Multiple Genotypes and Reassortants of Severe Fever With Thrombocytopenia Syndrome Virus Co-Circulating in Hangzhou in Southeastern China, 2013-2023.

Severe fever with thrombocytopenia syndrome (SFTS), a tick-borne infectious disease caused by the SFTS virus (SFTSV), is becoming a significant public health threat due to its high mortality rate. Knowledge of SFTSV in southeastern coastal China is limited. The whole genomes of 66 SFTSV strains collected from 2013 to 2023 in Hangzhou, a coastal city in China, were amplified and sequenced to elucidate the geography-related genetic and pathogenic diversity. Hangzhou SFTSVs could be classified into five pure genotype groups (A, B-2, D, E, and F); genotype A was dominant, and genotype E was significantly associated with SFTS fatality. An unclassified sublineage of the L segment was proposed as a novel B-4 subgenotype. Seven types of genetic reassortants (abbreviated as B-3B-3B-1, CCA, B-2AB-2, B-2CB-2, DFD, B-4FF, and B-4B-2B-1 for the L, M, and S segments) were identified, including three novel forms. Six recombination events and ten amino acid substitutions were identified in the Hangzhou viruses. Collectively, our results demonstrated that all known SFTSV genotypes co-circulated in Hangzhou, leading to a gradual increase in genetic diversity and the generation of novel reassortants. Increased surveillance is urgently needed in Hangzhou, a critical region for SFTSV genetic exchange.