What is Hantavirus (Hantavirus) disease?

From the Guidelines

Hantavirus is a rare but potentially deadly virus that requires immediate medical attention if symptoms occur, and prevention is the best approach to reduce the risk of infection. Hantavirus is transmitted to humans primarily through contact with infected rodents, particularly their urine, droppings, or saliva. It causes two main illnesses: Hantavirus Pulmonary Syndrome (HPS) in the Americas and Hemorrhagic Fever with Renal Syndrome (HFRS) in Europe and Asia. There is no specific treatment or vaccine for hantavirus infections. Management focuses on supportive care, including oxygen therapy, fluid management, and mechanical ventilation if respiratory failure develops, as recommended by the Centers for Disease Control and Prevention 1.

Some key points to consider in the management and prevention of hantavirus infections include:

• Eliminating rodent contact by sealing homes against rodents
• Properly cleaning rodent-infested areas with disinfectant
• Avoiding activities that stir up dust in rodent-prone areas
• Using rubber gloves and disinfecting with a bleach solution or commercial disinfectant when cleaning potentially contaminated areas
• Inspecting the interior and exterior of the home at least twice per year for any openings where rodents could enter the home and for conditions that could support rodent activity, as outlined in the guidelines for rodent control 1.

The virus cannot spread from person to person in most cases, except for rare instances with the Andes virus variant in South America. Hantavirus infections begin with flu-like symptoms including fever, muscle aches, and fatigue, potentially progressing to coughing, shortness of breath, and respiratory failure in HPS cases, or to kidney problems in HFRS cases. Prevention is crucial, and following the updated recommendations for risk reduction can significantly reduce the risk of hantavirus infection 1.

From the Research

Hantavirus Overview

• Hantavirus infection is an emerging zoonosis with two main clinical presentations: hemorrhagic fever with renal syndrome (HFRS) and Hantavirus pulmonary syndrome (HPS) 2, 3, 4, 5.
• The virus has a worldwide distribution, with over 200,000 individuals affected each year, and a high mortality rate 4.
• Hantaviruses are responsible for causing two acute febrile diseases in humans: Hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS) 4.

Clinical Presentations

• HFRS varies from subclinical, mild, and moderate to severe, depending on the causative agent of the disease 5.
• HFRS caused by Hantaan virus, Amur virus, and Dobrava virus are more severe with mortality rates from 5 to 15% 5.
• Seoul virus causes moderate and Puumala virus and Saaremaa virus cause mild forms of disease with mortality rates <1% 5.
• HCPS rapidly evolves into acute but reversible multiorgan dysfunction 6.

Treatment and Prevention

• Currently, there are no licensed treatments or vaccines available globally for Hantavirus infection 2, 3, 4, 5.
• Multiple antivirals have shown efficacy in increasing survival rates during the early stages of Hantavirus infection, including lactoferrin, ribavirin, ETAR, favipiravir, and vandetanib 4.
• Immunotherapy utilizing neutralizing antibodies (NAbs) generated from Hantavirus convalescent patients shows efficacy against Hantavirus infection 4.
• Rodent control and public health education and promotion play a major role in preventing Hantavirus infection 2.
• Intensive care, specifically hemodynamic and respiratory support, is often required for the treatment of HCPS, which may include veno-arterial extracorporeal membrane oxygenation (VA-ECMO) 6.

Vaccine Candidates

• Multiple vaccine candidates have shown evidence of conferring long protective immunity against Hantaviruses, with some having been trialed on humans 2, 3, 4.
• The development of vaccines and antivirals, used independently and/or in combination, is critical for elucidating hantaviral infections and the impact on public health 4.

Pathogenesis

• The central phenomena behind the pathogenesis of both HFRS and HCPS are increased vascular permeability and acute thrombocytopenia 5.
• The pathogenesis is likely to be a complex multifactorial process that includes contributions from immune responses, platelet dysfunction, and the deregulation of endothelial cell barrier functions 5.
• A genetic predisposition, related to HLA type, seems to be important for the severity of the disease 5.