Hemorrhagic fever with renal syndrome (nephropathia epidemica) in Norway: seroepidemiology 1981-1985.

An indirect fluorescent antibody technique (IFAT) was applied to serologically confirm the clinical diagnosis in 507 nephropathia epidemica (NE) suspected patients. Hantaan virus (HV), the agent of Korean hemorrhagic fever, which is serologically related to the NE agent, was used as antigen. Both IgG and IgM reactions were detected. High levels of IgG antibodies to HV were common, even in the acute phase of illness. Over a 5-year period, a total of 35% of the NE suspected patients revealed antibodies to HV, but this varied considerably in the different years. In 2 endemic areas the serological confirmation of the NE diagnosis was 60%. 82% of the seropositive NE patients lived in 4 endemic areas. The bank vole (Clethrionomys glareolus) was common in all areas and predominant in 2. The wood mouse (Apodemus sylvaticus) was abundant in the other 2. In years with high bank vole population, the number of seropositive NE cases increased, with a peak in October/November. When the bank vole population was low, the relatively few seropositive NE cases occurred more regularly throughout the year. Subclinical infections were common. Antibodies to HV were detected in 74% male and 26% female NE patients, but the ratio varied between age groups.