info:eu-repo/semantics/article
''Super-Spreaders'' and Person-to-Person Transmission of Andes Virus in Argentina
Fecha
2020-12Registro en:
Martinez, Valeria Paula; Di Paola, Nicholas; Alonso, Daniel Oscar; Pérez Sautu, Unai; Bellomo, Carla María; et al.; ''Super-Spreaders'' and Person-to-Person Transmission of Andes Virus in Argentina; Massachusetts Medical Society; New England Journal of Medicine; 383; 23; 12-2020; 2230-2241
0028-4793
1533-4406
CONICET Digital
CONICET
Autor
Martinez, Valeria Paula
Di Paola, Nicholas
Alonso, Daniel Oscar
Pérez Sautu, Unai
Bellomo, Carla María
Iglesias, Ayelén Aluminé
Coelho, Rocío María
López, Beatriz
Periolo, Natalia
Larson, Peter A.
Nagle, Elyse R.
Chitty, Joseph A.
Pratt, Catherine B.
Díaz, Jorge Daniel
Cisterna, Daniel Marcelo
Campos, Josefina
Sharma, Heema
Dighero Kemp, Bonnie
Biondo, Emiliano
Lewis, Lorena
Anselmo, Constanza
Olivera, Camila P.
Pontoriero, Fernanda
Lavarra, Enzo
Kuhn, Jens H.
Strella, Teresa
Edelstein, Alexis
Burgos, Miriam I.
Kaler, Mario
Rubinstein, Adolfo Luis
Kugelman, Jeffrey R.
Sanchez Lockhart, Mariano
Perandones, Claudia
Palacios, Gustavo Guido
Resumen
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.