Dataset Information

Spatiotemporal Variation and Hot Spot Detection of Visceral Leishmaniasis Disease in Kashi Prefecture, China.

ABSTRACT: Visceral leishmaniasis (VL) remains a serious public health problem in China. To explore the temporal, spatial, and spatiotemporal characteristics of visceral leishmaniasis (VL), the spatial and spatiotemporal clustering distribution and their relationships with the surrounding geographic environmental factors were analyzed. In this study, the average nearest-neighbor distance (ANN), Ripley's K-function and Moran's I statistics were used to evaluate spatial autocorrelation in the VL distribution of the existing case patterns. Getis?Ord Gi* was used to identify the hot-spot and cold-spot areas based on Geographic Information System (GIS), and spatiotemporal retrospective permutation scan statistics was used to detect the spatiotemporal clusters. The results indicated that VL continues to be a serious public health problem in Kashi Prefecture, China, particularly in the north-central region of Jiashi County, which is a relatively high-risk area in which hot spots are distributed. Autumn and winter months were the outbreak season for VL cases. The detection of spatial and spatiotemporal patterns can provide epidemiologists and local governments with significant information for prevention measures and control strategies.

SUBMITTER: Zheng C

PROVIDER: S-EPMC6313707 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Spatiotemporal Variation and Hot Spot Detection of Visceral Leishmaniasis Disease in Kashi Prefecture, China.

Zheng Canjun C Fu Jingying J Li Zeng Z Lin Gang G Jiang Dong D Zhou Xiao-Nong XN

International journal of environmental research and public health 20181208 12

Visceral leishmaniasis (VL) remains a serious public health problem in China. To explore the temporal, spatial, and spatiotemporal characteristics of visceral leishmaniasis (VL), the spatial and spatiotemporal clustering distribution and their relationships with the surrounding geographic environmental factors were analyzed. In this study, the average nearest-neighbor distance (ANN), Ripley's K-function and Moran's I statistics were used to evaluate spatial autocorrelation in the VL distribution ...[more]

PMID: 30544811

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Project description:BACKGROUND:Despite the overall decrease in visceral leishmaniasis (VL) incidence on the Indian subcontinent, there remain spatiotemporal clusters or 'hotspots' of new cases. The characteristics of these hotspots, underlying transmission dynamics, and their importance for shaping control strategies are not yet fully understood and are investigated in this study for a VL endemic area of ~100,000 inhabitants in Bihar, India between 2007-2015. METHODOLOGY/PRINCIPAL FINDINGS:VL incidence (cases/10,000/year) dropped from 12.3 in 2007 to 0.9 in 2015, which is just below the World Health Organizations' threshold for elimination as a public health problem. Clustering of VL was assessed between subvillages (hamlets), using multiple geospatial and (spatio)temporal autocorrelation and hotspot analyses. One to three hotspots were identified each year, often persisting for 1-5 successive years with a modal radius of ~500m. The relative risk of having VL was 5-86 times higher for inhabitants of hotspots, compared to those living outside hotspots. Hotspots harbour significantly more households from the two lowest asset quintiles (as proxy for socio-economic status). Overall, children and young adelescents (5-14 years) have the highest risk for VL, but within hotspots and at the start of outbreaks, older age groups (35+ years) show a comparable high risk. CONCLUSIONS/SIGNIFICANCE:This study demonstrates significant spatiotemporal heterogeneity in VL incidence at subdistrict level. The association between poverty and hotspots confirms that VL is a disease of 'the poorest of the poor' and age patterns suggest a potential role of waning immunity as underlying driver of hotspots. The recommended insecticide spraying radius of 500m around detected VL cases corresponds to the modal hotspot radius found in this study. Additional data on immunity and asymptomatic infection, and the development of spatiotemporally explicit transmission models that simulate hotspot dynamics and predict the impact of interventions at the smaller geographical scale will be crucial tools in sustaining elimination.

Project description:Introduction:To sustain the achievement of kala-azar elimination program (KEP), early detection and treatment of the visceral leishmaniasis (VL) cases and associated modalities such as treatment failure (TF), relapse VL (RVL), and Post-kala-azar dermal leishmaniasis (PKDL) is the cornerstone. A predictive biomarker for VL development and related complications could also play a crucial role in curtailing disease incidence and transmission. Investigations to find a biomarker with prospective capabilities are, however, scarce. Using samples and known clinical outcomes generated within two previous longitudinal cohort studies, we aimed to determine if fluctuations in serum anti-rK39 antibody levels could provide such predictive value. Materials and Methods:Serum samples collected at four different time points (Baseline, 12, 18, and 24 months) from 16 patients who had developed VL within the monitoring period and 15 of their asymptomatic healthy controls counterparts were investigated. To investigate potential prediction of VL related complications, serum samples of 32 PKDL, 10 RVL, 07 TF, and 38 cured VL from a single dose AmBisome trial were analyzed. Of this second panel, all patients were monitored for 5 years and sera were collected at four time points (Baseline then 1, 6, and 12 months after treatment). The level of anti-rK39 antibodies in archived samples was measured by a semi-quantitative ELISA. Results:The mean antibody level was significantly higher in VL patients compared to their asymptomatic healthy counterparts at each time point. Likewise, we observed a trend toward elevations in antibody levels for PKDL, RVL, TF relative to the reducing levels observed in cured VL. Receiver operating characteristic (ROC) analysis found a promising predictive power of rK39 antibody levels to reveal progression from asymptomatic Leishmania donovani infection stage to VL, defined as 87.5% sensitive and 95% specific. Following treatment, rk39 antibody notably showed 100% sensitivity and 95% specificity in predicting TF. Conclusion:Our data indicate that the relative quantity of serum anti-rK39 antibody has promise within either a predictive or prognostic algorithm for VL and VL-related modalities. These could enable VL control programs to implement more effective measures to eliminate the disease. Further research is, however, imperative to standardize the rK39 antibody ELISA between sites prior to broader use.

Dataset Information

Spatiotemporal Variation and Hot Spot Detection of Visceral Leishmaniasis Disease in Kashi Prefecture, China.

Publications

Spatiotemporal Variation and Hot Spot Detection of Visceral Leishmaniasis Disease in Kashi Prefecture, China.

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