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Epidemiology and Ecology of Different Types of Hemorrhagic Fever with Renal Syndrome Endemic Areas in China: A Nationwide Observational Study from 2014 to 2018
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  • Xiao Wei,
  • Shaolong Ren,
  • Xinlou Li,
  • Rui Li,
  • Ting Fu,
  • Shuxuan Song,
  • Chenxi Zhao,
  • Zhongjun Shao,
  • Liping Wang,
  • Liqun Fang,
  • Kun Liu
Xiao Wei
Fourth Military Medical University
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Shaolong Ren
Fourth Military Medical University
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Xinlou Li
PLA Strategic Support Force Medical Center
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Rui Li
Fourth Military Medical University
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Ting Fu
Fourth Military Medical University
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Shuxuan Song
Fourth Military Medical University
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Chenxi Zhao
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Zhongjun Shao
Fourth Military Medical University
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Liping Wang
Chinese Center for Disease Control and Prevention
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Liqun Fang
Beijing Institute of Microbiology and Epidemiology
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Kun Liu
Fourth Military Medical University

Corresponding Author:[email protected]

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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.