Special Pathogens BranchDVRD/NCID/CDC

Hantavirus Pulmonary Hantavirus Pulmonary

Syndrome (HPS)Syndrome (HPS)

Genus Genus Human diseaseHuman disease

BunyavirusBunyavirus LaCrosse encephalitis, othersLaCrosse encephalitis, others

PhlebovirusPhlebovirus Rift Valley fever, sandfly feverRift Valley fever, sandfly fever

NairovirusNairovirus Crimean-Congo hemorrhagic feverCrimean-Congo hemorrhagic fever

TospovirusTospovirus Plant virus, no known human diseasePlant virus, no known human disease

HantavirusHantavirus Hemorrhagic fever with renal syndromeHemorrhagic fever with renal syndrome

Hantavirus pulmonary syndromeHantavirus pulmonary syndrome

5 genera, 250 species5 genera, 250 species

Family BunyaviridaeFamily Bunyaviridae

• No arthropod vector establishedNo arthropod vector establishedUnique among genera of BunyaviridaeUnique among genera of Bunyaviridae

• Rodent hostsRodent hosts Genus and possibly species specificGenus and possibly species specific

• TransmissionTransmission Aerosolization of rodent excretaAerosolization of rodent excreta

Characteristics of HantavirusesCharacteristics of Hantaviruses

Chronically infected Chronically infected rodentrodent

Virus is present in aerosolized Virus is present in aerosolized excreta, particularly urineexcreta, particularly urine

Horizontal transmission of infection Horizontal transmission of infection by intraspecific aggressive behaviorby intraspecific aggressive behavior

Virus also present in throat Virus also present in throat swab and fecesswab and feces

Secondary aerosols, mucous membrane Secondary aerosols, mucous membrane contact, and skin breaches are also contact, and skin breaches are also

sources of infectionsources of infection

Transmission of HantavirusesTransmission of Hantaviruses

HTN Korea HTN Korea ApodemusApodemus agrariusagrarius

DOB SloveniaDOB Slovenia Apodemus flavicollisApodemus flavicollisSEOSEO JapanJapan Rattus norvegicusRattus norvegicus

PUUPUU FinlandFinland Clethrionomys glareolusClethrionomys glareolus

PUU RussiaPUU Russia Clethrionomys glareolusClethrionomys glareolus

PUU SwedenPUU Sweden Clethrionomys glareolusClethrionomys glareolus

SS

PUU BelgiumPUU Belgium Clethrionomys glareolusClethrionomys glareolusTOP RussiaTOP Russia Lemmus sibiricusLemmus sibiricusKBRKBR RussiaRussia Microtus fortisMicrotus fortis

TUL RussiaTUL Russia Microtus arvalisMicrotus arvalis

TUL CzechTUL Czech Microtus arvalisMicrotus arvalisTUL SlovakiaTUL Slovakia Microtus arvalisMicrotus arvalis

PHPH New YorkNew York Microtus pennsylvanicusMicrotus pennsylvanicusPHPH MarylandMaryland Microtus pennsylvanicusMicrotus pennsylvanicus

ISLAISLA CaliforniaCalifornia Microtus californicusMicrotus californicusMULEMULE Southern US Southern US Sigmodon hispidus (texianus)Sigmodon hispidus (texianus)

BCCBCC FloridaFlorida Sigmodon hispidus Sigmodon hispidus BAYBAY Southeastern US Southeastern US Oryzomys palustrisOryzomys palustris

ANDESANDES Argentina & ChileArgentina & Chile Oligoryzomys longicaudatusOligoryzomys longicaudatusLEC LEC ArgentinaArgentina Oligoryzomys flavescens Oligoryzomys flavescens

RIOM RIOM Bolivia & PeruBolivia & Peru Oligoryzomys microtisOligoryzomys microtisLNLN Paraguay & Bolivia Paraguay & Bolivia Calomys lauchaCalomys laucha

SN SN New Mexico New Mexico Peromyscus maniculatusPeromyscus maniculatus SNSN California California Peromyscus maniculatus Peromyscus maniculatus

NY NY New York New York Peromyscus leucopus Peromyscus leucopus NY NY RhodeRhode Island Island Peromyscus leucopusPeromyscus leucopus

MON MON West Virginia West Virginia Peromyscus maniculatusPeromyscus maniculatus ELMCELMC Western US & Mexico Western US & Mexico Reithrodontomys megalotisReithrodontomys megalotis

RIOS RIOS Costa Rica Costa Rica Reithrodontomys mexicanusReithrodontomys mexicanus

Phylogeny of Hantaviruses: Based on Sequence of S SegmentPhylogeny of Hantaviruses: Based on Sequence of S Segment (Subfamily, Hantavirus, Location, Host)(Subfamily, Hantavirus, Location, Host)

MURINAEMURINAE

ARVICOLINAEARVICOLINAE

SIGMODONTINAESIGMODONTINAE

HTN Korea HTN Korea ApodemusApodemus agrariusagrarius

HTN ChinaHTN China Apodemus agrariusApodemus agrariusMM

Phylogeny of Hantaviruses: Based on Sequence of M SegmentPhylogeny of Hantaviruses: Based on Sequence of M Segment(Subfamily, Hantavirus, Location,(Subfamily, Hantavirus, Location, Host) Host)

SEO Japan SEO Japan RattusRattus norvegicusnorvegicusSEO Korea SEO Korea RattusRattus norvegicusnorvegicus

THAI Thailand THAI Thailand Bandicotta indicaBandicotta indicaDOB Slovenia DOB Slovenia ApodemusApodemus flavicollisflavicollis

PUUPUU Sweden Sweden Clethrionomys glareolusClethrionomys glareolus

PUU Russia PUU Russia Clethrionomys glareolusClethrionomys glareolus PUU Finland PUU Finland Clethrionomys glareolusClethrionomys glareolus

PUU Belgium PUU Belgium ClethrionomysClethrionomys glareolusglareolusTUL Czech TUL Czech MicrotusMicrotus arvalisarvalisPH Maryland PH Maryland MicrotusMicrotus pennsylvanicuspennsylvanicus

BCC Florida BCC Florida SigmodonSigmodon hispidushispidusBAY Southeastern US BAY Southeastern US Oryzomys palustrisOryzomys palustris

Hu39694 Argentina Hu39694 Argentina unknownunknownLEC Argentina LEC Argentina OligoryzomysOligoryzomys flavescensflavescens

ORN Argentina ORN Argentina OligoryzomysOligoryzomys longicaudatuslongicaudatusLNLN Paraguay & Bolivia Paraguay & Bolivia Calomys lauchaCalomys laucha

SN CaliforniaSN California PeromyscusPeromyscus maniculatusmaniculatusSN New Mexico SN New Mexico Peromyscus maniculatusPeromyscus maniculatus

NY RhodeNY Rhode IslandIsland Peromyscus leucopusPeromyscus leucopusNY New YorkNY New York Peromyscus leucopusPeromyscus leucopus

BR OklahomaBR Oklahoma Peromyscus leucopusPeromyscus leucopusBR IndianaBR Indiana Peromyscus leucopusPeromyscus leucopus

ELMC Western US & MexicoELMC Western US & Mexico Reithrodontomys megalotisReithrodontomys megalotis

MURINAEMURINAE

ARVICOLINAEARVICOLINAE

SIGMODONTINAE

SEO China SEO China RattusRattus norvegicusnorvegicus

Subfamily Murinae associated viruses Virus Host Location Disease

Hantaan Apodemus agrarius Asia, Far East Russia HFRS

Dobrava Apodemus flavicollis Balkans HFRS Apodemus agrarius Europe

Seoul Rattus norvegicus Worldwide HFRS Rattus rattus

Subfamily Arvicolinae associated viruses Virus Host Location Disease

Puumala Clethrionomys glareolus Europe HFRS

Numerous other hantaviruses have been identified but not linked to human disease

Hantaviruses in the Old WorldHantaviruses in the Old World

Subfamily Sigmodontinae associated virusesSubfamily Sigmodontinae associated viruses

VirusVirus HostHost LocationLocation DiseaseDisease

Sin NombreSin Nombre Peromyscus maniculatusPeromyscus maniculatus West & Central West & Central HPSHPS

U.S. & CanadaU.S. & Canada

Monongahela Monongahela Peromyscus maniculatusPeromyscus maniculatus Eastern U.S. & Eastern U.S. & HPSHPS

Canada Canada

New YorkNew York Peromyscus leucopusPeromyscus leucopus Eastern U.S. Eastern U.S. HPSHPS

BayouBayou Oryzomys palustrisOryzomys palustris Southeastern U.S. Southeastern U.S. HPSHPS

Black Creek Canal Black Creek Canal Sigmodon hispidusSigmodon hispidus Florida Florida HPSHPS

Numerous other hantaviruses have been identified but not linked to human diseaseNumerous other hantaviruses have been identified but not linked to human disease

Hantaviruses in the New World (1)Hantaviruses in the New World (1)

Subfamily Sigmodontinae associated viruses (cont.)Subfamily Sigmodontinae associated viruses (cont.)VirusVirus HostHost LocationLocation DiseaseDisease

AndesAndes Oligoryzomys longicaudatusOligoryzomys longicaudatus Argentina & ChileArgentina & Chile HPSHPS

OranOran Oligorozomys longicaudatusOligorozomys longicaudatus Northwestern ArgentinaNorthwestern Argentina

LechiguanasLechiguanas Oligoryzomys flavescensOligoryzomys flavescens Central ArgentinaCentral Argentina

Hu39694Hu39694 UnknownUnknown Central ArgentinaCentral Argentina

Laguna NegraLaguna Negra Calomys lauchaCalomys laucha Paraguay &Paraguay & HPSHPSBoliviaBolivia

BermejoBermejo Oligoryzomys chacoensisOligoryzomys chacoensis NorthwesternNorthwestern HPSHPS

ArgentinaArgentina

JuquitibaJuquitiba UnknownUnknown BrazilBrazil HPSHPS

ChocloChoclo Oligoryzomys fulvescensOligoryzomys fulvescens PanamaPanama HPSHPS

Numerous other hantaviruses have been identified but not linked to human diseaseNumerous other hantaviruses have been identified but not linked to human disease

Hantaviruses in the New WorldHantaviruses in the New World (2) (2)

Sin NombreSin NombrePeromyscus maniculatus

Rio SegundoRio SegundoReithrodontomys mexicanusReithrodontomys mexicanus

El Moro CanyonEl Moro CanyonReithrodontomys megalotisReithrodontomys megalotis

AndesAndesOligoryzomys longicaudatusOligoryzomys longicaudatus

BayouBayouOryzomys palustrisOryzomys palustris

Black Creek CanalBlack Creek CanalSigmodon hispidusSigmodon hispidus

Rio MamoreRio MamoreOligoryzomys microtisOligoryzomys microtis

Laguna NegraLaguna NegraCalomys lauchaCalomys laucha

MuleshoeMuleshoeSigmodon hispidus

New YorkNew YorkPeromyscus leucopusPeromyscus leucopus

JuquitibaJuquitibaUnknown HostUnknown Host

MacielMacielNecromys benefactusNecromys benefactus

Hu39694Hu39694Unknown HostUnknown Host

LechiguanasLechiguanasOligoryzomys flavescensOligoryzomys flavescens

PergaminoPergaminoAkodon azaraeAkodon azarae

OrOránánOligoryzomys longicaudatusOligoryzomys longicaudatus

CCañaño Delgaditoo DelgaditoSigmodon alstoniSigmodon alstoni

Isla VistaIsla VistaMicrotus californicus

Bloodland LakeBloodland LakeMicrotus ochrogasterMicrotus ochrogaster

Prospect HillProspect HillMicrotus pennsylvanicusMicrotus pennsylvanicus

New World HantavirusesNew World Hantaviruses

BermejoBermejoOligoryzomys chacoensisOligoryzomys chacoensis

CalabazoCalabazoZygodontomys brevicaudaZygodontomys brevicauda

ChocloChocloOligoryzomys fulvescensOligoryzomys fulvescens

HantavirusPulmonary Syndrome

Chile (273)5

Argentina (404)4

Brazil(168)2

Uruguay (23) 1

Paraguay (74)1

Panama (31) 6

Bolivia (20)4

United States (335)7

Canada (36)3

Number of cases by date

1PAHO 01 2January 02 3May 02 4August 02

5 September 02 6 October 02 7 November 02

Countries with reported cases of HPS(no of cases)

Countries with no reported cases of HPS

Peromyscus maniculatusDeer mouse

Sigmodon hispidusCotton rat

FamilyFamily

TransmissionTransmission

Viral particlesViral particles

Structural Structural proteinsproteins

Genome Genome

BunyaviridaeBunyaviridae

vertebrate hosts,vertebrate hosts,no arthropod vectorsno arthropod vectors

spherical, 80-120 nmspherical, 80-120 nm

Glycoproteins: G1, G2Glycoproteins: G1, G2nucleoprotein: Nnucleoprotein: N

ss-RNA, trisegmented,ss-RNA, trisegmented,negative polarity negative polarity

Sin Nombre Virus CharacteristicsSin Nombre Virus Characteristics

Most FrequentMost Frequent OtherOther RareRare

FeverFever DizzinessDizziness RhinorrheaRhinorrhea

MyalgiaMyalgia ArthralgiaArthralgia Sore ThroatSore Throat

Nausea/VomitingNausea/Vomiting

CoughCough

Shortness ofShortness ofBreath Breath (late in (late in the course of the course of

disease)disease)

Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeClinical PresentationClinical Presentation

• TachypneaTachypnea

• TachycardiaTachycardia

• HypotensionHypotension

• Crackles or rales on lung Crackles or rales on lung examination examination

Hantavirus Pulmonary SyndromeHantavirus Pulmonary Syndrome Physical ExaminationPhysical Examination

• Bilateral interstitial infiltratesBilateral interstitial infiltrates - moderate to rapid progression - moderate to rapid progression

• Bilateral alveolar infiltratesBilateral alveolar infiltrates

• Pleural effusionPleural effusion

Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeRadiographic FindingsRadiographic Findings

May 27, May 27, 19931993

May 30, 1993May 30, 1993

May 31, 1993May 31, 1993Source: Dr. L. Ketai

Radiographic Progression of HPS Radiographic Progression of HPS in the Lungsin the Lungs

ChemistryChemistry

Low albuminLow albumin

Elevated LDHElevated LDH

Elevated AST (SGOT)Elevated AST (SGOT)

Elevated ALT (SGPT)Elevated ALT (SGPT)

HematologyHematology

Low platelet count Low platelet count

Atypical lymphocytes (immunoblasts)Atypical lymphocytes (immunoblasts)

Left shift on WBC differentialLeft shift on WBC differential

Elevated hematocritElevated hematocrit

Elevated WBCElevated WBC

Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeCommon Laboratory FindingsCommon Laboratory Findings

+++

FeverFeverPulmonaryPulmonaryedemaedemaShockShock

DiuresisDiuresis

ProdromeProdrome CardiorespiratoryCardiorespiratory ConvalescenceConvalescence

ImmunoblastsImmunoblasts

HCTHCTASTASTLDHLDH

3-6 days3-6 days 7-10 days7-10 days

PlateletsPlatelets +

+++

+

++

+

++

++

+

+

++

+

+

++

+

+

++

+

+

+++++++

++++

Clinical Progression of HPSClinical Progression of HPS

• Early aggressive intensive careEarly aggressive intensive care

• Early use of inotropic agents Early use of inotropic agents (Dobutamine)(Dobutamine)

• Early ventilationEarly ventilation

• Careful monitoringCareful monitoring

– OxygenationOxygenation

– Fluid balanceFluid balance

– Blood pressureBlood pressure

HPS ManagementHPS Management

• Early use of inotropic agentsEarly use of inotropic agents

• Mechanical ventilationMechanical ventilation

• Judicious volume resuscitation Judicious volume resuscitation

• Early PA catheter Early PA catheter

SQS 6/95

ICU Monitoring and TherapyICU Monitoring and Therapy

• SerologySerology

IgMIgM

IgGIgG

• ImmunohistochemistryImmunohistochemistry

• Reverse transcription Reverse transcription and polymerase chain and polymerase chain

reaction (RT-PCR)reaction (RT-PCR)

Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeLaboratory-confirmed DiagnosisLaboratory-confirmed Diagnosis

Interstitial PneumonitisInterstitial Pneumonitis

– CongestionCongestion

– Interstitial infiltrate of Interstitial infiltrate of

enlarged mononuclear enlarged mononuclear

cells (immunoblasts) cells (immunoblasts)

– Intra-alveolar and septal Intra-alveolar and septal

edema edema

– Focal hyaline membranesFocal hyaline membranes

HistopathologyHistopathologyLung (1)Lung (1)

Absence or minimal evidence of:Absence or minimal evidence of:

– Cellular debrisCellular debris

– NeutrophilsNeutrophils

– Epithelial injuryEpithelial injury

– Viral inclusionsViral inclusions

– Fungi or bacteria by Fungi or bacteria by

specific stains specific stains

HistopathologyHistopathologyLung (2)Lung (2)

• Enlarged mononuclear cells (immunoblasts)Enlarged mononuclear cells (immunoblasts)

– Lymph nodes Lymph nodes

(sinuses and paracortex) (sinuses and paracortex)

– Spleen (red pulp and Spleen (red pulp and

periarteriolar sheaths) periarteriolar sheaths)

– Liver (triaditis)Liver (triaditis)

– Vessels (different organs)Vessels (different organs)

• Other changes (minor)Other changes (minor)

SpleenSpleen

HistopathologyHistopathologyOther OrgansOther Organs

Peridomestic exposurePeridomestic exposure

Peridomestic & occupationalPeridomestic & occupational exposureexposure

Peridomestic & recreational exposurePeridomestic & recreational exposure

Occupational exposure Occupational exposure

Entering/cleaning rodent-infested Entering/cleaning rodent-infested structuresstructures

Armstrong, L.R. et al., JID 1995; 172 (October)Armstrong, L.R. et al., JID 1995; 172 (October)

69% (48/70)69% (48/70)

19% (13/70)19% (13/70)

9% (6/70)9% (6/70)

4% (3/70)4% (3/70)

9% (6/70)9% (6/70)

Rodent ExposureRodent Exposure70 confirmed HPS cases70 confirmed HPS cases

Risk groupRisk groupForest workersForest workers11

Health care workersHealth care workers22

Prodromal HPSProdromal HPS33

ContactsContacts44

Rural OCCRural OCC55

Rodent workersRodent workers66

TotalTotal

Location/timeLocation/timeSW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1994SW US, 1994US, 1994US, 1994

Postive/tested (%)Postive/tested (%)0/1430/1430/3960/3963/299 (1.0%)3/299 (1.0%)3/239 (1.3%)3/239 (1.3%)1/522 (0.2%)1/522 (0.2%)8/932 (0.9%)8/932 (0.9%)

15/2531 (0.6%)15/2531 (0.6%)1. Vitek et al, 19961. Vitek et al, 1996 2. Vitek et al, 19962. Vitek et al, 1996 3. Simonsen et al, 19953. Simonsen et al, 19954. Zeitz et al, 19954. Zeitz et al, 1995 5. Zeitz et al, 19955. Zeitz et al, 1995 6. Armstrong et al, 19956. Armstrong et al, 1995

Prevalence of SNV IgG Antibodies in Prevalence of SNV IgG Antibodies in Select U.S. PopulationsSelect U.S. Populations

CountryCountry Positive/tested (%)Positive/tested (%) TimeTimeParaguayParaguay11 44/345 (12.8%)44/345 (12.8%) 19951995Western ParaguayWestern Paraguay2 2 78/193 (40.4%)78/193 (40.4%) 1993-19951993-1995(Indian Population)(Indian Population)

ArgentinaArgentina33 <1%<1% 19961996 Salta ProvinceSalta Province22 38/222 (17.1%)38/222 (17.1%) 1993-19951993-1995(Indian Population)(Indian Population)

ChileChile33 2-13%2-13% 19971997

1. Williams, 19971. Williams, 1997 2. Ferrer, 1998 3. Peters, 1998; Weissenbacher, 1996 2. Ferrer, 1998 3. Peters, 1998; Weissenbacher, 1996

Prevalence of SNV IgG Antibodies in Prevalence of SNV IgG Antibodies in Select South American PopulationsSelect South American Populations

Control Mice InsideControl Mice Inside

Control Mice OutsideControl Mice Outside

Use Safety PrecautionsUse Safety Precautions

HPS PreventionHPS Prevention

• Eliminate food sourcesEliminate food sources

– Wash dishes and clean the floor Wash dishes and clean the floor

and counters and counters

– Put pet food and water away at Put pet food and water away at

nightnight

– Store food / garbage in containers Store food / garbage in containers

with tight lids with tight lids

Control Mice InsideControl Mice Inside

• Prevent mice from enteringPrevent mice from entering

– Clear brush and grass from Clear brush and grass from around foundation around foundation

– Seal holes or use flashing Seal holes or use flashing around the base of the house around the base of the house

• Use continuous trapping effortsUse continuous trapping efforts

Control Mice InsideControl Mice Inside

Control Mice InsideControl Mice Inside

• Eliminate possible nesting sitesEliminate possible nesting sites

– Elevate hay, woodpiles, and Elevate hay, woodpiles, and

garbage cansgarbage cans

– Locate them at least 100 feet Locate them at least 100 feet

from housefrom house

– Eliminate junk or things that Eliminate junk or things that

provide shelter to rodentsprovide shelter to rodents

Control Mice OutsideControl Mice Outside

• Eliminate food sourcesEliminate food sources– Store all animal feed in Store all animal feed in

containers with lidscontainers with lids

– Discard excess food in the Discard excess food in the

evening into containers evening into containers

with lidswith lids

– Take up water bowls in the Take up water bowls in the

eveningevening

Control Mice OutsideControl Mice Outside

• Natural predators are beneficialNatural predators are beneficial– Non-poisonous snakesNon-poisonous snakes

– OwlsOwls

– HawksHawks

Control Mice OutsideControl Mice Outside

• When cleaning in areas infested with When cleaning in areas infested with

rodentsrodents– Wear rubber glovesWear rubber gloves

– Don't stir up and breathe dustDon't stir up and breathe dust

– Wet contaminated areas with Wet contaminated areas with

disinfectant disinfectant

– Dispose of dead animals properlyDispose of dead animals properly

– Disinfect used glovesDisinfect used gloves

Use Safety PrecautionsUse Safety Precautions

• When enjoying outdoor activitiesWhen enjoying outdoor activities

– Avoid contact with rodentsAvoid contact with rodents

– Stay away from rodent burrows or nestsStay away from rodent burrows or nests

– Keep campsite clean and food tightly Keep campsite clean and food tightly

sealedsealed

– Open unused cabins and air out before Open unused cabins and air out before

entering or cleaningentering or cleaning

– Avoid sleeping on bare groundAvoid sleeping on bare ground

Use Safety PrecautionsUse Safety Precautions

Hantavirus InfectionHantavirus Infection

HPSHPS

Hantavirus IllnessHantavirus Illness

Spectrum of IllnessSpectrum of Illness

MMWR 1993; 42: 816-820MMWR 1993; 42: 816-820

• Febrile illness (T Febrile illness (T >> 38.3 38.3°C°C) )

• Unexplained ARDS or bilateral infiltrates following Unexplained ARDS or bilateral infiltrates following

hospitalizationhospitalization

• Supplemental oxygenSupplemental oxygen

oror

• Noncardiogenic pulmonary edema at autopsyNoncardiogenic pulmonary edema at autopsy

• No identifiable specific cause of deathNo identifiable specific cause of death

HPS National SurveillanceHPS National SurveillanceHPS Case DefinitionHPS Case Definition

• Febrile illness (T > 38.0Febrile illness (T > 38.0º Cº C) )

• No bilateral diffuse interstitial or No bilateral diffuse interstitial or alveolar infiltratesalveolar infiltrates

HPS National SurveillanceHPS National Surveillance Mild Hantaviral Illness Case DefinitionMild Hantaviral Illness Case Definition

• Full clinical spectrum of HPS is undefinedFull clinical spectrum of HPS is undefined– Cases with mild pulmonary diseaseCases with mild pulmonary disease

– Cases with accompanying renal diseaseCases with accompanying renal disease

• Depending on resources, screening Depending on resources, screening criteria could includecriteria could include::

– Mild pulmonary diseaseMild pulmonary disease

– Unexplained acute febrile renal diseaseUnexplained acute febrile renal disease

– Other febrile syndromesOther febrile syndromes

HPS National SurveillanceHPS National SurveillanceCommentsComments

• SafetySafety– Label as infectious substance and/or human Label as infectious substance and/or human blood precautions blood precautions – Double container with absorbent material sufficient Double container with absorbent material sufficient

for volume being sentfor volume being sent– Plastic tubes preferable over glassPlastic tubes preferable over glass

• ConditionsConditions– Sera -- room temperature or cold pack Sera -- room temperature or cold pack – Clot or buffy coat -- dry iceClot or buffy coat -- dry ice– Fresh tissues (1-cm cubes) -- dry iceFresh tissues (1-cm cubes) -- dry ice– Formalin-fixed tissue and blocks -- room temperature Formalin-fixed tissue and blocks -- room temperature

(don't freeze)(don't freeze)

ShippingShipping

For details on:For details on:- Specimen types and volumes- Specimen types and volumes- HPS Case Report Forms- HPS Case Report Forms- National Surveillance Laboratory Specimen Forms- National Surveillance Laboratory Specimen Forms

CallCall 404-639-1511404-639-1511oror

Visit Visit www.cdc.gov/ncidod/diseases/hanta/hps/index.htm

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