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Association of haemorrhagic fever with renal syndrome and weather factors in Junan County, China: a case-crossover study

  • J. LIU (a1) (a2), F. Z. XUE (a1), J. Z. WANG (a1) and Q. Y. LIU (a2) (a3)

Haemorrhagic fever with renal syndrome (HFRS) is a type of vector-borne zoonosis sensitive to climate change. To explore the short-term effect of air temperature and amount of precipitation on HFRS incidence, a total of 13 722 clinically confirmed HFRS cases from January 1977 to December 2001 in Junan County, China were included in this study. According to symmetric bidirectional case-crossover design, the hazard period (the three calendar months preceding the month when the case was diagnosed) and the control period (the same calendar month of the year before and the year after the hazard period) matched and conditional logistic regression was used to examine the effect of monthly mean temperature and precipitation on the risk of HFRS. The results showed the facilitating climatic conditions for HFRS included: condition with moderate mean air temperature (10–25 °C) and abundant precipitation (>120 mm) 3 months before [odds ratio (OR) 1·346, 95% confidence interval (CI) 1·191–1·522] and 2 months before (OR 1·193, 95% CI 1·063–1·339); and condition with temperature >25 °C and abundant precipitation (>120 mm) 3 months before (OR 1·17, 95% CI 1·004–1·363). Temperature of 10–25 °C and moderate precipitation (10–120 mm) in the current month was the most favourable condition for HFRS incidence.

Corresponding author
*Author for correspondence: J. Liu, Ph.D., Institute of Epidemiology and Biostatistics, Shandong University, Jinan City, China250012. (Email:
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1.Shi J. Research progress of hemorrhagic fever with renal syndrome in China [in Chinese]. Chinese Journal of Zoonoses 2007; 23: 296298.
2.Lei Y, et al. Landscape elements and hantaan virus-related hemorrhagic fever with renal syndrome, People's Republic of China. Emerging Infectious Diseases 2007; 13: 13011306.
3.Song G. Epidemiological progresses of hemorrhagic fever with renal syndrome in China. Chinese Medical Journal 1999; 112: 472477.
4.Fang LQ, et al. Spatial analysis of hemorrhagic fever with renal syndrome in China. BMC Infectious Diseases 2006; 6: 7786.
5.Lin HL, et al. Analysis of the geographic distribution of HFRS in Liaoning Province between 2000 and 2005. BMC Public Health. Published online: 15 August 2007. doi:10.1186/1471-2458-7-207.
6.Song G. Epidemiological study and prevention of hemorrhagic fever with renal syndrome [in Chinese]. Chinese Journal of Public Health 2004; 20: 766768.
7.Clement JP. Hantavirus. Antiviral Research 2003; 57: 121127.
8.Viel JF, et al. Environmental risk factors for haemorrhagic fever with renal syndrome in a French new epidemic area. Epidemiology and Infection 2011; 139: 867874.
9.Engelthaler DM, et al. Climatic and environmental patterns associated with hantavirus pulmonary syndrome, Four Corners region, United States. Emerging Infectious Diseases 1999; 5: 8794.
10.Hjelle B, Glass GE. Outbreak of hantavirus infection in the Four Corners region of the United States in the wake of the 1997–1998 El Nino–Southern Oscillation. Journal of Infectious Disease 2000; 181: 15691573.
11.Kausrud KL, et al. Climatically driven synchrony of gerbil populations allows large-scale plague outbreaks. Proceedings of the Royal Society of London, Series B: Biological Sciences 2007; 274: 19631969.
12.Tersago K, et al. Hantavirus disease (nephropathia epidemica) in Belgium: effects of tree seed production and climate. Epidemiology and infection 2009; 137: 250256.
13.Zhang WY, et al. Climate variability and hemorrhagic fever with renal syndrome transmission in northeastern China. Environmental Health Perspective 2010; 118: 915920.
14.Carracedo-Martinez E, et al. Case-crossover analysis of air pollution health effects: a systematic review of methodology and application. Environmental Health Perspectives 2010; 118: 11731182.
15.Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. American Journal of Epidemiology 1991; 133: 144153.
16.Bateson TF, Schwartz J. Control for seasonal variation and time trend in case-crossover studies of acute effects of environmental exposures. Epidemiology 1999; 10: 539544.
17.Nitta H, et al. An introduction to epidemiologic and statistical methods useful in environmental epidemiology. Journal of Epidemiology 2010; 20: 177184.
18.Song G. Manual of Prevention and Treatment of Hemorrhagic Fever with Renal Syndrome [in Chinese], 2nd edn.Beijing: People's Medical Publishing House, 1998, pp. 30120.
19.Shi XC, Zhang YJ (eds). Murine Ecology and Murine Diseases [in Chinese]. Jinan: Shandong University Publishing House, 1991, pp. 7273.
20.Liu YX, et al. Study on ecology of rodents and their medical importance in hilly areas of South Shandong [in Chinese]. Chinese Journal of Vector Biology and Control 2003; 14: 265268.
21.Hu W, et al. Time-series analysis of the risk factors for haemorrhagic fever with renal syndrome: comparison of statistical models. Epidemiology and Infection 2007; 135: 245252.
22.Zhang XL, et al. Study on the law of population change of Apodemus agrarius and the prevention and treatment to their damage [in Chinese]. Chinese Journal of Vector Biology and Control 1994; 5: 5759.
23.Li SD, Pu WL, Mu WD. A research on the breeding pattern of the species composition of Rattus norvegicus in the farmland in central Yunnan [in Chinese]. Plant Protection Technology and Extension 1998; 18: 2426.
24.Zhang Y, et al. The epidemic characteristics and preventive measures of hemorrhagic fever with renal syndrome [in Chinese]. Chinese Journal of Epidemiology 2004; 25: 466469.
25.Fang LQ, et al. Study on the application of geographic information system in spatial distribution of hemorrhagic fever with renal syndrome in China [in Chinese]. Chinese Journal of Epidemiology 2003; 24: 265268.
26.Bi P, et al. Climate, reservoir and occupational variables and the transmission of hemorrhagic fever with renal syndrome in China. International Journal of Epidemiology 2002; 31: 189193.
27.Chen ZG, et al. Meteorological factors and rats density [in Chinese]. Chinese Journal of Vector Biology and Control 2002; 13: 135.
28.Luo L, et al. An analysis on the relationships among the climatic indices and incidence of HFRS and the mice density [in Chinese]. Modern Preventive Medicine 2005; 32: 205206, 222.
29.Yang H, Xia XC, Wu YJ. Analysis of incidence trend of hemorrhagic fever with renal syndrome in Xi'an City, 1990–2000 [in Chinese]. Literature and Information of Preventive Medicine 2002; 8: 599600.
30.Yang ZX, Guo SP. A preliminary study on the population dynamics of Rattus norvegicus [in Chinese]. Acta Phytophylacica Sinica 1996; 23: 6165.
31.Holly J, Lianne S, Thomas L. Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias. Epidemiology 2005; 16: 717726.
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Epidemiology & Infection
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