Ecological Correlates and Spatiotemporal Trends of Hemorrhagic Fever with Renal Syndrome in West Kazakhstan: A 25-Year One Health Surveillance Study (2001–2025)

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-borne zoonosis of public health concern in West Kazakhstan, yet long-term studies linking human and reservoir surveillance are scarce. We analyzed laboratory-confirmed HFRS cases (2001–2025) and routine rodent surveillance data from five districts of the West Kazakhstan Region within a One Health framework. Associations were estimated using negative binomial regression with district fixed effects and year-clustered robust standard errors (2002–2024; 115 district-years). Overall, 314 cases were recorded (81.2% male), with a major outbreak in 2005 (85 cases) and a resurgence in 2024–2025 (27 and 41 cases). Burlinsky District reported the most cases (44.9%), whereas Baiterek District had the highest incidence in 2016–2025. Of 132,694 rodents examined, 1083 (0.82%) were hantavirus antigen-positive. A larger share of the annual Mus musculus catch obtained in spring–summer was associated with higher case counts (incidence rate ratio 1.051 per percentage point; 95% CI: 1.024–1.080), and this was robust to excluding outbreak years. The number of positive rodents was associated with cases, but not after standardization for sampling effort. These associations do not establish M. musculus as a reservoir and are consistent with, but do not demonstrate, increased peridomestic exposure.