1. What do we want know about Hantavirus Pulmonary Syndrome (HPS)? Susan Redwood PUBH 6165 Walden University

2. A global public health problem

3. Stakeholders Community members Community members Immunocompromised patients including those with HIV/AIDS, cancers and other blood borne diseases Immunocompromised patients including those with HIV/AIDS, cancers and other blood borne diseases Government at all levels (local, state, national) Government at all levels (local, state, national) Healthcare facilities (Clinics, hospitals, nursing home, group home etc) Healthcare facilities (Clinics, hospitals, nursing home, group home etc) Education institutions (primary schools, colleges, universities, libraries) Education institutions (primary schools, colleges, universities, libraries) Community centers Community centers CDC, EPA, FDA, WHO CDC, EPA, FDA, WHO

4. Stakeholders contd. Landlords and people who live in poor and overcrowded environment Landlords and people who live in poor and overcrowded environment Local businesses (restaurants, shopping malls, place of employment) Local businesses (restaurants, shopping malls, place of employment) Homeless shelters Homeless shelters Mass media (Internet, TV, Radio, Twitter, Face book, Cell phones) Mass media (Internet, TV, Radio, Twitter, Face book, Cell phones) Doctors office Doctors office Churches Churches

5. Should you be afraid of a mouse in your house?

6. What is Hantavirus Pulmonary Syndrome? A severe and sometimes fatal respiratory disease in humans caused by infection with a hantavirus. A severe and sometimes fatal respiratory disease in humans caused by infection with a hantavirus. Lipid-enveloped, spherical viruses approximately 80-110 in diameter Lipid-enveloped, spherical viruses approximately 80-110 in diameter From Bunyaviridae family with 3 RNA segment (small, medium, large which encode From Bunyaviridae family with 3 RNA segment (small, medium, large which encode Viral nucleocapsid (N) Viral nucleocapsid (N) Glycoproteins (G1and G2) Glycoproteins (G1and G2) RNA polymerase (Pol) RNA polymerase (Pol)(Skehan,n.d.)

7. Molecular Structure ( Infection landscape, 2012)

8. History First discovered in Asia during the Korean War First discovered in Asia during the Korean War Virus was not isolated until 1976 Virus was not isolated until 1976 Classified under its own genus "hantavirus” Classified under its own genus "hantavirus” First American outbreak occurred in May of 1993 among healthy members of the Navajo Nation in New Mexico who died within a short period of time First American outbreak occurred in May of 1993 among healthy members of the Navajo Nation in New Mexico who died within a short period of time (Hantavirus info, 1998)

9. Etiology Deer mouse Deer mouse White-tailed mouse White-tailed mouse Cotton rat Cotton rat Rice rat Rice rat

10. How is the virus transmitted

11. Cases reported by race Caucasians 78% Caucasians 78% American Indians 18% American Indians 18% African Americans 2% African Americans 2% Asian 1% Asian 1% ( CDC, 2014)

12. Diagnosis Physical examination difficult to diagnose in early stage because symptoms mimic influenza Physical examination difficult to diagnose in early stage because symptoms mimic influenza Serological testing immunofluorescent antibody test (IFA), enzyme-linked immunosorbent assays (ELISA), immunoblotting and virus neutralization Serological testing immunofluorescent antibody test (IFA), enzyme-linked immunosorbent assays (ELISA), immunoblotting and virus neutralization Obtain tissue samples for antigens with immunohistochemistry Obtain tissue samples for antigens with immunohistochemistry Chest X-Ray Chest X-Ray Pulse oximetry to measure oxygen saturation Pulse oximetry to measure oxygen saturation (Cfsph, 2009)

13. Early Signs and Symptoms Fatigue Fatigue Fever Fever Muscle aches Muscle aches Headache Headache Dizziness Dizziness Chills Chills Nausea Nausea Vomiting Vomiting Diarrhea Diarrhea Abdominal pain Abdominal pain (Health crafter, 2013)

14. Late Signs and Symptoms Cough Cough Shortness of breath with or without chest tightness Shortness of breath with or without chest tightness Fluid filled lungs Fluid filled lungs http://www.cdc.gov/hantavirus/technical/hps/clinical-manifestation.html

15. Complications Acute Respiratory Distress Syndrome (ARDS) Acute Respiratory Distress Syndrome (ARDS) Kidney failure Kidney failure Hypoxia Hypoxia Hypotension Hypotension Death Death http://media.victoriaadvocate.com/img/photos/2013/09/28/hanta_virus_ew_092913_04_221015.jpg

16. Treatment Confirmed diagnoses admission to hospital Confirmed diagnoses admission to hospital Intravenous fluids Intravenous fluids Medication administration Medication administration Oxygen Oxygen Ventilator support for respiratory complication Ventilator support for respiratory complication

17. Prevention No vaccine available at present No vaccine available at present Avoid contact with rodents in home, worksite, camp, barn, shed Avoid contact with rodents in home, worksite, camp, barn, shed Seal gaps and holes Seal gaps and holes Set up rodent traps Set up rodent traps Keep all area clean and free of food Keep all area clean and free of food Use gloves and mask for contact with rodents Use gloves and mask for contact with rodents Avoid the use of vacuum for rodent debris Avoid the use of vacuum for rodent debris Decontaminate surface areas with detergent and bleach solution Decontaminate surface areas with detergent and bleach solution

18. Challenges Prognosis is fair to poor: Prognosis is fair to poor: Misdiagnosis Misdiagnosis Recovery rate 62% Recovery rate 62% Mortality rate 38% Mortality rate 38% Prolonged hospitalization Prolonged hospitalization Poverty Poverty Lack of or inadequate access to medical care Lack of or inadequate access to medical care http://www.cdc.gov/hantavirus/surveillance/annual-cases.html

19. Future Research Combine ecology and change in other host-virus ecosystems via modeling and hypothesis-driven research Combine ecology and change in other host-virus ecosystems via modeling and hypothesis-driven research Concentrate on risk of exposure, multidirectional transmission, and human disease ( Johnson, Figueiredo, &Vapalahti, 2010) Concentrate on risk of exposure, multidirectional transmission, and human disease ( Johnson, Figueiredo, &Vapalahti, 2010) (CDC, 2012)

20. The future of vaccination (Medcity News, 2012)

21. References Centers for Disease Control and Prevention. (2012). Hantavirus. Retrieved from http://www.cdc.gov/hantavirus/technical/hanta/ecology.html Centers for Disease Control and Prevention. (2012). Hantavirus. Retrieved from http://www.cdc.gov/hantavirus/technical/hanta/ecology.html Centers for Disease Control and Prevention. (2013). CDC, Hantavirus Pulmonary Syndrome. Retrieved from http://www.cdc.gov/hantavirus/hps/index.html Centers for Disease Control and Prevention. (2013). CDC, Hantavirus Pulmonary Syndrome. Retrieved from http://www.cdc.gov/hantavirus/hps/index.html Centers for Disease Control and Prevention. (2014). Reported cases of HPS. Retrieved from http://www.cdc.gov/hantavirus/surveillance/index.html Centers for Disease Control and Prevention. (2014). Reported cases of HPS. Retrieved from http://www.cdc.gov/hantavirus/surveillance/index.html http://www.cdc.gov/hantavirus/surveillance/index.html Center for Food Security and Public Health. (2009). Hantavirus. Retrieved from http://www.cfsph.iastate.edu/Factsheets/pdfs/hantavirus.pdf Center for Food Security and Public Health. (2009). Hantavirus. Retrieved from http://www.cfsph.iastate.edu/Factsheets/pdfs/hantavirus.pdf Hantavirusinfo. (1998). Basic facts about HPS and the hantivirus. Retrieved from http://www.hantavirus.net/info1.html Hantavirusinfo. (1998). Basic facts about HPS and the hantivirus. Retrieved from http://www.hantavirus.net/info1.html http://www.hantavirus.net/info1.html Healthcrafter. (2013). Step to avoid hantivirus outbreak. Retrieved from http://healthcrafter.net/steps-to-avoid-hantavirus-outbreak/3069 Healthcrafter. (2013). Step to avoid hantivirus outbreak. Retrieved from http://healthcrafter.net/steps-to-avoid-hantavirus-outbreak/3069 http://healthcrafter.net/steps-to-avoid-hantavirus-outbreak/3069 Hepojoki,J., Strandin,T., Lankinen,H., & Vaheri,A. (2012). Hantavirus structure—molecular interactions behind the scene. Journal of General Virology, 93(8), 1631-44. Hepojoki,J., Strandin,T., Lankinen,H., & Vaheri,A. (2012). Hantavirus structure—molecular interactions behind the scene. Journal of General Virology, 93(8), 1631-44. Infection Landscape. (2012). Hantaviruses. Retrieved from http://www.infectionlandscapes.org/2012/09/hantaviruses.html Infection Landscape. (2012). Hantaviruses. Retrieved from http://www.infectionlandscapes.org/2012/09/hantaviruses.html http://www.infectionlandscapes.org/2012/09/hantaviruses.html

22. References Johnson,C., Figueiredo, L., & Vapalahti, A. (2010). A global perspective on hantavirus ecology, epidemiology and disease. Clinical Microbiology Reviews, 23(2), 412-441. Johnson,C., Figueiredo, L., & Vapalahti, A. (2010). A global perspective on hantavirus ecology, epidemiology and disease. Clinical Microbiology Reviews, 23(2), 412-441. Mayo Clinic. (2014). Hantavirus pulmonary syndrome cause- disease and conditions. Retrieved from http://www.mayoclinic.org/diseases-conditions/hantavirus-pulmonary- syndrome/basics/causes/con-20030129 Mayo Clinic. (2014). Hantavirus pulmonary syndrome cause- disease and conditions. Retrieved from http://www.mayoclinic.org/diseases-conditions/hantavirus-pulmonary- syndrome/basics/causes/con-20030129http://www.mayoclinic.org/diseases-conditions/hantavirus-pulmonary- syndrome/basics/causes/con-20030129http://www.mayoclinic.org/diseases-conditions/hantavirus-pulmonary- syndrome/basics/causes/con-20030129 Medcity News. (2012). Cross-kingdom vaccine may protect against fungal and bacterial infection. Retrieved from http://medcitynews.com/2012/05/cross-kingdom-vaccine-may-protect-against-fungal- and-bacterial-infections/ Medcity News. (2012). Cross-kingdom vaccine may protect against fungal and bacterial infection. Retrieved from http://medcitynews.com/2012/05/cross-kingdom-vaccine-may-protect-against-fungal- and-bacterial-infections/ Skehan, E. (n.d). Hantavirus Pulmonary Syndrome (HPS). Retrieved from http://www.austincc.edu/microbio/2421c/hps.htm Skehan, E. (n.d). Hantavirus Pulmonary Syndrome (HPS). Retrieved from http://www.austincc.edu/microbio/2421c/hps.htm Worthy, S. (2009). Earth end: New beginning. Retrieved from http://www.earthend- newbeginning.com/page/32/ Worthy, S. (2009). Earth end: New beginning. Retrieved from http://www.earthend- newbeginning.com/page/32/