Latest / Culture Positive: An Infection Prevention Podcast / What in the Hanta?
Transcript
- Ally: Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at culturepositivepod at gmail.com. References for the episode can be found in the show notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious. If there are three things you should know about me, it's that my dog is the queen of my life. I make a mean sourdough bread, and I live to make travel plans. While I would personally never get on a cruise ship, listen to how incredible this trip sounds. For around 20 days, you are able to visit some of the world's Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each episode will dive into healthcare stories. Most remote islands. You start your adventure in the southernmost city in Argentina and eventually make it all the way to St. Helena Island in the middle of the Atlantic, off the southwestern coast of Africa. Not only are you able to see beautiful landscapes, but also animals you would never dream of seeing. A trip of a lifetime, right? Public health conversation, workplace reality, historical context, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. Stay compassionate and keep building a culture that's truly positive. This itinerary been in the news recently, but unfortunately some disembarked off at Cape Verde, ⁓ and ⁓ a few individuals didn't make it off the cruise alive. Starting to sound familiar, I'm sure by now you know where this is going. Hontavirus. Let's get into it. Hontaviruses are a large group of viruses that are zoonotic. Remember, zoonotic means that transmission occurs between animals and humans. Oftentimes, rodents are naturally infected with hantaviruses and can transmit to humans via infected urine, saliva, or feces from the rodent. Now, I know what you're thinking. Do you have to ingest bodily fluids of an infected rat in order to get hantavirus? The answer is no. You can actually be exposed by inhaling the airborne particles of the virus. Some examples of this kind of exposure could be cleaning up feces or urine in a poorly ventilated room, or even disrupting a nesting area. Of course, it is possible for direct contact like a scratch or bite. Unfortunately, infection in people can cause severe morbidity and can also lead to death. Different parts of the world are noted to have various hantaviruses. For example, in Europe and Asia, some hantaviruses can cause hemorrhagic fever with renal syndrome, while in the Americas, records of hontivirus have led to cardiopulmonary syndrome. The Andes virus, the strain reported from the cruise ship, is a severe strain of hantivirus that is from South America, often found in Argentina and Chile. Symptoms reported are fever, chills, headaches, fatigue, muscle aches, nausea, and diarrhea. this strain of hontivirus can also lead to hantavirus pulmonary syndrome. Also known as HPS, it's a severe, ⁓ respiratory disease that starts out with flu-like symptoms and rapidly progresses to pulmonary failure and shock. The fatality rate for hontivirus pulmonary syndrome is around 30 to 40 percent. The anti-strain can also have person to person transmission. Now, this is not true for all Hontaviruses, which is why it is particularly devastating for this strain to end up on a cruise ship. And if the antistrain couldn't be more complicated, it also has a lengthy incubation period. First, let's address what even is an incubation period. It is the time between an exposure to an infectious agent, in this situation, a virus, and the first signs of a symptom in an individual. The antistrain of hontivirus Has an incubation period that ranges from 4 to 42 days. Remember the length of the incubation period. This will become helpful later on in the episode. ⁓ and icing on the cake? There is no specific treatment for hontivirus. Now that we have a little background into the virus itself, let's play a game of tracing a real life outbreak, shall we? The infamous cruise ship took sail from Argentina on April 1st and made several anticipated stops, including Antarctica, and several small islands in the South Atlantic Ocean. On April 6th, We had our first passenger on the cruise ship reporting symptoms including fever, headache, and diarrhea. The passenger was a 70-year-old Dutchman who, before boarding the ship with his wife, had reportedly been traveling throughout Argentina and Chile. As an epidemiologist, these are the kind of details we're looking for. in an investigation. the man passed away on April 11th due to developing respiratory distress. At this time, the medical care on board did not know what caused the patient to develop respiratory distress. But knowing what we know now, It is likely hantavirus pulmonary syndrome. On April 24th, the ship stops at St. Helena and the man's body is taken off of the cruise ship with his wife joining his remains. For some passengers on the ship, this was their scheduled end of the cruise, and there were around two dozen passengers who disembarked from the ship. The next day on April 25th, the wife of the index passenger reported symptoms and traveled on a commercial flight from St. Helena to South Africa. One day later on April 26th, The wife of the Dutchman who passed away dies while trying to board another plane to go home. Checking in on the passengers left board the ship, it is reported on April 27th that a British man becomes ill and is evacuated to Ascension Island. Keep in mind this is 21 days after the index case reported symptoms. The British passenger developed a high fever, shortness of breath, and signs of pneumonia. That eventually put him in an intensive care unit in a South African hospital. Just a day later on april twenty eighth, a German woman on board falls sick and unfortunately four days later passes away. This is the third death. Our index patient reported symptoms on April sixth. Look at how much has happened in such a short amount of time. May second, the day of the third death, is also the same day a positive hantavirus test comes back for the British passenger that was in the ICU in South Africa. This marks the first time hontivirus has been officially identified. The following day on May 3rd is when the World Health Organization ⁓ got involved and started responding to what was labeled as a suspected outbreak of hantavirus. Remember the Dutch woman, the wife of the first case, who passed away trying to get back home? It was decided that she should be tested for the virus after passing away. And guess what? She also came back positive for hontavirus. Since there are now officially two cases, we have an outbreak. More people reported feeling unwell on the ship, and on May 6th, we have two more people test positive for Hontavirus, and another person was reported as positive from an individual who got off the ship at St. Helena. Our total confirmed cases have moved to five. Speaking of the man who got off the ship at St. Helena. He was one of about twenty four that disembarked. Those who left the cruise started to be monitored by health officials in South Africa, Singapore, Switzerland, Britain, the Netherlands, and France. Finally, on May 10th, the ship anchored in Spain's Canary Islands, and around 60 passengers were finally able to get off the cruise ship. This, however, was not the end of the Hontavirus journey for those ship passengers. They were flown back to their respective countries to complete a quarantine. Okay, earlier in the episode, I said to remember the incubation period for hantavirus. It is quite a long incubation period of 4 to 42 days. Incubation periods drive how long a quarantine can be. And ⁓ the cruise passengers got to their home country, they had to complete a 42-day quarantine. From their last exposure to Hontavirus. For the US, eighteen passengers were sent to the National Quarantine Unit at Nebraska Medical Center. Did you know we have a national quarantine unit in the United States? It is a part of the training, simulation, and quarantine center in Omaha, Nebraska that not only has the only federally funded 20-bed quarantine unit, but also provides a biocontaminant unit training center, incident management and skills training, and an emergency operation center. The National Quarantine Unit itself is actually a team of volunteers. Subject matter experts who complete quarterly training in infection prevention and control. If you are interested in bioterrorism work, you should definitely check this center out. Who knows? Maybe you can be a member of the team one day. ⁓ The National Quarantine Unit is fairly new, with opening its doors in November of 2019. Can you believe the timing? Just about two months later, the unit stood up for the first time, taking in and monitoring Americans who were evacuated from China. Wuhan, China, to be specific. What we now know as the beginning of the COVID nineteen pandemic. I don't know if anyone else has been seeing the videos on social media, but it's been really interesting to see people recording their day to day while at the National Quarantine Unit. I can't imagine how scary and intimidating it would be entering that facility with the burden of the unknown. I really admire and appreciate those individuals for not only prioritizing their own health. but also the well being of the public. As of june eighteenth, here is where we stand with the Hontavirus cruise outbreak. There are twelve confirmed cases, and of those cases, three deaths. We started out with 18 Americans at the National Quarantine Unit, and six remain. Passengers who left the National Quarantine Unit are continuing to be monitored by their local health departments, with the quarantine period ending. June twenty first. Fingers crossed, by the time you are hearing this, prevention has prevailed and the work of public health officials has led to containment. When working up an outbreak, you always try to find the source. A lot of times we can speculate, come up with theories, but it can be challenging to confirm a clear source. How did Hontivirus end up on the cruise ship? Was the Dutch couple exposed to Hontavirus and their travels before even getting on the ship? Did a rodent sneak onto the cruise ship during one of the initial stops on the remote islands in South Atlantic Ocean? We may never know. From what I have read in the news and my background in infectious disease, I think it's likely the Dutch couple were exposed to hontivirus during their travels to Chile and Argentina before embarking on the cruise. Since this strain of hantivirus, the Andes strain, does allow for person to person transmission, it would have been possible for there to be close contact between passengers. Especially with the nature of a cruise ship. Tighter quarterssailor For our huddle corner, a section for some takeaways before signing off. Reminder hontiviruses are zoonotic. They can spread between animals and humans, and for hantiviruses specifically, infection usually happens with contact of infected rodents' urine or drumpings. Also, don't forget How long the incubation period is, specifically for the Andes strain, of 4 to 42 days. And this is also why those in the National Quarantine Unit had to isolate for such a long time. And finally, I am a big proponent of a good travel moment. But maybe give a second thought to booking that next cruise ship.