title: Hantavirus disease outbreak in Germany: limitations of routine serological diagnostics and clustering of virus sequences of human and rodent origin.
abstract: In Europe, hemorrhagic fever with renal syndrome results mainly from infection with Puumala virus (PUUV) or Dobrava virus. For 31 patients from a hantavirus disease outbreak in Lower Bavaria, a district in southeast Germany, serodiagnosis was undertaken by enzyme-linked immunosorbent assay, immunofluorescence assay, and immunoblot analysis. In a few of these cases, however, PUUV-specific typing of antibodies by these standard assays failed and a virus neutralization assay under biosafety level 3 conditions was required to verify the infection by this virus type. PUUV RNA was amplified by reverse transcription-PCR from acute-phase sera of three patients and was found to be very closely related to virus sequences obtained from bank voles (Clethrionomys glareolus) trapped in the same area. These findings link the outbreak with a novel PUUV lineage, "Bavaria," circulating in the local rodent population. The Bavaria lineage associated with the outbreak is only distantly related to other PUUV lineages from Germany.
authors.affiliation: Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schilling
authors.forename: Petra
authors.initials: P
authors.lastname: Emmerich
authors.forename: Boris
authors.initials: B
authors.lastname: Klempa
authors.forename: Brita
authors.initials: B
authors.lastname: Auste
authors.forename: Ebbo
authors.initials: E
authors.lastname: Schnaith
authors.forename: Herbert
authors.initials: H
authors.lastname: Schmitz
authors.forename: Detlev H
authors.initials: DH
authors.lastname: Krüger
authors.forename: Stephan
authors.initials: S
authors.lastname: Günther
authors.forename: Helga
authors.initials: H
authors.lastname: Meisel
mesh_terms: D000328:Adult; D000818:Animals; D016000:Cluster Analysis; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005455:Fluorescent Antibody Technique; D005858:Germany / Q000453:epidemiology; D018778:Hantavirus Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015151:Immunoblotting; D008297:Male; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D009500:Neutralization Tests; D010802:Phylogeny; D029262:Puumala virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D012367:RNA, Viral / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012377:Rodentia / Q000821:virology; D017422:Sequence Analysis, DNA; D012698:Serologic Tests; D044967:Serum / Q000821:virology
chemical_list: D012367:RNA, Viral