Indwara y’amahaha y’umugera wa Hantavirus (HPS): Igituma udategerezwa kwigera ukubura canke gukubura amavyi y’imbeba mu nzu canke mu nzu y’imbohe¶

Iyo ufunguye inzu y’ibihe vyugarijwe, ububiko, ikiraro, inzu yo hejuru, garage, ahantu ho gukwegera, canke RV/camper ihagaze maze ukabona amavyi y’imbeba yumye canke ibikoresho vyo gutera ivyatsi vyumye, **gufata umukubuzo, uburoso bwo gukubita, canke umukubuzo wo mu nzu kugira ngo ukubure ubuzima. Gukubura canke gukubura mu buryo bwumye bitera umuyaga utugingo ngengabuzima dutoduto tw’amaso y’imbeba yumye, amacandwe n’amavyi y’imbeba birimwo Hantavirus (such as Sin Nombre virus carried by the North American Deer Mouse, or Puumala and Dobrava viruses in Europe and Asia) ugororotse mu kirere, aho uhumekera uwo mugera gushika kure mu mahaha yawe. Iyo umuntu afise umuriro, akabonge, ububabare bukomeye bw’imitsi (especially in the thighs, hips, back, and shoulders), kumeneka umutwe, gusesa amaraso canke gukorora mu . 1 to 8 weeks y’ukwinjira mu nyubakwa yuzuye imbeba - hanyuma inyuma y’imisi 3 gushika kuri 5 ugakorora canke guhumeka nabi bukwi na bukwi, hamagara ku nimero y’ivyihutirwa yo mu karere kawe uciye kuri telefone yacu inomero z'ivyihutirwa directory maze ugende mu bitaro vy’amashure yisumbuye vy’Igisata c’Ivyihutirwa n’ECMO (Extracorporeal Membrane Oxygenation) ubushobozi ubwo nyene. Suzuma kandi uburongozi bwacu ku sepsis n'ukwemera ivy'uguhungabana, leptospirose (indwara ya Weil) iva ku mazi y’umwuzure be n’amasobe y’imbeba, gufata umuti wica imbeba (ubumara bw'imbeba), na kurumwa n'ibikoko no kwirinda indwara y'ibicurane.

Nk’uko Ibigo bijejwe kugenzura no kwirinda indwara (CDC), Ishirahamwe ry’ubuzima ryo muri Amerika yose (PAHO / WHO), na Ikigo c’Uburaya co kwirinda no gucungera indwara (ECDC), Indwara y'amahaha iterwa n'umugera wa Hantavirus (HPS, kandi yitwa indwara y’umutima n’amahaha ya Hantavirus / . HCPS) itwara igipimo c'urupfu c'abarwayi ba 100.000. 35% to 38% (and up to 50% mu biza bikomeye vy’umugera wa Andes) - mbere no mu bakiri bato bafise amagara meza kandi ata ndwara n’imwe bari bafise imbere y’aho. Igituma Hantavirus Pulmonary Syndrome ihenda cane kandi yica mu buvuzi bw’ibihe vyihutirwa ni umutego wayo w’ubuvuzi w’inzira zibiri: mu misi 3 gushika ku 6 ya mbere (the Febrile Prodrome), umurwayi asa n’uwufise gusa indwara y’ibicurane canke indwara y’ibihaha iterwa n’imigera (fever, severe thigh/back muscle aches, headache, nausea, abdominal pain, and a completely clear chest X-ray with ZERO runny nose or sore throat), ni co gituma amavuriro y’ubuvuzi bwihutirwa abarungika muhira ubudasiba. Hanyuma, ata n’umwe amugabishije, uwo murwayi yinjira mu Cardiopulmonary Capillary-Leak Phase, aho uwo mugera utuma uruzitiro rw’amahaha ruvuza cane, urusesa amahaha yose kuva imbere gushika hanze n’amaraso yuzuye poroteyine mu masaha 4 gushika ku 8 gusacardiogenic + non-cardiogenic shock). Ikibi kuruta, iyo umuganga wo mu cumba c’ubuvuzi bwihutirwa yihenze ko umurwayi wa Hantavirus afise indwara y’imigera isanzwe maze akamuha imiti myinshi y’umunyu (30 mL/kg), ayo mazi y’inyongera asuka agororotse mu mitsi y’amahaha ivuza maze akaroha umurwayi ku ntambaro. Kumenya neza Itegeko ryo Gusukura Imbeba ry’Igihugu ry’Igihugu n’Itegeko ryo Gutoranya Amaraso y’Imibare 5 (Hantavirus Triad) ikiza ubuzima.

Ivyo ubikore ubu¶

1. **HAGARARA ubwo nyene iyo ubonye amavyi y’imbeba, ivyari, canke imbeba zipfuye mu nzu y’imbohe, mu nzu y’imbere, mu nzu yo hejuru, mu nzu yo hasi: NTUKIGEZE ukoresha umukubuzo, NTUKIGERE ukoresha igikoresho co gusukura (mbere n’igikoresho co gusukura HEPA), kandi NTUKIGERE ufuha inkungugu n’umukubuzo canke umukubuzo itanguye amamiliyoni y’ibintu bitaboneka 1-to-5-micron inkungugu yuzuye virusi mu karere kawe ko guhema aho imanika mu kirere kidahinduka amasaha menshi.
2. Ubanze ushire umwuka ahantu hafunze nibura 30 full minutes mu gufungura inzugi n’amadirisho yo hanze no kugenda GUSUBIRAMWO HANZE (staying upwind while fresh outdoor air flushes the room). Hantavirus ni umugera wa ARN upfutse (Bunyavirales / Orthohantavirus) iyo ibahasha ryayo ry’amaraso rigaca ridakora ningoga kubera umuco wo hanze (UV) umuco w’izuba n’umuyaga mwiza.
3. Mwambare amaganzu y’imipira/nitrile (n’ N100 / P100 canke FFP3 igikoresho co guhumeka c’ibihimba vy’umubiri ku bijanye n’indwara zikomeye), hanyuma UKONYEKEZE neza amavyi yose, ivyari vyose be n’ibikoko vy’ibinyogomba vyapfuye n’ikintu gishasha kivanze . 1:10 Household Bleach Solution (1 part liquid chlorine bleach to 9 parts water, canke umuti wo gukuramwo imigera wo mu bucuruzi wanditswe na EPA nka Lysol) hanyuma ukawureka ukaguma utose mu kiringo c’imisi . 5 to 10 full minutes imbere yo gukora ikintu cose. Gutobeka amavyi bifatanya inkungugu kugira ngo ntishobore gushika mu kirere mu gihe sodium hypochlorite isenya 100% y’ibara ry’amaraso ry’umugera.
4. Tora amavyi yanyowe n’amazi n’ibikoresho vyo gutera ivyatsi ukoresheje ibitambaro vy’impapuro bitose (NTUZIGEZE ubikubura), ufunge ibitambaro vy’impapuro bitose n’imbeba zipfuye mu mifuko ibiri y’ibikoresho vy’impuzu, hanyuma woze ibiganza vyawe bifise amaganzu n’amazi n’isabune IMBERE yo gukurako amaganzu yawe.
5. Iyo ufise umuriro (>= 38.0 C / 100.4 F), ububabare bukomeye bw’imitsi (thighs, lower back, hips), kumeneka umutwe, gusesa amaraso, gukorora canke guciramwo mu . 1 to 8 weeks (7 to 56 days) umaze gusukura inzu/ibaraza, gukambika, canke gufata inkwi: genda mu bitaro vy’Ivyihutirwa UBWO nyene (naho woba utarakorora).
6. Vuga aya majambo nyayo umuforoma n’umuganga wo mu cumba c’ubuvuzi bw’ivyihutirwa mu masegonda 30 ya mbere: "I was exposed to rodent droppings / mice ___ weeks ago and now have fever and muscle aches. Please evaluate immediately for Hantavirus Pulmonary Syndrome (HPS), order a STAT Complete Blood Count (CBC) with manual peripheral blood smear (checking for the Hantavirus Triad: thrombocytopenia, hemoconcentration, and immunoblasts), and AVOID aggressive IV fluid boluses that can trigger fatal pulmonary edema."

Igiti c'ingingo: Gusukura neza imbeba n'ugutoranya indwara y'amahaha ya Hantavirus¶

Kurikiza iki kigereranyo c’ibikorwa n’ubuvuzi ku bijanye no kwirinda mu gihe c’isuku n’ugutoranya ubuvuzi vyihutirwa inyuma yo gushikirwa n’indwara.

flowchart TD
    Start["Amavyi y’imbeba, ivyari, amabara y’amasobe, canke imbeba zipfuye ziboneka mu nzu, mu nzu y’imbohe, mu kigega, mu nzu yo hejuru, mu garage canke mu nzu y’ibarabara"] --> Scenario{"Woba Uriko Urasukura Ubu CANKE Uriko Urabona Ibimenyetso Inyuma Yo Gushikirwa Na Bihe Biheze?"}

    Scenario -->|"GUSUKUZA AMATONDA Y'INYENGA UBU"| CleanRule["CDC INTAMBWE 5 ZO GUSUKURA IVYO GUSUKUZA IVYO GUSUKURA: 1. NTUZIGEZE GUSUKURA, gusukura, canke gukoresha umuyaga 2. Fungurira inzugi zose n’amadirisho maze uve mu nyubakwa IMINOTWA 30 kugira ngo ushiremwo umwuka 3. Shirako amaganzu ya Nitrile + N100/P40. Fumbisha 1:10 Bleach Solution (agakombe 1 k’isuku ku bikombe 9 vy’amazi) ku mavyi/ivyari gushika bitose neza -> Rindira IMINOTA 5 gushika kuri 10 YUZUYE 5. Hanagura n’ibitambaro vy’impapuro bitose -> Double-bag -> Hanagura hasi n’amaganzu y’isuku imbere y’uko wosubira guhanagura"]

    Scenario -->|"KUBONA IBIMENYETSO (Indwi 1 gushika ku 8 Inyuma y’Imbeba / Inzu / Ibaraza / Inkwi)"| ProdromeCheck{"Ni Intambwe Iyihe Y’Ibimenyetso Biriho?"}

    ProdromeCheck -->|"INTAMBWE YA 1 UMURIRO (Imisi 1 gushika ku 5): Umuriro (>38 C / 100.4 F), Ugukonja, Ububabare bukomeye bw’imitsi (Amatako, Amafyigo, Umugongo), Umutwe, Ugusesa amaraso/Ugusesa amaraso/Ububabare bwo mu nda, Ugusesa amaraso (Iciyumviro: Kenshi nta n’umwe asohoka)"| ERTriage["ER TRIAGE YIHUTIRE YO MU BITARO (NTUREKE IKINYOMA KIKURIRE NGO 'IKIRINGO'): 1. Genda mu bitaro vy'ivyihutirwa Ubwo nyene 2. Menyesha ivy'imbeba/ivy'imbere mu nzu -> Usabe STAT CBC n'Igipimo c'Amaraso c'Amaboko + the Chest Check-of5 C-Ray. Ubutatu: - Ugugwa kw'amaraso (<150.000/uL - ikimenyetso ca mbere) - Ukwiyongera kw'amaraso (Ukwiyongera kw'amaraso biva ku gusohoka kw'amaraso) - Igitigiri c'amaraso y'umubiri gihindutse ibubamfu gifise >10% vy'amaraso atari yo (Immunoblastes)"]

    ProdromeCheck -->|"INTAMBWE YA 2 GUKOMERA KW’UMUTIMA (Imisi ya 4 gushika ku ya 7 - Idirisha ry’amasaha 4): Guhema kwumye, Guhema nabi, Guhema vyihuta (>22/min), SpO2 <94%, Gusenyuka kw’amahaha ku mpande zompi, Amahembe akonje, canke Gutera umuvuduko w’amaraso"| ECMORush["UBUZIMA BUTERA AKAGA ECMO & ICU (38% y'impfu): 1. Hamagara 911 / 112 / 999 -> Usabe kwimurirwa mu kigo ca ECMO co mu rwego rwa gatatu 2. AMATEGEKO AKAMARO YA ICU: - GUBUZA AMAZI BIKOMEYE (Ntugabanye boluses) - Igikoresho co gukura amaraso mu mubiri + Inotrope (Norepinephrine + Dobutamine) ku bijanye n’uguhungabana kw’umutima - Gutera VA-ECMO mbere y’igihe iyo Index y’Umutima <2.0 L/min/m2 canke PaO2/FiO2 <60"]

    ERTriage -->|"Niba amaplateleti agwa (<150k) canke imirongo ya Kerley B iri hagati y’imitsi ku gifu"| ECMORush

Igice ca 1: Uko womenya ibikoko bishobora gutera ingorane nyinshi be n’aho bishobora gushikirwa n’ibikoko (Why You Never Have to Touch a Mouse to Get Hantavirus)¶

Birenze 70% mu barwayi bavuwe ko bafise indwara y’amahaha yitwa Hantavirus bavuga ko batigeze bakora ku mbeba nzima canke yapfuye. Ahubwo, barahumekera utugingo ngengabuzima dutoduto tw’inkungugu igihe bariko barakora, baryamye canke basukura mu kibanza gikingijwe aho imbeba zo mw’ishamba zari zari zasohoye canke zisohotse amayinga menshi imbere y’aho.

1. Ubwoko bw’Ibinyabuzima vy’Ibanze (New World HPS vs. Old World HFRS)¶

Hantavirus zigabanywemwo imiryango ibiri y’aho hantu n’iy’ubuvuzi, umwe wese itwarwa n’ikigega c’ibikoko vy’ishamba (note: common domestic pet hamsters/gerbils and urban house mice *Mus musculus* do NOT carry Sin Nombre HPS virus):

2. Ibibanza indwi vyihishije abantu bahumekeramwo umugera wa Hantavirus batabizi¶

1. Gufungura Inzu y’Igihe, Inzu y’Uguhigira, Inyubakwa yo Hanze, canke Ikiraro mu Ci/Ici: Gufungura umuyaga wo mu gisenge, gukubita amaburengeti/amaterasi y’inkungugu aho imbeba zagendagenda mu gihe c’imbeho, canke gukubura hasi mu gikoni.
2. Imodoka & RV Ivyuma bikoresha umuyaga n'ibiyunguruzo vy'umuyaga wo mu nzu (A Major Overlooked Source): Imbeba z’ibisiga zikunda gukwegakwega zija mu nzu isusurutse y’umuyaga w’umuyaga, mu nzu y’umuyaga, no mu nzu y’umuyaga w’imiduga, amakamyo, amataratara yo mu mirima, n’ama RV zihagaze, zikaba zikora ivyari vy’umuyaga vy’imiduga bimenetse hejuru cane y’iyunguruzo ry’umuyaga wo mu nzu**. Iyo utanguje imodoka ugaca ufungura igikoresho co gushushanya canke igikoresho co gushushanya, ico gikoresho gitera amazi y’imbeba n’amavyi y’imbeba agororotse mu maso hawe. Ntukigere ufuha icunguru c’umuyaga co mu nzu y’imodoka gifise urusenga rw’imbeba n’umuyaga ufunze: ushire urusenga munsi y’igipfukisho ca Lysol/umuti wo gukuramwo imigera mu gihe wambaye igipfukisho ca N100/P100 n’amaganzu.
3. Gutwara Inkwi Zirundanijwe mu Maboko ku Gikiriza Cawe: Imbeba zitera imbere mu birundo vy’inkwi vyo hanze; guterura ibiti vyumye no gukaraba inkungugu y’igishishwa ku mpuzu yawe aerosols amasobe yumye munsi y’izuru ryawe nyene.
4. Gusukura amasandugu y'amakarata mu bibanza vyo hejuru, mu bibanza vyo munsi y'ubutaka, mu bibanza vy'ugukwegakwega, canke mu bibanza vyo kwibikamwo.
5. Kuryama hasi canke hasi mu nzu y'ubuhungiro, mu kigega, canke mu nzu y'ibarabara idapfutse.

Igice ca 2: Intambwe ku yindi itegeko ryemewe rya CDC ryo gusukura imbeba zitose¶

Hantavirus imara igihe kingana iki hanze y’imbeba? Mu muco w’izuba wo hanze, imishwarara ya UV yica uwo mugera mu 2 to 3 hours. Ariko rero, imbere mu nzu y’umwiza, ikonje, yumye, mu nzu y’ibaraza, mu kabati, canke mu nzu y’ibikoresho, Hantavirus yandukira iri mu mavyi canke mu mavyi yumye iguma ari nzima kandi ishobora kwanduza abantu ku myaka 2019. 2 to 3 full days mu bushuhe bwo mu cumba (kandi gushika ku 2 weeks mu bidukikije bikanye).

Ntukigere ukora ku mukubuzo canke ku gikoresho co gusukura. Kurikiza neza iyi Intambwe 6 zo Gukuraho Ubuhumane:

+-------------------------------------------------------------------------+
|  CDC STEP-BY-STEP WET-BLEACH RODENT DROPPINGS CLEANUP PROTOCOL          |
|                                                                         |
|  STEP 1: CROSS-VENTILATE FOR 30 MINUTES BEFORE ENTERING                 |
|  - Open all exterior doors, garage doors, and windows wide.             |
|  - Walk OUTSIDE and stay out for at least 30 FULL MINUTES so fresh air  |
|    exchanges the stagnant indoor air (never turn on indoor fans while   |
|    you are inside the room).                                            |
|                                                                         |
|  STEP 2: PUT ON PERSONAL PROTECTIVE EQUIPMENT (PPE)                     |
|  - Wear non-absorbent Nitrile, Latex, or Rubber Household Gloves.       |
|  - For light mouse droppings in a ventilated kitchen: gloves + eye      |
|    protection are sufficient if you strictly wet-spray without sweeping.|
|  - For HEAVY rodent infestations (piles of nests, dead mice, crawlspaces|
|    or unventilated attics): wear a tight-fitting NIOSH N100 or P100     |
|    Particulate Respirator (or European FFP3 mask) and unvented goggles. |
|                                                                         |
|  STEP 3: MIX FRESH 1:10 BLEACH SOLUTION & SOAK FOR 5 TO 10 MINUTES      |
|  - Mix 1 part household liquid chlorine bleach (5% to 8.25% sodium      |
|    hypochlorite) with 9 parts water (e.g., 1.5 cups / 360 mL of bleach  |
|    in 1 gallon / 3.8 Liters of water) in a pump/trigger spray bottle    |
|    (OR use a commercial phenol/quaternary disinfectant like Lysol if    |
|    bleach will ruin fabric/upholstery).                                 |
|  - Gently mist and SOAK all droppings, urine stains, nests, and dead    |
|    rodents until thoroughly wet (do not blast them with a hard jet).    |
|  - WAIT 5 TO 10 FULL MINUTES for the bleach to inactivate the virus.    |
|                                                                         |
|  STEP 4: WIPE UP WITH PAPER TOWELS & DOUBLE-BAG                         |
|  - Use disposable paper towels to pick up the wet droppings, nest, and  |
|    dead mouse. Place everything inside a plastic bag, seal it shut,     |
|    place that bag inside a SECOND plastic trash bag, seal it, and       |
|    place in an outdoor covered trash bin.                               |
|                                                                         |
|  STEP 5: WET-MOP FLOORS & STEAM/LAUNDER FABRICS                         |
|  - Mop hard floors and wipe countertops with the 1:10 bleach solution.  |
|  - Wash bedding/clothing in HOT water (`>= 60 C / 140 F`) with laundry  |
|    detergent and dry on HIGH heat (or leave heavy rugs/mattresses out   |
|    in direct bright noon sunlight for several hours after disinfecting).|
|                                                                         |
|  STEP 6: SAFE GLOVE REMOVAL                                             |
|  - Wash your GLOVED hands thoroughly with soap and water (or bleach     |
|    solution) FIRST, peel off the gloves turning them inside out, and    |
|    then wash your bare hands with soap and warm water for 30 seconds.   |
+-------------------------------------------------------------------------+

Igice ca 3: Kwemera Ivyiyumviro Bibiri vy’Ubuvuzi bwa Hantavirus (Why Urgent Care Doctors Mistake Phase 1 for the Flu)¶

Kuko igihe c’ugutera kwa Hantavirus ni ** .1 to 8 weeks (median 14 to 21 days)** bamaze guhema inkungugu, abarwayi kenshi baribagira ko basukuye urusenga indwi zitatu imbere y’aho iyo umuriro wabo utanguye. Fata mu mutwe ibice bibiri bitandukanye vy’ubuvuzi n’ingene womenya Hantavirus itandukanye n’igituntu gisanzwe canke COVID-19:

1. Icigwa ca 1: Indwara y’umuriro (Days 1 to 5 - Idirisha ry'inzahabu ryo gupima)¶

Ku misi ya mbere 3 gushika kuri 5 (urugero 1 to 7 days), umurwayi afise inkorora zero n’uguhema nabi, kandi igipimo c’igikiriza kenshi kigaragara nk’ikisanzwe: - Ibimenyetso vy'isi yose (Present in >90% of Patients): - Umuriro mwinshi utunguranye (38.3 to 40.0 C / 101 to 104 F)** n’uguhungabana kw’imbeho. - Ububabare bukomeye, bukomeye bw'imitsi (myalgias) bitera imigwi MININI y'imitsi (thighs, hips, lower back, and shoulders). - Umutwe utera imbere, urushe cane, n’ugusinzira / gusinzira (orthostasis). - Ikimenyetso ca GI (Present in 50% of Patients): - Gusesa amaraso, gusubiramwo, gucika intege nk’amazi, n’ububabare bwo mu nda** bukwiragira (rimwe na rimwe bukaba bukomeye cane ku buryo bushobora kwigana indwara y’ibihaha canke indwara y’ibihaha). - IKIMENYETSO #1 C'UBUVUZI KO ATARI IKINYOMA CANKE IKINTU (Absence of Upper Respiratory Symptoms): - Mu buryo butandukanye n’indwara y’ibicurane, COVID-19, RSV, canke umusonga, Abarwayi ba Hantavirus hafi NTIBIGERA bagira amazi mu zuru (rhinorrhea), gufunga amazuru, gusesa amaraso, kubabara mu muhogo (pharyngitis), canke ububabare bwo mu bihaha. - Itegeko ry'ubuvuzi: Fever + Severe Thigh/Back Muscle Aches + Nausea/Vomiting + ZERO Runny Nose or Sore Throat (1 to 8 weeks after rural/rodent exposure) = Gukeka Hantavirus Gushika Bigaragajwe ko Atari vyo.

2. Icigwa ca 2: Impanuka y’Imitsi y’Umutima n’Amahaha (Starts Abruptly on Day 4 to 6)¶

Ata n’umwe amugabishije - kenshi nk’uko umuriro w’umurwayi utangura gusenyuka - umurwayi yinjira mu Igice c’Umutima n’Amahaha: - Isaha ya 0 gushika ku isaha ya 2: Igikororo cyumye bukwi na bukwi, kitagira ico kivamwo kiratangura, kijana n’ugufata mu gikiriza gatoyi be n’uguhema gukomeye (> 20 to 24 breaths per minute). - Isaha ya 2 gushika ku isaha ya 6: Utugingo ngengabuzima tw’amaraso mu mahaha yompi turatakaza ubutungane bw’intambamyi: Plasma y’amaraso irimwo poroteyine nyinshi (with an edema-fluid-to-serum protein ratio > 0.8) isuka mu mitsi y’amaraso ikaja mu nzira y’amahaha n’inzira y’amahaha. Uguhazwa kw'umwuka (SpO2) biva ku 97% hasi mu 80s na 70s, umurwayi atangura gukorora amazi menshi y’ibara ry’agahama canke ry’ivyatsi, kandi imishwarara y’igifu iratera imbere ningoga kuva ku gupfuka igifu n’imirongo ya Kerley B gushika ku gusenyuka kw’ibihaha ku mpande zompi ("white-out") mu masaha 4 gushika ku 8. - Isaha ya 6 gushika ku isaha ya 24 (Umutego w’Imitsi y’Umutima): Bitandukanye n’uguhungabana kw’imigera (which causes "warm shock" with high cardiac output and low vascular resistance), Hantavirus irekura ikintu gitera umutima guhagarika umutima kigatuma Ihungabana rikomeye ry’Umutima (low Cardiac Index < 2.0 L/min/m2, ubushobozi bwo guhangana n'imitsi SVR, ibihimba vy’umubiri bifise amabara akonje, indwara y’umutima, n’uguhagarara kw’umutima gutunguranye/ugukora kw’umuyagankuba udatera . PEA gufatwa, cane cane mu gihe co gutera umuti mu muhogo).

Igice ca 4: "Ubutatu bw'amaraso y'inyuma y'umugera wa Hantavirus" (How Any Hospital Lab Can Spot Hantavirus in 45 Minutes)¶

Ivyemezo IgM/IgG ELISA y'umugera wa Hantavirus na RT-PCR vyoherezwa mu gisata c'ubuzima ca leta canke mu laboratwari y'ivyigwa bifata 24 to 72 hours - kandi umurwayi ari mu rwego rw'umutima n'amahaha ashobora gupfa mu masaha 6. Ikintu ciza ni uko abashakashatsi bo muri Kaminuza ya New Mexico (UNM, ikigo gihambaye kw’isi co gupima umugera wa Sin Nombre Hantavirus) cerekanye ko Ibara ry’amaraso ryose (CBC) n’Igipimo c’Amaraso y’Igihimba c’Igihugu gikorwa mu laboratwari y’ibitaro iyo ari yo yose mu minota 45 kigaragaza Hantavirus n’> 95% sensitivity n’ubudasa igihe nibura 4 muri ivyo bipimo 5 vy’amaraso (including the "Hantavirus Triad") bariho:

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Hantavirus ni ikibazo c'ibikoko gishobora kumenyeshwa mu gihugu cose gifise imihora yihariye y'ubuvuzi n'ubuhinga bwo gupima:

• Leta Zunze Ubumwe za Amerika:
• Ivyoherezwa vyihutirwa: Hamagara 911 usabe gutwara mu kigo c'ubuvuzi c'amashure yisumbuye gifise Veno-Arterial ECMO y'abantu bakuze/abana (VA-ECMO) ubushobozi (in the American Southwest, the University of New Mexico Health Sciences Center in Albuquerque is the regional HPS ECMO referral hub).
• Ivyiyumviro vya CDC: Abaganga bo mu bitaro barashobora guhamagara Ishami rya CDC ry’Ibitera Indwara Bidasanzwe (VSPB) biciye ku Kigo c’Ibikorwa vy’Ivyihutirwa vya CDC 24/7 (770-488-7100) canke Umurongo w'ubutumwa ku ndwara ya Hantavirus ya CDC (877-232-3322) ku bijanye n’ugupima serologie/PCR n’ubuyobozi bwo kuvura.
• Kanada:
• Hamagara 911. Ikigo c'ubuzima ca Canada (PHAC) Laboratwari y’Igihugu y’Ivy’Imigera (Winnipeg) akora ivyigwa vyihutirwa vy’umugera wa Sin Nombre; intara za ICU ECMO zihuza ivy’ugutora abantu vyihuse mu Burengero no hagati muri Canada.
• Ubwongereza n'Ubumwe bw'Uburaya:
• Hamagara kuri 999 (Ubwongereza) canke 112 (Ubumwe bw’Uburayi). Mu Buraya bwo mu Buraruko no hagati (Finlande, Suède, Ubudage, Ubufaransa, Ububirigi), umugera wa Puumala (Bank Vole) itera Indwara y'amafyigo (acute kidney injury, thrombocytopenia, fever, back pain, and transient blurred vision), mu gihe mu bihugu vya Balkans no mu Buraya bwo mu Bumanuko bushira Ubuseruko (Slovenia, Croatia, Serbia, Greece), Umugera wa Dobrava-Belgrade utera Umuriro w’amaraso n’indwara y’amafyigo (HFRS) bisaba gusukura amaraso hakiri kare no gufashwa n’abarwayi ba ICU (Laboratoire y’ibitera indwara bidasanzwe n’ibiva hanze ya UKHSA / ECDC).
• Amerika y'Epfo n'iyo hagati (Andes Virus Zone):
• Muri Shili, Argentine, Brezile, Paragwayi, Uruguway, na Panama, Umugera wa Andes (ANDV) n’ibindi bikoko bifitaniye isano n’ivyo bitera HPS ikaze cane (Ivyihutirwa: 131 muri Shili, 107 / 911 muri Argentine, 192 muri Brezile). Itegeko ry’ingenzi: Kubera ko Umugera wa Andes ushobora gukwiragira ku muntu ku muntu mu gihe c’ubumuga bwo mu mutwe no mu gihe c’ubumuga bwo mu bitaro, abakozi bo mu buvuzi n’abantu bafitaniye ubucuti bwa hafi muri Amerika y’Epfo bakoresha Ivyiyumviro vyo kwirinda gutera mu kirere + Droplet + Contact (N95/FFP2 respirator, eye protection, gown, gloves) n’ugushirwa mu gace/gukurikirana inyuma y’ugushikirwa n’iyo ndwara.
• Ubushinwa, Koreya y'Epfo, Ubuyapani, na Aziya-Pacifique:
• Umugera wa Hantaan na Umugera wa Seoul bitera Umuriro w'amaraso n'indwara y'amafyigo (HFRS) mu misozi no mu bisagara vyo muri Aziya y’Uburasirazuba (120 mu Bushinwa, 119 muri Koreya y’Epfo no mu Buyapani). Ostraliya na Nouvelle-Zélande nta migera y’imbeba y’imbeba y’isi nshasha yitwa hantavirus (000 / 111), naho nyene abagenzi bava muri Amerika canke muri Euraziya basubirayo basaba ko baca batoranywa ubwo nyene. Raba inomero z'ivyihutirwa.

Ibibazo bikunda kubazwa¶

Ni kuki ntashobora gukoresha igikoresho co gusukura amazi gifise akayunguruzo ka HEPA kugira ngo nsukure amavyi y’imbeba yumutse?¶

Naho igikoresho co mu nzu canke co mu maduka coba gifise akayunguruzo k’umuyaga HEPA, umuyaga uzunguruka n’umuyaga wo mu mfuruka y’umuyaga wo hasi biravyura cane kandi **bitera umuyaga utugingo ngengabuzima dutoduto tw’amasobe n’amacandwe y’imbeba vyumye ku rugero rw’umuyagankuba wo hasi** imbere y’uko bihinduka ibikoko bitera imigera y’imigera hanze mu cumba. Vyongeye, gufungura umufuko canke igitereko c’amazi mu nyuma biragushira ahabona ubugira kabiri. **Ntukigere uhanagura canke ukubura amavyi y’imbeba**: wama ukoresha umwuka mu minota 30, ushiremwo **1:10 household bleach** gushika bitose, urindire **iminota 5 gushika kuri 10**, hanyuma ubihanagure n’ibitambaro vy’impapuro bitose.

Ni gute umuganga yomenya itandukaniro riri hagati ya Hantavirus ya kera n’indwara y’ibicurane isanzwe canke igikoko co mu nda mu misi 3 ya mbere?¶

Mu vy’ubuvuzi, Hantavirus ya kera (`Days 1 to 4`) bitera umuriro mwinshi, ububabare bukomeye bw’imitsi mu **migwi minini y’imitsi (`thighs, hips, and lower back`)**, kumeneka umutwe, kandi kenshi n’ugusesa amaraso, ugusesa amaraso, canke ububabare bwo mu nda, **n’ibimenyetso bitangaje vy’uguhumeka kwo hejuru (`no runny nose, no stuffy nose, no sneezing, and no sore throat`)**. Ku **pima amaraso yoroshe y'iminota 45 (`Complete Blood Count / CBC`)**, umurwayi afise Hantavirus hafi y’igihe cose yerekana **igitigiri c’utugingo ngengabuzima (`thrombocytopenia < 150,000/uL`)** mu misi ya mbere nyene y’umuriro, hanyuma hakaza hematocrite, utugingo ngengabuzima twera twinshi dufise utugingo ngengabuzima tutarakura, n’utugingo ngengabuzima tudasanzwe (`immunoblasts`).

Ni kuki ari akaga cane iyo ivyumba vy’ubuvuzi vyihutirwa biha umurwayi wa Hantavirus imifuko minini y’amazi y’umunyu yo mu maraso nk’uko babigira ku ndwara y’ibicurane isanzwe?¶

Mu ndwara isanzwe iterwa n’imigera, abarwayi barafise imitsi y’amaraso yagutse kandi baraheza bakavyungukirako `2 to 3 liters` y’umunyu wo mu mutsi. Ariko rero, mu **Hantavirus Pulmonary Syndrome**, uwo mugera utera **ugusohoka kw’amaraso kwinshi cane mu mitsi y’amaraso y’amahaha** mu gihe nyene ugabanya inkomezi z’imitsi y’umutima yo gupompa. Iyo umuganga asutse . `2 to 3 liters` y’umunyu wo mu mitsi y’umurwayi wa Hantavirus, ayo mazi akava mu mitsi y’amahaha akaja mu mifuko y’umuyaga (`alveoli`), bikaba bitera **ugusenyuka kw’amahaha gukomeye cane kuroha umurwayi mu masaha makeyi**. Ahubwo, abaganga bo mu bitaro vy’abarwayi bikomeye bakoresha **uguhagarika amazi cane**, **imiti y’amaraso n’imiti y’amaraso (`Norepinephrine + Dobutamine`)**, n’imbere y’igihe **VA-ECMO umutima n’amahaha**.

Hantavirus yoba ishobora gukwiragira kuva ku muntu umwe ikaja ku wundi, canke kuva ku mbwa canke ku nkoko yanje?¶

**Imigera ya Hantavirus yo muri Amerika y'Uburaruko (`such as Sin Nombre virus carried by deer mice in the US and Canada`) n’imigera y’i Buraya/Aziya yitwa Hantavirus (`Puumala, Hantaan, Seoul`) NTUKWIZE kuva ku muntu uja ku wundi** - ntushobora gufata HPS yo muri Amerika y’Uburaruko mu gusoma, gukorako, canke kwitwararika umurwayi yanduye. *(Ikintu kimwe gusa kidasanzwe kw’isi yose ni **Umugera wa Andes wo muri Amerika y’Epfo** muri Chili na Argentine, ushobora gukwiragira hagati y’abantu bo mu rugo rwa hafi kandi usaba kwitandukanya n’abandi mu kirere/amatonyanga.)* Imbwa n’inyabu **ntizirwara Hantavirus kandi ntizisuka uwo mugera mu mavyi yazo**, naho nyene umuntu yo hanze ashobora kwandukira imbeba mu nzu yawe canke mu ibaraza ryawe.

Iyo mbonye urusenga rw’imbeba hejuru y’iyunguruzo ry’umuyaga wo mu modoka yanje canke munsi y’igipfukisho c’imodoka yanje, noyisukura gute ata nkomanzi?¶

Ntukigere ufungura igikoresho co gushushanya imbere mu modoka canke igikoresho co gufuha A/C nimba wicura ko imbeba zari ziteye imbere mu gasandugu k’umuyaga ka HVAC, kandi **ntiwigere ufuha mu gice ca moteri canke mu gicungera umuyaga wo mu nzu ukoresheje igikoresho co gufuha umuyaga**. Sunika canke uhagarike imodoka **hanze mu kirere n’umuco w’izuba ryinshi**, ufungure igipfukisho c’imodoka n’inzugi zose zine z’imodoka mu minota **30**, wambare **amaganzu y’ivyuma n’igikoresho co guhumeka N100/P100**, ufumbire neza urusenga n’inzu y’iyunguruzo ry’indege n’umuti w’ubudandaji (`like Lysol`) canke `1:10` umuti wo gusukura (`avoiding bare electrical connectors`), rindira **iminota 10**, ushire hejuru urusenga rwo mu mazi n’akayunguruzo ka kera mu gafuko k’impuzu kapfutse, hanyuma ushiremwo akayunguruzo gashasha k’umuyaga wo mu nzu y’indege imbere y’uko ufungura ivyuho vy’impwemu vyo mu nzu.

Iyi nkuru itanga amakuru yerekeye ubuvuzi bwihutirwa n’umutekano w’ibidukikije kandi ntisubirira ubuvuzi bwihutirwa bw’ibitaro vy’abahinga canke ubuvuzi bw’abarwayi bakomeye. Kubera ko indwara y’amahaha yitwa Hantavirus Pulmonary Syndrome ishobora kuva ku gukorora gutoyi gushika ku guhagarara kw’impwemu no mu mutima mu masaha atarenga 4, turahimiriza cane gufata inyigisho yemewe y’ubutabazi bwa mbere n’ubuvuzi bwa CPR ivuye ku Musaraba Mutukura, St John Ambulance, canke umuhinga mu vy’imyimenyerezo yemewe wo mu karere.

Inyobora zifitaniye isano¶

• Leptospirose (indwara ya Weil) inyuma yo gutemba mu mazi y’umwuzure canke mu mazi meza: amaso atukura n’ububabare bw’inyana
• Sepsis na septic shock kwemera no gutoranya vyihutirwa
• Umuti wica imbeba ugabanya amaraso (ubumara bw’imbeba), superwarfarin, n’imiti yitwa zinc phosphide
• Inyamaswa zirumwa, gufumbira ibikomere, no kwirinda indwara y'ibicurane inyuma yo gushikirwa n'iyo ndwara
• Inomero z'ivyihutirwa

Amasoko n'ubuyobozi buzwi¶

• Ibigo bijejwe kugenzura no kwirinda indwara (CDC Ishami ry’Ibitera Indwara Bidasanzwe vy’Imigera, Leta Zunze Ubumwe za Amerika): Gusukura Inyuma y’Imbeba: Itegeko ryemewe ryo Gukuraho Indwara z’Imigera 1:10 na Indwara y’Amahaha y’Imigera ya Hantavirus (HPS) Gupima indwara, Gupima amaraso yo mu mpande, no gucungera amazi yo mu bitaro (cdc.gov/hantavirus).
• Kaminuza ya New Mexico (UNM) Ikigo c'ubuhinga bw'ubuzima & Porogarama y'ubushakashatsi ku ndwara ya Hantavirus (Koster, Hjelle, Crowley, & Wernly): Ivyagezwe vyo gutoranya amaraso yihuta (5-of-5 Rule) n’Ugutanga Umwuka w’Ikirere (VA-ECMO) Gukiza indwara y’umutima n’amahaha y’umugera wa Hantavirus.
• Ishirahamwe ry'ubuzima ryo muri Amerika yose (PAHO) & Ishirahamwe mpuzamakungu ry'ubuzima (WHO): Hantavirus muri Amerika: Amabwirizwa yo gupima, kuvura, kwirinda no kuyicungera (Harimwo n’ukwirinda umuntu ku muntu ku ndwara ya Andes Virus yo muri Amerika y’Epfo).
• Ikigo c'Uburayi kijejwe gukingira no gucungera indwara (ECDC) & Ikigo ca Robert Koch (RKI, Ubudage): Urupapuro rwerekeye amakuru n’ubuyobozi bw’ubuvuzi ku migera ya Orthohantavirus yo mw’isi ya kera (Puumala Indwara y’amafyigo n’ Dobrava Umuriro w’amaraso n’indwara y’amafyigo).
• Ikigo c'igihugu kijejwe umutekano n'ubuzima ku kazi (NIOSH, Leta Zunze Ubumwe za Amerika): Kwirinda indwara y'amahaha iterwa n'umugera wa Hantavirus (HPS) Mu Bakozi Bakorana n’Imbeba canke Basukura Ibibanza n’Ibinyabiziga Vyandujwe n’Imbeba (N100/P100 Guhitamwo Ivyuma Bihumeka).