Purpose of review: This article focuses on recent developments in knowledge about hantavirus infections and hantavirus cardiopulmonary syndrome in children. We highlight clinical characterization, epidemiology, pathogenesis, diagnostic techniques, and current alternatives for treatment and prevention.
Recent findings: After the first description of hantavirus pulmonary syndrome (HPS) in 1993 in the United States, new cases of HPS and new hantavirus species have been described throughout the Americas. The factors involved in the expression of hantavirus disease have, in part, been recognized, but there have been descriptions of newer viruses and newer rodent reservoirs. Several seroprevalence studies suggest that the virus-host interaction has been taking place for many years, and changes in human behavior and wild rodent ecology, sometimes secondary to industrial progress, facilitate the clinical recognition of disease. Sin nombre virus (SNV) and Andes virus (ANDV) are examples of the same disease with differences in the virus virulence and in the host response. The North American syndrome and the Southern HPS differ in epidemiologic patterns and in the spectrum of disease.
Summary: Currently, no Food and Drug Administration (FDA)-approved antiviral drugs, vaccines, or immunotherapeutic agents are available for treatment of the disease, and therapy is primarily supportive. Intensive care medicine has played an outstanding role in decreasing the lethality of HPS. A ribavirin trial in the United States did not support the use of the drug in fully developed HCPS. Recently published data suggest that a strong neutralizing antibody response may be a predictor of effective clearance of and recovery from SNV infection. This has raised the possibility that passive immunotherapy may be useful in HCPS. Extensive work has been done to develop a hantavirus vaccine, but at present it seems unlikely that a vaccine will be in commercial development in the near future.