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Hantavirus: Could it occur in
the United States?
Danny L. Self (Ph.D.)
Walden University
PUBH 8165-3
Dr. Lezah Brown-Ellington
Winter 2012-2013
Hantavirus
• Old World Hantavirus
• New World Hantavirus
(Centers for Disease Control and Prevention, 2012)
Host of the Hantavirus
• Rodents
–
–
–
–
Deer mouse
Cotton rat
Rice rat
White-footed mouse
Deer mouse (Peromyscus
maniculatus)
(Centers for Disease Control and Prevention, 2012)
Cotton rat (Sigmodon
hispidus)
Rice rat (Oryzomys
palustris)
White-footed mouse
(Peromyscus leucopus)
Hemorrhagic Fever with
Renal Syndrome (HFRS)
• Korean
hemorrhagic fever
• Epidemic
hemorrhagic fever
• Nephropathis
epidemica
•
•
•
•
•
Hantaan virus
Dobrava virus
Saaremaa virus
Seoul virus
Puumala virus
Hantavirus Pulmonary
Syndrome (HPS)
• Infectious disease caused by the
Hantavirus
– Flu-like symptoms
• Occur irregularly in rural areas
• Numerous types
– Sin Nombre hantavirus
– Carried by rodents
• Treatment limited
Characteristics of some
known Hantaviruses
Hantaviruses
Geographic
Region
Reservoir
Pathology
Mortality
Hantaan
Asia
Field mouse
Renal
5-15%
Seoul
Worldwide
Domestic rat
Renal
1%
Puumala
Northern
Europe
Bank vole
Renal
1%
Prospect Hill
United
States
Meadow vole
No known
human
disease
N/A
Sin Hombre
North
America
Deer mouse
Pulmonary
50%
(Centers for Disease Control and Prevention, 2012)
Comparison of HFRS & HPS
Feature
HFRS
HPS
Major target organ
Kidney
Lung
First phase
Febrile
Febrile “prodrome”
Second phase
Shock
Shock, pulmonary
edema
Evolution
Oliguria, diuresis,
convalescence
Diuresis,
convalescence
Mortality
1-15%
50%
(Centers for Disease Control and Prevention, 2012)
Clinical Case Definition
• A febrile illness (body temperature of 101° F or
greater) characterized by bilateral diffuse
interstitial edema that may radiographically
resemble ARDS, with respiratory compromise
which requires supplemental oxygen, which
develops within 72 hours of hospitalization, and
occurring in a previously healthy person
• Unexplained respiratory illness resulting in death,
with an autopsy examination demonstrating
noncardiogenic pulmonary edema without an
identifiable cause
Laboratory Criteria for
Diagnosis
• Detection of hantavirus-specific
immunoglobulin M or rising titers of
hantavirus-specific immunoglobulin G
• Detection of hantavirus-specific ribonucleic
acid sequence by polymerase chain
reaction in clinical specimens
• Detection of hantavirus antigen by
immunohistochemistry
Incidence
• Human to human transmission does
not exist
• U.S. national parks
• One’s own home
Potential risk activities for
HPS
• Opening and cleaning previously
unused buildings
• Housecleaning activities
• Work-related exposure
• Campers
• Hikers
Ecology
Enzootic Cycle
Epizootic Cycle
(Centers for Disease Control and Prevention, 2012)
Transmission of the
Hantavirus
(Arizona Geographic Alliance, 2001)
Symptoms
•
•
•
•
•
•
•
Early Symptoms
Fatigue
Fever
Muscle aches
Headaches
Dizziness
Chills
Abdominal problems
Late Symptoms
• Lungs fill with fluid
• Shortness of breath
Signs & Tests
Results from physical exam
• Acute respiratory distress
syndrome (ARDS)
• Kidney failure
• Low blood pressure
(hypotension)
• Low blood oxygen levels
•
•
•
•
•
Tests
Blood tests to check for
Hantavirus
Complete blood count
(CBC)
Complete metabolic
panel
Kidney and liver function
tests
Chest x-ray
Treatment
• Oxygen
• Breath tube or machine
• Ribavirin
Complications
• Kidney failure
• Heart failure
• Lung failure
Expectations(Prognosis)
• Advances rapidly
• If lungs are infected death will follow
Mortality
• 50%
Prevention
• Avoid exposure to rodent urine or
droppings
Incidences in the United
States
• 1993
– Four Corners
– Appalachian Trail
• 2012
– Yosemite National Park
(Centers for Disease Control and Prevention, 2012)
Annual U.S. HPS Cases & Case-fatality
(1993-2011)
(Centers for Disease Control and Prevention, 2012)
Yosemite National Park
• September 2012
– 10 confirmed cases
– 3 deaths
September 6, 2012:
Case Count (State of Residence) Map
(Centers for Disease Control and Prevention, 2012)
September 13, 2012:
Case Count (State of Residence) Map
(Centers for Disease Control and Prevention, 2012)
Current Case Count (State of
Residence) Map
(Centers for Disease Control and Prevention, 2012)
Incidences Outside the
United States
• HFRS
– 150,000 – 200,000 cases
• HPS
– 200 cases
Geographical representation of approximate Hantaviral disease
incidence by country per year.
Jonsson C B et al. Clin. Microbiol. Rev. 2010;23:412-441
Questions?
References
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•
•
Arizona Geographic Alliance. (2001). Hantavirus Student Guide: Arizona Geographic Alliance .
Retrieved from Arizona Geographic Alliance:
http://alliance.la.asu.edu/model/geoliteracyCD/LessonFiles/DornVaagen/DornHantaS.pdf
Bi, Z., Formenty, P. B., & Roth, C. E. (2007). Hantavirus Infection: A Review and Global Update. J
Infect Developing Countries 2008, 3-23.
Ceneters for Disease Control and Prevention. (1994, December 4). MMWR - Emerging Infectious
Diseases Hantavirus Puolmonary Syndrome --Virginia, 1993: Ceneters for Disease Control and
Prevention . Retrieved from Ceneters for Disease Control and Prevention:
•
•
•
http://www.cdc.gov/mmwr/preview/mmwrhtml/00033796.htm
Centers for Disease Control and Prevention. (2011, May 17). Hantavirus: Hemorrhagic Fever with
Renal Syndrome (HFRS): Centers for Disease Control and Prevention. Retrieved from Centers for
Disease Control and Prevention: http://www.cdc.gov/hantavirus/hfrs/index.html
Centers for Disease Control and Prevention. (2012 , August 29). Rodents in the United States that
caryy Hantavirus: Centers for Disease Control and Prevention. Retrieved from Centers for Disease
Control and Prevention: http://www.cdc.gov/hantavirus/rodents/index.html
Centers for Disease Control and Prevention. (2012, August 29). Deer mouse habitat in North
America: Centers for Disease Control and Prevention. Retrieved from Centers for Disease Control
and Prevention: http://www.cdc.gov/hantavirus/rodents/deer-mouse.html
References
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Centers for Disease Control and Prevention. (2012, August 29). Ecology - Hantavirus: Centers for
Disease Control and Prevention. Retrieved from Centers for Disease Control and Prevention:
http://www.cdc.gov/hantavirus/technical/hanta/ecology.html
Centers for Disease Control and Prevention. (2012, December 26). Hantavirus - Surveillance:
Centers for Disease Control and Prevention. Retrieved from Centers for Disease Control and
Prevention: http://www.cdc.gov/hantavirus/surveillance/state-of-exposure.html
Centers for Disease Control and Prevention. (2012, August 29). Hantavirus Pulmonary Syndrome
(HPS) Case Definition: Centers for Disease Control and Prevention. Retrieved from Centers for
Disease Control and Prevention: http://www.cdc.gov/hantavirus/health-care-workers/hps-casedefinition.html
Centers for Disease Control and Prevention. (2012, August 29). Hantavirus: Virology: Centers for
Disease Control and Prevention. Retrieved from Centers for Disease Control and Prevention:
http://www.cdc.gov/hantavirus/technical/hanta/virology.html
Centers for Disease Control and Prevention. (2012, August 29). How people get Hantavirus
Pulmonary Syndrome: Centers for Disease Control and Prevention. Retrieved from Centers for
Disease Control and Prevention: http://www.cdc.gov/hantavirus/hps/transmission.html
References
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Centers for Disease Control and Prevention. (2012, September 17). Outbreak of Hantavirus Infection
in Yosemite National Park: Centers for DiseaseControl and Prevention. Retrieved from Centers for
DiseaseControl and Prevention: http://www.cdc.gov/hantavirus/outbreaks/yosemite-national-park2012.html
Centers for Disease Control and Prevention. (2012, August 29). Signs & Symptoms for Hantavirus
Pulmonary Syndrome: Centers for Disease Control and Prevention. Retrieved from Centers for
Disease Control and Prevention: http://www.cdc.gov/hantavirus/hps/symptoms.html
Jonsson, C. B., Figueiredo, L. T., & Vapalahti, O. (2010). A Global Perspective on Hantavirus
Ecology, Epidemiology, and Disease. American Society of Microbiology, 415-441.
Mayo Clinic Staff. (2011, February 11). Hantavirus Pulmonary Syndrom: Mayo Clinic. Retrieved from
Mayo Clinic: http://www.mayoclinic.com/health/hantavirus-pulmonary-syndrome/DS00900
PubMed Health. (2011, March 11). Hantavirus: PubMed Health. Retrieved from PubMed Health:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002358/
The Free Dictionary. (2013). Medical-dictionary: The Free Dictionary. Retrieved from The Free
Dictionary: http://medical-dictionary.thefreedictionary.com