Hantavirus disease symptoms and treatment

Hantavirus diseasesHantaviruses can be contracted from rodents or from dust containing the pathogen. The course of the disease is similar to that of the flu. The kidneys are often affected as well. Severe courses can be fatal, but occur in Germany only rarely.

At a glance

– Rodents excrete hantaviruses with saliva, feces and urine. – People usually become infected through dust that is stirred up or through bites. – Flu-like symptoms occur during an illness. – Kidney function is often impaired, in the worst case kidney failure may occur. – Severe courses are rare, but can be fatal. – You can protect yourself from the disease with hygiene measures and contact avoidance.

What is a hantavirus disease??

You can become infected with hantaviruses if you have had contact with rodents such as rats or mice and their excrement. Infection with the viruses is also possible through dust that is stirred up. This sometimes happens, for example, when cleaning a dusty shed or attic. The disease is similar to influenza, but often also affects the kidneys. Severe courses are rare, but can be fatal.

In Germany, the frequency of the disease varies from year to year. It depends on how many rodents there are that can carry the pathogen. In the last eight years, cases reported by health departments and state offices ranged from 161 to 2.823 per year. Hygiene rules and contact avoidance help to protect against infection and thus against the disease.

What are the symptoms of hantavirus disease??

80 to 85 percent of hantavirus infections proceed without symptoms or only with mild symptoms.

Typical symptoms are fever for three to four days with back, head and limb pain. Symptoms appear about two to four weeks after infection. Depending on the type of virus, the disease can be more severe. Then particularly damaging to kidneys or lungs.

If the following symptoms occur together, this can indicate a hantavirus disease:

– abrupt onset of fever of more than 38.5 degrees Celsius – back, head and limb pain – foamy or bloody urine – increased kidney values in the blood, especially creatinine – increased protein in the urine – fewer platelets (thrombocytes) in the blood – first a reduced, later an increased urine excretion

Which pathogens cause hantavirus disease?

There are different hantaviruses that cause a similar clinical picture. They occur worldwide. Carriers of a hantavirus disease to humans are mainly rodents, but also other small mammals.

Important to know: Each virus type prefers a different host animal. Therefore, certain hantavirus diseases occur only in the regions where these host animals are indigenous.

The following potentially pathogenic hantaviruses occur in Germany:


Puumala viruses are the most common in Germany and occur mainly in the south and west of the country. Host animal and carrier is the red-backed vole. In recent years, the disease has broken out mainly in the following regions: Swabian and Franconian Alb, Upper Swabia, Bavarian Forest, Spessart, Lower Franconia, Odenwald, northeastern Hesse, Teutoburg Forest, western Thuringia, the Osnabruck area and Munsterland.

Red-backed mice transmit hantaviruses. If they find a lot of food, they multiply strongly and with them also the virus. Increased risk of becoming infected via a bite or stirred-up feces.

Dobrava-Belgrade virus

Dobrava-Belgrade viruses occur mainly in the north and east of Germany. Host animal and carrier is the fire mouse, which is native to the northern and eastern parts of Germany. These viruses are used by breeders-. Wild rats harbored. First cases were found in Lower Saxony in 2019.


Tulaviruses have as a carrier the field mouse, which occurs everywhere in Germany. The first confirmed infection was detected in Germany in 2019. However, since there is no regular testing for tulavirus, it is amed that the number of infections is significantly higher.

What increases the risk for hantavirus disease? Hantaviruses persist in mice. Rats as well as other small mammals. These hosts excrete the viruses through saliva, urine, and feces, keeping them infectious for several days. People usually become infected by inhaling dust containing the virus or by getting it into skin wounds. Transmission via bites or contaminated food is also possible.

People who perform the following activities are particularly at risk: Gardening, work in forestry and agriculture, especially when cleaning sheds and stables where rodents are present.

In principle, however, one can also become infected with hantaviruses during outdoor activities such as jogging, hunting or camping. Military personnel who take part in outdoor exercises must also be included in this figure.

Important to know: Middle-aged men are particularly frequently affected. The likelihood of contracting the disease is greatest from April to September.

How common is hantavirus disease?

Hantaviruses are spread worldwide. The more host animals there are, the more frequently the condition occurs. If the food supply is good for rodents like bank voles, they can multiply greatly. Accordingly, the amount of virus-contaminated mouse excrement in the environment also increases, causing hantaviruses to spread faster and diseases to increase. The amount of precipitation per year also plays a role. For example, high precipitation leads to a fattening of beech or acorns in the following year, which favors the reproduction of the animals.

As food supply and rainfall fluctuate throughout the year, so do disease rates. For example, only about 230 cases were reported in Germany in 2018, compared with slightly more than 1 in 2019.500.

What is the course of a hantavirus disease??

The virus types that occur in Germany only rarely cause severe courses. Flu-like symptoms are in the foreground. Kidney dysfunction. One speaks then of a so-called Nephropathia epidemica. Recovery can take several weeks to months, but remains without lasting consequences.

In addition, there are two severe forms of progression that can be fatal:

Hemorrhagic fever with renal syndrome

The disease begins like an uncomplicated hantavirus illness. But after a few days the following symptoms develop:

– Severe abdominal and back pain – Diarrhea and vomiting – Dizziness and drop in blood prere up to shock – Bleeding in the conjunctiva and skin – Impaired kidney function up to kidney failure

In 5 to 15 percent of cases, the disease is fatal. Hemorrhagic fever with renal syndrome, caused by the virus types found in Germany, is usually milder and without bleeding or shock. The mortality rate here is less than one percent.

Hantavirus-induced cardiopulmonary syndrome

The disease starts suddenly with high fever, nausea and vomiting, feeling of weakness, abdominal and limb pain. Lung symptoms can worsen quickly. Lead to acute respiratory distress syndrome. This form of the disease is fatal in 25 to 40 percent of those who contract it.

How to prevent hantavirus disease?

No vaccine available in Europe so far. You can only prevent disease by preventing infection and avoiding contact with rodents and their droppings. Wash hands and hair thoroughly after spending time in basements, attics, or sheds. Wear mouth/nose protection when working in areas potentially contaminated with mouse droppings. Wash work clothes at 60 degrees Celsius after completing the activity.

In addition, you can take other effective measures:

How to prevent a mouse infestation

– Keep food safe and tightly closed, such as in cupboards and plastic and metal cans. Leave pet food. Do not leave water open overnight. – Dispose of waste in sealable trash cans and garbage cans. – Do not put food scraps or animal waste in the compost. – Eliminate rodent nesting sites, i.e., trash piles, bulky trash, and old tires.

How to control mice and rats

– Place mouse or rat traps (beat traps) in dark corners and along walls. – Make sure traps are inaccessible to children and pets. – Check the traps regularly. – Consult a professional pest controller if necessary. Put on gloves. Put on a mouth-nose protection. – Put dead mice in the household garbage, sealed in a plastic bag. – Ventilate rooms with mouse infestation for 30 minutes before cleaning. – Prevent dust from being kicked up by wetting surfaces before cleaning. – Do not use a vacuum cleaner, as viruses are spread in the air by the blower. – Clean all contaminated surfaces with household cleaner. – Wash hands and hair after cleaning, shower, and launder work clothes.

For more on the topic, see the Robert Koch Institute fact sheet "Information on avoiding hantavirus infections".

How to diagnose hantavirus disease?

If infection with hantavirus is suspected, doctors will draw blood to have a lab determine if there are antibodies to the virus. The virus itself can only be detected in the blood for a short time in the early phase of the disease.

How to treat hantavirus disease?

There is no special medication that directly targets the hantaviruses. Antipyretic painkillers such as acetaminophen can relieve symptoms. In severe cases, patients come. Patients to the intensive care unit. Sometimes they also need to be mechanically ventilated.


– Drug Commission of the German Medical Association. Hantaviral diseases. Retrieved 05.11.2020. – German Federal Center for Health Education. Website infectious diseases.en. Pathogen profile of hantaviruses. Information about human pathogens. Retrieved 05.11.2020. – Robert Koch Institute (RKI). Infectious diseases A-Z: Hantavirus infections. Retrieved 05.11.2020. – Robert Koch Institute (RKI). RKI guidebook. Hantavirus disease. Retrieved 05.11.2020. – Robert Koch Institute (RKI). SurvStat@RKI 2.0.

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