Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 29, 2023
Date Accepted: Apr 29, 2024
Epidemic Characteristic and Risk Meteorological Factors of Hemorrhagic Fever with Renal Syndrome (HFRS) in 151 cities of China From 2015 to 2021: Retrospective Analysis
ABSTRACT
Background:
Hemorrhagic fever with renal syndrome (HFRS) continues to pose a significant public health threat to the population in China. Previous epidemiological evidence indicated the climate sensitivity of HFRS, influenced by meteorological factors. However, past studies either focused on too narrow geographical regions or investigated during a period too early in time. There is an urgent need for a comprehensive analysis to interpret the epidemiological patterns of meteorological factors affecting the incidence of HFRS across diverse climate zones.
Objective:
In this study, we aimed to describe the overall epidemic characteristics of HFRS and explore the linkage between monthly HFRS cases and meteorological factors at different climate levels in China.
Methods:
The HFRS reported cases and meteorological data were collected from 151 cities during 2015 to 2021 in China. We conducted three-stage analysis, adopting distributed lag nonlinear model (DLNM) and generalized additive model (GAM), to estimate the interactions and marginal effects of meteorological factors on HFRS.
Results:
This study included a total of 63,180 cases of HFRS, and the epidemic trends showed seasonal fluctuations, with patterns varying different climate zones. Temperature had the greatest impact on the incidence of HFRS, with the maximum hysteresis effects being 1-month (-19 ℃, RR:1.64, 95% CI: 1.24-2.15) in mid temperate zone, 0-month (28 ℃, RR:3.15, 95% CI: 2.13-4.65) in warm temperate zone, and 0-month (4 ℃, RR:1.72, 95% CI: 1.31-2.25) in subtropical zone. Interactions were discovered between the average temperature, relative humidity (RH) and precipitation in different temperature zones. Moreover, the influence of precipitation and relative humidity on the incidence of HFRS had different characteristics under different temperature layers. The hysteresis effect of meteorological factors would not finish after an epidemic season, but gradually weakened in the following one or two popular seasons.
Conclusions:
Weather variability, especially low temperature, plays an important role in the epidemics of HFRS in China. Long hysteresis effect indicates the necessity of continuous intervention following the HFRS epidemic. This finding can help public health department guide the prevention and control of HFRS, and develop strategies to cope with the impacts of climate change according to the climate change in different regions.
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