


SASTM Newsflash - Argentine hemorrhagic fever - Argentina (Santa Fe) suspected


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SASTM Newsflash




The [Santa Fe] provincal Ministry of Health, through the Office of Health Protection and Promotion, confirmed the death of a young man who resided in Region 4 -Rosario Node, with a probable clinical case of Argentina hemorrhagic fever.  Also, there are 2 probable cases [of this disease] currently in serious condition, interned in intensive care units in Rosario. This was reported by the head of the unit, Andrea Uboldi, who stated that, in general, "these serious types [of cases] occur infrequently, observing that these cases progress favorably with adequate treatment."


Concerning the disease, also known as "stubble disease", she explained that "it is caused by Junin virus, that affects a region of the country that involves the provinces of Buenos Aires, southern Santa Fe, Cordoba and La Pampa," and that, "it is contracted mainly by people who live or work in or visit the countryside or were in contact with localities invaded by countryside rodents."



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Junin virus is found in certain rodent species in the countryside. The rodents are small (measuring 6-8 cm).  Their color is brownish on the back with a white belly [probably referring to _Calomys spp._]. They construct nests in cultivated areas, in weeds along fences, paths, railroad rights of way, mill waterways, river banks, streams and shoulders of roads that cross these localities. They are very rarely found in human habitations, but they invade villages, finding refuge in vacant lots, vegetable gardens and weeds in the front and back of the house.


These rodents continually excrete the virus in saliva and urine, contaminating the environment in which they live, where humans are accidentally infected. The virus is also found in the blood of these animals. Because of this, when agricultural machinery kills these animals, they are contaminated by their infected blood.



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The term Argentine hemorrhagic fever is due to disease that occurs with, among other characteristic symptoms: fever and hemorrhagic tendency, [this is] usually very mild. Only in a few cases and in seriously ill individuals, severe hemorrhage occurs. The term Argentina is used because the disease only occurs in our country.  The hemorrhagic fever symptoms presented begin with fever, malaise and headache. Later, muscle, joint and retro orbital pain may occur, [with] nausea and vomiting. Given this, Uboldi emphasized that before any of these symptoms appear, "it is important to consult a physician since there is a treatment available, if it is administered in time, that increases the possibility of curing the disease." The treatment is done with plasma from convalescent individuals, that is to say, people who have been cured [or recovered from] Argentina hemorrhagic fever. It has proved that ill individuals treated during the 1st 8 days of the disease, the mortality is less than 1 per cent. In contrast, if the treatment is delayed, the mortality increases to 30 per cent. The only way to obtain plasma from convalescent individuals is through the collaboration of people who had been cured to donate their plasma. In this sense, the health office stated that a person who had Argentina hemorrhagic fever could form part of a supporting chain donating their plasma and making it possible for others could be treated.



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The main way to prevent Argentine hemorrhagic fever is through vaccination -- with live Junin virus vaccine Candid 1 -- [this is] highly effective and which is in the official schedule in the 4 provinces and is available in the Ministry of Health dispensaries.

Those people who reside or carry out activities in 4 provinces in the endemic for Argentine hemorrhagic fever, consisting of men and women over 15 - 65 years of age who have not received the Candid 1 vaccine previously should be vaccinated. Individuals not to be vaccinated include: pregnant women or those breast feeding, people with acute or chronic diseases who are receiving systemic corticoids or who present with congenital or acquired immunosuppressive clinical conditions.


As a condition [of vaccination with Candid 1] it is required that [individuals] not have received any other vaccines in the previous month, nor will receive them in the following month after receiving Candid 1 [vaccine]. There is assurance that the dose [vaccine] is available in southern provincial [health] dispensaries. 


Concerning other kinds of prevention, she underscored the importance of carrying out careful hygiene, mainly hand [washing] and clothing change every time one has frequented areas with rodents. Houses in rural areas: maintain short grass at least 30 m [33 yards] to keep rodents from coming in, use closed containers for storing grain or animal feed, garbage and waste foodstuff, keep storage areas clean where machinery and other implements are stored and carry out rodent control with rodenticides (poisons for rodents) and placing traps, trying to close holes in houses and storage buildings so that mice cannot enter, keep vegetable gardens far from houses so that the rodents that are there do not come into the house and maintain them weed free.


In towns and cities: maintain weed free the railroad rights of way, vacant lots, around houses and their gardens, avoiding refuges that the rodents might encounter. If weed elimination is not done in springtime or summer, in autumn is it preferable that 1st use rodenticides and then shortly after eliminate weeds. It is also important to maintain the streets and sidewalks clean without trash

accumulation that could promote rodents coming in.  


Finally, the Santa Fe Health Office stated that "we all must contribute to control of Argentina hemorrhagic fever," that the person who "lives or works in the risk area must be vaccinated, which is just once in a lifetime," if "[a person] presents with a febrile disease they must immediately [seek] medical attention," and if, "[a person] has had the disease, collaborate by donating blood to provide treatment for other ill individuals."


Communicated by: ProMED-mail


Argentine hemorrhagic fever occurs sporadically in the endemic area mentioned above, including last year (2012). The hosts of Junin virus are rodents, particularly _Mus musculus_, _Calomys spp_. and _Akodon azarae_. The animals have a chronic, asymptomatic infection and shed virus through saliva, urine, and blood. Human infections occur through contact with skin, mucosa, and inhalation of aerosolized particles carrying the virus.


According to the GIDEON database, most cases of this vaccine-preventable disease occur in Cordoba, Buenos Aires, and Santa Fe provinces, and the peak year was 1964 with over 3000 cases, with 120 cases in each of 1993 and 1994. Prevention of human cases is the same as for hantaviruses: avoidance of activities that result in contact with aerosols in areas where the rodent hosts are present.




South African Society of Travel Medicine (SASTM)

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