Active targeted surveillance to identify sites of emergence of hantavirus

Won Keun Kim, Jin Sun No, Daesang Lee, Jaehun Jung, Hayne Park, Yongjin Yi, Jeong Ah Kim, Seung Ho Lee, Yujin Kim, Sunhye Park, Seungchan Cho, Geum Young Lee, Dong Hyun Song, Se Hun Gu, Kkothanahreum Park, Heung Chul Kim, Michael R. Wiley, Patrick S.G. Chain, Seong Tae Jeong, Terry A. KleinGustavo Palacios, Jin Won Song

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background. Endemic outbreaks of hantaviruses pose a critical public health threat worldwide. Hantaan orthohantavirus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS) in humans. Using comparative genomic analyses of partial and nearly complete sequences of HTNV from humans and rodents, we were able to localize, with limitations, the putative infection locations for HFRS patients. Partial sequences might not reflect precise phylogenetic positions over the whole-genome sequences; finer granularity of rodent sampling reflects more precisely the circulation of strains. Methods. Five HFRS specimens were collected. Epidemiological surveys were conducted with the patients during hospitalization. We conducted active surveillance at suspected HFRS outbreak areas. We performed multiplex polymerase chain reaction-based next-generation sequencing to obtain the genomic sequence of HTNV from patients and rodents. The phylogeny of human- and rodent-derived HTNV was generated using the maximum likelihood method. For phylogeographic analyses, the tracing of HTNV genomes from HFRS patients was defined on the bases of epidemiological interviews, phylogenetic patterns of the viruses, and geographic locations of HTNV-positive rodents. Results. The phylogeographic analyses demonstrated genetic clusters of HTNV strains from clinical specimens, with HTNV circulating in rodents at suspected sites of patient infections. Conclusions. This study demonstrates a major shift in molecular epidemiological surveillance of HTNV. Active targeted surveillance was performed at sites of suspected infections, allowing the high-resolution phylogeographic analysis to reveal the site of emergence of HTNV. We posit that this novel approach will make it possible to identify infectious sources, perform disease risk assessment, and implement preparedness against vector-borne viruses.

Original languageEnglish (US)
Pages (from-to)464-473
Number of pages10
JournalClinical Infectious Diseases
Issue number3
StatePublished - Feb 1 2020
Externally publishedYes


  • Active targeted surveillance
  • Epidemiology
  • Hantavirus
  • Hemorrhagic fever with renal syndrome
  • Next-generation sequencing

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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