Epidemiological Characteristics and Spatiotemporal Analysis of Acute Hemorrhagic Conjunctivitis from 2004 to 2018 in Chongqing, China

Abstract

Chongqing is one of the five provinces in China that has the highest incidence of acute hemorrhagic conjunctivitis (AHC). Data of AHC cases from 2004 to 2018 were obtained from National Notifiable Diseases Reporting Information System (NNDRIS). Descriptive statistical methods were used to analyze the epidemiological characteristics; incidence maps were used to reflect incidence trends in each district; spatial autocorrelation was used to identify hotspot regions and spatiotemporal patterns of AHC outbreaks; spatiotemporal scan were conducted to identify AHC clusters. A total of 30,686 cases were reported with an annual incidence of 7.04 per 100,000. The incidence rates were high in 2007 and 2014, and large epidemics were observed in 2010 with the seasonal peak in September. Individuals aged 10-19 years, males, students and farmers were the prime high-risk groups. Except for 2012 and 2013, the spatial distribution of AHC did not exhibit significant global spatial autocorrelation. Local indicators of spatial association showed that the high-risk regions are Chengkou and Wuxi. The spatiotemporal scan indicated that all clusters occurred in September 2010, and the high-incidence clusters were mainly distributed in the northeast of Chongqing. The results could assist public health agencies to consider effective preventive measures based on epidemiological factors and spatiotemporal clusters in different regions. Acute hemorrhagic conjunctivitis (AHC) is a highly infectious viral disease caused by enterovirus 70 (EV70), coxsackievirus A24 variant (CA24v), or adenoviruses 1,2. It is characterized by rapid onset of symptoms, quick dissemination and short incubation period 3. The main manifestations of AHC are bilateral eye pain, eyelid swelling, conjunctival congestion, keratitis, foreign body sensation and increased ocular secretions 4. Generally, the majority of patients exhibit obvious symptoms but good prognosis. A small number of patients will rapidly develop systemic symptoms such as fever, fatigue and limb pain. A few patients develop serious complications and fatal infections 5. Since it was first reported in Ghana in 1969 6 , AHC has seen several periodic outbreaks around the world 7 , mainly in Asia, Africa and Latin America 4. The first outbreak of AHC in China was reported in Hong Kong in 1971 8. At present, it has spread to all provinces and cities, including some remote areas 9. From 2005 to 2012, the reported incidence of AHC in China was 4.12 per 100,000, and Guangxi, Guangdong, Chongqing, Sichuan and Hubei were ranked as the top 5 incidence provinces 10. Currently, AHC is still an important public health problem in China 11 , which is worth exploring and studying. Most of the previous studies on AHC focused on the epidemiological and etiological characteristics 12. However, the research on the spatial and temporal characteristics of AHC was still scarce. The geographical information system (GIS) has been widely used to analyze the spatiotemporal characteristics of diseases, helping to monitor and prevent...

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