Epidemiology

Hantaviruses are an emerging and significant global public health threat, which impact more than 200,000 people globally each year.[7]

Hantavirus cardiopulmonary syndrome (HCPS) was first identified in the US in 1993 during the Four Corners (the southwestern part of the US, which covers Utah, Colorado, New Mexico, and Arizona) outbreak.[7]​ It occurs in the US, Canada, and Central and South America. 

The hantavirus subtypes identified as causing HCPS in the US are:[8][9][10][11][12]

  • Sin Nombre virus (SNV) causes most cases of HCPS, initially identified from the Four Corners outbreak and vectored by the deer mouse (Peromyscus maniculatus)​

  • Bayou virus (BAYV) has caused rarer cases, identified in Louisiana and hosted by the rice rat (Oryzomys palustris)

  • Black Creek Canal virus (BCCV) initially identified in Florida and hosted by the cotton rat (Sigmodon hispidus)

  • New York virus (NYV) and Monongahela virus (MONV) hosted by the white-footed mouse (Peromyscus leucopus).

In the US, 890 cases of hantavirus disease have been reported since surveillance began in 1993 according to the Centers for Disease Control (CDC), as of the end of 2023.[13]​ The mean age of patients is 39 years (range 5 to 88 years), with 62% of cases in males and 38% of cases in females. The case fatality rate is 35%.[13]​ A multi-state outbreak of laboratory-confirmed human and/or pet rat Seoul virus infections was initially reported in January 2017 and by March 2017 the outbreak was reported across 11 states, with 17 people affected.[14]​​

Cruise ship outbreak 2026

Year-to-year variation in cases is probably related to rodent vector densities as driven by annual fluctuations in environmental temperature and rainfall, and resulting rodent food supplies.[15] Human risk is related to rodent exposure, particularly peridomestic activities such as cleaning in and around homes with evidence of infestation, and cleaning or inhabiting seasonally closed structures that have had rodent habitation.[16][17]

Other hantaviruses are the cause of HCPS in Central and South America (e.g., most commonly ANDV in South America). See Classification.

In Latin America, the diversity and distribution of hantavirus is highly complex. The epidemiology of hantavirus mainly depends on the microhabitat of its reservoir, the rodents belonging to the Sigmodontinae subfamily. Landscape composition, climate and seasonality, human agricultural activity, and environmental degradation are all important factors of hantavirus epidemiology. The hantaviruses responsible for HCPS in Central and South America belong to three monophyletic clades: Andes, Laguna Negra clade, and Rio Mamore. Each of these clades has been classified as a unique species.[4]

Since the identification of HCPS, cases have been reported in many countries in Central and South America, and an increasing number of hantaviruses and their rodent hosts have been identified. Outbreaks have been reported in Argentina, Bolivia, Chile, Brazil, Peru, Paraguay, French Guiana, Uruguay, Panama, Barbados, and Venezuela. An average of 100 confirmed cases were registered annually in Argentina between 2013 and 2018. Buenos Aires, Salta, and Jujuy had the highest numbers of cases.[18]​​

Rarely, sporadic travel-associated cases have been reported (e.g., the US, Europe). In 2018, the first imported case of ANDV infection into the US was reported in Delaware in a traveler returning from Chile and Argentina.[19]​​

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