What are the first symptoms of hantavirus

• For the pulmonary syndrome, oxygen and drugs to stabilize blood pressure

• For the renal syndrome, dialysis and ribavirin

Treatment of hantavirus infection is mostly supportive.

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What is hantavirus?

Hantaviruses are a group of viruses that are carried by rodents. One of them, Sin Nombre virus, is found in deer mice in North America. Sin Nombre virus is the cause of Hantavirus Pulmonary Syndrome (HPS) in people.

Hantavirus in Washington State

Hantavirus-infected deer mice (Peromyscus maniculatus) can excrete the virus in their urine, saliva, and droppings. Infected deer mice live throughout the state and people are at risk for HPS in any part of Washington. Deer mice pass the virus to each other and some of the population is usually infected, but deer mice do not get sick or have any symptoms.

A person may be exposed to hantavirus by breathing contaminated dust after disturbing or cleaning rodent droppings or nests, or by living or working in rodent-infested settings. Typically one to five cases are reported each year and about one out of three people diagnosed with HPS have died.

Hantavirus Cases and Deaths in Washington State

How do I prevent Hantavirus pulmonary syndrome?

Keep rodents out of your home and workplace. Always take precautions when cleaning, sealing and trapping rodent-infested areas.

Seal up cracks and gaps in buildings that are larger than 1/4 inch including window and door sills, under sinks around the pipes, in foundations, attics and any potential rodent entry point.

• Trap indoor rats and mice with snap traps.
• Remove rodent food sources. Keep food (including pet food) in rodent proof containers.

Clean up rodent infested areas:

• Wear rubber, latex, vinyl or nitrile gloves. Note that dust mask may provide some protection against dusts encountered during cleaning, but does not protect against viruses.
• Do not stir up dust by vacuuming, sweeping, or any other means.
• Thoroughly wet contaminated areas including trapped mice, droppings, and nests with a 10% hypochlorite (bleach) solution: Mix 1½ cups of household bleach in 1 gallon of water (or 1 part bleach to 9 parts water). Once everything is soaked for 10 minutes, remove all of the nest material, mice or droppings with damp towel and then mop or sponge the area with bleach solution.
• Steam clean or shampoo upholstered furniture and carpets with evidence of rodent exposure.
• Spray dead rodents with disinfectant and then double-bag along with all cleaning materials. Bury, burn, or throw out rodent in appropriate waste disposal system.
• Disinfect gloves with disinfectant or soap and water before taking them off.
• After taking off the clean gloves, thoroughly wash hands with soap and water (or use a waterless alcohol-based hand rub when soap is not available).
• For more tips on cleaning up rodent debris, visit our rodents page.

What precautions should I use working, hiking, or camping outdoors?

• Avoid coming into contact with rodents and rodent burrows or disturbing dens.
• Air out cabins and shelters, then check for signs of rodent infestation. Do not sweep out infested cabins. Instead, use the guidelines above for disinfecting cabins or shelters before sleeping in them.
• Do not pitch tents or place sleeping bags near rodent droppings or burrows.
• If possible, do not sleep on the bare ground. Use tents with floors or a ground cloth.
• Keep food in rodent-proof containers!
• Handle trash according to site restrictions and keep it in rodent proof containers until disposed of.
• Do not handle or feed wild rodents.

How are people commonly exposed?

Any activity that puts you in contact with deer mouse droppings, urine, saliva, or nesting materials can place you at risk for infection. There is no evidence that the disease spreads from one person to another.

Can dogs and cats get hantavirus?

There's evidence that animals, notably dogs and cats can be infected by hantavirus, however they do not get sick or have any symptoms. Dogs and cats are most likely exposed to the virus when preying on infected deer mice. Though dogs and cats can't spread hantavirus directly to other animals or people, they could put people at risk by bringing infected rodents into homes or places where exposure to rodent excretions may occur.

What are the symptoms of Hantavirus Pulmonary Syndrome?

Symptoms begin one to eight weeks after inhaling the virus and typically start with 3-5 days of illness including fever, sore muscles, headaches, nausea, vomiting, and fatigue. As the disease gets worse, it causes shortness of breath due to fluid filled lungs. Hospital care is usually required. It is serious disease and about one out of three people diagnosed with HPS have died.

What should I do if I think I have been exposed to hantavirus?

If you have been exposed to deer mice mice or mice-infested buildings and have symptoms of fever, muscle aches, and severe shortness of breath, see your health care provider immediately. Inform your health care provider of possible deer mouse exposure so that he/she is alerted to the possibility of rodent-borne diseases, such as hantavirus pulmonary syndrome.

What does the deer mouse look like?

The deer mouse is about six inches long from the nose to the tip of its tail. It is grayish to light brown on top, with large ears, a white belly, and a furry tail that is white on the underside. There are many other types of mice in Washington that don't have those features.

How long does hantavirus remain infectious in the environment?

The length of time hantaviruses can remain infectious in the environment is variable and depends on environmental conditions, such as temperature and humidity, whether the virus is indoors or outdoors or exposed to the sun, and even on the mouse's diet (which would affect the chemistry of its urine). The bottom line is that you can't tell how old a dropping is, so all rodent droppings should be handled as if they are infectious. Areas with ongoing rodent infestation are particularly risky and the recommendations for prevention should be followed.

More Information

Hantavirus and hantavirus pulmonary syndrome (HPS) facts

• Hantaviruses are RNA viruses transmitted to humans by rodents (rodent-borne).
• Hantavirus pulmonary syndrome also referred to as HPS, is a disease in which, in the late stage of infection with a hantavirus subtype.
• Early symptoms of hantavirus infections (fatigue, fever, muscle aches) are not caused by anything specific.
• Signs and symptoms of HPS as it spreads throughout the body include;
  • lung congestion,
  • fluid accumulation in the lungs, and
  • shortness of breath.
• Besides, some hantaviruses can cause hemorrhagic fever with renal syndrome (HFRS) as the disease progresses.
• Health officials first identified hantavirus in an outbreak in 1993 in the "Four Corners" area of the southwestern United States. Hantavirus is spread to humans by particles of;
  • rodent urine,
  • feces,
  • saliva, and
  • airborne particles containing these excretions. 
• The 2012 outbreak of hantavirus at Yosemite National Park was due to deer mice that transferred the virus to humans.
• So far, the transmission of hantavirus in the US has not transferred from human-to-human contact.
• Hantavirus is not contagious in North America.
• In South America, some investigators suggest hantavirus there may be contagious.
• It takes about one to five weeks (incubation period) for the signs and symptoms of hantavirus pulmonary syndrome to begin.
• About 38% of hantavirus infections are fatal (mortality rate).
• Lung capillaries leak fluid into the lung tissue, which causes hantavirus.
• Doctors usually diagnose HPS infections based on hantavirus lung symptoms are associated with rodents or probable contact with rodent-contaminated airborne dust, and chest X-rays provide additional evidence, but definitive diagnosis is usually done at a specialized lab or the U.S. Centers for Disease Control and Prevention (CDC).
• There is no specific treatment, vaccine, or cure for hantavirus pulmonary syndrome.
• Usually, treatment is in an intensive care facility and often require respiratory support (intubation and mechanical ventilation).
• Special doctors usually care for people with hantavirus infections.
• Risk factors are any association with rodents and their airborne body excretions.
• If a person with HPS survives, there are usually no long-term complications.
• Prevention of HPS centers on avoiding rodent contamination.
• There is no vaccine available to prevent hantavirus infection or pulmonary syndrome.
• There is no cure for hantavirus pulmonary syndrome.

The flu (influenza) is a viral disease of the respiratory tract. Characteristic symptoms are

• fever,
• chills,
• cough,
• malaise, and
• headache.

Other symptoms can occur, like

• nausea and vomiting,
• muscle or body aches,
• tiredness and fatigue,
• appetite loss,
• sore throat, and
• diarrhea.

Read about other flu symptoms »

What is hantavirus and pulmonary syndrome (HPS)?

The term hantavirus represents several groups of RNA-containing viruses (that are members of the virus family of Bunyaviridae) that are carried by rodents and can cause severe respiratory infections termed hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS).

HPS is found mainly in the Americas (Canada, U.S., Argentina, Brazil, Chile, Panama, and others) while hemrrhatic fever with renal syndrome (HFRS) is found mainly in Russia, China, and Korea but may be found in Scandinavia and Western Europe and occasionally in other areas.

Like HPS, HFRS results from hantaviruses that are transmitted by

• rodent urine,
• rodent droppings, or
• saliva (rodent bite), by direct contact with
• the animals
• by aerosolized dust contaminated with rodent urine or feces to human skin breaks or to mucous membranes of the mouth, nose, or eyes.
• The vast majority of HPS and HFRS infections do not transfer from person to person.

The goal of this article is to discuss HPS; however, much of what is presented about HPS applies to HFRS -- the main difference is that the predominant symptoms in the late stages of disease vary somewhat between the two diseases (lung fluid and shortness of breath in HPS and low blood pressure, fever, and kidney failure in HFRS).

HPS is a disease caused by hantavirus that results in human lungs filling with fluid (pulmonary edema) and causing death in about 38% of all infected patients.

What are the early symptoms and signs of HPS?

The symptoms and signs of HPS fall into early and late stages.

Early HPS signs and symptoms begin about one to five weeks after the person contacts hantavirus associated with rodent urine, feces, or saliva. The early symptoms are flu-like, last about four to 10 days, and include

• ffatigue,
• fever, and
• muscle aches, especially large muscles in the legs, back, and hips).

Almost every infected person develops these symptoms. Other symptoms of HPS that may occur in about half of infected patients include

Early symptoms of can cause diagnostic confusion. In 2018, Kiley Lane, a 27-year-old mother who lived in New Mexico, was diagnosed as having the flu but her symptoms got worse. She was diagnosed with having hantavirus about a month after her flu diagnosis and died about one month later of the disease.

Late symptoms of HPS occur about four to 10 days after the early symptoms and include;

• coughing,
• chest pain, and
• shortness of breath that can become severe.

Some infected people may develop hemorrhagic fever and kidney failure that may require dialysis (HFRS or hemorrhagic fever with renal syndrome).

What are the causes and risk factors for HPS?

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The cause of HPS is infection of the patient by hantavirus. Currently, about 14 subtypes of hantaviruses have been identified. Many subtypes have been named

• Sin Nombre
• Black Creek hantavirus
• Seoul virus
• New York hantavirus

Some researchers and doctytors simply them under the term of "New World hantaviruses." The Sin Nombre subtype has caused the majority of current HPS disease.

Hantavirus apparently damages cells that compose blood vessel capillaries, causing them to leak fluids. This fluid leak, if it is profound in the lungs, causes the life-threatening pulmonary syndrome.

Hantaviruses live their lifecycle in rodents but apparently do no harm; the viruses multiply and shed in the rodent's urine, feces, and saliva. A recent study in California suggested about 15% of all deer mice examined tested positive for hantavirus. Although the deer mouse has been the source of most HPSinfections, many other rodents may carry a different hantavirus subtype virus (for example, the white-footed mouse, the cotton rat, and the rice rat).

HPS risk factors

The major risk factor for HPS is association with

• Rodent infestation.
• Rodent saliva.
• Rodent urine.
• Feces or with dust, dirt.
• Surfaces contaminated with such rodent excretions, either by direct contact or by aerosol.
• Barns, sheds, homes, or buildings easily entered by rodents (for example, deer mouse or Peromyscus maniculatus) are potential places for hantaviruses to come in contact with humans.
• Rural areas that have forests and fields that can support a large rodent population are areas that increase the risk of exposure to hantavirus.
• Camping and hiking in areas known to have a high rodent population and occupying areas where rodents may seek shelter increase one's risk.
• Working in areas that may be shelter for rodents (for example, crawl spaces, vacated buildings, construction sites) may also have increased risk of hantavirus syndrome.
• The risk is higher in people who work in areas known to have produced hantavirus pulmonary syndrome infections.

Is hantavirus contagious, and how long is it before symptoms begin?

Is hantavirus contagious?

There is no evidence that HPS is not contagious from person to person contact in the US. The virus spreads from rodents to humans. Although outbreaks seem like there is person-to-person transfer, outbreaks are usually noted among groups of people exposed to the same infected rodent population while those with hantavirus infections do not transfer them to other uninfected individuals.

How long is hantaviris contagious?

• As of January 2017 in the US, hantavirus has affected about 800 people.
• South America, an estimated 16-35 days was the contagious period for a rare few patients who investigators considered to have exhibited person-to-person transfer with a type of hanta virus termed Andes virus.
• While this is the situation in North America, there are reports that in 1996, mild infections with hantaviruses were transmissible in an outbreak in Argentina. 
• Small outbreaks are reported each year; for example, Texas had its first person diagnosed with hantavirus in 2015.

What is the incubation period for hantavirus?

• According to the CDC, in North America, the incubation period (time from initial exposure to the virus and development of the first symptoms) is between one to five weeks after initial exposure to infected rodent urine, droppings, or saliva.
• In South American outbreaks, researchers estimate that the incubation period varies from about 12-27 days.

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What exams and tests diagnose HPS?

A test considered to diagnose HPS, is a positive serological test result, which is evidence of viral antigen in tissue by immunohistochemistry, or the presence of amplifiable viral RNA sequences in blood or tissue, with compatible history of HPS, is considered diagnostic for HPS.

What is the treatment for HPS?

• Unfortunately, hantavirus infections can lead to HPS. According to the CDC, hantavirus infections according have a mortality rate of about 38%.
• At this time, there is no definitive treatment for HPS other than early recognition of HPS and subsequent medical support (usually consisting of symptomatic medical treatment and respiratory support or mechanical ventilation).
• The CDC suggests that early treatment in an intensive care unit may allow the patient to survive severe HPS.
• Experimentally, doctors have administered the antiviral medication ribavirin (Rebetol, Copegus), but there are no clear data currently that establish that the drug is effective against HPS; however, its use against HFRS early in the disease suggests ribavirin can decrease illness and deaths.
• There is no vaccine available to protect against any hantaviruses to date.

Consequently, most patients diagnosed with HPS are usually cared for in the intensive care unit by specialists trained in critical care, and usually, in consultation with an infectious-disease doctor. Because the lungs are the most compromised organ in these infections, a lung doctor (pulmonologist) also is usually consulted. Moreover, specialists from the CDC are often involved to help locate the outbreak source and to help healthcare personnel at the outbreak site prevent further infections.

What are the complications of HPS?

The major complication of HPS is death from respiratory failure. Those who survive may take a few weeks to recover fully. Those patients who survive do not have chronic infections nor do they experience other chronic problems or complications.

Can you die from HPS?

The prognosis of HPS is fair to poor because currently, about 62% of patients recover, while about 38% will die. The prognosis may be better if the patient gets his/her diagnosis early and given support in an intensive care unit in a hospital. However, the early diagnosis of HPS is difficult; some patients did not know they had been exposed to rodents that carried hantavirus.

Can you prevent HPS?

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There are no vaccines available to protect against any hantavirus types. The CDC recommends elimination or reduction of contact with any rodents (for example, at home, worksites, campsites, barns, sheds) by reducing rodent access or rodent-proofing. Sealing up gaps and holes, placing traps, and keeping areas as clean and food free as possible will help. If a person must come in contact with rodents or areas where they live, precautions such as gloves and masks may reduce the chances for infection; disinfectant treatment of possible contaminated surfaces may also help prevent the disease.

Do not attempt to use a vacuum or use a broom to remove rodent urine or feces; this action may increase the risk of HPS by generating an aerosol. The risk of HPS can be reduced by inactivating hantaviruses in the environment by using a household detergent and 1½ cups of bleach per gallon of water to wipe or spray the potentially infected area and while minimizing contact by wearing gloves and a mask. Take similar precautions with rodents caught in traps.

When was hantavirus pulmonary syndrome first discovered?

• In 1993, health officials noted the first recognized outbreak of HPS in the "Four Corners" area of the U.S., where the states of Arizona, New Mexico, Colorado, and Utah meet. Two otherwise healthy young people, a Navajo Indian and his fiancée, suddenly became short of breath and died. This unusual situation triggered a review of deaths in the four states that resulted in identification of five other young people who recently died with similar breathing problems. During the next few weeks, health care providers treated additional people in the same geographic area with similar pulmonary syndromes.
• Tissues from affected patients were sent to the CDC, where researchers searched for causes and found a link among the patients: infection with a previously unknown type of hantavirus. Since other known hantaviruses (in Asia and Europe) were known to be transmitted to people by rodents, the researchers started trapping rodents from June to August 1993 to determine if the virus was associated with the animals.
• In November 1993, a rodent (a deer mouse) trapped by CDC researchers in a house where a person who developed the pulmonary syndrome lived yielded the previously unknown virus. In addition, army researchers soon isolated the same virus from an infected patient who also had exposures to mice. This new hantavirus was first termed Muerto Canyon virus, then Sin Nombre virus (SNV), and eventually simply hantavirus.
• The disease caused by this virus was termed hantavirus pulmonary syndrome (HPS).
• Further investigations suggested that other people had died from this infection in the past, as autopsy tissue contained the virus.
• When health researchers studied Navajo Indian medical traditions, the Navajo medical culture apparently recognized the disease and had associated it with mice.
• The outbreak in 1993 probably occurred because environmental factors led to favorable survival and proliferation of mice. The mouse population was about tenfold greater in 1993 than in 1992 in the Four Corners area.
• A large, more recent outbreak of HPS occurred at Yosemite National Park, California, in 2012. The outbreak was linked to deer mouse dropping contamination in campsites (tent-cabins) used by tourists.
• This zoonotic (animal-to-person) transmission probably happened with a rodent infestation augmented by favorable nesting conditions like woodpiles in or near the campsites. At least three deaths occurred, and seven other infected people recovered.

Medically Reviewed on 1/15/2021

References

Cennimo, DJ, MD, et al. Hantavirus Pulmonary Syndrome. Medscape. Updated: Jan 15, 2019.<https://emedicine.medscape.com/article/236425-overview> Hantavirus Disease, by State of Reporting. CDC. Updated: Sep 13, 2017. <https://www.cdc.gov/hantavirus/surveillance/reporting-state.html> br />

Martinez, V., et al. "Hantavirus Pulmonary Syndrome in Argentina, 1995-2008." Emerging Infectious Diseases 16.12 Dec. 2010. <http://wwwnc.cdc.gov/eid/article/16/12/09-1170_article>

United States. Centers for Disease Control and Prevention. "Virology: Hantaviruses." Aug. 29, 2012. <http://www.cdc.gov/hantavirus/technical/hanta/virology.html>.