This study found that the HFRS epidemic in Hu showed a similar temporal trend to that seen in China; the HFRS incidence in Hu reached its peak in the 1980s and decreased significantly after 1988, which suggests that HFRS was also well-controlled in Hu. There are numerous studies highlighting the effectiveness of the HFRS vaccine [7] and [9]. This study found that with the increasing HFRS vaccination compliance after 1994 in Hu, the HFRS incidence and mortality rate decreased and there was no time cluster of high HFRS

risk during this time period. This phenomenon suggests that the HFRS vaccination may play a role in the control and prevention of HFRS in Hu. In order to verify this inference, we explored the relationship between HFRS incidence IOX1 supplier and vaccination compliance using cross correlation analysis and http://www.selleckchem.com/products/Abiraterone.html wavelet analysis. The cross correlation analysis was used to detect the correlation of two time series in two different time points [29], which is better than a simple correlation analysis

that only analyzes this correlation in one time point. The results of the cross correlation analysis showed that HFRS vaccination compliance can influence the HFRS incidence within one or two years after vaccination, which further suggests the effectiveness of the HFRS vaccination program. In addition, the wavelet analysis showed that the periodicity of the HFRS epidemic was prolonged from about 5 years during 1976–1988 to 15 years after 1988, especially after the start of the HFRS vaccination program in 1994. This transition in cyclical fluctuation of the HFRS epidemic reflected the effective control of HFRS in Hu. It may be driven by the increase of vaccination compliance, which decreased the annual effective recruitment rate of HFRS susceptible individuals and then decreased the HFRS incidence. Although the declining incidence of

HFRS may be attributed to many factors, such as vaccination, public health awareness, rodent control, the changing socioeconomic structure and development of China, the relationship between HFRS epidemic and vaccination can be detected obviously. Therefore, we conclude that the HFRS vaccination was effective PD184352 (CI-1040) in the control and prevention of HFRS in Hu. It should be noted that although the vaccination compliance was high, the annual effective recruitment rate of susceptible individuals and the HFRS incidence did rebound after 2006. This phenomenon may be attributed to many factors that influence an HFRS epidemic, such as climate [30] and [31], land cover [32], rodent density, and so on. In addition, the HFRS incidence of people younger than 16 and older than 60 has increased in Hu in recent years [33]. Therefore, we recommend expanding the scope of HFRS vaccination to people younger than 16 and older than 60. In this study, the periodicity of 15 years was not significant, which may be due to the relatively short study period that was difficult to detect the relatively long periodicity of HFRS.