Sin nombre hantavirus disease in a ten-year-old boy and his mother

Hantavirus pulmonary syndrome in children: case report and case series from an endemic area of Brazil

Hantavirus Cardiopulmonary Syndrome (HCPS) is an important emergent zoonosis associated with wild rodents in Brazil, where this viral infection in children is generally rare. We present HCPS in a child from the Pantanal Biome and a review of all reported pediatric cases in Mato Grosso State, an endemic area for HCPS in Brazil. The investigation used the Information System for Notifiable Diseases database (SINAN). A 12-year-old boy was hospitalized with fever and respiratory failure and hantavirus IgM and IgG antibodies were detected by ELISA in serum samples. During the period of 1999 to 2016, 32 HCPS pediatric cases confirmed by serology were reported to SINAN with a mortality rate of 34.4%. The possibility of hantavirus infection in children with acute febrile illness associated with respiratory failure should be considered mainly in recognized endemic areas as Mato Grosso State, contradicting a hypothesis that children are more protected from lung involvement.

Hantavirus infections among overnight visitors to Yosemite National Park, California, USA, 2012

TOC summary: A rare hantavirus outbreak reaffirms the need for control of deer mice and public awareness of the risks posed by contact with them.

In summer 2012, an outbreak of hantavirus infections occurred among overnight visitors to Yosemite National Park in California, USA. An investigation encompassing clinical, epidemiologic, laboratory, and environmental factors identified 10 cases among residents of 3 states. Eight case-patients experienced hantavirus pulmonary syndrome, of whom 5 required intensive care with ventilatory support and 3 died. Staying overnight in a signature tent cabin (9 case-patients) was significantly associated with becoming infected with hantavirus (p<0.001). Rodent nests and tunnels were observed in the foam insulation of the cabin walls. Rodent trapping in the implicated area resulted in high trap success rate (51%), and antibodies reactive to Sin Nombre virus were detected in 10 (14%) of 73 captured deer mice. All signature tent cabins were closed and subsequently dismantled. Continuous public awareness and rodent control and exclusion are key measures in minimizing the risk for hantavirus infection in areas inhabited by deer mice.

Hantavirus pulmonary syndrome clinical findings: evaluating a surveillance case definition

Clinical cases of hantavirus pulmonary syndrome (HPS) can be challenging to differentiate from other acute respiratory diseases, which can lead to delays in diagnosis, treatment, and disease reporting. Rapid onset of severe disease occurs, at times before diagnostic test results are available. This study's objective was to examine the clinical characteristics of patients that would indicate HPS to aid in detection and reporting. Test results of blood samples from U.S. patients suspected of having HPS submitted to the Centers for Disease Control and Prevention from 1998-2010 were reviewed. Patient information collected by case report forms was compared between HPS-confirmed and test-negative patients. Diagnostic sensitivity, specificity, predictive values, and likelihood ratios were calculated for individual clinical findings and combinations of variables. Of 567 patients included, 36% were HPS-confirmed. Thrombocytopenia, chest x-rays with suggestive signs, and receiving supplemental oxygenation were highly sensitive (>95%), while elevated hematocrit was highly specific (83%) in detecting HPS. Combinations that maximized sensitivity required the presence of thrombocytopenia. Using a national sample of suspect patients, we found that thrombocytopenia was a highly sensitive indicator of HPS and should be included in surveillance definitions for suspected HPS. Using a sensitive suspect case definition to identify potential HPS patients that are confirmed by highly specific diagnostic testing will ensure accurate reporting of this disease.

Performance indicators for response to selected infectious disease outbreaks: a review of the published record

The purpose of this study was to determine whether published reports of infectious disease outbreaks could serve as a source of evidence for public health practice, particularly in responding to bioterrorism. Such performance indicators are measures of practice and process that lead to optimal health outcomes. We collected data from 116 individual articles that described 59 outbreaks of eight different pathogens with potential for bioterrorist use. Analysis of these reports determined whether they addressed 12 process indicators and four outcome indicators--each generally recognized as a component of effective outbreak response. The results showed that outbreak reports typically included information about these process and outcome indicators, thus validating their practical importance. However, few reports had been written with specificity to document the chronology of outbreak response, or the dissemination of information to protect healthcare workers, or the communication with law enforcement and emergency operations that are important in response to bioterrorism. We conclude that the published record of infectious disease outbreaks can, in the future, be used as a source for practice-based evidence if agreed-upon measures for effective performance become standard components of outbreak reports.

Infection with Sin Nombre hantavirus: clinical presentation and outcome in children and adolescents

OBJECTIVE

Sin Nombre hantavirus (SNV) is the leading causative agent of hantavirus cardiopulmonary syndrome (HCPS) in the United States and Canada. Relatively few cases of HCPS have involved children. This report describes the clinical characteristics of a series of pediatric cases of SNV infection in the United States and Canada from 1993 through March 2000.

METHODS

We analyzed clinical and laboratory data on 13 patients who were </=16 years old with SNV infection from 1993 through March 2000 identified from a database at the University of New Mexico.

RESULTS

The patients ranged from 10 to 16 years of age, with a median of 14. Fifty-four percent were female. Fifty-four percent were Native American. The most common prodromal symptoms were fever, headache, and cough or dyspnea (100%); nausea or vomiting (90%); and myalgia (80%). The most common physical findings at admission were tachypnea (67%) and fever (56%); hypotension was seen in 33% of patients. On admission, all patients manifested thrombocytopenia (median platelet count: 67 000/mm(3)) and elevated lactate dehydrogenase (median level: 1243 IU/L), and >85% of patients had elevated levels of serum aspartate aminotransferase, alanine aminotransferase, and hypoalbuminemia. Leukocytosis and hemoconcentration were seen in less than one third of patients at admission. HCPS developed in 12 of the 13 patients (92%), and 4 of those 12 died (33% case-fatality ratio). The majority of HCPS patients (8 of 12 [67%]) were critically ill and required mechanical ventilation. Extracorporeal membrane oxygenation was used in 2 patients, 1 of whom survived. An elevated prothrombin time (>/=14 seconds) at admission was predictive of mortality.

CONCLUSIONS

Infection with SNV in children and adolescents causes HCPS with a clinical course and mortality rate similar to that described in adults. We believe that early recognition of HCPS in children and adolescents and appropriate referral to tertiary care centers that are experienced with HCPS are important in reducing mortality.

Hantavirus pulmonary syndrome: at the crossroads

The initial identification in 1993 of hantavirus pulmonary syndrome as a novel, highly fatal respiratory illness among American Indians in the southwestern USA in 1993 opened the window to the recognition of a well-established pan-American zoonosis with a myriad of causative viruses and rodent vectors, although all are New World hantaviruses among New World sigmodontine rodents. The clinical spectrum of symptoms has also been expanded to include asymptomatic infection through to fulminant hemorrhagic fever. Although the use of ribavirin, an antiviral drug, was disappointing in an early, open-labeled trial, early detection and supportive care is much better refined. However, much work remains in probing the pathogenesis of this syndrome to help define and explore therapeutic options and the mechanism of person-to-person transmission with Andes virus, one of the viruses that cause hantavirus pulmonary syndrome. Current remote sensing efforts and longitudinal ecologic investigations need to be expanded in order to focus prevention efforts better.