INTRODUCTION

Hantaviruses belong to the enveloped viruses within the family Bunyaviridae, genus Hantavirus, and all medically important species are carried by rodents of the family Muridae. Named for the Hantaan River in Korea, hantaviruses were first isolated in 1976, though the clinical syndrome they cause came to widespread attention in the early 1950s when more than 3000 United States and United Nations Korean War forces contracted an acute febrile illness associated with renal failure and coagulopathy. Hantaviruses are also believed to have been responsible for outbreaks of hemorrhagic fevers in Russia (1913), Scandinavia (1932–1935), and Finland (1945), though they have become clinically significant in the United States only over the past 15 years.

Hantavirus infection causes two distinct clinical syndromes characterized, respectively, by renal failure or cardiovascular collapse. The so-called “Old World” hantaviruses endemic to Asia and Europe cause hemorrhagic fever with renal syndrome (HFRS), whereas the “New World” hantaviruses endemic to North America cause hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS). Both diseases appear to be immunopathologic.

EPIDEMIOLOGY

There are 20 distinct hantavirus species, but only 11 are associated with human disease. HFRS can be caused by any of the Old World hantavirus strains including Hantaan, Seoul, Dobrava-Belgrade, and Puumala viruses. (See Figure 70.1.)