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. 2020 Apr 11;7(5):ofaa125.
doi: 10.1093/ofid/ofaa125. eCollection 2020 May.

Investigation of Heartland Virus Disease Throughout the United States, 2013-2017

J Erin Staples  1 , Daniel M Pastula  1 , Amanda J Panella  1 , Ingrid B Rabe  1 , Olga I Kosoy  1 , William L Walker  1 , Jason O Velez  1 , Amy J Lambert  1 , Marc Fischer  1
Affiliations

Investigation of Heartland Virus Disease Throughout the United States, 2013-2017

J Erin Staples et al. Open Forum Infect Dis. .

Abstract

Background: Heartland virus (HRTV) was first described as a human pathogen in 2012. From 2013 to 2017, the Centers for Disease Control and Prevention (CDC) implemented a national protocol to evaluate patients for HRTV disease, better define its geographic distribution, epidemiology, and clinical characteristics, and develop diagnostic assays for this novel virus.

Methods: Individuals aged ≥12 years whose clinicians contacted state health departments or the CDC about testing for HRTV infections were screened for recent onset of fever with leukopenia and thrombocytopenia. A questionnaire was administered to collect data on demographics, risk factors, and signs and symptoms; blood samples were tested for the presence of HRTV RNA and neutralizing antibodies.

Results: Of 85 individuals enrolled and tested, 16 (19%) had evidence of acute HRTV infection, 1 (1%) had past infection, and 68 (80%) had no infection. Patients with acute HRTV disease were residents of 7 states, 12 (75%) were male, and the median age (range) was 71 (43-80) years. Illness onset occurred from April to September. The majority reported fatigue, anorexia, nausea, headache, confusion, arthralgia, or myalgia. Fourteen (88%) cases were hospitalized; 2 (13%) died. Fourteen (88%) participants reported finding a tick on themselves in the 2 weeks before illness onset. HRTV-infected individuals were significantly older (P < .001) and more likely to report an attached tick (P = .03) than uninfected individuals.

Conclusions: Health care providers should consider HRTV disease testing in patients with an acute febrile illness with either leukopenia or thrombocytopenia not explained by another condition or who were suspected to have a tickborne disease but did not improve following appropriate treatment.

Keywords: Heartland virus; phlebovirus; tickborne diseases.

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Figures

Figure 1.
Figure 1.
State of residence for participants with acute Heartland virus disease (n = 16).
Figure 2.
Figure 2.
Month of illness onset for participants with acute Heartland virus disease (n = 16).
See this image and copyright information in PMC

References

    1. McMullan LK, Folk SM, Kelly AJ, et al. . A new phlebovirus associated with severe febrile illness in Missouri. N Engl J Med 2012; 367:834–41. - PubMed
    1. Brault AC, Savage HM, Duggal NK, Eisen RJ, Staples JE. Heartland virus epidemiology, vector association, and disease potential. Viruses. 2018; 10:piiE48. - PMC - PubMed
    1. Godsey MS, Savage HM, Burkhalter KL, et al. . Transmission of Heartland virus (Bunyaviridae: Phlebovirus) by experimentally infected Amblyomma americanum (Acari: Ixodidae). J Med Entomol 2016; 53:1226–33. - PubMed
    1. Savage HM, Godsey MS Jr, Panella NA, et al. . Surveillance for Heartland virus (Bunyaviridae: Phlebovirus) in Missouri during 2013: first detection of virus in adults of Amblyomma americanum (Acari: Ixodidae). J Med Entomol 2016; 53:607–12. - PubMed
    1. Savage HM, Godsey MS, Lambert A, et al. . First detection of heartland virus (Bunyaviridae: Phlebovirus) from field collected arthropods. Am J Trop Med Hyg 2013; 89:445–52. - PMC - PubMed