In the article [

Below are responses to the problems additionally raised by the reader.

First, it is problematic since the age-adjusted and sex-adjusted incidences including 95% confidence intervals were not used.

The second is regarding the reader’s comment on the use of Mann-Whitney U-test in statistical analysis. The author of the present study aimed to examine whether the annual incidence rates per 100,000 population were significantly different between two independent areas, A and B, during the 6 years. Using Mann-Whitney U-test in such a case is also recommended in the reference cited by the reader. Because what the author wanted to find out was whether or not there were a regional difference between A and B, trend analysis was irrelevant in the present study.

The third is regarding the reader’s comment on Table 3. This table shows the distributions of cases by main cause of scrub typhus in each region. The table was intended to demonstrate that “the distribution was different across 6 regions,” rather than to show “prevalence odds ratios” with respect to risk factors. As discussed in the article [

Fourth, the relevance of high incidence in 2016 to the mean temperature and dryness in August was not an argument made by the author. The author simply cited the inference made by the Korea Centers for Disease Control and Prevention [

With these, the author expresses his thanks for the interest in the present study and the work of the reader and closes this reply.

The author has no conflicts of interest to declare for this study.

Supplementary material (Korean version) is available at

Average age-adjusted incidence rate per 100,000 of scrub typhus in Jeju Island, 2011-2016 (1, Jeju-si;2, Seogwipo-si; 3, Jocheoneup; 4, Gujwa-eup; 5, Udo-myeon; 6, Aewol-eup; 7, Hallim-eup; 8, Hangyeong-myeon; 9, Seongsan-eup;10, Pyoseon-myeon; 11, Namwon-eup; 12, Daejeong-eup; 13, Andeok-myeon).

Age-adjusted incidence rate^{1} of scrub typhus per 100,000 by region in Jeju province

Regions | 2011 |
2012 |
2013 |
2014 |
2015 |
2016 |
p-value^{2} |
|||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|

Case (n) | Incidence | Case (n) | Incidence | Case (n) | Incidence | Case (n) | Incidence | Case (n) | Incidence | Case (n) | Incidence | |||

City | Jeju-si | 9 | 0.7 | 16 | 2.0 | 13 | 1.6 | 14 | 1.9 | 6 | 0.3 | 34 | 4.0 | 0.004 |

Seogwipo-si | 12 | 18.0 | 10 | 10.7 | 8 | 8.8 | 9 | 10.5 | 13 | 19.8 | 16 | 12.2 | ||

Country-side | Jeju East | 1 | 0.7 | 7 | 28.8 | 8 | 49.4 | 4 | 10.8 | 7 | 29.6 | 10 | 25.3 | 0.20 |

Jeju West | 10 | 28.2 | 13 | 40.9 | 8 | 20.2 | 11 | 33.8 | 18 | 80.8 | 21 | 45.9 | ||

Seogwipo East | 18 | 152.5 | 18 | 130.4 | 13 | 89.6 | 16 | 120.7 | 13 | 71.5 | 60 | 629.3 | 0.004 | |

Seogwipo West | 7 | 57.9 | 8 | 64.7 | 2 | 5.3 | 1 | 1.2 | 4 | 16.7 | 8 | 27.8 |

Population distribution data by age was applied as of January 2016 for estimating age-adjusted incidence.

p-value by Mann–Whitney U-test for the incidence.