Abstract
Aim
Hemorrhagic fever with renal syndrome (HFRS) remains a serious public health problem in China. Although the number of cases has been decreasing, its incidence shows geographical variability, and risk regions change over time. The aim of this study was to observe temporal and geographic dynamics of HFRS in Jiangsu Province and the impact of demographic characteristics.
Subject and Methods
Surveillance data of HFRS in Jiangsu Province for the period of 1963–2017 were retrieved and analyzed. We first plotted the overall incidence and created a heat map of the annual incidence rate to visualize the long-term change over the 55-year period by county. The HFRS incidence map was then depicted to show its spatial and geographic distributions. Changes of demographic characteristics, including gender, age, occupation, and region of patients’ residence were considered.
Results
A total of 73,305 confirmed cases of HFRS were reported during the study period and the peak years were in 1964 (13.7 cases/million), 1977 (31.4 cases/million), 1983 (150.9 cases/million), and 1991 (40.1 cases/ million) historically. HFRS affected the southern region of Jiangsu Province first (incidence relatively scattered), then northern regions (relatively high in 1983–1986, 1990–1995), and finally, other parts of the province. Extensive spreading and expanded spatial distribution of risk areas were seen over the past several decades. Most cases occurred in people 16–60 years of age, males, and farmers. Cases involving people over 60 years of age showed a trend of increasing risk. The risk to females over 60 years of age is higher than that of males.
Conclusion
HFRS incidence showed substantial geographical and temporal variations, which may be associated with rodent migration and urbanization. The detected hotspots of HFRS for future control emphasis are Guanyun, Dafeng, Gaochun, and Sihong Counties. The focus should be on young adult males, farmers, and the elderly.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
17 February 2022
A Correction to this paper has been published: https://doi.org/10.1007/s10389-021-01643-6
References
Backhans A, Fellstrom C (2012) Rodents on pig and chicken farms - a potential threat to human and animal health. Infect Ecol Epidemiol 2(1). https://doi.org/10.3402/iee.v2i0.17093
Bao C, Liu W, Zhu Y et al (2014) The Spatial Analysis on Hemorrhagic Fever with Renal Syndrome in Jiangsu Province, China Based on Geographic Information System. PLoS One 9. https://doi.org/10.1371/journal.pone.0083848
Du H, Wang PZ, Li J et al (2014) Clinical characteristics and outcomes in critical patients with hemorrhagic fever with renal syndrome. BMC Infect Dis 14:191. https://doi.org/10.1186/1471-2334-14-191
Fang L, Yan L, Liang S et al (2006) Spatial analysis of hemorrhagic fever with renal syndrome in China. BMC Infect Dis 6:77. https://doi.org/10.1186/1471-2334-6-77
Fang LQ, Wang XJ, Liang S et al (2010) Spatiotemporal trends and climatic factors of hemorrhagic fever with renal syndrome epidemic in Shandong Province, China, PLoS Negl Trop Dis 4. https://doi.org/10.1371/journal.pntd.0000789
He X, Wang S, Huang X, Wang X (2013) Changes in age distribution of hemorrhagic fever with renal syndrome: an implication of China’s expanded program of immunization. BMC Public Health 13:394. https://doi.org/10.1186/1471-2458-13-394
Jiang F, Wang L, Wang S et al (2017) Meteorological factors affect the epidemiology of hemorrhagic fever with renal syndrome via altering the breeding and hantavirus-carrying states of rodents and mites: a 9 years’ longitudinal study. Emerg Microbes Infect 6:e104. https://doi.org/10.1038/emi.2017.92
Liang W, Gu X, Li X et al (2018) Mapping the epidemic changes and risks of hemorrhagic fever with renal syndrome in Shaanxi Province, China, 2005–2016. Sci Rep 8:749. https://doi.org/10.1038/s41598-017-18819-4
Liu X, Jiang B, Gu W, Liu Q (2011) Temporal trend and climate factors of hemorrhagic fever with renal syndrome epidemic in Shenyang City, China. BMC Infect Dis 11:331. https://doi.org/10.1186/1471-2334-11-331
Tian HY, Yu PB, Luis AD et al (2015) Changes in rodent abundance and weather conditions potentially drive hemorrhagic fever with renal syndrome outbreaks in Xi’an, China, 2005–2012. PLoS Negl Trop Dis 9. https://doi.org/10.1371/journal.pntd.0003530
Tian H, Yu P, Cazelles B et al (2017) Interannual cycles of Hantaan virus outbreaks at the human-animal interface in Central China are controlled by temperature and rainfall. Proc Natl Acad Sci U S A 114:8041–8046. https://doi.org/10.1073/pnas.1701777114
Tian H, Hu S, Cazelles B et al (2018) Urbanization prolongs hantavirus epidemics in cities. Proc Natl Acad Sci U S A 115:4707–4712. https://doi.org/10.1073/pnas.1712767115
Wang L, Wang T, Cui F et al (2016) Hemorrhagic fever with renal syndrome, Zibo City, China, 2006-2014. Emerg Infect Dis 22:274–276. https://doi.org/10.3201/eid2202.151516
Wu J, Wang DD, Li XL et al (2014) Increasing incidence of hemorrhagic fever with renal syndrome could be associated with livestock husbandry in Changchun. Northeastern China. BMC Infect Dis 14:301. https://doi.org/10.1186/1471-2334-14-301
Xiao H, Tong X, Gao L et al (2018a) Spatial heterogeneity of hemorrhagic fever with renal syndrome is driven by environmental factors and rodent community composition. PLoS Negl Trop Dis 12. https://doi.org/10.1371/journal.pntd.0006881
Xiao H, Tong X, Huang R et al (2018b) Landscape and rodent community composition are associated with risk of hemorrhagic fever with renal syndrome in two cities in China, 2006–2013. BMC Infect Dis 18(37). https://doi.org/10.1186/s12879-017-2827-5
Yan L, Fang LQ, Huang HG et al (2007) Landscape elements and Hantaan virus-related hemorrhagic fever with renal syndrome, People’s Republic of China. Emerg Infect Dis 13:1301–1306. https://doi.org/10.3201/eid1309.061481
Zhang Y-Z, Zou Y, Fu ZF, Plyusnin A (2010) Hantavirus infections in humans and animals, China. Emerg Infect Dis 16:1195–1203. https://doi.org/10.3201/eid1608.090470
Zhang S, Wang S, Yin W et al (2014a) Epidemic characteristics of hemorrhagic fever with renal syndrome in China, 2006-2012. BMC Infect Dis 14:384. https://doi.org/10.1186/1471-2334-14-384
Zhang W, Wang L, Liu Y et al (2014b) Spatiotemporal transmission dynamics of hemorrhagic fever with renal syndrome in China, 2005-2012. Plos Neglect Trop Dis 8. https://doi.org/10.1371/journal.pntd.0003344
Zhu YG, Ioannidis JP, Li H, Jones KC, Martin FL (2011) Understanding and harnessing the health effects of rapid urbanization in China. Environ Sci Technol 45:5099–5104. https://doi.org/10.1021/es2004254
Availability of data and material
Not applicable.
Code availability
Not applicable.
Funding
This work was supported by the National Natural Science Foundation of China [grant numbers: 81973102], Public Health Talents Training Program of Shanghai Municipality [grant number: GWV-10.2-XD21], the National Major Infectious Disease Project of the Ministry of Science and Technology of China [grant number:2017ZX10305501002], Key projects of the PLA logistics Scientific research Program [BHJ17J013] (ZZ) and “Six One Project” Top Talent Research Plan of Jiangsu High Level Health Talents [JL Hu: LGY2019073] (JH).
Author information
Authors and Affiliations
Contributions
Jianli Hu and Zhijie Zhang conceived, designed, and supervised the study. Wenge Wang and Xiaochen Wang designed the study, finalized the analysis, and interpreted the findings. Shuang Xiao, Jun Zhang, Yiheng Li, Shangzhi Hong, Jian Hu, and Yi Hu assisted in data analysis. Yue Chen, Lili Yu, Liqun Fang, and Yuanfang Qin commented on and helped revise drafts of the manuscript. Jianli Hu, Xiaochen Wang, Ming Yue, Yun Zhang, and Bin Zhang participated in collection and management of data.
Corresponding authors
Ethics declarations
Ethical Approval
The National Health Commission of China determined that the collection of data from human cases of Hemorrhagic fever with renal syndrome was part of public health surveillance of a notifiable infectious disease and was exempt from institutional review board assessment. The National Health Commission of China has confirmed that no ethical approval is required.
Consent to Participate
Not applicable.
Consent to Publish
Not applicable.
Conflicts of interest
The authors have no conflicts of interest to declare that are relevant to the content of this article.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Wenge Wang and Xiaochen Wang contributed equally to this article and share first authorship.
The original version of the article was revised: Wenge Wang and Xiaochen Wang contributed equally to this article and share first authorship.
The original version of the article was revised: Wenge Wang and Xiaochen Wang contributed equally to this article and share first authorship. Also, Figure 2 was updated.
Supplementary Information
Supplementary Table 1
Diagnostic criteria for hemorrhagic fever with renal syndrome. (DOC 32 kb)
Supplementary Fig. 1
Enlarged heat map of counties with HFRS cases for Fig. 1 panel D. (PDF 4.22 mb)
Rights and permissions
About this article
Cite this article
Wang, W., Wang, X., Chen, Y. et al. Changing epidemiology of hemorrhagic fever with renal syndrome in Jiangsu Province, China, 1963–2017. J Public Health (Berl.) 30, 2929–2936 (2022). https://doi.org/10.1007/s10389-021-01526-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10389-021-01526-w