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Epidemiological characteristics of severe fever with thrombocytopenia syndrome in China from 2010 to 2023
DU Shanshan, SHI Yue, CHEN Xi, LIU Huihui, ZHANG Lijie, HUANG Xiaoxia
Chinese Journal of Schistosomiasis Control
2025, 37 (4 ):
371-379.
Objective To investigate the epidemiological characteristics of severe fever with thrombocytopenia syndrome (SFTS) and to identify factors affecting deaths among SFTS patients in China from 2010 to 2023, so as to provide insights into scientific prevention and control of SFTS. Methods Demographic and epidemiological characteristics of reported, definitively diagnosed SFTS cases in China from 2010 to 2023 were captured from National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention, including current residence address, age, gender, occupation, time of incidence and date of death, and the temporal, spatial and population distributions of SFTS cases were analyzed. The county⁃level incidence of reported SFTS cases in China from 2010 to 2023 was subjected to spatial autocorrelation analysis, and the global Moran's I index was calculated. The high⁃incidence clusters for SFTS were identified using space⁃time scan analysis based on a Poisson distribution model, and the relative risk (RR) and log⁃likelihood ratio (LLR) were estimated. In addition, factors affecting the death and their risk levels were identified among SFTS cases using chi⁃square test and logistic regression models, and the risk of death was evaluated with odds ratio (OR). Results A total of 27 457 SFTS cases were reported in China from 2010 to 2023, and the number of SFTS cases increased from 71 in 2010 to 5 062 in 2023, appearing a tendency towards a rise (b = 5.567, t = 51.35, P < 0.05). A total of 1 326 deaths occurred during the 14⁃year study period, with a case fatality rate of 4.82%, and the annual incidence and fatality of SFTS were 0.005/105 to 0.359/105, and 2.70% to 12.70%. SFTS cases were reported across 27 provinces in China, which were predominantly reported in 7 provinces of Shandong (7 890 cases, 28.74%), Henan (6 286 cases, 22.89%), Anhui (5 718 cases, 20.83%), Hubei (3 938 cases, 14.34%), Liaoning (1 418 cases, 5.16%), Zhejiang (990 cases, 3.61%), and Jiangsu (957 cases, 3.49%), accounting for 99.05% (27 197/27 457) of totally reported cases in China. The time of SFTS incidence appeared a seasonal distribution, and the incidence of SFTS peaked during the period from May to July, with a significant difference in the time of SFTS incidence among provinces (P < 0.01). Among all SFTS cases, there were 12 894 men (46.96%) and 14 563 women (53.04%), and there were 61.27% (16 823/27 457) of SFTS cases at ages of 61 years and older, with farmers as the predominant occupation (84.74%, 23 266/27 457). The annual Moran's I index for SFTS incidence ranged from 0.326 2 to 0.607 5 from 2010 to 2023, and there were significant differences in the Moran's I index for SFTS incidence each year from 2011 to 2023 (z = 10.207 to 18.101, all P values < 0.001), presenting spatial clusters. Local spatial autocorrelation analysis identified "high⁃high", "low⁃high", "high⁃low", and "low⁃low" clusters of reported SFTS cases in China, with "high⁃high" clusters predominantly distributed in 5 provinces of Shandong, Anhui, Hubei, Henan, and Liaoning, covering 63 counties (cities, districts) in 2011 to 134 counties (cities, districts) in 2023. Monthly space⁃time scans identified three high⁃incidence clusters for SFTS in 4 provinces of Henan, Shandong, Jiangsu and Anhui. Univariate analysis revealed the risk of death of reported SFTS cases was associated with province ([χ2] = 605.48, P < 0.01), gender ([χ2] = 23.421, P < 0.01), age ([χ2] = 254.18, P < 0.01), duration from disease onset to diagnosis ([χ2] = 49.895, P < 0.01), and occupation ([χ2] = 30.685, P < 0.01), and multivariate logistic regression analysis revealed a higher risk of death among SFTS cases reported in three provinces of Shandong [OR = 3.081, 95% confidence interval (CI): (2.605, 3.643)], Zhejiang [OR = 4.280, 95% CI: (3.367, 5.441)], and Jiangsu [OR = 2.733, 95% CI: (2.059, 3.628)]; among SFTS cases at ages of 70 years and older [> 70 to 80 years: OR = 4.511, 95% CI: (1.626, 12.511); > 80 years and older: OR = 3.632, 95% CI: (1.241, 10.631)]; among male SFTS cases males than among female cases [OR = 1.243, 95% CI: (1.114, 1.387)]; and among SFTS cases 31 days and longer duration from disease onset to diagnosis [OR = 1.660, 95% CI: (1.254, 2.197)]. Conclusions The number of reported SFTS cases has remarkably risen in China in recent years, with expanded geographic distributions, seasonal distribution and spatial clusters. Targeted preventive and control measures for SFTS are urgently needed.
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