Investigation on risk factors of haemorrhagic fever with renal syndrome (HFRS) in Xuancheng City in Anhui Province, Mainland China

Abstract

Haemorrhagic fever with renal syndrome (HFRS), a rodent-borne disease, is a major public health concern in both developed and developing countries. China is the most severe endemic country in the world, constituting 90% of the cases. Although the incidence of HFRS has substantively decreased in most areas of China, HFRS has rebounded remarkably in some epidemic areas. Xuancheng is one of these areas. In this study, we collected the case data reported recently in Xuancheng and designed a 1:3 case−control study. The Chi-square test, univariate and multivariate logistic regression analysis were performed. In all cases, farmers made up the highest proportion of occupations. And there were 20 variables with statistical significance including indoor hygienic conditions; the surrounding environment; whether bitten by rats at work and other criteria. In addition, exposure to rodents and rats bites is a high-risk factor for HFRS. Rodent density was calculated at 20.9% (159/760), the virus carrier rate was 9.4% (15/159) and the index of rats with a virus was about 2.0%. Exposure to rodents and insect bites is also high-risk factors for HFRS among local residents in Xuancheng. More importantly, during the flood years, the increased density of rodents led to an increased risk of human exposure to rodents. As our statistical analysis proves, targeted strategies should be developed and implemented to reduce the incidence of local diseases in the future.

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

“…Another finding from the current study is that farmers and workers are the two most common occupations contracting HFRS, which is consistent with findings from previous studies in other regions of China and Korea [ 17 – 20 ]. This occupation distribution could be partly explained by the fact that both farmers and essential workers are engaged with frequent outdoor activities and therefore have higher chances contacting with rodents or their body fluids containing hantaviruses.…”

Estimating the Long-Term Epidemiological Trends and Seasonality of Hemorrhagic Fever with Renal Syndrome in China

“…Different from prior studies that reported a re-emerging risk in the HFRS morbidity in China, 5 , 6 , 8 , 10 our study indicated an evident reduction in the numbers of HFRS cases over the 26 years of data (AAPC=−6.767, 95% CIs: −10.592 to −2.778; t=−3.278, p =0.001), consistent with the epidemiological trends reported in several countries in Asia, 57 and yet in disagreement with that in Russia. 4 This discrepancy may be related to the different causative agents, geographical environments, social economy, preventive measures, and public awareness.…”

“… 8 Since the 1990s, a considerable reduction in the HFRS incidence has been witnessed, attributable to the implementation of such comprehensive interventions as effective rodent control, environmental management, improvement of people living standards, and vaccination in China. 5 However, HFRS seemingly signals a recurring risk in China in recent years owing to its continued rise in case notifications and the extension of geographical distribution to 31 provinces across China. 5 , 8 , 10 Basic to any development of prevention and control measures is an accurate quantitative analysis for the secular epidemiological trends and seasonality of diseases.…”

“… 5 However, HFRS seemingly signals a recurring risk in China in recent years owing to its continued rise in case notifications and the extension of geographical distribution to 31 provinces across China. 5 , 8 , 10 Basic to any development of prevention and control measures is an accurate quantitative analysis for the secular epidemiological trends and seasonality of diseases. Therefore, it is essential to make a long-term estimation for the timing, extent, and duration of HFRS by use of a forecasting model with good reliability and strong robustness.…”

“…3 In Asia, the HFRS-causing pathogenic agents predominantly include Hantaan virus (HTNV), Seoul virus (SEOV), and Amur virus (AMRV); whereas in Europe, mainly comprising Puumala virus (PUUV), Sochi virus (SOCV), and Dobrava-Belgrade virus (DOBV). [3][4][5] HFRS is currently found in more than 70 countries, but it is mainly endemic in Asian and European continents, especially in China, Russia, and Korea. 1,3,4 Among them, China is always hit the hardest country with HFRS in the past, accounting for around 70-90% documented case notifications throughout the world each year.…”