Epidemiological Features and Spatial–Temporal Distribution of Hemorrhagic Fever With Renal Syndrome—China, 2004–2023

Introduction Hemorrhagic fever with renal syndrome is a zoonotic disease caused by hantavirus and transmitted through rodent vectors. China accounts for approximately 90% of global hemorrhagic fever with renal syndrome cases. Methods In this study, data of cases were obtained from the Chinese Information System for Disease Control and Prevention. Surveillance data of rodent hosts was derived from the designated surveillance sites across the country. Results During the study period, 204,039 HFRS cases were reported, with 1,801 deaths and a case fatality rate of 0.88%. Average annual reductions of –4.26% (95% CI, –7.13% to –1.78%, p < 0.001) in incidence rate and –5.39% (95% CI, –8.02% to –3.60%, p < 0.001) in case fatality rate were observed. A concerning upward trend was observed in both the proportion and incidence rate among individuals aged 60–69 years. The proportion increased from 7.70% in 2004 to 18.91% in 2020, with incidence rates reaching 10.35/1,000,000 in 2020. The primary disease cluster has shifted from Heilongjiang to Guanzhong Plain. Higher hantavirus carrying rates were observed in Heilongjiang, Yunnan, and Shaanxi provinces. Conclusions The incidence rate of HFRS has been steadily decreasing in China, accompanied by changes in demographic and geographic distributions. In light of shifting epidemiological patterns, the current Expanded Programme on Immunisation (EPI) strategy should be reconfigured to encompass individuals aged 10–70 years. Given the observed changes in disease clusters and high hantavirus prevalence, enhanced rodent host surveillance is essential. Surveillance scope and frequency should be dynamically adjusted in response to prevailing epidemiological trends to facilitate early intervention. Prevention strategies should precisely target high‐risk populations and hotspots while enhancing the integrated application of the One Health approach.