Hantavirus Pulmonary Syndrome

1. Hantavirus Pulmonary Syndrome Investigation

2. Disease History • First officially diagnosed in in U.S. in1993 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.

3. 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.

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

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

6. 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

9. The Investigation

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

11. 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

12. 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

14. 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?

15. 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