Epidemiology and Ecology of Different Types of Hemorrhagic Fever with
Renal Syndrome Endemic Areas in China: A Nationwide Observational Study
from 2014 to 2018
Abstract
Hemorrhagic fever with renal syndrome (HFRS) poses a significant public
health threat in China, yet its endemic distribution remains poorly
defined. In this study, we collected HFRS cases and environmental
factors from 2014 to 2018 in China and developed a two-stage ecological
machine learning model to investigate the drivers, environment
suitability, and potential risk areas of HFRS. Finally, we identified
three endemic types, with Type I (HTNV-type dominant) accounting for
approximately 16.96% of the total potential risk areas
(468,000/2,759,000 square kilometers). Meteorological factors, crop
fields, grassland, wetland, rural residential land, and normalized
difference vegetation index were the main drivers in these endemic
areas. Type II (SEOV-type dominant) risk areas, on the other hand,
accounted for around 718,100 square kilometers (26.03%), with HFRS
epidemics being primarily associated with the percentage of grassland,
wetland, open woodland, rural residential land, urban construction rate,
and meteorological factors. Type III(Mixed-type) endemic foci spanned
large potential risk areas throughout mainland China, covering
approximately 1,572,900 square kilometers (57.01% of the total
potential endemic areas). Three HFRS-endemic areas in China varied in
epidemic features, ecological drivers, and spatial risk areas. Targeted
surveillance and intervention strategies were needed for different
endemic areas to control the spread of HFRS.