Hantavirus: An Emerging or Endemic Infection?

Transcription

1 Hantavirus: An Emerging or Endemic Infection? Presented by Jason Austin Senior Environmental Health Officer Slide 1

2 What is Hantavirus? A group of viruses that are normally carried by rodents, such as rats, mice and voles Transmitted through the inhalation of infected animal excreta and fluids, such as urine, faeces and saliva Causes 2 serious infections in humans, i.e. haemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) Very few cases of hantavirus infection have been confirmed in the United Kingdom Slide 2

3 What is Hantavirus? Found in both pet and wild rodents Once infected the rodent will secrete infectious virus for prolonged periods, probably for life Incubation period is generally 2 to 4 weeks but can range from 2 days to 8 weeks. Fever, headache, gastrointestinal symptoms and kidney problems The more severe forms of disease can result in haemorrhage (bleeding) from internal organs and the skin Slide 3

4 Control Measures Good personal hygiene, handwashing etc Do not kiss pet rodents or hold them close to your face. Cover cuts, scratches or sores Keep your pet rodent out of food preparation rooms and limit access around house Use of a suitable face mask (FFP3 would be best) and gloves when cleaning animal housing Supervise children Slide 4

5 22 nd July 2015 Case of suspected Hantavirus reported by Health Protection Team 26 year old, male Admitted to Nevill Hall Hospital on 17 July 2015 and discharged on 21 July Feeling generally unwell, vomiting with a subsequent diagnosis of renal injury. Range of bloods taken. Case informed medical staff he kept rats. Slide 5

6 Investigation Kept fancy rats in a shed in back garden Kept snakes and various reptiles in the Reptile Room in house Sold rats (live and frozen for food) and snakes Lives with partner and 3 children (aged 2, 4 & 8) All symptomless, no contact with rats or snakes Slide 6

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12 An Underground World Bought from a supplier who did not wish to be named Majority of sales via social media - preloved.com and/or Facebook Informal Reptile Group Agreed for case to provide some public health advice leaflets However, evidence required that this had been undertaken. Slide 12

13 Supplier List Rats sold (or swapped) across South East Wales Names, telephone numbers and addresses provided Infection Control Leaflets sent both by and post (if address given) Advised to seek G.P Advice if concerned and inform them that they have handled rodent(s). Slide 13

14 Other Contacts The case has had direct contact with contaminated bedding, dust etc. Father and a friend has also looked after rats whilst case was unwell. Used PPE (dust mask, gloves, overalls) and Virkon S disinfectant in sachets Some of contaminated bedding taken away for composting Slide 14

15 Next Steps Case keen to stop keeping rodents and reptiles Euthanasia discussed and arranged Environmental cleaning and disinfection required Laboratory testing desirable Contaminated bedding (and some carcasses) bagged and left in shed. Virus should be inactive after 3-4 weeks All carcasses taken for laboratory testing Slide 15

16 The Results 20 out of 30 rats randomly sampled from a total of 300 by APHA Weybridge were positive for hantavirus by PCR. Seoul hantavirus confirmed Very similar to those obtained for pet rats in other incidents/outbreaks in Cheltenham and Banbury/Wrexham. Not surprising given known intermixing or shared sourcing of rats between locations. Slide 16

17 28 DAYS LATER Slide 17

18 Breeder NE Customer / CS Customer KM Supplier SM Customer/ caretaker Case 1 Customer Case 2 Case 3 s brother in law Case 3 DM Customer / caretaker Rodent movement Human Association No test undertaken

19 Case 3 Worked 5 days/week in a commercial rat farm Rats were bred, killed and frozen at varying ages for sale to pet shops His job was to clean out the cages where the rats were housed and feed the rats Also had rats at home, one of which was purchased from Case 1 Slide 19

20 The Rat Farm Five interlinked former articulated lorry trailers. 3 members of staff, plus the owner, 2,000-3,000 rats kept on site. Gloves and masks are provided Handwashing facilities consist of a cold tap and some gel (no soap). Picnic bench in the centre aisle of one trailer for food/eating Slide

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25 The Results - Part II Case 3 - Six pet rats were culled, both adults positive Breeder - 25 rats culled: 12/25 tested positive - 10/16 females and 2/9 males. Rat Farm - 14 out of 30 were Hantavirus positive, notably the older rats. Slide 25

26 Partner Customers: NE Customer / CS Customer Breeder RL Sister EL Sister Partner KM Supplier SM Customer/ caretaker Case 1 Customer Case 2 Case 3 s brother in law Case 3 Mother Father Nephew DM Customer / caretaker Rat Farm Workmate Manager Workmate Case 3 s girlfriend/ workmates sister Rodent movement Human Association No test undertaken Negative Positive Positive:acute clinical case Positive: consistent clinical symptoms identified during contact tracing

27 Public Health Implications Hantavirus is out there,.,. Are online sellers considered to be pet shops Infectious Disease focused project to raise awareness among the pet shop trade and Vets. Encourage the passing on of information about hantavirus, salmonella and cleanliness to all their customers. Euthanasia of infected rodents a step too far? Slide 27

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29 Acknowledgements Cardiff City Council Newport City Council Public Health Wales Public Health England Animal and Plant Health Agency Welsh Government Aneurin Bevan Health Board Slide 29