An epidemic of hemorrhagic fever with renal syndrome at the therapeutic community for treatment of psychoactive drug dependence in Ivanovac]

The outbreak of hemorrhagic fever with renal syndrome (HFRS) at the Ivanovac Drug Therapeutic Community near Nova Gradiska was analyzed. The major epidemiologic, clinical and serologic findings are presented.During the HFRS outbreak, serum samples were obtained from 31 men from the Community and analyzed by ELISA IgM and IgG tests for Puumala (PUUV) and Dobrava (DOBV) viruses. The main epidemiologic and clinical data were analyzed.At the beginning of March 2002, a-30-year-old male from the Community developed severe clinical picture of HFRS with fulminant systemic hemorrhage, acute renal failure and consecutive death. IgM antibodies to DOBV were detected. HFRS was serologically confirmed in 15 subjects in total. All others were infected with PUUV. During the mild and dry winter, the Community members cut bushes, collected trash, branches and dry leaves near the beech-wood forest border to prepare that part of the field as a garden. They observed a number of rodents, their nests and holes. Most of the patients developed mild to moderate clinical picture with fever, headache, backache, myalgia, abdominal pain, melena, oliguria, polyuria, epistaxis, and conjunctival injection. Hepatitis B (HBV) and/or C (HCV) infection was recorded in 58.1% of Community members. Interestingly, 86.7% of the HFRS patients were HBV and/or HCV positive.This is the first HFRS outbreak described among drug addicts in Europe, mostly caused by PUUV. Further studies are needed to identify additional risk factors that may contribute to hantavirus infection among drug addicts in HFRS endemic regions in Croatia as well as in Europe.