National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; National Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China.
School of Global Health, Chinese Center for Tropical Diseases Research-School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
PLoS Negl Trop Dis. 2021 Mar 22;15(3):e0009152. doi: 10.1371/journal.pntd.0009152. eCollection 2021 Mar.
With several decades of concerted control efforts, visceral leishmaniasis(VL) eradication had almost been achieved in China. However, VL cases continue to be detected in parts of western China recent years. Using data of reported cases, this study aimed to investigate the epidemiology and spatio⁃temporal distribution, of mountain-type zoonotic visceral leishmaniasis (MT-ZVL) in China between the years 2015 and 2019. Epidemiological data pertaining to patients with visceral leishmaniasis (VL) were collected in Gansu, Shaanxi, Sichuan, Shanxi, Henan and Hebei provinces between the years 2015 and 2019. Joinpoint regression analysis was performed to determine changes in the epidemic trend of MT-ZVL within the time period during which data was collected. Spatial autocorrelation of infection was examined using the Global Moran's I statistic wand hotspot analysis was carried out using the Getis-Ord Gi* statistic. Spatio-temporal clustering analysis was conducted using the retrospective space-time permutation flexible spatial scanning statistics. A total of 529 cases of MT-ZVL were detected in the six provinces from which data were collected during the study time period, predominantly in Gansu (55.0%), Shanxi (21.7%), Shaanxi (12.5%) and Sichuan (8.9%) provinces. A decline in VL incidence in China was observed during the study period, whereas an increase in MT-ZVL incidence was observed in the six provinces from which data was obtained (t = 4.87, P < 0.05), with highest incidence in Shanxi province (t = 16.91, P < 0.05). Significant differences in the Moran's I statistic were observed during study time period (P < 0.05), indicating spatial autocorrelation in the spatial distribution of MT-ZVL. Hotspot and spatial autocorrelation analysis revealed clustering of infection cases in the Shaanxi-Shanxi border areas and in east of Shanxi province, where transmission increased rapidly over the study duration, as well as in well know high transmission areas in the south of Gansu province and the north of the Sichuan province. It indicates resurgence of MT-ZVL transmission over the latter three years of the study. Spatial clustering of infection was observed in localized areas, as well as sporadic outbreaks of infection.
经过几十年的协同控制努力，内脏利什曼病（VL）在中国几乎已经被根除。然而，近年来，中国西部部分地区仍有 VL 病例被发现。本研究利用报告病例数据，旨在调查 2015 年至 2019 年间中国山地型动物源性内脏利什曼病（MT-ZVL）的流行病学和时空分布。2015 年至 2019 年期间，在甘肃、陕西、四川、山西、河南和河北省收集了内脏利什曼病（VL）患者的流行病学数据。采用 Joinpoint 回归分析确定了收集数据期间 MT-ZVL 流行趋势的变化。采用全局 Moran's I 统计量检验感染的空间自相关，采用 Getis-Ord Gi*统计量进行热点分析。采用回顾性时空置换灵活空间扫描统计量进行时空聚类分析。在研究期间，从六个省份共发现 529 例 MT-ZVL，主要分布在甘肃（55.0%）、山西（21.7%）、陕西（12.5%）和四川（8.9%）。研究期间，中国 VL 发病率呈下降趋势，而六个省份的 MT-ZVL 发病率呈上升趋势（t=4.87，P<0.05），山西发病率最高（t=16.91，P<0.05）。研究期间 Moran's I 统计量存在显著差异（P<0.05），表明 MT-ZVL 空间分布存在空间自相关。热点和空间自相关分析显示，感染病例在陕西-山西边境地区和山西省东部呈聚集分布，在研究期间传播迅速增加，在甘肃省南部和四川省北部已知的高传播地区也是如此。这表明在研究的后三年，MT-ZVL 传播出现了反弹。在局部地区观察到感染的空间聚集，以及感染的散发性爆发。
