title: [Spatial analysis of autumn-winter type scrub typhus in Shandong province, 2006-2014].
abstract: OBJECTIVE
  To discuss the spatial-temporal distribution and epidemic trends of autumn-winter type scrub typhus in Shandong province, and provide scientific evidence for further study for the prevention and control of the disease.
  
  
  METHODS
  The scrub typhus surveillance data during 2006-2014 were collected from Shandong Disease Reporting Information System. The data was analyzed by using software ArcGIS 9.3(ESRI Inc., Redlands, CA, USA), GeoDa 0.9.5-i and SatScan 9.1.1. The Moran' s I, log-likelihood ratio(LLR), relative risk(RR)were calculated and the incidence choropleth maps, local indicators of spatial autocorrelation cluster maps and space scaning cluster maps were drawn.
  
  
  RESULTS
  A total of 4 453 scrub typhus cases were reported during 2006-2014, and the annual incidence increased with year. Among the 17 prefectures(municipality)in Shandong, 13 were affected by scrub typhus. The global Moran's I index was 0.501 5(P<0.01). The differences in local Moran' s I index among 16 prefectures were significant(P<0.01). The " high-high" clustering areas were mainly Wulian county, Lanshan district and Juxian county of Rizhao, Xintai county of Tai' an, Gangcheng and Laicheng districts of Laiwu, Yiyuan county of Zibo and Mengyin county of Linyi. Spatial scan analysis showed that an eastward moving trend of high-risk clusters and two new high-risk clusters were found in Zaozhuang in 2014. The centers of the most likely clusters were in the south central mountainous areas during 2006-2010 and in 2012, eastern hilly areas in 2011, 2013 and 2014, and the size of the clusters expanded in 2008, 2011, 2013 and 2014. One spatial-temporal cluster was detected from October 1, 2014 to November 30, 2014, the center of the cluster was in Rizhao and the radius was 222.34 kilometers.
  
  
  CONCLUSIONS
  A positive spatial correlation and spatial agglomerations were found in the distribution of autumn-winter type scrub typhus in Shandong. Since 2006, the epidemic area of the disease has expanded and the number of high-risk areas has increased. Moreover, the eastward moving and periodically expanding trends of high-risk clusters were detected.
authors.affiliation: Department of Epidemiology, School of Public Health, Shandong University, Jinan 250012, China.
authors.forename: H
authors.initials: H
authors.lastname: Yang
authors.affiliation: Institute for Bacterial Infectious Disease Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, China.
authors.forename: Z W
authors.initials: ZW
authors.lastname: Bi
authors.affiliation: Institute for Bacterial Infectious Disease Control and Prevention, Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, China.
authors.forename: Z Q
authors.initials: ZQ
authors.lastname: Kou
authors.affiliation: Department of Epidemiology, School of Public Health, Shandong University, Jinan 250012, China.
authors.forename: L
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Epidemiology, School of Public Health, Shandong University, Jinan 250012, China.
authors.forename: Z T
authors.initials: ZT
authors.lastname: Zhao
mesh_terms: D002681:China / Q000453:epidemiology; D002947:Cities; D016000:Cluster Analysis; D058872:Epidemics; D005843:Geography; D006801:Humans; D015994:Incidence; D008962:Models, Theoretical; D012285:Orientia tsutsugamushi / Q000302:isolation & purification*; D012612:Scrub Typhus / Q000175:diagnosis / Q000453:epidemiology*; D012621:Seasons; D012984:Software; D062206:Spatial Analysis; D013997:Time Factors