Objective  To systematically assess the non-linear and lag effects of daily mean temperature on varicella incidence in Weifang using a distributed lag non-linear model (DLNM).

Methods Surveillance data on varicella cases and concurrent meteorological data in the Weifang area from January 2014 to December 2023 were collected. A DLNM was applied to analyze the exposure-response relationship between daily mean temperature and varicella incidence in Weifang area.

Results A total of 7,871 varicella cases were reported in Weifang area during the study period. Daily mean temperature correlated negatively with case counts (r_s=−0.235, P<0.001). With the median of daily mean temperature (15.69 ℃) as the reference value, the relative risk (RR) value was higher under low temperature conditions, and the influence of low temperature appeared in the early lag period (0~9 d), while the effect of hightemperature showed a two-stage characteristic. Inthe earlylag (0~7days), it was a weak riskfactor, but inthe later lag(e.g., 14 days), it may turnintoa protective factor. Subgroup analysis revealed that varicella incidence had significant seasonal heterogeneity and age differences, and the incidence risk of the 3~6 years old group in winter was 1.9 times that in summer, showing an obvious seasonal fluctuation pattern. Sensitivity analysis confirmed model robustness.

Conclusion Temperature nonlinearly influences varicella incidence in Weifang, with low temperatures posing sustained risks and high temperatures exhibiting a mild and biphasic lag pattern. Prevention and control measures should be strengthened in crowded places such as schools and childcare institutions.

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