Hantavirus Pulmonary Syndrome (HPS): Ko e ʻuhinga ʻoku ʻikai totonu ke ke teitei tafi-māfana pe vekiumeʻi ai ʻa e ngaahi ʻuhikiʻi manupuna ʻi ha fale nofoʻanga pe fale¶

'I he taimi 'oku ke fakaava ai ha fale 'o e fa'ahita'u tapuni, fale tauhi'anga koloa, fale tauhi'anga koloa, fale 'i 'olunga, fale tau'anga me'alele, crawlspace, pe tu'u RV/camper pea 'ilo'i 'a e ngaahi 'uhiki'i manupuna 'oku fakamomoa pe shredded 'a e naunau 'o e 'uhiki'i manupuna, **puke ha tafi'anga, whisk 'a e polosi, pe 'api vekiume ke tafi hake 'a e mi-ss. Ko e tafi-momoko pe vekiume aerosolizes 'a e ngaahi momo'i me'a si'isi'i 'o e mimi 'o e rodent momoko, saliva, mo e feces 'oku 'i ai 'a e Hantavirus (such as Sin Nombre virus carried by the North American Deer Mouse, or Puumala and Dobrava viruses in Europe and Asia) hangatonu ki he ‘eá, ‘a ia ‘okú ke mānava‘i ai ‘a e vailasí ‘o loloto ki ho ma‘ama‘á. Kapau 'e ma'u 'e ha taha 'a e mofi, momoko, mamahi lahi 'a e uoua (especially in the thighs, hips, back, and shoulders), mamahi ‘ulu, ngāvaivai, pe lua ‘i loto ‘i he . 1 to 8 weeks ‘o e hū ki ha fale ‘oku ‘i ai ‘a e fanga ki‘i manupuna - pea hoko atu hili ha ‘aho ‘e 3 ki he 5 ‘e ha tale mōmoa pe nounou fakafokifā ‘a e mānava, tā ki ho‘o fika fakavavevave fakalotofonuá ‘o fakafou ‘i he‘emau ngaahi fika fakavavevave directory pea 'alu ki ha Potungaue Fakavavevave 'a e falemahaki ma'olunga mo e ECMO (Extracorporeal Membrane Oxygenation) ngaahi malava 'i he taimi pe ko ia. Toe vakaiʻi foki ʻetau ngaahi fakahinohinó ʻi he . sepsis mo e 'ilo'i 'o e 'ohovale septic ., leptospirosis (mahaki ‘o Weil) mei he vai ‘o e tāfeá mo e mimi ‘o e ‘ikale ., kai ‘o e faito‘o fakatupu toto (kona ‘o e fanga ki‘i iká), mo e . u'u 'e he fanga monumanu mo e malu'i 'o e rabies.

Fakatatau ki he Senitā ki hono Puleʻi mo e Taʻofi ʻo e Ngaahi Mahakí (CDC), ko e Kautaha Mo'ui 'a Pan 'Amelika (PAHO / WHO), pea mo e Senitā ‘Iulope ki hono Ta‘ofi mo Pule‘i ‘o e Ngaahi Mahakí (ECDC), Mahaki ʻo e Maʻamaʻa ʻo e Hanitavailasí (HPS, ‘oku toe ui ko e Hantavailasi ‘o e Mahaki ‘o e Lotó / . HCPS) 'oku ne 'ave 'a e tu'unga 'o e keisi-mate 'o e 100. 35% to 38% (and up to 50% 'i he ngaahi mahaki faka'auha lahi 'o e vailasi 'o e Andes) - na'a mo e kakai lalahi kei talavou mo'ui lelei 'oku 'ikai ha'anau ngaahi tu'unga fakafaito'o kimu'a. Ko e me'a 'oku ne 'ai 'a e Hantavirus Pulmonary Syndrome ke fu'u kākā mo fakatupu mate 'i he faito'o fakavavevave ko 'ene tauhele fakafaito'o siteisi 'e ua: lolotonga 'a e 'uluaki 'aho 'e 3 ki he 6 (the Febrile Prodrome), 'oku 'asi 'a e mahaki 'oku nau ma'u pe 'a e 'inifluensa pe ko e gastroenteritis 'o e vailasi (fever, severe thigh/back muscle aches, headache, nausea, abdominal pain, and a completely clear chest X-ray with ZERO runny nose or sore throat), ko ia ‘oku fekau‘i ma‘u pē kinautolu ‘e he ngaahi kiliniki tauhi fakavavevavé ki ‘api. Pea, 'o 'ikai ha fakatokanga, 'oku hū 'a e mahaki ki he Cardiopulmonary Capillary-Leak Phase, 'a ia 'oku fakatupu 'e he vailasi 'a e 'aofi endothelial 'o e ngaahi capillaries 'o e ma'ama'a ke hoko 'o leaky vao, tafea 'a e ongo ma'ama'a mei loto ki tu'a mo e polotini-koloa'ia 'i he toto plasma 'i he houa pe 'e 4 ki he 8 'o e uoua lolotonga 'a e simultacardiogenic + non-cardiogenic shock). Ko e kovi angé, kapau ʻe fakahalaʻi ʻe ha toketā ʻi he loki fakavavevavé ha mahaki Hantavirus ki he sepsis fakapekitilia angamahení pea ʻoange ʻa e standard boluses saline ʻi he ngaahi uoua ʻo e voliume lahi (30 mL/kg), ko e vai lahi ko ia 'oku lilingi hangatonu ia 'i he ngaahi capillaries 'o e ma'ama'a 'oku tafe pea melemo 'a e mahaki 'i he stretcher. Mastering 'a e Polokalama Fakama'a 'o e Rodent 'a e CDC Wet-Bleach mo e Tu'utu'uni 'o e 5-Lau 'o e Toto Smear Triage (Hantavirus Triad) fakahaofi mo'ui.

Fai ʻeni he taimí ni .¶

1. **TU'U leva kapau 'oku ke sio ki he 'uhiki'i manupuna, ngaahi 'uhiki, pe fanga ki'i miule mate 'i loto 'i ha fale 'o e fanga ki'i manupuna, fale nofo'anga, 'aati, 'o e misini 'o e me'alele, pe 'i he lalo fale: 'OUA 'E TEITEI tafi-momoko 'aki ha tafi'anga, 'OUA 'E TEITEI faka'aonga'i ha vekiume (na'a mo ha HEPA falekoloa-vac), pea 'OUA 'E TEITEI puhi'i leaf compresse efuefu pe S ‘okú ne tukuange mai ‘a e ngaahi me‘a ta‘ehāmai ‘e laui miliona . 1-to-5-micron vailasi-laden aerosols efuefu ki ho sone mānava ‘a ia ‘oku nau tautau ai ‘i he ‘ea tu‘uma‘u ‘i ha ngaahi houa.
2. 'Uluaki 'ea 'a e feitu'u tapuni 'o 'ikai si'i hifo he 10.00. 30 full minutes ‘aki hono fakaava ‘a e ngaahi matapā mo e ngaahi matapā sio‘ata ‘i tu‘á pea lue KI TU‘A (staying upwind while fresh outdoor air flushes the room). Ko e Hantavailasi ko ha vailasi RNA ʻoku ʻufiʻufi (Bunyavirales / Orthohantavirus) 'a ia ko hono 'enivolope lipid 'oku vave hono faka'auha 'e he ultraviolet 'i tu'a (UV) maama 'o e la'a mo e 'ea fo'ou 'o e dilution.
3. Tui ha ngaahi kofunima kapa/nitrile (pea mo ha N100 / P100 pe . FFP3 particulate respirator ki he ngaahi infestations mamafa), pea SOAK fakalelei ‘a e ngaahi me‘a kotoa pē, ngaahi ‘uhiki‘i manupuna, mo e fanga ki‘i manupuna mate ‘aki ha me‘a kuo toki fefiofi . 1:10 Household Bleach Solution (1 part liquid chlorine bleach to 9 parts water, pe ko ha faito‘o faka‘auha mahaki fakakomēsiale kuo lesisita ‘e he EPA hangē ko e Lysol) pea tuku ke tangutu ‘o momoko ki he . 5 to 10 full minutes kimu'a pea toki ala ki ha me'a. Ko hono fakamomoko 'o e 'uhiki'i manu 'oku ne fakapipiki 'a e efuefu ki lalo ke 'oua na'a lava ke hoko 'o 'ea lolotonga ia 'oku faka'auha 'e he sotiume hypochlorite 'a e 100% 'o e 'envelope lipid 'o e vailasi.
4. To'o hake 'a e ngaahi 'uhiki'i manupuna kuo fakamomoko 'aki 'a e bleach mo e naunau 'o e nesting 'aki 'a e ngaahi taueli pepa 'oku 'uha ('OUA 'E TEITEI ke tafi), sila'i 'a e ngaahi taueli pepa 'oku 'uha mo e fanga ki'i mice mate 'i loto 'i he ngaahi kato veve pelesitiki 'e ua, pea fufulu ho nima 'oku 'i ai 'a e to'ukupu 'aki 'a e sopu mo e vai KIMU'A pea ke to'o ho'o to'ukupu.
5. Kapau te ke ma'u ha mofi (>= 38.0 C / 100.4 F), mamahi loloto ‘i he uoua (thighs, lower back, hips), mamahi ‘ulu, ngāvaivai, lua, pe ngāvaivai ‘i loto ‘i he . 1 to 8 weeks (7 to 56 days) hili hono fakama’a ha fale nofo’anga/fale nofo’anga, kemi, pe to’oto’o ha fefie: ‘alu ki ha Potungaue Fakavavevave ‘a e falemahaki ‘i he taimi pe ko ia (neongo ‘oku te’eki ke ke tale).
6. Lea'aki 'a e ngaahi lea pau ko 'eni ki he Neesi mo e Toketā 'o e Emergency Room Triage 'i he 'uluaki sekoni 'e 30: "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."

'Akau 'o e tu'utu'uni: Malu 'a e fakama'a 'o e fanga ki'i manupuna mo e Hantavailasi Pulmonary Syndrome triage fakafaito'o¶

Muimui ki he flowchart fakangaue mo fakakiliniki ko 'eni ki he fakatou'osi 'a e ta'ofi lolotonga 'a e fakama'a mo e triage fakafaito'o fakavavevave hili hono faka'ali'ali.

flowchart TD
    Start["Rodent Droppings, Ngaahi 'uhiki, ngaahi 'uli 'o e mimi, pe fanga ki'i miule mate 'oku ma'u 'i he fale nofo'anga, fale tauhi'anga koloa, fale tauhi'anga koloa, 'i 'olunga, fale tau'anga me'alele, pe RV"] --> Scenario{"'Oku Ke Fakama'a He Taimi Ni PE 'Oku Ke A'usia 'a e Ngaahi Faka'ilonga Hili 'a e Faka'ali'ali 'i he Kuohili?"}

    Scenario -->|"FAKAMA'A 'A E NGAAHI TO'O 'O E RODENT HE TAIMI NI"| CleanRule["CDC SITEPU 5 KI HE FAKAMA'A 'O E 'ULU-VUA: 1. 'OUA 'E TEITEI tafi-momoko, vekiume, pe ngaue'aki 'a e 'ea 'oku fakama'u 2. Fakaava 'a e ngaahi matapa kotoa pe & ngaahi matapa sio'ata pea mavahe mei he fale 'i ha MINITI 'e 30 ke 'ea 3. Tui 'a e Nitrile Respirated Gloves + N100/P40. Spray 1:10 Bleach Solution (1 ipu bleach ki he ipu vai 'e 9) ki he droppings/nests kae 'oua kuo 'osi 'a e 'uhiki -> Tatali 5 ki he 10 MINITI KAKATO 5. Holoholo'i hake 'aki 'a e ngaahi taueli pepa 'oku 'i ai 'a e vai -> Double-bag -> Mop 'a e faliki fefeka 'aki 'a e nima -> Mo fufulu"]

    Scenario -->|"A'USIA 'A E NGAAHI FAKA'ilonga (Uike 'e 1 ki he 8 Hili 'a e Rodent / Cabin / Shed / Fefie)"| ProdromeCheck{"Ko e hā e Tuʻunga ʻo e Ngaahi Fakaʻilonga ʻOku ʻI Aí?"}

    ProdromeCheck -->|"STAGE 1 FEBRILE PRODROME ('Aho 1 ki he 5): Mofi (>38 C / 100.4 F), Momoko, Mamahi lahi 'a e uoua (Ngaahi 'uhiki, Hips, Tu'a), Mamahi 'ulu, 'Ulu/Lua/Mamahi 'i he kete, 'Ulu (Fakatokanga'i ange: 'Oku angamaheni 'aki 'a e 'ikai ha th runnyat)"| ERTriage["FAKAVAVEVAVE ER TRIAGE 'I HE FALEMAHAKI ('OUA 'E TUKU 'A E KILINIKI KE TU'U KO E 'FLU'): 1. 'Alu ki he Potungaue Fakavavevave 'a e Falemahaki 'i he taimi pe ko ia 2. Fakaha 'a e 'asi 'a e rodent/cabin -> Kole STAT CBC mo e Manual Blood Smear + Chest Check5-5 ki he Hanvi5 X-Ray. Tolu: - Hifo 'a e ngaahi peleti (<150,000/uL - fuofua faka'ilonga) - Hake 'a e Hematocrit/Hemokolopini (Hemokolopini mei he 'alu 'a e kapila) - Lau 'o e WBC 'oku hiki ki he to'ohema mo e >10% 'o e ngaahi Lymphocytes 'oku 'ikai angamaheni (Immunoblasts)"]

    ProdromeCheck -->|"SITESI 2 CARDIOPULMONARY CRASH ('Aho 4 ki he 7 - Houa 'e 4 'o e Matapa): Tale Momoko, Nounou 'o e Manava, Manava Vave (>22/min), SpO2 <94%, Crackles 'o e Ma'ama'a 'o e ongo tafa'aki, Momoko 'o e ngaahi tafa'aki, pe Hifo 'a e Toto"| ECMORush["ECMO & ICU FAKATU'UTAMAKI KI HE MO'UI (38% Mate): 1. Ta mai ki he 911 / 112 / 999 -> Kole ke Hiki Vave ki he Senitā ECMO Fakaako Ma'olunga 2. NGAAHI TU'UTU'UNI MAHU'INGA 'O E ICU: - FAKATATAU'I 'O E VAI ('OUA boluses) - Vasopresser vave + Inotrope (Norepinephrine + Dobutamine) ki he 'ohovale 'o e loto/Kapila - 'Oku vave 'a e VA-ECMO 'o e 'uto kapau 'oku 'i he 'Inisi 'o e loto <2.0 L/min/m2 pe PaO2/FiO2 <60"]

    ERTriage -->|"Kapau 'oku to 'a e ngaahi peleti (<150k) pe ngaahi laine 'o e Kerley B 'i he vaha'a 'o e ngaahi laine 'i he X-Ray 'o e fatafata"| ECMORush

Konga 1: Founga ke ʻiloʻi ai ʻa e fanga kiʻi manupuna ʻoku fakatuʻutāmaki lahi mo e ngaahi feituʻu ʻoku fufuuʻi ai ʻa e ʻasi (Why You Never Have to Touch a Mouse to Get Hantavirus)¶

Laka hake he 70% ‘o e kau mahaki ‘oku ma’u ‘oku nau ma’u ‘a e mahaki Hantavirus Pulmonary Syndrome ‘oku nau lipooti ‘o pehē na’e ‘ikai ke nau teitei ala ki ha ki’i mouse mo’ui pe mate**. Ka, na‘a nau mānava‘i ‘a e ngaahi momo‘i efuefu si‘isi‘i ‘aupito lolotonga ‘enau ngāue, mohe, pe fakama‘a ‘i ha feitu‘u tāpuni ‘a ia na‘e mimi pe ‘alu ai ‘a e fanga ki‘i manupuna vaó ‘i he ngaahi uike ki mu‘á.

1. Ko e Fa'ahinga Vekiume Tefito (New World HPS vs. Old World HFRS)¶

'Oku vahevahe 'a e Hantaviruses ki he ongo famili fakasiokalafi mo fakakiliniki, 'oku takitaha 'ave 'e ha reservoir pau 'o e rodent vao (note: common domestic pet hamsters/gerbils and urban house mice *Mus musculus* do NOT carry Sin Nombre HPS virus):

2. Ngaahi Feituʻu Fufū ʻe Fitu ʻOku Mānau ai ʻe he Kakaí ʻa e Hantavirus ʻo ʻIkai Ke Nau ʻIloʻi¶

1. Fakaava ha Seasonal Cabin, Hunting Shack, Outbuilding, pe Barn 'i he Spring/Summer: Fakamo'ui ha fan 'i he silingí, lulululu 'a e ngaahi palanikete/me'a-mohe efuefu na'e luelue ai 'a e fanga ki'i miusi 'i he fa'ahita'u momokó, pe tafi 'a e faliki 'o e loki kuí.
2. Ka & RV 'ea fakamokomoko Vents mo e ngaahi filita 'ea 'o e fale (A Major Overlooked Source): 'Oku fa'a totolo hake 'a e fanga ki'i miule 'o e 'asi ki he fale mafana 'o e HVAC blower, cowl 'ea 'o e 'ea, mo e loki 'o e misini 'o e ngaahi me'alele 'oku tu'u, ngaahi loli, ngaahi talatala 'o e faama, mo e RVs, langa 'a e ngaahi 'uhiki'i insulation shredded 'i 'olunga tonu 'i he filter 'ea 'o e fale. 'I he taimi 'oku ke kamata ai 'a e me'alele pea fakamo'ui 'a e me'a fakamokomoko pe A/C fan, 'oku blasts 'e he blower 'a e mimi 'o e mouse aerosolized mo e 'uhiki'i manupuna hangatonu ki ho fofonga. 'Oua 'aupito na'a ke puhi'i atu ha filter 'ea 'o e fale 'o e me'alele 'oku 'i ai ha ki'i mouse 'aki 'a e 'ea 'oku fakafefeka'i: fakamomoko 'a e 'uhiki 'i lalo 'i he hood 'aki 'a e Lysol/disinfectant lolotonga hono tui ha N100/P100 mask mo e ngaahi to'ukupu.
3. 'Ave 'a e Armloads 'o e Fefie Kuo Fakatoka 'o Fakafepaki'i Ho Ufatafata: 'Oku 'uhiki 'a e fanga ki'i mice 'i loto 'i he ngaahi fu'u fefie 'i tu'a; hiki hake 'a e ngaahi 'akau momoko mo fufulu 'a e efu 'o e kili ki ho'o kote aerosols momoko 'a e mimi 'i lalo tonu 'i ho ihu.
4. Fakama'a 'a e ngaahi puha kaati 'i he ngaahi loki 'i 'olunga, ngaahi loki 'i lalo, ngaahi feitu'u totolo, pe ngaahi 'iuniti tauhi'anga koloa 'a e tokotaha pe.
5. Mohe Hangatonu 'i he Kelekele pe Folo 'o ha Fale Malu'anga 'o e Hala 'oku 'ikai ke sila'i, Fale tauhi'anga manu, pe Kapin.

Konga 2: Ko e founga fakama'a 'o e Rodent 'o e CDC faka'ofisiale 'o e sitepu-ki-he-sitepu 'o e Wet-Bleach Rodent¶

Ko e hā hono fuoloa ʻo e moʻui ʻa e Hantavirus ʻi tuʻa ʻi he kiʻi mousé? ‘I he maama fakahangatonu ‘o e la‘aá ‘i tu‘á, ‘oku tāmate‘i ai ‘e he ngaahi huelo UV ‘a e vailasí ‘i he . 2 to 3 hours. Kae kehe, ‘i loto ‘i ha fale fakapo‘uli, momoko, mōmoa, fale tauhi‘anga koloa, loki, pe puha to‘ukupu ‘o e kaá, ‘oku kei mo‘ui pē ‘a e Hantavirus pipihi ‘i he mimi pe ‘uhiki‘i manu mōmoá pea ‘oku pipihi ia ki he . 2 to 3 full days ‘i he mafana ‘o e lokí (pea a‘u ki he 100). 2 weeks 'i he ngaahi 'atakai momoko).

‘Oua ‘aupito na‘á ke ala ki ha tafi‘anga pe vekiume. Muimui ki he tonu ko 'eni 6-Sitepu 'o e Fakahokohoko 'o e Decontamination 'o e Momoa:

+-------------------------------------------------------------------------+
|  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.   |
+-------------------------------------------------------------------------+

Konga 3: Ko hono 'ilo'i 'o e ongo konga fakafaito'o 'o e Hantavirus (Why Urgent Care Doctors Mistake Phase 1 for the Flu)¶

Koe'uhi ko e taimi 'o e fakatupu 'o e Hantavirus ko e ** .1 to 8 weeks (median 14 to 21 days)** hili hono huhu ‘o e efuefu, ‘oku fa‘a ngalo ‘i he kau mahakí na‘a nau fakama‘a ha fale ‘i he uike ‘e tolu ki mu‘á ‘i he taimi ‘oku kamata ai honau mofí. Maʻuloto ʻa e ongo konga fakafaitoʻo kehekehe mo e founga ke tala ai ʻa e Hantavirus kehe mei he ʻinfluensa angamahení pe COVID-19:

1. Konga 1: Ko e Prodrome ‘o e Mofi (Days 1 to 5 - Ko e Matapa Koula Fakatotolo)¶

Mo e 'uluaki 'aho 'e 3 ki he 5 (range 1 to 7 days), ko e mahakí ‘oku ‘ikai ha‘ane tale pea ‘ikai ha‘ane nounou ‘a e mānavá**, pea ‘oku fa‘a hā ngali angamaheni ‘aupito ‘a e X-ray ‘o e fatafatá: - Ngaahi Faka'ilonga Faka'univeesi (Present in >90% of Patients): - Fakafokifā ʻa e maʻolunga mofi (38.3 to 40.0 C / 101 to 104 F) mo e tetetete 'a e momoko. - Mamahi lahi, loloto 'a e uoua (myalgias) 'oku ne uesia 'a e ngaahi kulupu uoua LAHI (thighs, hips, lower back, and shoulders). - Mamahi 'ulu 'i mu'a 'oku tetetete, vaivai loloto, mo e pule / 'ulu ma'ama'a (orthostasis). - Ko e Faka'ilonga GI (Present in 50% of Patients): - Ko e 'u'ulu, toutou 'u'ulu, 'u'ulu vai, mo e diffuse mamahi 'i he kete ('i he taimi 'e ni'ihi 'oku lahi fe'unga ke fa'ifa'itaki ki he appendicitis pe gastroenteritis 'oku 'ikai ke fu'u lahi). - KO E #1 CLUE FAKAKILINIKALE 'OKU 'IKAI KO HA MOMOKO PE FLU (Absence of Upper Respiratory Symptoms): - ‘Oku ‘ikai ke hangē ko e ‘inifluensá, COVID-19, RSV, pe ko e momoko anga-mahení, Ko e kau mahaki ‘o e Hantavirus prodrome ‘oku meimei ‘IKAI TEITEI ke nau ma‘u ha ihu ‘oku tafe (rhinorrhea), fufuu‘i ‘a e ihú, mafu, mamahi ‘a e kongalotó (pharyngitis), pe mamahi 'i he sinus. - Tu'utu'uni Fakafaito'o: Fever + Severe Thigh/Back Muscle Aches + Nausea/Vomiting + ZERO Runny Nose or Sore Throat (1 to 8 weeks after rural/rodent exposure) = Mahalo'i 'a e Hantavailasi Kae 'oua kuo fakamo'oni'i 'oku kehe.

2. Konga 2: Ko e Fakatu'utamaki 'o e Kapila-Leaka 'o e Loto (Starts Abruptly on Day 4 to 6)¶

Ta'e fakatokanga - 'oku fa'a hoko 'i he taimi pe 'oku kamata ke motuhia ai 'a e mofi 'o e mahaki - 'oku hu 'a e mahaki ki he Cardiopulmonary Phase: - Houa 0 ki he Houa 2: Kamata ha tale fakafokifā mo momoko, ‘ikai ke ola, ‘o ‘alu fakataha mo ha fufuu‘i si‘isi‘i ‘o e fatafatá pea mo ha hiki hake ‘a e tu‘unga ‘o e mānavá (> 20 to 24 breaths per minute). - Houa 2 ki he Houa 6: 'Oku mole 'a e ngaahi selo endothelial 'o e capillary 'i he ongo ma'ama'a 'a e angatonu 'o e pa: polotini-koloa'ia 'i he toto plasma (with an edema-fluid-to-serum protein ratio > 0.8) 'oku lilingi atu mei he ngaahi halanga toto ki he vaha'a 'o e ma'ama'a mo e alveoli. Ko e fakafonu ‘o e ‘osikena (SpO2) ‘oku holo hifo mei he . 97% hifo ki he . 80s pea . 70s, 'oku kamata ke tale 'a e mahaki lahi 'a e vai lanu pingikī pe lanu 'o e vao, pea 'oku vave 'a e fakalakalaka 'a e ngaahi X-ray 'o e fatafata mei he peribronchial cuffing mo e ngaahi laine Kerley B ki he fakakakato 'a e tafea 'o e alveolar 'o e ongo tafa'aki ("hinehina-ki tu'a") 'i loto 'i he houa 'e 4 ki he 8. - Houa 6 ki he Houa 24 (Ko e Tauhele 'o e Loto-mafasia 'o e Myocardial): 'Oku 'ikai ke hange ko e 'ohovale 'a e septic 'o e pekitilia (which causes "warm shock" with high cardiac output and low vascular resistance), 'Oku tukuange 'e he Hantavirus ha me'a fakatupu loto-mafasia 'a e myocardial 'oku ne fakatupu 'a e Faka'ohovale loloto 'o e loto (low Cardiac Index < 2.0 L/min/m2, ma'olunga 'a e Fakafepaki'i 'o e Vascular 'o e Sisitemi . SVR, ngaahi tafa‘aki momoko ‘oku ‘i ai hono ngaahi fo‘i ‘uhiki‘i manu, lactic acidosis, mo e bradycardia fakafokifā/‘ekitivitī ‘uhila ta‘e-pulse . PEA puke, tautautefito ki he lolotonga 'o e endotracheal).

Konga 4: Ko e "Totolu 'o e Toto 'o e Hantavailasi" (How Any Hospital Lab Can Spot Hantavirus in 45 Minutes)¶

Fakapapau'i Hantavailasi IgM/IgG ELISA serology mo e RT-PCR 'oku 'ave ki ha potungaue mo'ui 'a e siteiti pe 'oku to'o 'e he lapi 'o e lave 24 to 72 hours - pea ko e mahaki 'i he Vahe Cardiopulmonary 'e lava ke mate 'i he houa 'e 6. Meʻamālié, ko e kau fakatotolo ʻi he ʻUnivēsiti ʻo Niu Mekisikoú (UNM, ko e senitā ECMO tuʻukimuʻa taha ʻi he māmaní ʻo e Sin Nombre Hantavirus) naʻe fakamoʻoniʻi ai ko ha founga angamaheni Lau Toto Kakato (CBC) mo ha Manual Peripheral Blood Smear fakahoko 'i he ha fa'ahinga lapi 'o e falemahaki 'i he miniti 'e 45 'oku ne 'ilo'i 'a e Hantavirus mo e > 95% ongo'ingofua mo e pau 'i he taimi 'oku 'ikai si'i hifo 'i he 4 'o e ngaahi tu'unga hematologic 'e 5 ko 'eni (including the "Hantavirus Triad") 'oku 'i ai:

Ngaahi fika fakavavevave fakavahefonua mo e ngaahi tu'utu'uni 'a e ngaahi potungaue¶

Ko e Hantavirus ko ha fakatu'utamaki fakavavevave zoonotic 'oku fakatokanga'i fakafonua mo e ngaahi netiueka fakatapui 'o e tokanga'i fakatu'utamaki mo e ngaahi netiueka 'o e lapi 'o e lave:

• 'Amelika:
• Fakafoki Fakavavevave: Ta ki he 911 pea kole ke fetuku ki ha senitā fakafaitoʻo ʻoku ʻi ai ʻa e Veno-Arterial ECMO ʻo e kakai lalahí/fānaú (VA-ECMO) malava (in the American Southwest, the University of New Mexico Health Sciences Center in Albuquerque is the regional HPS ECMO referral hub).
• Fetalanoa'aki 'a e CDC: 'E lava ke fetu'utaki 'a e kau toketaa 'o e falemahaki ki he Va'a 'o e CDC ki he Ngaahi Me'a Fakatupu Makehe 'o e Vailasi (VSPB) fakafou ʻi he Senitā Ngāue Fakavavevave ʻa e CDC 24/7 (770-488-7100) pe ko e Laine Vela ki he Hantavailasi ʻa e CDC (877-232-3322) ki he serology/PCR fakatotolo mo e fakahinohino ki hono pule'i fakafaito'o.
• Kānata:
• Ta ki he 911. Potungaue Mo'ui 'a e Kakai 'o Kanata (PHAC) Fale Fakatotolo Fakafonua ki he Mikolopaiolosia (Winnipeg) fakahoko 'a e ngaahi sivi fakavavevave 'o e vailasi Sin Nombre; fakavahefonua ICU ECMO fefononga'aki 'a e ngaahi netiueka 'oku nau fakafekau'aki 'a e vave 'o e kumi 'i he Hihifo mo e Lotolotonga 'o Kanata.
• Pule'anga Fakatahataha & 'Iunioni 'Iulope:
• Ta ki he 999 (Pilitania) pe 112 (IU). ‘I ‘Iulope Tokelau mo Lotolotó (Finilani, Suēteni, Siamane, Falanisē, Pelisiume), vailasi Puumala (Bank Vole) 'oku ne fakatupu 'a e Mahaki Faka'auha 'o e Nefo (acute kidney injury, thrombocytopenia, fever, back pain, and transient blurred vision), lolotonga ia ʻi he Balkans mo e Tonga-hahake ʻo ʻIulopé (Slovenia, Croatia, Serbia, Greece), Ko e vailasi Dobrava-Belgrade 'oku ne fakatupu 'a e Mofi toto lahi mo e mahaki 'o e 'uto (HFRS) fiema'u ke vave 'a e hemodialysis mo e poupou 'a e ICU (UKHSA 'a e fale fakatotolo fakakemi 'o e ngaahi me'a fakatupu mahaki 'oku 'ikai ke fa'a ma'u mo 'omi mei muli / ECDC).
• 'Amelika Tonga mo e Lotolotonga (Andes Virus Zone):
• ʻI he Sili, ʻĀsenitiná, Pelēsila, Palakuai, ʻIulaki, mo Panama, Vailasi ʻAnitesí (ANDV) mo e ngaahi vailasi orthohanta fekau'aki 'oku nau fakatupu 'a e HPS lahi (Fakavavevave: 131 ʻi Silē, . 107 / 911 ‘i ‘Āsenitiná, . 192 ʻi Pelēsila). Polokalama Fakatu'utamaki: Koe'uhi ko e Andes Virus 'e lava ke mafola mei he tokotaha ki he tokotaha lolotonga 'a e prodrome mo e konga 'o e falemahaki 'i he kamata'anga, 'oku ngaue'aki 'e he kau ngaue fakamo'ui mo e ngaahi fetu'utaki ofi 'a e famili 'i 'Amelika Tonga Airborne + Droplet + Fetu'utaki Fakatokanga (N95/FFP2 respirator, eye protection, gown, gloves) mo e kolonitini/siofi hili ‘a e faka’ali’ali.
• Siaina, Kolea Tonga, Siapani, mo 'Esia-Pasifiki:
• Vailasi Hantaan mo e vailasi Seoul 'oku na fakatupu 'a e Mofi toto lahi mo e Renal Syndrome (HFRS) ‘i he ngaahi tukui kolo mo e ngaahi kolo lalahi ‘o ‘Ēsia Hahake (120 ‘i Siaina, 119 ‘i Kōlea Tonga mo Siapani). 'Aositelelia mo Nu'u Sila 'oku 'ikai ha hantavailasi fakafonua 'o e Mamani Fo'ou HPS deer-mouse (000 / 111), neongo ko e kau fononga ‘oku nau foki mai mei ‘Amelika pe ‘Iulāsiá ‘oku fiema‘u ke fai ha sivi vave. Vakai ki he ngaahi fika fakavavevave.

Ngaahi fehu'i 'oku toutou 'eke .¶

Ko e hā ʻoku ʻikai lava ai ke u fakaʻaongaʻi ha meʻa fakamaʻa ʻoku ʻi ai ha meʻa fakamaʻa HEPA ke fakamaʻa ʻaki ʻa e ʻuʻulu ʻo e mouse kuo fakamāfanaʻí?¶

Neongo kapau ko ha vekiume 'i 'api pe falekoloa 'oku 'i ai ha HEPA 'o e 'ea 'o e 'ea, 'a e takai 'o e polosi vilo mo e tafe 'a e 'ea suction vave-ma'olunga 'i he nozzle 'o e faliki 'oku fakamālohi'i 'a e ue'i hake mo e **aerosolize 'a e ngaahi momo'i me'a efuefu si'isi'i 'o e mimi rodent fakamomoa mo e saliva totonu 'i he levolo 'o e faliki 'a e hocuak mo e 'ikai ke nau en -round . 'oku pahū 'e he fanga sila 'a e ngaahi aerosols vailasi ki tu'a ki he loki. Tānaki atu ki aí, ko hono fakaava ‘a e kato vekiumé pe kanisá ‘okú ne fakahaa‘i koe ki mui ‘i ha taimi hono ua. **'Oua 'aupito na'a ke vekiume pe dry-sweep 'a e 'uhiki'i manupuna**: 'ea ma'u pe 'i ha miniti 'e 30, spray 'aki 'a e **1:10 household bleach** kae 'oua kuo 'osi 'a e 'uha, tatali **miniti 'e 5 ki he 10**, pea holoholo'i 'aki 'a e ngaahi taueli pepa 'oku 'uha.

‘E lava fēfē ke ‘ilo ‘e ha toketā ‘a e faikehekehe ‘o e Hantavirus vave mo e influenza angamahení pe ko ha fo‘i ‘uhiki‘i manu ‘i he keté ‘i he ‘uluaki ‘aho ‘e 3?¶

Fakafaito'o, 'a e Hantavailasi 'o e kamata'anga (`Days 1 to 4`) 'oku ne fakatupu 'a e mofi lahi, mamahi lahi 'a e uoua 'i he **ngaahi kulupu uoua lalahi (`thighs, hips, and lower back`)**, mamahi 'ulu, pea fa'a 'uto, lua, pe mamahi 'i he kete, **mo ha 'IKAI 'I AI fakaofo 'o e ngaahi faka'ilonga 'o e manava 'i 'olunga (`no runny nose, no stuffy nose, no sneezing, and no sore throat`)**. ‘I ha sivi toto faingofua **miniti ‘e 45 (`Complete Blood Count / CBC`)**, ko ha mahaki ‘oku ‘i ai ‘a e Hantavirus ‘oku meimei ke ne fakahaa‘i ma‘u pē ha **‘oku holo hifo ‘a e lau ‘o e ngaahi peleti (`thrombocytopenia < 150,000/uL`)** lolotonga ‘a e ngaahi ‘uluaki ‘aho ‘o e mofí, pea hoko atu ai ‘a e tupulaki ‘a e hematocrit, lahi ‘a e ngaahi sela hinehina ‘o e totó mo e ngaahi sela ‘o e band ‘oku te‘eki ke matu‘otu‘á, mo e ngaahi lymphocytes atypical (`immunoblasts`).

Ko e ha 'oku fu'u fakatu'utamaki ai kapau 'e 'oange 'e ha loki fakavavevave ki ha mahaki Hantavirus ha ngaahi kato lalahi 'o e IV saline fluid 'o hange ko ia 'oku nau fai ki he sepsis angamaheni?¶

‘I he sepsis pekitilia anga-mahení, kuo fakalahi ‘e he kau mahakí ‘a e ngaahi halanga totó pea ‘oku nau ma‘u ‘aonga mei he . `2 to 3 liters` ‘o e saline ‘i he uoua. Ka 'i he **Hantavirus Pulmonary Syndrome**, 'oku fakatupu 'e he vailasi ha fu'u **capillary leak 'oku 'ata pe 'i he ngaahi halanga toto ma'ama'a 'o e ma'ama'a** lolotonga ia 'oku ne fakavaivai'i 'i he taimi tatau 'a e malohi pamu 'o e uoua 'o e loto. Kapau 'e lilingi 'e ha toketaa . `2 to 3 liters` ‘o e IV saline ki he ngaahi veini ‘o ha tokotaha mahaki Hantavirus, ‘oku tafe hangatonu mai ‘a e vai ko iá mei he ngaahi fo‘i huhu‘a ‘o e ma‘ama‘á ki he ngaahi kato ‘eá (`alveoli`), ‘o fakatupu ai ‘a e **fulminant pulmonary edema ‘a ia ‘oku ne melemo ‘a e tokotaha mahaki ‘i ha ngaahi houa si‘i**. Ka, 'oku faka'aonga'i 'e he kau toketaa ICU **fakangatangata fefeka 'o e vai**, vave **vasopressor mo e ngaahi faito'o inotropic (`Norepinephrine + Dobutamine`)**, pea mo e vave **VA-ECMO loto-ma'ama'a 'o e 'alu**.

‘E lava ke mafola ‘a e Hantavirus mei he tokotaha ki he tokotaha, pe mei he‘eku kulií pe pusí?¶

**Ngaahi Hantavailasi 'o 'Amelika Tokelau (`such as Sin Nombre virus carried by deer mice in the US and Canada`) mo e ngaahi Hantavailasi ‘Iulope/‘Ēsia (`Puumala, Hantaan, Seoul`) 'OUA 'e mafola mei he tokotaha ki he tokotaha** - 'e 'ikai lava ke ke ma'u 'a e HPS 'o 'Amelika Tokelau mei he 'uma, ala, pe tokanga'i ha taha mahaki 'oku puke. *(Ko e tukukehe fakamamani lahi pe 'e taha ko e **Vailasi 'o 'Amelika Tonga** 'i Sili mo 'Asenitiná, 'a ia 'e lava ke mafola 'i he vaha'a 'o e ngaahi fetu'utaki ofi 'i 'api pea 'oku fie ma'u ke fakamavahe'i 'a e 'ea/droplet.)* 'Oku 'ikai ke puke 'a e fanga kulii mo e fanga pusi mei he Hantavirus pea 'oku 'ikai ke nau lilingi 'a e vailasi 'i honau mimi** pe 'oku lava ke ma'u 'e ha fanga pusi 'i tu'a mouse ki ho fale pe holisi.

Kapau te u maʻu ha ʻuhikiʻi mouse ʻi ʻolunga ʻi he filita ʻea ʻo e kāpiní ʻo ʻeku kaá pe ʻi lalo ʻi he ʻuluʻi kaá, te u fakamaʻa malu ia?¶

'Oua 'aupito na'a ke kamata 'a e me'a fakamokomoko 'i loto 'o e me'alele pe A/C blower fan kapau 'oku ke mahalo kuo nested 'a e fanga ki'i miule 'i loto 'i he puha 'ea HVAC, pea **'oua 'aupito na'a ke puhi'i 'a e 'ea 'o e misini pe 'ea 'o e fale 'aki ha 'ea compressor**. Teke pe fakatu'u 'a e me'alele **'i tu'a 'i he 'ea 'ata'ataa mo e maama 'o e la'aa**, fakaava 'a e hood mo e ngaahi matapa kotoa 'o e me'alele 'e fa 'i he **miniti 'e 30**, tui **ngaahi to'ukupu nitrile mo ha me'a manava N100/P100**, spray fakalelei 'a e 'uhiki mo e fale 'o e filter 'o e fale 'aki ha spray fakakomesiale (`like Lysol`) pe . `1:10` fakaleleiʻi ʻo e valitaá (`avoiding bare electrical connectors`), tatali **miniti 'e 10**, hiki hake 'a e 'uhiki'i 'uhiki'i manupuna mo e filita motu'a ki ha kato pelesitiki kuo sila'i, pea fokotu'u ha filita 'ea fo'ou 'o e fale kimu'a pea toki fakamo'ui 'a e ngaahi 'ea 'i loto.

Ko e fakahinohino ko eni ‘oku ne ‘omai ‘a e fakamatala fakafaito’o fakavavevave mo e malu faka’atakai pea ‘oku ‘ikai ke ne fetongi ‘a e tokanga’i fakavavevave fakapalofesinale ‘i he falemahaki pe ko e fetu’utaki ki he tokanga’i lahi. Koe'uhi 'e lava ke fakalakalaka 'a e Hantavirus Pulmonary Syndrome mei he tale si'isi'i ki he puke 'a e manava mo e loto 'i lalo he houa 'e 4, 'Oku mau fokotu'u atu ke ke fai ha ako tokoni 'uluaki mo e CPR kuo fakamo'oni'i mei he Kolosi Kulokula, St John Ambulance, pe ko ha kautaha ako fakalotofonua kuo fakangofua.

Ngaahi fakahinohino fekau'aki¶

• Leptospirosis (mahaki ‘o Weil) hili ‘a e luelue ‘i he vai tāfeá pe vai ma‘á: mata kulokula mo e mamahi ‘a e fo‘i pulú
• Sepsis mo e septic shock 'ilo'i mo e triage fakavavevave .
• Ko e faito‘o fakatupu toto (kona ‘o e fanga ki‘i iká), superwarfarin, mo e sinki phosphade
• U'u 'e he fanga monumanu, fakaviviku 'o e lavea, mo e prophylaxis 'o e rabies hili hono faka'ali'ali
• Ngaahi fika fakavavevave

Ngaahi ma'u'anga fakamatala mo e fakahinohino faka'ofisiale .¶

• Senitā ki hono Puleʻi mo e Taʻofi ʻo e Ngaahi Mahakí (CDC Va'a 'o e Ngaahi Me'a Fakatupu Mahaki Makehe 'o e Vailasi, 'Iunaiteti Siteiti): Fakama'a Hili 'a e Ngaahi 'Ulu: Polokalama Faka'ofisiale 1:10 Faka'auha 'o e Ngaahi Mahaki Faka'uli mo e Hantavirus Pulmonary Syndrome (HPS) Fakatotolo Fakafaito'o, Peripheral Toto Smear Triad, mo e Pule'i 'o e Vai 'o e ICU (cdc.gov/hantavirus).
• Univēsiti ʻo Niu Mekisikoú (UNM) Senitā Saienisi Moʻui & Polokalama Fakatotolo Fakafaitoʻo ʻo e Hantavirus (Koster, Hjelle, Crowley, & Wernly): Ngaahi Tu'unga 'o e Triage 'o e Toto Smear Vave 'o e Peripheral (5-of-5 Rule) mo e 'Okisikena 'o e Membrane 'o e Veno-'Atelia 'o e Mu'aki (VA-ECMO) Fakahaofi ki he Mahaki 'o e Loto mo e Ma'ama'a 'o e Hantavirus 'oku 'ikai ke lava 'o tali.
• Kautaha Mo'ui 'a Pan 'Amelika (PAHO) & Kautaha Mo'ui 'a Mamani (WHO): Hantavirus 'i 'Amelika: Ngaahi Fakahinohino ki hono Fakatotolo'i, Faito'o, Ta'ofi, mo e Pule'i (Kau ai 'a e Ngaahi Fakatokanga 'a e Tokotaha ki he Tokotaha ki he Vailasi 'o e Andes 'o 'Amelika Tonga).
• Senitā ʻIulope ki hono Taʻofi mo Puleʻi ʻo e Ngaahi Mahakí (ECDC) & ʻInisititiuti ʻo Lōpeti Koki (RKI, Siamane): Pepa Mo'oni mo e Fakahinohino Fakafaito'o ki he Ngaahi Vailasi 'o e Mamani Motu'a 'o e Orthohantavirus (Puumala Ko e Mahaki Fakaʻauha ʻo e Nefolopatí mo e . Dobrava Ko e Mofi Toto mo e Mahaki 'o e Renal).
• 'Inisititiuti Fakafonua ki he Malu mo e Mo'ui Lelei 'i he Ngaue (NIOSH, ʻIunaiteti Siteiti): Taʻofi ʻo e Mahaki ʻo e Maʻamaʻa ʻo e Hantavailasi (HPS) ‘I he Lotofonua ‘o e Kau Ngāue ‘Oku Nau Tokanga‘i ‘a e Ngaahi ‘Ulu pe Fakama‘a ‘a e Ngaahi Fale mo e Ngaahi Me‘alele ‘oku ‘Ikai ‘a e ‘Ulu (N100/P100 Fili 'o e Me'a Fakamanava).