Prediction of hot spot areas of hemorrhagic fever with renal syndrome in Hunan Province based on an information quantity model and logistical regression model

BackgroundChina’s “13^th 5-Year Plan” (2016–2020) for the prevention and control of sudden acute infectious diseases emphasizes that epidemic monitoring and epidemic focus surveys in key areas are crucial for strengthening national epidemic prevention and building control capacity. Establishing an epidemic hot spot areas and prediction model is an effective means of accurate epidemic monitoring and surveying. Objective: This study predicted hemorrhagic fever with renal syndrome (HFRS) epidemic hot spot areas, based on multi-source environmental variable factors. We calculated the contribution weight of each environmental factor to the morbidity risk, obtained the spatial probability distribution of HFRS risk areas within the study region, and detected and extracted epidemic hot spots, to guide accurate epidemic monitoring as well as prevention and control. Methods: We collected spatial HFRS data, as well as data on various types of natural and human social activity environments in Hunan Province from 2010 to 2014. Using the information quantity method and logistic regression modeling, we constructed a risk-area-prediction model reflecting the epidemic intensity and spatial distribution of HFRS. Results: The areas under the receiver operating characteristic curve of training samples and test samples were 0.840 and 0.816. From 2015 to 2019, HRFS case site verification showed that more than 82% of the cases occurred in high-risk areas.DiscussionThis research method could accurately predict HFRS hot spot areas and provided an evaluation model for Hunan Province. Therefore, this method could accurately detect HFRS epidemic high-risk areas, and effectively guide epidemic monitoring and surveyance.     

An epidemiological analysis of hemorrhagic fever with renal syndrome morbidity in the Republic of Bashkortostan in 1997

The outbreak of hemorrhagic fever with renal syndrome (HFRS) in the Republic of Bashkortostan, resulting in 10,057 registered cases of the disease (287 cases per 100,000 of the population), was analyzed. HFRS cases among the population were registered in 52 out of 54 regions of Bashkortostan. 31% of the total number of patients were the inhabitants of rural regions (170 cases per 100,000) and 69% were urban dwellers (295 cases per 100,000), mainly in Ufa (512 cases per 100,000). HFRS morbidity among males was fourfold higher than among females. In 70% of cases persons aged 20-49 years were affected. 5% of the total number of patients were children aged up to 14 years. In 34 cases (0.4%) the severe clinical course of the disease had a fatal outcome. Cases of HFRS were registered from April 1997 till March 1998 with the highest morbidity rate observed during the period of August-December. In most cases (46.8%) both urban and rural dwellers contacted infection during a short-term stay in the forest. As the result of the serological examination of the patients, all HFRS cases were etiologically attributed to hantavirus, serotype Puumala. The main natural reservoir of this virus and the source of human infection in Bashkortostan were bank voles (Clethrionomys glareolus), the domination species among small mammals in this region.     

Epidemiology of hemorrhagic fever with renal syndrome in the north Volga-Viatka region

The results of the ecological and epidemiological study of hemorrhagic fever with the renal syndrome (HFRS) in the Kirov region for the period of 1987-2000 are presented. HFRS morbidity rate varied from 1.3 to 13.7 per 100,000 population, which corresponded to the figures registered in the Volga Vyatka region. Cases of HRFS were mainly (90%) registered in three southern districts of the region. The moderate degree of correlation between morbidity rate and the number of wild mammals (r = 0.55) was established. Periodic morbidity rise occurred every 3 years. In 1998-2000 the contamination of wild mammals with HFRS virus increased and reached 7.6-9.5%. Infection factors connected with everyday human activities somewhat prevailed, industrial and agricultural types of infection constituting 43.8%. Males aged 20-49 years prevailed among the patients. Morbidity rate among urban dwellers exceeded that among town residents.     

肾综合征出血热Ⅱ型疫苗(L99株)免疫效果及对Ⅰ型病毒攻击的保护作用

为探讨Ⅱ型肾综合征出血热（ＨＦＲＳ）疫苗的实际流行病学免疫效果及对姬鼠型ＨＦＲＳ的交叉保护作用,我们选择混合型疫区为研究现场,应用Ⅱ型ＨＦＲＳ疫苗（Ｌ９９株）进行人群接种观察,研究结果表明,该疫苗对以家鼠型为主的混合型疫区具有明显的保护效果,保护率为１００％,接种组家鼠型和姬鼠型ＨＦＲＳ的理论发病数和实际发病数间均具有显著性差异（Ｐ值分别为Ｐ＜０．０５,Ｐ＜０．０１）,由此可见,Ⅱ型ＨＦＲＳ苗（Ｌ９９株）除适合家鼠型疫区外,还可在混合型疫区和姬鼠型疫区推广使用     

Cyclic morbidity of certain natural foci infections in the Russian Federation

A special search program for finding out hidden periodicity was used; such program made it possible to put in order the apparently chaotic sequence of numerical data that are summed up to form the resulting curve, the latter reflecting the actual dynamics of the epidemic process. The cyclic character of morbidity in tick-borne encephalitis, hemorrhagic fever with the renal syndrome (HFRS), tularemia and leptospirosis among the population of Russia for the last 45-54 years was revealed. In tick-borne encephalitis cycles lasting 17-18 years with secondary wave having the period of 3-4 years were found out. In HFRS the main cycle lasts for 16 years and has secondary rises every 3-4 years. In tularemia the main cycles last for 17 years; secondary rises and drops in morbidity were also found to occur every 3-4 years. In leptospirosis regular rises and drops in morbidity were found to occur every 4-5 years.     

Spatiotemporal Trends and Climatic Factors of Hemorrhagic Fever with Renal Syndrome Epidemic in Shandong Province,China

Background

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease caused by Hantaviruses. It is endemic in all 31 provinces, autonomous regions, and metropolitan areas in mainland China where human cases account for 90% of the total global cases. Shandong Province is among the most serious endemic areas. HFRS cases in Shandong Province were first reported in Yutai County in 1968. Since then, the disease has spread across the province, and as of 2005, all 111 counties were reported to have local human infections. However, causes underlying such rapid spread and wide distribution remain less well understood.

Methods and Findings

Here we report a spatiotemporal analysis of human HFRS cases in Shandong using data spanning 1973 to 2005. Seasonal incidence maps and velocity vector maps were produced to analyze the spread of HFRS over time in Shandong Province, and a panel data analysis was conducted to explore the association between HFRS incidence and climatic factors. Results show a rapid spread of HFRS from its epicenter in Rizhao, Linyi, Weifang Regions in southern Shandong to north, east, and west parts of the province. Based on seasonal shifts of epidemics, three epidemic phases were identified over the 33-year period. The first phase occurred between 1973 and 1982 during which the foci of HFRS was located in the south Shandong and the epidemic peak occurred in the fall and winter, presenting a seasonal characteristic of Hantaan virus (HTNV) transmission. The second phase between 1983 and 1985 was characterized by northward and westward spread of HFRS foci, and increases in incidence of HFRS in both fall-winter and spring seasons. The human infections in the spring reflected a characteristic pattern of Seoul virus (SEOV) transmission. The third phase between 1986 and 2005 was characterized by the northeast spread of the HFRS foci until it covered all counties, and the HFRS incidence in the fall-winter season decreased while it remained high in the spring. In addition, our findings suggest that precipitation, humidity, and temperature are major environmental variables that are associated with the seasonal variation of HFRS incidence in Shandong Province.

Conclusions

The spread of HFRS in Shandong Province may have been accompanied by seasonal shifts of HTNV-dominated transmission to SEOV-dominated transmission over the past three decades. The variations in HFRS incidence were significantly associated with local precipitation, humidity, and temperature.     

A large-scale epidemic of diphtheria in Moscow in recent years: patterns of development

Data on the dynamics of diphtheria morbidity in Moscow in 1958-1999 are presented. The last epidemic which started at the end of the 1980s and reached its peak in 1994, giving a 59-fold rise in morbidity in comparison with the pre-epidemic period, is characterized in detail. During the epidemic 12,267 persons fell ill, 454 of them died (mortality rate was 4%). Having started in Moscow, the epidemic gradually spread not only over the territory of Russia, but also over some other republics of the former Soviet Union (Ukraine, Belarus, etc.). Possible causes of this epidemic emergency are considered. The ever increasing share of adult population among persons affected by the epidemic (75%) is noted. The infection adults is characterized by severity of clinical manifestations and increased morbidity among adults, is shown. Under complicated social and economic conditions (crisis situation) the increase of groups of high risk which included unemployed adults of working age, retirees as well as socially non-adapted persons, was registered. Mainly these groups determined tense epidemiological situation in diphtheria in Moscow.     

Etiology of the epidemic outbreak of community-acquired pneumonia in children in St. Petersburg

In September-December 1998 the epidemic rise of outhospital pneumonia (EP) among children was observed in St. Petersburg, which led to a twofold increase in morbidity rate this year. The study of the etiology of EP during the period of 1998-2001 confirmed the prime role of Streptococcus pneumoniae (74.5%) and, for the first time in Russia, revealed the epidemic outbreak of acute chlamydiosis (Chlamydia pneumoniae), diagnosed in 67.3% of children, the maximum occurrence (87.5%) in 1998 with only 19% of the patients having the disease in the form of monoinfection. The prevalence of S. pneumoniae and C. pneumoniae in the etiology of EP and more severe course of mixed infection suggested that these infective agents played a leading role in the epidemic outbreak of acute respiratory infections in St. Petersburg.     

东北三省6株肾综合征出血热病毒生物学性状的研究

肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)是我国重点防治的急性传染病,对于流行于不同地区的汉坦病毒(hanatavirus)进行分离和系统地鉴定,可以为HFRS的防治提供科学依据,特别是对流行株血清型及基因型的确定,是研制疫苗和确定防治重点及对策的重要前提,也为研究我国汉坦病毒的遗传和进化特征奠定了基础。研究对6株流行于东北三省的汉坦病毒进行了全面鉴定,其中H8205、H8207株为人源性汉坦病毒,其余均为鼠源性汉坦病毒。研究表明,6株病毒具有病毒型别明确,抗原性较为广谱,免疫原性好,在Vero细胞上适应能力强及病毒滴度高,以及来源及传代历史清楚等特点,适合作为双价HFRS纯化灭活疫苗候选毒株,并且可建立起完善和合格的生产用毒种库,为我国生产以Vero细胞为基质的双价肾综合征出血热纯化灭活疫苗奠定了坚实的基础。     

Discovery, clinical and etiological characteristic of hemorrhagic fever with renal syndrome in the subtropical zone of Krasnodar region

Twenty-six patients with hemorrhagic fever with renal syndrome (HFRS) were revealed as a result of serological examination of 582 patients with fever living around Sochi town. Etiologic role of Dobrava virus subtype as the cause of HFRS was assessed by immunofluorescent and ELISA assays, and neutralization test. The principal host of this virus and source of infection for humans is Caucasian forest mouse Apodemus ponticus. HFRS morbidity was sporadic and not dependent from patients' occupation and season. Comparative analysis of clinical and laboratory data from HFRS cases caused by DOB/Sochi and DOB/Lipetsk subspecies, as well as Puumala virus showed higher proportion of severe forms of disease in patients with HFRS from Sochi.     

HIV infection in Saint Petersburg: the changing face of the epidemic

The specific features of the epidemiological situation in St. Petersburg at the first stage (1987-1995) and the second stage (1986-1999) of the development of HIV infection are described. During this period morbidity in HIV infection, starting from the insignificant rate of growth, sharply increased. For the first time injecting drug users were noted to come out to the foreground in the structure of the contingent of persons affected by HIV infection (57.5% and 72.6% in 1998 and 1999 respectively). Such change on the epidemic situation requires corrections in the strategy and tactics of preventive measures and medical assistance. To control HIV infection among drug users, only the combination of medical assistance given by narcologists with the realization of all elements of the program "Harm Reduction" can be effective.     

Spatiotemporal association of rapid urbanization and water-body distribution on hemorrhagic fever with renal syndrome: A case study in the city of Xi’an,China

Hemorrhagic fever with renal syndrome (HFRS) is a zoonosis characterized by clinical features of high fever, hemorrhage, and renal damage. China has the largest number of HFRS cases worldwide, accounting for over 90% of the total reported cases. In this paper, we used surveyed HFRS data and satellite imagery to conduct geostatistical analysis for investigating the associations of rapid urbanization, water bodies, and other factors on the spatiotemporal dynamics of HFRS from year 2005 to 2018 in Xi’an City, Northwest China. The results revealed an evident epidemic aggregation in the incidence of HFRS within Xi’an City with a phenomenal fluctuation in periodic time series. Rapid urbanization was found to greatly affect the HFRS incidence in two different time phases. HFRS caused by urbanization influences farmers to a lesser extent than it does to non-farmers. The association of water bodies with the HFRS incidence rate was found to be higher within the radii of 696.15 m and 1575.39 m, which represented significant thresholds. The results also showed that geomatics approaches can be used for spatiotemporally investigating the HFRS dynamic characteristics and supporting effective allocations of resources to formulate strategies for preventing epidemics.     

Investigating the Effects of Food Available and Climatic Variables on the Animal Host Density of Hemorrhagic Fever with Renal Syndrome in Changsha,China

Background

The transmission of hemorrhagic fever with renal syndrome (HFRS) is influenced by population dynamics of its main host, rodents. It is therefore important to better understand rodents’ characteristic in epidemic areas.

Methodology/Principal Findings

We examined the potential impact of food available and climatic variability on HFRS rodent host and developed forecasting models. Monthly rodent density of HFRS host and climate data in Changsha from January 2004 to December 2011 were obtained. Monthly normalized difference vegetation index (NDVI) and temperature vegetation dryness index (TVDI) for rice paddies were extracted from MODIS data. Cross-correlation analysis were carried out to explore correlation between climatic variables and food available with monthly rodent data. We used auto-regressive integrated moving average model with explanatory variables to examine the independent contribution of climatic variables and food supply to rodent density. The results indicated that relative rodent density of HFRS host was significantly correlated with monthly mean temperatures, monthly accumulative precipitation, TVDI and NDVI with lags of 1–6 months.

Conclusions/Significance

Food available plays a significant role in population fluctuations of HFRS host in Changsha. The model developed in this study has implications for HFRS control and prevention.     

The HIV infection epidemic in the city of Irkutsk under the conditions of drug abuse prevalence

The data on the spread of HIV infection in Irkutsk and Irkutsk Province, starting from March 9, 1999, are presented. The simultaneous appearance of 17 multiple morbidity foci of HIV infection, involving 2,227 persons into the epidemic, within the period of 8 months was noted. The age structure of the epidemic process was represented by 1,846 adults aged 18-50 years (83%), 256 adolescents aged 16-17 years (12.9%), 78 children aged 10-15 years (3.5%) and 17 persons of other ages (0.53%). The leading role in the age structure of the epidemic process belonged to young people aged 10-29 years (90.4% of cases). The epidemiological analysis made it possible to establish the fact that the epidemic was linked with the intravenous injection of heroin. The viral contamination of the drug is not excluded also in the process of its preparation for injection.     

Modeling and Predicting Hemorrhagic Fever with Renal Syndrome Trends Based on Meteorological Factors in Hu County,China

Background

Hu County is a serious hemorrhagic fever with renal syndrome (HFRS) epidemic area, with notable fluctuation of the HFRS epidemic in recent years. This study aimed to explore the optimal model for HFRS epidemic prediction in Hu.

Methods

Three models were constructed and compared, including a generalized linear model (GLM), a generalized additive model (GAM), and a principal components regression model (PCRM). The fitting and predictive adjusted R² of each model were calculated. Ljung-Box Q tests for fitted and predicted residuals of each model were conducted. The study period was stratified into before (1971–1993) and after (1994–2012) vaccine implementation epochs to avoid the confounding factor of vaccination.

Results

The autocorrelation of fitted and predicted residuals of the GAM in the two epochs were not significant (Ljung-Box Q test, P>.05). The adjusted R² for the predictive abilities of the GLM, GAM, and PCRM were 0.752, 0.799, and 0.665 in the early epoch, and 0.669, 0.756, and 0.574 in the recent epoch. The adjusted R² values of the three models were lower in the early epoch than in the recent epoch.

Conclusions

GAM is superior to GLM and PCRM for monthly HFRS case number prediction in Hu County. A shift in model reliability coincident with vaccination implementation demonstrates the importance of vaccination in HFRS control and prevention.     

Misdiagnosis of scrub typhus as hemorrhagic fever with renal syndrome and potential co-infection of both diseases in patients in Shandong Province,China, 2013–2014

BackgroundScrub typhus, caused by Orientia tsutsugamushi, an obligate intracellular gram-negative bacterium, along with hemorrhagic fever with renal syndrome (HFRS), caused by hantaviruses, are natural-focus infectious diseases prevalent in Shandong Province, China. Both diseases have similar clinical manifestations in certain disease stages and similar epidemic seasons, which has caused difficulties for physicians in distinguishing them. The aim of this study was to investigate whether misdiagnosis of scrub typhus as HFRS occurred in patients in Shandong Province.MethodsSerum samples (N = 112) of clinically suspected HFRS patients from 2013 to 2014 in Shandong Province were analyzed with enzyme-linked immunosorbent assay (ELISA) for antibodies to both hantavirus and Orientia tsutsugamushi.ResultsELISA showed that 56.3% (63/112) and 8.0% (9/112) of clinically suspected HFRS patients were IgM antibody positive to hantavirus and O. tsutsugamushi, respectively. Among the hantavirus IgM antibody positive patients, 7.9% (5/63) were also IgM antibody positive to O. tsutsugamushi. Among the hantavirus IgM antibody negative sera, 8.2% (4/49) of sera were positive to O. tsutsugamushi.ConclusionsWe concluded that some scrub typhus patients were misdiagnosed as HFRS and co-infection of scrub typhus and HFRS might exist in China. Due to the different treatments for scrub typhus and HFRS, physicians should carefully differentiate between scrub typhus and HFRS and consider administering anti-rickettsia antibiotics if treatment for HFRS alone does not work.     

Monocyte subset redistribution from blood to kidneys in patients with Puumala virus caused hemorrhagic fever with renal syndrome

Innate immune cells like monocytes patrol the vasculature and mucosal surfaces, recognize pathogens, rapidly redistribute to affected tissues and cause inflammation by secretion of cytokines. We previously showed that monocytes are reduced in blood but accumulate in the airways of patients with Puumala virus (PUUV) caused hemorrhagic fever with renal syndrome (HFRS). However, the dynamics of monocyte infiltration to the kidneys during HFRS, and its impact on disease severity are currently unknown. Here, we examined longitudinal peripheral blood samples and renal biopsies from HFRS patients and performed in vitro experiments to investigate the fate of monocytes during HFRS. During the early stages of HFRS, circulating CD14–CD16+ nonclassical monocytes (NCMs) that patrol the vasculature were reduced in most patients. Instead, CD14+CD16– classical (CMs) and CD14+CD16+ intermediate monocytes (IMs) were increased in blood, in particular in HFRS patients with more severe disease. Blood monocytes from patients with acute HFRS expressed higher levels of HLA-DR, the endothelial adhesion marker CD62L and the chemokine receptors CCR7 and CCR2, as compared to convalescence, suggesting monocyte activation and migration to peripheral tissues during acute HFRS. Supporting this hypothesis, increased numbers of HLA-DR+, CD14+, CD16+ and CD68+ cells were observed in the renal tissues of acute HFRS patients compared to controls. In vitro, blood CD16+ monocytes upregulated CD62L after direct exposure to PUUV whereas CD16– monocytes upregulated CCR7 after contact with PUUV-infected endothelial cells, suggesting differential mechanisms of activation and response between monocyte subsets. Together, our findings suggest that NCMs are reduced in blood, potentially via CD62L-mediated attachment to endothelial cells and monocytes are recruited to the kidneys during HFRS. Monocyte mobilization, activation and functional impairment together may influence the severity of disease in acute PUUV-HFRS.     

Epidemiological investigations of chikungunya epidemic at Barsi, Maharashtra state, India

During the summer of 1973, an epidemic of Chikungunya broke out in Barsi, Sholapur district. Epidemiological investigations carried out during the decline phase revealed that all age groups and both sexes were involved with varying morbidity. The absence of previous immunity was demonstrated by a very high morbidity of 37.53 per cent for the whole town. The clinical picture encountered during the epidemic was quite characteristic of chikungunya. Besides gingivitis and epistaxis there were no frank haemorrhagic episodes. Reports about the presence of demonstrable rash varied. Except for one possible case, there was no mortality as a result of the epidemic. Results of the search for the index case are also described.