Hantavirus Pulmonary Syndrome (HPS) Case Definition

The following case definition was published under: Case Definitions for Infectious Conditions Under Public Health Surveillance (Morbidity and Mortality Weekly Report May 02, 1997/Vol 46/No. RR10;1)

Revised: September 1996

Hantavirus pulmonary syndrome (HPS), commonly referred to as hantavirus disease, is a febrile illness characterized by bilateral interstitial pulmonary infiltrates and respiratory compromise usually requiring supplemental oxygen and clinically resembling Acute Respiratory Disease Syndrome (ARDS). The typical prodrome consists of fever, chills, myalgia, headache, and gastrointestinal symptoms. Typical clinical laboratory findings include hemoconcentration, left shift in the white blood cell count, neutrophilic leukocytosis, thrombocytopenia, and circulating immunoblasts.

Clinical Case Definition

An illness characterized by one or more of the following clinical features:

  • A febrile illness (i.e., temperature greater than 101.0° F (greater than 38.3° C) characterized by bilateral diffuse interstitial edema that may radiographically resemble ARDS, with respiratory compromise requiring supplemental oxygen, developing within 72 hours of hospitalization, and occurring in a previously healthy person.
  • An unexplained respiratory illness resulting in death, with an autopsy examination demonstrating noncardiogenic pulmonary edema without an identifiable cause.

Laboratory Criteria for Diagnosis

  • Detection of hantavirus-specific immunoglobulin M or rising titers of hantavirus-specific immunoglobulin G.
  • Detection of hantavirus-specific ribonucleic acid sequence by polymerase chain reaction in clinical specimens.
  • Detection of hantavirus antigen by immunohistochemistry.

Case Classification

Confirmed: a clinically compatible case that is laboratory confirmed.


Laboratory testing should be performed or confirmed at a reference laboratory. Because the clinical illness is nonspecific and ARDS is common, a screening case definition can be used to determine which patients to test. In general, a predisposing medical condition (e.g., chronic pulmonary disease, malignancy, trauma, burn, and surgery) is a more likely cause of ARDS than HPS, and patients who have these underlying conditions and ARDS need not be tested for hantavirus.

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