Mapping the Distribution of Anthrax in Mainland China, 2005-2013.
BACKGROUND
Anthrax, a global re-emerging zoonotic disease in recent years is enzootic in mainland China. Despite its significance to the public health, spatiotemporal distributions of the disease in human and livestock and its potential driving factors remain poorly understood.


RESULTS
Using the national surveillance data of human and livestock anthrax from 2005 to 2013, we conducted a retrospective epidemiological study and risk assessment of anthrax in mainland China. The potential determinants for the temporal and spatial distributions of human anthrax were also explored. We found that the majority of human anthrax cases were located in six provinces in western and northeastern China, and five clustering areas with higher incidences were identified. The disease mostly peaked in July or August, and males aged 30-49 years had higher incidence than other subgroups. Monthly incidence of human anthrax was positively correlated with monthly average temperature, relative humidity and monthly accumulative rainfall with lags of 0-2 months. A boosted regression trees (BRT) model at the county level reveals that densities of cattle, sheep and human, coverage of meadow, coverage of typical grassland, elevation, coverage of topsoil with pH > 6.1, concentration of organic carbon in topsoil, and the meteorological factors have contributed substantially to the spatial distribution of the disease. The model-predicted probability of occurrence of human cases in mainland China was mapped at the county level.


CONCLUSIONS
Anthrax in China was characterized by significant seasonality and spatial clustering. The spatial distribution of human anthrax was largely driven by livestock husbandry, human density, land cover, elevation, topsoil features and climate. Enhanced surveillance and intervention for livestock and human anthrax in the high-risk regions, particularly on the Qinghai-Tibetan Plateau, is the key to the prevention of human infections.
The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
Wan-Jun
WJ
Chen
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China.|Department of Geography and Environment, University of Southampton, Southampton, United Kingdom.|Flowminder Foundation, Stockholm, Sweden.
Sheng-Jie
SJ
Lai
Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America.
Yang
Y
Yang
The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
Kun
K
Liu
The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
Xin-Lou
XL
Li
The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
Hong-Wu
HW
Yao
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China.
Yu
Y
Li
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China.
Hang
H
Zhou
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China.
Li-Ping
LP
Wang
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China.
Di
D
Mu
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China.
Wen-Wu
WW
Yin
The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
Li-Qun
LQ
Fang
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China.
Hong-Jie
HJ
Yu
The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
Wu-Chun
WC
Cao
D000328:Adult; D000367:Age Factors; D000822:Animal Husbandry; D000818:Animals; D000881:Anthrax / Q000453:epidemiology* / Q000662:veterinary*; D002417:Cattle; D002681:China / Q000453:epidemiology; D002980:Climate; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D058751:Livestock; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D012189:Retrospective Studies; D018570:Risk Assessment; D012621:Seasons; D012756:Sheep; D062211:Spatio-Temporal Analysis; D019371:Topography, Medical; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology*