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Epidemiology and diagnosis of hantavirus infections

INTRODUCTION

Hantaviruses comprise a genus of enveloped viruses within the family Bunyaviridae. All medically important hantaviruses are carried by rodents of the families Muridae and Cricetidae. These pathogens are associated with two severe, acute febrile illnesses:

Hemorrhagic fever with renal syndrome (HFRS, caused by viruses of the Old World)

Hantavirus cardiopulmonary syndrome (HCPS, caused by viruses of the New World), also known as hantavirus pulmonary syndrome (HPS)

The epidemiology and diagnosis of hantavirus infections, with a special emphasis on HCPS, will be reviewed here. The clinical manifestations, pathogenesis, and prevention of hantavirus infection are discussed separately. (See "Hantavirus cardiopulmonary syndrome" and "Renal involvement with hantavirus infection (hemorrhagic fever with renal syndrome)" and "Pathogenesis of hantavirus infections".)

VIROLOGY

The precise number of identified hantavirus species is a matter of debate, but at least 20 distinct viral species exist in nature; at least 11 are associated with human disease (table 1).

             

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Literature review current through: Mar 2014. | This topic last updated: Feb 25, 2014.
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References
Top
  1. Gavrilovskaya IN, Shepley M, Shaw R, et al. beta3 Integrins mediate the cellular entry of hantaviruses that cause respiratory failure. Proc Natl Acad Sci U S A 1998; 95:7074.
  2. Schmaljohn C, Hjelle B. Hantaviruses: a global disease problem. Emerg Infect Dis 1997; 3:95.
  3. Peters CJ, Khan AS. Hantavirus pulmonary syndrome: the new American hemorrhagic fever. Clin Infect Dis 2002; 34:1224.
  4. Hjelle B, Glass GE. Outbreak of hantavirus infection in the Four Corners region of the United States in the wake of the 1997-1998 El Nino-southern oscillation. J Infect Dis 2000; 181:1569.
  5. Fulhorst CF, Milazzo ML, Armstrong LR, et al. Hantavirus and arenavirus antibodies in persons with occupational rodent exposure. Emerg Infect Dis 2007; 13:532.
  6. Trencséni, T, Keleti, B. Clinical aspects and epidemiology of haemorrhagic fever with renal syndrome. Budapest: Akadémai Kiadó, 1971.
  7. Padula PJ, Edelstein A, Miguel SD, et al. [Epidemic outbreak of Hantavirus pulmonary syndrome in Argentina. Molecular evidence of person to person transmission of Andes virus]. Medicina (B Aires) 1998; 58 Suppl 1:27.
  8. Young JC, Hansen GR, Graves TK, et al. The incubation period of hantavirus pulmonary syndrome. Am J Trop Med Hyg 2000; 62:714.
  9. Ferres M, Vial P, Marco C, et al. Prospective evaluation of household contacts of persons with hantavirus cardiopulmonary syndrome in chile. J Infect Dis 2007; 195:1563.
  10. Pettersson L, Klingström J, Hardestam J, et al. Hantavirus RNA in saliva from patients with hemorrhagic fever with renal syndrome. Emerg Infect Dis 2008; 14:406.
  11. Lee HW, van der Groen G. Hemorrhagic fever with renal syndrome. Prog Med Virol 1989; 36:62.
  12. SHEEDY JA, FROEB HF, BATSON HA, et al. The clinical course of epidemic hemorrhagic fever. Am J Med 1954; 16:619.
  13. Lee HW, Lee PW, Johnson KM. Isolation of the etiologic agent of Korean Hemorrhagic fever. J Infect Dis 1978; 137:298.
  14. Lee HW, Baek LJ, Johnson KM. Isolation of Hantaan virus, the etiologic agent of Korean hemorrhagic fever, from wild urban rats. J Infect Dis 1982; 146:638.
  15. Brummer-Korvenkontio M, Vaheri A, Hovi T, et al. Nephropathia epidemica: detection of antigen in bank voles and serologic diagnosis of human infection. J Infect Dis 1980; 141:131.
  16. Avsic-Zupanc T, Xiao SY, Stojanovic R, et al. Characterization of Dobrava virus: a Hantavirus from Slovenia, Yugoslavia. J Med Virol 1992; 38:132.
  17. Tsai TF, Bauer SP, Sasso DR, et al. Serological and virological evidence of a Hantaan virus-related enzootic in the United States. J Infect Dis 1985; 152:126.
  18. LeDuc JW, Smith GA, Johnson KM. Hantaan-like viruses from domestic rats captured in the United States. Am J Trop Med Hyg 1984; 33:992.
  19. Lee PW, Goldgaber D, Gibbs CJ Jr, et al. Other serotypes of hemorrhagic fever with renal syndrome viruses in Europe. Lancet 1982; 2:1405.
  20. Glass GE, Watson AJ, LeDuc JW, Childs JE. Domestic cases of hemorrhagic fever with renal syndrome in the United States. Nephron 1994; 68:48.
  21. Woods C, Palekar R, Kim P, et al. Domestically acquired seoul virus causing hemorrhagic fever with renal syndrome-Maryland, 2008. Clin Infect Dis 2009; 49:e109.
  22. Roig IL, Musher DM, Tweardy DJ. Severe pulmonary involvement in a case attributed to domestically acquired Seoul hantavirus in the United States. Clin Infect Dis 2012; 54:91.
  23. From the Centers for Disease Control and Prevention. Infectious diseases update: outbreak, hantavirus infection--southwestern United States, 1993. JAMA 1993; 270:25.
  24. Jenison S, Hjelle B, Simpson S, et al. Hantavirus pulmonary syndrome: clinical, diagnostic, and virologic aspects. Semin Respir Infect 1995; 10:259.
  25. Nichol ST, Spiropoulou CF, Morzunov S, et al. Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science 1993; 262:914.
  26. Chizhikov VE, Spiropoulou CF, Morzunov SP, et al. Complete genetic characterization and analysis of isolation of Sin Nombre virus. J Virol 1995; 69:8132.
  27. Hjelle B, Jenison S, Mertz G, et al. Emergence of hantaviral disease in the southwestern United States. West J Med 1994; 161:467.
  28. Hjelle B, Jenison S, Torrez-Martinez N, et al. A novel hantavirus associated with an outbreak of fatal respiratory disease in the southwestern United States: evolutionary relationships to known hantaviruses. J Virol 1994; 68:592.
  29. Johnson AM, Bowen MD, Ksiazek TG, et al. Laguna Negra virus associated with HPS in western Paraguay and Bolivia. Virology 1997; 238:115.
  30. Hjelle B, Krolikowski J, Torrez-Martinez N, et al. Phylogenetically distinct hantavirus implicated in a case of hantavirus pulmonary syndrome in the northeastern United States. J Med Virol 1995; 46:21.
  31. López N, Padula P, Rossi C, et al. Genetic identification of a new hantavirus causing severe pulmonary syndrome in Argentina. Virology 1996; 220:223.
  32. Morzunov SP, Feldmann H, Spiropoulou CF, et al. A newly recognized virus associated with a fatal case of hantavirus pulmonary syndrome in Louisiana. J Virol 1995; 69:1980.
  33. Rollin PE, Ksiazek TG, Elliott LH, et al. Isolation of black creek canal virus, a new hantavirus from Sigmodon hispidus in Florida. J Med Virol 1995; 46:35.
  34. Vincent MJ, Quiroz E, Gracia F, et al. Hantavirus pulmonary syndrome in Panama: identification of novel hantaviruses and their likely reservoirs. Virology 2000; 277:14.
  35. Centers for Disease Control and Prevention (CDC). Notes from the field: hantavirus pulmonary syndrome --- Maine, April 2011. MMWR Morb Mortal Wkly Rep 2011; 60:786.
  36. Klein SL, Marks MA, Li W, et al. Sex differences in the incidence and case fatality rates from hemorrhagic fever with renal syndrome in China, 2004-2008. Clin Infect Dis 2011; 52:1414.
  37. Jameson LJ, Logue CH, Atkinson B, et al. The continued emergence of hantaviruses: isolation of a Seoul virus implicated in human disease, United Kingdom, October 2012. Euro Surveill 2013; 18:4.
  38. Taori SK, Jameson LJ, Campbell A, et al. UK hantavirus, renal failure, and pet rats. Lancet 2013; 381:1070.
  39. Zaki SR, Khan AS, Goodman RA, et al. Retrospective diagnosis of hantavirus pulmonary syndrome, 1978-1993: implications for emerging infectious diseases. Arch Pathol Lab Med 1996; 120:134.
  40. Frampton JW, Lanser S, Nichols CR. Sin Nombre virus infection in 1959. Lancet 1995; 346:781.
  41. Wilson C, Hjelle B, Jenison S. Probable hantavirus pulmonary syndrome that occurred in New Mexico in 1975. Ann Intern Med 1994; 120:813.
  42. MacNeil A, Ksiazek TG, Rollin PE. Hantavirus pulmonary syndrome, United States, 1993-2009. Emerg Infect Dis 2011; 17:1195.
  43. Centers for Disease Control and Prevention. US HPS cases, by state of exposure. http://www.cdc.gov/hantavirus/surveillance/state-of-exposure.html (Accessed on March 29, 2013).
  44. Centers for Disease Control and Prevention (CDC). Hantavirus pulmonary syndrome--five states, 2006. MMWR Morb Mortal Wkly Rep 2006; 55:627.
  45. Centers for Disease Control and Prevention (CDC). Hantavirus pulmonary syndrome in visitors to a national park--Yosemite Valley, California, 2012. MMWR Morb Mortal Wkly Rep 2012; 61:952.
  46. Núñez JJ, Fritz CL, Knust B, et al. Hantavirus Infections among Overnight Visitors to Yosemite National Park, California, USA, 2012. Emerg Infect Dis 2014; 20:386.
  47. Ruo SL, Li YL, Tong Z, et al. Retrospective and prospective studies of hemorrhagic fever with renal syndrome in rural China. J Infect Dis 1994; 170:527.
  48. Ferrer JF, Jonsson CB, Esteban E, et al. High prevalence of hantavirus infection in Indian communities of the Paraguayan and Argentinean Gran Chaco. Am J Trop Med Hyg 1998; 59:438.
  49. Williams RJ, Bryan RT, Mills JN, et al. An outbreak of hantavirus pulmonary syndrome in western Paraguay. Am J Trop Med Hyg 1997; 57:274.
  50. Armien B, Pascale JM, Bayard V, et al. High seroprevalence of hantavirus infection on the Azuero peninsula of Panama. Am J Trop Med Hyg 2004; 70:682.
  51. Gonzalez LM, Lindsey AE, Hjelle B, et al. Prevalence of antibodies to Sin Nombre virus in humans living in rural areas of southern New Mexico and western Texas. Virus Res 2001; 74:177.
  52. Hjelle B, Jenison S, Torrez-Martinez N, et al. Rapid and specific detection of Sin Nombre virus antibodies in patients with hantavirus pulmonary syndrome by a strip immunoblot assay suitable for field diagnosis. J Clin Microbiol 1997; 35:600.
  53. Centers for Disease Control and Prevention (CDC). Hantavirus pulmonary syndrome in five pediatric patients - four states, 2009. MMWR Morb Mortal Wkly Rep 2009; 58:1409.
  54. Pini NC, Resa A, del Jesús Laime G, et al. Hantavirus infection in children in Argentina. Emerg Infect Dis 1998; 4:85.
  55. Niklasson B, Hornfeldt B, Lundkvist A, et al. Temporal dynamics of Puumala virus antibody prevalence in voles and of nephropathia epidemica incidence in humans. Am J Trop Med Hyg 1995; 53:134.
  56. Castillo C, Naranjo J, Sepúlveda A, et al. Hantavirus pulmonary syndrome due to Andes virus in Temuco, Chile: clinical experience with 16 adults. Chest 2001; 120:548.
  57. Toro J, Vega JD, Khan AS, et al. An outbreak of hantavirus pulmonary syndrome, Chile, 1997. Emerg Infect Dis 1998; 4:687.
  58. Howard MJ, Doyle TJ, Koster FT, et al. Hantavirus pulmonary syndrome in pregnancy. Clin Infect Dis 1999; 29:1538.
  59. Pai RK, Bharadwaj M, Levy H, et al. Absence of infection in a neonate after possible exposure to sin nombre hantavirus in breast milk. Clin Infect Dis 1999; 29:1577.
  60. Bharadwaj M, Nofchissey R, Goade D, et al. Humoral immune responses in the hantavirus cardiopulmonary syndrome. J Infect Dis 2000; 182:43.
  61. Ksiazek TG, Peters CJ, Rollin PE, et al. Identification of a new North American hantavirus that causes acute pulmonary insufficiency. Am J Trop Med Hyg 1995; 52:117.
  62. Hjelle B. Hantavirus pulmonary syndrome. In: Laboratory Diagnosis of Viral Infections, Lennette EH, Smith TF (Eds), Marcel Decker, New York 1999. p.421.
  63. Lee HW. Korean hemorrhagic fever. Prog Med Virol 1982; 28:96.
  64. Elgh F, Lundkvist A, Alexeyev OA, et al. Serological diagnosis of hantavirus infections by an enzyme-linked immunosorbent assay based on detection of immunoglobulin G and M responses to recombinant nucleocapsid proteins of five viral serotypes. J Clin Microbiol 1997; 35:1122.
  65. Kallio-Kokko H, Lundkvist A, Plyusnin A, et al. Antigenic properties and diagnostic potential of recombinant dobrava virus nucleocapsid protein. J Med Virol 2000; 61:266.
  66. Sjölander KB, Elgh F, Kallio-Kokko H, et al. Evaluation of serological methods for diagnosis of Puumala hantavirus infection (nephropathia epidemica). J Clin Microbiol 1997; 35:3264.
  67. Vapalahti O, Kallio-Kokko H, Närvänen A, et al. Human B-cell epitopes of Puumala virus nucleocapsid protein, the major antigen in early serological response. J Med Virol 1995; 46:293.
  68. Padula PJ, Rossi CM, Della Valle MO, et al. Development and evaluation of a solid-phase enzyme immunoassay based on Andes hantavirus recombinant nucleoprotein. J Med Microbiol 2000; 49:149.
  69. Saksida A, Duh D, Korva M, Avsic-Zupanc T. Dobrava virus RNA load in patients who have hemorrhagic fever with renal syndrome. J Infect Dis 2008; 197:681.
  70. Zaki SR, Greer PW, Coffield LM, et al. Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am J Pathol 1995; 146:552.
  71. Green W, Feddersen R, Yousef O, et al. Tissue distribution of hantavirus antigen in naturally infected humans and deer mice. J Infect Dis 1998; 177:1696.
  72. Hjelle B, Tórrez-Martínez N, Koster FT, et al. Epidemiologic linkage of rodent and human hantavirus genomic sequences in case investigations of hantavirus pulmonary syndrome. J Infect Dis 1996; 173:781.