Overview
Hantaviruses are zoonotic viruses associated with two clinical syndromes: Hemorrhagic Haemmorhagic Fever with Renal Syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS; also called Hantavirus Cardiopulmonary Syndrome, HCPS). These syndromes differ in symptoms, geography, and virus species, with HPS linked primarily to Sin Nombre and Andes viruses found primarily in rodent hosts in South and North America. Argentina, Chile, Bolivia, Brazil and Paraguay are core endemic countries. Hantavirus is not endemic to South Africa; and recent cases occurred with travel-related exposures outside the country.
Transmission
In endemic regions, individuals who become exposed to the secretions/excreta of infected rodents can develop HPS. Less commonly, persons may become infected following a bite or scratch from an infected rodent. Persons at high risk of infection include farmers, forestry workers, construction workers and people who clean or occupy rodent-infested buildings. Person-to-person transmission is uncommon, except for hantavirus infections associated with close contact in healthcare facilities and households and involving the Andes virus.
Clinical Presentation
Early symptoms (prodrome phase) include fever, fatigue, muscle aches, headache, dizziness, chills, nausea, vomiting, diarrhoea, and abdominal pain in the first 3 to 5 days. The cardio-pulmonary phase can progress rapidly (within hours) with coughing, shortness of breath, pulmonary oedema and shock developing as the disease progresses. Common differential diagnoses of suspected cases of HPS include (but are not limited to) influenza, COVID-19, RSV, Legionnaire’s disease, mycoplasma and severe community-acquired pneumonia.
Diagnosis
HPS is diagnosed based on clinical presentation, exposure/travel history, and laboratory testing. In South Africa, laboratory testing for suspected cases of HPS is conducted at the National Institute for Communicable Diseases, and the tests offered include serology (IgM/IgG antibodies) and PCR. See laboratory guidance for submission of samples HPS lab guidance.
Notification
A suspected case of HPS should be reported promptly on the Notifiable Medical Conditions Surveillance System as a novel respiratory pathogen (Category 1).
A suspected case is any person with:
- Acute respiratory illness (fever + cough or dyspnoea) or unexplained cardiopulmonary compromise
AND - Exposure within 6 weeks to any of the following:
- Passenger or crew member on the cruise ship
- Passenger or crew on the implicated commercial flight
- Airport or airline staff linked to the flight
- Healthcare worker or facility contact with the index case
- Close contact (household or social) of any symptomatic traveller
Treatment
There is no specific antiviral treatment for HPS, and management is supportive and may include hospitalisation, mechanical ventilation, and intensive care. Early recognition and treatment may improve outcomes.
Prevention
In endemic countries, prevention focuses on reducing exposure to rodents and using protective equipment when necessary. Since most hantaviruses that cause HPS are not readily transmissible from person-to-person, no other precautions are recommended, and for patients with HPS, isolation precautions may not be required. In the case of the Andes virus, however, patients diagnosed with HPS should be isolated with droplet precautions and careful handling of respiratory secretions.
For more information about Hantavirus Pulmonary Syndrome, click here.
