Ulyana Gubareva ^1,2,3* Roberta Horth ^3,4 Dilyara Nabirova ^3,4 Nur Tukhanova ^5,6 Elmira Utegenova ^1,7 Zhanna Shapiyeva ¹ Zangar Turliyev ¹ Nazym Tleumbetova ⁸ Nurbek Maykanov ⁹ Manar Smagul ^10,3 Alan Landay ¹¹ Gavin Cloherty ^12,13 Francisco Averhoff ^12,13 Edmond F. Maes ¹⁴

• ¹ Scientific and Practical Center of Sanitary and Epidemiological Expertise and Monitoring, Almaty, Kazakhstan
• ² Project Implementation unit of The Global Fund to Fight AIDS, Tuberculosis and Malaria in Kazakhstan, Almaty, Kazakhstan
• ³ Central Asia Field Epidemiology Training Program, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
• ⁴ Division of Global Health Protection in Central Asia, United States Centers for Disease Control and Prevention, Almaty, Kazakhstan
• ⁵ Kazakh National Medical University, Almaty, Kazakhstan
• ⁶ M. Aikimbaev National Research Center for Especially Dangerous Infections, Almaty, Kazakhstan
• ⁷ International Institution of Postgraduate Education, Almaty, Kazakhstan
• ⁸ Reference laboratory for the control of Especially Dangerous Infections, Almaty, Kazakhstan, Almaty, Kazakhstan
• ⁹ Ural anti-plague station, Uralsk, Kazakhstan
• ¹⁰ National Center for Public Health, Astana, Kazakhstan
• ¹¹ University of Texas Medical Center, Galvelston, Texas, United States
• ¹² Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
• ¹³ Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
• ¹⁴ Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States

Background: Orthohantaviruses (also known as hantaviruses) are pathogens, primarily transmitted by rodents, that can cause hemorrhagic fever with renal syndrome (HFRS). In endemic regions of Kazakhstan, no confirmed HFRS cases were detected between 2020 and 2022 raising concerns about detection. estimate antibody seroprevalence for hantaviruses and identify associated risk factors among high-risk adults in western Kazakhstan in 2023. Methods: In this cross-sectional study, adults were randomly sampled from public clinic registries in 14 villages in West Kazakhstan during June–July 2023. We interviewed 921 participants and collected serum samples which were tested for presence of hantavirus specific IgG antibodies using enzyme-linked immunosorbent assay (ELISA). Socio-demographic, clinical characteristics, and residential risk-factor data were self-reported. We assessed factors associated with seropositivity using multivariable Poisson regression, adjusting for key variables such as age and gender. Results: Among 921 participants, 63.0% were female, median age was 53 years, 72.0% resided in single houses and 38.0% reported encounters with rodents. Among 921 participants we found 3.1% (n=28) hantavirus seroprevalence (95% confidence interval [CI]: 2.1–4.3). No seropositive participants had prior hospitalization or symptoms consistent with hantavirus. Three seronegative participants had previous hospitalization for hemorrhagic fever with renal syndrome. Over one-third (38%) of participants encountered rodents or droppings in the past year in their homes or workplaces. Higher seroprevalence was found among office occupational workers than unemployed people (prevalence ratio [PR]:7.3, 95%CI: 1.3–53.5), and among those who lived near ponds than those who did not (PR:11.5, 95%CI: 1.6–54.7). Conclusion: Overall, the seroprevalence was low, but indicated some risk of infection among the adult population. Our results highlight potential occupational and residential risk factors for hantavirus infection in West Kazakhstan. Relevant public health interventions should include educating the population about promoting preventive practices, workplace hygiene, rodent control measures, and enhanced case diagnosis and management.