Hantavirus Research Articles

Spatial-temporal patterns and influencing factors for hemorrhagic fever with renal syndrome: A 16-year national surveillance analysis in China

BackgroundChina is confronted with the significant menace posed by hemorrhagic fever with renal syndrome (HFRS). Nevertheless, the long-term spatial-temporal variations, regional prevalence patterns, and fundamental determinants' mechanisms for HFRS remain inadequately elucidated. MethodsNewly diagnosed cases of HFRS from January 2004 to December 2019 were acquired from the China Public Health Science Data repository. We used Age-period-cohort and Bayesian Spacetime Hierarchy models to identify high-risk populations and regions in mainland China. Additionally, the Geographical Detector model was employed to quantify the determinant powers of significant driver factors to the disease. ResultsA total of 199,799 cases of HFRS were reported in mainland China during 2004–2019. The incidence of HFRS declined from 1.93 per 100,000 in 2004 to 0.69 per 100,000 in 2019. The incidence demonstrated an inverted U-shaped trend with advancing age, peaking in the 50–54 age group, with higher incidences observed among individuals aged 20–74 years. Hyperendemic areas were mainly concentrated in the northeastern regions of China, while some western provinces exhibited a potential upward trend. Geographical detector model identified that the spatial variations of HFRS were significantly associated with the relative humidity (Q = 0.36), forest cover (Q = 0.26), rainfall (Q = 0.18), temperature (Q = 0.16), and the surface water resources (Q = 0.14). ConclusionsThis study offered comprehensive examinations of epidemic patterns, identified high-risk areas quantitatively, and analyzed factors influencing HFRS transmission in China. The findings may contribute to the necessary implementations for the effective prevention and control of HFRS.

Hantavirus Infections: Review of the Epidemiological Situation around the World. Analysis of the Epidemiological Situation on Hemorrhagic Fever with Renal Syndrome in the Russian Federation in 2023 and Forecast of Its Development for 2024

The paper describes the epidemiological situation in the countries of the world in terms of the incidence of Hantavirus diseases. The results of an epidemiological analysis of the incidence of hemorrhagic fever with renal syndrome (HFRS) in the Russian Federation in 2023 by federal districts are presented and a forecast for 2024 is made. In 2023, 5 093 cases of HFRS were registered in the Russian Federation (3.47 per 100 thousand population). The incidence was reported in 7 out of 8 federal districts of the country. The age structure was dominated by people in the 30–59 age category (65.7 %); 247 cases of the disease were noted among children under 17 years of age. The proportion of the male population was 70.3 %. 63.2 % of the total number of cases was registered among the urban residents. The mortality rate was at the level of 0.49 % – 25 lethal outcomes. Analysis of the data has revealed a decrease in the incidence of HFRS in Russia by 27.2 % as compared to the previous year. However, the data from epizootiological monitoring and the results of laboratory research of field material indicate a continuing tense situation in the country as a whole. In a number of regions, a high risk of complications of the epidemiological situation is predicted (mainly, in the constituent entities of the Volga and Central Federal Districts). Moderate risks of developing local complications of the epidemiological situation at the level of long-term average morbidity are expected to be realized in the entities of the Northwestern, Ural and Far Eastern Federal Districts. Sporadic cases of the disease in the territory of the Southern Federal District are not excluded. The aggravation of the situation on HFRS in the territory of the North-Caucasian and Siberian Federal Districts is not anticipated in 2024.

Viral shedding and viraemia of Andes virus during acute hantavirus infection: a prospective study

Andes virus (ANDV) is a zoonotic Orthohantavirus leading to hantavirus cardiopulmonary syndrome. Although most transmissions occur through environmental exposure to rodent faeces and urine, rare person-to-person transmission has been documented, mainly for close contacts. This study investigates the presence and infectivity of ANDV in body fluids from confirmed cases and the duration of viraemia. In this prospective study, 131 participants with confirmed ANDV infection were enrolled in Chile in a prospective study between 2008 and 2022. Clinical samples (buffy coat, plasma, gingival crevicular fluid [GCF], saliva, nasopharyngeal swabs [NPS], and urine) were collected weekly for 3 weeks together with clinical and epidemiological data. Samples were categorised as acute or convalescent (up to and after 16 days following onset of symptoms). Infectivity of positive fluids was assessed after the culture of samples on Vero E6 cells and use of flow cytometry assays to determine the production of ANDV nucleoprotein. ANDV RNA was detected in 100% of buffy coats during acute phase, declining to 95% by day 17, and to 93% between days 23-29. ANDV RNA in GCF and saliva decreased from 30% and 12%, respectively, during the acute phase, to 12% and 11% during the convalescent phase. Successful infectivity assays of RT-qPCR-positive fluids, including GCF, saliva, NPS, and urine, were observed in 18 (42%) of 43 samples obtained during the acute phase of infection. After re-culture, the capacity to infect Vero E6 cells was maintained in 16 (89%) of 18 samples. Severity was associated with the presence of ANDV RNA in one or more fluids besides blood (odds ratio 2·58 [95% CI 1·42-5·18]). ANDV infection is a systemic and viraemic infection, that affects various organs. The presence of infectious particles in body fluids contributes to our understanding of potential mechanisms for person-to-person transmission, supporting the development of preventive strategies. Detection of ANDV RNA in additional fluids at hospital admission is a predictor of disease severity. National Institutes of Health and Agencia de Investigación y Desarrollo. For the Spanish translation of the abstract see Supplementary Materials section.

Nephropathia Epidemica Caused by Puumala Virus in Bank Voles, Scania, Southern Sweden.

In 2018, a local case of nephropathia epidemica was reported in Scania, southern Sweden, more than 500 km south of the previously known presence of human hantavirus infections in Sweden. Another case emerged in the same area in 2020. To investigate the zoonotic origin of those cases, we trapped rodents in Ballingslöv, Norra Sandby, and Sörby in southern Sweden during 2020‒2021. We found Puumala virus (PUUV) in lung tissues from 9 of 74 Myodes glareolus bank voles by screening tissues using a hantavirus pan-large segment reverse transcription PCR. Genetic analysis revealed that the PUUV strains were distinct from those found in northern Sweden and Denmark and belonged to the Finnish PUUV lineage. Our findings suggest an introduction of PUUV from Finland or Karelia, causing the human PUUV infections in Scania. This discovery emphasizes the need to understand the evolution, cross-species transmission, and disease outcomes of this newly found PUUV variant.

Hybrid capture-based next-generation sequencing of new and old world Orthohantavirus strains and wild-type Puumala isolates from humans and bank voles

Orthohantaviruses, transmitted primarily by rodents, cause hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus pulmonary syndrome in the Americas. These viruses, with documented human-to-human transmission, exhibit a wide case-fatality rate, 0.5–40 %, depending on the virus species, and no vaccine or effective treatment for severe Orthohantavirus infections exists. In Europe, the Puumala virus (PUUV), carried by the bank vole Myodes glareolus, causes a milder form of HFRS. Despite the reliance on serology and PCR for diagnosis, the three genomic segments of Swedish wild-type PUUV have yet to be completely sequenced.We have developed a targeted hybrid-capture method aimed at comprehensive genomic sequencing of wild-type PUUV isolates and the identification of other Orthohantaviruses. Our custom-designed panel includes >11,200 probes covering the entire Orthohantavirus genus. Using this panel, we sequenced complete viral genomes from bank vole lung tissue, human plasma samples, and cell-cultured reference strains. Analysis revealed that Swedish PUUV isolates belong to the Northern Scandinavian lineage, with nucleotide diversity ranging from 2.8 % to 3.7 % among them. Notably, no significant genotypic differences were observed between the viral sequences from reservoirs and human cases except in the nonstructural protein.Despite the high endemicity of PUUV in Northern Sweden, these are the first complete Swedish wild-type PUUV genomes and substantially increase our understanding of PUUV evolution and epidemiology. The panel's sensitivity enables genomic sequencing of human samples with viral RNA levels reflecting the natural progression of infection and underscores our panel's diagnostic value, and could help to uncover novel Orthohantavirus transmission routes.

Species-specific responses during Seoul orthohantavirus infection in human and rat lung microvascular endothelial cells.

Seoul orthohantavirus (SEOV) is a rat-borne zoonotic virus that is transmitted via inhalation of aerosolized infectious excreta, and can cause hemorrhagic fever with renal syndrome (HFRS) in humans worldwide. In rats, SEOV predominantly exists as a persistent infection in the absence of overt clinical signs. Lack of disease in rats is attributed to downregulation of pro-inflammatory and upregulation of regulatory host responses. As lung microvascular endothelial cells (LMECs) represent a primary target of infection in both human and rats, infections in these cells provide a unique opportunity to study the central role of LMECs in the dichotomy between pathogenicity in both species. In this study, host responses to SEOV infection in primary human and rat LMECs were directly compared on a transcriptional level. As infection of rat LMECs was more efficient than human LMECs, the majority of anti-viral defense responses were observed earlier in rat LMECs. Most prominently, SEOV-induced processes in both species included responses to cytokine stimulus, negative regulation of innate immune responses, responses to type I and II interferons, regulation of pattern recognition receptor signaling and MHC-I signaling. However, over time, in the rat LMECs, responses shifted from an anti-viral state towards a more immunotolerant state displayed by a PD-L1, B2M-, JAK2-focused interaction network aiding in negative regulation of cytotoxic CD8-positive T cell activation. This suggests a novel mechanism by which species-specific orthohantavirus-induced endothelium and T cell crosstalk may play a crucial role in the development of acute disease in humans and persistence in rodents.

Hantavirus infection in a child: clinical case

Hantavirus infection is a rare zoonotic viral disease characterized by fever, interstitial pneumonia, acute respiratory failure, respiratory distress syndrome, acute heart failure, renal failure and digestive tract disorders. The aim of the work is to acquaint practitioners with the case of hantavirus infection in a child. Materials and methods. The child was treated at Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using hospital equipment. Determination of immunoglobulins M and G to hantavirus by immunofluorescence analysis was conducted in a reference laboratory. Results. The child was admitted with complaints of headache, fever, epigastric pain, vomiting and stools with blood, shortness of breath, cough, blood in sputum, muscle pain, decreased diuresis. Laboratory findings included leukocytosis, anemia, thrombocytopenia, elevated ESR, elevated procalcitonin and creatinine levels, and hypercoagulability. Instrumentally, right-sided interstitial pneumonia and duodenal ulcer were diagnosed. The positive result for hantavirus infection was confirmed by the levels of immunoglobulins M and G to hantavirus and the increase in their titers in the dynamics. Comprehensive intensive care resulted in relatively rapid recovery of the child. Conclusions. The criteria for the diagnosis of hantavirus infection with pulmonary and renal syndromes are: the presence of interstitial pulmonary edema, fever with myalgias, arthralgias, cephalgia, nausea, vomiting and headache, followed by oliguria. Neutrophilic leukocytosis, anemia, thrombocytopenia, increased hematocrit, proteinuria, and microhematuria are characteristic. Determination of IgM and G to hantavirus and their dynamics is effective for confirming the diagnosis. Hantavirus infection is rather rare in Ukraine. Clinical discussions of diseases that are rarely occurring in practice are useful for physicians and will facilitate a faster diagnostic search.

Epidemiological situation of natural focal infections in the Volgograd region in 2023

Objective: analysis of epizootiological and epidemiological aspects of natural focal infections, namely plague, tularemia, HFRS, West Nile fever, Crimean hemorrhagic fever, Ixodic tick-borne borreliosis, Cu fever, leptospirosis and rabies, in the Volgograd region over 10 months in 2023.Materials and methods: the article analyzes the epidemiological manifestations of natural focal infections (NFI) in the Volgograd region for 10 months of 2023. The work uses official statistical data from institutions of Rospotrebnadzor of the Volgograd region on NFI for 2023. The main research method is epidemiological analysis.Results: the numbers of small mammals, potential carriers of NFI, on the territory of the Volgograd region in the 2023 season were within the same indicators of the previous year (SIPY), while the number of ticks in the spring-summer period was higher than the SIPY, but in the fall the number of arthropods in stationary points was lower than in previous seasons. The number of mosquitoes carrying arbovirus infections exceeded the long-term average. When studying environmental objects for the presence of markers of NFI pathogens, a slight decrease in the proportion of positive samples was noted compared to SIPY for all nosological forms. Over the 10 months of this year, there has been a deterioration in the epidemiological situation in the Volgograd region for several infections compared to the same period in 2022. There were 18 cases of West Nile fever (WNF), 10 cases of ixodid tick-borne borreliosis (ITB), and 6 cases of hemorrhagic fever with renal syndrome (HFRS). No patients with plague, tularemia, rabies, leptospirosis, Crimean hemorrhagic fever (CHF) and Q fever were identified.Conclusion: the presence of natural foci of dangerous infectious diseases of varying degrees of activity on the territory of the Volgograd region requires constant monitoring and an adequate response to changes in the foci in order to prevent complications of the epidemiological situation due to NFI.

Comparison of simulation and predictive efficacy for hemorrhagic fever with renal syndrome incidence in mainland China based on five time series models.

Hemorrhagic fever with renal syndrome (HFRS) is a zoonotic infectious disease commonly found in Asia and Europe, characterized by fever, hemorrhage, shock, and renal failure. China is the most severely affected region, necessitating an analysis of the temporal incidence patterns in the country. We employed Autoregressive Integrated Moving Average (ARIMA), Long Short-Term Memory (LSTM), Convolutional Neural Network (CNN), Nonlinear AutoRegressive with eXogenous inputs (NARX), and a hybrid CNN-LSTM model to model and forecast time series data spanning from January 2009 to November 2023 in the mainland China. By comparing the simulated performance of these models on training and testing sets, we determined the most suitable model. Overall, the CNN-LSTM model demonstrated optimal fitting performance (with Root Mean Square Error (RMSE), Mean Absolute Percentage Error (MAPE), and Mean Absolute Error (MAE) of 93.77/270.66, 7.59%/38.96%, and 64.37/189.73 for the training and testing sets, respectively, lower than those of individual CNN or LSTM models). The hybrid CNN-LSTM model seamlessly integrates CNN's data feature extraction and LSTM's recurrent prediction capabilities, rendering it theoretically applicable for simulating diverse distributed time series data. We recommend that the CNN-LSTM model be considered as a valuable time series analysis tool for disease prediction by policy-makers.

Etiological agent and clinical characteristics of haemorrhagic fever with renal syndrome in the southern Republic of Korea: a genomic surveillance study

ObjectivesHigh incidences of haemorrhagic fever with renal syndrome (HFRS) have been reported in the southern Republic of Korea (ROK). A distinct southern genotype of Orthohantavirus hantanense (HTNV) was identified in Apodemus agrarius chejuensis on Jeju Island. However, its association with HFRS cases in southern ROK remains elusive. We investigated the potential of the southern HTNV genotype as an etiological agent of HFRS. MethodsSamples from 22 patients with HFRS and 193 small mammals were collected in the southern ROK. The clinical characteristics of patients infected with the southern HTNV genotype were analysed. Amplicon-based MinION sequencing was employed for southern HTNV from patients and rodents, facilitating subsequent analyses involving phylogenetics and genetic reassortment. ResultsHigh-throughput sequencing of HTNV exhibited higher coverage with a cycle of threshold value below 32, acquiring nearly whole-genome sequences from six patients with HFRS and seven A. agrarius samples. The phylogenetic pattern of patient-derived HTNV demonstrated genetic clustering with HTNV from Apodemus species on Jeju Island and the southern Korean peninsula, revealing genetic reassortment in a single clinical sample between the M and S segments. DiscussionThese findings imply that the southern HTNV genotype has the potential to induce HFRS in humans. The phylogenetic inference demonstrates the diverse and dynamic characteristics of the southern HTNV tripartite genomes. Therefore, this study highlights the significance of active surveillance and amplicon sequencing for detecting orthohantavirus infections. It also raises awareness and caution for physicians regarding the emergence of a southern HTNV genotype as a cause of HFRS in the ROK.

Spatial and temporal patterns of haemorrhagic fever with renal syndrome (HFRS) and the impact of environmental drivers in a border area of the Russian Far East.

Haemorrhagic fever with renal syndrome (HFRS) is a significant zoonotic disease transmitted by rodents. The distribution of HFRS in the European part of Russia has been studied quite well; however, much less is known about the endemic area in the Russian Far East. The mutual influence of the epidemic situation in the border regions and the possibility of cross-border transmission of infection remain poorly understood. This study aims to identify the spatiotemporal hot spots of the incidence and the impact of environmental drivers on the HFRS distribution in the Russian Far East. A two-scale study design was performed. Kulldorf's spatial scan statistic was used to conduct spatiotemporal analysis at a regional scale from 2000 to 2020. In addition, an ecological niche model based on maximum entropy was applied to analyse the contribution of various factors and identify spatial favourability at the local scale. One spatiotemporal cluster that existed from 2002 to 2011 and located in the border area and one pure temporal cluster from 2004 to 2007 were revealed. The best suitability for orthohantavirus persistence was found along rivers, including those at the Chinese-Russian border, and was mainly explained by land cover, NDVI (as an indicator of vegetation density and greenness) and elevation. Despite the stable incidence in recent years in, targeted prevention strategies are still needed due to the high potential for HRFS distribution in the southeast of the Russian Far East.

Zoonotic Spillover: Global Diversity Of Mammals And Distribution Of Hantaviral Strains In Synathropic Animals And The Perspective For Public Health

Introduction: Viral hemorrhagic fevers (VHF) refer to a group of diseases caused by different viral families. Rodents represent 42% of the world’s mammalian biodiversity and are reservoir hosts for a wide range of disease agents. Hantaviruses are harbored in numerous mammalian reservoirs, including rodents. To prevent and mitigate possible outbreaks of zoonotic diseases, it is necessary to know the geographic distribution, intra-specific relationships, diversity and identity of the incriminated species. Objectives: To describe the ecology, epidemiology, epizootiology and natural history of hemorrhagic infections caused by hantavirus serotypes and their respective reservoirs. Methodology: Bibliographical consultations and online articles were carried out in the databases relating the highlighted subjects. Results: Rodents from the subfamilies Murinae, Arvicolinae, Neotominae and Sigmodontinae are the main reservoirs of hantavirus disease. Orthohantaviruses are the most studied group, highlighting the Hantaan, Seoul, Puumala and Dobrava serotypes. Rodents of the genus Oligoryzomys, include several species and have parasite-host relationships reported for the genus Hantavirus. Other species of mammals, such as bats, squirrels and opossums, have already been described as possible reservoirs. Conclusion: Hantavirus infections occur as a result of close interactions between humans and animals. One Health approaches highlight concerns through interdisciplinary collaboration and development of public health interventions when animals become vectors of infections, with the aim of achieving global results by recognizing the interconnection between wildlife, humans and the environment.

Rosuvastatin as a Supplemental Treatment for the Clinical Symptoms of Nephropathia Epidemica: A Pilot Clinical Study.

Nephropathis epidemica (NE), a mild form of hemorrhagic fever with renal syndrome (HFRS), is an acute zoonotic disease endemic in the Republic of Tatarstan. This study aimed to assess the impact of rosuvastatin on the clinical and laboratory results of NE. A total of 61 NE patients and 30 controls were included in this study; 22 NE patients and 7 controls received a daily dose of rosuvastatin (10 mg) for ten consecutive days. Serum samples were collected on days 1, 5, and 10 after admission to the hospital. These samples were analyzed to determine the levels of lipids, cytokines, and kidney toxicity markers. Our findings indicate that rosuvastatin reduced the duration of the second wave of fever and alleviated back pain and headache symptoms. Additionally, low-density lipoprotein cholesterol (LDL-C) serum levels were significantly decreased on days 5 and 10 upon rosuvastatin treatment. Furthermore, rosuvastatin decreased the levels of cytokines in the serum, particularly proinflammatory cytokines IL-1β and IL-8. NE patients had significantly altered levels of the kidney toxicity markers albumin and osteopontin. The data from our study provide evidence supporting the therapeutic potential of rosuvastatin in NE cases.

Epizootological situation and epidemiological risks for natural focal infections in the territory of new subjects of the Russian Federation (Donetsk People's Republic, Lugansk People's Republic, Zaporozhye and Kherson regions)

An epizootological inspection of the liberated territories of the Donetsk and Lugansk People's Republics, Zaporozhye and Kherson regions was carried out. It was established that the faunal complex of small mammals, hare-like and ectoparasites, as well as their number, make it possible to ensure the circulation of natural focal infections identified by the results of laboratory studies: tularemia, Crimean hemorrhagic fever (CHF), West Nile fever (WNF), ixodic tick-borne borreliosis (ITB), rickettsiosis, human granulocytic anaplasmosis (HGA), leptospirosis, hemorrhagic fever with renal syndrome (HFRS), Q fever, intestinal yersiniosis, Batai, Inco, Sindbis, Tyaginya fevers. For the first time, the PCR method in field material from the Zaporozhye region (Berdyansk and Melitopol regions) detected the Crimean-Congo hemorrhagic fever virus, on the territory of the Donetsk and Lugansk People's Republics in the populations of small mammals (rodents and insectivores), the circulation of viruses Inco, Sindbis, Tyagin, Batai was established. In the territories of Kherson and Zaporozhye regions, the presence of combined and conjugated natural foci of ixodic tick-borne borreliosis, rickettsiosis and human granulocytic anaplasmosis is determined. According to the results of molecular genetic analysis, it was shown that the causative agents of natural focal infections (Crimean hemorrhagic fever, West Nile fever, ixodic tick-borne borreliosis, rickettsiosis) identified in 2023 are genetically close to strains circulating in the regions of the south European part of Russia.

Epidemiology of Hemorrhagic Fever with Renal Syndrome and Host Surveillance in Zhejiang Province, China, 1990-2021.

Hemorrhagic fever with renal syndrome (HFRS) is caused by hantaviruses (HVs) and is endemic in Zhejiang Province, China. In this study, we aimed to explore the changing epidemiology of HFRS cases and the dynamics of hantavirus hosts in Zhejiang Province. Joinpoint regression was used to analyze long-term trends in the incidence of HFRS. The comparison of animal density at different stages was conducted using the Mann-Whitney Test. A comparison of HV carriage rates between stages and species was performed using the chi-square test. The incidence of HFRS shows a continuous downward trend. Cases are widely distributed in all counties of Zhejiang Province except Shengsi County. There was a high incidence belt from west to east, with low incidence in the south and north. The HFRS epidemic showed two seasonal peaks in Zhejiang Province, which were winter and summer. It showed a marked increase in the age of the incidence population. A total of 23,073 minibeasts from 21 species were captured. Positive results were detected in the lung tissues of 14 rodent species and 1 shrew species. A total of 80% of the positive results were from striped field mice and brown rats. No difference in HV carriage rates between striped field mice and brown rats was observed (χ2 = 0.258, p = 0.611).

Distribution and prevalence of Sin Nombre hantavirus in rodent species in eastern New Mexico.

Orthohantaviruses are diverse zoonotic RNA viruses. Small mammals, such as mice and rats are common chronic, asymptomatic hosts that transmit the virus through their feces and urine. In North America, hantavirus infection primarily causes hantavirus cardiopulmonary syndrome (HCPS), which has a mortality rate of nearly 36%. In the United States of America, New Mexico (NM) is leading the nation in the number of HCPS-reported cases (N = 129). However, no reported cases of HCPS have occurred within eastern NM. In this study, we assessed the prevalence of Sin Nombre virus (SNV) in rodent assemblages across eastern NM, using RT-qPCR. We screened for potential rodent hosts in the region, as well as identified areas that may pose significant infection risk to humans. We captured and collected blood and lung tissues from 738 rodents belonging to 23 species. 167 individuals from 16 different species were positive for SNV RNA by RT-qPCR, including 6 species unreported in the literature: Onychomys leucogaster (Northern grasshopper mouse), Dipodomys merriami (Merriam's kangaroo rat), Dipodomys ordii (Ord's kangaroo rat), Dipodomys spectabilis (Banner-tailed kangaroo rat), Perognathus flavus (Silky pocket mouse), and Chaetodipus hispidus (Hispid pocket mouse). The infection rates did not differ between sexes or rodent families (i.e., Cricetidae vs. Heteromyidae). Generalized linear model showed that disturbed habitat types positively influenced the prevalence of SNV at sites of survey. Overall, the results of this study indicate that many rodent species in east New Mexico have the potential to maintain SNV in the environment, but further research is needed to assess species specific infectivity mechanisms and potential risk to humans.

Spatiotemporal trends of hemorrhagic fever with renal syndrome (HFRS) in China under climate variation

Hemorrhagic fever with renal syndrome (HFRS) is a zoonotic disease caused by the rodent-transmitted orthohantaviruses (HVs), with China possessing the most cases globally. The virus hosts in China are Apodemus agrarius and Rattus norvegicus, and the disease spread is strongly influenced by global climate dynamics. To assess and predict the spatiotemporal trends of HFRS from 2005 to 2098, we collected historical HFRS data in mainland China (2005-2020), historical and projected climate and population data (2005-2098), and spatial variables including biotic, environmental, topographical, and socioeconomic. Spatiotemporal predictions and mapping were conducted under 27 scenarios incorporating multiple integrated representative concentration pathway models and population scenarios. We identify the type of magistral HVs host species as the best spatial division, including four region categories. Seven extreme climate indices associated with temperature and precipitation have been pinpointed as key factors affecting the trends of HFRS. Our predictions indicate that annual HFRS cases will increase significantly in 62 of 356 cities in mainland China. Rattus regions are predicted to be the most active, surpassing Apodemus and Mixed regions. Eighty cities are identified as at severe risk level for HFRS, each with over 50 reported cases annually, including 22 new cities primarily located in East China and Rattus regions after 2020, while 6 others develop new risk. Our results suggest that the risk of HFRS will remain high through the end of this century, with Rattus norvegicus being the most active host, and that extreme climate indices are significant risk factors. Our findings can inform evidence-based policymaking regarding future risk of HFRS.

Levels of peripheral blood routine, biochemical and coagulation parameters in patients with hemorrhagic fever with renal syndrome and their relationship with prognosis: an observational cohort study

BackgroundHantaan virus (HTNV), Seoul virus (SEOV) and Puumala virus (PUUV) are major serotypes of the Hantavirus, which can cause hemorrhagic fever with renal syndrome (HFRS). The pathophysiology of HFRS in humans is complex and the determinants associated with mortality, especially the coagulation and fibrinolysis disorders, are still not been fully elucidated. Severe patients usually manifest multiple complications except for acute kidney injury (AKI). The aim of this study was to observe the levels of peripheral blood routine, biochemical and coagulation parameters during the early stage, so as to find independent risk factors closely related to the prognosis, which may provide theoretical basis for targeted treatment and evaluation.MethodsA total of 395 HFRS patients from December 2015 to December 2018 were retrospectively enrolled. According to prognosis, they were divided into a survival group (n = 368) and a death group (n = 27). The peripheral blood routine, biochemical and coagulation parameters were compared between the two groups on admission. The relationship between the parameters mentioned above and prognosis was analyzed, and the dynamic changes of the coagulation and fibrinolysis parameters during the first week after admission were further observed.ResultsIn addition to AKI, liver injury was also common among the enrolled patients. Patients in the death group manifested higher levels of white blood cell counts (WBC) on admission. 27.30% (107/392) of the patients enrolled presented with disseminated intravascular coagulation (DIC) on admission and DIC is more common in the death group; The death patients manifested longer prothrombin time (PT) and activated partial thromboplastin time (APTT), higher D-dimer and fibrinogen degradation product (FDP), and lower levels of platelets (PLT) and fibrinogen (Fib) compared with those of the survival patients. The proportion of D-dimer and FDP abnormalities are higher than PT, APTT and Fib. Prolonged PT, low level of Fib and elevated total bilirubin (TBIL) on admission were considered as independent risk factors for prognosis (death).ConclusionsDetection of PT, Fib and TBIL on admission is necessary, which might be benefit to early predicting prognosis. It is also important to pay attention to the dynamic coagulation disorders and hyperfibrinolysis during the early stage in the severe HFRS patients.

Analysis on the characteristics of natural foci of hemorrhagic fever with renal syndrome in Gansu Province, 2012-2022

Objective: To explore the characteristics of natural foci of hemorrhagic fever with renal syndrome (HFRS) in Gansu Province. Methods: The information of HFRS case data and rodent density monitoring data from 2012 to 2022 in Gansu Province were collected and epidemiological methods were used to analyze and investigate the characteristics of the epidemic focus. Results: A total of 869 cases of HFRS were reported, and four patients died from 2012 to 2022. The annual incidence rate is between 0.05 per 100 000 and 1.21 per 100 000. The cases were mainly distributed in the eastern, southeast, southern, and south of the central region of Gansu Province. Most cases were distributed between age 20-60, and the sex ratio was 1.85∶1 (564∶305). Most cases were farmers (61.80%, 537/869), herdsmen (19.79%,172/869) and students (6.33%, 55/869). In a wild rat-type epidemic focus,the incidence peak was from November to January of the following year. The natural rodent hosts of HFRS were Rattus norvegicus, Apodemus agrarius, and Mus musculus. The hantaan virus carriage rates were 2.79% (21/754), 0.42% (5/1 179) and 0.31% (2/643),respectively. Three epidemic foci were defined: two derived from the Pingliang and Gannan prefecture new outbreaks epidemic foci, respectively, while the other was the residue of the Dingxi epidemic focus. Conclusions: The southern, south of the central region and eastern part of Gansu Province are current key HFRS epidemic foci dominated by Rattus norvegicus, Apodemus agrarius, and Mus musculus, respectively. The virus genotype is hantaan virus. Case reporting areas should strengthen epidemic monitoring; the key epidemic areas should strengthen and implement various prevention and control measures to reduce the harm caused by HFRS.

Ranking of the Territory of Sochi by the Risk of Infection with HFRS Using the Method of Maximum Entropy

Relevance. Hemorrhagic fever with renal syndrome (HFRS), due to the severity of the course and high mortality, poses a serious threat to the health of the population of both the city of Sochi and its guests. Therefore, in order to implement more effective and less economically costly anti-epidemic and preventive measures, it is very important to constantly monitor the activity of the natural focus of HFRS, as well as to have a clear idea of the territories most dangerous for the risk of infection with this infection.Aims. Assessment of the epidemiological significance of the territory of the city of Sochi for the risk of infection with HFRS based on the maximum entropy method using a geographical information system.Materials & Methods. Based on the application of the maximum entropy algorithm implemented in the MaxEnt program, as well as the ArcGIS 10 program.8. Ranking of the territory of the city of Sochi according to the risk of infection with HFRS was performed. The paper uses: data on positive epizootological findings (a total of 131) for 2016-2021, which were obtained from the Sochi branch of the Federal Medical Institution «Center of Hygiene and Epidemiology in the Krasnodar Territory», the Sochi branch of the Federal Medical Institution «Black Sea Plague Station» of Rospotrebnadzor, as well as the Stavropol Plague Control Research Institute of the Rospotrebnadzor; materials on environmental conditions from the Biolclim data bank, vegetation index for 9 months (https://land.copernicus.eu/global/products/NDVI ). Preliminary preparation of the information was carried out using the ArcGIS 10 program.8. As a tool for building a training model, the MaxEnt program version 3.4.4 was used (https://biodiversityinformatics.amnh.org/open_source/maxent /).Results and discussion. The practical implementation of the tasks was to obtain maps of the epidemiological significance of the territory for the risk of infection with HFRS by superimposing the points of occurrence of the species (reservoir and carrier of HFRS) on maps of abiotic environmental factors affecting its spread. The implementation of this work consisted of the sequential implementation of four main stages: the first – the collection, generalization and transformation of bioclimatic and epizootic-epidemiological data; the second – the selection of the most significant data for the construction of the model; the third – the ranking of the territory of the city. Sochi on the risk of the spread of HFRS using GIS; the fourth is the analysis of the data obtained. In the course of the work, a model was obtained that allows dividing the study area according to the degree of risk of infection with HFRS with a high degree of reliability and significant prognostic value.Conclusions. The use of the model makes it possible to obtain new, more detailed data from a spatial point of view on the boundaries of potentially dangerous sites in the region in terms of GLPS. In particular, this applies to those territories where positive epizootological findings and cases of infection with HFRS have not been previously noted.