Clinical and epidemiological aspects of hemorrhagic fever with renal syndrome (HFRS) in Greece

Twenty-three cases of hemorrhagic fever with renal syndrome were serologically diagnosed in rural populations of Greece between 1982 and 1985. The clinical picture of the disease was severe, (3 deaths recorded among 23 cases) and more closely resembled Korean hemorrhagic fever than nephropathia epidemica. Examination of patients' sera by indirect immunofluorescence (IFA) assays and plaque reduction neutralization (PRNT) tests using Hantaan 76-118, Puumala, and Seoul (Urban rat-associated Hantaan-like) viruses, suggested that the virus existing in Greece is either prototype Hantaan virus or a distinct virus which is closely related to Hantaan. Small mammal survey results suggest that Apodemus flavicollis may be the host of this virus. Serosurvey results of 2,653 blood samples taken from apparently healthy residents (farmers, shepherds, and woodcutters) from 22 of 54 counties in Greece, showed the percentage of seropositives to be 4%, with a range from 0 to 14%. Fifteen of 22 counties were characterized as endemic areas of the virus due to the presence of seropositive individuals. In 6 of the 15 endemic areas, overt human disease was serologically diagnosed.