1887
Outbreaks Open Access
Like 0

Abstract

In 2021, a large outbreak of hantavirus disease (HAVID) in Croatia with 334 notified cases coincided with a COVID-19 wave and included patients from areas previously not considered endemic, challenging HAVID recognition and patient management. We analysed clinical and epidemiological data on all 254 patients with HAVID treated in the Clinical Hospital Center Rijeka (CHC Rijeka) between February and November 2021. Most patients (n = 246; 96.9%) had antibodies against Puumala virus, 212 (83.5%) were residents of endemic areas for HAVID, 93 (36.6%) reported occupational exposure and 86 (33.9%) had observed rodents or rodent excreta. Thirty-seven (14.6%) patients were not notified to the public health authorities. Most patients (n = 177; 69.7%) were male. The median age of the patients was 43 years (range: 17–79 years) in males and 54 years (range: 14–77 years) in females. More severe courses of disease were observed in males aged < 45 years than in older males and females of any age (OR = 2.27; 95% CI: 1.21–4.24; p < 0.005). Measures to prevent exposure, early detection and notification of cases and close collaboration between primary and secondary healthcare teams with public health personnel are essential to improve surveillance and prevent hantavirus outbreaks.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2025.30.3.2400127
2025-01-23
2025-01-24
/content/10.2807/1560-7917.ES.2025.30.3.2400127
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/30/3/eurosurv-30-3-3.html?itemId=/content/10.2807/1560-7917.ES.2025.30.3.2400127&mimeType=html&fmt=ahah

References

  1. European Centre for Disease Prevention and Control (ECDC). Hantavirus infection. Annual epidemiological report for 2020. Stockholm: ECDC; Jan 2023. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Hantavirus-AER-2020.pdf
  2. Clement J, Maes P, van Ypersele de Strihou C, van der Groen G, Barrios JM, Verstraeten WW, et al. Beechnuts and outbreaks of nephropathia epidemica (NE): of mast, mice and men. Nephrol Dial Transplant. 2010;25(6):1740-6.  https://doi.org/10.1093/ndt/gfq122  PMID: 20237057 
  3. Centers for Disease Control and Prevention (CDC). Hantavirus. Atlanta: CDC; 13 May 2024. Available from: https://www.cdc.gov/hantavirus
  4. Croatian Institute of Public Health (CIPH). Croatian Health Statistics Yearbook 2022. Zagreb: CIPH; 2023. Available from: https://www.hzjz.hr/wp-content/uploads/2024/05/HZSLj_2022_12-2023.pdf
  5. Tadin A, Bjedov L, Margaletic J, Zibrat B, Krajinovic LC, Svoboda P, et al. High infection rate of bank voles (Myodes glareolus) with Puumala virus is associated with a winter outbreak of haemorrhagic fever with renal syndrome in Croatia. Epidemiol Infect. 2014;142(9):1945-51.  https://doi.org/10.1017/S095026881300321X  PMID: 24800636 
  6. Avšič Županc T, Korva M, Markotić A. HFRS and hantaviruses in the Balkans/South-East Europe. Virus Res. 2014;187:27-33.  https://doi.org/10.1016/j.virusres.2013.12.042  PMID: 24472777 
  7. Salimović-Bešić I, Hrvo S, Zahirović E, Đulić EJ, Baljić R, Dedeić-Ljubović A. Expansion of hantavirus infection during the SARS-CoV-2 pandemic in Bosnia and Herzegovina, 2021. J Med Microbiol. 2023;72(5).  https://doi.org/10.1099/jmm.0.001687  PMID: 37255412 
  8. Vaheri A, Henttonen H, Voutilainen L, Mustonen J, Sironen T, Vapalahti O. Hantavirus infections in Europe and their impact on public health. Rev Med Virol. 2013;23(1):35-49.  https://doi.org/10.1002/rmv.1722  PMID: 22761056 
  9. Reusken C, Heyman P. Factors driving hantavirus emergence in Europe. Curr Opin Virol. 2013;3(1):92-9.  https://doi.org/10.1016/j.coviro.2013.01.002  PMID: 23384818 
  10. Radoŝević Z, Mohacek I. The problem of nephropathia epidemica Myhrman-Zetterholm in relation to acute interstitial nephritis. Acta Med Scand. 1954;149(3):221-8.  https://doi.org/10.1111/j.0954-6820.1954.tb11429.x  PMID: 13180229 
  11. Markotić A, Nichol ST, Kuzman I, Sanchez AJ, Ksiazek TG, Gagro A, et al. Characteristics of Puumala and Dobrava infections in Croatia. J Med Virol. 2002;66(4):542-51.  https://doi.org/10.1002/jmv.2179  PMID: 11857535 
  12. Vilibic-Cavlek T, Furic A, Barbic L, Tabain I, Stevanovic V, Mlinaric-Galinovic G. Clinical and virological characteristics of hantavirus infections in a 2014 Croatian outbreak. J Infect Dev Ctries. 2017;11(1):73-80.  https://doi.org/10.3855/jidc.7987  PMID: 28141593 
  13. Cekinović Grbeša Đ, Zahirović N, Flego V, Livajić M, Rončević Filipović M, Knežević S, et al. Epidemiology and clinical course of haemorrhagic fever with renal syndrome in new endemic area for hantavirus infection in Croatia. Life (Basel). 2023;13(8):1767-74.  https://doi.org/10.3390/life13081767  PMID: 37629623 
  14. Ministry of Health of Croatia. Narodne novine (official gazette) 9/2024. [Regulation on reporting infectious diseases 9/2024]. Zagreb: Ministry of Health of Croatia; Jan 2024. Croatian. Available from: https://www.zakon.hr/cms.htm?id=59413
  15. Croatian Institute of Public Health (CIPH). Definicije zaraznih bolesti koje se obvezno prijavljuju. [Case definitions for notifiable diseases]. Zagreb: CIPH; 2024. Croatian. Available from: https://www.hzjz.hr/wp-content/uploads/2023/04/definicije-24_01_2024_promjenaCOVID19.pdf
  16. Primorsko-Goranska County (PGZ). COVID-19 PGŽ. [COVID-19 in Primorsko-Goranska County]. Zagreb: PGZ; 2021. Croatian. Available from: https://www.pgz.hr/wp-content/uploads/2021/04/Covid070421.png
  17. Flegar-Meštrić Z, Perkov S, Radeljak A. Standardization in laboratory medicine: Adoption of common reference intervals to the Croatian population. World J Methodol. 2016;6(1):93-100.  https://doi.org/10.5662/wjm.v6.i1.93  PMID: 27019800 
  18. Robert Koch Institut (RKI). Hantavirus-Erkrankung. [Hantavirus disease]. Berlin: RKI; 13 Nov 2020. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Hantaviren.html
  19. Getz LL, Oli MK, Hofmann JE, McGuire B. Vole population fluctuations: factors that initiate and determine intervals between them in Microtus pennsylvanicus. J Mammal. 2006;87(5):841-7.  https://doi.org/10.1644/05-MAMM-A-292R1.1 
  20. Madrières S, Castel G, Murri S, Vulin J, Marianneau P, Charbonnel N. The needs for developing experiments on reservoirs in hantavirus research: accomplishments, challenges and promises for the future. Viruses. 2019;11(7):664-85.  https://doi.org/10.3390/v11070664  PMID: 31331096 
  21. Riccò M, Peruzzi S, Ranzieri S, Magnavita N. Occupational hantavirus infections in agricultural and forestry workers: a systematic review and metanalysis. Viruses. 2021;13(11):2150-74.  https://doi.org/10.3390/v13112150  PMID: 34834957 
  22. Kuzman I, Markotić A, Turcinov D, Beus I. Epidemija hemoragijske vrućice s bubreznim sindromom u Hrvatskoj 1995. godine. [An epidemic of haemorrhagic fever with renal syndrome in Croatia in 1995]. Lijec Vjesn. 1997;119(11-12):311-5. Croatian. PMID: 9658776 
  23. Watson DC, Sargianou M, Papa A, Chra P, Starakis I, Panos G. Epidemiology of hantavirus infections in humans: a comprehensive, global overview. Crit Rev Microbiol. 2014;40(3):261-72.  https://doi.org/10.3109/1040841X.2013.783555  PMID: 23607444 
  24. Pavletić M, Mazor M, Lerga M, Mileta T, Železnjak J, Ružić T, et al. Fast, reliable, and simple point-of-care-like adaptation of RT-qPCR for the detection of SARS-CoV-2 for use in hospital emergency departments. Viruses. 2021;13(12):2413-29.  https://doi.org/10.3390/v13122413  PMID: 34960682 
  25. Joyce AK, Oliver TT, Kofman AD, Talker DL, Safaeian S, Peker Barclift D, et al. Hantavirus disease and COVID-19. Am J Clin Pathol. 2022;157(3):470-5.  https://doi.org/10.1093/ajcp/aqab155  PMID: 34643226 
  26. Wilson TM, Paddock CD, Reagan-Steiner S, Bhatnagar J, Martines RB, Wiens AL, et al. Intersecting paths of emerging and reemerging infectious diseases. Emerg Infect Dis. 2021;27(5):1517-9.  https://doi.org/10.3201/eid2705.204779  PMID: 33704045 
  27. Mustonen J, Vaheri A, Pörsti I, Mäkelä S. Long-term consequences of Puumala hantavirus Infection. Viruses. 2022;14(3):598-605.  https://doi.org/10.3390/v14030598  PMID: 35337005 
  28. Van Epps HL, Terajima M, Mustonen J, Arstila TP, Corey EA, Vaheri A, et al. Long-lived memory T lymphocyte responses after hantavirus infection. J Exp Med. 2002;196(5):579-88.  https://doi.org/10.1084/jem.20011255  PMID: 12208874 
  29. Saavedra F, Díaz FE, Retamal-Díaz A, Covián C, González PA, Kalergis AM. Immune response during hantavirus diseases: implications for immunotherapies and vaccine design. Immunology. 2021;163(3):262-77.  https://doi.org/10.1111/imm.13322  PMID: 33638192 
  30. Turčinov D, Puljiz I, Markotić A, Kuzman I, Begovac J. Clinical and laboratory findings in patients with oliguric and non-oliguric hantavirus haemorrhagic fever with renal syndrome: an analysis of 128 patients. Clin Microbiol Infect. 2013;19(7):674-9.  https://doi.org/10.1111/j.1469-0691.2012.03994.x  PMID: 22963396 
  31. Malinin OV, Kiryanov NA. Fatal cases of hemorrhagic fever with renal syndrome in Udmurtia, Russia, 2010 to 2019. Eur J Clin Microbiol Infect Dis. 2022;41(7):1059-64.  https://doi.org/10.1007/s10096-022-04463-y  PMID: 35668333 
  32. Koster F, Foucar K, Hjelle B, Scott A, Chong YY, Larson R, et al. Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review. Am J Clin Pathol. 2001;116(5):665-72.  https://doi.org/10.1309/CNWF-DC72-QYMR-M8DA  PMID: 11710682 
  33. Koskela S, Mäkelä S, Strandin T, Vaheri A, Outinen T, Joutsi-Korhonen L, et al. Coagulopathy in acute Puumala hantavirus infection. Viruses. 2021;13(8):1553-67.  https://doi.org/10.3390/v13081553  PMID: 34452419 
  34. Connolly-Andersen AM, Whitaker H, Klingström J, Ahlm C. Risk of venous thromboembolism following hemorrhagic fever with renal syndrome: a self-controlled case series study. Clin Infect Dis. 2018;66(2):268-73.  https://doi.org/10.1093/cid/cix777  PMID: 29020303 
  35. Outinen TK, Mäkelä S, Pörsti I, Vaheri A, Mustonen J. Severity biomarkers in Puumala hantavirus infection. Viruses. 2021;14(1):45-57.  https://doi.org/10.3390/v14010045  PMID: 35062248 
  36. Nusshag C, Uhrig J, Gruber G, Schreiber P, Zeier M, Krautkrämer E. Glomerular injury is associated with severe courses of orthohantavirus infection. Pathogens. 2024;13(8):693.  https://doi.org/10.3390/pathogens13080693  PMID: 39204293 
  37. Mackow ER, Gorbunova EE, Dalrymple NA, Gavrilovskaya IN. Role of vascular and lymphatic endothelial cells in hantavirus pulmonary syndrome suggests targeted therapeutic approaches. Lymphat Res Biol. 2013;11(3):128-35.  https://doi.org/10.1089/lrb.2013.0006  PMID: 24024573 
  38. Tsheten T, Clements ACA, Gray DJ, Adhikary RK, Furuya-Kanamori L, Wangdi K. Clinical predictors of severe dengue: a systematic review and meta-analysis. Infect Dis Poverty. 2021;10(1):123-32.  https://doi.org/10.1186/s40249-021-00908-2  PMID: 34627388 
/content/10.2807/1560-7917.ES.2025.30.3.2400127
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error