CO– 32

lornajarrettblanchard April 1, 1993

–>45 1993-1995. Scott, Michon. “Hantavirus Risk Maps.” NASA Earth Observatory, 2-5-2002.
— 42 LA Times. Deadly Desert Plague Left Scars on Kin of Victims: Hantavirus…” 5-29-1994.
–>40 Stumpff, Linda Moon. Hantavirus and the Navajo Nation – A Double-Jeopardy Disease.
— 32 CDC. “Hantavirus Pulmonary Syndrome – [U.S.], 1993.” MMWR, 43/3, 1-28-1994, p. 45-48.
— 27 Kohn. Encyclopedia of Plague & Pestilence. 2001, p. 360.
— 27 NYT/L.W. Altman. “Virus That Caused Deaths Among Navajos Is Isolated.” 11-21-1993.
— 26 Garrett, Laurie. The Coming Plague. 1994, p. 545-546 .
— 25 Grady, Denise. “Death at the Corners.” Discover Magazine, 1-18-1993.
— 22 CDC. “Update: Hantavirus Pulmonary Syndrome – [U.S.], 1993, Figure 2. MMWR, 1993.
—<16 CDC. Update: Outbreak of Hantavirus Infection…” MMWR, 42/23, 6-18-1993, 441-443. -->16 Santa Fe New Mexican. “Official: It takes time to get virus.” 6-19-1993, p. 1.
— 13 Borowski. “The virus that rock the Four Corners reemerges.” AAAS, 1-8-2013.
— 13 By June 3. Daily Times, Farmington, NM. “Navajo Nation, state under siege.” 6-3-1993, 4
— 12 CDC. “Outbreak of Acute Illness — [SW US], 1993.” MMWR, 42/22, 6-11-1993, 421-24.
— 12 By June 2. Daily Times, Farmington, NM. “It’s still a mystery; 12 dead.” 6-2-1993, p. 1.
— 12 Wikipedia. “1993 Four Corners hantavirus outbreak.” 9-27-2017 edit. (Cites CDC.)
— 11 By June 1 in NM & AZ. AP. “Mystery illness: Doctors search for cause.” 6-1-1993.
— 10 By May 30. Daily Times, Farmington, NM. “Gallup girl dies; death toll 10.” 5-30-1993, 1.
— 10 Greenberg. Disasters: Terrorist, Natural and Man-Made. 2006, pp. 93-94.

Arizona ( 4) 11 reported cases. NYT. “Virus That Caused Deaths…” 11-21-1993, p. 24.
–4 AP. “‘It isn’t over, I’m afraid.’” Daily Times, Farmington, NM, 6-10-1993, p. A4.
–1 Navajo Reservation.
California ( 2)
–1 Northern CA coastal area. Ranch-hand, 29. Garrett. The Coming Plague. 1994, p. 544.
–1 Sierra Mountains. Jeanne Messier, ecology researcher, 27, working out of isolated cabin.
California/Nevada border area: ( 1)
–1 Garrett, Laurie. The Coming Plague. 1994, p. 544. (Female; infected mice found on property.)
Colorado ( 1)
–1 Grand Junction. April; female.
Idaho ( ?) Two reported cases. NYT. “Virus That Caused Deaths…” 11-21-1993, p. 24
Louisiana, western ( 1)
–1 Late July. Bridge inspector, 58. Garrett, Laurie. The Coming Plague. 1994, p. 545.
Montana ( ?) One reported case. NYT. “Virus That Caused Deaths…” 11-21-1993, p. 24
Nevada ( ?) Two reported cases. NYT. “Virus…Caused Deaths…” 11-21-1993, p.24.
New Mexico (>8) 16 reported cases. NYT. “Virus That Caused Deaths…” 11-21-1993, p. 24.
–8 On or near Navajo Reservation. NYT. “Virus That Caused Deaths…” 11-21-1993, p. 24.
–1 April. Gallup Indian Medical Center; Navajo female, 30.
–1 May 9. Navajo reservation rural reservation clinic; young athletic female, 21.
–1 May 14. Gallup Indian Medical Ctr. Emer. Room. Navajo young man; good health.
–2 May. Previously healthy Navajo tribal members, other than two mentioned above.
–1 By May 24 six people in tribal areas had died (we note five above).
–1 July 8, Canoncito home; died University Hosp., Albuquerque; Bobby Francisco, 36.
–7 Northwestern NM in or near Navajo reservation.
North Dakota ( ?) One reported case. NYT. “Virus That Caused Deaths…” 11-21-1993, p. 24.
Oregon ( ?) One reported case. NYT. “Virus That Caused Deaths…” 11-21-1993, p. 24.
South Dakota ( ?) Two reported cases; deaths not noted. NYT. “Virus…” 11-21-1993, p. 24.
Texas ( 1)
–1 Lufkin, East TX. Garrett, Laurie. The Coming Plague. 1994, p. 543-544.

Narrative Information

CDC 1994: “In June 1993, a newly recognized hantavirus was identified as the etiologic agent of an outbreak of severe respiratory illness (hantavirus pulmonary syndrome {HPS}) in the southwestern United States (1-3). Since this problem was recognized, sporadic cases have been identified from a wide geographic area in the western United States (2). This report summarizes the epidemiologic characteristics of HPS cases reported to CDC from May 1 through December 31, 1993.

“Through December 31, 53 persons with illnesses meeting the surveillance case definition of HPS (2) have been reported to CDC. Patients’ ages have ranged from 12 years to 69 years (median age: 31 years), and 32 (60%) were aged 20-39 years; 30 (57%) were male. Twenty-six (49%) were American Indians; 22 (42%), non-Hispanic whites; four (8%), Hispanic; and one (2%), non-Hispanic black. Thirty-two (60%) patients died; persons with fatal cases and persons with nonfatal cases were similar in age, sex, and race….” (CDC. “Hantavirus Pulmonary Syndrome – United States,, 1993.” MMWR, Vol. 43, No. 3, 1-28-1994.)

CDC, 2020: “In May 1993, an outbreak of an unexplained pulmonary illness occurred in the southwestern United States, in an area shared by Arizona, New Mexico, Colorado and Utah known as “The Four Corners”. A young, physically fit Navajo man suffering from shortness of breath was rushed to a hospital in New Mexico and died very rapidly.

“While reviewing the results of the case, medical personnel discovered that the young man’s fiancée had died a few days before after showing similar symptoms, a piece of information that proved key to discovering the disease. As Dr. James Cheek of the Indian Health Service (IHS) noted, ‘I think if it hadn’t been for that initial pair of people that became sick within a week of each other, we never would have discovered the illness at all’.

“An investigation combing the entire Four Corners region was launched by the New Mexico Office of Medical Investigations (OMI) to find any other people who had a similar case history. Within a few hours, Dr. Bruce Tempest of IHS, working with OMI, had located five young, healthy people who had all died after acute respiratory failure.

“A series of laboratory tests had failed to identify any of the deaths as caused by a known disease, such as bubonic plague. At this point, the CDC Special Pathogens Branch was notified. CDC, the state health departments of New Mexico, Colorado and Utah, the Indian Health Service, the Navajo Nation, and the University of New Mexico all joined together to confront the outbreak.

“During the next few weeks, as additional cases of the disease were reported in the Four Corners area, physicians and other scientific experts worked intensively to narrow down the list of possible causes. The particular mixture of symptoms and clinical findings pointed researchers away from possible causes, such as exposure to a herbicide or a new type of influenza, and toward some type of virus. Samples of tissue from patients who had gotten the disease were sent to CDC for exhaustive analysis. Virologists at CDC used several tests, including new methods to pinpoint virus genes at the molecular level, and were able to link the pulmonary syndrome with a virus, in particular a previously unknown type of hantavirus….” (CDC. Tracking a Mystery Disease: The Detailed Story of Hantavirus Pulmonary Syndrome (HPS). 3-11-2020 webpage.)

CDC, June 11, 1993: “Beginning in May 1993, cases of acute illness characterized by fever, myalgias, headache, and cough, followed by rapid development of respiratory failure, have been reported to the New Mexico Department of Health (NMDOH), Arizona Department of Health Services (ADHS), Colorado Department of Health (CDH), and Utah Department of Health (UDH). This report presents preliminary findings from an ongoing investigation of this problem, which suggest this illness is associated with a previously unrecognized hantavirus.

“On May 14, the NMDOH was notified by the Office of the Medical Investigator that two persons living in the same household had died within 5 days of each other. Their illnesses were characterized by abrupt onset of fever, myalgias, headache, and cough, followed by the rapid development of respiratory failure. Tests for Yersinia pestis and other bacterial and viral pathogens were negative. After additional persons who had recently died following a similar clinical course were reported to the NMDOH by the Indian Health Service (IHS), the ADHS, CDH, and UDH were contacted by the NMDOH seeking other possible cases….

“Through June 7, a total of 24 case-patients have been identified. Case-patients had onsets of illness beginning in December 1992; most (14) had onset in May… The most recent case-patient had onset of illness June 1. Case-patients resided in New Mexico (17), Arizona (five), Utah (one), and Colorado (one). Their median age was 34 years (range: 13-87 years; 17 were aged 18-50 years). Thirteen were male. Fourteen case-patients were American Indians, nine were white, and one was Hispanic. Twelve (50%) case-patients have died….

“Editorial Note…. Rodents are the natural hosts for all known hantaviruses (3). Humans are thought to be at risk for infection after exposure to rodent excreta, either through the aerosol route or direct inoculation. There is no evidence of person-to-person transmission for any of the known hantaviruses, nor has occupational transmission been documented to health-care workers. Laboratory workers practicing universal precautions while processing routine clinical materials (such as blood, urine, and respiratory specimens) are not considered to be at increased risk for hantavirus infection. However, laboratory-acquired infections have occurred among persons who handled infected wild or laboratory rodents (7). Therefore, laboratory work that may result in propagation of hantaviruses should be conducted in a biosafety level 3 facility….

“This cluster of unexplained acute illnesses in the Southwest illustrates the potential for new infectious disease problems to emerge at any time within the United States (10). These diseases may emerge because of microbial adaptation, environmental disturbances or changes, or population shifts. Vigilance and surveillance are required to rapidly recognize and determine the etiology of these emerging microbial threats to health so that prevention and control strategies can be implemented.” (CDC. “Outbreak of Acute Illness — Southwestern United States, 1993.” MMWR, 42/22, 6-11-1993, pp. 421-424.)

CDC, June 18, 1993: “….Through June 15, seven confirmed cases of hantavirus illness had been identified; four of these case-patients have died. Of the seven case-patients, four were from New Mexico, two from Arizona, and one from Colorado. Similar illnesses in an additional 22 persons, 12 of whom died, are being investigated….

“During the week of June 6, rodents were collected from peridomestic settings of several case-patients. Of 42 rodents tested, 12 (29%) had serologic evidence of hantavirus infection; all 12 were of the species Peromyscus maniculatus (deer mouse)….” (CDC. “Update: Outbreak of Hantavirus Infection — Southwestern United States, 1993.” MMWR, 42/23, 6-18-1993, 441-43.)

CDC, 2012: “In May 1993, an outbreak of an unexplained pulmonary illness occurred in the southwestern United States, in an area shared by Arizona, New Mexico, Colorado and Utah known as “The Four Corners”. A young, physically fit Navajo man suffering from shortness of breath was rushed to a hospital in New Mexico and died very rapidly.

“While reviewing the results of the case, medical personnel discovered that the young man’s fiancée had died a few days before after showing similar symptoms, a piece of information that proved key to discovering the disease. As Dr. James Cheek of the Indian Health Service (IHS) noted, “I think if it hadn’t been for that initial pair of people that became sick within a week of each other, we never would have discovered the illness at all”.

“Researchers knew that all other known hantaviruses were transmitted to people by rodents, such as mice and rats. Therefore, an important part of their mission was to trap as many different species of rodents living in the Four Corners region as possible to find the particular type of rodent that carried the virus. From June through mid-August of 1993, all types of rodents were trapped inside and outside homes where people who had hantavirus pulmonary syndrome had lived, as well as in piñon groves and summer sheep camps where they had worked. Additional rodents were trapped for comparison in and around nearby households as well. Taking a calculated risk, researchers decided not to wear protective clothing or masks during the trapping process. “We didn’t want to go in wearing respirators, scaring…everybody”, John Sarisky, an Indian Health Service environmental disease specialist said. However, when the almost 1,700 rodents trapped were dissected to prepare samples for analysis at CDC, protective clothing and respirators were worn.

“Among rodents trapped, the deer mouse (Peromyscus maniculatus) was found to be the main host to a previously unknown type of hantavirus. Since the deer mouse often lives near people in rural and semi-rural areas—in barns and outbuildings, woodpiles, and inside people’s homes—researchers suspected that the deer mouse might be transmitting the virus to humans. About 30% of the deer mice tested showed evidence of infection with hantavirus. Tests also showed that several other types of rodents were infected, although in lesser numbers.

“The next step was to pin down the connection between the infected deer mice and households where people who had gotten the disease lived. Therefore, investigators launched a case-control investigation. They compared “case” households, where people who had gotten the disease lived, with nearby “control” households. Control households were similar to those where the case-patients lived, except for one factor: no one in the control households had gotten the disease.

“The results? First, investigators trapped more rodents in case households than in control households, so more rodents may have been living in close contact with people in case households. Second, people in case households were more likely than those in control households to do cleaning around the house or to plant in or hand-plow soil outdoors in fields or gardens. However, it was unclear if the risk for contracting HPS was due to performing these tasks, or with entering closed-up rooms or closets to get tools needed for these tasks.

“In November 1993, the specific hantavirus that caused the Four Corners outbreak was isolated. The Special Pathogens Branch at CDC used tissue from a deer mouse that had been trapped near the New Mexico home of a person who had gotten the disease and grew the virus from it in the laboratory. Shortly afterwards and independently, the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) also grew the virus, from a person in New Mexico who had gotten the disease as well as from a mouse trapped in California.

“The new virus was called Muerto Canyon virus — later changed to Sin Nombre virus (SNV) — and the new disease caused by the virus was named hantavirus pulmonary syndrome, or HPS….” (CDC. Tracking a Mystery Disease: The Detailed Story of Hantavirus Pulmonary Syndrome (HPS). 8-29-2012.)

Kohn: “U.S. Hantavirus (Sin Nombre Virus, Four Corners Disease) Outbreak of 1993

“Small but powerful outbreak that swept through the vast (25,000) square miles) Navajo reservation (population 175,000) in the southwestern United States in the spring of 1993, leading to the identification of yet another strain of hantavirus…

“On May 14, 1993, a 19-year-old Navajo long-distance runner, Merrill Bahe, collapsed and died in a car as he was heading to Gallup, New Mexico, for the funeral of his 26-year-old wife, Florena Woody, who had died days earlier in an Indian Health Service (HIS) clinic 60 miles away. Bahe had complained of fever and headache prior to this journey. During the drive, suddenly and inexplicably, he began gasping for breath and within minutes died of acute respiratory distress. The attending physician at Gallup’s HIS clinic realized that Bahe’s symptoms were remarkably similar to that of another recent case that a colleague had mentioned. It turned out that the colleague was referring to Bahe’s wife, who had died of identical symptoms. Within a week, her brother and his girlfriend who lived in a nearby trailer were struck; she died. The deaths of those healthy, athletic young people stunned the entire Navajo community living in the Four Corners region (so called because it is located at the convergence of Arizona community living in the Four Corners region (so called because it is located at the convergence of Arizona, New Mexico, Utah, and Colorado). Investigation revealed that there had been several such cases of acute respiratory distress in the reservation during the spring with at least five deaths, all among healthy young people. The autopsy on Bahe and Woody showed fluid-filled lungs that weighed twice as much as normal. The health departments of all four states ere put on alert as researchers examined the autopsied samples. They did not find flu or other common viruses or bacteria. The initial hypothesis was that it was pneumonic plague but this was not corroborated by lab studies. Samples were sent to the Centers for Disease Control and Prevention (CDC) in Atlanta where they were studied in high-security Level 4 laboratories.

“Several weeks later, scientists had established that the virus – which they now know to be a more lethal type of hantavirus – was carried by the prairie deer mouse (Peromyscus maniculatus). Heavy precipitation after two years of drought had created an abundance of piñon nus, which in turn had created an explosion in the population of deer mice. The virus is shed in rodent droppings and inhaled when the soil or dust containing these is disturbed. It can also enter the human body through the eyes or through broken skin or through food and water contaminated with rodent excretions. Between June and August 1993, the virus was found in 30 percent of the 1,700 trapped rodents. According to Navaho oral tradition, the virus has been around a long time, with outbreaks in 1918 and 1933. It does not spread through direct human-to-human contact. However, initial media descriptions associating the disease with the Navajos led many non-Navajo persons, such as tourists to shun them and thus intensify the discrimination they already felt.

“By November 1993, there were 45 cases reported – 27 of them ending in sudden death, with the victims literally choking on their own body fluids. Cases of the newly christened hantavirus pulmonary syndrome (HPS) were reported in 12 states from Oregon to Texas. However, the death rate had plummeted from 60 percent to 35 percent, with only three new cases (none fatal) in the Four Corners area during November. The public information campaign in English, Spanish, and Navajo – distributed to churches, schools, public health and extermination workers – coupled with a decline in the population of deer mice may have prevented the outbreak from spreading further….

“Further reading: Garrett, The Coming Plague; Harper and Meyer, Of Mice, Men and Microbes – Hantavirus.” (Kohn, George Childs (Ed.). Encyclopedia of Plague and Pestilence From Ancient Times to the Present (Revised Edition). NY: Checkmark Books, 2001, p. 360.)

Stumpff: “In 1993 a young Navajo woman died suddenly of respiratory failure without a history of previous illness. A few days later, her fiancé died in a similar way, leading to widespread concern. On May 18, the New Mexico Department of Health called in the Centers for Disease Control and Prevention (CDC), and soon many health organizations and research institutions were involved. At first, the disease was tagged ‘the Navajo flu’ in USA Today and the Arizona Republic called it ‘the Navajo epidemic,’ only because this outbreak of new viral strain was discovered in the Four Corners Region. It was ultimately identified as a new strain of a long-known hantavirus family. A year later, over forty people in seventeen states were dead from similar strains. Scientific research eventually pointed to hantavirus as the explanation for the outbreak and for earlier deaths, going back to1959….

(Stumpff, Linda Moon. Hantavirus and the Navajo Nation – A Double-Jeopardy Disease.)

Newspapers

May 27: “Albuquerque (AP)–New Mexico health officials have alerted doctors around the Four Corners about a deadly respiratory illness that has claimed the lives of six people in recent weeks. State epidemiologist Dr. Mack Sewell said Wednesday the illness has mostly affected young people on the Navajo reservation in northwestern New Mexico. Two of the 10 cases under investigation occurred across the state line in Arizona, said Dr. Maggie Gallaher of the state epidemiology office. ‘The thing that’s unusual is the clustering and the timing,’ Sewell said. ‘It’s a period where we’re seeing many young people in otherwise healthy communities dying suddenly.’

“All the victims — eight Navajos and two non-Indians — lived on or near the Navajo Reservation, Sewell said….he said three of the victims were from the same family residence.

“The Albuquerque Journal reported in its Thursday editions that the three family members included former Santa Fe Indian School standout runner Merrill Bahe, his fiancée, Florina Woody, and the couple’s infant son. Bahe and Woody died of the affliction, while the child was hospitalized, the Journal reported. The three lived in Littlewater, near Crownpoint….

“The illness progresses very quickly, Sewell said. Victims first reported flu-like symptoms — fever, muscle aches and a cough — followed by great respiratory difficulties, Sewell said. ‘And then these people rapidly progress to death,’ Sewell said. Two infants were treated for the illness, the Journal said. The adult victims ranged in age from 19 to 58.” (AP. “Medical investigators seek cause of mystery illness striking young.” Alamogordo Daily News, NM, 5-27-1993, p. 9.)

May 28: “Santa Fe (AP)– State and federal health officials are baffled by a flu-like illness hat has killed at least eight people on or near the Navajo reservation….Two weeks of investigation has turned up new cases of the mystery illness but no clues it its cause….Sewell said 14 cases–including the eight deaths–fit the profile of the mystery illness. All have been in northwestern New Mexico and neighboring Arizona, although health officials are investigating a few reports of similar-sounding illnesses from other parts of New Mexico….

“One of the deaths and one other case occurred on the Navajo reservation in Arizona….Two cases occurred in non-Indians who live in Grants and Farmington….” (AP. “Strange illness baffling experts.” Clovis News Journal, NM, 5-28-1993, p. 1.)

May 30: “The state Department of Health is advising anyone in the Navajo Reservation area with flu-like symptoms to see a doctor. The warning was issued Friday [May 28] in response to the mysterious, deadly illness that health officials say has claimed 10 lives in the region. A 13-year-old girl who collapsed at a party in Gallup Friday and died Saturday became the 10th fatality blamed on the mysterious flu-like illness that continues to baffle state health officials….” (Daily Times, Farmington, NM. “Gallup girl dies; death toll 10.” 5-30-1993, p. 1.)

June 1: “Albuquerque (AP) — A virus seems the most likely explanation for a mystery illness that has killed 11 people in New Mexico and Arizona, say doctors and public health officials who met over the Memorial Day weekend. A team working to track the illness includes nearly three dozen lab specialists, epidemiologists and others….

“The illness, first investigated in mid-May, has stricken 18 people, mostly in the Four Corners area of New Mexico and Arizona. It has killed 11 within hours or at most a few days of their becoming ill….”(Associated Press. “Mystery illness: Doctors search for cause.” Alamogordo Daily News, NM, 6-1-1993, p. 1.)

June 2: “A Farmington patient, suspected of suffering from a mysterious illness and transferred to the Albuquerque hospital caring for victims of the sometimes-fatal syndrome, may have died, a spokesman for the local medical center said….

“State health officials announced Tuesday afternoon [June 1] they have identified 12 who died of the unexplained, acute respiratory distress syndrome. Two other deaths, one in Kansas and one in Utah, remained unconfirmed Tuesday night.

“The Associated Press reported 19 confirmed cases of the illness, but a spokeswoman for the state’s epidemiologist’s office said Tuesday that there are now 23….” (Daily Times, Farmington, NM. “It’s still a mystery; 12 dead.” 6-2-1993, p. 1.)

June 3: “Crownpoint….Medical investigators are struggling to find a cause for the illness they believe has struck 21 and killed 13. Thirteen of those diagnosed with the mystery illness, which often begins with flu-like symptoms, have been Indian….” (Daily Times, Farmington, NM. “Navajo Nation, state under siege.” 6-3-1993, p. 4.)

June 10: “Albuquerque (AP) — The state Office of the Medical Investigator took custody of the body of a local 22-year-old Navajo woman who died of mystery illness symptoms Wednesday [June 9], state officials said….

“Dr. Norton Kalishman, chief medical officer for the New Mexico Health Department…said a new suspected case also was reported Wednesday in Arizona and that both the Arizona patient and the Indian woman had the same symptoms as confirmed cases — respiratory distress, swollen lungs, low oxygen levels and high white blood cell count.

“State health officials on Wednesday also confirmed four more cases of the illness, adding cases that had occurred as early as February and as recently as last week. Those four included two from the Albuquerque area, one from north-central New Mexico and one from south-central New Mexico. That brought to 18 the total number of confirmed cases in New Mexico alone — 10 women, eight men, 11 Indians and seven Anglos. Eight people have died in New Mexico, four in Arizona. The woman who died Wednesday was not among the confirmed cases. Kalishman said it would take weeks of blood tests to establish whether the new suspected cases are part of the outbreak….

“The new cases, if confirmed, would be the first since May 28, when a 13-year-old girl collapsed near Gallup and died the following day. Until Wednesday, there had been 18 confirmed cases and 11 deaths, mostly Navajos.” (Associated Press. “‘It isn’t over, I’m afraid.’” Daily Times, Farmington, NM, 6-10-1993, p. A4.)

June 19: “People are far more likely to contract the sometimes fatal respiratory illness that has surfaced in the Four Corners region in recent weeks of they have had prolonged or direct exposure to rodents, a state health official said Friday [June 18]. Dr. Gary Simpson, medical director of infectious diseases for the New Mexico Department of Health, said it was unlikely that a single exposure or even occasional exposure to rodents could result in someone catching the disease, which has killed at least 16 people — most of them in northwestern New Mexico and northeastern Arizona. ‘No case to our knowledge had casual exposure (to rodents),’ Simpson said of the illness, believed to be a previously unknown type of hantavirus carried through the air by dust particles containing rodent feces, urine or saliva….

“Researchers suspect that one or more species of the common deer mouse may carry the virus…

“Simpson said that in Asia a type of hantavirus known as the Hantaan virus, after a river in Korea, strikes agricultural workers almost exclusively because rodents are prevalent in fields….

“Simpson…said many of the victims of the disease on the Navajo Reservation lived in houses in which rats were prevalent, both inside and outside the homes. ‘The cluster of cases in Littlewater (the town on the Navajo Reservation where several people have been killed by the virus) had significant exposure to a number of rodents in their homes.’….

“Health officials reported earlier this month that a woman from Grand Junction, Colo., who died of the virus in April, lived in a rodent-infested home…the risk that someone will inhale the virus is greater indoors where the air volume is limited….” (Santa Fe New Mexican. “Official: It takes time to get virus.” 6-19-1993, p. 1.)

Sources

Associated Press. “‘It isn’t over, I’m afraid.’” Daily Times, Farmington, NM, 6-10-1993, p. A4. Accessed 11-6-2017 at: https://newspaperarchive.com/farmington-daily-times-jun-10-1993-p-4/

Associated Press. “Medical investigators seek cause of mystery illness striking young.” Alamogordo Daily News, NM, 5-27-1993, p. 9. Accessed 11-6-2017 at: https://newspaperarchive.com/alamogordo-daily-news-may-27-1993-p-9/

Associated Press. “Mystery illness: Doctors search for cause.” Alamogordo Daily News, NM, 6-1-1993, p. 1. Accessed 11-6-2017 at: https://newspaperarchive.com/alamogordo-daily-news-jun-01-1993-p-1/

Associated Press. “Strange illness baffling experts.” Clovis News Journal, NM, 5-28-1993, p. 1. Accessed 11-6-2017 at: https://newspaperarchive.com/clovis-news-journal-may-28-1993-p-1/

Borowski, Susan. “The virus that rock the Four Corners reemerges.” AAAS (American Association for the Advancement of Science), 1-8-2013. Accessed 11-6-2017 at: https://www.aaas.org/blog/scientia/virus-rocked-four-corners-reemerges

Centers for Disease Control and Prevention.. “Hantavirus Pulmonary Syndrome – United States,, 1993.” MMWR (Morbidity and Mortality Weekly Report) Vol. 43, No. 3, 1-28-1994, pp. 45-48. Accessed 3-31-2021 at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00025007.htm

Centers for Disease Control and Prevention. “Outbreak of Acute Illness — Southwestern United States, 1993.” MMWR (Morbidity and Mortality Report), Vol. 42, No. 22, June 11, 1993, pp. 421-424. Accessed 11-6-2017 at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00020769.htm

Centers for Disease Control and Prevention. Tracking a Mystery Disease: The Detailed Story of Hantavirus Pulmonary Syndrome (HPS). Website. 8-29-2012. Accessed 11-6-2017 at: https://www.cdc.gov/hantavirus/outbreaks/history.html

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Daily Times, Farmington, NM. “In Shiprock, life goes on.” 6-6-1993, p. D1. Accessed 11-6-2017 at: https://newspaperarchive.com/farmington-daily-times-jun-06-1993-p-21/

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Scott, Michon. “Hantavirus Risk Maps.” NASA Earth Observatory, 2-5-2002. Accessed 4-1-2021 at: https://earthobservatory.nasa.gov/features/Hanta

Stumpff, Linda Moon. Hantavirus and the Navajo Nation – A Double-Jeopardy Disease. Accessed 4-1-2021 at: http://nativecases.evergreen.edu/sites/nativecases.evergreen.edu/files/case-studies/Stumpff%20hantavirus.pdf

Van Hook, Charles J. “Hantavirus Pulmonary Syndrome – The 25th Anniversary of the Four Corners Outbreak.” Emerging Infectious Diseases, Vol. 24, No. 11, 2018, pp. 2056-2060. Accessed 3-31-2021 at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199996/

Wikipedia. “1993 Four Corners hantavirus outbreak.” 9-27-2017 edit. Accessed 11-6-2017 at: https://en.wikipedia.org/wiki/1993_Four_Corners_hantavirus_outbreak

Additional References

Centers for Disease Control and Prevention. Hantavirus (website). 9-9-2020 last review. Accessed 4-1-2021 at: https://www.cdc.gov/hantavirus/