#312 Hantavirus Readiness For Anesthesia Teams

A virus can feel “far away” right up until it lands in a preop bay with a fever, abdominal pain, and a story that only makes sense weeks later. We walk through what anesthesia, perioperative, and critical care teams need to know about hantavirus, why the incubation period (often 7 to 42 days) complicates detection, and how the Andes virus changes the conversation because it is the only hantavirus known to spread person to person.

We start with the basics that matter at the bedside: common transmission pathways like inhalation of aerosolized particles from rodent droppings, the two major clinical syndromes (hantavirus cardiopulmonary syndrome and hemorrhagic fever with renal syndrome), and the pathophysiology that drives non cardiogenic pulmonary edema, shock, thrombocytopenia, and organ failure. We also cover diagnosis (PCR and antibody testing), reporting to public health, and why supportive care remains the foundation, including when ECMO may be considered as a bridge to recovery.

Then, we bring it into the perioperative space with clear, practical infection control guidance for operating rooms and procedural areas. We talk elective case delays after known exposure, emergency surgery planning with bleeding risk, negative pressure isolation rooms, and PPE choices like N95 or PAPR for clinicians. We also share concrete anesthesia circuit precautions recommended by occupational health experts, including HEPA filtration placement, safer gas sampling scavenging, and how to handle circuit disconnections to reduce room contamination.

If you want a focused, evidence aware checklist for hantavirus preparedness in anesthesia care, hit play, share this with a colleague, and subscribe so you do not miss the next safety update. After listening, leave a review and tell us: what is the single biggest gap in your OR infection control plan right now?

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/312-hantavirus-readiness-for-anesthesia-teams/

© 2026, The Anesthesia Patient Safety Foundation

Transcript

The Next Outbreak Is Coming

SPEAKER_00 0:00

Unfortunately, whether it's this strain of the Hakavirus or the rapidly spreading Bundybujo Ebola virus, I do believe that another major emerging infectious disease outbreak or worldwide pandemic is not a matter of if, but when. I believe that the knowledge, skills, and training that we as anesthesia clinicians possess are invaluable in large-scale emergencies, whether they're pandemics, mass casualty events, natural disasters, or the care of casualties of large-scale combat operations. My hope is that more anesthesia clinicians will become engaged in health security and large-scale emergency preparedness and response in the future.

Hantavirus Facts And Current Cluster

Alli 0:38

Hello and welcome back to the Anesthesia Patient Safety Podcast. I'm your host, Ali Bechtel. Here are some quick hantivirus facts and information about the recent outbreak. It is a single-stranded RNA zoonotic virus that usually infects small rodents with little impact on the host. On May 6th, the World Health Organization confirmed a hantivirus infection cluster caused by the Andes virus, which is endemic in areas of South America. The Andes virus is the only hantivirus known to be able to spread person to person, usually following prolonged and close contact. By the 15th of May, there were 10 cases, including three deaths. Today, we are discussing everything you need to know about hantivirus infection to help keep you and your patients safe during anesthesia care. So stay tuned. Before we dive further into the episode today, we'd like to recognize Frazinius Kabi, a major corporate supporter of APSF. Frazinius Kabi has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, Frazinius Kabi. We wouldn't be able to do all that we do without you. Our featured article is Hantivirus Awareness for Anesthesia and Critical Care Professionals by Sharnin and colleagues. This is an APSF newsletter article that was published online May 19, 2026. To follow along with us, head over to apSF.org and click on the newsletter heading. The first one down is Newsletter Articles. Then you can scroll down until you get to our featured article today, and I will include a link in the show notes as well. The most common transmission pathway for human hantivirus infection involves inhalation of aerosolized viral particles while cleaning rodent droppings. Contact with rodent saliva can also lead to infection. Disease latency is variable with an incubation period of 7 to 42 days. This makes it difficult to identify the original exposure. If we look at hantavirus around the world, there are the Andes and Cynobray viruses that cause hantavirus cardiopulmonary syndrome in the Americas. Hemorrhagic fever with renal syndrome is caused by the HANTA and Pumela viruses in Europe, Asia, and Africa. The case fatality rate from hantavirus cardiopulmonary syndrome, which is associated with severe respiratory failure, is really high at 10 to 50%. Hemorrhagic fever with renal syndrome, which may lead to bleeding and renal failure, has a fatality rate of 1 to 12%. Hantavirus attacks capillary endothelial cells, leading to increased capillary permeability and non-cardiogenic pulmonary edema in both syndromes. Check out the figure in the article for a quick review of hantivirus infections for anesthesia professionals. You can find it in the show notes too.

How Hantavirus Spreads

Alli 3:40

Let's take a closer look at hantivirus transmission. At this time, the andes virus is the only one known to spread person to person. There was a 2011 outbreak of the Andes virus that involved transmission to close contacts during the febrile illness leading to infection. The close contacts included spouses who shared a bed or healthcare professionals involved in direct patient care. During another Andes virus outbreak in 2018, there were no nosocomial transmission events, even to healthcare professionals involved in high-risk procedures such as intubation. It is likely that transmission depends on significant exposure to bodily fluids, especially saliva, from an affected person during the prodromal phase of the illness. Keep in mind that there is a long latency phase, so confirming person-to-person spread is often difficult. If we look at the most recent outbreak on the cruise ship, it is likely that extended contact or shared living spaces played a role in the person-to-person

Symptoms Diagnosis And Supportive Care

Alli 4:43

spread. Now it's time to evaluate the clinical features of hantivirus infection. Patients may develop fever, mygias, backache, and headache initially. Severe abdominal pain has been reported, which presents as an acute abdomen. Patients have been taken to the operating room for appendectomy and then were later diagnosed as having hantivirus infection. Disease progression may include thrombocytopenia, oligua, kidney injury, and respiratory failure. Severe respiratory failure is more likely to occur with hantivirus cardiopulmonary syndrome. The highest concentration of viral particles is found in the blood, but maybe in other bodily fluids, so there is a risk of nosocomial viral transmission. Testing for hantiviruses with PCR techniques, and in the United States, a clinical PCR test for the Andes virus is under development. Antibody testing may also be used later in the infection. There are moderately effective vaccines for hemorrhagic fever with renal syndromes available in Korea and China. It is important to report hantivirus infections to local public health officers, and patients with suspected or confirmed infection should be evaluated by the infectious disease team and hospital infection control. Treatment for hantivirus is supportive care, and in cases of respiratory failure, ECMO may be considered as a bridge to recovery. Viral therapy has been studied, and treatment with ribovirin alone was not effective. Combination therapy with ribovirin and Favipir has been shown to work against the virus in vitro, and further research is needed in this area.

Elective Versus Emergency Surgery Decisions

Alli 6:27

Let's move this discussion into the perioperative space and operating rooms. But I warn you, we will be proceeding without recommendations. This is a difficult situation. Often the exposure timing is only determined in retrospect, and there is a long latency with this infection. For elective surgery considerations, you may consider delaying elective surgery for patients with a known exposure until after the patient is through the latent period, about 39 days. Patients with acute hantivirus infection should have elective surgery delayed until return to full health, which may be months later. For emergency surgery for patients with hantivirus infection, be prepared for bleeding due to thrombocytopenia and coagulation system dysfunction. Following surgery, patients will need to recover in a negative pressure isolation room.

OR PPE And Cleaning Playbook

Alli 7:20

When it comes to infection control, what protective strategies are recommended to prevent nosocomial transmission? HANTA viruses are enveloped and similar in size to the SARS-CoV-2 virus, so similar protective strategies should be used. There are some institutions that use the highest level of precaution, similar to other hemorrhagic fevers like Ebola and Marburg. Check out the show notes for a video demonstration of the recommended protective strategies. And here are the recommendations for anesthesia professionals when providing care for patients with known or suspected hantivirus infection. N95 masking or powered air purifying respirator use during airway management and other aerosol generating procedures. Eye protection. Due to the small size of the virus, personal use of nasal povidone iodine in conjunction with masks may be considered. A gargle of dilute 1 to 10 povidone iodine in water may also be used for additional protection. Hand hygiene should be used with alcohol-based hand sanitizers. Designation of clean and dirty areas within the anesthesia workspace. After induction of anesthesia, perform a top cleaning of the anesthesia machine and equipment with a quaternary ammonium compound and alcohol wipes. Needless ports should be disinfected prior to access. And between cases, perform a terminal-level operating room cleaning with UVC irradiation if available using evidence-based approaches.

Why Transmission Risk Still Matters

Alli 8:55

Next up, we are going to check out the response to Hantavirus Awareness for Anesthesia and Critical Care Professionals by Brent Lee. And we happen to have some exclusive content from the author.

SPEAKER_00 9:07

Hi, I'm Brent Lee, and I am the Director of Clinical Excellence and Performance Improvement at North American Partners in Anesthesia, and an associated scholar and affiliate at the National Center for Health Security and Resilience at Georgetown University.

Alli 9:22

I asked Brent what got him interested in this topic. Let's take a listen to what he had to say.

SPEAKER_00 9:28

Early in my career, I served as an epidemic intelligence service officer at the CDC. So when the COVID-19 pandemic hit, and I was serving as the patient safety officer at NAPA, I saw firsthand the devastation caused by this novel pathogen not only to the patients we cared for, but also the profound physical and emotional toll it took on our anesthesia clinicians. That experience deepened my interest in health security and specifically the role anesthesia clinicians play in disaster preparedness and response. More recently, I completed a graduate program in biodse, where I happened to write a term paper on hantavirus. So when news emerged about the outbreak on the cruise ship, my immediate thought was our community needs to be as prepared as possible for whatever may be coming down the pike.

Alli 10:15

And now let's check out Brent's response to the editor. He reports that with the recent hantivirus outbreak aboard the cruise ship, the risk of a pandemic-level threat to the global population is low, according to the World Health Organization. But there are reasons to be concerned, including the high case fatality rate, prolonged and variable incubation period, and no effective vaccine or treatment. There is another important consideration: transmission of the virus. While public health officials have stated that person-to-person transmission is rare and requires prolonged and intimate contact with a symptomatic person, this may not be true according to the currently available evidence. So let's look at that available evidence. The International Hantivirus Society published a statement on May 7th of this year about transmission of the Andes strain of hantivirus. During the 2018-2019 outbreak in Argentina, there was an index patient with fever and malaise who attended a birthday party for 90 minutes. Five guests who were seated near this patient became infected. Then one of these birthday party guests infected six other people and later died from the infection. At his wake, his spouse was symptomatic and passed on the infection to 10 people. There were 33 people who became infected during this superspreader outbreak with 11 deaths. If we look at the cruise ship outbreak, there are some parallels, since many of the infected patients, the primary known exposures were shared indoor environments in the cruise ship, like dining rooms and lecture halls. Another signal from the literature is that patients may not need to be symptomatic to effectively transmit the virus. There is a 2024 publication by Ferris and colleagues, Viral Shedding and Viremia of Andes Virus during acute hantivirus infection, a prospective study that found infective virus in the urine, saliva, and nasopharyngeal secretions before patients develop symptoms. We hope that you will check out the show notes for the citations so that you can check out these studies. Brent points out that these findings reveal what is possible with hantivirus transmission. Even if this is not how the virus usually behaves, we need to be prepared. This is an area where anesthesia professionals excel. We are trained to be prepared for rare events or for when things don't go according to plans, as evidenced by simulation training for malignant hyperthermia or performing a rapid sequence induction for patients with an unknown fasting history. And speaking of being prepared, it is important to use full airborne and contact precautions when caring for patients with known or suspected Andes hantavirus infection.

Ventilation Precautions And Preparedness Mindset

Alli 13:02

Other recommendations from the ASA Committee on Occupational Health include the following. If manual or mechanical ventilation is necessary, then place a HEPA filter between the patient's airway and the distal end of the disposable portion of the breathing circuit. Protect the anesthesia gas sampling port with HEPA filtration or at a minimum scavenge the gases exiting the gas analyzer and do not allow the gases to return to the room air. If temporary disconnection from the breathing circuit is required, keep the HEPA filter attached to the patient's airway. If a portable bag valve mask device is used, place the HEPA filter between the device and the patient's airway to prevent room air contamination. Brent reminds us that patients with hantavirus infection may require intensive care with mechanical ventilation, invasive monitoring, ECMO, and careful fluid and electrolyte management. While the public health messaging focuses on reassurance and preventing panic, health care professionals need to remain prepared and up to date to make safe and informed decisions. Before we wrap up for today, we are going to hear from Brent again. I also asked him what he hopes to see going forward. Here's his response.

SPEAKER_00 14:20

Unfortunately, whether it's this strain of the hantavirus or the rapidly spreading Bundibujo Ebola virus, I do believe that another major emerging infectious disease outbreak or worldwide pandemic is not a matter of if, but when. I believe that the knowledge, skills, and training that we as anesthesia clinicians possess are invaluable in large-scale emergencies, whether they're pandemics, mass casualty events, natural disasters, or the care of casualties of large-scale combat operations. My hope is that more anesthesia clinicians will become engaged in health security and large-scale emergency preparedness and response in the future.

Alli 14:59

Thank you so much to Brent for contributing to the show today. If you have any questions or comments from today's show, please email us at podcast at apSF.org. Please keep in mind that the information in the show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit apSF.org for detailed information and check out the show notes for links to all the topics we discussed today. Until next time, stay vigilant and stay informed so that no one shall be harmed by anesthesia care.