What do we want know about Hantavirus Pulmonary Syndrome (HPS)?

1. What do we want know about Hantavirus Pulmonary Syndrome (HPS)? Susan Redwood PUBH 6165 Walden University

2. A global public health problem

3. Stakeholders • Community members • Immunocompromised patients including those with HIV/AIDS, cancers and other blood borne diseases • Government at all levels (local, state, national) • Healthcare facilities (Clinics, hospitals, nursing home, group home etc) • Education institutions (primary schools, colleges, universities, libraries) • Community centers • CDC, EPA, FDA, WHO

4. Stakeholders contd. • Landlords and people who live in poor and overcrowded environment • Local businesses (restaurants, shopping malls, place of employment) • Homeless shelters • Mass media (Internet, TV, Radio, Twitter, Face book, Cell phones) • Doctors office • Churches

5. Should you be afraid of a mouse in your house?

6. What is Hantavirus Pulmonary Syndrome? • A severe and sometimes fatal respiratory disease in humans caused by infection with a hantavirus. • Lipid-enveloped, spherical viruses approximately 80-110 in diameter • From Bunyaviridae family with 3 RNA segment (small, medium, large which encode • Viral nucleocapsid (N) • Glycoproteins (G1and G2) • RNA polymerase (Pol) (Skehan,n.d.)

7. Molecular Structure (Infection landscape, 2012)

8. History • First discovered in Asia during the Korean War • Virus was not isolated until 1976 • Classified under its own genus "hantavirus” • First American outbreak occurred in May of 1993 among healthy members of the Navajo Nation in New Mexico whodied within a short period of time (Hantavirus info, 1998)

9. Etiology • Deer mouse • White-tailed mouse • Cotton rat • Rice rat

10. How is the virus transmitted

11. Cases reported by race • Caucasians 78% • American Indians 18% • African Americans 2% • Asian 1% (CDC, 2014)

12. Diagnosis • Physical examination difficult to diagnose in early stage because symptoms mimic influenza • Serological testing immunofluorescent antibody test (IFA), enzyme-linked immunosorbent assays (ELISA), immunoblotting and virus neutralization • Obtain tissue samples for antigens with immunohistochemistry • Chest X-Ray • Pulse oximetry to measure oxygen saturation (Cfsph, 2009)

13. Early Signs and Symptoms • Fatigue • Fever • Muscle aches • Headache • Dizziness • Chills • Nausea • Vomiting • Diarrhea • Abdominal pain (Health crafter, 2013)

14. Late Signs and Symptoms • Cough • Shortness of breath with or without chest tightness • Fluid filled lungs http://www.cdc.gov/hantavirus/technical/hps/clinical-manifestation.html

15. Complications • Acute Respiratory Distress Syndrome (ARDS) • Kidney failure • Hypoxia • Hypotension • Death http://media.victoriaadvocate.com/img/photos/2013/09/28/hanta_virus_ew_092913_04_221015.jpg

16. Treatment • Confirmed diagnoses admission to hospital • Intravenous fluids • Medication administration • Oxygen • Ventilator support for respiratory complication

17. Prevention • No vaccine available at present • Avoid contact with rodents in home, worksite, camp, barn, shed • Seal gaps and holes • Set uprodent traps • Keep all area clean and free of food • Use gloves and mask for contact with rodents • Avoid the use of vacuum for rodent debris • Decontaminate surface areas with detergent and bleach solution

18. Challenges • Prognosis is fair to poor: • Misdiagnosis • Recovery rate 62% • Mortality rate 38% • Prolonged hospitalization • Poverty • Lack of or inadequate access to medical care http://www.cdc.gov/hantavirus/surveillance/annual-cases.html

19. Future Research • Combine ecology and change in other host-virus ecosystems via modeling and hypothesis-driven research • Concentrate on risk ofexposure, multidirectional transmission, and human disease (Johnson, Figueiredo, &Vapalahti, 2010) (CDC, 2012)

20. The future of vaccination (Medcity News, 2012)

21. References • Centers for Disease Control and Prevention. (2012). Hantavirus. Retrieved from http://www.cdc.gov/hantavirus/technical/hanta/ecology.html • Centers for Disease Control and Prevention. (2013). CDC, Hantavirus Pulmonary Syndrome. Retrieved from http://www.cdc.gov/hantavirus/hps/index.html • Centers for Disease Control and Prevention. (2014). Reported cases of HPS. Retrieved from http://www.cdc.gov/hantavirus/surveillance/index.html • Center for Food Security and Public Health. (2009). Hantavirus. Retrieved from http://www.cfsph.iastate.edu/Factsheets/pdfs/hantavirus.pdf • Hantavirusinfo. (1998). Basic facts about HPS and the hantivirus. Retrieved from http://www.hantavirus.net/info1.html • Healthcrafter. (2013). Step to avoid hantivirus outbreak. Retrieved from http://healthcrafter.net/steps-to-avoid-hantavirus-outbreak/3069 • Hepojoki,J., Strandin,T., Lankinen,H., & Vaheri,A. (2012). Hantavirus structure—molecular interactions behind the scene. Journal of General Virology, 93(8), 1631-44. • Infection Landscape. (2012). Hantaviruses. Retrieved from http://www.infectionlandscapes.org/2012/09/hantaviruses.html

22. References • Johnson,C., Figueiredo, L., & Vapalahti, A. (2010). A global perspective on hantavirus ecology, epidemiology and disease. Clinical Microbiology Reviews, 23(2), 412-441. • Mayo Clinic. (2014). Hantavirus pulmonary syndrome cause- disease and conditions. Retrieved from http://www.mayoclinic.org/diseases-conditions/hantavirus-pulmonary-syndrome/basics/causes/con-20030129 • Medcity News. (2012). Cross-kingdom vaccine may protect against fungal and bacterial infection. Retrieved from http://medcitynews.com/2012/05/cross-kingdom-vaccine-may-protect-against-fungal-and-bacterial-infections/ • Skehan, E. (n.d). Hantavirus Pulmonary Syndrome (HPS). Retrieved from http://www.austincc.edu/microbio/2421c/hps.htm • Worthy, S. (2009). Earth end: New beginning. Retrieved from http://www.earthend-newbeginning.com/page/32/