Microsoft PowerPoint - 4 HOUSE Hantavirus_AIHA.pptx

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1 HANTAVIRUS IN COLORADO, OCCUPATIONAL RISK Jennifer House, DVM, MPH, DACVPM State Public Health Veterinarian

2 PACIFIC/CDPHE/HANTAVIRUS

3 Family Bunyaviridae RNA virus Genus Hantavirus Transmitted by rodents More than 25 hantavirus species HANTAVIRUSES Center for Food Security and Public Health Iowa State University

4 Lipid envelope Deactivated by ordinary disinfectants A viral hemorrhagic fever Hantavirus Pulmonary Syndrome (HPS) Hemorrhagic Fever with Renal Syndrome (HFRS) HANTAVIRUSES Center for Food Security and Public Health Iowa State University

5 HANTAVIRUSES IN THE OLD WORLD Serotype Host Location Hantaan Dobrava Seoul Apodemus agrarius (striped field mouse) A. agrarius, A. flavicollis (yellow neck mouse) Rattus norvegicus, R. rattus (Norway brown rat, roof rat) Asia, Far East Russia Europe Balkans Worldwide Puumala Clethrionomys glareolus (red bank vole) Europe Center for Food Security and Public Health Iowa State University

6 HANTAVIRUSES IN THE NEW WORLD Serotype Host Location Sin Nombre Monongahela New York Bayou Black Creek Canal Peromyscus maniculatus (deer mouse) Peromyscus maniculatus (deer mouse) Peromyscus leucopus (white-footed mouse) Oryzomys palustris (rice rat) Sigmodon hispidus (cotton rat) Central & West U.S., Canada Eastern U.S., Canada Eastern U.S., Canada SE U.S. SE U.S. Center for Food Security and Public Health Iowa State University

7 HANTAVIRUSES IN THE NEW WORLD Serotype Host Location Andes Oligoryzomys longicaudatus (longtailed pygmy rice rat) Argentina/Chile Oran O. longicaudatus NW Argentina Lechiguanas O. flavescens Central Argentina Hu39694 Unknown Central Argentina Laguna Negra Calomys laucha Paraguay/ Bolivia Juquitiba Unknown Brazil Center for Food Security and Public Health Iowa State University

8 New World Hantaviruses Sin Nombre Peromyscus maniculatus Muleshoe Sigmodon hispidus Isla Vista Microtus californicus El Moro Canyon Reithrodontomys megalotis Caño Delgadito Sigmodon alstoni Juquitiba Unknown Host Rio Mamore Oligoryzomys microtis Orán Oligoryzomys longicaudatus Bermejo Oligoryzomys chacoensis Andes Oligoryzomys longicaudatus New York Peromyscus leucopus Prospect Hill Microtus pennsylvanicus Bloodland Lake Microtus ochrogaster Bayou Oryzomys palustris Black Creek Canal Sigmodon hispidus Rio Segundo Reithrodontomys mexicanus Laguna Negra Calomys laucha Maciel Necromys benefactus Hu39694 Unknown Host Lechiguanas Oligoryzomys flavescens Pergamino Akodon azarae Center for Food Security and Public Health Iowa State University

9 FOUR CORNERS OUTBREAK Center for Food Security and Public Health Iowa State University

10 THE FOUR CORNERS OUTBREAK May 1993 First clinical case Abrupt fever, myalgia, pulmonary edema June fatalities Unexplained Adult Respiratory Distress Syndrome (ARDS) Sera cross-reacted with Hantaan, Seoul, Puumala virus Rodents trapped - deer mouse main reservoir Center for Food Security and Public Health Iowa State University

11 Winter and spring 1993 Drought for several years followed by snow and rain Vegetation blossomed rodent population grew tenfold Virus isolated and named Sin Nombre Virus (SNV) Newly emerging virus - present since year old Utah man THE FOUR CORNERS OUTBREAK Center for Food Security and Public Health Iowa State University

12 Rodents Reservoir Asymptomatic carriers Antigen present in virtually all organs Infectious for life Other mammals seronegative DISEASE IN ANIMALS

13 Deer Mouse Peromyscus maniculatus House Mouse Mus musculus L.L. Masters Cotton Rat Sigmodon hispidus Center for Food Security and Public Health Iowa State University

14 Deer Mouse Peromyscus maniculatus House Mouse Mus musculus L.L. Masters Cotton Rat Sigmodon hispidus Center for Food Security and Public Health Iowa State University

LOCATION OF HPS CASES BY VIRUS TYPES: 2004 Total Cases (N=366 in 31 States) Although serologically confirmed as HPS, sequence data are not available for all

15 LOCATION OF HPS CASES BY VIRUS TYPES: 2004 Total Cases (N=366 in 31 States) Although serologically confirmed as HPS, sequence data are not available for all cases. For non-sequenced cases, the specific infecting hantavirus is assumed to be that corresponding with the known rodent reservoir in the area of probable exposure.

16 Total Cases (N=366 in 31 States) DISTRIBUTION* OF PEROMYSCUSMANICULATUS AND HPS CASES AS OF JULY 6, 2004 *Rodent distributions from: Burt WH, Grossenheider RP. A Field Guide to the Mammals. 3rd ed. New York, New York. Houghton Mifflin Company. 1980

17 Map from CDC (last updated April 21, 2014)

18 ANNUAL U.S. CASES AND CASE-FATALITY, Centers for Disease Control and Prevention (

19 Hantavirus Cases by Outcome Colorado, Year Deaths Survived # Cases

21 Relatively low Rare disease High case fatality rate Contact with rodent excrement puts you at greatest risk Cleaning a rodent infested dwelling Opening or cleaning buildings that have been closed for a while Especially over winter RISK OF CONTRACTING HPS

22 Being in closed spaces where rodents are actively living Hikers, campers, and forestry employees Granary and agriculture workers Construction and utility workers Enter crawl spaces under buildings RISK OF CONTRACTING HPS

TRANSMISSION OF HANTAVIRUSES Chronically infected rodent Horizontal transmission of infection between same species by contact Virus is present in aerosolized excreta,

23 TRANSMISSION OF HANTAVIRUSES Chronically infected rodent Horizontal transmission of infection between same species by contact Virus is present in aerosolized excreta, particularly urine Secondary aerosols, mucous membrane contact, and skin breaches are also a consideration Center for Food Security and Public Health Iowa State University

24 Incubation period 1-6 weeks Average is ~ 14 days Early stage Fatigue, fever, myalgia, headache Lasts 3-5 days Half of the patients experience headaches, dizziness, chills, nausea, vomiting, diarrhea, abdominal pain CLINICAL SIGNS OF HPS

25 Later stage 4 to 10 days after initial signs Coughing and shortness of breath Rapidly progressive, non-cardiogenic pulmonary edema and severe hypotension Hospitalization and ventilation required usually within 24 hours CLINICAL SIGNS OF HPS

26 Serology ELISA used by CDC IgM, IgG Exposure? No, there is no test to tell if you have been exposed. Have to wait for clinical illness to develop DIAGNOSIS

27 No specific treatment, supportive care Early, aggressive intensive care Avoidance of hypoxia Assisted ventilation Electrolyte balance Maintaining normal blood pressure Careful monitoring HPS TREATMENT Center for Food Security and Public Health Iowa State University

28 Patients can recover With early supportive care Poor prognosis If undiagnosed or do not seek treatment HPS PROGNOSIS

29 Eliminate food and water sources Prevent access to human and pet food Clean-up rodent habitats Dispose of nesting materials Prevent entry indoor (seal up) Trap existing rodents RODENT CONTROL

30 Avoid contact with rodents Do not camp near rodent burrows Keep campsite clean Tightly seal all food Air out unused cabins before entering Avoid sleeping on the bare ground MINIMIZING OUTDOOR EXPOSURE Center for Food Security and Public Health Iowa State University

31 1. Wear rubber or plastic gloves 2. Never sweep or vacuum rodent areas 3. Spray droppings, nests, and dead rodents with disinfectant Wait 5-10 minutes then wipe with a paper towel 4. Seal dead rodents and excrement in bags and dispose 5. Disinfect gloves before removal and Wash Hands! CLEAN UP RODENT AREAS

32 Use N-100 (HEPA) filters on respirators Effective in removing virus particles less than 5 microns Not tested in transmission of HPS OTHER MEASURES Center for Food Security and Public Health Iowa State University

33 Companies with high risk jobs should include hantavirus in their injury and illness prevention protocols. Protective Clothing and Respirators Rodent mitigation Employees in close proximity to rodents and/or rodent habitat should be trained Awareness of Hantavirus Safety protocols to avoid exposure FIT testing if respirators are needed EMPLOYEE PROTECTION

34 INTERNET RESOURCES Center for Food Security and Public Health, Iowa State University CDC All About Hantavirus /phys/clinical.htm CDC Infectious Disease Pathology Activity /printgenlsection.htm Center for Food Security and Public Health Iowa State University

35 ACKNOWLEDGMENTS Development of portions of this presentation was funded by a grant from the Centers for Disease Control and Prevention to the Center for Food Security and Public Health at Iowa State University. Center for Food Security and Public Health Iowa State University

36 Jennifer House State Public Health Veterinarian Colorado Department of Public Health and Environment THANK YOU!

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$(Microsoft PowerPoint - \272~\245L\257f\254r\267P\254V.ppt)$ 漢他病毒感染衛生署疾病管制局中區傳染病防治醫療網王任賢指揮官 Overview Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control The Organism Hantaviruses Family Bunyaviridae RNA virus