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Hantavirus

Hantavirus. WKY University ACVPM Exam Review. Marc E. Mattix , DVM, MSS Diplomate, ACVP. Originally developed 2007. Hantavirus Timeline. January 14 Patient hospitalized January 15 Patient deceased January 22 Diagnosis made January 23-24 Investigation- 5 sites

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Hantavirus

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  1. Hantavirus WKY University ACVPM Exam Review Marc E. Mattix, DVM, MSS Diplomate, ACVP Originally developed 2007

  2. Hantavirus Timeline • January 14 Patient hospitalized • January 15 Patient deceased • January 22 Diagnosis made • January 23-24 Investigation- 5 sites • February 8 Controversial site cleaned & reinspected • February 12 BOH technical review • February 16 County Commissioners briefed • Site owner noncompliance • No greater risk of Hanta • Cleanup completed ~2 weeks post-Dx • External review ~3 weeks post-Dx • No additional cases

  3. 10 Essential Public Health Services • Monitor public health risks • Investigate PH hazards • Inform & educate • Mobilize community partnerships • Support environmental health efforts • Enforce regulations that protect PH • Link people with services • Assure competent PH workforce • Evaluate effectiveness of PH services • Look for innovative solutions

  4. 90% score on independent March 2005 Local Public Health System Assessment 10 Essential Public Health Services • Monitor public health risks • Investigate PH hazards • Inform & educate • Mobilize community partnerships • Support environmental health efforts • Enforce regulations that protect PH • Link people with services • Assure competent PH workforce • Evaluate effectiveness of PH services • Look for innovative solutions

  5. BOH Guidelines • Public Health Goals • Prevent epidemics & spread of disease • Protect against environmental hazards • Guiding Principles • Assure decisions are grounded in science • Promote partnerships • Surveillance is key to prevention • Patient confidentiality is sacred

  6. Communicable Disease Program Standards • Effective surveillance reporting system • Communicable disease investigation & control procedures in place • Disease investigations begin within 1 working day • Evaluation of investigation & response • Public health communication • Communicable disease response procedures routinely evaluated

  7. Sin Nombre virus Genus Human disease BunyavirusLaCrosse encephalitis, others PhlebovirusRift Valley fever, sandfly fever NairovirusCrimean-Congo hemorrhagic fever TospovirusPlant virus, no known human disease HantavirusHantavirus Pulmonary syndrome -small enveloped RNA viruses -non-vector borne -maintained in >430 species of rodent hosts

  8. Well-adapted virus of rodents • Deer mouse (Peromyscus maniculatus) • First recognized in US: 14 May 1993 • “Four Corners Virus” • 80% mortality initially • 43% mortality in first 217 cases • Oldest retrospective case • 38 year-old Utah man (1959)

  9. New World Hantaviruses New York Peromyscus leucopus Sin Nombre Peromyscus maniculatus Prospect Hill Microtus pennsylvanicus Muleshoe Sigmodon hispidus Bloodland Lake Microtus ochrogaster Isla Vista Microtus californicus Bayou Oryzomys palustris Black Creek Canal Sigmodon hispidus El Moro Canyon Reithrodontomys megalotis Rio Segundo Reithrodontomys mexicanus Calabazo Zygodontomys brevicauda Juquitiba Unknown Host Laguna Negra Calomys laucha Caño Delgadito Sigmodon alstoni Choclo Oligoryzomys fulvescens Maciel Necromys benefactus Rio Mamore Oligoryzomys microtis Hu39694 Unknown Host Orán Oligoryzomys longicaudatus Lechiguanas Oligoryzomys flavescens Bermejo Oligoryzomys chacoensis Pergamino Akodon azarae Andes Oligoryzomys longicaudatus

  10. 0 Cases 1-4 Cases 5-9 Cases >=10 Cases Hantavirus Pulmonary Syndrome Cases United States – as of September 19, 2006 Total Cases (N=453 in 31 States)

  11. Epidemiology • Exposure • Virus shed in saliva & excreta (urine & droppings) from healthy infected mice • Primary route: Inhalation of viable virus • Less common routes: • Direct contact • Mucus membranes • Ingestion • Incubation period • 2 weeks (few days to 6 weeks) • Highest incidence: Spring & Summer

  12. On presentation to Hospital • Rapid breathing & rapid heart rate • Low blood pressure • Dehydration (sunken eyes) • Respiratory noise (crackles & rales) • Most deaths occur within 24 hours

  13. Control • Personal protection • Minimize aerosolization • Control rodents inside • Control rodents outside • Eliminate food sources • Eliminate bedding • Eliminate shelter

  14. Report to local health authority • Isolation: none • Concurrent disinfection: none • Quarantine: none • Immunization of contacts: none • Investigation of contacts & sources • Recommend exterminating rodents in & around household if feasible

  15. Sin Nombre virus • Today in the US • 460 total cases with 35% case fatality rate • Today in Montana • 27 cases with 7 deaths (26% fatality) • In Context… • 14 years • 200 million US citizens • Cyclic 0-35% seropositivity in mice • Average 10% positive • Ubiquitous human exposure to rodents

  16. Human nature “One becomes interested in geology the day after the earthquake”

  17. Hantavirus Marc E. Mattix, DVM, MSS Diplomate, ACVP

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