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Duan Q, Wang Y, Jiang X, Ding S, Zhang Y, Yao M, Pang B, Tian X, Ma W, Kou Z, Wen H. Spatial-temporal drivers and incidence heterogeneity of hemorrhagic fever with renal syndrome transmission in Shandong Province, China, 2016-2022. BMC Public Health 2024; 24:1032. [PMID: 38615002 PMCID: PMC11015691 DOI: 10.1186/s12889-024-18440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/26/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome (HFRS) signals a recurring risk in Eurasia in recent years owing to its continued rise in case notifications and the extension of geographical distribution. This study was undertaken to investigate the spatiotemporal drivers and incidence heterogeneity of HFRS transmission in Shandong Province. METHODS The epidemiological data for HFRS, meteorological data and socioeconomic data were obtained from China Information System for Disease Control and Prevention, China Meteorological Data Sharing Service System, and Shandong Statistical Yearbook, respectively. The spatial-temporal multicomponent model was employed to analyze the values of spatial-temporal components and the heterogeneity of HFRS transmission across distinct regions. RESULTS The total effect values of the autoregressive, epidemic, and endemic components were 0.451, 0.187, and 0.033, respectively, exhibiting significant heterogeneity across various cities. This suggested a pivotal role of the autoregressive component in propelling HFRS transmission in Shandong Province. The epidemic component of Qingdao, Weifang, Yantai, Weihai, and Jining declined sharply at the onset of 2020. The random effect identified distinct incidence levels associated with Qingdao and Weifang, signifying regional variations in HFRS occurrence. CONCLUSIONS The autoregressive component emerged as a significant driver in the transmission of HFRS in Shandong Province. Targeted preventive measures should be strategically implemented across various regions, taking into account the predominant component influencing the epidemic.
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Affiliation(s)
- Qing Duan
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Yao Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xiaolin Jiang
- Ministry of Research and Education, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Shujun Ding
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Yuwei Zhang
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Mingxiao Yao
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Bo Pang
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Xueying Tian
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Zengqiang Kou
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China.
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Disease Prevention and Control, Jinan, 250014, China.
| | - Hongling Wen
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
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Vial PA, Ferrés M, Vial C, Klingström J, Ahlm C, López R, Le Corre N, Mertz GJ. Hantavirus in humans: a review of clinical aspects and management. THE LANCET. INFECTIOUS DISEASES 2023; 23:e371-e382. [PMID: 37105214 DOI: 10.1016/s1473-3099(23)00128-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 04/29/2023]
Abstract
Hantavirus infections are part of the broad group of viral haemorrhagic fevers. They are also recognised as a distinct model of an emergent zoonotic infection with a global distribution. Many factors influence their epidemiology and transmission, such as climate, environment, social development, ecology of rodent hosts, and human behaviour in endemic regions. Transmission to humans occurs by exposure to infected rodents in endemic areas; however, Andes hantavirus is unique in that it can be transmitted from person to person. As hantaviruses target endothelial cells, they can affect diverse organ systems; increased vascular permeability is central to pathogenesis. The main clinical syndromes associated with hantaviruses are haemorrhagic fever with renal syndrome (HFRS), which is endemic in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), which is endemic in the Americas. HCPS and HFRS are separate clinical entities, but they share several features and have many overlapping symptoms, signs, and pathogenic alterations. For HCPS in particular, clinical outcomes are highly associated with early clinical suspicion, access to rapid diagnostic testing or algorithms for presumptive diagnosis, and prompt transfer to a facility with critical care units. No specific effective antiviral treatment is available.
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Affiliation(s)
- Pablo A Vial
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Pediatría Clínica Alemana de Santiago, Santiago, Chile.
| | - Marcela Ferrés
- Department of Pediatric Infectious Disease and Immunology, Infectious Disease and Molecular Virology Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Vial
- Programa Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Jonas Klingström
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - René López
- Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Paciente Crítico Clínica Alemana, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Disease and Immunology, Infectious Disease and Molecular Virology Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gregory J Mertz
- Department of Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
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Li R, Sun J, Chen Y, Fan X, Wang X, Zhang X, Zhang K, Han Q, Liu Z. Clinical and laboratory features and factors predicting disease severity in pediatric patients with hemorrhagic fever with renal syndrome caused by Hantaan virus. J Med Virol 2023; 95:e28339. [PMID: 36418181 DOI: 10.1002/jmv.28339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
The clinical features and factors associated with disease severity in children with hemorrhagic fever with renal syndrome (HFRS) have not been well characterized. This study analyzed the clinical and laboratory factors associated with disease severity in children with HFRS caused by Hantaan virus. Data in pediatric patients with HFRS were retrospectively collected from Xi'an Children's Hospital over a 9-year period. Independent factors associated with disease severity were identified. Nomogram predicting disease severity was constructed based on variables filtered by feature selection. In total, 206 children with HFRS were studied. Fever, digestive tract symptoms, headache, backache, bleeding, and renal injury signs were the common symptoms. Elevated white blood cell, reduced platelet, hematuria, proteinuria, coagulation abnormalities, increased blood urea nitrogen (BUN) and procalcitonin (PCT), decreased estimated glomerular filtration rate and low serum Na+ , Cl- , and Ca2+ were the common laboratory findings. In the 206 patients, 21 patients had critical type disease and 4 patients (1.9%) died. Hydrothorax, hypotension and cerebral edema/cerebral herniation at hospital admission were independent clinical characteristics, and neutrophil %, prothrombin activity, PCT, BUN, and Ca2+ at hospital admission were independent laboratory factors associated with critical disease. Feature selection identified BUN, PCT and prothrombin time as independent factors related to critical disease. A nomogram integrating BUN and PCT at admission was constructed and calibration showed high accuracy for the probability prediction of critical disease. In conclusion, this study characterized the clinical and laboratory features and constructed a nomogram predicting disease severity in pediatric HFRS, providing references for disease severity evaluation in managing children HFRS.
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Affiliation(s)
- Ruina Li
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi, China
| | - Jingkang Sun
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuting Chen
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiude Fan
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoyun Wang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoge Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kun Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qunying Han
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhengwen Liu
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Seo MH, Kim CM, Kim DM, Yun NR, Park JW, Chung JK. Emerging hantavirus infection in wild rodents captured in suburbs of Gwangju Metropolitan City, South Korea. PLoS Negl Trop Dis 2022; 16:e0010526. [PMID: 35737659 PMCID: PMC9223619 DOI: 10.1371/journal.pntd.0010526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses is a frequently reported acute hemorrhagic fever in South Korea. These viruses are transmitted by various rodent species such as Apodemus agrarius. Methodology/Principal findings To investigate hantavirus infection and seroprevalence in rodents, wild rodents were captured from two districts in the suburbs of Gwangju Metropolitan City from January 2016 to December 2018. Nested reverse-transcription polymerase chain reaction (RT-PCR) targeting the hantavirus-specific L segment and indirect immunofluorescence antibody (IFA) assay using Hantaan virus antigen slides were performed. A total of 585 wild rodents were captured—512 A. agrarius, 49 Crocidura lasiura, and 24 Myodes regulus. Nested RT-PCR was performed to examine the rate of hantavirus infection in wild rodents, and 1.88% (11/585) of all rodents, 1.17% (6/512) of A. agrarius, 6.12% (3/49) of C. lasiura, and 8.33% (2/24) of M. regulus tested positive. The nucleotide sequence analysis of the eleven PCR-positive products revealed that six PCR products showed over 85% sequence similarity with the Jeju virus, four showed over 99.7% similarity with the Hantaan virus, and one showed over 95.3% homology with the Imjin virus. Moreover, IgG antibodies against the Hantaan virus were detected in 6.15% (36/585) of all rodents, 6.8% (35/512) of A. agrarius, and 4.17% (1/24) of M. regulus. IgG antibodies were not detected in C. lasiura. Conclusions/Significance Hantaviruses were detected in all three wild rodent species of A. agrarius, C. lasiura, and M. regulus captured in the suburbs of Gwangju Metropolitan City, South Korea, and it was demonstrated that they were various strains of hantaviruses such as the Hantaan, Jeju, and Imjin viruses. Hantaviruses (family Hantaviridae, genus Hantavirus) are rodent viruses that can cause two fatal human diseases—hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. These viruses are transmitted by various rodent species such as Apodemus agrarius. In the present study, wild rodents captured in the suburbs of Gwangju Metropolitan City were analyzed by nested reverse-transcription polymerase chain reaction targeting the hantavirus-specific L segment and indirect immunofluorescence antibody assay using Hantaan virus antigen slides. A total of 585 wild rodents were captured and 1.88% (11/585) of all rodents, 1.17% (6/512) of A. agrarius, 6.12% (3/49) of Crocidura lasiura, and 8.33% (2/24) of Myodes regulus were PCR-positive. Of the eleven PCR-positive wild rodents, six PCR products showed over 85% sequence similarity with the Jeju virus, four showed over 99.7% similarity with the Hantaan virus, and one showed over 95.3% homology with the Imjin virus. Moreover, IgG antibodies against the Hantaan virus were detected in 6.15% (36/585) of all rodents, 6.8% (35/512) of A. agrarius, and 4.17% (1/24) of M. regulus. IgG antibodies were not detected in C. lasiura. When we examined the detection rate of hantavirus genes in different seasons, hantaviruses were most commonly detected in fall (seven cases [5.69%]) and winter (four cases [2.76%]). No hantaviruses were detected in spring or summer. However, the seasonal prevalence of IgG antibodies was higher in spring and summer (12 [7.32%] and 11 [7.10%] cases, respectively) than in fall and winter (seven [5.69%] and six [4.14%] cases, respectively). This study was performed on a monthly basis throughout a three-year period, and thus, it provides reliable data that may provide insight into preventive measures against HFRS. Our results suggest that various types of hantaviruses, including Hantaan, Jeju, and Imjin viruses, are distributed throughout Gwangju Metropolitan City, South Korea. Data regarding the rate of Hantaan virus infection in rodents in Gwangju and knowledge of the hantavirus seroprevalence, species, and genotypes circulating in these domestic rodent species will provide useful information for developing vaccines and diagnostic testing using sequence data. These will help increase preparedness for the emergence of new species.
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Affiliation(s)
- Mi hee Seo
- Division of Infectious Disease Investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Republic of Korea
| | - Choon-Mee Kim
- Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Dong-Min Kim
- Departments of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
- * E-mail:
| | - Na Ra Yun
- Departments of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Jung Wook Park
- Division of Infectious Disease Investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Republic of Korea
| | - Jae Keun Chung
- Division of Infectious Disease Investigation, Health and Environment Research Institute of Gwangju City, Gwangju, Republic of Korea
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Guo Q, Xu J, Shi Q, Du B. Acute pancreatitis associated with hemorrhagic fever with renal syndrome: a cohort study of 346 patients. BMC Infect Dis 2021; 21:267. [PMID: 33731024 PMCID: PMC7967104 DOI: 10.1186/s12879-021-05964-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/08/2021] [Indexed: 01/18/2023] Open
Abstract
Background To assess the prevalence, risk factors, clinical characteristics, and outcomes of acute pancreatitis (AP) in patients with hemorrhagic fever with renal syndrome (HFRS). Methods All patients diagnosed with HFRS admitted to the First Affiliated Hospital of Xi’an Jiaotong University from January 2013 to July 2020 were enrolled. Patients with and without AP were compared by two risk stratification models: (1) a multivariate regression analysis using propensity score to adjust for confounding and (2) a propensity-matched nested case-control study. Results A total of 346 patients were enrolled in the cohort study, 29 of whom (8.4%) were diagnosed as AP. There was no significant difference between patients with and without AP with regards to common risk factors and presenting signs/symptoms other than gastrointestinal symptoms (p < 0.01). The patients with AP had a significantly higher 90-day mortality rate (24.1% vs. 3.5%, OR 8.9, 95% CI 1.3 to 103.4, p = 0.045), and significantly shorter duration of therapy free-days to 28 day such as RRT and mechanical ventilation free days (p < 0.05, respectively). Conclusions Our study indicated that AP was independently associated with higher mortality in HFRS patients. While considering the difficulty of early recognition of AP among HFRS patients with similar signs and/or symptoms, further laboratory and imaging studies might help identify these patients at risk of poor clinical prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05964-5.
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Affiliation(s)
- Qinyue Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Jing Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Qindong Shi
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China
| | - Bin Du
- State Key Laboratory of Complex, Severe and Rare Diseases, Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, China.
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Zhang L, Ma QS, Zhang Y, Sun BC, Zhao LY. Analysis of misdiagnosed cases of hemorrhagic fever with renal syndrome in children: two cases and literature review. BMC Nephrol 2019; 20:383. [PMID: 31646967 PMCID: PMC6813044 DOI: 10.1186/s12882-019-1562-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome (HFRS) is an acute disease caused by hantavirus infection and is clinically characterized by fever, various hemorrhagic manifestations and transient renal and hepatic dysfunctions. Although various cases of HFRS have been reported, cases in children have rarely been described. Herein, we report two atypical cases of HFRS in children without distinctive manifestations and typical disease clinically progresses. CASE PRESENTATION Patient 1 was a 11-year-old girl who attended our clinic for fever accompanying with acute renal failure, proteinuria and decreased level of complement 3 (C3) and thrombocytopenia without any hemorrhagic manifestations, acute glomerulonephritis was suspected first, especially lupus nephritis. Patient 2 was misdiagnosed as encephalitis at local hospital because of fever and headache for 4 days. With elevated liver transaminases, proteinuria and normal cerebrospinal fluid examination, HFRS was taken into consideration. Both of the two cases were supported and confirmed by serological test for Hantavirus. CONCLUSIONS Clinical manifestations of HFRS in children often presented atypically and were milder than adults. Febrile disease accompanying with thrombocytopenia may lead to the suspected diagnosis of HFRS.
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Affiliation(s)
- Li Zhang
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Qing-shan Ma
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Yan Zhang
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Bai-chao Sun
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
| | - Leng-yue Zhao
- 0000 0004 1760 5735grid.64924.3dDepartment of Pediatrics Nephrology, First Hospital, Jilin University, Changchun, 130021 Jilin China
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Risteska-Nejashmikj V, Ristikj-Stomnaroska D, Bosevska G, Papa A, Stojkovska S. Facing of Family Doctor with Hantavirus Infection. Open Access Maced J Med Sci 2019; 7:1660-1664. [PMID: 31210818 PMCID: PMC6560302 DOI: 10.3889/oamjms.2019.468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/18/2019] [Accepted: 05/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hantavirus infection is manifested as an urgent, severe and life-threatening disease caused by Hantavirus. The virus affects human endothelial cells. The natural reservoir of the Hantaviruses is chronically infected rodents. Human infection is accidental. Occurs by intake of contaminated food or inhalation of contaminated secretion from infected rodents' excretions have an increased risk of contamination. The most affected persons are people who work in nature. The virus causes haemorrhages, fever and acute renal failure. The disease appears more frequently in endemic regions with the lethality of 6-15%. The disease can surprise doctors with severity, urgency and undefined clinical picture. Fast clinical evaluation, proper and urgent diagnosis and treatment can improve the safe life of these patients. CASE REPORT We report a case of 45 -year-old male patient worked as a shepherd on mountain Babuna near the city of Veles in the Republic of Macedonia at the end of the summer in the year 2017, presented with prolonged hemorrhagic fever with renal syndrome. The clinical presentation and lab findings support the diagnosis of Hantavirus infection with acute renal failure. CONCLUSION It is necessary to raise the awareness of the family doctors for the hantavirus disease, especially in countries with sporadic cases, as in our country. It needs for prompt and timely diagnosis, timely hospitalisation and initiation of therapy.
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Affiliation(s)
- Valentina Risteska-Nejashmikj
- Center for Family Medicine, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | | | - Golubinka Bosevska
- Institute of Public Health, Laboratory for Virology and Molecular Diagnostics, Skopje, Republic of Macedonia
| | - Anna Papa
- Medical School Aristotle, University of Thessaloniki, Thessaloniki, Greece
| | - Snezhana Stojkovska
- University Clinic for Infectious Diseases and Febrile States, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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