HANTAVIRUS PULMONARY SYNDROME UPDATE 2004 - THE AMERICAS (04)
In this update:
[1] Brazil - 3 cases and 2 deaths in Ribeirao Proto region
[2] USA - New Hampshire; 1st confirmed case
[3] USA - California; 1st 2 cases in San Diego County
http://eptv.globo.com/noticias/ {edited from spanish}
Brazil: 2 deaths Due to Hantavirus Infection Confirmed
On Thu 23 Sep 2004 the Epidemiologic Surveillance Unit of Ribeirao Proto confirmed 2 deaths due to hantavirus infection in the region. One of the cases occurred in Cravinhos, more than a month ago. The Secretary of
Health of the Municipality suspected that the case had been infected in the rural zone of Bonfim Paulista. In addition, there was a 2nd case identified from Jaboticabal in May 2004 who also died from hantavirus pulmonary syndrome. A 3rd case was reported in Batatais; this patient survived. The disease is transmitted by rodents and attacks the respiratory system.
[In summary; 3 cases of hantavirus pulmonary syndrome have occurred in this region since May 2004; 2 patients have died and a 3rd survived. It is not clear whether this reflects greater exposure to infection this year, or more efficient surveillance. Further information would be welcomed. -
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New Hampshire: Dartmouth College Employee Contracts Hantavirus Infection
A Dartmouth College employee has tested positive for hantavirus, a
non-contagious but potentially fatal respiratory disease carried by
rodents, the College announced on Thu 30 Sep 2004. The male employee is
believed to have contracted the disease after a stay in a Dartmouth-owned
cabin in the Second College Grant in late August. If it is confirmed that
the patient has hantavirus, it will be the 1st such case in New Hampshire,
and one of the few confirmed cases in New England. The New Hampshire
Department of Health and Human Services has not provided Dartmouth College
with the man's name, according to Outdoor Programs director Andrew Harvard.
Harvard declined to provide The Dartmouth with records detailing who stayed
in the cabin during August.
The cabin where the patient stayed and 2 other cabins in the Hellgate area
of the Grant have been closed for decontamination at the recommendation of
the state's Public Health Department and the U.S. Centers for Disease
Control and Prevention. The patient had reported seeing mouse droppings in
the cabin and touching a blanket with droppings on it. The cabin was in use
when the suspected case of hantavirus was discovered, and the residents
were relocated on Wed 29 Sep 2004 to cabins south of the area. Dartmouth
officials are currently contacting the approximately 350 people who have
stayed in the cabins since they opened in May 2004. The cabins are
primarily used by Dartmouth alumni, employees and their guests, and it has
been determined that no students stayed at the cabins during the Dartmouth
Outing Club freshman trips in early September.
The virus is spread when the droppings, urine and saliva of infected
rodents are aerosolized and inhaled. The disease's primary carrier is the
deer mouse, according to the CDC. Harvard said the Outing Club attempts to
control rodent populations in cabins with poison, but that it is difficult
to keep mice out of cabins. "As anyone with experience in the outdoors
knows, the tug of war between cabin users and mice is constant in the
outdoors," said Harvard.
The symptoms of hantavirus infection, which 1st appeared in the southwest
United States in 1993, generally appear approximately 2 weeks after contact
with the virus and can include fever, chills and vomiting. Extreme cases of
the virus can escalate into hantavirus pulmonary syndrome, which may result
in respiratory failure and death. No cure, vaccine, or treatment for the
disease currently exist, but early referral to an intensive care unit can
alleviate respiratory distress caused by the disease, according to the CDC.
The next steps of the inquiry depend on the outcome of the CDC's
investigation, said Harvard, but an assessment of other cabins in the Grant
is expected and Dartmouth will continue to work closely with State and
Federal Health Officials while monitoring the case. "We want to respond
very quickly to suggestions from the CDC and respond to needs of the
Dartmouth community," said Harvard. "Paramount concern is that there is a
new health risk in the area and [we] want to manage it and control it."
Health officials say they don't expect an outbreak in New Hampshire. "It's
a rare disease in the United States, and this is the 1st time its been seen
in the area," said Rachel Plotinsky, an epidemiologist for the New
Hampshire Department of Health and Human Services. "I wouldn't imagine it's
something we'll see too often."
[This is the 1st recorded case of hantavirus infection in New Hampshire.
Since the virus was discovered in the southeast of the United States in
1993, a total of 379 cases of hantavirus pulmonary syndrome has been
recorded (see: CDC, Special Pathogens Branch, Epidemiology of HPS web-site
http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/epislides/episls.htm Most cases have occurred in southeastern and western states, with 8 states
(Arizona, California, Colorado, Idaho, Montana, New Mexico, Utah and
Washington) accounting for 70 percent. In the northeast, single cases have
been recorded in Massachusetts, New York, Rhode Island and Vermont. Prior
to this report no case has been reported in Maine or New Hampshire. - Mod.CP]
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California: 1st 2 Cases of Hantavirus Infection in San Diego County
The rare and deadly disease, hantavirus pulmonary syndrome, has struck for
the 2nd time in San Diego County, public officials said on Fri 1 Oct 2004.
County officials said a 65-year-old San Diego man had become the 2nd person
to contract the disease locally.
Environmental health workers had found evidence of hantavirus in rodents in
some parts of the county in previous years. But no human cases had been
recorded in the county until this year. County Public Health Officer Dr.
Nancy Bowen said the man was "surviving," but that she could not give any
other information about him. In June a 32-year-old woman became the 1st
person to contract the disease in the county; she has since recovered.
The virus is carried in the feces, urine and saliva of rodents, deer mice
in particular, and is typically spread to humans when they breathe in the
infected matter after it dries into dust. Health officials say the virus
may also be spread by touching the mouth and nose after handling infected
rodents or contaminated objects.
County officials said the man was believed to have contracted the disease
in the Laguna Mountains in East County. Bowen said county environmental
health crews planned to begin testing for evidence of the virus in the
areas around where the man is believed to have been exposed, and that the
presence of the disease in the county was not to be taken lightly.
Hantavirus pulmonary syndrome kills 36 percent of all people who contract
the virus, according to the National Centers for Disease Control and
Prevention in Atlanta. Bowen said the 1st signs of the disease are, like
many other viral infections, similar to the flu: tiredness, fever and
muscle aches. But they also may include headache, dizziness, chills,
nausea, vomiting, diarrhea and abdominal pain. People in the later stages
of the disease will experience coughing, shortness of breath progressing to
severe difficulty in breathing -- and sometimes death.
The disease cannot be spread from person to person. Bowen said people are
most likely to contract the disease when cleaning around areas where
infected rodents have been. People stir up the infected particles into the
air and breathe them in. Because of that, Bowen said, people who live or
play in areas where rodents live should take extra care when cleaning. She
said people should wet down areas they're cleaning, and use bleach to
disinfect. CDC officials also recommend that people seal up holes in their
homes and to set traps to kill the mice. "Precautions really need to be
taken when you are cleaning up unused buildings or cabins out in rural
areas where deer mice are," Bowen said.