Clinical severity and health-seeking behaviors of cases with hemorrhagic fever with renal syndrome: A comparative study across spatial clusters in Jiangxi Province, China
- 1Jiangxi 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
- 2School of Public Health, Jiangxi Medical College, Nanchang University/ Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang, Jiangxi, China
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.
Related
- Clinical severity predominates over routine inflammatory and metabolic biomarkers in predicting hemorrhagic transformation after intravenous thrombolysis: internal temporal validation of incremental biomarker value
- Perceived severity and benefits show a preliminary conditional association with kidney-protective behaviors in type 2 diabetes with early kidney function decline: an exploratory health belief model analysis
- Early warning indicators for severe hemorrhagic fever with renal syndrome
- Compositional associations of 24-hour movement behaviors with metabolic syndrome in Korean older adults: a nationwide cross-sectional study using KNHANES 2022-2024
- CREBBP variants underlying Menke-Hennekam syndrome exhibit histone acetyltransferase hyperactivity with divergent phase behaviors
BibTeX
@article{xia2026clinical,
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}},
author = {Guanghui Xia and Rui Gao and Huanhong Pan and Jun Zong and Zhili Zeng and Zifen Li and Chenwei Li and Shiyu Liao and Tong Luo and Guai Tang and Zijing Peng and Xiaoqing Liu and Shiwen Liu and Jianxiong Li and Tianchen Zhang},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = sep,
doi = {10.1371/journal.pntd.0014746},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014746},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical severity and health-seeking behaviors of cases with hemorrhagic fever with renal syndrome: A comparative study across spatial clusters in Jiangxi Province, China
AU - Guanghui Xia
AU - Rui Gao
AU - Huanhong Pan
AU - Jun Zong
AU - Zhili Zeng
AU - Zifen Li
AU - Chenwei Li
AU - Shiyu Liao
AU - Tong Luo
AU - Guai Tang
AU - Zijing Peng
AU - Xiaoqing Liu
AU - Shiwen Liu
AU - Jianxiong Li
AU - Tianchen Zhang
PY - 2026
DA - 2026/09/23
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014746
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014746
AB - 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.
SN - 1935-2735
ER -