title: Spatiotemporal transmission dynamics of hemorrhagic fever with renal syndrome in China, 2005-2012.
abstract: BACKGROUND
  Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by many serotypes of hantaviruses. In China, HFRS has been recognized as a severe public health problem with 90% of the total reported cases in the world. This study describes the spatiotemporal dynamics of HFRS cases in China and identifies the regions, time, and populations at highest risk, which could help the planning and implementation of key preventative measures.
  
  
  METHODS
  Data on all reported HFRS cases at the county level from January 2005 to December 2012 were collected from Chinese Center for Disease Control and Prevention. Geographic Information System-based spatiotemporal analyses including Local Indicators of Spatial Association and Kulldorff's space-time scan statistic were performed to detect local high-risk space-time clusters of HFRS in China. In addition, cases from high-risk and low-risk counties were compared to identify significant demographic differences.
  
  
  RESULTS
  A total of 100,868 cases were reported during 2005-2012 in mainland China. There were significant variations in the spatiotemporal dynamics of HFRS. HFRS cases occurred most frequently in June, November, and December. There was a significant positive spatial autocorrelation of HFRS incidence during the study periods, with Moran's I values ranging from 0.46 to 0.56 (P<0.05). Several distinct HFRS cluster areas were identified, mainly concentrated in northeastern, central, and eastern of China. Compared with cases from low-risk areas, a higher proportion of cases were younger, non-farmer, and floating residents in high-risk counties.
  
  
  CONCLUSIONS
  This study identified significant space-time clusters of HFRS in China during 2005-2012 indicating that preventative strategies for HFRS should be particularly focused on the northeastern, central, and eastern of China to achieve the most cost-effective outcomes.
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Zhang
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Li-Ya
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, People's Republic of China.
authors.forename: Yun-Xi
authors.initials: YX
authors.lastname: Liu
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
authors.forename: Wen-Wu
authors.initials: WW
authors.lastname: Yin
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
authors.forename: Wen-Biao
authors.initials: WB
authors.lastname: Hu
authors.affiliation: School of Veterinary Science, The University of Queensland, Brisbane, Australia; WHO Collaborating Centre for Children Environmental Health, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia.
authors.forename: Ricardo J Soares
authors.initials: RJ
authors.lastname: Magalhaes
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
authors.forename: Fan
authors.initials: F
authors.lastname: Ding
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Hai-Long
authors.initials: HL
authors.lastname: Sun
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
authors.forename: Hang
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Shen-Long
authors.initials: SL
authors.lastname: Li
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Geography, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Ubydul
authors.initials: U
authors.lastname: Haque
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
authors.forename: Shi-Lu
authors.initials: SL
authors.lastname: Tong
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Geography, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Glass
authors.affiliation: Discipline of Public Health, University of Adelaide, Adelaide, Australia.
authors.forename: Peng
authors.initials: P
authors.lastname: Bi
authors.affiliation: Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Archie C A
authors.initials: AC
authors.lastname: Clements
authors.affiliation: State Key Laboratory for 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.
authors.forename: Qi-Yong
authors.initials: QY
authors.lastname: Liu
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Li
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062211:Spatio-Temporal Analysis