title: Mapping risk of leptospirosis in China using environmental and socioeconomic data.
abstract: Leptospirosis is a water-borne and widespread spirochetal zoonosis caused by pathogenic bacteria called leptospires. Human leptospirosis is an important zoonotic infectious disease with frequent outbreaks in recent years in China. Leptospirosis's emergence has been linked to many environmental and ecological drivers of disease transmission. In this paper, we identified the environmental and socioeconomic factors associated with leptospirosis in China, and predict potential risk area of leptospirosis using predictive models.
  
  
  
  Leptospirosis incidence data were derived from the database of China's web-based infectious disease reporting system, a national surveillance network maintained by Chinese Center for Disease Control and Prevention. We built statistical relationship between occurrence of leptospirosis and nine environmental and socioeconomic risk factors using logistic regression model and Maxent model.
  
  
  
  Both logistic regression model and Maxent model have high performance in predicting the occurrence of leptospirosis, with AUC value of 0.95 and 0.96, respectively. Annual mean temperature (Bio1) and annual total precipitation (Bio12) are two most important variables governing the geographic distribution of leptospirosis in China. The geographic distributions of areas at risk of leptospirosis predicted from both models show high agreement. The risk areas are located mainly in seven provinces of China: Sichuan Province, Chongqing Municipality, Hunan Province, Jiangxi Province, Guangdong Province, Guangxi Province, and Hainan Province, where surveillance and control programs are urgently needed. Logistic regression model and Maxent model predicted that 403 and 464 counties are at very high risk of leptospirosis, respectively.
  
  
  
  Our results highlight the importance of socioeconomic and environmental variables and predictive models in identifying risk areas for leptospirosis in China. The values of Geographic Information System and predictive models were demonstrated for investigating the geographic distribution, estimating socioeconomic and environmental risk factors, and enhancing our understanding of leptospirosis in China.
authors.affiliation: Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Biological Sciences, University of Notre Dame, Notre Dame, USA.
authors.forename: Jishan
authors.initials: J
authors.lastname: Liao
authors.affiliation: Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Huang
authors.affiliation: Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yeping
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jinghuan
authors.initials: J
authors.lastname: Ren
authors.affiliation: Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xiaoye
authors.initials: X
authors.lastname: Wang
authors.affiliation: Disease Control and Emergency Response Office, Chinese Center for Disease Control and Prevention, Beijing, China. dingfan@chinacdc.cn.
authors.forename: Fan
authors.identifier: 0000-0002-6672-2247
authors.initials: F
authors.lastname: Ding
mesh_terms: D000818:Animals; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D018563:Disease Notification; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D004463:Ecology; D006801:Humans; D015994:Incidence; D007922:Leptospirosis / Q000453:epidemiology*; D008288:Malaria / Q000453:epidemiology; D012307:Risk Factors; D012621:Seasons; D012959:Socioeconomic Factors; D013696:Temperature; D019371:Topography, Medical; D015047:Zoonoses / Q000453:epidemiology*
keywords: Ecological niche modeling; Geographic Information System; Leptospirosis; Logistic regression; Maximum Entropy model