Kuo Chi-Chien, Wardrop Nicola, Chang Chung-Te, Wang Hsi-Chieh, Atkinson Peter M
Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
Geography and Environment, University of Southampton, Southampton, United Kingdom.
PLoS Negl Trop Dis. 2017 Mar 6;11(3):e0005430. doi: 10.1371/journal.pntd.0005430. eCollection 2017 Mar.
International seaports are hotspots for disease invasion and pathogens can persist in seaports even after ports are abandoned. Transmitted by fleas infected by Rickettsia typhi, murine typhus, a largely neglected and easily misdiagnosed disease, is known to occur primarily in large seaports. However, the significance of seaports in the occurrence of murine typhus has never been validated quantitatively.
METHODOLOGY/PRINCIPAL FINDINGS: We studied the spatial distribution of murine typhus, a notifiable disease, in Taiwan. We investigated whether risk of infection was correlated with distance to international seaports and a collection of environmental and socioeconomic factors, using a Bayesian negative binomial conditionally autoregressive model, followed with geographically weighted regression. Seaports that are currently in use and those that operated in the 19th century for trade with China, but were later abandoned due to siltation were analyzed. A total of 476 human cases of murine typhus were reported during 2000-2014 in the main island of Taiwan, with spatial clustering in districts in southwest and central-west Taiwan. A higher incidence rate (case/population) was associated with a smaller distance to currently in-use international seaports and lower rainfall and temperature, but was uncorrelated with distance to abandoned ports. Geographically weighted regression revealed a geographic heterogeneity in the importance of distance to in-use seaports near the four international seaports of Taiwan.
CONCLUSIONS/SIGNIFICANCE: Our study suggests that murine typhus is associated with international seaports, especially for those with large trading volume. Thus, one of the costs of global trade in Taiwan might be elevated risks of murine typhus. Globalization has accelerated the spread of infectious diseases, but the burden of disease varies geographically, with regions surrounding major international seaports warranting particular surveillance.
国际海港是疾病入侵的热点地区，即使港口废弃后，病原体仍可能在海港持续存在。鼠型斑疹伤寒主要通过感染了伤寒立克次体的跳蚤传播，这是一种很大程度上被忽视且易被误诊的疾病，主要发生在大型海港。然而，海港在鼠型斑疹伤寒发生中的重要性从未得到过定量验证。
方法/主要发现：我们研究了台湾法定传染病鼠型斑疹伤寒的空间分布。我们使用贝叶斯负二项条件自回归模型，并结合地理加权回归，调查了感染风险是否与到国际海港的距离以及一系列环境和社会经济因素相关。分析了目前仍在使用的海港以及19世纪用于与中国贸易、但后来因淤积而废弃的海港。2000 - 2014年期间，台湾本岛共报告了476例人类鼠型斑疹伤寒病例，在台湾西南部和中西部地区呈空间聚集。发病率较高（病例数/人口数）与到目前仍在使用的国际海港的距离较短、降雨量和温度较低有关，但与到废弃港口的距离无关。地理加权回归显示，在台湾四个国际海港附近，到仍在使用的海港的距离的重要性存在地理异质性。
结论/意义：我们的研究表明，鼠型斑疹伤寒与国际海港有关，尤其是那些贸易量较大的海港。因此，台湾全球贸易的成本之一可能是鼠型斑疹伤寒风险的增加。全球化加速了传染病的传播，但疾病负担在地理上存在差异，主要国际海港周边地区需要特别监测。
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