Successful Implementation of a Rapid Screening Tool for Hantavirus Cardiopulmonary Syndrome: 5 Years of Experience From a Community Hospital in an Endemic Region

OBJECTIVES

Hantavirus is endemic in the Four Corners region of Arizona, Colorado, New Mexico, and Utah, and hantavirus cardiopulmonary syndrome (HCPS) disproportionately affects the Navajo Nation. We describe the application of a rapid screening tool for identification of HCPS.

METHODS

A rapid screening tool for HCPS was implemented at Tséhootsooí Medical Center (TMC) in collaboration with academic partners.

RESULTS

Since its implementation in 2016, 20 TMC staff members have been trained to perform this test, and 189 screens for HCPS have been reported. Although hantavirus infection is rare even in high-risk areas, use of this tool resulted in the identification of 4 acute cases of hantavirus infection.

CONCLUSIONS

The results demonstrate the successful implementation of a 5-point screening tool for hantavirus infection in an endemic setting by a laboratory in a small community hospital.

Hantavirus Disease and COVID-19

OBJECTIVES

Navajo Nation is disproportionately affected by hantavirus cardiopulmonary syndrome (HCPS), a severe respiratory disease that can quickly progress to respiratory failure and cardiogenic shock. The initial signs and symptoms of HCPS are indistinguishable from coronavirus disease 2019 (COVID-19). However, this distinction is critical, as the disease course differs greatly, with most patients with COVID-19 experiencing mild to moderate illness. We set out to determine if the evaluation of peripheral blood smears for five hematopathologic criteria previously identified as hallmarks of hantavirus infection, or "the hantavirus 5-point screen," could distinguish between COVID-19 and HCPS.

METHODS

The hantavirus 5-point screen was performed on peripheral blood smears from 139 patients positive for COVID-19 seeking treatment from Tséhootsooí Medical Center and two Emory University hospitals.

RESULTS

Of these 139 individuals, 136 (98%) received a score of 3/5 or below, indicating low suspicion for HCPS. While thrombocytopenia, one of the key signs of HCPS, was seen in the patients with COVID-19, it was generally mild and remained stable on repeat specimens collected 12 to 24 hours later.

CONCLUSIONS

Given these findings, the 5-point screen remains a useful rapid screening tool for potential HCPS cases and may be useful to distinguish early HCPS from COVID-19 in HCPS endemic regions.