Also known as: Hantavirus Disease, HPS
Hospital: Report by IDSS, facsimile, mail or phone
Lab: Report by IDSS, facsimile, mail or phone
Physician: Report by facsimile, mail or phone
Local public health agency (LPHA): Follow-up required
Iowa Department of Public Health
Disease Reporting Hotline: (800) 362-2736
Secure Fax: (515) 281-5698
The genus Hantavirus, family Bunyaviridae, comprises at least 14 viruses, including those that cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Hantaviruses are primarily rodent-borne.
Hantavirus pulmonary syndrome (HPS) occurs in the U.S. with most of the cases being associated with Sin Nombre virus (SNV). Other agents include Black Creek Canal virus and Bayou virus.
HFRS is caused by puumala virus in Europe. Seoul virus, which is widely distributed, also causes HFRS of variable severity as does Hantaan virus, which is found principally in Asia. Renal failure and hemorrhagic manifestations, common in HFRS, have been mild or absent in most recognized cases of HPS.
B. Clinical Description
Symptoms: during the 3 to 5 day prodrome are non-specific flu-like symptoms, including fever, fatigue, and muscle aches, especially in the large muscle groups. Gastrointestinal manifestations or dizziness may also occur.
Onset: As the disease progresses, symptoms can include cough and shortness of breath as the lungs fill with fluid. Once the cardiopulmonary phase begins, the disease progresses rapidly, necessitating hospitalization and often assisted ventilation within 24 hours.
Complications: of HPS include an acute febrile illness that progresses rapidly to severe respiratory failure (acute respiratory distress syndrome or ARDS) and shock. The mortality rate is still not well known but appears to be approximately 40%. For survivors, recovery from the acute illness is rapid with apparent restoration of normal lung function.
Common reservoirs: The main reservoir for Sin Nombre virus is the deer mouse, Peromyscus maniculatus, native to most of the United States.
Less Common reservoirs: Black Creek Canal virus is associated with the cotton rat, Sigmodon hispidus, is found in the southeastern U.S. The rice rat, Oryzomys palustris, found in the southern U.S., is a reservoir for Bayou virus.
D. Modes of Transmission
Infected rodents shed live virus in their saliva, feces and urine.
Airborne: Humans are infected when they inhale dust that contains dried contaminated rodent urine or feces. Transmission may also occur when dried materials contaminated by rodent feces or urine are disturbed and are directly introduced into broken skin or the eyes, nose or mouth.
Person-to-person: There is no evidence of person-to-person transmission of HPS in the United States.
E. Incubation period
The incubation period is weakly defined, but is thought to be approximately 2 weeks, with a range of a few days to 6 weeks.
F. Period of Communicability or Infectious Period
Person to person spread of hantaviruses appears to be rare, but further study is needed.
HPS was first recognized in 1993 following an outbreak in the southwestern United States. As of November, 2013, 585 cases have been identified in the U.S. About 75% of patients with HPS have been residents of rural areas. Most cases have occurred in spring or summer, although cases have occurred throughout the year. Cases of HPS have also been reported in Canada and in several countries in South America. Anyone whose occupational activities (biologists, pest-control workers, etc.) or recreational activities (hikers, campers, etc.) put them in frequent contact with rodents or their droppings are potentially at risk. Disturbing, cleaning or inhabiting closed, actively rodent-infested structures is an important risk factor.
H. Bioterrorism Potential
Category C agent. Third-highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of availability, ease of production and dissemination and potential for high morbidity and mortality and major health impact.
I. Additional Information
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for Hantavirus can be found at: www.cdc.gov/osels/ph_surveillance/nndss/phs/infdis.htm#top
CSTE case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases, 66th Edition. Illinois, American Academy of Pediatrics, 2006.
CDC Website. Hantavirus, www.cdc.gov/hantavirus/
Heymann, D. L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC: American Public Health Association, 2015.