known as Epidemic Hemorrhagic Fever and Hemorrhagic Fever with Renal
Stella Lee RN, Seoul University, Seoul Gary Podolsky MD University
an acute febrile disease caused the infection of Hantaan virus (or
Seoul virus). This is a separate but related disease from that of
the Hanta virus known in North America.
wide distribution: 150,000~200,000 people are hospitalized every
year and more than half of them occur from China, Korea, Japan,
Russia, Finland, Sweden, and the Balkan Peninsula.
Korea: It occurred 100 people per year from 1995 to 1998. It increased
by 200 people after 1998. It occurred frequently in Kyonggi, Seoul
and Kyongbuk provinces.
begins in October and with a peak apex in November, until December
and until January. It occurred frequently in people aged 40-49 years
old but also in those 20-39 years of age and children.
carrier of the pathogen are rodents the wild rat ( Apodemus
agrarius ). Infected
Apodemus agrarius are responsible for transmission in
most cases (71-90%) Contagion is through infected rat fluids (urine
and feces, saliva) and with direct contact of rat faeces (aerosolized
)to lungs or with a wound (cutaneous). High-risk
groups include men who do outdoor activities, military personnel,
farmer, and lab technicians exposed to infected animals.
incubation period is 1-3 weeks, and then patients become feverish
with the hemorrhage and renal lesions occurring later.
clinical course is:
days) which is characterized by sudden onset fever, malaise and
severe headache. A red rash develops on the face and trunk along
with conjunctival hyperemia, ecchymosis, thrombocytopenia and proteinuria.
days), is characterized by persistence of generalized symptoms and
anxiety. Hypotension, delirium, hematemesis, coma may present. Severe
proteinuria and frequent urination.Other
laboratory features include thrombocytopenia, leukocytosis, and
hematuria and increased hematocrit.
days), is characterized by nausea, vomiting, oliguria, naturemia,
electrolyte imbalance, hyperkalemia, and hypertension. Occasional
cerebral and pulmonary edema. Purpura are noted. Gastrointestinal
hemorrhage may be noted.
days) involves a partial recovery of renal function with polyuria.
Severe dehydration and hypovolemic shock is a danger. Death from
pulmonary complication may result.
weeks) follows the 5 phases. Patients may still have polyuria or
nocturia and anemia.
cases may show variations from the 5 phases and may not involve
diagnosis is made with a combination of the history, clinical symptoms,
lab data and the progression of the disease. It can be confirmed
with IGM antibody test, ELISA and Hantdia kit (available in Korea).
diagnoses include acute G-I disorders, Hepatitis, Meningococcal
sepsis, acute nephritis, Central Nerve System disorders, other febrile
and viral hemorrhagic fever infections
is individualized for each of the phases of the progression of the
Rest is the most important thing, it gives the symptomatic therapy
against pain and vomiting Hydration is maintained with 10% Dextrose
solution. If patients have low blood pressure they may be given
low salt serum albumin or plasma expanders (Reomacrodex). Oliguria
or anuria patient treatment follows the same for renal failure.
When the hemorrhagic tendency is serious observation for pulmonary
hemorrhage is important. During the Oliguric phase patients are
restricted their intake of potassium. In the Diuretic phase careful
attention to adequate hydration and potassium is important. It has
been reported that Ribavirin decreases a mortality rate.
no treatment, more than 15% mortality occurs. With treatment mortality
is less than 5%.
and Contact person Management
care: Does not need isolation
person care: No isolation.
with the inactivated Hantavirus vaccine inoculation is recommended
for those frequently exposed to environments which can be contaminated
by the Hantaan virus or for persons who belongs in the high risk
vaccine is given in 3 doses: an initial inoculation vaccine 0.5
ml followed by two boosters at one and 12 months. The vaccine may
be given subcutaneously or intra muscularly.
are no guidelines for further boostings.
Lee has worked as a Internal Medicine nurse at Seoul National University
hospital in Korea with Korean Hemorrhagic fever and now works in
Canada as a Travel Nurse with Dr Podolsky at the Skylark Medical
clinic in Winnipeg Manitoba, Canada.