Hemorrhagic Fever with Renal Syndrome | CDC EID

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Volume 15, Number 12–December 2009
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Spatiotemporal Dynamics of Hemorrhagic Fever with Renal Syndrome, Beijing, People's Republic of China
Li-Qun Fang,1 Wen-Juan Zhao,1 Sake J. de Vlas, Wen-Yi Zhang, Song Liang, Caspar W.N. Looman, Lei Yan, Li-Ping Wang, Jia-Qi Ma, Dan Feng, Hong Yang, and Wu-Chun Cao
Author affiliations: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China (L.-Q. Fang, W.-J. Zhao, W.-Y. Zhang, L. Yan, D. Feng, H. Yang, W.-C. Cao); University Medical Center Rotterdam, Rotterdam, the Netherlands (L.-Q. Fang, S.J. de Vlas, C.W.N. Looman); Second Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing (W.-J. Zhao); Ohio State University, Columbus, Ohio, USA (S. Liang); and Chinese Center for Disease Control and Prevention, Beijing (L.-P. Wang, J.-Q. Ma)

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Abstract
We used geographic information systems to characterize the dynamic change in spatial distribution of hemorrhagic fever with renal syndrome (HFRS) in Beijing, People's Republic of China. The seasonal variation in its incidence was observed by creating an epidemic curve. HFRS was associated with developed land, orchards, and rice paddies.

Hemorrhagic fever with renal syndrome (HFRS), a rodent-borne disease caused by hantaviruses (family Bunyaviridae), is characterized by fever, acute renal dysfunction, and hemorrhage manifestations. Various rodent species are natural hosts and serve as sources of infection (1). Humans usually acquire hantavirus infection by contact with or inhalation of aerosols or excreta from infected rodents (2,3). In the People's Republic of China, HFRS is caused mainly by 2 types of hantaviruses, Hantaan virus (HTNV) and Seoul virus (SEOV), each of which has co-evolved with a distinct rodent host. HTNV is associated with Apodemus agrarius, whereas SEOV, which causes a less severe form of HFRS, is associated with Rattus norvegicus. Although HFRS infection has long been recognized in many places throughout mainland China, HFRS was first reported in metropolitan Beijing in 1997. Since then, the natural foci have been established, and human cases were continuously diagnosed in the new disease-endemic region (4).

The presence and transmission of hantavirus depend on the distribution and infection of its animal hosts, which largely determine the incidence and extent of HFRS; such distribution and infection are usually determined by environmental elements (5,6). Ecologic studies in China demonstrated that elevation, precipitation, temperature, vegetation type, and soil type influenced transmission of HTNV (7,8). However, these studies were conducted on a relatively large scale, usually at the county or even province level. Environmental factors driving variability in HFRS incidence at a finer scale (e.g., township) remain poorly understood. The availability of detailed records of HFRS cases and environmental information in the newly established disease-endemic region provides an opportunity to explore possible factors underlying the emergence of the rodent-borne disease. In this study, we aimed to learn the current situation of endemic HFRS in Beijing, characterize its spatiotemporal distribution, and identify environmental factors possibly contributing to the incidence of the disease.

The Study
The study area covered metropolitan Beijing (between 115°20´ and 117°30´E and 39°28´ and 41°05´N), including 220 townships of 18 districts with an area of 16,800 km2. The data on reported HFRS cases were obtained from the National Notifiable Disease Surveillance System, which included information about sex, age, residential address, and onset date of symptoms for each case.

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