# Epidemiological Features and Environmental Factors of Severe Fever with Thrombocytopenia Syndrome Patients in a Highly Endemic Region: A 12-Year Surveillance Study

## TL;DR

This study tracks a severe fever disease in China over 12 years, finding rising cases linked to tick populations, land use, and goat farming, especially affecting the elderly.

## Contribution

The study provides a 12-year epidemiological analysis of SFTS in Yantai, integrating human and tick data to identify environmental and livestock risk factors.

## Key findings

- SFTS incidence in Yantai increased by 13.56% annually from 2013 to 2024, with the highest rise among the elderly.
- Tick infection rates rose from 0.54% in 2019 to 3.24% in 2024 and correlated strongly with human SFTS cases.
- Grassland coverage, woodland coverage, goat density, and tick infection rates were identified as independent risk factors for SFTS.

## Abstract

Background: Severe fever with thrombocytopenia syndrome (SFTS) has become an increasing public health threat in China, with Yantai City representing a major endemic focus. A fine-scale, long-term epidemiological analysis integrating human case data with vector surveillance is essential for understanding local transmission dynamics. Methods: We conducted a retrospective analysis using 12-year (2013–2024) county-level SFTS surveillance data from Yantai City. Temporal trends were analyzed by Joinpoint regression. Concurrent field surveillance of Haemaphysalis longicornis (2019–2024) was used to quantify local SFTSV infection rates in ticks. Associations between SFTS incidence and environmental/livestock factors were evaluated using Spearman’s correlation and multivariable negative binomial regression. Results: A total of 1964 SFTS cases were reported. The annual incidence rate increased from 0.65 to 5.12 per 100,000 population, with an average annual percentage change (AAPC) of 13.56% 2013–2024, showing the most substantial rise among the elderly. Marked spatial heterogeneity was observed, with county-level mean incidence ranging from 0.30 to 5.23 per 100,000. The SFTSV infection rate in ticks surged from 0.54% in 2019 to 3.24% in 2024, and showed a strong positive correlation with human incidence both seasonally (ρ = 0.998) and across counties (ρ = 0.79), a pattern likely driven by shared environmental factors. Multivariable analysis identified grassland coverage (adjusted IRR [aIRR] = 1.21), woodland coverage (aIRR = 2.31), goat density (aIRR = 1.49), and tick infection rate (aIRR = 1.65) as independent risk factors, while urban land was protective (aIRR = 0.83). The overall case fatality rate was 8.86%, showing a declining trend, but was significantly higher in males (10.90%) than in females (7.04%), particularly among the elderly. Conclusions: SFTS incidence in Yantai increased significantly over the past decade, characterized by a heightened burden on the elderly and strong spatiotemporal clustering. Risk is independently mediated by ecological interfaces, notably woodland/grassland habitats and goat rearing. These findings delineate high-risk areas and populations, offering crucial insights for developing targeted public health strategies.