title: Spatiotemporal Dynamics of Scrub Typhus Transmission in Mainland China, 2006-2014.
abstract: Scrub typhus is endemic in the Asia-Pacific region including China, and the number of reported cases has increased dramatically in the past decade. However, the spatial-temporal dynamics and the potential risk factors in transmission of scrub typhus in mainland China have yet to be characterized.
  
  
  
  This study aims to explore the spatiotemporal dynamics of reported scrub typhus cases in mainland China between January 2006 and December 2014, to detect the location of high risk spatiotemporal clusters of scrub typhus cases, and identify the potential risk factors affecting the re-emergence of the disease.
  
  
  
  Monthly cases of scrub typhus reported at the county level between 2006 and 2014 were obtained from the Chinese Center for Diseases Control and Prevention. Time-series analyses, spatiotemporal cluster analyses, and spatial scan statistics were used to explore the characteristics of the scrub typhus incidence. To explore the association between scrub typhus incidence and environmental variables panel Poisson regression analysis was conducted.
  
  
  
  During the time period between 2006 and 2014 a total of 54,558 scrub typhus cases were reported in mainland China, which grew exponentially. The majority of cases were reported each year between July and November, with peak incidence during October every year. The spatiotemporal dynamics of scrub typhus varied over the study period with high-risk clusters identified in southwest, southern, and middle-eastern part of China. Scrub typhus incidence was positively correlated with the percentage of shrub and meteorological variables including temperature and precipitation.
  
  
  
  The results of this study demonstrate areas in China that could be targeted with public health interventions to mitigate the growing threat of scrub typhus in the country.
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
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: Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Brisbane, Australia.|Child Health Research Center, The University of Queensland, Brisbane, Australia.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Soares Magalhaes
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: 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: Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America.|Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Weppelmann
authors.affiliation: Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors.forename: Yun-Xi
authors.initials: YX
authors.lastname: Liu
authors.affiliation: 517 Military Hospital, Kelan, Shanxi, People's Republic of China.
authors.forename: Xin-Lou
authors.initials: XL
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
authors.affiliation: Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Archie C A
authors.initials: AC
authors.lastname: Clements
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: 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
mesh_terms: D002681:China / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D012285:Orientia tsutsugamushi; D012044:Regression Analysis; D012307:Risk Factors; D012612:Scrub Typhus / Q000453:epidemiology* / Q000635:transmission*; D012621:Seasons; D062211:Spatio-Temporal Analysis; D013696:Temperature