IDSA Media Briefing: Hantavirus: What’s The Risk?

Jeanne Marrazzo: [00:00:00] Hello, everybody. Welcome to our press briefing this morning on behalf of the Infectious Disease Society of America. I'm Doctor Jeanne Marrazzo. I'm the Chief Executive Officer of IDSA. IDSA represents more than 13,000 physicians, scientists and public health experts whose focus is the prevention, treatment and cure of infectious diseases. So today we're going to be talking about the current hantavirus outbreak on the MV Hondius, what risks there are to the public and the broader public health implications. And I'm going to be joined by my colleague, Dr. Carlos Del Rio, a past president of IDSA. Carlos is also the chair of the Department of Medicine at Emory University School of Medicine and a professor of global health and epidemiology at the Rollins School of Public Health. We're going to start with a brief recap of what we know, and then we're going to open the floor to questions. As you know, to ask a question, please click the Raise My Hand button or for those on the phone, select star nine and you'll be added to the queue. So I'll say a couple of introductory things. I want to be very clear that the accounts today that we're going to give you are based on compiling a number of reports that are circulating in the media, some conversations with colleagues at WHO.

Jeanne Marrazzo: [00:01:19] But there have not been briefings from any US government agencies that we would have expected to occur in a situation like this, including CDC and NIH. So be aware that we are like, you are relying on a lot of information coming from a lot of sources. I won't recap the events of this, but just very briefly, a reminder, this all started on April 1st when the ship left the port in Ushuaia, Argentina. That may be an important piece of information, as I'll come to in a moment. The first victim died on board the ship on April 11th, and then the body of that Dutch man was deposited on Saint Helena. Um, in on, on April 24th. Um, and that is a remote island in the South Atlantic. That man's wife also disembarked there. She then flew to South Africa a day later and died there. It's not clear how they became infected, but there were reports yesterday that they had been bird watching, uh, not normally considered a hazardous sport, at a landfill outside of Ushuaia, Argentina, where it's possible that they encountered the vector for what we now know is the Andes virus, that is the cause of these infections. That's the Andes virus, variant of hantavirus. The vector there is the long tailed pygmy rat, rice rat.

Jeanne Marrazzo: [00:02:42] So it's quite possible that that was the source. But this is really speculative. And I want to, uh, to emphasize that. We also learned hours ago that a flight attendant who worked that flight is now being cared for. This is the flight that the ill woman of the husband who died on the boat took to South Africa after leaving Saint Helena. Um, a flight attendant who worked that flight is now being cared for with some symptoms at a hospital in Amsterdam. We don't have a lot of information on this, but my interpretation is that given that the cruise ship passenger on that flight died immediately upon arrival at the airport, it's likely that she was symptomatic on the plane. The flight attendant, unsung heroes, often in these situations, may have been exposed to her when she was taking, I'm sure she was probably taking care of her or attending to her. We do know that when people are very symptomatic, particularly with fever, that is when they are most infectious for this virus. And we're going to hear more about that from Dr. Del Rio when I hand it off to him in a minute.

Jeanne Marrazzo: [00:03:49] A couple of other updates during that stop in Saint Helena, so when the wife disembarked, who ultimately died at the South Africa airport. 29 other passengers also left that vessel, and that's actually relatively new information. We believe, again, we believe that six of these are Americans. These include people from Georgia, Arizona, California, at least some of these are being monitored by health authorities. So overall, so far, three people have died. Several others are sick. The ship's doctor was evacuated Wednesday while the ship was near the West African island country of Cape Verde and taken to Europe for treatment. The body of the third fatality, a German woman, is still on board the ship. So the vessel, as you now know, is still at sea. Um, it is near the Canary Islands. There are still a number of people on board and we're following this very, very, very closely. The Ande strain that I mentioned is the only hantavirus strain that we are aware can spread from human to human. Typically people are exposed from excreta of rodents like feces, urine and saliva. So now that we know it's the Andes virus, I'm going to turn this over to Dr. Del Rio, who's going to comment on the virus, some of the clinical manifestations and some of the implications for public health and infectiousness. And then we'll turn it over to your questions.

Carlos del Rio: [00:05:13] Thank you very much, Doctor Marrazzo. Hantavirus is, as you mentioned, is the name of given to a group of viruses that carries is carried by rodents and transmitted by their droppings and urines. These viruses were first identified during the Korean War. And in fact, it was the, uh, the name hantavirus comes from a river, the Hantaan virus, which is in Korea, right south of the of the demilitarized zone. Uh, they cause a wide range of diseases from a mild flu like illness to severe respiratory distress syndrome. And in fact, it also causes a renal insufficiency syndrome, uh, sort of shuts down the kidneys and the person will require dialysis. Infections in humans are rare in the United States. The first outbreak was recognized in 1993 in the Four Corners states, and since then about 1000 cases have occurred, mostly west of the of the Mississippi. They tend to occur in places where people and rodents coexist, most commonly in rural areas, agricultural settings. And the virus, you know, sometimes is seen when you're cleaning a barn or cleaning a home. Most hantavirus do not spread easily between humans. In fact, there's very little known about human-to-human transmission. Probably the only hantavirus that is known to spread human to human is, as you mentioned, is the so-called Andes strain of hantavirus.

Carlos del Rio: [00:06:37] And an outbreak in Argentina that occurred in 2018, 2019 is really the only one that that we know about. So, so it is a, it's a virus of which we don't know a lot. And we still are studying. At this point in time, my feeling is that what we know is, is that it's unlikely to transmit very effectively. The reproductive number is fairly low. It is transmitted in a very short period of time. So the risk to the general public is small. But I think this outbreak is an opportunity for us to learn a lot more about the transmission of this virus and what happens to individuals who get sick with this virus. I would say that from past experience, the mortality rate is high. It's about 30 to 40%. And it's worth noting that for none of the hantavirus, we have a vaccine and for not, we have we don't have effective or specific treatments, specific antivirals. When you say somebody was evacuated to be treated, what are we talking about is really placing them in intensive care unit, giving them respiratory support with a ventilator, give them ECMO, doing other things in the ICU to keep them alive until they recover from the virus. But, you know, research to help us develop vaccines and develop treatments is urgently needed. And I think this is a good example of why ongoing infectious disease research needs to continue and cannot stop. I will turn it over now to Dr. Marazzo and open for questions.

Jeanne Marrazzo: [00:07:59] Carlos, thank you so much. That was that was terrific. Um, one thing I'd add when we talk about those high mortality rates, um, we often don't know what the denominator of people infected is because mild cases might be missed. So while those are very scary number, remember, it's not like you can go into a drugstore and buy a test to detect this infection. You've got to send your samples to specialized laboratories, including the CDC. Which gets me to my next comment, which Carlos alluded to, which, as you know, we have seen large scale funding and workforce cuts made in the last year, not just to the centers for Disease Control and Prevention, but to global health. Our withdrawal from WHO, our decimation of USAID and also cuts to scientific research, particularly the development of mRNA viruses and to public health. So all of these things are having really profound ripple effects. And as Carlos said, this is a situation where you really are seeing crystallized the need for bio preparedness. And without adequate funding, without adequate bio preparedness and without adequate workforce capacity, everybody from infectious disease physicians to people who screen passengers on cruise ships, to people at CDC who are responsible for making sure that health on cruise ships is maintained and if there is an outbreak, can be tracked.

Jeanne Marrazzo: [00:09:24] These things are all really not robust right now because of what's been going on. So I think there are many examples. We can see this as a sentinel event. It's not limited to hantavirus. It's really how well the country is prepared for a disease threat. And right now, I'm very sorry to say that we are not prepared. And part of our job at IDSA, before I turn to the questions, is just to remind people that we advocate for federal policies that strengthen the country's bio preparedness, increase the workforce capacity, invest in public health, and restore research funding. So we really need our federal policy makers here to take action for everybody, um, for benefit to benefit everybody in the United States and indeed globally. So I am going to stop there and turn it over for some questions. And it looks like this morning's first question comes from Margaret at notice. Margaret, please unmute your line to ask your question. And I think maybe Carlos will ask you to take this one unless it makes sense for me to do so.

Caller 1: [00:10:27] Hi. Yes. Thank you so much for holding this briefing. Um, this is a question, I guess, for both of you. Could you speak a little bit more to what exactly you would expect from the CDC and NIH in this outbreak? Are there, you know, additional response groups that you would expect to be involved? I've seen reports about cuts to the CDC's vessel sanitation program. Is that something that you would expect to be involved at this point? Um, and yeah, just beyond briefings, is there anything else that you would normally see them doing at this point?

Carlos del Rio: [00:10:58] As somebody living in Atlanta with very close proximity to CDC and a lot of friends working at CDC, I would say what you typically would see in something like this, and let's go back to Covid, for example, when remember the first outbreaks occurred in cruise ships. CDC would typically be asked by WHO to or by our country to help in technical assistance. And we would then not uncommonly have a team from CDC deploy to that area to provide technical assistance to provide to help with epi tracing, to do interviews, to do, you know, uh, to obtain samples,  to do many of the things that are necessary in order to really investigate the outbreak. Outbreak investigation is what CDC does and what they, they do very, very effectively. So I would envision that by now, many, many days ago, we would have seen a, you know, a team from CDC deployed to the area. And we haven't seen that. So to me, we also would have had a press briefing from CDC. We would have had information coming. CDC typically would put out something called HANS, the Health Alert Network notice when something happens. And we haven't seen a hand related to this. So a lot of the things that you would like to see, we haven't seen. And to me that that's very concerning, that the silence that we're seeing from our premier public health institution is really concerning to me.

Jeanne Marrazzo: [00:12:16] And, Margaret, let me just build on that. If you go to the health alert network, the HAN, that Carlos just mentioned at the CDC, it's defined as the CDC's primary method of sharing clear information about urgent public health incidents. And the last hand on that page is from April 2nd, 2026. So this, to me, not overstating it, is a travesty in terms of NIH response. Again, I don't know what's going on at the NIH because we haven't heard anything. I hope people are mobilizing and they're convening people across the spheres of academics, researchers, public health industry, all of those people, because we really want to make sure we know whether there are any agents in the pipeline to treat these folks right. There are monoclonal antibodies out there that are experimental that in an emergency like this, you would very much like to be talking to people about urgently getting an emergency authorization for. Right. Because again, because of the high level of fatality for this disease. So, I mean, maybe that stuff is happening, but it does not give me a lot of assurance or reassurance that we're not hearing about any of it. It's very, very concerning. So thanks Carlos for that and thanks. Thanks, Margaret, for that, for that question. Let's go to Mike from the Associated Press. Mike, please unmute your line to ask your question.

Caller 2: [00:13:36] Uh, good morning. Thank you for doing this. I have two questions. Uh, what's our best understanding, if it's transmitting between people, how is it transmitting? Is it are people coughing and there are droplets? Is it on your hands and people touch surfaces? Is there any information we have about how that might be happening? And also, I was wondering if you could comment on what we know, if anything, about contact tracing that's going on in the United States with those folks who disembarked on April 24th.

Jeanne Marrazzo: [00:14:06] Let me take the first piece. And then, Carlos, why don't you take the one about contact tracing? Because I think you know, a little bit more about that. So in answer to your first question about human to human transmission, again, theoretically, both potential methods, people could have infected material on their hands. They could potentially transmit it that way. But we believe, at least from the outbreak in Argentina that occurred that was written up in the New England Journal several years ago, pre-pandemic, that it probably is transmitted through respiratory material, whether it's airborne, whether it's droplet, we don't really know. But again, the period of infectiousness in that outbreak, one silver lining here, did appear to be very brief. It was when people had fever the first day they got fever. So one hope is that even though the incubation period of this virus is very long, we haven't talked about that. It's 1 to 7 weeks, which is another reason contact tracing and potential limitation limiting of exposure is going to be a real challenge, even though that this is really scary, the fact that maybe the infectiousness is limited to a single day or so might help us, but I think the respiratory route is probably most likely. Carlos, why don't you comment on contact tracing, please?

Carlos del Rio: [00:15:24] First of all, I would just say on the transmission, there's a lot of information we don't know. And it's just this outbreak is a great opportunity to learn a little more about how the transmission is occurring, because a lot of it is very interesting. In the previous outbreak in Argentina, there were clearly what we call superspreaders individuals that were able to transmit to a lot of people. But there was also evidence that you need as well, very close contact, for example. And what I mean by close contact is sharing a bed or having sexual intercourse with somebody. But at the same time, in this case, we, we in this outbreak, we may be seeing a flight attendant that took care of a patient on a flight. So there's a lot of information we don't know. And I want to emphasize to people the importance of hygiene, the importance of respiratory precautions, wearing a mask, etc. As far as what happens, as Dr. Marrazzo says, the incubation period could be, it's typically 14 to 17 days, but could be as long as eight weeks. In the previous outbreak in Argentina, the incubation period was a lot shorter. It was probably in the neighborhood of about a week, to ten days. So what happens? Well, you know, 17 passengers disembarked...I think 24 passengers I can't remember.

Jeanne Marrazzo: [00:16:41] - in Saint Helena, yeah.

Carlos del Rio: [00:16:42] In Saint Helena, of which some are Americans. There's I think six Americans. There's also 17 Americans still on board. Those Americans, you know, then went back to the US. And there was really very little information of them. Again, very important to have information on all passengers. So you can actually do contact tracing. Having said that, we know that one is in Arizona, that two are in Georgia, and that the rest are in California. And from what I understand, uh, as of today, what I information I received is that they all have been at least the ones in Arizona and in, in Georgia have been contacted. They've been being followed. And at this point in time, they're asymptomatic. But if I was one of the passengers, I would be exceedingly careful because you don't know how long the incubation period is. You don't know when the onset of symptoms are going to be. They obviously can be can be tested. You can detect a, you know, the virus in the in the blood by PCR before the onset of symptoms. So I think blood testing needs to be done. And again, knowing who they have been in contact with, I think the problem also you have is people that got on a plane and they didn't know they were infected. So other people close to them on the plane could have gotten infected. So really, the ripple effect of this outbreak is much higher. It's much bigger than just the passengers of the cruise ship.

Jeanne Marrazzo: [00:17:57] Yeah. Excellent points. The other thing I wanted to add to that, um, is that this whole issue of transmissibility, you know we have to emphasize what we know might change tomorrow, what we know, what we're saying might change in an hour. We really have to have humility here in terms of making pronouncements about definitive routes and percentages and transmission in particular, because this is changing very rapidly. And as Carlos said, we're going to learn a lot from this outbreak, unfortunately, at the cost of lives. But we really need to sort of approach this cautiously in terms of giving people advice and coming up with some policy. Okay. Thanks, Carlos. Next is Maya from Axios. Maya, please unmute your line. Oh, I think you lowered your hand. I'm sorry. As did our colleague from Politico. Uh, Gabrielle from NPR. Don't hear Gabrielle, but if if you do come back, please put your statement in the chat. In the chat. Um, we do have an email question from Mary at ProMED. And Carlos, I'm going to read this. Should pandemic prevention measures be different when cruise ships, especially expedition vessels are involved? Frequent mandatory and innovative testing and prior agreements to comply with control measures. Tricky to determine and implement, but is that worth considering? Carlos, you want to comment on that one?

Carlos del Rio: [00:19:29] Well I mean it's not only ships, we're all going to places we didn't go before. Right. Expeditions and people were taking more adventurous travel. I think about people going, you know, fishing in the Amazonian jungle, who then could be exposed to yellow fever and they need to get yellow fever vaccine, but some of them don't. And then we see them back in in the US or in other places with yellow fever after they've been got infected. So I think we're traveling more. We're more likely to be in places that we normally didn't go to. And I think it's that interaction that getting close to nature in places where we're not typically gone, it's beautiful. You'll see things you've never seen before. But at the same time, we don't know what the risks involved. I think what's very, very important is that we need, you know, basic principles of hygiene. I'm going to go back to the importance of hand hygiene really critically important. But I'm also going to go importance about, you know, making sure that nobody's sick on board a ship or aboard a plane, ensuring that, you know, you have information about that individual as they go to other places and the ships need to be, you know, very, very clean. There's a CDC had and hopefully continues to have groups that inspects cruise ships that ensures that there's a complete sanitation on board. Cruise ships are known for other types of outbreaks, for example, norovirus, respiratory viruses, influenza, Covid 19. And those are the things that tend to be spread in close quarters. But other things can happen. I frankly, if somebody had said to me, oh, we're going to see a hantavirus outbreak on a cruise ship, that would have been like the hundredth thing I would have to think about it.

Jeanne Marrazzo: [00:21:02] Not on your bingo card.

Carlos del Rio: [00:21:03] It's not on my bingo card. So obviously, you know, again, things that we're learning are because of things that we're doing that we didn't used to do before. And therefore we need to, yes, we need to be on board and we need to be, uh, you know, awake and we need to be aware and we need to rapidly respond to outbreaks. To contain them, but also because this is how we learn and this is how we prevent other things in the future, what impact is this is going to be in future travels to Antarctica? I really don't know. But I suspect that Argentinian authorities in Australia, I know they're rapidly going and trying to figure out what's going on, because this is a very important industry for them. People going to Antarctica and leaving out of Australia. And they, you know, all of a sudden passengers are not going there. That's going to be an impact in their economy. So I'm sure the health authorities and the political authorities in Argentina are very concerned about that.

Jeanne Marrazzo: [00:21:51] Yeah. And reminder what the hit that the tourism industry hit you had with the pandemic. I mean, some of the many people went out of business. Um, many entities are still trying to recover. I want to take this opportunity because you mentioned the Amazon and adventure travel to point out another very short sighted decision by the administration. You may not be aware. You may remember that last June, there was a nice article in science publicizing the fact that NIH terminated a network of research centers that were aimed at stopping pandemics before they start. Those were the ten centers for Research and Emerging Infectious Diseases. I know that because I visited this group in Brazil, who was looking at emerging vector borne viruses, like chikungunya or Oropouche dengue. Um, and those centers have now been unfunded for well, almost a year. So again, don't understand why these decisions are made. They put us back. They are making us be less prepared for exactly this type of thing. We need to understand where these infections are coming from, the environment so people can protect themselves when they do travel to some of these more remote areas, or when they get on a plane. Right. Okay. So let's go to Leanne from CBS news. Please unmute your phone.

Caller 3: [00:23:05] Thank you doctor. Good to see you both. Um, I have two questions when you talk about the blood test, could you clarify if a blood test is definitive if it's taken before there are symptoms? Or is it only positive when there are symptoms? And secondly, given the unknowns and as you said, the humility we need, um what is the best course of action with the passenger still on the ship, given that we don't want them to possibly expose others, but we also probably don't want them in the middle of the ocean if they do need urgent care like ECMO. Thank you.

Carlos del Rio: [00:23:40] So a positive PCR for hantavirus is a way to confirm the infection is occurring. It detects the virus's RNA and you can detect it. It becomes positive roughly about five days or so before the onset of symptoms. And what it will tell you is that the person is infected, have not yet developed symptoms. But again, the virus starts to replicate. Then the levels rapidly increase. And then that's when the person becomes infectious and becomes infectious, probably from at the time that they start developing symptoms when they develop fever, not before. So really, an asymptomatic person is not transmitting this disease, but you can detect it before about a five days or so before. I think it's also, as Dr. Marrazzo said at the beginning of this, I think this this outbreak gives us an opportunity to truly understand, you know, what the denominator is. Again, we talk about the 40% mortality, but it may be that a lot of people got infected and are asymptomatic or mildly symptomatic, and therefore the mortality may be lower. We don't know those findings. And again, this this outbreak gives an opportunity to try to understand better the virus, the dynamics, the transmission, and really what the spectrum of disease happens to be.

Jeanne Marrazzo: [00:24:52] Leanne, you raised a really critical point. And this is the concept of leaving sick people on the ship. Last night, a reporter asked me about what the responsibility is of ports to allow passengers to disembark. And I think it brings up two key questions in that Argentina outbreak, there were, um, some nosocomial transmissions. So there were some health care workers who got infected from people who were part of that outbreak. But PPE, appropriate PPE in health care workers, including things like N95s, probably will prevent that. So I think health care workers, if they are appropriately using PPE, should feel relatively comfortable. Again, this is early days, but they should feel able to take care of these patients. So not taking care of patients because of those concerns is similar to Ebola or anything else is not an issue. The other thing is this is not a disease I would want when I was on a cruise ship. As you mentioned, ECMO, intubation, all kinds of things. People get critically ill very fast. They can go from just having upper respiratory symptoms to not being able to breathe and having complete body shutdown in hours. So really important point. We got to take care of these people. I really can't emphasize that enough.

Carlos del Rio: [00:26:10] If I can add something there, Dr. Marrazzo, is that we also need to remember that in the US after the Ebola outbreak, the national emergency, you know, Special Pathogens Training and Education Center at the Department of...established the at US health care systems across the country, there are ten regional emergency special pathogen treatment units. And these are facilities. One of them we have it at Emory University in region four, that really specialized in the care of people with you know, high communicable diseases like Ebola, like hantavirus. So one of the Americans were to get sick, that's one of the places that you want to send them, because these units are not, they're special units that are actually trained to manage this individuals and to prevent nosocomial spread from happening. So funding those units is like funding your fire department. You need to have them in cases like this in case you need a patient transfer there. And we need those are the kinds of investments that are very important that we do not cut in the future.

Jeanne Marrazzo: [00:27:12] I could not agree more. Thanks for bringing that up. And I will remind people that those centers are largely funded by NIH. And I would be very concerned about the continuity of the funding for those centers in the current environment. So as Carlos mentioned, we really, really need them. All right. Next we have Patrick from NBC News. Patrick, please go ahead.

Caller 4: [00:27:33] Hi. Thank you for taking my question. So I was just curious. We talked about the incubation period, but is there a standard operating procedure for quarantine for these people? How long are they going to have to stay quarantined?

Jeanne Marrazzo: [00:27:47] I don't know, this is a fantastic question. And I think Carlos alluded to this before in the Argentina outbreak, when people got sick after exposure, it happened relatively quickly. Um, so you could imagine that you could implement quarantine for the period where people were most likely to get sick. Maybe that's two weeks, maybe it's three weeks. We don't really know. And I have not seen any specific guidance on that. The WHO is doing a press briefing at the same time as we are. And in fact, Dr. Maria Van Kerkhove was supposed to join us this morning and had to divert because of that. And maybe we'll hear some more guidance from WHO in that press briefing. Carlos, what do you think?

Carlos del Rio: [00:28:34] You know, this is a fascinating question, something I've been thinking about. How long do you keep people isolated? Because, you know, do you go all the way to eight weeks? I think that what we understand from the Andes outbreak is the transmission, people got infected fairly quickly. The transmission was fairly soon after exposure. The manifestations were fairly soon after exposure. So I would say that after the last contact with an infected individual, I would assume 2 to 3 weeks would be the time that I would keep somebody probably in quarantine and, and then go and, and do blood testing at the end of quarantine. If they're negative at that point in time, I would probably say that you could lift the quarantine. But this is really based on just that one outbreak that we know about. And this outbreak may be very different. So I think we're learning as we go along, I think as we hear from. But so far, what we've heard, for example, think about that flight attendant. She was on a flight with somebody and see when she got infected. So the contact again, we are seeing the same thing we saw in Argentina. Fairly quick presentation. Now there may be cases that happened, you know, 6 to 8 weeks from now. That wasn't the case in Argentina. And I suspect it's not going to be the case here, but it's something that is always in the back of our mind.

Jeanne Marrazzo: [00:29:48] Yeah. And also just a reminder that the diaspora of contacts is going to be huge, right? People are flying fly to South Africa. You get a connection to other places. Some of the places people are going to may not have the capacity to screen or may not have the capacity to do intensive contact follow up. So this is another reason that we need a really robust public health infrastructure. All right. I believe it's Valeria from the Public Good Projects right now. Valeria. Go ahead.

Caller 5: [00:30:19] Hi. Can you hear me?

Jeanne Marrazzo: [00:30:20] Yes.

Caller 5: [00:30:21] Okay. Thank you so much for this briefing and information. Um, I'm just curious, like, is there anything in particular that the general public can do to prevent getting infected, especially in the US, like from hantavirus in general. Uh. Anything I know Dr. Del Rio mentioned hygiene and like, you know, good hygiene and everything, but like, is there anything in general that people should know about prevention right now? And also, what would you say to people worried about, you know, is this the next pandemic? Um, it's going to get us bad? What would you say to that? 

Carlos del Rio: [00:30:58] Well, I would, I would start by saying that for the general public, for the average person in the US, uh, this is not a concern. Uh, I would worry. I tell people I would be more concerned about getting my car or crossing the street and having an accident than getting hantavirus. So I think we need to put things in perspective. From an infectious disease perspective, I am I'm not worried about this outbreak becoming a pandemic. I'm incredibly curious about what's going on. And I want to understand more. And I want to learn more. And I think it's a great opportunity to learn more. Uh, for the average American, I go back to saying hand hygiene is very important. You know, respiratory hygiene is very important. If you're sick, you should stay home. If you're sick, you should go to the doctor fairly soon. Uh, if you've been in a trip, I think, you know, developing symptoms after a trip is something that you need to rapidly get in touch with, with health care facilities and let them know. One of the things that we infectious disease doctors do is we take a travel history when somebody shows up. So I think it's very important that, as I said, we travel down all over the world. So it's very common to I see a patient with fever.

Carlos del Rio: [00:32:03] Well, yep that patient was in Rwanda two weeks ago. And what does that mean? What is the likelihood that they'll have a disease. Did they take malaria prophylaxis or not. Malaria continues to be the number one, uh, problem that we see in returning travelers that are critically ill. But we also see diarrheal illness. We see other diseases. So again, remind Americans that travel is very important to do your pretravel health consultation, get the appropriate vaccines, get the appropriate antibiotics, Get the appropriate tests that you need before you travel and then when you come back, if you're sick, you know you got to go back and let them know, hey, I was here, I was there, this is what I have. Uh, do I worry about this hantavirus? Specifically recommendations for hantavirus? Absolutely not. I don't think we need to worry about that. But I would say, you know, if you if you. I'll give you a personal experience. I was traveling in the Sierra Nevada region last August, and I was in a remote place, in a cabin. And I arrived late at night and, you know, used the bathroom and the lighting was not very good. And then the next day I saw that there was some urine and, and, you know, mice droppings in the bathroom.

Carlos del Rio: [00:33:08] And then I looked at my shower and guess what? There was a mouse that transmits hantavirus there in my room. So obviously I had been exposed to the urine. I had been exposed to the aerosolized, uh, you know, uh, droppings. And there had just been a couple cases in, in Douglas County happening right before we were there. And me and my wife were immediately saying, okay, when are we going to get sick? What do we need to do? So. And nothing happens. So again, transmission of this virus is, not everybody gets infected and you need to have to begin with the vector needs to be infected. I suspect maybe I didn't test them, but I suspect that little mouse that was in my cabin probably didn't have the infection. So it is...There's a lot of questions here. And you know, when you travel, a lot of things happen. But for the average American, my, my recommendation would be what you need to do is you need to call your congressperson and say, continue funding CDC, continue funding NIH, continue funding bio preparedness. By keeping those organizations funded and functional, we're protecting the health of Americans.

Jeanne Marrazzo: [00:34:07] And continue to support the ID workforce and public health workforce. Um, one question we get a lot about the rodent thing is, is my common house mouse a problem? If I find a house in my basement, a mouse in my basement, and the answer is no, it's not the mus musculus, which is your common house mouse. It's actually the deer mouse in the United States. And in every place you look, you know, the vectors or the rodents. Each rodent, each virus strain has a specific rodent, it turns out. So in Europe it's something called the bank vole. So it's largely wild rodents who can end up in our in our in our houses, though in our cabins as, as Carlos said. So I wouldn't be worried about your common house mouse, which is something I think that is is somewhat reassuring. All right. Let's go to Jonathan from the Bulwark. Hi, Jonathan.
Caller 6: [00:34:57] Hey, can you hear me? Okay.

Jeanne Marrazzo: [00:34:58] Perfect.

Caller 6: [00:34:59] Terrific. Thank you so much for doing this. I just want to double check. So I'm thinking you're both saying. And you were just saying, doctor, uh, that, uh, you're not too concerned about this, and I want to make sure I understand why you're not too concerned. Is that because basically, uh, assuming this looks like what we think it looks like, um, it really takes very close contact. Uh, you know, like this flight attendant, you know, maybe caring for this patient in order to get, uh, to get the human to human transmission, and that even though there might be people now scattered all over the world, you figure between contact tracing and isolating, you can isolate it.

Jeanne Marrazzo: [00:35:34] No. Let me jump in there because I'm going to, um, take Carlos's words maybe. I am very concerned and I, and I think Carlos is too, but I'm going to let him speak for himself. But I am very concerned because this episode of what it might be, an inflight transmission is unprecedented. And, um, that's very concerning. Other people were sitting close to that passenger, and if she was as sick as it seemed, she was dying upon arrival at the airport, that could spark a pretty serious chain of transmission. So I think what I'm trying to say, and I suspect what Carlos was trying to say, is that our level of concern should be really high, elevated, escalated. But don't panic. It's not the situation where it's going to start outbreak everywhere in the world, across the world, from probably the sort of little kindling cases. We don't know that yet, but we really have to sort of try to just be calm and focus on the context and look at the risk in those situations. Carlos, go ahead, please comment.

Carlos del Rio: [00:36:36] I think you said exactly what I think. I mean, is this going to become another pandemic? No. Are we learning a lot? Yes. And is this something that I you know, that again, some funny total, totally unprecedented yet. And that becomes concerning. Right. But I think I want to bring up another issue that I think we have not talked about and is very important. Argentina has actually seen a significant increase in cases of Andes antivirus. And this past through this past year, there have been over 100 cases of hantavirus in Argentina. Uh, this is roughly double the number of cases seen last year. And more than, more than was seen the year before. And what is causing that? Well, the main cause of that is climate change. Argentina is becoming more tropical. Uh, and therefore we're seeing, you know, uh, disruptions in the environment. We're seeing the ecosystems change. We're seeing, uh, the rodents, the, the vectors go to places that they didn't go before. We're seeing, uh, they thrive in more places. And we're seeing that not only in hantavirus, we're seeing that globally in other diseases such as dengue, yellow fever and other tropical diseases. So I think we need to go back to say what is why is this happening? And is this happening because of cruise ships? No, this is happening because of climate change. This is happening before individuals travel to places they didn't used to go before. And therefore the whole ecosystem and the whole risk is changing on a day to day basis. And I think we need to not forget the impact of climate change. And climate change is not a hoax. Climate change is a reality, and it has a significant impact on infectious diseases.

Jeanne Marrazzo: [00:38:17] Carlos, thank you. That is so critical. And, you know, again, we're focusing on the cruise ship here because, I mean, it's a pretty amazing story, a tragic story, but the cruise ship is kind of a bit player. Um, it just happened to be a great incubation incubator for transmission of this virus. But the real culprit, the real source almost certainly is back in Argentina, as we mentioned early on. And we're seeing the spread of tons of vector borne diseases into places have not seen it before. If you look at the range of malaria and dengue, we're not seeing cases in the United States that are autochthonous or endemic from the United States. So really, really, really critical. And that's sadly what the Centers for Research in Emerging Infectious Diseases, the CREIDs, set up to do, the ones that were unfunded as of last June. All right. Let's go back to Mike at the AP. Mike, I think you had a follow up question.

Caller 2: [00:39:10] Um, I did, thanks. Actually slightly different. I was wondering about the possibility that this is signs of a new strain. Do we think it's basically the same Andes virus or is there testing going on to see if there's been a recent mutation? I'm wondering if you can help us with that. Thank you.

Jeanne Marrazzo: [00:39:28] So I'll just start really quickly. Um, we don't know. Um the South African lab that has been doing the sequencing is continuing to work on it. And I'm sure samples are now, uh, have been obtained and sent to other labs, given that we have other patients in the, um, Argentinian outbreak from a few years ago, one reassuring thing, they did beautiful genetic epidemiology, um, from the Argentine science community, which we owe a real debt to, um, to, to, to understand that outbreak. It didn't look like in that particular outbreak, there was a significant series of mutations that happened over time. That's very different than something like the respiratory viruses that we worry about so much Covid, influenza, right. Covid, we knew mutated very rapidly. We were looking at different strains constantly. Hopefully that won't happen with this, although given that we don't have any licensed treatments. Um, you know, it may not really matter because we're still not in a very good place.

Carlos del Rio: [00:40:29] Yeah. The only thing I would add to that, I agree 100%. The only thing I would add is, is that the fact that it's South Africa that is doing the testing is a testament of the importance of global health investments. It is the work that was done, uh, setting up infrastructure through PEPFAR in HIV to do genetic sequencing of HIV that is now paying off, being able to do genetic sequencing of viruses like this virus. And again, investments in global health are significant, are important. And I worry that as we disinvest in global health, we're losing our capacity, our global capacity to, to deal with diseases. What South Africa is doing is not accidental. As a result of significant investment in science in South Africa that was done through PEPFAR and many other organizations.

Jeanne Marrazzo: [00:41:22] Absolutely. I know firsthand the investment in South Africa from NIAID was substantial and huge. And many of the people who are now globally famous scientists in South Africa, um, have either trained or worked very closely with us scientists and have grown up in those systems that were supported by NIH. And those are very, very much at risk and really could put us in at an additional disadvantage. All right. Um. Now let's go to Anthony from Helio. Anthony, please go ahead.

Caller 7: [00:41:57] Hi. Uh, thank you so much for hosting this meeting and taking my question. Would this meeting not be happening if the CDC hadn't been so silent on this situation? And, uh, I guess in other words, do you feel that it's now your responsibility to fill the gaps of communication and get the facts out on this virus?

Jeanne Marrazzo: [00:42:19] Very insightful, incisive question. And the answer is yes. I can tell you that in my four months now, almost four months of being the CEO at IDSA, we have been approached and asked to fill many gaps, many of them informational, informational. Many of them related to guidance about conditions that just are not really being addressed or populations that have been frankly, um, disenfranchised, uh, by our health authorities. So, um, I, you know, it's possible that even with good CDC and, uh, US government updates, we would still be doing this because we want to support our members. We want to support communication with people in the media like you who are really our, you know, our ambassadors into the world in terms of information and countering misinformation. But as you can tell from my comment about the health advisory network that that is not made a statement about this from CDC, There is a huge void right now, and I think that professional societies like ours, working with our colleagues across the globe, working with public health authorities, have to urgently fill that gap. And that's exactly what we're trying to do. Thanks for asking.

Carlos del Rio: [00:43:36] And I would just add to that, that, again, if I go back to Covid, IDSA was partnered with CDC in something called the Clinician Calls. So the difference, I think would have been, we would still be hosting this call. It's important for us to inform our members. It's important for us to inform the press. We want to be a trusted source of a source of information. But I think missing in this in this press briefing is somebody from CDC. We would have loved to have somebody from CDC join us at this press briefing. We would have loved to have somebody from WHO, which unfortunately was going to join us, but unfortunately wasn't able to. But we want to be sure that we partner with our health authorities and helping them get the information out. Getting information during outbreaks is probably one of the most important things we can do as a society.

Jeanne Marrazzo: [00:44:21] Absolutely. And believe me, we would love to have had someone from CDC here or NIH for that matter. So it's certainly not about us wanting to take over the turf at all. It really takes a, it takes a lot of people to get the facts right, to emphasize that the facts are changing by the minute as these things evolve. And our guidance is going to necessarily and transparently change as we learn more. So I am going to wrap us up. I really can't thank our team enough at IDSA. And Dr. Del Rio for participating, this morning, all of you, for your excellent questions. If you'd like more information on the Infectious Disease Society of America, you can visit us at idsociety.org. And we will look forward to hopefully updating you more as the situation evolves. So thanks everybody, and stay safe out there.