Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014
Open accessAbstract
P athogenic hantaviruses are members of the fam- ily Hantaviridae and genus Orthohantavirus.These viruses are responsible for hantavirus pulmonary syndrome (HPS) in the Americas.In Argentina, HPS was first described in 1995 during an outbreak in the Andean region of Patagonia, leading to the characterization of Andes virus (ANDV) (1).Since then, >1,200 cases have been confirmed in Argentina (2,3).Hantaviruses are enveloped, single-stranded, RNA viruses with tripartite negative sense genomes.The small (S, 1.8-2.1 kb) segment encodes a nucleocapsid protein, the medium (M, 3.6-3.8kb) a glycoprotein precursor, and the large (L, 6.5-6.7 kb) an RNA-dependent RNA polymerase (4).Humans usually become infected with hantaviruses through inhalation of aerosolized excreta produced by infected rodents.ANDV is the unique hantavirus capable of being transmitted from personto-person (5-7).Infection by this route takes place during the early prodromal phase, and the incubation period ranges from 9 to 40 days (8).In previous outbreaks, genetic analysis was performed on partial sequences of ANDV, which represented ≈10% of the genome.Thus, the aim of this study was to analyze a cluster of 3 case-patients for whom epidemiologic data were available and compare complete viral genome sequences to assess person-to-person transmission or co-exposure to the same rodent population. The StudyThe occurrence of 3 clustered cases during 2014 led us to suspect person-to-person transmission.The cases were reported during a 43-day period in El Bolsón, Rio Negro.The 3 case-patients had severe disease; 2 of these case-patients (P1 and P2) died (Table 1).P1 and P2, who were twin brothers, had symptoms develop 2 weeks apart, and each sought care at a primary healthcare center (Hospital Area El Bolsón, Rio Negro).P3 was a nurse who attended P2 during this initial hospitalization.After the beginning of the cardiopulmonary phase, each patient was transferred to a high-complexity hospital in Bariloche (Hospital Zonal Bariloche).P1 died 5 days and P2 7 days after symptom onset; P3 survived.For our investigation, we included 2 unrelated HPS case-patients (NCR1 and NCR2) from the same area for comparison.We confirmed HPS in all 5 patients by using laboratory detection of ANDVspecific IgM and reverse transcription quantitative PCR, as described (3).All patients, except P2, had ANDV-specific IgG.For whole-genome sequencing, we extracted RNA from peripheral blood of patients and prepared Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014
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The use of genetic sequencing data to confirm human-to-human transmission has the limitation of only providing strong evidence when cases that occur in different geographic areas have identical sequences.
“While the use of genetic sequencing data to confirm human-to-human transmission has been used in investigations of clusters in Argentina and Chile [7–11, 25, 26, 32, 35], it has the limitation of only providing strong evidence when cases that occur in different geographic areas have identical sequences.”
From Evidence for Human-to-Human Transmission of Hantavirus: A Systematic Review (2022) · cites this paper as [26]
In The Study, the paper uses whole-genome sequencing to investigate a transmission cluster and notes that co-exposure to rodents can be difficult to rule out for patients in the same area. It does not state that sequencing provides strong evidence only when cases occur in different geographic areas and have identical sequences; it considers person-to-person transmission most probable for P1 and P2 despite two nucleotide differences. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOf the 14 noncomparative studies, 7 were conducted in Argentina (6 analyses of clusters and 1 seroprevalence study) and 3 in Chile (2 analyses of clusters and 1 seroprevalence study).
“Of the 14 noncomparative studies, 7 were conducted in Argentina (6 analyses of clusters and 1 seroprevalence study) [8–10, 13, 25, 26, 32] and 3 in Chile (2 analyses of clusters and 1 seroprevalence study) [11, 14, 35] (Supplementary Table 2).”
From Evidence for Human-to-Human Transmission of Hantavirus: A Systematic Review (2022) · cites this paper as [26]
For the noncomparative studies, the evidence for human-to-human transmission is limited to analyses of clusters in Chile and Argentina, and these findings are not supported by seroprevalence studies conducted in these countries after hantavirus outbreaks in the population.
“For the noncomparative studies, the evidence for human-to-human transmission is limited to analyses of clusters in Chile [11, 35] and Argentina [8–10, 26, 32] and these findings are not supported by seroprevalence studies conducted in these countries after hantavirus outbreaks in the population [13, 14].”
From Evidence for Human-to-Human Transmission of Hantavirus: A Systematic Review (2022) · cites this paper as [26]
In Argentina, all but 1 of the studies showed some evidence of human-to-human transmission in investigations of clusters, with up to 16 likely cases reported between 1996 and 2014.
“In Argentina, all but 1 of the studies showed some evidence of human-to-human transmission in investigations of clusters [8–10, 25, 26, 32], with up to 16 likely cases of human-to-human transmission reported between 1996 and 2014.”
From Evidence for Human-to-Human Transmission of Hantavirus: A Systematic Review (2022) · cites this paper as [26]
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- [8]Martinez VP. A major outbreak of hantavirus pulmonary syndrome caused by person-to-person transmission of Andes virus Epuyén, southwestern Argentina. Presented at: 11th International Conference on Hantaviruses; 2019 Sep 3; Leuven, Belgium.
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- Authors
- Alonso, D. O., Pérez-Sautu, U., Bellomo, C. M., Prieto, K., Iglesias, A., Coelho, R., Periolo, N., Domenech, I., Talmon, G., Hansen, R., Palacios, G., & Martinez, V. P.
- Affiliations
- United States Army Medical Research Institute of Infectious Diseases (US)
- Venue
- Emerging Infectious Diseases
- Published
- 2020-04
- Volume
- 26
- Issue
- 4
- Pages
- 756-759
- ISSN
- 1080-6040 (ISSN-L)
- 1080-6059
- PMC
- PMC7101103
- OpenAlex
- W3009705500
- Cited by
- 76
- References
- 11
- Citations by year
- 2026: 40 · 2025: 8 · 2024: 4 · 2023: 10 · 2022: 5 · 2021: 4 · 2020: 5
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Emerging infectious diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- CONICET Digital (CONICET) (submittedVersion, cc-by-nc-sa)
- Greater South Information System
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Vectors
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Keywords
- Andes virus, hantavirus pulmonary syndrome, human-to-human transmission, case clusters, Argentina, hantavirus outbreak, nosocomial transmission, rodent reservoirs, Hantaviridae, hantavirus
- MeSH terms
- Argentina, Orthohantavirus, Humans, Hantavirus Pulmonary Syndrome
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