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. 2020 Oct 15;14(10):e0008772.
doi: 10.1371/journal.pntd.0008772. eCollection 2020 Oct.

Epidemiology of tsutsugamushi disease and its relationship with meteorological factors in Xiamen city, China

Li Luo  1 , Zhinan Guo  2 , Zhao Lei  1 , Qingqing Hu  3 , Min Chen  2 , Fanghua Chen  2 , Zeyu Zhao  1 , Jia Rui  1 , Xingchun Liu  1 , Yuanzhao Zhu  1 , Yao Wang  1 , Meng Yang  1 , Tianmu Chen  1
Affiliations

Epidemiology of tsutsugamushi disease and its relationship with meteorological factors in Xiamen city, China

Li Luo et al. PLoS Negl Trop Dis. .

Abstract

Tsutsugamushi disease (TD) is an acute infectious disease caused by Orientia tsutsugamushi. This study aimed to analyze the epidemiological features of TD, investigate chigger mites and their hosts, and investigate the meteorological factors affecting TD incidence and the host of O. tsutsugamushi in Xiamen city, China. Data on reported TD cases were collected from 2006 to 2018. Spearman's correlation test were used for identifying the relationship between meteorological factors and TD incidence and whether meteorological factors affect the host of O. tsutsugamushi. The incidence of reported TD increased gradually from 2006, reached a peak of 4.59 per 100,000 persons in 2014, and then decreased gradually. The TD incidence was seasonal, with epidemic periods occurred mainly in summer and autumn. Patients aged 40-60 years had the highest proportion of cases, accounting for 44.44% of the total cases. Farmers had the largest number of cases among all occupational groups. Rattus Norvegicus was the most common host, accounting for the largest proportion of rats (73.00%), and the highest rat density was observed in March and October every year. There were significant positive correlations between the number of reported cases and average temperature, sunshine duration, and rainfall as well as between rat density and average temperature. On phylogenetic analysis, 7 sequences of hosts and human TD cases obtained from health records demonstrated the highest similarities to the Kato, Karp, and Gilliam strains. No correlations were observed between rat density, and sunshine duration and rainfall. The transmission of TD in Xiamen city, China, was seasonal, and its incidence was affected by several meteorological factors including average temperature, sunshine duration, and rainfall. However, the host of O. tsutsugamushi was only affected by average temperature.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Number of reported cases and reported incidence in Xiamen city, China, 2006–2018.
Fig 2
Fig 2. Month distribution of TD cases, Xiamen city, China, 2006–2018.
Fig 3
Fig 3. Gender distribution of TD cases, Xiamen city, China, 2006–2018.
A, Men distribution of TD cases; B, Women distribution of TD cases.
Fig 4
Fig 4. Age distribution of TD cases, Xiamen city, China, 2006–2018.
Fig 5
Fig 5. Geographical distribution of TD cases, Xiamen city, China, 2006–2018.
Fig 6
Fig 6. Distribution of duration from illness onset date to diagnosed date of 819 TD cases, Xiamen city, China, 2006–2018.
Fig 7
Fig 7. Month distribution of rat density, Xiamen city, China, 2008–2017.
Fig 8
Fig 8. Phylogenetic analysis of O. tsutsugamushi isolated from host and human TD cases (noted as red color), Xiamen city, China.
Fig 9
Fig 9. The relationship between meteorological factors and the reported incidence of TD cases, Xiamen city, China, 2006–2018.
A, the relationship between monthly average temperature and the reported incidence of TD cases; B, the relationship between rainfall and the reported incidence of TD cases; C, the relationship between monthly average daily sunshine duration and the reported incidence of TD cases.
Fig 10
Fig 10. The relationship between meteorological factors and the rat density, Xiamen city, China, 2008–2017.
A, the relationship between monthly average temperature and the rat density; B, the relationship between rainfall and the rat density; C, the relationship between monthly average daily sunshine duration and rat density.
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