Hantavirus pulmonary syndrome in five pediatric patients - four states, 2009

Hantavirus pulmonary syndrome (HPS) is a reportable infectious disease with a high case-fatality rate, transmitted to humans by exposure to rodents. Each year, 20--40 cases of HPS occur in the United States; cases in persons aged <17 years make up fewer than 7% of those cases, and cases in children aged <10 years are exceptionally rare. CDC received reports of five pediatric cases of HPS occurring during May 16--November 25, 2009, among children aged 6--14 years from Arizona, California, Colorado, and Washington. Three of the children were aged <10 years, and all five had exposure to rodents. This report summarizes the five cases, including the clinical findings and likely means of transmission of a hantavirus. Thrombocytopenia, elevated white blood cell (WBC) count, and pulmonary infiltrates were observed in all five children; elevated hematocrit was observed in three. One child died, and three of the four children who recovered required mechanical ventilation during hospitalization. Clinicians should consider HPS in the differential diagnosis for children with unexplained acute respiratory distress, especially if recent rodent exposure is noted. Public health agencies should promote preventive measures, including rodent control in housing and play areas, and children should be advised to avoid contact with rodents and areas of infestation.