Hantavirus infections

Abstract

Over the past few decades understanding and recognition of hantavirus infection has greatly improved worldwide, but both the amplitude and the magnitude of hantavirus outbreaks have been increasing. Several novel hantaviruses with unknown pathogenic potential have been identified in a variety of insectivore hosts. With the new hosts, new geographical distributions of hantaviruses have also been discovered and several new species were found in Africa. Hantavirus infection in humans can result in two clinical syndromes: haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) caused by Old World and New World hantaviruses, respectively. The clinical presentation of HFRS varies from subclinical, mild, and moderate to severe, depending in part on the causative agent of the disease. In general, HFRS caused by Hantaan virus, Amur virus and Dobrava virus are more severe with mortality rates from 5 to 15%, whereas Seoul virus causes moderate and Puumala virus and Saaremaa virus cause mild forms of disease with mortality rates <1%. The central phenomena behind the pathogenesis of both HFRS and HCPS are increased vascular permeability and acute thrombocytopenia. The pathogenesis is likely to be a complex multifactorial process that includes contributions from immune responses, platelet dysfunction and the deregulation of endothelial cell barrier functions. Also a genetic predisposition, related to HLA type, seems to be important for the severity of the disease. As there is no effective treatment or vaccine approved for use in the USA and Europe, public awareness and precautionary measures are the only ways to minimize the risk of hantavirus disease.

Hantavirus maintenance and transmission in reservoir host populations

“…While spillover to sympatric rodents has been identified [51], human infection is by far the most extensively studied form of spillover. All currently known human hantaviruses infections are derived from rodents, with disease severity ranging from asymptomatic to fatal, and the case fatality rate and proportion of asymptomatic infections largely determined by the virus type and human genetic predispositions [52]. These infections are considered dead-end events for the virus, due to an absence of human-to-human transmission.…”

Orthohantavirus pulmonary syndrome in Santa Cruz and Tarija, Bolivia, 2018

“…During the last few decades, understanding and recognition of infections due to species of the genus Orthohantavirus (formerly Hantavirus) have improved significantly worldwide (Avsic-Zupanc et al, 2019;Vargas et al, 2006). In many regions and countries, the amplitude and magnitude of orthohantavirus outbreaks have been increasing (Avsic-Zupanc et al, 2019;Jonsson et al, 2010). Nevertheless, only a limited number of studies on these infections have been performed in certain countries.…”

“…The eco-epidemiology of orthohantavirus infections is complex, particularly as related to their maintenance by rodents and insectivores, and there is usually a tight pairing between the specific virus and host species (Avsic-Zupanc et al, 2019;Montgomery et al, 2012;Montoya-Ruiz et al, 2014). All orthohantaviruses known to cause human disease are associated with rodent hosts (Montgomery et al, 2012).…”

Hantavirus Infection with Renal Failure and Proteinuria, Colorado, USA, 2019

“…Hantavirus pulmonary syndrome (HPS) is associated with pneumonitis and has a broad clinical spectrum that ranges from mild or no symptoms to fulminant respiratory failure. Hemorrhagic fever with renal syndrome (HFRS) is a characteristic clinical entity that manifests with fever, hypotension, and renal failure (1) and can also manifest as a mild glomerulonephritis and renal insufficiency (2). Eurasian hantaviruses (Hantaan virus, Puumala virus, and Seoul virus [SEOV]) cause HFRS; SEOV has a worldwide distribution (1).…”

“…Hemorrhagic fever with renal syndrome (HFRS) is a characteristic clinical entity that manifests with fever, hypotension, and renal failure (1) and can also manifest as a mild glomerulonephritis and renal insufficiency (2). Eurasian hantaviruses (Hantaan virus, Puumala virus, and Seoul virus [SEOV]) cause HFRS; SEOV has a worldwide distribution (1). However, HPS is the clinical manifestation of most domestically acquired hantavirus infections in the United States.…”