title: The spatiotemporal expansion of human rabies and its probable explanation in mainland China, 2004-2013.
abstract: BACKGROUND
  Human rabies is a significant public health concern in mainland China. However, the neglect of rabies expansion and scarce analyses of the dynamics have made the spatiotemporal spread pattern of human rabies and its determinants being poorly understood.
  
  
  METHODS
  We collected geographic locations and timeline of reported human rabies cases, rabies sequences and socioeconomic variables for the years 2004-2013, and integrated multidisciplinary approaches, including epidemiological characterization, hotspots identification, risk factors analysis and phylogeographic inference, to explore the spread pattern of human rabies in mainland China during the last decade.
  
  
  RESULTS
  The results show that human rabies distribution and hotspots were expanding from southeastern regions to north or west regions, which could be associated with the evolution of the virus, especially the clade I-G. A Panel Poisson Regression analysis reveals that human rabies incidences had significant correlation with the education level, GDP per capita, temperature at one-month lag and canine rabies outbreak at two-month lag.
  
  
  CONCLUSIONS
  The reduction in the overall human rabies incidence was accompanied by a westward and northward expansion of the circulating region in mainland China. Higher risk of human rabies was associated with lower level of education and economic status. New clades of rabies, especial Clade I-G, played an important role in recent spread. Our findings provide valuable information for rabies control and prevention in the future.
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Hong-Wu
authors.initials: HW
authors.lastname: Yao
authors.affiliation: Department of Biostatistics and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Xin-Lou
authors.initials: XL
authors.lastname: Li
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Shu-Qing
authors.initials: SQ
authors.lastname: Zuo
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Ruo-Xi
authors.initials: RX
authors.lastname: Sun
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Fang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Wu-Chun
authors.initials: WC
authors.lastname: Cao
mesh_terms: D000818:Animals; D005075:Biological Evolution; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D004283:Dog Diseases / Q000453:epidemiology* / Q000821:virology; D004285:Dogs; D004522:Educational Status; D005843:Geography; D006801:Humans; D015994:Incidence; D058974:Phylogeography / Q000706:statistics & numerical data; D011818:Rabies / Q000453:epidemiology* / Q000821:virology; D011819:Rabies Vaccines; D011820:Rabies virus / Q000235:genetics*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013696:Temperature
chemical_list: D011819:Rabies Vaccines