PLoS ONE (Jan 2015)

Clinical characteristics and risk factors of an outbreak with scrub typhus in previously unrecognized areas, Jiangsu province, China 2013.

  • Jianli Hu,
  • Zhongming Tan,
  • Dafei Ren,
  • Xiang Zhang,
  • Yilin He,
  • Changjun Bao,
  • Dapeng Liu,
  • Qianhua Yi,
  • Weijuan Qian,
  • Jun Yin,
  • Zhen Xu,
  • Chunxia Yu,
  • Shenjiao Wang,
  • Bin Wu,
  • Haiyu Yang,
  • Ming Yue,
  • Yun Zhang,
  • Wendong Liu,
  • Yefei Zhu,
  • Minghao Zhou,
  • Fenyang Tang

DOI
https://doi.org/10.1371/journal.pone.0125999
Journal volume & issue
Vol. 10, no. 5
p. e0125999

Abstract

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Scrub typhus, caused by Orientia tsutsugamushi, has emerged recently in Jingjiang City, China where the disease had not been known to exist. We analyzed epidemiological data, clinical characteristics and risk factors of scrub typhus outbreak in Jingjiang City, 2013. The 271 clinically diagnosed patients were predominantly farmers 50 to 69 years old and the peak of onset was early to mid-November. For the 187 laboratory-confirmed cases, the major clinical manifestations of the patients were fever (100%), eschar (88.2%), rash (87.7%), chills (87.7%), and headache (66.8%). A community-based case-control study was carried out to investigate the risk factors of the scrub typhus outbreak. Bundling or moving waste straw (OR=9.0, 95%CI 4.6-17.8) and living at the edge of village (OR=0.6, 95%CI 0.4-0.9) posed the highest risks through single- and multi-variable conditional logistic regression. Phylogenetic analysis of the 56-kDa TSA gene showed that the new cluster (GB-C2) and the previously reported cluster (GB-C1) of O. tsutsugamushi were associated with this outbreak. These findings are useful for the establishment of a detailed control strategy for scrub typhus infection in previously unrecognized areas of Jiangsu Province, China.