Background:Environmental exposures may influence irritable bowel syndrome (IBS) pathogenesis, but the interplay between genetic risk, residential green/blue space, and IBS incidence remains unexplored. Methods:We aimed to study the association between green/blue space and incident IBS, and to assess effect modification by genetic susceptibility. The study included 376 749 UK Biobank participants at baseline. Residential green space was measured using the normalised difference vegetation index (NDVI), and blue space was defined by distance to the nearest water bodies. For time-to-event analyses, we used Cox proportional hazards models, polygenic risk scores (PRS), and mediation analysis to test gene-environment interactions. Results are presented as hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results:During a follow-up of 11.73 years, 7091 incident IBS cases were documented. Higher residential green space exposure was associated with reduced risk of incident IBS. Specifically, within a 1000 m buffer, each interquartile range (IQR) increase in NDVI corresponded to a 5% lower IBS risk (HR = 0.95; 95% CI = 0.91-0.98), with consistent effects observed at 800 m and 500 m buffers. Conversely, a greater distance to water bodies was associated with reduced IBS risk. Stratification by PRS revealed a significant interaction: increased green space (1000 m buffer) reduced IBS risk by 8% exclusively among high-genetic-risk individuals (HR = 0.92; 95% CI = 0.88-0.96), whereas no interaction was observed for blue space. Moreover, physical activity mediated the association between green space and IBS. Conclusions:Increased residential green space exposure is associated with reduced IBS incidence, particularly among individuals with high genetic susceptibility. These findings underscore the importance of urban greening as a public health strategy to mitigate IBS risk, highlighting the potential for targeted environmental interventions to offset genetic predispositions.

Vitiligo is an autoimmune skin disease characterized by depigmentation, mainly due to CD8 + T cell–mediated destruction of melanocytes. Hyperglycemia exacerbates autoimmune responses and is associated with vitiligo; however, the underlying immunometabolic mechanisms are poorly understood. Here, we demonstrated the correlation between hyperglycemia and vitiligo in a case-control study and demonstrated that hyperglycemia aggravated vitiligo based on a mouse model. Targeted metabolomics identified succinate as the potential metabolite mediating hyperglycemia-aggravated vitiligo. Mechanistically, succinate promotes the activation of CD8 + T cells through succinate receptor 1 (SUCNR1) and promotes keratinocytes to secrete CXCL9 and CXCL10 by enhancing the stability and nuclear translocation of hypoxia-inducible factor-1α, facilitating the skin-homing of CD8 + T cells. Thus, hyperglycemia aggravates vitiligo through succinate/SUCNR1 axis–regulated CD8 + T cell hyperactivation. Our study provides insights into the long-observed yet previously unclear mechanism by which hyperglycemia accelerates vitiligo progression and highlights SUCNR1 as a potential therapeutic target.

Background Although amoebic dysentery (caused by Entamoeba histolytica ) and bacillary dysentery (caused by Shigella spp.) share highly similar clinical manifestations, their epidemiological profiles and transmission ecologies are likely to possess distinct. The lack of systematic and comprehensive comparative analyses poses a challenge to guiding pathogen-specific interventions. Methods We conducted a retrospective analysis of nationally notifiable surveillance data of amoebic and bacillary dysentery in mainland China from 2005 to 2020. We applied an age–period–cohort (APC) model to quantify longitudinal trends, a Bayesian space–time hierarchical model (BSTHM) to map the spatiotemporal heterogeneity, and an optimal parameters–based geographical detector (OPGD) to assess the distinct determinants driving transmission for each pathogen. Results A total of 28,889 cases of amoebic and 3,444,305 cases of bacillary dysentery were reported in mainland China from 2005 to 2020. Both diseases exhibited marked summer–autumn seasonality and a predilection for children < 5 years. However, their geographical architectures were fundamentally divergent: Amoebic dysentery was hyper–endemic in the humid southwest (Guizhou, Hunan, Guangxi), driven predominantly by socioeconomic factors (medical personnel density: Q = 20.12%, and GDP: Q = 18.17%). In contrast, bacillary dysentery hot spots spanned arid western provinces and the densely populated Beijing–Tianjin region, which were driven by environmental and demographic determinants (population density: Q = 39.11%, relative humidity: Q = 19.12%, temperature: Q = 18.85%, and rainfall: Q = 17.53%). Conclusions This study delineates the distinct eco–epidemiological profiles of dysentery in mainland China. The divergent drivers underscore the necessity of transitioning from generic diarrheal disease control to pathogen–specific precision public health strategies and interventions.

HBsAg and anti-HBs coexistence represents an unusual serological pattern in hepatitis B virus (HBV) infection. However, its natural course remains unclear. This study investigated the occurrence of this serological pattern in patients with HBV in acute and chronic phases and estimated the associated risks. Of the 215 adult patients diagnosed with acute-phase HBV, 19 (8.84 %) cases demonstrated HBsAg and anti-HBs coexistence. In the chronic phase, 54 new cases of HBsAg and anti-HBs coexistence were identified during a median follow-up of 14 months (interquartile range: 14-28) among 4593 HBsAg-positive patients. The average annual incidence of coexistence was 1.41 % ± 0.28 %. The cumulative risk of HBsAg and anti-HBs coexistence in chronic phase patients was higher in those aged ≥ 50 years (risk ratio [RR]: 1.79, 95 % confidence interval [CI]: 1.04-3.09, P = 0.035), with positive HBeAg (RR: 3.43, 95 % CI: 1.91-6.19, P < 0.001), baseline alanine transaminase abnormalities (RR: 3.62, 95 % CI: 1.93-6.79, P < 0.001), and higher HBV DNA levels (RR: 1.97, 95 % CI: 1.12-3.49, P = 0.017). The quasispecies heterogeneity of the "a" determinant mutation demonstrated no significant change during the occurrence of coexistence with HBsAg and anti-HBs in HBV infection. Therefore, HBsAg and anti-HBs coexistence may be the intermediate process in the natural history of HBV infection, unrelated to "a" determinant mutation but associated with the disease phase.

Objective:Poxviruses are zoonotic pathogens that infect humans, mammals, vertebrates, and arthropods. However, the specific role of ticks in transmission and evolution of these viruses remains unclear. Methods:Transcriptomic and metatranscriptomic raw data from 329 sampling pools of seven tick species across five continents were mined to assess the diversity and abundance of poxviruses. Chordopoxviral sequences were assembled and subjected to phylogenetic analysis to trace the origins of the unblasted fragments within these sequences. Results:Fifty-eight poxvirus species, representing two subfamilies and 20 genera, were identified, with 212 poxviral sequences assembled. A substantial proportion of AT-rich fragments were detected in the assembled poxviral genomes. These genomic sequences contained fragments originating from rodents, archaea, and arthropods. Conclusion:Our findings indicate that ticks play a significant role in the transmission and evolution of poxviruses. These viruses demonstrate the capacity to modulate virulence and adaptability through horizontal gene transfer, gene recombination, and gene mutations, thereby promoting co-existence and co-evolution with their hosts. This study advances understanding of the ecological dynamics of poxvirus transmission and evolution and highlights the potential role of ticks as vectors and vessels in these processes.

BACKGROUND:The Ebola epidemic has persisted in Africa since it was firstly identified in 1976. However, few studies have focused on spatiotemporally assessing the ecological adaptability of this virus and the influence of multiple factors on outbreaks. This study quantitatively explores the ecological adaptability of Ebola virus and its response to different potential natural and anthropogenic factors from a spatiotemporal perspective. METHODOLOGY:Based on historical Ebola cases and relevant environmental factors collected from 2014 to 2022 in Africa, the spatiotemporal distribution of Ebola adaptability is characterized by integrating four distinct ecological models into one synthesized spatiotemporal framework. Maxent and Generalized Additive Models were applied to further reveal the potential responses of the Ebola virus niche to its ever-changing environments. FINDINGS:Ebola habitats appear to aggregate across the sub-Saharan region and in north Zambia and Angola, covering approximately 16% of the African continent. Countries presently unaffected by Ebola but at increasing risk include Ethiopia, Tanzania, Côte d'Ivoire, Ghana, Cameroon, and Rwanda. In addition, among the thirteen key influencing factors, temperature seasonality and population density were identified as significantly influencing the ecological adaptability of Ebola. Specifically, those regions were prone to minimal seasonal variations in temperature. Both the potential anthropogenic influence and vegetation coverage demonstrate a rise-to-decline impact on the outbreaks of Ebola virus across Africa. CONCLUSIONS:Our findings suggest new ways to effectively respond to potential Ebola outbreaks in Sub-Saharan Africa. We believe that this integrated modeling approach and response analysis provide a framework that can be extended to predict risk of other worldwide diseases from a similar epidemic study perspective.

This study sought to perform a meta-analysis of the risk factors for the complications of oral and maxillofacial space infections (OMSI), aiming to provide insights for identifying cases at elevated risk and facilitating the further clinical prevention strategies. A comprehensive search of international (PubMed, Web of Science, Cochrane Library and CTdatabase) and Chinese (CNKI, Wanfang and VIP) databases was conducted through August 2024. The identified literature was assessed for quality, and meta-analysis was conducted using RevMan 5.0 software. A total of 12 studies were included, comprising 2,205 participants, among whom 417 experienced complications, yielding a complication rate of 18.91

Bartonellosis is a global vector-borne zoonosis caused by Bartonella, a genus of intracellular Gram-negative bacteria. It is one of 14 emerging infectious diseases that have recently been identified in China, and the prevalence varies by region. A more in-depth understanding is needed regarding the role and influencing factors of ticks in the transmission of Bartonella, including the infection rate of ticks with Bartonella in different regions. This study explored the prevalence of Bartonella in ticks and the factors that influence it. Databases (PubMed, Embase, Elsevier ScienceDirect, Cochrane Library, Web of Science, CNKI, VIP, CBM, and WanFang) were searched to review the preliminary research on Bartonella-carrying ticks in China. We identified and included 22 articles. Bartonella infection rates in ticks varied from 0 to 22.79

The transmission and prevalence of Hand, Foot and Mouth Disease (HFMD) are affected by a variety of natural and socio-economic environmental factors. This study aims to quantitatively investigate the non-stationary and spatially varying associations between various environmental factors and HFMD risk. We collected HFMD surveillance cases and a series of relevant environmental data from 2013 to 2021 in Xi'an, Northwest China. By controlling the spatial and temporal mixture effects of HFMD, we constructed a Bayesian spatiotemporal mapping model and characterized the impacts of different driving factors into global linear, non-stationary and spatially varying effects. The results showed that the impact of meteorological conditions on HFMD risk varies in both type and magnitude above certain thresholds (temperature: 30 °C, precipitation: 70 mm, solar radiation: 13000 kJ/m2, pressure: 945 hPa, humidity: 69%). Air pollutants (PM2.5, PM10, NO2) showed an inverted U-shaped relationship with the risk of HFMD, while other air pollutants (O3, SO2) showed nonlinear fluctuations. Moreover, the driving effect of increasing temperature on HFMD was significant in the 3-year period, while the inhibitory effect of increasing precipitation appeared evident in the 5-year period. In addition, the proportion of urban/suburban/rural area had a strong influence on HFMD, indicating that the incidence of HFMD firstly increased and then decreased during the rapid urbanization process. The influence of population density on HFMD was not only limited by spatial location, but also varied between high and low intervals. Higher road density inhibited the risk of HFMD, but higher night light index promoted the occurrence of HFMD. Our findings further demonstrated that both ecological and socioeconomic environmental factors can pose multiple driving effects on increasing the spatiotemporal risk of HFMD, which is of great significance for effectively responding to the changes in HFMD epidemic outbreaks.

Ticks are obligate ectoparasites and vectors of a variety of pathogens in humans and animals. Certain tick-borne pathogens (TBPs) have been identified as the cause of zoonoses, posing potentially significant threats to the human health and livestock industries. Fungi are one of the major TBPs that can affect ticks and cause disease in humans. At present, there are few studies on the diversity of fungal microbial communities carried by Ixodes. Therefore, profiling tick-borne fungi will contribute to understanding the tick-fungal interaction. This study evaluated the community profile and differences in the fungal microbiome in Ixodidae collected on parasitic ticks or nonparasitic ticks in Wuwei, Gansu Province, China. The Shannon index, Simpson index, and Richness index were used to evaluate the diversity of mycobiome. Principle coordinates analysis (PCoA) was conducted to determine patterns of diversity in mycobiome. Using correlation analysis to determine the correlation of mycobiome. The results show that the high-throughput sequencing of the internal transcribed spacer gene generated 3,634,943 raw reads and 7,482 amplicon sequence variants. The dominant tick species in this region was Dermacentor nuttalli (Ixodidae). The mycobiome belonged to four classes-Dothideomycetes, Sordariomycetes, Ustilaginomycetes, and Tremellomycetes-and more than 261 genera, the most abundant genera were Cladosporium, Purpureocillium, Aureobasidium, Tranzscheliella, and Sporormiella. Alpha diversity indicated that the abundance and evenness of mycobiome were marginally higher in nonparasitic ticks than in parasitic ticks. PCoA showed that the community structures of parasitic ticks vary from nonparasitic ticks, samples from nonparasitic ticks tended to cluster more closely than those from the parasitic ticks. Correlation analysis indicated that there was a significant positive correlation or negative correlation between the mycobiome. Our results indicate that the mycobiome carried by Dermacentor nuttalli had rich diversity, and there was a significant difference in mycobiome between parasitic ticks and nonparasitic ticks. These findings may conducive to understand the complex interaction between ticks and commensal fungi and provide help for the further exploration of the behavioral characteristics of ticks and formulation of effective biological control measures.

Background Despite ongoing changes in the global epidemiology of cystic echinococcosis (CE), there is a lack of research conducted to date. Methods We extracted data on incidence and disability-adjusted life years for 204 countries and territories from 1990 to 2019 to evaluate the epidemiological characteristics and burden of CE through the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We used locally weighted linear regression to analyse the primary driving factors of the prevalence of CE at the national and regional levels and utilised a Bayesian Age-Period-Cohort model to forecast the global incidence of CE in the next decade. Results Globally, the incidence of CE remained constantly high from 1990 (2.65 per 100 000 population) to 2019 (2.60 per 100 000 population), resulting in an estimated 207 368 new cases in 2019. We observed substantial variations in the disease burden regarding its spatiotemporal distribution, population demographics, and Socio-Demographic Index levels. According to established models, factors such as health care capacity, livestock husbandry, agricultural activities, rural populations, and education levels are likely to play significant roles in determining the prevalence of CE across different countries. By 2030, the worldwide number of CE cases could reach as high as 235 628, representing an increase of 13.63% compared to 2019. Conclusions Over the past three decades, the global burden of CE has persistently remained high, especially in Central Asia, as well as North Africa and the Middle East. Efforts should focus on more effective prevention and control measures in these key regions and should specifically target vulnerable populations to prevent the escalation of epidemics.

Purpose: The characteristics of cytokine/chemokine(CK) profiles across different courses of chronic hepatitis B virus infection and the effects of NAs antiviral therapy on cytokine profiles remain unclear. Methods: This report provides evidence from 383 patients with chronic HBV infection. The Luminex multiple cytokine detection technology was used to detect CK profiles. The predictive power of CKs across course of disease was assessedusing univariate analyses and with receiver operating characteristic (ROC) curves.Results: Compared to healthy control (HC), expression levels of interleukin 6 (IL)-6, IL-8, IL-21, matrix metal-loproteinases (MMP)-2 and tumor necrosis factor receptor (TNFR)-1 showed a significant increasing trend during chronic HBV infection. IL-23 and IL-33 increased respectively in chronic hepatitis B patients (CHB). interferon (IFN)-gamma and TNF-alpha changed significantly only in liver cirrhosis (LC) patients. Whereas, myeloid-related markers decreased dramatically in those with hepatocellular carcinoma (HCC). The ROC result suggests that combining IL-6, IL-8, CXCL9 and CXCL13 into a nomogram has closely correlation with HCC during chronic HBV infection. In addition, nucleotide analogues (NAs) antiviral treatments are capable of recoveringnormal liver functions and significantly reducing the viral loads, however, they seem to have a limited effect in changing CKs, especially specific antiviral factors. Conclusion: The differential CK and virological markers may serve as potential indicators of distinct immune statuses in chronic HBV infection. They also underscore the varying efficacy and limitations of NAs antiviral therapies. This next step would to break new ground in the optimization of current anti-HBV treatment programs although this requires further research.

Human brucellosis has reemerged in China, with a distinct change in its geographical distribution. The incidence of human brucellosis has significantly risen in inland regions of China. To gain insights into epidemic characteristics and identify factors influencing the geographic spread of human brucellosis, our study utilized the Extreme Gradient Boosting (XGBoost) algorithm and interpretable machine learning techniques. The results showed a consistent upward trend in the incidence of human brucellosis, with a significant increase of 8.20% from 2004 to 2021 (95% CI: 1.70, 15.10). The northern region continued to face a serious human situation, with a gradual upward trend. Meanwhile, the western and southern regions have experienced a gradual spread of human brucellosis, encompassing all regions of China over the past decade. Further analysis using Shapley Additive Explanations (SHAP) demonstrated that higher Gross Domestic Product (GDP) per capita and increased funding for education have the potential to reduce the spread. Conversely, the expansion of human brucellosis showed a positive correlation with bed availability per 1000 individuals, humidity, railway mileage, and GDP. These findings strongly suggest that socioeconomic factors play a more significant role in the spread of human brucellosis than other factors.

As one of the most neglected zoonotic diseases, brucellosis has posed a serious threat to public health worldwide. This study is purposed to apply different machine learning models to improve the prediction accuracy of human brucellosis (HB) in Shaanxi, China from 2008 to 2020, under livestock husbandry intensification from a spatiotemporal perspective. We quantitatively evaluated the performance and suitability of ConvLSTM, RF, and LSTM models in epidemic forecasting, and investigated the spatial heterogeneity of how different factors drive the occurrence and transmission of HB in distinct sub-regions by using Kernel Density Analysis and Shapley Additional Explanations. Our findings demonstrated that ConvLSTM network yielded the best predictive performance with the lowest average RMSE of 13.875 and MAE values of 18.393. RF model generated an underestimated outcome while LSTM model had an overestimated one. In addition, climatic conditions, intensification of livestock keeping and socioeconomic status were identified as the dominant factors that drive the occurrence of HB in Shaanbei Plateau, Guanzhong Plain, and Shaannan Region, respectively. This work provided a comprehensive understanding of the potential risk of HB epidemics in Northwest China driven by both anthropogenic activities and natural environment, which can support further practice in disease control and prevention.

Backgrounds: Visceral leishmaniasis (VL) is a vector-borne disease posing increasing public health concerns. Although efforts to eliminate VL are underway, its global risk distribution remains unclear, because of changes in transmission risk. Methods: Worldwide province-level data on VL incidence were obtained from multiple sources. We analyzed the global evolution features of VL and estimated its ecological niches with boosted regression tree models. A risk map was generated to analyze regions with high VL risk. Results: A total of 558 articles and 2,694 records from 310 provinces were included. The model indicated that precipitation in the warmest quarter and poor socio-demographic index were the most significant risk factors affecting VL distribution. The risk map indicated that Brazil, Iran, Ethiopia, and India were the regions with the highest probability of infection. We estimated that 5.3 billion people live in regions at risk of VL. Conclusions: VL is undergoing geographic expansion. Our study increases understanding of VL’s global-risk distribution and how risk factors influencing the disease transmission. Our findings may aid in promoting disease control in future surveillance activities.

Background: In this study, we present a case of Japanese spotted fever (JSF) caused by Rickettsia japonica and use this case to investigate the process of diagnosing and reintegrating traceability of infectious diseases via metagenomic next-generation sequencing (mNGS). Methods: From data relating to epidemiological history, clinical and laboratory examinations, and mNGS sequencing, a diagnosis of severe JSF was concluded. Results: A detailed field epidemiological investigation discovered parasitic Haemaphysalis longicornis from a host animal (dog) in the domicile of the patient, within which R. japonica was detected, along with a diverse array of other potentially pathogenic microorganisms that could cause other infectious diseases. Conclusion: The mNGS provided an efficient method to diagnose JSF infection. This methodology could also be applied to field epidemiological investigations to establish the traceability of infectious diseases.

Background:China is confronted with the significant menace posed by hemorrhagic fever with renal syndrome (HFRS). Nevertheless, the long-term spatial-temporal variations, regional prevalence patterns, and fundamental determinants' mechanisms for HFRS remain inadequately elucidated. Methods:Newly diagnosed cases of HFRS from January 2004 to December 2019 were acquired from the China Public Health Science Data repository. We used Age-period-cohort and Bayesian Spacetime Hierarchy models to identify high-risk populations and regions in mainland China. Additionally, the Geographical Detector model was employed to quantify the determinant powers of significant driver factors to the disease. Results:A total of 199,799 cases of HFRS were reported in mainland China during 2004-2019. The incidence of HFRS declined from 1.93 per 100,000 in 2004 to 0.69 per 100,000 in 2019. The incidence demonstrated an inverted U-shaped trend with advancing age, peaking in the 50-54 age group, with higher incidences observed among individuals aged 20-74 years. Hyperendemic areas were mainly concentrated in the northeastern regions of China, while some western provinces exhibited a potential upward trend. Geographical detector model identified that the spatial variations of HFRS were significantly associated with the relative humidity (Q = 0.36), forest cover (Q = 0.26), rainfall (Q = 0.18), temperature (Q = 0.16), and the surface water resources (Q = 0.14). Conclusions:This study offered comprehensive examinations of epidemic patterns, identified high-risk areas quantitatively, and analyzed factors influencing HFRS transmission in China. The findings may contribute to the necessary implementations for the effective prevention and control of HFRS.

AbstractBackground and AimsVarious inflammatory and immune cytokines play key roles in the progression of hepatitis B virus (HBV)‐related liver cirrhosis (LC). This study explored the relationship between single nucleotide polymorphisms (SNPs) in cytokines with the combined effect of polymorphisms and gender‐polymorphisms interaction and LC risk.MethodsIn this study, a case–control design was used, samples were selected from 45 patients with hepatitis B‐related cirrhosis and 45 age‐gender‐matched chronic HBV‐infected patients without cirrhosis attending the tumor hospital of Wuwei Academy of Medical Sciences. Fifteen SNPs were examined using a real‐time polymerase chain reaction allelic discrimination system. Logistic regression was utilized to assess cytokine‐associated SNPs and the association between SNPs and LC progression in HBV‐infected patients.ResultsThe multivariate‐adjusted logistic model revealed that the GG/AG dominant model (OR, 16.38; 95% CI, 1.13–236.70) and G allele (OR, 5.93; 95% CI, 0.98–36.01) of rs1800896 were associated with an increased risk of cirrhosis in CHB patients. Instead, rs2227306 CT presented a reduced cirrhosis risk (OR, 0.22; 95% CI, 0.04–1.38). Rs2055979 AA/AC was negatively associated with the risk of cirrhosis, potentially reversed in males (p = 0.021). Rs1799964 CC/CT was positively related to the risk of cirrhosis but reduced the risk of cirrhosis in males (OR, 0.13; 95% CI, 0.022–0.808; p = 0.028). Both rs1799964 TT and rs1799724 CT/TT genotype showed a synergistic effect in reducing the risk of cirrhosis with rs1800896 AA (OR, 0.08; 95% CI, 0.01–1.43 and OR, 0.12; 95% CI, 0.01–2.21).ConclusionPolymorphisms rs1800896 and rs2227306 are potentially associated with the risk of cirrhosis. For the first time, the study highlights that the rs2055979 AA/AC and rs1799964 CC/CT polymorphism interact with gender and its potential reversal of cirrhosis risk in males. Furthermore, rs1800896 AA showed a synergistic effect with rs1799964 TT and rs1799724 CT/TT to prevent the progression of HBV infection to cirrhosis.

With the booming of worldwide agriculture intensification, brucellosis, one of the most neglected zoonotic diseases, has become an increasing challenge for global public health. Although the transmission patterns of human brucellosis (HB) have been studied in many regions, the dynamic transfer processes of risk and its driving factors remain poorly understood, especially in the context of agricultural intensification. This study attempted to explore the risk transfer of HB between the exact epidemic areas and the neighboring or distant low-risk areas to explain the impact of livestock agriculture intensification and foodborne infections on the transmission of HB in Shaanxi Province as a case study. We adopted multiple approaches, including test-based methods, model-based methods, and a geographical detector to detect the spatial-temporal dynamic changes of high-risk epidemic areas of HB at the county scale. We also quantitatively estimated how the related factors drove the risk transfer of the disease. Results confirmed the risk transfer pattern of HB with an expansion from north to south in Shaanxi Province and identified two primary transfer routes. In particular, in the traditional epidemic areas of the Shaanbei plateau, the farm agglomeration effect can significantly increase the risk of HB. Meanwhile, retail outlets for milk and dairy products were partially responsible for the foodborne infections of HB in the emerging epidemic areas of Xi'an. This study not only contributed helpful insights to support HB control and prevention in the rapid transition of livestock agriculture but also provided possible directions for further research on foodborne HB infections in urbanized areas.