The scrub typhus in mainland China: spatiotemporal expansion and risk prediction underpinned by complex factors.,Emerging Microbes & Infections

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The scrub typhus in mainland China: spatiotemporal expansion and risk prediction underpinned by complex factors.
Emerging Microbes & Infections ( IF 8.4 ) Pub Date : 2019-06-25 , DOI: 10.1080/22221751.2019.1631719
Hongwu Yao ₁ , Yixing Wang ₂ , Xianmiao Mi ₂ , Ye Sun _{2,

3} , Kun Liu _{2,

4} , Xinlou Li _{2,

5} , Xiang Ren ₆ , Mengjie Geng ₆ , Yang Yang ₇ , Liping Wang ₆ , Wei Liu _{2,

8} , Liqun Fang ₂

Affiliation

a Department of Infection Management and Disease Control , Chinese PLA General Hospital , Beijing , People's Republic of China.
b The State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , People's Republic of China.
c Center for Disease Control and Prevention of the North Military region , Jinan , People's Republic of China.
d Department of Epidemiology and Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment , School of Public Health, Fourth Military Medical University , Xi'an , People's Republic of China.
e PLA Strategic Support Force Characteristic Medical Center , Beijing , People's Republic of China.
f Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease , Chinese Centre for Disease Control and Prevention , Beijing , People's Republic of China.
g Department of Biostatistics , College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida , Gainesville , FL , USA.
h Beijing Key Laboratory of Vector Borne and Natural Focus Infectious Diseases , Beijing , People's Republic of China.

In mainland China, a geographic northward expansion of scrub typhus has been seen, highlighting the need to understand the factors and identify the risk for disease prevention. Incidence data from 1980 to 2013 were used. A Cox proportional hazard model was used to identify drivers for spatial spread, and a boosted regression tree (BRT) model was constructed to predict potential risk areas. Since the 1980s, an invasive expansion from South Natural Foci towards North Natural Foci was clearly identified, with the epidemiological heterogeneity observed between two regions, mainly in spatial distribution, seasonality, and demographic characteristics. Survival analysis disclosed significant factors contributing to the spatial expansion as following: being intersected by freeway (HR = 1.31, 95% CI: 1.11-1.54), coverage percentage of broadleaf forest (HR = 1.10, 95% CI: 1.06-1.15), and monthly average temperature (HR = 1.27, 95% CI: 1.25-1.30). The BRT models showed that precipitation, sunshine hour, temperature, crop field, and relative humidity contributed substantially to the spatial distribution of scrub typhus. A county-scale risk map was created to predict the regions with high probability of the disease. The current study enabled a comprehensive overview of epidemiological characteristics of scrub typhus in mainland China.

更新日期：2019-11-01

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