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We defined a case-patient as a person who had 1) illness onset June 1–October 31, 2012, clinically compatible with hantavirus disease; 2) laboratory confirmation of SNV infection by detection of IgM against SNV or increasing titers of IgG in serum, SNV-specific antigen shown by immunohistochemical test (IHC), or SNV-specific nucleic acid sequences by reverse transcription PCR (RT-PCR); and 3) a history of visiting Yosemite during the 6 weeks preceding illness onset. HPS was defined as fever≥ 38.3 C with bilateral diffuse interstitial edema and respiratory compromise within 72 hours of hospitalization, occurring in a previously healthy person, or an unexplained respiratory illness resulting in death, for which an autopsy demonstrated noncardiogenic pulmonary edema without an identifiable cause (15).

Finding case-patients was facilitated through health alerts issued by CDPH, NPS, and CDC to health care …