• Valeria P Martínez, Nicholas Di Paola, Daniel O Alonso, Unai Pérez-Sautu, Carla M Bellomo, Ayelén A Iglesias, Rocio M Coelho, Beatriz López, Natalia Periolo, Peter A Larson, Elyse R Nagle, Joseph A Chitty, Catherine B Pratt, Jorge Díaz, Daniel Cisterna, Josefina Campos, Heema Sharma, Bonnie Dighero-Kemp, Emiliano Biondo, Lorena Lewis, Constanza Anselmo, Camila P Olivera, Fernanda Pontoriero, Enzo Lavarra, Jens H Kuhn, Teresa Strella, Alexis Edelstein, Miriam I Burgos, Mario Kaler, Adolfo Rubinstein, Jeffrey R Kugelman, Mariano Sanchez-Lockhart, Claudia Perandones, and Gustavo Palacios.
• 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.
• N. Engl. J. Med. 2020 Dec 3; 383 (23): 2230-2241.

BackgroundFrom 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.MethodsClinical 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.ResultsAfter 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.ConclusionsAmong 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.).Copyright © 2020 Massachusetts Medical Society.

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