Prevention of Hantavirus Presented by: April L. Burdorf, MPH student Walden University PUBH 6165-5 Dr. Stephen D. Arnold Fall Semester, 2010 The target audience of this presentation, are the rural residents that reside within Boulder County, Colorado. This presentation would be appropriate at any small community gathering such as: church meetings, rotary meetings, health fairs and other gatherings where local residents are present in small groups. Specifically today this program is being presented to the Martin Acres Neighborhood Association , you may access their neighborhood association website at http://www.martinacres.org/. Archived information on their website suggests issues with rodent control within their composting piles, which indicates that this would be an appropriate target audience.

Agenda: Background Prevalence Symptoms Prevention Good morning and welcome. My name is April Burdorf; I am a registered nurse and a public health student attending Walden University. I have been asked to speak to you today regarding Hantavirus Pulmonary Syndrome and its prevention. As residents of rural Boulder County you and your families are at risk of being exposed to this illness. I would like to share with you today some prevention strategies. This presentation will discuss: The background of Hantavirus Pulmonary Syndrome and its discovery The prevalence of the disease within the United States Symptoms of Illness and Prevention Strategies

Learning Objective: What is Hantavirus Who is at risk of acquiring the virus What are the associated symptoms How can you protect yourself & your family from Hantavirus At the end of this presentation, I hope that you will have an increased understanding of what Hantavirus is, who is at risk of acquiring the illness, what the symptoms of the illness are and how you can prevent the illness from affecting you, your family and your neighbors. As I share this presentation with you, please feel free to ask questions as we go along.

Sin Nombre Virus *Image courtesy Center for Disease Control In 1993, an outbreak of an unexplained respiratory illness occurred in the four corners area of our state. Many young previously healthy individuals developed severe respiratory symptoms, about half of the affected individuals died. (Colorado Department of Public Health and Environment [CDPHE], 2010) Researchers’ investigating the outbreak became suspicious that these individuals were affected by a Hantavirus. The Hantavirus was suspected to have been transmitted to humans via rodents, which had heavily infested the area that year. Upon further investigation it was discovered that the Sin Nombre virus was the causative agent of the illness and the resulting disease was referred to as Hantavirus Pulmonary Syndrome. (Colorado Department of Public Health and Environment [CDPHE], 2010) *Image courtesy Center for Disease Control (Colorado Department of Public Health and Environment [CDPHE], (Centers for Disease Control [CDC], 2010) 2010)

Colorado has one of the highest rates of Hantavirus Pulmonary Syndrome in the United States. As you can see from the map, the four corners area has the highest prevalence of disease in the United States. Since discovery of the illness in 1993, Colorado has had 70 confirmed cases of HPS; approximately 36% of all cases have been fatal. The highest concentration of illness remains in the four corners area; however those of you who reside in rural areas are also at increased risk with nearly 75% of all U.S. cases residing in rural areas. (CDC, 2010) (CDC, 2010)

Deer Mouse Image Courtesy of CDC, 2010 White-Footed Mouse The Rice Rat The Cotton Rat So what is Hantavirus Pulmonary Syndrome or (HPS)? HPS is a virus which is carried by some rodents and can potentially be transmitted to humans via contaminated rodent urine or feces. In the United States the most common rodents capable of transmitting illness are the deer mouse, which is common in Colorado, the white footed mouse, the rice rat, and the cotton rat. Recent studies have estimated that nearly 10% of all deer mice carry the Sin Nombre virus. (Centers for Disease Control [CDC], n.d.) Deer Mouse Image Courtesy of CDC, 2010 (Centers for Disease Control [CDC], n.d.)

1 to 5 Weeks After Initial Exposure Initial Symptoms Fever Muscle Aches Progressive Symptoms Shortness of Breath Headaches Dizziness Nausea/Vomiting Diarrhea Stomach pain Chills Symptom Onset Occurs 1 to 5 Weeks After Initial Exposure Initial symptoms of HPS include fever, severe muscle aches, (especially large muscle groups such as the thighs) and fatigue. These initial symptoms typically occur within 1 to 5 weeks of urine and fecal exposure. As the virus progresses, affected individuals may begin experiencing respiratory symptoms and complaining of severe shortness of breath. In addition to the respiratory complaints advanced infections may present with symptoms of: headaches, dizziness, chills, nausea, vomiting, diarrhea, and stomach pain. (CDC, n.d.) (CDC, n.d.)

Disease Prevention Deter Rodents Seal-up Trap-up Clean-up The primary means of preventing HPS is reducing the number of human/rodent contacts. As homeowners we should deter rodents from inhabiting our living areas and outbuildings. Seal-up any areas which may allow rodents to enter our home, trap any rodents if there is evidence of their inhabitance in our homes or outbuildings and properly clean-up excrement and any deceased rodents to avoid virus exposure.(CDC, 2002) (CDC, 2002)

Deter Rodents Inside The Home Eliminate food & water sources Remove Clutter & Waste Store Bedding off of floor Keep Doors & Windows securely closed Deterring rodent infestation inside of homes and outbuildings will significantly reduce human/rodent exposures. There are several interventions that homeowners can take to reduce rodent infestation within homes and outbuildings. First it is important to eliminate all potential food and water sources within your home. Store foods in air tight rodent proof containers, pet foods should also be stored in rodent proof containers; picking-up pet dishes in the evenings and fixing any water leaks within the home will eliminate potential food and water sources. Keep your inside environment clean and avoid clutter. Ensure after meals that food is stored promptly, trash removed and counters and floors cleaned after spills. All trash and recycling containers stored indoors should have tight fitting lids, emptied regularly and bins cleaned routinely to remove food debris. Store any boxes and other potential sources of rodent nesting materials off of the floor or in rodent proof containers. Keep all doors and windows closed unless fitted with tight fitting screens. (CDC, n.d.)   (CDC, n.d.)

Deter Rodents Outside The Home Place Woodpiles and Other Potential Nesting Sites At Least 100 feet Away From Homes. Store Grains & Animal Feed in Rodent Proof Containers Store Trash in Rodent Proof Containers Avoid birdfeeders near homes Remove Rubbish and Tall Grasses and Plantings near homes Outside of homes it is important to ensure woodpiles and other potential nesting areas such as bricks, lumber or stones are stored at least 100 feet away from homes. Ensure that animal feed and grains are stored in rodent proof containers and that pet foods are removed nightly. Ensure excess rubbish such as abandoned automobiles and tires are removed and that trash is stored in rodent proof containers at least 100 feet away from homes. Bird feeders are a potential source of food for rodents, if you use a bird feeder ensure that it is squirrel proof and clean discarded seeds on the ground nightly. Lastly maintain landscaping surrounding homes and outbuildings. Mow all grasses and trim other plants within 100 feet of foundations. (Centers for Disease Control [CDC], 2002) (Centers for Disease Control [CDC],2002)

Seal-up Assess areas of entry Seal-up holes Eliminate sources of entry Areas larger than a pencil Steel Wool Caulking Lath Metal Concrete Inside and outside of your homes and outbuilding it is important to look for potential routes in which rodents can enter your home. Any hole the size that a pencil can fit through is a potential access point for rodent entry. Seal holes with steel wool and caulking, or for larger holes you can use, lath metal or concrete. (CDC, 2002) (CDC, 2002)

Snap Trap If there is evidence of rodent infestation within your homes of outbuildings, after sealing potential entry points it is important to trap them for a time period of approximately two weeks. Use only snap traps as other types of traps such as glue traps increase risk of exposure to rodent excrement. Rodents who are scared when trapped may urinate, causing potential contamination near the area and on the deceased rodent. (CDC, n.d.) (CDC, n.d.)

T Formation of Snap-Trap Set snap traps in areas where you have witnessed evidence of rodent infestations. Areas which have evidence of droppings, nibbled food or recent sightings are some of the best areas to trap rodents. Traps should be placed next to base boards forming a T formation for the best results. When setting a snap trap use approximately a pea sized amount of chunky peanut butter for the best results. (CDC, n.d.) (CDC, n.d.)

Mask will not prevent illness Clean-up Air Outbuildings Open Doors & Windows Do Not Sweep or Vacuum Mask will not prevent illness Exposure to Hantavirus primarily occurs as a result of human contact with rodent excrement; therefore the clean-up phase is especially important. Prior to cleaning any sheds or other outbuildings, open all doors and windows and allow the building to air out for at least 30 minutes prior to entering the area. Do not sweep or vacuum areas that are contaminated with rodent waste as this may potentially aerosolize the virus and increase chances of human illness. Masks do not prevent exposure to the illness; therefore individuals should not wear masks as a substitute for these recommendations. (CDC, 2002) (CDC, 2002)

Use 10% bleach solution or household disinfectant 10% Bleach or Household disinfectant Gloves Papertowels Plastic Bags Disinfect Gloves Wash Hands When cleaning up droppings, nesting material and rodent carcasses it is essential to spray them with disinfectant prior to touching or moving. A 10% bleach solution or any household cleaner labeled as a disinfectant can be used for this purpose. Choose one solution or the other as mixing chemicals can result in deadly exposure to toxic gases. Prior to beginning you should don plastic or rubber gloves; spray the area with the disinfectant solution. Let the solution soak the area for 5 minutes and then clean with a paper towel. Dispose of the paper towel in the trash. Clean the area with a clean mop or rag with fresh disinfectant solution. Spray contaminated gloves with disinfectant prior to removing. Wash hands immediately after removing gloves. (CDC, 2002) (CDC, 2002)

Properly Dispose of Waste Spray contaminated area and/or carcass with disinfectant & allow to soak for 5 minutes Clean with paper towels Dispose in sealed plastic bag If disposing of carcass double bag To dispose of a rodent carcass or clean up a nest, don plastic or rubber gloves, spray the rodent, nest and/or surrounding area with disinfectant and allow to sit for at least 5 minutes. After allowing the disinfectant to sit, remove the rodent or nesting material and place into a plastic bag and seal. Place the sealed bag into a second plastic bag and dispose of the nest or deceased rodent. If reusing the trap, you must disinfect it prior to handling it. Prior to removing gloves disinfect them, wash hands immediately after removing gloves. (CDC, 2002) (CDC, 2002)

Additional Precautions For Outbuildings & Delicate Items Mop floors Clean Counters Clean Inside Drawers Steam Clean Furniture & Carpet Launder With Hot Water & Detergent Place delicate items in the sun Wipe clean with a cloth moistened with a disinfectant solution For outbuildings, in addition to the previous precautions, clean all countertops, cabinets and drawers. Disinfect floors, steam clean furniture and carpets and launder all linens with hot water, and detergent prior to using. (CDC, 2002) Delicate items such as books and papers that cannot be cleaned with a disinfectant, can be placed outdoors in the sunshine. Leave these items in the sun for several hours, followed by cleaning with a cloth moistened with a disinfectant solution. (CDC, n.d.)   (CDC, 2002), (CDC, n.d)

Removal of Rodent Carcasses Prevent Other Vector-borne diseases Wear Long Sleeves & Pant Legs Wear Insect Repellant With DEET Dispose of Carcass in Doubled Plastic Bag In some areas of Colorado removing dead rodents may place you at risk of exposure to the plague from fleas. Ensure that when removing dead rodents that you utilize insect repellent with DEET and long sleeves and pant legs to avoid flea bites.(CDC, 2002) (CDC, 2002)

Summary Seal-up Trap-up Clean-up Eliminate sources of rodent entry Utilize snap-traps only No poisons or glue-traps Clean-up Do not sweep Moisten carcass with disinfectant In summary, to prevent hantavirus pulmonary syndrome it is important to ensure that you take all the necessary measures to: seal-up your home to prevent rodents from entering if you find evidence of rodents in your home, trap them utilizing snap-traps rather than poisons and ensure that you clean-up any deceased rodents safely following the precautions that were presented here today. On the back table I have provided brochures which may be found at the link provided on the additional links slide. Please feel free to take a brochure with you for future reference. (CDC, 2002)

Questions?? For additional information please consult the websites provided on the next slide, or help yourself to one of the pamphlets that I have provided in the back of the room. The pamphlets can be found at the first website on the next slide. I’d like to thank you for your time and attention, I would be happy to answer any questions related to the presentation at this time.

Additional Links http://www.cdc.gov/ncidod/dvrd/spb/mnpages/HPS_Brochure.pdf http://www.cdc.gov/mmwr/PDF/rr/rr5109.pdf http://www.cdc.gov/ncidod/diseases/hanta/hps/graphics/prevcard/prevcardside1.gif http://www.cdc.gov/ncidod/diseases/hanta/hps/graphics/prevcard/prevcardside2.gif http://www.bouldercounty.org/health/hpe/cdc/diseases/hantaVirus/index.htm

References Centers for Disease Control. (2002). Hantavirus Pulmonary Syndrome — United States: Updated Recommendations for Risk Reduction (No. RR-9). Washington, DC: U.S. Government Printing Office. Centers for Disease Control. (Cartographer). (2010). Hanta Virus Pulmonary Syndrome (HPS) By State of Exposure [Case Count Map]. Retrieved from http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/epislides/episls.htm Centers for Disease Control. (n.d.). Facts about Hantavirus. What You Need To Know To Prevent The Disease Hantavirus Pulmonary Syndrome (HPS) [Brochure]. Atlanta, Georgia: Centers for Disease Control. Colorado Department of Public Health and Environment. (2010). Hantavirus Pulmonary Syndrome (Fact Sheet). Retrieved from Colorado Department of Public Health and Environment website: http://www.cdphe.state.co.us/dc/zoonosis/hanta/index.html