BackgroundNon-pharmaceutical interventions (NPIs) have been implemented worldwide to suppress the spread of coronavirus disease 2019 (COVID-19). However, few studies have evaluated the effect of NPIs on other infectious diseases and none has assessed the avoided disease burden associated with NPIs. We aimed to assess the effect of NPIs on the incidence of infectious diseases during the COVID-19 pandemic in 2020 and evaluate the health economic benefits related to the reduction in the incidence of infectious diseases.MethodsData on 10 notifiable infectious diseases across China during 2010-2020 were extracted from the China Information System for Disease Control and Prevention. A two-stage controlled interrupted time-series design with a quasi-Poisson regression model was used to examine the impact of NPIs on the incidence of infectious diseases. The analysis was first performed at the provincial-level administrative divisions (PLADs) level in China, then the PLAD-specific estimates were pooled using a random-effect meta-analysis.ResultsA total of 61,393,737 cases of 10 infectious diseases were identified. The implementation of NPIs was associated with 5.13 million (95% confidence interval [CI] 3.45-7.42) avoided cases and USD 1.77 billion (95% CI 1.18-2.57) avoided hospital expenditures in 2020. There were 4.52 million (95% CI 3.00-6.63) avoided cases for children and adolescents, corresponding to 88.2% of total avoided cases. The top leading cause of avoided burden attributable to NPIs was influenza [avoided percentage (AP): 89.3%; 95% CI 84.5-92.6]. Socioeconomic status and population density were effect modifiers.ConclusionsNPIs for COVID-19 could effectively control the prevalence of infectious diseases, with patterns of risk varying by socioeconomic status. These findings have important implications for informing targeted strategies to prevent infectious diseases.

目的 通过德尔菲法确定军人应力性骨折预警指标体系及各级指标权重,为防治应力性骨折提供依据.方法 在既往研究基础上结合文献分析方法,初步编制军人应力性骨折预警指标体系框架和专家咨询表,选择20名骨科学、运动医学、体能训练和预防医学专家进行2轮德尔菲专家论证.使用肯德尔和谐系数评价结果的一致性,并采用百分权重法确定各指标权重进而建立应力性骨折预警指标体系.结果 2轮专家咨询积极系数分别为100.00％与88.24％;专家权威系数为0.90;Ⅰ级与Ⅱ级指标的协调系数检验结果均显著(P<0.05).构建的军人应力性骨折预警指标体系包括5个Ⅰ级指标和25个Ⅱ级指标.权重最高的Ⅰ级指标是"组训因素与条件(21.87％)";权重前3的Ⅱ级指标是"组训施训(6.16％)""训练环境(5.44％)"和"足弓异常(5.35％)".结论 军人应力性骨折预警指标体系具有一定的科学性和适用性,对减少军事训练伤发生与指导军事训练工作开展具有重要意义.

Background Despite the increasing number of cases of scrub typhus and its expanding geographical distribution in China, its potential distribution in Fujian Province, which is endemic for the disease, has yet to be investigated. Methods A negative binomial regression model for panel data mainly comprising meteorological, socioeconomic and land cover variables was used to determine the risk factors for the occurrence of scrub typhus. Maximum entropy modeling was used to identify the key predictive variables of scrub typhus and their ranges, map the suitability of different environments for the disease, and estimate the proportion of the population at different levels of infection risk. Results The final multivariate negative binomial regression model for panel data showed that the annual mean normalized difference vegetation index had the strongest correlation with the number of scrub typhus cases. With each 0.1% rise in shrubland and 1% rise in barren land there was a 75.0% and 37.0% increase in monthly scrub typhus cases, respectively. In contrast, each unit rise in mean wind speed in the previous 2 months and each 1% increase in water bodies corresponded to a decrease of 40.0% and 4.0% in monthly scrub typhus cases, respectively. The predictions of the maximum entropy model were robust, and the average area under the curve value was as high as 0.864. The best predictive variables for scrub typhus occurrence were population density, annual mean normalized difference vegetation index, and land cover types. The projected potentially most suitable areas for scrub typhus were widely distributed across the eastern coastal area of Fujian Province, with highly suitable and moderately suitable areas accounting for 16.14% and 9.42%, respectively. Of the total human population of the province, 81.63% reside in highly suitable areas for scrub typhus. Conclusions These findings could help deepen our understanding of the risk factors of scrub typhus, and provide information for public health authorities in Fujian Province to develop more effective surveillance and control strategies in identified high risk areas in Fujian Province.

Background: Tuberculosis (TB) is a severe public health problem globally. Previous studies have revealed insufficient and inconsistent associations between air pollutants, meteorological factors and TB cases. Yet few studies have examined the associations between air pollutants, meteorological factors and TB cases in Beijing. Objective: The purpose of this study was to explore the impact of air pollutants and meteorological factors on TB in Beijing, and to provide novel insights into public health managers to formulate control strategies of TB.Methods: Data on the daily case of TB in Beijing during 2014-2020 were obtained from Chinese tuberculosis information management system. Concurrent data on the daily PM10, PM2.5, SO2, NO2, CO and O-3, were obtained from the online publication platform of the Chinese National Environmental Monitoring Center. Daily average temperature, average wind speed, relative humidity, sunshine duration and total precipitation were collected from the China Meteorological Science Data Sharing Service System. A distributed lag non-linear model was fitted to identify the non-linear exposure-response relationship and the lag effects between air pollutions, meteorological factors and TB cases in Beijing.Results: In the single-factor model, the excess risk (ER) of TB was significantly positively associated with every 10 mu g/m(3) increase in NO2 in lag 1 week (ER: 1.3%; 95% confidence interval [CI]: 0.4%, 2.3%) and every 0.1 m/s increase in average wind speed in lag 5 weeks (ER: 0.3%; 95% CI: 0.1%, 0.5%), and was negatively associated with every 10 mu g/m(3) increase in O-3 in lag 1 week (ER:-1.2%; 95% CI:-1.8%,-0.5%), every 5 degrees C increase in average temperature (ER:-1.7%; 95% CI:-2.9%,-0.4%) and every 10% increase in average relative humidity (ER:-0.4%; 95% CI:-0.8%,-0.1%) in lag 10 weeks, respectively. In the multi-factor model, the lag effects between TB cases and air pollutants, meteorological factors were similar. The subgroup analysis suggests that the effects of NO2, O-3, average wind speed and relative humidity on TB were greater in male or labor age subgroup, while the effect of CO was greater in the elderly. In addition, no significant associations were found between PM2.5, SO2, sunshine duration and TB cases.Conclusion: Our findings provide a better understanding of air pollutants and meteorological factors driving tuberculosis occurrence in Beijing, which enhances the capacity of public health manager to target early warning and disease control policy-making.

This study aims to describe the epidemiological characteristics of scrub typhus, detect the spatio-temporal patterns of scrub typhus at county level, and explore the associations between the environmental variables and scrub typhus cases in Anhui Province. Time-series analysis, spatial autocorrelation analysis, and space–time scan statistics were used to explore the characteristics and spatiotemporal patterns of the scrub typhus in Anhui Province. Negative binomial regression analysis was used to explore the association between scrub typhus and environmental variables. A total of 16,568 clinically diagnosed and laboratory-confirmed cases were reported from 104 counties of 16 prefecture-level cities. The number of female cases was higher than male cases, with a proportion of 1.32:1. And the proportion of cases over 65 years old was the highest, accounting for 33.8% of the total cases. Two primary and five secondary high-risk clusters were detected in the northwestern, northeastern, and central-eastern parts of Anhui Province. The number of cases in primary and secondary high-risk clusters accounted for 60.27% and 3.00%, respectively. Scrub typhus incidence in Anhui Province was positively correlated with the population density, normalized difference vegetation index, and several meteorological variables. The mean monthly sunshine duration with 3 lags (SSD_lag3), mean monthly ground surface temperature with 1 lag (GST_lag1), and mean monthly relative humidity with 3 lags (RHU_lag3) had the most significant association with increased cases of scrub typhus. Our findings indicate that public health interventions need to be focused on the elderly farmers in north of the Huai River in Anhui Province.

应力性骨折是军事训练伤中的常见损伤,严重影响参训人员的训练和健康.应力性骨折发生后,若没有得到及时的治疗,可能会导致严重后果,如长期疼痛或残疾,甚至可能会导致骨折不愈合,使参训者难以重返训练.应力性骨折的发生受多种因素影响,本文简述了应力性骨折的发生现状和分布特征,并从人口学特征、生活习惯、身体形态、体能和动作能力、组训因素与条件、遗传易感性6个方面来分析其影响因素,为开展相关研究提供参考.

Background Scrub typhus has become a serious public health concern in the Asia-Pacific region including China. There were new natural foci continuously recognized and dramatically increased reported cases in mainland China. However, the epidemiological characteristics and spatiotemporal patterns of scrub typhus in Fujian province have yet to be investigated. Objective This study proposes to explore demographic characteristics and spatiotemporal dynamics of scrub typhus cases in Fujian province, and to detect high-risk regions between January 2012 and December 2020 at county/district scale and thereby help in devising public health strategies to improve scrub typhus prevention and control measures. Method Monthly cases of scrub typhus reported at the county level in Fujian province during 20122020 were collected from the National Notifiable Disease Surveillance System. Time-series analyses, spatial autocorrelation analyses and space-time scan statistics were applied to identify and visualize the spatiotemporal patterns of scrub typhus cases in Fujian province. The demographic differences of scrub typhus cases from high-risk and low-risk counties in Fujian province were also compared. Results A total of 11,859 scrub typhus cases reported in 87 counties from Fujian province were analyzed and the incidence showed an increasing trend from 2012 (2.31 per 100,000) to 2020 (3.20 per 100,000) with a peak in 2018 (4.59 per 100,000). There existed two seasonal peaks in June-July and September-October every year in Fujian province. A significant positive spatial autocorrelation of scrub typhus incidence in Fujian province was observed with Moran's I values ranging from 0.258 to 0.471 (P<0.001). Several distinct spatiotemporal clusters mainly concentrated in north and southern parts of Fujian province. Compared to low-risk regions, a greater proportion of cases were female, farmer, and older residents in high-risk counties. Conclusions These results demonstrate a clear spatiotemporal heterogeneity of scrub typhus cases in Fujian province, and provide the evidence in directing future researches on risk factors and effectively assist local health authorities in the refinement of public health interventions against scrub typhus transmission in the high risk regions.

Scrub typhus (ST) is expanding its geographical distribution in China and in many regions worldwide raising significant public health concerns. Accurate ST time-series modeling including uncovering the role of environmental determinants is of great importance to guide disease control purposes. This study evaluated the performance of three competing time-series modeling approaches at forecasting ST cases during 2012–2020 in eight high-risk counties in China. We evaluated the performance of a seasonal autoregressive-integrated moving average (SARIMA) model, a SARIMA model with exogenous variables (SARIMAX), and the long–short term memory (LSTM) model to depict temporal variations in ST cases. In our investigation, we considered eight environmental variables known to be associated with ST landscape epidemiology, including the normalized difference vegetation index (NDVI), temperature, precipitation, atmospheric pressure, sunshine duration, relative humidity, wind speed, and multivariate El Niño/Southern Oscillation index (MEI). The first 8-year data and the last year data were used to fit the models and forecast ST cases, respectively. Our results showed that the inclusion of exogenous variables in the SARIMAX model generally outperformed the SARIMA model. Our results also indicate that the role of exogenous variables with various temporal lags varies between counties, suggesting that ST cases are temporally non-stationary. In conclusion, our study demonstrates that the approach to forecast ST cases needed to take into consideration local conditions in that time-series model performance differed between high-risk areas under investigation. Furthermore, the introduction of time-series models, especially LSTM, has enriched the ability of local public health authorities in ST high-risk areas to anticipate and respond to ST outbreaks, such as setting up an early warning system and forecasting ST precisely.

Hemorrhagic fever with renal syndrome (HFRS) is highly endemic in mainland China. The current study aims to characterize the spatial-temporal dynamics of HFRS in mainland China during a long-term period (1950-2018). A total of 1 665 431 cases of HFRS were reported with an average annual incidence of 54.22 cases/100 000 individuals during 1950-2018. The joint regression model was used to define the global trend of the HFRS cases with an increasing-decreasing-slightly increasing-decreasing-slightly increasing trend during the 68 years. Then spatial correlation analysis and wavelet cluster analysis were used to identify four types of clusters of HFRS cases located in central and northeastern China. Lastly, the prophet model outperforms auto-regressive integrated moving average model in the HFRS modeling. Our findings will help reduce the knowledge gap on the transmission dynamics and distribution patterns of the HFRS in mainland China and facilitate to take effective preventive and control measures for the high-risk epidemic area.

Background: Scrub Typhus (ST) is a rickettsial disease caused by Orientia tsutsugamushi. The number of ST cases has been increasing in China during the past decades, which attracts great concerns of the public health. Methods: We obtained monthly documented ST cases greater than 54 cases in 434 counties of China during 2012-2020. Spatiotemporal wavelet analysis was conducted to identify the ST clusters with similar pattern of the temporal variation and explore the association between ST variation and El Nin tilde o and La Nin tilde a events. Wavelet coherency analysis and partial wavelet coherency analysis was employed to further explore the co-effects of global and local climatic factors on ST. Results: Wavelet cluster analysis detected seven clusters in China, three of which are mainly distributed in Eastern China, while the other four clusters are located in the Southern China. Among the seven clusters, summer and autumn-winter peak of ST are the two main outbreak periods; while stable and fluctuated periodic feature of ST series was found at 12-month and 4-(or 6-) month according to the wavelet power spectra. Similarly, the three -character bands were also found in the associations between ST and El Nin tilde o and La Nin tilde a events, among which the 12-month period band showed weakest climate-ST association and the other two bands owned stronger association, indicating that the global climate dynamics may have short-term effects on the ST variations. Meanwhile, 12-month period band with strong association was found between the four local climatic factors (precipitation, pressure, relative humidity and temperature) and the ST variations. Further, partial wavelet co-herency analysis suggested that global climatic dynamics dominate annual ST variations, while local climatic factors dominate the small periods. Conclusion: The ST variations are not directly attributable to the change in large-scale climate. The existence of these plausible climatic determinants stimulates the interests for more insights into the epidemiology of ST, which is important for devising prevention and early warning strategies.

The COVID-19 epidemic spread rapidly through China and subsequently proliferated globally leading to a pandemic situation around the globe. Human-to-human transmission, as well as asymptomatic transmission of the infection, have been confirmed. As of April 03, 2020, public health crisis in China due to COVID-19 was potentially under control. We compiled a daily dataset of case counts, mortality, recovery, temperature, population density, and demographic information for each prefecture during the period of January 11 to April 07, 2020. Understanding the characteristics of spatial clustering of the COVID-19 epidemic and R0 is critical in effectively preventing and controlling the ongoing global pandemic. Considering this, the prefectures were grouped based on several relevant features using unsupervised machine learning techniques. Subsequently, we performed a computational analysis utilizing the reported cases in China to estimate the revised R0 among different regions. Finally, our overall research indicates that the impact of temperature and demographic factors on virus transmission may be characterized using a stochastic transmission model. Such predictions will help in prevention planning in an ongoing global pandemic, prioritizing segments of a given community/region for action and providing a visual aid in designing prevention strategies for a specific geographic region. Furthermore, revised estimation and our methodology will aid in improving the human health consequences of COVID-19 elsewhere.

Objective To analyze the epidemiological characteristics and control strategy of different types of respiratory adenovirus from 1995 to 2016 in foreign countries, to expound the research progress of respiratory adenovirus infection, and to provide theoretical basis and practical experience for effective prevention and control of respiratory adenovirus infection. Methods All articles from 1995 to 2016 were retrieved with the keywords " adenovirus" and " outbreak", among which 1 067 articles were retrieved in PubMed. There was a total of 38 articles being included in the research literature, excluding clinical case analysis literature, infection reports of single case, review literature, repeated reports, and non - human cases of infection. Results The main types of respiratory adenovirus epidemic in the world were type 3, type 4, type 7 and type 14. Infected groups were mainly children and soldiers. Among them, the epidemic serotypes of adenovirus in Israel were mainly 1, 2, 3, and 7. The serotypes 1, 2, 3, 14, 41 and 1, 2, 3, 7 21 adenovirus were the main serotypes of adenovirus in the United Kingdom and Canada respectively. The dominant serotypes of adenovirus were 4, 7, 14 and 3, 7 in the United States and Japan respectively. The dominant serotypes of adenovirus in South Korea and Malaysia was 7. And the serotype of adenovirus 55 had been detected in Turkey and Singapore. International adenovirus prevention and control strategies were based on the laboratory surveillance of pathogenic mutations and vaccination. For countries without vaccines, the outbreak of respiratory adenovirus could be effectively controlled by increasing the contact distance of the aggregators, reducing the spread of the source of infection among the personnel, and ensuring the personal hygiene of the personnel. Conclusion The prevention and control of respiratory adenovirus depends not only on laboratory surveillance of the virus epidemic, but also on the development of new vaccines and the active prevention and control measures. Respiratory adenovirus prevention and control experience also provide a reference for other respiratory diseases.

Objective To evaluate the interventional of bare-handed core muscle strength training and the sling exercise therapy (SET) on low back pain.Methods The soldiers of an Air Force Station who suffered from low back pain participated in the study.One hundred and forty-four patients were equally divided into three groups: the core muscle strength group (using core muscle strength training and the general physical therapy), the SET group (using SET and general physical therapy), and the control group (using the general physical therapy).All the groups were tested for 6 weeks.Questionnaires were distributed to the three groups before intervention, two weeks, four weeks and six weeks after intervention in order to find out about the degree of LBP, lumbar function and activity of these cases.Changes in the lumbar muscle strength were observed.Results The number of the patients who completed the test included 43 cases in the bare-handed core muscle strength group, 43 cases in the SET group and 44 cases in the control group, respectively, the VAS scores were 3.25, the Roland scores were 5.83,the FFD scores were 8.58 of the bare-handed core muscle strength group;the VAS scores were 3.30, the Roland scores were 5.93,the FFD scores were 8.10 of the SET group;the VAS scores were 2.41, the Roland scores were 3.03,the FFD scores were 7.40 of the control group.The LBP intervention efficiency of the three groups was 90.90%, 85.13% and 46.82%, respectively.There was no significant difference in indexes between the test groups(P>0.05).But compared with the control group,there was significant difference(P<0.05).Conclusion The bare-handed core muscle strength training and SET have obvious effects on LBP cases.According to their own infrastructure and facilities, military health care organizations in different environments can intervene in LBP cases with the bare-handed core muscle strength training or SET to alleviate the pain effectively.

Objective To analyze the epidemiological characteristics of epidemic hemorrhagic fever (EHF) in Chinese PLA, and to provide scientific evidence for its prevention and control in military troops .Methods Surveillance data from January 1991 to July 2016 and articles of EHF about PLA were collected and analysed .Results A total of 23 EHF outbreaks were reported by articles in PLA and 17 outbreaks were reported in Northeast , predominant of all reported area and accounting for 73.91%( P <0.01).1666 cases and 12 outbreaks were reported by the system of army epidemic situation inspection information administration and army public health emergencies and infectious disease reporting information from January 1991 to July 2016 , with downward trend of overall incidence , which distributed 734 cases in North China and accounted for 46%(P<0.01).The number of male patients is more than the female (P<0.01).The number of soldier patients is obviously increased compared with the officer (P<0.05).Camp is the most infected place(P<0.05). Conclusion The occurrence of EHF become stable in the PLA , which showed significant difference in gender , occupation categories and infected regions was found .Monitoring should be straightened and comprehensive prevention and control measures should be developed to enhance the ability and level to prevent and control the EHF in high epidemic area in PLA .

Objective To investigate the characteristics and related factors of stress fracture in the army,and to provide reference for the prevention and treatment of stress fracture.Methods A descriptive epidemiological method was used to analyze the surveillance data of stress fracture collected from July 2013 to September 2016.Results Between July 2013 and September 2016,a total of 3273 cases of stress fractures were reported,without any case of death.The number of cases among compulsory servicemen accounted for 73.21％ of the totalwhile petty officers accounted for 21.36％ of the total.Infantrymen and artillerymen were the most vulnerable,and their sites of injury were mostly limbs.The incidence of stress fracture was high between October and January.Training programs that were likely to induce stress fractures included five km cross-country running,short-distance running,middle-and long-distance running and jumping over hurdles.The main influencing factors were the constitution,levels of knowledge of protection and technical proficiency.Conclusion The incidence of stress fractureis high among officers and soldiers,so we should enhance protection in the process of training.

Objective To analyze the epidemiological characteristics of an outbreak caused by respiratory adenovirus in a university,and study the factors of respiratory adenovirus outbreak and ways of prevention and control.Methods The pharyngeal swabs of each case were identified by real time-PCR and sequencing.All the epidemiological and clinical information of these cases was collected via field interviews and medical records.Epidemiological characteristics of the outbreak were analyzed descriptively.Results 193 cases,including 89 cases of pneumonia,from a total of 807 cases,were admitted to the hospital.The incidence was 32.79%(807/2461).798 adenovirus positive samples were detected from 2461 pharyngeal swab samples.The total positive detection rate was 32.42%(798/2461).The positive rate of adenovirus was 98.88%(798/807).Clinical symptoms included fever(95.7%), cough(76.9%)and sore throat(52.2%).The outbreak was brought under effective control after integrated intervention measures were taken.Conclusion Respiratory adenovirus often causes outbreaks in crowded populations.Early symptomatic surveillance and standardized laboratory detection methods are crucial for prevention and control of outbreaks.Integrated control measures should be taken according to the field conditions and characteristics of the outbreak.

Objective To analyze the epidemiology of outbreaks and epidemic characteristics of respiratory diseases caused by human adenovirus in China so as to provide some data for its epidemic and outbreak control and clinical diagnosis .Methods Data on respiratory adenovirus outbreaks and surveillance from 1997 to 2015 was collected from PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Databases.All the data was analyzed according to the descriptive epidemiology , including the time , area and population distribution .Clinical data and the serotypes of adenovirus were also analyzed.Results From 1997 to 2015, the epidemical serotypes of adenovirus included 1 to 7, 11, 14 and 55 in China, and the dominating serotypes were 7 and 3, which accounted for 62.33％(599/961) and 24.97％(240/961)of the total cases of outbreaks, and for 36.79％(312/848) and 53.18％(451/848) of the total cases of surveillance.The peaks of annual outbreaks were in 2004 and 2013, which made up 41.12％(2212/5380) and 16.49％(887/5380)of the total outbreak cases in this study .Most of the surveillance cases years occurred in 2010 and 2011, which accounted for 17.59％(297/1688) and 17.77％(300/1688) of the total cases of surveillance .The seasonal distribution of the outbreaks was characterized by the highest possibility in spring and winter .Outbreaks of respiratory adenovirus were reported by 12 provinces or municipalities .The number of reported outbreaks related to serotype 3 was the largest in Jiangsu Province, which made up 58.33％(140/240) of the total.Most of the reported cases related to serotype 7 occurred in Hubei Province, which made up 67.41％ (333/494) of the total.Most of cases were found in Peking and Jiangsu , which accounted for 57.56％(971/1687)and 32.42％(547/1687)of the total positive cases respectively.The high-risk populations were children and new recruits , who accounted for 73.97％(2907/3930) of the total.The clinical features of adenovirus infection were fever (63％-100％),sore throat (31.9％-100％), pharyngeal hyperemia (60％-100％) and cough (5.88％ -100％).Conclusion Human respiratory adenovirus has become one of the main pathogenic microorganisms that induce acute respiratory diseases in schools and in the military in China , so human adenovirus and related respiratory disease should be monitored in such populations .The epidemiological characteristics of different types of respiratory adenovirus and the patterns of spread should be analyzed in order to reduce morbidity and mortality.

Background 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. Objective 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. Method 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. Results 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. Conclusions 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.

Objective To investigate the epidemic characteristics of human cutaneous anthrax (CA) in China, detect the spatiotemporal clusters at the county level for preemptive public health interventions, and evaluate the differences in the epidemiological characteristics within and outside clusters. Methods CA cases reported during 2005–2012 from the national surveillance system were evaluated at the county level using space-time scan statistic. Comparative analysis of the epidemic characteristics within and outside identified clusters was performed using using the χ2 test or Kruskal-Wallis test. Results The group of 30–39 years had the highest incidence of CA, and the fatality rate increased with age, with persons ≥70 years showing a fatality rate of 4.04%. Seasonality analysis showed that most of CA cases occurred between May/June and September/October of each year. The primary spatiotemporal cluster contained 19 counties from June 2006 to May 2010, and it was mainly located straddling the borders of Sichuan, Gansu, and Qinghai provinces. In these high-risk areas, CA cases were predominantly found among younger, local, males, shepherds, who were living on agriculture and stockbreeding and characterized with high morbidity, low mortality and a shorter period from illness onset to diagnosis. Conclusion CA was geographically and persistently clustered in the Southwestern China during 2005–2012, with notable differences in the epidemic characteristics within and outside spatiotemporal clusters; this demonstrates the necessity for CA interventions such as enhanced surveillance, health education, mandatory and standard decontamination or disinfection procedures to be geographically targeted to the areas identified in this study.