Regional heterogeneity of spatial-temporal characteristics and meteorological-environmental driving factors of hemorrhagic fever with renal syndrome in China

Hemorrhagic fever with renal syndrome (HFRS), a major rodent-borne disease in China, exhibits shifting spatial and incidence patterns due to climate change. From a One Health perspective—integrating human, animal, and environmental health—this China-wide survey aims to identify spatiotemporal characteristics of HFRS and assess regional heterogeneity associated with meteorological and environmental factors. Using HFRS case data from 2005 to 2022 in China, this study employed a distributed lag non-linear model to examine associations with meteorological factors, and used a generalized additive mixed model to examine associations with environmental factors. The spatiotemporal effects of these factors were further analyzed across different epidemic types, climate zones, and geographical regions to identify key drivers of HFRS risk. A bimodal seasonal pattern was observed, with HFRS incidence peaking in autumn/winter ( Apodemus -Type epidemic regions) and spring ( Rattus -Type epidemic regions). The effects of monthly mean temperature and relative humidity exhibited inverted U-shaped curves, peaking at 7.5 °C and 38%, respectively, with corresponding relative risks of 1.85 (95% CI: 1.35–2.54) and 1.21 (95% CI: 1.04–1.40). HFRS risk initially rose as precipitation increased and then declined, while extreme precipitation and snow depth inhibited HFRS risk. Impervious surface and water body percentages had greater impacts in Apodemus -Type epidemic regions, whereas shrubland and wetland percentages had greater impacts in Rattus -Type epidemic regions, indicating significant regional differences. HFRS exhibits geographical clustering and bimodal seasonal pattern in China, driven by regional heterogeneity in host species, meteorological and environmental factors. These spatiotemporal patterns, viewed through a One Health lens, necessitate region-specific interventions to guide precision prevention and early warning nationwide. • HFRS seasonality in China varied by host: Apodemus (autumn) vs Rattus (spring). • Optimal temperature (0.6–11 °C) & humidity (38%) increased HFRS risk. • Impervious surface was key in Apodemus regions; NDVI was key in Rattus regions.