disease outbreak news
January 23, 2019
On December 19, 2018, Argentina Ministry of Health and Social Development issued an epidemiological alert about the increasing cases of hantavirus pulmonary syndrome (HPS) in Epuyén, Chubut Province. Between 2018-20 October 28 January 2019, a total of 29 laboratory-confirmed cases of HPS, including 11 deaths have been reported in Epuyén, Chubut Province. Epuyén has a population of about 2000 people, and is located in the Chubut province of Patagonia in southern Argentina.
The index case had environmental exposures before the onset of symptoms on Nov. 2, and then attend a party on 3 November. Six cases were also attending the party experiencing the onset of symptoms between 20 to 27 November 2018. Additional 17 cases, all of which are epidemiologically-linked to previously confirmed cases, experienced symptom onset between 7 December 2018 and January 3, 2019 (Figure 1). Potential human to human transmission are currently being investigated.
Of the confirmed cases, 59% were women, and has an incubation period ranging from 8 to 31 days. Approximately 50% of the confirmed cases reported symptoms in the last three weeks. Cases were confirmed by ELISA IgM u-captura or by polymerase chain reaction (PCR).
On January 17, 2019, a total of 98 asymptomatic contacts have been identified and are being monitored for potential development of symptoms.
In Argentina, four endemic areas have been identified: North (Salta, Jujuy), Centro (Buenos Aires, Santa Fe, and Entre Ríos), Northeast (Misiones) and Sur (Neuquen, Rio Negro and Chubut). Between 2013 and 2018, an average of 100 confirmed cases registered each year, with the province of Buenos Aires, Salta, and Jujuy have the highest number of cases. Between 2013 and 2018, 114 confirmed deaths from hantavirus reported in Argentina, with a case-fatality rate of 18.6%, although this figure is close to 40% for some provinces in the southern region of the country.
In Chile, one of the confirmed cases was a health worker who lives in the Palena Province, Los Lagos Region, and reported experiencing symptoms on 2 January 2019. This case has a travel history to Epuyén for one day in mid-November, and then the hosts and treated confirmed cases of Epuyén when he was in his prodromal phase. This is the first confirmed case of hantavirus in Los Lagos Region in 2019. During 2018, there were eight cases of hantavirus were reported in Chile, including two deaths.
Source: Published by the Department of Health Chubut Province and reproduced by PAHO / WHO
Health authorities in Argentina and Chile implementing public health measures as follows:
HPS is a respiratory disease of zoonotic virus. The causative agent belongs to the genus Hantavirus, family Bunyaviridae. Infection is acquired primarily through inhalation of aerosols or contact with the feces of infected rodents, droppings, or saliva of infected rodents. Human cases of hantavirus infection usually occurs in rural areas (forests, fields, and farms) where the host mice sylvatic virus might be found and where people can be exposed to the virus. The disease is characterized by headache, dizziness, fever, chills, myalgias, and gastrointestinal problems such as nausea, vomiting, diarrhea, and abdominal pain, followed by the sudden onset of respiratory distress and hypotension. Symptoms of HPS usually occur two to four weeks after initial exposure to the virus. However, symptoms can appear since one week and up to the end of the eight weeks after exposure. Case-fatality rate can reach 35-50%.
In the United States, cases of HPS have been reported in several countries. environmental and ecological factors that influence rodent population can have a seasonal impact on disease trends. Since the reservoir for Hantavirus is sylvatic rodents, especially species Sigmodontinae, transmission can occur when people come in contact with rodent habitat. from human to human transmission is limited HPS for Andes virus in Argentina has been documented previously. There is no specific evidence-based procedure for HPS patients isolation. Precautions1 standards should always be put in place, as well as measures of rodent control.
PAHO / WHO recommends that Member States continue efforts detection, investigation, reporting, and case management for the prevention and control of infections caused by hantavirus.
Special attention should be paid to travelers returning from affected areas. early identification and timely medical treatment greatly improve the clinical outcome. To raise awareness about the potential of HPS cases, a doctor should be consulted for guidance epidemiological data of exposure as possible, and be wary of patients with clinical signs suspicious and symptoms such as fever, myalgia, and thrombocytopenia.
Care in the early stages of this disease should include antipyretic and analgesic required. In some situations, patients should receive broad spectrum antibiotics while confirming the etiologic agent. Given the rapid development of HPS, clinical management must focus on the monitoring of the patient’s hemodynamic status, fluid management, and ventilatory support. Severe cases should be immediately transferred to the intensive care unit (ICU).
Ribavirin, antiviral agent, is not approved for either treatment or prophylaxis of infection hantavirus pulmonary syndrome.
health awareness campaign should aim to improve the detection and timely treatment and prevent disease by reducing exposure to the public. Precautions should include labor and eco-tourism related hazards. Most of the usual tourism activities pose little or no risk of exposure rating for rodents or their droppings. However, people involved in outdoor activities such as camping or hiking, should take precautions to reduce possible exposure to potentially infectious material.
HPS surveillance should be part of a comprehensive national surveillance system and should include clinical, laboratory, and environmental components. Implementation of integrated environmental management, with the aim of reducing the rodent population, is recommended.
1 standard precautions refers to a set of practices that are applied to patient care, regardless of the state of infection (suspicion or confirmation), in every place where health services are provided. These practices aim to protect health professionals and patients and include: hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe handling of materials sharp objects, the practice of injection are safe, the use of sterile instruments and equipment and cleaning up the environment hospitals and the environment. Adapted from “Prevention and Control of Healthcare associated infections – Basic Recommendations” – PAHO, 2017. Accessed 8 Jan 2019. Available at:
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