Emerging tick-borne diseases in mainland China over the past decade: a systematic review and mapping analysis.

Background: Emerging tick-borne infectious diseases have become increasingly prevalent worldwide. In a previous review, we summarized tick-borne infections in mainland China from 1980 to May, 2015. Here we conducted systematic review and mapping analysis of emerging tick-borne diseases over the past decade.

Methods: We searched multiple sources for publications regarding tick-borne diseases in mainland China from June, 2015 to January, 2025. Subsequently, we collected data on tick infections of related pathogens from secondary literature review, GenBank, and our field survey, without time limitation. The clinical manifestations of each kind of tick-borne diseases were summarized. The thematic maps showing geographical distribution of emerging tick-borne diseases and related tick infections were produced by ArcGIS.

Findings: Over the past decade, 28 emerging tick-borne diseases have been identified in mainland China, including 11 viral diseases, ten rickettsiosis, one anaplasmosis, one ehrlichiosis, two spirochetal diseases, and three protozoan diseases. These emerged diseases, caused by diverse pathogens, exhibit distinct geographic distribution patterns. Clinically, they are primarily characterized by febrile and non-specific symptoms, underscoring the importance of pathogen-specific diagnostic methods for accurate diagnosis. The tick-borne pathogens responsible for these emerging diseases were identified in 40 tick species and more widely distributed across China, implying cases of the emerging tick-borne diseases underdiagnosed.

Interpretation: Emerging tick-borne diseases have become an unprecedented public health threat in mainland China. Increased awareness and enhanced surveillance are required to understand the burden of tick-borne diseases in China and countries where tick vectors are present.

Funding: National Key Research and Development Program of China.