Scrub typhus in Jiangsu Province, China: epidemiologic features and spatial risk analysis

Background: With the increasing incidence of scrub typhus in recent years, it is of great value to analyse the spatial and temporal distribution of scrub typhus by applying micro-geographical studies at a reasonably fine scale, and to guide the control and management. Methods: We explored the use of maximum entropy modelling method to confirm the spatial and temporal distribution of scrub typhus according to the occurrence locations of human cases in Jiangsu Province. The risk prediction map under specific environmental factors was therefore drawn by projecting the training model across China. The area under the curve and the omission rate were used to validate the model. Meanwhile, Jackknife tests were applied to enumerate the contribution of different environmental variables, then to predict the final model. The predicted results were validated by using China's known occurrence locations. Results: A total of 566 occurrence locations with known 4865 scrub typhus occurrence records were used in our study. The number of female cases was higher than male cases, with a proportion of 1.17:1, and people in any age group could be infected. The number of cases presented an inverted-U relation with age. The percentage of cases aged from 60 to 69 years old was the highest, accounting for 30.50% of all cases. Ecological niche modelling results indicated that the locations of scrub typhus cases, which was of great importance in the disease transmission cycle, had a certain ecological niche with environmental elements in many dimensions. Moreover, the key environmental factors for determining scrub typhus occurrence were temperature (including temperature seasonality, min temperature of coldest month, mean diurnal range, and monthly mean temperature), precipitation of wettest month, and land cover types. The risk prediction maps indicated that mid-eastern China was the potential risk areas for scrub typhus of "autumn type". Meanwhile, in our results, Guangdong Province was the high-risk region for "autumn type" scrub typhus, where cases were mainly reported as "summer type". Conclusion: The combination of climatic and geographic factors with GIS methods is an appropriate option to analyse and estimate the spatial and temporal distribution of scrub typhus.