Hantavirus RNA in Saliva from Patients with Hemorrhagic Fever with Renal Syndrome

Lisa Pettersson,Clas Ahlm,Jonas Klingström,Magnus Evander,Åke Lundkvist,Jonas Hardestam

doi:10.3201/eid1403.071242

Lisa Pettersson, Clas Ahlm + Show 4 more

Open Access

https://doi.org/10.3201/eid1403.071242

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Abstract

Hantaviruses cause 2 zoonotic diseases, hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome. Infection is usually initiated after inhalation of virus-contaminated rodent excreta. In addition to the zoonotic infection route, growing evidence suggests person-to-person transmission of Andes virus. For this reason, we studied whether saliva from HFRS patients contained hantavirus. During an outbreak in northern Sweden of nephropathia epidemica (NE), a milder form of hemorrhagic fever with renal syndrome, we collected saliva and plasma from 14 hospitalized NE patients with verified Puumala virus (PUUV) infection. PUUV RNA was detected in saliva from 10 patients (range 1,530-121,323 PUUV RNA copies/mL) by quantitative reverse transcription-PCR. The PUUV S-segment sequences from saliva and plasma of the same patients were identical. Our data show that hantavirus RNA could be detected in human saliva several days after onset of disease symptoms and raise the question whether interhuman transmission of hantavirus may occur through saliva.

Highlights

Hantaviruses cause 2 zoonotic diseases, hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome
Hantavirus RNA in Saliva from nephropathia epidemica (NE) Patients We collected saliva 2–9 days after onset of symptoms from 14 hospitalized NE patients to determine whether hantaviruses were present in human saliva
All patients were positive for Puumala virus (PUUV) RNA in plasma by a real-time RTPCR, and 13 patients had PUUV-specific IgM antibodies in serum (Table)

Summary

Introduction

Hantaviruses cause 2 zoonotic diseases, hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome. Because the saliva of hantavirus-infected rodents contains infectious virus that is transmitted to humans [3,4,7] and person-to-person transmission is strongly suspected for ANDV [13], we studied whether the virus could be detected in saliva of hantavirus-infected patients. For this reason, we collected saliva from patients during an NE outbreak in northern Sweden and analyzed the samples for the presence and levels of PUUV RNA by using a real-time reverse transcription–PCR (RT-PCR) assay

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