Hantaviruses

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Hantaviruses
Sin Nombre virus Hanta TEM 1137 lores.jpg

Sin Nombre Virus

Systematics
Classification : Viruses
Area : Riboviria
Empire : Orthornavirae
Phylum : Negarnaviricota
Subphylum : Polyploviricotina
Class : Ellioviricetes
Order : Bunyavirales
Family : Hantaviridae
Genre : Orthohantavirus
Taxonomic characteristics
Genome : (-) ss RNA segmented
Baltimore : Group 5
Symmetry : helical
Cover : available
Scientific name
Hantaviridae
Left
NCBI  Taxonomy: 11598
ViralZone ( ExPASy , SIB): 213
ICTVdB Virus Code : 00.011.0.02

The family Hantaviridae from the order of the Bunyavirales includes not only a few species of the genera Loanvirus , Mobatvirus and Thottimvirus, but above all numerous species of the genus Orthohantavirus : among others the human pathogenic species Hantaan virus (HTNV), Puumala virus (PUUV), Dobrava-Belgrade- Virus (DOBV), Seoul Virus (SEOV), Sin Nombre Virus (SNV) and Andes Virus (ANDV). These enveloped single-strand (-) - RNA viruses [ss (-) RNA] cause different diseases depending on the virus type. These include severe lung diseases ( pneumonia ), acute kidney failure ( nephrotic syndrome ) or haemorrhagic fevers . The viruses are distributed worldwide and also occur in Central Europe. They are transmitted to humans through the feces or urine of infected rodents (mice and rats) that are inhaled as dust. The infected rodents themselves show no symptoms of the disease. Human diseases have different degrees of severity. While the Puumala and Dobrava virus infections occurring in Central Europe are fatal in less than 1 percent of clinically conspicuous cases, the mortality rate for infections with the Hantaan virus, which occurs in East Asia and with the Dobrava virus, which can be found in the Balkans, is up to 15 percent and for the American hantaviruses (Sin-Nombre virus, Andes virus and others) about 30-40 percent.

The name Hanta goes back to the Hantan River in South Korea , where more than 3,000 American soldiers developed an unusually high fever during the Korean War in the 1950s, which subsequently led to frequent kidney failure. It was not until 1977 that Ho Wang Lee and others succeeded in isolating the previously unknown Hantaan virus (HTNV). In this history, the name is Korean for fever caused by human pathogenic Orthohantaviren diseases ( english Hantavirus hemorrhagic fever with renal syndrome , HFRS) back.

Transmission and incubation period

It is transmitted by various rodents , which excrete large amounts of pathogens with their saliva , faeces and urine ( viruria ). In rodents, mice in particular, especially the bank vole in Germany , have been identified as vectors, but they do not become ill themselves, even if, once infected, they remain infectious for life. The transmission to humans occurs both through contact infection and through oral , but mainly through respiratory uptake of the pathogen through the respiratory tract, less often through rodent bites. A typical situation in which a transmission can take place with a relatively high probability is, for example, sweeping out a hut that is not used in winter in spring. In general, people who work in agriculture and forestry or who spend a lot of time in nature are particularly at risk. Rice farmers are often affected in Asia. Human-to-human transmission has only been described in one outbreak in South America in 1996.

The incubation period is between 5 and 60 days, depending on the type of virus.

Caused human diseases

Hantaviruses in Europe and Asia

The bank vole is the main vector of the Puumala virus in Central Europe

In the case of European and Asian hantaviruses, kidney damage, which can lead to (mostly reversible) acute kidney failure , as well as a febrile illness with disruption of blood clotting and a tendency to bleed are in the foreground. The symptom complex is often referred to as "Hemorrhagic Fever with Renal Syndrome" (HFRS). The Dobrava-Belgrade virus and Puumala virus occur in Europe and cause mild to moderate courses. The bank vole, for the Dobrava virus, the fire mouse and the yellow-necked mouse are identified as carriers of the Puumala virus . The kidney damage caused by the Puumala virus, which is also common in Germany and Scandinavia, is also known as nephropathia epidemica (NE). Bleeding occurs very rarely.

Clinically, the infection manifests itself with an abrupt onset of fever, headache, body aches, drop in blood pressure, changes in the blood count ( thrombopenia ), neurological symptoms (visual disturbances) and signs of kidney damage (increase in serum creatinine , microhematuria , proteinuria ). Acute attacks of glaucoma , central nervous system (CNS) involvement , myocarditis, and intestinal bleeding (affecting the bowel) can be complications. The disease usually heals without consequences.

The HFRS diseases caused by the southeast European variant of the Dobrava virus tend to be significantly more severe and have a mortality rate of up to 12%. The same applies to the East Asian disease picture caused by the Hantaan genotype, in which the death rate is around 15%.

Diseases caused by hantaviruses must be treated in hospital if the course is severe, otherwise the disease can lead to death. An anemia can continue months. Evidence of hantaviruses or a hantavirus infection has been notifiable in Germany since January 1, 2001 .

Hantaviruses in North and South America

The American deer mouse ( Peromyscus maniculatus ) from the genus of whitefoot mice, one of the main carriers of hantaviruses
The long-tailed pygmy rice rat ( Oligoryzomys longicaudatus ), a major vector in South America

In the case of the hantaviruses occurring on the American double continent, the focus is usually not on kidney damage or hemorrhagic fever, but on severe pneumonia with pulmonary edema (hantavirus-associated pulmonary syndrome, HPS for short, also synonymous with Hantavirus cardiopulmonary syndrome , HCPS). The disease was first described in 1993 after several cases of severe pneumonia in Navajo Indians occurred in the border area of ​​the four states of New Mexico , Utah , Arizona, and Colorado (a region known as the " Four Corners ") , some of them ended fatally. The circumstances and epidemiology of this outbreak suggested an infectious cause of the pneumonia. Scientists at the Centers for Disease Control and Prevention (CDC) were subsequently able to prove that the disease was caused by a new, previously unknown hantavirus. The virus was isolated at both the CDC and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) and was initially named Muerto Canyon virus , later changed to Sin Nombre virus (SNV, "nameless virus"). As it was known that hantaviruses were transmitted by rodents, an extensive search for the carrier of this local hantavirus epidemic in the affected region was initiated. Numerous rodents were trapped and examined. It turned out that white-footed mice ( Peromyscus maniculatus , English deer mouse ) were the main vectors of this newly discovered hantavirus. These New World mice often live in the vicinity of human settlements or directly in older houses. Investigations in the same year 1993 showed that other, related hantaviruses can trigger a similar clinical picture. Two new hantaviruses were discovered in two people from Louisiana and Florida with HPS, later named Bayou virus and Black Creek Canal virus . Rice rats ( Oryzomys ) and cotton rats ( Sigmodon hispidus ) were identified as carriers .

With the North American hantaviruses ("new world hanta viruses") and especially with the Sin Nombre virus, the incubation period is two to four weeks, followed by a prodromal phase. This results in a high fever , muscle pain , severe headache and neck pain, with a general feeling of illness and weakness, with abdominal pain accompanied by nausea and vomiting , occasionally diarrhea . Severe leukocytosis with bandemia and thrombocytopenia develops . The kidneys and liver are typically not involved. After three to five days there can be an abrupt deterioration and progression into the "cardiopulmonary phase" with dyspnoea , non-purulent secretion, up to acute lung failure and myocardial decompensation, which is associated with a mortality of 40%. Specific antibodies are formed very early , in addition to IgM , IgG antibodies are also formed within a few days .

Other hantaviruses were later described in patients with pulmonary symptoms in Argentina , Brazil , Canada , Chile , Paraguay, and Uruguay . In the Southern Cone of South America, the Langschwanz- true dwarf oryzomys Oligoryzomys longicaudatus as the main carrier of hantavirus, which ever the feverish kidney shape (HFRS) and the very dangerous cardiopulmonary form (HCPS) cause about half of infections of Hantavirenkrankheit. The dominant pathogen is the Andes virus (ANDV) identified in Argentina in 1998 , which, in addition to HPS / HCPS, causes HFRS more frequently than the Sin Nombre virus .

diagnosis

The diagnosis of a hantavirus infection is based on the one hand on the typical clinical picture (see above) and on the other hand on the basis of specific laboratory values. Direct isolation of the pathogen is possible in animal experiments and in cell cultures at the onset of the disease, but it is uncommon. Serological detection (i.e. detection of antibodies against the virus in the blood) is provided in the immunofluorescence test and ELISA . IgM antibodies are only detectable for a few weeks, whereas the IgG antibodies that appear 14 days after the onset of the disease can persist for years.

therapy

The therapy is primarily symptomatic and supportive with adequate fluid intake, intensive medical care and intubation in the case of acute lung failure or dialysis in the case of acute renal insufficiency .

The antiviral effective ribavirin shows in laboratory tests while a good activity against hantavirus, but the therapeutic results are inconclusive and the serious side effects cause it is not generally used.

prevention

vaccination

A vaccination against hantaviruses is only in the development stage.

hygiene

To prevent infection, rodents in the vicinity of human settlements can be fought . If contact cannot be avoided, for example when cleaning infected areas, it is recommended that rodent carcasses only be removed using disposable gloves. Moistening the affected areas, for example in sheds or barns, reduces the whirling up of dust; mouth protection and gloves should be worn when cleaning; Tightly closing rubbish bins and regular cleaning and ventilation are also among the preventive measures recommended by the Robert Koch Institute. Soiled surfaces should be disinfected after cleaning.

Occurrence

Worldwide incidence of hantavirus infections (absolute case numbers per year and country). These are mostly estimates or mean values. For many countries there are no exact number of cases.

Europe (NE)

  • 0-5 cases
  • 6–20 cases
  • 21-100 cases
  • 101-1000 cases
  • 1001-5000 cases
    • East Asia (HFRS)
  • 0-5 cases
  • 100-1000 cases
  • 10,000-20,000 cases
    • Russia (HFRS & NE)
  • 1000-5000 cases
    • North and South America (HPS)
  • 0-5 cases
  • 6–20 cases
  • 21-100 cases
  • 101-1000 cases
  • 1001-5000 cases
    • Others
  • no data

    • NE = Nephropathia epidemica
    HFRS = Hemorrhagic fever with renal syndrome
    HPS = Hantavirus-associated pulmonary syndrome

    Hantaviruses are spread all over the world. For most countries, however, there are no precise epidemiological indicators. The adjacent map gives an impression. It can be assumed that many hantavirus infections, especially in countries with less developed health systems, will not be recognized. B. is not thought of the possibility of an infectious cause.

    Asia

    In China, one death and other suspected cases were reported in Yunnan Province on March 24, 2020 .

    Europe

    The highest case numbers are reported from Sweden and Finland. In Central Europe, for example, some regions in Lower Saxony , Hesse , Bavaria and Baden-Württemberg as well as parts of Styria in Austria are known as endemic areas for the Puumala virus , while in northern Germany, but especially in Eastern and Southeastern Europe, the Dobrava-Belgrade virus is endemic. This can lead to diseases with sudden kidney failure, especially in spring.

    Germany

    Since hantavirus diseases have only been notifiable in Germany since 2001, no reliable data are available for the incidence rates from previous years. About 1–2 percent of the population have hantavirus-specific antibodies. However, the number of reported diseases is far lower, which indicates on the one hand that the infection often proceeds without clinical symptoms, on the other hand, even with clinical symptoms (kidney damage), an infectious cause is not always considered. With cases reported in 2017, hantavirus infections were among the five most common reportable viral diseases in Germany in 2010 (after noroviruses (140519), rotaviruses (54051), hepatitis C (5301) and influenza (3468)). The large annual differences in the number of cases are striking: while in some years well over 1,000 cases were reported, in other years the number of cases was only a few hundred in some cases. In 2006 only 72 illnesses were reported. In 2016, 282 cases were recorded nationwide, compared to 1731 in 2017. There are also regional differences: high numbers of cases were reported in 2007 and 2010 from Baden-Württemberg from the Swabian Alb , but also from the Bavarian Forest , the Spessart , Cologne and the Münsterland . A connection with the occurrence of beech forests is assumed, since the bank vole feeds on beechnuts.

    Hantavirus cases in Germany in 2012 by district (place of residence / residence of the case) Cases according to the reference definition of the Robert Koch Institute; Data status: Aug 29, 2012:
  • 0 cases
  • 1st case
  • 2 cases
  • 3 - 8 cases
  • > 8 cases
    • year Number of infections *
    2001 182
    2002 228
    2003 144
    2004 242
    2005 447
    2006 72
    2007 1,687
    2008 243
    2009 181
    2010 2.016
    2011 305
    2012 2,825
    2013 161
    2014 574
    2015 829
    2016 282
    2017 1,731
    2018 235
    2019 1,451
    total 13,803
    Source: RKI; Status: February 10, 2020 *

    *) only clinical laboratory diagnostic cases

    Austria

    In Austria, the Puumala virus is the most frequently detected hantavirus. Between 2004 and 2011, an average of 20 infections were known across the country, albeit with large differences between individual years. In 2007 there were almost 80 infections. In 2012, as in Germany, there was an unusual increase in hantavirus infections; 180 cases were counted in the first seven months. The mortality is given as 0.2%. In 2011, an infection with dobravaviruses, which had probably been acquired in Austria, was diagnosed for the first time, which causes more severe disease processes. Most of the hantavirus infections documented between 1993 and 2010 occurred in Styria , Carinthia (especially in the Wolfsberg district ), in southern Burgenland and in the Rohrbach district in Upper Austria . In contrast, no cases were known from the federal states of Tyrol and Vorarlberg in 2012.

    Switzerland

    In Switzerland, hantavirus infections have so far only been described as isolated cases.

    Luxembourg

    No data are available on hantavirus infections acquired in Luxembourg.

    United States

    Cases of HPS in the United States by State from 1993 to July 2012:
  • > 50 cases
  • 16-50 cases
  • 1-15 cases
    • In the Yosemite National Park (here: Curry Village, photo from 2008), several tourists were infected with hantavirus in July / August 2012, some of which were fatal.

    In the United States, a total of 587 cases of hantavirus-associated pulmonary syndrome were recorded between 1993 and 2011, with an average of 37% fatal. Most of the states in the southwest are affected.

    year Number of
    infections    		 Fatal outcome
    (in percent)
    1993 48 56.3
    1994 32 37.5
    1995 24 41.7
    1996 22nd 31.8
    1997 23 21.7
    1998 33 27.3
    1999 43 32.6
    2000 46 23.9
    2001 11 27.3
    2002 23 43.5
    2003 31 29.0
    2004 27 18.5
    2005 34 29.4
    2006 41 41.5
    2007 29 41.4
    2008 24 50.0
    2009 20th 25.0
    2010 21st 29.0
    2011 24 50.0
    2012 30th 40.0
    total 586 34.9
    Source: CDC

    In the summer of 2012, a series of HPS illnesses resulted in three deaths among tourists staying in Yosemite National Park, California . The exact location of the infection has not yet been determined: after rodents were initially suspected in the vicinity of tent cabins, another case occurred in another part of the park. As a result, in September 2012, all park visitors during the summer season were warned and asked to seek medical help immediately if symptoms of a lung disease occurred and to inform them of their visit to the park.

    Latin America

    Hantavirus infections have been documented from various South and Central American countries. These include Argentina , Bolivia , Brazil , Chile , Ecuador , Paraguay , Panama , Uruguay and Venezuela . Hantaviruses have been found in Mexico , Colombia, and Costa Rica , which are similar to the Sin Nombre virus but do not appear to cause disease in humans. Most of the cases occurred in Brazil. The mortality rate for hantavirus-associated pulmonary syndrome there was about 37% of that in the United States.

    In Argentina and Chile, the Andes virus (ANDV), identified in 1998, dominates, causing both the febrile kidney form (HFRS) and the dangerous heart-lung form (HCPS) of the hantavirus disease. In Chile, 204 cases of HCPS were counted between 1993 and 2001, of which more than half were initially fatal and finally around a third. In Argentina, where the Andes virus was first isolated following the severe HPS outbreaks of 1995 and 1996, the human-to-human transmissibility of the virus is also said to have been observed.

    Systematics

    According to ICTV as of autumn 2018, the Hantaviridae family is divided as follows:

    • Species Amga orthohantavirus
    • Species Andes orthohantavirus
    • Andes virus (ANDV) - Hantavirus-associated cardiopulmonary syndrome (HCPS), but often also HFRS
    • Oran virus
    • Asama orthohantavirus species
    • Species Asikkala orthohantavirus
    • Species bayou orthohantavirus
    • Species Black Creek Canal orthohantavirus
    • Species Bowe orthohantavirus
    • Species Bruges orthohantavirus
    • Species Cano Delgadito orthohantavirus
    • Species Cao Bang orthohantavirus
    • Species Choclo orthohantavirus
    • Species Dabieshan orthohantavirus
    • Species Dobrava-Belgrade orthohantavirus
    • Dobrava Belgrade Virus (DOBV) - HFRS.
    • Kurkino virus (KURV)
    • Sochi virus and Sochi virus
    • Saaremaa virus (SAAV) - presumably HFRS
    • Species El Moro Canyon orthohantavirus
    • Species Fugong orthohantavirus
    • Species Fusong orthohantavirus
    • Species Hantaan orthohantavirus
    • Hantaan Virus (HTNV) aka Hantaan River Virus - Hemorrhagic Fever with Renal Syndrome (HFRS)
    • Amur virus (AMRV)
    • Soochong virus (SOOV)
    • Species Jeju orthohantavirus
    • Species Kenkeme orthohantavirus
    • Species Khabarovsk orthohantavirus
    • Species Laguna Negra orthohantavirus
    • Species Luxi orthohantavirus
    • Species Maporal orthohantavirus
    • Species Montano orthohantavirus
    • Species Necocli orthohantavirus
    • Species Oxbow orthohantavirus
    • Species Prospect Hill orthohantavirus
    • Species Puumala orthohantavirus
    • Puumala Virus (PUUV) - HFRS
    • Hokkaido Virus (HOKV)
    • Muju virus (MUJV)
    • Species Rockport orthohantavirus
    • Species Sangassou orthohantavirus
    • Species Seoul orthohantavirus
    • Species Sin Nombre orthohantavirus
    • Sin Nombre Virus (SNV) alias Four Corner Virus , Muerto Canyon Virus , Convict Creek Virus - HCPS
    • New York Virus (NYV)
    • Blue River Virus
    • Monongahela virus
    • Species Thailand orthohantavirus
    • Species Tula orthohantavirus
    • Species Yakeshi orthohantavirus

    The following viruses of the genus Orthohantavirus without assignment to a species are no longer listed by the ICTV due to poor data:

    The following bat hantaviruses have not yet been recorded by ICTV:

    • Magboi virus (MGBV) - First bat-associated hantavirus, in Sierra Leone and Ivory Coast, khE
    • Mouyassue virus ( MOYV ) in Sierra Leone, likely same species as Magboi virus
    • Huangpi virus (HUPV) in China
    • Makokou virus (MAKV) in Gabon
    • Xuan Son Virus (XSV) in Vietnam
    • Brno virus alias Brno virus (BRNV) in the Czech Republic

    More suggestions:

    • ' Azagny virus ' (AZGV) attacks the white-toothed shrew Crocidura obscurior (en .: African pygmy shrew)
    • ' Bloodland Lake Virus ' (BLV), related to Puumala orthohantavirus
    • ' Calabazo Virus '
    • ' Gou virus '
    • ' Limestone Canyon Virus '
    • ' Playa de Oro virus ' in Mexico, affects the rice rats Oryzomys couesi and the cotton rat Sigmodon mascotensis
    • ' Tanganya virus ' (TGNV) attacks the white-toothed shrew Crocidura theresae (en .: Therese's shrew)

    Reporting requirement

    In Germany, the direct or indirect evidence of hantaviruses is notifiable by name in accordance with Section 7 of the Infection Protection Act , if the evidence indicates an acute infection. Above all, the heads of the laboratories etc. are required to report ( Section 8 IfSG).

    In Austria, Hanta virus infections are notifiable in the event of illness or death in accordance with Section 1, Paragraph 1, Number 2, Epidemic Act 1950 . Doctors and laboratories, among others, are obliged to report this ( Section 3 Epidemics Act).

    In Switzerland, the positive and negative laboratory analytical finding is a Hanta virus notifiable and that after the Epidemics Act (EpG) in connection with the epidemic Regulation and Annex 3 of the Regulation of EDI on the reporting of observations of communicable diseases of man . The testing laboratory is required to report. In addition, the disease Hanta fever is notifiable in accordance with the standards mentioned and Appendix 1 of the EDI ordinance mentioned. Doctors, hospitals, etc. are required to report.

    literature

    • DH Krüger, RG Ulrich, J. Hofmann: Hantaviruses as zoonotic pathogens in Germany . In: Dtsch Arztebl Int . tape 110 , no. 27–28 , 2013, pp. 461–467 , doi : 10.3238 / arztebl.2013.0461 .
    • Steffen Geis, Judith Koch, Helmut Uphoff, Anja M. Hauri: Current information on hantaviruses (PDF; 1.1 MB) - Hessisches Ärzteblatt 4/2009.
    • Connie Sue Schmaljohn, ST Nichol, Stuart T. Nichol: Hantaviruses . Springer 2001, ISBN 3-540-41045-7 .
    • Christian G. Meyer: Tropical Medicine: Infectious Diseases . ecomed Medizin, Landsberg 2007, ISBN 978-3-609-16334-5 , pp. 64-66 ( excerpt (Google) )
    • Matthew J. Hepburn, David P. Dooley: Hantaviruses. In: Robert H. Gates: Infectious Disease Secrets . Elsevier Health Sciences 2003, ISBN 1-56053-543-1 , pp. 409-414 ( excerpt (Google) )
    • Lothar Zöller, Sandra Essbauer: Hantaviruses . In: Lexicon of human infectious diseases: pathogens, symptoms, diagnosis, therapy and prophylaxis . Springer, 2012, pp. 354–360 ( excerpt (Google) )

    Web links

    Individual evidence

    1. ↑ ICTV Master Species List 2018b v1 MSL # 34, Feb. 2019
    2. ↑ a b ICTV: ICTV Taxonomy history: Akabane orthobunyavirus , EC 51, Berlin, Germany, July 2019; Email ratification March 2020 (MSL # 35)
    3. ↑ a b c d e Detlev Krüger: Hantavirus infections. (PDF; 66 kB) Society for Virology e. V., accessed December 10, 2018 . , in web archive, archive date April 26, 2005
    4. ↑ a b c d e Andreas Frey: Virus in transit - attention, mouse: The hantavirus is rampant in Baden-Württemberg, but it only affects Swabia - why? In: Badische Zeitung . August 4, 2010, HealthyLIFE, p 29 ( online ).
    5. ↑ a b c d Robert Koch Institute (Ed.): Epidemiological Bulletin 24/2011: RKI advice for doctors: Hantaviruses . June 20, 2011 ( rki.de [accessed September 22, 2012]).
    6. ↑ P. Padula et al. a .: Epidemic outbreak of Hantavirus pulmonary syndrome in Argentina. Molecular evidence of person to person transmission of Andes virus. In: Medicina (Buenos Aires), year 2004, issue 58-1, pp. 27-36.
    7. ↑ a b c d Hantavirus: International HPS Cases. CDC, August 29, 2012, accessed June 12, 2018 .
    8. ↑ 2012 - another bank vole and hantavirus year? (No longer available online.) Friedrich Loeffler Institute , March 23, 2012, archived from the original on September 16, 2012 ; Retrieved September 9, 2012 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.fli.bund.de
    9. ↑ Lothar Zöller, Sandra Essbauer: Hantaviruses . In: Lexicon of infectious diseases in humans. Pathogen, symptoms, diagnosis, therapy and prophylaxis . Springer, 2012, pp. 354-360 (here: 356).
    10. ↑ a b c Tracking a Mystery Disease: The Detailed Story of Hantavirus Pulmonary Syndrome (HPS). CDC, August 29, 2012, accessed September 4, 2012 .
    11. ↑ a b Nicolas Barros, Shaunagh McDermott, Alexandra K. Wong, Sarah E. Turbett: Case 12-2020: A 24-Year-Old Man with Fever, Cough, and Dyspnea New England Journal of Medicine 2020, Volume 382, ​​Issue 16 of April 16, 2020, pages 1544–1553, DOI: 10.1056 / NEJMcpc1916256
    12. ^ Carlos Martínez: Ojo con el Virus Hanta. In: InfoGate , February 2, 2017, accessed June 11, 2018 (Spanish).
    13. ↑ a b Constanza Castillo H., Gonzalo Ossa A .: Síndrome pulmonar por hantavirus Andes en Chile. In: Revista chilena de enfermedades respiratorias , Volume 18, No. 1 (January 2002), doi: 10.4067 / S0717-73482002000100005 .
    14. ↑ a b Andes virus. In: DocCheck Flexikon , accessed on June 12, 2018.
    15. ↑ a b Fact Sheet about Andes Virus. Centers for Disease Control and Prevention, last review: February 2018, accessed June 12, 2018.
    16. ↑ DM Custer, E. Thompson, CS Schmaljohn, TG Ksiazek, JW Hooper: Active and Passive Vaccination against Hantavirus Pulmonary Syndrome with Andes Virus M Genome Segment-Based DNA Vaccine. In: Journal of Virology. 2003 September, 77 (18), pp. 9894–9905, doi: 10.1128 / JVI.77.18.9894-9905.2003 , PMC 224585 (free full text)
    17. ↑ J. Klingström, KI Falk, Å. Lundkvist: Delayed viremia and antibody responses in Puumala hantavirus challenged passively immunized cynomolgus macaques . In: Archives of Virology. Volume 150, Number 1 / January 2005, doi: 10.1007 / s00705-004-0389-5 , pp. 79-92.
    18. ↑ Experimental Hantavirus Vaccine Elicits Strong Antibody Response in Primates ( December 30, 2006 memento in the Internet Archive ) - News Release, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
    19. ↑ DH Krüger, R. Ulrich, AA Lundkvist: Hantavirus infections and their prevention. In: Microbes Infect. 2001 Nov; 3 (13), pp. 1129-1244, PMID 11709294 .
    20. ↑ RWTH Aachen University, University Hospital, Virology: Mice, Fever, Hantaviruses .
    21. ↑ Universitätsklinikum Aachen, www.ukaachen.de, from: Aachener Nachrichten dated May 18, 2005: Uni-Klinikum speaks of a "mini epidemic" ( Memento of the original from January 12, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. . @1@ 2Template: Webachiv / IABot / www.ukaachen.de
    22. ↑ based on data from Douglas Goodin, Kansas State University, published in: CB Jonsson, LT Moraes Figueiredo, O. Vapalahti: A Global Perspective on Hantavirus Ecology, Epidemiology, and Disease. In: Clin Microbiol Rev. 2010, 23 (2), p. 412. doi: 10.1128 / CMR.00062-09
    23. ↑ German business news, The Hanta virus has now broken out in China , first death in Yunnan , accessed on March 25, 2020.
    24. ↑ Reporting data according to the Infection Protection Act (IfSG) .
    25. ↑ Epidemiological Bulletin d. Robert Koch Institute 03/2018 , January 18, 2018.
    26. ↑ http://www.rki.de/DE/Content/Infekt/SurvStat/survstat_node.html
    27. ↑ a b c Stephan Aberle: Hantavirus infections in Austria . In: Department of Virology at the Medical University of Vienna (ed.): Virus epidemiological information . No. 08 , 2012 ( Online PDF 541 kB [accessed September 4, 2012]). Online ( Memento of the original from July 10, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.virologie.meduniwien.ac.at
    28. ↑ Hantavirus: Strong increase in Austria. In: Der Standard , September 3, 2012, accessed June 30, 2018.
    29. ↑ Hanta virus infections. (No longer available online.) Federal Department of the Interior: Federal Office of Public Health, archived from the original on July 26, 2013 ; Retrieved September 5, 2012 .
    30. ↑ Annual US HPS Cases and Case-fatality, 1993-2011. Centers for Disease Control and Prevention , accessed September 1, 2012 .
    31. ^ Ronnie Cohen: Yosemite extends hantavirus warning; death toll rises. Reuters, September 6, 2012, archived from the original on November 26, 2012 ; accessed on September 9, 2012 (English).
    32. ^ National Park Service: Hantavirus in Yosemite , September 13, 2012.
    33. ↑ Deaths after Hantavirus infections in Yosemite National Park: Press release from the Robert Koch Institute (RKI). Robert Koch Institute, September 17, 2012, accessed January 5, 2013 .
    34. ↑ MR Elkhoury, MY Wada, EH Carmo, EJA Luna, A. N. S. M. Elkhoury, K. G. Teixeira, M. L. Nunes, N. P. Barbosa: Aspectos Epidemiológicos da Infecção e da Patogenicidade por Hantavírus no Brasil (PDF; 454 kB). In: Boletim eletrônico epidemiológico , 5th vol., No. 3 (November 15, 2005), pp. 1-5.
    35. ↑ SIB: Orthohantavirus , on: ViralZone
    36. ↑ a b c d e f g h i j k l m n o Piet Maes, Sergey V. Alkhovsky, Yīmíng Bào, Martin Beer, Monica Birkhead, Thomas Briese, Michael J. Buchmeier, Charles H. Calisher, Rémi N. Charrel , Il Ryong Choi, Christopher S. Clegg, Juan Carlos de la Torre, Eric Delwart, Joseph L. DeRisi, Patrick L. Di Bello et al. : Taxonomy of the family Arenaviridae and the order Bunyavirales : update 2018 , in: Archives of Virology, Springer August 2018, Volume 163, Issue 8, Pages 2295-2310, https://doi.org/10.1007/s00705-018-3843 -5
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    40. ↑ Luiz Tadeu Moraes Figueiredo, Gilberto Sabino-Santos Jr, Ronaldo Bragança Martins, Felipe Gonçalves Motta Maia: Museum specimens of terrestrial vertebrates are sensitive indicators of environmental change in the Anthropocene , January 2019 (planned) PHILOS TR SOC B, online since June 2018
    41. ↑ Petra Straková: 'Zoonotické viry u volně žijících endotermních obratlovců - Dizertační práce' (dissertation on viruses in wild endothermic vertebrates), MASARYKOVA UNIVERZITA, PŘÍRODOVĚDECKÁ of all previously published hantaviruses from bats)
    42. ↑ The Hantaviruses of Europe: from the Bedside to the Bench , 1st International Conference on Emerging Zoonoses, Jerusalem, Israel, 24.-28. November 1996, in: Emerging Infectious Diseases, Vol. 3, No. 2, April-June 1997, pp. 205-211
    43. ↑ Carolina Montoya-Ruiz, Francisco J. Diaz, Juan D. Rodas: Recent Evidence of Hantavirus Circulation in the American Tropic , in: Viruses 2014, 6 (3), 1274–1293, {DOI | 10.3390 / v6031274}
    44. ↑ ICTV 9th Report (2011)