Abstract
A resurgence of scarlet fever has caused many pediatric infections in East Asia and the United Kingdom. Although scarlet fever in Taiwan has not been a notifiable infectious disease since 2007, the comprehensive national health insurance data can still track its trend. Here, we used data from the open data portal of the Taiwan Centers for Disease Control. The scarlet fever trend was measured by outpatient and hospitalization rates from 2009 to 2017. In order to elucidate the spatio-temporal hotspots, we developed a new method named the spatio-temporal Gi* statistic, and applied Joinpoint regression to compute the annual percentage change (APC). The overall APCs in outpatient and hospitalization were 15.1% (95% CI: 10.3%-20.2%) and 7.7% (95%CI: 4.5% -10.9%). The major two infected groups were children aged 5–9 (outpatient: 0.138 scarlet fever diagnoses per 1,000 visits; inpatient: 2.579 per 1,000 visits) and aged 3–4 (outpatient: 0.084 per 1,000 visits; inpatient: 1.469 per 1,000 visits). We found the counties in eastern Taiwan and offshore counties had the most hotspots in the outpatient setting. In terms of hospitalization, the hotspots mostly occurred in offshore counties close to China. With the help of the spatio-temporal statistic, health workers can set up enhanced laboratory surveillance in those hotspots.
Highlights
Streptococcus pyogenes causes a variety of human diseases, including relatively mild skin infections as well as severe invasive diseases [1]
Among the diseases caused by this pathogen, scarlet fever, characterized by a sore throat, fever, headaches, swollen lymph nodes, and a characteristic rash, is predominantly an infectious disease of childhood, though it can occur in older children and adults [2]
The objective of this paper is to investigate the spatio-temporal patterns for scarlet fever in Taiwan and use the proposed spatio-temporal Gi statistic for the detection of local clusters and anomalies in outpatients and hospital admissions
Summary
Streptococcus pyogenes causes a variety of human diseases, including relatively mild skin infections as well as severe invasive diseases [1]. Among the diseases caused by this pathogen, scarlet fever, characterized by a sore throat, fever, headaches, swollen lymph nodes, and a characteristic rash, is predominantly an infectious disease of childhood, though it can occur in older children and adults [2]. With improved nutrition and widespread use of antibiotics, scarlet fever is a common, mild contagious disease. It is still a notifiable disease in many countries and regions. In Taiwan, scarlet fever was removed in 2007 from the list of notifiable diseases because of improved medical care capacities [14]. Through using national health insurance data, the Taiwan Centers for Disease Control (Taiwan CDC) can still monitor the morbidity and hospitalization trends of scarlet fever
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