Date: Mon 28 Jan 2019 19:10 ART
Source: Tiempo Sur [in Spanish trans. ProMED Mod.TY, edited]
<https://www.tiemposur.com.ar/nota/165198-hay-31-casos-confirmados-por-el-brote-de-epuyen>

There are now a total of 31 confirmed cases of hantavirus [infections] in the Epuyen [Chubut province] outbreak. The positive cases during recent weeks were under observation and isolation. The numbers of cases of people under observation are reduced to 89.

The Chubut [province] Ministry of Health confirmed in its most recent official statement that there are now 31 confirmed cases of hantavirus [infections], while there are others who are currently under observation. The details of the information provided by the provincial health office explained that on [Fri 25 Jan 2019] an adult patient who had been convalescent from this disease was released from the Esquel Zone Hospital. Also, the same statement mentioned that a hantavirus infection positive patient was released from the intensive care unit in the same hospital and is convalescing in a ward in that hospital.

As an additional comment, the Ministry of Health also remarked the same [Fri 25 Jan 2019] that an adult patient, resident of the El Maiten locality [Chubut province] who was maintained under strict, supervised isolation at home, was later sent to the Esquel Zone Hospital and was confirmed positive for this disease, bringing to 31 the number of confirmed cases.

In the same statement, it was explained that during Friday afternoon [25 Jan 2019] there was notification of the admission of a patient under observation in the Sub Zonal Hospital in El Maiten and is currently under strict isolation.

In that respect, it also is worth clarifying that the measure of selective respiratory isolation effectively accomplished at home is continued, a measure pushed by the same Chubut Ministry of Health, that has reached 89 people.

Coordinated tasks
-----------------
Within the guidelines set by the Ministry of Health of Chubut, the Under secretariat of Human Rights, under the Ministry of Government, coordinated a working day at the local Epuyen Cultural Center, where the different emerging issues of the health contingency affecting the locality were addressed. The proposal arose from attitudes and behaviours that show negative beliefs, as well as forms of stigma and discriminatory practices in the community that transcend the theme of health and have an impact on the lives of the people.
======================
[The number of confirmed cases of hantavirus infection continues to increase. The last ProMED-mail post on 19 Jan 2019 (Hantavirus - Americas (06): Argentina (4 provinces) http://promedmail.org/post/20190123.6274142), reported that since the beginning of the epidemiological contingency (on 3 Dec 2018) in that province, there were 29 confirmed cases (27 in Esquel, one in Bariloche, and another in Chile), of which 11 died. The total case count given above is now 31. The current total of deaths is not mentioned in the report above. Except for the index case, the transmission that followed is presumed to be interpersonal and is the reason for isolation of potential contacts. As mentioned in the previous ProMED-mail post, interpersonal transmission of the current Andes hantavirus outbreak in Chubut is unusual. However, person to person transmission has happened before. Mod.PMB provided a reference that indicates that in 1996 there was an outbreak of Andes virus Epilink/96 variant in El Bolson, Rio Negro province, and that starting with the index case, a molecular analysis indicated that 15 cases occurred subsequently. Of these 16 patients, 9 died. Of the total cases, 8 probably became infected in a hospital environment, including 5 physicians (3 died) and a receptionist in a private clinic where 4 more cases occurred. The receptionist died. The data in this study suggest the possible existence of 3- and 4-person transmission chains, assuming that only one rodent-to-human transmission event occurred. It is prudent to see that the relevant agencies working in the area are addressing the social dimensions of this outbreak. There is a small population in this locality and it is easy to understand how this outbreak has sparked rumors and false information that can lead to socially adverse opinions, attitudes, and behaviors.

Reference
---------
Padula PJ, Edelstein A, Miguel SD, et al. Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus. Virology. 1998; 241(2): 323-30;  <https://www.sciencedirect.com/science/article/pii/S0042682297989765?via%3Dihub>.

An additional study described 4 clusters of cases in Argentina with probable interpersonal transmission: the 1st a father to son, the 2nd in a rural family, the 3rd among 4 friends who shared a rural cabin, and the 4th a person in contact with another person who, in turn contacted a further person.

Reference
---------
Martinez VP, Bellomo C, San Juan J, et al. Person-to-person transmission of Andes virus. Emerg Infect Dis. 2005; 11(12): 1848-53;
<https://wwwnc.cdc.gov/eid/article/11/12/05-0501_article>.

It is clear that interpersonal Andes hantavirus transmission occurs, although infrequently, more often than ProMED-mail has reported. - ProMed Mod.TY

[Maps of Argentina:
<https://www.ezilon.com/maps/south-america/argentina-maps.html> and
<http://healthmap.org/promed/p/21365>]
Date: Thu 17 Jan 2019
Source: Express [edited]
<https://www.express.co.uk/news/world/1073844/argentina-Hantavirus-outbreak-symptoms-Entre-R-os-Adolfo-Rubinstein-rodents-rats>

Argentina is on lockdown after a deadly virus typically found in rodents has spread to humans, killing 12. A dozen deaths have already been confirmed following a horrific outbreak of the so-called hantavirus, a dangerous disease that affects the pulmonary system after patients become infected through the faeces and urine of rats. Horrifying symptoms, which come on in stages and begin with a fever before ending with haemorrhaging organs, spread at a frighteningly fast rate. The 1st death was a 25-year-old man on Wednesday morning [16 Jan 2019], and another 11 had been announced in just 24 hours. The outbreak happened in the northeast Argentine province of Entre Rios, medical sources have confirmed. Health officials are in the process of battling to control the illness.

The Secretary of Health of Argentina, Adolfo Rubinstein, said in a local radio interview: "Fundamentally, up to now, the route of contagion was the sporadic cases by inhalation of mice secretions. The difference is that it is interhuman contagion; this is what is much more worrisome from the epidemiological point of view."

He also said that the government suspects the Hantavirus outbreak is a "mutation" since "interhuman contagion" can occur.  He stressed that the patients go through a "very serious condition" since this outbreak is registering a "very high mortality, of more than 40%."  He also said the chain of symptoms in humans began when a couple shared a table at a restaurant, which triggered the virus after germs were transited between the pair.

The disease is transmitted by contact with urine, saliva, and droppings of rodents infected with the virus. For transmission between people, a close contact must be made with the patients in the initial period of the febrile episode, which goes from the first 48-72 hours.  The route of propagation is inhalation, so kisses and hugs can get people infected, as well as the saliva particles when speaking. Other symptoms include muscular pains, chills, headaches, nausea, or diarrhoea.

The deer mouse, the white-footed mouse, the rice rat, and the cotton rat are the only types of rodents capable of passing the virus onto humans, with the breeds prominent in Argentina and other areas of South America. [This is incorrect. None of these species occur in Argentina. The deer mouse (_Peromyscus maniiculatus_) and the white-footed mouse (_P. leucopus_) are distributed from Canada to Mexico. The rice rats, several species in the genus _Oryzomys_, and cotton rats, several species in the genus _Sigmodon_, occur from the USA to northern South America. Several other species are hosts of various hantaviruses in Argentina that can infect humans (see the list in the comment above). - ProMED Mod.TY].  [Byline: Carly Read]
======================
[There have been a few sporadic cases of hantavirus infection in Entre Rios province in the past. In 2011, there were 4 confirmed cases of hantavirus pulmonary syndrome in the province, 2 of which died (see ProMED-mail Hantavirus update 2011 - Americas (26): Chile, Argentina, USA http://promedmail.org/post/20110523.1562). In 2013, there was a single case there. The specific hantaviruses involved in these cases, including the current ones above, are not specified. This report states that the 12 cases were confirmed, but the specific hantavirus involved is not mentioned, nor if the confirmation was made on clinical grounds or by laboratory test (and if so, which test). The unusual human-to-human transmission raises several questions that are discussed below for this Entre Rios outbreak and for the one in Chubut province. - ProMED Mod.TY]
Date: Tue 15 Jan 2019
Source: Buenos Aires Times [edited]
<http://www.batimes.com.ar/news/argentina/hantavirus-claims-new-death-in-argentinas-north.phtml>

The death of a man in Salta province on Tuesday [15 Jan 2019] brings the total number of dead in Argentina as a result of the latest outbreak of hantavirus [infections] to 11; 28 people with the virus remain in hospital under observation.

A man died in Tartagal hospital in Salta province on Tuesday [15 Jan 2019] after a week spent in the hospital, Doctor Viviana Heredia confirmed to local media. Another patient, a 19-year-old man, is isolated in the same hospital. He appeared with a high fever and headaches, local newspaper El Tribuno reported.

"We have no evidence that the virus has been transmitted person-to-person like in Chubut (province), but we do know that it is transmitted in rat faeces and urine, which is why people must avoid food contamination and entering places where rats may have been," Dr Heredia said.

Hantavirus is also known as Orthohantavirus. Humans can contract the virus, which infects rodents but does not cause disease in them, as a result of contact with rodent urine, saliva, or faeces.
====================
[There were several cases of hantavirus infections scattered over the province last year (2018). A total of 21 confirmed cases of hantavirus infections, with 7 deaths from the disease, were registered in the entire province since 1 Jan 2018. The confirmed cases corresponded to localities in Oran, Tartagal, Pichanal, Colonia Santa Rosa, Apolinario Saravia, and Irigoyen. The patients ranged from 22-52 years of age. Although the hantavirus involved is not mentioned, since the report indicates that the cases have occurred in Salta province, including Oran, Oran virus seems likely.

Although rodents were mentioned as possible hosts in the report above, the rodent host of the suspected hantavirus endemic in this area was not reported but likely is the long-tailed pygmy rice rat host, _O. longicaudatus_. An image of this rodent can be accessed at <https://alchetron.com/Oligoryzomys>. - ProMED Mod.TY]
Date: Tue 15 Jan 2019
Source: El Tribuno [in Spanish, trans. ProMED Mod.TY, edited]
<https://www.eltribuno.com/salta/nota/2019-1-15-10-57-0-confirman-el-primer-caso-de-hantavirus-en-jujuy>

The Jujuy provincial minister of health yesterday [Mon 14 Jan 2019] confirmed a hantavirus [infection] case in San Pedro. This is one of the 4 suspected cases evaluated in this Ramallo city and was diagnosed in a 56-year-old patient who is being treated and is progressing well.

This was confirmed for El Tribuno in Jujuy by the subsecretariat for Health Promotion, Prevention, and Attention, Veronica Serra, who stated that there were 4 suspected hantavirus [infection] cases in the province: 3 in the public sector that were negative and one in the private sector that was positive. "Recently, yesterday afternoon, the diagnosis was confirmed for a patient hospitalized in the Santa Maria Clinic in San Pedro, who is being treated and is progressing favourably," the official stated.

She also explained that there is blocking work now, but all epidemiological research will start today [Tue 15 Jan 2019] in the morning.

Serra also remarked that this specific case is different from the type of hantavirus that is circulating in Chubut province and is a milder strain. "The one circulating in Jujuy is a completely different strain [species] than the hantavirus in the south. The transmission of the hantavirus that we have in the province occurs via aspiration of urine of the rodent, not person-to-person as is occurring in the south [See the Chubut comments below. - ProMED Mod.TY]. It is a variant of the disease that is milder as for its transmission," she said.

In Jujuy province last year [2018], 7 cases of hantavirus [infection] were registered, the majority on the Ramal and Valles area. "In 2018 there were 4 cases in Libertador General San Martin, one in San Pedro, one in El Carmen, and the other in Cochinoca department, of which none were fatal; all were treated and progressed favorably."

The health office requests adoption of extreme security measures in order to avoid future cases.

The 1st symptoms are similar to those of flu: high fever, chills, muscular pain, headache, nausea or vomiting, abdominal pain, and diarrhoea, but without upper respiratory tract (cold) symptoms. This mild picture may evolve to cases with severe cardiopulmonary effects.

Some of the recommendations in order to prevent the infection [include]
- Avoid living with rodents and contact with their secretions.
- Avoid entry of rodents and nest-making in houses.
- Close openings in doors, walls, and around pipes.
- Perform cleaning with one part of bleach to 9 parts of water (let stand for 30 minutes and later rinse). Wet the floor before sweeping it in order to not raise dust.
- Ventilate for at least 30 minutes before entering places that have been closed (houses or sheds). Cover the nose and mouth with a damp handkerchief or respiratory mask before entering.
- Take special care when starting up fans or air conditioners whose filters or ducts could have been in contact with [virus] contaminated dust, rodents, or their excreta.

Hantavirus infections represent an emerging zoonosis transmitted to humans by rodents infected with the virus. The natural reservoirs of the infection [virus] are certain wild rodents that have a chronic, asymptomatic infection with persistent viremia and shed the virus in urine, saliva, and excrement.
In Argentina, 2 species of hantaviruses circulate (Andes and Laguna Negra). [This is not correct; there are several more. See comments below. - ProMED Mod.TY].

The hantaviruses are fundamentally transmitted by inhalation of aerosols carrying virus particles coming from feces, urine, and saliva of infected rodents. Other possible routes of transmission are contact of conjunctival, nasal, or oral mucosas with the secretions of infected rodents, or by the bite of an infected rodent.  There is evidence for person-to-person transmission (Andes virus, in the south in Epuyen), and because of this, the secretions of human fluids should be considered dangerous.
========================
[This report apparently presumes that the hantavirus involved in this case is Laguna Negra, although it is not stated that this virus has been laboratory confirmed. As noted in ProMED-mail archive no. http://promedmail.org/post/20110430.1348, several hantaviruses have been associated with human infection and hantavirus pulmonary syndrome in Argentina: Andes virus (western Argentina, in the long-tailed pygmy rice rat host, _Oligoryzomys longicaudatus_); related Andes-like viruses Hu39694 (in central Argentina; rodent host unknown); Lechiguana (in central Argentina in the yellow pygmy rice rat, _O. flavescens_); Oran (in northwestern Argentina in _O. longicaudatus_); Bermejo (western Argentina in _O. flavescens_); and Laguna Negra (in northern Argentina in _Calomys laucha_).

Without laboratory confirmation, it is not possible to say with certainty which hantavirus was involved. Andes virus seems unlikely in this case. - ProMED Mod. TY]
Date: Mon 10 Dec 2018
Source: El Dia [in Spanish, trans. ProMED Corr.SB, edited]
<https://www.eldia.com/nota/2018-12-10-2-33-28-tres-nuevos-casos-sospechosos-de-hantavirus-en-chubut-informacion-general>

The rural hospital in Epuyen in Chubut province [in southern Argentina] has reported 3 new suspected cases of [a] hantavirus [infection], progressing well, according to the establishment doctors.

It should be noted that Epuyen has already registered 5 confirmed cases positive for hantavirus [infections], one of which was fatal, certificated by the Institute of Infectious Diseases "Carlos Malbran."
=====================
[The previous ProMED-mail post (Hantavirus - Americas (65): Argentina (CH) fatal, susp http://promedmail.org/post/20181205.6178716) reported 5 suspected cases of hantavirus infections. The above report indicated that these 5 suspected cases are now confirmed, but the specific hantavirus involved is not mentioned. Now, there are 3 new suspected cases.

Epuyen is located in the Andes mountains, and the virus most likely involved is Andes hantavirus, which is endemic in the southern Andes. This is the beginning of the summer season, when cases of hantavirus infection occur. The patients likely came into contact with areas inhabited by the rodent reservoir of the virus in the region.

Andes virus is rarely transmitted directly person to person and only through close physical contact, usually within the family. The most common source of the infection is the long-tailed pygmy rice rat.

Images of the long-tailed pygmy rice rat (_Oligoryzomys longicaudatus_), the Sigmodontine rodent host of Andes hantavirus, can be seen at
<https://en.wikipedia.org/wiki/Oligoryzomys_longicaudatus#/media/File:Raton_colilarga.jpg>. - ProMed Mod.TY]

[HealthMap/ProMED-mail maps:
Argentina:
<https://www.ezilon.com/maps/south-america/argentina-maps.html>
Chubut Province, Argentina: <http://healthmap.org/promed/p/53508>]
More ...