Spatiotemporal and demographic characteristics of scrub typhus in Southwest China, 2006–2017: An analysis of population‐based surveillance data

Transboundary and Emerging DiseasesVolume 67, Issue 4 p. 1585-1594 ORIGINAL ARTICLE Spatiotemporal and demographic characteristics of scrub typhus in Southwest China, 2006–2017: An analysis of population-based surveillance data Hualei Xin, Hualei Xin orcid.org/0000-0001-8944-3980 Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Qingdao City Center for Disease Control and Prevention, Qingdao, ChinaSearch for more papers by this authorJunling Sun, Junling Sun Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, ChinaSearch for more papers by this authorJianxing Yu, Corresponding Author Jianxing Yu interconnect-yu@163.com Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Ministry of Health Key Laboratory of Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, CAMS-Foundation Mérieux, Institute of Pathogen Biology, Academy of Medical Sciences of China and Peking Union Medical College, Beijing, China Correspondence Jianxing Yu and Zhongjie Li, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Emails: interconnect-yu@163.com (J.Y.); lizj@chinacdc.cn (Z.L.)Search for more papers by this authorJilei Huang, Jilei Huang Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, ChinaSearch for more papers by this authorQiulan Chen, Qiulan Chen Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, ChinaSearch for more papers by this authorLiping Wang, Liping Wang Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, ChinaSearch for more papers by this authorShengjie Lai, Shengjie Lai Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, ChinaSearch for more papers by this authorArchie C. A. Clements, Archie C. A. Clements Faculty of Health Sciences, Curtin University, Bentley, WA, Australia Telethon Kids Institute, Nedlands, WA, AustraliaSearch for more papers by this authorWenbiao Hu, Wenbiao Hu School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, AustraliaSearch for more papers by this authorZhongjie Li, Corresponding Author Zhongjie Li lizj@chinacdc.cn Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Correspondence Jianxing Yu and Zhongjie Li, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Emails: interconnect-yu@163.com (J.Y.); lizj@chinacdc.cn (Z.L.)Search for more papers by this author Hualei Xin, Hualei Xin orcid.org/0000-0001-8944-3980 Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Qingdao City Center for Disease Control and Prevention, Qingdao, ChinaSearch for more papers by this authorJunling Sun, Junling Sun Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, ChinaSearch for more papers by this authorJianxing Yu, Corresponding Author Jianxing Yu interconnect-yu@163.com Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Ministry of Health Key Laboratory of Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, CAMS-Foundation Mérieux, Institute of Pathogen Biology, Academy of Medical Sciences of China and Peking Union Medical College, Beijing, China Correspondence Jianxing Yu and Zhongjie Li, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Emails: interconnect-yu@163.com (J.Y.); lizj@chinacdc.cn (Z.L.)Search for more papers by this authorJilei Huang, Jilei Huang Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, ChinaSearch for more papers by this authorQiulan Chen, Qiulan Chen Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, ChinaSearch for more papers by this authorLiping Wang, Liping Wang Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, ChinaSearch for more papers by this authorShengjie Lai, Shengjie Lai Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, ChinaSearch for more papers by this authorArchie C. A. Clements, Archie C. A. Clements Faculty of Health Sciences, Curtin University, Bentley, WA, Australia Telethon Kids Institute, Nedlands, WA, AustraliaSearch for more papers by this authorWenbiao Hu, Wenbiao Hu School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, AustraliaSearch for more papers by this authorZhongjie Li, Corresponding Author Zhongjie Li lizj@chinacdc.cn Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China Correspondence Jianxing Yu and Zhongjie Li, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Emails: interconnect-yu@163.com (J.Y.); lizj@chinacdc.cn (Z.L.)Search for more papers by this author First published: 24 January 2020 https://doi.org/10.1111/tbed.13492Citations: 5 Xin and Sun contributed equally to this work. 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. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat 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- to 4-year-old and 45- to 64-year-old subgroups had the highest cumulative incidence rates (57.46 and 32.98/100,000, respectively). Furthermore, since 2006, the 0- to 4-year-old (slope = 0.83, p < .01) and 45–64-year-old (slope = 0.69, p < .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 < .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. CONFLICT OF INTEREST The authors declare that they have no competing interests. Open Research DATA AVAILABILITY STATEMENT All data generated or analysed during this study are included in this published article and its Supporting Information. Citing Literature Supporting Information Filename Description tbed13492-sup-0001-tableS1.docxWord document, 28.1 KB tbed13492-sup-0002-figureS1.tifTIFF image, 3.9 MB tbed13492-sup-0003-figureS2.tifTIFF image, 1.4 MB Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume67, Issue4July 2020Pages 1585-1594 RelatedInformation