Ahead of Print -Person-to-Person Household and Nosocomial Transmission of Andes Hantavirus, Southern Chile, 2011 - Volume 20, Number 10—October 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Person-to-Person Household and Nosocomial Transmission of Andes Hantavirus, Southern Chile, 2011 - Volume 20, Number 10—October 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 10—October 2014

Research

Person-to-Person Household and Nosocomial Transmission of Andes Hantavirus, Southern Chile, 2011

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• Materials and Methods
• Results
• Discussion
• Suggested Citation

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• Figure 1
• Figure 2

Tables

• Table 1
• Table 2
• Table 3
• Table 4

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Constanza Martinez-Valdebenito, Mario Calvo, Cecilia Vial, Rita Mansilla, Claudia Marco, R. Eduardo Palma, Pablo A. Vial, Francisca Valdivieso, Gregory Mertz, and Marcela Ferrés 

Author affiliations: Pontificia Universidad Católica de Chile, Santiago, Chile (C. Martinez-Valdebenito, R.E. Palma, M. Ferrés); Universidad Austral de Chile, Valdivia, Chile (M. Calvo); Clínica Alemana–Universidad del Desarrollo, Santiago, Chile (C. Vial, C. Marco, P.A. Vial, F. Valdivieso); Secretaría Regional Ministerial, Valdivia, Chile (R. Mansilla); University of New Mexico, Albuquerque, New Mexico, USA (G. Mertz)

Suggested citation for this article

Abstract

Andes hantavirus (ANDV) causes hantavirus cardiopulmonary syndrome in Chile and is the only hantavirus for which person-to-person transmission has been proven. We describe an outbreak of 5 human cases of ANDV infection in which symptoms developed in 2 household contacts and 2 health care workers after exposure to the index case-patient. Results of an epidemiologic investigation and sequence analysis of the virus isolates support person-to-person transmission of ANDV for the 4 secondary case-patients, including nosocomial transmission for the 2 health care workers. Health care personnel who have direct contact with ANDV case-patients or their body fluids should take precautions to prevent transmission of the virus. In addition, because the incubation period of ANDV after environmental exposure is longer than that for person-to-person exposure, all persons exposed to a confirmed ANDV case-patient or with possible environmental exposure to the virus should be monitored for 42 days for clinical symptoms.

Hantavirus cardiopulmonary syndrome (HCPS) is caused by infection with New World hantaviruses. First described in 1993 in the southwestern United States, HCPS has been documented throughout the Americas (1,2). For human cases, the mean incubation period of hantavirus infection from exposure to illness onset is 18.5 (range 7–42) days (3). As of December 31, 2013, a total of 848 human HCPS cases had been reported in Chile; the case-fatality rate has ranged from 32% to 35% per year (4).

The sole confirmed etiologic agent of HCPS in Chile is Andes virus (ANDV). Human infection with this virus occurs from exposure to contaminated excreta and secretions of rodents of the family Cricetidae. Transmission of ANDV between rodents has been experimentally documented after exposure of seronegative rodents to inhalation of aerosolized infected rodent secretions (5). ANDV is endemic in Chile and Argentina and is the only hantavirus for which person-to-person transmission has been documented. Person-to-person transmission of ANDV occurs mainly in family clusters or, less commonly, after activities in which close contact with an infected case-patient has occurred, primarily during the disease prodrome (6–8). A prospective study in Chile found that sexual partners and other close household contacts of ANDV-infected persons showed a 10-fold higher risk of acquiring the virus than household contacts who did not share bed or bedroom with the index case-patient (3,9).

Nosocomial transmission of ANDV has been a matter of concern for infection control practice and for health care workers who provide care for these patients, and in particular for workers who perform invasive procedures. In Argentina, person-to-person transmission of ANDV was documented in a physician who acquired infection after exposure to an ANDV-infected patient shortly after onset of the febrile prodrome (7,8). Although person-to-person transmission in Chile has been epidemiologically documented (10), nosocomial transmission has not been reported. Seroprevalence studies conducted among health care workers in hospitals in Chile where patients with ANDV infection have been treated have reported that health care workers exhibited ANDV IgG antibody at a proportion similar to that of the general population (11,12). Similarly, a study in the southwestern United States found no evidence of nosocomial transmission of another hantavirus, Sin Nombre virus (13).

We describe an outbreak of 5 cases of ANDV infection that occurred in a small, rural community in southern Chile in 2011. We present the epidemiologic and the clinical features of the cases, along with the molecular analysis of the virus strains from each case. Epidemiologic and virus sequence analyses support person-to-person transmission of ANDV in 4 of these cases, including nosocomial transmission in 2 cases.

Ms Martínez-Valdebenito is a research assistant in the Infectious Diseases and Molecular Virology Laboratory, at Pontificia Universidad Católica de Chile School of Medicine. Her research interests focus on understanding the pathogenicity of hantavirus infection and development of novel approaches for prevention and treatment of viral infections.

Acknowledgments

We thank Viviana Sotomayor and Andrea Olea for facilitating communication with local authorities from Corral.

Support for this research was provided by the National Institutes of Health “Andes virus transmission and pathogenesis in Chile” (NIH 2UO1AI045452) and Fondecyt “Evolutionary dynamics of Andes virus in Chile” (1110664).

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Figures

• Figure 1. Timelines showing progression and key events related to each case-patient (A–E) in a cluster of 5 Andes hantavirus cases, southern Chile, 2011. Blue boxes along timeline for index case-patient...
• Figure 2. Phylogenetic analyses of the medium RNA segment (Gc and Gn) of concatenated sequences of Andes hantavirus (ANDV). Isolates from the case-patients (A–E) from the 2011 outbreak in Chile were...

Tables

• Table 1. Primers used for M segment amplification and sequencing of Andes hantavirus
• Table 2. Clinical and epidemiologic features of 5 patients involved in outbreak of ANDV infection, Chile, 2011
• Table 3. Results of environmental investigation for 4 cases of ANDV infection, Chile, 2011
• Table 4. Identity matrix of concatenated Gn and Gc sequences of ANDV isolates from the 5 case-patients in this study compared with sequences from ANDV samples from previous case-patients in the same geographic...

Suggested citation for this article: Martinez-Valdebenito C, Calvo M, Vial C, Mansilla R, Marco C, Palma RE, et al. Person-to-person household and nosocomial transmission of Andes hantavirus, southern Chile. Emerg Infect Dis [Internet]. 2014 Oct [date cited].http://dx.doi.org/10.3201/eid2010.140353

DOI: 10.3201/eid2010.140353