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Increasing incidence of hemorrhagic fever with renal syndrome could be associated with livestock husbandry in Changchun, Northeastern China

Jing Wu12, Dan-Dan Wang34, Xin-Lou Li4, Sake J de Vlas5, Ya-Qin Yu1, Jian Zhu1, Ying Zhang2, Bo Wang2, Li Yan12, Li-Qun Fang4*, Ya-Wen Liu1* and Wu-Chun Cao34*

Author Affiliations

1 Department of Epidemiology and Statistics, Jilin University, Changchun, People’s Republic of China

2 Changchun Center for Disease Control and Prevention, Changchun, People’s Republic of China

3 School of Public Health, Central South University, Changsha, People’s Republic of China

4 State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People’s Republic of China

5 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

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BMC Infectious Diseases 2014, 14:301  doi:10.1186/1471-2334-14-301

Published: 3 June 2014



Since the end of the 1990s, the incidence of hemorrhagic fever with renal syndrome (HFRS) has been increasing dramatically in Changchun, northeastern China. However, it is unknown which, and how, underlying risk factors have been involved in the reemergence of the disease.


Data on HFRS cases at the county scale were collected from 1998 to 2012. Data on livestock husbandry including the numbers of large animals (cattle, horses, donkeys and mules), sheep, and deer, and on climatic and land cover variables were also collected. Epidemiological features, including the spatial, temporal and human patterns of disease were characterized. The potential factors related to spatial heterogeneity and temporal trends were analyzed using standard and time-series Poisson regression analysis, respectively.


Annual incidence varied among the 10 counties. Shuangyang County in southeastern Changchun had the highest number of cases (1,525 cases; 35.9% of all cases), but its population only accounted for 5.6% of the total population. Based on seasonal pattern in HFRS incidence, two epidemic phases were identified. One was a single epidemic peak at the end of each year from 1988 to 1997 and the other consisted of dual epidemic peaks at both the end and the beginning of each year from 1998 to the end of the study period. HFRS incidence was higher in males compared to females, and most of the HFRS cases occurred in peasant populations. The results of the Poisson regression analysis indicated that the spatial distribution and the increasing incidence of HFRS were significantly associated with livestock husbandry and climate factors, particularly with deer cultivation.


Our results indicate that the re-emergence of HFRS in Changchun has been accompanied by changing seasonal patterns over the past 25 years. Integrated measures focusing on areas related to local livestock husbandry could be helpful for the prevention and control of HFRS.