Increased incidence of hemorrhagic fever…

IN Russiawas observed in Republic of Kareliaan administrative subdivision of North Western Federal Districtincidence of hemorrhagic fever with renal syndrome was twice as high during January-November 2022 as in the same period of 2021 and 1.8 times higher than in 2020. For the first 11 months of 2022, 9 cases of FHSR were recorded in the Republic of Karelia , including 1 in a child.

The incidence in 2022 was 1.3 per 100,000 inhabitants, 27.4% lower than the average incidence in the period 2012-2021 (1.79 per 100,000 inhabitants). Data for the first 11 months of 2022 show that the incidence of HFSR in the Republic of Karelia is 78% higher than the incidence of HFSR for the same period in the Northwestern Federal District (0.73 per 100,000 and 52.9% over that of the Russian Federation as a whole.

Hemorrhagic fever with renal syndrome (HFRS) accounts for more than 90% of all hemorrhagic fevers registered in the Russian Federation.

Hemorrhagic fever with renal syndrome (HFRS) reminder.

Hemorrhagic fever with renal syndrome is an infection caused by hantaviruses, family viruses Bunyaviridae which are present on all continents.

Hantaviruses have natural reservoirs of rodents (one species is specific for one type of hantavirus) which, once infected, are healthy carriers that eliminate the virus in their feces.

of human pollution it is generally done by inhaling dust and aerosols contaminated by the feces of infected animals. Other rarer ways of transmission are possible: by bite; eating food contaminated with the urine, feces, or saliva of an infected rodent; if you touch an object contaminated with rodent urine, feces or saliva, then if you touch your nose or mouth. No human-to-human transmission has been described to date, except for the South American Andean hantavirus.

The duration ofincubation The average illness is 15 days, with extremes from one to six weeks.

clinical expression Hantavirus infections vary according to the pulmonary or renal tropism of the virus. The infection appears in two clinical forms:

  • hemorrhagic fever with renal syndrome (HFRS) due to Old World hantaviruses circulating in Europe and Asia with Hantaan, Amur and Seoul viruses responsible for FHSR in Asia and the Balkans, Puumala, Saaremaa and Dobrava viruses responsible for FHSR of the clinical expression of moderate (epidemic nephropathy) in Europe;
  • Hantavirus cardiopulmonary syndrome (HCPS) due to New World hantaviruses circulating in North and South America (the most common viruses are Sin Nombre virus in North America and Andes virus in South America; Choclo virus in Central America, etc.).

All clinical forms have in common a sudden onset accompanied by flu-like symptoms: fever, headache, muscle pain, abdominal and/or chest pain, chills, etc.

In the typical form, the pain follows the flu syndrome, but it can be in the foreground: back pain, back pain, abdominal or chest pain.

Transient visual disturbances of the acute myopic type suggest FHSR.

Kidney damage is manifested by lower back pain, decreased urine volume. It is common in European forms with the Puumala virus. Acute renal failure is rare.

The hypotensive phase, described from the fifth day, is especially described in Asian forms. She may experience a state of shock accompanied by neurological manifestations.

Hemorrhagic signs are more often moderate when present. Hemorrhagic manifestations are more frequent in Asia and are not related to the importance of thrombocytopenia, which is frequent and early.

In Asian and European forms, respiratory manifestations are present in a third of cases, but moderate. In the American forms due to the virus of the Sin number type, cardio-respiratory manifestations are in the foreground. They can lead to acute respiratory distress and/or shock. There are no hemorrhagic signs or kidney damage.

The highly variable clinical course is characterized by a prolonged convalescent phase of three weeks to three months. Mortality ranges from less than 0.5% for Puumala virus infections, to 5 to 10% for Asian forms, and nearly 40% for HCPS syndromes associated with Sin-type viruses limited to the Americas.

of diagnostic it is probably serological. Virus isolation and gene amplification (PCR) techniques from patient blood are reserved for specialized laboratories.

of treatment The infection is symptomatic. There is no vaccine against hantavirus infections.

Prevention of hantavirus infections:

Avoid breathing pollution:

  • Do not enter closed or abandoned premises;
  • Wear a mask, ventilate and spray with water (or better, disinfectant or bleach) before cleaning the floors of premises that have been closed or unoccupied for a long time (cabins, attics, barns, basements, etc.) ;
  • Ventilate closed rooms before and during cleaning – Use a vacuum cleaner instead of a vacuum cleaner – Do not use high pressure water jets.

The fight against the presence of rodents in the premises:

  • Dwellings Doors located in the forest or on the edge of the forest, as well as barns, cellars, sheds
  • Preventing the entry of rodents into apartments;
  • Avoid their attraction: put food in closed places inaccessible to rodents;
  • Eliminate shelters that can be used by rodents (woodsheds, etc.).

Avoid contact with rodent droppings

  • Put a bandage on a wound before handling wood or working with the soil;
  • Avoid handling live or dead rodents or their nests. Wear rubber or latex gloves.

References :
(1) Centers for Disease Control and Prevention. Hantavirus. (2) ePILLY too. Tropical infectious diseases. 2022. Third online edition updated June 2022. (3) Ministry of Health and Prevention. Hantavirus and hemorrhagic fever with renal syndrome (HFRS)..

Source: Promed.

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