Sex Differences in the Incidence and Case Fatality Rates From Hemorrhagic Fever With Renal Syndrome in China, 2004–2008

Klein, Sabra L.; Marks, Morgan A.; Li, Wei; Glass, Gregory E.; Fang, Li Qun; Qi, Jianni; Cao, Wu Chun

doi:10.1093/cid/cir232

Cited by 68 publications

(70 citation statements)

References 26 publications

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“…In Sweden and Finland, gender-specific differences in symptoms as well as mortality rates were identified for epidemic nephropathy [27,28]. A similar observation was reported for HFRS in China [29]. Our results showed no association between gender and severity of disease (p = 0.945), which is similar to results reported in German patients [30].…”

Section: Discussionsupporting

confidence: 90%

Clinical and virological characteristics of hantavirus infections in a 2014 Croatian outbreak

Vilibić-Čavlek

Furic²,

Barbić

et al. 2017

J Infect Dev Ctries

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Introduction: Croatia is endemic for hemorrhagic fever with renal syndrome (HFRS), with both Puumala (PUUV) and Dobrava virus (DOBV) documented. Several large outbreaks were recorded in 1995, 2002, and 2012. We analyzed demographic, clinical, laboratory, and virological characteristics of HFRS cases detected in three geographically close natural foci (Ogulin, Slunj, and the Plitvice Lakes surroundings) during the 2014 outbreak. Methodology: From January to December 2014, 122 patients with suspected HFRS were tested for hantavirus IgM/IgG antibodies using an indirect immunofluorescence assay (IFA). Cross-reactive samples were further tested using a western blot (WB). For hospitalized patients from Ogulin area, clinical and laboratory data were analyzed. Results: Acute infection was documented in 57 (46.7%) patients, of whom 75.4% were hospitalized. Ten (8.2%) patients were found to be IgG seropositive. Patients were 15-69 years of age and predominantly male (74.5%). The outbreak started in winter months, with most cases recorded from May to July (80.7%). The most frequently reported symptoms were fever (96.3%), chills/shivering (62.9%), and lumbar pain (48.1%). Mild clinical form was found in 66.7% patients, moderate in 18.5%, and severe in 14.8% patients (all but one infected with PUUV). One patient died. Using IFA, 48.8% patients showed monotypic antibody response, while in 51.2%, cross-reactive antibodies were found. PUUV was confirmed in 94.7% and DOBV in 5.3% HFRS cases by WB. Conclusions: Central mountainous Croatian regions are still highly endemic areas for HFRS. A higher percentage of severe PUUV infections could be at least partly associated with a patient's immune status.

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Section: Discussionsupporting

confidence: 90%

Clinical and virological characteristics of hantavirus infections in a 2014 Croatian outbreak

Vilibić-Čavlek

Furic²,

Barbić

et al. 2017

J Infect Dev Ctries

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“…A similar pattern is found in cancer research, where male research subjects dominate the trials 11 , or in studies of cell tissue and laboratory animals, where the sex of the subject often goes unrecorded 12,13 . Even in research involving both sexes, data is often not analysed by sex, and results may therefore not be accurate for either male or female subjects 14 . Both women and men face disadvantages under these circumstances.…”

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confidence: 99%

One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis

et al. 2017

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“…Although some risk factors are known, for example, age, sex, and living in a rural region (4,26,27), evidence is conflicting (28,29). Some studies have shown that seropositivity is significantly higher in men than in woman, and some have reported sex as a risk factor for Hantavirus infection (7,29,31). In one retrospective study, which investigated the clinical signs of 75 patients with Hantavirus infection aged 16-82 years, the infection rate was 2.5 times higher in men than in women (10).…”

Section: Discussionmentioning

confidence: 99%

“…Yet, other studies have shown no association between sex and frequency of Hantavirus infection (27,30). There is also a lack of consensus regarding the etiology of this sex imbalance, although some hypotheses suggest hormonal, behavioral, immunologic, or genetic factors (31).…”

Section: Discussionmentioning

confidence: 99%

Serologic Investigation of Hantavirus Infection in Patients with Previous Thrombocytopenia, and Elevated Urea and Creatinine Levels in an Epidemic Region of Turkey

Sevencan

Gözalan²,

Uyar

et al. 2015

Jpn J Infect Dis

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SUMMARY:The first cases of Hantavirus infection in Turkey were reported in early 2009 in the Zonguldak and Bartin provinces. The aim of this study was to investigate the presence of Hantavirus antibodies in patients who had clinical and laboratory findings that were potentially associated with Hantavirus infection prior to the epidemic in Bartin in 2009. After screening 314,577 medical records from between 2007 and 2009, the clinical and laboratory data for 442 patients meeting the criteria of coexistent thrombocytopenia, and elevated urea and creatinine levels were transferred to a statistical program. Home visits were made to 170 patients, 84 of whom consented to participate in the study. The participants completed a questionnaire and provided a blood sample. Commercial anti-Hantavirus IgG and IgM ELISA and immunoblotting assays were used, with seropositive samples being confirmed by focus reduction neutralization tests (FRNT). ELISA and/or immunoblotting assays detected 10 positive samples; however, only 7 of these were recorded as positive by FRNT. FRNT positivity was significantly associated with female sex, the presence of a barn near to the house, and working in a forest (P ＜ 0.05). In a Hantavirus endemic region, physicians must keep in mind that thrombocytopenia, and elevated urea and creatinine levels may indicate Hantavirus infection.

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Sex Differences in the Incidence and Case Fatality Rates From Hemorrhagic Fever With Renal Syndrome in China, 2004–2008

Abstract: These data illustrate a paradox in which the incidence of disease is greater for males, but the severity of disease outcome is worse for females. Several behavioral, societal, and biological factors are hypothesized to be involved.

Cited by 68 publications

References 26 publications

Clinical and virological characteristics of hantavirus infections in a 2014 Croatian outbreak

Clinical and virological characteristics of hantavirus infections in a 2014 Croatian outbreak

One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis

Serologic Investigation of Hantavirus Infection in Patients with Previous Thrombocytopenia, and Elevated Urea and Creatinine Levels in an Epidemic Region of Turkey

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