Scrub Typhus in Mainland China, 2006–2012: The Need for Targeted Public Health Interventions

Zhang, Wenyi; Wang, Li Ya; Ding, Fan; Hu, Wenbiao; Magalhães, Ricardo J. Soares; Sun, Haiyan; Liu, Yunxi; Liu, Qiyong; Huang, Liuyu; Clements, Archie C. A.; Li, Shenlong; Li, Chengyi

doi:10.1371/journal.pntd.0002493

Cited by 53 publications

(59 citation statements)

References 13 publications

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“…This could be the result of lower awareness of scrub typhus and reduced use of protective measures when playing in grassland or woods. 11 The results of our study indicated that from 2006 to 2014 scrub typhus occurred mainly in southern provinces and also documented an increase in both the number of reported cases and counties that reported scrub typhus cases. The increase of scrub typhus in southern provinces could be associated with societal changes.…”

Section: Discussionsupporting

confidence: 51%

“…This change in the population distribution could have increased the rate of human exposure to forests, riverbanks, and grassy regions that provide optimal environmental conditions for infected mites to thrive. 11,15 Moreover, the results showed deaths caused by scrub typhus mainly occurred in southern provinces, which could be explained by differences in the virulence of O. tsutsugamushi strains or by differences in vector competence between regions. In southern provinces of China, the primary vector of scrub typhus, Leptotrombidium deliense, is associated with higher pathogenicity compared with Leptotrombidium scutellare, which is the dominant species in the northern provinces.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Increase in Scrub Typhus Incidence in Mainland China, 2006–2014

Wu¹,

Qian²,

Magalhães³

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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Abstract. Scrub typhus is a vector-borne disease, which has recently reemerged in China. In this study, we describe the distribution and incidence of scrub typhus cases in China from 2006 to 2014 and quantify differences in scrub typhus cases with respect to sex, age, and occupation. The results of our study indicate that the annual incidence of scrub typhus has increased during the study period. The number of cases peaked in 2014, which was 12.8 times greater than the number of cases reported in 2006. Most (77.97%) of the cases were reported in five provinces (Guangdong, Yunnan, Anhui, Fujian, and Shandong). Our study also demonstrates that the incidence rate of scrub typhus was significantly higher in females compared to males (P < 0.001) and was highest in the 60-69 year age group, and that farmers had a higher incidence rate than nonfarmers (P < 0.001). Different seasonal trends were identified in the number of reported cases between the northern and southern provinces of China. These findings not only demonstrate that China has experienced a large increase in scrub typhus incidence, but also document an expansion in the geographic distribution throughout the country.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Rapid Increase in Scrub Typhus Incidence in Mainland China, 2006–2014

Wu¹,

Qian²,

Magalhães³

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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“…Identifying clusters is of practical importance by providing health authorities with a rational basis to redirect their efforts to new or more specific high risk regions for environmental management, and implementing public health interventions, such as vaccinations and health education, in high-risk populations. Our study also demonstrates that GIS-based spatiotemporal analyses serve as useful tools to analyze the changing patterns of infectious diseases that have wider application in the field of surveillance and infectious disease management [6] , [10] , [13] , [23] , [24] , [26] , [28] . Additionally, these methods serve as an important strategy to better identify and characterize the dynamics of environmental correlates influencing pathogen maintenance.…”

Section: Discussionmentioning

confidence: 71%

Spatiotemporal Transmission Dynamics of Hemorrhagic Fever with Renal Syndrome in China, 2005–2012

et al. 2014

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BackgroundHemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by many serotypes of hantaviruses. In China, HFRS has been recognized as a severe public health problem with 90% of the total reported cases in the world. This study describes the spatiotemporal dynamics of HFRS cases in China and identifies the regions, time, and populations at highest risk, which could help the planning and implementation of key preventative measures.MethodsData on all reported HFRS cases at the county level from January 2005 to December 2012 were collected from Chinese Center for Disease Control and Prevention. Geographic Information System-based spatiotemporal analyses including Local Indicators of Spatial Association and Kulldorff's space-time scan statistic were performed to detect local high-risk space-time clusters of HFRS in China. In addition, cases from high-risk and low-risk counties were compared to identify significant demographic differences.ResultsA total of 100,868 cases were reported during 2005–2012 in mainland China. There were significant variations in the spatiotemporal dynamics of HFRS. HFRS cases occurred most frequently in June, November, and December. There was a significant positive spatial autocorrelation of HFRS incidence during the study periods, with Moran's I values ranging from 0.46 to 0.56 (P<0.05). Several distinct HFRS cluster areas were identified, mainly concentrated in northeastern, central, and eastern of China. Compared with cases from low-risk areas, a higher proportion of cases were younger, non-farmer, and floating residents in high-risk counties.ConclusionsThis study identified significant space-time clusters of HFRS in China during 2005–2012 indicating that preventative strategies for HFRS should be particularly focused on the northeastern, central, and eastern of China to achieve the most cost-effective outcomes.

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“…Importantly, all 4 fatal cases had severe chronic conditions, putting them at increased the risk of fatality [24]. The median age of cases was 58, much higher than those reported from other areas [8,9,25], it is to be anticipated that older, particularly elderly, scrub typhus patients will be more likely to develop complications, which may be one of the reasons contributing to the high mortality observed in this outbreak. In addition, since this outbreak occurred before the seasonal epidemic peak of Guangzhou, the time of diagnosis may have been delayed by insufficient awareness among clinicians.…”

Section: Discussionmentioning

confidence: 99%

A city park as a potential epidemic site of scrub typhus: a case–control study of an outbreak in Guangzhou, China

et al. 2014

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BackgroundScrub typhus is an important public health problem in China, especially in Guangzhou city. Typical outbreaks of scrub typhus have been previously reported in rural areas, affecting mainly farmers. We describe an atypical outbreak of the disease with case fatalities, from a park in Haizhu District, Guangzhou, that could turn out to be a potential scrub typhus epidemic site.MethodsFrom May 2012 to June 2012, a case–control study was conducted to identify source and risk factors of this outbreak. Reported cases of scrub typhus in Xiaogang Park were confirmed by Weil–Felix test or a nested polymerase chain reaction (NPCR). Controls were matched with their neighbors by gender and age. Multivariate conditional logistic regression was used to identify risk factors and protective factors.ResultsA total of 29 cases were confirmed by Weil–Felix test, including 4 deaths by both Weil–Felix test and NPCR. All patients presented with fever (100%), while 28 (96.6%) cases had eschars, 10 (34.5%) headache, 10 (34.5%) chills, 6 (20.7%) lymphadenopathy, 5 (17.2%) rash, 2 (6.9%) vomiting and 1 (3.5%) presented with conjunctival congestion. The proportion of cases with activity history in Xiaogang Park was much higher than the control group (72.4% vs 24.1%, P < 0.001), and morning exercise in park or field was also as a risk factor for scrub typhus (adjusted OR = 3.0, 95% CI: 1.1 - 8.2). Four factors were significantly associated with the risk of developing scrub typhus: sitting on the lawn (adjusted OR = 8.0, 95% CI: 1.4 - 44.5), close contact with rats (adjusted OR = 3.3, 95% CI: 1.2 -9.6), sitting near the rat holes (OR = 6.8, 95% CI: 1.2 - 38.1) and wearing long-sleeved clothing when outside (adjusted OR = 0.3, 95% CI: 0.1 - 0.7).ConclusionsWe confirmed an atypical outbreak of scrub typhus in a park in Guangzhou city, which has the potential to develop into an important epidemic site. This public health risk should not be neglected and requires more attention from authorities.

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Scrub Typhus in Mainland China, 2006–2012: The Need for Targeted Public Health Interventions

Cited by 53 publications

References 13 publications

Rapid Increase in Scrub Typhus Incidence in Mainland China, 2006–2014

Rapid Increase in Scrub Typhus Incidence in Mainland China, 2006–2014

Spatiotemporal Transmission Dynamics of Hemorrhagic Fever with Renal Syndrome in China, 2005–2012

A city park as a potential epidemic site of scrub typhus: a case–control study of an outbreak in Guangzhou, China

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