Clinical severity and health-seeking behaviors of cases with hemorrhagic fever with renal syndrome: A comparative study across spatial clusters in Jiangxi Province, China.

BACKGROUND: Hemorrhagic fever with renal syndrome (HFRS) is a significant public health concern in Jiangxi Province, China, where both Hantaan (HTNV) and Seoul (SEOV) co-circulate. Previous studies have identified three distinct clusters of HFRS epidemic in Jiangxi Province, characterized by geographical separation and heterogeneous incidence levels. We hypothesized that clinical severity and healthcare-seeking behaviors may vary across these clusters, and thus conducted a retrospective study to examine this hypothesis. METHODS: We retrospectively analyzed 4,614 HFRS cases (13-year period) from 63 counties. Cases were classified into four areas based on prior spatial study, representing distinct hilly and plain regions with different proximity to major water bodies and mountains. Data on HFRS cases were collected by county-level CDC staff using a nationally standardized case investigation questionnaire. Clinical severity and healthcare-seeking behaviors (hospital level, onset-to-visit interval) were compared. RESULTS: HFRS cases in Cluster I exhibited the highest clinical severity (22.41% severe, 6.65% critical), while cases in Cluster II were strikingly mild (2.62% severe, 1.31% critical). Median onset-to-visit interval was longest in Cluster II (5 days) vs others (2-4 days). Hospital preference varied: Cluster I primarily used Class II hospitals (65.88%); Cluster II showed near-equal use of Class II (48.44%) and III (47.01%); Cluster III and non-clustered areas favored higher-level hospitals. CONCLUSION: Our findings confirmed that Jiangxi Province, though a mixed epidemic focus, exhibited distinct spatial heterogeneity in clinical severity, and healthcare-seeking behaviors. These findings underscore the need for regionally tailored strategies in HFRS prevention and control.