Spatiotemporal distribution and ecological factors of brucellosis among children from 2016 to 2020 in Inner Mongolia, China Short Title： Epidemiological characteristics of brucellosis in children

Spatiotemporal distribution and ecological factors of brucellosis among children from 2016 to 2020 in Inner Mongolia, China Short Title： Epidemiological characteristics of brucellosis in children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Spatiotemporal distribution and ecological factors of brucellosis among children from 2016 to 2020 in Inner Mongolia, China Short Title： Epidemiological characteristics of brucellosis in children Yideng Wang, Huiqiu Zheng, Yanling Wang, Xinyan Wang, Xuemei Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4590275/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Oct, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted 4 You are reading this latest preprint version Abstract Objective: In recent years, the increasing incidence of brucellosis in children has become more serious in recent years, however, relatively few studies have been conducted to characterize the spatialtemporal distribution of brucellosis in children. This study aimed to analyze the spatiotemporal distribution characteristics and ecological influencing factors of brucellosis incidence among children in Inner Mongolia. Methods: Using reported incidence data for brucellosis in children aged 0-14 years in Inner Mongolia from 2016 to 2020, the spatiotemporal distribution of childhood brucellosis through Bayesian model and a geographically-weighted regression model was used to analyze ecological factors affecting brucellosis incidence in children. Result: Bayesian spatiotemporal analysis indicated that the highest brucellosis risk and increased disease incidence were observed in Hinggan, Inner Mongolia,in children aged 0-14 years. Alxa had the lowest risk but the incidence rate increased rapidly. The incidence of childhood brucellosis was positively associated with the number of sheep at the year-end (β: 2.590940~ 2.592615, P <0.01), average temperature (β: 2.897817~ 2.902964, P <0.05), and precipitation level (β: 3.326089~ 3.326833, P <0.01). Conclusion: Brucellosis in children needs urgent attention. From 2016 to 2020, the overall incidence of brucellosis in children in Inner Mongolia showed an upward trend, with cases exhibiting spatial aggregation. While we are concerned about areas at high risk of brucellosis in children, we should also be concerned about areas where the incidence is rising fast. The number of sheep at the end of the year, average temperature, and precipitation were ecological factors that affected the incidence of childhood brucellosis. Childhood brucellosis incidence spatiotemporal distribution risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Implications and Contribution Arthralgia of brucella was often misdiagnosed and underdiagnosed due to the inability of infants and children to provide detailed complaints, which brought difficulties in clinical diagnosis and treatment, seriously affecting children's growth and development, and even causing irreversible damage, such as joint and muscle deformity. The potential threat should therefore be taken seriously, and it is particularly important to pay attention to brucellosis in children. In this study, we analyzed the spatiotemporal distribution characteristics of childhood brucellosis in Inner Mongolia through the Bayesian model,our study showed that from 2016 to 2020, the overall incidence of brucellosis in children in Inner Mongolia was on the rise and there was a spatial aggregation. In this study, we analyzed the ecological influencing factors of childhood brucellosis in Inner Mongolia through geographically weighted regression, our study showed that the number of sheep at the end of the year, average temperature, and precipitation were ecological influences on the incidence of childhood brucellosis. Introduction Brucellosis is a widespread zoonotic disease that is endemic worldwide [ 1 ] . In recent years, the global incidence of brucellosis has risen annually, with 1.6 to 2.1 million new cases of human brucellosis being reported each year [ 2 ] . Brucellosis posed a serious threat to human and animal health and was a widespread problem in some developing countries [ 3 ] . In 2014, the reported incidence rate of brucellosis was 4.22/100,000 in China, marking the highest rate ever recorded [ 4 ] . In 2016, an outbreak of brucellosis in China led to a rapid increase in incidence, with 40,328 cases reported in 2018, representing an increase of more than 120 times compared to the year 2000 [ 5 ] . It was previously believed that children were rarely affected by brucellosis. However, a recent study conducted in India has shown that the incidence of brucellosis in children was usually underestimated, and was higher in endemic areas. In these areas, the incidence of brucellosis in children ranged from 11–56% [ 6 ] . The results of a study conducted in China showed that among children under 14 years of age, the proportion of children with brucellosis was 17% [ 7 ] . Brucellosis in children lacked specificity, symptoms were predominantly tachyphylactic fever, and complaints of osteoarthropathy were more common in children [ 8 ] . A study reported that the incidence of arthralgia was as high as 77.4% in children with brucellosis, and it would still recur after treatment. Arthralgia of brucella was often misdiagnosed and underdiagnosed due to the inability of infants and children to provide detailed complaints, which brought difficulties in clinical diagnosis and treatment, seriously affecting children's growth and development, and even causing irreversible damage, such as joint and muscle deformity [ 9 ] . The potential threat should therefore be taken seriously, and it is particularly important to pay attention to brucellosis in children. Inner Mongolia was a remote region in China, and there was a large gap in the economic development of Inner Mongolia's cities, a large gap in the number of hospitals distributed, and an overall low efficiency in the allocation of medical and health resources [ 10 ] . Inner Mongolia, historically known to be an area with brucellosis infected individuals, has a vast area, grasslands, forests, and the largest per capita arable land in China. It is also the largest grassland pastoral area in China, which provides the basis for the rapid development of animal husbandry [ 11 ] . The geography and climate of Inner Mongolia are favorable for the survival of brucellosis. During years of high brucellosis incidence, Inner Mongolia accounted for 40 to 50 percent of reported brucellosis cases, becoming the top-ranking region for reported cases in China [ 12 ] . A previous study showed that cases of brucellosis in children were reported annually in Inner Mongolia from 2013–2017. It was revealed that primary and secondary schoolchildren in the region often came into contact with sheep and had a low level of awareness regarding brucellosis. They often become infected with Brucella through activities such as handling abortions, milking, consumption of undercooked meat products and fresh milk, and vaccinating sheep [ 13 ][ 14 ] . Brucellosis has a certain spatial aggregation. Bayesian spatiotemporal analysis incorporates the concept of time, allowing for the simultaneous analysis and processing of spatiotemporal distribution characteristics of brucellosis. This process offers more advantages than the traditional spatiotemporal analysis model [ 15 ] . In this study, we analyzed the spatiotemporal distribution characteristics of childhood brucellosis in Inner Mongolia using the Bayesian model. The ecological influencing factors of childhood brucellosis in Inner Mongolia through geographically weighted regression, to provide scientific basis for the reduction of the occurrence of childhood brucellosis as well as its transmission. Methods Study Design Data sources Data on the incidence of brucellosis among children aged 0–14 years were obtained from the direct reporting system of the infectious disease network of the Center for Disease Control and Prevention in Inner Mongolia. Population, socio-economic, and meteorological data for each league and city in Inner Mongolia from 2016 to 2020 were obtained from the Statistical Yearbook of Inner Mongolia. The number of medical and health institutions, number of sheep at the end of the year, average temperature (℃), precipitation level (mm), humidity (%), and number of hours of sunshine were calculated every month, and all data were standardized using the following equation: . Diagnostic criteria for brucellosis The diagnosis was based on the “Diagnostic Criteria for Brucellosis” issued by the National Health Commission of the People's Republic of China (WS2697-2019) [ 16 ] . Definition of Variables Age Children were classified into the following four age groups: 0 to 2 years old, 3 to 5 years old, 6 to 9 years old, and 10 to 14 years old. This classification was based on a combination of the direct reporting system of the infectious disease network of the Center for Disease Control and Prevention of Inner Mongolia and the "China's Child Population Situation in 2020: Facts and Figures" published by the National Bureau of Statistics. Incidence of a disease The incidence of a disease was defined as the frequency of new cases of a disease in a given population over a given period. Brucellosis incidence rate = number of cases of brucellosis in a given year/population at the end of the same year × 100,000/100,000 Statistical analysis Seasonal index The seasonal index is the ratio of the average number of cases in the same month as the observation date to the average of all months during the observation period. The seasonal index can be determined using the following formula: Here, A is the average of all yearly incidence cases in a given month within the observation period. B is the average of all yearly incidence cases within the observation period. Finally, C represents the seasonal index; when C ≥ 100%, it is considered to be an epidemic season [ 17 ] . Spatial auto-correlation In this study, the coefficient of spatial autocorrelation, Moran's I , ranges from − 1 to 1. When the Moran's I of a region is greater than 0, the incidence of brucellosis in children is clustered in that region, and there is a positive spatial correlation. When the Moran's I tends to be 1, the distribution is more clustered. When the Moran's I for a region is less than 0, the incidence of brucellosis in children is discrete, and there is a negative spatial correlation. When Moran's I tends to be -1, the distribution is more discrete [ 18 ] . Bayesian spatiotemporal model In this study, the Bayesian spatiotemporal model was used to analyze the spatial effect of childhood brucellosis alone, temporal effect alone, and interaction-associated effects of time and space, using the following formula: Here, α denotes the intercept, and (s i +b 0 t*+v) is the first part of the equation, where s i refers to the distribution of children's brucellosis risk. The common time-varying trend of children's brucellosis in the twelve allied cities of Inner Mongolia is represented by (b 0 t*+v t ). The second part of the equation, ((b 1i t*+ε it ), simultaneously accounts for the role of time and space together. Here, b 1i t* represents the independent time-varying trend of each allied city in Inner Mongolia, and ε it refers to the random error term outside the model that affects the observed data [ 19 ] . Geographical weighted regression In this study, a geographically weighted regression model was developed to explore the spatial relationships between geographic phenomena and accurately analyze and predict the relationship between the predictor and dependent variables for each location. The model was constructed using the following formula: In the above equation, Y i is the i th sample point, which also represents the dependent variable, u i is the coordinate of longitude, and v i is the coordinate of latitude, while ( u i , v i ) is the coordinate of latitude and longitude at the center point of the allied city I. β 0 ( u i , v i ) is a constant parameter, while β k ( u i , v i ) represents the k th regression parameter of the allied city i , and X ik represents the k th variable at the allied city i [ 20 ] . Statistical analysis was performed using SPSS 25.0. Bayesian spatiotemporal analysis was performed using Open BUGS and ArcGIS 10.8. GWR analysis and spatial auto-correlation were performed through ArcGIS10.8. P < 0.05 was considered statistically significant. Results Temporal trends in the incidence of brucellosis among children in Inner Mongolia A total of 703 cases of brucellosis were reported in children aged 0–14 years in Inner Mongolia from 2016 to 2020, with an average incidence rate of 4.32/100,000. The incidence rate has shown a rising trend (AAPC = 36.95%, P < 0.05, Fig. S1 , Fig. S2). From 2016 to 2020, the number of cases of brucellosis (incidence rate) among children aged 0–14 years in Inner Mongolia was 84 (2.69/100,000), 72 (2.18/100,000), 116 (3.61/100,000), 170 (5.40/100,000), and 261 (7.73/100,000), respectively. Trends in the incidence of childhood brucellosis according to sex There were 425 cases of brucellosis in boys (60.46%) and 278 cases in girls (30.54%) in Inner Mongolia from 2016 to 2020. In the same year, the incidence rate in boys was higher than that of girls. From 2016 to 2020, the incidence rates for boys were 3.04/100000, 2.35/100000, 3.98/100000, 7.15/100000, and 8.94/100000, respectively, and showed a trend of increase (AAPC boys =39.5%, P < 0.05). From 2016 to 2020, the incidence rates for girls were 2.32/100000, 2.01/100000, 3.21/100000, 3.54/100000, and 6.47/100000, respectively, and showed an increasing trend (AAPC girls =33.6%, P < 0.05). A trend of a more rapid increase in the incidence rate was observed for boys compared to girls (Fig. S3, Fig. S4). Trends in the incidence of childhood brucellosis according to month s The incidence of brucellosis in children in Inner Mongolia was notably seasonal from 2016 to 2020, peaking mainly in May, June, and July, which accounted for 14.22%, 12.09%, and 15.50% of the total number of cases, respectively (Fig. 1). Geographic variation in the incidence of childhood brucellosis Spatial distribution of the incidence of brucellosis in children From 2016 to 2020, all the allied cities of Inner Mongolia except for Wuhai had reported cases of childhood brucellosis, and these cases were mainly concentrated in the Central and Eastern regions of Inner Mongolia. The highest and lowest average incidences of childhood brucellosis in Inner Mongolia were observed in Hinggan (10.05/100,000) and Alxa (1.15/100,000), respectively, from 2016 to 2020 (Table S1 , Table S2, Table S3). The results of the trend surface analysis showed that the incidence of brucellosis in children in Inner Mongolia increased from South to North and from West to East during 2016–2020 (Fig. S5). Spatial autocorrelation of childhood brucellosis The incidence of brucellosis among children in Inner Mongolia in 2016–2020 showed significant geographic clustering ( P < 0.05) (Table 1 ). Moran’s I values for global spatial auto-correlation were − 0.014, 0.131, 0.422, 0.728, and 0.426 from 2016 to 2020, respectively. Hinggan had "high - high" aggregation for 3 out of 5 years, Tongliao had "high - high" aggregation for 2 out of 5 years, and Ordos had "low - low" aggregation in 2 out of 5 years. Over five years, the types of regional agglomerations increased, and the number of cities with agglomerations also gradually increased (Fig. 2). Table 1 Spatial auto-correlation of childhood brucellosis incidence in Inner Mongolia from 2016 to 2020 Year Moran’s I Z score P 2016 -0.014 0.40166 0.687934 2017 0.131 1.098049 0.272183 2018 0.422 2.561197 < 0.05 2019 0.728 3.892184 < 0.001 2020 0.426 2.569764 < 0.05 Spatiotemporal trends in the incidence of childhood brucellosis An upward trend was commonly observed as a temporal trend for childhood brucellosis incidence from 2016 to 2020 (Fig. 3b). The highest risk of childhood brucellosis and the most rapidly rising incidence rate was observed in Hinggan. The most rapidly rising incidence rate was observed in Chifeng and Tongliao, although the highest risk of childhood brucellosis was not observed in these regions. The highest risk of childhood brucellosis but a slower rising incidence rate were observed in XilinGol and HulunBuir. The lowest risk of childhood brucellosis was observed in Alxa, but the incidence rate in this region increased more rapidly than in Ordos and all the other cities in the central region (Fig. 3a, Fig. 3c). Ecological factors associated with the incidence of brucellosis in children A GWR model was established based on the incidence rates of childhood brucellosis in each city of Inner Mongolia as the dependent variables, and the number of sheep at year-end, number of medical and health institutions, average temperature, precipitation, humidity, and number of hours of sunshine in each city as the independent variables. The results showed that the R 2 value of the GWR model was 0.837, and the residuals in most areas were distributed between − 1.5 to 0.5 and 0.5 to 1.5. The fit of this GWR model was good (Fig. S6). The incidence of childhood brucellosis was positively associated with the number of sheep at year-end (β: 2.590940 ~ 2.592615, P < 0.01) (Fig. 4a), average temperature (β: 2.897817 ~ 2.902964, P < 0.05) (Fig. 4c), and precipitation (β: 3.326089 ~ 3.326833, P 0.05) (Fig. 4b), humidity (β: 2.140696 ~ 2.148671, P > 0.05) (Fig. 4e), number of hours of sunshine (β: -1.635841~ -1.631948, P > 0.05) (Fig. 4f), and brucellosis in children. Discussion From 2016 to 2020, the incidence of brucellosis in children aged 0 to 14 years in Inner Mongolia showed an overall trend of increase. The incidence of brucellosis in children decreased only in 2017. The joint project on brucellosis in humans and animals was launched in 2010 and China's National Brucellosis Prevention and Control Plan (2016–2020) was promulgated in 2016 [ 21 ][ 22 ] . As a result, residents' awareness of brucellosis prevention and control has improved, and the government has paid more attention to brucellosis surveillance. In 2017, the price of mutton began to rise in Inner Mongolia, leading to an increase in the number of individuals engaged in the breeding, trading, and transportation of cattle and sheep. This phenomenon resulted in increased livestock mobility and increased contact frequency between people and livestock [ 21 ] . In addition, the diet structure of the residents of Inner Mongolia was evolving, with children being infected with brucellosis because of drinking unsterilized or undercooked fresh milk and eating undercooked mutton [ 23 ] . With the rapid development of the economy, the number of local pet dogs increased gradually, leading to cases where children with low immunity were infected with Brucella through contact with pet dogs [ 24 ] . Children in rural areas are at increased risk of brucellosis infection as they had fed cattle and goats with their families and played with calves [ 13 ] . Moreover, the large disparity in economic development among Inner Mongolian cities, the relatively backward level of education, and the scarcity of medical and health resources pushed up the incidence of childhood brucellosis even further. It is therefore particularly important to strengthen the focus on brucellosis in children to prevent it from affecting their physical growth and development and causing irreversible damage. The results of this study showed that the rate of incidence of brucellosis among boys was higher than that among girls in Inner Mongolia each year from 2016 to 2020. Boys had a lively and active personality, which led them to interact more with animals and have a higher chance of contracting infections than girls. Children do not always have sufficient knowledge regarding brucellosis and adequate protective measures to be taken while playing with animals, thus increasing the chances of acquiring a brucellosis infection [ 25 ] . Our results showed that the highest number of cases of brucellosis in children were mainly reported in May, June, and, July. The increase in the temperature during spring marks the start of the breeding season for cattle and sheep. Farmers and workers start shearing the sheep, and children come into close contact with sheep out of curiosity, increasing the risk of brucellosis infection [ 26 ] . Children with low knowledge of brucellosis helped to dispose of lambs and feces at home without wearing protective gear and helped to clean the sheep pen. Most farmers typically graze their livestock more frequently in summer than in winter. Children are often in close proximity to assist in feeding these animals, increasing the risk of brucellosis infection [ 27 ] . The results of Bayesian spatio-temporal analysis showed that a higher risk of childhood brucellosis and a rapid increase in the incidence rate were observed in the Hinggan, Tongliao, and Chifeng regions. The results of GWR analysis in this study showed that the number of sheep at the end of the year, average temperature, and precipitation were some of the factors influencing the brucellosis incidence rate among children in Inner Mongolia from 2016 to 2020. The number of sheep at the end of the year was positively correlated with the incidence of childhood brucellosis. The Inner Mongolia Statistical Yearbook showed that the highest number of sheep were observed at the end of the year in Chifeng and Hinggan, with these areas ranking among the top two in Inner Mongolia. These areas also had a higher risk of childhood brucellosis and rapidly increasing incidence rates. Chifeng and Hinggan have a large number of forests and pastures, which serve as important bases for cattle and sheep breeding in Inner Mongolia. In recent years, the price of beef and mutton has risen, the breeding industry has developed rapidly, and the number of livestock has increased. Consequently, the increased frequency of contact between children and livestock has led to an increased risk of brucellosis infection. The average temperature was positively correlated with childhood brucellosis incidence. The Inner Mongolia Statistical Yearbook showed that the average temperatures in Hinggan, Tongliao, and Chifeng, where the risk of childhood brucellosis was higher, with rapidly increasing incidence rates, had the top three average temperatures in the Eastern region of Inner Mongolia. The warm environment created a good living environment for Brucellosis, which was conducive to the production and spread of bacteria [ 28 ] . Children were more likely to play outside when the temperature was relatively warm than in cold weather. Their close contact with lambs, sheep, and dogs, while playing and feeding the animals, increased the risk of infection with Brucellosis. Compared with winter, people were more willing to take children out to eat barbecues in summer and autumn. Due to the change in residents' diet structure, people blindly pursued the freshness of food. In the process of eating hot pot and barbecue, due to the intake of raw meat that was not fully cooked, the risk of brucella infection increased [ 29 ] . There was a positive correlation between the precipitation level and the incidence of childhood brucellosis. The Inner Mongolia Statistical Yearbook showed that Hinggan, Tongliao, and Chifeng, where the risk of childhood brucellosis was higher and the incidence rate increased rapidly, had the top three precipitation levels in Inner Mongolia. The environment was humid due to heavy rainfall, which provided a suitable environment for the survival and reproduction of Brucella [ 30 ] . Brucella occurred in cattle and sheep feces and proliferated in a humid environment, thus increasing the risk of brucella infection in children [ 31 ] . During the rainy season, the birth rate of livestock tends to increase. However, livestock miscarriages are prone to occur during this season, which makes Brucella infection and transmission easier among animals. Interestingly, the risk of childhood brucellosis in Alxa was the lowest among all cities in Inner Mongolia, but the increase in disease incidence was more rapid than that in Ordos and all the cities in the central region. The Inner Mongolia Statistical Yearbook showed a low year-end sheep population and low average precipitation in Alxa, which might contribute to the low risk of brucellosis in children. In Alxa, where animal husbandry is the main source of income, brucellosis is usually detected using serological techniques. The city had inadequate health facilities and a shortage of health care providers. According to the Statistical yearbook of Inner Mongolia, Alxa has 18 hospitals, 330 health institutions, 1,433 beds, and 3,076 personnel in health institutions, which is the lowest among all cities in Inner Mongolia [ 10 ] . In recent years, Alxa Central Hospital has introduced advanced medical equipment, and the ability to diagnose and detect brucellosis has improved greatly. Despite the nonspecific symptoms of childhood brucellosis, which generally include fever and pain, advancements in tools and techniques for pathology testing have facilitated the detection of more cases among children [ 32 ] . This suggests that increased attention to childhood brucellosis is particularly important. In addition to focusing on areas at high risk of childhood brucellosis, priority should be given to areas where the incidence of the disease is growing rapidly in order to prevent the emergence of new high-risk areas. Conclusions Brucellosis in children needs urgent attention. From 2016 to 2020, the overall incidence of brucellosis in children in Inner Mongolia showed an upward trend, with cases exhibiting spatial aggregation. Areas at high risk of brucellosis areas as well as areas where the incidence rate is increasing rapidly should both be focused upon, to prevent low-risk areas from becoming high-risk areas. The number of sheep at the end of the year, average temperature, and precipitation were ecological factors that affected the incidence of childhood brucellosis. Declarations Funding This study was supported by the Inner Mongolia Autonomous Region Science and Technology Major Project; Inner Mongolia Autonomous Region Science and Technology Achievement Transformation Project (2021CG0032); Key Project of Inner Mongolia Medical University (YKD2022ZD014); and Inner Mongolia Higher Education Institutions Innovation Project (NMGIRT2303); Medical Science and Technology Project of Health (No. 202201181). Competing interests The authors declare that they have no competing conflict of interest. Ethics approval and consent to participate Not applicable. This study did not involve ethical approval or consent to participate. Availability of data and materials The datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. Consent for publication Not applicable. Authors' contributions YW, HZ, and XW designed the study. YW and HZ conducted the data analysis and drafted the manuscript. XW contributed to the discussion and extensively reviewed and edited the manuscript. All authors (YW, HZ, XW, YW, XW) contributed to the interpretation of data and were involved in revising the manuscript critically for important intellectual content. All authors have reviewed and approved the manuscript. Acknowledgments The authors alone are responsible for the interpretation of the data. We wish to thank the study participants for their contribution to the research. We also thank EssentialsLink Language Services, Edanz Group China (https://www.essentialslink.cn/), for editing the English text of a draft of this manuscript. Author information Yideng Wang and Huiqiu Zheng contributed equally to this article. Authors and Affiliations Center for Data Science in Health and Medicine, School of Public Health,Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China Yideng Wang, Xuemei Wang, Xinyan Wang Department of Child and Adolescent Health and Health Education, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China Huiqiu Zheng, Yanling Wang Corresponding author Correspondence to Xuemei Wang. References Hanwei L. Epidemic Situation and Infection Factors of Brucellosis in Inner Mongolia. Inner Mongolia Med Univ. 2020. 10.27231/d.cnki.gnmyc.2020.000497 . Laine CG, Johnson VE, Scott HM, Arenas-Gamboa AM. Global Estimate of Human Brucellosis Incidence. Emerg Infect Dis. 2023;29(9):1789–97. 10.3201/eid2909.230052 . Zhu Y, Shi L, Zeng Y, Piao D, Xie Y, Du J, Gao M, Gao W, Tian J, Yue J, Li M, Guo X, Yao Y, Kang Y. Key immunity characteristics of diverse stages of brucellosis in rural population from Inner Mongolia, China. Infect Dis Poverty. 2022;11(1):63. 10.1186/s40249-022-00989-7 . Buyun C, Hai J. Surveillance data of brucellosis in China, 2005–2016. Disease Surveillance; 033(003):188–92. Fengju Z. The prevalence and danger of brucellosis. Chin Abstracts Anim Husb Veterinary Med. 2011;27(2):62–3. Dutta D, Sen A, Gupta D, Kuila P, Chatterjee D, Sanyal S, Das S. Childhood Brucellosis in Eastern India. Indian J Pediatr. 2018;85(4):266–71. https://doi.org/10.1007/s12098-017-2513-z . Zhiyun W, Xiaofang W, Yaqin H. Epidemic characteristics of brucellosis in children aged 14 and below in Shanxi Province from 2008 to 2017. Chin J Control Endemic Diseases;2020, 35(03):253–5. Yan W. A series of MRI-based multisequence imaging studies for the diagnosis of Brucella osteoarthritis. Xinjiang Med Univ, 10.27433/d.cnki.gxyku.2020.000055 . Hua B, Zhixian D, Xuehong Z. Analysis of clinical characteristics of 48 cases of brucellosis in children. Ningxia Med J, 10.13621/j.1001-5949.2015.12.1190 . Qi Hai. Research on the Optimisation of Medical and Healthcare Resource Allocation in Inner Mongolia. Inner Mongolia University for Nationalities.,2023. 10.27228/d.cnki.gnmmu.2022.000079 . Zihan L. The spatiotemporal variation characteristics and influencing factors of carbon water coupling in Inner Mongolia. Inner Mongolia University; 2023. Hanwei L, Na T, Jingchuan M. Spatial and temporal distribution of human brucellosis in Inner Mongolia, 2009–2018. Volume 34. Disease Surveillance; 2019. pp. 1058–63. 12. Xiang Y. Analysis of knowledge and infection status of brucellosis among Mongolian primary and middle school students in Xinin Gol League and Tongliao, Inner Mongolia. Inner Mongolia Medical University; 2022. 10.27231/d.cnki.gnmyc.2021.000025 . Yingying Z, Yanling W, Ying L. Epidemiological characteristics of human brucellosis in Xilin Gol League from 2013 to 2017. Chin J Control Endemic Dis. 2020;35(05):537–9. Tianhong M. Temporal and spatial distribution of human brucellosis in Jilin Province and its relationship with Study on the Relationship between Cattle and Sheep Breeding Quantity and Other Related Factors. Shenyang Agricultural University; 2023. 10.27327/d.cnki.gshnu.2022.000797 . Wenhong G, Xinru X. Expression and clinical significance of Tim-3 and its related cytokines on CD4 + T cells in patients with brucellosis. China Trop Med. 2024;24(04):433–7. 10.13604/j.cnki.46-1064/r.2024.04.13 . Jingjing Z, Yongpeng L, Qing T. Seasonal characteristics of hand, foot, and mouth disease in Shandong Province from 2005 to 2020. Mod Prev Med. 2021;48(22):4054–8. Ruhai B, Lingling W, Qi Z. Spatial distribution and clustering in birth defects from 2010 to 2013 in Shaanxi Province; 2017,42(04):451–6. Lu C, Daming Z. A Review of the Application of Space Epidemiological Model in Plague Prevention and Control Early Warning. Softw Guide. 2021;20(03):189–94. Xiaowen L. Spatial Epidemiology and the Geographical Risk Factors of Tuberculosis on a Smaller Scale. Shandong University; 2023. 10.27272/d.cnki.gshdu.2023.003938 . Huifang W, Liang L, Xiaohui Y. Epidemiological analysis of human brucellosis from 2014 to 2019 in Baotou, Inner Mongolia. Mod Prev Med. 2021;48(06):973–5. Yanwei C, Xu L, Fu L. Epidemiological characteristics and spatial distribution of human brucellosis in Beijing, 2013 – 2022. Volume 38. Disease Surveillance; 2023. pp. 1168–73. 10. Bing L. Epidemiological analysis of human brucellosis in Pingchuan district of Baiyin city. Bull Disease Control Prevention(China). 2020;35(06):26–9. 10.13215/j.cnki.jbyfkztb.1912018 . Chuangye S. Investigation on Brucella Infection of Dogs And Cats in Shengyang of Liaoning Province. Shenyang Agricultural Aniversity. 2020. 10.27327/d.cnki.gshnu.2020.000587 . Huiju Q, Yali W, Suqin W. Clinical characteristics of 20 children of Brucellar arthritis. J Med Forum. 2023;44(12):70–4. Wang Z, Wang SS, Wang GL et al. A pregnant mouse model for the vertical transmission of Brucella melitensi. Veterinary Journal, Veterinary journal (London, England: 1997), 200(1), 116–121. https://doi.org/10.1016/j.tvjl.2013.12.02 . Quan F. Analysis of the epidemiological characteristics of brucellosis in Xilin Gol League and establishment ofARIMAmodel. Inner Mongolia Medical University; 2021. 10.27231/d.cnki.gnmyc.2021.000018 . Yuqian W. Application of Distributed Lag Nonlinear Model to Two Types of Infectious Diseases in Inner Mongolia. Inner Mongol University of Technology; 2020. 10.27225/d.cnki.gnmgu.2020.000133 . Liyuan M. Retrospective comparative analysis of clinical characteristics of brucellosis in children and adults in Ning Xia and surrounding area. Ningxia Medical University; 2020. 10.27258/d.cnki.gnxyc.2020.000303 . Gao S, Peng R, Zeng Z et al. Risk transboundary transmission areas and driving factors of brucellosis along the borders between China and Mongolia. Travel Med Infect Dis, 56, 102648. https://doi.org/10.1016/j.tmaid.2023.102648 . Nyerere N, Luboobi LS, Mpeshe SC, et al. Modeling the impact of seasonal weather variations on the infectiology of brucellosis[J]. Comput Math Methods Med. 2020;8972063. https://doi.org/10.1155/2020/8972063 . Chuangze X, Ridong P, Hai J. Study on epidemiological characteristics and pathogen typing of brucellosis in Alxa league, Inner Mongolia, China. Chin J Vector Biology Control. 2020;31(06):648–51. Additional Declarations No competing interests reported. Supplementary Files Fig.S1.jpg Fig.S2.jpg Fig.S3.jpg Fig.S4.jpg Fig.S5.jpg Fig.S6.jpg SupplmentaryTables.docx Cite Share Download PDF Status: Published Journal Publication published 08 Oct, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 19 Jun, 2024 Editor assigned by journal 19 Jun, 2024 Submission checks completed at journal 18 Jun, 2024 First submitted to journal 16 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4590275","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":316329070,"identity":"a8bd97b4-5767-4437-aa68-84df8c518f0d","order_by":0,"name":"Yideng Wang","email":"","orcid":"","institution":"Inner Mongolia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yideng","middleName":"","lastName":"Wang","suffix":""},{"id":316329072,"identity":"c2b484ce-bc09-4f9a-9bf0-46ee1c4919fd","order_by":1,"name":"Huiqiu Zheng","email":"","orcid":"","institution":"Inner Mongolia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huiqiu","middleName":"","lastName":"Zheng","suffix":""},{"id":316329074,"identity":"6a0b533d-3fbb-4f1b-9f28-1ff9717e4085","order_by":2,"name":"Yanling Wang","email":"","orcid":"","institution":"Inner Mongolia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanling","middleName":"","lastName":"Wang","suffix":""},{"id":316329076,"identity":"d15ec598-3a36-48c9-a42f-9b15a4dbc68a","order_by":3,"name":"Xinyan Wang","email":"","orcid":"","institution":"Inner Mongolia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinyan","middleName":"","lastName":"Wang","suffix":""},{"id":316329077,"identity":"107fa4a8-08cf-4d99-aeed-02f270374967","order_by":4,"name":"Xuemei Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYHAD5gMHPvwgTQtb4sGZPaRp4TE+zMFGhDqD42cPv+bNYbCXn5Hz4TADD4M8v9gBAlrO5KVZztzGwGxwI3fD4QILBsOZsxPwazE7kGNm8HEbA5uBBFDLDB6GBIPbhLScf2NmkLiNgQfosAeHediI0XIjx/gB0BYJhhs5DMRpsb/xxowR6BcDgzPPDICBLEHYL5L9OcafebcBQ6w9+fGHDz9s5PmlCWgBAjYJBob/MI4EQeUgwPyBKGWjYBSMglEwcgEAXiNEfSd+x8kAAAAASUVORK5CYII=","orcid":"","institution":"Inner Mongolia Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-06-16 15:25:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4590275/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4590275/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-024-09992-9","type":"published","date":"2024-10-08T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60170207,"identity":"63f2f5f7-8885-4816-8edc-dde8a0aea3f3","added_by":"auto","created_at":"2024-07-12 15:05:10","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":162522,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/9cb1f8028fc47246c9136473.jpg"},{"id":60171851,"identity":"ccf0c52c-7b2c-4e00-8969-d7cf5b0b9396","added_by":"auto","created_at":"2024-07-12 15:13:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":63739,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/349b01e7f53cc3d35121d076.jpg"},{"id":60170210,"identity":"a09755f8-3c3d-412a-bbb1-c41af6afbb43","added_by":"auto","created_at":"2024-07-12 15:05:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1798071,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/622dbcfe2cce834319ca5076.png"},{"id":60173342,"identity":"3ab586cd-59c9-4f15-871d-2a00b8848375","added_by":"auto","created_at":"2024-07-12 15:21:10","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":184626,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/f813477c09a6b1c9ea95e9a3.jpg"},{"id":66597672,"identity":"f9a05aad-1ec1-47a7-b070-cba24d2cde6b","added_by":"auto","created_at":"2024-10-14 16:11:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2961399,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/8eea9b0c-ee7e-4611-9fd9-ffed05d5f70b.pdf"},{"id":60171852,"identity":"03d864e8-2835-4613-893e-697e72f79d87","added_by":"auto","created_at":"2024-07-12 15:13:10","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":180222,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.S1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/90d27ac69d741fb0f2404f74.jpg"},{"id":60170206,"identity":"262a083c-ddf5-4b6c-b334-7a4fb62404aa","added_by":"auto","created_at":"2024-07-12 15:05:10","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":70055,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.S2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/f6bb3770d6bc920d4f99f522.jpg"},{"id":60170215,"identity":"02a15595-8a4a-4648-bffd-1670b43b0955","added_by":"auto","created_at":"2024-07-12 15:05:11","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":244658,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.S3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/eab5c10bd338ed661c7f3d4a.jpg"},{"id":60170209,"identity":"a187478a-50ba-43dc-9cd8-64af6aa269e4","added_by":"auto","created_at":"2024-07-12 15:05:10","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":73981,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.S4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/5c365519d95a4711106dd5cc.jpg"},{"id":60171854,"identity":"23387db4-c232-4177-b631-8ae9e477b635","added_by":"auto","created_at":"2024-07-12 15:13:11","extension":"jpg","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":127176,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.S5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/fbcce1d12fab6a66eb7d1790.jpg"},{"id":60173343,"identity":"1b074ae6-f91b-4531-a128-34aff6fc62b9","added_by":"auto","created_at":"2024-07-12 15:21:10","extension":"jpg","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":99910,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.S6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/299ab066091f0b895b59a1b7.jpg"},{"id":60170214,"identity":"cbf6aeae-5a61-4d35-8247-64d41b6784e1","added_by":"auto","created_at":"2024-07-12 15:05:11","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":21389,"visible":true,"origin":"","legend":"","description":"","filename":"SupplmentaryTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4590275/v1/90138b82ff4c76998b5158bd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Spatiotemporal distribution and ecological factors of brucellosis among children from 2016 to 2020 in Inner Mongolia, China Short Title： Epidemiological characteristics of brucellosis in children","fulltext":[{"header":"Implications and Contribution","content":"\u003cp\u003eArthralgia of brucella was often misdiagnosed and underdiagnosed due to the inability of infants and children to provide detailed complaints, which brought difficulties in clinical diagnosis and treatment, seriously affecting children's growth and development, and even causing irreversible damage, such as joint and muscle deformity. The potential threat should therefore be taken seriously, and it is particularly important to pay attention to brucellosis in children.\u003c/p\u003e\n\u003cp\u003eIn this study, we analyzed the spatiotemporal distribution characteristics of childhood brucellosis in Inner Mongolia through the Bayesian model,our study showed that from 2016 to 2020, the overall incidence of brucellosis in children in Inner Mongolia was on the rise and there was a spatial aggregation.\u003c/p\u003e\n\u003cp\u003eIn this study, we analyzed the ecological influencing factors of childhood brucellosis in Inner Mongolia through geographically weighted regression, our study showed that the number of sheep at the end of the year, average temperature, and precipitation were ecological influences on the incidence of childhood brucellosis.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eBrucellosis is a widespread zoonotic disease that is endemic worldwide\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In recent years, the global incidence of brucellosis has risen annually, with 1.6 to 2.1\u0026nbsp;million new cases of human brucellosis being reported each year\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Brucellosis posed a serious threat to human and animal health and was a widespread problem in some developing countries\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. In 2014, the reported incidence rate of brucellosis was 4.22/100,000 in China, marking the highest rate ever recorded\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. In 2016, an outbreak of brucellosis in China led to a rapid increase in incidence, with 40,328 cases reported in 2018, representing an increase of more than 120 times compared to the year 2000\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIt was previously believed that children were rarely affected by brucellosis. However, a recent study conducted in India has shown that the incidence of brucellosis in children was usually underestimated, and was higher in endemic areas. In these areas, the incidence of brucellosis in children ranged from 11\u0026ndash;56%\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. The results of a study conducted in China showed that among children under 14 years of age, the proportion of children with brucellosis was 17%\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Brucellosis in children lacked specificity, symptoms were predominantly tachyphylactic fever, and complaints of osteoarthropathy were more common in children\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. A study reported that the incidence of arthralgia was as high as 77.4% in children with brucellosis, and it would still recur after treatment. Arthralgia of brucella was often misdiagnosed and underdiagnosed due to the inability of infants and children to provide detailed complaints, which brought difficulties in clinical diagnosis and treatment, seriously affecting children's growth and development, and even causing irreversible damage, such as joint and muscle deformity\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The potential threat should therefore be taken seriously, and it is particularly important to pay attention to brucellosis in children.\u003c/p\u003e \u003cp\u003eInner Mongolia was a remote region in China, and there was a large gap in the economic development of Inner Mongolia's cities, a large gap in the number of hospitals distributed, and an overall low efficiency in the allocation of medical and health resources\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Inner Mongolia, historically known to be an area with brucellosis infected individuals, has a vast area, grasslands, forests, and the largest per capita arable land in China. It is also the largest grassland pastoral area in China, which provides the basis for the rapid development of animal husbandry\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The geography and climate of Inner Mongolia are favorable for the survival of brucellosis. During years of high brucellosis incidence, Inner Mongolia accounted for 40 to 50 percent of reported brucellosis cases, becoming the top-ranking region for reported cases in China\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. A previous study showed that cases of brucellosis in children were reported annually in Inner Mongolia from 2013\u0026ndash;2017. It was revealed that primary and secondary schoolchildren in the region often came into contact with sheep and had a low level of awareness regarding brucellosis. They often become infected with Brucella through activities such as handling abortions, milking, consumption of undercooked meat products and fresh milk, and vaccinating sheep\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBrucellosis has a certain spatial aggregation. Bayesian spatiotemporal analysis incorporates the concept of time, allowing for the simultaneous analysis and processing of spatiotemporal distribution characteristics of brucellosis. This process offers more advantages than the traditional spatiotemporal analysis model\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. In this study, we analyzed the spatiotemporal distribution characteristics of childhood brucellosis in Inner Mongolia using the Bayesian model. The ecological influencing factors of childhood brucellosis in Inner Mongolia through geographically weighted regression, to provide scientific basis for the reduction of the occurrence of childhood brucellosis as well as its transmission.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design\u003c/h2\u003e\n \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\n \u003ch2\u003eData sources\u003c/h2\u003e\n \u003cp\u003eData on the incidence of brucellosis among children aged 0–14 years were obtained from the direct reporting system of the infectious disease network of the Center for Disease Control and Prevention in Inner Mongolia.\u003c/p\u003e\n \u003cp\u003ePopulation, socio-economic, and meteorological data for each league and city in Inner Mongolia from 2016 to 2020 were obtained from the Statistical Yearbook of Inner Mongolia. The number of medical and health institutions, number of sheep at the end of the year, average temperature (℃), precipitation level (mm), humidity (%), and number of hours of sunshine were calculated every month, and all data were standardized using the following equation:\u003cimg src=\"data:image/png;base64,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\"\u003e.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eDiagnostic criteria for brucellosis\u003c/h2\u003e\n \u003cp\u003eThe diagnosis was based on the “Diagnostic Criteria for Brucellosis” issued by the National Health Commission of the People's Republic of China (WS2697-2019)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eDefinition of Variables\u003c/h2\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003eAge\u003c/h2\u003e\n \u003cp\u003eChildren were classified into the following four age groups: 0 to 2 years old, 3 to 5 years old, 6 to 9 years old, and 10 to 14 years old. This classification was based on a combination of the direct reporting system of the infectious disease network of the Center for Disease Control and Prevention of Inner Mongolia and the \"China's Child Population Situation in 2020: Facts and Figures\" published by the National Bureau of Statistics.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eIncidence of a disease\u003c/h2\u003e\n \u003cp\u003eThe incidence of a disease was defined as the frequency of new cases of a disease in a given population over a given period.\u003c/p\u003e\n \u003cp\u003eBrucellosis incidence rate = number of cases of brucellosis in a given year/population at the end of the same year × 100,000/100,000\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eSeasonal index\u003c/h2\u003e\n \u003cp\u003eThe seasonal index is the ratio of the average number of cases in the same month as the observation date to the average of all months during the observation period. The seasonal index can be determined using the following formula:\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003cp\u003eHere, A is the average of all yearly incidence cases in a given month within the observation period. B is the average of all yearly incidence cases within the observation period. Finally, C represents the seasonal index; when C ≥ 100%, it is considered to be an epidemic season\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSpatial auto-correlation\u003c/h2\u003e\n \u003cp\u003eIn this study, the coefficient of spatial autocorrelation, Moran's \u003cem\u003eI\u003c/em\u003e, ranges from − 1 to 1. When the Moran's \u003cem\u003eI\u003c/em\u003e of a region is greater than 0, the incidence of brucellosis in children is clustered in that region, and there is a positive spatial correlation. When the Moran's \u003cem\u003eI\u003c/em\u003e tends to be 1, the distribution is more clustered. When the Moran's \u003cem\u003eI\u003c/em\u003e for a region is less than 0, the incidence of brucellosis in children is discrete, and there is a negative spatial correlation. When Moran's \u003cem\u003eI\u003c/em\u003e tends to be -1, the distribution is more discrete\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eBayesian spatiotemporal model\u003c/h2\u003e\n \u003cp\u003eIn this study, the Bayesian spatiotemporal model was used to analyze the spatial effect of childhood brucellosis alone, temporal effect alone, and interaction-associated effects of time and space, using the following formula:\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u0026nbsp;\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eHere, α denotes the intercept, and (s\u003csub\u003ei\u003c/sub\u003e+b\u003csub\u003e0\u003c/sub\u003et*+v) is the first part of the equation, where s\u003csub\u003ei\u003c/sub\u003e refers to the distribution of children's brucellosis risk. The common time-varying trend of children's brucellosis in the twelve allied cities of Inner Mongolia is represented by (b\u003csub\u003e0\u003c/sub\u003et*+v\u003csub\u003et\u003c/sub\u003e). The second part of the equation, ((b\u003csub\u003e1i\u003c/sub\u003et*+ε\u003csub\u003eit\u003c/sub\u003e), simultaneously accounts for the role of time and space together. Here, b\u003csub\u003e1i\u003c/sub\u003et* represents the independent time-varying trend of each allied city in Inner Mongolia, and ε\u003csub\u003eit\u003c/sub\u003e refers to the random error term outside the model that affects the observed data\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eGeographical weighted regression\u003c/h2\u003e\n \u003cp\u003eIn this study, a geographically weighted regression model was developed to explore the spatial relationships between geographic phenomena and accurately analyze and predict the relationship between the predictor and dependent variables for each location. The model was constructed using the following formula:\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eIn the above equation, \u003cem\u003eY\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e is the \u003cem\u003ei\u003c/em\u003eth sample point, which also represents the dependent variable, \u003cem\u003eu\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e is the coordinate of longitude, and \u003cem\u003ev\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e is the coordinate of latitude, while (\u003cem\u003eu\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ev\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e) is the coordinate of latitude and longitude at the center point of the allied city I. \u003cem\u003eβ\u003c/em\u003e\u003csub\u003e\u003cem\u003e0\u003c/em\u003e\u003c/sub\u003e (\u003cem\u003eu\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ev\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e) is a constant parameter, while \u003cem\u003eβ\u003c/em\u003e\u003csub\u003e\u003cem\u003ek\u003c/em\u003e\u003c/sub\u003e (\u003cem\u003eu\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ev\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e) represents the \u003cem\u003ek\u003c/em\u003eth regression parameter of the allied city \u003cem\u003ei\u003c/em\u003e, and \u003cem\u003eX\u003c/em\u003e\u003csub\u003e\u003cem\u003eik\u003c/em\u003e\u003c/sub\u003e represents the \u003cem\u003ek\u003c/em\u003eth variable at the allied city \u003cem\u003ei\u003c/em\u003e\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003eStatistical analysis was performed using SPSS 25.0. Bayesian spatiotemporal analysis was performed using Open BUGS and ArcGIS 10.8. GWR analysis and spatial auto-correlation were performed through ArcGIS10.8. \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eTemporal trends in the incidence of brucellosis among children in Inner Mongolia\u003c/h2\u003e\n\u003cp\u003eA total of 703 cases of brucellosis were reported in children aged 0\u0026ndash;14 years in Inner Mongolia from 2016 to 2020, with an average incidence rate of 4.32/100,000. The incidence rate has shown a rising trend (AAPC\u0026thinsp;=\u0026thinsp;36.95%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig. \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e, Fig. S2). From 2016 to 2020, the number of cases of brucellosis (incidence rate) among children aged 0\u0026ndash;14 years in Inner Mongolia was 84 (2.69/100,000), 72 (2.18/100,000), 116 (3.61/100,000), 170 (5.40/100,000), and 261 (7.73/100,000), respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eTrends in the incidence of childhood brucellosis according to sex\u003c/h2\u003e\n\u003cp\u003eThere were 425 cases of brucellosis in boys (60.46%) and 278 cases in girls (30.54%) in Inner Mongolia from 2016 to 2020. In the same year, the incidence rate in boys was higher than that of girls. From 2016 to 2020, the incidence rates for boys were 3.04/100000, 2.35/100000, 3.98/100000, 7.15/100000, and 8.94/100000, respectively, and showed a trend of increase (AAPC\u003csub\u003eboys\u003c/sub\u003e=39.5%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). From 2016 to 2020, the incidence rates for girls were 2.32/100000, 2.01/100000, 3.21/100000, 3.54/100000, and 6.47/100000, respectively, and showed an increasing trend (AAPC\u003csub\u003egirls\u003c/sub\u003e=33.6%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A trend of a more rapid increase in the incidence rate was observed for boys compared to girls (Fig. S3, Fig. S4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrends in the incidence of childhood brucellosis according to month\u003c/strong\u003e \u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of brucellosis in children in Inner Mongolia was notably seasonal from 2016 to 2020, peaking mainly in May, June, and July, which accounted for 14.22%, 12.09%, and 15.50% of the total number of cases, respectively (Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eGeographic variation in the incidence of childhood brucellosis\u003c/h2\u003e\n\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\n\u003ch2\u003eSpatial distribution of the incidence of brucellosis in children\u003c/h2\u003e\n\u003cp\u003eFrom 2016 to 2020, all the allied cities of Inner Mongolia except for Wuhai had reported cases of childhood brucellosis, and these cases were mainly concentrated in the Central and Eastern regions of Inner Mongolia. The highest and lowest average incidences of childhood brucellosis in Inner Mongolia were observed in Hinggan (10.05/100,000) and Alxa (1.15/100,000), respectively, from 2016 to 2020 (Table \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e, Table S2, Table S3).\u003c/p\u003e\n\u003cp\u003eThe results of the trend surface analysis showed that the incidence of brucellosis in children in Inner Mongolia increased from South to North and from West to East during 2016\u0026ndash;2020 (Fig. S5).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eSpatial autocorrelation of childhood brucellosis\u003c/h2\u003e\n\u003cp\u003eThe incidence of brucellosis among children in Inner Mongolia in 2016\u0026ndash;2020 showed significant geographic clustering (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Moran\u0026rsquo;s \u003cem\u003eI\u003c/em\u003e values for global spatial auto-correlation were \u0026minus;\u0026thinsp;0.014, 0.131, 0.422, 0.728, and 0.426 from 2016 to 2020, respectively. Hinggan had \"high - high\" aggregation for 3 out of 5 years, Tongliao had \"high - high\" aggregation for 2 out of 5 years, and Ordos had \"low - low\" aggregation in 2 out of 5 years. Over five years, the types of regional agglomerations increased, and the number of cities with agglomerations also gradually increased (Fig.\u0026nbsp;2).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSpatial auto-correlation of childhood brucellosis incidence in Inner Mongolia from 2016 to 2020\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYear\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMoran\u0026rsquo;s \u003cem\u003eI\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eZ\u003c/em\u003e score\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.40166\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.687934\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.098049\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.272183\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.422\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.561197\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.728\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.892184\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.426\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.569764\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003eSpatiotemporal trends in the incidence of childhood brucellosis\u003c/h2\u003e\n\u003cp\u003eAn upward trend was commonly observed as a temporal trend for childhood brucellosis incidence from 2016 to 2020 (Fig.\u0026nbsp;3b). The highest risk of childhood brucellosis and the most rapidly rising incidence rate was observed in Hinggan. The most rapidly rising incidence rate was observed in Chifeng and Tongliao, although the highest risk of childhood brucellosis was not observed in these regions. The highest risk of childhood brucellosis but a slower rising incidence rate were observed in XilinGol and HulunBuir. The lowest risk of childhood brucellosis was observed in Alxa, but the incidence rate in this region increased more rapidly than in Ordos and all the other cities in the central region (Fig.\u0026nbsp;3a, Fig.\u0026nbsp;3c).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n\u003ch2\u003eEcological factors associated with the incidence of brucellosis in children\u003c/h2\u003e\n\u003cp\u003eA GWR model was established based on the incidence rates of childhood brucellosis in each city of Inner Mongolia as the dependent variables, and the number of sheep at year-end, number of medical and health institutions, average temperature, precipitation, humidity, and number of hours of sunshine in each city as the independent variables. The results showed that the \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e value of the GWR model was 0.837, and the residuals in most areas were distributed between \u0026minus;\u0026thinsp;1.5 to 0.5 and 0.5 to 1.5. The fit of this GWR model was good (Fig. S6).\u003c/p\u003e\n\u003cp\u003eThe incidence of childhood brucellosis was positively associated with the number of sheep at year-end (\u0026beta;: 2.590940\u0026thinsp;~\u0026thinsp;2.592615, \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.01) (Fig.\u0026nbsp;4a), average temperature (\u0026beta;: 2.897817\u0026thinsp;~\u0026thinsp;2.902964, \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05) (Fig.\u0026nbsp;4c), and precipitation (\u0026beta;: 3.326089\u0026thinsp;~\u0026thinsp;3.326833, \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.01) (Fig.\u0026nbsp;4d). There was no correlation between the number of medical and health institutions (\u0026beta;: -1.523148~ -1.522030, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;4b), humidity (\u0026beta;: 2.140696\u0026thinsp;~\u0026thinsp;2.148671, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;4e), number of hours of sunshine (\u0026beta;: -1.635841~ -1.631948, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;4f), and brucellosis in children.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFrom 2016 to 2020, the incidence of brucellosis in children aged 0 to 14 years in Inner Mongolia showed an overall trend of increase. The incidence of brucellosis in children decreased only in 2017. The joint project on brucellosis in humans and animals was launched in 2010 and China's National Brucellosis Prevention and Control Plan (2016\u0026ndash;2020) was promulgated in 2016\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e][\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. As a result, residents' awareness of brucellosis prevention and control has improved, and the government has paid more attention to brucellosis surveillance. In 2017, the price of mutton began to rise in Inner Mongolia, leading to an increase in the number of individuals engaged in the breeding, trading, and transportation of cattle and sheep. This phenomenon resulted in increased livestock mobility and increased contact frequency between people and livestock\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. In addition, the diet structure of the residents of Inner Mongolia was evolving, with children being infected with brucellosis because of drinking unsterilized or undercooked fresh milk and eating undercooked mutton\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. With the rapid development of the economy, the number of local pet dogs increased gradually, leading to cases where children with low immunity were infected with Brucella through contact with pet dogs\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Children in rural areas are at increased risk of brucellosis infection as they had fed cattle and goats with their families and played with calves\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Moreover, the large disparity in economic development among Inner Mongolian cities, the relatively backward level of education, and the scarcity of medical and health resources pushed up the incidence of childhood brucellosis even further. It is therefore particularly important to strengthen the focus on brucellosis in children to prevent it from affecting their physical growth and development and causing irreversible damage.\u003c/p\u003e \u003cp\u003eThe results of this study showed that the rate of incidence of brucellosis among boys was higher than that among girls in Inner Mongolia each year from 2016 to 2020. Boys had a lively and active personality, which led them to interact more with animals and have a higher chance of contracting infections than girls. Children do not always have sufficient knowledge regarding brucellosis and adequate protective measures to be taken while playing with animals, thus increasing the chances of acquiring a brucellosis infection\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur results showed that the highest number of cases of brucellosis in children were mainly reported in May, June, and, July. The increase in the temperature during spring marks the start of the breeding season for cattle and sheep. Farmers and workers start shearing the sheep, and children come into close contact with sheep out of curiosity, increasing the risk of brucellosis infection\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Children with low knowledge of brucellosis helped to dispose of lambs and feces at home without wearing protective gear and helped to clean the sheep pen. Most farmers typically graze their livestock more frequently in summer than in winter. Children are often in close proximity to assist in feeding these animals, increasing the risk of brucellosis infection\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe results of Bayesian spatio-temporal analysis showed that a higher risk of childhood brucellosis and a rapid increase in the incidence rate were observed in the Hinggan, Tongliao, and Chifeng regions. The results of GWR analysis in this study showed that the number of sheep at the end of the year, average temperature, and precipitation were some of the factors influencing the brucellosis incidence rate among children in Inner Mongolia from 2016 to 2020. The number of sheep at the end of the year was positively correlated with the incidence of childhood brucellosis. The Inner Mongolia Statistical Yearbook showed that the highest number of sheep were observed at the end of the year in Chifeng and Hinggan, with these areas ranking among the top two in Inner Mongolia. These areas also had a higher risk of childhood brucellosis and rapidly increasing incidence rates. Chifeng and Hinggan have a large number of forests and pastures, which serve as important bases for cattle and sheep breeding in Inner Mongolia. In recent years, the price of beef and mutton has risen, the breeding industry has developed rapidly, and the number of livestock has increased. Consequently, the increased frequency of contact between children and livestock has led to an increased risk of brucellosis infection.\u003c/p\u003e \u003cp\u003eThe average temperature was positively correlated with childhood brucellosis incidence. The Inner Mongolia Statistical Yearbook showed that the average temperatures in Hinggan, Tongliao, and Chifeng, where the risk of childhood brucellosis was higher, with rapidly increasing incidence rates, had the top three average temperatures in the Eastern region of Inner Mongolia. The warm environment created a good living environment for Brucellosis, which was conducive to the production and spread of bacteria\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Children were more likely to play outside when the temperature was relatively warm than in cold weather. Their close contact with lambs, sheep, and dogs, while playing and feeding the animals, increased the risk of infection with Brucellosis. Compared with winter, people were more willing to take children out to eat barbecues in summer and autumn. Due to the change in residents' diet structure, people blindly pursued the freshness of food. In the process of eating hot pot and barbecue, due to the intake of raw meat that was not fully cooked, the risk of brucella infection increased\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere was a positive correlation between the precipitation level and the incidence of childhood brucellosis. The Inner Mongolia Statistical Yearbook showed that Hinggan, Tongliao, and Chifeng, where the risk of childhood brucellosis was higher and the incidence rate increased rapidly, had the top three precipitation levels in Inner Mongolia. The environment was humid due to heavy rainfall, which provided a suitable environment for the survival and reproduction of Brucella\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Brucella occurred in cattle and sheep feces and proliferated in a humid environment, thus increasing the risk of brucella infection in children\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. During the rainy season, the birth rate of livestock tends to increase. However, livestock miscarriages are prone to occur during this season, which makes Brucella infection and transmission easier among animals.\u003c/p\u003e \u003cp\u003eInterestingly, the risk of childhood brucellosis in Alxa was the lowest among all cities in Inner Mongolia, but the increase in disease incidence was more rapid than that in Ordos and all the cities in the central region. The Inner Mongolia Statistical Yearbook showed a low year-end sheep population and low average precipitation in Alxa, which might contribute to the low risk of brucellosis in children. In Alxa, where animal husbandry is the main source of income, brucellosis is usually detected using serological techniques. The city had inadequate health facilities and a shortage of health care providers. According to the Statistical yearbook of Inner Mongolia, Alxa has 18 hospitals, 330 health institutions, 1,433 beds, and 3,076 personnel in health institutions, which is the lowest among all cities in Inner Mongolia\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. In recent years, Alxa Central Hospital has introduced advanced medical equipment, and the ability to diagnose and detect brucellosis has improved greatly. Despite the nonspecific symptoms of childhood brucellosis, which generally include fever and pain, advancements in tools and techniques for pathology testing have facilitated the detection of more cases among children\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. This suggests that increased attention to childhood brucellosis is particularly important. In addition to focusing on areas at high risk of childhood brucellosis, priority should be given to areas where the incidence of the disease is growing rapidly in order to prevent the emergence of new high-risk areas.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBrucellosis in children needs urgent attention. From 2016 to 2020, the overall incidence of brucellosis in children in Inner Mongolia showed an upward trend, with cases exhibiting spatial aggregation. Areas at high risk of brucellosis areas as well as areas where the incidence rate is increasing rapidly should both be focused upon, to prevent low-risk areas from becoming high-risk areas. The number of sheep at the end of the year, average temperature, and precipitation were ecological factors that affected the incidence of childhood brucellosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Inner Mongolia Autonomous Region Science and Technology Major Project; Inner Mongolia Autonomous Region Science and Technology Achievement Transformation Project (2021CG0032); Key Project of Inner Mongolia Medical University (YKD2022ZD014); and Inner Mongolia Higher Education Institutions Innovation Project (NMGIRT2303); Medical Science and Technology Project of Health (No. 202201181).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study did not involve ethical approval or consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYW, HZ, and XW designed the study. YW and HZ conducted the data analysis and drafted the manuscript. XW contributed to the discussion and extensively reviewed and edited the manuscript. All authors (YW, HZ, XW, YW, XW) contributed to the interpretation of data and were involved in revising the manuscript critically for important intellectual content. All authors have reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors alone are responsible for the interpretation of the data. We wish to thank the study participants for their contribution to the research. We also thank EssentialsLink Language Services, Edanz Group China (https://www.essentialslink.cn/), for editing the English text of a draft of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYideng Wang\u0026nbsp;and\u0026nbsp;Huiqiu Zheng\u0026nbsp;contributed equally to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCenter for Data Science in Health and Medicine, School of Public Health,Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China\u003c/p\u003e\n\u003cp\u003eYideng Wang, Xuemei Wang, Xinyan Wang\u003c/p\u003e\n\u003cp\u003eDepartment of Child and Adolescent Health and Health Education, School of Public Health, Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China\u003c/p\u003e\n\u003cp\u003eHuiqiu Zheng, Yanling Wang\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Xuemei Wang.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHanwei L. Epidemic Situation and Infection Factors of Brucellosis in Inner Mongolia. Inner Mongolia Med Univ. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27231/d.cnki.gnmyc.2020.000497\u003c/span\u003e\u003cspan address=\"10.27231/d.cnki.gnmyc.2020.000497\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaine CG, Johnson VE, Scott HM, Arenas-Gamboa AM. Global Estimate of Human Brucellosis Incidence. Emerg Infect Dis. 2023;29(9):1789\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3201/eid2909.230052\u003c/span\u003e\u003cspan address=\"10.3201/eid2909.230052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu Y, Shi L, Zeng Y, Piao D, Xie Y, Du J, Gao M, Gao W, Tian J, Yue J, Li M, Guo X, Yao Y, Kang Y. Key immunity characteristics of diverse stages of brucellosis in rural population from Inner Mongolia, China. Infect Dis Poverty. 2022;11(1):63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40249-022-00989-7\u003c/span\u003e\u003cspan address=\"10.1186/s40249-022-00989-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuyun C, Hai J. Surveillance data of brucellosis in China, 2005\u0026ndash;2016. Disease Surveillance; 033(003):188\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFengju Z. The prevalence and danger of brucellosis. Chin Abstracts Anim Husb Veterinary Med. 2011;27(2):62\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDutta D, Sen A, Gupta D, Kuila P, Chatterjee D, Sanyal S, Das S. Childhood Brucellosis in Eastern India. Indian J Pediatr. 2018;85(4):266\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12098-017-2513-z\u003c/span\u003e\u003cspan address=\"10.1007/s12098-017-2513-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhiyun W, Xiaofang W, Yaqin H. Epidemic characteristics of brucellosis in children aged 14 and below in Shanxi Province from 2008 to 2017. Chin J Control Endemic Diseases;2020, 35(03):253\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan W. A series of MRI-based multisequence imaging studies for the diagnosis of Brucella osteoarthritis. Xinjiang Med Univ, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27433/d.cnki.gxyku.2020.000055\u003c/span\u003e\u003cspan address=\"10.27433/d.cnki.gxyku.2020.000055\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHua B, Zhixian D, Xuehong Z. Analysis of clinical characteristics of 48 cases of brucellosis in children. Ningxia Med J, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13621/j.1001-5949.2015.12.1190\u003c/span\u003e\u003cspan address=\"10.13621/j.1001-5949.2015.12.1190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQi Hai. Research on the Optimisation of Medical and Healthcare Resource Allocation in Inner Mongolia. Inner Mongolia University for Nationalities.,2023.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27228/d.cnki.gnmmu.2022.000079\u003c/span\u003e\u003cspan address=\"10.27228/d.cnki.gnmmu.2022.000079\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZihan L. The spatiotemporal variation characteristics and influencing factors of carbon water coupling in Inner Mongolia. Inner Mongolia University; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanwei L, Na T, Jingchuan M. Spatial and temporal distribution of human brucellosis in Inner Mongolia, 2009\u0026ndash;2018. Volume 34. Disease Surveillance; 2019. pp. 1058\u0026ndash;63. 12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiang Y. Analysis of knowledge and infection status of brucellosis among Mongolian primary and middle school students in Xinin Gol League and Tongliao, Inner Mongolia. Inner Mongolia Medical University; 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27231/d.cnki.gnmyc.2021.000025\u003c/span\u003e\u003cspan address=\"10.27231/d.cnki.gnmyc.2021.000025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYingying Z, Yanling W, Ying L. Epidemiological characteristics of human brucellosis in Xilin Gol League from 2013 to 2017. Chin J Control Endemic Dis. 2020;35(05):537\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTianhong M. Temporal and spatial distribution of human brucellosis in Jilin Province and its relationship with Study on the Relationship between Cattle and Sheep Breeding Quantity and Other Related Factors. Shenyang Agricultural University; 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27327/d.cnki.gshnu.2022.000797\u003c/span\u003e\u003cspan address=\"10.27327/d.cnki.gshnu.2022.000797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWenhong G, Xinru X. Expression and clinical significance of Tim-3 and its related cytokines on CD4\u0026thinsp;+\u0026thinsp;T cells in patients with brucellosis. China Trop Med. 2024;24(04):433\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13604/j.cnki.46-1064/r.2024.04.13\u003c/span\u003e\u003cspan address=\"10.13604/j.cnki.46-1064/r.2024.04.13\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJingjing Z, Yongpeng L, Qing T. Seasonal characteristics of hand, foot, and mouth disease in Shandong Province from 2005 to 2020. Mod Prev Med. 2021;48(22):4054\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuhai B, Lingling W, Qi Z. Spatial distribution and clustering in birth defects from 2010 to 2013 in Shaanxi Province; 2017,42(04):451\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu C, Daming Z. A Review of the Application of Space Epidemiological Model in Plague Prevention and Control Early Warning. Softw Guide. 2021;20(03):189\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiaowen L. Spatial Epidemiology and the Geographical Risk Factors of Tuberculosis on a Smaller Scale. Shandong University; 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27272/d.cnki.gshdu.2023.003938\u003c/span\u003e\u003cspan address=\"10.27272/d.cnki.gshdu.2023.003938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuifang W, Liang L, Xiaohui Y. Epidemiological analysis of human brucellosis from 2014 to 2019 in Baotou, Inner Mongolia. Mod Prev Med. 2021;48(06):973\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYanwei C, Xu L, Fu L. Epidemiological characteristics and spatial distribution of human brucellosis in Beijing, 2013\u0026thinsp;\u0026ndash;\u0026thinsp;2022. Volume 38. Disease Surveillance; 2023. pp. 1168\u0026ndash;73. 10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBing L. Epidemiological analysis of human brucellosis in Pingchuan district of Baiyin city. Bull Disease Control Prevention(China). 2020;35(06):26\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13215/j.cnki.jbyfkztb.1912018\u003c/span\u003e\u003cspan address=\"10.13215/j.cnki.jbyfkztb.1912018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChuangye S. Investigation on Brucella Infection of Dogs And Cats in Shengyang of Liaoning Province. Shenyang Agricultural Aniversity. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27327/d.cnki.gshnu.2020.000587\u003c/span\u003e\u003cspan address=\"10.27327/d.cnki.gshnu.2020.000587\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuiju Q, Yali W, Suqin W. Clinical characteristics of 20 children of Brucellar arthritis. J Med Forum. 2023;44(12):70\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Z, Wang SS, Wang GL et al. A pregnant mouse model for the vertical transmission of Brucella melitensi. Veterinary Journal, Veterinary journal (London, England: 1997), 200(1), 116\u0026ndash;121. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.tvjl.2013.12.02\u003c/span\u003e\u003cspan address=\"10.1016/j.tvjl.2013.12.02\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuan F. Analysis of the epidemiological characteristics of brucellosis in Xilin Gol League and establishment ofARIMAmodel. Inner Mongolia Medical University; 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27231/d.cnki.gnmyc.2021.000018\u003c/span\u003e\u003cspan address=\"10.27231/d.cnki.gnmyc.2021.000018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuqian W. Application of Distributed Lag Nonlinear Model to Two Types of Infectious Diseases in Inner Mongolia. Inner Mongol University of Technology; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27225/d.cnki.gnmgu.2020.000133\u003c/span\u003e\u003cspan address=\"10.27225/d.cnki.gnmgu.2020.000133\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiyuan M. Retrospective comparative analysis of clinical characteristics of brucellosis in children and adults in Ning Xia and surrounding area. Ningxia Medical University; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.27258/d.cnki.gnxyc.2020.000303\u003c/span\u003e\u003cspan address=\"10.27258/d.cnki.gnxyc.2020.000303\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao S, Peng R, Zeng Z et al. Risk transboundary transmission areas and driving factors of brucellosis along the borders between China and Mongolia. Travel Med Infect Dis, 56, 102648. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.tmaid.2023.102648\u003c/span\u003e\u003cspan address=\"10.1016/j.tmaid.2023.102648\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNyerere N, Luboobi LS, Mpeshe SC, et al. Modeling the impact of seasonal weather variations on the infectiology of brucellosis[J]. Comput Math Methods Med. 2020;8972063. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2020/8972063\u003c/span\u003e\u003cspan address=\"10.1155/2020/8972063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChuangze X, Ridong P, Hai J. Study on epidemiological characteristics and pathogen typing of brucellosis in Alxa league, Inner Mongolia, China. Chin J Vector Biology Control. 2020;31(06):648\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Childhood, brucellosis, incidence, spatiotemporal distribution, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-4590275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4590275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eIn recent years, the increasing incidence of brucellosis in children has become more serious in recent years, however, relatively few studies have been conducted to characterize the spatialtemporal distribution of brucellosis in children. This study aimed to analyze the spatiotemporal distribution characteristics and ecological influencing factors of brucellosis incidence among children in Inner Mongolia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eUsing reported incidence data for brucellosis in children aged 0-14 years in Inner Mongolia from 2016 to 2020, the spatiotemporal distribution of childhood brucellosis through Bayesian model and a geographically-weighted regression model was used to analyze ecological factors affecting brucellosis incidence in children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eBayesian spatiotemporal analysis indicated that the highest brucellosis risk and increased disease incidence were observed in Hinggan, Inner Mongolia,in children aged 0-14 years. Alxa had the lowest risk but the incidence rate increased rapidly. The incidence of childhood brucellosis was positively associated with the number of sheep at the year-end (β: 2.590940~ 2.592615, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.01), average temperature (β: 2.897817~ 2.902964, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), and precipitation level (β: 3.326089~ 3.326833, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eBrucellosis in children needs urgent attention. From 2016 to 2020, the overall incidence of brucellosis in children in Inner Mongolia showed an upward trend, with cases exhibiting spatial aggregation. While we are concerned about areas at high risk of brucellosis in children, we should also be concerned about areas where the incidence is rising fast. The number of sheep at the end of the year, average temperature, and precipitation were ecological factors that affected the incidence of childhood brucellosis.\u003c/p\u003e","manuscriptTitle":"Spatiotemporal distribution and ecological factors of brucellosis among children from 2016 to 2020 in Inner Mongolia, China Short Title： Epidemiological characteristics of brucellosis in children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 15:05:05","doi":"10.21203/rs.3.rs-4590275/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-19T09:52:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-19T04:17:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-19T02:25:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-06-16T15:24:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b832a8bd-2065-4b8a-920c-b528bc5e90aa","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:07:57+00:00","versionOfRecord":{"articleIdentity":"rs-4590275","link":"https://doi.org/10.1186/s12879-024-09992-9","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2024-10-08 15:57:36","publishedOnDateReadable":"October 8th, 2024"},"versionCreatedAt":"2024-07-12 15:05:05","video":"","vorDoi":"10.1186/s12879-024-09992-9","vorDoiUrl":"https://doi.org/10.1186/s12879-024-09992-9","workflowStages":[]},"version":"v1","identity":"rs-4590275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4590275","identity":"rs-4590275","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}