title: Spatial cluster analysis of human cases of Crimean Congo hemorrhagic fever reported in Pakistan.
abstract: BACKGROUND
  Crimean Congo hemorrhagic fever (CCHF) is a tick-borne viral zoonotic disease that has been reported in almost all geographic regions in Pakistan. The aim of this study was to identify spatial clusters of human cases of CCHF reported in country.
  
  
  METHODS
  Kulldorff's spatial scan statisitc, Anselin's Local Moran's I and Getis Ord Gi* tests were applied on data (i.e. number of laboratory confirmed cases reported from each district during year 2013).
  
  
  RESULTS
  The analyses revealed a large multi-district cluster of high CCHF incidence in the uplands of Balochistan province near it border with Afghanistan. The cluster comprised the following districts: Qilla Abdullah; Qilla Saifullah; Loralai, Quetta, Sibi, Chagai, and Mastung. Another cluster was detected in Punjab and included Rawalpindi district and a part of Islamabad.
  
  
  CONCLUSIONS
  We provide empirical evidence of spatial clustering of human CCHF cases in the country. The districts in the clusters should be given priority in surveillance, control programs, and further research.
authors.affiliation: Section of Veterinary Preventive Medicine and Public Health, University College of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
authors.forename: Tariq
authors.initials: T
authors.lastname: Abbas
authors.affiliation: Department of Pathobiology, College of Veterinary and Animal Sciences, Jhang, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Younus
authors.affiliation: Department of Clinical Sciences, College of Veterinary and Animal Sciences, Jhang, Pakistan.
authors.forename: Sayyad Aun
authors.initials: SA
authors.lastname: Muhammad
keywords: Adjusted cumulative incidence; Clusters; Crimean Congo hemorrhagic fever; Pakistan; Spatial autocorrelation