TABLE III. Cases of specified notifiable diseases, United States, weeks ending
February 13, 1988 and February 14, 1987 (6th Week)

TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending February 13, 1988 and February 14, 1987 (6th Week)

*For measles only, imported cases includes both out-of-state and international importations. N: Not notifiable U: Unavailable *International Out-of-state

TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending February 13, 1988 and February 14, 1987 (6th Week)

*Mortality data in this table are voluntarily reported from 121 cities in the United states, most of which have populations of 100,000 or more. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included.

**Pneumonia and influenza.

* Because of changes in reporting methods in these 3 Pennsylvania cities, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks.

††Total includes unknown ages.

§ Data not available. Figures are estimates based on average of past 4 weeks.

epidemica is typically the least severe disease and causes very few deaths, although some patients may require dialysis. Some severe cases with hemorrhagic tendency have occurred in some European countries, particularly France (12). A severe disease caused by the local Apodemus species has been recently reported from Greece (13). Hemorrhagic fever with renal syndrome has classically been divided into five stages: febrile, shock, oliguric, polyuric, and convalescent (2). In practice these stages frequently overlap, particularly the shock and oliguric phases. The initial symptoms are usually fever, flushed face, periorbital edema, and palatal and axillary petechiae. Conjunctivitis, headache, eye pain, lumbar pain, and tenderness are also common. Principal laboratory findings are proteinuria, hemoconcentration, and thrombocytopenia. Most patients recover spontaneously from this stage. A few progress to a phase of oliguria or anuria that is short and usually self-limiting. Shock can be managed by careful fluid replacement; the greatest danger to the patient is inadvertent fluid overload. Although petechiae, thrombocytopenia, and platelet functional abnormalities are very common, overt bleeding is not. In hospitals in some endemic areas of the People's Republic of China, the infection is most often self-limiting and without a severe phase, and the few deaths are usually due to intracranial hemorrhage or generalized uncontrollable bleeding.

The outbreak being reported is typical of endemic Apodemus-associated HFRS in Asia. There were no asymptomatic seropositives among those at risk for the disease. There was no evidence for a point source. The cases occurred sporadically during the fall season and were localized in an area presumably infested with infected A. agrarius. The experience mirrors those of the Japanese during their occupation of China and of the United Nations forces during the Korean conflict. The attack rate of the outbreak in this report is higher than that usually reported in civilian populations and probably reflects the relatively intense exposure to the virus encountered during the military operation.

References

1. Chen H-X, Qiu F-X, Dong B-J, et al. Epidemiological studies on hemorrhagic fever with renal syndrome in China. J Infect Dis 1986;154:394-8.

2. Fisher-Hoch SP, McCormick JB. Haemorrhagic fever with renal syndrome: a review. Abstracts on Hygiene and Communicable Diseases 1985;60:R1-20.

3. Earle DP. Analysis of sequential physiologic derangements in epidemic hemorrhagic fever. Am J Med 1954;16:690-709.

4. Sheedy JA, Froeb HF, Batson HA, et al. The clinical course of epidemic hemorrhagic fever. Am J Med 1954;16:619-28.

5. Lee HW, Lee PW, Johnson KM. Isolation of the etiologic agent of Korean hemorrhagic fever. J Infect Dis 1978;137:298-308.

6. Schmaljohn CS, Hasty SE, Dalrymple JM, et al. Antigenic and genetic properties of viruses linked to hemorrhagic fever with renal syndrome. Science 1985;227:1041-4.

7. Desmyter J, LeDuc JW, Johnson KM, Brasseur F, Deckers C, van Ypersele de Strihou C. Laboratory rat associated outbreak of haemorrhagic fever with renal syndrome due to Hantaan-like virus in Belgium. Lancet 1983;2:1445-8.

8. Tsai TF, Bauer SP, Sasso DR, et al. Serological and virological evidence of a Hantaan virus-related enzootic in the United States. J Infect Dis 1985;152:126-36.

9. Lee HW, Baek LJ, Johnson KM. Isolation of Hantaan virus, the etiologic agent of Korean hemorrhagic fever, from wild urban rats. J Infect Dis 1982;146:638-44.

10. Lähdevirta J. Nephropathia epidemica in Finland: a clinical histological and epidemiological study. Ann Clin Res 1971;3:1-54.

11. Centers for Disease Control. Hemorrhagic fever with renal syndrome-France. MMWR 1984;33:228,233-4.