欧洲疾控中心-汉坦病毒感染-2021年度流行病学报告（英）_6页_1mb

Summary of the Annual Epidemiological Report for Hantavirus Infection in the EU/EEA, 2021

Core Content

This report presents the epidemiological data on hantavirus infections in the European Union and European Economic Area (EU/EEA) for the year 2021, based on data collected through the European Surveillance System (TESSy) as of 25 October 2022.

Key Facts

• A total of 4,860 cases of hantavirus infection were reported in 2021 across 29 EU/EEA countries, representing a notification rate of 1.1 cases per 100,000 population.
• This was the highest rate recorded between 2017 and 2021, with previous years ranging from 0.4 to 0.8 cases per 100,000.
• Germany and Finland accounted for 63.7% of all reported cases.
• 99.8% of the reported cases were classified as confirmed.
• 5 deaths were reported in 2021, from Austria, Slovakia, Slovenia, and Germany.
• Slovenia had the highest notification rate in 2021 (27.0 cases per 100,000), while Finland had the second-highest (25.8 cases per 100,000).
• PUUV (Puumala virus) was the most commonly identified pathogen, responsible for 99.0% of the cases with known causative agents.
• Hantaan virus and DOBV (Dobrava virus) were identified in 6 and 17 cases, respectively.

Main Clinical Syndromes

Hantavirus infections can lead to three main clinical syndromes:

• Haemorrhagic fever with renal syndrome (HFRS), primarily caused by Seoul virus, PUUV, and DOBV.
• Nephropathia epidemica, a mild form of HFRS caused by PUUV.
• Hantavirus cardiopulmonary syndrome, caused by Andes virus, Sin Nombre virus, and other hantaviruses prevalent in the Americas.

The severity of the clinical presentation varies depending on the causative agent.

Prevention and Control

• No curative treatment exists for hantavirus infections.
• Prevention focuses on rodent control, avoiding contact with rodent excreta, and disinfecting contaminated areas.
• Occupational risk is associated with forestry, farming, and outdoor activities such as camping or staying in summer houses.
• Communication of preventive measures is essential for reducing seasonal infections.

Surveillance Methods

• The report is based on TESSy data collected from 2021.
• 27 countries reported case-based data, while Belgium and Bulgaria reported aggregate data.
• 20 countries used the EU case definition, 5 used alternative definitions, and 4 did not specify.
• Surveillance was comprehensive in most countries, with exceptions in Belgium (sentinel system) and Cyprus (unspecified).
• Passive surveillance was the main approach used.
• The United Kingdom (UK) did not report data for 2020-2021 due to its withdrawal from the EU.

Epidemiological Trends

• The number of cases increased by 194% in 2021 compared to 2020.
• The case distribution throughout the year showed a low number of cases in January to March, followed by a steady rise in May and June, and a decline until September.
• The number of cases in 2021 was above the mean recorded between 2017 and 2020 in all months.
• 91.3% of the cases were reported in people aged 25 years and older.
• The notification rate was highest among those aged 45-64 years (1.6 per 100,000 population).
• Males were more affected than females in all age groups except those aged 0-4 years, with an overall male-to-female ratio of 1.7:1.

Outbreaks and Regional Variations

• In 2021, an outbreak was reported in Primorje-Gorski Kotar County (bordering Slovenia) and Lika-Senj County (Croatia), with 246 confirmed and 8 probable cases caused by PUUV.
• However, only 7 cases were reported by Croatia to ECDC.

Seasonal and Multi-Annual Fluctuations

• Hantavirus infections are known to follow seasonal and multi-annual fluctuations, influenced by rodent population dynamics.
• Environmental and climatic factors, such as changes in landscape, are also believed to affect the epidemiology of hantavirus.
• The increase in cases may also be attributed to improved diagnosis and awareness.

Diagnostic and Surveillance Capabilities

• Serological diagnosis is at a satisfactory level in Europe, as noted by a recent External Quality Assessment through EVD-LabNet.
• Additional information on surveillance systems and data availability can be found in the ECDC's Surveillance Atlas of Infectious Diseases.

Public Health Implications

• No vaccines are available in Europe for hantavirus-related diseases.
• Preventive measures are the main strategy for controlling infections.
• Prevention and communication strategies are emphasized, particularly for high-risk groups and occupational settings.

References

• [1] Avšić-Zupanc T, Saksida A, Korva M. Hantavirus infections. Clinical Microbiology and Infection. 2019.
• [2] European Centre for Disease Prevention and Control (ECDC). Methods chapter of the Annual epidemiological report for 2016.
• [3] ECDC. Overview of national surveillance systems.
• [4] ECDC. Surveillance atlas of infectious diseases.
• [5] Rončević Filipović M, et al. Outbreak of hantavirus disease caused by Puumala virus, Croatia, 2021.
• [6] Kallio ER, et al. Cyclic hantavirus epidemics in humans — Predicted by rodent host dynamics.
• [7] Zeimes CB, et al. Landscape and Regional Environmental Analysis of the Spatial Distribution of Hantavirus Human Cases in Europe.
• [8] Reusken C, Heyman P. Factors driving hantavirus emergence in Europe.
• [9] Erdin M, et al. External quality assessment of orthohantavirus and lymphocytic choriomeningitis virus molecular detection and serology in Europe, 2021.
• [10] Ricò M, et al. Occupational Hantavirus Infections in Agricultural and Forestry Workers.
• [11] Winter CH, et al. Survey and case-control study during epidemics of Puumala virus infection.
• [12] ECDC. Prevention measures and communication strategies for hantavirus infection in Europe.