Andes Hantavirus: From Research to Clinical Preparedness

Jill Morgan (2): Hello, and welcome to Transmission Interrupted.

My name is Jill Morgan.

I'm a nurse here at Emory University Hospital in Atlanta.

For those of you not yet familiar with NETEC, our mission is to set the gold

standard for special pathogen preparedness and response across health systems in

the U.S., with the goals of driving best practices and closing knowledge gaps

and developing innovative resources.

NETEC works alongside and in cooperation with the CDC, and is

funded by ASPR, the Administration for Strategic Preparedness and Response.

And today we are going to talk about Andes hantavirus.

So this was all in the news recently with a certain cruise ship, but

we are going to talk about this particular strain of hantavirus and

what we know about it and how we can think about at least treating it.

And as with many, many emerging infectious diseases, a lot of the

things that we will talk about today are not officially approved therapeutics.

They're things that people are trying in this landscape of new pathogens

emerging that need treatment.

And so I'm really excited today to have two expert guests with me.

I have Dr. Gaby Frank, who's a professor of medicine and the director of Johns

Hopkins Special Pathogens Center, and also Dr. Gavin Harris, who's an

associate medical director of Emory's Serious Communicable Diseases Unit.

So thank you both for being here.

And we're gonna talk about this article that you have recently written.

And I'd love to dive into a little bit about what you guys know about Andes

hanta and where we can go from here.

I mean, I think it was just such a worrisome time because there

was so much unknown about it.

I think it was a surprise to many people in the Northern Hemisphere that

there was a hantavirus that could be spread person to person, but perhaps

less so, Gaby, as you're familiar with in the Southern Hemisphere.

So let's just start with that.

Tell us a little bit about Andes as a virus and its transmission route.

So Gaby, I'm gonna start with you with that, and then maybe Gavin, you can

kind of fill in the bits and pieces about this most recent outbreak.

And I think to start with Andes virus, it's one of

the species for hanta-- for ortho hantaviruses are those hantaviruses

that cause diseases in humans.

What is important to know is that Andes virus is one of the species

that is present in both Argentina and Chile in the Patagonia area.

It is the only one so far that is known to cause human-to-human transmission.

However, that's also not, like-- Although there was a lot of scare with

what happened on the cruise ship, we need to keep in mind that this is not

a danger for people that are not in the area, and even for people that live in

endemic area, the majority of the cases actually don't cause cluster infections.

So if we think about the latest hanta season in Argentina, only ten percent

of the cases in the whole country were associated or thought to be

associated with Andes virus, and only like two-- there was only a single

cluster, and there were two people that lived in the same household.

So even though it is known to cause human-to-human transmission, and

there have been some clusters like the latest one that we all heard

about because of the cruise ship, but also there have been some other

clusters between Argentina and Chile.

But in general, most of the infections occur through exposure to environmental

areas or where the mouse is present, but not necessarily human-to-human.

So we do need to recognize that it has the trans- this transmission, but also,

people need to feel safe that at least it's not the huge risk that maybe, um…

Well, there's nothing to be scared about at this point.

It's to know a little more about it and and know how to protect themselves and

like, particularly if they're gonna be doing some ecotourism in areas where

it's endemic, what to do, what not to do.

But other than that, it's not something to be scared about.

Jill Morgan (2): So hantaviruses are a family of-- orthohantaviruses are

a family of viruses that are caused by exposure to the urine and feces,

maybe even saliva of mice, rodents.

probably not just a single mouse or rodent, but mice and rodents, and

that for all the mice and rodents in the world, this particular strain of

hantavirus is restricted to this area in Chile and Argentina, and then you

have to get exposed to lots of mice and rodents, in a small geographic area.

You have to get exposed to that rodent droppings or rodent spit,

or have pretty darn close contact with a person who's gotten sick.

So it really does come down pretty quickly from a risk standpoint.

So Gavin, tell us about this new outbreak and, you know, from your

perspective about sort of the, the risk here or how you see things

Thanks so much, Jill.

And, and, uh, y-yes, it's a very interesting confluence of

factors that led to this outbreak.

And I will say, back when the original World Cup draws were announced in

terms of what teams would be going where; this was in December twenty

twenty-five, we were actually thinking about Andes virus because the teams

from Argentina were coming, and their fans were coming to the United States.

And so it was something that we were thinking about, but more as, you know, a,

an exposure risk on a, on a larger scale.

It's interesting that around the same time we had this cruise ship outbreak.

But cruise ships, in general, are really interesting and unique environments.

But like you mentioned, typically you need exposure to the right virus at the

right time with the right vector, right?

So the mice and their bodily fluids or excreta or things of that nature.

One of the challenges, too, with Andes virus is the incubation period

is incredibly long, can be up to six or even eight weeks or so.

And so that really remains a challenge in terms of diagnosis and thinking

about when people develop symptoms, although they most commonly develop

symptoms within those first two weeks.

And the challenge is, too, those symptoms overlap with a lot of other things that

people experience, you know, seasonally with influenza-like illnesses, but

then also when they're on cruise ships or under, uh, undergoing ecotourism

activities or things of that nature.

So it presents a real challenge in terms of diagnosis.

And then to think about, well, that prolonged contact that Gaby

was mentioning that typically people will get Andes virus from.

A cruise ship is a really unique environment for that.

There's a lot of close contact.

There may be even intimate contact on those ships, and there's not

a lot of places to go, honestly.

So these confluences of factors really just unfortunately aligned to

you know, preceding this outbreak.

Jill Morgan (2): And Gaby, correct me if I'm wrong, but I think that even

though obviously this outbreak of Andes hanta that occurred on the cruise ship

and was brought to attention, obviously with the passing of three people

total, which is a terrible tragedy, but when people get Andes hanta, what

is the likelihood that they're gonna develop something that critical?

Do people have mild cases of Andes virus?

I think that there's more research that is needed because

the incubation, as we said before, is so, so long that sometimes for

those who develop mild symptoms, they never get diagnosed, correct?

So, there was this study from Chile that actually they, they studied four

hundred and seventy-something contacts of seventy-six people who actually

developed and were confirmed hantaviruses.

And out of those, a little less than 3% actually did end up developing Andes.

And those were very close follow-ups, so even if they developed mild

symptoms, they would have been detected.

So at this point, we don't know if everybody will develop symptoms that are

severe enough to require hospitalization.

Not necessarily critical care, but that require hospitalization

or if there are some other milder cases that are being missed.

Based on whatever is out there in the literature, it appears that when they

did the study in Chile, that 3% of the contacts actually end up developing, and

they actually monitor and test all of those almost five hundred people, right?

So, can we say for sure that that is the case and that there are no mild cases?

I think that is-- well, that would be premature.

We don't have the literature.

We know that for other hantaviruses, particularly in Europe, there was a

seroprevalence of 15% in some areas of the population, which suggests

that maybe some people got exposed, but that is a different hantavirus,

and that is a hantavirus that doesn't cause hanta pulmonary syndrome.

So I think that at this point it would be premature to say that, yes,

some people may be asymptomatic.

It could happen with a lot of viruses, but I don't think that

the literature is out there to, to make a definite statement about it

Jill Morgan (2): So we don't have like seroprevalence studies from

the Patagonia region to know whether people have had an exposure before

that there was perhaps subclinical.

There are so many needs out there for research.

It's amazing.

So all right, we have people that are diagnosed.

We have the possibility, at least if you you have traveled to this area, or you are

living in this area, you have exposure to fields or trash dumps or food store

areas, or you're cleaning something out, anything that would have exposed

you to this potential rodent source.

The next step, Gavin, is how do we diagnose Andes hanta?

It's a great question, Jill, and it's an interesting discussion too.

So, you know, when we think about exposure risk, we think about epidemiologic risk.

If you have someone who is young, who comes in with a rapidly progressive

febrile and respiratory illness with consistent epidemiologic exposure

to the things you just mentioned, we're thinking about hantavirus.

And not just Andes virus itself, but really any of the, in this

hemisphere, the New World hantaviruses.

And then with comparatively, in the other parts of the world, Old

World hantaviruses as well.

So that's the first thing: clinical suspicion is super

super important here as well too.

In terms of laboratory findings, we sometimes find thrombocytopenia,

so low platelets, high white blood cells, or leukocytosis.

And then if we're able to get a peripheral smear from the blood,

circulating immunoblasts, which is a very uncommon but pathognomonic finding for

Andes virus itself is pretty classic.

And then later in the stage of the illness, we do find hemoconcentration

or, you know, we'd find that by a rise in hemoglobin and hematocrit

and things of that nature too.

Now, definitive diagnosis, it really relies on molecular and serologic testing.

This is typically performed at designated reference laboratories,

although there are some laboratories in the United States that are starting

to, as the visibility from this most recent outbreak has occurred or

increased, are starting to bring on some of this molecular testing itself.

So, and that is really PCR testing when I, when I say molecular testing too.

But there's also been a very important study that has shown that people can

actually diagnose or detect the RNA of Andes virus two weeks prior to showing

symptoms, which is incredibly important.

Now, it doesn't necessarily mean or definitively mean that they

are contagious two weeks prior to when they show symptoms.

But if you think about it, you can detect it in someone who may

have been exposed to Andes virus.

And then typically, we will detect that virus in the first

two weeks of illness itself.

And then, of course, as the illness progresses, the level of

virus, as well, will increase too.

So PCR testing, just to sum it up.

So PCR testing and then also Andes virus-specific, serologic assays

looking for IgM and IgG proteins.

Jill Morgan (2): Excellent.

So Gaby, so here we have, for instance, let's say somebody's-- we have this

person who presents with a potential exposure, a rapid onset of a fever,

we're working on this diagnosis.

What is our first line of treatment, at for instance, in an emergency department?

What do you recommend that people start with?

So before we talk about treatment, I think that the

key when we're talking about a point of entry to the healthcare

system, in this case the emergency department is the three I's, right?

So the first thing that we need to do is make sure that we can identify,

and that is, again, good history.

And when we talk about, like, Gavin just brought this up, it's a suspicious

case with the right epidemiology.

And one thing to highlight is that because the incubation could be up to six weeks,

again, Gavin already mentioned this; it is important to, when someone has this

rapid respiratory worsening on someone that is healthy, to make sure that you

go and ask about those epidemiologic exposures or environmental exposures

like six weeks back and not just stick to the last two weeks.

So I think that the first thing when we're talking about an emergency department

is the identification of the patient.

Then we're gonna isolate those patients, just to make sure that we

prevent anybody else from actually getting in contact with the patient,

but we still need to provide care.

So we need to don the appropriate PPE.

And then when we're in the emergency department, we're gonna have to

inform whoever is gonna guide the treatment of that patient.

However, the most important thing is to provide the right supportive care

and critical care for the patient.

So without talking about what other experimental things can be tested, the

most important thing is to provide the correct level of care, that a lot

of these patients require critical care and very appropriate supportive care.

Jill Morgan (2): And so you say supportive care.

You know, so we have somebody with respiratory symptoms, with

high fever, so we need IV access.

We need to think about checking people's electrolytes.

We need to make sure we're offering respiratory support.

Are these people likely, Gavin, to get critically ill quickly?

If they truly have Andes virus and that progresses to hantavirus

pulmonary syndrome or HPS, yes, they can progress rapidly within hours to days.

And so the early recognition and the initiation of that supportive care

characteristics that you just mentioned, Jill, is so essential to preempt the

the virus and its effects, and also to provide that supportive care as well, too.

And even things incredibly invasive, such as aggressive fluid management

has sometimes been utilized.

Things like extracorporeal membrane oxygenation, or ECMO, have also

been utilized to important effect, especially when patients rapidly

progress into that severe phase

Jill Morgan (2): Wow

Can I add something, Jill?

What Gavin said is like, I-- people need to know that.

And when we talk about fluid management, that usually, in the beginning, we're

doing very judicious fluid management.

It's aggressive for that patient, but it's judicious.

We don't do a lot of IV fluids because those patients tend to do worse.

So those patients need very, very close monitoring to maybe adjust the

amount of fluid that we're giving aggressively to what are the losses

on that patient, but not to go over.

So it's like it's judicious, but there's no one number that we can tell people,

"Oh, this is what you're supposed to do," but just make sure that they do

very strict I's and O's, and they're trying to keep up with the patient's

losses, but not necessarily go above.

Jill Morgan (2): Yeah.

I remember in early septic care it was like this idea in critical care

medicine at the time was to give them fluids until you need to increase their

oxygen, because you don't want to go overboard and then end up with a lot of

fluid where you didn't wish it to be.

So Andes has been in the news a lot, but tell me what we have

as far as treatment options.

Gavin, I know that there are no approved therapeutics that are, certainly at

least approved for this use, but what kind of things are people trying or

using, uh, in the treatment of, of Andes?

Yeah.

So, just to reiterate, Jill as well too, what Gaby mentioned, there

are no licensed therapeutics; there are no licensed vaccines right now.

But the only thing that is consistently shown to improve mortality in these

patients is that early optimized critical care that we just talked about.

So I really can't highlight that enough.

You know, and also since you brought up traditional sepsis management

and critically ill, or the management of a critically ill patient, high-dose

glucocorticoids or steroids have often have often been used in these patients.

And like we do in other cases of septic shock or

multi-organ dysfunction syndrome.

But what's interesting is, specifically Andes virus, there was a study done out

of Chile that did show that high-dose methylprednisolone actually did not

result in a significant clinical benefit or difference in mortality.

And the most recent guidance that we actually have from two thousand and

seven explicitly lists glucocorticoids as contraindicated as patients with exposure

to Andes virus or other orthohantaviruses.

So I just wanted to highlight that as well.

Of course, data may be changing, and this was simply one study, of course, too.

But some other things that we've tried, and I say we, the medical community

has utilized; number one is ribavirin.

So this is a nucleoside analog.

It's been used in many viral infections, including Lassa fever,

hepatitis C, respiratory syncytial virus, or RSV, and measles as well.

And it's actually shown significant antiviral activity against Andes virus.

And it's been used not just in therapeutics and treatment, but

also in post-exposure prophylaxis.

But again, there's no high-quality clinical trial that has shown

efficacy in humans or in hantavirus pulmonary syndrome itself as well.

So, it-it's just important to recognize and to highlight again that there's a

real opportunity for additional research in this specific area as well.

So and then some other therapeutic and investigational agents that have been

utilized include convalescent plasma.

So this is looking at or taking the plasma of survivors of Andes virus

and giving that plasma to patients who may be infected with Andes virus.

And this actually has shown some good efficacy, especially outside the United

States, so in Argentina and Chile.

Monoclonal antibodies, which are really, kind of an avenue for

every sort of high-consequence infectious disease that we're seeing,

have shown really great promise.

But again, there's no efficacy data in humans as of yet.

And then we have some other direct, uh, antivirals, favipiravir,

baloxavir, mamipiravir.

These have also, uh, are undergoing clinical trials, or clinical

studies as we, as we speak here too.

Again, we, we lack, clinical effec-effec-- excuse me, efficacy data as of yet.

And one of the challenges is that in the grand scheme of things,

Andes virus is really incredibly rare, except for these regions, as

of now that we're talking about.

Jill Morgan (2): Yeah, but they're beautiful regions of the world.

They're beautiful regions of the world with that have a fair amount of tourism,

not just people going down to Ushuaia to get on a cruise to Antarctica.

But, you know, uh, volcanoes and, and all sorts of gorgeous landscapes down there.

And I think that, that we don't wanna discourage people from going

to places like this and to have these travel experiences, but understanding

that every part of the world has its own set of risks, whether

that's, you know, coming into contact with measles somewhere or coming into

contact with a rodent who might have something in another part of the world.

And rodents worldwide do spread a fair amount of pathogens, but it does

take a m- a measure of contact with them or with somebody else who's sick

in order to make somebody else sick.

And I, I wanna make sure that we're clear for people who

aren't familiar with Andes hanta.

So, so hantaviruses in general, big, wide category of pathogens,

many of which don't cause diseases in the animals themselves, so

the animals don't look sick.

And then exposure to humans that might cause a disease in humans, doesn't

necessarily mean that that disease can be spread from person to person.

So the person has to get it and then be able to spread it to someone else.

And right now, the Andes version of hanta is the only one we know of that

has that sort of person-to-person spread.

But as Gavin, you mentioned, the Old World hanta and New World hanta have different

syndromes that cause critical illness.

And c- can perhaps, and I'm not sure which one of you would like to sort of

give a very brief explanation of that difference between what happens with

Old World hantaviruses that make people sick versus what happens with New World

hantaviruses and what makes people sick.

But this was, I think, a little bit of a confusion even during, uh, the,

the cruise ship episode of what kind of syndrome people were likely to see.

So I can do a quick start.

So I think that the big difference between-- There's over 28 different

hantavirus, uh, or orthohantavirus species that can cause disease in humans.

Usually, those that are present in Europe and Asia, they will cause a renal

syndrome with hemorrhagic fever, right?

It's very different from what they cause, the one in the new world that is all

the Americas, North, Central, and South America, and those are the hantaviruses

that cause hanta pulmonary syndrome.

So the presentations are different and so are the pathogenesis.

Some are a little more virulent or cause disease that is

mu-more severe, particularly within those that there's a lot more

and like the clinical presentation, particularly in the Old World hantaviruses

than in the New World hantaviruses.

So the new world orthohantaviruses, which are those that cause disease

in humans, most of them will cause a severe pulmonary disease that

is the hanta pulmonary syndrome.

And then in the United States, we have Sin Nombre.

We have the New York virus.

There's, there's a lit- there's a handful of viruses here that are, the,

in the hanta species that is best known as the Sin Nombre in Four Corners.

But in the US, we also have hantaviruses that can cause the same syndrome minus the

person-to-person transmission possibility.

And I'm gonna argue that some Argentinians will say that there's a different species

of the virus that is the Buenos Aires virus that is also known to cause human-to-human

transmission and has a different geographic area than the Andes virus.

But there's still some nomenclature challenges of whether it's a different

species or is the same one or is a variant of the same species.

But we do have hantaviruses in the U.S., and I think that exposure to rodents

and rodent excreta can also potentially lead to hantavirus, and that's something

that people need to keep in mind.

That it's not if someone didn't travel to Patagonia and they present with

something that is similar to a hanta pulmonary syndrome; it could be, even

if they didn't travel to Patagonia

Jill Morgan (2): Right.

Right.

And we have had a case, I think, in people's collective memory in the

United States, um, not too long ago that involved sort of a famous couple

and the unfortunate death of, of, uh, someone from hantavirus that was

not-- did not have person-to-person spread, but still led to the demise.

So it is, I think, important for people to understand there's a risk

in the United States of exposure to hantavirus from exposure to the

same kind of this idea of mice.

And typically we think of those being in the desert Southwest and

and the mountainous regions.

But I think, Gaby, from the last time we had a podcast about hanta, we

learned that, oh my gosh, well, maybe it's been identified in a lot of other

mice as well, and there have been some cases, I think, in Vermont and

in other parts of the United States.

So it is something that if you've been camping, if you've been dealing with or

cleaning out something that had perhaps mouse or rodent droppings, and you

suddenly have a fever, you need to mention those things when you present for care.

And you might have something that is at least dangerous to you, even if

it's not dangerous to other people.

So, keeping that in mind, bad things don't always come from somewhere else.

So it's not just something that's limited to travel to some exotic locale.

So I want to ask you both, was there something as you were researching

this, this article about the treatments for, for Andes virus, uh, was there

something that you learned, in doing this research that you thought, "Oh

gosh, I mean, I'm so glad we get the opportunity to elevate this or to

amplify this because I didn't know this.

This was news to me?

So I, I think, Jill, from my perspective, it again

highlights the potential avenues for repurposing of therapeutics, right?

And so we think about, of course, ribavirin.

It's been around for decades, but it has shown some potential.

But we've even shown some great-- there's some great evidence and

signals coming out of studies now for favipiravir and baloxavir, right,

and of course, monoclonal antibodies.

Um, and so I think it's really important to understand the potential that one

drug can have for many, potentially many different pathogens, which is something

that I, I don't think we always recognize.

I also think that this outbreak, uh, and the research that we did certainly

highlights, again, the importance of infection control practices.

What's, what's interesting is that in all of the studies that we looked

at and all of the published data that we have, there were very,

very few, less than five nosocomial transmissions of this virus when the

proper infection control practices and appropriate personal protective

equipment, PPE, practices were followed.

Which I think, again, lends weight to how important some of these fundamentals

of care, not just for something like Andes virus or other HCIDs, but also

just the care of patients in general.

And I, I, I think I, I really can't emphasize that enough, and I was

actually quite surprised to find that low a number of nosocomial challenges.

Jill Morgan (2): Anytime we get to promote the importance of the early

and correct use of PPE makes me happy.

Gaby, anything surprising to you?

Well, what I was gonna say is by-- not just by doing the research and

review of the literature for this article, but also, we have done the review of literature

right before this happened, right?

So we had this article ready to go before the most recent outbreak.

And I think that we had the opportunity to talk to a lot of our

international colleagues that actually care for some of those patients.

And I think that also, um, hopefully will lead to a lot of

publications with their anecdotal experience of the treatments that they

use that I don't want to bring up here because they didn't publish them yet.

But I think that people are trying to repurpose medications and try to, based

on the pathophysiology of hanta pulmonary syndrome, propose certain therapeutics

that may be helpful in the future.

So I think that there's gonna be some publications coming, and it's important

to stay tuned for those as well.

They're not from us, but, um, because, like, we didn't have to

treat any of the patients in the US.

But, you know, we have a lot of international colleagues who did,

and they learned a lot from it, and I think we learn from them, and they're

gonna be sharing that experience with the rest of the medical community.

Hopefully very soon.

Jill Morgan (2): I think that it's such a great reminder that not only is our

world small because people travel quickly and can be anywhere very fast, but how

important it is that people like you two have contacts and keep open dialogues with

places that are treating these pathogens so that if you were to get a patient

you can understand what this has looked like from people who have treated more

than a single case in their lifetime.

The knowledge base being shared worldwide is so important because we never know

where things are gonna pop up, who we're gonna need to rely on as the

resident expert in these new pathogens or these pathogens that are new to us.

And knowing that we can reach out to people in other parts of the world who

have better experience, more experience, better expertise in these things is

really important, and we wanna keep those lines of communication open.

We wanna keep sharing what we can share with people because, um,

it makes everybody's care better, and safer for healthcare workers,

which is, you know, one of my primary concerns for all of this.

So I wanna give you guys the opportunity, if there's something

else you want to really get out there as a message about Andes hanta.

Uh, we will definitely be sharing the link to the article

about this recent publication.

And, you know, really highlighting the importance of this kind of work and that

we continue to work on emerging infectious diseases of any kind so that we can

make healthcare safer here in the United States and wherever people need care.

So I think I have said this before.

I think that history and physical exam are key.

Identifying those patients, asking the ri- right questions is very, very important

to have a high index of suspicion, and that is the first part of the diagnosis.

So I think that following the three I's- so identify, isolate, inform,

is key to keep everybody safe.

But for that first, we really need to dedicate some time to talk to the

patients and maybe say, "Okay, this will require me to stay a little longer

talking to the patient because the history may be a little more complex."

Um, and then what we have available to all of us is the supportive care.

And while we're thinking, can this or can this not be hanta, we still

need to care for our patients.

So feeling very comfortable wearing our PPE is key to

provide excellent clinical care

If I might just add, I do hope this article not

only sheds some light on Andes virus itself, but also on other hantaviruses

like we've been talking about.

And to illustrate what you already have mentioned, Jill, too, that--

and Gaby, we have hantaviruses in this country, and it's important

to be aware of how they come about.

It's important for everyone to be aware of how to properly clean things like barns

and crawl spaces and areas where there might be rodent droppings, because we

can certainly have similar presentations.

And then this goes back to ensuring that we get the appropriate exposure

history, that people don't have to get things from elsewhere, right?

They can happen in our own backyard, up and down the East Coast or out

West in the Four Corners region too.

Jill Morgan (2): And whether that's travel, whether that's mountain

climbing, whether that's, you know, being on a cruise ship or eating oysters

in the Gulf, whatever it is, you, you need to do some, some sleuthing.

Um, and it doesn't just end with those screening questions that might pop up on

on your electronic medical record screen.

I wanna thank you guys so much for putting this article together, for coming and

talking to us today about the Andes virus, about the treatments, limited as they

may be right now, but also perhaps repurposing some things that have been

around for a while to help us treat and prevent, hopefully, the devolution

of a patient into hantapulmonary syndrome or some of the other really

critical care negative effects that can happen when cases progress.

So early identification is key.

If you have questions about Andes hantavirus, we'll have some links

attached to this podcast episode.

And certainly, again, as Gavin and Gaby have both said, it's so important to

just have this on your radar whenever you're treating patients that

they may have an exposure to rodents or rodent droppings, and that you think

about some of the pathogens that are associated with that kind of exposure.

So I want to thank you guys both so much.

For those of you listening at home, we appreciate you joining us for this episode

on Andes hantavirus and the new article on the treatment options for such things.

We hope you'll join us for future episodes on a wide range of topics

from healthcare worker safety to personal protective equipment,

all kinds of infectious diseases.

If you have any questions for NETEC or ideas for future shows, please feel

free to contact us at info@netec.org.

You can also find us on the web at netec.org/podcast, where you can

subscribe to future episodes and find out more about today's topic.

So thank you, Dr. Frank and Dr. Harris, and we'll see you next

time on Transmission Interrupted.