Upload
rolf-lynch
View
216
Download
1
Tags:
Embed Size (px)
Citation preview
Special Pathogens BranchDVRD/NCID/CDC
Hantavirus Pulmonary Hantavirus Pulmonary
Syndrome (HPS)Syndrome (HPS)
Genus Genus Human diseaseHuman disease
BunyavirusBunyavirus LaCrosse encephalitis, othersLaCrosse encephalitis, others
PhlebovirusPhlebovirus Rift Valley fever, sandfly feverRift Valley fever, sandfly fever
NairovirusNairovirus Crimean-Congo hemorrhagic feverCrimean-Congo hemorrhagic fever
TospovirusTospovirus Plant virus, no known human diseasePlant virus, no known human disease
HantavirusHantavirus Hemorrhagic fever with renal syndromeHemorrhagic fever with renal syndrome
Hantavirus pulmonary syndromeHantavirus pulmonary syndrome
5 genera, 250 species5 genera, 250 species
Family BunyaviridaeFamily Bunyaviridae
• No arthropod vector establishedNo arthropod vector establishedUnique among genera of BunyaviridaeUnique among genera of Bunyaviridae
• Rodent hostsRodent hosts Genus and possibly species specificGenus and possibly species specific
• TransmissionTransmission Aerosolization of rodent excretaAerosolization of rodent excreta
Characteristics of HantavirusesCharacteristics of Hantaviruses
Chronically infected Chronically infected rodentrodent
Virus is present in aerosolized Virus is present in aerosolized excreta, particularly urineexcreta, particularly urine
Horizontal transmission of infection Horizontal transmission of infection by intraspecific aggressive behaviorby intraspecific aggressive behavior
Virus also present in throat Virus also present in throat swab and fecesswab and feces
Secondary aerosols, mucous membrane Secondary aerosols, mucous membrane contact, and skin breaches are also contact, and skin breaches are also
sources of infectionsources of infection
Transmission of HantavirusesTransmission of Hantaviruses
HTN Korea HTN Korea ApodemusApodemus agrariusagrarius
DOB SloveniaDOB Slovenia Apodemus flavicollisApodemus flavicollisSEOSEO JapanJapan Rattus norvegicusRattus norvegicus
PUUPUU FinlandFinland Clethrionomys glareolusClethrionomys glareolus
PUU RussiaPUU Russia Clethrionomys glareolusClethrionomys glareolus
PUU SwedenPUU Sweden Clethrionomys glareolusClethrionomys glareolus
SS
PUU BelgiumPUU Belgium Clethrionomys glareolusClethrionomys glareolusTOP RussiaTOP Russia Lemmus sibiricusLemmus sibiricusKBRKBR RussiaRussia Microtus fortisMicrotus fortis
TUL RussiaTUL Russia Microtus arvalisMicrotus arvalis
TUL CzechTUL Czech Microtus arvalisMicrotus arvalisTUL SlovakiaTUL Slovakia Microtus arvalisMicrotus arvalis
PHPH New YorkNew York Microtus pennsylvanicusMicrotus pennsylvanicusPHPH MarylandMaryland Microtus pennsylvanicusMicrotus pennsylvanicus
ISLAISLA CaliforniaCalifornia Microtus californicusMicrotus californicusMULEMULE Southern US Southern US Sigmodon hispidus (texianus)Sigmodon hispidus (texianus)
BCCBCC FloridaFlorida Sigmodon hispidus Sigmodon hispidus BAYBAY Southeastern US Southeastern US Oryzomys palustrisOryzomys palustris
ANDESANDES Argentina & ChileArgentina & Chile Oligoryzomys longicaudatusOligoryzomys longicaudatusLEC LEC ArgentinaArgentina Oligoryzomys flavescens Oligoryzomys flavescens
RIOM RIOM Bolivia & PeruBolivia & Peru Oligoryzomys microtisOligoryzomys microtisLNLN Paraguay & Bolivia Paraguay & Bolivia Calomys lauchaCalomys laucha
SN SN New Mexico New Mexico Peromyscus maniculatusPeromyscus maniculatus SNSN California California Peromyscus maniculatus Peromyscus maniculatus
NY NY New York New York Peromyscus leucopus Peromyscus leucopus NY NY RhodeRhode Island Island Peromyscus leucopusPeromyscus leucopus
MON MON West Virginia West Virginia Peromyscus maniculatusPeromyscus maniculatus ELMCELMC Western US & Mexico Western US & Mexico Reithrodontomys megalotisReithrodontomys megalotis
RIOS RIOS Costa Rica Costa Rica Reithrodontomys mexicanusReithrodontomys mexicanus
Phylogeny of Hantaviruses: Based on Sequence of S SegmentPhylogeny of Hantaviruses: Based on Sequence of S Segment (Subfamily, Hantavirus, Location, Host)(Subfamily, Hantavirus, Location, Host)
MURINAEMURINAE
ARVICOLINAEARVICOLINAE
SIGMODONTINAESIGMODONTINAE
HTN Korea HTN Korea ApodemusApodemus agrariusagrarius
HTN ChinaHTN China Apodemus agrariusApodemus agrariusMM
Phylogeny of Hantaviruses: Based on Sequence of M SegmentPhylogeny of Hantaviruses: Based on Sequence of M Segment(Subfamily, Hantavirus, Location,(Subfamily, Hantavirus, Location, Host) Host)
SEO Japan SEO Japan RattusRattus norvegicusnorvegicusSEO Korea SEO Korea RattusRattus norvegicusnorvegicus
THAI Thailand THAI Thailand Bandicotta indicaBandicotta indicaDOB Slovenia DOB Slovenia ApodemusApodemus flavicollisflavicollis
PUUPUU Sweden Sweden Clethrionomys glareolusClethrionomys glareolus
PUU Russia PUU Russia Clethrionomys glareolusClethrionomys glareolus PUU Finland PUU Finland Clethrionomys glareolusClethrionomys glareolus
PUU Belgium PUU Belgium ClethrionomysClethrionomys glareolusglareolusTUL Czech TUL Czech MicrotusMicrotus arvalisarvalisPH Maryland PH Maryland MicrotusMicrotus pennsylvanicuspennsylvanicus
BCC Florida BCC Florida SigmodonSigmodon hispidushispidusBAY Southeastern US BAY Southeastern US Oryzomys palustrisOryzomys palustris
Hu39694 Argentina Hu39694 Argentina unknownunknownLEC Argentina LEC Argentina OligoryzomysOligoryzomys flavescensflavescens
ORN Argentina ORN Argentina OligoryzomysOligoryzomys longicaudatuslongicaudatusLNLN Paraguay & Bolivia Paraguay & Bolivia Calomys lauchaCalomys laucha
SN CaliforniaSN California PeromyscusPeromyscus maniculatusmaniculatusSN New Mexico SN New Mexico Peromyscus maniculatusPeromyscus maniculatus
NY RhodeNY Rhode IslandIsland Peromyscus leucopusPeromyscus leucopusNY New YorkNY New York Peromyscus leucopusPeromyscus leucopus
BR OklahomaBR Oklahoma Peromyscus leucopusPeromyscus leucopusBR IndianaBR Indiana Peromyscus leucopusPeromyscus leucopus
ELMC Western US & MexicoELMC Western US & Mexico Reithrodontomys megalotisReithrodontomys megalotis
MURINAEMURINAE
ARVICOLINAEARVICOLINAE
SIGMODONTINAE
SEO China SEO China RattusRattus norvegicusnorvegicus
Subfamily Murinae associated viruses Virus Host Location Disease
Hantaan Apodemus agrarius Asia, Far East Russia HFRS
Dobrava Apodemus flavicollis Balkans HFRS Apodemus agrarius Europe
Seoul Rattus norvegicus Worldwide HFRS Rattus rattus
Subfamily Arvicolinae associated viruses Virus Host Location Disease
Puumala Clethrionomys glareolus Europe HFRS
Numerous other hantaviruses have been identified but not linked to human disease
Hantaviruses in the Old WorldHantaviruses in the Old World
Subfamily Sigmodontinae associated virusesSubfamily Sigmodontinae associated viruses
VirusVirus HostHost LocationLocation DiseaseDisease
Sin NombreSin Nombre Peromyscus maniculatusPeromyscus maniculatus West & Central West & Central HPSHPS
U.S. & CanadaU.S. & Canada
Monongahela Monongahela Peromyscus maniculatusPeromyscus maniculatus Eastern U.S. & Eastern U.S. & HPSHPS
Canada Canada
New YorkNew York Peromyscus leucopusPeromyscus leucopus Eastern U.S. Eastern U.S. HPSHPS
BayouBayou Oryzomys palustrisOryzomys palustris Southeastern U.S. Southeastern U.S. HPSHPS
Black Creek Canal Black Creek Canal Sigmodon hispidusSigmodon hispidus Florida Florida HPSHPS
Numerous other hantaviruses have been identified but not linked to human diseaseNumerous other hantaviruses have been identified but not linked to human disease
Hantaviruses in the New World (1)Hantaviruses in the New World (1)
Subfamily Sigmodontinae associated viruses (cont.)Subfamily Sigmodontinae associated viruses (cont.)VirusVirus HostHost LocationLocation DiseaseDisease
AndesAndes Oligoryzomys longicaudatusOligoryzomys longicaudatus Argentina & ChileArgentina & Chile HPSHPS
OranOran Oligorozomys longicaudatusOligorozomys longicaudatus Northwestern ArgentinaNorthwestern Argentina
LechiguanasLechiguanas Oligoryzomys flavescensOligoryzomys flavescens Central ArgentinaCentral Argentina
Hu39694Hu39694 UnknownUnknown Central ArgentinaCentral Argentina
Laguna NegraLaguna Negra Calomys lauchaCalomys laucha Paraguay &Paraguay & HPSHPSBoliviaBolivia
BermejoBermejo Oligoryzomys chacoensisOligoryzomys chacoensis NorthwesternNorthwestern HPSHPS
ArgentinaArgentina
JuquitibaJuquitiba UnknownUnknown BrazilBrazil HPSHPS
ChocloChoclo Oligoryzomys fulvescensOligoryzomys fulvescens PanamaPanama HPSHPS
Numerous other hantaviruses have been identified but not linked to human diseaseNumerous other hantaviruses have been identified but not linked to human disease
Hantaviruses in the New WorldHantaviruses in the New World (2) (2)
Sin NombreSin NombrePeromyscus maniculatus
Rio SegundoRio SegundoReithrodontomys mexicanusReithrodontomys mexicanus
El Moro CanyonEl Moro CanyonReithrodontomys megalotisReithrodontomys megalotis
AndesAndesOligoryzomys longicaudatusOligoryzomys longicaudatus
BayouBayouOryzomys palustrisOryzomys palustris
Black Creek CanalBlack Creek CanalSigmodon hispidusSigmodon hispidus
Rio MamoreRio MamoreOligoryzomys microtisOligoryzomys microtis
Laguna NegraLaguna NegraCalomys lauchaCalomys laucha
MuleshoeMuleshoeSigmodon hispidus
New YorkNew YorkPeromyscus leucopusPeromyscus leucopus
JuquitibaJuquitibaUnknown HostUnknown Host
MacielMacielNecromys benefactusNecromys benefactus
Hu39694Hu39694Unknown HostUnknown Host
LechiguanasLechiguanasOligoryzomys flavescensOligoryzomys flavescens
PergaminoPergaminoAkodon azaraeAkodon azarae
OrOránánOligoryzomys longicaudatusOligoryzomys longicaudatus
CCañaño Delgaditoo DelgaditoSigmodon alstoniSigmodon alstoni
Isla VistaIsla VistaMicrotus californicus
Bloodland LakeBloodland LakeMicrotus ochrogasterMicrotus ochrogaster
Prospect HillProspect HillMicrotus pennsylvanicusMicrotus pennsylvanicus
New World HantavirusesNew World Hantaviruses
BermejoBermejoOligoryzomys chacoensisOligoryzomys chacoensis
CalabazoCalabazoZygodontomys brevicaudaZygodontomys brevicauda
ChocloChocloOligoryzomys fulvescensOligoryzomys fulvescens
HantavirusPulmonary Syndrome
Chile (273)5
Argentina (404)4
Brazil(168)2
Uruguay (23) 1
Paraguay (74)1
Panama (31) 6
Bolivia (20)4
United States (335)7
Canada (36)3
Number of cases by date
1PAHO 01 2January 02 3May 02 4August 02
5 September 02 6 October 02 7 November 02
Countries with reported cases of HPS(no of cases)
Countries with no reported cases of HPS
FamilyFamily
TransmissionTransmission
Viral particlesViral particles
Structural Structural proteinsproteins
Genome Genome
BunyaviridaeBunyaviridae
vertebrate hosts,vertebrate hosts,no arthropod vectorsno arthropod vectors
spherical, 80-120 nmspherical, 80-120 nm
Glycoproteins: G1, G2Glycoproteins: G1, G2nucleoprotein: Nnucleoprotein: N
ss-RNA, trisegmented,ss-RNA, trisegmented,negative polarity negative polarity
Sin Nombre Virus CharacteristicsSin Nombre Virus Characteristics
Most FrequentMost Frequent OtherOther RareRare
FeverFever DizzinessDizziness RhinorrheaRhinorrhea
MyalgiaMyalgia ArthralgiaArthralgia Sore ThroatSore Throat
Nausea/VomitingNausea/Vomiting
CoughCough
Shortness ofShortness ofBreath Breath (late in (late in the course of the course of
disease)disease)
Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeClinical PresentationClinical Presentation
• TachypneaTachypnea
• TachycardiaTachycardia
• HypotensionHypotension
• Crackles or rales on lung Crackles or rales on lung examination examination
Hantavirus Pulmonary SyndromeHantavirus Pulmonary Syndrome Physical ExaminationPhysical Examination
• Bilateral interstitial infiltratesBilateral interstitial infiltrates - moderate to rapid progression - moderate to rapid progression
• Bilateral alveolar infiltratesBilateral alveolar infiltrates
• Pleural effusionPleural effusion
Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeRadiographic FindingsRadiographic Findings
May 27, May 27, 19931993
May 30, 1993May 30, 1993
May 31, 1993May 31, 1993Source: Dr. L. Ketai
Radiographic Progression of HPS Radiographic Progression of HPS in the Lungsin the Lungs
ChemistryChemistry
Low albuminLow albumin
Elevated LDHElevated LDH
Elevated AST (SGOT)Elevated AST (SGOT)
Elevated ALT (SGPT)Elevated ALT (SGPT)
HematologyHematology
Low platelet count Low platelet count
Atypical lymphocytes (immunoblasts)Atypical lymphocytes (immunoblasts)
Left shift on WBC differentialLeft shift on WBC differential
Elevated hematocritElevated hematocrit
Elevated WBCElevated WBC
Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeCommon Laboratory FindingsCommon Laboratory Findings
+++
FeverFeverPulmonaryPulmonaryedemaedemaShockShock
DiuresisDiuresis
ProdromeProdrome CardiorespiratoryCardiorespiratory ConvalescenceConvalescence
ImmunoblastsImmunoblasts
HCTHCTASTASTLDHLDH
3-6 days3-6 days 7-10 days7-10 days
PlateletsPlatelets +
+++
+
++
+
++
++
+
+
++
+
+
++
+
+
++
+
+
+++++++
++++
Clinical Progression of HPSClinical Progression of HPS
• Early aggressive intensive careEarly aggressive intensive care
• Early use of inotropic agents Early use of inotropic agents (Dobutamine)(Dobutamine)
• Early ventilationEarly ventilation
• Careful monitoringCareful monitoring
– OxygenationOxygenation
– Fluid balanceFluid balance
– Blood pressureBlood pressure
HPS ManagementHPS Management
• Early use of inotropic agentsEarly use of inotropic agents
• Mechanical ventilationMechanical ventilation
• Judicious volume resuscitation Judicious volume resuscitation
• Early PA catheter Early PA catheter
SQS 6/95
ICU Monitoring and TherapyICU Monitoring and Therapy
• SerologySerology
IgMIgM
IgGIgG
• ImmunohistochemistryImmunohistochemistry
• Reverse transcription Reverse transcription and polymerase chain and polymerase chain
reaction (RT-PCR)reaction (RT-PCR)
Hantavirus Pulmonary SyndromeHantavirus Pulmonary SyndromeLaboratory-confirmed DiagnosisLaboratory-confirmed Diagnosis
Interstitial PneumonitisInterstitial Pneumonitis
– CongestionCongestion
– Interstitial infiltrate of Interstitial infiltrate of
enlarged mononuclear enlarged mononuclear
cells (immunoblasts) cells (immunoblasts)
– Intra-alveolar and septal Intra-alveolar and septal
edema edema
– Focal hyaline membranesFocal hyaline membranes
HistopathologyHistopathologyLung (1)Lung (1)
Absence or minimal evidence of:Absence or minimal evidence of:
– Cellular debrisCellular debris
– NeutrophilsNeutrophils
– Epithelial injuryEpithelial injury
– Viral inclusionsViral inclusions
– Fungi or bacteria by Fungi or bacteria by
specific stains specific stains
HistopathologyHistopathologyLung (2)Lung (2)
• Enlarged mononuclear cells (immunoblasts)Enlarged mononuclear cells (immunoblasts)
– Lymph nodes Lymph nodes
(sinuses and paracortex) (sinuses and paracortex)
– Spleen (red pulp and Spleen (red pulp and
periarteriolar sheaths) periarteriolar sheaths)
– Liver (triaditis)Liver (triaditis)
– Vessels (different organs)Vessels (different organs)
• Other changes (minor)Other changes (minor)
SpleenSpleen
HistopathologyHistopathologyOther OrgansOther Organs
Peridomestic exposurePeridomestic exposure
Peridomestic & occupationalPeridomestic & occupational exposureexposure
Peridomestic & recreational exposurePeridomestic & recreational exposure
Occupational exposure Occupational exposure
Entering/cleaning rodent-infested Entering/cleaning rodent-infested structuresstructures
Armstrong, L.R. et al., JID 1995; 172 (October)Armstrong, L.R. et al., JID 1995; 172 (October)
69% (48/70)69% (48/70)
19% (13/70)19% (13/70)
9% (6/70)9% (6/70)
4% (3/70)4% (3/70)
9% (6/70)9% (6/70)
Rodent ExposureRodent Exposure70 confirmed HPS cases70 confirmed HPS cases
Risk groupRisk groupForest workersForest workers11
Health care workersHealth care workers22
Prodromal HPSProdromal HPS33
ContactsContacts44
Rural OCCRural OCC55
Rodent workersRodent workers66
TotalTotal
Location/timeLocation/timeSW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1993SW US, 1994SW US, 1994US, 1994US, 1994
Postive/tested (%)Postive/tested (%)0/1430/1430/3960/3963/299 (1.0%)3/299 (1.0%)3/239 (1.3%)3/239 (1.3%)1/522 (0.2%)1/522 (0.2%)8/932 (0.9%)8/932 (0.9%)
15/2531 (0.6%)15/2531 (0.6%)1. Vitek et al, 19961. Vitek et al, 1996 2. Vitek et al, 19962. Vitek et al, 1996 3. Simonsen et al, 19953. Simonsen et al, 19954. Zeitz et al, 19954. Zeitz et al, 1995 5. Zeitz et al, 19955. Zeitz et al, 1995 6. Armstrong et al, 19956. Armstrong et al, 1995
Prevalence of SNV IgG Antibodies in Prevalence of SNV IgG Antibodies in Select U.S. PopulationsSelect U.S. Populations
CountryCountry Positive/tested (%)Positive/tested (%) TimeTimeParaguayParaguay11 44/345 (12.8%)44/345 (12.8%) 19951995Western ParaguayWestern Paraguay2 2 78/193 (40.4%)78/193 (40.4%) 1993-19951993-1995(Indian Population)(Indian Population)
ArgentinaArgentina33 <1%<1% 19961996 Salta ProvinceSalta Province22 38/222 (17.1%)38/222 (17.1%) 1993-19951993-1995(Indian Population)(Indian Population)
ChileChile33 2-13%2-13% 19971997
1. Williams, 19971. Williams, 1997 2. Ferrer, 1998 3. Peters, 1998; Weissenbacher, 1996 2. Ferrer, 1998 3. Peters, 1998; Weissenbacher, 1996
Prevalence of SNV IgG Antibodies in Prevalence of SNV IgG Antibodies in Select South American PopulationsSelect South American Populations
Control Mice InsideControl Mice Inside
Control Mice OutsideControl Mice Outside
Use Safety PrecautionsUse Safety Precautions
HPS PreventionHPS Prevention
• Eliminate food sourcesEliminate food sources
– Wash dishes and clean the floor Wash dishes and clean the floor
and counters and counters
– Put pet food and water away at Put pet food and water away at
nightnight
– Store food / garbage in containers Store food / garbage in containers
with tight lids with tight lids
Control Mice InsideControl Mice Inside
• Prevent mice from enteringPrevent mice from entering
– Clear brush and grass from Clear brush and grass from around foundation around foundation
– Seal holes or use flashing Seal holes or use flashing around the base of the house around the base of the house
• Use continuous trapping effortsUse continuous trapping efforts
Control Mice InsideControl Mice Inside
• Eliminate possible nesting sitesEliminate possible nesting sites
– Elevate hay, woodpiles, and Elevate hay, woodpiles, and
garbage cansgarbage cans
– Locate them at least 100 feet Locate them at least 100 feet
from housefrom house
– Eliminate junk or things that Eliminate junk or things that
provide shelter to rodentsprovide shelter to rodents
Control Mice OutsideControl Mice Outside
• Eliminate food sourcesEliminate food sources– Store all animal feed in Store all animal feed in
containers with lidscontainers with lids
– Discard excess food in the Discard excess food in the
evening into containers evening into containers
with lidswith lids
– Take up water bowls in the Take up water bowls in the
eveningevening
Control Mice OutsideControl Mice Outside
• Natural predators are beneficialNatural predators are beneficial– Non-poisonous snakesNon-poisonous snakes
– OwlsOwls
– HawksHawks
Control Mice OutsideControl Mice Outside
• When cleaning in areas infested with When cleaning in areas infested with
rodentsrodents– Wear rubber glovesWear rubber gloves
– Don't stir up and breathe dustDon't stir up and breathe dust
– Wet contaminated areas with Wet contaminated areas with
disinfectant disinfectant
– Dispose of dead animals properlyDispose of dead animals properly
– Disinfect used glovesDisinfect used gloves
Use Safety PrecautionsUse Safety Precautions
• When enjoying outdoor activitiesWhen enjoying outdoor activities
– Avoid contact with rodentsAvoid contact with rodents
– Stay away from rodent burrows or nestsStay away from rodent burrows or nests
– Keep campsite clean and food tightly Keep campsite clean and food tightly
sealedsealed
– Open unused cabins and air out before Open unused cabins and air out before
entering or cleaningentering or cleaning
– Avoid sleeping on bare groundAvoid sleeping on bare ground
Use Safety PrecautionsUse Safety Precautions
Hantavirus InfectionHantavirus Infection
HPSHPS
Hantavirus IllnessHantavirus Illness
Spectrum of IllnessSpectrum of Illness
MMWR 1993; 42: 816-820MMWR 1993; 42: 816-820
• Febrile illness (T Febrile illness (T >> 38.3 38.3°C°C) )
• Unexplained ARDS or bilateral infiltrates following Unexplained ARDS or bilateral infiltrates following
hospitalizationhospitalization
• Supplemental oxygenSupplemental oxygen
oror
• Noncardiogenic pulmonary edema at autopsyNoncardiogenic pulmonary edema at autopsy
• No identifiable specific cause of deathNo identifiable specific cause of death
HPS National SurveillanceHPS National SurveillanceHPS Case DefinitionHPS Case Definition
• Febrile illness (T > 38.0Febrile illness (T > 38.0º Cº C) )
• No bilateral diffuse interstitial or No bilateral diffuse interstitial or alveolar infiltratesalveolar infiltrates
HPS National SurveillanceHPS National Surveillance Mild Hantaviral Illness Case DefinitionMild Hantaviral Illness Case Definition
• Full clinical spectrum of HPS is undefinedFull clinical spectrum of HPS is undefined– Cases with mild pulmonary diseaseCases with mild pulmonary disease
– Cases with accompanying renal diseaseCases with accompanying renal disease
• Depending on resources, screening Depending on resources, screening criteria could includecriteria could include::
– Mild pulmonary diseaseMild pulmonary disease
– Unexplained acute febrile renal diseaseUnexplained acute febrile renal disease
– Other febrile syndromesOther febrile syndromes
HPS National SurveillanceHPS National SurveillanceCommentsComments
• SafetySafety– Label as infectious substance and/or human Label as infectious substance and/or human blood precautions blood precautions – Double container with absorbent material sufficient Double container with absorbent material sufficient
for volume being sentfor volume being sent– Plastic tubes preferable over glassPlastic tubes preferable over glass
• ConditionsConditions– Sera -- room temperature or cold pack Sera -- room temperature or cold pack – Clot or buffy coat -- dry iceClot or buffy coat -- dry ice– Fresh tissues (1-cm cubes) -- dry iceFresh tissues (1-cm cubes) -- dry ice– Formalin-fixed tissue and blocks -- room temperature Formalin-fixed tissue and blocks -- room temperature
(don't freeze)(don't freeze)
ShippingShipping
For details on:For details on:- Specimen types and volumes- Specimen types and volumes- HPS Case Report Forms- HPS Case Report Forms- National Surveillance Laboratory Specimen Forms- National Surveillance Laboratory Specimen Forms
CallCall 404-639-1511404-639-1511oror
Visit Visit www.cdc.gov/ncidod/diseases/hanta/hps/index.htm
Submitting SpecimensSubmitting Specimens