Hantavirus Pulmonary Syndrome, USA, 1993–2009 | CDC EID

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Volume 17, Number 7–July 2011
Research
Hantavirus Pulmonary Syndrome, United States, 1993–2009
Adam MacNeil, Thomas G. Ksiazek, and Pierre E. RollinAuthor affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. MacNeil, T.G. Ksiazek, P.E. Rollin); and University of Texas Medical Branch, Galveston, Texas, USA (T.G. Ksiazek)

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Abstract
Hantavirus pulmonary syndrome (HPS) is a severe respiratory illness identified in 1993. Since its identification, the Centers for Disease Control and Prevention has obtained standardized information about and maintained a registry of all laboratory-confirmed HPS cases in the United States. During 1993–2009, a total of 510 HPS cases were identified. Case counts have varied from 11 to 48 per year (case-fatality rate 35%). However, there were no trends suggesting increasing or decreasing case counts or fatality rates. Although cases were reported in 30 states, most cases occurred in the western half of the country; annual case counts varied most in the southwestern United States. Increased hematocrits, leukocyte counts, and creatinine levels were more common in HPS case-patients who died. HPS is a severe disease with a high case-fatality rate, and cases continue to occur. The greatest potential for high annual HPS incidence exists in the southwestern United States.

In May 1993, a series of cases of an acute illness associated with rapid development of respiratory failure were noted in the Four Corners region of the United States. Surveillance initiated in the area identified 24 cases of compatible illness that had occurred in New Mexico, Arizona, Colorado, and Utah since December 1992; the case-fatality rate was 50%. Preliminary serologic data for case-patients suggested infection with an unknown virus in the family Bunyaviridae and genus Hantavirus (1). This observation was surprising, given that hantaviruses had not been associated with any human diseases in North or South America at that time, and the only known clinical syndrome associated with hantaviruses, hemorrhagic fever with renal syndrome, did not have a predominantly respiratory involvement. However, nucleic acid sequence from a novel hantavirus was rapidly identified in tissue samples of multiple patients, and similarly from deer mice (Peromyscus maniculatus) trapped near the residence of cases, implicating a novel hantavirus as the cause of the disease (2). Additional serologic and molecular data from case-patients and results of trapping studies in the Four Corners region supported these conclusions (3,4).

Since its identification in 1993, hantavirus cardiopulmonary syndrome (HPS) and numerous New World hantavirus species have been described across a wide geographic range of North, Central, and South America (5). In the United States, most HPS cases are likely caused by Sin Nombre virus (6), the virus responsible for the initially identified HPS cases. Other HPS-associated viruses include New York and Monongahela viruses (mice of the genus Peromyscus are reservoirs), associated with HPS in the eastern United States (7–9), Bayou virus, found in the southeastern United States (Oligoryzomys palustris rice rats are reservoirs) (10–12), and Black Creek Canal virus (Sigmodon hispidus cotton rats are reservoirs), which was associated with 1 case of HPS in Florida (13,14).

Hantaviruses are believed to be transmitted by inhalation of rodent secretions and excreta, or possibly through direct contact with an infected rodent. Although clusters of human cases have been identified in the United States, no evidence exists of human-to-human or nosocomial transmission of hantaviruses in North America (15,16) Infrequent but clear instances of human-to-human transmission of Andes virus in Argentina and Chile have been documented (17–19).

The incubation period of HPS is believed to range from 1 to 5 weeks (20). HPS typically begins with a prodromal syndrome, and common symptoms include fever, myalgias, headache, and nausea/vomiting (21,22). After the prodrome, the hallmark of HPS is rapid onset of a severe pulmonary illness, often involving hypoxia, pulmonary edema, and myocardial depression (22–25). Death typically occurs rapidly after hospitalization (21) and often as the result of cardiogenic shock (25). In this report, we evaluate the epidemiologic and clinical characteristics of all known laboratory-confirmed cases of HPS in the United States during 1993–2009.

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Hantavirus Pulmonary Syndrome, USA, 1993–2009 CDC EID

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MacNeil A, Ksiazek TG, Rollin PE. Hantavirus pulmonary syndrome, United States, 1993–2009. Emerg Infect Dis [serial on the Internet]. 2011 Jul [date cited]. http://www.cdc.gov/EID/content/17/7/1195.htm

DOI: 10.3201/eid1707.101306

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Please use the form below to submit correspondence to the authors or contact them at the following address: Adam MacNeil, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop G14, Atlanta, GA 30333, USA; email: aho3@cdc.gov