The role of health mediation in investigation of Hantavirus cases among informal settlements inhabitants of Cayenne area, French Guiana, 2022-2023.

Context: In 2022, four severe cases of Hantavirus pulmonary syndrome (HPS) were reported in patients from informal settlements around Cayenne, the main city in French Guiana. Regional Health Agency (RHA) was commissioned by the French Public Health Agency to estimate the seroprevalence of Hantavirus infections in the neighborhoods of confirmed cases of HPS. RHA then commissioned the French Red Cross (FRC) mobile public health team, providing support in environmental health issues to the population living in informal settlements by health mediators, to facilitate the investigation. The objective of this study was to describe the health mediators' activities set up to improve the efficiency of the investigation. Methods: The health mediators' team was specifically trained by virologist and infectiologist specialized in HPS. They helped the investigating team and health workers at various steps of the investigation. These interventions are then described in the results section. Results: The investigation took place between Nov. 2022 and March 2023 in three neighborhoods. During the pre-investigation activities, the mediators raised awareness about HPS of 343 people, among whom 319 (93%) planned to participate in the investigation. Altogether, 274 people finally participated in the investigation, including, i.e., 30.8% of the estimated population living in the three concerned settlements. The global proportion of patients with positive IgG anti-Hantavirus was 5.1%. The health mediators team supported the following steps: preliminary meetings and training modules, identification of resource persons, field visits and awareness and information campaigns (pre-investigation); on field data collection in informal settlements (per-investigation) and communication of individual results, public feedback meeting (post-investigation). Discussion/Conclusion: The involvement of mediators was probably a factor in the success of the public health response to socially vulnerable people living in the investigated neighborhoods. The preliminary prevention activities helped to raise awareness of the health risk and to enroll participants. Health mediation and outreach activities seem relevant tools of epidemiological field investigations in diseases affecting inhabitants of informal settlements.

Critical care management of hantavirus cardiopulmonary syndrome. A narrative review.

Hantaviruses, members of the Bunyaviridae family, can cause two patterns of disease in humans, hantavirus hemorrhagic fever with renal syndrome (HFRS) and cardiopulmonary syndrome (HCPS), being the latter hegemonic on the American continent. Andesvirus is one of the strains that can cause HCPS and is endemic in Chile. Its transmission occurs through direct or indirect contact with infected rodents' urine, saliva, or feces and inhalation of aerosol particles containing the virus. HCPS rapidly evolves into acute but reversible multiorgan dysfunction. The hemodynamic pattern of HCPS is not identical to that of cardiogenic or septic shock, being characterized by hypovolemia, systolic dysfunction, and pulmonary edema secondary to increased permeability. Given the lack of specific effective therapies to treat this viral infection, the focus of treatment lies in the timely provision of intensive care, specifically hemodynamic and respiratory support, which often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This narrative review aims to provide insights into specific ICU management of HCPS based on the available evidence and gathered experience in Chile and South America including perspectives of pathophysiology, organ dysfunction kinetics, timely life support provision, safe patient transportation, and key challenges for the future.

Orthohantaviruses in Misiones Province, Northeastern Argentina.

Few cases of hantavirus pulmonary syndrome have been reported in northeastern Argentina. However, neighboring areas show a higher incidence, suggesting underreporting. We evaluated the presence of antibodies against orthohantavirus in small rodents throughout Misiones province. Infected Akodon affinis montensis and Oligoryzomys nigripes native rodents were found in protected areas of Misiones.

Preventive Practices of Hantavirus in a Rural Community in Panama: An Explanatory Sequential Mixed Methods Study.

INTRODUCTION: Preventive care practices are a challenge in community care. This study examined hantavirus preventive practices and their relationship with personal and social factors, lifestyle, and cultural beliefs. METHOD: An explanatory sequential mixed methods design, guided by Leininger's Theory of Culture Care Diversity and Universality, was used in two phases: (a) a cross-sectional relational design (n = 109) and (b) ethnonursing research (n = 30), in an endemic community in Panama. Univariate and bivariate analyses were used to analyze the quantitative data, whereas the Leininger's analysis model was used to analyze the qualitative data. RESULTS: In the quantitative phase, the most frequent preventive practice was household hygiene, and the least frequent was vector control. Two of the eight preventive practices were associated with personal factors and two were associated with social factors. In the qualitative phase, lifestyle, beliefs, and context were found to influence the adoption of hantavirus preventive practices and help explain the quantitative findings. DISCUSSION: Knowledge and understanding of the social and cultural contexts are essential for hantavirus prevention.

Enfoque Rápido en Contexto Comunitario (ERCC): evaluando las medidas preventivas para Hantavirus en la Comarca Andina Patagónica desde la perspectiva de la participación comunitaria / Rapid Approach in Community Context (ERCC): evaluating preventive measures for Hantavirus in the Andean Patagonian Region from the perspective of community participation

Introducción: la creciente preocupación por eventos epidémicos de origen zoonótico generó la necesidad de estrategias integrales que corrigiesen la baja adaptabilidad y tensiones que se generan al implementar acciones de orden jerárquico superior en el contexto comunitario. Con el objeto de explicar un Enfoque Rápido en Contexto Comunitario (ERCC), este trabajo se propone evaluar dentro del contexto de un programa de salud pública la participación comunitaria en la prevención del Hantavirus en la Comarca Andina del Paralelo 42. Metodología: El presente ERCC utilizó visitas y observaciones al sitio, entrevistas cara a cara y grupales, precedidas por una revisión documental de la literatura. La información se recopiló en un corto período de tiempo y el análisis se utilizó para desarrollar recomendaciones informadas para los tomadores de decisiones de salud pública. Resultados: Se observo que cada comunidad enfrenta desafíos más allá del hantavirus y es esencial que epidemiólogos, prestadores de servicios asistenciales y municipalidades trabajen más estrechamente con la población local para prevenir y manejar mejor cualquier brote de enfermedad. Se pudieron identificar 6 recomendaciones que le permitirían a las comunidades un mejor manejo de futuros brotes con un enfoque participativo. Conclusiones: El ERCC es una intervención rápida y discreta que puede ser llevada a cabo por un pequeño equipo con una interferencia mínima en la comunidad. El ERCC también podría ser adaptado por las autoridades de salud pública a muchos contextos diferentes, incluso con grupos vulnerables, para ayudar a que la promoción y la prevención sean más relevantes y efectivas a nivel local (AU)

Introduction: the growing concern for epidemic events of zoonotic origin generated the need for comprehensive strategies that correct the low adaptability and tensions generated when implementing actions of higher hierarchical order in the community context. In order to explain a Rapid Approach in Community Context (ERCC), this paper aims to evaluate within the context of a public health program community participation in the prevention of Hantavirus in the Andean Region of the 42nd Parallel. Methodology: The present ERCC used site visits and observations, face-to-face and group interviews, preceded by a documentary review of the literature. The information was collected over a short period of time and the analysis was used to develop informed recommendations for public health decision makers. Results: It was observed that each community faces challenges beyond hantavirus and it is essential that epidemiologists, care providers and municipalities work more closely with the local population to better prevent and manage any disease outbreak. We were able to identify 6 recommendations that would allow communities to better manage future outbreaks with a participatory approach. Conclusions: The ERCC is a rapid and discreet intervention that can be carried out by a small team with minimal interference in the community. The ERCC could also be adapted by public health authorities to many different contexts, including with vulnerable groups, to help make promotion and prevention more relevant and effective at the local level (AU)

Potential Pathways and Pathophysiological Implications of Viral Infection-Driven Activation of Kallikrein-Kinin System (KKS).

Microcirculatory and coagulation disturbances commonly occur as pathological manifestations of systemic viral infections. Research exploring the role of the kallikrein-kinin system (KKS) in flavivirus infections has recently linked microvascular dysfunctions to bradykinin (BK)-induced signaling of B2R, a G protein-coupled receptor (GPCR) constitutively expressed by endothelial cells. The relevance of KKS activation as an innate response to viral infections has gained increasing attention, particularly after the reports regarding thrombogenic events during COVID-19. BK receptor (B2R and B1R) signal transduction results in vascular permeability, edema formation, angiogenesis, and pain. Recent findings unveiling the role of KKS in viral pathogenesis include evidence of increased activation of KKS with elevated levels of BK and its metabolites in both intravascular and tissue milieu, as well as reports demonstrating that virus replication stimulates BKR expression. In this review, we will discuss the mechanisms triggered by virus replication and by virus-induced inflammatory responses that may stimulate KKS. We also explore how KKS activation and BK signaling may impact virus pathogenesis and further discuss the potential therapeutic application of BKR antagonists in the treatment of hemorrhagic and respiratory diseases.

Filling the gaps in the Argentinian distribution of orthohantavirus: First finding of Lechiguanas virus in rodents from Corrientes, Argentina.

Hantavirus Pulmonary Syndrome (HPS) is an emerging infectious disease caused by orthohantaviruses in the Americas. In Argentina, since 1995, several reservoirs and virus variants have been described, but the northeastern and central endemic zones in the country include an area without human or rodent infections, despite sharing rodent species with areas with that disease. The aim of this study was to search for orthohantavirus in rodent communities that inhabit this area, which borders two endemic areas of HPS. Small rodents were captured in June of 2022 through a total effort of 644 trap nights distributed in five grids located in the Iberá National Park, Corrientes, Northeastern Argentina. All rodents were sexed, weighed, and the species was recorded. Blood samples were extracted to detect ANDV-specific immunoglobulin G (IgG), and to extract the RNA virus. Trimmed sequences were mapped against reference sequences from GenBank. We captured a total of 36 Oligoryzomys flavescens and 15 Oxymycterus rufus. We detected the O. flavescens species infected with Lechiguanas orthohantavirus in the camping area of the National Park. A nucleotide comparison with previously published sequences shows a 98.34% similarity to the virus obtained from a human case of HPS reported in the adjacent Misiones province. This study demonstrated, for the first time, that O. flavescens is a host of the Lechiguanas orthohantavirus in this zone and contributes to closing information gaps on the distribution of orthohantavirus in Argentina. Additionally, the high similarity with the hantavirus found in the human case of Misiones suggests that the reservoir in that province would also be O. flavescens (not previously confirmed). This information permits us to focus on the preventive measurements to protect the human population.

Epidemiological profile of Hantavirus in the Ñuble region period 2002-2018, Chile / Perfil epidemiológico do Hantavirus na região Ñuble período 2002-2018, Chile

Hantavirus infection is an endemic zoonosis in Chile, with an average lethality of around 36%. The highest lethality (60%) was recorded in 1997. Prevention strategies have been applied since then. Early diagnosis and technologies, such as the use of ECMO (Extracorporeal Membrane Oxygenation) and Hantavirus immune plasma, have contributed to increasing the survival of people due to this disease at the national level. In the newly created Region of Ñuble in Chile, the incidence and lethality of Hantavirus cases are unknown; therefore, the objective of this research is to describe the epidemiological profile of Hantavirus cases in the Region of Ñuble, Chile from 2002 to 2018. This knowledge contributes to substantiating and justifies the need to invest in technology and reinforce interventions related to the early diagnosis and prevention of this disease in the region. Cases reported in the Ñuble region during the period 2002-2018, extracted from the Epidemiological Survey of Environmental Research of Hantavirus cases of the Ministry of Health of Chile, were analyzed retrospectively. The epidemiological profile of the Ñuble region is very similar to the national one in terms of characterizing the individual suffering from the disease. The most affected population is young men, residents in rural areas, and mainly from a low socioeconomic segment. The regional profile of Hantavirus cases makes it possible to identify three communes with the highest number of cases: El Carmen, Coihueco, and San Carlos. A political-administrative response is expected to focus on and optimize strategies and resources to reduce the incidence and lethality of this pathology in the Ñuble region.

A infecção por hantavírus é uma zoonose endêmica no Chile, com letalidade média em torno de 36%. A maior letalidade (60%) foi registrada em 1997. Estratégias de prevenção vêm sendo aplicadas desde então. O diagnóstico precoce e tecnologias como o uso de ECMO (Extracorporeal Membrane Oxygenation) e plasma imune ao Hantavírus, têm contribuído para aumentar a sobrevida das pessoas por esta doença em nível nacional. Na recém-criada Região de Ñuble no Chile, a incidência e letalidade dos casos de Hantavírus são desconhecidas; portanto, o objetivo desta pesquisa é descrever o perfil epidemiológico dos casos de Hantavírus na Região de Ñuble, Chile de 2002 a 2018. Esse conhecimento contribui para fundamentar e justificar a necessidade de investir em tecnologia e reforçar as intervenções relacionadas ao diagnóstico precoce e prevenção desta doença na região. Os casos notificados na região de Ñuble durante o período 2002-2018, extraídos do Inquérito Epidemiológico de Pesquisa Ambiental de casos de Hantavírus do Ministério da Saúde do Chile, foram analisados ​​retrospectivamente. O perfil epidemiológico da região de Ñuble é muito semelhante ao nacional no que diz respeito à caracterização do indivíduo acometido pela doença. A população mais afetada são homens jovens, residentes em áreas rurais e, principalmente, de um segmento socioeconômico baixo. O perfil regional dos casos de Hantavírus permite identificar três municípios com maior número de casos: El Carmen, Coihueco e San Carlos. Espera-se uma resposta político-administrativa que enfoque e otimize estratégias e recursos para reduzir a incidência e letalidade desta patologia na região de Ñuble.

Seroprevalence of Hantavirus among Manual Cane Cutters and Epidemiological Aspects of HPS in Central Brazil.

Hantavirus pulmonary syndrome (HPS) is a rodent-borne zoonotic disease that is endemic throughout the Americas. Agricultural activities increase exposure to wild rodents, especially for sugarcane cutters. We carried out a survey of the epidemiological aspects of HPS and investigated the prevalence of hantavirus infection in the sugarcane cutter population from different localities in the Brazilian Midwest region. We conducted a retrospective study of all confirmed HPS cases in the state of Goiás reported to the National HPS surveillance system between 2007 and 2017, along with a seroepidemiological study in a population of sugarcane cutters working in Goiás state in 2016, using the anti-hantavirus (Andes) ELISA IgG. A total of 634 serum samples from cane cutters were tested for hantavirus antibodies, with 44 (6.9%) being IgG-reactive according to ELISA. The destination of garbage was the only statistically significant variable (p = 0.03) related to the detection of hantavirus IgG (p < 0.05). We described the epidemiological profile of reported hantavirus cases in Goiás-a highly endemic area for HPS, and where the seroepidemiological study was conducted. Our results increase our knowledge about hantavirus infections in Brazil and highlight the vulnerability of sugarcane cutters to a highly lethal disease that, to date, has no specific treatment or vaccination.

Assessing Pulmonary Epithelial Damage in Hantavirus Cardiopulmonary Syndrome: Challenging the Predominant Role of Vascular Endothelium through sRAGE as a Potential Biomarker.

Hantavirus cardiopulmonary syndrome (HCPS) is a severe respiratory illness primarily associated with microvascular endothelial changes, particularly in the lungs. However, the role of the pulmonary epithelium in HCPS pathogenesis remains unclear. This study explores the potential of soluble Receptors for Advanced Glycation End-products (sRAGE) as a biomarker for assessing pulmonary epithelial damage in severe HCPS, challenging the prevailing view that endothelial dysfunction is the sole driver of this syndrome. We conducted a cross-sectional study on critically ill HCPS patients, categorizing them into mild HCPS, severe HCPS, and negative control groups. Plasma sRAGE levels were measured, revealing significant differences between the severe HCPS group and controls. Our findings suggest that sRAGE holds promise as an indicator of pulmonary epithelial injury in HCPS and may aid in tracking disease progression and guiding therapeutic strategies. This study brings clarity on the importance of investigating the pulmonary epithelium's role in HCPS pathogenesis, offering potential avenues for enhanced diagnostic precision and support in this critical public health concern.

Mathematical Model of the Spread of Hantavirus Infection.

A mathematical epidemiological model incorporating the mobility of rodents and human groups among zones of less or major contact between them is presented. The hantavirus infection dynamics is expressed using a model type SEIR (Susceptible-Exposed-Infectious-Removed), which incorporates the displacement of the rodent and the human, between the urban and rural sector, the latter being subdivided in populated and non-populated. The results show the impact that rodent or human displacement may have on the propagation of hantavirus infection. Human mobility is more significant than rodents in increasing the number of hantavirus infection cases. The results found may be used as a reference by the health authorities to develop more specific campaigns on the territorial dynamics of the rodent, attend to the mobility of humans in these territories, mainly agricultural and forestry workers, and strengthen control-prevention actions in the community, to prevent future outbreaks that are fatal.

Etiologies of Zoonotic Tropical Febrile Illnesses That Are Not Part of the Notifiable Diseases in Colombia.

In Colombia, tropical febrile illnesses represent one of the most important causes of clinical attention. Febrile illnesses in the tropics are mainly zoonotic and have a broad etiology. The Colombian surveillance system monitors some notifiable diseases. However, several etiologies are not monitored by this system. In the present review, we describe eleven different etiologies of zoonotic tropical febrile illnesses that are not monitored by the Colombian surveillance system but have scientific, historical, and contemporary data that confirm or suggest their presence in different regions of the country: Anaplasma, Arenavirus, Bartonella, relapsing fever group Borrelia, Coxiella burnetii, Ehrlichia, Hantavirus, Mayaro virus, Orientia, Oropouche virus, and Rickettsia. These could generate a risk for the local population, travelers, and immigrants, due to which they should be included in the mandatory notification system, considering their importance for Colombian public health.

Deep Sequencing to Reveal Phylo-Geographic Relationships of Juquitiba Virus in Paraguay.

Several hantaviruses result in zoonotic infections of significant public health concern, causing hemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome (HCPS) in the Old and New World, respectively. Given a 35% case fatality rate, disease-causing New World hantaviruses require a greater understanding of their biology, genetic diversity, and geographical distribution. Juquitiba hantaviruses have been identified in Oligoryzomys nigripes in Brazil, Paraguay, and Uruguay. Brazil has reported the most HCPS cases associated with this virus. We used a multiplexed, amplicon-based PCR strategy to screen and deep-sequence the virus harbored within lung tissues collected from Oligoryzomys species during rodent field collections in southern (Itapúa) and western (Boquerón) Paraguay. No Juquitiba-like hantaviruses were identified in Boquerón. Herein, we report the full-length S and M segments of the Juquitiba hantaviruses identified in Paraguay from O. nigripes. We also report the phylogenetic relationships of the Juquitiba hantaviruses in rodents collected from Itapúa with those previously collected in Canindeyú. We showed, using the TN93 nucleotide substitution model, the coalescent (constant-size) population tree model, and Bayesian inference implemented in the Bayesian evolutionary analysis by sampling trees (BEAST) framework, that the Juquitiba virus lineage in Itapúa is distinct from that in Canindeyú. Our spatiotemporal analysis showed significantly different time to the most recent ancestor (TMRA) estimates between the M and S segments, but a common geographic origin. Our estimates suggest the additional geographic diversity of the Juquitiba virus within the Interior Atlantic Forest and highlight the need for more extensive sampling across this biome.

Zoonotic febrile illnesses misdiagnosed as COVID-19: a review of reported clinical cases.

COVID-19 is a zoonotic coronavirus disease caused by SARS-CoV-2. Its fast spreading by aerosol transmission has made it a highly contagious disease, causing the most recent 2020 pandemic. Although it mainly affects the respiratory system, atypical forms of the disease have been described, including developing an undifferentiated febrile illness without respiratory symptoms, that can represent a diagnostic challenge, mainly in tropical areas where several zoonotic febrile diseases are circulating. Thus, despite the broad clinical spectrum of COVID-19, in the tropics, other zoonotic etiologies should always be considered as differential diagnoses. According to our case reports review, eight different zoonotic febrile diseases misdiagnosed as COVID-19 have been reported in the available scientific literature of four databases. These were only suspected due to the epidemiological history. Thus, making a complete and detailed clinical history of a febrile patient in the tropics is essential to suspect the etiology and request the necessary confirmatory tests. Therefore, COVID-19 must be included as a differential diagnosis of undifferentiated febrile illness in the tropics, but other zoonotic infectious diseases must not be ruled out.

Hantavirus in Panama: Twenty Years of Epidemiological Surveillance Experience.

Twenty years have passed since the emergence of hantavirus zoonosis in Panama at the beginning of this millennium. We provide an overview of epidemiological surveillance of hantavirus disease (hantavirus pulmonary syndrome and hantavirus fever) during the period 1999-2019 by including all reported and confirmed cases according to the case definition established by the health authority. Our findings reveal that hantavirus disease is a low-frequency disease, affecting primarily young people, with a relatively low case-fatality rate compared to other hantaviruses in the Americas (e.g., ANDV and SNV). It presents an annual variation with peaks every 4-5 years and an interannual variation influenced by agricultural activities. Hantavirus disease is endemic in about 27% of Panama, which corresponds to agroecological conditions that favor the population dynamics of the rodent host, Oligoryzomys costaricensis and the virus (Choclo orthohantavirus) responsible for hantavirus disease. However, this does not rule out the existence of other endemic areas to be characterized. Undoubtedly, decentralization of the laboratory test and dissemination of evidence-based surveillance guidelines and regulations have standardized and improved diagnosis, notification at the level of the primary care system, and management in intensive care units nationwide.

Infección por hantavirus en la Provincia de Buenos Aires-Argentina. Comportamiento de la serie temporal 1997-2021 / Hantavirus infection in the Province of Buenos Aires-Argentina. Characteristics of the time series 1997-2021

INTRODUCCIÓN: La infección por hantavirus es endémica en América del Sur, con un amplio espectro de gravedad y una letalidad que varía entre 17 y 40 por ciento. El presente estudio recoge información de 25 años de vigilancia epidemiológica en Buenos Aires, Argentina. OBJETIVO: Caracterizar el comportamiento de la serie temporal 1997-2021, observando tendencia y estacionalidad. MÉTODOS: La función de serie temporal utilizada empleó la media móvil centrada según periodos trimestrales, de forma que cada año se dividió en cuartiles. Se consideró un modelo multiplicativo. RESULTADOS: Con una tasa de mortalidad de la serie de 0,15 por 100 mil y de letalidad de 22,6, la razón varones : mujeres fue de 3,4:1. La distribución sindrómica mostró mayor compromiso renal, siendo la tasa de mortalidad prácticamente igual en ambos sexos. CONCLUSIÓN: Como enfermedad infecciosa, la infección por hantavirus reflejó en los últimos 25 años un comportamiento, recurrente y estacional, endémico y compartido en sus características clínicas con el resto de la región andina.

BACKGROUND: Hantavirus infection is endemic in South America, with a wide spectrum of severity and a fatality rate that varies between 17-40 percent. This study collects information from 25 years of epidemiological surveillance in Buenos Aires, Argentina. AIM: To characterize the behavior of the 1997-2021 time series, observing trends and seasonality. METHODS: The time series function used the moving average centered according to quarterly periods, so that each year was divided into quartiles. A multiplicative model is missed. RESULTS: With a mortality rate for the series of 0.15 per 100,000 and a fatality rate of 22.6, the male : female ratio was 3.4:1. The syndromic distribution showed greater renal involvement, with the mortality rate being practically the same in both sexes. CONCLUSION: As an infectious disease, hantavirus has reflected in the last 25 years a behavior, recurrent and seasonal, endemic and shared in its clinical characteristics with the rest of the Andean region.

Aplicación de la Teoría del Cuidado Cultural a la investigación: prácticas de cuidado preventivas de hantavirus / Applying Cultural Care Theory to research: hantavirus preventive care practices

INTRODUCCIÓN: La investigación en enfermería surge de las necesidades y experiencias en la práctica y debe contribuir a generar, redefinir y actualizar el conocimiento de enfermería a través de comprobación o generación de nuevas teorías de enfermería. El conocimiento nuevo generado o actualizado debe retornar y mejorar la práctica del cuidado de enfermería dirigido las personas, familia y comunidad. Sin embargo en ocasiones la interrelación investigación y teoría no es clara, afectando de esta manera la relevancia de la aplicación de las teorías de enfermería en la práctica del cuidado de enfermería. OBJETIVO: La presente reflexión responde al objetivo de ejemplificar cómo se aplicó la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger al estudio del fenómeno de las prácticas de cuidado preventivas de hantavirus. DESARROLLO: Sistematización crítica de la experiencia investigativa a través de una propuesta metodológica, que describe cómo la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger guio el proceso de investigación sobre las prácticas de cuidado preventivas de hantavirus, factores personales, sociales, modos de vida y creencias culturales. CONCLUSIONES: Un elemento fundamental en toda investigación de enfermería es mostrar de manera clara y explícita cómo la teoría se interconecta con todas las fases de la investigación y en consecuencia genera conocimiento de enfermería para la práctica del cuidado.

INTRODUCTION: Nursing research arises from needs and experiences in practice and should contribute to generate, redefine and update nursing knowledge by testing or developing new nursing theories. Such new or updated knowledge should lead to improvements in the practice of nursing care applied to persons, family, and community. However, sometimes the interrelationship between research and theory is unclear, affecting the relevance of such theories to nursing care practice. OBJECTIVE: The present reflection aims to exemplify how Leininger's Theory of Cultural Care Universality and Diversity was applied to the study of hantavirus preventive care practices. DEVELOPMENT: Critical systematization of the research experience through a proposed methodology that describes how Leininger's Theory of Cultural Care Universality and Diversity guided research related to hantavirus preventive practices, personal and social factors, lifestyles, and cultural beliefs. CONCLUSIONS: A fundamental element in all nursing research is to clearly and explicitly show how theory interfaces with all phases of research and consequently generates nursing knowledge for caring practice.

Características e diagnóstico laboratorial das infecções causadas pelo hantavírus: revisão integrativa / Characteristics and laboratory diagnosis of infections caused by hantavirus: integrative review

A hantavirose é uma zoonose de distribuição mundial que utiliza como vetores roedores, musaranhos, toupeiras e morcegos. Os sintomas da infecção pelo hantavírus assemelham-se aos de diversas doenças, por isso o diagnóstico laboratorial é crucial para o tratamento precoce. Objetivo: Realizar uma revisão da literatura sobre as características e diagnóstico laboratorial da hantavirose. Métodos: Trata-se de uma revisão integrativa da literatura com base no modelo PRISMA, com seleção de estudos nas bases de dados Portal de Periódicos da Capes, PubMed/Medline, SciELO, ScienceDirect e Biblioteca Virtual em Saúde (BVS). Foram empregados os descritores: hantavírus, diagnóstico laboratorial, exames e zoonose, em português e inglês, no período de 2015 a 2022, sendo selecionados 19 artigos científicos em atendimento aos critérios de inclusão. Resultados e Discussão: Diversas técnicas diagnósticas podem ser empregadas em casos de hantavirose, sendo a biologia molecular a mais empregada, conjuntamente com a imunologia. Há outros recursos utilizados para monitoramento e evolução da doença, como a bioquímica, a hematologia e a imagenologia. Para a ocorrência de hantavirose é necessário um ambiente propício, clima específico e contato com hospedeiro suscetível, podendo evoluir para quadros assintomáticos ou sintomáticos com complicações graves. Conclusão: O diagnóstico dessa doença é desafiador e requer investigação detalhada que inclua a sintomatologia do paciente, o histórico de exposição a animais reservatórios e os resultados de exames laboratoriais. Como desfechos negativos da hantavirose incluem-se a febre hemorrágica com síndrome renal, a síndrome pulmonar por hantavírus e o óbito

Hantavirus is a worldwide distributed zoonosis that uses rodents, shrews, moles and bats as vectors. The symptoms of hantavirus infection resemble those of many diseases, so laboratory diagnosis is crucial for early treatment. Objective: The present study aimed to conduct a literature review on the characteristics and laboratory diagnosis of hantavirus. Methods: This is an integrative literature review based on the PRISMA model, with a selection of studies in the Capes Portal de Periódicos, PubMed/Medline, SciELO, ScienceDirect and Virtual Health Library databases, using the descriptors: hantavirus, laboratory diagnosis, exams, and zoonosis, in portuguese and english, from 2015 to 2022, and nineteen scientific articles that met the inclusion criteria were selected. Results and Discussion: Several techniques can be used in cases of hantavirus, with molecular biology being the most evidenced along with immunology. There are other parameters that are used for monitoring and evolution of the disease, such as biochemistry, hematology, and imaging. For the hantavirus disease, an adequate environment, specific climate and contact with a susceptible host are necessary, which may lead to asymptomatic conditions or symptoms with more serious complications. Conclusion: The diagnosis of this disease is challenging and requires detailed investigation that includes the patient's symptoms, the history of exposure to reservoir animals and the results of laboratory tests. Negative outcomes of hantavirus infection include hemorrhagic fever with renal syndrome, hantavirus pulmonary syndrome, and death

Actualización de áreas de riesgo y perfil epidemiológico de hantavirus en Paraguay (2013-2020)

El síndrome pulmonar por hantavirus (SPH) en el Paraguay es una infección relacionada a extensas áreas geográficas del Chaco o Región Occidental. Sin embargo, en los últimos años se han reportado casos fuera del área endémica conocida. Con el objetivo de describir el perfil epidemiológico de la enfermedad en nuestro país, y actualizar las áreas de transmisión, se realizó una revisión retrospectiva de los casos registrados desde el 2013 al 2020. Fueron confirmados 90 casos de SPH, siendo la Región Occidental la de mayor proporción de casos, con 92% en dicho periodo. La Región Oriental registró el 5,5% de los casos, mientras que en el 2,5% de los casos no fue posible determinar el territorio de ocurrencia del contagio. El perfil de la enfermedad en el país se presenta como una afección principalmente de hombres en la edad adulta - joven, ligados a actividades de campo. Los principales desafíos para el abordaje de esta enfermedad son sensibilizar a la población de las nuevas áreas de riesgo identificadas, fortalecer la vigilancia en dichos lugares a fin de captar en forma oportuna a los casos, y actualizar los conocimientos sobre los virus circulantes y los reservorios zoonóticos de la enfermedad.

Hantavirus Pulmonary Syndrome in Paraguay is an infection related to the Chaco area or Western Region. However, in recent years cases it has been reported outside the known endemic area. In order to describe the epidemiological profile of the disease in our country, and update the transmission areas, a retrospective review of the cases registered from 2013 to 2020. Ninety HPS cases were confirmed, being the Western Region the one that contributed the highest proportion of cases, with 92% in the study period. The Eastern Region registered 5.5% of the cases, while in 2.5% of the cases it was not possible to determine the place. The profile of the disease in the country is presented as a condition mainly of men in adulthood - young, linked to field activities. The main challenges were to sensitize the population of the newly identified risk areas, strengthen the surveillance in these places in order to capture cases in a timely manner and update knowledge about the circulating viruses and zoonotic reservoirs of the disease.

Diagnostico Serológico de Hantavirus en el Departamento de La Paz, Bolivia, en la gestión 2022 / Serological diagnosis of Hantavirus in the department of La Paz, Bolivia in the 2022 management

INTRODUCCIÓN: el síndrome pulmonar por hantavirus (SPHV) es una enfermedad viral aguda causada por miembros del género Orthohantavirus, familia Bunyaviridae transmitida por roedores presente en zonas tropicales y semitropicales del departamento de La Paz. OBJETIVOS: diagnosticar hantavirus por serología IgG e IgM, en el noreste del Departamento de La Paz, Bolivia, en pacientes con sospecha de infección por Hantavirus mediante la prueba de ELISA y realizar un análisis epidemiológico básico. MATERIALES Y MÉTODOS: este trabajo es un estudio de tipo transversal descriptivo, se utilizó el método de diagnóstico ELISA (Euroinmun) para detectar la presencia de anticuerpos inmunoglobulina M (IgM) e inmunoglobulina G(IgG) para hantavirus en muestras de suero, con un universo de 138 muestras de Enero a Agosto de la gestión 2022 en pacientes con sospecha de infección por Hantavirus enviadas de distintos hospitales y centros de salud al Laboratorio de Virología del Instituto Nacional de Laboratorios en Salud (INLASA). RESULTADOS Y CONCLUSIONES: se detectó presencia de IgM e IgG para hantavirus en las muestras de suero procesadas por serología en el Laboratorio de Virología, de las cuales de 138 muestras, un 12% son positivas para IgG, 4% positivos para IgM y el 84%, restante es negativo. Estas muestras provienen de centros y establecimientos de salud del noreste del Departamento de La Paz, observándose un mayor porcentaje de casos en el sexo masculino afectando al grupo etario de 41 a 50 años y existiendo un número elevado de casos presentes entre los meses de febrero y abril, además de observar signos y síntomas registradas en fichas epidemiológicas.

INTRODUCTION: Hantavirus pulmonary syndrome (SPHV) is an acute viral disease caused by members of the genus Orthohantavirus, family Bunyaviridae, transmitted by rodents present in tropical and semitropical areas of the department of La Paz. OBJECTIVES: diagnose hantavirus by IgG and IgM serology, in the northeast of the Department of La Paz, Bolivia, in patients with suspected Hantavirus infection using the ELISA test and perform a basic epidemiological analysis. MATERUAKS AND METHODS: this work is a descriptive cross-sectional study, the ELISA (Euroimmun) diagnostic method was used to detect the presence of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies to hantavirus in serum samples, with a universe of 138 samples. from January to August of the 2022 management in patients with suspected Hantavirus infection sent from different hospitals and health centers to the Virology Laboratory of the National Institute of Health Laboratories (INLASA). RESULTS AND CONCLUSIONS: the presence of IgM and IgG for hantavirus was detected in the serum samples processed by serology in the Virology Laboratory, of which 138 samples, 12% are positive for IgG, 4% positive for IgM and the remaining 84% are negative. These samples come from health centers and establishments in the northeast of the Department of La Paz, observing a higher percentage of cases in the male sex, affecting the age group of 41 to 50 years, and there being a high number of cases present between the months of February and April, in addition to observing signs and symptoms recorded in epidemiological files.