What Flight Attendants Need to Know about Hantaviruses

The World Health Organization (WHO) is monitoring five confirmed hantavirus infections that have been identified among people connected to the cruise ship MV Hondius. On May 7, Dutch media reported that one person who went to an Amsterdam hospital for testing is a KLM airline crew member who had contact with a 69-year-old Dutch woman who died in South Africa last month. The results of their test are not known yet. 

This is concerning, especially with the involvement of a KLM crew. However, this virus is recognized (unlike COVID-19 was in 2020) and is known to not regularly spread from human to human. We will continue to monitor the developments from WHO officials. For now, make sure you know what hantaviruses are and how to protect yourself. 

ITF Statement

What are Hantaviruses?

Hantaviruses are a family of viruses, most of which are spread by either inhaling contaminated rodent droppings/urine or getting bitten/scratched by a rodent. The risk of person-to-person transmission is considered low, but one type of hantavirus (Andes) is transmitted by close contact between people. Flight attendants may be exposed to hantavirus by close contact with infected passengers. CDC information site.

Occupational guidelines

• Cabin environment: Flight attendants should report sightings of rodents and rodent droppings. Cleaning staff should clean rodent droppings by wetting down the area with disinfectant or bleach before wiping them up so that the particles are not aerosolized. 

• Mask usage: Wearing a surgical or N-95 mask will mitigate the risk of inhalation exposure. Airlines should make masks available to flight attendants and to any passenger who becomes symptomatic during a flight. 

• Screening passengers: Prior to travel, airlines should notify passengers that if they have had contact with either rodents or symptomatic people within the past 45 days, they must not fly but can rebook their travel for a later date without penalty. Ticket/gate agents should ask all passengers the same questions upon check-in and make an announcement in the boarding area. If a passenger answers in the affirmative, then they should not be boarded to reduce the risk of disease spread onboard. 

• Managing sick passengers: Flight attendants should treat all bodily fluids as infectious. If a passenger shows symptoms (fever, muscle aches, or severe respiratory distress), use personal protective equipment (PPE) from the UPK. 

• Monitor symptoms: Flight attendants who had contact with a symptomatic passenger should notify their airline’s occupational health department immediately. They may be instructed to monitor for symptoms—such as fever, chills, and muscle aches—for up to 45 days. 

• In-flight reporting: The pilot must report any suspected contagious illness to the CDC Port Health Station via Air Traffic Control before arrival.

There are two main groups of hantaviruses: (1) Strains from Asia/Europe can cause Hantavirus Pulmonary Syndrome (HPS) which damages the lungs; and (2) Strains from the Americas can cause Hemorrhagic Fever with Renal Syndrome (HFRS) which damages the kidneys. Both are serious and potentially fatal diseases.

Symptoms of HPS usually start to show 1 to 8 weeks after contact with an infected rodent. Early symptoms can include:

• fatigue

• fever

• muscle aches, especially in the large muscle groups like the thighs, hips, back, and sometimes shoulders

About half of all HPS patients also experience:

• headaches

• dizziness

• chills

• abdominal problems, like nausea, vomiting, diarrhea, and abdominal pain

Symptoms of HFRS usually develop within 1 to 2 weeks after exposure but can take as long as 8 weeks. Initial symptoms begin suddenly and include:

• intense headaches

• back and abdominal pain

• fever/chills

• nausea

• blurred vision

Testing 

Per CDC, “diagnosing hantavirus in a person who has been infected less than 72 hours is difficult. If the initial test is done before the virus can be found, repeat testing is often done 72 hours after symptoms start. Early symptoms such as fever, headache, muscle aches, nausea, and fatigue are easily confused with influenza.” Source: CDC

If you suspect hantavirus disease, see a physician immediately and mention a potential rodent exposure or close contact with a symptomatic person.

Treatment

Per CDC, “there is no specific treatment for hantavirus infection. Patients should receive supportive care, including rest, hydration, and treatment of symptoms.” HPS can cause breathing difficulties, and patients may need breathing support. HFRS can disrupt kidney function and patients may need dialysis.