When hantavirus cardiopulmonary syndrome (HCPS, formerly known as hantavirus pulmonary syndrome, or HPS) struck without warning in the summer of 1993, the University of New Mexico Hospital was faced with a sudden onslaught of patients with symptoms compatible with early HCPS. Our phone lines were bombarded with inquiries from physicians from the most heavily affected area (the Four Corners region of northwestern New Mexico). The answers we could provide were extremely limited, because the disease had never before been described. At that time there was no specific diagnostic test; antibody tests using reagents derived from distantly related hantaviruses were available from the CDC, but the these insensitive tests took 3 weeks or more to be reported. Unfortunately, that was long after the patient had died or recovered. The clinical syndrome was at that time poorly defined, making identification of HCPS patients difficult on clinical grounds alone. Furthermore, at that time it was unknown whether the newly identified Four Corners virus (now "Sin Nombre" virus, SNV) might be transmissible to workers in the hospital, laboratory, or autopsy suite. (In retrospect, we now know that those fears were probably unfounded.)
The University Hospital was in urgent need of rapid diagnostic tests for the new virus. Initially, we collaborated with the CDC to show that the peripheral blood mononuclear cells and blood clots of HCPS patients contained viral RNA, at least in the days of acute illness (ref) Thus a reverse transcription-PCR (RT-PCR) test for infection was available by late July 1993. However, a serological test was greatly preferred. For this reason, we cloned and expressed all of the antigens of SNV in the bacterium E. coli, and used these expressed proteins to identify the diagnostic epitopes of the viral core and envelope antigens (ref, ref, ref, ref). A serologic test based upon the expressed N and G1 antigens was available by the end of August 1993. This test was made available to the people of New Mexico and other affected areas in October 1993 (ref, ref).
Since 1993, our laboratory has become a reference laboratory for hantavirus diagnosis worldwide. In the course of our referral work we have discovered a number of new hantaviruses in the Americas, including pathogens such as New York virus and Rio Mamoré virus (essentially the same as Laguna Negra virus), the first known South American hantavirus. Through recombinant DNA technology we have developed specific serological tests for pathogens such as SNV/NYV, Bayou virus, Andes virus, Puumala virus, Seoul virus, and Hantaan virus.
Currently available tests include:
