Pediatric Hantavirus Pulmonary Syndrome Follow-up
- Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD more...
Further Inpatient Care
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Patients should be transferred to the ICU for close observation and aggressive management.
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.
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 . 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.
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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.
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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. 
The case fatality rate for Hantavirus pulmonary syndrome is approximately 35%. 
If hypoxia is managed and shock is not fatal, the vascular leak reverses in a few days and the recovery is apparently complete.
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Patients should be educated in avoidance of rodent contact through strategies outlined under Deterrence/Prevention.
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- Table 1. Hantaviruses That Cause HFRS, Rodent Hosts and Geographic Distribution
- Table 2. Hantavirus Pulmonary Syndrome Virus Types, Rodent Hosts, and Distribution in the United States
- Table 3. Hantavirus Types, Rodent Hosts, and Geographic Distribution in the Western Hemisphere (other than the United States)
|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|
|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|
|Hantavirus Type||Rodent Host||Geographic Distribution|
|Andes||Oligoryzomys longicaudatus||Argentina and Chile|
|Oran||O longicaudatus||Northwest Argentina|
|Lechiguanas||Oligoryzomys flavescens||Central Argentina|
|Laguna Negra||Calomys laucha||Paraguay and Bolivia|