Epidemiology and Pathogenesis of Hemorrhagic Fever with Renal Syndrome

Abstract

The outbreak of deadly hantavirus pulmonary syndrome (HPS) in the United States in 1993 (CDC., 1993) changed the concept of hemorrhagic fever with renal syndrome (HFRS) (WHO, 1983) because the clinical manifestations of this newly described hantavirus infection (Duchin et al., 1994) are quite different from the known typical forms of HFRS caused by Hantaan, Seoul, and Puumala viruses and because it occurred in the United States, where hantavirus disease had not been known to exist previously. Recent data on hantavirus disease show that HFRS occurs in the Old World and HPS, caused by novel hantaviruses, occurs in the New World. Epidemiological studies of HFRS progressed rapidly after the discovery of Hantaan virus, the etiologic agent of Korean hemorrhagic fever (Lee and Lee, 1976; Lee et al., 1978) through seroepidemiologic surveys of hantavirus infections in humans and in animals. It was long believed that HFRS only occurs in certain limited rural areas of Eurasia, such as Korea, China, Far East of Russia, and Northern Europe (Lee, 1982). Recent findings (Lee and van der Groen, 1989; Lee et al., 1990b), however, have shown that HFRS patients can be found not only in rural areas but also in urban cities in many parts of the world.