Abstract
Hemorrhagic fever with renal syndrome (HFRS) is a major rodent-borne zoonosis. Each year worldwide, 60,000–100,000 HFRS human cases are reported in more than seventy countries with almost 90% these cases occurring in China. Shaanxi Province in China has been among the most seriously affected areas since 1955. During 2009–2013, Shaanxi reported 11,400 human cases, the most of all provinces in China. Furthermore, the epidemiological features of HFRS have changed over time. Using long-term data of HFRS from 2005 to 2016, we carried out this retrospective epidemiological study combining ecological assessment models in Shaanxi. We found the majority of HFRS cases were male farmers who acquired infection in Guanzhong Plain, but the geographic extent of the epidemic has slowly spread northward. The highest age-specific attack rate since 2011 was among people aged 60–74 years, and the percentage of HFRS cases among the elderly increased from 12% in 2005 to 25% in 2016. We highly recommend expanding HFRS vaccination to people older than 60 years to better protect against the disease. Multivariate analysis revealed artificial area, cropland, pig and population density, GDP, and climate conditions (relative humidity, precipitation, and wind speed) as significant risk factors in the distribution of HFRS.
Highlights
Hemorrhagic fever with renal syndrome (HFRS) is a major rodent-borne zoonosis
In China, Hantaan virus (HTNV) and Seoul virus (SEOV) were identified as the predominant serotypes of HVs which caused human infections. The former is carried by Apodemus agrarius, while the latter is associated with Rattus norvegicus[6]
From 1950 to 2007, approximately 1.56 million HFRS cases have been reported in China, and 46,427 people died from the disease with a fatality rate of 3.0%6
Summary
60,000–100,000 HFRS human cases are reported in more than seventy countries with almost 90% these cases occurring in China. During 2009–2013, Shaanxi reported 11,400 human cases, the most of all provinces in China. HFRS is endemic in all 31 provinces, autonomous regions and municipalities of mainland China, and Hong Kong and Taiwan found human cases and infected animal reservoirs diagnosed by serology detection[12,13]. Since 2004, the government has supplied a free bivalent vaccine to high-risk people aged 16–60 years in Xi’an Prefecture, the most serious epidemic regions in Shaanxi Province, and gradually expanded the vaccination population[8,15]. According to the Chinese Center for Disease Control and Prevention (CCDC), Shaanxi reported 11,400 HFRS human cases during 2009–2013, the highest of all provinces in China[3,16,17]. A key research priority for effective HFRS prevention and control is improving the knowledge of epidemic characteristics and understanding the underlying risk factors for disease transmission
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