1. HANTAVIRUS WHAT YOU NEED TO KNOW
Presented by: Angelique Rusk
Public Health Graduate Student at Walden University
Welcome everyone. My name is Angelique Rusk and I am a first year graduate student at Walden University studying Public Health. Today I am here to talk to you about Hantavirus.

2. WHAT YOU WILL LEARN TODAY
Illness
Transmission
Risks
Prevention
In talking about Hantavirus we will cover a few different topics. Those topics include information regarding hantavirus as an illness and its mode of transmission. We will also discuss different activities or areas in your life that could increase your risk of contracting hantavirus as well as some preventative tools to lower your risk. So let’s begin our discussion.

3. Washington Department of Health. Hantavirus
WHAT IS HANTAVIRUS?
Group of viruses
Carried by rodents
Can cause rare but deadly disease called Hantavirus Pulmonary Syndrome or HPS for short
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 or HPS in people. HPS is a rare but deadly disease. We will discuss HPS in more detail a bit later. But first let us discuss the source of hantavirus.
Washington Department of Health. Hantavirus

4. THE SOURCE Deer mouse Cotton rat Deer mouse
Hantavirus is found in rodents, their droppings and urine as well as their nesting materials. Many mice and rats can give people hantavirus that cause HPS. In North America they are the deer mouse, white-footed mouse, the rice rate, and the cotton rat. Here are some images of two different rodents that can carry hantavirus.
Deer mice are 5-8 inches long and their fur resembles that of deer, dark on the back and white on the legs and underside. They are usually found in Western U.S.
Cotton Rats make their nests out of cotton. Primarily found in the Southern U.S. they have small ears and dark brown coats.
It is important to remember that not every single rodent is a carrier of hantavirus so caution should be taken around all rodents as there are not any outward visible signs that the rodent is indeed infected.
Photos courtesy of the Washington State Department of Labor and Industries

5. Picture courtesy of the Centers for Disease Control and Prevention
TRANSMISSON OF VIRUS
Here is a really great explanation from the Centers for Disease Control and Prevention showing the transmission of hantavirus. Infected rodents shed the virus through urine, droppings, and saliva. HPS is transmitted through a process called aerosolization. Aerosolization occurs when dried materials contaminated by rodent droppings, urines, or saliva are disturbed. Humans become infected by breathing in these infectious aerosols.
Picture courtesy of the Centers for Disease Control and Prevention

6. THE VIRUS 1-5 weeks after exposure A few days after symptoms begin
Fever
Severe muscle aches
Fatigue
A few days after symptoms begin
Difficulty breathing
Can sometimes include headaches, dizziness, chills, nausea, vomiting, diarrhea, and stomach pain
Infection can lead to lung failure and death
Symptom of the virus can begin anywhere from 1 to 5 weeks after exposure of an infected source. That could be an infected rodent, droppings, urine, or nesting material.
Fever, sever muscle aches, and fatigue are the first noticeable symptoms. This is followed by difficulty in breathing. People infected with HPS can also notice headaches, dizziness, chills, nausea, vomiting, diarrhea, and stomach pain.
HPS can lead to lung failure and possible death if treatment is not sought. There is no specific treatment for HPS but if the symptoms are recognized early, supportive care can increase a person’s chance of survival.
Centers For Disease Control and Prevention. Facts about hantaviruses

7. Washington State Department of Health 1999 &2010
VIRUS STATISTICS
Washington:
Since 1993 there have been 40 cases reported with 13 (33%) associated deaths
One to five cases reported each year
14% of over 1,100 tested deer mice have been infected with Sin Nombre virus
United States:
Cases reported in all states except for Hawaii and Alaska
Through June of 1999, 217 cases reported
5 pediatric cases reported in 2009
Though the numbers are not huge for reported cases of HPS we still need to be aware of our risks. In Washington state there have been 40 reported cases with 13 deaths since Each year there are between 1 and 5 cases reported. The department of health in Washington does testing on wild mice and has found that about 14% of the 1,100 tested deer mice have been infected with Sin Nombre virus.
Through June of 1999 there have been 217 reported cases of HPS. Cases have been found in all states except Hawaii and Alaska.
According to a Morbidity and Mortality Weekly report from the CDC in cases were reported in children between the ages of 6 and 14(CDC,2009). The children were located in Arizona, Washington, California and Colorado. All children had exposure to rodents.
Now that you know what HPS is and how it is transmitted from an infected source to a person let’s discuss some areas in your life that may be putting you at risk of contracting HPS.
Washington State Department of Health 1999 &2010
CDC

8. ACTIVITES THAT INCREASE YOUR RISK
Sweeping out a barn and other ranch buildings
Trapping and studying mice
Entering a barn infested with mice
Planting or harvesting field crops
Occupying previously vacant dwellings
Disturbing rodent-infested areas while hiking or camping
Living in dwellings with a sizable indoor rodent population
Most rodents do not live in urban areas, mainly rural areas. However many rodents are adaptable and can be found in homes as well as commercial and industrial buildings.
Some common places that can contain infected rodents, their droppings, urine, or nesting are listed here. This can include activities like sweeping out a barn or entering a barn infested with rodents. Trapping and studying rodents. Planting or harvesting field crops, occupying a previously vacant building, disturbing rodent-infested areas while hiking or camping as well as living in dwellings with a sizeable indoor rodent population
Work Safe BC. A hantavirus risk control program for employers and workers.

9. OCCUPATIONAL RISKS Some occupations will put people at a higher risk
Plumbers
Maintenance workers
Telephone installers
Electricians
Construction workers
Your job may possibly put you are risk. Plumbers, maintenance workers, telephone installers, electricians, and construction workers are all occupations that can put people in contact with hantavirus. These types of jobs may increase your risk by increasing your exposure to areas where there are rodents and their droppings or nesting materials. This includes areas outdoors, in basements, attics, under sinks, in old buildings and so on.
Employers should instruct workers on how to eliminate or reduce their risk of contract with rodent saliva, urine, or droppings. Employers should also provide workers with the tools, equipment, and personal protective equipment needed to deal with unexpected contact.
Now let’s move on to discussion prevention.
Work Safe BC. A hantavirus exposure control program for employers and workers.

10. PREVENTION INDOORS Prevent access to food Trap mice
Keep food in thick plastic or
metal containers with tight lids
Do not leave pet food out overnight
Keep garbage in thick plastic or
Trap mice
You now know what kinds of activities can increase your risk. Let’s talk about how we can prevent some exposures. We will discuss indoor and outdoor prevention.
Indoor prevention will help keep mice out of your home. A few things a person can do is prevention access to food. If mice can’t find anything to eat they will hopefully move on to another location. Keeping food and garbage in containers that rodents cannot get into will perhaps starve them out. It is also a good idea to not leave pet food out over night.
Another tip is to trap mice. Use baited snap traps and place these in attics, basement, and under sinks and cabinets.
Photo courtesy of getridofpests.com

11. PREVENTION INDOORS Prevent entry to home
Check home for holes or gaps and seal
It is also a good idea to check inside your home for gaps or holes that a pencil can fit into. Rodents can fit into holes much smaller than their bodies width. Seal holes with steel wool, lath metal, and caulk.
Photo courtesy of Centers for Disease Control and Prevention: Facts about hantavirus

12. Centers for Disease Control and Prevention: Facts about hantavirus
WHERE TO CHECK INDOORS
Basement or crawl space
Attic
Inside, under and behind kitchen cabinets
Around fireplace, doors, and floor air vents
Around pipes under sinks and washing machines
Around pipes going to hot water heaters and furnaces
Some key areas in your home that should be thoroughly checked for entry points for rodents are the basement or crawl space and the attic.
Kitchen cabinets should be examined inside and under as well as around fireplaces, doors, and air vents. Areas around pipes are often not properly sealed so take a look under sinks, around washing machines and pipes leading to hot water heaters and furnaces.
Centers for Disease Control and Prevention: Facts about hantavirus

13. Centers for Disease Control and Prevention: Facts about hantavirus
PREVENTION OUTDOORS
Eliminate nesting sites
Keep composting bins and wood piles 100 feet or more form the house
Clean up trash, brush, and weeds
Eliminate food sources
Use thick plastic or metal with tight fitting lids for garbage, grains, and animal feed
Eliminate entry places to home
Seal all holes larger than the width of a pencil
There are a few things a person can do outdoors to protect their home from rodents. First eliminate nesting sites for rodents by keeping composting bins and wood piles at least 100 feet from your house. Cleaning up trash, brush, and weeds around your home will also help.
Again, we want to starve the rodents out. So make sure you keep garbage, grains, and animal feed in thick plastic or metal containers with tight fitting lids.
On the outside of your home you can eliminate entry places as you did on the inside by sealing holes larger than a pencil width.
Centers for Disease Control and Prevention: Facts about hantavirus

14. Centers For Disease Control and Prevention: Facts about hantavirus
WHERE TO LOOK OUTSIDE
In the roof around rafters, gables, and eaves
Around windows and doors
Between the foundation of your house and ground
Attic vents and crawl space vents
Around holes for electrical, plumbing, and gas lines
When looking for places to seal around the outside of the home pay close attention to the roof around rafters, gables and the eaves. Also look around windows and doors and even between the foundation of your house and the ground. Look from the outside at attic and crawl space vents. Just like on the inside of your home areas around electrical, plumbing, and gas lines may not be properly seals so make sure to asses those areas.
Centers For Disease Control and Prevention: Facts about hantavirus

15. OTHER AREAS OF RISK: CAMPING
Air out and inspect cabin
Check campsite
Avoid disturbing nests
Avoid sleeping on bare ground
Store food in rodent-proof containers
Promptly discard, bury, or burn garbage
Guide For Campers
One activity that I mentioned earlier that can put a person at risk of coming into contact with infected rodents is camping. Here in Washington we are so lucky to have many beautiful areas to camp with our friends and families. If you camp or hike in a area that is inhabited by rodents there are a few things you can do to minimize your risk for hantavirus infection.
Make sure that you air out and inspect a cabin for rodents after it has been unused for sometime. If sleeping outdoors check the area for rodent droppings and burrows and do not disturb these areas. Avoid sleeping on the bare ground or near nesting areas.
Last but not least, store your food in rodent-proof containers and discard, bury, or burn your garbage.
(Click on Link)Here is a brochure put out by the Centers For Disease Control and Prevention that has a lot of the information we discussed about camping and hiking safety. The brochure is a bit dated, but the information provided still holds true today.
So what happens if you do find areas of your home that are contaminated by rodents? Let’s talk about safe clean up.
Centers for Disease Control and Prevention: Prevent hantavirus pulmonary syndrome

16. Photos courtesy of Google Images
SAFE CLEAN UP
Do not vacuum or sweep! This will cause virus particles to go into the air where they can then be breathed in!
Cleaning rodent urine and droppings properly is very important. As we discussed earlier transmission of hantavirus from rodents to humans occurs through the air. We do not want to sweep or vacuum up rodent droppings or nests as this will cause virus particles to go into the air where they then can be breathed in.
Photos courtesy of Google Images

17. CLEANING INFECTED AREAS Urine and droppings
Wear rubber or latex gloves
Spray urine and droppings with a disinfectant or a bleach/water mixture
Let soak 5 minutes
Use a paper towel to wipe up urine and droppings and place all in garbage
Mop or sponge the area with a disinfectant or bleach mixture
Wash gloved hands with soap and water or disinfectant
Wash hands after glove removal
The steps may seem simple enough but are very important to follow. Protect your hands with gloves and spray the urine and droppings with a disinfectant spray or with a mixture of bleach and water. 1 cup bleach to 10 cups water. Soak the area until very wet and let soak for 5 minutes.
Using a paper towel wipe up the sprayed urine and droppings and place in garbage.
Using a sponge or mop clean the area with the bleach mixture or disinfectant. It is important to clean off your gloves before removing them so make sure and spray hands with beach mixture, disinfectant, or soap and water.
Wash your hands after removal of gloves.
Centers For Disease Control and Prevention: Taking steps to prevent hantavirus

18. CLEANING INFECTED AREAS Dead rodent removal
Wear rubber or latex gloves
Spray dead rodent and surrounding area with bleach mixture or disinfectant and let soak
Place nesting materials or trap with dead rodent in a plastic bag
Seal bag in two bags
Throw bag in a regularly emptied trash can that covers
Wash gloved hands with soap and water, disinfectant spray, or bleach mixture
Remove gloves and wash hands
If you come across a dead rodent or have caught one in a trap a few steps are necessary to follow in order to reduce your risk of hantavirus exposure.
Just as with cleaning, you want to make sure your hands are gloved before doing any of these steps. Spray the rodent and surrounding area with a disinfectant spray or a bleach and water mixture making sure to let it soak.
Place the rodent, nesting materials, or the trap with dead rodent in a plastic bag and seal. Place this bag into another plastic bag and seal again.
This can then be thrown into a trash can that has a cover and is regularly emptied. Wash your gloved hands with soap and water, disinfectant, or bleach mixture.
Once you have removed your gloves wash your hands.
Now that you how to avoid putting yourself at risk of hantavirus from rodent exposure lets talk about another level of protection.
Centers For Disease Control and Prevention: Facts about hantavirus

19. VACCINE? Currently no vaccine or antiviral drug to protect
Small amount of studies to create vaccine
Is it necessary?
Currently there is no approved vaccine or antiviral drug that protects humans against hantavirus.
There have been studies throughout the years to develop a vaccine.
These studies utilize techniques that vary from recombinant DNA to killed virus strains in hopes of finding a successful vaccine.
Vaccines for hantavirus infections have been developed against other strains. In Korea inactivated Hantaan virus vaccine is licensed (Fabbri & Maslow,2001). This vaccine showed 75% of patients producing a neutralizing antibody after their first booster dose (Fabbri &Maslow, 2001).
Because of the relatively low numbers of HPS in the United States there may not be an urgent need for a vaccine however, some in the public health field believe that studies still need to be done. One day we may come across a vaccine that not only protects against the Sin Nombre strain of hantavirus but others that are still emerging.

20. IN CONCLUSION
Hantavirus Pulmonary Syndrome is a rare but serious disease that can occur after contact with an infected rodent.
Reduce your risk
Prevention
Proper cleaning methods
I hope this presentation has given you adequate information to reduce your risk of HPS. Remember hantavirus pulmonary syndrome is uncommon but if contracted it can be deadly.
Reduce your risk by knowing what activities can put you into contact with infected rodents, indoor and outdoor preventative “treatment” and by following proper cleaning methods of possible infected materials.
I want to that you for taking the time to allow me to present this information to you.

21. STILL HAVE QUESTIONS? Washington Department of Health
Hantavirus Fact Sheet
Hantavirus Pulmonary Syndrome(HPS)
Centers For Disease Control and Prevention
All about hantavirus
If you need further information regarding the topic of hantavirus here are a few website links that have information on the topic.
Thank you again.

22. REFERERNCES
Boortz.(2007) Image retrieved from: Centers for Disease Control and Prevention. (1995). Prevent hantavirus pulmonary syndrome: A public information guide for tourists, campers, and hikers. Retrieved from: Centers for Disease Control and Prevention. (2004). HPS teaching slideset. Retrieved from : Centers for Disease Control and Prevention. (2009). Hantavirus pulmonary syndrome in five pediatric patients-four states Morbidity & Mortality Weekly Report, 58(50), Retrieved from Academic Search Complete. (Accession number: ). Centers for Disease Control and Prevention (nd). Facts about hantaviruses: what you need to know to know to prevent the disease hantavirus pulmonary syndrome (HPS). Retrieved from: Fabbri, M., & Maslow, M.J. (2001). Hantavirus pulmonary syndrome in the united states. Current Infectious Disease Reports, 3(3), Retrieved from ProQuest Central. (Document ID: ).

23. REFERENCES CONT.
Washington Department of Health. (2010). Hantavirus. Retrieved from: Washington Department of Health. (2010). Notifiable conditions: hantavirus pulmonary syndrome (HPS). Retrieved from : Washington Department of Health. (1999). Rodent control: taking steps to prevent Hantavirus. Retrieved from: prevent-hantavirus/24_RodentHV_E99L.pdf Work Safe BC.(2006). A hantavirus risk control program for employers and workers. Retrieved from: 74.pdf