Objective: To understand the epidemiological characteristics of tick-borne infectious diseases (TBID) and the risk factors of severe illness and death in Hubei Province from 2016 to 2021. Methods: Based on the incidence data of fever with thrombocytopenia syndrome (SFTS), tsutsugamushi disease, typhus and other TBID reported during 2016-2021, the epidemiological analysis was conducted. Field investigation results of TBID in areas with high incidence in 2021, logistic regression analysis of population characteristics, epidemiological history and other factors were used to explore the risk factors of severe and fatal cases. In the field vector investigation, free ticks and surface ticks of the host animals in the cases' home and surrounding grassland were monitored and detected. Results: A total of 3 826 TBID cases were reported in Hubei from 2016 to 2021, of which 71.30% (2 728/3 826) were SFTS, 13.04% (499/3 826) were tsutsugamushi disease and 15.66% (599/3 826) were typhus. A total of 44 cases died in 6 years; the fatality rate was 1.15% (44/3 826). In the peak seasons of incidence from May to July, the cases in people engaged in agriculture related work accounted for 84.61% (3 237/3 826). The incidence rate in women was higher than that in men, and the cases aged ≥50 years accounted for 81.02% of the total (3 100/3 826), and the incidence rate increased with age (P<0.001). The TBID cases were distributed in 86 counties and districts in 16 prefectures (municipality). The incidence rates of different areas had significant differences (P<0.05), and there was a certain spatial-temporal clustering and expasion. Bovis microplus and Haemaphysalis longicornis were captured in the field, and the positive rates in host animals and grassland ticks were 10.94% (7/64) and 40.00% (2/5), respectively. Univariate logistic regression analysis results showed that age ≥50 years and leukocyte <2.0×10⁹/L were risk factors for severe illness and death. Conclusions: The TBID reported in Hubei were mainly SFTS, tsutsugamushi disease and typhus. In order to reduce the incidence of TBID, it is necessary to strengthen the prevention and control in women aged ≥50 years and reduce field exposure and tick bites during the epidemic period.
Animals ; Female ; Typhus, Epidemic Louse-Borne ; Scrub Typhus/epidemiology* ; Severe Fever with Thrombocytopenia Syndrome ; Ticks ; Communicable Diseases ; Phlebovirus ; China/epidemiology* ; Tick-Borne Diseases/epidemiology*

Objective: To analyze the epidemiological characteristics of typhus in China from 1950 to 2021, and discuss the challenges in typhus prevention and control in China and suggest future prevention and control strategies. Methods: Based on the reported data of typhus from 1950 to 2021 in China from the Infectious Disease History Database of China Public Health Science Data Center and the National Notifiable Infectious Disease Reporting Information System of Chinese Center for Disease Control and Prevention, we conducted a descriptive statistical analysis. Mann-Kendall test and circular distribution method were used to analyze the incidence, mortality and case fatality of typhus to reveal the temporal, spatial and population distributions and diagnosis of typhus in China. Results: From 1950 to 2021, a total of 452 965 typhus cases and 7 339 typhus deaths were reported in China, with the cases numbers exceeding 10 000 in 14 years of the 1950s, 1960s and 1980s, respectively. Since 1990s, the reported cases and incidence rate of typhus have decreased dramatically and the most cases were sporadic. However, the reported typhus cases in Anhui, Hubei, Hunan Provinces showed significant uptrends. Although typhus could occur all the year round, but the seasonality was observed with the incidence mainly in summer and autumn. For different provinces from the north to the south, the peaks of typhus' monthly incidence tended to shift to earlier dates. The male to female ratio of the cases was 1.01∶1 (18 529∶18 366). However, more cases occurred in women in recent years. The cases aged ≤9 years accounted for the highest proportion (18.9%), but the number of cases aged ≥50 years showed an upward trend. Most cases were farmers with the proportion increasing year by year. Moreover, the cases in students and scattered-living children also accounted for relatively higher proportions. The median of the interval between onset and diagnosis of typhus was 6 days. Most cases were clinically diagnosed, while the proportion of laboratory-confirmed cases was low and most laboratory cases were confirmed by Well-Felix reaction. Conclusions: Although the incidence and mortality of typhus in China has decreased significantly, the risk for local typhus outbreaks still exists. The prevention and control of typhus still face many challenges. It is indispensable to strengthen the pathogen detection and surveillance for typhus in China.
Child ; Humans ; Male ; Female ; Scrub Typhus/epidemiology* ; Typhus, Epidemic Louse-Borne/epidemiology* ; China/epidemiology* ; Incidence ; Disease Notification

Bacteriology ; history ; France ; History, 19th Century ; History, 20th Century ; Humans ; Male ; Philately ; Typhus, Epidemic Louse-Borne ; history ; therapy

In this study, new real-time PCR method based on the groEL gene was developed and investigated. Four spotted fever group (SFG) strains, four typhus group (TG) strains, and four scrub typhus group (STG) strains were easily differentiated as a distinct entity. This PCR assay was applied to detect Rickettsia DNA from 100 ticks. Twelve Haemaphysalis longicornis ticks were found positive and identified as spotted fever group Rickettsia. This real-time PCR method could simultaneously perform the rapid identification of rickettsiae and the differential diagnosis of SFG, TG, and STG in a single reaction.
Diagnosis, Differential ; DNA ; Fever ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Rickettsia ; Scrub Typhus ; Ticks ; Typhus, Epidemic Louse-Borne

BACKGROUND/AIMS: The aim of the study was to investigate the gastric involvement of Orientia tsutsugamushi and the relationship between the clinical features and gastritis in patients with scrub typhus. METHODS: The study included 98 patients who had been diagnosed with scrub typhus between January 2003 and December 2006. Sixteen patients were selected to undergo gastroduodenoscopy with endoscopic biopsy for molecular study. The clinical severity index score (CSIS) was evaluated. Rickettsial DNA was amplified using the paraffin- embedded biopsy tissue by performing nested PCR. The expressions of ICAM-1 and VCAM-1 were investigated by immunohistochemistry to evaluate their roles in the pathogenesis of scrub typhus. RESULTS: The endoscopic findings were gastritis (n=1), erosion (n=4) and ulcer (n=11). The average CSIS was 3.65+/-1.09. Four cases of nested PCR of the 16 gastric mucosal biopsies were positive. The gastric samples that were taken earlier after therapy tended to be PCR-positive (2.00+/-00 days vs. 3.83+/-1.27 days, p<0.001). There was no difference of the clinical features and the CSISs between the PCR-positive and PCR-negative patients. The biopsied tissue revealed no vasculitis findings. Staining for ICAM-1 was more expressed in the scrub typhus group as compared with the normal control group. Staining for VCAM-1 was sporadically expressed in the scrub typhus group and normal control group. In comparison with the patients with Helicobacter pylori-associated gastritis, the immunohistochemical staining showed no difference of expression in the patients with O. tsutsugamushi-infected gastritis. CONCLUSIONS: The gastritis seen in scrub typhus patients could be typhus that is related to the direct involvement of O. tsutsugamushi. The increased expression of ICAM-1 may be related with gastric mucosal endothelial injury due to direct infection.
Biopsy ; DNA ; Gastritis ; Helicobacter ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Orientia tsutsugamushi ; Polymerase Chain Reaction ; Scrub Typhus ; Typhus, Epidemic Louse-Borne ; Ulcer ; Vascular Cell Adhesion Molecule-1 ; Vasculitis

OBJECTIVETo develop a quantitative real-time polymerase chain reaction (PCR) for detecting Rickettsia prowazekii.

METHODSPrimers and TaqMan-MGB probes designed based on ompB gene of R. prowazekii, were used to develop this method.

RESULTSFor the quantitative real-time PCR, the relationship between the values of threshold cycle (Ct) and the DNA copy number was linear (r = 0.999) and the sensitivity was about 100 times higher than that of the nested PCR for detecting the same DNA sample. The results of the genomic DNA samples of other rickettsial and bacterial agents detected by real-time PCR were all negative. DNAs extracted from blood samples of guinea pig infected with R. prowazekii were examined by real-time PCR and the positive results were obtained from some of these samples. However, the results of some samples in nested PCR assay were all negative.

CONCLUSIONThese results suggested that the real-time PCR was highly specific and sensitive for detection of R. prowazekii that was useful for the detection of tiny DNA of R. prowazekii in blood samples from patients suspected of having epidemic typhus.

DNA Primers ; DNA, Bacterial ; analysis ; Humans ; Polymerase Chain Reaction ; methods ; Rickettsia prowazekii ; genetics ; isolation & purification ; Sensitivity and Specificity ; Typhus, Epidemic Louse-Borne ; diagnosis

BACKGROUND: Although tetracycline or doxycycline is the drug of choice for the treatment of scrub typhus, they are not recommended for children and pregnant women. Futhermore, the emergence of doxycycline resistant strain of Orientia tustusgamushi has aroused to find new therapeutic drugs. So, this study was aimed to evaluate the clinical efficacy of telithromycin, the first ketolide antibiotic for the treatment of scrub typhus in comparison with doxycycline. MATERIALS AND METHODS: Mild scrub typhus patients who were admitted to two university hospitals located in Incheon city from October 2004 through November 2004 were enrolled. Patients were assigned to telithromcyin (the first day, oral 800 mg every 12 hours and then 800 mg/day) and doxycycline treatment groups (oral 200 mg/day). Time and days to defevescence were analysed to evaluate the efficacy of the two antibiotics. RESULTS: Among a total of fifty patients, twenty six (52.0%) patients were excluded. Twenty four (48.0%) enrolled patients, telithromcyin and doxycycline were administered to thirteen (54.2%) and eleven patients (45.8%), respectively. In telithromycin treatment group, one patient (7.6%) was dropped out due to nausea and diarrhea. In doxycycline group, the mean age was higher (P=0.031) but the duration of fever before admission was shorter (P=0.015) than telithromycin group. There was no treatment failure nor relapse in either treatment groups. The mean time to defevescence was 17.7 hours for telithromycin group and 30.7 hours for doxycycline group (P=0.003). Ten patients (83.3%) in telithromycin group and four patients (36.4%) in doxycycline group became afebrile within the first day (P=0.048). CONCLUSION: Telithromycin has achieved good therapeutic outcome and more rapid response than doxycycline for the treatment of mild to moderate scrup typhus, so it suggests that telithromycin would be an alternative therapeutic agent for scrub typhus.
Anti-Bacterial Agents ; Child ; Diarrhea ; Doxycycline ; Female ; Fever ; Hospitals, University ; Humans ; Incheon ; Nausea ; Pregnant Women ; Recurrence ; Scrub Typhus* ; Tetracycline ; Treatment Failure ; Typhus, Epidemic Louse-Borne

BACKGROUND: Spotted fever group rickettsiosis occurs worldwide and includes various causative organisms depending on the region and clinical features. In Korea, previous studies have shown that several kinds of spotted fever rickettsiae have been identified in ticks, and in stored sera obtained from febrile patients. Previously, it was difficult to correlate the results of serologic or molecular biologic tests with the clinical or epidemiological features of this disease in humans. In 2004, the first Korean patient with Japanese spotted fever (JSF) was identified on Mueui Island, Incheon, Korea. To estimate the prevalence of JSF and to compare the incidence of JSF with those of other infectious diseases endemic to Korea, we performed a serosurvey of Japanese spotted fever and other rickettsiosis (scrub typhus and murine typhus), hemorrhagic fever with renal syndrome and leptospirosis on the island where the patient had been living. MATERIALS AND METHODS: In October 2004, we performed a seroprevalence survey of Mueui Island where nearly 300 persons resided. There were 91 persons who participated in the survey and answered the questionnaire. The participants included 30 healthy subjects receiving a check up at the Health Promotion Center at Inha University Hospital, and 30 patients with rheumatoid factor as control groups for the serologic tests. RESULTS: Of the 91 residents, only one person showed a positive reaction to R. japonica at a titer of 1:80. IgG antibodies against O. tsutsugamushi were positive at a titer of 1:32 in 3 persons, and those against R. typhi were at 1:32 in 1 person and at 1:64 in 2 persons. Serum IgG antibodies to Hantan virus were positive at a dilution of 1:64 in 2 persons and those to leptospira were negative. All 30 healthy persons and 30 patients with rheumatoid factor in the control group showed negative results in 1:40 diluted sera. CONCLUSION: This study demonstrates that the seroprevalence of R. japonica is not as high in Korea as it is in Japan. Further studies should be performed in a large number of patients, including residents of other islands and the Korean peninsula.
Antibodies ; Asian Continental Ancestry Group* ; Communicable Diseases ; Fever* ; Health Promotion ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunoglobulin G ; Incheon ; Incidence ; Islands ; Japan ; Korea ; Leptospira ; Leptospirosis ; Prevalence ; Rheumatoid Factor ; Rickettsia* ; Scrub Typhus ; Seroepidemiologic Studies* ; Serologic Tests ; Ticks ; Typhus, Endemic Flea-Borne ; Typhus, Epidemic Louse-Borne ; Surveys and Questionnaires

BACKGROUND: Although tetracycline or doxycycline is the drug of choice for the treatment of scrub typhus, they are not recommended for children and pregnant women. Futhermore, the emergence of doxycycline resistant strain of Orientia tustusgamushi has aroused to find new therapeutic drugs. So, this study was aimed to evaluate the clinical efficacy of telithromycin, the first ketolide antibiotic for the treatment of scrub typhus in comparison with doxycycline. MATERIALS AND METHODS: Mild scrub typhus patients who were admitted to two university hospitals located in Incheon city from October 2004 through November 2004 were enrolled. Patients were assigned to telithromcyin (the first day, oral 800 mg every 12 hours and then 800 mg/day) and doxycycline treatment groups (oral 200 mg/day). Time and days to defevescence were analysed to evaluate the efficacy of the two antibiotics. RESULTS: Among a total of fifty patients, twenty six (52.0%) patients were excluded. Twenty four (48.0%) enrolled patients, telithromcyin and doxycycline were administered to thirteen (54.2%) and eleven patients (45.8%), respectively. In telithromycin treatment group, one patient (7.6%) was dropped out due to nausea and diarrhea. In doxycycline group, the mean age was higher (P=0.031) but the duration of fever before admission was shorter (P=0.015) than telithromycin group. There was no treatment failure nor relapse in either treatment groups. The mean time to defevescence was 17.7 hours for telithromycin group and 30.7 hours for doxycycline group (P=0.003). Ten patients (83.3%) in telithromycin group and four patients (36.4%) in doxycycline group became afebrile within the first day (P=0.048). CONCLUSION: Telithromycin has achieved good therapeutic outcome and more rapid response than doxycycline for the treatment of mild to moderate scrup typhus, so it suggests that telithromycin would be an alternative therapeutic agent for scrub typhus.
Anti-Bacterial Agents ; Child ; Diarrhea ; Doxycycline ; Female ; Fever ; Hospitals, University ; Humans ; Incheon ; Nausea ; Pregnant Women ; Recurrence ; Scrub Typhus* ; Tetracycline ; Treatment Failure ; Typhus, Epidemic Louse-Borne

BACKGROUND: Spotted fever group rickettsiosis occurs worldwide and includes various causative organisms depending on the region and clinical features. In Korea, previous studies have shown that several kinds of spotted fever rickettsiae have been identified in ticks, and in stored sera obtained from febrile patients. Previously, it was difficult to correlate the results of serologic or molecular biologic tests with the clinical or epidemiological features of this disease in humans. In 2004, the first Korean patient with Japanese spotted fever (JSF) was identified on Mueui Island, Incheon, Korea. To estimate the prevalence of JSF and to compare the incidence of JSF with those of other infectious diseases endemic to Korea, we performed a serosurvey of Japanese spotted fever and other rickettsiosis (scrub typhus and murine typhus), hemorrhagic fever with renal syndrome and leptospirosis on the island where the patient had been living. MATERIALS AND METHODS: In October 2004, we performed a seroprevalence survey of Mueui Island where nearly 300 persons resided. There were 91 persons who participated in the survey and answered the questionnaire. The participants included 30 healthy subjects receiving a check up at the Health Promotion Center at Inha University Hospital, and 30 patients with rheumatoid factor as control groups for the serologic tests. RESULTS: Of the 91 residents, only one person showed a positive reaction to R. japonica at a titer of 1:80. IgG antibodies against O. tsutsugamushi were positive at a titer of 1:32 in 3 persons, and those against R. typhi were at 1:32 in 1 person and at 1:64 in 2 persons. Serum IgG antibodies to Hantan virus were positive at a dilution of 1:64 in 2 persons and those to leptospira were negative. All 30 healthy persons and 30 patients with rheumatoid factor in the control group showed negative results in 1:40 diluted sera. CONCLUSION: This study demonstrates that the seroprevalence of R. japonica is not as high in Korea as it is in Japan. Further studies should be performed in a large number of patients, including residents of other islands and the Korean peninsula.
Antibodies ; Asian Continental Ancestry Group* ; Communicable Diseases ; Fever* ; Health Promotion ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunoglobulin G ; Incheon ; Incidence ; Islands ; Japan ; Korea ; Leptospira ; Leptospirosis ; Prevalence ; Rheumatoid Factor ; Rickettsia* ; Scrub Typhus ; Seroepidemiologic Studies* ; Serologic Tests ; Ticks ; Typhus, Endemic Flea-Borne ; Typhus, Epidemic Louse-Borne ; Surveys and Questionnaires