Since 2006, all scrub typhus cases have been reported via the National Notifiable Infectious Disease Reporting Information System (NNIDRIS) of the China Center for Disease Control and Prevention (China CDC). This time-series analysis included weekly typhus cases from 59 prefecture-level administrative regions in 10 provinces in mainland China from January 1, 2006, to December 31, 2020 (Figure 1 ). This study included all clinically diagnosed cases and laboratory-confirmed cases.
The diagnostic criteria for suspected scrub typhus cases (meet criteria 1 and 2.1, and meet 1 of criteria 2.2 and 2.3), clinical scrub typhus cases (meet the diagnostic criterion of suspected scrub typhus and meet criterion 2.4; or meet criteria 1, 2.1, and 2.4), and confirmed scrub typhus cases (meet the diagnostic criterion of suspected scrub typhus and meet 1 of the criteria of 3.2, 3.3, and 3.4; meet the diagnostic criterion of clinical scrub typhus and meet 1 of criteria 3) were identified according to the guidebook for prevention and control of scrub typhus issued by the China CDC (Chinese Center for Disease Control and Prevention, 2009 ). One field exposure history: A person who had a field exposure history of being in a scrub typhus-endemic area 3 weeks before the onset of illness during the scrub typhus transmission season: 2 Clinical manifestations. 2.1 A person who had clinical manifestations of high fever; 2.2 A person who had clinical manifestations of lymphadenopathy; 2.3 A person who had clinical manifestations of skin rash; 2.4 A person who had clinical manifestations of typical cutaneous lesions (eschars or ulcers); 3 Laboratory tests: 3.1 Weil-Felix OX-K agglutination titer ≥ 1:160; 3.2 A 4-fold or greater rise in serum IgG antibody titers between acute and convalescent sera as detected by indirect immune fluorescence antibody assay (IFA); 3.3 Positive results of O. tsutsugamushi in clinical specimens by polymerase chain reaction (PCR); 3.4 Isolation of O. tsutsugamushi from clinical specimens.
The diagnostic criteria for suspected scrub typhus cases (meet criteria 1 and 2.1, and meet 1 of criteria 2.2 and 2.3), clinical scrub typhus cases (meet the diagnostic criterion of suspected scrub typhus and meet criterion 2.4; or meet criteria 1, 2.1, and 2.4), and confirmed scrub typhus cases (meet the diagnostic criterion of suspected scrub typhus and meet 1 of the criteria of 3.2, 3.3, and 3.4; meet the diagnostic criterion of clinical scrub typhus and meet 1 of criteria 3) were identified according to the guidebook for prevention and control of scrub typhus issued by the China CDC (Chinese Center for Disease Control and Prevention, 2009 ). One field exposure history: A person who had a field exposure history of being in a scrub typhus-endemic area 3 weeks before the onset of illness during the scrub typhus transmission season: 2 Clinical manifestations. 2.1 A person who had clinical manifestations of high fever; 2.2 A person who had clinical manifestations of lymphadenopathy; 2.3 A person who had clinical manifestations of skin rash; 2.4 A person who had clinical manifestations of typical cutaneous lesions (eschars or ulcers); 3 Laboratory tests: 3.1 Weil-Felix OX-K agglutination titer ≥ 1:160; 3.2 A 4-fold or greater rise in serum IgG antibody titers between acute and convalescent sera as detected by indirect immune fluorescence antibody assay (IFA); 3.3 Positive results of O. tsutsugamushi in clinical specimens by polymerase chain reaction (PCR); 3.4 Isolation of O. tsutsugamushi from clinical specimens.
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