Objective To understand the epidemiological and clinical characteristics of hemorrhagic fever with renal syndrome (HFRS) in Jingzhou, Hubei province, from 2018 to 2022, identify factors associated with severe cases, and provide evidence for the effective prevention and control of HFRS.

Methods The information was collected from 855 HFRS cases reported in Jingzhou from 2018 to 2022 for a descriptive epidemiological analysis. Logistic regression model was used for the analysis on the factors associated with severe HFRS cases.

Results In the 855 cases, 36(27.60%) were mild cases, 333(38.95%) were moderate cases, 169(19.77%) were severe cases, 49(5.73%) were cases with critical illness, and 68 (7.95%) were cases with unknown severity. Thirteen cases were fatal, 737 cases recovered, and the outcomes of 105 cases were unknown. The case fatality rate was 1.73%. The incidence of HFRS showed a bimodal pattern, with the peak occurring during April-July (586 cases, 68.54%) and the sub-peak occurring during November-January (143 cases, 16.73%). The top three areas with high average annual incidence rates were Jiangling (7.12/100 000), Gong'an (5.68/100 000), and Jianli (3.89/100 000). In the 855 HFRS cases, farmers accounted for the highest proportion (532 cases, 62.22%), and 90.60% of the cases had been involved in the productions of rice, shrimp, and other crops. The exposure factor investigation showed a higher proportion of workplaces with rats or rat excrement (74.09%), households with rats (65.28%), and food/grain stores without protection against rodent (61.34%). The top three clinical symptoms and signs were fatigue (783 cases, 94.00%), fever (777 cases, 93.93%), and headache (530 cases, 63.93%). The top three laboratory examination results were decreased platelets (670 cases, 87.13%), positive urine protein (497 cases, 76.46%), and increased white blood cells (470 cases, 62.42%). The analysis on risk factors for severe HFRS, after controlling for area difference, showed that the presence of membranous substances, casts in urine, or hematuria (odds ratio=2.60, 95% confidence interval: 1.47-4.61) was the risk factor.

Conclusion The epidemiology of HFRS in Jingzhou showed significant spatiotemporal clustering, with the high incidence in middle-aged and elderly male farmers, especially those being engaged in rice planting and rice-shrimp farming. The clinical symptoms of HFRS are atypical, necessitating increased health education efforts for key populations and areas. Additionally, it is essential to strengthen the training of medical personnel to improve the diagnosis, treatment and prevention of HFRS.