Spatiotemporal and demographic characteristics of scrub typhus in Southwest China, 2006-2017: an analysis of population-based surveillance data
Spatiotemporal and demographic characteristics of scrub typhus in Southwest China, 2006-2017: an analysis of population-based surveillance data
Scrub typhus is a life-threatening vector-borne disease. During the past decade, the number of areas affected by this disease has expanded in many countries. In this study, we aim to identify the spatiotemporal and demographic characteristics of scrub typhus in Southwest China, an emerging endemic region for scrub typhus. Population-based surveillance data capturing scrub typhus cases in two provinces of Southwest China during 2006-2017 were retrieved. Descriptive temporal and spatial analyses were conducted and stratified by age group. The space-time scan statistic was used to identify spatiotemporal clusters of scrub typhus occurrence at the county level. During the study period, 30,001 scrub typhus cases were recorded in Southwest China, with a total of 61.0% (191/313) of counties being affected; most cases (94.3%) occurred in rural areas. The annual incidence rate increased substantially from 0.25/100,000 in 2006 to 5.38/100,000 in 2017 (> 21-fold change). The 0-4-year-old and 45-64-year-old subgroups had the highest cumulative incidence rates (57.46 and 32.98/100,000, respectively). Furthermore, since 2006, the 0-4-year-old (slope=0.83, p<0.01) and 45-64-year-old (slope=0.69, p<0.01) age groups have had the highest increases in incidence of all age groups. The most likely spatial cluster of overall cases (relative risk=4.13, p<0.01) occurred in the southern region of Southwest China and included 41 high-risk counties. In conclusion, scrub typhus appears to be widely distributed and rapidly increasing in Southwest China. Young children and middle-aged adults were the most severely affected groups, and the disease appeared to predominantly cluster in the southern part of Southwest China. Further in-depth surveys to determine the epidemiological characteristics and driving factors of this emerging disease and to facilitate effective control programmes among high-risk groups in the affected areas should be promoted.
Southwest China, demographic, scrub typhus, spatiotemporal
1585-1594
Xin, Hualei
7931a8f1-70e3-439a-b86e-94246e546200
Sun, Junling
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Yu, Jianxing
992198dd-6055-4905-ab28-11ced790c57c
Huang, Jilei
385ee30d-3894-4f9c-8bcd-db71853f7513
Chen, Qiulan
ba6f6420-7bdd-4650-b34d-b5e084baff96
Wang, Liping
ef5828b8-d874-42db-bb25-713890281af2
Lai, Shengjie
b57a5fe8-cfb6-4fa7-b414-a98bb891b001
Clements, Archie C A
8598767d-7b06-4c07-b261-efad315c9ee0
Hu, Wenbiao
ac87e378-67ae-4fa0-abf1-4cefcb0870f9
Li, Zhongjie
f89a98f7-f6d3-4312-995a-bc658ae9a93f
1 July 2020
Xin, Hualei
7931a8f1-70e3-439a-b86e-94246e546200
Sun, Junling
4f56058d-f603-4758-9b92-873ac36de30f
Yu, Jianxing
992198dd-6055-4905-ab28-11ced790c57c
Huang, Jilei
385ee30d-3894-4f9c-8bcd-db71853f7513
Chen, Qiulan
ba6f6420-7bdd-4650-b34d-b5e084baff96
Wang, Liping
ef5828b8-d874-42db-bb25-713890281af2
Lai, Shengjie
b57a5fe8-cfb6-4fa7-b414-a98bb891b001
Clements, Archie C A
8598767d-7b06-4c07-b261-efad315c9ee0
Hu, Wenbiao
ac87e378-67ae-4fa0-abf1-4cefcb0870f9
Li, Zhongjie
f89a98f7-f6d3-4312-995a-bc658ae9a93f
Xin, Hualei, Sun, Junling, Yu, Jianxing, Huang, Jilei, Chen, Qiulan, Wang, Liping, Lai, Shengjie, Clements, Archie C A, Hu, Wenbiao and Li, Zhongjie
(2020)
Spatiotemporal and demographic characteristics of scrub typhus in Southwest China, 2006-2017: an analysis of population-based surveillance data.
Transboundary and Emerging Diseases, 67 (4), .
(doi:10.1111/tbed.13492).
Abstract
Scrub typhus is a life-threatening vector-borne disease. During the past decade, the number of areas affected by this disease has expanded in many countries. In this study, we aim to identify the spatiotemporal and demographic characteristics of scrub typhus in Southwest China, an emerging endemic region for scrub typhus. Population-based surveillance data capturing scrub typhus cases in two provinces of Southwest China during 2006-2017 were retrieved. Descriptive temporal and spatial analyses were conducted and stratified by age group. The space-time scan statistic was used to identify spatiotemporal clusters of scrub typhus occurrence at the county level. During the study period, 30,001 scrub typhus cases were recorded in Southwest China, with a total of 61.0% (191/313) of counties being affected; most cases (94.3%) occurred in rural areas. The annual incidence rate increased substantially from 0.25/100,000 in 2006 to 5.38/100,000 in 2017 (> 21-fold change). The 0-4-year-old and 45-64-year-old subgroups had the highest cumulative incidence rates (57.46 and 32.98/100,000, respectively). Furthermore, since 2006, the 0-4-year-old (slope=0.83, p<0.01) and 45-64-year-old (slope=0.69, p<0.01) age groups have had the highest increases in incidence of all age groups. The most likely spatial cluster of overall cases (relative risk=4.13, p<0.01) occurred in the southern region of Southwest China and included 41 high-risk counties. In conclusion, scrub typhus appears to be widely distributed and rapidly increasing in Southwest China. Young children and middle-aged adults were the most severely affected groups, and the disease appeared to predominantly cluster in the southern part of Southwest China. Further in-depth surveys to determine the epidemiological characteristics and driving factors of this emerging disease and to facilitate effective control programmes among high-risk groups in the affected areas should be promoted.
Text
Xin_et_al-2020-Transboundary_and_Emerging_Diseases
- Accepted Manuscript
More information
Accepted/In Press date: 13 January 2020
e-pub ahead of print date: 24 January 2020
Published date: 1 July 2020
Additional Information:
Funding Information:
This study was supported by the National Science and Technology Major Project (No: 2018ZX10713-001-005, 2018ZX10713-001-006, 2018ZX10101002-003-002), Emergency Response Mechanism Operation Program, Chinese Center for Disease Control and Prevention (No: 131031001000015001) and the Program of Qingdao Scrub Typhus Research (No. 2018-WJZD120). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We gratefully thank the staff members of the county-, city- and province-level Center for Disease Control and Prevention of Yunnan and Sichuan provinces for their assistance in the data collection, validation and cleaning. We also thank all the medical care institutions of Yunnan and Sichuan for their hard work on data input.
Publisher Copyright:
© 2020 Blackwell Verlag GmbH
Keywords:
Southwest China, demographic, scrub typhus, spatiotemporal
Identifiers
Local EPrints ID: 437802
URI: http://eprints.soton.ac.uk/id/eprint/437802
ISSN: 1865-1674
PURE UUID: 9056f3f0-0e9c-4749-a86d-75a9d3d40ab7
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Date deposited: 17 Feb 2020 17:32
Last modified: 06 Jun 2024 04:17
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Contributors
Author:
Hualei Xin
Author:
Junling Sun
Author:
Jianxing Yu
Author:
Jilei Huang
Author:
Qiulan Chen
Author:
Liping Wang
Author:
Archie C A Clements
Author:
Wenbiao Hu
Author:
Zhongjie Li
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