Background

Hantaviruses are a family of viruses that can cause serious illnesses and death. Different types of hantavirus are present in the United States. The hantaviruses found in the United States are not known to spread between people.

From 1993 to 2023, the United States reported 890 laboratory-confirmed cases primarily in the western U.S. where hantavirus is endemic. Hantaviruses are not endemic in the District, meaning that the virus is not regularly found locally.

Hantaviruses cause two syndromes:

• Hantavirus pulmonary syndrome (HPS): A severe and potentially deadly disease that affects the lungs. Among patients who have respiratory symptoms, the case fatality rate is approximately 38%. The Sin Nombre virus is the most common hantavirus that causes HPS in the United States.
• Hemorrhagic fever with renal syndrome (HFRS): A severe and sometimes deadly disease that affects the kidneys. HFRS is caused by hantaviruses found mostly in Europe and Asia. However, Seoul virus, a type of hantavirus that causes HFRS, is found worldwide, including in the United States.

Transmission

Hantaviruses are most commonly spread to humans through contact with infected rodents (e.g., urine, droppings, saliva). Those who have contact with hantavirus-carrying rodents, or their droppings, urine, saliva, or nesting materials are at higher risk of HPS. Rodent infestation in and around the home remains the primary risk for hantavirus exposures.

The Andes virus, found in Argentina and Chile, is the only type of hantavirus that is known to spread person-to-person and also causes HPS. Individuals infected with the Andes virus are generally only contagious while symptomatic. Signs and symptoms of HPS due to the Andes virus appear 4-42 days after exposure.

Signs and Symptoms

Hantavirus Pulmonary Syndrome (HPS)

Symptoms of HPS usually appear 1-8 weeks after contact with an infected rodent.

Early symptoms include:

• Fatigue
• Fever
• Muscle aches, especially in large muscle groups, like the thighs, hips, back, and sometimes shoulders.

About half of the people infected with hantavirus will also develop headache, dizziness, chills, and gastrointestinal symptoms like nausea, vomiting, diarrhea, and abdominal pain.

Late symptoms appear approximately 4-10 days after the initial phase of illness and can include the following:

• Coughing
• Shortness of breath
• Chest tightness

Hemorrhagic Fever with Renal Syndrome (HFRS)

Symptoms of HFRS usually develop within 1 to 2 weeks after exposure, but can take up to 8 weeks to develop.

Initial symptoms include:

• Intense headaches
• Back and abdominal pain
• Fever/chills
• Nausea
• Blurred vision
• Flushing of the face, eye redness, or a rash

Later symptoms include:

• Low blood pressure
• Lack of blood flow (acute shock)
• Internal bleeding (vascular leakage)
• Acute kidney failure, which can cause severe fluid overload

Prevention

Rodents can carry many diseases that can spread directly or indirectly to people. District residents should take usual precautions to prevent disease transmission when interacting with wild rodents or their environments, including:

• Avoid exposure to rodents and their urine, droppings, or saliva.
• Clean up fresh urine, droppings, or nesting materials of rodents safely.
  • Use a general-purpose household disinfectant cleaning product or a bleach solution.
  • Wear rubber or plastic gloves.
  • Do not vacuum or sweep rodent droppings. This can cause tiny droplets containing viruses to become airborne.
  • Spray urine and droppings with bleach solution or an EPA-registered disinfectant until very wet. Let it soak for 5 minutes or according to instructions on the disinfectant label.
  • Use paper towels to wipe up the urine or droppings and cleaning products.
  • Throw the paper towels in a covered garbage can that is regularly emptied.
  • Mop or sponge the area with a disinfectant. Clean all hard surfaces including floors, countertops, cabinets, and drawers.
  • Wash gloved hands with soap and water or a disinfectant before removing gloves.
  • Wash hands with soap and warm water after removing gloves. Use a waterless alcohol-based hand rub when soap is not available, and hands are not visibly soiled.
• Clean up dead rodents or nests
  • Wear rubber or plastic gloves.
  • Spray the dead rodent, nest, and surrounding area with a disinfectant. Let it soak for 5 minutes or according to instructions on the disinfectant label.
  • Place the dead rodent or nesting materials in a plastic bag along with any used traps. Follow these steps if you plan to reuse the trap.
  • Tie the ends of the bag together in a knot to seal the bag. Place the full bag in a second plastic bag. Seal the second bag by tying the ends together in a knot.
  • Throw the bag into a covered garbage can that is regularly emptied.
  • Wash gloved hands with soap and water or a disinfectant before removing gloves.
  • Wash hands with soap and warm water after removing gloves. Use a waterless alcohol-based hand rub when soap is not available and hands are not visibly soiled.
• Clean up spaces like cabins, sheds, barns, air ducts, vehicles, and other surfaces by following these instructions.

Information for Healthcare Providers

Diagnosis & Treatment

Healthcare providers should be aware of the potential for imported cases, although the risk of broad spread to the United States is considered extremely unlikely at this time.

Assessing patients for hantavirus can be difficult early in the infection because symptoms are non-specific and can resemble many other viral infections like COVID-19, influenza, legionnaire’s, leptospirosis, mycoplasma, and Q fever. Consider testing for more common illnesses in acutely ill patients with epidemiological risk factors and compatible symptoms.

No specific treatment is recommended for hantavirus infection. Early supportive care is critical even before the diagnosis is confirmed. Patients with suspected HPS can deteriorate rapidly, and delayed care reduces the chance of survival.

Resources

• CDC | About Hantavirus
• DC Health Hantavirus Fact Sheet