Heartland and Bourbon Virus Diseases


Heartland virus

Where Found

As of 2017, more than 50 cases of Heartland virus disease have been reported from states in the Midwest and the South.

Heartland virus disease blood smear

Incubation Period

Specific ranges are unknown; most patients report a tick bite in the 2 weeks prior to illness.

Signs and Symptoms

  • Fever
  • Fatigue
  • Decreased appetite
  • Headache
  • Arthralgia
  • Myalgia
  • Nausea
  • Diarrhea

General Laboratory Findings

  • Leukopenia
  • Thrombocytopenia
  • Mild to moderate elevation of hepatic transaminases
Bourbon Virus Disease

As of 2017, a limited number of Bourbon virus disease cases have been identified in the Midwest and southern United States. Some people who have been infected later died. Scientists continue to investigate possible symptoms caused by this new virus. Symptoms of people diagnosed with Bourbon virus disease included fever, tiredness, rash, headache, body aches, nausea, and vomiting. General laboratory findings included leukopenia and thrombocytopenia.

Laboratory Diagnosis

Molecular and serologic testing for Heartland virus infection can be performed at CDC. There are no commercially available tests for Heartland virus infection in the United States. Please contact your state health department if you have a patient with an acute illness that may be compatible with Heartland virus disease.


Treatment of Heartland virus disease is supportive. Many patients diagnosed with the disease have required hospitalization. With supportive care, most people have fully recovered; however, a few older individuals with medical comorbidities have died.


Basile AJ, Horiuchi K, Goodman CH, et al. Development of diagnostic microsphere-based immunoassays for Heartland virus. J Clin Virol. 2021;134:104693.

Brault AC, Savage HM, Duggal NK et al. Heartland Virus Epidemiology, Vector Association, and Disease Potential. Viruses. 2018 Sep 14;10(9):498.

McMullan LK, Folk SM, Kelly AJ, et al. A new phlebovirus associated with severe febrile illness in Missouri. N Eng J Med 2012;367:834-41.

Muehlenbachs A, Fata CR, Lambert AJ, et al. Heartland virus associated death in Tennessee. Clin Infect Dis 2014;59(6):845-850.

Godsey MS, Savage HM, Burkhalter KL, et al. Transmission of Heartland virus (Bunyaviridae: Plebovirus) by experimentally infected Amblyomma americanum (Acari: Ixodidae). J Med Entomol 2016;53(5):1226-1233.

Savage HM, Godsey MS, Panella NA, et al. Surveillance for Heartland virus (Bunyaviridae: Phlebovirus) in Missouri during 2014: First detection of virus in adults of Amblyomma americanum (Acari: Ioxodidae). J Med Entomol 2016;53(3):607-612.

Staples JE, Pastula DM, Panella AJ, et al. Investigation of Heartland virus disease throughout the United States, 2013-2017. Open Forum Infect Dis. 2020 Apr 11;7(5):ofaa125.