title: Spatiotemporal pattern of bacillary dysentery in China from 1990 to 2009: what is the driver behind?
abstract: BACKGROUND
  Little is known about the spatiotemporal pattern of bacillary dysentery (BD) in China. This study assessed the geographic distribution and seasonality of BD in China over the past two decades.
  
  
  METHODS
  Data on monthly BD cases in 31 provinces of China from January 1990 to December 2009 obtained from Chinese Center for Disease Control and Prevention, and data on demographic and geographic factors, as well as climatic factors, were compiled. The spatial distributions of BD in the four periods across different provinces were mapped, and heat maps were created to present the seasonality of BD by geography. A cosinor function combined with Poisson regression was used to quantify the seasonal parameters of BD, and a regression analysis was conducted to identify the potential drivers of morbidity and seasonality of BD.
  
  
  RESULTS
  Although most regions of China have experienced considerable declines in BD morbidity over the past two decades, Beijing and Ningxia still had high BD morbidity in 2009. BD morbidity decreased more slowly in North-west China than other regions. BD in China mainly peaked from July to September, with heterogeneity in peak time between regions. Relative humidity was associated with BD morbidity and peak time, and latitude was the major predictor of BD amplitude.
  
  
  CONCLUSIONS
  The transmission of BD was heterogeneous in China. Improved sanitation and hygiene in North-west China, and better access to clean water and food in the big floating population in some metropolises could be the focus of future preventive interventions against BD. BD control efforts should put more emphasis on those dry areas in summer.
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Xu
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Wenbiao
authors.initials: W
authors.lastname: Hu
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, P. R. China.
authors.forename: Yewu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Wang
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Shilu
authors.initials: S
authors.lastname: Tong
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China.
authors.forename: Maigeng
authors.initials: M
authors.lastname: Zhou
mesh_terms: D002681:China / Q000453:epidemiology; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000266:history; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D009017:Morbidity; D012621:Seasons; D062211:Spatio-Temporal Analysis
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