The changing epidemiology of hemorrhagic fever with renal syndrome in Southeastern China during 1963-2020: A retrospective analysis of surveillance data.

Rong Zhang,Ying Liu,Shelan Liu,Jiangping Ren,Huaiyu Tian,Xuguang Shi,Song Guo,Xuan Li,Jun Yang,Jimin Sun,Feng Ling,Zhen Wang,Zhiyuan Mao,Shuwen Qin,Ran Wang

doi:10.1371/journal.pntd.0009673

Abstract

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by hantavirus which was endemic Zhejiang Province, China. In this study, we aim to explore the changing epidemiology of HFRS in Zhejiang, identify high-risk areas and populations, and evaluate relevant policies and interventions to better improve HFRS control and prevention. Surveillance data on HFRS during 1963-2020 in Zhejiang Province were extracted from Zhejiang Provincial Center for Disease Control and Prevention archives and the Chinese Notifiable Disease Reporting System. The changing epidemiological characteristics of HFRS including seasonal distribution, geographical distribution, and demographic features, were analyzed using joinpoint regression, autoregressive integrated moving average model, descriptive statistical methods, and Spatio-temporal cluster analysis. From 1963 to 2020, 114 071 HFRS cases and 1269 deaths were reported in Zhejiang Province. The incidence increased sharply from 1973 and peaked in 1986, then decreased steadily and maintained a stable incidence from 2004. HFRS cases were reported in all 11 prefecture-level cities of Zhejiang Province from 1963 to 2020. The joint region (Shengzhou, Xinchang, Tiantai, and surrounding areas), and Kaihua County are the most seriously affected regions throughout time. After 1990, the first HFRS incidence peak was in May-June, with another one from November to January. Most HFRS cases occurred in 21- (26.48%) and 30- years group (24.25%) from 1991 to 2004, but 41- (25.75%) and 51-years (23.30%) had the highest proportion from 2005 to 2020. Farmers accounted for most cases (78.10%), and cases are predominantly males with a male-to-female ratio of 2.6:1. It was found that the median time from onset to diagnosis was 6.5 days (IQR 3.75-10.42), and the time from diagnosis to disease report was significantly shortened after 2011. We observed dynamic changes in the seasonal distribution, geographical distribution, and demographic features of HFRS, which should be well considered in the development of control and prevention strategies in future. Additional researches are warranted to elucidate the environmental, meteorological, and social factors associated with HFRS incidence in different decades.

Highlights

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne illness caused by hantaviruses including Hantaan (HTNV), Seoul (SEOV), Dobrava-Belgrade virus, Saaremma, and Puumala [1]
From 1963 to 2020, 114 071 HFRS cases and 1269 deaths were reported in Zhejiang Province
HFRS cases were reported in all 11 prefecture-level cities of Zhejiang Province from 1963 to 2020

Summary

Introduction

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne illness caused by hantaviruses including Hantaan (HTNV), Seoul (SEOV), Dobrava-Belgrade virus, Saaremma, and Puumala [1]. From 1950 to1953, over 3,000 United Nations soldiers acquired Korean hemorrhagic fever, which is the old name of HFRS [4]. HFRS outbreaks kept occurring in Asia and Europe in the following decades [4]. It remained poorly understood until 1978 when HFRS’s etiological agent—Hantaan Virus and its reservoir—Apodemus agrarius were discovered by Lee et al [5]. Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by hantavirus which was endemic Zhejiang Province, China. We aim to explore the changing epidemiology of HFRS in Zhejiang, identify high-risk areas and populations, and evaluate relevant policies and interventions to better improve HFRS control and prevention

Objectives

Results

Conclusion