A Review of Hantavirus Research in Indonesia: Prevalence in Humans and Rodents, and the Discovery of Serang Virus

Abstract

Dengue and other common tropical infectious diseases of similar clinical presentation are endemic in Indonesia, which may lead to an underestimation of the prevalence of hantavirus (HTV) infection in the country. To better understand the current burden of HTV infection, this study aimed to both identify acute HTV infection among hospitalized patients with fever and to determine the overall seroprevalence of HTV. These results were further considered within the context of previously reported HTV infection in humans and animals in Indonesia by conducting a review of published literature. As part of an observational cohort study of acute febrile illness, this sub-study retrospectively analyzed blood specimens obtained during admission, during the 2–4-week convalescent period, and three months after admission. Convalescent specimens from patients with clinical signs and symptoms of HTV infection were first screened for HTV IgG. When positive, convalescent specimens and paired acute specimens were screened for HTV IgM, and paired acute specimens were tested for HTV by Reverse Transcription Polymerase Chain Reaction (RT-PCR). A literature review of HTV in Indonesia was conducted on manuscripts manually reviewed for relevance after identification from a search using the terms “hantavirus/Seoul virus” and “Indonesia”. From patients at eight hospitals in seven provincial capitals, HTV IgG seroprevalence was 11.6% (38/327), with the highest being in Denpasar (16.3%, 7/43) and the lowest being in Yogyakarta (3.4%, 1/31). Anti-HTV IgG was most prevalent in adults (13.5%, 33/244) and males (15.6%, 29/186). Acute HTV infections were identified in two subjects, both of whom had Seoul virus. In Indonesia, HTVs have been studied in humans and animals since 1984. Over the past 35 years, the reported seroprevalences in rodents ranged from 0% to 34%, and in humans from 0% to 13%. Fourteen acute infections have been reported, including one in a tourist returning to Germany, but only two have been confirmed by RT-PCR. Almost all rodent and human surveillance results demonstrated serological and molecular evidence of Seoul virus infection. However, in Semarang, anti-Puumala virus IgM has been detected in humans and Puumala RNA in one rodent. In Serang, a new virus named Serang virus was identified due to its differences from Seoul virus. In Maumere, HTV and Leptospira spp. were identified simultaneously in rodents. The burden of HTV infection in Indonesia is underestimated, and additional studies are needed to understand the true prevalence. Seroprevalence data reported here, previous observations of HTV co-infections in rodents, and the prevalence of rodent-borne bacterial infections in Indonesia suggest that the population may be routinely encountering HTVs. While Seoul virus appears to be the most prevalent HTV in the country, further studies are needed to understand which HTVs are circulating.

Serological Evidence of Human Orthohantavirus Infections in Barbados, 2008 to 2016

“…Severe gastrointestinal (GI) symptoms including abdominal pain, nausea and vomiting were previously found to be common in patients with PUUV infection and co-circulation of Leptospira , ZIKV, CHIKV and DENV exists in Barbados [ 33 , 34 , 35 , 36 ]. Thus, the high frequency of gastrointestinal-related symptoms, joint and muscle pain among orthohantavirus patients in Barbados is not unexpected, as this has been previously observed in Indonesia [ 31 , 32 , 37 ]. Simultaneous or previous DENV, ZIKV and or CHIKV infections can lead to rash and chronic arthralgia lasting several months after infection [ 37 , 38 , 39 , 40 , 41 ].…”

“…Thus, the high frequency of gastrointestinal-related symptoms, joint and muscle pain among orthohantavirus patients in Barbados is not unexpected, as this has been previously observed in Indonesia [31,32,37]. Simultaneous or previous DENV, ZIKV and or CHIKV infections can lead to rash and chronic arthralgia lasting several months after infection [37][38][39][40][41]. This potentially highlights the need for orthohantavirus studies in regions other than those traditionally reporting orthohantavirus to expand knowledge of orthohantavirus clinical presentations and its epidemiology in different geographical, pathogen endemicity and host genetic contexts.…”

Identification of Mites in Wild Rats in Simpang Limun Traditional Wet Market Area, Medan - Indonesia

“…Other studies also described similar findings, citing that the habitat of this rat was sewers in urban and rural areas [18,21]. Some potential public health impacts, especially due to the high presence of Rattus tanezumi, are the direct spread of zoonoses such as Hantavirus transmission [22], which increased by 13% in humans in Indonesia. It is also an intermediate host for the transmission of parasitic worms such as Trychostrongylidae and Hymenolaepis diminuta.…”

Hantavirus: Structure, Mechanism of Transmission of Disease, Development of Drugs and Vaccines, and Prevention in Indonesia

“…Di Indonesia, penelitian tentang Hantavirus pada manusia dan hewan telah dilakukan sejak tahun 1984. Selama 35 tahun tersebut didapatkan data seroprevalensi pada rodensia berkisar antara 0% sampai 34% dan pada manusia antara 0% sampai 13% (Lukman et al 2019 Berbagai penelitian yang telah dilakukan tersebut dapat memberikan sedikit gambaran tentang bagaimana kondisi Hantavirus di Indonesia yang tentunya harus disikapi dengan bijak. Dengan melihat kondisi Indonesia seperti yang telah disebutkan sebelumnya, tidak menutup kemungkinan jika Hantavirus dapat menjadi wabah di negara ini apabila tidak dilakukan berbagai tindakan pencegahan.…”