eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Hantavirus Pulmonary Syndrome: Follow-up

Author: Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Coauthor(s): Veronica A Mas Casullo, MD, Assistant Professor, Department of Pediatric Infectious Diseases, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Aug 11, 2008

Follow-up

Further Inpatient Care

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

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.9 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.

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.

Prognosis

  • In a report of 281 patients of Hantavirus pulmonary syndrome by the CDC, a case-fatality rate of 38% was noted.
  • If hypoxia is managed and shock is not fatal, the vascular leak reverses in a few days and the recovery is apparently complete.

Patient Education

  • Patients should be educated in avoidance of rodent contact through strategies outlined under Deterrence/Prevention.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis of Hantavirus pulmonary syndrome (HPS) in an appropriate epidemiologic setting
  • Failure to promptly transfer patients suspected of having Hantavirus pulmonary syndrome to facilities with ICUs and ventilatory support

Special Concerns

  • Diagnosis of HPS may not be considered unless an appropriate epidemiologic history of rodent exposure is solicited.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Maria A Horga, MD, to the development and writing of this article.



More on Hantavirus Pulmonary Syndrome

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Differential Diagnoses & Workup: Hantavirus Pulmonary Syndrome
Treatment & Medication: Hantavirus Pulmonary Syndrome
Follow-up: Hantavirus Pulmonary Syndrome
Multimedia: Hantavirus Pulmonary Syndrome
References
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References

  1. CDC. Update: hantavirus pulmonary syndrome--United States, 1993. MMWR Morb Mortal Wkly Rep. Oct 29 1993;42(42):816-20. [Medline].

  2. 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].

  3. 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].

  4. Mills JN, Ksiazek TG, Ellis BA, et al. Patterns of association with host and habitat: antibody reactive with Sin Nombre virus in small mammals in the major biotic communities of the southwestern United States. Am J Trop Med Hyg. Mar 1997;56(3):273-84. [Medline].

  5. Kuenzi AJ, Douglass RJ, Bond CW. Sin nombre virus in deer mice captured inside homes, southwestern Montana. Emerg Infect Dis. Jul-Aug 2000;6(4):386-8. [Medline].

  6. Armstrong LR, Zaki SR, Goldoft MJ, et al. Hantavirus pulmonary syndrome associated with entering or cleaning rarely used, rodent-infested structures. J Infect Dis. Oct 1995;172(4):1166. [Medline].

  7. 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].

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

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

  10. 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].

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

  12. 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].

  13. Bennett SG, Webb JP Jr, Madon MB, et al. Hantavirus (Bunyaviridae) infections in rodents from Orange and San Diego counties, California. Am J Trop Med Hyg. Jan 1999;60(1):75-84. [Medline].

  14. 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].

  15. CDC. From the Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome--Panama, 1999-2000. JAMA. May 3 2000;283(17):2232-3. [Medline].

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

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

  18. Cheney PR. Update on emerging infections from the Centers for Disease Control and Prevention. Hantavirus pulmonary syndrome--Colorado and New Mexico, 1998. Ann Emerg Med. Jan 1999;33(1):121-3. [Medline].

  19. 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].

  20. 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].

  21. Drebot MA, Artsob H, Werker D. Hantavirus pulmonary syndrome in Canada, 1989-1999. Can Commun Dis Rep. Apr 15 2000;26(8):65-9. [Medline].

  22. Duchin JS, Koster FT, Peters CJ, et al. Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus Study Group. N Engl J Med. Apr 7 1994;330(14):949-55. [Medline].

  23. Ferreira MS, Nishioka Sd, Santos TL, et al. Hantavirus pulmonary syndrome in Brazil: clinical aspects of three new cases. Rev Inst Med Trop Sao Paulo. Jan-Feb 2000;42(1):41-6. [Medline].

  24. Hallin GW, Simpson SQ, Crowell RE, et al. Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med. Feb 1996;24(2):252-8. [Medline].

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

  26. 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].

  27. Khan AS, Gaviria M, Rollin PE, et al. Hantavirus pulmonary syndrome in Florida: association with the newly identified Black Creek Canal virus. Am J Med. Jan 1996;100(1):46-8. [Medline].

  28. 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].

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

  30. 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].

  31. 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].

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

  33. 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].

  34. 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].

  35. 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].

  36. 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].

  37. Shope RE. A midcourse assessment of hantavirus pulmonary syndrome. Emerg Infect Dis. Jan-Feb 1999;5(1):172-4. [Medline].

  38. 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].

  39. Wells RM, Sosa Estani S, Yadon ZE, et al. An unusual hantavirus outbreak in southern Argentina: person-to-person transmission? Hantavirus Pulmonary Syndrome Study Group for Patagonia. Emerg Infect Dis. Apr-Jun 1997;3(2):171-4. [Medline].

  40. Zaki SR, Greer PW, Coffield LM, et al. Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am J Pathol. Mar 1995;146(3):552-79. [Medline].

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Further Reading

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Keywords

Hantavirus pulmonary syndrome, Hantavirus, HPS, HPS disease, hemorrhagic fever with renal syndrome, HFRS, Sin Nombre virus, nameless virus, Peromyscus maniculatus, infectious rodent, pulmonary capillary permeability, severe pulmonary edema, viremia, atypical myocarditis, Hantavirus pulmonary syndrome shock, viral upper respiratory tract infections, rhinorrhea, pharyngitis

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Contributor Information and Disclosures

Author

Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Vinod K Dhawan, MD, FACP, FRCP(C) 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 None None

Coauthor(s)

Veronica A Mas Casullo, MD, Assistant Professor, Department of Pediatric Infectious Diseases, Mount Sinai School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

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 School of Medicine
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.

CME Editor

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: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap 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: None None None

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