在阿根廷，超级传播者与安第斯病毒人际传播。

"Super-Spreaders" and Person-to-Person Transmission of Andes Virus in Argentina.

机构信息

From Laboratorio Nacional de Referencia de Hantavirus (V.P.M., D.O.A., C.M.B., A.A.I., R.M.C., N.P.) and Plataforma Genomica (B.L., D.C., J.C.), Instituto Nacional de Enfermedades Infecciosas, and Unidad Operativa Centro de Contención Biológica (A.E.), Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán (C.P.), Secretaría de Gobierno de Salud (M.I.B., M.K., A.R.), Área Programática Esquel (J.D., E.B.), and Hospital Zonal de Esquel (L.L., C.A., C.P.O., E.L.), Ministerio de Salud de Chubut, Esquel, and Argentina Ministerio de Salud de Chubut, Rawson (T.S.), Chubut, and Hospital Zonal de Bariloche Dr. Ramón Carrillo, Ministerio de Salud de Río Negro, San Carlos de Bariloche, Río Negro (F.P.) - all in Argentina; the Center for Genome Sciences, U.S. Army Medical Research Institute of Infectious Diseases (N.D.P., U.P.-S., P.A.L., E.R.N., J.A.C., C.B.P., J.R.K., M.S.-L., G.P.), and the Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health (H.S., B.D.-K., J.H.K.), Fort Detrick, Frederick, MD; and the College of Public Health (C.B.P.) and Department of Pathology and Microbiology (M.S.-L.), University of Nebraska Medical Center, Omaha.

出版信息

N Engl J Med. 2020 Dec 3;383(23):2230-2241. doi: 10.1056/NEJMoa2009040.

DOI:10.1056/NEJMoa2009040

PMID:33264545

Abstract

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. (Funded by the Ministerio de Salud y Desarrollo Social de la Nación Argentina and others.).

摘要

背景

2018 年 11 月至 2019 年 2 月，阿根廷丘布特省发生了安第斯病毒（ANDV）汉坦病毒肺综合征的人际传播，导致 34 例确诊感染和 11 人死亡。了解 ANDV 人际传播的基因组、流行病学和临床特征对于设计有效的干预措施至关重要。

方法

通过患者报告和公共卫生中心获取临床和流行病学信息。血清学检测、接触追踪和下一代测序用于确定 ANDV 感染是此次汉坦病毒肺综合征暴发的原因，并重建人际传播事件。

结果

在单个啮齿动物储主向人类群体引入 ANDV 后，传播由 3 名出现症状的人驱动，他们参加了拥挤的社交活动。在确认了 18 例病例后，公共卫生官员对确诊病例实施了隔离，并对可能的接触者实施了自我隔离；这些措施很可能阻止了进一步的传播。在实施控制措施之前，中位繁殖数（受感染者在传染期内引起的继发病例数）为 2.12，实施措施后降至 0.96。对本次暴发涉及的 ANDV 株进行了全基因组测序，共检测了 27 例患者的样本，结果表明，目前存在的菌株（Epuyén/18-19）与 1996 年在阿根廷 El Bolsón 首次发生的由 ANDV 引起的首例已知人传人汉坦病毒肺综合征的致病株（Epilink/96）相似。对本次暴发的 ANDV 汉坦病毒肺综合征患者进行的临床研究表明，病毒载量高且肝损伤的患者比其他患者更有可能传播感染。疾病严重程度、基因组多样性、年龄和住院时间与二次传播无明显关联。