EPIDEMIOLOGY AND TRANSMISSION OF HANTAVIRAL CARDIOPULMONARY SYNDROME

汉坦病毒心肺综合征(HCPS)是一种经常致命的急性病毒感染，于1993年首次被发现。引起猪瘟的病毒是通过野生啮齿动物传播给人类的。北美已经报告了200多例病例，其中45%是致命的。事实证明，在南美，HCPS与北美的HCPS一样常见，也同样致命。南美洲携带HCPS病毒的啮齿动物不同，但与北美携带HCPS病毒的啮齿动物有关。截至1998年8月，智利和阿根廷总共经历了与美国和加拿大一样多的病例(228例)，病死率为50%。南美活跃的病毒与北美的病毒非常相似，但并不相同。北美和南美的疾病都有可能导致流行病，因为啮齿动物数量可能会因气候和生态变化而急剧增加。然而，直到最近，我们还可以得到一些安慰，因为我们知道汉坦病毒只在啮齿动物之间传播，而这种人与人之间的传播是闻所未闻的。因此，如果向公众提供关于如何避免接触野生啮齿动物的足够和有用的建议，疫情就可以得到控制。1996年底，阿根廷南部爆发了一场疫情，涉及人与人之间传播猪瘟的非常明显的例子。受影响最大的是治疗HCPS患者的医院工作人员。这一结果完全出乎人们的意料，并导致人们更加关注在北美和南美洲增加的HCPS的流行潜力。令人不安的是，我们对阿根廷/智利病毒--安第斯病毒的人际传播机制几乎一无所知。阿根廷的安全做法与美国或其他地方没有明显不同。此外，阿根廷和智利出现了“聚集性”病例的非同寻常的例子，这表明阿根廷1996年的疫情并不是独一无二的。在这项申请中，我们将进行流行病学和实验室研究，试图准确确定安第斯病毒是如何在智利南部传播的。具体地说，我们将研究人群中的汉坦病毒抗体，并使用问卷调查来确定什么样的啮齿动物或人际接触可能导致安第斯病毒的传播。我们将研究HCPS患者的血液、尿液和肺部分泌物，以确定体液中是否存在大量安第斯病毒。我们还将确定除安第斯病毒外，哪些病毒可能与智利的HCPS有关。根据从这项建议中获得的信息，我们希望能够就如何降低感染引起猪瘟的病毒的风险提供非常具体的建议。

Hantavirus cardiopulmonary syndrome (HCPS) is an often-fatal acute viral infection that was first recognized in 1993. The viruses that cause HCPS are transmitted to man from wild rodents. More than 200 cases with 45% of them fatal have been reported in North America. In South America, HCPS is proving to be more common and just as lethal as its North American counterpart. The rodents that carry HCPS viruses in South America are different but related to those that carry HCPS viruses in North America. As of August 1998, Chile and Argentina combined have experienced about as many cases (228) as the US and Canada, and with a case-fatality rate of 50%. The viruses active in South America are quite similar to those in North America, but not the same. Both the North American and South American diseases have the potential to cause epidemics, because rodent populations can increase drastically in response to climatological and ecological changes. Up until recently, however, we could take some comfort in knowing that hantaviruses are transmitted solely from rodent to man, and that person-to-person transmission was unheard of. Thus, epidemics could be controlled if the public was given sufficient and helpful advice about how to avoid contact with wild rodents. In late 1996, an outbreak occurred in southern Argentina involving very clear examples of person-to-person transmission of HCPS. Especially affected were hospital workers who treated patients with HCPS. This result was completely unexpected and led to heightened concern about increased epidemic potential of HCPS in both North and South America. It is disturbing that we know virtually nothing about the mechanism of interpersonal transmission of the Argentine/Chilean virus, Andes virus. Safety practices in Argentina were not noticeably different from those in the US or elsewhere. In addition, extraordinary examples of "clustering" of cases in Argentina and Chile have emerged since that suggest that the Argentine outbreak of 1996 was not unique. In this application, we will conduct both epidemiology and laboratory studies to try to define exactly how Andes virus is transmitted in southern Chile. Specifically we will study populations for hantavirus antibodies and use questionnaires to establish what kinds of rodent or interpersonal exposures might result in Andes virus transmission. We will study the blood, urine and lung secretions of patients with HCPS to determine whether Andes virus is present in high quantities in bodily fluids. We will also determine what viruses other than Andes virus might be associated with HCPS in Chile. With the information learned from this proposal, we hope to be able to offer very specific advice about ways to reduce the risk of contracting the viruses that cause HCPS.