Hantavirus Cardiopulmonary Syndrome: What You Need to Know - HealthProAdvice - Health and Wellness
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Hantavirus Cardiopulmonary Syndrome: What You Need to Know

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Liz is a licensed veterinary medical technologist with an interest in zoonotic diseases, comparative medicine, and One Health.

What is Hantavirus Cardiopulmonary Syndrome (also known as HCPS)?

Hantavirus cardiopulmonary syndrome (HCPS) is a rare but serious, sometimes deadly, respiratory disease that has been found mainly in rural areas of the western U.S. This disease has a mortality rate of about 35-40%. The condition is caused by multiple strains of hantaviruses, which are carried by rodents and transmitted to humans through vectors such as infected rodent urine, saliva (bites), or droppings (stool). This disease was first described in the southwestern U.S. in 1993. Though the disease occurs mostly in the western U.S., some random cases in some northeastern states have been reported. To date, no cases of HCPS have been reported in the United States in which the virus was transmitted from person to person.

The deer mouse is the primary carrier of the viruses that cause HCPS. This rodent and other similar species are found throughout the U.S. Not all rodents are carriers of hantaviruses; however, since the types of rodents that often carry hantavirus are difficult to identify, all wild rodents should be considered potential carriers and should be avoided. For more information on the history and story of hantaviruses and HCPS, Of Mice, Men, and Microbes: Hantavirus is an excellent read.

What are the symptoms of HCPS, and how long after infection do they appear?

The exact incubation time of HCPS has not been defined. Hantavirus enters the body primarily by inhaling particles from infected rodent bodily fluids. The heart, lungs, and kidneys are typically most affected. The virus also enters the bloodstream, where it continues to replicate and spread. Symptoms of HCPS usually begin manifesting within 2-4 weeks of initial exposure, but can begin as early as 7 days or as late as 3 months after exposure. First symptoms are non-specific and resemble influenza: fever, chills, lethargy, headache, abdominal pain, joint pain, and pain of large muscle groups like the thighs and lower back. Sometimes dizziness, nausea, vomiting, and diarrhea may occur as well. Later symptoms include coughing and shortness of breath. The primary symptom of this disease is difficulty breathing, which is caused by the rapid build-up of fluid in the lungs (pulmonary effusion). This may quickly progress to an inability to breathe.

This AP chest x-ray reveals the mid-staged bilateral pulmonary effusion due to hantavirus pulmonary syndrome, or HPS.

This AP chest x-ray reveals the mid-staged bilateral pulmonary effusion due to hantavirus pulmonary syndrome, or HPS.

How is the virus spread, and how do I prevent it?

Hantavirus is spread directly and indirectly from wild rodents to people. The virus is found in rodent urine, saliva, and feces, and can be aerosolized in confined areas when stirred by either by the rodents themselves or by human movement. Inhaling the virus is the most common way of becoming infected, yet you can also become infected by touching your nose or mouth after handling anything contaminated. A rodent’s bite can also transmit the virus, although this rarely happens. Hantavirus has not been recorded to have spread from person to person, meaning you cannot become infected by coming into contact with a person who has HCPS. Pets and domestic animals have also not been found to transmit hantaviruses.

Hantaviruses, which survive in the environment (in dirt and dust in enclosed areas or in rodent nests) only for a few hours or a few days, can be killed by the majority of modern household disinfectants, such as bleach, alcohol, and most detergents. Exposure to UV rays (the sun) also deactivates the virus. The best way to reduce exposure to hantaviruses is to prevent rodent infestations altogether. If you have a rodent problem in your living quarters, contact an exterminator or your local health department for further help. Snap traps are recommended over live and glue traps. After eliminating all rodents from an area, you should reduce factors that attract them, such as food left on countertops, open food containers, piles of garabage, etc. Possible rodent entry points should be sealed off.

Buildings and rooms that were previously unoccupied with possible rodent infestations should first be opened up and aired out before re-occupying. Leave windows and doors open for a few days before entering, if possible. Rodent droppings, nests, and any other infested debris should be thoroughly sprayed until saturated with a disinfectant solution to reduce aerosolizing the dust particles that may contain the virus. Droppings and other debris must be removed while wearing disposable gloves. Place used gloves, paper towels, and any other items used in the cleaning process in a bag that can be tied or sealed and dispose of promptly. Do not sweep or use a vacuum before wetting the area with disinfectants and before applying proper masks, eyewear, and protective clothing, as these activities aerosolize potentially infected dust particles. Wash hands thoroughly and shower after cleanup is complete.

A Sin Nombre virus particle shown budding from a Vero cell. This virus causes hantavirus pulmonary syndrome in North America. Credit: NIAID

A Sin Nombre virus particle shown budding from a Vero cell. This virus causes hantavirus pulmonary syndrome in North America. Credit: NIAID

Should tourists, campers, and hikers worry about hantavirus infection?

HCPS is a rare disease, and most tourists are not at increased risk for hantavirus infection. However, visitors to rural areas and nature resorts — campers, hikers, and others who take part in activities outdoors — can become exposed to rodent urine, saliva, or droppings and become infected with hantavirus. Additionally, construction workers and pest control workers can be exposed when working underneath houses, in crawl spaces, or in vacant buildings. As this disease is quite rare, travel to and within all areas where hantavirus infection has been reported as safe.

How do I identify rodents, burrows, and droppings?

A rodent nest or burrow is usually a pile of interwoven nonspecific material under which the rodent lives. The pile can contain a variety of materials, such as twigs, paper, insulation, styrofoam, grass, and leaves. Suspected nests should be avoided, and one should wear a mask, gloves, and wash hands thoroughly if a nest must be handled or removed.

What should I do if I think I have hantavirus infection?

If any combination of the aforementioned symptoms, particularly difficulty breathing, occur after direct or indirect exposure to rodents, go to the emergency room or contact your doctor immediately. Be sure to mention your recent exposure to rodents.

Is there a cure or vaccine against hantavirus infection?

There is no specified treatment, cure, or vaccine for any hantavirus infection. When this disease was first described, about 50% of affected patients died. Ribavirin was once used experimentally against hantavirus infections, but was not successful. Modern treatment usually consists of supportive care, and has greatly reduced the mortality rate. Early diagnosis is key; if the disease is recognized early enough, and patients receive medical care immediately, the prognosis is much better. In intensive care units, patients with HCPS are given oxygen therapy (and intubated in severe cases) to help them through the phase of severe respiratory distress.

How to Survive a Hantavirus

To minimize the risk for hantavirus infection, follow these precautions:

  • Avoid touching wild rodents, alive or dead. If avoidable, do not disturb rodents, burrows, or nests. If contact is a must, wear protective gloves and clothing.
  • Before occupying abandoned or vacant living quarters, open windows and doors to air them out first. Inspect the area for signs of rodents. Do not use living quarters if you find signs of rodent infestation, such as nests or droppings until the area has been thoroughly cleaned and disinfected.
  • If sleeping outdoors, check campsites for rodent burrows and droppings before occupying. Do not sleep directly on the ground.
  • Disinfect droppings and nesting materials before removal by spraying until wet with a disinfectant. Wear protective gloves. Dispose of disinfected materials in a plastic bag and dispose.
  • Avoid loitering near dumpsters or compost areas that may be frequented by rodents.
  • Use a tent with a floor, mat, or disinfected elevated cots if they are available.
  • Do not leave pet food open or in feeding dishes.
  • Store all foods in rodent-proof containers and promptly discard, bury, or burn all garbage.

Sources/Additional Reading

HCPS Quiz

For each question, choose the best answer. The answer key is below.

  1. What is the primary carrier of HCPS?
    • Deer
    • Birds
    • Deer mice
  2. Hantavirus can be spread from person to person.
    • True
    • False
  3. What is the primary symptom of HCPS?
    • Vomiting
    • Difficulty breathing
    • Rash

Answer Key

  1. Deer mice
  2. False
  3. Difficulty breathing

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2018 Liz Hardin

Comments

Liz Hardin (author) from Tennessee on May 22, 2018:

Thank you for reading, Pamela Oglesby. I am glad I live in the east as well!

Pamela Oglesby from Sunny Florida on May 22, 2018:

Interesting article. I had not heard of this particular disease. Glad I live on the East coast!

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