title: The epidemic characteristics and changing trend of hemorrhagic fever with renal syndrome in Hubei Province, China.
abstract: BACKGROUND
  Hemorrhagic fever with renal syndrome (HFRS) is caused by different hantaviruses within the Bunyaviridae family. HFRS is a fulminant, infectious disease that occurs worldwide and is endemic in all 31 provinces of China. Since the first HFRS case in Hubei Province was reported in 1957, the disease has spread across the province and Hubei has become one of the seriously affected areas in China with the greatest number of reported HFRS cases in the 1980's. However, the epidemic characteristics of HFRS in Hubei are still not entirely clear and long-term, systematic investigations of this epidemic area have been very limited.
  
  
  METHODS
  The spatiotemporal distribution of HFRS was investigated using data spanning the years 1980 to 2009. The annual HFRS incidence, fatality rate and seasonal incidence between 1980 and 2009 were calculated and plotted. GIS-based spatial analyses were conducted to detect the spatial distribution and seasonal pattern of HFRS. A spatial statistical analysis, using Kulldorff's spatial scan statistic, was performed to identify clustering of HFRS.
  
  
  RESULTS
  A total of 104,467 HFRS cases were reported in Hubei Province between 1980 and 2009. Incidence of and mortality due to HFRS declined after the outbreak in 1980s and HFRS cases have been sporadic in recent years. The locations and scale of disease clusters have changed during the three decades. The seasonal epidemic pattern of HFRS was characterized by the shift from the unimodal type (autumn/winter peak) to the bimodal type.
  
  
  CONCLUSIONS
  Socioeconomic development has great influence on the transmission of hantaviruses to humans and new epidemic characteristics have emerged in Hubei Province. It is necessary to reinforce preventative measures against HFRS according to the newly-presented seasonal variation and to intensify these efforts especially in the urban areas of Hubei Province.
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Yi-Hui
authors.initials: YH
authors.lastname: Zhang
authors.affiliation: Tianjin Institute of Surveying and Mapping, Tianjin, PR China.
authors.forename: Liang
authors.initials: L
authors.lastname: Ge
authors.affiliation: Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, PR China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, PR China.
authors.forename: Xi-Xiang
authors.initials: XX
authors.lastname: Huo
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Hai-Rong
authors.initials: HR
authors.lastname: Xiong
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Yuan-Yuan
authors.initials: YY
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Dong-Ying
authors.initials: DY
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Fan
authors.initials: F
authors.lastname: Luo
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Jin-Lin
authors.initials: JL
authors.lastname: Li
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Jia-Xin
authors.initials: JX
authors.lastname: Ling
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Hou
authors.affiliation: Institute of Military Medical Sciences, Nanjing Command, Nanjing, PR China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Information Engineering in Survey, Mapping and Remote Sensing, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Hong
authors.initials: H
authors.lastname: Fan
authors.affiliation: State Key Laboratory of Virology, Institute of Medical Virology, School of Medicine, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Zhan-Qiu
authors.initials: ZQ
authors.lastname: Yang
mesh_terms: D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D005843:Geography; D018063:Hantaan virus; D006480:Hemorrhagic Fever with Renal Syndrome / Q000453:epidemiology* / Q000266:history; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D012621:Seasons; D062211:Spatio-Temporal Analysis