Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016
Abstract Background Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, and specific antimicrobial medicine is available. Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis...
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doaj-588d26176fe64d3cb6aea4472d33a5812020-11-25T03:31:52ZengBMCInfectious Diseases of Poverty2049-99572019-06-018111210.1186/s40249-019-0566-0Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016Hua-Lei Xin0Jian-Xing Yu1Mao-Gui Hu2Fa-Chun Jiang3Xiao-Jing Li4Li-Ping Wang5Ji-Lei Huang6Jin-Feng Wang7Jun-Ling Sun8Zhong-Jie Li9Qingdao City Center for Disease Control and PreventionKey Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and PreventionState Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of SciencesQingdao City Center for Disease Control and PreventionQingdao City Center for Disease Control and PreventionKey Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and PreventionKey Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and PreventionState Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of SciencesKey Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and PreventionKey Laboratory of Surveillance and Early Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and PreventionAbstract Background Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, and specific antimicrobial medicine is available. Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China, and the results will benefit both clinical practice and the disease surveillance system. Methods We extracted individual scrub typhus case data 2006–2016 from a national disease surveillance system in China. The diagnosis category and interval time from illness onset to diagnosis were compared among three levels of medical care institutions and provinces. The descriptive analysis method was performed in our study. Results During the 11-year study period, 93 481 scrub typhus cases, including 57 deaths, were recorded in the nationwide surveillance system. The overall proportion of laboratory-confirmed cases was only 4.7%, and this proportion varied greatly among primary medical centres (2.8%), county level hospitals (4.2%), and city level hospitals (6.3%). Notably, the proportion of laboratory-confirmed cases has consistently decreased from 16.3% in 2006 to 2.6% in 2016, and the same decreasing trend was found among all three levels of medical care institutions. The interval from illness onset to case diagnosis (Tdiag) for all cases was 5 days (interquartile range [IQR]: 2–9 days) and decreased from 7 days (IQR: 3–11 days) in 2006 to 5 days (IQR: 2–8 days) in 2016. The risk of death for patients with a Tdiag of > 7 days was 2.2 times higher (OR = 2.21, 95% CI: 1.05–5.21) than that of patients with a Tdiag of < 2 days. Conclusions The interval time from illness onset to diagnosis for scrub typhus cases decreased greatly in China; however, the diagnosis rate of cases with laboratory-confirmed results must be increased among all levels of medical care institutions to reduce both the risk of death and the misuse of antibiotics associated with scrub typhus.http://link.springer.com/article/10.1186/s40249-019-0566-0Scrub typhusDiagnosisEvaluationChina |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hua-Lei Xin Jian-Xing Yu Mao-Gui Hu Fa-Chun Jiang Xiao-Jing Li Li-Ping Wang Ji-Lei Huang Jin-Feng Wang Jun-Ling Sun Zhong-Jie Li |
spellingShingle |
Hua-Lei Xin Jian-Xing Yu Mao-Gui Hu Fa-Chun Jiang Xiao-Jing Li Li-Ping Wang Ji-Lei Huang Jin-Feng Wang Jun-Ling Sun Zhong-Jie Li Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016 Infectious Diseases of Poverty Scrub typhus Diagnosis Evaluation China |
author_facet |
Hua-Lei Xin Jian-Xing Yu Mao-Gui Hu Fa-Chun Jiang Xiao-Jing Li Li-Ping Wang Ji-Lei Huang Jin-Feng Wang Jun-Ling Sun Zhong-Jie Li |
author_sort |
Hua-Lei Xin |
title |
Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016 |
title_short |
Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016 |
title_full |
Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016 |
title_fullStr |
Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016 |
title_full_unstemmed |
Evaluation of scrub typhus diagnosis in China: analysis of nationwide surveillance data from 2006 to 2016 |
title_sort |
evaluation of scrub typhus diagnosis in china: analysis of nationwide surveillance data from 2006 to 2016 |
publisher |
BMC |
series |
Infectious Diseases of Poverty |
issn |
2049-9957 |
publishDate |
2019-06-01 |
description |
Abstract Background Scrub typhus is a life-threatening disease caused by Orientia tsutsugamushi, and specific antimicrobial medicine is available. Early and accurate diagnosis is essential for reducing the risk of severe complications and death. In this study, we aimed to evaluate the case diagnosis situation among medical care institutions and geographical regions in China, and the results will benefit both clinical practice and the disease surveillance system. Methods We extracted individual scrub typhus case data 2006–2016 from a national disease surveillance system in China. The diagnosis category and interval time from illness onset to diagnosis were compared among three levels of medical care institutions and provinces. The descriptive analysis method was performed in our study. Results During the 11-year study period, 93 481 scrub typhus cases, including 57 deaths, were recorded in the nationwide surveillance system. The overall proportion of laboratory-confirmed cases was only 4.7%, and this proportion varied greatly among primary medical centres (2.8%), county level hospitals (4.2%), and city level hospitals (6.3%). Notably, the proportion of laboratory-confirmed cases has consistently decreased from 16.3% in 2006 to 2.6% in 2016, and the same decreasing trend was found among all three levels of medical care institutions. The interval from illness onset to case diagnosis (Tdiag) for all cases was 5 days (interquartile range [IQR]: 2–9 days) and decreased from 7 days (IQR: 3–11 days) in 2006 to 5 days (IQR: 2–8 days) in 2016. The risk of death for patients with a Tdiag of > 7 days was 2.2 times higher (OR = 2.21, 95% CI: 1.05–5.21) than that of patients with a Tdiag of < 2 days. Conclusions The interval time from illness onset to diagnosis for scrub typhus cases decreased greatly in China; however, the diagnosis rate of cases with laboratory-confirmed results must be increased among all levels of medical care institutions to reduce both the risk of death and the misuse of antibiotics associated with scrub typhus. |
topic |
Scrub typhus Diagnosis Evaluation China |
url |
http://link.springer.com/article/10.1186/s40249-019-0566-0 |
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