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

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.