Infección por hantavirus en la Provincia de Buenos Aires-Argentina. Comportamiento de la serie temporal 1997-2021

Introducción: La infección por hantavirus es endémica en América del Sur, con un amplio espectro de gravedad y una letalidad que varía entre 17 y 40 por ciento. El presente estudio recoge información de 25 años de vigilancia epidemiológica en Buenos Aires, Argentina. Objetivo: Caracterizar el comportamiento de la serie temporal 1997-2021, observando tendencia y estacionalidad. Métodos: La función de serie temporal utilizada empleó la media móvil centrada según periodos trimestrales, de forma que cada año se dividió en cuartiles. Se consideró un modelo multiplicativo. Resultados: Con una tasa de mortalidad de la serie de 0,15 por 100 mil y de letalidad de 22,6, la razón varones : mujeres fue de 3,4:1. La distribución sindrómica mostró mayor compromiso renal, siendo la tasa de mortalidad prácticamente igual en ambos sexos. Conclusión: Como enfermedad infecciosa, la infección por hantavirus reflejó en los últimos 25 años un comportamiento, recurrente y estacional, endémico y compartido en sus características clínicas con el resto de la región andina.

Background: Hantavirus infection is endemic in South America, with a wide spectrum of severity and a fatality rate that varies between 17-40 percent. This study collects information from 25 years of epidemiological surveillance in Buenos Aires, Argentina. Aim: To characterize the behavior of the 1997-2021 time series, observing trends and seasonality. Methods: The time series function used the moving average centered according to quarterly periods, so that each year was divided into quartiles. A multiplicative model is missed. Results: With a mortality rate for the series of 0.15 per 100,000 and a fatality rate of 22.6, the male : female ratio was 3.4:1. The syndromic distribution showed greater renal involvement, with the mortality rate being practically the same in both sexes. Conclusion: As an infectious disease, hantavirus has reflected in the last 25 years a behavior, recurrent and seasonal, endemic and shared in its clinical characteristics with the rest of the Andean region.

Características e diagnóstico laboratorial das infecções causadas pelo hantavírus: revisão integrativa / Characteristics and laboratory diagnosis of infections caused by hantavirus: integrative review

A hantavirose é uma zoonose de distribuição mundial que utiliza como vetores roedores, musaranhos, toupeiras e morcegos. Os sintomas da infecção pelo hantavírus assemelham-se aos de diversas doenças, por isso o diagnóstico laboratorial é crucial para o tratamento precoce. Objetivo: Realizar uma revisão da literatura sobre as características e diagnóstico laboratorial da hantavirose. Métodos: Trata-se de uma revisão integrativa da literatura com base no modelo PRISMA, com seleção de estudos nas bases de dados Portal de Periódicos da Capes, PubMed/Medline, SciELO, ScienceDirect e Biblioteca Virtual em Saúde (BVS). Foram empregados os descritores: hantavírus, diagnóstico laboratorial, exames e zoonose, em português e inglês, no período de 2015 a 2022, sendo selecionados 19 artigos científicos em atendimento aos critérios de inclusão. Resultados e Discussão: Diversas técnicas diagnósticas podem ser empregadas em casos de hantavirose, sendo a biologia molecular a mais empregada, conjuntamente com a imunologia. Há outros recursos utilizados para monitoramento e evolução da doença, como a bioquímica, a hematologia e a imagenologia. Para a ocorrência de hantavirose é necessário um ambiente propício, clima específico e contato com hospedeiro suscetível, podendo evoluir para quadros assintomáticos ou sintomáticos com complicações graves. Conclusão: O diagnóstico dessa doença é desafiador e requer investigação detalhada que inclua a sintomatologia do paciente, o histórico de exposição a animais reservatórios e os resultados de exames laboratoriais. Como desfechos negativos da hantavirose incluem-se a febre hemorrágica com síndrome renal, a síndrome pulmonar por hantavírus e o óbito

Hantavirus is a worldwide distributed zoonosis that uses rodents, shrews, moles and bats as vectors. The symptoms of hantavirus infection resemble those of many diseases, so laboratory diagnosis is crucial for early treatment. Objective: The present study aimed to conduct a literature review on the characteristics and laboratory diagnosis of hantavirus. Methods: This is an integrative literature review based on the PRISMA model, with a selection of studies in the Capes Portal de Periódicos, PubMed/Medline, SciELO, ScienceDirect and Virtual Health Library databases, using the descriptors: hantavirus, laboratory diagnosis, exams, and zoonosis, in portuguese and english, from 2015 to 2022, and nineteen scientific articles that met the inclusion criteria were selected. Results and Discussion: Several techniques can be used in cases of hantavirus, with molecular biology being the most evidenced along with immunology. There are other parameters that are used for monitoring and evolution of the disease, such as biochemistry, hematology, and imaging. For the hantavirus disease, an adequate environment, specific climate and contact with a susceptible host are necessary, which may lead to asymptomatic conditions or symptoms with more serious complications. Conclusion: The diagnosis of this disease is challenging and requires detailed investigation that includes the patient's symptoms, the history of exposure to reservoir animals and the results of laboratory tests. Negative outcomes of hantavirus infection include hemorrhagic fever with renal syndrome, hantavirus pulmonary syndrome, and death

Aplicación de la Teoría del Cuidado Cultural a la investigación: prácticas de cuidado preventivas de hantavirus / Applying Cultural Care Theory to research: hantavirus preventive care practices

INTRODUCCIÓN: La investigación en enfermería surge de las necesidades y experiencias en la práctica y debe contribuir a generar, redefinir y actualizar el conocimiento de enfermería a través de comprobación o generación de nuevas teorías de enfermería. El conocimiento nuevo generado o actualizado debe retornar y mejorar la práctica del cuidado de enfermería dirigido las personas, familia y comunidad. Sin embargo en ocasiones la interrelación investigación y teoría no es clara, afectando de esta manera la relevancia de la aplicación de las teorías de enfermería en la práctica del cuidado de enfermería. OBJETIVO: La presente reflexión responde al objetivo de ejemplificar cómo se aplicó la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger al estudio del fenómeno de las prácticas de cuidado preventivas de hantavirus. DESARROLLO: Sistematización crítica de la experiencia investigativa a través de una propuesta metodológica, que describe cómo la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger guio el proceso de investigación sobre las prácticas de cuidado preventivas de hantavirus, factores personales, sociales, modos de vida y creencias culturales. CONCLUSIONES: Un elemento fundamental en toda investigación de enfermería es mostrar de manera clara y explícita cómo la teoría se interconecta con todas las fases de la investigación y en consecuencia genera conocimiento de enfermería para la práctica del cuidado.

INTRODUCTION: Nursing research arises from needs and experiences in practice and should contribute to generate, redefine and update nursing knowledge by testing or developing new nursing theories. Such new or updated knowledge should lead to improvements in the practice of nursing care applied to persons, family, and community. However, sometimes the interrelationship between research and theory is unclear, affecting the relevance of such theories to nursing care practice. OBJECTIVE: The present reflection aims to exemplify how Leininger's Theory of Cultural Care Universality and Diversity was applied to the study of hantavirus preventive care practices. DEVELOPMENT: Critical systematization of the research experience through a proposed methodology that describes how Leininger's Theory of Cultural Care Universality and Diversity guided research related to hantavirus preventive practices, personal and social factors, lifestyles, and cultural beliefs. CONCLUSIONS: A fundamental element in all nursing research is to clearly and explicitly show how theory interfaces with all phases of research and consequently generates nursing knowledge for caring practice.

Actualización de áreas de riesgo y perfil epidemiológico de hantavirus en Paraguay (2013-2020)

El síndrome pulmonar por hantavirus (SPH) en el Paraguay es una infección relacionada a extensas áreas geográficas del Chaco o Región Occidental. Sin embargo, en los últimos años se han reportado casos fuera del área endémica conocida. Con el objetivo de describir el perfil epidemiológico de la enfermedad en nuestro país, y actualizar las áreas de transmisión, se realizó una revisión retrospectiva de los casos registrados desde el 2013 al 2020. Fueron confirmados 90 casos de SPH, siendo la Región Occidental la de mayor proporción de casos, con 92% en dicho periodo. La Región Oriental registró el 5,5% de los casos, mientras que en el 2,5% de los casos no fue posible determinar el territorio de ocurrencia del contagio. El perfil de la enfermedad en el país se presenta como una afección principalmente de hombres en la edad adulta - joven, ligados a actividades de campo. Los principales desafíos para el abordaje de esta enfermedad son sensibilizar a la población de las nuevas áreas de riesgo identificadas, fortalecer la vigilancia en dichos lugares a fin de captar en forma oportuna a los casos, y actualizar los conocimientos sobre los virus circulantes y los reservorios zoonóticos de la enfermedad.

Hantavirus Pulmonary Syndrome in Paraguay is an infection related to the Chaco area or Western Region. However, in recent years cases it has been reported outside the known endemic area. In order to describe the epidemiological profile of the disease in our country, and update the transmission areas, a retrospective review of the cases registered from 2013 to 2020. Ninety HPS cases were confirmed, being the Western Region the one that contributed the highest proportion of cases, with 92% in the study period. The Eastern Region registered 5.5% of the cases, while in 2.5% of the cases it was not possible to determine the place. The profile of the disease in the country is presented as a condition mainly of men in adulthood - young, linked to field activities. The main challenges were to sensitize the population of the newly identified risk areas, strengthen the surveillance in these places in order to capture cases in a timely manner and update knowledge about the circulating viruses and zoonotic reservoirs of the disease.

Diagnostico Serológico de Hantavirus en el Departamento de La Paz, Bolivia, en la gestión 2022 / Serological diagnosis of Hantavirus in the department of La Paz, Bolivia in the 2022 management

INTRODUCCIÓN: el síndrome pulmonar por hantavirus (SPHV) es una enfermedad viral aguda causada por miembros del género Orthohantavirus, familia Bunyaviridae transmitida por roedores presente en zonas tropicales y semitropicales del departamento de La Paz. OBJETIVOS: diagnosticar hantavirus por serología IgG e IgM, en el noreste del Departamento de La Paz, Bolivia, en pacientes con sospecha de infección por Hantavirus mediante la prueba de ELISA y realizar un análisis epidemiológico básico. MATERIALES Y MÉTODOS: este trabajo es un estudio de tipo transversal descriptivo, se utilizó el método de diagnóstico ELISA (Euroinmun) para detectar la presencia de anticuerpos inmunoglobulina M (IgM) e inmunoglobulina G(IgG) para hantavirus en muestras de suero, con un universo de 138 muestras de Enero a Agosto de la gestión 2022 en pacientes con sospecha de infección por Hantavirus enviadas de distintos hospitales y centros de salud al Laboratorio de Virología del Instituto Nacional de Laboratorios en Salud (INLASA). RESULTADOS Y CONCLUSIONES: se detectó presencia de IgM e IgG para hantavirus en las muestras de suero procesadas por serología en el Laboratorio de Virología, de las cuales de 138 muestras, un 12% son positivas para IgG, 4% positivos para IgM y el 84%, restante es negativo. Estas muestras provienen de centros y establecimientos de salud del noreste del Departamento de La Paz, observándose un mayor porcentaje de casos en el sexo masculino afectando al grupo etario de 41 a 50 años y existiendo un número elevado de casos presentes entre los meses de febrero y abril, además de observar signos y síntomas registradas en fichas epidemiológicas.

INTRODUCTION: Hantavirus pulmonary syndrome (SPHV) is an acute viral disease caused by members of the genus Orthohantavirus, family Bunyaviridae, transmitted by rodents present in tropical and semitropical areas of the department of La Paz. OBJECTIVES: diagnose hantavirus by IgG and IgM serology, in the northeast of the Department of La Paz, Bolivia, in patients with suspected Hantavirus infection using the ELISA test and perform a basic epidemiological analysis. MATERUAKS AND METHODS: this work is a descriptive cross-sectional study, the ELISA (Euroimmun) diagnostic method was used to detect the presence of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies to hantavirus in serum samples, with a universe of 138 samples. from January to August of the 2022 management in patients with suspected Hantavirus infection sent from different hospitals and health centers to the Virology Laboratory of the National Institute of Health Laboratories (INLASA). RESULTS AND CONCLUSIONS: the presence of IgM and IgG for hantavirus was detected in the serum samples processed by serology in the Virology Laboratory, of which 138 samples, 12% are positive for IgG, 4% positive for IgM and the remaining 84% are negative. These samples come from health centers and establishments in the northeast of the Department of La Paz, observing a higher percentage of cases in the male sex, affecting the age group of 41 to 50 years, and there being a high number of cases present between the months of February and April, in addition to observing signs and symptoms recorded in epidemiological files.

Factores pronósticos de síndrome cardio-pulmonar y muerte por hantavirus Andes Sur: estudio de cohorte en San Carlos de Bariloche y su zona de influencia sanitaria / Prognostic factors for cardio-pulmonary syndrome and death by hantavirus Andes Sur: cohort study in San Carlos de Bariloche and health influence área

Resumen Las infecciones por hantavirus, ocurren a través de la inhalación de aerosoles provenientes de excretas de roedores infectados. Estos virus causan síndrome cardiopulmonar en el caso de la variante Andes Sur, con una mortalidad que puede alcanzar el 50%. Se presenta como casos esporádicos o en pequeños conglomerados, en los que predomina el contagio interhumano. En este estudio observacional de tipo cohorte histórica, en personas infectadas con hantavirus Andes Sur durante los años 2009 a 2019 que fueron asistidas en el subsector público de salud de San Carlos de Bariloche(Argentina), se buscó identificar factores que pudieran predecir mala evolución (síndrome cardiopulmonar y muerte). Para ello se caracterizó el riesgo para cada una de las variables y, para obtener información clave sobre las relaciones entre las mismas, se aplicó además un análisis de correspondencias múltiples. Durante el período de estudio, 38 personas fueron incluidas. La edad media fue de 35 años. Se sospechó contagio de persona a persona en 10/38 (26.8%) casos. El 21.1% (8/28) tuvo al momento del diagnóstico un síndrome pulmonar por hantavirus. Mientras que, 55.3% (21/38) lo desarrolló durante su evolución y 44.7% (17/38) de los infectados fallecieron durante la internación. La edad mayor a 15 años y la plaquetopenia, se asociaron con un mayor riesgo de progresión clínica, mientras que las formas de leves o las personas asintomáticas, el contagio persona a persona o durante un brote epidemiológico, se asociaron con un menor riesgo de muerte.

Abstract Hantavirus infections occur through the inhalation of aerosols from the excreta of infected rodents. These viruses cause a cardiopulmonary syn drome in the case of the Andes Sur variant, with a mortality that can reach 50%. It occurs in sporadic cases or in small clusters, in which interhuman contagion predominates. In this historical cohort-type observational study, in people infected with Andes Sur hantavirus during the years 2009 to 2019 who was assisted in the public health subsector of San Carlos de Bariloche (Argentina), it was sought to identify factors that could predict poor evolution (cardiopulmonary syndrome and death). For this, the risk for each of the variables was characterized and, to obtain key information about the relationships between them, a multiple correspondence analysis was also applied. During the study period, 38 people were included. The mean age was 35 years. Person-to-person contagion was suspected in 10/38 (26.8%) cases. 21.1% (8/28) presented a hantavirus pulmonary syndrome at the time of diagnosis, while 55.3% (21/38) developed it during their evolution, and 44.7% (17/38) of those infected died during hospitalization. Age over 15 years and thrombocytopenia were associated with a higher risk of clinical progression, while mild forms or asymptomatic people, person-to-person transmission, or during an epidemiological outbreak, were associated with a lower risk of death.

Modelamiento del síndrome cardiopulmonar por hantavirus / Modeling of hantavirus cardiopulmonary syndrome

INTRODUCCIÓN: El síndrome cardiopulmonar por hantavirus es una enfermedad causada por un virus perteneciente al orden bunyanvirales, y transmitida hacia los humanos a través de roedores. Esta enfermedad en Chile es considerada endémica, la cual tiene una alta tasa de letalidad. En la actualidad existen estudios que evidencian el contagio entre personas del virus Andes, cuya localidad se concentra en los países de Argentina y Chile. OBJETIVOS: Analizar la posibilidad de transmisión de hantavirus entre humanos, mediante un modelo matemático tipo SEIR. MÉTODOS: Se plantea un modelo matemático tipo SEIR (susceptible, expuesto, infeccioso y recuperado) para expresar la dinámica de la enfermedad por hantavirus, incluyendo la posibilidad de transmisión entre humanos y la percepción del riesgo. Resultados: El máximo de contagio entre humanos disminuye cerca de 25% tras aumentar la percepción de riesgo de las personas, mediante la reducción de la tasa de resistencia al cambio y aumento la velocidad de reaccionar de las personas. CONCLUSIONES: Es urgente revisar las estrategias de comunicación de riesgo y medidas de prevención ante esta posibilidad de contagios masivos entre humanos, además de fortalecer la investigación y proyectar el desarrollo de una vacuna para proteger las poblaciones expuestas a esta enfermedad con alta tasa de letalidad.

INTRODUCTION: Hantavirus cardiopulmonary syndrome is an infection caused by rodents of the Bunyanvirales family towards humans. This disease in Chile is considered endemic, which has a high fatality rate. At present, some studies show the contagion between people of the Andes virus, whose locality is concentrated in Argentina and Chile. OBJECTIVES: Analyze the possibility of hantavirus transmission between humans using an SEIR-type mathematical model. METHODS: An SEIR (Susceptible, Exposed, Infectious and Recovered) mathematical model to express the dynamics of hantavirus disease is proposed, including the possibility of human-to-human transmission and the perception of risk. RESULTS: The peak of human-to-human contagion decreases by about 25% after increasing people's perception of risk by reducing the rate of resistance to changeand increasing the speed of people's reaction. CONCLUSIONS: It is urgent to review risk communication strategies and prevention measures in the face of this possibility of massive human-tohuman infections, in addition to strengthening research and planning the development of a vaccine to protect populations exposed to this disease with a high fatality rate.

Diseño y validación de un cuestionario para medir prácticas preventivas de hantavirus en una comunidad endémica / Design and validation of a questionnaire to measure hantavirus preventive practices in an endemic community

RESUMEN Objetivo. Diseñar y analizar las evidencias de validez de contenido, estructura interna y fiabilidad de un cuestionario de prácticas preventivas de hantavirus en una comunidad endémica en el contexto panameño. Materiales y métodos. Estudio cuantitativo de diseño instrumental. Esta investigación se desarrolló en cuatro etapas: revisión de literatura, validez de contenido a través de juicio de expertos con el método de agregados individuales y el cálculo de la V de Aiken; prueba piloto y validación psicométrica, a través del análisis factorial exploratorio (AFE) y análisis de fiabilidad de las puntuaciones del instrumento con el alfa ordinal. Resultados. Se evidenció validez de contenido y se reportó valores de V de Aiken superiores a 0,70 en el límite inferior del intervalo de confianza al 95%. En la estructura interna se identificó que los 8 ítems subyacen a un solo factor que explica el 60,70% de la varianza total de la prueba y con cargas factoriales superiores a 0,40; en el análisis de fiabilidad se obtuvo un valor de alfa ordinal de 0,84, valor considerado como bueno. Conclusiones. El cuestionario de práctica preventivas de hantavirus es un instrumento breve que muestra propiedades psicométricas aceptables para medir las actividades o conductas que realizan las personas para prevenir el hantavirus.

ABSTRACT Objective. To design and analyze the evidence of content validity, internal structure, and reliability of a questionnaire of preventive practices for hantavirus in an endemic community in the Panamanian context. Material and methods. Quantitative study of instrumental design. This research was conducted in four phases: Literature review, content validity through expert judgment with the individual aggregate method and the calculation of the V Aiken, pilot test and psychometric validation, through exploratory factor analysis (EFA) and reliability analysis of instrument scores with ordinal alpha. Results. Content validity was evidenced and V Aiken values higher than 0.70 were reported in the lower limit of 95% CI. In the internal structure we identified that the 8 items underlie a single factor that explains 60.70% of the total variance of the test and with factor loadings greater than 0.40; during the reliability analysis, we obtained an ordinal alpha value of 0.84, which is considered good. Conclusions. The Hantavirus preventive practical questionnaire is a brief instrument that shows acceptable psychometric properties to measure the activities or behaviors that people carry out to prevent hantavirus.

Expanded distribution of orthohantavirus Pergamino genotype: First record in Entre Rios province, Argentina / Ampliación de la distribución del Orthohantavirus genotipo Pergamino: Primer registro en la Provincia de Entre Ríos, Argentina

Abstract Hantavirus Pulmonary Syndrome (HPS) is an emerging infectious disease of the Americas. Eight native rodent species have been identified as HPS virus reservoirs in Argentina. The aim of this work was to detect the orthohantavirus genotypes present in a rodent commu-nity that inhabits a zone where a fatal HPS case occurred within an endemic locality of Central Argentina. We captured 27 rodents with a trapping effort of 723 trap nights. We detected 14.3% of infected Akodon azarae with the Pergamino genotype. This result expands the known distribution of this orthohantavirus. Although the Pergamino genotype has not been associated with human cases, the information about its distribution is relevant for risk assessment against potential changes in the virus infectivity.

Resumen El síndrome pulmonar por hantavirus (SPH) es una enfermedad infecciosa emergente en América. Ocho especies de roedores nativos han sido identificadas como reservorios del virus causante del SPH en la Argentina. El objetivo de este trabajo fue detectar los genotipos de orthohantavirus presentes en una comunidad de roedores que habita en una zona donde ocurrió un caso fatal de SPH, en una localidad endémica de Argentina central. Se capturaron 27 individuos con un esfuerzo de 723 trampas-noche. Se detectó un 14,3% de Akodon azarae infectados con el genotipo pergamino. Este resultado amplía el conocido rango de distribución de este orthohantavirus. A pesar de que el genotipo pergamino no ha sido asociado con casos humanos hasta el momento, la información sobre su distribución es relevante para analizar el riesgo ante un potencial cambio en la infectividad del virus.

Epidemic characteristics and genetic analysis of hemorrhagic fever with renal syndrome in an industrial park in Daishan County, Zhejiang Province / 中华地方病学杂志

Objective:To analyze the epidemic characteristics and virus gene sequence of hemorrhagic fever with renal syndrome (HFRS) in an industrial park in Daishan County, Zhejiang Province, and to provide clues and basis for local HFRS prevention and control.Methods:According to the case questionnaire in the "National Surveillance Program for Hemorrhagic Fever with Renal Syndrome", general and epidemiological investigation of HFRS cases was carried out in the epidemic-related industrial park. Serum samples of the cases, people and host animals in the same living environment were collected for hantavirus antibody or nucleic acid detection, the M, S gene amplification and sequence determination. MEGAX 10.1.8 software was used to construct the phylogenetic tree of M and S genes for virus genotyping and evolutionary analysis.Results:A total of 3 confirmed cases of HFRS were reported. They were all workers in the epidemic-related industrial park, male, who lived in the park for more than half a year and had no history of HFRS vaccination. There were no rodent-proof facilities in the industrial park's dormitories and canteens, and the living items were placed in a disorderly manner, the rodents and its excrement could be seen; a total of 38 host animals were captured in the same living environment with cases, all of which were Rattus norvegicus. The 3 reported cases of HFRS were all mild, with atypical clinical manifestations in the early stage of onset, mainly fever and fatigue. The serum specific antibodies of hantavirus IgG and IgM were positive (3/3), and the antibodies of people in the same living environment were negative (100.0%, 100/100). The serum samples of 2 reported cases of HFRS and 4 Rattus norvegicus were positive for nucleic acid, all of which were SEOV type hantavirus. The M gene segment homology of 6 positive serum samples was 100.0%, which was closely related to Rod/2012/QHD/4/Gc isolated from Hebei and RuianRn180 isolated from Ruian Zhejiang Province; the homology of S gene segment was 99.6% to 99.8%, which was closely related to JiangxiXinjianRn-09-2011, a strain isolated from Jiangxi Province. Conclusions:The HFRS epidemic in the industrial park is caused by the transmission of SEOV type hantavirus to humans via Rattus norvegicus; poor living environment, poor hygiene habits of personnel and lack of vaccination are all related to the incidence of HFRS; the main epidemic strains shows high homology and geographical aggregation.

Controversias sobre el uso de corticoides en el síndrome cardiopulmonar por hantavirus / Controversies on corticosteroid therapy in hantavirus cardiopulmonary syndrome

Resumen El síndrome cardiopulmonar por hantavirus es una zoonosis emergente en la Argentina, que presenta baja incidencia, pero elevada mortalidad. No existe tratamiento farmacológico especifico y la única alternativa actual es la terapia de apoyo. En este artículo se expone la patogenia del síndrome cardiopulmonar por hantavirus a través de la revisión de las experiencias clínicas de otros países de Sudamérica, en particular Chile, y la adquirida en el Hospital de Infecciosas Francisco Javier Muñiz de Buenos Aires, Argentina. Se discute sobre la administración temprana de corticoides en este síndrome, teniendo en cuenta que la evidencia a favor de su uso es insuficiente.

Abstract Hantavirus cardiopulmonary syndrome is an emerging zoonosis in Argentina, which has low incidence but high death rates. No specific pharmacological therapy is available and symptomatic therapy is the only current alterna tive. This article presents the pathogenesis of hantavirus cardiopulmonary syndrome through a review of clinical experiences in neighbor South American countries, mainly Chile, and the experience acquired at the Infectious Diseases Hospital Francisco Javier Muñiz, Buenos Aires, Argentina. The role of early corticosteroid therapy is discussed taking into account that there is insufficient evidence favoring its use in the hantavirus cardiopulmonary syndrome.

Epidemic process and influencing factors of hemorrhagic fever with renal syndrome: a review / 中国血吸虫病防治杂志

Hemorrhagic fever with renal syndrome (HFRS) is a category B infectious disease caused by hantaviruses that cause acute kidney injury and has a high mortality rate, and HFRS control has been given a high priority in China. It has been found that hantavirus types are closely associated with selective host transformation and regional adaption, and continue to evolve in the form of gene recombination. The severity of HFRS varies in hantavirus types. In addition, global environmental changes and alteration of host animal behaviors accelerate Hantavirus genome variations, and large-scale land reclamation and infrastructure building increases the likelihood of human contacts with hosts and disease-transmitting vectors, thereby increasing the risk of HFRS development. This review summarizes the main characteristics and influencing factors pertaining to the epidemic process of HFRS, so as to provide insights into effective prevention and control of this infectious disease.

Hantavirus and criminality: disease and family / Hantavírus e criminalidade: doença e família / Hantavirus y criminalidad: enfermedad y la familia

Background and objectives: Hantavirus is a pathogen that causes a viral disease with an acute and severe presentation, and a high mortality rate. In face of a sudden loss, some families may not conceive the complete absence of the deceased relative. Thus, we sought to understand the changes that took place in a family after the death of the provider by Hantavirus Pulmonary Syndrome (HPS). Methods: A descriptive exploratory study with a qualitative approach of the type case report. Data collection took place between October and December 2016 through recorded individual interviews and using questions about family dynamics after family provider's death of HPS, which were assessed by content analysis in the light of Roy's theory. Results: It was observed that the illness and death of the family patriarch weakened the family's strengths and resources, leading to a period of mourning and despair. In addition, unemployment among other family members worsened socioeconomic conditions, seeing drugs as an alternative for support as it became a commercial activity, and the rise of a command in the region that culminated in the arrest of the wife, two daughters and a son of the deceased. Conclusions: In this case, it was evidenced that the family was weakened due to the illness and death of their loved one by HPS, and because of the lack of support and welcome from the reference social services, they chose to act in criminality and it ended up with the arrest of four members.(AU)

Justificativa e objetivos: O hantavírus é um patógeno que causa uma doença viral com caráter agudo e grave e alta taxa de mortalidade. Em face da perda súbita, algumas famílias podem não conceber a completa ausência do parente falecido. Assim, procuramos entender as mudanças que ocorrem em uma família após a morte do provedor pela Síndrome Pulmonar por Hantavírus (SPH). Métodos: Estudo descritivo-exploratório com abordagem qualitativa do tipo estudo de caso. A coleta de dados ocorreu entre outubro e dezembro de 2016 por meio de entrevistas individuais gravadas e com o uso de perguntas sobre a dinâmica familiar após a morte por SPH, sendo analisadas por análise de conteúdo sob a luz da teoria de Roy. Resultados: Observou-se que a doença e a morte do patriarca fragilizaram as forças e recursos da família, levando a um período de luto e desespero. Além disso, o desemprego entre os demais membros da família agravou as condições socioeconômicas, vendo as drogas como uma alternativa para o apoio, o que assumiu o caráter de comércio e a ascensão de um comando na região que culminou com a prisão da esposa, duas filhas e um filho do falecido. Conclusão: Neste caso descrito foi evidenciado que a família ficou fragilizada diante da enfermidade e óbito do seu ente querido por SPH e, em decorrência da falta de apoio e acolhimento dos serviços de referência sociais, optou por atuar na criminalidade e findar com a prisão de quatro membros.(AU)

Justificación y objetivos: El hantavirus es un patógeno que causa una enfermedad viral con un carácter agudo y grave y alta tasa de mortalidad. Ante la pérdida repentina, algunas familias pueden no concebir la ausencia completa del familiar fallecido. Por lo tanto, tratamos de comprender los cambios que se produjeron en una familia después de la muerte del proveedor por Sindrome Pulmonar por Hantavirus (SPH). Métodos: Estudio descriptivo-exploratorio con enfoque cualitativo del tipo estudio de caso. La recopilación de datos ocurrió entre octubre y diciembre de 2016, a través de entrevistas individuales grabadas y con el uso de preguntas sobre la dinámica familiar después de la muerte por SPH, que se analizaron a través del análisis de contenido a la luz de la teoría de Roy. Resultados: Se observó que la enfermedad y la muerte del patriarca familiar debilitaron las fortalezas y los recursos de la familia, lo que llevó a un período de duelo y desesperación. Además, el desempleo entre otros miembros de la familia empeoró las condiciones socioeconómicas, haciéndolos ver a las drogas como una alternativa de renta, lo que asumió el carácter de un comercio y el surgimiento de un comando en la región que culminó con el arresto de la esposa, dos hijas y un hijo del difunto. Conclusiones: En este caso, se evidenció que la familia se debilitó debido a la enfermedad y la muerte de su ser querido por SPH y debido a la falta de apoyo y recepción de los servicios de referencia social, eligieron actuar con criminalidad y por fin terminaron com cuatro miembros detenidos.(AU)

Frecuencia de anticuerpos contra Hantavirus en agricultores de arroz de una región tropical en el noreste del Perú / Hantavirus antibody frequency in rice farmers from a tropical region in northeast Peru

RESUMEN Introducción. Existe limitada evidencia acerca de la exposición al hantavirus en el Perú. Los casos sintomáticos y estudios de seroprevalencia en febriles y población asintomática provienen de la región Loreto; sin embargo, existen grupos ocupacionales expuestos a los reservorios en regiones sin circulación conocida del virus. Objetivo. Determinar la frecuencia de anticuerpos contra el hantavirus en arroceros de un valle ubicado en una zona subtropical del Perú. Métodos. Estudio transversal en una muestra aleatoria de 250 agricultores de arroz obtenida en 2010 en el valle Alto Mayo (región San Martín), que incluyó la obtención de una muestra de sangre en cuyo suero se determinó la presencia de anticuerpos inmunoglobulinas G (IgG) mediante ELISA indirecto, y anticuerpos inmunoglobulinas M (IgM) mediante ELISA de captura. Resultados. Identificamos un caso con anticuerpos IgM (0,40%, IC95%: 0,01 a 2,21), pero no encontramos agricultores con anticuerpos IgG. El caso tenía contacto frecuente con ratas y roedores en la vivienda y campo de cultivo. Conclusión. Mostramos la primera evidencia serológica de infección por hantavirus en la región San Martín.

ABSTRACT Introduction. There is little evidence of hantavirus exposition in Peru. Cases and seroprevalence studies in febrile and asymptomatic persons are from Loreto region; however, there are occupational groups exposure to reservoirs in areas without know virus circulation. Objectives. To determinate the frequency of antibodies against hantavirus in rice farmers of a valley in a subtropical area of Peru. Methods. Cross-sectional study in a random sample of 250 rice farmers enrolled in 2010 in Alto Mayo Valley (San Martin region) that included blood sample obtention, in whose serum the presence of IgG antibodies was determined by indirect ELISA, and IgM antibodies by capture ELISA. Results. We identified a case with IgM antibodies (0,40%, 95% CI: 0,01 to 2,21), we did not find farmers with IgG antibodies. The case had frequent contact with rats and rodents in the home and crop field. Conclusion. We show the first serological evidence of hantavirus infection in the San Martin region.

Factores ambientales y síndrome cardiopulmonar por virus hanta en Chile / Environmental factors and cardiopulmonary syndrome due to hanta virus in Chile

RESUMEN Objetivo Evaluar la relación entre la temperatura ambiente, humedad relativa y el material particulado ambiental 2,5 con el número de casos de síndrome cardiopulmonar por virus hanta en Chile durante el periodo 2015-2017. Métodos Estudio observacional transversal en 197 casos de síndrome cardiopulmonar por virus hanta notificados y confirmados, ocurridos entre los años 2015 y 2017 en Chile. Se realizó análisis bi- y multivariado entre variables de estudio. Resultados Se determinó una relación positiva y significativa entre temperatura ambiente y número de casos de Síndrome Cardiopulmonar por virus Hanta y una relación negativa y significativa entre el número de casos de Síndrome Cardiopulmonar por virus Hanta y la humedad relativa. Además se observó que la temperatura ambiental junto con material particulado 2,5 aumentan significativamente el número de casos de Síndrome Cardiopulmonar por virus Hanta. Conclusiones Los factores ambientales están relacionados con el número de casos de síndrome cardiopulmonar por virus Hanta en Chile entre los años 2015 y 2017.(AU)

ABSTRACT Objective Evaluate the relationship between ambient temperature, relative humidity and particulate matter 2,5 with the number of cases Hantavirus Cardiopulmonary Syndrome in Chile between 2015 and 2017. Methods Observational, cross-sectional study in 197 cases of Hantavirus Cardiopulmonary Syndrome reported and confirmed, occurring between 2015 and 2017 in Chile. Results Positive and significant relationship was identified between ambient temperature and number of cases of Hantavirus Cardiopulmonary Syndrome and a negative and significant relationship between the number of cases Hantavirus Cardiopulmonary Syndrome and the relative humidity. Also, ambient temperature together with particulate matter 2,5 was observed to increase significantly the number of cases of Hantavirus Cardiopulmonary Syndrome. Conclusions Environmental factors are related to the number of cases Hantavirus Pulmonary Syndrome in Chile between the years 2015 to 2017.(AU)

Fatores prognósticos associados ao óbito por hantavirose no Brasil, 2007 a 2015 / Prognostic factors associated with death due to hantavirus in Brazil, 2007 to 2015

Objetivo: Analisar fatores associados ao óbito por hantavirose no Brasil. Método: trata-se de um estudo epidemiológico analítico do tipo caso-controle aninhado em uma coorte de casos contidos no Sistema de Informação de Agravos de Notificação. Para a análise bruta univariada, foi realizada regressão logística considerada p<0,20 e, para análise multivariada, foi realizada regressão logística do tipo stepwise-backwards, adotando p<0,05. Resultados: foram identificadas associações significativas com maior letalidade por hantavirose para os seguintes grupos: mulheres (Odds Ratio (OR): 1,43 - IC95% 1,02 a 2,00) para indivíduos com escolaridade não informada (OR: 3,86 ­ IC95% 1,71a 8,66) e ensino fundamental completo (OR: 3,88 - IC95% 1,51 a 9,96). Moradores da zona urbana (OR: 1,56 ­ IC95%. 1,15 a 2,12), indivíduos com choque e/ou hipotensão (OR: 3,37 - IC95% 2,51 a 4,51), sintomas respiratórios, e indivíduos cujo primeiro atendimento foi realizado com até três dias do início de sintoma (OR: 3,76 ­ IC95%: 2,51 a 4,51). Conclusão: algumas características do paciente podem aumentar as chances de óbito principalmente devido à baixa suspeição clínica e a possível demora na adoção do manejo adequado dos casos. A busca precoce de atenção, além da presença choque, hipotensão e/ou sinais respiratórios podem indicar evolução rápida da doença e maior gravidade.

Objetive: to analyze factors associated with death from hantavirus in Brazil. Method: This is an analytical case-control type epidemiological study nested in a cohort of cases contained in the Notifiable Diseases Information System. For the univariate crude analysis, a logistic regression was performed considering p <0.20 and for the multivariate analysis, a stepwise-backwards logistic regression was performed, adopting p <0.05. Results: Significant associations with higher lethality due to hantavirosis were identified for the following groups: women (Odds Ratio (OR): 1.43 - 95% CI 1.02 to 2.00) for individuals with uninformed schooling (OR: 3.86 - IC95% 1.71a 8.66) and complete elementary education (OR: 3.88 - 95% CI 1.51 to 9.96). Urban residents (OR: 1.56 - 95% CI 1.15 to 2.12), individuals with shock and / or hypotension (OR: 3.37 - 95% CI 2.51 to 4.51), respiratory symptoms (OR: 3.76 - 95% CI: 2.51 to 4.51), and individuals whose first care was performed within 3 days from the onset of symptoms. Conclusion: some characteristics of the patient may increase the chances of death mainly due to the low clinical suspicion and possible delay in adopting appropriate management of cases. The early search for attention, in addition to the presence of shock, hypotension and / or respiratory signs may indicate rapid disease progression and greater severity.

A Retrospective Survey of Rodent-borne Viruses in Rural Populations of Brazilian Amazon

Abstract INTRODUCTION: The Amazon tropical rainforest has the most dense and diverse ecosystem worldwide. A few studies have addressed rodent-borne diseases as potential hazards to humans in this region. METHODS: A retrospective survey was conducted using enzyme-linked immunosorbent assay for detecting mammarenavirus and orthohantavirus antibodies in 206 samples collected from rural settlers of the Brazilian Western Amazonian region. RESULTS: Six (2.91%) individuals in the age group of 16 to 36 years were found to possess antibodies against mammarenavirus. CONCLUSION: Evidence of previous exposure to mammarenavirus in the rural population points to its silent circulation in this region.

Estimaciones de la distribución espacial del riesgo relativo de mortalidad por las principales zoonosis en Chile: enfermedad de Chagas, hidatidosis, síndrome cardiopulmonar por hantavirus y leptospirosis / Estimates of the spatial distribution of the relative risk of mortality of the main zoonoses in Chile: Chagas disease, hydatidosis, Hantavirus cardiopulmonary syndrome and leptospirosis

Resumen Introducción: Las zoonosis son enfermedades o infecciones causadas por todo tipo de agentes etiológicos transmisibles desde animales vertebrados a humanos. Durante las últimas décadas, el riesgo para la salud ocasionado por diferentes zoonosis, ha sido generado por la distribución natural de los distintos agentes etiológicos y por la emergencia y reemergencia de estas enfermedades. Objetivo: Estudiar la distribución del riesgo de mortalidad de las cuatro principales zoonosis en Chile continental, basados en datos nacionales de mortalidad, con el objetivo de visualizar geográficamente donde focalizar los esfuerzos de control de estas enfermedades. Metodología: Se estima el riesgo relativo de las principales zoonosis en Chile, mediante estadística Bayesiana. Resultados: Se obtuvo la distribución de las cuatro principales zoonosis de Chile. Discusión/Conclusión: Se obtuvo la distribución de las cuatro principales zoonosis de Chile. Los mapas de riesgo obtenidos muestran una enfermedad parasitaria transmitida por vectores de alto riesgo en el norte, la enfermedad de Chagas; una enfermedad parasitaria de comunidades biológicas en que el hombre es un hospedero accidental, asociada a zonas ganaderas, prevalente en el sur, la hidatidosis; una enfermedad bacteriana transmitida por vertebrados, especialmente por roedores, donde el agua es un vehículo importante, dominante en el centro, la leptospirosis; y una enfermedad viral transmitida por roedores, muy dominante en el sur, la infección por hantavirus.

Background: Zoonoses are infections caused by all types of etiological transmissible agents from vertebrate animals to humans. During the last decades, the risk to health caused by different zoonoses has been a consequence of the natural distribution of the different etiological agents and by the emergence and reemergence of these diseases. Aim: To study the distribution of the risk of mortality of the four main zoonoses in continental Chile, based on national mortality data, with the objective of visualizing geographically where to focus the control efforts of these diseases. Methods: Relative risk was estimated by means of Bayesian Statistics. Results: The distribution in Chile of the main zoonoses was obtained. Discussion/Conclusion: The risk maps obtained show a parasitic disease transmitted by high-risk vectors in the north, Chagas disease; a parasitic disease of biological communities in which man is an accidental host, associated with livestock areas, more prevalent in the south, hydatidosis; a bacterial disease transmitted by vertebrates, especially by rodents, where water is an important vehicle, dominant in the center, leptospirosis; and a viral disease transmitted by rodents, very dominant in the south, the hantavirus infection.

Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus / Sociodemographic risk factors of hantavirus cardiopulmonary syndrome

Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.

Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.