Puumala hantavirus outbreak among U.S. military health care beneficiaries, Stuttgart, Germany--2012

Hantaviruses are viruses of the family Bunyaviridae that are transmitted to humans via inhalation of the aerosolized excrement of rodents. The geographic distribution of hantavirus includes the Americas, Asia, and Europe. An outbreak of Puumala hantavirus infections among U.S. military health care beneficiaries was identified by the U.S. Army Public Health Command Region-Europe at U.S. Army installations in Stuttgart, Germany, during 2012. Overall, five cases (one probable and four confirmed) were identified in three service members, one U.S. civilian employee, and one dependent family member. Four cases were hospitalized, one of whom required dialysis. The outbreak investigation revealed that all cases exercised in forested areas and most were active smokers (4 out of 5). This report reviews the types of hantaviruses found worldwide and suggests that health care providers should suspect and consider possible hantavirus infections when evaluating patients with histories and clinical presentations consistent with such infections.