Hantavirus Pulmonary Syndrome

Hantavirus pulmonary syndrome (HPS) is a viral disease that spreads through infected mice and rats. It can damage your organs and be deadly. Early symptoms include fever, fatigue and aches. Later symptoms include trouble breathing and a rapid heartbeat. Treatment may include oxygen therapy, medications, ventilation and dialysis.


What is hantavirus pulmonary syndrome?

Hantavirus pulmonary syndrome (HPS) is a rare viral disease that can damage your heart, lungs and other organs.

It progresses quickly and can be fatal.

Another name for HPS is hantavirus cardiopulmonary syndrome (HCPS).


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How do you get hantavirus pulmonary syndrome?

People get HPS when they inhale, eat, drink or otherwise come into contact with infected mouse or rat feces (droppings or poop), urine (pee) or saliva (spit).

Can you survive hantavirus?

Yes, you can survive HPS. However, up to 40% of all cases are fatal.

Do all mice and rats carry the hantavirus?

No, not all mice and rats carry hantaviruses. The only mice and rats that carry hantaviruses in North America are:

  • Deer mice.
  • White-footed mice.
  • Rice rats.
  • Cotton rats.

However, you can’t tell if a mouse or rat has a hantavirus just by looking at it. It’s a good idea to be cautious. Avoid wild mice and rats, and safely clean up and disinfect any signs of them in your home, including pee, poop or nests.

Who does hantavirus pulmonary syndrome affect?

HPS can affect anyone who comes in contact with infected mouse or rat poop, pee or spit. Cases occur throughout the world.

In the United States, most cases of HPS occur in states west of the Mississippi River.


How common is hantavirus pulmonary syndrome?

Hantavirus pulmonary syndrome is rare. As of December 2020, there have only been 833 recorded cases of HPS in the United States since medical researchers began tracking it in 1993.

What happens when you have hantavirus pulmonary syndrome?

Once the hantavirus enters your body, it replicates and spreads.

In your lungs, the virus causes your blood vessels to weaken and leak. The air sacs in your lungs can fill with blood, which makes breathing difficult.

In your heart, the virus damages your heart muscle itself and causes your blood vessels to become weak and leak. Weak, leaky blood vessels affect your heart’s ability to pump oxygen-filled blood and nutrients to cells and organs in your body. When your cells and organs can’t get enough blood, your body goes into shock.

If your body goes into shock, you can quickly experience organ failure and die.


Symptoms and Causes

What are the first signs of hantavirus?

Hantavirus causes three different phases of symptoms as the infection progresses.

The first stage of HPS is the incubation (development) phase. This phase can last up to eight weeks. During this period, you have the hantavirus, but you don’t have any outward signs of infection.

The second phase of HPS develops quickly and produces the first signs. They include:

The second phase lasts between two and eight days.

What are the symptoms of later phase hantavirus pulmonary syndrome?

About four to 10 days after early HPS symptoms start, the third phase of symptoms begins. This stage can be severe. It may involve:

  • Internal bleeding.
  • Your lungs filling up with fluid.

These symptoms can cause life-threatening organ and respiratory problems. Signs that you’re entering this phase include:

  • Coughing.
  • Trouble breathing.
  • Rapid heartbeat.
  • Chest tightness.

What causes hantavirus pulmonary syndrome?

Hantaviruses cause HPS. Certain types of mice and rats carry these viruses.

In most cases, people get HPS after inhaling particles from infected mouse poop. However, hantaviruses can also spread through:

  • Bites from an infected mouse or rat.
  • Touching a surface contaminated with infected mouse or rat secretions (poop, pee or spit) and then touching your nose or mouth.
  • Eating food contaminated with infected secretions.

Is it contagious?

HPS is very rarely contagious among people. Medical researchers have only observed a person-to-person transmission through a hantavirus found in Argentina and Chile.

Diagnosis and Tests

How is hantavirus pulmonary syndrome diagnosed?

A healthcare provider will ask about your symptoms and conduct a physical examination. They’ll also ask you questions, such as:

  • Have you had any recent contact with wild mice or rats?
  • Have you recently camped or stayed in a cabin?
  • Do you live or work in wooded areas?
  • Have you noticed any mouse or rat poop around your home or job site?

This information will let the provider know to test for HPS and other diseases that mice and rats carry.

What tests will be done to diagnose hantavirus pulmonary syndrome?

A healthcare provider can diagnose HPS with a blood test.

During a blood test, they’ll use a thin needle (about the size of a small earring) to withdraw a small amount of blood from a vein in your arm. Then, they’ll examine your blood under a microscope to help identify virus antibodies (proteins). Your immune system creates antibodies to help fight infections.

Blood tests can also reveal signs of HPS. These signs may include larger-than-normal white blood cells (part of your body’s immune system that helps fight infections) and an abnormally low amount of platelets (a substance that helps your blood clot). A provider may also check the oxygen levels in your blood.

Management and Treatment

How is hantavirus pulmonary syndrome treated?

It’s important to treat HPS as soon as possible. If you have flu-like symptoms after being around mouse or rat droppings, visit a healthcare provider right away.

HPS treatment usually involves intensive care. Healthcare providers will monitor your needs and may provide specific treatments, including:

In severe cases, providers treat HPS with extracorporeal membrane oxygenation (ECMO).

Does hantavirus pulmonary syndrome go away?

If you survive the first few days of late-stage HPS symptoms, you should start to feel better in a few weeks.

How do I take care of myself?

It’s important to see a healthcare provider if you start to feel sick after being around mouse or rat droppings. Follow your provider’s treatment plan to help ensure a full recovery.

In mild cases, you can help speed up your recovery by getting plenty of rest and drinking lots of fluids.

How soon after treatment will I feel better?

Most people make a complete recovery from HPS a few weeks after starting treatment.


How can I reduce my risk of developing hantavirus pulmonary syndrome?

There isn’t a vaccine for HPS. But there are steps you can take to help reduce your risk, including:

  • Staying away from wild mice and rats, and avoiding areas where they leave droppings.
  • Wearing rubber gloves and a mask that covers your nose and mouth during exposure to mouse and rat droppings.
  • Using disinfectant to sanitize areas that contain mouse or rat droppings.
  • Avoiding sweeping mouse or rat droppings with a broom. Sweeping can cause infected particles to enter dust in the air.
  • Sealing holes in and around your home so mice and rats can’t enter.
  • Setting mouse or rat traps in and around your home to decrease the population.
  • Avoiding leaving food out in your home or while camping.
  • Airing out areas that you know have mice or rats in them.

Outlook / Prognosis

What can I expect if I have hantavirus pulmonary syndrome?

It’s important to get treatment right away if you have HPS. If you don’t receive treatment quickly, HPS can be fatal.

Most people with HPS fully recover with no lasting effects after it’s treated.

Living With

When should I see a healthcare provider?

HPS symptoms are similar to other illnesses, including pneumonia and the flu. Treatment is essential, and HPS can get worse quickly. If you develop HPS symptoms after contact with wild mice or rats or their secretions, contact a healthcare provider.

When can I go back to my regular activities?

After successful treatment, you should feel better quickly — usually in a few days. Some lung functions may take a month or more to return. A healthcare provider will tell you exactly when you can return to your normal activities, including exercising.

What questions should I ask a healthcare provider?

  • How do you know that I have hantavirus pulmonary syndrome?
  • How did I get hantavirus pulmonary syndrome?
  • What tests will you conduct to diagnose hantavirus pulmonary syndrome?
  • How serious is my condition?
  • Are there any side effects to your recommended treatment?
  • When will I start to feel better?
  • What else can I do to help my recovery?

A note from Cleveland Clinic

With big eyes, big ears, pink noses and tiny paws, mice and rats may look cute. But wild mice and rats may carry diseases that can make you sick. One of the diseases they can carry is the hantavirus. The hantavirus can cause hantavirus pulmonary syndrome (HPS) in people. HPS is a rare but serious disease that initially causes flu-like symptoms. As the condition progresses and affects other organs, you may have trouble breathing and your heartbeat may get faster. HPS can be deadly without proper treatment.

If you develop flu-like symptoms after being around mouse or rat droppings or in an area where mice and rats live, see a healthcare provider immediately. Tell them when you first encountered the droppings and where you were. The faster you get an HPS diagnosis, the better your chance of a full recovery.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 12/08/2022.

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