Abstract
Zhejiang Province is one of the six provinces in China that has the highest incidence of haemorrhagic fever with renal syndrome (HFRS). Data on HFRS cases in Zhejiang Province from January 2007 to July 2017 were obtained from the China Information Network System of Disease Prevention and Control. Joinpoint regression analysis was used to observe the trend of the incidence rate of HFRS. The monthly incidence rate was predicted by autoregressive integrated moving average(ARIMA) models. Spatial autocorrelation analysis was performed to detect geographic clusters. A multivariate time series model was employed to analyze heterogeneous transmission of HFRS. There were a total of 4,836 HFRS cases, with 15 fatal cases reported in Zhejiang Province, China in the last decade. Results show that the mean absolute percentage error (MAPE) of the modelling performance and the forecasting performance of the ARIMA model were 27.53% and 16.29%, respectively. Male farmers and middle-aged patients account for the majority of the patient population. There were 54 high-high clusters and 1 high-low cluster identified at the county level. The random effect variance of the autoregressive component is 0.33; the spatio-temporal component is 1.30; and the endemic component is 2.45. According to the results, there was obvious spatial heterogeneity in the endemic component and spatio-temporal component but little spatial heterogeneity in the autoregressive component. A significant decreasing trend in the incidence rate was identified, and obvious clusters were discovered. Spatial heterogeneity in the factors driving HFRS transmission was discovered, which suggested that a targeted preventive effort should be considered in different districts based on their own main factors that contribute to the epidemics.
Highlights
Hantaviruses represent an emerging global threat to public health, affecting approximately 30,000 humans annually, which may lead to hantavirus pulmonary syndrome (HPS) in the Americas and haemorrhagic fever with renal syndrome (HFRS) in Europe and Asia[1]
There were more than 300 HFRS cases identified every year during the last ten years, some of which led to deaths
The epidemic of HFRS remainsa public health threat in Zhejiang Province, China. This province is one of the top six provinces with the highest incidence rate of HFRS4, though its deaths and fatality rates are much lower than the overall averages for China
Summary
Hantaviruses represent an emerging global threat to public health, affecting approximately 30,000 humans annually, which may lead to hantavirus pulmonary syndrome (HPS) in the Americas and haemorrhagic fever with renal syndrome (HFRS) in Europe and Asia[1]. According to previous studies[3,4,7,8,9], more than 10,000 cases are reported annually in China, representing almost 90% of all cases worldwide. This disease remains a severe public health issue in mainland China[10]. Zhejiang, ranked sixth highest in HFRS incidence, is located in the Yangtze River Delta region of the southeast China[4]. We used multivariate time series model to analyze the heterogeneous transmission of this disease These models additively decompose HFRS risk into endemic, autoregressive and spatiotemporal components
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