What is the treatment and prevention for Hantavirus infection?

Hantavirus Infection Treatment and Prevention

The treatment of Hantavirus infection is primarily supportive care, while prevention focuses on rodent control and avoiding exposure to rodent excreta through proper protective measures and cleaning techniques. 1

Clinical Presentations of Hantavirus Infection

Hantavirus infections present as two distinct clinical syndromes:

1. Hemorrhagic Fever with Renal Syndrome (HFRS)

   • Predominant in Asia and Europe
   • Caused by Hantaan, Seoul, Puumala, Porogia, and Belgrade viruses
   • Severity varies by virus type (Hantaan, Porogia, and Belgrade more severe)
   • Features renal failure as a characteristic sign 2

2. Hantavirus Pulmonary Syndrome (HPS)/Hantavirus Cardiopulmonary Syndrome (HCPS)

   • Occurs in the Americas
   • Higher mortality rate (approximately 40%)
   • Characterized by respiratory failure and shock 3, 4

Treatment Approach

Supportive Care (Primary Treatment)

• Intensive medical care is the mainstay of treatment 2
• For HFRS/Nephropathia Epidemica:
  • Bed rest
  • Sedation
  • Circulatory support
  • Renal dialysis as needed 5

For HPS/HCPS:

• Avoid fluid overload (critical)
• Use vasopressors to maintain cardiac output
• Consider extracorporeal membrane oxygenation (ECMO) in severe cases 6

Antiviral Therapy

• Ribavirin:
  • May be beneficial for HFRS if administered early in the illness 5
  • Not proven effective for New World hantavirus infections (HPS) when started in the cardiopulmonary phase 6

Prevention Strategies

Rodent Control and Avoidance

1. Reduce rodent shelter and food sources:

   • Keep food and water covered in rodent-proof containers
   • Store pet food properly and remove uneaten portions
   • Dispose of trash frequently
   • Eliminate clutter that could serve as nesting sites 7

2. Rodent-proofing homes:

   • Seal all entry holes >¼-inch in diameter
   • Use appropriate materials (cement, wire screening, hardware cloth)
   • Install barriers around foundations
   • Consider professional pest control for severe infestations 7

Cleaning Areas with Rodent Infestations

Standard Cleaning Protocol

1. Wear protective gloves (rubber, latex, vinyl, or nitrile)
2. Spray rodent droppings with disinfectant until thoroughly soaked
3. Never vacuum or sweep dry droppings
4. Use paper towels to pick up wetted droppings
5. Disinfect all potentially contaminated surfaces 7

For Heavy Infestations

1. Ventilate the building for at least 30 minutes before entering
2. Wear comprehensive PPE:
   • Disposable coveralls
   • Rubber boots/shoe covers
   • Protective gloves
   • Goggles
   • Appropriate respiratory protection 7, 1
3. Double-bag all waste materials and label as infectious 1

Disinfection Solutions

• Commercial household disinfectants (phenols, quaternary ammonium compounds, hypochlorite)
• Freshly prepared chlorine solution (1½ cups household bleach in 1 gallon of water) 7

Occupational Considerations

For individuals with frequent rodent exposure (pest control, forestry, agriculture):

1. Employers should provide:

   • Education about transmission and symptoms
   • Comprehensive medical screening and surveillance
   • Appropriate respiratory protection
   • Proper protective equipment 1

2. Post-exposure monitoring:

   • Monitor for 45 days after potential exposure
   • Seek immediate medical attention if febrile or respiratory illness develops
   • Inform healthcare providers of potential hantavirus exposure 1

Important Caveats

1. No person-to-person transmission has been documented for most hantaviruses (exception: some evidence for Andes virus) 5, 6

2. No licensed vaccine is available in many countries, including Germany 2

3. Rapid progression can occur in HPS despite the long incubation period (6-39 days), requiring high clinical suspicion 4

4. In western United States, use insect repellent containing DEET when handling rodents to prevent plague transmission from fleas 7