What is the treatment and prevention for Hantavirus infection?

Hantavirus: Treatment and Prevention

Treatment

There is no FDA-approved antiviral treatment or vaccine for hantavirus infection; management is entirely supportive with intensive care monitoring and aggressive cardiopulmonary support. 1, 2

Immediate Supportive Care

• Secure the airway immediately if the patient demonstrates CNS depression, loss of protective reflexes, or respiratory compromise 3
• Establish hemodynamic support and correct critical vital signs before pursuing other interventions 3
• Avoid aggressive fluid administration due to the high risk of worsening noncardiogenic pulmonary edema—this is a critical pitfall that can accelerate decompensation 1, 4
• Do not use gastrointestinal decontamination (activated charcoal, ipecac, or gastric lavage) as these provide no benefit for viral infections and delay definitive care 3

Intensive Care Management

• Rapid ICU admission is mandatory as the cardiopulmonary phase can progress to catastrophic decompensation within hours 1
• Mechanical ventilation is frequently required for acute respiratory distress syndrome 1, 4
• Vasoactive agents for hemodynamic support in the cardiopulmonary phase 1
• Extracorporeal mechanical ventilation (ECMO) may be necessary in severe cases 1
• Monitor for metabolic derangements requiring immediate correction 3

Specific Complications

• Perform EEG monitoring for non-convulsive seizures in patients with altered mental status 3
• Administer benzodiazepines for seizures or agitation, particularly if intracranial hemorrhage develops 3

Experimental Therapies

• Ribavirin has been investigated but remains experimental with limited evidence of efficacy 2, 4
• Multiple antivirals show in vitro activity but lack conclusive human clinical trial data 2
• Immunotherapy studies have not been conclusive 2

---

Prevention

Prevention relies entirely on rodent control and avoiding exposure to rodent excreta, as no vaccine is available in the United States or Europe. 2, 5

Environmental Rodent Control

Inside the Home

• Keep all food and water covered and stored in rodent-proof containers 6, 7
• Store pet food in rodent-proof containers and remove excess food after each meal 6
• Dispose of trash frequently in rodent-proof containers 6, 7
• Eliminate clutter and keep items off floors to prevent rodent nesting 6, 7
• Repair water leaks and insulate cold water pipes to deny rodents access to moisture 6
• Use spring-loaded traps with peanut butter (pea-sized amount) placed perpendicular to baseboards 6, 7
• Continue trapping for at least 1 week after the last rodent is caught 6

Outside the Home

• Seal all entry holes >¼-inch (>6 mm) in diameter using cement, wire screening, hardware cloth, or steel wool with caulk 6
• Inspect and seal gaps around windows, doors, foundations, utility lines, pipes, vents, and roof areas 6
• Construct hardware cloth barriers (14-inch wide, <¼-inch mesh) around foundations if rodent burrows are present, buried 2 inches below ground 6
• Consult pest-control professionals for severe or persistent infestations 6

Safe Cleanup Procedures

Standard Cleanup

• Ventilate closed buildings for at least 30 minutes before entering by opening doors and windows with cross ventilation 6, 3
• Wear rubber, latex, vinyl, or nitrile gloves during all cleanup activities 6, 7, 3
• Spray all rodent droppings, urine, nests, and dead rodents with disinfectant or 1:10 bleach solution until thoroughly soaked before handling 6, 7, 3
• Never vacuum or sweep contaminated areas until after disinfection, as this aerosolizes infectious particles 6, 3
• Use paper towels to pick up disinfected materials, then disinfect all potentially contaminated surfaces 6, 7
• Double-bag all contaminated materials in plastic bags and dispose by burying 2-3 feet deep, burning, or placing in regularly emptied covered trash 6, 3

Heavy Rodent Infestations

• Contact local or state public health agencies for guidance before cleanup 6, 3
• Workers must wear coveralls (disposable if possible), rubber boots, protective goggles, and appropriate respiratory protection (N-100 or P-100 filters) 6, 3
• Decontaminate or safely dispose of personal protective gear at the end of each day 6
• Launder contaminated clothing on-site or immerse in liquid disinfectant until washing is possible 6

Occupational Precautions

• Workers frequently exposed to rodents (mammalogists, pest-control workers, farm workers, building inspectors) require enhanced precautions 6
• Employers must provide comprehensive medical screening including respirator clearance, baseline evaluation, and periodic examination 6
• On-call medical services should be available for 45 days after last potential exposure 6
• Workers developing febrile or respiratory illness within 45 days must immediately seek medical attention and inform physicians of hantavirus exposure risk 6, 3
• Physicians must contact local public health authorities promptly if hantavirus infection is suspected, and blood samples should be forwarded to state health departments for antibody testing 6

Special Considerations

• In western United States, use DEET-containing insect repellent on clothing, shoes, and hands when handling dead rodents to prevent plague transmission from fleas 6
• Use insecticide before trapping in areas with heavy indoor rodent infestations in plague-endemic regions 6

---

Critical Pitfalls

• Do not delay supportive care while awaiting diagnostic confirmation—treatment must begin immediately based on clinical presentation 1
• Avoid aggressive fluid resuscitation as this worsens pulmonary edema and accelerates respiratory failure 1, 4
• Never vacuum or sweep before disinfection as this creates infectious aerosols 6, 3
• Maintain high clinical suspicion in patients with severe respiratory symptoms and rodent exposure or rural/wilderness travel, especially during summer and early fall 1