Hemorrhagic fever with renal syndrome in 4 US soldiers, South Korea, 2005

Abstract

Four US soldiers acquired hemorrhagic fever with renal syndrome while training near the Demilitarized Zone, South Korea, in 2005. Hantaan virus sequences were amplified by reverse transcription-PCR from patient serum samples and from lung tissues of striped field mice (Apodemus agrarius) captured at training sites. Epidemiologic investigations specified the ecology of possible sites of patient infection.

Figure 1

Location of training sites where hemorrhagic fever with renal syndrome (HFRS) patients 1–4 conducted training exercises 50 days before the onset of illness. Rodent surveillance was not conducted at Watkins Range due to limited exposure. DMZ, Demilitarized Zone; LTA, local training area; solid circles, military training sites of patient 1; solid squares, military training sites of patients 2, 3, 4; star, base camp.

Figure 2

Phylogenetic tree by maximum parsimony method, rooted at the midpoint, based on the 320-bp region of G2 glycoprotein–encoding medium segment of 4 hemorrhagic fever with renal syndrome patients who were US soldiers in South Korea (patients 1–4), 2005 (GenBank accession nos. FJ561275–FJ561278) and field mice (Apodemus spp.)–borne Hantaan viruses (HTNV). HTNV sequence amplified from patient 1 was identical with a HTNV sequence (Aa04–1325) from A. agrarius mice captured at firing point (FP) 60. HTNV sequences from patients 2 and 4 were the same as 3 HTNV sequences (Aa05–1437, Aa06–119, Aa06–171) from A. agrarius mice captured at Twin Bridge Training Area–South (TBTA-S), and the HTNV sequence from patient 3 was identical to 11 HTNV sequences (Aa05–1465, Aa07–2, Aa07–21, Aa07–196, Aa07–206, Aa07–223, Aa07–280, Aa07–284, Aa07–288, Aa07–306 and Aa07–318) from A. agrarius mice at Twin Bridge Training Area-North (TBTA-N). Branch lengths are proportional to the number of nucleotide substitutions, while vertical distances are for clarity only. The numbers at each node are bootstrap probabilities (expressed as percentages), as determined for 100 iterations by using PAUP version 4.0b (http://paup.csit.fsu.poly). The colors indicate patients and corresponding training sites.