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Infect Dis Poverty. 2018 May 18;7(1):57. doi: 10.1186/s40249-018-0435-2.

Epidemiological shift and geographical heterogeneity in the burden of leptospirosis in China.

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Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, 4343, Australia.
National Institute of Health Research and Development (NIHRD), Ministry of Health of Indonesia, Unit of Vector-borne Diseases Control, Pangandaran, West Java, 46396, Indonesia.
Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia.
Center for Disease Surveillance and Research, Institute of Disease Control and Prevention of PLA, Beijing, 100071, People's Republic of China.
Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China.
Scientific Data Center, Computer Network Information Center, Chinese Academy of Sciences, Beijing, 100190, People's Republic of China.
School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, BA, 40296-710, Brazil.
Instituto da Saúde Coletiva, Federal University of Bahia (UFBA), Salvador, BA, 40110-040, Brazil.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06520, USA.
Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, 4343, Australia.
Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, 4101, Australia.



Leptospirosis morbidity and mortality rates in China have decreased since the 2000s. Further analyses of the spatiotemporal and demographic changes occurring in the last decade and its implication on estimates of disease burden are required to inform intervention strategies. In this study, we quantified the epidemiological shift and geographical heterogeneity in the burden of leptospirosis during 2005-2015 in China.


We used reported leptospirosis case data from 1st January 2005 to 31st of December 2015 that routinely collected by the China Information System for Disease Control and Prevention (CISDCP) to analyze the epidemiological trend and estimate the burden in terms of disability-adjusted life-years (DALYs) over space, time, and demographical groups.


A total of 7763 cases were reported during 2005-2015. Of which, 2403 (31%) cases were the laboratory-confirmed case. Since 2005, the notified incidence rate was gradually decreased (P < 0.05) and it was relatively stable during 2011-2015 (P > 0.05). During 2005-2015, we estimated a total of 10 313 DALYs were lost due to leptospirosis comprising a total of 1804 years-lived with disability (YLDs) and 8509 years-life lost (YLLs). Males had the highest burden of disease (7149 DALYs) compared to females (3164 DALYs). The highest burden estimate was attributed to younger individuals aged 10-19 years who lived in southern provinces of China. During 2005-2015, this age group contributed to approximately 3078 DALYs corresponding to 30% of the total DALYs lost in China. Yet, our analysis indicated a declining trend in burden estimates (P < 0.001) since 2005 and remained relatively low during 2011-2015. Low burden estimates have been identified in the endemic regions where infections principally distributed. Most of the changes in DALY estimates were driven by changes in YLLs.


In the last 11-years, the burden estimates of leptospirosis have shown a declining trend across the country; however, leptospirosis should not be neglected as it remains an important zoonotic disease and potentially affecting the young and productive population in economically less-developed provinces in southern of China. In addition, while in the last five years the incidence has been reported at very low-level, this might not reflect the true incidence of leptospirosis. Strengthened surveillance in the endemic regions is, hence, substantially required to capture the actual prevalence to better control leptospirosis in China.


Burden; China; DALY; Epidemiology; Leptospirosis; Spatiotemporal trends

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