Spatiotemporal Clustering Analysis and Risk Assessments of Human Cutaneous Anthrax in China, 2005-2012

doi:10.1371/journal.pone.0133736

. 2015 Jul 24;10(7):e0133736.

doi: 10.1371/journal.pone.0133736. eCollection 2015.

Spatiotemporal Clustering Analysis and Risk Assessments of Human Cutaneous Anthrax in China, 2005-2012

Wen-Yi Zhang ¹, Li-Ya Wang ¹, Xiu-Shan Zhang ¹, Zhi-Hai Han ², Wen-Biao Hu ³, Quan Qian ¹, Ubydul Haque ⁴, Ricardo J Soares Magalhaes ⁵, Shen-Long Li ¹, Shi-Lu Tong ³, Cheng-Yi Li ¹, Hai-Long Sun ¹, Yan-Song Sun ⁶

Affiliations

¹ Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
² Navy General Hospital of PLA, Beijing, People's Republic of China.
³ School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
⁴ Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Geography, University of Florida, Gainesville, Florida, United States of America.
⁵ School of Veterinary Science, The University of Queensland, Brisbane, Australia; Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
⁶ Academy of Military Medical Science, Beijing, People's Republic of China.

PMID: 26208355
PMCID: PMC4514625
DOI: 10.1371/journal.pone.0133736

Spatiotemporal Clustering Analysis and Risk Assessments of Human Cutaneous Anthrax in China, 2005-2012

Wen-Yi Zhang et al. PLoS One. 2015.

. 2015 Jul 24;10(7):e0133736.

doi: 10.1371/journal.pone.0133736. eCollection 2015.

Authors

Wen-Yi Zhang ¹, Li-Ya Wang ¹, Xiu-Shan Zhang ¹, Zhi-Hai Han ², Wen-Biao Hu ³, Quan Qian ¹, Ubydul Haque ⁴, Ricardo J Soares Magalhaes ⁵, Shen-Long Li ¹, Shi-Lu Tong ³, Cheng-Yi Li ¹, Hai-Long Sun ¹, Yan-Song Sun ⁶

Affiliations

¹ Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China.
² Navy General Hospital of PLA, Beijing, People's Republic of China.
³ School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
⁴ Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America; Department of Geography, University of Florida, Gainesville, Florida, United States of America.
⁵ School of Veterinary Science, The University of Queensland, Brisbane, Australia; Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
⁶ Academy of Military Medical Science, Beijing, People's Republic of China.

PMID: 26208355
PMCID: PMC4514625
DOI: 10.1371/journal.pone.0133736

Abstract

Objective: To investigate the epidemic characteristics of human cutaneous anthrax (CA) in China, detect the spatiotemporal clusters at the county level for preemptive public health interventions, and evaluate the differences in the epidemiological characteristics within and outside clusters.

Methods: CA cases reported during 2005-2012 from the national surveillance system were evaluated at the county level using space-time scan statistic. Comparative analysis of the epidemic characteristics within and outside identified clusters was performed using using the χ2 test or Kruskal-Wallis test.

Results: The group of 30-39 years had the highest incidence of CA, and the fatality rate increased with age, with persons ≥70 years showing a fatality rate of 4.04%. Seasonality analysis showed that most of CA cases occurred between May/June and September/October of each year. The primary spatiotemporal cluster contained 19 counties from June 2006 to May 2010, and it was mainly located straddling the borders of Sichuan, Gansu, and Qinghai provinces. In these high-risk areas, CA cases were predominantly found among younger, local, males, shepherds, who were living on agriculture and stockbreeding and characterized with high morbidity, low mortality and a shorter period from illness onset to diagnosis.

Conclusion: CA was geographically and persistently clustered in the Southwestern China during 2005-2012, with notable differences in the epidemic characteristics within and outside spatiotemporal clusters; this demonstrates the necessity for CA interventions such as enhanced surveillance, health education, mandatory and standard decontamination or disinfection procedures to be geographically targeted to the areas identified in this study.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1

Fig 1. Epidemic curve, seasonal pattern and temporal clusters of human cutaneous anthrax in mainland China, 2005–2012.

(A)The figure shows epidemic curve of monthly CA cases (blue line) and significant temporal clusters (red line) from 2005–2012; (B) The seasonal pattern of CA. The bottom and top of the box represents the lower quartile (P₂₅) and the upper quartile (P₇₅) respectively; the bottom, middle and top line is minimum, median and maximum value; dot and asterisk with number represent value of outlier and extreme outlier, respectively.

Fig 2

Fig 2. Annual incidence of human cutaneous anthrax in mainland China, 2005–2012.

Fig 3

Fig 3. Spatiotemporal clusters of human cutaneous anthrax in mainland China, 2005–2012.

See this image and copyright information in PMC

References

1. Doganay M, Metan G, Alp E. A review of cutaneous anthrax and its outcome. J Infect Public Health. 2010;3(3):98–105. 10.1016/j.jiph.201007004 - DOI - PubMed
1. Ringertz SH, Hoiby EA, Jensenius M, Maehlen J, Caugant DA, Myklebust A, et al. Injectional anthrax in a heroin skin-popper. Lancet. 2000;356(9241):1574–5. - PubMed
1. Ramsay CN, Stirling A, Smith J, Hawkins G, Brooks T, Hood J, et al. An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland. Euro surveillance. 2010;15(2). - PubMed
1. Holzmann T, Frangoulidis D, Simon M, Noll P, Schmoldt S, Hanczaruk M, et al. Fatal anthrax infection in a heroin user from southern Germany, June 2012. Euro surveillance. 2012;17(26). - PubMed
1. Palmateer NE, Ramsay CN, Browning L, Goldberg DJ, Hutchinson SJ. Anthrax infection among heroin users in Scotland during 2009–2010: a case-control study by linkage to a national drug treatment database. Clin infect dis. 2012; 55(5): 706–10. 10.1093/cid/cis511 - DOI - PubMed

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[1] Doganay M, Metan G, Alp E. A review of cutaneous anthrax and its outcome. J Infect Public Health. 2010;3(3):98–105. 10.1016/j.jiph.201007004 - DOI - PubMed

[2] Doganay M, Metan G, Alp E. A review of cutaneous anthrax and its outcome. J Infect Public Health. 2010;3(3):98–105. 10.1016/j.jiph.201007004 - DOI - PubMed

[3] Ringertz SH, Hoiby EA, Jensenius M, Maehlen J, Caugant DA, Myklebust A, et al. Injectional anthrax in a heroin skin-popper. Lancet. 2000;356(9241):1574–5. - PubMed

[4] Ringertz SH, Hoiby EA, Jensenius M, Maehlen J, Caugant DA, Myklebust A, et al. Injectional anthrax in a heroin skin-popper. Lancet. 2000;356(9241):1574–5. - PubMed

[5] Ramsay CN, Stirling A, Smith J, Hawkins G, Brooks T, Hood J, et al. An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland. Euro surveillance. 2010;15(2). - PubMed

[6] Ramsay CN, Stirling A, Smith J, Hawkins G, Brooks T, Hood J, et al. An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland. Euro surveillance. 2010;15(2). - PubMed

[7] Holzmann T, Frangoulidis D, Simon M, Noll P, Schmoldt S, Hanczaruk M, et al. Fatal anthrax infection in a heroin user from southern Germany, June 2012. Euro surveillance. 2012;17(26). - PubMed

[8] Holzmann T, Frangoulidis D, Simon M, Noll P, Schmoldt S, Hanczaruk M, et al. Fatal anthrax infection in a heroin user from southern Germany, June 2012. Euro surveillance. 2012;17(26). - PubMed

[9] Palmateer NE, Ramsay CN, Browning L, Goldberg DJ, Hutchinson SJ. Anthrax infection among heroin users in Scotland during 2009–2010: a case-control study by linkage to a national drug treatment database. Clin infect dis. 2012; 55(5): 706–10. 10.1093/cid/cis511 - DOI - PubMed

[10] Palmateer NE, Ramsay CN, Browning L, Goldberg DJ, Hutchinson SJ. Anthrax infection among heroin users in Scotland during 2009–2010: a case-control study by linkage to a national drug treatment database. Clin infect dis. 2012; 55(5): 706–10. 10.1093/cid/cis511 - DOI - PubMed

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Spatiotemporal Clustering Analysis and Risk Assessments of Human Cutaneous Anthrax in China, 2005-2012

Affiliations

Spatiotemporal Clustering Analysis and Risk Assessments of Human Cutaneous Anthrax in China, 2005-2012

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Supplementary concepts

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical