1. 'Super-Spreaders' and Person-to-Person Transmission of Andes Virus in Argentina
- Author
-
Lorena Lewis, Elyse R. Nagle, Camila P Olivera, Carla Bellomo, Josefina Campos, JA Diaz, Constanza Anselmo, Valeria P. Martinez, Fernanda Pontoriero, Bonnie Dighero-Kemp, Jens H. Kuhn, Enzo Lavarra, Daniel Cisterna, Miriam I Burgos, Peter A. Larson, Ayelén A Iglesias, Mario Kaler, Beatriz López, Rocío Coelho, Daniel Oscar Alonso, Adolfo Rubinstein, Emiliano Biondo, Natalia Periolo, Jeffrey R. Kugelman, Heema Sharma, Unai Pérez-Sautu, Gustavo Palacios, Teresa Strella, Mariano Sanchez-Lockhart, Claudia Perandones, Alexis Edelstein, Catherine B. Pratt, Nicholas Di Paola, and Joseph A. Chitty
- Subjects
Adult ,Male ,Orthohantavirus ,2019-20 coronavirus outbreak ,Adolescent ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Andes virus ,Argentina ,Rodentia ,Hantavirus Pulmonary Syndrome ,030204 cardiovascular system & hematology ,Disease Outbreaks ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,law ,Animals ,Humans ,Medicine ,Infection transmission ,030212 general & internal medicine ,Phylogeny ,Hantavirus ,Hantavirus pulmonary syndrome ,business.industry ,Carrier state ,High-Throughput Nucleotide Sequencing ,General Medicine ,Middle Aged ,Viral Load ,Virology ,Transmission (mechanics) ,Carrier State ,Female ,business ,Blood Chemical Analysis - Abstract
From November 2018 through February 2019, person-to-person transmission of Andes virus (ANDV) hantavirus pulmonary syndrome occurred in Chubut Province, Argentina, and resulted in 34 confirmed infections and 11 deaths. Understanding the genomic, epidemiologic, and clinical characteristics of person-to-person transmission of ANDV is crucial to designing effective interventions.Clinical and epidemiologic information was obtained by means of patient report and from public health centers. Serologic testing, contact-tracing, and next-generation sequencing were used to identify ANDV infection as the cause of this outbreak of hantavirus pulmonary syndrome and to reconstruct person-to-person transmission events.After a single introduction of ANDV from a rodent reservoir into the human population, transmission was driven by 3 symptomatic persons who attended crowded social events. After 18 cases were confirmed, public health officials enforced isolation of persons with confirmed cases and self-quarantine of possible contacts; these measures most likely curtailed further spread. The median reproductive number (the number of secondary cases caused by an infected person during the infectious period) was 2.12 before the control measures were enforced and decreased to 0.96 after the measures were implemented. Full genome sequencing of the ANDV strain involved in this outbreak was performed with specimens from 27 patients and showed that the strain that was present (Epuyén/18-19) was similar to the causative strain (Epilink/96) in the first known person-to-person transmission of hantavirus pulmonary syndrome caused by ANDV, which occurred in El Bolsón, Argentina, in 1996. Clinical investigations involving patients with ANDV hantavirus pulmonary syndrome in this outbreak revealed that patients with a high viral load and liver injury were more likely than other patients to spread infection. Disease severity, genomic diversity, age, and time spent in the hospital had no clear association with secondary transmission.Among patients with ANDV hantavirus pulmonary syndrome, high viral titers in combination with attendance at massive social gatherings or extensive contact among persons were associated with a higher likelihood of transmission. (Funded by the Ministerio de Salud y Desarrollo Social de la Nación Argentina and others.).
- Published
- 2020