Endemic Melioidosis in Southern China: Past and Present

Abstract

Melioidosis is a severe tropical infectious disease caused by the soil-dwelling bacterium Burkholderia pseudomallei, predominantly endemic to Southeast Asia and northern Australia. Between the 1970s and the 1990s, the presence of B. pseudomallei causing melioidosis in humans and other animals was demonstrated in four coastal provinces in southern China: Hainan, Guangdong, Guangxi, and Fujian, although indigenous cases were rare and the disease failed to raise concern amongst local and national health authorities. In recent years, there has been a rise in the number of melioidosis cases witnessed in the region, particularly in Hainan. Meanwhile, although China has established and maintained an effective communicable disease surveillance system, it has not yet been utilized for melioidosis. Thus, the overall incidence, social burden and epidemiological features of the disease in China remain unclear. In this context, we present a comprehensive overview of both historical and current information on melioidosis in Southern China, highlighting the re-emergence of the disease in Hainan. Surveillance and management strategies for melioidosis should be promoted in mainland China, and more research should be conducted to provide further insights into the present situation.

Keywords: Burkholderia pseudomallei; China; epidemiology; melioidosis.

Figure 1

Number of melioidosis cases by year identified during surveillance, Hainan, China, 2002–2016.

Figure 2

Location of Burkholderia pseudomallei and melioidosis cases in China. (a) The distribution of endemic areas (n = 4, with green shading) and melioidosis cases in mainland China, with locations of environmental isolation of B. pseudomallei and indigenous or imported human/animal cases of melioidosis indicated (The number of human cases for each province was indicated in parentheses. The patients outside the four endemic provinces all have a history of residence or travel to Hainan or overseas endemic areas and thus are deemed as imported cases); (b) The distribution of melioidosis cases according to different prefectures in Hainan (data only available for 289 of 401 cases) and in the Leizhou Peninsula (46 cases) of Guangdong, China.

Figure 3

Age distribution of 288 human melioidosis patients from Hainan, China, 2002–2014.

Figure 4

Monthly distribution of 289 melioidosis cases across 13 years (2002–2014) in Hainan, China.