Key facts about Hantavirus and Ebola virus disease

Two deadly infectious diseases, Ebola and hantavirus have made headlines in recent weeks as they pose serious threats to public health. They both require rigorous infection and prevention control (IPAC) practices and often present with similar early symptoms. Two succinct articles in Canadian Medical Association Journal provide information about each disease for clinicians.

Hantavirus:

Hantavirus infection is a nationally notifiable disease in Canada, with 4 to 5 cases reported every year. These are usually acquired from rodents in agricultural settings in Manitoba, Saskatchewan, Alberta, and British Columbia. The Andes strain is unique as it can be transmitted from person to person.

Hantavirus infection causes 2 clinical symptoms. Strains in the Americas, which include the Andes virus featured recently in the news, cause hantavirus cardiopulmonary syndrome. The European and Asian strains cause hemorrhagic fever and kidney dysfunction. Both forms take about 2 to 4 weeks to incubate, and symptoms include fever, headache, muscle aches, and abdominal pain.

Hantavirus infection is diagnosed through serology and polymerase chain reaction (PCR) tests however there is no specific antiviral treatment or vaccine for hantavirus, ans so treatment is supportive to help alleviate symptoms.

IPAC protocols are essential. Patients with suspected Andes strain infection must be isolated with airborne, droplet, and contact precautions, with infectious diseases experts involved and public health notified.

Ebola virus disease:

Sporadic outbreaks of Ebola virus disease have occurred in Central and West Africa since 1976. There are 3 main viruses that can infect humans, and evidence suggests they come from fruit bats. Ebola virus is spread via person-to-person contact through bodily fluids like vomit, sperm, diarrhea, and blood, as well as by touching infected surfaces or objects. The current outbreak in the Democratic Republic of Congo is Bundibugyo ebolavirus, with a fatality rate of 30% to 50%.

Clinically fewer than 50% of patients have hemorrhagic symptoms but other symptoms include fever of 38°C or higher, fatigue, muscle pain, and gastrointestinal distress. Incubation is 2 to 21 days.

PCR testing is used to diagnose infection and anyone with potential symptoms and exposure risk should be tested including people who have travelled to countries with Ebola virus disease or who have been in close contact with infected people or bats, primates, or game from the affected areas should be tested.

Important advances in prevention and management of the disease have been made. Vaccines to prevent Zaire ebolavirus are very effective, and 2 antivirals can reduce mortality from 50% to 35%. However, there are no current vaccines or medications to prevent or treat Bundibugyo ebolavirus, for which supportive care is the main approach.

Stringent IPAC must be used for suspected cases. Health Canada has a detailed process for screening, assessment, and IPAC precautions, which must include a fit-tested N95 respirator, face shield, gloves, and fluid-impermeable gear for full protection.