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NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

CSTE Position Statement(s)

  • 09-ID-17

Clinical Description

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 Criteria

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]) corroborated by bilateral diffuse interstitial edema or a clinical diagnosis of ARDS or radiographic evidence of noncardiogenic pulmonary edema, or unexplained respiratory illness resulting in death, 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, OR
  • Detection of hantavirus-specific ribonucleic acid sequence by polymerase chain reaction in clinical specimens, OR
  • Detection of hantavirus antigen by immunohistochemistry

Case Classification


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.

Related Case Definition(s)