Argentina: 2018/2019 Hantavirus - Andes strain outbreak

[sharon sanders]

“Super-Spreaders” and Person-to-Person Transmission of Andes Virus in Argentina

Authors: Valeria P. Martínez, Ph.D., Nicholas Di Paola, Sc.D. https://orcid.org/0000-0002-9694-3913, Daniel O. Alonso, B.Sc., Unai Pérez-Sautu, Ph.D. https://orcid.org/0000-0001-8587-7001, Carla M. Bellomo, Ph.D., Ayelén A. Iglesias, B.Sc., Rocio M. Coelho, B.Sc., +26 , and Gustavo Palacios, Ph.D. https://orcid.org/0000-0001-5062-1938Author Info & Affiliations
Published December 2, 2020
N Engl J Med 2020;383:2230-2241
DOI: 10.1056/NEJMoa2009040
VOL. 383 NO. 23

Abstract

Background

From November 2018 through February 2019, person-to-person transmission of Andes virus (ANDV) hantavirus pulmonary syndrome occurred in Chubut Province, Argentina, and resulted in 34 confirmed infections and 11 deaths. Understanding the genomic, epidemiologic, and clinical characteristics of person-to-person transmission of ANDV is crucial to designing effective interventions.​


Methods

Clinical and epidemiologic information was obtained by means of patient report and from public health centers. Serologic testing, contact-tracing, and next-generation sequencing were used to identify ANDV infection as the cause of this outbreak of hantavirus pulmonary syndrome and to reconstruct person-to-person transmission events.


Results

After a single introduction of ANDV from a rodent reservoir into the human population, transmission was driven by 3 symptomatic persons who attended crowded social events. After 18 cases were confirmed, public health officials enforced isolation of persons with confirmed cases and self-quarantine of possible contacts; these measures most likely curtailed further spread. The median reproductive number (the number of secondary cases caused by an infected person during the infectious period) was 2.12 before the control measures were enforced and decreased to 0.96 after the measures were implemented. Full genome sequencing of the ANDV strain involved in this outbreak was performed with specimens from 27 patients and showed that the strain that was present (Epuyén/18–19) was similar to the causative strain (Epilink/96) in the first known person-to-person transmission of hantavirus pulmonary syndrome caused by ANDV, which occurred in El Bolsón, Argentina, in 1996. Clinical investigations involving patients with ANDV hantavirus pulmonary syndrome in this outbreak revealed that patients with a high viral load and liver injury were more likely than other patients to spread infection. Disease severity, genomic diversity, age, and time spent in the hospital had no clear association with secondary transmission. Conclusions

Among patients with ANDV hantavirus pulmonary syndrome, high viral titers in combination with attendance at massive social gatherings or extensive contact among persons were associated with a higher likelihood of transmission. (Funded by the Ministerio de Salud y Desarrollo Social de la Nación Argentina and others.)​

https://www.nejm.org/doi/full/10.1056/NEJMoa2009040

 

[Shiloh]

A quinceañera party, 34 infected and 12 dead: Argentina's biggest hantavirus outbreak provides clues for the MV Hondius case

Source: https://www-lanacion-com-ar.transla...tr_sl=es&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=sc


A quinceañera party, 34 infected and 12 dead: Argentina's biggest hantavirus outbreak provides clues for the MV Hondius case
Crisis committees in more than a dozen countries are closely following the experience with containing the transmission of the Andes virus eight years ago in Epuyén and other towns in the Andean region.
May 12, 202616:14
10- minute read​

“Make an appointment and come back during the week,” Víctor Díaz recalls the doctor telling him at the rural hospital in Epuyén . It wasn't a regular appointment day. And so he did, that first Sunday of November eight years ago. Although the symptoms he had been attributing to a common cold had worsened since dawn, he made an appointment for the following week. The doctor, who a month later would sign the first official statement about the hantavirus outbreak in that town in Cushamen, Chubut, didn't even suspect that the patient he was letting go would be the first case from which the largest outbreak of that disease in the country would be investigated.

Today, following the cases on the MV Hondius cruise ship and the health deployment in more than a dozen countries to limit the transmission of the Andes South virus – the only one known at the moment that can be passed from person to person – the world is looking at what happened and how work was done in Epuyén and the surrounding Andean region in 2018-2019 to contain a disease that decimated families and caused disability in survivors.​..