title: Rapid increase of scrub typhus incidence in Guangzhou, southern China, 2006-2014.
abstract: In the last decade, scrub typhus (ST) has been emerging or re-emerging in some areas of Asia, including Guangzhou, one of the most affected endemic areas of ST in China.
  
  
  
  Based on the data on all cases reported in Guangzhou from 2006 to 2014, we characterized the epidemiological features, and identified environmental determinants for the spatial distribution of ST using a panel negative binomial model.
  
  
  
  A total of 4821 scrub typhus cases were reported in Guangzhou during 2006-2014. The annual incidence increased noticeably and the increase was relatively high and rapid in rural townships and among elderly females. The majority of cases (86.8%) occurred during May-October, and farmers constituted the majority of the cases, accounting for 33.9% in urban and 61.6% in rural areas. The number of housekeeper patients had a rapid increment in both rural and urban areas during the study period. Atmospheric pressure and relative humidity with lags of 1 or 2 months, distributions of broadleaved forest and rural township were identified as determinants for the spatiotemporal distribution of scrub typhus.
  
  
  
  Our results indicate that surveillance and public education need to be focused on the elderly farmers in rural areas covered with broadleaf forest in southern China.
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.|Center for Disease Control and Prevention of Jinan Military Region, Shandong Province, Jinan, 250014, People's Republic of China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, 510440, People's Republic of China.
authors.forename: Yue-Hong
authors.initials: YH
authors.lastname: Wei
authors.affiliation: Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, 32311, Florida, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, 510440, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, 999025, Rotterdam, The Netherlands.
authors.forename: Sake J
authors.initials: SJ
authors.lastname: de Vlas
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
authors.forename: Hong-Wu
authors.initials: HW
authors.lastname: Yao
authors.affiliation: Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, 510440, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
authors.forename: Mai-Juan
authors.initials: MJ
authors.lastname: Ma
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, 510440, People's Republic of China.
authors.forename: Xiao-Ning
authors.initials: XN
authors.lastname: Li
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
authors.forename: Xin-Lou
authors.initials: XL
authors.lastname: Li
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Zhang
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China. fanglq@bmi.ac.cn.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Fang
authors.affiliation: Guangzhou Center for Disease Control and Prevention, Guangdong Province, Guangzhou, 510440, People's Republic of China. yangzc@gzcdc.org.cn.
authors.forename: Zhi-Cong
authors.initials: ZC
authors.lastname: Yang
authors.affiliation: The State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China. caowc@bmi.ac.cn.
authors.forename: Wu-Chun
authors.initials: WC
authors.lastname: Cao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012612:Scrub Typhus / Q000453:epidemiology*; D012621:Seasons