stigma and internally directed self-devaluation; the Fertility Problem Inventory, which measures five distinct domains of fertility-related stress including social concern, sexual concern, relationship concern, the need for parenthood, and rejection of a childfree lifestyle; the Patient Health Questionnaire-9 for depressive symptoms; and the Family APGAR Questionnaire, a brief measure of perceived family function across adaptation, partnership, growth, affection, and resolve.

Methodologically, the study stands out for pairing two complementary analytical frameworks. The first, latent profile analysis, is a person-centered technique that searches for hidden subgroups of individuals who share similar patterns across multiple measured variables. Rather than asking which symptoms correlate with which, it asks whether distinct types of people exist. The researchers fed four stigma subscales and five stress subscales into the model and tested solutions with increasing numbers of profiles, using statistical fit indices including the Akaike and Bayesian information criteria, adjusted Bayesian information criterion, the Lo-Mendell-Rubin test, and a bootstrap likelihood ratio test. As a robustness check, they repeated the classification with k-means clustering, a fundamentally different algorithm.

The answer that emerged was strikingly orderly. Three profiles were retained, and they differed from one another in degree rather than in kind. The largest group, 563 women or 43.5 percent of the sample, showed low stigma paired with low stress. A nearly equal second group of 540 women, 41.7 percent, occupied the moderate range on both dimensions. The smallest and most concerning group comprised 191 women, 14.8 percent, who carried high levels of both stigma and stress simultaneously. Notably, the researchers found no evidence of profiles in which stigma was high but stress was low, or vice versa, which is precisely the pattern one would expect if the two constructs formed genuinely distinct psychosocial subtypes. Instead, the data describe a severity continuum.

Who ended up in the high-burden group was far from random. Using an automatic three-step multinomial logistic regression corrected for classification error, the team identified several sociodemographic and clinical correlates. Women living in rural areas, those with lower educational attainment, and those reporting greater perceived financial strain had significantly higher odds of belonging to the high stigma-high stress profile. The diagnostic picture also mattered: women whose infertility was attributed to male factors or remained of unknown origin had lower odds of high-burden membership than women diagnosed with female-factor infertility, a finding that likely reflects the differential blame and social judgment attached to female infertility in many communities. Meanwhile, a longer time since diagnosis was associated with membership in the moderate-burden profile rather than the low-burden one, suggesting that the psychological weight of infertility does not simply dissipate with time spent in the treatment system.

The second analytical framework, symptom-level network analysis, shifted the lens from whole persons to individual symptoms and their pairwise relationships. Network analysis treats psychological variables as nodes in a graph, with statistical associations drawn as edges connecting them. Using the EBICglasso estimator, which applies a least absolute shrinkage and selection operator penalty with an extended Bayesian information criterion to prune spurious connections, the researchers built a network spanning all stigma, stress, depressive symptom, and family function items. They then assessed the stability of the resulting structure through bootstrapping, verified that centrality rankings held across alternative estimation methods, estimated exploratory networks within each latent profile, and formally compared networks across profiles using statistical difference tests.

The full-sample network pinpointed the specific nodes that act as the psychological system’s most influential hubs. On the stigma and stress side, public stigma, the perception of devaluing attitudes from the wider community, and self-devaluation, the internalization of those attitudes, carried the highest expected influence, a centrality metric that captures a node’s total capacity to activate the rest of the network. Among depressive symptoms, sad mood, self-harm and suicidal ideation, and psychomotor symptoms ranked highest, alongside sexual concern from the stress inventory. When the researchers examined which nodes bridged distinct psychological communities, self-devaluation again led, followed by the need for parenthood and social withdrawal. These findings carry a practical implication: interventions that target self-devaluation, such as cognitive approaches that interrupt the internalization of stigmatizing messages, may propagate benefits across stigma, stress, and depressive symptom domains simultaneously.

Family function emerged as a protective counterweight within the network. Its nodes were negatively connected with distress-related symptoms, meaning that women who perceived their families as adaptable, communicative, and emotionally supportive reported fewer and less strongly interconnected psychological difficulties. The expected influence estimates showed good stability under bootstrapping, and centrality rankings were consistent across estimators, lending credibility to the hub identification. Perhaps the most sobering network result, however, was a null one: when the researchers compared networks across the three latent profiles, they found no statistically detectable differences in global network strength or overall structure after applying Benjamini-Hochberg correction for multiple comparisons. The psychological architecture of low-burden and high-burden women, in other words, appears fundamentally similar; what differs is how intensely the same machinery is running.

Taken together, the study’s two strands deliver a coherent message for clinicians and public health planners. Because stigma and stress co-occur along a severity gradient rather than forming discrete subtypes, screening in fertility clinics can reasonably use a single integrated assessment of psychosocial burden rather than separate pathways for stigma and stress. Because a substantial minority of roughly one in seven women occupies the high-burden tier, and because rural residence, lower education, and financial strain flag elevated risk, outreach resources can be targeted toward the women least likely to advocate for themselves. And because self-devaluation, public stigma, sad mood, and suicidal ideation sit at the network’s center, clinicians should treat self-blame not as a downstream byproduct of infertility but as a plausible intervention target with cascading effects. The authors caution that the cross-sectional design cannot establish causal direction, and the sample was limited to treatment-seeking women in a single Chinese province, so generalization requires care. Still, in a field where psychological screening is often an afterthought to hormonal protocols and embryo transfers, this analysis makes a data-driven case that the wound of infertility is as much social as it is medical, and that the two wounds share a single nervous system.

Subject of Research: Infertility stigma and fertility-related stress profiles and their symptom-level associations with depression and family function among infertile women in China

Article Title: Infertility stigma-fertility stress profiles and symptom-level associations among infertile women in Hainan Province: a latent profile and network analysis

Article References: Deng, S., Wang, Y., Liu, J., Wang, M., Lin, C., Liu, M., Petersen, J. D., Yang, H., & Qiu, L. (2026). Infertility stigma-fertility stress profiles and symptom-level associations among infertile women in Hainan Province: a latent profile and network analysis. BMC Public Health. https://doi.org/10.1186/s12889-026-29453-z

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29453-z

Keywords: infertility stigma, fertility-related stress, latent profile analysis, network analysis, depressive symptoms, family function, infertile women, BMC Public Health, Hainan Province, public stigma, self-devaluation, reproductive psychology