{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T15:41:45Z","timestamp":1791042105519,"version":"4.1.0"},"reference-count":62,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Public Health Surveill"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Scrub typhus (ST), also known as tsutsugamushi disease, is a common febrile vector-borne illness in South Korea, transmitted by trombiculid mites infected with\n Orientia tsutsugamushi<\/jats:italic>\n , with rodents serving as the main hosts. Although vector-borne diseases like ST require both a One Health approach and a spatiotemporal perspective to fully understand their complex dynamics, previous studies have often lacked integrated analyses that simultaneously address disease dynamics, vectors, and environmental shifts.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aimed to explore spatiotemporal trends, high-risk areas, and risk factors of ST by simultaneously incorporating host and environmental information.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n ST cases were extracted from the 2013\u20102019 Korea National Health Insurance Service data at 250 municipal levels and by epidemiological weeks (\n International Classification of Diseases, Tenth Revision, Clinical Modification code<\/jats:italic>\n : A75.3). Data on potential risk factors, including the maximum probability of rodent presence, area of dry field farming, forest coverage, woman farmer population, and financial independence, were obtained from publicly available sources. In particular, the maximum rodent presence probability was estimated using a maximum entropy model incorporating ecological and climate variables. Spatial autocorrelation was assessed using Global Moran\n I<\/jats:italic>\n statistics with 999 Monte Carlo permutations. Spatial and temporal clusters were identified using Getis-Ord\n \n \n \n \n G<\/mml:mi>\n <\/mml:mrow>\n \n i<\/mml:mi>\n <\/mml:mrow>\n \n *<\/mml:mi>\n <\/mml:mrow>\n <\/mml:msubsup>\n <\/mml:math>\n <\/jats:inline-formula>\n and hot and cold spot trend analyses. Bayesian hurdle models with a spatiotemporal interaction term, accounting for zero-inflated Poisson distribution, were used to identify associations between ST incidence and regional factors. Stratification analyses by gender and age group (0\u201039, 40\u201059, 60\u201079, and \u226580 years) were performed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Between 2013 and 2019, 95,601 ST patients were reported. ST incidence had positive spatial autocorrelation (\n I<\/jats:italic>\n =0.600;\n P<\/jats:italic>\n =.01), with spatial expansion from southwestern to northeastern regions. Spatiotemporal models demonstrated better fit compared with spatial and temporal models, as indicated by lower Watanabe-Akaike information criterion (WAIC) values. Municipalities with higher rodent suitability (\u03b2 coefficient=0.618; 95% credible interval [CrI] 0.425\u20100.812) and lower financial independence from central government (\u03b2 coefficient=\u22120.304; 95% CrI \u22120.445 to \u22120.163) had higher likelihoods of increased ST incidence, even after adjusting for spatiotemporal autocorrelation. However, risk factors varied by age group: among individuals aged 40 years or older, ST incidence was positively associated with rodent suitability, while patients in the 0\u201039 years age group showed no association with rodent suitability (\u03b2 coefficient=0.028; 95% CrI \u22120.072 to 0.126), and ST incidence was negatively associated with the women farmer population (\u03b2 coefficient=-0.115; 95% Crl=\u22120.223 to \u22120.006).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This is the first study to investigate ST in South Korea using a spatiotemporal framework grounded in a holistic One Health perspective. We elucidated the critical role of spatiotemporal dynamics in ST distribution, highlighting rodent suitability and economic independence as key drivers of disease distribution. Our findings lay the groundwork for evidence-based, region-specific intervention strategies and may inform targeted public health strategies in South Korea and other settings with similar ecological conditions.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/68437","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T20:41:18Z","timestamp":1757536878000},"page":"e68437-e68437","source":"Crossref","is-referenced-by-count":4,"title":["Distribution and Risk Factors of Scrub Typhus in South Korea, From 2013 to 2019: Bayesian Spatiotemporal Analysis"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9745-3887","authenticated-orcid":false,"given":"Jeehyun","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4904-5352","authenticated-orcid":false,"given":"Penelope","family":"Vounatsou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6576-8916","authenticated-orcid":false,"given":"Byung Chul","family":"Chun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"issue":"11","key":"R1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006062","article-title":"A review of the global epidemiology of scrub typhus","volume":"11","author":"Xu","journal-title":"PLoS Negl Trop Dis"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinmicnews.2025.01.004","article-title":"A comparative analysis of Orientia Tsutsugamushi (Scrub Typhus): essential information on causes, symptoms, and care","volume":"50","author":"Jindal","journal-title":"Clin Microbiol Newsl"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"436","DOI":"10.3961\/jpmph.2010.43.5.436","article-title":"Correlations between climate change-related infectious diseases and meteorological factors in Korea","volume":"43","author":"Kim","journal-title":"J Prev Med Public Health"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"315","DOI":"10.3947\/ic.2019.51.3.315","article-title":"Historical review of leptospirosis in the Korea (1945 - 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