Abstract
ObjectiveMany studies focused on reasons behind the increasing incidence and the spread of human brucellosis in mainland China, yet most of them lacked comprehensive consideration with quantitative evidence. Hence, this study aimed to further investigate the epidemic mechanism and associated factors of human brucellosis so as to provide thoughts for future countermeasures in China and the rest of the world.MethodsData of human brucellosis incidence and some associated factors in economy, animal husbandry, transportation as well as health and hygiene were collected at provincial level from 2005–2016. Time series plots were first used to visualize the annual incidence and annual rate of change of human brucellosis for each province, then cluster analysis categorized all the 31 provinces of mainland China based on their incidence time series during the study period. In addition, according to the characteristics of data, the dynamic panel data model in combination with supervised principal component analysis was proposed to explore effects of associated factors on human brucellosis.Results1. The incidence rate of human brucellosis in mainland China increased three-fold from 1.41 per 100,000 people in 2005 to 4.22 per 100,000 people in 2014, though it went down a little in 2015 and 2016. Incidence rates in the north have always been higher than those in the south, but the latter also experienced an upward trend especially between 2012 and 2016. 2. The 31 provinces of mainland China were categorized into three clusters, and each cluster had its own characteristics of incidence time series. 3. The impact of health and hygiene situations on the prevention and control work of human brucellosis was still very limited and trivial (regression coefficient = -0.02). Therefore, it was plausible to presume that improving the personal average number of medical institutes and the proportion of rural medical expenditure might be helpful in preventing and controlling human brucellosis.ConclusionsThe epidemic status of human brucellosis has changed in both spatial and temporal dimensions in recent years in mainland China. Apart from traditional control measures, more attention should be paid to the improvement of medical healthcare especially in rural areas in the hope of enhancing the control effect.
Highlights
Human brucellosis is a highly contagious zoonotic disease mainly caused by unpasteurized milk or undercooked meat products that were made of infected animals
The 31 provinces of mainland China were categorized into three clusters, and each cluster had its own characteristics of incidence time series
In China, it has been listed as the class B notifiable infectious disease since 2005 [4,5], as well as one of the most serious types of class B diseases among those listed in the Detailed Rules for the Implementation of the Regulations on Livestock and Poultry Epidemic Prevention [6]
Summary
Human brucellosis is a highly contagious zoonotic disease mainly caused by unpasteurized milk or undercooked meat products that were made of infected animals. Apart from the temporal trend, the epidemic of human brucellosis in mainland China had some spatial characteristics. Since the massive number of pastures increased local residents’ risks of exposure to infected animals or their products, brucellosis (both among humans and animals) was severest in north-eastern China in the past [7]. Some recent studies [8,9] showed that human brucellosis epidemics were spreading from traditional high-incidence pastoral and half-pastoral areas in the north to low-incidence non-pastoral areas in the south. Such a rapid trend of increase and spread deserved much attention. Though the government has noticed the problem and some countermeasures have already been taken (e.g. the application of brucellosis vaccine and the setup of brucellosis prevention institutes) [10,11], the situation has not been optimized yet
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