Abstract
Human leptospirosis outbreaks still persistently occur in part of China, indicating that leptospirosis remains an important zoonotic disease in the country. Spatiotemporal pattern of the high-risk leptospirosis cluster and the key characteristics of high-risk areas for leptospirosis across the country are still poorly understood. Using spatial analytical approaches, we analyzed 8,158 human leptospirosis cases notified during 2005–2016 across China to explore the geographical distribution of leptospirosis hotspots and to characterize demographical, ecological and socioeconomic conditions of high-risk counties for leptospirosis in China. During the period studied, leptospirosis incidence was geographically clustered with the highest rate observed in the south of the Province of Yunnan. The degree of spatial clustering decreased over time suggesting changes in local risk factors. However, we detected residual high-risk counties for leptospirosis including counties in the southwest, central, and southeast China. High-risk counties differed from low-risk counties in terms of its demographical, ecological and socioeconomic characteristics. In high-risk clusters, leptospirosis was predominantly observed on younger population, more males and farmers. Additionally, high-risk counties are characterized by larger rural and less developed areas, had less livestock density and crops production, and located at higher elevation with higher level of precipitation compare to low-risk counties. In conclusion, leptospirosis distribution in China appears to be highly clustered to a discrete number of counties highlighting opportunities for elimination; hence, public health interventions should be effectively targeted to high-risk counties identified in this study.
Highlights
Species have been identified so far and it is likely that novel species will be continuously discovered[6,7]
During the last two decades, there was a decline in the number of notified leptospirosis cases and mortality in China, which might be partly due to the effectiveness of control programmes deployed by Chinese authorities including rodent control, improvement in sanitation conditions, and vaccination during epidemic season especially in high-risk communities[22,23]
There was a gradual decline in the notified leptospirosis incidence and a reduction in the number of counties reporting leptospirosis during the period studied, our analysis has revealed residual counties with high leptospirosis incidence in the southwestern, central and southeastern China
Summary
Species have been identified so far and it is likely that novel species will be continuously discovered[6,7]. A better understanding of such characteristics would help guide health authorities at identifying potential areas for leptospirosis transmission as well as to target vulnerable population. Little is known about the location of residual high-risk foci of leptospirosis and key demographic, ecological and socio-economic characteristics that could explain residual disease transmission in those areas. This knowledge gap hinders the design and implementation of targeted interventions towards reducing risk and eliminating leptospirosis in China. Findings from the present study would have much value for policymaking, especially at county-level, to strengthen disease surveillance programs and intervention strategies for leptospirosis
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