HANTAVIRUS IN COLORADO, OCCUPATIONAL RISK
Jennifer House, DVM, MPH, DACVPM State Public Health Veterinarian HTTPS://WWW.COLORADO.GOV/ PACIFIC/CDPHE/HANTAVIRUS 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 - 2004 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 - 2004 HANTAVIRUSES IN THE OLD WORLD
Serotype Host Location Hantaan Apodemus agrarius Asia, Far (striped field mouse) East Russia Dobrava A. agrarius , A. flavicollis Europe (yellow neck mouse) Balkans Seoul Rattus norvegicus, R. rattus Worldwide (Norway brown rat, roof rat) Puumala Clethrionomys glareolus (red Europe bank vole)
Center for Food Security and Public Health Iowa State University - 2004 HANTAVIRUSES IN THE NEW WORLD Serotype Host Location Sin Nombre Peromyscus maniculatus Central & (deer mouse) West U.S., Canada Monongahela Peromyscus maniculatus Eastern U.S., (deer mouse) Canada New York Peromyscus leucopus Eastern U.S., (white-footed mouse) Canada Bayou Oryzomys palustris SE U.S. (rice rat) Black Creek Sigmodon hispidus SE U.S. Canal (cotton rat)
Center for Food Security and Public Health Iowa State University - 2004 HANTAVIRUSES IN THE NEW WORLD Serotype Host Location Andes Oligoryzomys Argentina/Chile longicaudatus (long- tailed pygmy rice rat) 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 - 2004 New World Hantaviruses
New York Sin Nombre Peromyscus leucopus Peromyscus maniculatus Prospect Hill Muleshoe Microtus pennsylvanicus Sigmodon hispidus Bloodland Lake Microtus ochrogaster Isla Vista Bayou Microtus californicus Oryzomys palustris Black Creek Canal El Moro Canyon Sigmodon hispidus Reithrodontomys megalotis Rio Segundo Caño Delgadito Reithrodontomys mexicanus Sigmodon alstoni Laguna Negra Juquitiba Calomys laucha Unknown Host Maciel Rio Mamore Necromys benefactus Oligoryzomys microtis Hu39694 Orán Unknown Host Oligoryzomys longicaudatus Lechiguanas Bermejo Oligoryzomys flavescens Oligoryzomys chacoensis Pergamino Andes Akodon azarae Oligoryzomys longicaudatus
Center for Food Security and Public Health Iowa State University - 2004 FOUR CORNERS OUTBREAK
Center for Food Security and Public Health Iowa State University - 2004 THE FOUR CORNERS OUTBREAK May 1993
First clinical case
Abrupt fever, myalgia, pulmonary edema June 1993
12 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 - 2004 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 1959 38 year old Utah man
THE FOUR CORNERS OUTBREAK
Center for Food Security and Public Health Iowa State University - 2004 Rodents
Reservoir
Asymptomatic carriers
Antigen present in virtually all organs
Infectious for life
Other mammals seronegative
DISEASE IN ANIMALS Deer Mouse Peromyscus maniculatus
L.L. Masters Cotton Rat Sigmodon hispidus House Mouse Center for Food Security and Public Health Iowa State University - 2004 Mus musculus Deer Mouse Peromyscus maniculatus
L.L. Masters Cotton Rat Sigmodon hispidus House Mouse Center for Food Security and Public Health Iowa State University - 2004 Mus musculus 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. Total Cases (N=366 in 31 States)
DISTRIBUTION* OF PEROMYSCUS MANICULATUS 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 Map from CDC (last updated April 21, 2014) ANNUAL U.S. CASES AND CASE-FATALITY, 1993-2013
Centers for Disease Control and Prevention (http://www.cdc.gov/hantavirus/surveillance/annual- cases.html) Hantavirus Cases by Outcome Colorado, 1995-2015 12
10
8
6 Deaths # # Cases 4 Survived 2
0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year
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 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, particularly urine Secondary aerosols, mucous membrane contact, and skin breaches are also a consideration Center for Food Security and Public Health Iowa State University - 2004 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 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 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 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 - 2004 Patients can recover
With early supportive care
Poor prognosis
If undiagnosed or do not seek treatment
HPS PROGNOSIS 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 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 - 2004 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 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 - 2004 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 INTERNET RESOURCES
Center for Food Security and Public Health, Iowa State University
http://www.cfsph.iastate.edu/
CDC All About Hantavirus
www.cdc.gov/ncidod/diseases/hanta/hps/noframes /phys/clinical.htm
CDC Infectious Disease Pathology Activity
www.cdc.gov/ncidod/diseases/hanta/hps/noframes /printgenlsection.htm
Center for Food Security and Public Health Iowa State University - 2004 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 - 2004 Jennifer House State Public Health Veterinarian Colorado Department of Public Health and Environment
303-692-2628 [email protected]
THANK YOU!