International HPS Cases

Outside of North America, numerous individual cases and small clusters of HPS cases have been reported in Argentina, Bolivia, Brazil, Chile, Ecuador, Paraguay, Panama and Uruguay and Venezuela. Large outbreaks have been rare and have usually been associated with human disturbance and land-use changes or with unusual environmental events such as increased rainfall or periodic bamboo flowering.

In Colombia, Costa Rica and Mexico, rodents carrying viruses similar to Sin Nombre virus found in the United States have been found, but these particular hantaviruses have not been associated with disease in humans. More detailed information is provided below.

Argentina

An outbreak of 18 cases of hantavirus pulmonary syndrome (HPS) occurred in the southern Andean city of El Bolson, in the Rio Negro Province, Argentina, between September 22 and December 5, 1996. All of these cases displayed the common characteristics of HPS. However, some patients displayed a flushed facial appearance reminiscent of some viral hemorrhagic fevers.

Polymerase chain reaction from lung and liver tissues of a patient who had died of the same disease in this region March of 1995 identified a new hantavirus, named Andes virus.

Nearly all of the people who became sick during the outbreak were either permanent residents of the El Bolson area, or had been visitors to it between two and five weeks before their admission to the hospital. In addition, three doctors who treated patients with the disease became ill themselves.

One feature of this outbreak that makes it highly unusual for hantavirus-associated illnesses is that the available data strongly suggest person-to-person transmission. Specifically, the majority of cases had had contact with another patient two to three weeks before becoming ill, and patients tended to become ill within two weeks of each other. This was especially clear in the case of a physician in Buenos Aires (well outside the El Bolson area) who became ill 27 days after taking care of an HPS patient who had been transferred from the outbreak area to Buenos Aires. Person-to-person transmission has not been observed previously with any other hantavirus, either those causing HPS in North, Central and South America, or those causing HFRS in Europe and Asia.

Further reading on hantavirus and HPS in Argentina

R. M. Wells, S. S. Estani, Z. E. Yadon, D. Enría, P. Padula, N. Pini, J. N. Mills, C. J. Peters, and E. L. Segura. An Unusual Hantavirus Outbreak in Southern Argentina: Person-to-Person Transmission? Emerg. Infect. Dis. 3 (2):171-174, 1997.

M. E. Lazaro, G. E. Cantoni, L. M. Calanni, A. J. Resa, E. R. Herrero, M. A. Iacono, D. A. Enría, and S. M. Gonzalez Cappa. Clusters of Hantavirus Infection, Southern Argentina. Emerg. Infect. Dis. 13 (1):104-110, 2007.

N. Pini, S. Levis, G. E. Calderón, J. Ramirez, D. Bravo, E. Lozano, C. Ripoll, S. C. Jeor, T. G. Ksiazek, R. M. Barquez, and D. Enría. Hantavirus Infection in Humans and Rodents, Northwestern Argentina. Emerg. Infect. Dis. 9 (9):1070-1076, 2003.

N. C. Pini, A. Resa, G. Laime, G. Lecot, T. G. Ksiazek, S. Levis, and D. A. Enría. Hantavirus Infection in Children in Argentina. Emerg. Infect. Dis. 4 (1):85-87, 1998.

G. E. Calderón, N. Pini, J. Bolpe, S. Levis, J. Mills, E. Segura, N. Guthmann, G. Cantoni, J. Becker, A. Fonollat, C. Ripoll, M. Bortman, R. Benedetti, M. Sabattini, and D. Enría. Hantavirus Reservoir Hosts Associated with Peridomestic Habitats in Argentina. Emerg. Infect. Dis. 5 (6):792-797, 1999.

P. Padula, M. G. la Valle, M. G. Alai, P. Cortada, M. Villagra, and A. Gianella. Andes Virus and First Case Report of Bermejo Virus Causing Fatal Pulmonary Syndrome. Emerg. Infect. Dis. 8 (4):437-439, 2002.

Bolivia

R. Espinoza, P. Vial, L. M. Noriego, A. Johnson, S. T. Nichol, P. E. Rollin, R. Wells, S. Zaki, E. Reynolds, and T. G. Ksiazek. Hantavirus Pulmonary Syndrome in a Chilean Patient with Recent Travel in Bolivia. Emerg. Infect. Dis. 4 (1):93-95, 1998.

P. Padula, M. G. la Valle, M. G. Alai, P. Cortada, M. Villagra, and A. Gianella. Andes Virus and First Case Report of Bermejo Virus Causing Fatal Pulmonary Syndrome. Emerg. Infect. Dis. 8 (4):437-439, 2002.

Brazil

J. E. Limongi, F. C. da Costa, R. M. C. Pinto, R. C. de Oliveira, C. Bragagnolo, E.R.S. Lemos, M. B.C. de Paula, A. A. Pajuaba Neto, and M. S. Ferreira. Cross-sectional Survey of Hantavirus Infection, Brazil. Emerg. Inf. Dis. 15 (12):1981-1983, 2009.

M. Cordeiro dos Santos, M. V. Guimaraes de Lacerda, S. M. Benedetti, B. C. Albuquerque, A. A. B. Vieira de Aguiar Filho, M. R. Elkhoury, E. S. Travassos da Rosa, P. F. Vasconcelos, D. Barbosa de Almeida, and M. P. Gomes Mourao. Human Hantavirus Infection, Brazilian Amazon. Emerg. Infect. Dis. 12 (7):1165-1167, 2006.

M. R. Elkhoury, M. Y. Wada, E. H. Carmo, E. J. A. Luna, A. N. S. M. Elkhoury, K. G. Teixeira, M. L. Nunes, and N. P. Barbosa. Aspectos Epidemiológicos da Infecção e da Patogenicidade por Hantavírus No Brasil (2004) [PDF – 454 KB]. Boletim Eletronico Epidemiologico 5 (3):1-5, 2005.

L. T. Figueiredo, M. L. Moreli, R. L. de-Sousa, A. A. Borges, G. G. de-Figueiredo, A. M. Machado, I. Bisordi, T. K. Nagasse-Sugahara, A. Suzuki, L. E. Pereira, R. P. de-Souza, L. T. de-Souza, C. T. Braconi, C. M. Harsi, and P. M. de-Andrade-Zanotto. Hantavirus Pulmonary Syndrome, Central Plateau, Southeastern, and Southern Brazil. Emerg. Infect. Dis. 15 (4):561-567, 2009.

L. T. M. Figueiredo, M. L. Moreli, G. M. Campos, and R. L. M. Sousa. Hantaviruses in São Paulo State, Brazil. Emerg. Infect. Dis. 9 (7):891-892, 2003.

R. Holmes, R. Boccanera, L. T. M. Figueiredo, S. R. Mancano, and C. Pane. Seroprevalence of Human Hantavirus Infection in the Ribeirão Preto Region of São Paulo State, Brazil. Emerg. Infect. Dis. 6 (5):560-561, 2002.

W. S. Mendes, A. A. M. da Silva, L. F. C. Aragao, N. J. L. Aragao, M. L. Raposo, M. R. Elkhoury, A. Suzuky, I. B. Ferreira, L. T. de Sousa, and C. S. Pannuit. Hantavirus Infection in Anajatuba, Maranhão, Brazil. Emerg. Infect. Dis. 10 (8(:1496-1498, 2004.

E. S. Rosa, J. N. Mills, P. J. Padula, M. R. Elkhoury, T. G. Ksiazek, W. S. Mendes, E. D. Santos, G. C. Aruojo, V. P. Martinez, and A. Edelstein. Newly Recognized Hantaviruses Associated with Hantavirus Pulmonary Syndrome in Northern Brazil: Partial Genetic Characterization of Viruses and Serologic Implication of Likely Reservoirs. Vector Borne Zoonotic Dis. 5 (1):11-19, 2005.

A. Suzuki, I. Bisordi, S. Levis, J. Garcia, L. E. Pereira, R. P. Souza, T. K. N. Sugahara, P. Noemi, E. Delia, and L. T. M. Souza. Identifying Rodent Hantavirus Reservoirs, Brazil. Emerg. Infect. Dis. 10 (12):2127-2134, 2004.

Canada

M. A. Drebot, H. Artsob, and D. H. Werker. Hantavirus Pulmonary Syndrome in Canada, 1989-1999. Canada Communicable Disease Report 26 (8):65-68, 2000.

S. Reynolds, E. Galanis, M. Krajden, M. Morshed, D. Bowering, W. Abelson, and T. R. Kollmann. Imported Fatal Hantavirus Pulmonary Syndrome. Emerg. Infect. Dis. 13 (9):1424-1425, 2007.

C. Stephen, M. Johnson, and A. Bell. First Reported Cases of Hantavirus Pulmonary Syndrome in Canada. Canada Communicable Disease Report 20 (15):121-125, 1994.

D. H. Werker, A. E. Singh, H. Artsob, and J. Hockin. Hantavirus Pulmonary Syndrome in Canada [PDF – 132 KB]. Canada Communicable Disease Report 21 (9):77-80, 1995.

Chile

Between August 1 and October 8, 1997, an outbreak of HPS occurred in Chile. A total of 25 cases was reported, including three family case clusters. Officials in Chile requested epidemiological assistance from Special Pathogens Branch at CDC, and a team left for the region on September 24 to investigate the outbreak. Viral RNA from captured rodents and patients implicated Andes hantavirus, previously identified in southern Argentina as a cause of HPS, as the infectious agent. Evidence suggests that person-to-person transmission was likely occurring.

Further reading on hantavirus and HPS in Chile

Hantavirus Pulmonary Syndrome — Chile, 1997. MMWR, Vol. 46, No. 40: 949-951, 1997.

R. Espinoza, P. Vial, L. M. Noriego, A. Johnson, S. T. Nichol, P. E. Rollin, R. Wells, S. Zaki, E. Reynolds, and T. G. Ksiazek. Hantavirus Pulmonary Syndrome in a Chilean Patient with Recent Travel in Bolivia. Emerg. Infect. Dis. 4 (1):93-95, 1998.

M. T. Frey, P. C. Vial, C. H. Castillo, P. M. Godoy, B. Hjelle, and M. G. Ferres. Hantavirus Prevalence in the IX Region of Chile. Emerg. Infect. Dis. 9 (7):827-832, 2003.

H. Galeno, J. Mora, E. Villagra, J. Fernandez, J. Hernandez, G. J. Mertz, and E. Ramirez. First Human Isolate of Hantavirus (Andes virus) in the Americas. Emerg. Infect. Dis. 8 (7):657-661, 2002.

B. Murgue, Y. Domart, D. Coudrier, P. E. Rollin, J. P. Darchis, D. Merrien, and H. G. Zeller. First Reported Case of Imported Hantavirus Pulmonary Syndrome in Europe. Emerg. Infect. Dis. 8 (1):106-107, 2002.

R. Riquelme, M. Riquelme, A. Torres, M. L. Rioseco, J. A. Vergara, L. Scholz, and A. Carriel. Hantavirus Pulmonary Syndrome, Southern Chile. Emerg. Infect. Dis. 9 (11):1438-1443, 2003.

J. Toro, J. D. Vega, A. S. Khan, J. N. Mills, P. Padula, W. Terry, Z. Yadón, R. Valderrama, B. A. Ellis, C. Pavletic, R. Cerda, S. Zaki, S. Wun-Ju, R. Meyer, M. Tapia, C. Mansilla, M. Baro, J. A. Vergara, M. Concha, G. Calderon, D. Enria, C.J. Peters, and T. G. Ksiazek. An Outbreak of Hantavirus Pulmonary Syndrome, Chile, 1997. Emerg. Inf. Dis. 4 (4):687-694, 2007.

See also: Ministerio de Salud, Chile (Chilean Ministry of Health).

Colombia

S. Mattar and M. Parra. Serologic Evidence of Hantavirus Infection in Humans, Colombia. Emerg. Infect. Dis. 10 (12):2263-2264, 2004.

Panama

In mid-January 1999, an outbreak of HPS occurred in Panama. The Special Pathogens Branch of the CDC and the Pan-American Health Organization (PAHO) collaborated with health authorities in Panama to investigate the outbreak. Initial CDC testing of specimens implicated Sin Nombre hantavirus as the infectious agent.

Further Reading on Hantavirus and HPS in Panama

V. S. Bayard, P. D. Kitsutani, E. O. Barria, L. A. Ruedas, D. S. Tinnin, I. B. de Mosca, G. Guerrero, R. Kant, A. Garcia, L. Caceres, F. G. Gracia, E. Quiroz, B. Armien, M. Libel, J. N. Mills, A. S. Khan, S. T. Nichol, P. E. Rollin, T. G. Ksiazek, and C. J. Peters. Outbreak of Hantavirus Pulmonary Syndrome, Los Santos, Panama, 1999–2000. Emerg. Infect. Dis. 10 (9):1635-1642, 2004.

Hantavirus Pulmonary Syndrome — Panama, 1999–2000. MMWR 49 (10):205-207, 2000.

Paraguay

P. Padula, V. P. Martinez, C. Bellomo, S. Maidana, Juan J. San, P. Tagliaferri, S. Bargardi, C. Vazquez, N. Colucci, J. Estevez, and M. Almiron. Pathogenic Hantaviruses, Northeastern Argentina and Eastern Paraguay. Emerg. Infect. Dis. 13 (8):1211-1214, 2007.

Uruguay

A. Delfraro, L. Tome, G. D’Elia, M. Clara, F. Achaval, J. C. Russi, and J. R. Rodonz. Juquitiba-like Hantavirus from 2 Nonrelated Rodent Species, Uruguay. Emerg. Infect. Dis. 14 (9):1447-1451, 2008.

A. Delfraro, M. Clara, L. Tome, F. Achaval, S. Levis, G. E. Calderón, D. Enría, M. Lozano, J. Russi, and J. Arbiza. Yellow Pygmy Rice Rat (Oligoryzomys flavescens) and Hantavirus Pulmonary Syndrome in Uruguay. Emerg. Infect. Dis. 9 (7):846-852, 2003.

General Information on International Hantaviruses

PAHO – This regional office of the World Health Organization tracks HPS, among many other diseases and health issues.

C. Schmaljohn and B. Hjelle. Hantaviruses: A Global Disease Problem. Emerg. Infect. Dis. 3 (2):95-104, 1997.