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Open AccessArticle

Spatio-Temporal Epidemiology of Viral Hepatitis in China (2003–2015): Implications for Prevention and Control Policies

by Bin Zhu 1,2, Jinlin Liu 1, Yang Fu 3, Bo Zhang 4 and Ying Mao 1,*
1
School of Public Policy and Administration, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China
2
Department of Public Policy, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
3
College of Management, Shenzhen University, Nanhai Ave 3688, Shenzhen 518060, China
4
School of Human Settlements and Civil Engineering, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an 710049, China
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(4), 661; https://doi.org/10.3390/ijerph15040661
Received: 13 February 2018 / Revised: 19 March 2018 / Accepted: 30 March 2018 / Published: 2 April 2018
(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)
Viral hepatitis, as one of the most serious notifiable infectious diseases in China, takes heavy tolls from the infected and causes a severe economic burden to society, yet few studies have systematically explored the spatio-temporal epidemiology of viral hepatitis in China. This study aims to explore, visualize and compare the epidemiologic trends and spatial changing patterns of different types of viral hepatitis (A, B, C, E and unspecified, based on the classification of CDC) at the provincial level in China. The growth rates of incidence are used and converted to box plots to visualize the epidemiologic trends, with the linear trend being tested by chi-square linear by linear association test. Two complementary spatial cluster methods are used to explore the overall agglomeration level and identify spatial clusters: spatial autocorrelation analysis (measured by global and local Moran’s I) and space-time scan analysis. Based on the spatial autocorrelation analysis, the hotspots of hepatitis A remain relatively stable and gradually shrunk, with Yunnan and Sichuan successively moving out the high-high (HH) cluster area. The HH clustering feature of hepatitis B in China gradually disappeared with time. However, the HH cluster area of hepatitis C has gradually moved towards the west, while for hepatitis E, the provincial units around the Yangtze River Delta region have been revealing HH cluster features since 2005. The space-time scan analysis also indicates the distinct spatial changing patterns of different types of viral hepatitis in China. It is easy to conclude that there is no one-size-fits-all plan for the prevention and control of viral hepatitis in all the provincial units. An effective response requires a package of coordinated actions, which should vary across localities regarding the spatial-temporal epidemic dynamics of each type of virus and the specific conditions of each provincial unit. View Full-Text
Keywords: viral hepatitis; spatio-temporal epidemiology; spatial autocorrelation; space-time scan; Moran’s I; HAV; HBV; HCV; HEV; China viral hepatitis; spatio-temporal epidemiology; spatial autocorrelation; space-time scan; Moran’s I; HAV; HBV; HCV; HEV; China
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Zhu, B.; Liu, J.; Fu, Y.; Zhang, B.; Mao, Y. Spatio-Temporal Epidemiology of Viral Hepatitis in China (2003–2015): Implications for Prevention and Control Policies. Int. J. Environ. Res. Public Health 2018, 15, 661.

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