Treatment and Prevention of Hantaviruses Infection
E. Treatment and Prevention
Attentive and supportive therapy is important during the first
3 phases of the illness. Trials with ribavirin suggested a
reduction in mortality if the treatment is started within the
first 5 days of illness. A trial with a
-interferon was not successful. HVD is mainly a disease of
poverty and war. Control should be directed at reducing the
contact between rodent populations and humans. An inactivated
cell culture vaccine had been prepared in China where clinical
trials are due to begin soon. A portion of the Hantaan virus
genome has been cloned into vaccinia.
F. Comparative Clinical Features of Recognized
Hantavirus Disease_HVD
Nephropathia Far
Eastern
Rat-bourne Balkan
Epidermica
HVD
HVD
HVD
Virus type Puumala Hantaan Seoul Porogia
Overall Severity ..... 1-2 2-4 1-3 2-4
Multiphasic Disease occasionally Yes Blurred Yes
Hepatic abnormalities 0 0-1 1-3 0-1
Haemorrhagic phenomenon 0-1 1-4 1-2 1-4
Mortality <1% 5-10% 1% 5-35%
Score = 0 to 4
G. Hantavirus Pulmonary Syndrome
A unique hantavirus has been identified as the cause of the outbreak of respiratory illness (hantavirus pulmonary syndrome) first recognized in the "Four Corners" region SW USA in 1993. The rodent reservoir is the deer mouse. Onset of the illness is characterized by a prodrome consisting of fever, myalgia and variable respiratory symptoms eg. cough followed by the abrupt onset of acute respiratory distress. Headache and GI complaints have also been documented. Overall, the mortality rate had been 62%. The pathology is essentially the same as for the classical hantaviruses whereby damage to the capilliries and blood leakage occurs. In this case, the lungs rather than the kidneys are predominantly affected. Diagnosis is usually made by the demonstration of IgM by serological tests. RT-PCR and immunehistochemistry had also been reported to be useful. Virus isolation is not an option since the virus has never been isolated from clinical specimens.Ribavirin is being currently assessed in the treatment of hantavirus pulmonary syndrome. The virus involved is most closely related to the Prospect Hill virus and is called Sin Nombre virus. Deer mouse is distributed in most parts of the U.S., parts of Canada and Mexico. The risk to campers and hikers from hantaviruses is very small, the CDC have published guidelines for reducing the risk of exposure to rodents. Hantaviruses found in other rodents such as the white-footed mouse, the cotton rat and the rice rat have also been associated with hantavirus pulmonary syndrome. At present, at least three hantaviruses are associated with the syndrome.
Link to CDC's slide set on "Hantavirus Pulmonary Syndrome and Sin Nombre Virus"
