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Jitvaropas R, Sawaswong V, Poovorawan Y, Auysawasdi N, Vuthitanachot V, Wongwairot S, Rodkvamtook W, Lindroth E, Payungporn S, Linsuwanon P. Identification of Bacteria and Viruses Associated with Patients with Acute Febrile Illness in Khon Kaen Province, Thailand. Viruses 2024; 16:630. [PMID: 38675971 PMCID: PMC11054472 DOI: 10.3390/v16040630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The majority of cases of undifferentiated acute febrile illness (AFI) in the tropics have an undefined etiology. In Thailand, AFI accounts for two-thirds of illnesses reported to the Ministry of Public Health. To characterize the bacterial and viral causes of these AFIs, we conducted molecular pathogen screening and serological analyses in patients who sought treatment in Chum Phae Hospital, Khon Kaen province, during the period from 2015 to 2016. Through integrated approaches, we successfully identified the etiology in 25.5% of cases, with dengue virus infection being the most common cause, noted in 17% of the study population, followed by scrub typhus in 3.8% and rickettsioses in 6.8%. Further investigations targeting viruses in patients revealed the presence of Guadeloupe mosquito virus (GMV) in four patients without other pathogen co-infections. The characterization of four complete genome sequences of GMV amplified from AFI patients showed a 93-97% nucleotide sequence identity with GMV previously reported in mosquitoes. Nucleotide substitutions resulted in amino acid differences between GMV amplified from AFI patients and mosquitoes, observed in 37 positions. However, these changes had undergone purifying selection pressure and potentially had a minimal impact on protein function. Our study suggests that the GMV strains identified in the AFI patients are relatively similar to those previously reported in mosquitoes, highlighting their potential role associated with febrile illness.
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Affiliation(s)
- Rungrat Jitvaropas
- Division of Biochemistry, Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
| | - Vorthon Sawaswong
- Center of Excellence in Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Nutthanun Auysawasdi
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
| | | | - Sirima Wongwairot
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
| | - Wuttikon Rodkvamtook
- Analytic Division, Royal Thai Army Component-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand;
| | - Erica Lindroth
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
| | - Sunchai Payungporn
- Center of Excellence in Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Piyada Linsuwanon
- Department of Entomology, US Medical Directorate-Armed Forces Research Institute of Medical Science, Bangkok 10400, Thailand; (N.A.); (S.W.); (E.L.)
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Olajide OS, Okonkwo P, Ajayi O, Adetoye D, Ogunsola OO, Ogundele O, Elujide O, Adurogbola F, Jwanle P. Predictors of tuberculosis treatment outcomes among people living with HIV in some States in Nigeria. Pan Afr Med J 2024; 47:149. [PMID: 38933432 PMCID: PMC11204984 DOI: 10.11604/pamj.2024.47.149.35719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/08/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health threats globally and worse when they co-exist in susceptible individuals. The study examined TB treatment outcomes and their predictive factors among people living with HIV (PLHIVs). Methods a review of TB/HIV co-infected patients who had TB treatments across comprehensive antiretroviral therapy (ART) sites with ≥500 patients was conducted in seven United States of America President's Emergency Plan for AIDS Relief (PEPFAR)-supported States in Nigeria. Data on patient background, HIV and TB care, and TB treatment outcomes were collected using an Excel abstraction template. The data was analyzed using SPSS and an association was examined using a chi-square test while binary logistic regression was used to determine predictors of TB treatment outcomes (P< 0.05). Results two thousand six hundred and fifty-two co-infected patients participated in the study. The mean age of participants was 37 ± 14 years. A majority had TB treatment success (cured = 1059 (39.9%), completed = 1186 (44.7%)). Participants who had pulmonary TB, virally suppressed and commenced isoniazid (INH) before TB diagnosis were more likely to have a favorable TB treatment outcome compared to those who had extrapulmonary TB (AOR = 7.110, 95% CI = 1.506 - 33.565), virally unsuppressed (AOR = 1.677, 95% CI = 1.036 - 2.716) or did not commence INH before TB diagnosis (AOR = 1.486, 95% CI = 1.047 - 2.109). Conclusion site of infection, immune status, exposure to ART, and INH prophylaxis were found to predict TB treatment outcomes among PLHIVs. Stakeholders should ensure early commencement of ART and INH prophylaxis for PLHIVs.
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Affiliation(s)
| | - Prosper Okonkwo
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
| | - Oluseye Ajayi
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
| | | | | | | | - Oluwasogo Elujide
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
| | | | - Plang Jwanle
- APIN Public Health Initiatives, Abuja Federal Capital Territory, Nigeria
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Pan K, Huang R, Xu L, Lin F. Exploring the effects and interactions of meteorological factors on the incidence of scrub typhus in Ganzhou City, 2008-2021. BMC Public Health 2024; 24:36. [PMID: 38167033 PMCID: PMC10763082 DOI: 10.1186/s12889-023-17423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Scrub typhus poses a substantial risk to human life and wellbeing as it is transmitted by vectors. Although the correlation between climate and vector-borne diseases has been investigated, the impact of climate on scrub typhus remains inadequately comprehended. The objective of this study is to investigate the influence of meteorological conditions on the occurrence of scrub typhus in Ganzhou City, Jiangxi Province. METHODS: From January 1, 2008 to December 31, 2021, we gathered weekly records of scrub typhus prevalence alongside meteorological data in Ganzhou city. In order to investigate the correlation between meteorological factors and scrub typhus incidence, we utilized distributional lag nonlinear models and generalized additive models for our analysis. RESULTS Between 2008 and 2021, a total of 5942 cases of scrub typhus were recorded in Ganzhou City. The number of females affected exceeded that of males, with a male-to-female ratio of 1:1.86. Based on the median values of these meteorological factors, the highest relative risk for scrub typhus occurrence was observed when the weekly average temperature reached 26 °C, the weekly average relative humidity was 75%, the weekly average sunshine duration lasted for 2 h, and the weekly mean wind speed measured 2 m/s. The respective relative risks for these factors were calculated as 3.816 (95% CI: 1.395-10.438), 1.107 (95% CI: 1.008-1.217), 2.063 (95% CI: 1.022-4.165), and 1.284 (95% CI: 1.01-1.632). Interaction analyses showed that the risk of scrub typhus infection in Ganzhou city escalates with higher weekly average temperature and sunshine duration. CONCLUSION The findings of our investigation provide evidence of a correlation between environmental factors and the occurrence of scrub typhus. As a suggestion, utilizing environmental factors as early indicators could be recommended for initiating control measures and response strategies.
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Affiliation(s)
- Kailun Pan
- School of Public Health and Health Management, Gannan Medical University, Jiangxi Province, Ganzhou, 341000, China
| | - Renfa Huang
- Ganzhou Municipal Center for Disease Control and Prevention, Jiangxi Province, Ganzhou, 341000, China.
| | - Lingui Xu
- School of Public Health and Health Management, Gannan Medical University, Jiangxi Province, Ganzhou, 341000, China
| | - Fen Lin
- School of Public Health and Health Management, Gannan Medical University, Jiangxi Province, Ganzhou, 341000, China.
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Liu L, Xiao Y, Wei X, Li X, Duan C, Jia X, Jia R, Guo J, Chen Y, Zhang X, Zhang W, Wang Y. Spatiotemporal epidemiology and risk factors of scrub typhus in Hainan Province, China, 2011-2020. One Health 2023; 17:100645. [PMID: 38024283 PMCID: PMC10665174 DOI: 10.1016/j.onehlt.2023.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background The re-emergence of scrub typhus in the southern provinces of China in recent decades has been validated, thereby attracting the attention of public health authorities. There has been a spatial and temporal expansion of scrub typhus in Hainan Province, but the epidemiological characteristics, environmental drivers, and potential high-risk areas for scrub typhus have not yet been investigated. Objective The aims of this study were to characterize the spatiotemporal epidemiology of scrub typhus, identify dominant environmental risk factors, and map potential risk areas in Hainan Province from 2011 to 2020. Methods The spatiotemporal dynamics of scrub typhus in Hainan Province between 2011 and 2020 were analyzed using spatial analyses and seasonal-trend decomposition using regression (STR). The maximum entropy (MaxEnt) model was applied to determine the key environmental predictors and environmentally suitable areas for scrub typhus, and the demographic diversity of the predicted suitable zones was evaluated. Results During 2011-2020, 3260 scrub typhus cases were recorded in Hainan Province. The number of scrub typhus cases increased continuously each year, particularly among farmers (67.61%) and individuals aged 50-59 years (23.25%) who were identified as high-risk groups. A dual epidemic peak was detected, emerging annually from April to June and from July to October. The MaxEnt-based risk map illustrated that highly suitable areas, accounting for 25.36% of the total area, were mainly distributed in the northeastern part of Hainan Province, where 75.43% of the total population lived. Jackknife tests revealed that ground surface temperature, elevation, cumulative precipitation, evaporation, land cover, population density, and ratio of dependents were the most significant environmental factors. Conclusion In this study, we gained insights into the spatiotemporal epidemiological dynamics, pivotal environmental drivers, and potential risk map of scrub typhus in Hainan Province. These results have important implications for researchers and public health officials in guiding future prevention and control strategies for scrub typhus.
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Affiliation(s)
- Lisha Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yang Xiao
- Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xianyu Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Chunyuan Duan
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, Shenyang, China
| | - Xinjing Jia
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, Shenyang, China
| | - Ruizhong Jia
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Jinpeng Guo
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, Shenyang, China
| | - Yong Chen
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, Shenyang, China
| | - Xiushan Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wenyi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, Shenyang, China
| | - Yong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, China Medical University, Shenyang, China
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Huang J, Deng K, Chen J, Zhang M. Epidemiological and clinical characteristics of scrub typhus in northern Fujian, China, from 2015 to 2019. BMC Infect Dis 2023; 23:479. [PMID: 37464324 PMCID: PMC10354924 DOI: 10.1186/s12879-023-08451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study aimed to analyze the epidemiological and clinical characteristics of scrub typhus in northern Fujian Province on the southeast coast of China. METHODS A retrospective analysis was performed on 303 patients with scrub typhus admitted to the First Hospital of Nanping City, Fujian Province, from January 2015 to December 2019. The epidemic characteristics were analyzed, such as the annual number of cases, age distribution, sex distribution, and seasonal distribution in each region. The patient's clinical manifestations, signs, complications, auxiliary examinations, and prognosis were analyzed. RESULTS From 2015 to 2019, the age distribution of scrub typhus cases was mainly concentrated in 40-49 y (17.16%), 50-59 y (24.09%), and 60-69 y (26.73%). There were no sex differences among the patients. 68.98% of the cases were concentrated in rural areas, with farmers having the highest proportion. However, this study compared prognostic factors in the cured and uncured groups, and found significant differences in non-farmer occupation and diagnosis time ≥ 8 days. Scrub typhus showed two peaks north of Fujian; the prominent peak was from June to July, and the other slight rise was from October to November. The SDE plot showed that the cases were mainly concentrated in Yanping, Shunchang, Zhenghe, and Songxi counties. The number of cases in hilly and mountainous areas was higher than in plain areas. The main diagnostic methods in this area are based on specific eschar and epidemiology, while the positive rate of the Weil-Felix test is low. CONCLUSIONS The results of this study can guide primary care institutions to improve the level of diagnosis and treatment of scrub typhus and take effective public health intervention measures in endemic areas.
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Affiliation(s)
- Jin Huang
- Department of Infectious Diseases, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Wusi Road, Fuzhou, China.
| | - Kaixiang Deng
- Department of Traditional Chinese Medicine, First Hospital of Nanping City, Nanping, China
| | - Jiawei Chen
- Department of Infectious Diseases, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Wusi Road, Fuzhou, China
| | - Meiquan Zhang
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Geriatric Hospital, Fuzhou, China
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Huang X, Xie B, Long J, Chen H, Zhang H, Fan L, Chen S, Chen K, Wei Y. Prediction of risk factors for scrub typhus from 2006 to 2019 based on random forest model in Guangzhou, China. Trop Med Int Health 2023. [PMID: 37230481 DOI: 10.1111/tmi.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Scrub typhus is an increasingly serious public health problem, which is becoming the most common vector-borne disease in Guangzhou. This study aimed to analyse the correlation between scrub typhus incidence and potential factors and rank the importance of influential factors. METHODS We collected monthly scrub typhus cases, meteorological variables, rodent density (RD), Normalised Difference Vegetation Index (NDVI), and land use type in Guangzhou from 2006 to 2019. Correlation analysis and a random forest model were used to identify the risk factors for scrub typhus and predict the importance rank of influencing factors related to scrub typhus incidence. RESULTS The epidemiological results of the scrub typhus cases in Guangzhou between 2006 and 2019 showed that the incidence rate was on the rise. The results of correlation analysis revealed that a positive relationship between scrub typhus incidence and meteorological factors of mean temperature (Tmean ), accumulative rainfall (RF), relative humidity (RH), sunshine hours (SH), and NDVI, RD, population density, and green land coverage area (all p < 0.001). Additionally, we tested the relationship between the incidence of scrub typhus and the lagging meteorological factors through cross-correlation function, and found that incidence was positively correlated with 1-month lag Tmean , 2-month lag RF, 2-month lag RH, and 6-month lag SH (all p < 0.001). Based on the random forest model, we found that the Tmean was the most important predictor among the influential factors, followed by NDVI. CONCLUSIONS Meteorological factors, NDVI, RD, and land use type jointly affect the incidence of scrub typhus in Guangzhou. Our results provide a better understanding of the influential factors correlated with scrub typus, which can improve our capacity for biological monitoring and help public health authorities to formulate disease control strategies.
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Affiliation(s)
- Xiaobin Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Binbin Xie
- Department of Surveillance and Control, Hainan Tropical Diseases Research Center, Haikou, China
| | - Jiali Long
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Haiyan Chen
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Hao Zhang
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Lirui Fan
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Shouyi Chen
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Kuncai Chen
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuehong Wei
- Department of Parasitic Disease and Endemic Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
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Wei X, He J, Yin W, Soares Magalhaes RJ, Wang Y, Xu Y, Wen L, Sun Y, Zhang W, Sun H. Spatiotemporal dynamics and environmental determinants of scrub typhus in Anhui Province, China, 2010-2020. Sci Rep 2023; 13:2131. [PMID: 36747027 PMCID: PMC9902522 DOI: 10.1038/s41598-023-29373-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
This study aims to describe the epidemiological characteristics of scrub typhus, detect the spatio-temporal patterns of scrub typhus at county level, and explore the associations between the environmental variables and scrub typhus cases in Anhui Province. Time-series analysis, spatial autocorrelation analysis, and space-time scan statistics were used to explore the characteristics and spatiotemporal patterns of the scrub typhus in Anhui Province. Negative binomial regression analysis was used to explore the association between scrub typhus and environmental variables. A total of 16,568 clinically diagnosed and laboratory-confirmed cases were reported from 104 counties of 16 prefecture-level cities. The number of female cases was higher than male cases, with a proportion of 1.32:1. And the proportion of cases over 65 years old was the highest, accounting for 33.8% of the total cases. Two primary and five secondary high-risk clusters were detected in the northwestern, northeastern, and central-eastern parts of Anhui Province. The number of cases in primary and secondary high-risk clusters accounted for 60.27% and 3.00%, respectively. Scrub typhus incidence in Anhui Province was positively correlated with the population density, normalized difference vegetation index, and several meteorological variables. The mean monthly sunshine duration with 3 lags (SSD_lag3), mean monthly ground surface temperature with 1 lag (GST_lag1), and mean monthly relative humidity with 3 lags (RHU_lag3) had the most significant association with increased cases of scrub typhus. Our findings indicate that public health interventions need to be focused on the elderly farmers in north of the Huai River in Anhui Province.
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Affiliation(s)
- Xianyu Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Junyu He
- Ocean College, Zhejiang University, Zhoushan, China.,Ocean Academy, Zhejiang University, Zhoushan, China
| | - Wenwu Yin
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ricardo J Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Brisbane, Australia.,Child Health Research Center, The University of Queensland, Brisbane, Australia
| | - Yanding Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yuanyong Xu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Liang Wen
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yehuan Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.
| | - Hailong Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China. .,Chinese PLA Center for Disease Control and Prevention, Beijing, China.
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Li X, Wei X, Yin W, Soares Magalhaes RJ, Xu Y, Wen L, Peng H, Qian Q, Sun H, Zhang W. Using ecological niche modeling to predict the potential distribution of scrub typhus in Fujian Province, China. Parasit Vectors 2023; 16:44. [PMID: 36721181 PMCID: PMC9887782 DOI: 10.1186/s13071-023-05668-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the increasing number of cases of scrub typhus and its expanding geographical distribution in China, its potential distribution in Fujian Province, which is endemic for the disease, has yet to be investigated. METHODS A negative binomial regression model for panel data mainly comprising meteorological, socioeconomic and land cover variables was used to determine the risk factors for the occurrence of scrub typhus. Maximum entropy modeling was used to identify the key predictive variables of scrub typhus and their ranges, map the suitability of different environments for the disease, and estimate the proportion of the population at different levels of infection risk. RESULTS The final multivariate negative binomial regression model for panel data showed that the annual mean normalized difference vegetation index had the strongest correlation with the number of scrub typhus cases. With each 0.1% rise in shrubland and 1% rise in barren land there was a 75.0% and 37.0% increase in monthly scrub typhus cases, respectively. In contrast, each unit rise in mean wind speed in the previous 2 months and each 1% increase in water bodies corresponded to a decrease of 40.0% and 4.0% in monthly scrub typhus cases, respectively. The predictions of the maximum entropy model were robust, and the average area under the curve value was as high as 0.864. The best predictive variables for scrub typhus occurrence were population density, annual mean normalized difference vegetation index, and land cover types. The projected potentially most suitable areas for scrub typhus were widely distributed across the eastern coastal area of Fujian Province, with highly suitable and moderately suitable areas accounting for 16.14% and 9.42%, respectively. Of the total human population of the province, 81.63% reside in highly suitable areas for scrub typhus. CONCLUSIONS These findings could help deepen our understanding of the risk factors of scrub typhus, and provide information for public health authorities in Fujian Province to develop more effective surveillance and control strategies in identified high risk areas in Fujian Province.
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Affiliation(s)
- Xuan Li
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xianyu Wei
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wenwu Yin
- grid.198530.60000 0000 8803 2373Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ricardo J. Soares Magalhaes
- grid.1003.20000 0000 9320 7537Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Brisbane, Australia ,grid.1003.20000 0000 9320 7537Child Health Research Center, The University of Queensland, Brisbane, Australia
| | - Yuanyong Xu
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Liang Wen
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hong Peng
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Quan Qian
- grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hailong Sun
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wenyi Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China ,grid.488137.10000 0001 2267 2324Chinese PLA Center for Disease Control and Prevention, Beijing, China
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He J, Wang Y, Liu P, Yin W, Wei X, Sun H, Xu Y, Li S, Soares Magalhaes RJ, Guo Y, Zhang W. Co-effects of global climatic dynamics and local climatic factors on scrub typhus in mainland China based on a nine-year time-frequency analysis. One Health 2022; 15:100446. [PMID: 36277104 PMCID: PMC9582591 DOI: 10.1016/j.onehlt.2022.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/04/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Scrub Typhus (ST) is a rickettsial disease caused by Orientia tsutsugamushi. The number of ST cases has been increasing in China during the past decades, which attracts great concerns of the public health. Methods We obtained monthly documented ST cases greater than 54 cases in 434 counties of China during 2012-2020. Spatiotemporal wavelet analysis was conducted to identify the ST clusters with similar pattern of the temporal variation and explore the association between ST variation and El Niño and La Niña events. Wavelet coherency analysis and partial wavelet coherency analysis was employed to further explore the co-effects of global and local climatic factors on ST. Results Wavelet cluster analysis detected seven clusters in China, three of which are mainly distributed in Eastern China, while the other four clusters are located in the Southern China. Among the seven clusters, summer and autumn-winter peak of ST are the two main outbreak periods; while stable and fluctuated periodic feature of ST series was found at 12-month and 4-(or 6-) month according to the wavelet power spectra. Similarly, the three-character bands were also found in the associations between ST and El Niño and La Niña events, among which the 12-month period band showed weakest climate-ST association and the other two bands owned stronger association, indicating that the global climate dynamics may have short-term effects on the ST variations. Meanwhile, 12-month period band with strong association was found between the four local climatic factors (precipitation, pressure, relative humidity and temperature) and the ST variations. Further, partial wavelet coherency analysis suggested that global climatic dynamics dominate annual ST variations, while local climatic factors dominate the small periods. Conclusion The ST variations are not directly attributable to the change in large-scale climate. The existence of these plausible climatic determinants stimulates the interests for more insights into the epidemiology of ST, which is important for devising prevention and early warning strategies.
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Affiliation(s)
- Junyu He
- Ocean College, Zhejiang University, Zhoushan, China,Ocean Academy, Zhejiang University, Zhoushan, China
| | - Yong Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Ping Liu
- Department of General Practice, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Wenwu Yin
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xianyu Wei
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hailong Sun
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yuanyong Xu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ricardo J. Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Brisbane, Australia,Child Health Research Center, The University of Queensland, Brisbane, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Correspondence to: Y Guo, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China,Correspondence to: W Zhang, Chinese PLA Center for Disease Control and Prevention, 20 Dong-Da Street, Fengtai District, Beijing 100071, China.
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10
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Qian L, Wang Y, Wei X, Liu P, Magalhaes RJS, Qian Q, Peng H, Wen L, Xu Y, Sun H, Yin W, Zhang W. Epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province during 2012–2020. PLoS Negl Trop Dis 2022; 16:e0010278. [PMID: 36174105 PMCID: PMC9553047 DOI: 10.1371/journal.pntd.0010278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/11/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Scrub typhus has become a serious public health concern in the Asia-Pacific region including China. There were new natural foci continuously recognized and dramatically increased reported cases in mainland China. However, the epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province have yet to be investigated. Objective This study proposes to explore demographic characteristics and spatiotemporal dynamics of scrub typhus cases in Fujian province, and to detect high-risk regions between January 2012 and December 2020 at county/district scale and thereby help in devising public health strategies to improve scrub typhus prevention and control measures. Method Monthly cases of scrub typhus reported at the county level in Fujian province during 2012–2020 were collected from the National Notifiable Disease Surveillance System. Time-series analyses, spatial autocorrelation analyses and space-time scan statistics were applied to identify and visualize the spatiotemporal patterns of scrub typhus cases in Fujian province. The demographic differences of scrub typhus cases from high-risk and low-risk counties in Fujian province were also compared. Results A total of 11,859 scrub typhus cases reported in 87 counties from Fujian province were analyzed and the incidence showed an increasing trend from 2012 (2.31 per 100,000) to 2020 (3.20 per 100,000) with a peak in 2018 (4.59 per 100,000). There existed two seasonal peaks in June-July and September-October every year in Fujian province. A significant positive spatial autocorrelation of scrub typhus incidence in Fujian province was observed with Moran’s I values ranging from 0.258 to 0.471 (P<0.001). Several distinct spatiotemporal clusters mainly concentrated in north and southern parts of Fujian province. Compared to low-risk regions, a greater proportion of cases were female, farmer, and older residents in high-risk counties. Conclusions These results demonstrate a clear spatiotemporal heterogeneity of scrub typhus cases in Fujian province, and provide the evidence in directing future researches on risk factors and effectively assist local health authorities in the refinement of public health interventions against scrub typhus transmission in the high risk regions. Scrub typhus is a vector-borne zoonotic disease caused by Orientia tsutsugamushi and is popular in the Asia-Pacific area. Nowadays scrub typhus has been recognized as a considerable burden on public health in Fujian province. We explored the epidemiological characteristics, spatiotemporal patterns and diffusion characteristics of scrub typhus, and detected high-risk regions at the county level in Fujian province between January 2012 and December 2020. Our results indicated that the majority of cases were reported in June-July and September-October and that that middle aged and elderly people were more prone to infection every year in Fujian province. The spatial autocorrelation analysis revealed clustering in geographic distribution of cases and several distinct spatiotemporal clusters were identified in north and southern parts of Fujian province. Compared with cases from low-risk areas, a higher proportion of cases were female, farmer, and older residents in high-risk counties.
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Affiliation(s)
- Li Qian
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, China
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yong Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xianyu Wei
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Ping Liu
- Department of General Practice, Chinese PLA General Hospital-Sixth Medical Center, Beijing, China
| | - Ricardo J. Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Brisbane, Australia
- Child Health Research Center, The University of Queensland, Brisbane, Australia
| | - Quan Qian
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hong Peng
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Liang Wen
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yuanyong Xu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hailong Sun
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wenwu Yin
- Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (WY); (WZ)
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- * E-mail: (WY); (WZ)
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11
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Wu DL, Shih HC, Wang JK, Teng HJ, Kuo CC. Commensal Rodent Habitat Expansion Enhances Arthropod Disease Vectors on a Tropical Volcanic Island. Front Vet Sci 2021; 8:736216. [PMID: 34692809 PMCID: PMC8531417 DOI: 10.3389/fvets.2021.736216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
On volcanic islands, the release of animals from predators and competitors can lead to increased body size and population density as well as the expanded habitat use of introduced animals relative to their mainland counterparts. Such alterations might facilitate the spread of diseases on islands when these exotic animals also carry pathogenic agents; however, this has rarely been investigated. The commensal Asian house rat (Rattus tanezumi) is confined to human residential surroundings in mainland Taiwan but can be observed in the forests of nearby Orchid Island, which is a tropical volcanic island. Orchid Island is also a hot spot for scrub typhus, a lethal febrile disease transmitted by larval trombiculid mites (chiggers) that are infected primarily with the rickettsia Orientia tsutsugamushi (OT). We predicted an increase in chigger abundance when rodents (the primary host of chiggers) invade forests from human settlements since soils are largely absent in the latter habitat but necessary for the survival of nymphal and adult mites. A trimonthly rodent survey at 10 sites in three habitats (human residential, grassland, and forest) found only R. tanezumi and showed more R. tanezumi and chiggers in forests than in human residential sites. There was a positive association between rodent and chigger abundance, as well as between rodent body weight and chigger load. Lastly, >95% of chiggers were Leptotrombidium deliense and their OT infection rates were similar among all habitats. Our study demonstrated potentially elevated risks of scrub typhus when this commensal rat species is allowed to invade natural habitats on islands. Additionally, while the success of invasive species can be ascribed to their parasites being left behind, island invaders might instead obtain more parasites if the parasite requires only a single host (e.g., trombiculid mite), is a host generalist (e.g., L. deliense), and is transferred from unsuitable to suitable habitats (i.e., human settlements on the mainland to forests on an island).
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Affiliation(s)
- De-Lun Wu
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Han-Chun Shih
- Epidemic Intelligence Center, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Jen-Kai Wang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Hwa-Jen Teng
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chi-Chien Kuo
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
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12
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Lu J, Liu Y, Ma X, Li M, Yang Z. Impact of Meteorological Factors and Southern Oscillation Index on Scrub Typhus Incidence in Guangzhou, Southern China, 2006-2018. Front Med (Lausanne) 2021; 8:667549. [PMID: 34395468 PMCID: PMC8355740 DOI: 10.3389/fmed.2021.667549] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Scrub typhus was epidemic in the western Pacific Ocean area and East Asia, scrub typhus epidemic in densely populated areas in southern China. To better understand the association between meteorological variables, Southern Oscillation Index (SOI), and scrub typhus incidence in Guangzhou was benefit to the control and prevention. Methodology/Principal Findings: We collected weekly data for scrub typhus cases and meteorological variables in Guangzhou, and Southern Oscillation Index from 2006 to 2018, and used the distributed lag non-linear models to evaluate the relationships between meteorological variables, SOI and scrub typhus. The median value of each variable was set as the reference. The high-risk occupations were farmer (51.10%), house worker (17.51%), and retiree (6.29%). The non-linear relationships were observed with different lag weeks. For example, when the mean temperature was 27.7°C with1-week lag, the relative risk (RR) was highest as 1.08 (95% CI: 1.01–1.17). The risk was the highest when the relative humidity was 92.0% with 9-week lag, with the RR of 1.10 (95% CI: 1.02–1.19). For aggregate rainfall, the highest RR was 1.06 (95% CI: 1.03–1.11), when it was 83.0 mm with 4-week lag. When the SOI was 19 with 11-week lag, the highest RR was 1.06 (95% CI: 1.01–1.12). Most of the extreme effects of SOI and meteorological factors on scrub typical cases were statistically significant. Conclusion/Significance: The high-risk occupations of scrub typhus in Guangzhou were farmer, house worker, and retiree. Meteorological factors and SOI played an important role in scrub typhus occurrence in Guangzhou. Non-linear relationships were observed in almost all the variables in our study. Approximately, mean temperature, and relative humidity positively correlated to the incidence of scrub typhus, on the contrary to atmospheric pressure and weekly temperature range (WTR). Aggregate rainfall and wind velocity showed an inverse-U curve, whereas the SOI appeared the bimodal distribution. These findings can be helpful to facilitate the development of the early warning system to prevent the scrub typhus.
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Affiliation(s)
- Jianyun Lu
- Department of Infectious Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yanhui Liu
- Department of Infectious Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaowei Ma
- Department of Public Health Emergency Preparedness and Response, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Meixia Li
- Department of Infectious Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
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13
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Lu CT, Wang LS, Hsueh PR. Scrub typhus and antibiotic-resistant Orientia tsutsugamushi. Expert Rev Anti Infect Ther 2021; 19:1519-1527. [PMID: 34109905 DOI: 10.1080/14787210.2021.1941869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Scrub typhus is one of the most underdiagnosed and under-reported febrile illnesses requiring hospitalization, mainly occurring in Southeast and East Asia and the Pacific Islands, in an area referred to as the 'Tsutsugamushi Triangle.' Scrub typhus is a zoonotic rickettsial disease that is transmitted to humans by trombiculid mites.Areas covered: A MEDLINE/PubMed search of the available literature was performed to describe the role of antibiotic-resistant scrub typhus in therapy failure.Expert opinion: Scrub typhus is characterized by an eschar that may appear 2-3 days before sudden-onset fever with chills, headache, backache, myalgia, profuse sweating, vomiting, and enlarged lymph nodes. A macular or maculopapular skin rash can develop within 3-8 days after the onset of fever. Various antibiotics, such as chloramphenicol, tetracycline, doxycycline, macrolides, quinolones, and rifampicin, have been used to treat scrub typhus. Resistance to tetracycline has been proposed to underlie delayed clinical improvement since 1996, but recent reports have questioned the existence of doxycycline resistance. Nevertheless, the existence and importance of antibiotic-resistant scrub typhus remain uncertain and require further study.
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Affiliation(s)
- Chin-Te Lu
- Department of Infectious Diseases, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Lih-Shinn Wang
- Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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14
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Li Z, Xin H, Sun J, Lai S, Zeng L, Zheng C, Ray SE, Weaver ND, Wang L, Yu J, Feng Z, Hay SI, Gao GF. Epidemiologic Changes of Scrub Typhus in China, 1952-2016. Emerg Infect Dis 2021; 26:1091-1101. [PMID: 32441637 PMCID: PMC7258452 DOI: 10.3201/eid2606.191168] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Scrub typhus, a miteborne rickettsiosis, has emerged in many areas globally. We analyzed the incidence and spatial–temporal distribution of scrub typhus in China during 1952–1989 and 2006–2016 using national disease surveillance data. A total of 133,623 cases and 174 deaths were recorded. The average annual incidence was 0.13 cases/100,000 population during 1952–1989; incidence increased sharply from 0.09/100,000 population in 2006 to 1.60/100,000 population in 2016. The disease, historically endemic to southern China, has expanded to all the provinces across both rural and urban areas. We identified 3 distinct seasonal patterns nationwide; infections peaked in summer in the southwest, summer-autumn in the southeast, and autumn in the middle-east. Persons >40 years of age and in nonfarming occupations had a higher risk for death. The changing epidemiology of scrub typhus in China warrants an enhanced disease control and prevention program.
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15
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Wu JY, Guo C, Xia Y, Bao HM, Zhu YS, Guo ZM, Wei YH, Lu JH. Genomic characterization of Wenzhou mammarenavirus detected in wild rodents in Guangzhou City, China. One Health 2021; 13:100273. [PMID: 34179329 PMCID: PMC8214141 DOI: 10.1016/j.onehlt.2021.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/30/2021] [Accepted: 05/30/2021] [Indexed: 10/31/2022] Open
Abstract
Wenzhou mammarenavirus (WENV) is a zoonotic pathogen newly discovered in east and southeast Asia. WENV has been found in wild rodent animals around the world while its standing is barely understood in Guangzhou city, where is known as a region of outbreak hotspot for zoonotic emerging infectious diseases. To investigate the prevalence and genomic characteristics of mammarenavirus in Guangzhou City, lung tissue samples from wild rodent species were collected from five districts of Guangzhou City in the year 2015 and 2016. The viral RNA was extracted and then subjected to mammarenavirus-specific PCR. The result revealed approximately 1.0% (3/306) nucleic acid positivity for lung tissue samples obtained from three rodent species: Mus musculus, Rattus flavipectus, and Rattus norvegicus. Viral metagenomic sequencing of three samples was then carried out and two full segment L and three full segment S sequences were obtained. Phylogenetics analysis indicated the sequences of the new mammarenavirus strain have 76.2% - 94.4% similarity to known WENV encoded genes, with the highest similarity to the WENV 9-24 strain. Population structure analysis grouped all known WENV into seven lineages, and this WENV Guangzhou strain was grouped with WENV 9-24 as well. Though the seroprevalence result was not available, our data provides the first nucleic acid evidence of circulating WENV in Guangzhou city, and it suggested WENV had a broader host tropism than previously known.
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Affiliation(s)
- Jian-Yong Wu
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Cheng Guo
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York 10032, USA
| | - Yao Xia
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.,Kunming Institute of Zoology, Chinese Acadamy of Sciences, Kunming 650201, China
| | - Hui-Min Bao
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yan-Shan Zhu
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Zhong-Min Guo
- Laboratory Animal Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yue-Hong Wei
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jia-Hai Lu
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.,One Health Center of Excellence for Research & Training, Sun Yat-Sen University, Guangzhou 510080, China.,Key Laboratory for Tropical Disease Control of Ministry of Education, Sun Yat-Sen University, Guangzhou 510080, China.,NMPA Key Laboratory for Quality Monitoring and Evaluation of Vaccines and Biological Products, Sun Yat-Sen University, Guangzhou 510080, China
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16
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Gu XL, Qi R, Li WQ, Jiao YJ, Yu H, Yu XJ. Misdiagnosis of scrub typhus as hemorrhagic fever with renal syndrome and potential co-infection of both diseases in patients in Shandong Province, China, 2013-2014. PLoS Negl Trop Dis 2021; 15:e0009270. [PMID: 33784301 PMCID: PMC8009391 DOI: 10.1371/journal.pntd.0009270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/23/2021] [Indexed: 01/27/2023] Open
Abstract
Background Scrub typhus, caused by Orientia tsutsugamushi, an obligate intracellular gram-negative bacterium, along with hemorrhagic fever with renal syndrome (HFRS), caused by hantaviruses, are natural-focus infectious diseases prevalent in Shandong Province, China. Both diseases have similar clinical manifestations in certain disease stages and similar epidemic seasons, which has caused difficulties for physicians in distinguishing them. The aim of this study was to investigate whether misdiagnosis of scrub typhus as HFRS occurred in patients in Shandong Province. Methods Serum samples (N = 112) of clinically suspected HFRS patients from 2013 to 2014 in Shandong Province were analyzed with enzyme-linked immunosorbent assay (ELISA) for antibodies to both hantavirus and Orientia tsutsugamushi. Results ELISA showed that 56.3% (63/112) and 8.0% (9/112) of clinically suspected HFRS patients were IgM antibody positive to hantavirus and O. tsutsugamushi, respectively. Among the hantavirus IgM antibody positive patients, 7.9% (5/63) were also IgM antibody positive to O. tsutsugamushi. Among the hantavirus IgM antibody negative sera, 8.2% (4/49) of sera were positive to O. tsutsugamushi. Conclusions We concluded that some scrub typhus patients were misdiagnosed as HFRS and co-infection of scrub typhus and HFRS might exist in China. Due to the different treatments for scrub typhus and HFRS, physicians should carefully differentiate between scrub typhus and HFRS and consider administering anti-rickettsia antibiotics if treatment for HFRS alone does not work. Scrub typhus is caused by O. tsutsugamushi and hemorrhagic fever with renal syndrome (HFRS) is caused by hantavirus. Both diseases have similar manifestations and have their peak epidemic season in the fall, which makes their clinical differentiation difficult to be differentiated from each other clinically. In this study, we found that scrub typhus was indeed misdiagnosed as HFRS and co-infection of O. tsutsugamushi and hantaviruses might exist in China. Owing to different treatments of HFRS and scrub typhus, physicians need pay attention to differentiate them; identify co-infection of HFRS and scrub typhus; and consider administering antibiotics if antiviral treatment alone does not work.
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Affiliation(s)
- Xiao-lan Gu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Rui Qi
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Wen-qian Li
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yong-jun Jiao
- Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Key Laboratory of Enteric Pathogenic Microbiology, Ministry Health, Nanjing, China
| | - Hao Yu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xue-jie Yu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
- * E-mail:
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17
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Bhopdhornangkul B, Meeyai AC, Wongwit W, Limpanont Y, Iamsirithaworn S, Laosiritaworn Y, Tantrakarnapa K. Non-linear effect of different humidity types on scrub typhus occurrence in endemic provinces, Thailand. Heliyon 2021; 7:e06095. [PMID: 33665401 PMCID: PMC7905364 DOI: 10.1016/j.heliyon.2021.e06095] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 01/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background Reported monthly scrub typhus (ST) cases in Thailand has an increase in the number of cases during 2009–2014. Humidity is a crucial climatic factor for the survival of chiggers, which is the disease vectors. The present study was to determine the role of humidity in ST occurrence in Thailand and its delayed effect. Methods We obtained the climate data from the Department of Meteorology, the disease data from Ministry of Public Health. Negative binomial regression combined with a distributed lag non-linear model (NB-DLNM) was employed to determine the non-linear effects of different types of humidity on the disease. This model controlled overdispersion and confounder, including seasonality, minimum temperature, and cumulative total rainwater. Results The occurrence of the disease in the 6-year period showed the number of cases gradually increased summer season (Mid-February – Mid-May) and then reached a plateau during the rainy season (Mid-May – Mid-October) and then steep fall after the cold season (Mid-October – Mid-February). The high level (at 70%) of minimum relative humidity (RHmin) was associated with a 33% (RR 1.33, 95% CI 1.13–1.57) significant increase in the number of the disease; a high level (at 14 g/m3) of minimum absolute humidity (AHmin) was associated with a 30% (RR 1.30, 95% CI 1.14–1.48); a high level (at 1.4 g/kg) of minimum specific humidity (SHmin) was associated with a 28% (RR 1.28, 95% CI 1.04–1.57). The significant effects of these types of humidity occurred within the past month. Conclusion Humidity played a significant role in enhancing ST cases in Thailand, particularly at a high level and usually occurred within the past month. NB-DLNM had good controlled for the overdispersion and provided the precise estimated relative risk of non-linear associations. Results from this study contributed the evidence to support the Ministry of Public Health on warning system which might be useful for public health intervention and preparation in Thailand.
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Affiliation(s)
- Bhophkrit Bhopdhornangkul
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Aronrag Cooper Meeyai
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Waranya Wongwit
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Yanin Limpanont
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Sopon Iamsirithaworn
- Bureau of Communicable Disease, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Yongjua Laosiritaworn
- Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
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18
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Zheng C, Jiang D, Ding F, Fu J, Hao M. Spatiotemporal Patterns and Risk Factors for Scrub Typhus From 2007 to 2017 in Southern China. Clin Infect Dis 2020; 69:1205-1211. [PMID: 30535175 DOI: 10.1093/cid/ciy1050] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Substantial outbreaks of scrub typhus, coupled with the discovery of this vector-borne disease in new areas, suggest that the disease remains remarkably neglected. The objectives of this study were to map the contemporary and potential transmission risk zones of the disease and to provide novel insights into the health burden imposed by scrub typhus in southern China. METHODS Based on the assembled data sets of annual scrub typhus cases and maps of environmental and socioeconomic correlates, a boosted regression tree modeling procedure was used to identify the environmental niche of scrub typhus and to predict the potential infection zones of the disease. Additionally, we estimated the population living in the potential scrub typhus infection areas in southern China. RESULTS Spatiotemporal patterns of the annual scrub typhus cases in southern China between 2007 and 2017 reveal a tremendous, wide spread of scrub typhus. Temperature, relative humidity, elevation, and the normalized difference vegetation index are the main factors that influence the spread of scrub typhus. In southern China, the predicted highest transmission risk areas of scrub typhus are mainly concentrated in several regions, such as Yunnan, Guangxi, Guangdong, Hainan, and Fujian. We estimated that 162 684 million people inhabit the potential infection risk zones in southern China. CONCLUSIONS Our results provide a better understanding of the environmental and socioeconomic factors driving scrub typhus spread, and estimate the potential infection risk zones beyond the disease's current, limited geographical extent, which enhances our capacity to target biosurveillance and help public health authorities develop disease control strategies.
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Affiliation(s)
- Canjun Zheng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dong Jiang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.,College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China.,Key Laboratory of Carrying Capacity Assessment for Resource and Environment, Ministry of Land & Resources, Beijing, China
| | - Fangyu Ding
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.,College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China
| | - Jingying Fu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.,College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China
| | - Mengmeng Hao
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.,College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China
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19
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Xin H, Sun J, Yu J, Huang J, Chen Q, Wang L, Lai S, Clements ACA, Hu W, Li Z. Spatiotemporal and demographic characteristics of scrub typhus in Southwest China, 2006–2017: An analysis of population‐based surveillance data. Transbound Emerg Dis 2020; 67:1585-1594. [DOI: 10.1111/tbed.13492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Hualei Xin
- 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 China
| | - Junling Sun
- Key Laboratory of Surveillance and Early Warning on Infectious Disease Division of Infectious Disease Chinese Center for Disease Control and Prevention Beijing China
| | - Jianxing Yu
- 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
| | - 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 China
| | - Qiulan Chen
- Key Laboratory of Surveillance and Early Warning on Infectious Disease Division of Infectious Disease Chinese Center for Disease Control and Prevention Beijing China
| | - Liping Wang
- Key Laboratory of Surveillance and Early Warning on Infectious Disease Division of Infectious Disease Chinese Center for Disease Control and Prevention Beijing China
| | - 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 China
| | - Archie C. A. Clements
- Faculty of Health Sciences Curtin University Bentley WA Australia
- Telethon Kids Institute Nedlands WA Australia
| | - Wenbiao Hu
- School of Public Health and Social Work Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Australia
| | - 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
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20
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Sankar S, Saravanan N, Rajendiran P, Ramamurthy M, Sasimohan A, Vineeta V, Varghese G, Idikula M, Jesudason M, Mangalakumar R, Nair A, Babujanarthanam R, Nandagopal B, Sridharan G. Detection of scrub typhus by real-time polymerase chain reaction and immunoglobulin M ELISA among patients with acute febrile illness. J Nat Sci Biol Med 2020. [DOI: 10.4103/jnsbm.jnsbm_156_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Yue Y, Ren D, Liu X, Wang Y, Liu Q, Li G. Spatio-temporal patterns of scrub typhus in mainland China, 2006-2017. PLoS Negl Trop Dis 2019; 13:e0007916. [PMID: 31790406 PMCID: PMC6917297 DOI: 10.1371/journal.pntd.0007916] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/17/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022] Open
Abstract
Background Scrub typhus, a serious public health problem in the Asia-Pacific area, is endemic in the “tsutsugamushi triangle” area. Scrub typhus has been widespread and has become a significant health concern in China. However, spatiotemporal patterns need to be investigated further. Objective This study aims to explore spatiotemporal patterns, diffusion characteristics and regional distribution differences of scrub typhus cases in mainland China from January 2006 to December 2017. Method Monthly cases of scrub typhus reported at the county level during 2006–2017 were obtained. Time-series analyses, spatial distribution analyses, spatial diffusion analyses, spatial autocorrelation analyses and space-time scan statistic analyses were used to explore spatiotemporal characteristics of scrub typhus. Results A total of 121 251 scrub typhus cases were reported in 30 provinces (or municipalities) of mainland China during 2006–2017, which rose exponentially. There were seasonal characteristics from June to November for scrub typhus. Scrub typhus had been diffused from south, southwest, southeast and eastern coasts to center, north, northeast and northwest in mainland China. Scrub typhus occurrences were from point to surrounding regions, and from south to north every year. The peak periods of scrub typhus became longer and longer from north to southwest to south in mainland China. There existed a single peak in Southwest region and North region, respectively, but existed a bimodal peak for South region. Scrub typhus cases were clustered in Yunnan, Guangdong, Guangxi, Fujian and Anhui among June to November. The scrub typhus epidemics in Guangdong and Yunnan were the most serious. Conclusions The results in this study can be guide targeted public health interventions against scrub typhus at the county level. Scrub typhus is a bacterial zoonosis caused by Orientia tsutsugamushi and is popular in the Asia-Pacific area. Nowadays scrub typhus has been widespread and causes a considerable burden on public health and economy in China. We investigated spatiotemporal patterns, diffusion characteristics and regional distribution differences of scrub typhus cases in mainland China from 2006 to 2017. The majority of scrub typhus cases were reported in June to November, and 98.3% of the total scrub typhus cases during 2006–2017 were reported in South region, Southwest region and North region. Scrub typhus had been diffused in mainland China except Qinghai. Scrub typhus occurrences were from point to surrounding regions, and from south to north every year. The peak periods of scrub typhus turn longer, and there existed a single peak to a bimodal peak from north to south. Scrub typhus cases were clustered in Yunnan, Guangdong, Guangxi, Fujian and Anhui during June to November. The scrub typhus epidemics in Guangdong and Yunnan were the most serious.
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Affiliation(s)
- Yujuan Yue
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Dongsheng Ren
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Xiaobo Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yujiao Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- School of Public Health, Jiamusi University, Jiamusi, People’s Repubulic of China
| | - Qiyong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Guichang Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- * E-mail:
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22
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Yao H, Wang Y, Mi X, Sun Y, Liu K, Li X, Ren X, Geng M, Yang Y, Wang L, Liu W, Fang L. The scrub typhus in mainland China: spatiotemporal expansion and risk prediction underpinned by complex factors. Emerg Microbes Infect 2019; 8:909-919. [PMID: 31233387 PMCID: PMC6598543 DOI: 10.1080/22221751.2019.1631719] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Hongwu Yao
- a Department of Infection Management and Disease Control , Chinese PLA General Hospital , Beijing , People's Republic of China
| | - Yixing Wang
- b The State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , People's Republic of China
| | - Xianmiao Mi
- b The State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , People's Republic of China
| | - Ye Sun
- 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
| | - Kun Liu
- b The State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , 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
| | - Xinlou Li
- b The State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , People's Republic of China.,e PLA Strategic Support Force Characteristic Medical Center , Beijing , People's Republic of China
| | - Xiang Ren
- 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
| | - Mengjie Geng
- 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
| | - Yang Yang
- g Department of Biostatistics , College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida , Gainesville , FL , USA
| | - Liping Wang
- 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
| | - Wei Liu
- b The State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , People's Republic of China.,h Beijing Key Laboratory of Vector Borne and Natural Focus Infectious Diseases , Beijing , People's Republic of China
| | - Liqun Fang
- b The State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , People's Republic of China
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23
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Lu M, Li F, Liao Y, Shen JJ, Xu JM, Chen YZ, Li JH, Holmes EC, Zhang YZ. Epidemiology and Diversity of Rickettsiales Bacteria in Humans and Animals in Jiangsu and Jiangxi provinces, China. Sci Rep 2019; 9:13176. [PMID: 31511528 PMCID: PMC6739303 DOI: 10.1038/s41598-019-49059-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/19/2019] [Indexed: 11/09/2022] Open
Abstract
Diseases caused by Rickettsiales bacteria are a global public health problem. To better understand the diversity and origins of Rickettsiales infection in humans and animals, we sampled 134 febrile patients, 173 rodents and 43 shrews, as well as 358 ticks, from two cities in Jiangsu and Jiangxi provinces, China. Our data revealed a relatively high prevalence of scrub typhus cases in both localities. In addition, both serological tests and genetic analysis identified three patients infected with Anaplasma bovis, Rickettsia monacensis, and Orientia tsutsugamushi bacteria. Molecular epidemiological investigation revealed the co-circulation of multiple species of Rickettsiales bacteria in small mammals and ticks in both provinces, potentially including novel bacterial species. In sum, these data demonstrate the ongoing importance of Rickettsiales infection in China and highlight the need for the regular surveillance of local arthropods, mammals and humans.
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Affiliation(s)
- Miao Lu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Feng Li
- Yancheng Center for Disease Control and Prevention, Yancheng, Jiangsu province, China
| | - Yong Liao
- Ganzhou Center for Disease Control and Prevention, Ganzhou, Jiangxi province, China
| | - Jin-Jin Shen
- Yancheng Center for Disease Control and Prevention, Yancheng, Jiangsu province, China
| | - Jian-Min Xu
- Jiangxi Center for Disease Control and Prevention, Nanchang, Jiangxi province, China
| | - Yin-Zhong Chen
- Yancheng Center for Disease Control and Prevention, Yancheng, Jiangsu province, China
| | - Jian-Hua Li
- Ganzhou Center for Disease Control and Prevention, Ganzhou, Jiangxi province, China
| | - Edward C Holmes
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences and Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia.,Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yong-Zhen Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China. .,Shanghai Public Health Clinical Center & Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
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24
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Xin HL, Yu JX, Hu MG, Jiang FC, Li XJ, Wang LP, Huang JL, Wang JF, Sun JL, Li ZJ. Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016. Infect Dis Poverty 2019; 8:59. [PMID: 31253202 PMCID: PMC6599364 DOI: 10.1186/s40249-019-0566-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/10/2019] [Indexed: 01/30/2023] Open
Abstract
Background Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, and specific antimicrobial medicine is available. Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China, and the results will benefit both clinical practice and the disease surveillance system. Methods We extracted individual scrub typhus case data 2006–2016 from a national disease surveillance system in China. The diagnosis category and interval time from illness onset to diagnosis were compared among three levels of medical care institutions and provinces. The descriptive analysis method was performed in our study. Results During the 11-year study period, 93 481 scrub typhus cases, including 57 deaths, were recorded in the nationwide surveillance system. The overall proportion of laboratory-confirmed cases was only 4.7%, and this proportion varied greatly among primary medical centres (2.8%), county level hospitals (4.2%), and city level hospitals (6.3%). Notably, the proportion of laboratory-confirmed cases has consistently decreased from 16.3% in 2006 to 2.6% in 2016, and the same decreasing trend was found among all three levels of medical care institutions. The interval from illness onset to case diagnosis (Tdiag) for all cases was 5 days (interquartile range [IQR]: 2–9 days) and decreased from 7 days (IQR: 3–11 days) in 2006 to 5 days (IQR: 2–8 days) in 2016. The risk of death for patients with a Tdiag of > 7 days was 2.2 times higher (OR = 2.21, 95% CI: 1.05–5.21) than that of patients with a Tdiag of < 2 days. Conclusions The interval time from illness onset to diagnosis for scrub typhus cases decreased greatly in China; however, the diagnosis rate of cases with laboratory-confirmed results must be increased among all levels of medical care institutions to reduce both the risk of death and the misuse of antibiotics associated with scrub typhus. Electronic supplementary material The online version of this article (10.1186/s40249-019-0566-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hua-Lei Xin
- Qingdao City Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China.,Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Jian-Xing Yu
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.,Ministry of Health Key Laboratory of Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, CAMS-Fondation Mérieux, Institute of Pathogen Biology, Academy of Medical Sciences of China and Peking Union Medical College, Beijing, 100000, China
| | - Mao-Gui Hu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100000, China
| | - Fa-Chun Jiang
- Qingdao City Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China
| | - Xiao-Jing Li
- Qingdao City Center for Disease Control and Prevention, Qingdao, 266033, Shandong, China
| | - Li-Ping Wang
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Ji-Lei Huang
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.,National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China
| | - Jin-Feng Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100000, China
| | - Jun-Ling Sun
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
| | - Zhong-Jie Li
- Key Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
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Rickettsial Infections and Q Fever Amongst Febrile Patients in Bhutan. Trop Med Infect Dis 2018; 3:tropicalmed3010012. [PMID: 30274410 PMCID: PMC6136613 DOI: 10.3390/tropicalmed3010012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/10/2018] [Accepted: 01/21/2018] [Indexed: 12/04/2022] Open
Abstract
There is limited evidence of rickettsial diseases in Bhutan. We explored the contribution of rickettsioses as a cause of undifferentiated febrile illness in patients presenting to 14 Bhutanese hospitals from October 2014 to June 2015. Obvious causes of fever were excluded clinically. Clinico-demographic information and acute blood samples were collected. Samples were tested by immunofluorescence assay (IFA) and qPCR against scrub typhus group (STG), spotted fever group (SFG) and typhus group (TG) rickettsiae, and Q fever (QF). Of the 1044 patients, 539 (51.6%) were female and the mean age was 31.5 years. At least 159 (15.2%) of the patients had evidence of a concurrent rickettsial infection. Of these, 70 (6.7%), 46 (4.4%), 4 (0.4%), and 29 (2.8%) were diagnosed as acute infections with STG, SFG, TG, and QF respectively. Ten (1.0%) patients were seropositive for both SFG and TG. Seven of the 70 STG patients were positive by qPCR. Eschar (p < 0.001), myalgia (p = 0.003), and lymphadenopathy (p = 0.049) were significantly associated with STG, but no specific symptoms were associated with the other infections. Disease incidences were not different between age groups, genders, occupations, and districts, except for students with significantly lower odds of infection with STG (OR = 0.43; 95% CI = 0.20, 0.93; p = 0.031). Rickettsioses were responsible for at least 15% of undifferentiated febrile illnesses in Bhutan, scrub typhus being the commonest. Health authorities should ensure that health services are equipped to manage these infections.
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Infection of Rodents by Orientia tsutsugamushi, the Agent of Scrub Typhus in Relation to Land Use in Thailand. Trop Med Infect Dis 2017; 2:tropicalmed2040053. [PMID: 30270910 PMCID: PMC6082056 DOI: 10.3390/tropicalmed2040053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022] Open
Abstract
The relationship between land use structures and occurrence of the scrub typhus agent, Orientia tsutsugamushi, in small wild mammals was investigated in three provinces of Thailand: Buriram, Loei, and Nan. O. tsutsugamushi detection was performed using 16S ribosomal DNA (rDNA) amplicon sequencing approach using Miseq Illumina platform. In total, 387 animals (rodents and shrews) were examined for the infection. The 16S rDNA sequences of the bacterium were found in nine animals, namely Bandicota savilei, Berylmys bowersi, Leopoldamys edwardsi, Rattus exulans, R. tanezumi, and Rattus sp. phylogenetic clade 3, yielding 2.3% infection rate, with two new rodent species found infected by the bacterium in Thailand: B. bowersi and L. edwardsi. Using a generalized linear mixed model (GLMM) and Random Forest analyses for investigating the association between human-land use and occurrence of the bacterium, forest habitat appeared as a strong explicative variable of rodent infection, meaning that O. tsutsugamushi-infected animals were more likely found in forest-covered habitats. In terms of public health implementation, our results suggest that heterogenous forested areas including forest-converted agricultural land, reforestation areas, or fallows, are potential habitats for O. tsutsugamushi transmission. Further understanding of population dynamics of the vectors and their hosts in these habitats could be beneficial for the prevention of this neglected zoonotic disease.
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Wee I, Lo A, Rodrigo C. Drug treatment of scrub typhus: a systematic review and meta-analysis of controlled clinical trials. Trans R Soc Trop Med Hyg 2017; 111:336-344. [PMID: 29253266 DOI: 10.1093/trstmh/trx066] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/24/2017] [Indexed: 09/19/2023] Open
Abstract
Scrub typhus, a potentially fatal infection caused by the pathogen Orientia tsutsugamushi, has a wide geographical distribution. This systematic review analyses the evidence from prospective controlled clinical studies for the efficacy of antibiotics in the treatment of scrub typhus. PubMed, Embase, Scopus, Cochrane Library, CINAHL and clinical trial registries in China, India and Sri Lanka were searched for controlled prospective clinical trials (randomized, quasi-randomized or non-randomized) enrolling patients with confirmed scrub typhus for treatment with antibiotics. The PROSPERO registration number for this review is CRD42017071374. Eleven studies (from Southeast Asia and China) that enrolled 957 patients into 28 study groups met the inclusion criteria. Doxycycline was the most frequent comparator with other antibiotics. Chloramphenicol, tetracycline and azithromycin (limited evidence for roxithromycin, telithromycin, levofloxacin and rifampicin) had equal efficacy to doxycycline in achieving clinical cure. The cure rates in all studies varied from 64 to 100%. Of the antibiotics frequently used in current practice, azithromycin had the best evidence compared with doxycycline for equal efficacy in clinical cure (three trials, 280 participants, moderate quality evidence) with fewer gastrointestinal adverse events. The preferred choice of antibiotics for each patient depends on the adverse effect profile, personal circumstances (e.g., age, pregnancy), cost and local prescription guidelines.
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Affiliation(s)
- Ian Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adeline Lo
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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