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Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016.

ABSTRACT: BACKGROUND:Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, and specific antimicrobial medicine is available. Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China, and the results will benefit both clinical practice and the disease surveillance system. METHODS:We extracted individual scrub typhus case data 2006-2016 from a national disease surveillance system in China. The diagnosis category and interval time from illness onset to diagnosis were compared among three levels of medical care institutions and provinces. The descriptive analysis method was performed in our study. RESULTS:During the 11-year study period, 93?481 scrub typhus cases, including 57 deaths, were recorded in the nationwide surveillance system. The overall proportion of laboratory-confirmed cases was only 4.7%, and this proportion varied greatly among primary medical centres (2.8%), county level hospitals (4.2%), and city level hospitals (6.3%). Notably, the proportion of laboratory-confirmed cases has consistently decreased from 16.3% in 2006 to 2.6% in 2016, and the same decreasing trend was found among all three levels of medical care institutions. The interval from illness onset to case diagnosis (Tdiag) for all cases was 5?days (interquartile range [IQR]: 2-9?days) and decreased from 7?days (IQR: 3-11?days) in 2006 to 5?days (IQR: 2-8?days) in 2016. The risk of death for patients with a Tdiag of >?7?days was 2.2 times higher (OR?=?2.21, 95% CI: 1.05-5.21) than that of patients with a Tdiag of

SUBMITTER: Xin HL

PROVIDER: S-EPMC6599364 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016.

Xin Hua-Lei HL Yu Jian-Xing JX Hu Mao-Gui MG Jiang Fa-Chun FC Li Xiao-Jing XJ Wang Li-Ping LP Huang Ji-Lei JL Wang Jin-Feng JF Sun Jun-Ling JL Li Zhong-Jie ZJ

Infectious diseases of poverty 20190629 1

<h4>Background</h4>Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, and specific antimicrobial medicine is available. Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China, and the results will benefit both clinical practice and the disease surveillance system.<h4>Methods</h4>We extracted indivi ...[more]

PMID: 31253202

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Project description:BACKGROUND:Scrub typhus is a major cause of acute febrile illness in the tropics and is endemic over large areas of the Asia Pacific region. The national and global burden of scrub typhus remains unclear due to limited data and difficulties surrounding diagnosis. METHODOLOGY/PRINCIPAL FINDINGS:Scrub typhus reporting data from 2003-2018 were collected from the Thai national disease surveillance system. Additional information including the district, sub-district and village of residence, population, geographical, meteorological and satellite imagery data were also collected for Chiangrai, the province with the highest number of reported cases from 2003-2018. From 2003-2018, 103,345 cases of scrub typhus were reported with the number of reported cases increasing substantially over the observed period. There were more men than women, with agricultural workers the main occupational group affected. The majority of cases occurred in the 15-64 year old age group (72,144/99,543, 72%). Disease burden was greatest in the northern region, accounting for 53% of the total reported cases per year (mean). In the northern region, five provinces-Chiangrai, Chiangmai, Tak, Nan and Mae Hong Son-accounted for 84% (46,927/55,872) of the total cases from the northern region or 45% (46,927/103,345) of cases nationally. The majority of cases occurred from June to November but seasonality was less marked in the southern region. In Chiangrai province, elevation, rainfall, temperature, population size, habitat complexity and diversity of land cover contributed to scrub typhus incidence. INTERPRETATION:The burden of scrub typhus in Thailand is high with disease incidence rising significantly over the last two decades. However, disease burden is not uniform with northern provinces particularly affected. Agricultural activity along with geographical, meteorological and land cover factors are likely to contribute to disease incidence. Our report, along with existing epidemiological data, suggests that scrub typhus is the most clinically important rickettsial disease globally.

Dataset Information

Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016.

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Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016.

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