In the second episode with Emory’s Gavin Harris, MD, he offers some insights about treating patients with the Andes virus, including supportive care as well as investigational antivirals.
This is part of a short series about high-consequence infectious diseases and the ongoing Hantavirus cluster associated with cruise ship travel and the Ebola outbreak in Africa. These discussions with clinicians with experience in these areas will include dealing with quarantines, monitoring protocols, treatment, and the significance of biopreparedness in the face of these ongoing health crises and a reduced US infectious disease health care budget.
On May 27, World Health Organization Director-General Tedros Adhanom Ghebreyesus, PhD, wrote on X (formerly Twitter) that there are now 13 cases of Hantavirus associated with the cruise ship cluster1: “Spain reported a new case among the passengers who are in quarantine…. There are no new deaths reported since May 2. The total number of deaths remains 3 out of 13 reported cases so far.”1
The specific strain is the Andes virus, and cases started appearing on April 6 on the Dutch cruise ship MV Hondius. What makes the Hantavirus unique is the long incubation period.
“Hantaviruses themselves have a very long incubation period, and what that means is it can be up to 6 or even 8 weeks before a person might develop symptoms,” said Gavin Harris, MD, associate medical director of the Serious Communicable Diseases Program (SCDP) at Emory University.
Harris said the Andes virus is typically found in Argentina and Chile and has shown person-to-person contact. “It's not clear yet entirely whether this is primarily through respiratory droplets, through the air, or primarily from close contact, sexual intimacy, the sharing of utensils, foods, things of that nature,” he said.
However, this strain of the virus is quite rare and the risk to the public is very low, explained Harris.
Earlier this month, 2 American cruise passengers were transferred to Emory University Hospital’s Serious Communicable Diseases Unit. One patient, who was experiencing symptoms, was treated in the hospital’s biocontainment unit, whereas the second patient remained asymptomatic.2 Both individuals have since been safely discharged3 and transported to the
One of the more severe complications is the Hantavirus pulmonary syndrome (HPS). This syndrome is a serious and potentially fatal respiratory illness. Symptoms typically develop 1 to 8 weeks after exposure.4
Early signs often include fatigue, fever, and muscle aches—particularly in large muscle groups such as the thighs, hips, back, and sometimes the shoulders. About half of patients also report headaches, dizziness, chills, and gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal pain.4
Four to 10 days after the initial phase, more severe symptoms can develop, including coughing and shortness of breath. As the disease progresses, fluid can accumulate in the lungs, leading to chest tightness and difficulty breathing. HPS can be fatal, and 38% of people who develop respiratory symptoms may die from the disease.4
Harris explained how HPS presents and how someone can quickly experience decompensation. “[For] people who do have an appropriate travel exposure or a history of going to these regions where this virus might be found, it can be several weeks before symptoms turn up, and what we also look for from a clinical perspective is a rapidly developing respiratory syndrome, so going from someone who is feeling fine, has no symptoms of cough or pneumonia, to within hours [someone]…in need of significant support from critical care measures. It's super, super rare, and I can't really stress that enough.”
Harris explained the challenging development of blood cell leakage within the lungs. “It causes what we call capillary leakage syndrome, in which fluid comes out of blood vessels, fills the lungs, damages the kidneys and other organs, which is quite different from other viruses that might attack the tissues of some of those organs themselves.”
Although there are no US Food and Drug Administration–approved treatments or vaccines for the Hantavirus, one significant modality is the aforementioned supportive care, explained Harris.
“We do have specific treatment measures that we use, and those are things like aggressive and early critical care support, so things like breathing machines, ventilators, and dialysis, if needed.”
And the use of supportive care combined with antivirals being used off-label may prove to be significant.
“Specific antiviral therapies that have been used for other viruses that are being explored for Andes virus, things like ribavirin, which has been around for almost 50 years now and is typically used for hepatitis C and Lassa fever, we use that and have used it,” Harris said. “Things like favipiravir and baloxavir, which were originally designed for influenza and COVID-19, have also shown activity against Andes virus. So we certainly have medical countermeasures that are being investigated…and the combination of that plus aggressive critical care, I think, is really vital for these patients.”
Through our Media Day series, Emory invited us to discuss their work treating patients with high-consequence infectious disease.
Learn more about their work here:
Emory Healthcare Media Day
Along with the current Hantavirus cluster, Emory has been involved in treating other high-consequence infectious disease. Back in 2014, Emory University Hospital was the first medical center in the US to treat 2 Americans with Ebola. Emory is part of the Regional Emerging Special Pathogen Treatment Centers network within the federally supported National Special Pathogen System.2
Watch the first episode with Harris about the Ebola outbreak:
Additionally, the SCDP, which Emory is a part of, was created in 2002 in collaboration with the Centers for Disease Control and Prevention and is a globally recognized program that provides training and best practices regarding care for patients with suspected or confirmed infectious diseases.2
In the next and final episode in the series, Harris and other clinicians discuss the continued need for biopreparedness even in this current public health climate.
