Hantavirus: Could it occur in the United States?
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Hantavirus: Could it occur in the United States?
Danny L. Self (Ph.D.)Walden University
PUBH 8165-3Dr. Lezah Brown-Ellington
Winter 2012-2013
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Hantavirus• Old World Hantavirus• New World Hantavirus
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(Centers for Disease Control and Prevention, 2012)
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Host of the Hantavirus• Rodents
– Deer mouse– Cotton rat– Rice rat– White-footed mouse
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Deer mouse (Peromyscus maniculatus)
(Centers for Disease Control and Prevention, 2012)
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Cotton rat (Sigmodon hispidus)
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Rice rat (Oryzomys palustris)
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White-footed mouse (Peromyscus leucopus)
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Hemorrhagic Fever with Renal Syndrome (HFRS)• Korean
hemorrhagic fever
• Epidemic hemorrhagic fever
• Nephropathis epidemica
• Hantaan virus• Dobrava virus• Saaremaa virus• Seoul virus• Puumala virus
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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
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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)
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Comparison of HFRS & HPS
Feature HFRS HPSMajor target organ Kidney Lung
First phase Febrile Febrile “prodrome”Second phase Shock Shock, pulmonary
edemaEvolution Oliguria, diuresis,
convalescenceDiuresis,
convalescenceMortality 1-15% 50%
(Centers for Disease Control and Prevention, 2012)
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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
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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
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Incidence• Human to human transmission
does not exist• U.S. national parks• One’s own home
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Potential risk activities for HPS• Opening and cleaning previously
unused buildings• Housecleaning activities• Work-related exposure• Campers• Hikers
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Ecology
Enzootic Cycle Epizootic Cycle
(Centers for Disease Control and Prevention, 2012)
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Transmission of the Hantavirus
(Arizona Geographic Alliance, 2001)
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SymptomsEarly Symptoms
• Fatigue• Fever• Muscle aches• Headaches• Dizziness• Chills• Abdominal problems
Late Symptoms• Lungs fill with fluid• Shortness of breath
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Signs & TestsResults 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
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Treatment• Oxygen• Breath tube or machine• Ribavirin
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Complications• Kidney failure• Heart failure• Lung failure
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Expectations(Prognosis)• Advances rapidly• If lungs are infected death will
follow
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Mortality• 50%
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Prevention• Avoid exposure to rodent urine
or droppings
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Incidences in the United States • 1993
– Four Corners– Appalachian Trail
• 2012 – Yosemite National Park
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(Centers for Disease Control and Prevention, 2012)
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Annual U.S. HPS Cases & Case-fatality (1993-2011)
(Centers for Disease Control and Prevention, 2012)
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Yosemite National Park• September 2012
– 10 confirmed cases– 3 deaths
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September 6, 2012: Case Count (State of
Residence) Map
(Centers for Disease Control and Prevention, 2012)
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September 13, 2012: Case Count (State of
Residence) Map
(Centers for Disease Control and Prevention, 2012)
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Current Case Count (State of Residence) Map
(Centers for Disease Control and Prevention, 2012)
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Incidences Outside the United States • HFRS
– 150,000 – 200,000 cases• HPS
– 200 cases
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Geographical representation of approximate Hantaviral disease incidence by country per year.
Jonsson C B et al. Clin. Microbiol. Rev. 2010;23:412-441
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Questions?
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References• 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
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References• 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-case-definition.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
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References• 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-park-2012.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