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Li MM, Hu SS, Xu L, Gao J, Zheng X, Li XL, Liu LL. TLR2/NF-кB signaling may control expansion and function of regulatory T cells in patients with severe fever with thrombocytopenia syndrome (SFTS). Heliyon 2024; 10:e35950. [PMID: 39224371 PMCID: PMC11367551 DOI: 10.1016/j.heliyon.2024.e35950] [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: 03/07/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a recently identified infectious ailment triggered by a new strain of bunyavirus. It is distinguished by elevated fatality rates, ranging from 12 % to 30 %. The mechanism underlying the development of severe illness caused by SFTS bunyavirus (SFTSV) is not yet fully understood. To evaluate the role of the TLR2 receptor pathway in regulating Treg function in the progression of SFTS disease and possible mechanisms, sequential serum samples from 29 patients with SFTS (15 mild, 14 severe cases) were examined. Flow cytometry was employed to scrutinize the phenotypic and functional characteristics of TLR2 expression on circulating CD4 T cells, CD8 T cells, and Tregs. In all admitted patients, the evaluation of correlations between the frequencies of the aforementioned cells and SFTS index (SFTSI) was conducted. For SFTS, the levels of TLR2 on CD4 T cells and Tregs were significantly heightened when compared to those in healthy subjects. Additionally, the expression of TLR2 on Tregs exhibited a positive correlation with Ki-67 expression in Tregs and the severity of disease. Additionally, compared with those in uninfected controls, the expression levels of NF-κB in Tregs were significantly increased. Collectively, Tregs may be activated and proliferate through the stimulation of the TLR2/NF-кB pathway in reaction to SFTSV infection.
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Affiliation(s)
- Meng-Meng Li
- Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Shan-Shan Hu
- Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Ling Xu
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Gao
- Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Xin Zheng
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Jiangxia Laboratory, Wuhan, 430200, China
| | - Xiu-Ling Li
- Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Le-Le Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang J, Luo M, Li T, Liu Y, Jiang G, Wu Y, Liu Q, Gong Z, Sun J. The ecological and etiological investigation of ticks and rodents in China: results from an ongoing surveillance study in Zhejiang Province. Front Vet Sci 2023; 10:1268440. [PMID: 38089699 PMCID: PMC10715276 DOI: 10.3389/fvets.2023.1268440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/13/2023] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES This study aimed to analyze the population density of vector ticks and reservoir hosts rodents, and to investigate the relevant pathogen infection in Zhejiang Province, China. METHODS In this surveillance study, the data of ticks density were collected with the tick picking method on animal body surface and the drag-flag method, while the rodent density with the night trapping method. The samples of ticks were examined for the severe fever with thrombocytopenia syndrome virus (SFTSV), and blood serum and organs from rodents were subjected for SFTSV, hantavirus, Leptospira, Orientia tsutsugamushi (O. tsutsugamushi) and Yersinia pestis (Y. pestis) screening in the laboratory. RESULTS From 2017 to 2022 in Zhejiang Province, 16,230 parasitic ticks were found in 1848 positive animals, with the density of parasitic ticks of 1.29 ticks per host animal, and a total of 5,201 questing ticks were captured from 1,140,910 meters of vegetation distance with the questing tick density of 0.46 ticks/flag·100 m. Haemaphysalis longicornis (H. longicornis) was the major species. A total of 2,187,739 mousetraps were distributed and 12,705 rodents were trapped, with the density of 0.58 per 100 trap-nights. Rattus norvegicus was the major species. For SFTSV screening, two groups nymphal ticks of H. longicornis were tested to be positive. For the rodents samples, the Leptospira had a positive rate of 12.28% (197/1604), the hantavirus was 1.00% (16/1604), and the O. tsutsugamushi was 0.15% (2/1332). No positive results were found with SFTSV and Y. pestis in the rodents samples. CONCLUSION Findings from this study indicated that the ticks and rodents were widely distributed in Zhejiang Province. Particularly, the positive detection of SFTSV, Leptospira, hantavirus and O. tsutsugamushi in ticks or rodents from this area suggested that more attention should be paid to the possibilities of relevant vector-borne diseases occurrence.
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Affiliation(s)
- Jinna Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Mingyu Luo
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Tianqi Li
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Guoqin Jiang
- Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Yuyan Wu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Qinmei Liu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhenyu Gong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jimin Sun
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Gong L, Zhang Y, Wang J, Xiong Y, Wang J, Wu J, Chen F, Zhu M, Cheng D, Jiang X. Evaluation of a community intervention program on knowledge, attitudes, and practices regarding severe fever with thrombocytopenia syndrome in Anhui Province, China. Front Public Health 2022; 10:891700. [PMID: 36388366 PMCID: PMC9659599 DOI: 10.3389/fpubh.2022.891700] [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: 03/08/2022] [Accepted: 10/13/2022] [Indexed: 01/21/2023] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is a novel infectious disease with no specific therapeutics and vaccines. We hypothesize that health education in vulnerable people would ameliorate their knowledge, attitudes and practices (KAP) regarding SFTS and reduce its prevalence. Methods A four-stage cluster cross-section study in sixteen community units was performed. Sixteen groups were allocated to the intervention or control groups. A 6 months education program was administrated. The primary outcome was KAP scores 6 months after intervention. Predictors of KAP score changes were also analyzed. Results Eight hundred and fifteen valid questionnaires pre-intervention and 767 ones post-intervention were retreated. No significant differences were found in demographic characteristics and KAP scores before intervention. A significant improvement in KAP score (16.8 ± 4.7 vs. 22.0 ± 4.2, p < 0.001) in the intervention group was observed compare with the controls. Educational level and intervention program were the common predictors of KAP score changes. Conclusions Education improved KAP scores in SFTS vulnerable people which may contribute to the control of the disease.
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Affiliation(s)
- Lei Gong
- Department of Acute Infectious Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yong Zhang
- Department of Acute Infectious Disease Prevention and Control, Chuzhou Municipal Center for Disease Control and Prevention, Chuzhou, China
| | - Jinsheng Wang
- Department of Acute Infectious Disease Prevention and Control, Anqing Municipal Center for Disease Control and Prevention, Anqing, China
| | - Yingying Xiong
- Department of Pediatrics, Affiliated First Hospital, University of Science and Technology of China (USTC), Hefei, China
| | - Jiling Wang
- Department of Respiratory and Critical Medicine, The Second People's Hospital of Hefei, Hefei, China
| | - Jiabing Wu
- Department of Acute Infectious Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Fang Chen
- Department of Acute Infectious Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Meng Zhu
- Department of Acute Infectious Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Donglin Cheng
- Department of Acute Infectious Disease Prevention and Control, Chuzhou Municipal Center for Disease Control and Prevention, Chuzhou, China
| | - Xuqin Jiang
- Department of Respiratory and Critical Medicine, Affiliated First Hospital, USTC, Hefei, China,*Correspondence: Xuqin Jiang
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Li JC, Zhao J, Li H, Fang LQ, Liu W. Epidemiology, clinical characteristics, and treatment of severe fever with thrombocytopenia syndrome. INFECTIOUS MEDICINE 2022; 1:40-49. [PMID: 38074982 PMCID: PMC10699716 DOI: 10.1016/j.imj.2021.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 02/23/2024]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by a novel phlebovirus (SFTS virus, SFTSV) in the family Phenuiviridae of the order Bunyavirales. The disease causes a wide spectrum of clinical signs and symptoms, ranging from mild febrile disease accompanied by thrombocytopenia and/or leukocytopenia to hemorrhagic fever, encephalitis, multiple organ failure, and death. SFTS was first identified in China and was subsequently reported in South Korea and Japan. The case-fatality rate ranges from 2.7% to 45.7%. Older age has been consistently shown to be the most important predictor of adverse disease outcomes. Older age exacerbates disease mainly through dysregulation of host immune cells and uncontrolled inflammatory responses. Tick-to-human transmission is the primary route of human infection with SFTSV, and Haemaphysalis longicornis is the primary tick vector of SFTSV. Despite its high case-fatality rate, vaccines and antiviral therapies for SFTS are not currently available. The therapeutic efficacies of several antiviral agents against SFTSV are currently being evaluated. Ribavirin was initially identified as a potential antiviral therapy for SFTS but was subsequently found to inefficiently improve disease outcomes, especially among patients with high viral loads. Favipiravir (T705) decreased both time to clinical improvement and mortality when administered early in patients with low viral loads. Anti-inflammatory agents including corticosteroids have been proposed to play therapeutic roles. However, the efficacy of other therapeutic modalities, such as convalescent plasma, is not yet clear.
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Affiliation(s)
| | | | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
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Jiang X, Wang Y, Zhang X, Pang B, Yao M, Tian X, Sang S. Factors Associated With Severe Fever With Thrombocytopenia Syndrome in Endemic Areas of China. Front Public Health 2022; 10:844220. [PMID: 35284401 PMCID: PMC8907623 DOI: 10.3389/fpubh.2022.844220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the influence of climatic, environmental and socioeconomic factors on SFTS occurrence in Shandong Province, China. Methods We used generalized additive model to estimate the association between SFTS cases and climatic factors, environmental factors and socioeconomic factors, including annual average temperature, precipitation, land cover, normalized difference vegetation index, altitude, population density, meat production, milk production, and gross domestic product (GDP). Results There were a total of 4,830 cases reported in 100 (70.9%) counties and districts in Shandong Province from 2010 to 2020. The results showed that the annual average temperature, precipitation, forest and grassland coverage rate, altitude and meat production (square root transform) had a reversed “V” relationship with SFTS occurrence, with the inflection points around 12.5–13.0°C in temperature, around 650 mm in precipitation, around 0.3 in forest and grassland coverage rate, around 300 m in altitude, and around 200–300 tons in meat production (square root transform), respectively. SFTS occurrence had a “V” relationship with milk production (square root transform) and GDP (square root transform), with the inflection points around 100–200 tons in milk production (square root transform), and around 150,000–200,000 yuan in GDP (square root transform), respectively. Conclusions Climatic, environmental, and socioeconomic factors contributed to the heterogeneous distribution of SFTS in Shandong Province, and the influence of these factors on SFTS occurrence was nonlinear.
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Affiliation(s)
- Xiaolin Jiang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
- Shandong Key Laboratory of Infectious Diseases, Jinan, China
| | - Yiguan Wang
- Ashworth Laboratories, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, United Kingdom
| | - Xiaomei Zhang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
- Shandong Key Laboratory of Infectious Diseases, Jinan, China
| | - Bo Pang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
- Shandong Key Laboratory of Infectious Diseases, Jinan, China
| | - Mingxiao Yao
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
- Shandong Key Laboratory of Infectious Diseases, Jinan, China
| | - Xueying Tian
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
- Shandong Key Laboratory of Infectious Diseases, Jinan, China
| | - Shaowei Sang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Shaowei Sang
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Vectors, Hosts, and the Possible Risk Factors Associated with Severe Fever with Thrombocytopenia Syndrome. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2021; 2021:8518189. [PMID: 34777671 PMCID: PMC8580678 DOI: 10.1155/2021/8518189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/26/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a disease caused by infection with the SFTS virus (SFTSV). SFTS has become a crucial public health concern because of the heavy burden, lack of vaccines, effective therapies, and high-fatality rate. Evidence suggests that SFTSV circulates between ticks and animals in nature and is transmitted to humans by tick bites. In particular, ticks have been implicated as vectors of SFTSV, where domestic or wild animals may play as the amplifying hosts. Many studies have identified antigens and antibodies against SFTSV in various animals such as sheep, goats, cattle, and rodents. Besides, person-to-person transmission through contact with blood or mucous of an infected person has also been reported. In this study, we reviewed the literature and summarized the vectors and hosts associated with SFTS and the possible risk factors.
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Cho G, Lee S, Lee H. Estimating severe fever with thrombocytopenia syndrome transmission using machine learning methods in South Korea. Sci Rep 2021; 11:21831. [PMID: 34750465 PMCID: PMC8575988 DOI: 10.1038/s41598-021-01361-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease in China, Japan, and Korea. This study aimed to estimate the monthly SFTS occurrence and the monthly number of SFTS cases in the geographical area in Korea using epidemiological data including demographic, geographic, and meteorological factors. Important features were chosen through univariate feature selection. Two models using machine learning methods were analyzed: the classification model in machine learning (CMML) and regression model in machine learning (RMML). We developed a novel model incorporating the CMML results into RMML, defined as modified-RMML. Feature importance was computed to assess the contribution of estimating the number of SFTS cases using modified-RMML. Aspect to the accuracy of the novel model, the performance of modified-RMML was improved by reducing the MSE for the test data as 12.6–52.2%, compared to the RMML using five machine learning methods. During the period of increasing the SFTS cases from May to October, the modified-RMML could give more accurate estimation. Computing the feature importance, it is clearly observed that climate factors such as average maximum temperature, precipitation as well as mountain visitors, and the estimation of SFTS occurrence obtained from CMML had high Gini importance. The novel model incorporating CMML and RMML models improves the accuracy of the estimation of SFTS cases. Using the model, climate factors, including temperature, relative humidity, and mountain visitors play important roles in transmitting SFTS in Korea. Our findings highlighted that the guidelines for mountain visitors to prevent SFTS transmissions should be addressed. Moreover, it provides important insights for establishing control interventions that predict early identification of SFTS cases.
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Affiliation(s)
- Giphil Cho
- Finance·Fishery·Manufacture Industrial Mathematics Center on Big Data, Pusan National University, Busan, 46241, Korea
| | - Seungheon Lee
- Department of Mathematics, Pusan National University, Busan, 46241, Korea
| | - Hyojung Lee
- Department of Statistics, Kyungpook National University, Daegu, 41566, Korea.
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Zhu T, Cai QQ, Yu J, Liang XS. Metagenomic next-generation sequencing (mNGS) confirmed a critical case of severe fever with thrombocytopenia syndrome virus (SFTSV). Clin Chem Lab Med 2021; 60:e42-e45. [PMID: 34674414 DOI: 10.1515/cclm-2021-0791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/16/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Tong Zhu
- Department of Infectious Disease, Shanghai Changhai Hospital, Navi Medical University, Shanghai, P.R. China
| | - Qing-Qing Cai
- Genoxor Medical Science and Technology Inc., Shanghai, P.R. China
| | - Jiao Yu
- Department of Infectious Disease, Shanghai Changhai Hospital, Navi Medical University, Shanghai, P.R. China
| | - Xue-Song Liang
- Department of Infectious Disease, Shanghai Changhai Hospital, Navi Medical University, Shanghai, P.R. China
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Clinical Update of Severe Fever with Thrombocytopenia Syndrome. Viruses 2021; 13:v13071213. [PMID: 34201811 PMCID: PMC8310018 DOI: 10.3390/v13071213] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an acute febrile illness characterized by fever, leukopenia, thrombocytopenia, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting resulting from infection with the SFTS virus (SFTSV). The SFTSV is transmitted to humans by tick bites, primarily from Haemaphysalis longicornis, Amblyomma testudinarium, Ixodes nipponensis, and Rhipicephalus microplus. Human-to-human transmission has also been reported. Since the first report of an SFTS patient in China, the number of patients has also been increasing. The mortality rate of patients with SFTS remains high because the disease can quickly lead to death through multiple organ failure. In particular, an average fatality rate of approximately 20% has been reported for SFTS patients, and no treatment strategy has been established. Therefore, effective antiviral agents and vaccines are required. Here, we aim to review the epidemiology, clinical manifestations, laboratory diagnosis, and various specific treatments (i.e., antiviral agents, steroids, intravenous immunoglobulin, and plasma exchange) that have been tested to help to cope with the disease.
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Miao D, Dai K, Zhao GP, Li XL, Shi WQ, Zhang JS, Yang Y, Liu W, Fang LQ. Mapping the global potential transmission hotspots for severe fever with thrombocytopenia syndrome by machine learning methods. Emerg Microbes Infect 2020; 9:817-826. [PMID: 32212956 PMCID: PMC7241453 DOI: 10.1080/22221751.2020.1748521] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with increasing spread. Currently SFTS transmission has expanded beyond Asian countries, however, with definitive global extents and risk patterns remained obscure. Here we established an exhaustive database that included globally reported locations of human SFTS cases and the competent vector, Haemaphysalis longicornis (H. longicornis), as well as the explanatory environmental variables, based on which, the potential geographic range of H. longicornis and risk areas for SFTS were mapped by applying two machine learning methods. Ten predictors were identified contributing to global distribution for H. longicornis with relative contribution ≥1%. Outside contemporary known distribution, we predict high receptivity to H. longicornis across two continents, including northeastern USA, New Zealand, parts of Australia, and several Pacific islands. Eight key drivers of SFTS cases occurrence were identified, including elevation, predicted probability of H. longicornis presence, two temperature-related factors, two precipitation-related factors, the richness of mammals and percentage coverage of water bodies. The globally model-predicted risk map of human SFTS occurrence was created and validated effective for discriminating the actual affected and unaffected areas (median predictive probability 0.74 vs. 0.04, P < 0.001) in three countries with reported cases outside China. The high-risk areas (probability ≥50%) were predicted mainly in east-central China, most parts of the Korean peninsula and southern Japan, and northern New Zealand. Our findings highlight areas where an intensive vigilance for potential SFTS spread or invasion events should be advocated, owing to their high receptibility to H. longicornis distribution.
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Affiliation(s)
- Dong Miao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Ke Dai
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Guo-Ping Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Xin-Lou Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Wen-Qiang Shi
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Jiu Song Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Yang Yang
- Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
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Crump A, Tanimoto T. Severe Fever with Thrombocytopenia Syndrome: Japan under Threat from Life-threatening Emerging Tick-borne Disease. JMA J 2020; 3:295-302. [PMID: 33225100 PMCID: PMC7676996 DOI: 10.31662/jmaj.2019-0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022] Open
Abstract
Japan, like many other parts of the world, is under threat from newly emerging, potentially fatal diseases. Severe fever with thrombocytopenia syndrome (SFTS), first clinically identified in 2009, is an emerging tick-borne hemorrhagic viral disease, currently limited in distribution to East Asia. Relatively little is known about the disease with an initial Case Fatality Rate ranging from 5% to 40%. It primarily affects the elderly living in rural areas, which is particularly troublesome given Japan’s rapidly aging population. Control efforts are severely hampered by lack of specific knowledge of the disease and its means of transmission, coupled with the absence of both a vaccine and an effective treatment regime, although some antiviral drugs and blood transfusions are successful in treating the disease. Despite both the causative virus and vector ticks being commonly found throughout Japan, the disease shows a very specific, limited geographical distribution for as yet unknown reasons.
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Huang XY, He ZQ, Wang BH, Hu K, Li Y, Guo WS. Severe fever with thrombocytopenia syndrome virus: a systematic review and meta-analysis of transmission mode. Epidemiol Infect 2020; 148:e239. [PMID: 32993819 PMCID: PMC7584033 DOI: 10.1017/s0950268820002290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a disease with a high case-fatality rate that is caused by infection with the SFTS virus (SFTSV). Five electronic databases were systematically searched to identify relevant articles published from 1 January 2011 to 1 December 2019. The pooled rates with 95% confidence interval (CI) were calculated by a fixed-effect or random-effect model analysis. The results showed that 92 articles were included in this meta-analysis. For the confirmed SFTS cases, the case-fatality rate was 0.15 (95% CI 0.11, 0.18). Two hundred and ninety-six of 1384 SFTS patients indicated that they had been bitten by ticks and the biting rate was 0.21 (95% CI 0.16, 0.26). The overall pooled seroprevalence of SFTSV antibodies among the healthy population was 0.04 (95% CI 0.03, 0.05). For the overall seroprevalence of SFTSV in animals, the seroprevalence of SFTSV was 0.25 (95% CI 0.20, 0.29). The infection rate of SFTSV in ticks was 0.08 (95% CI 0.05, 0.11). In conclusion, ticks can serve as transmitting vectors of SFTSVs and reservoir hosts. Animals can be infected by tick bites, and as a reservoir host, SFTSV circulates continuously between animals and ticks in nature. Humans are infected by tick bites and direct contact with patient secretions.
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Affiliation(s)
- X. Y. Huang
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - Z. Q. He
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - B. H. Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - K. Hu
- Henan Academy of Medical Sciences, Zhengzhou, China
| | - Y. Li
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
- Henan Key Laboratory of Pathogenic Microorganisms, Zhengzhou, China
| | - W. S. Guo
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
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Li M, Xiong Y, Li M, Zhang W, Liu J, Zhang Y, Xiong S, Zou C, Liang B, Lu M, Yang D, Peng C, Zheng X. Depletion but Activation of CD56 dimCD16 + NK Cells in Acute Infection with Severe Fever with Thrombocytopenia Syndrome Virus. Virol Sin 2020; 35:588-598. [PMID: 32430872 DOI: 10.1007/s12250-020-00224-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high mortality (12%-30%). The mechanism by which the SFTS bunyavirus (SFTSV) causes severe illness remains unclear. To evaluate the phenotypic and functional characteristics of the NK cell subsets in SFTS patients, twenty-nine SFTS patients were sequentially sampled from admission until recovery. Phenotypic and functional characteristics of NK cell subsets in circulating blood were analysed via flow cytometry. Then, correlations between NK cell subset frequencies and the SFTS index (SFTSI) were evaluated in all SFTS patients (15 mild, 14 severe) upon admission. The frequencies of CD56dimCD16+ NK cells were greatly decreased in early SFTSV infection and were negatively correlated with disease severity. Additionally, higher Ki-67 and granzyme B expression and relatively lower NKG2A expression in CD56dimCD16+ NK cells were observed in acute infection. Moreover, the effector function of CD56dim NK cells was increased in the acute phase compared with the recovery phase in nine severe SFTS patients. Additionally, interleukin (IL)-15, interferon (IFN)-α, IL-18 and IFN-γ secretion was markedly increased during early infection. Collectively, despite depletion of CD56dimCD16+ NK cells, activation and functional enhancement of CD56dimCD16+ NK cells were still observed, suggesting their involvement in defence against early SFTSV infection.
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Affiliation(s)
- Mengmeng Li
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Yan Xiong
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Mingyue Li
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wenjing Zhang
- Department of Paediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430032, China
| | - Jia Liu
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yanfang Zhang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Shue Xiong
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Congcong Zou
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Boyun Liang
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Mengji Lu
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, 45122, Germany
| | - Dongliang Yang
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Cheng Peng
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Xin Zheng
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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14
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Spatial-temporal characteristics of severe fever with thrombocytopenia syndrome and the relationship with meteorological factors from 2011 to 2018 in Zhejiang Province, China. PLoS Negl Trop Dis 2020; 14:e0008186. [PMID: 32255791 PMCID: PMC7164674 DOI: 10.1371/journal.pntd.0008186] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/17/2020] [Accepted: 03/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Zhejiang Province has the fifth-highest incidence of severe fever with thrombocytopenia syndrome (SFTS) in China. While the top four provinces are all located in northern and central China, only Zhejiang Province is located in the Yangtze River Delta region of southeast China. This study was undertaken to identify the epidemiological characteristics of SFTS in Zhejiang from 2011 to 2018. METHODS The epidemic data from SFTS cases in Zhejiang Province from January 2011 to December 2018 were obtained from the China Information Network System of Disease Prevention and Control. Meteorological data were collected from the China Meteorological Data Sharing Service System. A multivariate time series model was used to analyze the heterogeneity of spatial-temporal transmission of the disease. Random forest analysis was performed to detect the importance of meteorological factors and the dose-response association of the incidence of SFTS with these factors. RESULTS In total, 412 SFTS cases (49 fatal) were reported from January 2011 to December 2018 in Zhejiang Province, China. The number of SFTS cases and the number of affected counties increased year by year. The case fatality rate in Zhejiang Province was 11.89%, which was the highest in China. Elderly patients and farmers were the most affected. The total effect values of the autoregressive component, spatiotemporal component and endemic component of the model in all ranges were 0.4580, 0.0377 and 0.0137, respectively. There was obvious heterogeneity across counties for the mean values of the spatiotemporal component and the autoregressive component. The autoregressive component was obviously the main factor driving the occurrence of SFTS, followed by the spatiotemporal component. The importance scores of the monthly mean pressure, mean temperature, mean relative humidity, mean two-minute wind speed, duration of sunshine and precipitation were 10.64, 8.34, 8.16, 6.37, 5.35 and 2.81, respectively. The relationship between these factors and the incidence of SFTS is complicated and nonlinear. A suitable range of meteorological factors for this disease was also detected. CONCLUSIONS The autoregressive and spatiotemporal components played an important role in driving the transmission of SFTS. Targeted preventive efforts should be made in different areas based on the main component contributing to the epidemic. For most areas, early measures several months ahead of the suitable season for the occurrence of SFTS should be implemented. The level of reporting and diagnosis of this disease should be further improved.
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15
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Yasuo K, Nishiura H. Spatial epidemiological determinants of severe fever with thrombocytopenia syndrome in Miyazaki, Japan: a GWLR modeling study. BMC Infect Dis 2019; 19:498. [PMID: 31174484 PMCID: PMC6556057 DOI: 10.1186/s12879-019-4111-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/20/2019] [Indexed: 01/01/2023] Open
Abstract
Background Cases of severe fever with thrombocytopenia syndrome (SFTS) have increasingly been observed in Miyazaki, southwest Japan. It is critical to identify and elucidate the risk factors of infection at community level. In the present study, we aimed to identify areas with a high risk of SFTS virus infection using a geospatial dataset of SFTS cases in Miyazaki. Methods Using 10 × 10-km mesh data and a geographically weighted logistic regression (GWLR) model, we examined the statistical associations between environmental variables and spatial variation in the risk of SFTS. We collected geospatial and population census data as well as forest and agriculture mesh information. Altitude and farmland were selected as two specific variables for predicting the presence of SFTS cases in a given mesh area. Results Using GWLR, the area under the receiver operating characteristic curve (AUC) was estimated at 73.9%, outperforming the classical logistic regression model (72.4%). The sensitivity and specificity of the GWLR model were estimated at 90.9 and 58.7%, respectively. We identified altitude (odds ratio (OR) = 0.996, 95% confidence interval (CI): 0.994–0.999 per one-meter elevation) and farmland (OR = 0.999, 95% CI: 0.998–1.000 per % increase) as useful negative predictors of SFTS cases in Miyazaki. Conclusions Our study findings revealed that the risk of SFTS is high in geographic areas where farmland area begins to diminish and at mid-level altitudes. Our findings can help to improve the efficiency of ecological and animal surveillance in high-risk areas. Using finer geographic resolution, such surveillance can help raise awareness among local residents in areas with a high risk of SFTS. Electronic supplementary material The online version of this article (10.1186/s12879-019-4111-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kazuhiro Yasuo
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Sapporo, Japan.,Sapporo Higashi Tokushukai Hospital, 3-1 Kita 33 Jo, Higashi 14 Chome, Sapporo, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Sapporo, Japan.
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16
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Zhao Q, Li X, Zhang W, Chu C, Yao L, Zhang Y, Qian Q, Li M, Li S, Li N, Zhao X, Song H, Wang Y, Huang B. Epidemiological Characteristics and Spatial Analysis of Tick-Borne Encephalitis in Jilin Province, China. Am J Trop Med Hyg 2019; 101:189-197. [PMID: 31074410 DOI: 10.4269/ajtmh.18-0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Tick-borne encephalitis (TBE) is a viral infectious disease and has become a reemerging public health threat in recent years in northeastern China. However, no studies has characterized the epidemiologic features and explored the spatial dynamics and environmental factors of TBE cases in Jilin Province. In this study, we have described the epidemiological features of 846 reported human TBE cases from 2006 to 2016 in Jilin Province. There was an obvious single peak pattern of TBE cases from May to July in Jilin Province. More than 60% of TBE cases occurred in farmers, and the people in 50- to 59-year-old group had the high incidence of the disease. The results of Getis-Ord Gi* statistics demonstrated that the human TBE cases were more clustered in the northeastern border including Dunhua and Yanji cities and Antu and Wangqing counties, and southern areas including Huinan, Jingyu, Jiangyuan, and Liuhe counties in Jilin Province. We demonstrated that the temporal dynamics of TBE in Jilin was significantly associated with the dynamics of meteorological factors especially after 2009. The results from the auto-logistic regression analysis showed that the percentage coverage of forest, temperature, and autoregressive term were significantly associated with the occurrence of human TBE cases in Jilin Province. Our findings will provide a scientific evidence for the targeted prevention and control programs.
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Affiliation(s)
- Qinglong Zhao
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Xinlou Li
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China.,State Key Laboratory of Resources and Environmental Information System, Chinese Academy of Sciences, Beijing, China.,Center for Disease Control and Prevention of Aerospace System, Beijing, China
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Chenyi Chu
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Laishun Yao
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Yang Zhang
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Quan Qian
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Meina Li
- The First Hospital of Jilin University, Changchun, China
| | - Shenlong Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Na Li
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China.,Center for Disease Control and Prevention of Aerospace System, Beijing, China
| | - Xiaobo Zhao
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Haifeng Song
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yong Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Biao Huang
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
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17
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Yang L, Zhao Z, Hou G, Zhang C, Liu J, Xu L, Li W, Tan Z, Tu C, He B. Genomes and seroprevalence of severe fever with thrombocytopenia syndrome virus and Nairobi sheep disease virus in Haemaphysalis longicornis ticks and goats in Hubei, China. Virology 2019; 529:234-245. [PMID: 30738361 PMCID: PMC7127444 DOI: 10.1016/j.virol.2019.01.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 11/18/2022]
Abstract
Ticks are medically-important arthropods that maintain and transmit numerous emerging viruses. China suffers severely from tick-borne viral diseases such as tick-borne encephalitis and severe fever with thrombocytopenia syndrome (SFTS), but the background of tick-borne viruses is very limited. Here we report the virome profiling of ticks and goat sera from SFTS-epidemic areas, and serological investigation of SFTS virus (SFTSV) and Nairobi sheep disease virus (NSDV). Results revealed divergent viruses in ticks and goat sera, including SFTSV and NSDV. Sequence and phylogenetic analyses showed that the SFTSV identified here was most closely related to human SFTSV in sampling and surrounding areas, and the NSDV to the previously identified NSDV from northeast China. Serological investigation of SFTSV infection in goats revealed intensive activity in those areas. Surprisingly, two different methods of NSDV serological investigation showed no sera positive for this virus.
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Affiliation(s)
- Ling'En Yang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary Medicine, Academy of Military Medical Sciences, Changchun, Jilin Province, China
| | - Zihan Zhao
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary Medicine, Academy of Military Medical Sciences, Changchun, Jilin Province, China
| | - Guobin Hou
- Animal Husbandry and Veterinary Service Center of Xiaolin Town, Suizhou, Hubei Province, China
| | - Chang Zhang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary Medicine, Academy of Military Medical Sciences, Changchun, Jilin Province, China
| | - Jun Liu
- Centers for Animal Disease Control and Prevention of Suixian County, Suizhou, Hubei Province, China
| | - Lin Xu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary Medicine, Academy of Military Medical Sciences, Changchun, Jilin Province, China
| | - Wei Li
- Animal Health Inspection Institute of Xiangyang, Xiangyang, Hubei Province, China
| | - Zhizhou Tan
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary Medicine, Academy of Military Medical Sciences, Changchun, Jilin Province, China
| | - Changchun Tu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary Medicine, Academy of Military Medical Sciences, Changchun, Jilin Province, China; Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Biao He
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Institute of Military Veterinary Medicine, Academy of Military Medical Sciences, Changchun, Jilin Province, China; Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, Jiangsu Province, China
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18
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Sun J, Lu L, Yang J, Liu K, Wu H, Liu Q. Association between Severe Fever with Thrombocytopenia Syndrome Incidence and Ambient Temperature. Am J Trop Med Hyg 2018; 98:1478-1483. [PMID: 29557340 DOI: 10.4269/ajtmh.17-0991] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is emerging in China. To explore the lagged effects and nonlinear association between temperature and SFTS, we collected data on ambient temperature and SFTS cases and analyzed the data using a distributed lag nonlinear model. A total of 1,933 SFTS cases were reported in the study area from 2011 to 2015. Our study revealed a nonlinear relationship between weekly temperature and SFTS. The exposure-response curve was an approximately reversed U-shaped peak at 23°C. High temperatures had acute and short-term effects, whereas low temperatures had persistent and long-term effects. The effects of lower temperatures (1.62°C and 6.97°C) could last 24 weeks, but the effect of 29.30°C was not significant at lag 8 weeks. Our results provide information to better understand the effect of temperature variation on SFTS and may have policy implications for disease prevention and control.
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Affiliation(s)
- Jimin Sun
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.,State Key Laboratory of 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, Beijing, China
| | - Liang Lu
- State Key Laboratory of 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, Beijing, China
| | - Jun Yang
- State Key Laboratory of 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, Beijing, China
| | - Keke Liu
- State Key Laboratory of 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, Beijing, China
| | - Haixia Wu
- State Key Laboratory of 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, Beijing, China
| | - Qiyong Liu
- State Key Laboratory of 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, Beijing, China
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