* The National Institute of Human Viral Diseases “Dr. July I. Maiztegui,” Pergamino, Argentina
* The National Institute of Human Viral Diseases “Dr. July I. Maiztegui,” Pergamino , Argentina
* The National Institute of Human Viral Diseases “Dr. July I. Maiztegui,” Pergamino, Argentina
† Hospital of San Miguel, Yuto, Jujuy, Argentina
‡ Oscar Orias Hospital, Libertador General San Martin, Jujuy, Argentina
† Hospital of San Miguel, Yuto, Jujuy, Argentina
§Dirección of Epidemiology, Jujuy, Argentina
¶University of Nevada, Reno, Nevada, USA
#Centers Disease Control and Prevention, Atlanta, Georgia, USA
** National University of Tucuman, Argentina
†† National Council of Scientific and Technical Research, Tucuman, Argentina
* The National Institute of Human Viral Diseases “Dr. July I. Maiztegui,” Pergamino, Argentina
We Started studies to explain oak ologi and epidemiology of hantavirus infection in northern Argentina. Hantavirus Pulmonary Syndrome northwest (HPS) -endemic region of Salta and Jujuy Argentina consists Province. Between 1997 and 2000, 30 cases of HPS in Jujuy Province Do diagnosed (population 512.329). Most patients have mild clinical course, and mortality (13.3%) was low. We perform serological and epidemiological survey of residents in the area, in conjunction with serological studies in rodents. Hantavirus antibody prevalence in the overall population was 6.5% of humans, one of the highest reported in the literature. No evidence was found interhuman transmission, and the high prevalence of hantavirus antibodies Looks associated with high infestation of mice were detected in domestic and peridomestic habitat.
Hantaviruses (family Bunyaviridae, genus Hantavirus) is a viral zoonosis produced two mice major clinical syndromes in humans: with renal fever syndrome hemorrhagic (HFRS) in Asia and Europe and the hantavirus syndrome, pulmonary (HPS) in the Americas. Since HPS was INITIALLY Marked in the United States in 1993 and related hantavirus (Sin Nombre virus, or SNV) has been identified, an increase in the increasing number of human cases and SNV-related viruses have been identified in different countries from North and South America (). Three areas of HPS-endemic in Argentina have been recognized: north (Salta and Jujuy Province), middle (Buenos Aires, Santa Fe and Entre Rios province) and south (Rio Black, Neuquen, Chubut and Province). In the North, the case of acute respiratory syndrome distress unknown etiology has been reported since 1984 in Oran, Salta Province. disease, in an area known as the “Distress of Oran,” have described etiology Until the early 1990s, when the first case related Are these infections and Leptospira interrogans By then with hantaviruses. Of the 21 patients tested Between 1991 and 1993, eight Indicates new serologic evidence of infection with Leptospira microscopic agglutination test, and 4 have positive immunoglobulin (Ig) M enzyme-linked immunosorbent assay (ELISA) using Hantaan virus antigen (,). In the end, this patient recognized as having HPS and SNV-relevant new hantavirus, Oran virus now designated, it is recognized in the region (). The first case in Jujuy Province HPS Do confirmed in 1997, and since then, their number has-been increasingly rising. Is Some cases detected in a different locality (San Pedro, La Mendieta, Caimancito, Libertador General San Martin, Fraile Pintado, and San Salvador, capital of the province) Isolated, but comes from the city of Yuto and the surrounding MOST. A high percentage of confirmed cases of ordinary Got nonspecific prodrome but wasnt followed by distress syndrome. Number of death cases (4 [13.3%] of 30) were noticeably lower than in other regions and countries that reported in the literature. Some strains of hantavirus Is the hypothesis then to produce subclinical disease. Only one hantavirus antibody prevalence studies have been conducted among residents of the Gran Chaco Paraguay and Argentina (Salta Province), and hantavirus antibodies Was found in 20% to 40% of the participants ().
Some of the differences in clinical signs and symptoms of HPS have been recognized in other areas of the United Compared to Those Described after infection with SNV; This difference may be included Having person-to-person transmission, a different spectrum of clinical disease, increased incidence of infections in children, and higher antibody prevalence (). For example, patients from the area studied had normal clinical symptoms of mild and mortality rates low, supporting the idea that the less pathogenic hantavirus can circulate in that area or that host or environmental factors may be responsible for the observed pattern. The purpose of this study was to determine the prevalence of hantavirus antibodies in the general population, identifying risk factors, and investigate the rodent species involved in the transmission of hantavirus in Yuto.
Yuto is located in the Department of Ledesma, in the northeastern province of Jujuy (23 ° 38 ‘S, 64 ° 28’ W). general topography determined by remote spurs range of the Andes, and the area covered by dense subtropical vegetation. The most eastern part of the study area is flat or slightly wavy, very fertile, with many rivers and streams and an average altitude of 349 m. The average annual temperature is 20.7 ° C, ranging from 14.5 ° C in July (winter) to 25.8 ° C in January (summer). The rainy season begins in November as the annual rains, which lasted through the summer and into early fall; Average annual rainfall is 862 mm with a monthly maximum average of 191 mm in January and the average monthly minimum 4 mm in July. the same habitat and topography continues to the south (Province of Tucumán) and Holland (to Oran, in Salta Province). The original biome is a subtropical forest area called “Yungas forest,” with many tree species with high economic value (Anadenanthera Colubrina, Calycophyllum multiflorum, rhamnoides Phyllostylon, Astronium urundeuva, maclura tinctoria, Cordia trichotoma, among others). The forest area is now much fragmented and modified by human agricultural activity. The main cultivated crop is sugar cane, which grows from May to November. Other products include citrus fruits, avocados, pears, bananas, mangoes, papayas, cherimoyas, and vegetables. Agriculture is the main source of employment, most of which involve manual labor. Housing for farm laborers is usually very poor construction, in many cases consist of wooden huts saved and sheet metal. Domestic habitat types and peridomestic offers prime conditions for infestation of rats, mice provide easy access and poor sanitation, and are found even in urban areas Yuto.
A cross-sectional study conducted on a sample of the general population area (population 7,900). The sample size was estimated to document the overall prevalence of the total population is about 340 people. shows the distribution of the general population and that of survey participants by gender and age. Local doctors explain the purpose of the study to the participants, and informed consent agreement signed by each person or by a parent or legal guardian of a minor. Each participant had blood samples taken and fill out a questionnaire that covers personal data, ethnicity, household characteristics and work, work, the appearance of domestic mice, recreational activities, while staying in the area, the history of the way and abroad, before the disease is compatible with HPS, and contact with a confirmed HPS patients.
The distribution of the general population and the survey population by sex and age.
Sherman live traps were placed at the site of exposure possibilities previously documented cases of HPS. Nine sites were selected: four sites in the District Yuto (Guarani [13 lines, 347 traps], Jardín [4 lines, 60 trap], 17 Has [4 lines, 124 trap], and 8 Has [7 rows, 168 trap]) ; one in El Bananal, a small rural village 7 km outside Yuto (11 lines, 214 trap); three or adjacent to the farm (fincas [26 lines, 1,100 trap]); and one in the undergrowth (seminatural habitats [8 lanes, 500 trap]). One farm is situated in Urundel, Salta Province, in the immediate vicinity of Yuto, and the owners, workers, and residents of the community belong to Yuto. Of the 73 lines capture, 19 are in the household, 25 peridomestic, 6 are in the weeds near the culture of orange, 5 bush, 5 on the side of a river or stream, 3 in the vegetable garden, three on a side street, two in the orchard , 2 at the edge of the canal, and 3 adjacent to the wire fence, rail, or sewers. outside line consists of 25 traps, each separated by 5 m. line lallocated within and outside the home relates to both rural and urban areas. The number of traps in the house and in the urban path peridomestic depending on the area available at each site (8-20 traps). shows the location of trapping sites in Yuto and the surrounding areas.
Localization rodent trap at Yuto and the surrounding sites.
Trapping conducted from May 30 to June 4, 2000. Small mammals, collected each morning and transported to a field laboratory for processing. Once anesthetized with Isofluorane (Abbott Laboratories Ltd., Queenborough, England), the animals bleed from retroorbital sinus using heparinized capillary tube, and then killed by cervical dislocation while still sedated. Serum samples, blood clots, brain, heart, kidneys, liver, and lungs were placed in cryovials and stored in liquid nitrogen for subsequent analysis of them at the Instituto Nacional de Enfermedades Virales Humanas (INEVH). Carcass tentatively identified in the field and preserved in 10% formalin and sent to the Museum of Natural Sciences “Miguel Lillo” in San Miguel de Tucumán confirmation taxonomy. small mammal trapping and processing is done in accordance with established safety guidelines ().
Human blood samples were centrifuged at Hospital Yuto. Serum was separated and placed in cryovials and stored in liquid nitrogen until further testing in INEVH. samples were centrifuged in a field laboratory mice and stored as described. hantavirus antibodies were detected by ELISA. Briefly, 96-well microplates coated with SNV polyvinyl recombinant and control antigens overnight; later, serum samples and positive and negative controls were applied, followed by peroxidase-conjugated antihuman IgG for human serum and a mixture of peroxidase-conjugated anti-Rattus norvegicus and anti-Peromyscus maniculatus for rodent serum IgG. substrate used is 2,2-azino-di (3-etilbentiazolin sulfonate) (ABTS, Kierkegaard & Perry Laboratories, Inc., Gaithersburg, MD). serum dilution is considered positive if the optical density is> 0.2 after adjusting for the reduction of the corresponding optical density-antigen negative. serum samples with titers> 1 :. 400 is considered positive
Hantavirus IgG was found in 22 (6.5%) of 341 serum samples were tested. For men, the prevalence of hantavirus antibodies is 10%; females had a prevalence of 3.7%. Among the 341 participants, 56 were <10 years, 239 is 11-50 years, and 45 were> 51 years (1 without age data). The average age of the antibody-positive was 41 (range 18-87); 77% of those in the age group 11- 50 years. Hantavirus antibody prevalence by gender and age are shown in.
The majority (292/341, 85.6%) of the population in the survey locally born or native Argentina. Twenty-five (7.3%) foreign participants, including 24 Bolivia and Paraguay 1. Twenty-two people have Aboriginal ancestors (6.5%), with 17 belonging to Guarani communities. No information is available for two people. Only one participant Aboriginals had IgG antibodies to hantaviruses (1 [4.5%] of 22). The prevalence of antibodies indicates hantavirus among the study population by ethnicity or nationality.
ABY immunoglobulin G enzyme-linked immunosorbent assay.bNative, born in Argentina.
Dwellings are marked according to their location as urban (> 500 m from an open field), suburban (50-500 m of open field) and rural (<50 m of open field). show hantavirus antibody-prevalence findings in relation to the location of the house and the occupation of the participants. Forty people with urban jobs, including 10 administrators, 13 health care workers, housewives 5, 4 students, and the work of others (technicians, gardeners, masons, retired). Among the study participants suburbs, 23 housewives, 28 are students, and the rest are employed in various jobs (employees, health agents, servants, masons). Among rural participants, 75 are agricultural workers, 64 housewives, 29 students, 10 sawmill workers, and the rest have other jobs (employees, merchants, masons, retired). All participants three hantavirus-antibody-positive resided in urban areas to work in rural areas (masons, working sawmill and a farm workers), as did the two participants antibody-positive who live in houses of suburban (agricultural workers ). Thirteen (17.1%) of the 76 participants with antibodiesis the farm workers (owner of workers, peasants, fincas). the prevalence of antibodies to other work including housewives (4 [6.3%] of 64), and sawmill workers (1 [10%] of 10). We did not find hantavirus antibodies among 61 students or 20 health workers, including doctors, nurses, health agents and dentists.
Aas immunoglobulin G is determined by enzyme-linked immunosorbent assay.
If the work is considered as rural (IgG positive, 20 [10%] of 201) or rural (urban and suburban, positive IgG 1 [1.03%] of 97), the prevalence of hantavirus antibodies significantly higher in the former (chi-square = 7.95, p = 0.004); among those with rural work, their work includes agricultural activities have a higher prevalence of hantavirus antibodies (IgG positive 13 [17.1%] of 76; 7 [5.6%] of 125; chi square = 6.98, p = 0.008).
Clinical and epidemiological data show for the study population. Most (86%) hantavirus antibody-positive participants do not remember previous HPS clinical manifestations. The presence of rodents was reported by 77% of hantavirus antibody-positive and 79% of the antibody-negative hantavirus, both in setting peridomestic and workplaces.
Achi-square test for comparison of two proportions in two independent samples, p> 0.05 unimportant. EpiInfo version of 2000 (Centers for Disease Control, Atlanta, GA) .bHPS, hantavirus pulmonary syndrome.cAll positive contact relatives of the confirmed HPS patients.
Among those who had previous contact with HPS patients are known, 6 (6.1%) of 98 cases of hantavirus antibodies. Similar antibody prevalence was found in people who have no previous contact with HPS patients known (16 [6.6%] of 242; chi square p> 0.05). One hundred and five (30.8%) reported no travel outside the region, and the remaining 58% had traveled only to other areas within the province or near Salta Province; 41.6% reported traveling to Bolivia in addition to local travel. Only a small percentage (0.4%) had visited a relatively remote area of the country. hantavirus antibodies are found in 15 (6.4%) of the 233 people who travel outside the immediate area, and 7 (6.6%) of 105 who do not travel outside the immediate area.
A total of 2,427.5 361small mammals caught in the trap-nights (14.8% overall trap success). Captures represented two families of rodents, three subfamilies, and 13 species (). Calomys and Akodon are most often caught genera (38% and 40.2%, respectively) and the only taxa found with hantavirus antibodies. Hantavirus IgG was found in 4 (2.8%) of 140 Akodon simulator and 7 (5.1%) of 137 Calomys callosus. Oligoryzomys genus has several species that were previously identified as hantavirus reservoir in the area of three HPS-endemic countries. In this study, this genus accounted for 12 (3.3%) of 361 catches; However, none was positive for hantavirus antibodies. shows the distribution of the species according to different habitats sampled. C. callosus specimens trapped in a residence located in a different fincas.
aInside households.bImmediate around the house, including the yard, outbuildings, vegetable gardens, weeds, fence lines, and railroad.cIncludes grapefruit and banana plantations, vegetable cultivation, weeds, and the roadside habitat sites.dSeminatural the same which includes stream.
More than half (6 [54.5%] of 11) of positive mice caught in the weeds, a side street, or the site peridomestic on the fincas (fruit trees and vegetable gardens); four trapped in the thicket, and the last one on the river bank is very close to an HPS patients stay in El Bananal. Two lanes contribute to two positive rats in each. It is located in an orange plantation (weeds and roadsides).
The differences are found in South America hantavirus infection relative to the SNV-related syndrome classic in North America have been suggested to reflect the differences in the approach to supervision and pathogenicity of the virus, host-reservoirs, and ecological factors. Certain patterns of clinical disease lightweight and low CFR found in Yuto specified region selection for a detailed study. In this first investigation, we sought to determine the prevalence of past infection in the general population with hantavirus IgG antibody test, to identify risk factors, and to identify the rodent species involved in the transmission of hantaviruses
The prevalence of hantavirus antibodies found in a survey of the human population is one of the highest reported in Argentina, with an average of 6.5% (women 3.7%, men 10%). Other previous research HPS-endemic areas (central and southwest) from Argentina found the antibody prevalence varies from 0.1% to 1.5% (,). Men in their 30s and 40s showed that the prevalence of antibodies> 14% and 16%, respectively. Most carriers of antibodies (82%) did not report the clinical manifestations were consistent with HPS. Thus, the low number of death cases clearly reflect a milder clinical disease (reported case-fatality rate of 40% to 50% in the United States) (,).
In a previous study of asymptomatic contacts of HPS cases-patients from this area, we found a high prevalence of IgG (4 [9.5%] of 42). This finding could be the result of an infection from the same source or interhuman transmission (), as described in the outbreak in El Bolson-1996 Bariloche, southern Argentina (-). In this survey, we found no differences in the prevalence of hantavirus antibodies in people with and without known contact HPS cases (6.1% and 6.6%, respectively). No antibodies were found among health workers studied, and distribution of clinical cases and carriers of antibodies by sex showed male predominance (in patients from 1997 to 2000, the percentage of men was 76.7%, 23/30). These findings, collectively, do not support the hypothesis that interhuman deployment plays a big role in the transmission of hantaviruses in this area. These findings also reinforce the view that environmental factors, employment, housing and create an increased risk for exposure to rat in a work setting, domestic, and peridomestic. This conclusion is supported by the observation visible from the mice and their signs in households and workplaces were reported by the study population and patients. The risk factors that indicate a significant difference between the positive and antibody-negative is a rural occupation, especially that related to agricultural activity. This finding is also reflected in the high antibody prevalence observed men in the survey and male dominance among patients.
A high prevalence of antibodies that have previously been found in indigenous peoples of the Gran Chaco Paraguay (40.4%) and Argentina (17.1%) (Salta Province). In the study, evaluated the Aboriginal community property covered still fish, hunt, and gather their sustenance. Their main ethnic groups are Chorote, Chulupi, and wichi of the linguistic family Mataco-Mataguayan (). In areas in our study, aboriginal people and foreigners were in the minority (14% in the sample). Indigenous peoples (22 in this sample) belong to a different group; 77% is Guarinis of Paraguay. Only one person from the community Charagua, originating in Bolivia, participated in the study. This man has hantavirus antibodies. Among the 25 foreign participants, the only people belonging to the majority of antibody-positive Bolivia (). All normative population, including the ancestors of Aboriginal members and strangers, which is integrated in the general population, share household work and conditions with local people, and therefore share the same risk factors.
More than two-thirds of the studied group had traveled inside or outside the province, and / or to Bolivia. The trip often among migrant farm workers, who follow the harvest season. No differences were found in antibody prevalence among people who travel and those who do not, possibly because the trip were reported mainly in the same ecological region.
The genetic diversity of rodents sigmodontine in South America known (). Characterization of rodent species and their relationships with indigenous hantaviruses currently under study. Rodent suspected reservoirs of hantaviruses pathogens identified in Argentina so far belong to the genus Oligoryzomys (O. longicaudatus for Andes and Oran genotype, O. chacoensis to Bermejo genotype, and O. flavescens to Lechiguanas genotype). Three expeditions rodents previously done in the area of Argentina hantavirus-endemic northwest in relation to the study HPS: two in the province of Salta (in July 1995 and October 1996) and one in the Province of Jujuy (May 1998), which involved the village of La Mendieta and Libertador General San Martin. hantavirus antibody-positive species of Salta, including O. chacoensis (1 [3.7%] of 27), A. simulator (1 [3.8%] of 26), ad O. longicaudatus (2 [7.7%] of 26) and in Jujuy O. chacoensis, (1 [8.3%] of 12) ().
In this study, the prevalence of hantavirus antibodies in mice was similar to that previously reported in the country (2.7% to 12.5%, varying by region and species) (), but the species were found with antibodies different hantavirus. Genera hantavirus antibody-positive rats in touch with people with relatively high abundance, Akodon and Calomys. Akodon, associated with the virus in the central Pergamino Argentina, so far not reported pathogenic to humans (). Among Calomys species, C. laucha has been identified as a virus reservoir Laguna Negra in Paraguay, but there is no previous evidence showing that circulating in Argentina (). Sigmodontine mice collected in every rural habitat where we have used traps, including inside the residence, peridomestic site, weeds close to oranges and bananas plantations, vegetable fields, and especially natural habitats such as woodbrush and the rivers and streams. Most positive rats caught in the weeds or roadside in or close to the cultivated oranges or vegetables. other rodents captured in peridomestic sites associated with cases of HPS and in woodbrush near one fincas. focus concentration positive mice appear to happen, with some positive rodents often caught in the same trap line.
Household characteristics or the habitat work, including a lot of potential food and dessert available for rodents due to sub-standard housing and sanitation. Sigmodontine mice also trapped in peridomestic sites from urban areas (8 and 17 Has Had quarters), where the environment and building features that are similar to suburban or rural areas. C. callosus is just wild rodent species captured in the house. This observation is in accordance with previous descriptions of Bolivia in relation to an outbreak of dengue fever Bolivia; C. callosus is Machupo virus reservoir, which arenavirus associated with Bolivian hemorrhagic fever, in BHF-endemic area of El Beni (). Control of major Bolivian hemorrhagic fever outbreak in the 1960s achieved through measures directed to prevent infestation of C. callosus in towns and villages. The same measures should also be useful in this area to prevent transmission of hantavirus, at least from a rodent of the genus Calomys adapted to domestic settings and peridomestic.
Our results support the hypothesis that the less virulent hantaviruses responsible for the mild and subclinical disease circulating in the region. an ongoing investigation that includes the genetic characterization of the virus associated with different clinical forms will help to clarify this point.
We thank Horacio López, German O’Duyer, Cesar Polidoro, Enrique Serrrano, Miguel Canchi, Alberto Segobia, Julio Gil, Bernardino Perez, Monica Diaz, and David Flores for field work and John Boone’s reviewing the manuscript.
This work was supported by the Administración Nacional de Laboratorios e Institutos de Salud (ANLIS), Ministerio de Salud Pública de la Nacion, Argentina; and by the National Institutes of Health grants 1R01 AI45059.
Dr. Pini is a doctor who specializes in pathology. Since 1993, he has worked at the Instituto Nacional de Enfermedades Virales Humanas in hantavirus program
Suggested citation for this article :. Pini N, S Levis, G Calderon, Ramirez J, Bravo D, Lozano E, et al. Hantavirus infection in humans and rodents, northwest Argentina. Emerg Infect Dis [serial online] 2003 September [date cited]. Available from: URL:
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