That initial phase, however, is not full recovery, a process that takes much longer. Some hanta survivors seem to reach a plateau after a year or so. Yet almost all of the information sites for Sin Nombre virus infection state this information as "recovery is rapid." This raises false expectations of quick return to normalcy, both in the patient, and in their family, when the actual process can be a slower, much more difficult slog.
Even though hantavirus recovery is slow and difficult. It does happen, and patience is paramount.
As patients with hantavirus pulmonary syndrome regain consciousness, at some point a hantavirus survivor will become capable of first, precious, lucid thoughts.
One of the first hantavirus survivor's thoughts is often something along the lines of:
WTF! Why me?
As a hantavirus survivor's spouse, one of my first lucid thoughts after the acute phase of my wife's illness was something along the lines of:
WTF! How – and why – did my wife nearly die from this extremely rare disease, hantavirus pulmonary syndrome?
|A Big Leaf maple in our backyard. The trunk of this one is > 2' diameter.|
Deer mice, prime reservoir for hantavirus, feed on the seeds from these trees.
I believe those conclusions are well-supported by the evidence, just a brief description of which is provided in this post, and I believe that they should be disseminated to the public. Releasing current hantavirus information is what many states that have more experience dealing with Sin Nombre hantavirus do. For examples of this, see the U.S. hantavirus alerts issued recently that are linked, by the Program for Monitoring Emerging Diseases at the bottom of my 3/15/2016 post there at http://www.promedmail.org/post/4901561. States such as Arizona and Colorado routinely provide information about even single hantavirus cases, because they tend to occur in clusters.
[Note: The health department has issued a press release and updated their website in response to news from this blog. (Thank you!) That renders some of the statements following "past tense."]
Despite this, the King County health department has not, and apparently does not intend to, issue any kind of alert, or even present basic information to the public. They are awaiting guidance from the CDC. Since last December, apparently.
I want to emphasize, however, that they did not attempt to deter or discourage me from presenting this information to the public myself. On the contrary, they have offered to help me with information and support as I pursue this project, which I welcome.
I also agree with the local health authorities that it is critical that information about this local hantavirus cluster should not lead to over-reaction, but should be kept in proper perspective. Even given reason to believe that the risk is currently in a heightened state, which I will outline below, that risk is still quite low. I believe, however, that people should be provided with available public health information of this nature, so that they are enabled to make their own informed judgements.
With all that in mind...
What is a hantavirus hot spot?
A hantavirus "hot spot" is an area where the probability of humans contracting hantavirus is especially elevated, either in comparison to other areas, or significantly above the level that is typical for that area. For the Sin Nombre strain of hantavirus, which is believed to be extremely rare with only about 700 documented cases in total, an elevated risk doesn't mean that large numbers of people are contracting the illness, but only that a significant "uptick" has occurred. For the "uptick people" themselves, even though that number may be small, is at least one too high.
The abstract for a paper on the Four Corners hotspot, which is far "hotter" than any other area but is kind of the archetype, can be found here: http://www.bioone.org/doi/abs/10.1893/0005-3155-85.1.38?journalCode=bios The Four Corners region remains one of the most active hantavirus hot spots.
In contrast, there had been no previous cases of hantavirus pulmonary syndrome reported as contracted in King County, with a population of about two million people, since 2003 (CDC website). That makes 23 million person/years, if you will, without a single case of HPS.
This last Thanksgiving, 2016, my wife nearly died from hantavirus pulmonary syndrome. She contracted it right here in King County, near Redmond. For this unfortunate reason, I have direct information on her case, (likely greater detail about the progression of the "prodrome" etc. than is typically available), so I know that there was at least one local hantavirus case locally and recently. No official notification of any kind was issued to the community.
Now we have learned, purely through "the grapevine" rather than from any informative health authorities, that a man in Issaquah, about 10 miles away, died from hantavirus in late February, 2017.
After thirteen years without a single case, in just three months time there have been two positively confirmed cases of Sin Nombre hantavirus infections, with one fatality, here in King County.
That we know about.
That's a significant statistical uptick.
We do not know if there have been even more HPS cases, because authorities did not inform anyone about these two, now known cases. If you look at the King County website, as of 03/17/2017, it states that there have been no recent hantavirus infections, and that the last fatal case was in 1997. The page was recently updated, but not the data in it. "Last Updated March 14, 2017". We have notified them of this, and they responded, but not by correcting the misleading and erroneous material. They responded with bureaucratic reasons why they aren't going to correct it.
From King Co. website:
Those four cases since 1997 are from years ago, and do not include the recent HPS cases.
Don't worry. King County. Be happy. No hantavirus to look at here.
There is also an issue in that site focusing on combatting rats, rather than mice. Rats do not cause hantavirus infections in King County. Mice do.
The CDC guidelines for cleaning up rodent debris can be found here: https://www.cdc.gov/rodents/cleaning/index.html
Hantavirus Incidence and Climate Conditions
Back to the hot spot.
If these (at least) two cases of hantavirus had happened in isolation, out of the blue, as it were, the current state might be dismissed as being of anecdotal nature.
But this serious illness and the fatality happened in direct conjunction with the kind of sequence of climatic and environmental conditions that have been shown to cause increases in numbers of invading, hantavirus-shedding mice, directly increasing the probability of human infection and raising the actual toll in illness and death.
In fact, one of the most important emerging tools for coping with this disease on a public health level is prediction based on such climate, weather, and ecological conditions.
For example see this comment post in ProMED that was linked by them at the bottom of my comment.
As I will describe below, the climatic conditions over the last year or so have strongly favored just such an increase in hantavirus infection probability.
This condition appears to me to warrant particular caution among those that are in Deer mouse inhabited areas, whether they have a known intrusion or not. It merits an awareness effort to reach out to the population affected. Unfortunately, again, no such effort has been forthcoming from local health authorities.
So, I'm doing it myself.
|Hantavirus infections and mortality rate for U.S. by year. From CDC website.|
Hantavirus hot spots likely occur when the incidence of the disease within the local rodent population spikes up, along with the population of the rodents themselves. Not only are there more mice around to come into contact with people, but more of those mice are actively carrying the virus and capable of "shedding" the virus, predominantly in their feces and urine.
There appear to be correlations between climate conditions and the sequence of those conditions, with the incidence of hantavirus in humans. All such correlations, it should be noted, depend on the validity of the hantavirus incidence data. In a study in Mexico, where no cases were reported for many years despite widespread antibodies among the rodent population, clearly those data were wrong. The authors concluded that it was most probable that there were in fact, HPS cases in the Northern states of Mexico, bit that they were going undiagnosed and unreported. Other explanations offered were clearly unlikely, somehow less virulent hantavirus, or less intimate contact than on the U.S. side of the border.
From that paper's abstract:
"Nucleotide sequence data from 5 antibody-positive rodents indicated that Sin Nombre virus (the major cause of hantavirus pulmonary syndrome [HPS] in the United States) is enzootic in the Mexican states of Nuevo León, San Luis Potosí, Tamaulipas, and Veracruz. However, HPS has not been reported from these states, which suggests that in northeastern Mexico, HPS has been confused with other rapidly progressive, life-threatening respiratory diseases."
Geographic Distribution of Hantaviruses Associated with Neotomine and Sigmodontine Rodents, Mexico
A brief description of the correlation between human hantavirus and environmental changes, and a line of reasoning for why that correlation would occur, is as follows.
First Step: Some weather event, like a drought or an extreme cold period, depresses the population of mouse predators. Those events likely also depress mouse populations as well, so no increase in human hantavirus occurs at this stage. The few mice that survive the tough weather may be older and tougher than average, and so more likely to be infected with hantavirus, since they have been around longer to acquire it. The lower population would likely push against this trend, however.
|Snow day in our side yard.|
Second Step: Some other weather event happens that favors mouse population increase, like a really good year for acorns, or whatever they eat locally. Already aided by the reduction in the numbers of their predators, the mice can breed as often as every 40 days, yielding litters of 5-10 "pups." These pups can begin to breed at a month and a half old.
With plenty of food and mild conditions, leading to an increasing population of Deer mice, and good conditions for those mice, there will soon be more and older Deer mice. Those older mice are more likely to acquire hantavirus infection along the way. Hantavirus to a mouse is like our common cold, except that they never really get over it once they are infected. Perhaps that is not so different.
The typical Deer mouse life span in the wild is 6 to 18 months. The longer they live, the greater chances that they will acquire hantavirus through males fighting for dominance, (again, perhaps not so different) and through exposure to each other's excreta. Deer mice are copraphagic (don't ask).
Once a Deer mouse has hantavirus, always a Deer mouse with hantavirus. It is less well known how active long-term carriers are at shedding virions, but it is likely that they continue to do so, perhaps to a reduced extent.
The result is that you have a greater number of mice than usual, harboring a higher percentage of infected mice that are shedding hantavirus in their urine and feces.
The final step is a round of bad weather for mice, whatever that is. This is usually referred to as a "cold snap" but in the Seattle area it may have been any weather change that, along with depleting food supplies, convinced these mice that your home or garage was a better place to live and search for food than their home in the backyard.
It is important to realize that much that is written about this process was drawn from experience in desert locations. It should be applied to other climates like Seattle carefully. In particular, it is often stated that increased rainfall is what increases the mouse population, and that is clearly in reference to low precipitation areas.
Increased rainfall in the Seattle area is redundant.
|Snoqualmie Falls, nearby.|
The Deer mouse survivors of the bad weather event rebound at a rapid rate. They reach high population numbers, and a high rate of infection much faster than the far-slower breeding predator species. Then came winter, the seed supply began to run low, and they have been driven into our homes, our garages, and perhaps most dangerously, our automobiles.
Note: This article will be updated and refined.