WHO

Hantavirus disease – Republic of Panama

The Panama Ministry of Health has reported an increase in cases of hantavirus infection in Los Santos Province, Republic of Panama, to the Pan American Health Organization / World Health Organization (PAHO/WHO). Between 1 January and 22 December 2018, a total of 103 confirmed cases of hantavirus have been reported at the national level, 99 of which were reported in Los Santos Province. In Los Santos Province, 51 cases were classified as hantavirus fever¹ (HF) without pulmonary syndrome and 48 cases were classified as hantavirus pulmonary syndrome² (HPS), including four deaths.

• Of the 51 HF cases, 41% were female, 55% aged between 20-59 years, with 76% occurring between June 2018 and November 2018.
• Of the 48 HPS cases, 56% were female, 67% aged between 20-59 years, with more than half of the cases occurring in February 2018 (17%) and between June 2018 and September 2018 (42%).
• Four deaths were reported among HPS cases (two female, two male, all aged over 60 years).

Cases were confirmed by serology and polymerase chain reaction (PCR)³. Sequencing determined that the type of virus associated with this outbreak is Choclo virus. It was first isolated in 1999 in the western Republic of Panama.

Hantavirus cases have been reported in the Republic of Panama since 1999 (Figure 1). In the last five years, transmission has been documented in Los Santos, Herrera, Veraguas, and Cocle provinces. During 2018, cases have been reported in Los Santos (99 cases, Figure 2), Herrera (two cases), Cocle (one case) and Veraguas (one case) provinces (Figure 3). Since the reservoir for hantavirus is sylvatic rodents and transmission can occur when people come in contact with rodent habitats, the current increase in hantavirus cases in the Republic of Panama could be related to changes in the abundance and distribution of rodent species, as well as strengthened surveillance and laboratory capacity at the provincial level. Environmental and ecological factors affecting rodent populations can have a seasonal impact on disease trends.

Figure 1. Distribution of HF and HPS cases by year, Republic of Panama, 1999-2018 (as of November).

Figure 2. Distribution of confirmed hantavirus cases by epidemiological week, Los Santos Province, Republic of Panama, January–December 2018.

Source: Provided by the Panama Ministry of Health and reproduced by PAHO/WHO

Figure 3. Geographical distribution of confirmed hantavirus cases, Republic of Panama, January–November 2018.

Source: Provided by the Panama Ministry of Health and reproduced by PAHO/WHO

Public health response

The public health responses currently being implemented include:

• Investigation and monitoring of cases, including case management.
• Enhanced surveillance and active case finding.
• Rodent control and mitigation measures.
• Increasing awareness and health promotion in the affected areas.

References:

• Pan American Health Organization / World Health Organization (PAHO/WHO). Epidemiological Alert Hantavirus Pulmonary Syndrome (HPS). 17 October 2013.
• Hantavirus in the Americas: Guidelines for diagnosis, treatment, prevention and control.
• Hantavirus information: Centers for Disease Control and Prevention (CDC)