Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Hantavirus Pulmonary Syndrome Follow-up

  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
 
Updated: Nov 26, 2014
 

Further Inpatient Care

See the list below:

  • 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.

Host-reservoir control and human exposure prophylaxis interventions have led to a dramatic reduction of human cases in China over the past decades.[36]

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

See the list below:

  • 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

See the list below:

  • 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

See the list below:

  • 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, FRCPC, 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, FRCPC, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Pfizer Inc for speaking and teaching.

Specialty Editor Board

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 Minnesota American Legion and Auxiliary Heart Research Foundation 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, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Maria A Horga, MD Assistant Professor, Department of Pediatric Infectious Diseases, Bristol-Myers Squibb

Disclosure: Nothing to disclose.

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.

Veronica A Mas Casullo, MD Assistant Professor, Department of Pediatric Infectious Diseases, Mount Sinai School of Medicine

Disclosure: Nothing to disclose.

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

  2. Vinh DC, Embil JM. Hantavirus Pulmonary Syndrome: A Concise Clinical Review. South Med J. 2009 May 7. [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. 2009 Apr. 15(4):561-7. [Medline]. [Full Text].

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

  5. Macneil A, Nichol ST, Spiropoulou CF. Hantavirus pulmonary syndrome. Virus Res. 2011 Dec. 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. 1999 Feb. 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. 2004 Mar 1. 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. 1995 Oct. 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. 1994 Jun. 191(3):665-8. [Medline].

  10. Jonsson CB, Hooper J, Mertz G. Treatment of hantavirus pulmonary syndrome. Antiviral Res. 2008 Apr. 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. 2008 Mar. 135(3):579-84. [Medline].

  12. Cho HW, Howard CR. Antibody responses in humans to an inactivated hantavirus vaccine (Hantavax). Vaccine. 1999 Jun 4. 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. 2012 May. 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. 1999 Jan-Feb. 5(1):102-12. [Medline].

  15. Abel Borges A, Figueiredo LT. Mechanisms of shock in hantavirus pulmonary syndrome. Curr Opin Infect Dis. 2008 Jun. 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. 2007 May. 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. 2006 Nov. 48(5):593-4; discussion 594-5. [Medline].

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

  19. Chang B, Crowley M, Campen M, Koster F. Hantavirus cardiopulmonary syndrome. Semin Respir Crit Care Med. 2007 Apr. 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. 2000 Feb. 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. 2005 Summer. 5(2):189-92. [Medline].

  22. Hantavirus pulmonary syndrome--five states, 2006. MMWR Morb Mortal Wkly Rep. 2006 Jun 9. 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. 2000 May. 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. 1996 Jun. 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. 2000 Sep 1. 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. 2004 Jul. 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. 2006 Oct. 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. 2002 Jul 26. 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. 2009 Jan. 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. 2007 May 15. 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. 2006 Mar 21. [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. 2007 Nov 15. 113(2):117-20. [Medline].

  35. Núñez JJ, Fritz CL, Knust B, Buttke D, Enge B, Novak MG, et al. Hantavirus infections among overnight visitors to Yosemite National Park, California, USA, 2012. Emerg Infect Dis. 2014 Mar. 20(3):386-93. [Medline]. [Full Text].

  36. Watson DC, Sargianou M, Papa A, Chra P, Starakis I, Panos G. Epidemiology of Hantavirus infections in humans: a comprehensive, global overview. Crit Rev Microbiol. 2014 Aug. 40(3):261-72. [Medline].

  37. Avšic-Županc T, Saksida A, Korva M. Hantavirus Infections. Clin Microbiol Infect. 2013 Jun 24. [Medline].

  38. Knust B, Rollin PE. Twenty-year summary of surveillance for human hantavirus infections, United States. Emerg Infect Dis. 2013 Dec. 19(12):1934-7. [Medline]. [Full Text].

  39. Vial PA, Valdivieso F, Ferres M, Riquelme R, Rioseco ML, Calvo M, et al. High-dose intravenous methylprednisolone for hantavirus cardiopulmonary syndrome in Chile: a double-blind, randomized controlled clinical trial. Clin Infect Dis. 2013 Oct. 57(7):943-51. [Medline]. [Full Text].

  40. Hartline J, Mierek C, Knutson T, Kang C. Hantavirus infection in North America: a clinical review. Am J Emerg Med. 2013 Jun. 31(6):978-82. [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 December 31, 2013. Courtesy of the Centers for Disease Control and Prevention.
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 Type Rodent Host Geographic Distribution
Hantaan Apodemus agrarius (striped field mouse) Far East, Russia, Northern Asia, Balkans
Dobrava Apodemus flavicollis (yellow-necked field mouse) Balkans
Seoul Rattus norvegicus (urban rats) Worldwide
Puumala Clathrionomys glariolus (bank vole) Europe, Scandinavia, Western Russia
Table 2. Hantavirus Pulmonary Syndrome Virus Types, Rodent Hosts, and Distribution in the United States
Hantavirus Type Rodent Host Geographic Distribution of the Rodent Host in the United States
Sin Nombre virus, monongahela virus Deer mouse, P maniculatus Throughout the United States, except the Southeast and Atlantic seaboard
Bayou virus Rice rat, Oryzomys palustris Southeastern United States
Black Creek Canal virus Cotton rat, Sigmodon hispidus Southeastern United States
New York-1 virus White-footed mouse, Peromyscus leucopus Southern 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 Type Rodent Host Geographic Distribution
Andes Oligoryzomys longicaudatus Argentina and Chile
Oran O longicaudatus Northwest Argentina
Lechiguanas Oligoryzomys flavescens Central Argentina
Hu39694 Unknown Central Argentina
Laguna Negra Calomys laucha Paraguay and Bolivia
Juquitiba Unknown Brazil
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.