title: [Study on the epidemiological characteristics and influencing factors of scrub typhus in the autumn-winter natural foci, from 2006 to 2013].
abstract: OBJECTIVE
  To investigate the spatiotemporal expansion and risk factors of scrub typhus (ST) in Shandong, Jiangsu and Anhui provinces.
  
  
  METHODS
  Based on the reported cases in Shandong and Jiangsu from 2006 to 2013, and Anhui from 2008 to 2013 epidemiological characteristics of ST and associated environmental factors were analyzed, using the panel negative binomial regression model.
  
  
  RESULTS
  A total of 2 968, 2 331 and 3 447 ST cases were respectively reported in Shandong, Jiangsu and Anhui during 2006-2013, with the average annual incidence rates as 0.39, 0.38 and 0.94 per 100 000 population. Uptrend in Shandong and Jiangsu, but a slight rollback seen in Anhui were observed. Expansion of natural foci was found in the 3 provinces, with affected counties accounted for 38.0%, 48.2% and 46.5% in Shandong, Jiangsu and Anhui, respectively in 2013. Cases were clustered in autumn but with a peak of single epidemic appeared in October or November, in all the 3 provinces. More female and elderly patients were seen, than in the other age groups, in all the 3 provinces. Majority of the cases were farmers, with an increasing trend in incidence, in all these provinces, followed by housekeepers in Shandong and preschool children in Anhui. The risk factors of transmission in all the 3 provinces were negatively associated with the monthly precipitation, and showing an " inverted-U" pattern in association with monthly temperature. A positive relationship between the risk of transmission and monthly relative humidity was found in Shandong and Jiangsu provinces. However, an " inverted-U" pattern between the risk of transmission and the monthly sunshine hour, appeared in Shandong and Anhui provinces. The incidence of Scrub typhus in Shandong was also positively related to the coverage of forest.
  
  
  CONCLUSIONS
  Surveillance programs and health education measures should focus on the warm and moist areas in all the 3 provinces, and also on forestry areas in Shandong. Health education and prevention on mite-bite should be targeted, especially on high-risk populations as the elderly and farmers, in the 3 provinces. Housekeepers in Shandong and children in Anhui should also be under special concern.
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Sun
authors.forename: L Q
authors.initials: LQ
authors.lastname: Fang
authors.forename: W C
authors.initials: WC
authors.lastname: Cao
mesh_terms: D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D006266:Health Education; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D008962:Models, Theoretical; D012285:Orientia tsutsugamushi; D012307:Risk Factors; D012612:Scrub Typhus / Q000175:diagnosis / Q000453:epidemiology*; D012621:Seasons; D062211:Spatio-Temporal Analysis; D013696:Temperature; D013997:Time Factors