BHOJPUR: Four children have died of suspected hantavirus infection in eastern Nepal recently.

The deceased have been identified as Namrata Pandey (8) of Shyamshila VDC-8 in Bhojpur, Kalpana Subedi (8) of Dhupu VDC-5, Deepak Rai (13) of Pawakhola and an unnamed four-year-old child of Num in Sankhuwasabha, according to the District Health Offices.

Dr Nawal Kishor Jha, who is the chief of Bhojpur District Health Office, said the doctors at Dharan-based BP Koirala Institute of Health Sciences, where the children were referred to for further diagnosis and treatment, suspected that they suffered from hantavirus.

However, it is yet to be confirmed whether the children lost their life due to the virus, which is transmitted by rodents, according to Jha.

After suffering from headache and high fever, Subedi and Rai were first taken to the Khandbari-based District Hospital in Sankhuwasabha.  They were later admitted to the BPKIHS.

One girl from Kulung of the district who had developed similar symptoms, however, was successfully treated and discharged from the District Hospital.

Symptoms of the hantavirus infection include high fever, headache, swelling of kidney, heart and lungs as well as the swelling of the whole body, according to Dr Madan Kumar Upadhyaya, the chief of Sankhuwasabha District Health Office.

The direct contact with excreta of rodents or consumption of food contaminated by them increases the chances of contraction of the viral disease, Dr Upadhyaya said. The human-to-human transmission is not

known, according to him.

Based on the symptoms that she developed, doctors at the BPKIHS suspected that Subedi suffered from hantavirus infection after her death.

According to Dr Upadhyaya, samples of suspected cases should be sent to Bangkok as Nepal does not have any technology to carry out confirmatory tests.

He further informed that the lower health units' attention has been drawn towards the potential spread of the virus, asking them to launch awareness campaign on hygiene.

If confirmed, these would be the first cases of hantavirus infection in Nepal, according to health professionals.

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Hantavirus diseases

Hantavirus diseases are viral infections; important examples are haemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS).

Cause

Hantaviruses, which belong to the Bunyaviridae family.

Transmission

Hantaviruses are carried by various species of rodents; specific viruses have particular rodent hosts. Infection occurs through direct contact with the faeces, saliva or urine of infected rodents or by inhalation of the virus in rodent excreta.

Nature of the disease

Hantavirus diseases are acute viral diseases in which the vascular endothelium is damaged, leading to increased vascular permeability, hypotension, haemorrhagic manifestations and shock. Impaired renal function with oliguria is characteristic of HFRS. Respiratory failure caused by acute non-cardiogenic pulmonary oedema occurs in HPS. The outcome is fatal in up to 15% of HFRS cases and up to 50% of HPS cases.

Geographical distribution

Worldwide, in rodents.

Risk for travellers

Very low for most travellers. However, travellers may be at risk in any environment where rodents are present in large numbers and contact may occur.

Prophylaxis

None.

Precautions

Avoid exposure to rodents and their excreta. Adventure travellers, backpackers, campers and travellers with occupational exposure to rodents in countries or areas at risk for hantaviruses should take precautions to exclude rodents from tents or other accommodation and to protect all food from contamination by rodents.

Source: WHO