title: Risk factors associated with hantavirosis fatality: a regional analysis from a case-control study in Brazil.
abstract: BACKGROUND
  In Brazil, hantavirus cardiopulmonary syndrome (HCPS) has a high lethality rate that varies by region. This study aimed to identify the risk factors associated with fatal hantavirosis.
  
  
  METHODS
  This study was a case-control study that included all laboratory confirmed cases of hantavirosis. The cases were stratified by the different Brazilian regions using data from the Notifiable Diseases Information System. "Cases" were patients who progressed to death, whereas "controls" were patients who were cured. The odds ratio (OR) and the adjusted OR were calculated.
  
  
  RESULTS
  Overall, 158 cases and 281 controls were included in this study. In the Midwest region, the cases were 60% less likely to present with flank pain, and the time between the beginning of symptoms and death was shorter than the time between the beginning of symptoms and a cure. In the Southeast region, the cases were 60% less likely to present with thrombocytopenia or reside in rural areas compared to those who progressed to a cure. Additionally, the cases sought medical assistance, notification and investigation more quickly than the controls. In the Southern region, the cases that died were 70% less likely to be male compared to the controls.
  
  
  CONCLUSIONS
  HCPS manifests with nonspecific symptoms, and there are few published studies related to the condition, so determining a patient's therapeutic strategy is difficult. This study presents findings from different Brazilian regions and highlights the need for further investigations to improve comprehension about regional risk factors associated with hantavirosis and to reduce morbimortality.
authors.affiliation: Grupo Técnico de Análise e Informação, Programa Nacional de Imunizações, Departamento de Vigilância Epidemiológica, Secretaria de Vigilância em Saúde, Ministério da Saúde, BrasíliaDF, Grupo Técnico de Análise e Informação, Programa Nacional de Imunizações, Departamento de Vigilância Epidemiológica, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF.
authors.forename: Maria Cristina Antunes
authors.initials: MC
authors.lastname: Willemann
authors.affiliation: Unidade Técnica de Vigilância de Zoonoses, Coordenação Geral de Doenças Transmissíveis, Departamento de Vigilância Epidemiológica, Secretaria de Vigilância em Saúde, Ministério da Saúde, BrasíliaDF, Unidade Técnica de Vigilância de Zoonoses, Coordenação Geral de Doenças Transmissíveis, Departamento de Vigilância Epidemiológica, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF.
authors.forename: Stefan Vilges de
authors.initials: SV
authors.lastname: Oliveira
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D018563:Disease Notification; D004522:Educational Status; D005260:Female; D062306:Geography, Medical / Q000706:statistics & numerical data; D006480:Hemorrhagic Fever with Renal Syndrome / Q000401:mortality*; D006801:Humans; D008297:Male; D012307:Risk Factors