Hantavirus - a rare but fatal infection

According to news reports, renowned pianist, Betsy Arakawa, the partner of Gene Hackman died from the complications of cardiopulmonary syndrome caused by an organism called hantavirus.

This ends much speculation over the cause of her death. She died in her Santa Fe home in New Mexico.

How was she exposed and was it treatable if recognised?

Hantaviruses are a group of viruses mostly carried by rodents (mice, rats, voles). More than 20 species have been identified globally.

Hantavirus disease has been recognised for hundreds of years but the aetiologic agent was only first identified in field mice in 1976. It is named after the Hantan River in South Korea, near to where the field mice were found. The disease was commonly described in rural workers in the region.

Hantavirus is mostly transmitted to humans by inhalation and possibly by a bite. Outbreaks are often associated with rapid increases in the rodent population in a known area for the disease. New Mexico is a known location.

Hantavirus in the United States

In 1993 the “four corners” region of the United States (where New Mexico, Colorado, Utah and Arizona all meet) experienced an outbreak of a mysterious disease. More than 30 cases were identified over a short period of time. They all experienced influenza like symptoms and severe chest disease. No aetiological agent had been identified. CDC investigated the cases and identified similarities with hantavirus disease despite no previous cases of human disease being diagnosed in the United States.

It was also very different to the hantavirus described in China, Russia and Europe. CDC felt it was a new, as yet unrecognized species of hantavirus. Within a few months the team was able to identify the virus in a rodent, Peromyscus maniculatus, which is common to the area. It is often referred to as the deer mouse. The new agent was called Sin Nombre virus (without name virus). Fifty-three cases of hantavirus pulmonary syndrome were reported in the United States during 1993. There were 32 deaths. Eighteen cases came from New Mexico.

Biologists followed up on the good work of CDC and found that the population of rodents had increased 10-fold at the time of the outbreak. Environmental conditions were very favourable for a bumper crop. Grain storage was increased. Climate change is likely to increase these events in the future.

Hantavirus risk to travellers

Hantavirus is an emerging global infectious disease. The risk to travellers is very low.

Large outbreaks have been reported in Russia and China. Cases are reported annually in the USA, Canada and South America. According to CDC, 864 cases of hantavirus disease (both forms) have been reported in the United States (1993 to the end of 2022).

Respiratory tract issues are common in travellers. Hantavirus cardiopulmonary disease (HCPD) would not be high on the differential list. It might be considered in someone with a history of travel to areas of risk. This is important as survival of the severe form of the disease is very much dependent on early diagnosis and treatment.

Other chest diseases of consideration in a traveller include influenza, bacterial pneumonia, whooping cough, mycoplasma, legionella, melioidosis, plague, tularemia, leptospirosis and tuberculosis.