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Toledo J, Haby MM, Reveiz L, Sosa Leon L, Angerami R, Aldighieri S. Evidence for human-to-human transmission of hantavirus: a systematic review. J Infect Dis 2021; 226:1362-1371. [PMID: 34515290 PMCID: PMC9574657 DOI: 10.1093/infdis/jiab461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background Hantavirus is known to be transmitted from rodents to humans. However, some reports from Argentina and Chile have claimed that the hantavirus strain Andes virus (ANDV) can cause human-to-human transmission of the disease. The aim of this systematic review was to assess the evidence for human-to-human transmission of hantavirus. Methods We searched PubMed (inception to 28 February 2021), Cochrane Central, Embase, LILACS and SciELO (inception to 3 July 2020), and other sources. We included studies that assessed whether interpersonal contact with a person with laboratory-confirmed hantavirus infection led to human-to-human transmission. Two reviewers conducted screening, selection, data extraction, and risk of bias assessment. Results Twenty-two studies met the inclusion criteria. Meta-analysis was not possible due to heterogeneity. With the exception of 1 prospective cohort study of ANDV in Chile with serious risk of bias, evidence from comparative studies (strongest level of evidence available) does not support human-to-human transmission of hantavirus infection. Noncomparative studies with a critical risk of bias suggest that human-to-human transmission of ANDV may be possible. Conclusions The balance of the evidence does not support the claim of human-to-human transmission of ANDV. Well-designed cohort and case-control studies that control for co-exposure to rodents are needed to inform public health recommendations.
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Affiliation(s)
- Joao Toledo
- Department of Health Emergencies, Pan American Health Organization, Washington, District of Columbia, USA
| | - Michelle M Haby
- Correspondence: Michelle M. Haby, PhD, Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Col. Centro Hermosillo, Sonora 83000, Mexico ()
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, District of Columbia, USA
| | | | - Rodrigo Angerami
- Hospital Epidemiology Section, Hospital of Clinics, State University of Campinas, Campinas, São Paulo, Brazil
| | - Sylvain Aldighieri
- Hospital Epidemiology Section, Hospital of Clinics, State University of Campinas, Campinas, São Paulo, Brazil
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Abstract
ABSTRACT: Hantaviruses productively infect endothelial cells in their rodent reservoirs and humans, but the infection only causes disease in humans – hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome. Despite the enormous progress that has been made in understanding the pathogenesis and immune responses of hantavirus infection, there is a large gap in our molecular-based knowledge of hantaviral proteins in their structures, functions and the mechanisms that facilitate their entry, replication and assembly. Importantly, we know little about the specific viral determinants and viral protein–host interactions that drive differences noted in immune responses between the reservoir and humans. This review discusses our current understanding and future work needed for unraveling the biology of these viruses in their reservoirs and in humans.
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Affiliation(s)
- Ryan C McAllister
- Department of Pharmacology & Toxicology, University of Louisville, KY 40202, USA
- Center for Predictive Medicine for Biodefense & Emerging Infectious Diseases, KY, USA
| | - Colleen B Jonsson
- Department of Pharmacology & Toxicology, University of Louisville, KY 40202, USA
- Center for Predictive Medicine for Biodefense & Emerging Infectious Diseases, KY, USA
- Department of Microbiology and Immunology, University of Louisville, KY 40202, USA
- Departments of Microbiology & Immunology & Pharmacology & Toxicology, Center for Predictive Medicine for Biodefense & Emerging Infectious Diseases, University of Louisville, Clinical & Translational Research Building, 505 South Hancock Avenue, Louisville, KY 40202, USA
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Gimaque JBL, Bastos MDS, Braga WSM, Oliveira CMCD, Castilho MDC, Figueiredo RMPD, Galusso EDS, Itapirema EF, Figueiredo LTMD, Mourão MPG. Serological evidence of hantavirus infection in rural and urban regions in the state of Amazonas, Brazil. Mem Inst Oswaldo Cruz 2012; 107:135-7. [PMID: 22310547 DOI: 10.1590/s0074-02762012000100019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 11/25/2011] [Indexed: 11/22/2022] Open
Abstract
Hantavirus disease is caused by the hantavirus, which is an RNA virus belonging to the family Bunyaviridae. Hantavirus disease is an anthropozoonotic infection transmitted through the inhalation of aerosols from the excreta of hantavirus-infected rodents. In the county of Itacoatiara in the state of Amazonas (AM), Brazil, the first human cases of hantavirus pulmonary and cardiovascular syndrome were described in July 2004. These first cases were followed by two fatal cases, one in the municipality of Maués in 2005 and another in Itacoatiara in 2007. In this study, we investigated the antibody levels to hantavirus in a population of 1,731 individuals from four different counties of AM. Sera were tested by IgG/IgM- enzyme-linked immune-sorbent assay using a recombinant nucleocapsid protein of the Araraquara hantavirus as an antigen. Ten sera were IgG positive to hantavirus (0.6%). Among the positive sera, 0.8% (1/122), 0.4% (1/256), 0.2% (1/556) and 0.9% (7/797) were from Atalaia do Norte, Careiro Castanho, Itacoatiara and Lábrea, respectively. None of the sera in this survey were IgM-positive. Because these counties are distributed in different areas of AM, we can assume that infected individuals are found throughout the entire state, which suggests that hantavirus disease could be a local emerging health problem.
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Abstract
Hantavirus pulmonary syndrome, also known as hantavirus cardiopulmonary syndrome, is a recently described infectious syndrome found throughout the Americas. Although infection is sporadic and uncommon compared with other atypical pneumonia syndromes, its high mortality rate warrants the maintenance of a high index of suspicion in rural settings. Because no specific therapies are available for the disease, prevention and early recognition play an important role in reducing mortality from the disease. This article reviews the nature of the viruses that cause hantavirus pulmonary syndrome, the epidemiology and ecology of disease transmission, and disease recognition, treatment, and prevention.
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Affiliation(s)
- Steven Q Simpson
- Division of Pulmonary and Critical Care Medicine, University of Kansas, 3901 Rainbow Boulevard, Mail Stop 3007, Kansas City, KS 66160-7381, USA.
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Bayard V, Kitsutani PT, Barria EO, Ruedas LA, Tinnin DS, Muñoz C, de Mosca IB, Guerrero G, Kant R, Garcia A, Caceres L, Gracia FG, Quiroz E, de Castillo Z, Armien B, Libel M, Mills JN, Khan AS, Nichol ST, Rollin PE, Ksiazek TG, Peters CJ. Outbreak of hantavirus pulmonary syndrome, Los Santos, Panama, 1999-2000. Emerg Infect Dis 2004; 10:1635-42. [PMID: 15498167 PMCID: PMC3320309 DOI: 10.3201/eid1009.040143] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An outbreak of hantavirus pulmonary syndrome occurred in the province of Los Santos, Panama, in late 1999 and early 2000. Eleven cases were identified; 9 were confirmed by serology. Three cases were fatal; however, no confirmed case-patient died. Case-neighborhood serologic surveys resulted in an overall hantavirus antibody prevalence of 13% among household and neighborhood members from the outbreak foci. Epidemiologic investigations did not suggest person-to-person transmission of hantavirus infection. By use of Sin Nombre virus antigen, hantavirus antibodies were detected in Oligoryzomys fulvescens and Zygodontomys brevicauda cherriei. This outbreak resulted in the first documented cases of human hantavirus infections in Central America.
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Affiliation(s)
- Vicente Bayard
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
- University of Panama, Panama City, Panama
| | | | | | | | | | | | | | | | - Rudick Kant
- Pan American Health Organization, Washington DC, USA
| | - Arsenio Garcia
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Lorenzo Caceres
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | | | - Evelia Quiroz
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | | | - Blas Armien
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Marlo Libel
- Pan American Health Organization, Washington DC, USA
| | - James N. Mills
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ali S. Khan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart T. Nichol
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pierre E. Rollin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Larrieu E, Herrero E, Cachau MG, Labanchi JL, Mancini S, Padula P, Cantoni G, Cavagion L, Alvarez E, Bruni M, Albarracin S, Arellano O. Seroprevalencia de hantavirus en roedores y casos humanos en el sur de la Argentina. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2003. [DOI: 10.1590/s1415-790x2003000100009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
En la Provincia de Río Negro, Argentina, se presentaron casos humanos de síndrome pulmonar por hantavirus (SPH) en la región de la cordillera andino patagónica. El virus Andes ha sido identificado en la región, tanto en el roedor Oligoryzomys longicaudatus como en seres humanos, demostrándose la transmisión principalmente del roedor al hombre y la factibilidad de la transmisión de persona a persona. El objetivo del presente trabajo es presentar nueva información sobre especies de roedores portadores de hantavirus en Argentina, su prevalencia de anticuerpos para hantavirus (período 1999-2001) y la relación del tamaño de las poblaciones de roedores y su seroprevalencia con la ocurrencia de casos humanos (período 1996-2001). Para ello, se procedió a la colocación de 3973 trampas para captura viva de roedores, tipo sherman en seis operativos efectuados entre octubre de 1999 y mayo de 2001. Se obtuvieron muestras de sangre de los roedores las que fueron procesadas mediante enzimoinmunoensayo con antígenos elaborados a partir de virus Andes. Una síntesis de los resultados indica 397 roedores capturados, con un éxito de trampeo del 10% y una prevalencia de anticuerpos contra hantavirus del 1.0%. Se observaron importantes diferencias en las especies capturadas en cada una de las regiones. Se capturaron O. longicaudatus y A. Olivaceus seropositivos y O. flavescens y C. Laucha potencialmente portadores de hantavirus Se registraron 6 casos humanos en el período 1993-1995 (correspondientes a estudios retrospectivos), 21 casos se notificaron en el período 1996-1998 y 6 en el período 1999-2001 Se analiza la correlación entre ocurrencia de casos humanos, seroprevalencia en roedores y éxito de trampeo.
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Abstract
As hantaviroses constituem infecções zoonóticas amplamente distribuídas em todo o mundo. A febre hemorrágica com síndrome renal mostra-se endêmica na Ásia e Europa, acometendo milharea de pessoas anualmente. A síndrome cardiopulmonar pelo hantavírus, reconhecida como entidade clínica desde 1993, representa o protótipo das doenças emergentes e encontra-se distribuída em diversos países do continente americano, inclusive o Brasil. Ambas são transmitidas ao homem através da inalação de partículas virais eliminadas nas fezes e urina de roedores domésticos e silvestres. Trata-se de doenças sistêmicas febris que podem acometer vários órgãos, destacando-se o rim na febre hemorrágica com síndrome renal e os pulmões e o coração na síndrome cardiopulmonar. A taxa de letalidade da hantavirose americana alcança 50%. Diagnostica-se as hantaviroses através de provas sorológicas imunoenzimáticas ao identificar-se anticorpos específicos das classes IgM e IgG. Não há tratamento específico. Recomenda-se hidratação cuidadosa, indicação precoce de diálise nas formas renais e administração de drogas vasoativas nos períodos de hipotensão e choque. A administração de corticoesteróides e da ribavirina está sendo avaliada em estudos controlados. O número de casos dessas viroses tem crescido no Brasil ano a ano, e cumpre alertar os profissionais de saúde sobre a ocorrência dessas entidades nos vários estados do país, possibilitando diagnóstico precoce e tratamento adequado nos casos suspeitos da doença.
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Mendes WS, Aragão NJ, Santos HJ, Raposo L, Vasconcelos PF, Rosa ES, Elkhoury MR. Hantavirus pulmonary syndrome in Anajatuba, Maranhão, Brazil. Rev Inst Med Trop Sao Paulo 2001; 43:237-40. [PMID: 11558007 DOI: 10.1590/s0036-46652001000400013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors report a confirmed case of hantavirus pulmonary syndrome in the rural area of the municipality of Anajatuba, state of Maranhão. Two other suspected cases from the same region are also described. The confirmed case involved a previously healthy young woman who died with signs and symptoms of acute respiratory insufficiency 5 days after presenting fever, myalgia and a dry cough. The patient was a student who was helping her parents with work in the fields; it was a habit of the family to store rice inside the house. The suspected cases involved two first-degree relatives working as field hands who died of acute respiratory insufficiency 24 and 48 hours, respectively, after presenting fever, myalgia and a dry cough. Both stored rice and corn inside their home. People living in the region reported massive infestations with rats in the woods and fields.
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Affiliation(s)
- W S Mendes
- Núcleo de Patologia Tropical e Medicina Social, Universidade Federal do Maranhão, São Luís, MA, Brasil.
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Schelenz S. Hospital Infection Society International Activities. Argentina - British infection control experience. J Hosp Infect 2000; 44:317-8. [PMID: 10772839 DOI: 10.1053/jhin.2000.0709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Schelenz
- Department of Microbiology, St Thomas's Hospital, London, SE1 7EH
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Ferreira MS, Nishioka SD, Santos TL, Santos RP, Santos PS, Rocha A. Hantavirus pulmonary syndrome in Brazil: clinical aspects of three new cases. Rev Inst Med Trop Sao Paulo 2000; 42:41-6. [PMID: 10742726 DOI: 10.1590/s0036-46652000000100007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hantavirus pulmonary syndrome (HPS) has been recognized recently in Brazil, where 28 cases have been reported as of September 1999. We report here the clinical and laboratory findings of three cases whose diagnoses were confirmed serologically. All the patients were adults who presented a febrile illness with respiratory symptoms that progressed to respiratory failure that required artificial ventilation in two of them. Laboratory findings were most of the time consistent with those reported in the United States in patients infected with the Sin Nombre virus, and included elevated hematocrit and thrombocytopenia; presence of atypical lymphocytes was observed in one patient. The chest radiological findings observed in all the patients were bilateral, diffuse, reticulonodular infiltrates. Two patients died. Histopathological examination of the lungs of these patients revealed interstitial and alveolar edema, alveolar hemorrhage, and mild interstitial pneumonia characterized by infiltrate of immunoblasts and mononuclear cells. In the epidemiologic investigation of one of the cases, serologic (ELISA) tests were positive in 3 (25%) out of 12 individuals who shared the same environmental exposure. HPS should be included in the differential diagnosis of interstitial pneumonia progressing to acute respiratory failure.
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Affiliation(s)
- M S Ferreira
- Centro de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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