Objective To investigate the relationship between disease courses and severity and monocyte subsets distribution and surface CD31 intensity in patients of hemorrhagic fever with renal syndrome (HFRS). Methods Peripheral blood samples from 29 HFRS patients and 13 normal controls were collected. The dynamic changes of classical monocyte subsets (CD14⁺⁺CD16^-), intermediated monocyte subsets (CD14⁺⁺CD16⁺) and non-classical monocyte subsets (CD14⁺CD16⁺⁺) and the mean fluorescent intensity (MFI) of CD31 on monocyte subsets were detected by multiple-immunofluorescent staining and flow cytometry. Results In acute phase of HFRS, the ratio of classical monocyte subsets to total monocytes was dramatically decreased compared to convalescent phase and normal control. It was still much lower in convalescent phase compared to normal controls. The ratio of classical monocyte subsets to total monocytes were decreased in HFRS patients compared to that in normal control, whereas there was no difference between severe/critical groups and mild/moderate groups. On the contrary, the ratio of intermediate monocyte subsets to total monocytes in acute phase of HFRS was significantly increased compared to convalescent phase and normal control. The ratio of intermediate monocyte subsets to total monocytes were increased in HFRS patients compared to that in normal control, whereas no difference was found between severe/critical groups and mild/moderate groups. Phases or severity groups had no difference in ratio of non-classical monocyte subsets to total monocytes. Additionally, the ratio of classical monocyte subsets had a tendency to decline and that of intermediate monocyte subsets showed an increase both to total monocytes between the acute and convalescent phases in 11 HFRS patients with paired-samples. Moreover, in acute phase of HFRS, the mean fluorescent intensity (MFI) of CD31 on three monocyte subsets all decreased, specifically classical monocyte subsets showed the highest MFI of CD31 while the normal control reported the highest MFI of CD31 in non-classical monocyte subsets. In convalescent phase, the MFI of CD31 on classical and intermediated monocyte subsets were both lower than that of normal control, while MFI of CD31 was still significantly lower than normal control on non-classical monocyte subsets. Finally, MFI of CD31 on classical and intermediated monocyte subsets in severe/critical group were both lower than those in mild/moderate group, showing no statistical difference in MFI of CD31 on non-classical monocyte subset across groups of different disease severity. Conclusion The ratio of classical and intermediated monocyte subsets to total monocytes are correlated with the course of HFRS, and so are the surface intensity of CD31 on these monocyte subsets with the disease course and severity. The surface intensity of CD31 on non-classical monocyte subsets, however, is correlated only with the course of the disease. Together, the underlying mechanisms for the observed changes in monocyte subsets in HFRS patients should be further investigated.
Humans ; Monocytes ; Lipopolysaccharide Receptors ; Hemorrhagic Fever with Renal Syndrome ; Receptors, IgG ; Disease Progression

OBJECTIVE: The Guanzhong Plain of Shaanxi Province is a severely afflicted hemorrhagic fever with renal syndrome (HFRS) epidemic area, while HFRS prevalence has decreased in most epidemic areas in China. Little information is available regarding the leading fine-scale influencing factors in this highly HFRS-concentrated area and the roles of natural environmental and socioeconomic factors. To investigate this, two regions in the Guanzhong Plain, that is, the Chang'an District and Hu County, with similar geographical environments, different levels of economic development, and high epidemic prevalence, were chosen as representative areas of the HFRS epidemic. METHODS: Maximum entropy models were constructed based on HFRS cases and fine-scale influencing factors, including meteorological, natural environmental, and socioeconomic factors, from 2014 to 2016. RESULTS: More than 95% of the HFRS cases in the study area were located in the northern plains, which has an altitude of less than 800 m, with topography contributed 84.1% of the impact on the spatial differentiation of the HFRS epidemic. In the northern plains, precipitation and population density jointly affected the spatial differentiation of the HFRS epidemic, with contribution rates of 60.7% and 28.0%, respectively. By comparing the influencing factors of the northern plains of Chang'an District and Hu County, we found that precipitation and the normalized difference vegetation index (NDVI) dominated the HFRS epidemic in the relatively developed Chang'an District, while land-use type, temperature, precipitation and population density dominated the HFRS epidemic in the relatively undeveloped Hu County. CONCLUSION Topography was the primary key factor for HFRS prevalence in the Chang'an District and Hu County, and the spatial differentiation of HFRS was dominated by precipitation and population density in the northern plains. Compared with the influencing factors of the relatively developed Chang'an District, the developing Hu County was more affected by socioeconomic factors. When formulating targeted HFRS epidemic prevention and control strategies in the targeted areas, it is crucial to consider the local economic development state and combine natural environmental factors, including the meteorological environment and vegetation coverage.
Humans ; Hemorrhagic Fever with Renal Syndrome/epidemiology* ; China/epidemiology* ; Epidemics ; Socioeconomic Factors ; Altitude

We report 17 patients with human granulocytic anaplasmosis between January 2015 and September 2018 at two tertiary university hospitals in Korea. Monthly incidence peaked in May and June. Among these patients, we identified three who were co-infected with scrub typhus, and one patient with hemorrhagic fever with renal syndrome.
Anaplasmosis ; Animals ; Coinfection ; Hemorrhagic Fever with Renal Syndrome ; Hospitals, University ; Humans ; Incidence ; Korea ; Scrub Typhus

OBJECTIVES: This study aimed to assess the status of Scrub typhus, Leptospirosis and HFRS(hemorrhagic fever with renal syndrome) among farmers with febrile illness. METHODS: We involved a total of 841 farmers who had febrile illness(508 and 333 village residents were, respectively, three and four district of Gyeongju city) selected during autumn of 2014 and 2015. Data were collected by survey questionnaires and blood sample examination. RESULTS: Serum response rate for Scrub typhus and Leptospirosis was 1.5% each and 1.9% for HFRS. Serum response rate for Scrub typhus was significantly higher for tick-bite cases(38.5%), while Leptospirosis was significantly higher for those who were in fruit–planting work(23.1%). Similarly, serum response rate was significantly higher for HFRS who were working in venyl green house work(25.0%). CONCLUSIONS: Government authority should develop effective and efficient preventive strategies to create awareness of infectious diseases among farmers. Extending information, education and communication be reached to farmers that could change their perception and help early diagnosis and treatment and reduce the disease burden and its complication.
Communicable Diseases ; Early Diagnosis ; Education ; Farmers ; Fever ; Gyeongsangbuk-do ; Hemorrhagic Fever with Renal Syndrome ; Leptospirosis ; Risk Factors ; Scrub Typhus

The Ministry of Food and Drug Safety of Korea made an official announcement in March 2018 that the total number of inoculations of Hantaan virus vaccine (Hantavax®) would change from 3 to 4. Some aspects of this decision remain controversial. Based on the characteristics of Hantaan virus (HTNV) and its role in the pathogenesis of hemorrhagic fever with renal syndrome, it might be difficult to develop an effective and safe HTNV vaccine through the isolate-inactivate-inject paradigm. With the development of high-throughput ‘omics’ technologies in the 21st century, vaccinomics has been introduced. While the goal of vaccinomics is to develop equations to describe and predict the immune response, it could also serve as a tool for developing new vaccine candidates and individualized approaches to vaccinology. Thus, the possibility of applying the innovative field of vaccinomics to develop a more effective and safer HTNV vaccine should be considered.
Hantaan virus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunogenetics ; Korea ; Precision Medicine ; Vaccines ; Vaccines, Synthetic

BACKGROUND: Yeoncheon is an endemic region for hemorrhagic fever with renal syndrome (HFRS) and has been reporting HFRS cases intermittently in other seasons, including autumn. This study was conducted to determine whether a seasonal variation pattern of HFRS exists in Yeoncheon. MATERIALS AND METHODS: From 2002 to 2016, raw data of the number of patients with HFRS in Yeoncheon and nationwide was collected from the Korea Center for Disease Control and Prevention. On the basis of the raw data, the incidence per 100,000 population was calculated for each month of the year. The twelve months were divided into four quarters, and the proportion of the disease by each quarter was calculated. The effects of sex, age, quarter, and time on HFRS occurrence were analyzed by Poisson regression analysis. RESULTS: A total of 6,132 HFRS cases occurred nationwide, and 62 cases occurred in Yeoncheon. The incidence of the disease in Yeoncheon (9.07/100,000) was statistically higher than that nationwide (0.81/100,000). The quarterly incidence showed that occurrence proportion of HFRS was high in the third and fourth quarters (12.9%, 67.5%) nationwide, whereas it was relatively similar in all quarters in Yeoncheon (17.7%, 21.0%, 25.8%, 35.5%). The Poisson regression model showed that the relative risk of HFRS nationwide was 1.322 in the third quarter and 6.903 in the fourth quarter, but Yeoncheon had no risk increase by quarter. CONCLUSION: In this study, HFRS in Yeoncheon demonstrated no seasonal variation pattern compared to that in nationwide Korea, which may be considered a regional characteristic. Furthermore, in other regions where HFRS is endemic, like Yeoncheon, HFRS may arise regardless of seasonal variations.
Centers for Disease Control and Prevention (U.S.) ; Endemic Diseases ; Epidemiology ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Incidence ; Korea* ; Seasons*

No abstract available.
Gyeonggi-do* ; Hemorrhagic Fever with Renal Syndrome* ; Seasons*

BACKGROUND: Yeoncheon is an endemic region for hemorrhagic fever with renal syndrome (HFRS) and has been reporting HFRS cases intermittently in other seasons, including autumn. This study was conducted to determine whether a seasonal variation pattern of HFRS exists in Yeoncheon. MATERIALS AND METHODS: From 2002 to 2016, raw data of the number of patients with HFRS in Yeoncheon and nationwide was collected from the Korea Center for Disease Control and Prevention. On the basis of the raw data, the incidence per 100,000 population was calculated for each month of the year. The twelve months were divided into four quarters, and the proportion of the disease by each quarter was calculated. The effects of sex, age, quarter, and time on HFRS occurrence were analyzed by Poisson regression analysis. RESULTS: A total of 6,132 HFRS cases occurred nationwide, and 62 cases occurred in Yeoncheon. The incidence of the disease in Yeoncheon (9.07/100,000) was statistically higher than that nationwide (0.81/100,000). The quarterly incidence showed that occurrence proportion of HFRS was high in the third and fourth quarters (12.9%, 67.5%) nationwide, whereas it was relatively similar in all quarters in Yeoncheon (17.7%, 21.0%, 25.8%, 35.5%). The Poisson regression model showed that the relative risk of HFRS nationwide was 1.322 in the third quarter and 6.903 in the fourth quarter, but Yeoncheon had no risk increase by quarter. CONCLUSION: In this study, HFRS in Yeoncheon demonstrated no seasonal variation pattern compared to that in nationwide Korea, which may be considered a regional characteristic. Furthermore, in other regions where HFRS is endemic, like Yeoncheon, HFRS may arise regardless of seasonal variations.
Centers for Disease Control and Prevention (U.S.) ; Endemic Diseases ; Epidemiology ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Incidence ; Korea* ; Seasons*

No abstract available.
Gyeonggi-do* ; Hemorrhagic Fever with Renal Syndrome* ; Seasons*

BACKGROUND: An inactivated Hantaan virus vaccine (iHV) has been broadly used as a preventive strategy for hemorrhagic fever with renal syndrome (HFRS) by the South Korean Army. After the vaccination program was initiated, the overall incidence of HFRS cases was reduced in the military population. While there are about 400 HFRS cases annually, few studies have demonstrated the efficacy of the iHV in field settings. Therefore, this study aimed to evaluate the iHV efficacy on HFRS severity. METHODS: From 2009 to 2017, HFRS cases were collected in South Korean Army hospitals along with patients’ vaccination history. HFRS patients were classified retrospectively into two groups according to vaccination records: no history of iHV vaccination and valid vaccination. Vaccine efficacy on the severity of acute kidney injury (AKI) stage and dialysis events were investigated. RESULTS: The effects of the iHV on renal injury severity in between 18 valid vaccinated and 110 non-vaccinated patients were respectively evaluated. In the valid vaccination group, six of the 18 HFRS patients (33.3%) had stage 3 AKI, compared to 60 of the 110 (54.5%) patients in the non-vaccination group. The iHV efficacy against disease progression (VEp) was 58.1% (95% confidence interval, 31.3% to 88.0%). CONCLUSION: The iHV efficacy against the progression of HFRS failed to demonstrate statistically significant protection. However, different severity profiles were observed between the iHV and non-vaccination groups. Additional studies with larger populations are needed to demonstrate the effectiveness of the iHV in patients with HFRS.
Acute Kidney Injury ; Dialysis ; Disease Progression ; Hantaan virus ; Hantavirus* ; Hemorrhagic Fever with Renal Syndrome* ; Hospitals, Military ; Humans ; Incidence ; Military Personnel ; Preventive Medicine ; Retrospective Studies ; Vaccination