CDC Home
Safer, Healthier People
CDC HomeCDC SearchHealth Topics A-Z
  WONDER Home FAQ Help Contact Us Search  

CDC Prevention Guidelines Database (Archive)


This online archive of the CDC Prevention Guidelines Database is being maintained for historical purposes, and has had no new entries since October 1998. To find more recent guidelines, please visit the following:
  • MMWR at
  • CDC Web Search at

Hantavirus Disease -- Southwestern United States, 1993

MMWR 42(29);570-572

Publication date: 07/30/1993

Table of Contents

Reported by




Confirmed Cases Of Hantavirus Illness


Since May 1993, the state health departments in Arizona, Colorado, New Mexico, and Utah; the Indian Health Service; and CDC, with the assistance of the Navajo Nation Division of Health, have been investigating an outbreak of acute respiratory illness related to a newly recognized hantavirus (1-5). This report updates the investigation and presents information on a recent case of hantavirus-associated respiratory disease in a resident of Nevada.

Through July 27, laboratory evidence of acute hantavirus infection (*) has been confirmed in 18 persons in the four-corners area who were ill during 1993: 12 persons in New Mexico, four in Arizona, and two in Colorado. The median age of the 18 case- patients was 31 years (range: 13-64 years). Of these persons, 14 (78%) have died. The most recent onset of illness among the patients with confirmed cases was July 3 (Figure 1). Illnesses in an additional 28 persons in the four states are under investigation; 10 (36%) of these persons have died.

On July 10, CDC was contacted about a case of acute respiratory illness in a 24-year-old resident of central Nevada whose reported onset of illness was July 7. The case-patient had bilateral interstitial infiltrates and severe hypoxemia; she recovered fully. She had not traveled outside central Nevada during the 3-month period before illness onset. A serum specimen obtained July 10 demonstrated hantavirus-specific immunoglobulin M enzyme-linked immunosorbent assay antibodies. CDC and the Division of Health, Nevada State Department of Human Resources, are continuing the investigation of this case.

Through July 27, specimens from 55 persons with unexplained acute respiratory distress syndrome submitted by health authorities in 24 states outside the four-corners area and in the District of Columbia have been tested for evidence of hantavirus infection at CDC. In addition to the Nevada resident, specimens from a previously reported 58-year-old eastern Texas resident and a previously reported resident of another state who traveled to the four-corners area in 1992 have been positive (4,5).

(*) Any of the following tests positive: IgM antibodies to hantavirus antigens; fourfold or greater increase in antibody titers to hantavirus antigens in paired serum specimens; a positive immunohistochemical stain for hantavirus antigen in tissues; or positive polymerase chain reaction from tissue specimens.

Reported by

C Ward, DO, TB Callister, MD, H Hayes, Nye Regional Medical Center, Tonopah; LM Oksenholt, DO, Reno; D Nelson, AF DiSalvo, MD, State Health Laboratory, D Kwalick, MD, State Health Officer, Div of Health, Nevada State Dept of Human Resources. MJ Burkhardt, MPH, N Kalishman, MD, M Gallaher, MD, R Voorhees, MD, M Samuel, DrPH, M Tanuz, G Simpson, MD, L Hughes, PhD, E Umland, MD, G Oty, MS, L Nims, MS, CM Sewell, DrPH, State Epidemiologist, New Mexico Dept of Health. K Komatsu, MPH, C Kioski, MPH, K Fleming, MA, J Doll, PhD, C Levy, MS, TM Fink, P Murphy, B England, MD, M Smolinski, MD, B Erickson, PhD, W Slanta, L Sands, DO, Acting State Epidemiologist, Arizona Dept of Health Svcs. P Shillam, MSPH, RE Hoffman, MD, State Epidemiologist, Colorado Dept of Health. S Lanser, MPH, CR Nichols, MPA, State Epidemiologist, Utah Dept of Health. L Hubbard-Pourier, MPH, Div of Health, Navajo Nation, Window Rock, Arizona. J Cheek, MD, A Craig, MD, R Haskins, MPH, B Muneta, MD, B Tempest, MD, M Carroll, MD, LA Shands, MPH, JP Sarisky, MPH, RE Turner, P Bohan, MS, Indian Health Svc. Div of Field Epidemiology, Epidemiology Program Office; Div of Bacterial and Mycotic Diseases, Div of Vector-Borne Infectious Diseases, Scientific Resources Program, and Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC.


Newly diagnosed cases of respiratory illness with evidence of acute hantavirus infection continue to be detected in the four-corners area. However, the detection of persons with evidence of acute hantavirus infection associated with respiratory illness in Texas and Nevada indicates that the potential for infection is not confined to the four-corners region of the Southwest. The continued occurrence of cases in the Southwest demonstrates the importance of adherence to recommended measures to minimize risk for exposure to rodents or their excreta (6). Examination of rodents trapped in the four-corners area indicates that Peromyscus maniculatus (deer mouse) continues to be the species most commonly trapped and most likely to show evidence of hantavirus infection.


  1. CDC. Outbreak of acute illness -- southwestern United States, 1993. MMWR 1993;42:421-4.
  2. CDC. Update: outbreak of hantavirus infection -- southwestern United States, 1993. MMWR 1993;42:441-3.
  3. CDC. Update: outbreak of hantavirus infection -- southwestern United States, 1993. MMWR 1993;42:477-9.
  4. CDC. Update: outbreak of hantavirus infection -- southwestern United States, 1993. MMWR 1993;42:495-6.
  5. CDC. Update: outbreak of hantavirus infection -- southwestern United States, 1993. MMWR 1993;42:517-9.
  6. CDC. Hantavirus infection -- southwestern United States: interim recommendations for risk reduction. MMWR 1993;42(no. RR-12) (in press).


To request a copy of this document or for questions concerning this document, please contact the person or office listed below. If requesting a document, please specify the complete name of the document as well as the address to which you would like it mailed. Note that if a name is listed with the address below, you may wish to contact this person via CDC WONDER/PC e-mail.
For single issue purchase 800-843-6356
State/Fed Gov:For free copies,
write to:CDC, MMWR, MS(C-08)
Atlanta, GA 30333

Figure 1

Confirmed Cases Of Hantavirus Illness

Prevention Guidelines Image

This page last reviewed: Friday, July 25, 2014
This information is provided as technical reference material. Please contact us at to request a simple text version of this document.
  Home | Policies and Regulations | Disclaimer | e-Government | FOIA | Contact Us
 Safer, Healthier People
Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A.
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348
24 Hours/Every Day - Contact CDC-INFO HomeDepartment of Health and Human Services Department of Health
and Human Services