Andes virus (ANDV) is a zoonotic leading to hantavirus cardiopulmonary syndrome. Although most transmissions occur through environmental exposure to rodent faeces and urine, rare person-to-person transmission has been documented, mainly for close contacts. This study investigates the presence and infectivity of ANDV in body fluids from confirmed cases and the duration of viraemia. In this prospective study, 131 participants with confirmed ANDV infection were enrolled in Chile in a prospective study between 2008 and 2022. Clinical samples (buffy coat, plasma, gingival crevicular fluid [GCF], saliva, nasopharyngeal swabs [NPS], and urine) were collected weekly for 3 weeks together with clinical and epidemiological data. Samples were categorised as acute or convalescent (up to and after 16 days following onset of symptoms). Infectivity of positive fluids was assessed after the culture of samples on Vero E6 cells and use of flow cytometry assays to determine the production of ANDV nucleoprotein. ANDV RNA was detected in 100% of buffy coats during acute phase, declining to 95% by day 17, and to 93% between days 23–29. ANDV RNA in GCF and saliva decreased from 30% and 12%, respectively, during the acute phase, to 12% and 11% during the convalescent phase. Successful infectivity assays of RT-qPCR-positive fluids, including GCF, saliva, NPS, and urine, were observed in 18 (42%) of 43 samples obtained during the acute phase of infection. After re-culture, the capacity to infect Vero E6 cells was maintained in 16 (89%) of 18 samples. Severity was associated with the presence of ANDV RNA in one or more fluids besides blood (odds ratio 2·58 [95% CI 1·42–5·18]). ANDV infection is a systemic and viraemic infection, that affects various organs. The presence of infectious particles in body fluids contributes to our understanding of potential mechanisms for person-to-person transmission, supporting the development of preventive strategies. Detection of ANDV RNA in additional fluids at hospital admission is a predictor of disease severity. National Institutes of Health and Agencia de Investigación y Desarrollo. For the Spanish translation of the abstract see Supplementary Materials section.

中文翻译：

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急性汉坦病毒感染期间安第斯病毒的病毒脱落和病毒血症：一项前瞻性研究

安第斯病毒（ANDV）是一种人畜共患疾病，可导致汉坦病毒心肺综合征。尽管大多数传播是通过环境中接触啮齿动物粪便和尿液而发生的，但已记录了罕见的人际传播，主要是密切接触者。本研究调查了确诊病例体液中 ANDV 的存在和传染性以及病毒血症的持续时间。在这项前瞻性研究中，2008 年至 2022 年间在智利招募了 131 名确诊 ANDV 感染的参与者进行前瞻性研究。临床样本（血沉棕黄层、血浆、龈沟液 [GCF]、唾液、鼻咽拭子 [NPS] 和尿液）每周收集一次，持续三周，并附上临床和流行病学数据。样本被分为急性期和恢复期（症状出现后 16 天及之后）。在 Vero E6 细胞上培养样品并使用流式细胞术测定 ANDV 核蛋白的产生后，评估阳性液体的感染性。在急性期，100% 的血沉棕黄层中检测到 ANDV RNA，到第 17 天下降到 95%，第 23-29 天下降到 93%。 GCF和唾液中的ANDV RNA分别从急性期的30%和12%下降到恢复期的12%和11%。在感染急性期获得的 43 份样本中，有 18 份（42%）成功地对 RT-qPCR 阳性液体（包括 GCF、唾液、NPS 和尿液）进行了感染性测定。重新培养后，18 个样品中有 16 个（89%）保持了感染 Vero E6 细胞的能力。严重程度与除血液外的一种或多种液体中 ANDV RNA 的存在有关（比值比 2·58 [95% CI 1·42–5·18]）。 ANDV 感染是一种全身性病毒血症感染，会影响多个器官。体液中传染性颗粒的存在有助于我们了解人际传播的潜在机制，支持预防策略的制定。入院时额外液体中检测到 ANDV RNA 可以预测疾病严重程度。国立卫生研究院和 Agencia de Investigación y Desarrollo。有关摘要的西班牙语翻译，请参阅补充材料部分。