title: Ongoing spillover of Hantaan and Gou hantaviruses from rodents is associated with hemorrhagic fever with renal syndrome (HFRS) in China.
abstract: BACKGROUND
  Longquan City, Zhejiang province, China, has been seriously affected by hemorrhagic fever with renal syndrome (HFRS) since the first cases were registered in 1974. To understand the epidemiology and emergence of HFRS in Longquan, which may be indicative of large parts of rural China, we studied long-term incidence patterns and performed a molecular epidemiological investigation of the causative hantaviruses in human and rodent populations.
  
  
  RESULTS
  During 1974-2011, 1866 cases of HFRS were recorded in Longquan, including 20 deaths. In 2011, the incidence of HFRS remained high, with 19.61 cases/100,000 population, despite the onset of vaccination in 1997. During 1974-1998, HFRS cases in Longquan occurred mainly in winter, while in the past decade the peak of HFRS has shifted to the spring. Notably, the concurrent prevalence of rodent-borne hantaviruses in the region was also high. Phylogenetic analyses of viral sequences recovered from rodents in Longquan revealed the presence of novel genetic variants of Gou virus (GOUV) in Rattus sp. rats and Hantaan virus (HTNV) in the stripe field mice, respectively. Strikingly, viral sequences sampled from infected humans were very closely related to those from rodents.
  
  
  CONCLUSIONS
  HFRS represents an important public health problem in Longquan even after years of preventive measures. Our data suggest that continual spillover of the novel genetic variant of GOUV and the new genetic lineage of HTNV are responsible for the high prevalence of HFRS in humans. In addition, this is the first report of GOUV associated with human HFRS cases, and our data suggest that GOUV is now the major cause of HFRS in this region.
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.forename: Miao-Ruo
authors.initials: MR
authors.lastname: Wang
authors.forename: Xian-Dan
authors.initials: XD
authors.lastname: Lin
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Guo
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Li
authors.forename: Sheng-Hua
authors.initials: SH
authors.lastname: Mei
authors.forename: Zhao-Mei
authors.initials: ZM
authors.lastname: Li
authors.forename: Mei-Li
authors.initials: ML
authors.lastname: Cong
authors.forename: Rui-Lan
authors.initials: RL
authors.lastname: Jiang
authors.forename: Run-Hong
authors.initials: RH
authors.lastname: Zhou
authors.forename: Edward C
authors.initials: EC
authors.lastname: Holmes
authors.forename: Alexander
authors.initials: A
authors.lastname: Plyusnin
authors.forename: Yong-Zhen
authors.initials: YZ
authors.lastname: Zhang
mesh_terms: D000818:Animals; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D006476:Orthohantavirus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000453:epidemiology* / Q000662:veterinary* / Q000821:virology; D006801:Humans; D015994:Incidence; D051379:Mice; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D010802:Phylogeny; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics; D051381:Rats; D012376:Rodent Diseases / Q000453:epidemiology* / Q000821:virology; D012621:Seasons; D017422:Sequence Analysis, DNA; D015047:Zoonoses / Q000453:epidemiology* / Q000821:virology*
chemical_list: D012367:RNA, Viral