Hanta Virus Epidemics in Germany?
When I learned that a friend of mine came down with Hanta virus infection in Germany, I thought I had heard wrong.
Mice and voles shed hanta viruses in their excreta which – when aerosolized and inhaled – can cause significant disease. In some parts of Germany, it is Puumala, in others the Dobrava-Belgrade virus. In 2012, over 2800 cases were diagnosed in Germany alone [1]. This emerging infection is no longer so infrequent after all.
Voles can have large population fluctuations from 14 to 500 voles per acre
FUN FACTS ABOUT THE VOLE [4]
Initial clinical symptoms are high fever, headache, backaches, and thrombopenia +/- purpura which may lead to a hematologic work-up. Cases may progress to “nephropathia endemica”, characterized by oliguria and hematuria. Rarely, shock or organ failure may ensue.
Hence, the term “HFRS” (Hemorrhagic Fever with Renal Syndrome) summarizes the clinical features well.
Fortunately, unlike Sin Nombre virus cardiopulmonary syndrome, mortality is low. The disease runs its course with complete recovery in almost all cases. Still, it is not a benign affair: While recognizing reporting bias towards severe cases, a 55-65% hospitalization rate and 5% rate for temporary dialysis shows that this is not a trivial viral disease [2].
Exposure is from outdoors activities. The lovely little bank voles love to nest in forested areas at the edge of towns. Right were you live….
Epidemics occur mainly in winter and spring, in a 2-3 year rhythm.
Diagnosis is by serology.
Treatment is purely symptomatic. There is no vaccine yet but progress is being made and a Phase 2 study is underway [3].
References:
[1] Krueger. Dtsch Arztebl Int.110: 27; 2013
[2] Krautkrämer. Kidney International (2012) 82, 1243
[3] A Phase 2a Randomized, Double-Blind, Dose-Optimizing Study to Evaluate the Immunogenicity of Hantaan/Puumala Virus DNA Vaccine. http://clinicaltrials.gov/show/NCT02116205
[4] http://www.thejunglestore.com/Voles
