Hantavirus Pulmonary Syndrome Investigation Disease History

Hantavirus Pulmonary Syndrome Investigation

Disease History • First officially diagnosed in in U. S. in 1993 in “Four Corners”of the Southwest • Not a New Illness – Indian legends describe an illness with the same symptoms as HPS and associated it with mice.

Transmission • Aerosol transmission virus is found in the droppings and urine of infected rodents • Person to Person transmission has not been seen in the U. S.

The Deer Mouse The Cotton Rat The Rice Rat The White Footed Mouse

Symptoms OCCUR WITHIN ONE TO FIVE WEEKS AFTER EXPOSURE Initial Symptoms can be: Approximately four to ten days after the onset of the • Fever, initial symptoms late • Fatigue symptoms may appear. • Muscle aches especially in These include: the back, hips and shoulders • Coughing, • Headache • Shortness of breath with a • Dizziness feeling of tightness around • Chills the chest. • Nausea, vomiting • Abdominal pain.

Clinical Case Definition • Febrile illness (temp>101) characterized by bilateral diffuse interstitial pulmonary edema resembling ARDS and requiring supplemental oxygen within 72 hours of hospitalization

The Investigation

What We knew • Otherwise healthy 35 • Cats at home, one of year old male admitted which died short time with acute abdominal before illness pain. Developed a • Computer draftsman fever who worked in • Underwent exploratory architecture surgery • Developed ARDS postoperatively requiring ventilator support

Interview Questions • Had he traveled to Southwest recently • Had he received any shipments from Southwest • Had he been camping, fishing, or hunting • If yes had he been in a camper that had been closed up for a while • Had they seen mice around the outside of the house since late summer • Had the cats been seen with dead mice

Interview Questions • Had they seen evidence of mice inside house • Had he spent time in the basement of buildings in his work • Had he done work in fields, barns, or sheds • Had he been on a construction site recently? Where? • Had anyone else at home or work had a similar illness

The Environmental Investigation • Were there nesting sites in the wood pile or the area where it had been? • Were there potential food sources around the yard? – Pet food in bowls? – Uncovered trash cans close to the house? • Was there vegetation close to the house? • Were there open places in the foundation where rodents may have entered the house?

The Environmental Investigation • Were there rodents around the house? • Were there signs of rodents –Droppings –Gnawed areas –Nesting sites –Run areas, oil or dirt on surfaces –Openings in walls, floors or ground surfaces