Hantavirus Disease -- Southwestern United States, 1993
Since May 1993, the state health departments in Arizona,
Colorado, New Mexico, and Utah; the Indian Health Service; and CDC,
with the assistance of the Navajo Nation Division of Health, have
been investigating an outbreak of acute respiratory illness related
to a newly recognized hantavirus (1-5). This report updates the
investigation and presents information on a recent case of
hantavirus-associated respiratory disease in a resident of Nevada.
Through July 27, laboratory evidence of acute hantavirus
infection * has been confirmed in 18 persons in the four-corners
area who were ill during 1993: 12 persons in New Mexico, four in
Arizona, and two in Colorado. The median age of the 18 case-
patients was 31 years (range: 13-64 years). Of these persons, 14
(78%) have died. The most recent onset of illness among the
patients with confirmed cases was July 3 (Figure 1). Illnesses in
an additional 28 persons in the four states are under
investigation; 10 (36%) of these persons have died.
On July 10, CDC was contacted about a case of acute
respiratory illness in a 24-year-old resident of central Nevada
whose reported onset of illness was July 7. The case-patient had
bilateral interstitial infiltrates and severe hypoxemia; she
recovered fully. She had not traveled outside central Nevada during
the 3-month period before illness onset. A serum specimen obtained
July 10 demonstrated hantavirus-specific immunoglobulin M
enzyme-linked immunosorbent assay antibodies. CDC and the Division
of Health, Nevada State Department of Human Resources, are
continuing the investigation of this case.
Through July 27, specimens from 55 persons with unexplained
acute respiratory distress syndrome submitted by health authorities
in 24 states outside the four-corners area and in the District of
Columbia have been tested for evidence of hantavirus infection at
CDC. In addition to the Nevada resident, specimens from a
previously reported 58-year-old eastern Texas resident and a
previously reported resident of another state who traveled to the
four-corners area in 1992 have been positive (4,5).
Reported by: C Ward, DO, TB Callister, MD, H Hayes, Nye Regional
Medical Center, Tonopah; LM Oksenholt, DO, Reno; D Nelson, AF
DiSalvo, MD, State Health Laboratory, D Kwalick, MD, State Health
Officer, Div of Health, Nevada State Dept of Human Resources. MJ
Burkhardt, MPH, N Kalishman, MD, M Gallaher, MD, R Voorhees, MD, M
Samuel, DrPH, M Tanuz, G Simpson, MD, L Hughes, PhD, E Umland, MD,
G Oty, MS, L Nims, MS, CM Sewell, DrPH, State Epidemiologist, New
Mexico Dept of Health. K Komatsu, MPH, C Kioski, MPH, K Fleming,
MA, J Doll, PhD, C Levy, MS, TM Fink, P Murphy, B England, MD, M
Smolinski, MD, B Erickson, PhD, W Slanta, L Sands, DO, Acting State
Epidemiologist, Arizona Dept of Health Svcs. P Shillam, MSPH, RE
Hoffman, MD, State Epidemiologist, Colorado Dept of Health. S
Lanser, MPH, CR Nichols, MPA, State Epidemiologist, Utah Dept of
Health. L Hubbard-Pourier, MPH, Div of Health, Navajo Nation,
Window Rock, Arizona. J Cheek, MD, A Craig, MD, R Haskins, MPH, B
Muneta, MD, B Tempest, MD, M Carroll, MD, LA Shands, MPH, JP
Sarisky, MPH, RE Turner, P Bohan, MS, Indian Health Svc. Div of
Field Epidemiology, Epidemiology Program Office; Div of Bacterial
and Mycotic Diseases, Div of Vector-Borne Infectious Diseases,
Scientific Resources Program, and Div of Viral and Rickettsial
Diseases, National Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Newly diagnosed cases of respiratory illness with
evidence of acute hantavirus infection continue to be detected in
the four-corners area. However, the detection of persons with
evidence of acute hantavirus infection associated with respiratory
illness in Texas and Nevada indicates that the potential for
infection is not confined to the four-corners region of the
Southwest. The continued occurrence of cases in the Southwest
demonstrates the importance of adherence to recommended measures to
minimize risk for exposure to rodents or their excreta (6).
Examination of rodents trapped in the four-corners area indicates
that Peromyscus maniculatus (deer mouse) continues to be the
species most commonly trapped and most likely to show evidence of
hantavirus infection.
References
CDC. Outbreak of acute illness -- southwestern United States,
1993. MMWR 1993;42:421-4.
CDC. Update: outbreak of hantavirus infection -- southwestern
United States, 1993. MMWR 1993;42:441-3.
CDC. Update: outbreak of hantavirus infection -- southwestern
United States, 1993. MMWR 1993;42:477-9.
CDC. Update: outbreak of hantavirus infection -- southwestern
United States, 1993. MMWR 1993;42:495-6.
CDC. Update: outbreak of hantavirus infection -- southwestern
United States, 1993. MMWR 1993;42:517-9.
CDC. Hantavirus infection -- southwestern United States: interim
recommendations for risk reduction. MMWR 1993;42(no. RR-12) (in
press).
Any of the following tests positive: IgM antibodies to hantavirus
antigens; fourfold or greater increase in antibody titers to
hantavirus antigens in paired serum specimens; a positive
immunohistochemical stain for hantavirus antigen in tissues; or
positive polymerase chain reaction from tissue specimens.
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