Epidemiology

Hantavirus cardiopulmonary syndrome (HCPS) was first identified in the US in 1993 during the Four Corners (the southwestern part of the US, which covers Utah, Colorado, New Mexico, and Arizona) outbreak. It occurs in the US, Canada, and Central and South America. Haemorrhagic fever with renal syndrome (HFRS) occurs in Europe and Asia, but has not been reported in North America.

The hantavirus subtypes identified as causing HCPS in the US are:[2][3][5][6][7]

  • Sin Nombre virus (SNV) causes most cases of HCPS, initially identified from the Four Corners outbreak and vectored by the deer mouse (Peromyscus maniculatus)

  • Bayou virus (BAYV) has caused rarer cases, identified in Louisiana and hosted by the rice rat (Oryzomys palustris)

  • Black Creek Canal virus (BCCV) initially identified in Florida and hosted by the cotton rat (Sigmodon hispidus)

  • New York virus (NYV) and Monongahela virus (MONV) hosted by the white-footed mouse (Peromyscus leucopus).

In the US, 833 cases of hantavirus disease have been reported since surveillance began in 1993. The mean age of patients is 37.5 years (range 5 to 84 years), with 62% of cases in males and 38% of cases in females. The case fatality rate is 35%.[8] A multi-state outbreak of Seoul virus infection was reported in January 2017 with 17 people affected in 7 states.[9]

The 2019 European Centre for Disease Prevention and Control (ECDC) report stated that 29 European countries recorded a total of 4046 cases of hantavirus infection; Finland and Germany accounted for 69% of all reported cases.[10]

Year-to-year variation in cases is probably related to rodent vector densities as driven by annual fluctuations in environmental temperature and rainfall, and resulting rodent food supplies.[11] Human risk is related to rodent exposure, particularly peridomestic activities such as cleaning in and around homes with evidence of infestation, and cleaning or inhabiting seasonally closed structures that have had rodent habitation.[12][13]

In Latin America, the diversity and distribution of hantavirus is highly complex. The epidemiology of hantavirus mainly depends on the microhabitat of its reservoir, the rodents belonging to the Sigmodontinae subfamily. Landscape composition, climate and seasonality, human agricultural activity, and environmental degradation are all important factors of hantavirus epidemiology. The hantaviruses responsible for HCPS in Central and South America belong to three monophyletic clades: Andes, Laguna Negra clade, and Rio Mamore. Each of these clades has been classified as a unique species.[4]

Since the identification of HCPS, cases have been reported in many countries in Central and South America, and an increasing number of hantaviruses and their rodent hosts have been identified. Outbreaks have been reported in Argentina, Bolivia, Chile, Brazil, Peru, Paraguay, French Guiana, Uruguay, Panama, Barbados, and Venezuela. An average of 100 confirmed cases were registered annually in Argentina between 2013 and 2018. Beunos Aires, Salta, and Jujuy had the highest numbers of cases.[14]​​

In 2018, the first imported case of Andes virus into the US was reported in a traveller returning from Chile and Argentina.[15]​​

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