One health perspectives on the epidemiological features and changing incidence of natural focus and vector-borne infectious diseases in China: An observational trend study

Background: Natural focus and vector-borne infectious diseases (NVBDs) pose serious public health challenges in China, involving complex interactions among zoonotic reservoirs, arthropod vectors, and environmental factors that underscore the need for integrated One Health approaches. This study aims to evaluate incidence and mortality trends of 11 Category A and B NVBDs from 2004 to 2020 and assess prevention strategy effectiveness. Methods: Using data from the China Information System for Disease Control and Prevention covering 31 provinces, we analyzed 1,344,214 cases with standardized Joinpoint regression, integrating ecological and animal reservoir data where available to identify drivers across human-animal-environment interfaces. Results: Average annual incidence was 5.599 per 100,000, with brucellosis (2.567), malaria (1.084), and hemorrhagic fever (HFRS) (0.866) accounting for 80.68% of cases. Geographic and temporal patterns revealed key One Health drivers: livestock density correlated with brucellosis (r = 0.71); rodent indices predicted HFRS (AUC = 0.73); and climate anomalies explained 78.4% of dengue variance. Significant declines occurred for Japanese encephalitis (APC = -13.85%) and leptospirosis (APC = -11.81%), while high CFRs persisted for rabies (975.678/1000) and avian influenza (673.469/1000). Northern provinces showed highest incidence; southwestern provinces had highest CFRs. Conclusions: Brucellosis, malaria, hemorrhagic fever caused 80.7% of cases; rabies/avian influenza CFRs >600/1000. Elderly male brucellosis +8.9%, child vaccine-preventable diseases −62%. Southwestern provinces had fatality from limited healthcare. Livestock density (71%), climate anomalies (78.4%), and rodent indices (73%) explained risk variation. Policy: (1) synchronizing veterinary vaccination with human PEP for elderly pastoralists; (2) vector-index warnings in border regions; (3) enhance southwestern critical care; (4) integrate One Health indicators into surveillance.