title: Spatiotemporal Clustering Analysis and Risk Assessments of Human Cutaneous Anthrax in China, 2005-2012.
abstract: OBJECTIVE
  To investigate the epidemic characteristics of human cutaneous anthrax (CA) in China, detect the spatiotemporal clusters at the county level for preemptive public health interventions, and evaluate the differences in the epidemiological characteristics within and outside clusters.
  
  
  METHODS
  CA cases reported during 2005-2012 from the national surveillance system were evaluated at the county level using space-time scan statistic. Comparative analysis of the epidemic characteristics within and outside identified clusters was performed using using the χ2 test or Kruskal-Wallis test.
  
  
  RESULTS
  The group of 30-39 years had the highest incidence of CA, and the fatality rate increased with age, with persons ≥70 years showing a fatality rate of 4.04%. Seasonality analysis showed that most of CA cases occurred between May/June and September/October of each year. The primary spatiotemporal cluster contained 19 counties from June 2006 to May 2010, and it was mainly located straddling the borders of Sichuan, Gansu, and Qinghai provinces. In these high-risk areas, CA cases were predominantly found among younger, local, males, shepherds, who were living on agriculture and stockbreeding and characterized with high morbidity, low mortality and a shorter period from illness onset to diagnosis.
  
  
  CONCLUSIONS
  CA was geographically and persistently clustered in the Southwestern China during 2005-2012, with notable differences in the epidemic characteristics within and outside spatiotemporal clusters; this demonstrates the necessity for CA interventions such as enhanced surveillance, health education, mandatory and standard decontamination or disinfection procedures to be geographically targeted to the areas identified in this study.
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: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Xiu-Shan
authors.initials: XS
authors.lastname: Zhang
authors.affiliation: Navy General Hospital of PLA, Beijing, People's Republic of China.
authors.forename: Zhi-Hai
authors.initials: ZH
authors.lastname: Han
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: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Qian
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 Veterinary Science, The University of Queensland, Brisbane, Australia; Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Soares Magalhaes
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: 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: 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
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: Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Yan-Song
authors.initials: YS
authors.lastname: Sun
mesh_terms: D000881:Anthrax / Q000453:epidemiology* / Q000266:history; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D005260:Female; D049674:History, 21st Century; D006801:Humans; D008297:Male; D011159:Population Surveillance; D018570:Risk Assessment; D012621:Seasons; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000266:history; D062211:Spatio-Temporal Analysis