By Stan Deresinski, MD, FACP, FIDSA
On Feb. 26, 2025, it was announced that the bodies of actor Gene Hackman and his wife and caregiver Betsy Arakawa had been found in their Santa Fe, NM, home.1 It subsequently was reported that Arakawa had died of infection with the Sin Nombre hantavirus, and that Hackman, who was 95 years of age and had severe dementia, had died of cardiac disease seven days after the death of his caretaker.1 A dog kept in a cage because it had undergone surgery also was dead; two other dogs were found alive.
In 1993, an outbreak of infections due to a previously unknown hantavirus (eventually given the name Sin Nombre, or “no name” in Spanish) centered in the region where New Mexico, Utah, Arizona, and Colorado meet, known as the Four Corners. The outbreak resulted in 63 cases, with a 60% case fatality rate by the end of the year. Originally called the Four Corners virus, the name of the virus was changed after objections from residents of the area. The primary host of the Sin Nombre virus is the deer mouse, and infection results from contact with their droppings, urine, saliva, or nesting material.
Another outbreak of Sin Nombre infection of note occurred in Curry Village in Yosemite National Park in 2011 and affected 10 individuals, nine of whom had hantavirus cardiopulmonary syndrome and three of whom died.2 Nine had stayed in tented cabins where rodents were found in the wall insulation. Further cases did not occur after control of the rodents.
While Sin Nombre and other New World hantaviruses cause a cardiopulmonary syndrome (CPS), other Old World hantaviruses, each associated with a specific primary rodent host, often cause a hemorrhagic fever with renal syndrome (HFRS). An exception to this dichotomy is the Seoul hantavirus, which is a cause of HFRS in the United States. Human-to-human transmission of hantavirus infection does not occur, with the possible exception of the Andes virus, which, as its name implies, is found in South America.
The initial symptoms of infection are nonspecific with, among others, fever, cough, and myalgias.3 With progression to CPS, respiratory symptoms worsen around day 7 and then progress rapidly, consistent with acute respiratory distress syndrome (ARDS), leading to a need for ventilatory support within 24 hours. At this point, survival depends on rapid implementation of intensive care and may require extracorporeal membrane oxygenation (ECMO) in some cases.
There is no specific treatment for hantavirus infection and no vaccine. Prevention consists of control and avoidance of rodents and their body fluids and excreta. Laboratory diagnosis is made by antibody testing and polymerase chain reaction (PCR) at a reference site. Although the Centers for Disease Control and Prevention (CDC) states that they as well as public health laboratories perform testing, the CDC web site indicates the test order is unavailable until further notice.4
Stan Deresinski, MD, FACP, FIDSA, is Clinical Professor of Medicine, Stanford University.
References
1. NMHealth. Hantavirus death confirmed in Santa Fe County woman. March 7, 2025.https://www.nmhealth.org/news/awareness/2025/3/?view=2189
2. Deresinski S. The ‘No Name Virus’ in the land of ‘Those Who Kill’: Hantavirus in Yosemite. Infectious Disease Alert. 2012;32:145-147.
3. Centers for Disease Control and Prevention. Clinician Brief: Hantavirus Pulmonary Syndrome. May 23, 2024. https://www.cdc.gov/hantavirus/hcp/clinical-overview/hps.html
4. Centers for Disease Control and Prevention. Infectious Diseases Laboratories. Test Order. Hantavirus Testing. https://www.cdc.gov/laboratory/specimen-submission/detail.html?CDCTestCode=CDC-10319
There is no specific treatment for hantavirus infection and no vaccine. Prevention consists of control and avoidance of rodents and their body fluids and excreta.
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