title: A national assessment of the epidemiology of severe fever with thrombocytopenia syndrome, China.
abstract: First discovered in rural areas of middle-eastern China in 2009, severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonosis affecting hundreds of cases reported in China each year. Using the national surveillance data from 2010 to 2013, we conducted this retrospective epidemiological study and risk assessment of SFTS in China. We found that the incidence of SFTS and its epidemic areas are continuing to grow, but the case fatality rate (CFR) has steadily decreased. SFTS most commonly affected elderly farmers who acquired infection between May and July in middle-eastern China. However, other epidemiological characteristics such as incidence, sex ratio, CFR, and seasonality differ substantially across the affected provinces, which seem to be consistent with local agricultural activities and the seasonal abundance of ticks. Spatial scan statistics detected three hot spots of SFTS that accounted for 69.1% of SFTS cases in China. There was a strong association of SFTS incidence with temporal changes in the climate within the clusters. Multivariate modeling identified climate conditions, elevation, forest coverage, cattle density, and the presence of Haemaphysalis longicornis ticks as independent risk factors in the distribution of SFTS, based on which a predicted risk map of the disease was derived.
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China.
authors.forename: Hang
authors.initials: H
authors.lastname: Zhou
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China.|Anhui Medical University, Hefei, 230032, P. R. China.
authors.forename: Ruo-Xi
authors.initials: RX
authors.lastname: Sun
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China.
authors.forename: Hong-Wu
authors.initials: HW
authors.lastname: Yao
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Wang
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China.
authors.lastname: Di Mu
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China.
authors.forename: Xin-Lou
authors.initials: XL
authors.lastname: Li
authors.affiliation: Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, 32311, Florida, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Duke University School of Medicine, Durham, 27710, North Carolina, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Gray
authors.affiliation: The 154 Hospital, People's Liberation Army, Xinyang, 464000, P.R. China.
authors.forename: Ning
authors.initials: N
authors.lastname: Cui
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China.
authors.forename: Wen-Wu
authors.initials: WW
authors.lastname: Yin
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Fang
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing 102206, P. R. China.
authors.forename: Hong-Jie
authors.initials: HJ
authors.lastname: Yu
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, P. R. China.
authors.forename: Wu-Chun
authors.initials: WC
authors.lastname: Cao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000383:Agriculture; D000818:Animals; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D002980:Climate; D016000:Cluster Analysis; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012621:Seasons; D012720:Severity of Illness Index; D013577:Syndrome; D013921:Thrombocytopenia / Q000150:complications*; D055815:Young Adult; D015047:Zoonoses / Q000150:complications / Q000453:epidemiology* / Q000473:pathology