{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:24:06Z","timestamp":1781709846663,"version":"3.54.5"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T00:00:00Z","timestamp":1578528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004738","name":"E-Da Hospital","doi-asserted-by":"publisher","award":["EDAHP106016"],"award-info":[{"award-number":["EDAHP106016"]}],"id":[{"id":"10.13039\/501100004738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["104\u20102314\u2010B\u2010650\u2010004"],"award-info":[{"award-number":["104\u20102314\u2010B\u2010650\u2010004"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Zoonoses and Public Health"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Leptospirosis (LS) is a neglected tropical zoonosis of global importance. A nationwide investigation of characteristics, epidemiology, risk factors and outbreak is crucial for awareness of this disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A nationwide database of reported LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan, was analysed. Geographic information system software was used to map the distribution of confirmed LS cases and pigs. Cross\u2010matching with the databases of Q fever, scrub typhus and murine typhus was conducted to identify possible coinfections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 10,917 reported cases of LS were recorded in the database, which included 665 (6.1%) confirmed LS and 10,252 (93.9%) non\u2010confirmed LS cases. The major residences of confirmed LS were the Kaohsiung\u2010Pingtung (248, 37.3%) and Taipei (174, 26.2%) regions. The average annual incidence was 0.4\/100,000 people. Compared with non\u2010confirmed LS cases, confirmed LS cases had significantly higher percentages of male gender (83.6% vs. 67.9%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), high\u2010risk occupations (farmer, animal husbandry or veterinarian) (24.8% vs. 13.7%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), residence in the Kaohsiung\u2010Pingtung region (37.3% vs. 19.6%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) and exposure to rats (8.6% vs. 4.9%, <jats:italic>p\u00a0=\u00a0<\/jats:italic>.001) or pigs (9.4% vs. 1.9%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) but a lower mean age (47.8\u00a0\u00b1\u00a015.1 vs. 51.\u00b118.5\u00a0years old). Rat and pig exposure trends were found in the northern and southern regions, respectively. Distribution of LS was consistent with pigs, and one outbreak associated with flooding and pigs occurred in the Pingtung region in 2009. Twenty\u2010three and four patients with LS were coinfected with scrub typhus and Q fever, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LS is an endemic disease in Taiwan, particularly in the Kaohsiung\u2010Pingtung and Taipei regions. High\u2010risk occupations and animal exposure history are important for the clinical presumptive diagnosis of LS, particularly for rats in northern Taiwan and pigs in southern Taiwan. Although uncommon, clinicians should be aware of coinfection of LS with endemic rickettsial diseases.<\/jats:p><\/jats:sec>","DOI":"10.1111\/zph.12667","type":"journal-article","created":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T11:49:19Z","timestamp":1578570559000},"page":"156-166","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The epidemiology, characteristics and outbreaks of human leptospirosis and the association with animals in Taiwan, 2007\u20132014: A nationwide database study"],"prefix":"10.1111","volume":"67","author":[{"given":"Chia\u2010Ta","family":"Tsai","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine E\u2010Da Hospital I\u2010Shou University Kaohsiung Taiwan"},{"name":"Department of Infection Control  E\u2010Da Hospital I\u2010Shou University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiun\u2010Nong","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine E\u2010Da Hospital I\u2010Shou University Kaohsiung Taiwan"},{"name":"School of Medicine College of Medicine I\u2010Shou University Kaohsiung Taiwan"},{"name":"Department of Critical Care Medicine E\u2010Da Hospital I\u2010Shou University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen\u2010Hsiang","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"},{"name":"College of Medicine Chang Gung University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu","family":"Sun","sequence":"additional","affiliation":[{"name":"Infection Control Department Pao\u2010Chien Hospital Pingtung County Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Chin","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen\u2010Hsu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kaohsiung Municipal Ta\u2010Tung Hospital Kaohsiung Taiwan"},{"name":"School of Medicine Graduate Institute of Medicine Sepsis Research Center Center of Dengue Fever Control and Research Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Department of Biological Science and Technology College of Biological Science and Technology National Chiao Tung University HsinChu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-3673","authenticated-orcid":false,"given":"Chung\u2010Hsu","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine E\u2010Da Hospital I\u2010Shou University Kaohsiung Taiwan"},{"name":"School of Medicine College of Medicine I\u2010Shou University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2010.06.012"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2016.01.031"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00830-2"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11250-013-0508-y"},{"key":"e_1_2_9_6_1","volume-title":"Statistics of Communicable Diseases and Surveillance Report, Republic of China 2007","author":"Centers for Disease Control, Taiwan","year":"2008"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005228"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2013.1324"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2012.11-0465"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1405.070940"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003898"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2017.02.031"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1968.17.760"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1903.111260"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1142\/S1682648518500038"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/513431"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0095810"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1510.090007"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/zph.12333"},{"key":"e_1_2_9_20_1","first-page":"178","article-title":"Review of significant epidemics occurred in Taiwan and International Community in 2009 Taiwan","volume":"26","author":"Lai S. K.","year":"2010","journal-title":"Epidemiological Bulletin"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2007.77.525"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12917-017-1044-1"},{"key":"e_1_2_9_23_1","unstructured":"Leptospirosis Burden Epidemiology Reference Group (LERG). [updated 13 July 2010]. Retreived fromhttps:\/\/www.who.int\/zoonoses\/diseases\/lerg\/en\/"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.14.2.296-326.2001"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2007.09.011"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid0812.020180"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11250-016-1201-8"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir411"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1590\/0037-8682-0102-2015"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1707.101050"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1086\/425001"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268815000205"},{"key":"e_1_2_9_33_1","first-page":"129","article-title":"Serological surveillance of Leptospirosis in Italy: Two year national data (2010\u20132011)","volume":"52","author":"Tagliabue S.","year":"2016","journal-title":"Veterinaria Italiana"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2000.63.204"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2008.130450"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-13-191"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-9-147"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2003.68.89"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmii.2011.09.015"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1301.060718"},{"key":"e_1_2_9_41_1","first-page":"109","article-title":"Leptospirosis in Taiwan\u2013an underestimated infectious disease","volume":"30","author":"Yang C. W.","year":"2007","journal-title":"Chang Gung Med J"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1653-5"}],"container-title":["Zoonoses and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fzph.12667","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/zph.12667","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/zph.12667","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/zph.12667","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T06:38:49Z","timestamp":1694155129000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/zph.12667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,9]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1111\/zph.12667"],"URL":"https:\/\/doi.org\/10.1111\/zph.12667","archive":["Portico"],"relation":{},"ISSN":["1863-1959","1863-2378"],"issn-type":[{"value":"1863-1959","type":"print"},{"value":"1863-2378","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,9]]},"assertion":[{"value":"2019-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}