Abstract
Finland has the highest incidence of hantavirus infections globally, with a significant impact on public health. The large coverage of boreal forests and the cyclic dynamics of the dominant forest rodent species, the bank vole Myodes glareolus, explain most of this. We review the relationships between Puumala hantavirus (PUUV), its host rodent, and the hantavirus disease, nephropathia epidemica (NE), in Finland. We describe the history of NE and its diagnostic research in Finland, the seasonal and multiannual cyclic dynamics of PUUV in bank voles impacting human epidemiology, and we compare our northern epidemiological patterns with those in temperate Europe. The long survival of PUUV outside the host and the life-long shedding of PUUV by the bank voles are highlighted. In humans, the infection has unique features in pathobiology but rarely long-term consequences. NE is affected by specific host genetics and risk behavior (smoking), and certain biomarkers can predict the outcome. Unlike many other hantaviruses, PUUV causes a relatively mild disease and is rarely fatal. Reinfections do not exist. Antiviral therapy is complicated by the fact that when symptoms appear, the patient already has a generalized infection. Blocking vascular leakage measures counteracting pathobiology, offer a real therapeutic approach.
Highlights
Hantavirus diseases are currently classified into two categories: hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), hemorrhages occur in HCPS, and the heart and lungs are affected in HFRS
A review of hematological findings is included in this Special Issue [Koskela et al Coagulopathy in Puumala hantavirus infection
Three to seven years after the acute nephropathia epidemica (NE), patients had slightly more proteinuria, higher glomerular filtration rate (GFR), and higher systolic blood pressure compared with the healthy controls [83]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Nephropathia epidemica (NE) is a hemorrhagic fever; the clinical picture is dominated by acute hemorrhagic tubulointerstitial nephritis. The first detailed description of the clinical features of NE came from Finland [1]. PUUV, the only known hantaviral human pathogen in Finland [3], has a significant impact on public health [4]. The reported average incidence of diagnosed PUUV infections in Finland is 31 to 39 cases per 100,000 inhabitants [5,6,7]. Because of the high incidence of NE in the Finnish population, much research has been invested, in addition to NE epidemiology, virology, and clinical course, into the ecology of virus in the carrier species, the bank vole Myodes glareolus. We review here the main fields and results of hantavirus research in Finland. There are original and review articles in this Special Issue
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