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Volume 17, Number 7—July 2011

Hantavirus Pulmonary Syndrome, United States, 1993–2009

Adam MacNeilComments to Author , Thomas G. Ksiazek, and Pierre E. Rollin
Author affiliations: Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. MacNeil, T.G. Ksiazek, P.E. Rollin); and University of Texas Medical Branch, Galveston, Texas, USA (T.G. Ksiazek)

Main Article

Table 3

Clinical characteristics of HPS case-patients, United States, 1993–2009*

Characteristic No. patients reporting characteristic/no. patients for whom data were available for that characteristic (%)
p value†
All Died Survived
Fever 356/397 (90) 116/132 (88) 239/264 (91) 0.414
Thrombocytopenia‡ 405/418 (97) 131/134 (98) 273/283 (96) 0.477
Increased hematocrit‡ 261/389 (67) 103/130 (79) 157/258 (61) <0.001
Increased creatinine level‡ 120/286 (42) 54/93 (58) 66/193 (34) <0.001
Increased leukocyte count‡ 169/234 (72) 72/83 (87) 96/150 (64) <0.001
Chest radiograph showing unexplained bilateral infiltrates or suggestive of ARDS 390/406 (96) 135/141 (96) 255/265 (96) 0.812
Need for supplemental oxygen 390/405 (96) 134/135 (99) 255/269 (95) 0.025
Intubation of patient 265/430 (62) 129/139 (93) 135/290 (47) <0.001

*HPS, hantavirus pulmonary syndrome; ARDS, acute respiratory distress syndrome.
†By χ2 test for difference in the proportion of HPS case-patients with a clinical characteristic who died and those who survived.
‡Based on qualitative data (yes or no) regarding clinical characteristic from case investigation form. For a small number of case-patients for whom qualitative data were incomplete, but for whom laboratory values were available, qualitative values were assigned on the basis of described clinical cutoff values (24).

Main Article

  1. Centers for Disease Control and Prevention. Outbeak of acute illness—southwestern United States, 1993. MMWR Morb Mortal Wkly Rep. 1993;42:4214.PubMedGoogle Scholar
  2. Nichol  ST, Spiropoulou  CF, Morzunov  S, Rollin  PE, Ksiazek  TG, Feldmann  H, Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science. 1993;262:9147. DOIPubMedGoogle Scholar
  3. Ksiazek  TG, Peters  CJ, Rollin  PE, Zaki  S, Nichol  S, Spiropoulou  C, Identification of a new North American hantavirus that causes acute pulmonary insufficiency. Am J Trop Med Hyg. 1995;52:11723.PubMedGoogle Scholar
  4. Childs  JE, Ksiazek  TG, Spiropoulou  CF, Krebs  JW, Morzunov  S, Maupin  GO, Serologic and genetic identification of Peromyscus maniculatus as the primary rodent reservoir for a new hantavirus in the southwestern United States. J Infect Dis. 1994;169:127180. DOIPubMedGoogle Scholar
  5. Peters  CJ, Khan  AS. Hantavirus pulmonary syndrome: the new American hemorrhagic fever. Clin Infect Dis. 2002;34:122431. DOIPubMedGoogle Scholar
  6. Monroe  MC, Morzunov  SP, Johnson  AM, Bowen  MD, Artsob  H, Yates  T, Genetic diversity and distribution of Peromyscus-borne hantaviruses in North America. Emerg Infect Dis. 1999;5:7586. DOIPubMedGoogle Scholar
  7. Song  JW, Baek  LJ, Gajdusek  DC, Yanagihara  R, Gavrilovskaya  I, Luft  BJ, Isolation of pathogenic hantavirus from white-footed mouse (Peromyscus leucopus). Lancet. 1994;344:1637. DOIPubMedGoogle Scholar
  8. Hjelle  B, Lee  SW, Song  W, Torrez-Martinez  N, Song  JW, Yanagihara  R, Molecular linkage of hantavirus pulmonary syndrome to the white-footed mouse, Peromyscus leucopus: genetic characterization of the M genome of New York virus. J Virol. 1995;69:813741.PubMedGoogle Scholar
  9. Rhodes  LV III, Huang  C, Sanchez  AJ, Nichol  ST, Zaki  SR, Ksiazek  TG, Hantavirus pulmonary syndrome associated with Monongahela virus, Pennsylvania. Emerg Infect Dis. 2000;6:61621. DOIPubMedGoogle Scholar
  10. Morzunov  SP, Feldmann  H, Spiropoulou  CF, Semenova  VA, Rollin  PE, Ksiazek  TG, A newly recognized virus associated with a fatal case of hantavirus pulmonary syndrome in Louisiana. J Virol. 1995;69:19803.PubMedGoogle Scholar
  11. Ksiazek  TG, Nichol  ST, Mills  JN, Groves  MG, Wozniak  A, McAdams  S, Isolation, genetic diversity, and geographic distribution of Bayou virus (Bunyaviridae: hantavirus). Am J Trop Med Hyg. 1997;57:4458.PubMedGoogle Scholar
  12. Torrez-Martinez  N, Bharadwaj  M, Goade  D, Delury  J, Moran  P, Hicks  B, Bayou virus-associated hantavirus pulmonary syndrome in eastern Texas: identification of the rice rat, Oryzomys palustris, as reservoir host. Emerg Infect Dis. 1998;4:10511. DOIPubMedGoogle Scholar
  13. Rollin  PE, Ksiazek  TG, Elliott  LH, Ravkov  EV, Martin  ML, Morzunov  S, Isolation of Black Creek Canal virus, a new hantavirus from Sigmodon hispidus in Florida. J Med Virol. 1995;46:359. DOIPubMedGoogle Scholar
  14. Khan  AS, Gaviria  M, Rollin  PE, Hlady  WG, Ksiazek  TG, Armstrong  LR, Hantavirus pulmonary syndrome in Florida: association with the newly identified Black Creek Canal virus. Am J Med. 1996;100:468. DOIPubMedGoogle Scholar
  15. Vitek  CR, Breiman  RF, Ksiazek  TG, Rollin  PE, McLaughlin  JC, Umland  ET, Evidence against person-to-person transmission of hantavirus to health care workers. Clin Infect Dis. 1996;22:8246. DOIPubMedGoogle Scholar
  16. Wells  RM, Young  J, Williams  RJ, Armstrong  LR, Busico  K, Khan  AS, Hantavirus transmission in the United States. Emerg Infect Dis. 1997;3:3615. DOIPubMedGoogle Scholar
  17. Enría  D, Padula  P, Segura  EL, Pini  N, Edelstein  A, Posse  CR, Hantavirus pulmonary syndrome in Argentina. Possibility of person to person transmission. Medicina (B Aires). 1996;56:70911.PubMedGoogle Scholar
  18. Chaparro  J, Vega  J, Terry  W, Vera  JL, Barra  B, Meyer  R, Assessment of person-to-person transmission of hantavirus pulmonary syndrome in a Chilean hospital setting. J Hosp Infect. 1998;40:2815. DOIPubMedGoogle Scholar
  19. Martinez  VP, Bellomo  C, San Juan  J, Pinna  D, Forlenza  R, Elder  M, Person-to-person transmission of Andes virus. Emerg Infect Dis. 2005;11:184853.PubMedGoogle Scholar
  20. Young  JC, Hansen  GR, Graves  TK, Deasy  MP, Humphreys  JG, Fritz  CL, The incubation period of hantavirus pulmonary syndrome. Am J Trop Med Hyg. 2000;62:7147.PubMedGoogle Scholar
  21. Khan  AS, Khabbaz  RF, Armstrong  LR, Holman  RC, Bauer  SP, Graber  J, Hantavirus pulmonary syndrome: the first 100 US cases. J Infect Dis. 1996;173:1297303. DOIPubMedGoogle Scholar
  22. Duchin  JS, Koster  FT, Peters  CJ, Simpson  GL, Tempest  B, Zaki  SR, Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus Study Group. N Engl J Med. 1994;330:94955. DOIPubMedGoogle Scholar
  23. Nolte  KB, Feddersen  RM, Foucar  K, Zaki  SR, Koster  FT, Madar  D, Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent. Hum Pathol. 1995;26:11020. DOIPubMedGoogle Scholar
  24. Zaki  SR, Greer  PW, Coffield  LM, Goldsmith  CS, Nolte  KB, Foucar  K, Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am J Pathol. 1995;146:55279.PubMedGoogle Scholar
  25. Hallin  GW, Simpson  SQ, Crowell  RE, James  DS, Koster  FT, Mertz  GJ, Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med. 1996;24:2528. DOIPubMedGoogle Scholar
  26. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep. 1997;46:155.PubMedGoogle Scholar
  27. Zaki  SR, Albers  RC, Greer  PW, Coffield  LM, Armstrong  LR, Khan  AS, Retrospective diagnosis of a 1983 case of fatal hantavirus pulmonary syndrome. Lancet. 1994;343:10378. DOIPubMedGoogle Scholar
  28. Zaki  SR, Khan  AS, Goodman  RA, Armstrong  LR, Greer  PW, Coffield  LM, Retrospective diagnosis of hantavirus pulmonary syndrome, 1978–1993: implications for emerging infectious diseases. Arch Pathol Lab Med. 1996;120:1349.PubMedGoogle Scholar
  29. Schwarcz  SK, Shefer  AM, Zaki  SR. Retrospective diagnosis of a fatal case of the hantavirus pulmonary syndrome, 1980. West J Med. 1996;164:34850.PubMedGoogle Scholar
  30. Frampton  JW, Lanser  S, Nichols  CR. Sin Nombre virus infection in 1959. Lancet. 1995;346:7812. DOIPubMedGoogle Scholar
  31. Nerurkar  VR, Song  JW, Song  KJ, Nagle  JW, Hjelle  B, Jenison  S, Genetic evidence for a hantavirus enzootic in deer mice (Peromyscus maniculatus) captured a decade before the recognition of hantavirus pulmonary syndrome. Virology. 1994;204:5638. DOIPubMedGoogle Scholar
  32. Nichol  S. Genetic analysis of hantaviruses and their host relationships. In: Saluzzo J, Dodet B, editors. Factors in the emergence and control of rodent-borne viral diseases: San Francisco: Elsevier; 1999. p. 99–109.
  33. Mills  JN, Amman  BR, Glass  GE. Ecology of hantaviruses and their hosts in North America. Vector Borne Zoonotic Dis. 2010;10:56374. DOIPubMedGoogle Scholar
  34. Ramos  MM, Overturf  GD, Crowley  MR, Rosenberg  RB, Hjelle  B. Infection with Sin Nombre hantavirus: clinical presentation and outcome in children and adolescents. Pediatrics. 2001;108:E27. DOIPubMedGoogle Scholar
  35. Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome in five pediatric patients—four states, 2009. MMWR Morb Mortal Wkly Rep. 2009;58:140912.PubMedGoogle Scholar
  36. Vapalahti  K, Virtala  AM, Vaheri  A, Vapalahti  O. Case–control study on Puumala virus infection: smoking is a risk factor. Epidemiol Infect. 2010;138:57684. DOIPubMedGoogle Scholar
  37. Koster  F, Foucar  K, Hjelle  B, Scott  A, Chong  YY, Larson  R, Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review. Am J Clin Pathol. 2001;116:66572. DOIPubMedGoogle Scholar
  38. Crowley  MR, Katz  RW, Kessler  R, Simpson  SQ, Levy  H, Hallin  GW, Successful treatment of adults with severe hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. Crit Care Med. 1998;26:40914. DOIPubMedGoogle Scholar
  39. Dietl  CA, Wernly  JA, Pett  SB, Yassin  SF, Sterling  JP, Dragan  R, Extracorporeal membrane oxygenation support improves survival of patients with severe hantavirus cardiopulmonary syndrome. J Thorac Cardiovasc Surg. 2008;135:57984. DOIPubMedGoogle Scholar
  40. Ketai  LH, Williamson  MR, Telepak  RJ, Levy  H, Koster  FT, Nolte  KB, Hantavirus pulmonary syndrome: radiographic findings in 16 patients. Radiology. 1994;191:6658.PubMedGoogle Scholar

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