Hemorrhagic fever with renal syndrome (
HFRS) caused by hantaviruses and transmitted by rodents is a significant public health problem in China, and occurs more frequently in
selenium-deficient regions. To study the role of
selenium concentration in
HFRS incidence we used a multidisciplinary approach combining ecological analysis with preliminary experimental data. The incidence of
HFRS in humans was about six times higher in severe
selenium-deficient and double in moderate deficient areas compared to non-deficient areas. This association became statistically stronger after correction for other significant environment-related factors (low elevation, few grasslands, or an abundance of forests) and was independent of geographical scale by separate analyses for different climate regions. A case-control study of
HFRS patients admitted to the hospital revealed increased activity and plasma levels of
selenium binding proteins while
selenium supplementation in vitro decreased viral replication in an endothelial cell model after
infection with a low multiplicity of
infection (MOI). Viral replication with a higher MOI was not affected by
selenium supplementation. Our findings indicate that
selenium deficiency may contribute to an increased prevalence of
hantavirus infections in both humans and rodents. Future studies are needed to further examine the exact mechanism behind this observation before
selenium supplementation in deficient areas could be implemented for
HFRS prevention.