Spatiotemporal clustering analysis and risk assessments of human cutaneous anthrax in China, 2005–2012

Yu, Xue-jie, Zhang, Wen-Yi, Wang, Li-Ya, Zhang, Xiu-Shan, Han, Zhi-Hai, Hu, Wenbiao, Qian, Quan, Haque, Ubydul, Soares Magalhaes, Ricardo J., Li, Shen-Long, Tong, Shi-Lu, Li, Cheng-Yi, Sun, Hai-Long, & Sun, Yan-Song (2015) Spatiotemporal clustering analysis and risk assessments of human cutaneous anthrax in China, 2005–2012. PLoS ONE, 10(7), Article Number-e0133736.

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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.


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.


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.


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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ID Code: 92271
Item Type: Journal Article
Refereed: Yes
Keywords: Clustering analysis, Risk aassessments, Human Cutaneous Anthrax
DOI: 10.1371/journal.pone.0133736
ISSN: 1932-6203
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright: © 2015 Zhang et al
Copyright Statement: 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
Deposited On: 25 Jan 2016 05:04
Last Modified: 06 May 2016 04:09

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