Health professionals' perceptions of hemorrhagic fever with renal syndrome and climate change in China

https://doi.org/10.1016/j.gloplacha.2017.02.007Get rights and content

Highlights

  • About half of surveyed CDC staff believed climate change affect the transmission of rodent-borne diseases.

  • HFRS was more seriously endemic and re-emerged in Northeast China than Mideast China.

  • Climate change-related research, health education and vaccination will likely be vital in addressing the threat of HFRS.

Abstract

Background

Hemorrhagic fever with renal syndrome (HFRS) is a serious public health problem in China. Although the incidence of HFRS sharply reduced towards the end of the twentieth century, there has been a re-emergence of the disease after 2008 in some parts of China. The aim of this study was to gauge the perceptions of health professionals in China concerning HFRS control and climate change.

Methods

A cross-sectional survey about HFRS and climate change was conducted among staff in the Centers for Disease Control and Prevention (CDC) in Liaoning and Anhui Provinces, where HFRS is still a public health concern. Descriptive analyses were performed to assess survey results.

Results

In total, 412 questionnaires were distributed, and 381 participants completed the survey. > 80% of participants thought climate change would have an influence on population health and infectious diseases. However, fewer participants (< 60%) indicated that climate change would affect rodent-borne diseases, such as hantavirus infections. More than 40% of participants in Liaoning Province thought rodent populations had increased over the last ten years while 25.5% held this opinion in Anhui Province. Sixty-seven percent of participants in Liaoning indicated that HFRS had re-emerged, whereas < 40% of participants in Anhui endorsed the statement. The majority of participants (70.9%) indicated there were rodent control programs in their area. However, less than half of participants thought these were effective in reducing HFRS incidence. Participants viewed the main risk factors for HFRS in China as being increased rodent density and infected rodents, contact with rodents, and lack of health awareness among the population.

Conclusions

Although most participants thought that climate change would have negative impacts on population health and infectious diseases, fewer participants believed it would contribute to the transmission of rodent-borne diseases, such as hantavirus infections. More participants in Liaoning indicated that HFRS had re-emerged, and current prevention programs, especially rodent control programs, need to be improved. Furthermore, more climate change-related research, health promotion programs, extended vaccination coverage, and better environmental management will likely be vital in addressing the threat of HFRS in the face of climate change. The results will be useful to inform HFRS control and prevention strategies.

Introduction

Hemorrhagic fever with renal syndrome (HFRS) is a dangerous zoonotic disease caused by hantaviruses and is a serious public health problem in China in past decades (Zhang et al., 2010b, Liu et al., 2012). The disease is transmitted to humans via rodents and symptoms include fever, hemorrhage, hypotension and renal dysfunction (Xiao et al., 2014b, Zhang et al., 2011). About 90% of the world's cases are reported in China (Xiao et al., 2014b). Two species of hantavirus – Hantaan virus (HTNV) and Seoul virus (SEOV) are predominant in China (Zhang et al., 2011). The hosts for these viruses are Apodemus agrarius and Rattus norvegicus respectively. Humans can be infected by inhaling aerosols that are contaminated with the virus shed in excreta, saliva and urine of infected animals or by contact with contaminated food, water, and infected rodent hosts (Bi et al., 2002, Hansen et al., 2015). Apodemus agrarius is prevalent in agricultural regions of China while Rattus norvegicus is prevalent in urban areas (Xiao et al., 2013a).

There were > 1 million HFRS cases reported between 1931 and 1995 in China (Bi et al., 2002). Male farmers aged 30–50 years were the most vulnerable population (Liu et al., 2012). The incidence of HFRS peaked in 1986 (115,807 cases) and then declined in the late 1990s (about 20,000–50,000 cases annually) (Zhang et al., 2014a, Zhang et al., 2014b). This reduction could be due to numerous control measures such as deratization strategies, an introduced vaccination program, better health care access and health education. However, the incidence once again rebounded after 2008 (Zhang et al., 2014b). The majority of these cases in China are concentrated in north-eastern, central and eastern China, in the provinces of Liaoning, Heilongjiang, Shanxi, and Anhui (Zhang et al., 2014b, Bi et al., 2005, Liu et al., 2011). During 2004 and 2005, Liaoning had the highest incidence of HFRS in China, and is still one of the high-risk areas (Liu et al., 2011). Before that period, the incidence rate of HFRS was very high in Anhui - > 10 per 100,000 population during the 1980s and 1990s, and nowadays there are still a number of cases reported annually (Zou et al., 2016). Fig. 1 shows the annual incidence of HFRS from 2002 to 2013 in Liaoning and Anhui (National Health and Family Planning Commission of the PRC, 2016). In both provinces, the incidence of HFRS reduced gradually after 2004. However, there has been an increasing trend of HFRS cases in those regions since 2008. In Liaoning, for example, the incidence increased from 1.71/100,000 in 2008 to 2.96/100,000 in 2013. In Anhui the incidence of HFRS rose from 0.17/100,000 in 2008 to 0.32/100,000 in 2013. Although continuous control and prevention measures have been implemented in these provinces, there are still about 30,000 to 60,000 HFRS cases reported annually in China (Hansen et al., 2015, Xiao et al., 2013a).

There are a number of studies indicating the increasing number of HFRS cases is associated with climatic variables and possibly climate change, such as increasing temperature, precipitation and relative humidity (Hansen et al., 2015, Liu et al., 2011, Li et al., 2013, Zhang et al., 2010a, Guan et al., 2009, Bi et al., 2005). According to the most recent Intergovernmental Panel on Climate Change report (IPCC Fifth Assessment Report) in 2014, the average global land and ocean surface temperature is predicted to increase 1.1–6.4 °C from 1990 to 2100 (Intergovernmental Panel on Climate Change, 2013). This may have an influence on the ecology of the rodents, and increase the reproduction rate, and thus contribute to rodent-borne disease transmission (Xiao et al., 2014b, Hansen et al., 2015, Li et al., 2013, Liu et al., 2013).

In China, the Centers for Disease Control and Prevention (CDC) work to protect and improve population health and safety, and to control and prevent potential infectious disease threats (Chinese Center for Disease Control and Prevention, 2015). Although CDC health professionals are likely to be knowledgeable about HFRS and possible associations with climate change, to our knowledge there are no studies investigating health professionals' perceptions of this disease under the climate change scenario, which would contribute to our understanding of the relationship between climate change and HFRS.

The aim of this study was to gauge the perceptions of CDC health professionals in China concerning HFRS control and climate change. An examination of CDC professionals' understanding of the association between HFRS and climate change, and the main reasons responsible for HFRS emergence and re-emergence, will enhance understanding of this phenomenon, while providing policy makers and stakeholders with an evidence-base on which to formulate effective and feasible adaptation strategies for the control and prevention of HFRS in the future.

Section snippets

Study areas

A CDC-based cross-sectional survey was conducted in Liaoning and Anhui Provinces. These provinces were chosen as they historically have been high-risk areas for HFRS. They are also located in two different geographical areas of China and are in different climate zones.

Liaoning Province, located in Northeast China (Fig. 2), has a total area of 145,800 km2, a population of 42.7 million (The People's Government of Liaoning Province, 2016b). There are 4.09 million hectares of agricultural areas and

Demographic information

In this study, 381 participants who undertook duties such as communicable disease control and prevention, public health, medical laboratory testing and emergency response completed the questionnaires. Table 1 shows the demographic characteristics of participants. Of the total cohort, 59.6% were from Liaoning CDCs and 40.4% were from Anhui CDCs. More than half of the participants were from provincial CDCs, and others were from CDC in counties and prefectures within the provinces. Participants

Discussion

To our best knowledge, this is the first study to gauge the perceptions of CDC staff about the transmission of HFRS in relation to climate change in China. Results will provide scientific evidence to inform the capacity for improvement in control and prevention measures of HFRS in the face of climate change.

Most participants (> 80%) considered that climate change would have a negative effect on population health, and indicated that increasing temperature and precipitation would influence

Conclusions

Most CDC staff endorsed the statement that climate change would have an influence on population health and infectious disease transmission. However, many participants either did not think climate change would have an influence on rodent-borne diseases including hantavirus infections, or were undecided about the issue, indicating the uncertainties and lack of evidence that exists in this area. Further climate change related research concerning rodent-borne disease transmission is required to aid

Competing interests

The authors declare that they have no competing interests.

    Abbreviations

    HFRS

    Hemorrhagic fever with renal syndrome

    CDC

    Center for Disease Control and Prevention

    HTVN

    Hantaan virus

    SEOV

    Seoul virus

    IPCC

    Intergovernmental Panel on Climate Change

Acknowledgements

This study has been funded by the Department of Foreign Affairs and Trade through the Australian Development Research Awards Scheme under an award titled ‘How best to curb the public health impact of emerging and re-emerging infectious diseases due to climate change in China’ (Project ID: 66888) and the National Basic Research Program of China (973 Program) (Grant No. 2012CB955504). The views expressed in the publication are those of the authors and not necessarily those of the Department of

References (48)

  • Chinese Center for Disease Control and Prevention

    Center Introduction [Online]. Beijing

  • P. Guan et al.

    Investigating the effects of climatic variables and reservoir on the incidence of hemorrhagic fever with renal syndrome in Huludao City, China: a 17-year data analysis based on structure equation model

    BMC Infect. Dis.

    (2009)
  • X. Huang et al.

    Epidemiologic characteristics of haemorrhagic fever with renal syndrome in Mainland China from 2006 to 2010

    Western Pac. Surveill. Response J.

    (2012)
  • Intergovernmental Panel on Climate Change

    Climate change 2013: the physical science basis

  • S.H. Kim et al.

    Correlations between climate change-related infectious diseases and meteorological factors in Korea

    J. Prev. Med. Public Health

    (2010)
  • H. Li et al.

    Analysis on the epidemic characteristics of the epidemic hemorrhagic fever in Fujian province from 2004 to 2007

    Chinese Journal of Zoonoses

    (2009)
  • C.P. Li et al.

    Association between hemorrhagic fever with renal syndrome epidemic and climate factors in Heilongjiang Province, China

    Am.J.Trop. Med. Hyg.

    (2013)
  • Q. Li et al.

    Analysis of incidence and related factors of hemorrhagic fever with renal syndrome in Hebei Province, China

    PLoS One

    (2014)
  • S. Li et al.

    Spatiotemporal heterogeneity analysis of hemorrhagic fever with renal syndrome in China using geographically weighted regression models

    Int. J. Environ. Res. Public Health

    (2014)
  • X. Liu et al.

    Temporal trend and climate factors of hemorrhagic fever with renal syndrome epidemic in Shenyang City, China

    BMC Infect. Dis.

    (2011)
  • X. Liu et al.

    Prevalence of haemorrhagic fever with renal syndrome in mainland China: analysis of national surveillance data, 2004–2009

    Epidemiol. Infect.

    (2012)
  • J. Liu et al.

    Association of haemorrhagic fever with renal syndrome and weather factors in Junan County, China: a case-crossover study

    Epidemiol. Infect.

    (2013)
  • J.N. Mills et al.

    Ecologic studies of rodent reservoirs: their relevance for human health

    Emerg. Infect. Dis.

    (1998)
  • National Health and Family Planning Commission of the PRC

    China Health Statistical Yearbook [Online]

  • Cited by (0)

    View full text