Hantavirus Outbreaks in Latin America

Recently, severe or fatal hantavirus infections were reported in two Latin American countries. In Herrera Province, Panama, four cases were identified, with one fatality. Cardiopulmonary syndrome, a severe manifestation of hantavirus infection, occurred in three of these patients¹. Two cases were also reported in Concepción Province, Chile. Both patients were hospitalized².

Hantaviruses are negative-sense, single-stranded RNA viruses transmitted from rodents to people. Illness among soldiers during the Korean war during the 1950s brought attention to these infections. Hantavirus infections have been reported in Europe, Asia, and the Americas. These infections initially present with flu-like symptoms. In Europe and Asia, severe infections commonly manifest as hemorrhagic fever with renal syndrome (HFRS), characterized by blood pressure disturbances (hypotension followed by hypertension), bleeding and kidney injury. Fatality rates range from <1% to 15%, depending on the virus. Recovery from HFRS can last for months. Renal and cardiovascular sequelae can persist. In the Americas, severe infections present with hantavirus cardiopulmonary syndrome (HCPS), which can manifest with the accumulation of fluid in the lungs, hypotension, and in some cases, cardiogenic shock. Fatality rates range from 30% to 50%. Despite weakness during the recovery phase, patients generally do not have sequelae³.

Hantavirus cases are identified by a combination of compatible symptoms and laboratory evidence. Both HFRS and HCPS can present with fever, chills, myalgia, headache, and gastrointestinal symptoms. However, evidence of pulmonary edema distinguishes HCPS from HFRS. Tests for hantavirus-specific antibodies, antigens, and nucleic acids can provide laboratory evidence of infection^4,5. Hantavirus infections are largely treated with supportive care to maintain cardiovascular, renal, and pulmonary function. Administration of ribavirin within 5 days of the development of symptoms may reduce renal disease in cases of HFRS³.

Reducing the interaction between rodents and humans in and around dwellings is a mainstay of hantavirus infection prevention. Transmission is common by the inhalation of aerosols from rodent urine, feces, or saliva. These exposures can occur during crop harvesting or performing work, such as cleaning, in poorly ventilated spaces. Vaccines for the prevention of hantavirus infection are available in Korea and China. No vaccines have been approved for use in the United States nor Europe³.

 References