{ "abstract": "Background: Hemorrhagic fever with renal syndrome (HFRS) is a significant public health concern in Jiangxi Province, China, where both Hantaan (HTNV) and Seoul (SEOV) co-circulate. Previous studies have identified three distinct clusters of HFRS epidemic in Jiangxi Province, characterized by geographical separation and heterogeneous incidence levels. We hypothesized that clinical severity and healthcare-seeking behaviors may vary across these clusters, and thus conducted a retrospective study to examine this hypothesis. Methods: We retrospectively analyzed 4,614 HFRS cases (13-year period) from 63 counties. Cases were classified into four areas based on prior spatial study, representing distinct hilly and plain regions with different proximity to major water bodies and mountains. Data on HFRS cases were collected by county-level CDC staff using a nationally standardized case investigation questionnaire. Clinical severity and healthcare-seeking behaviors (hospital level, onset-to-visit interval) were compared. Results: HFRS cases in Cluster I exhibited the highest clinical severity (22.41% severe, 6.65% critical), while cases in Cluster II were strikingly mild (2.62% severe, 1.31% critical). Median onset-to-visit interval was longest in Cluster II (5 days) vs others (2–4 days). Hospital preference varied: Cluster I primarily used Class II hospitals (65.88%); Cluster II showed near-equal use of Class II (48.44%) and III (47.01%); Cluster III and non-clustered areas favored higher-level hospitals. Conclusion: Our findings confirmed that Jiangxi Province, though a mixed epidemic focus, exhibited distinct spatial heterogeneity in clinical severity, and healthcare-seeking behaviors. These findings underscore the need for regionally tailored strategies in HFRS prevention and control. Author summary: Hemorrhagic fever with renal syndrome (HFRS) is a serious infectious disease in China, with thousands of cases reported annually. Previous studies have shown that cases in Jiangxi Province tend to cluster in specific geographic areas. However, it remained unclear whether patients in these different areas experienced different disease outcomes or sought care in different ways. In this study, we analyzed data from more than 4,600 patients across 63 counties over 13 years. We found that disease severity and how quickly people sought care differed substantially between regions. Patients in Cluster I were much more likely to develop severe or critical illness, whereas cases in Cluster II were predominantly mild. We also identified significant inter-regional differences in healthcare-seeking behavior, including time to initial care and choice of healthcare facility. Cluster I patients predominantly utilized Class II hospitals, while those in other regions more often presented directly to Class III hospitals. These findings show that HFRS affects different parts of Jiangxi Province in different ways. This means that public health strategies—such as health education campaigns and hospital resource planning—should be tailored to the specific needs of each region, rather than using a one-size-fits-all approach.", "abstract_shown": true, "affiliations": [ "Jiangxi Provincial Key Laboratory of Major Epidemics Prevention and Control/ Medical Leading Discipline of Jiangxi Province (Epidemiology), Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi, China", "School of Public Health, Jiangxi Medical College, Nanchang University/ Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang, Jiangxi, China" ], "article_type": "Research Article", "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0 ], "name": "Guanghui Xia" }, { "affs": [ 1 ], "name": "Rui Gao" }, { "name": "Huanhong Pan" }, { "name": "Jun Zong" }, { "name": "Zhili Zeng" }, { "name": "Zifen Li" }, { "name": "Chenwei Li" }, { "name": "Shiyu Liao" }, { "name": "Tong Luo" }, { "name": "Guai Tang" }, { "name": "Zijing Peng" }, { "name": "Xiaoqing Liu" }, { "name": "Shiwen Liu" }, { "name": "Jianxiong Li" }, { "name": "Tianchen Zhang" } ], "bibtex": "https://research.draconitic.com/paper/c6k3ww4men4vn.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014746", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014746", "id": "c6k3ww4men4vn", "issns": [ "1935-2735" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014746", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|Viral Infections and Vectors" ], [ "plos", "/Earth sciences/Geography" ], [ "plos", "/Medicine and health sciences/Epidemiology" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Epidemiology/Spatial epidemiology" ], [ "plos", "/Medicine and health sciences/Health care/Health care facilities" ], [ "plos", "/Medicine and health sciences/Health care/Health care facilities/Hospitals" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/Hemorrhagic fever with renal syndrome" ], [ "plos", "/People and places/Geographical locations/Asia/China" ] ], "openalex": "W7214085621", "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014746&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-23", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/c6k3ww4men4vn.ris", "sources": [ { "first_seen": "2026-10-30T12:17:43Z", "native_id": "10.1371/journal.pntd.0014746", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014746" } ], "subjects": [ { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "Clinical severity and health-seeking behaviors of cases with hemorrhagic fever with renal syndrome: A comparative study across spatial clusters in Jiangxi Province, China", "title_text": "Clinical severity and health-seeking behaviors of cases with hemorrhagic fever with renal syndrome: A comparative study across spatial clusters in Jiangxi Province, China", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:43Z", "url": "https://research.draconitic.com/paper/c6k3ww4men4vn", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }