Pediatric Hantavirus Pulmonary Syndrome Follow-up

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 9, 2012
 

Further Inpatient Care

  • Patients should be transferred to the ICU for close observation and aggressive management.
Next

Deterrence/Prevention

Because Hantavirus pulmonary syndrome (HPS) is acquired through inhalation of the virus-laden rodent excreta, avoidance of rodent contact is of paramount importance in its prevention. Several strategies have been proposed in this regard, as follows:

  • Elimination of rodent nesting sites can be achieved through keeping food storage areas clean, keeping food properly covered, elevating garbage containers, sealing holes and cracks in dwellings to prevent entrance by rodents, and clearing the brush from around homes and outbuildings.
  • Rodent traps and rodenticides should be used to control rodent populations. Similarly, encouraging natural predators, such as nonpoisonous snakes, owls, and hawks, may reduce the rodent population.
  • The following special precautions should be used while cleaning up rodent-infested areas:
    • Air out rodent-infested areas before cleaning.
    • The area should be thoroughly wet with household disinfectant or 10% bleach solution spray before sweeping, vacuuming, or stirring the dust.
    • Rubber gloves should be worn during cleaning, and hands should be properly washed afterward.
    • Workers should wear a half-face air-purifying (or negative-pressure) respirator equipped with high-efficiency particulate air (HEPA) filters when removing rodents from traps or handling rodents in the affected area.
  • Outdoor rodent exposure should be avoided. Do not disturb rodent droppings or camp near rodent burrows or areas where trash is present. If sleeping outdoors, use elevated cots. Avoid feeding or handling rodents.

Vaccines are currently being studied for the prevention of Hantavirus infection in endemic areas. In a 1999 study of an inactivated Hantavirus vaccine by Cho and colleagues, 79% of the 64 human volunteers developed a significant Hantavirus antibody titer 30 days after vaccination[12] . Seroconversion rates increased to 97% one month after the booster dose. Antibody titers declined by one year, but a vigorous anamnestic response occurred with revaccination in almost all subjects. However, only 50% of the subjects produced neutralizing antibodies following the booster dose one year later. Improved vaccination for Hantavirus pulmonary syndrome is needed.

Previous
Next

Complications

  • ARDS may rapidly occur. Hantavirus pulmonary syndrome should be suspected when an otherwise healthy adult develops an ARDS-like picture without any of the known causes of ARDS.
Previous
Next

Prognosis

  • In a study from Brazil, adult respiratory distress syndrome and mechanical respiratory support were associated with risk of death; when these 2 variables were excluded from the multivariate analysis, dyspnea and hemoconcentration were associated with a higher risk of death.[13]
  • The case fatality rate for Hantavirus pulmonary syndrome is approximately 35%.[4]
  • If hypoxia is managed and shock is not fatal, the vascular leak reverses in a few days and the recovery is apparently complete.
Previous
Next

Patient Education

  • Patients should be educated in avoidance of rodent contact through strategies outlined under Deterrence/Prevention.
Previous
 
Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Specialty Editor Board

Rosemary Johann-Liang, MD  Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Maria A Horga, MD and Veronica A Mas Casullo, MD to the development and writing of this article.

References

  1. Simpson SQ, Spikes L, Patel S, Faruqi I. Hantavirus pulmonary syndrome. Infect Dis Clin North Am. Mar 2010;24(1):159-73. [Medline].

  2. Vinh DC, Embil JM. Hantavirus Pulmonary Syndrome: A Concise Clinical Review. South Med J. May 7 2009;[Medline].

  3. Figueiredo LT, Moreli ML, de-Sousa RL, Borges AA, de-Figueiredo GG, Machado AM, et al. Hantavirus pulmonary syndrome, central plateau, southeastern, and southern Brazil. Emerg Infect Dis. Apr 2009;15(4):561-7. [Medline].

  4. MacNeil A, Ksiazek TG, Rollin PE. Hantavirus pulmonary syndrome, United States, 1993-2009. Emerg Infect Dis. Jul 2011;17(7):1195-201. [Medline].

  5. Macneil A, Nichol ST, Spiropoulou CF. Hantavirus pulmonary syndrome. Virus Res. Dec 2011;162(1-2):138-47. [Medline].

  6. Mori M, Rothman AL, Kurane I, et al. High levels of cytokine-producing cells in the lung tissues of patients with fatal hantavirus pulmonary syndrome. J Infect Dis. Feb 1999;179(2):295-302. [Medline].

  7. Kilpatrick ED, Terajima M, Koster FT, et al. Role of specific CD8+ T cells in the severity of a fulminant zoonotic viral hemorrhagic fever, hantavirus pulmonary syndrome. J Immunol. Mar 1 2004;172(5):3297-304. [Medline]. [Full Text].

  8. Armstrong LR, Zaki SR, Goldoft MJ, Todd RL, Khan AS, Khabbaz RF. Hantavirus pulmonary syndrome associated with entering or cleaning rarely used, rodent-infested structures. J Infect Dis. Oct 1995;172(4):1166. [Medline].

  9. Ketai LH, Williamson MR, Telepak RJ, Levy H, Koster FT, Nolte KB. Hantavirus pulmonary syndrome: radiographic findings in 16 patients. Radiology. Jun 1994;191(3):665-8. [Medline].

  10. Jonsson CB, Hooper J, Mertz G. Treatment of hantavirus pulmonary syndrome. Antiviral Res. Apr 2008;78(1):162-9. [Medline].

  11. Dietl CA, Wernly JA, Pett SB, et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome. J Thorac Cardiovasc Surg. Mar 2008;135(3):579-84. [Medline].

  12. Cho HW, Howard CR. Antibody responses in humans to an inactivated hantavirus vaccine (Hantavax). Vaccine. Jun 4 1999;17(20-21):2569-75. [Medline].

  13. da Rosa Elkhoury M, da Silva Mendes W, Waldman EA, Dias JP, Carmo EH, Fernando da Costa Vasconcelos P. Hantavirus pulmonary syndrome: prognostic factors for death in reported cases in Brazil. Trans R Soc Trop Med Hyg. May 2012;106(5):298-302. [Medline].

  14. Abbott KD, Ksiazek TG, Mills JN. Long-term hantavirus persistence in rodent populations in central Arizona. Emerg Infect Dis. Jan-Feb 1999;5(1):102-12. [Medline].

  15. Abel Borges A, Figueiredo LT. Mechanisms of shock in hantavirus pulmonary syndrome. Curr Opin Infect Dis. Jun 2008;21(3):293-7. [Medline].

  16. Bartholomew DM, Hansen LA, Frank JJ, Farver DK. Case report of hantavirus pulmonary syndrome and review. S D Med. May 2007;60(5):189-91, 193-5. [Medline].

  17. Brillman J, Talan DA, Moran GJ, Pinner R. Update on emerging infections from the Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome--five states, 2006. Ann Emerg Med. Nov 2006;48(5):593-4; discussion 594-5. [Medline].

  18. CDC. Update: hantavirus pulmonary syndrome--United States, 1999. MMWR Morb Mortal Wkly Rep. Jun 25 1999;48(24):521-5. [Medline].

  19. Chang B, Crowley M, Campen M, Koster F. Hantavirus cardiopulmonary syndrome. Semin Respir Crit Care Med. Apr 2007;28(2):193-200. [Medline].

  20. Chin C, Chiueh TS, Yang WC, et al. Hantavirus infection in Taiwan: the experience of a geographically unique area. J Med Virol. Feb 2000;60(2):237-47. [Medline].

  21. Douglass RJ, Calisher CH, Bradley KC. State-by-state incidences of hantavirus pulmonary syndrome in the United States, 1993-2004. Vector Borne Zoonotic Dis. Summer 2005;5(2):189-92. [Medline].

  22. Hantavirus pulmonary syndrome--five states, 2006. MMWR Morb Mortal Wkly Rep. Jun 9 2006;55(22):627-9. [Medline].

  23. Hjelle B, Glass GE. Outbreak of hantavirus infection in the Four Corners region of the United States in the wake of the 1997-1998 El Nino-southern oscillation. J Infect Dis. May 2000;181(5):1569-73. [Medline].

  24. Khan AS, Khabbaz RF, Armstrong LR, et al. Hantavirus pulmonary syndrome: the first 100 US cases. J Infect Dis. Jun 1996;173(6):1297-303. [Medline].

  25. Klein SL, Calisher CH. Emergence and persistence of hantaviruses. Curr Top Microbiol Immunol. 2007;315:217-52. [Medline].

  26. Koraka P, Avsic-Zupanc T, Osterhaus AD, Groen J. Evaluation of two commercially available immunoassays for the detection of hantavirus antibodies in serum samples. J Clin Virol. Sep 1 2000;17(3):189-96. [Medline].

  27. Maeda K, West K, Toyosaki-Maeda T, et al. Identification and analysis for cross-reactivity among hantaviruses of H-2b-restricted cytotoxic T-lymphocyte epitopes in Sin Nombre virus nucleocapsid protein. J Gen Virol. Jul 2004;85(Pt 7):1909-19. [Medline].

  28. Maes P, Clement J, Gavrilovskaya I, Van Ranst M. Hantaviruses: immunology, treatment, and prevention. Viral Immunol. 2004;17(4):481-97. [Medline].

  29. Mertz GJ, Hjelle B, Crowley M, Iwamoto G, Tomicic V, Vial PA. Diagnosis and treatment of new world hantavirus infections. Curr Opin Infect Dis. Oct 2006;19(5):437-42. [Medline].

  30. Mills JN, Corneli A, Young JC, et al. Hantavirus pulmonary syndrome--United States: updated recommendations for risk reduction. Centers for Disease Control and Prevention. MMWR Recomm Rep. Jul 26 2002;51(RR-9):1-12. [Medline].

  31. Rivers MN, Alexander JL, Rohde RE, Pierce JR Jr. Hantavirus pulmonary syndrome in Texas: 1993-2006. South Med J. Jan 2009;102(1):36-41. [Medline].

  32. Saggioro FP, Rossi MA, Duarte MI, et al. Hantavirus infection induces a typical myocarditis that may be responsible for myocardial depression and shock in hantavirus pulmonary syndrome. J Infect Dis. May 15 2007;195(10):1541-9. [Medline].

  33. Seitsonen E, Hynninen M, Kolho E, et al. Corticosteroids combined with continuous veno-venous hemodiafiltration for treatment of hantavirus pulmonary syndrome caused by Puumala virus infection. Eur J Clin Microbiol Infect Dis. Mar 21 2006;[Medline].

  34. Terajima M, Hayasaka D, Maeda K, Ennis FA. Immunopathogenesis of hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome: Do CD8+ T cells trigger capillary leakage in viral hemorrhagic fevers?. Immunol Lett. Nov 15 2007;113(2):117-20. [Medline].

 
Previous
Next
 
Deer mouse, Peromyscus maniculatus. Courtesy of the Centers for Disease Control and Prevention.
Transmission electron micrograph of Sin Nombre virus. Courtesy of the Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention: Cumulative case count of Hantavirus pulmonary syndrome in the United States per state, valid as of March 9, 2012.
Characteristics of 465 Hantavirus pulmonary syndrome cases in the United States, March 26, 2007. Courtesy of the Centers for Disease Control and Prevention.
Histopathology of the lung in Hantavirus pulmonary syndrome. Courtesy of the Centers for Disease Control and Prevention.
Table 1. Hantaviruses That Cause HFRS, Rodent Hosts and Geographic Distribution
Hantavirus TypeRodent HostGeographic Distribution
HantaanApodemus agrarius (striped field mouse)Far East, Russia, Northern Asia, Balkans
DobravaApodemus flavicollis (yellow-necked field mouse)Balkans
SeoulRattus norvegicus (urban rats)Worldwide
PuumalaClathrionomys glariolus (bank vole)Europe, Scandinavia, Western Russia
Table 2. Hantavirus Pulmonary Syndrome Virus Types, Rodent Hosts, and Distribution in the United States
Hantavirus TypeRodent HostGeographic Distribution of the Rodent Host in the United States
Sin Nombre virus, monongahela virusDeer mouse, P maniculatusThroughout the United States, except the Southeast and Atlantic seaboard
Bayou virusRice rat, Oryzomys palustrisSoutheastern United States
Black Creek Canal virusCotton rat, Sigmodon hispidusSoutheastern United States
New York-1 virusWhite-footed mouse, Peromyscus leucopusSouthern New England, mid-Atlantic states, Southern states, and Midwest
Table 3. Hantavirus Types, Rodent Hosts, and Geographic Distribution in the Western Hemisphere (other than the United States)
Hantavirus TypeRodent HostGeographic Distribution
AndesOligoryzomys longicaudatusArgentina and Chile
OranO longicaudatusNorthwest Argentina
LechiguanasOligoryzomys flavescensCentral Argentina
Hu39694UnknownCentral Argentina
Laguna NegraCalomys lauchaParaguay and Bolivia
JuquitibaUnknownBrazil
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.