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      Analysis of epidemiological characteristics of four natural-focal diseases in Shandong Province, China in 2009-2017: A descriptive analysis

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          Abstract

          Background

          Natural-focal diseases are serious diseases that endanger human health. They threaten about 100 million people in Shandong Province, and cause illness in thousands of people each year. However, information on the epidemiological characteristics of natural-focal diseases in Shandong Province has been limited. The purpose of the study was to describe and analyze the epidemiological characteristics of natural-focal diseases in Shandong Province, 2009–2017.

          Methods

          We describe the incidence and distribution of four natural-focal diseases in Shandong Province using surveillance data from 2009–2017.

          Results

          From 2009–2017, 11123 cases of four natural-focal diseases including 257 deaths were reported in Shandong Province, China. The four natural-focal diseases were severe fever with thrombocytopenia syndrome (SFTS), human granulocytic anaplasmosis (HGA), typhus, and scrub typhus. The high-risk groups of the four diseases were farmers and the elderly. The incidence rate of scrub typhus was significantly higher in females. However, this difference was not seen in the other three diseases. The four diseases were mainly clustered in the middle-southern part of Shandong Province and the Shandong Peninsula. The annual incidence of SFTS and scrub typhus increased, typhus was relatively stable, and HGA declined. However, the range of SFTS expanded, while HGA shrunk, and typhus and scrub typhus were unchanged. The epidemic period of SFTS and HGA was from May to October, typhus was from October to November, and scrub typhus was from September to November. The fatality rates of SFTS, typhus, scrub typhus, and HGA were 9.19%, 0%, 0.01%, and 2.24%, respectively.

          Conclusions

          Our study described and analyzed the prevalence of natural-focal diseases in Shandong Province, and confirmed that age was closely related to the SFTS fatality rate. This study may help to improve the understanding of the prevalence of natural-focal diseases in Shandong Province in recent years and to better develop accurate prevention and control strategies for natural-focal diseases.

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          Most cited references 47

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          Fever with thrombocytopenia associated with a novel bunyavirus in China.

          Heightened surveillance of acute febrile illness in China since 2009 has led to the identification of a severe fever with thrombocytopenia syndrome (SFTS) with an unknown cause. Infection with Anaplasma phagocytophilum has been suggested as a cause, but the pathogen has not been detected in most patients on laboratory testing. We obtained blood samples from patients with the case definition of SFTS in six provinces in China. The blood samples were used to isolate the causal pathogen by inoculation of cell culture and for detection of viral RNA on polymerase-chain-reaction assay. The pathogen was characterized on electron microscopy and nucleic acid sequencing. We used enzyme-linked immunosorbent assay, indirect immunofluorescence assay, and neutralization testing to analyze the level of virus-specific antibody in patients' serum samples. We isolated a novel virus, designated SFTS bunyavirus, from patients who presented with fever, thrombocytopenia, leukocytopenia, and multiorgan dysfunction. RNA sequence analysis revealed that the virus was a newly identified member of the genus phlebovirus in the Bunyaviridae family. Electron-microscopical examination revealed virions with the morphologic characteristics of a bunyavirus. The presence of the virus was confirmed in 171 patients with SFTS from six provinces by detection of viral RNA, specific antibodies to the virus in blood, or both. Serologic assays showed a virus-specific immune response in all 35 pairs of serum samples collected from patients during the acute and convalescent phases of the illness. A novel phlebovirus was identified in patients with a life-threatening illness associated with fever and thrombocytopenia in China. (Funded by the China Mega-Project for Infectious Diseases and others.).
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            Person-to-person transmission of severe fever with thrombocytopenia syndrome virus.

            Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a newly discovered bunyavirus, SFTS virus (SFTSV), and causes high fatality (12% on average and as high as 30%). The objective of this study was to determine whether SFTSV could be transmitted from person to person. We analyzed sera of 13 patients from two clusters of unknown infectious diseases that occurred between September and November of 2006 in Anhui Province of China for SFTSV antibody by indirect immunofluorescence assay and for SFTSV RNA by RT-PCR. We found that all patients (n=14) had typical clinical symptoms of SFTS including fever, thrombocytopenia, and leukopenia and all secondary patients in both clusters got sick at 6-13 days after contacting or exposing to blood of index patients. We demonstrated that all patients in cluster 1 including the index patient and nine secondary patients and all three secondary patients in cluster 2 had seroconversion or fourfold increases in antibody titer to SFTSV and/or by RT-PCR amplification of SFTSV RNA from the acute serum. The index patient in cluster 2 was not analyzed because of lack of serum. No person who contacted the index patient during the same period, but were not exposed to the index patient blood, had got illness. We concluded that SFTSV can be transmitted from person to person through contacting patient's blood.
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              Haemaphysalis longicornis Ticks as Reservoir and Vector of Severe Fever with Thrombocytopenia Syndrome Virus in China

              Transstadial and transovarial virus transmission occur among ticks, and transmission to mice can occur through a tick bite.
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                Author and article information

                Affiliations
                [1 ] Department of Microbiological Laboratory Technology, School of Public Health, Shandong University, Key laboratory for the prevention and control of infectious diseases (key laboratory of China’s “13th Five-Year”, Shandong University), Jinan, Shandong Province, China
                [2 ] Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Prevention and Control, Jinan, Shandong Province, China
                Georgia Southern University Jiann-Ping Hsu College of Public Health, UNITED STATES
                Author notes

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

                Contributors
                Role: Data curation, Role: Formal analysis, Role: Methodology, Role: Software, Role: Writing – original draft
                Role: Data curation, Role: Formal analysis, Role: Resources, Role: Software, Role: Writing – original draft
                Role: Data curation, Role: Formal analysis, Role: Methodology
                Role: Data curation, Role: Formal analysis, Role: Project administration
                Role: Data curation, Role: Formal analysis, Role: Methodology
                Role: Data curation, Role: Formal analysis, Role: Methodology
                Role: Data curation, Role: Formal analysis, Role: Methodology, Role: Project administration
                ORCID: http://orcid.org/0000-0001-7405-0404, Role: Conceptualization, Role: Funding acquisition, Role: Methodology, Role: Project administration, Role: Supervision, Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 August 2019
                2019
                : 14
                : 8
                31454372 6711524 10.1371/journal.pone.0221677 PONE-D-19-22708
                © 2019 Chen et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Counts
                Figures: 6, Tables: 3, Pages: 19
                Product
                Funding
                This study was supported by Shandong Provincial Key Laboratory of Infectious Disease Prevention and Control (2017KEYLAB02) to HW. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Human Granulocytic Anaplasmosis
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Typhus
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Typhus
                Scrub Typhus
                People and Places
                Population Groupings
                Age Groups
                Biology and Life Sciences
                Population Biology
                Population Dynamics
                Geographic Distribution
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Age Distribution
                People and Places
                Geographical Locations
                Asia
                China
                Medicine and Health Sciences
                Geriatrics
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Uncategorized

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