{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:45:05Z","timestamp":1792759505574,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T00:00:00Z","timestamp":1625443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Zoonoses and Public Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Scrub typhus (ST) is one of the most underdiagnosed, potentially fatal febrile diseases in the Asia\u2010Pacific region. We conducted a comprehensive review of the risk factors of ST over 19\u00a0years using data from a nationwide database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data on ST from the nationwide database of the Taiwan Centers for Disease Control from 1996 to 2014 to analyse the incidence rates and relative risks of ST according to different regions. The trends of incidence rates over the study period were also evaluated. The distribution of confirmed ST cases was mapped using geographic information system software. The characteristics of confirmed ST cases and non\u2010ST cases (cases with suspected ST but negative test findings) were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 38,127 reported cases, there were 6,791 (17.8%) confirmed ST cases. The overall incidence rate of ST in Taiwan was 1.49 per 100,000 residents per year. The trend of incidence rates increased over time. The Island region had the highest incidence rate (56.55 per 100,000 residents per year), followed by the Eastern region (15.13 per 100,000 residents per year). More confirmed ST cases were distributed in mountainous areas of Taiwan Main Island and Island region. Compared to non\u2010ST cases, individuals with confirmed ST were younger (median [interquartile range] age: 44 [26\u201357] years versus 45 [30\u201360]\u00a0years,<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) and more likely to engage in at\u2010risk occupations (29.4% versus 13.3%,<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), including farming and animal husbandry (16.6% versus 9.0%,<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) and the armed forces (12.3% versus 3.5%,<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001); however, they had a lower rate of animal contact (12.8% versus 20.1%,<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ST is an endemic disease in Taiwan, particularly in the Island region, Eastern region and mountainous areas. Patients engaged in at\u2010risk occupations and presenting with acute febrile diseases should undergo investigations for ST.<\/jats:p><\/jats:sec>","DOI":"10.1111\/zph.12876","type":"journal-article","created":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T09:19:37Z","timestamp":1625476777000},"page":"876-883","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Epidemiology and risk factors of scrub typhus in Taiwan: A nationwide database study from 1996 to 2014"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0078-2052","authenticated-orcid":false,"given":"Yi\u2010Chin","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital 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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4417-5350","authenticated-orcid":false,"given":"Jiun\u2010Nong","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine E\u2010Da Hospital Kaohsiung Taiwan"},{"name":"Department of Critical Care Medicine E\u2010Da Hospital Kaohsiung Taiwan"},{"name":"School of Medicine College of Medicine I\u2010Shou University Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen\u2010Hsu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan"},{"name":"School of Medicine Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Graduate Institute of Medicine Kaohsiung Medical University Kaohsiung Taiwan"},{"name":"Sepsis Research Center Center of Dengue Fever Control and Research Kaohsiung Medical University Kaohsiung 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 Kaohsiung Taiwan"},{"name":"School of Medicine College of Medicine I\u2010Shou University Kaohsiung Taiwan"},{"name":"Division of Infection Control Laboratory E\u2010Da Hospital Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9302-5220","authenticated-orcid":false,"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"}]}],"member":"311","published-online":{"date-parts":[[2021,7,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005838"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmii.2019.04.004"},{"key":"e_1_2_10_4_1","volume-title":"Statistics. 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