{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:50:34Z","timestamp":1791910234642,"version":"4.3.4"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hantavirus infections cause hemorrhagic fever with renal syndrome and impose a potential burden on healthcare systems. However, comprehensive economic data remain scarce. We quantified the inpatient economic burden of hospitalized patients with Puumala virus (PUUV) infections in Styria, Austria\u2019s primary endemic region, to identify hospitalization costs and early admission predictors of costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cost-of-illness study analyzed 1049 serologically confirmed PUUV hospitalizations across 20 public hospitals in Styria, Austria between September 2003 and March 2024. Costs were estimated using the Austrian performance-oriented hospital financing (Leistungsorientierte Krankenanstaltenfinanzierung) diagnosis-related group system, standardized to 2024-equivalent Euros using consumer price index deflation. Admission predictors of cost were assessed using multivariable \u03b3-generalized linear modeling with multiple imputations. Temporal trends in length of stay were analyzed using weighted segmented linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cumulative inpatient cost was \u223c\u20ac10.3 million (mean per-case: \u20ac9788) for the entire study period of 21 years. Three epidemic years (2012, 2019, and 2021) accounted for 53.6% of cases and over \u20ac5.2 million in expenditure, with peak annual costs reaching \u20ac1.93 million (0.274% of total Styrian inpatient expenditure) in 2012. Prolonged activated partial thromboplastin time (aPTT; cost-ratio 1.024 per second, 95% CI 1.019\u20131.030) and older age (CR 1.004 per year, 95% CI 1.001\u20131.008) were independent admission-level predictors of higher cost. Median hospital length of stay declined by \u223c50% over the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PUUV hospitalizations impose a sharply episodic but recurrent economic burden on regional healthcare systems. Admission aPTT and age independently predicted cost, but clinical outcomes were not modeled and these variables do not constitute a triage tool. Epidemic preparedness strategies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag607","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:22:01Z","timestamp":1790335321000},"source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology and Economic Burden of Puumala Virus Infection in Styria, Austria, 2003 to 2024"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6266-0512","authenticated-orcid":false,"given":"Stefan","family":"Hatzl","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Intensive Care Unit, Medical University of Graz , Graz ,","place":["Austria"]},{"name":"BioTechMed Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4918-1749","authenticated-orcid":false,"given":"Christina","family":"Geiger","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-2196","authenticated-orcid":false,"given":"Lisa","family":"Kriegl","sequence":"additional","affiliation":[{"name":"BioTechMed Graz , Graz ,","place":["Austria"]},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Keldorfer","sequence":"additional","affiliation":[{"name":"Department of Children and Adolescent Medicine, Pediatric Intensive Care Unit, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4690-5097","authenticated-orcid":false,"given":"Gernot","family":"Schilcher","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, LKH S\u00fcdsteiermark\u2013Standort Wagna , Wagna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4121-776X","authenticated-orcid":false,"given":"Florian","family":"Krammer","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]},{"name":"Ignaz Semmelweis Institute, Interuniversity Institute for Infection Research, Medical University of Vienna , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6656-3648","authenticated-orcid":false,"given":"Robert","family":"Krause","sequence":"additional","affiliation":[{"name":"BioTechMed Graz , Graz ,","place":["Austria"]},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"2026101312134918500_ofag607-B1","doi-asserted-by":"crossref","first-page":"e371","DOI":"10.1016\/S1473-3099(23)00128-7","article-title":"Hantavirus in humans: a review of clinical aspects and management","volume":"23","author":"Vial","year":"2023","journal-title":"Lancet Infect 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