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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.


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.



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.


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.

Patient Education

See the list below:

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

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.


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.

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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
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