Case-generating patterns of hemorrhagic fever with renal syndrome in Chinese mainland, 2006–2025: a national surveillance analysis

Hemorrhagic fever with renal syndrome (HFRS) shows marked spatiotemporal heterogeneity and frequent zero counts in Chinese mainland. We analysed monthly HFRS surveillance data from 352 cities during 2006–2025 using a zero-inflated time-series model incorporating meteorological, environmental, and policy-related covariates. Adjusted structural-zero, endemic, autoregressive, and neighbourhood component weights were used to identify city-level case-generating patterns. Among 84,480 city-month observations, 189,680 HFRS cases were reported and 61.80% had zero reported cases. Four model-derived patterns were identified. These patterns provided information complementary to incidence magnitude and may support differentiated local, cross-boundary, and One Health surveillance and prevention.