Human Hantavirus Infections Research Articles

Non-human primates in outdoor enclosures: Risk for infection with rodent-borne hantaviruses

Different species of non-human primates have been exploited as animal disease models for human hantavirus infections. To study the potential risk of natural hantavirus infection of non-human primates, we investigated serum samples from non-human primates of three species living in outdoor enclosures of the German Primate Center (GPC), Göttingen, located in a hantavirus endemic region of central Germany. For that purpose we used serological assays based on recombinant antigens of the bank vole ( Myodes glareolus) transmitted Puumala virus (PUUV) and the common and field vole ( Microtus arvalis, Microtus agrestis) associated Tula virus (TULV) which are both broadly geographically distributed in Germany. In 24 out of 251 (9.6%) monkey sera collected in 2006 PUUV- and/or TULV-reactive immunoglobulin G (IgG) antibodies were detected. Investigation of follow-up sera from 13 animals confirmed for two animals a seroconversion due to hantavirus exposure at the GPC. To prove the origin of the infection, wild rodents from the surrounding regions were analyzed by hantavirus-specific reverse transcriptase-PCR analysis. In 6 of the 73 investigated bank voles and 3 of the 19 investigated Microtus spp. PUUV- and TULV-specific nucleic acid sequences, respectively, were detected. In conclusion, our investigations demonstrate for the first time natural infections of non-human primates in outdoor enclosures in Germany. These findings highlight the importance of hantavirus surveillance in those primate housings and corresponding preventive measures against wild rodents, particularly in hantavirus endemic regions.

Serologic Survey of Hantavirus Infection, Brazilian Amazon

To the Editor: Since the etiology of hantavirus cardiopulmonary syndrome (HCPS) was recognized in 1993 in the United States (1), various hantaviruses have been associated with the syndrome in South America (2,3). Depending on the viral genotype involved, hantavirus infection can take a wide variety of forms, from asymptomatic or oligosymptomatic to the classic clinical form (4,5). The first cases of HCPS in Brazil were reported in the state of Sao Paulo in 1993 (6,7). In 2000, an outbreak of HCPS was reported in the municipality of Anajatuba in the state of Maranhao in the Maranhao western lowlands, a microregion in the Brazilian Amazon (8,9). An ecologic study in this region identified antibodies against hantaviruses in wild rodents (Oligoryzomys fornesi and Holochilus sciureus). Analysis of RNA from the viruses isolated from these 2 rodent species showed 2 new hantaviruses, which were named Anajatuba and Rio Mearim, respectively (10). The Maranhao western lowlands is a swampy region that consists of 21 municipalities and ≈400,000 inhabitants. A cross-sectional study was conducted from August 2004 through September 2006 to identify exposures and activities associated with hantavirus infection. A convenience sample comprising 6 of the 21 municipalities in the region was selected: Pinheiro in the north, Vitoria do Mearim in the south, Sao Bento and Sao Joao Batista in the east, and Penalva and Viana in the west. In each municipality, a village in the countryside was randomly chosen. All members of those communities were invited to participate. Persons who agreed to take part in the study were interviewed, and a standardized questionnaire was used to collect demographic information. Participants provided blood samples after giving written informed consent. ELISA to detect immunoglobulin (Ig) G antibodies against hantaviruses was performed in the Arbovirology and Hemorrhagic Fevers Department at the Evandro Chagas Institute (Belem, PA, Brazil) by using antigen from the Sin Nombre virus supplied by the Centers for Disease Control and Prevention (Atlanta, GA, USA). Samples were initially screened at 1:100, and all positive results were confirmed in a serial dilution (starting at 1:400) test. Positive samples were those with titers >400 (10). Odds ratios (ORs) were estimated by logistic regression. Variables with p<0.20 in the univariate analysis were subjected to multivariate analysis. Our study comprised 1,386 persons. The seroprevalence of antihantavirus antibodies in the 6 municipalities was 4.7% (65/1,389), distributed as follows: Sao Joao Batista, 2.6% (8/307); Sao Bento, 3.1% (6/195); Penalva, 3.5% (5/145); Pinheiro, 4.8% (13/273); Viana, 5.6% (9/160); and Vitoria do Mearim, 7.8% (24/309). Most persons interviewed were farmers and illiterate and lived in rammed-earth huts. Killing rats in the fields was reported by 24.3% (337/1,389). According to univariate analysis, seeing rats in the dwelling or in the field, having killed rats in the dwelling or in the fields, being a farmer, being male, and being >20 years of age were associated with IgG against hantaviruses. No association was found between storage of grain inside a dwelling or presence of natural predators of rodents, e.g., domestic cats and snakes such as the red-tailed boa, and antibodies against hantaviruses (Table). Table Univariate analysis of risk factors associated with hantavirus infection in humans, Maranhao western lowlands, Brazil, 2006* Because of colinearity between rat exposure variables, only “having killed rats in the field” was submitted to adjusted analysis. In the multivariate analysis, being >20 years of age and having killed rats in the field remained associated with hantavirus infection. In the model that did not consider sex and age, being a farmer (OR 2.63, 95% confidence interval [CI] 1.56%–4.41%) and having killed rats in the field (OR 2.30, 95% CI 1.38%–3.84%) were independently associated with hantavirus infection. Hantavirus infection is endemic to the Maranhao western lowlands. It has characteristics of an occupational infection associated with agricultural work, but age mostly explained the effect of being a farmer (OR for being a farmer 1.29, 95% CI 0.74%–2.24%, adjusted for sex and age). Exposure to rodents appeared to occur both in fields and dwellings. Although serologic evidence indicated that hantaviruses were circulating in the 6 municipalities studied, no cases of HCPS were reported in any of them. This finding suggests that either only mild or asymptomatic cases were occurring and that these were not recognized as HCPS or that cases of hantavirus were not being detected and reported. However, in a study in 2000 in Anajatuba in a cohort of 234 persons who did not initially have IgG against hantaviruses, 4 seroconversions to IgG against these viruses were detected; 2 of these infections were asymptomatic and 2 were self-limiting febrile illnesses that occurred after 24 months of follow-up (9). The present study reinforces the suspicion that mild or atypical cases are occurring in this region and may be the main reason classical hantavirus infection has not been identified.

Hantaviruses in small mammals and humans in the coastal region of Zhejiang Province, China

To gain more insights into the epidemiology of hantaviruses in the coastal region of Zhejiang Province, China, the morbidity and mortality of hemorrhagic fever with renal syndrome (HFRS) were analyzed in two coastal areas: Cixi (hilly terrain) and Wenzhou (mountainous terrain). More HFRS cases have been reported in Cixi than in Wenzhou. Annual incidence rate of HFRS in Cixi had been on the level of approximately 1.5/100,000 from 1968 (when the first HFRS case was reported) to 2007, with the highest incidence rate of 8.54/100,000 in 1999. The annual incidence rate in Wenzhou has been relatively low, less than 0.5/100,000 since the first HFRS case was reported in 1981. A total of 461 rodents and 199 shrews were captured in these two areas. Hantavirus antibodies were detected in 16 of 241 (6.64%) Rattus norvegicus and 13 of 122 (10.66%) R. flavipectus. Interestingly, hantavirus antigens were identified in 6 of 196 (3.06%) Suncus murinus. Genetic analysis showed that partial M and S segment sequences recovered from rats in the two regions belong to Seoul virus (SEOV) and can be assigned into two genetic lineages. SEOV variants that belong to these two lineages of viruses are distributed widely in China and have been found outside China. As most trapped rodents were rats and SEOV was the only hantavirus detected, these results suggested that SEOV plays an important role in human hantavirus infections. They also reinforce the need for vigilance in preventing HFRS caused by hantaviruses in the coastal region.

Serological Evidence of Human Hantavirus Infections in Guinea, West Africa

We recently discovered a novel hantavirus, Sangassou virus, in Guinea, West Africa. Using enzyme-linked immunosorbent assays followed by confirmatory and serotyping assays, we retrospectively detected hantavirus antibodies in 3 (4.4%) of 68 patients with fever of unknown origin in Sangassou village, Forest Guinea. A population-based survey in Forest Guinea (n = 649) found the prevalence of hantavirus antibodies to be 1.2%. Specific neutralizing antibodies against Sangassou virus were demonstrated in serum samples from 2 patients and in 2 serum samples of the serosurvey. Our data allow us to conclude that hantavirus infections may be a significant unrecognized medical problem in at least this part of Africa.

Hemorrhagic Fever with Renal Syndrome, Vietnam

Hemorrhagic Fever with Renal Syndrome, Vietnam

Laboratory Diagnosis of Human Hantavirus Infection: Novel Insights and Future Potential

Infections by Hantavirus (Bunyaviridae) can cause severe human diseases, such as hemorrhagic fever with renal syndrome in Eurasia and cardiopulmonary syndrome in the Americas. These diseases are emergent and became a serious public health problem worldwide. Thus, rapid, sensitive and reliable methods for diagnosis of hantavirus infection are necessary in order to manage patients and control this rodent-borne virosis. Serological methods, such as neutralization tests, immunoblots and enzyme immunoassays using hantavirus-recombinant proteins as antigens, are discussed in this article, as well as new methods such as an immunochromatographic test. Hantavirus genome detection by different kinds of reverse transcription-PCR, including the real-time variant, is also discussed.

Predicting High Risk for Human Hantavirus Infections, Sweden

An increased risk for hemorrhagic fever with renal syndrome caused by Puumala hantavirus was forecast for Sweden in 2007. The forecast was based on a predicted increase in the number of Myodes glareolus rodents (reservoir hosts). Despite raised awareness and preparedness, the number of human cases during July 2007–June 2008 was 1,483, a new high.

Ecology, Genetic Diversity, and Phylogeographic Structure of Andes Virus in Humans and Rodents in Chile

Andes virus (ANDV) is the predominant etiologic agent of hantavirus cardiopulmonary syndrome (HCPS) in southern South America. In Chile, serologically confirmed human hantavirus infections have occurred throughout a wide latitudinal distribution extending from the regions of Valparaíso (32 to 33 degrees S) to Aysén (46 degrees S) in southern Patagonia. In this study, we found seropositive rodents further north in the Coquimbo region (30 degrees S) in Chile. Rodent seroprevalence was 1.4%, with Oligoryzomys longicaudatus displaying the highest seroprevalence (5.9%), followed by Abrothrix longipilis (1.9%) and other species exhibiting </=0.6% seropositivity. We sequenced partial ANDV small (S) segment RNA from 6 HCPS patients and 32 rodents of four different species collected throughout the known range of hantavirus infection in Chile. Phylogenetic analyses showed two major ANDV South (ANDV Sout) clades, congruent with two major Chilean ecoregions, Mediterranean (Chilean matorral [shrubland]) and Valdivian temperate forest. Human and rodent samples grouped according to geographic location. Phylogenetic comparative analyses of portions of S and medium segments (encoding glycoproteins Gn and Gc) from a subset of rodent specimens exhibited similar topologies, corroborating two major ANDV Sout clades in Chile and suggesting that yet unknown factors influence viral gene flow and persistence throughout the two Chilean ecoregions. Genetic algorithms for recombination detection identified recombination events within the S segment. Molecular demographic analyses showed that the virus is undergoing purifying selection and demonstrated a recent exponential growth in the effective number of ANDV Sout infections in Chile that correlates with the increased number of human cases reported. Although we determined virus sequences from four rodent species, our results confirmed O. longicaudatus as the primary ANDV Sout reservoir in Chile. While evidence of geographic differentiation exists, a single cosmopolitan lineage of ANDV Sout remains the sole etiologic agent for HCPS in Chile.

Emergence of hantavirus in South Germany: rodents, climate and human infections

Human hantavirus (serotype Puumala) infections are prevalent throughout Europe. The bank vole is the main reservoir of the Puumala virus (PUUV). Between 2001 and 2006, the annual incidences in Germany ranged from 0.1 to 0.5 per 100,000 inhabitants. About half of the cases were reported from the state of Baden-Württemberg (BW) in southwest Germany. In 2007, 1,089 PUUV infections were reported from BW. This reflects an incidence of 10.1:100,000, which is more than 11 times higher than the mean incidence of the previous 6 years. Spatial analysis highlights incidences up to 90:100,000 in the most affected district. The winter season 2006/2007 showed an all time high in reported mean temperature. The previous summer and autumn led to a beech mast year, resulting in favourable feed conditions for bank voles in the winter season 2006/2007. The causes of the observed increase in PUUV infections in 2007 cannot be restricted to known cycles in the bank vole population. Favourable feed conditions, a mild winter and an early onset of spring may have influenced bank vole population size as well as human exposure to infectious rodent excretions. Further epidemiologic studies are necessary to better understand the interaction between environmental factors, occurrence of Puumala virus in bank voles and the risk for human disease.

Network “Rodent-borne pathogens” in Germany: longitudinal studies on the geographical distribution and prevalence of hantavirus infections

Hantavirus infections are known in Germany since the 1980s. While the overall antibody prevalence against hantaviruses in the general human population was estimated to be about 1-2%, an average of 100-200 clinical cases are recorded annually. In the years 2005 and 2007 in particular, a large increase of the number of human hantavirus infections in Germany was observed. The most affected regions were located in the federal states of Baden-Wuerttemberg, Bavaria, North Rhine Westphalia, and Lower Saxony. In contrast to the well-documented situation in humans, the knowledge of the geographical distribution and frequency of hantavirus infections in their rodent reservoirs as well as any changes thereof was very limited. Hence, the network "Rodent-borne pathogens" was established in Germany allowing synergistic investigations of the rodent population dynamics, the prevalence and evolution of hantaviruses and other rodent-associated pathogens as well as their underlying mechanisms in order to understand their impact on the frequency of human infections. A monitoring of hantaviruses in rodents from endemic regions (Baden-Wuerttemberg, Bavaria, North Rhine Westphalia, Lower Saxony) and regions with a low number of human cases (Mecklenburg Western-Pomerania, Brandenburg, Saxony, Saxony-Anhalt) was initiated. Within outbreak regions, a high prevalence of Puumala virus (PUUV) was detected in bank voles. Initial longitudinal studies in North Rhine Westphalia (city of Cologne), Bavaria (Lower Bavaria), and Lower Saxony (rural region close to Osnabrück) demonstrated a continuing presence of PUUV in the bank vole populations. These longitudinal studies will allow conclusions about the evolution of hantaviruses and other rodent-borne pathogens and changes in their distribution, which can be used for a risk assessment of human infections. This may become very important in order to evaluate changes in the epidemiology of rodent-borne pathogens in the light of expected global climate changes in the future.

Hantavirus‐induced immunity in rodent reservoirs and humans

Hantaviruses are predominantly rodent-borne pathogens, although recently novel shrew-associated hantaviruses were found. Within natural reservoir hosts, hantairuses do not cause obvious pathogenetic effects; transmission to humans, however, can lead to hemorrhagic fever with renal syndrome or hantavirus cardiopulmonary syndrome, depending on the virus species involved. This review is focussed on the recent knowledge on hantavirus-induced immune responses in rodent reservoirs and humans and their impact on susceptibility, transmission, and outcome of hantavirus infections. In addition, this review incorporates a discussion on the potential role of direct cell-virus interactions in the pathogenesis of hantavirus infections in humans. Finally, questions for further research efforts on the immune responses in potential hantavirus reservoir hosts and humans are summarized.

How to diagnose hantavirus infections and detect them in rodents and insectivores

Hantaviruses are carried by rodents and insectivores in which they cause persistent and generally asymptomatic infections. Several hantaviruses can infect humans and many of them cause either haemorrhagic fever with renal syndrome (HFRS) in Eurasia or hantavirus cardiopulmonary syndrome (HCPS) in the Americas. In humans hantavirus infections are diagnosed using IgM-capture tests but also by RT-PCR detection of viral RNA. For detection of hantavirus infections in rodents and insectivores, serology followed by immunoblotting of, for example, lung tissue, and RT-PCR detection of viral RNA may be used, and if of interest followed by sequencing and virus isolation. For sero/genotyping of hantavirus infections in humans and carrier animals neutralisation tests/RNA sequencing are required. Hantaviruses are prime examples of emerging and re-emerging infections and it seems likely that many new hantaviruses will be detected in the near future.

Can Modeling of Fine-Scale Spatial Patterns of Environmental Markers of Zoonotic Infections Enhance Disease Prevention and Clinical Outcomes?

When evaluating patients with an undiagnosed infectious disease, physicians in general (and infectious disease specialists in particular) are trained to obtain a history of factors such as recent travel, location of residence, country of birth, occupation, and contact with animals. These factors are taken into account when generating a ranked differential diagnosis. For example, a history of work as a professional landscaper in the setting of a compatible clinical presentation would likely trigger specific diagnostic testing and presumptive treatment of tularemia. 1 Unfortunately, physicians generally lack the expertise to identify factors such as specific ecotones associated with risk of zoonotic infections. On the other hand, infectious disease ecologists and epidemiologists consider the role of the environment to be critical in vector-borne and zoonotic disease transmission, 2–4 and they are increasingly aware of the need to consider the effective range of transmission overlap of several pathogens, model the potential benefits of integrated control, and define the environmentally appropriate level for control efforts. 5,6 In this issue, Eisen and others 7 report the development of a fine-scale model to predict the risk of plague and hantavirus infection in humans in northwestern New Mexico and northeastern Arizona. The environmental risk of plague was related to precipitation and distance to pinon-juniper ecotones, whereas the risk of hantavirus infection was related to precipitation and elevation; half the area had risk for both zoonotic infections. The authors suggest that fine-scale identification of areas of increased disease risk would be useful for targeting education activities, resulting in improved disease prevention and management. Targeting disease prevention activities for these significant, rodent-borne infections should at a minimum lead to more efficient use of public health funding, which in turn could lead to more effective prevention activities. Education of healthcare providers also might lead to some improvement in disease management, but it is not clear whether targeted education with training on fine-scale identification of areas of increased disease risk or targeting training in areas of increased risk would be more effective than general, regional educational activities without this training. Early initiation of appropriate antibiotic therapy for plague reduces mortality; management by an experienced critical care team in a tertiary care center, including extracorporeal membrane oxygenation (ECMO) in some centers, reduces mortality in severe hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome. 8–10

Tumor Necrosis Factor-α Genetic Predisposing Factors Can Influence Clinical Severity in Nephropathia Epidemica

Severe human infection with Hantavirus is characterized by high fever, cold chills, thrombocytopenia, arterial hypotension, acute renal failure, and/or adult respiratory distress syndrome (ARDS)-like pulmonary involvement, but the clinical course varies greatly between individuals. We investigated whether genetically determined differences in tumor necrosis factor (TNF)-alpha production can influence the severity of Hantavirus disease. We studied a TNF-alpha single-nucleotide promoter polymorphism (SNP) at position -238 (a guanine [G]-to-adenine [A] transition) and ex vivo TNF-alpha production in a recall study of 36 Belgian patients who had a serologically proven form of Puumala virus-induced Hantavirus infection with the kidney as main target organ. In our study, the highest creatinine levels were found in patients with the lowest ex vivo TNF-alpha production. Creatinine levels correlated inversely with TNF-alpha production (R = -0.35, p < 0.05). The number of thrombocytes was significantly lower in patients with the GA-238 genotype (low TNF-alpha producers) compared with patients with the GG-238 genotype. In our study, genetically determined low production of TNF-alpha was associated with some parameters indicating a more severe clinical course of Puumala Hantavirus infection in humans, possibly by impaired activation of TNF-alpha-dependent antiviral mechanisms, which could in turn result in decreased clearance of Hantavirus.

Human Hantavirus Infection, Brazilian Amazon

Human Hantavirus Infection, Brazilian Amazon

A new Puumala hantavirus subtype in rodents associated with an outbreak of Nephropathia epidemica in South-East Germany in 2004

A micro-epidemic of hantavirus infections occurred in Lower Bavaria, South-East Germany, starting in April 2004. While only three cases were registered from 2001 to 2003, a dramatically increased number of clinically apparent human hantavirus infections (n=38) was observed in 2004, plus seven additional cases by June 2005. To determine the reservoir responsible for the infections, a total of 43 rodents were trapped in Lower Bavaria. Serological and genetic investigations revealed that Puumala virus (PUUV) is dominant in the local population of bank voles. Partial PUUV S segment nucleotide sequences originating from bank voles at four different trapping sites in Lower Bavaria showed a low divergence (up to 3.1%). This is contrasted by a nucleotide sequence divergence of 14-16% to PUUV strains detected in Belgium, France, Slovakia or North-Western Germany. PUUV sequences from bank voles in Lower Bavaria represent a new PUUV subtype which seems to be responsible for the observed increase of human hantavirus infections in 2004-2005.

Biological control agents elevate hantavirus by subsidizing deer mouse populations

Biological control of exotic invasive plants using exotic insects is practiced under the assumption that biological control agents are safe if they do not directly attack non-target species. We tested this assumption by evaluating the potential for two host-specific biological control agents (Urophora spp.), widely established in North America for spotted knapweed (Centaurea maculosa) control, to indirectly elevate Sin Nombre hantavirus by providing food subsidies to populations of deer mice (Peromyscus maniculatus), the primary reservoir for the virus. We show that seropositive deer mice (mice testing positive for hantavirus) were over three times more abundant in the presence of the biocontrol food subsidy. Elevating densities of seropositive mice may increase risk of hantavirus infection in humans and significantly alter hantavirus ecology. Host specificity alone does not ensure safe biological control. To minimize indirect risks to non-target species, biological control agents must suppress pest populations enough to reduce their own numbers.

Detection of Human Hantavirus Infections in Lithuania

In Europe certain hantaviruses are known to cause hemorrhagic fever with renal syndrome of different severity. The objective of the present investigation was to study the presence of hantavirus infections in Lithuania. Two different serum panels from cancer patients (n = 438) and blood donors (n = 299) from Lithuania were tested by monoclonal antibody capture IgG ELISA using yeast-expressed recombinant nucleocapsid (rN) proteins of Puumala virus (PUUV), Hantaan virus (HTNV) and Dobrava virus (DOBV). The reactivity of ELISA-positive sera was proven in Western blot tests using various hantavirus rN proteins. Selected serum samples were further analyzed by focus reduction neutralization assays. In the IgG ELISA 39 sera from the cancer patients and four sera from blood donors were found to be reactive with at least one of the rN proteins. By immunoblot using the three yeast-expressed rN proteins, the ELISA reactivity of 36 of 39 and two of four serum samples from cancer patients and blood donors, respectively, was confirmed; this corresponds to a seroprevalence of 8.2% and 0.7%, respectively. In ELISA, the majority of the samples reacted exclusively with rN proteins of HTNV and DOBV (31 of 36 and one of two in the two groups). In the group of sera selected for serotyping by focus reduction neutralization assay, this dominance was confirmed by the identification of eight DOBV but only four PUUV infections. No infection by HTNV or another hantavirus besides DOBV and PUUV was verified. Anti-hantavirus-positive human sera were detected in all seven investigated counties of Lithuania. In Lithuania at least two hantaviruses, DOBV and PUUV, circulate and cause human infections. Additional investigations are needed to study the seroprevalence more precisely and to search for clinical cases of hantavirus infections.

Development and evaluation of serological assays for detection of human hantavirus infections caused by Sin Nombre virus

The hantavirus cardiopulmonary syndrome (HCPS) was first recognized in 1993 after a cluster of acute respiratory distress syndrome deaths in the southwestern of the United States. The major causative agent of HCPS in North America is the Sin Nombre virus (SNV) carried by the deer mouse Peromyscus maniculatus. The first HCPS case imported to Europe was reported in 2002. The objective of the study was to develop and evaluate ELISA and Western blot tests for the serological detection of human infections caused by SNV including those imported to Europe. A polyhistidine (His)-tagged recombinant nucleocapsid (rN) protein of SNV was expressed in Saccharomyces cerevisiae and purified by nickel chelation chromatography. On the basis of the purified SNV rN protein mu-capture and indirect IgM and IgG ELISAs and an IgG Western blot were developed. The evaluation of the tests was performed using a negative serum panel and a blinded serum panel from the US containing acute-phase sera from HCPS patients. Based upon the results obtained using a panel of negative control sera the specificity for SNV mu-capture and indirect IgM and IgG ELISAs were found to be 100%. All 33 sera from SNV-infected HCPS patients included in the blinded panel were detected by the SNV mu-capture and indirect IgM ELISAs. Twenty-nine out of the 33 SNV-IgM positive sera reacted also in the SNV-IgG ELISA. An SNV-IgG Western blot confirmed the data of the SNV-IgG ELISA. Although the majority of anti-SNV positive sera cross-reacted with rN proteins of Puumala virus and Dobrava virus, the lacking reactivity of a few sera with these heterologous rN antigens in the corresponding IgM and IgG ELISAs demonstrates the value of virus-specific test formats for acute-phase sera. The novel SNV ELISA and Western blot tests represent a useful tool for the serological detection of SNV infections.

Serologic Evidence of Hantavirus Infection in Humans, Colombia

To the Editor: Several New World hantaviruses cause hantavirus pulmonary syndrome (HPS) in the Americas. All hantaviruses that cause HPS are hosted by the rodent family Muridae, subfamily Sigmodontinae (New World rats and mice). Since the Sin Nombre virus (SNV) was documented in 1993 (1), ≈25 sigmodontine hantavirus genotypes from the Americas have been described; each is associated with a different rodent species or subspecies. Hantaviruses have been documented in South America from Argentina, Chile, Paraguay, Uruguay, Bolivia, Brazil, Peru, and Venezuela (2), and in Central America from Costa Rica and Panama (3,4).