Heartland virus (HRTV) Agent Information Sheet

Research Occupational Health Program (ROHP)
Boston University
617-358-7647

Agent

Heartland virus (HRTV) is a phlebovirus in the Bunyaviridae family which is likely transmitted to humans by ticks. It was first detected in 2009 in Missouri. Active case finding has identified only a handful of additional confirmed cases in Missouri, Tennessee, Oklahoma, Arkansas, and Indiana.

  1. Disease/Infection
    Heartland virus symptoms include fever, lethargy, headache, muscle pain, nausea, diarrhea, bruising, low WBC, low platelet count and elevated LFT’s.
  2. Pathogenicity
    Much is still unknown about the pathogenicity of HRTV. Only a handful of cases, including 2 deaths, have been confirmed.
  3. Biosafety Information
    1. Risk Group/BSL
      Risk Group 2
      Biosafety level: BSL2/ABSL2
    2. Modes of Transmission
      Likely tickborne. The virus has been isolated from nymphal Lone Star ticks (Amblyomma americanum). Heartland virus is most closely related genetically to the severe fever with thrombocytopenia syndrome virus (SFTSV), which can be transmitted from human-to-human by contact with infected blood or bloody secretions. Although there has been no evidence to date for this route of transmission for the HRTV, the potential for human-to-human transmission should be considered.

      Transmission
      Skin Exposure (Needlestick, animal bite, or scratch):Accidental parenteral inoculation or exposure to non-intact skin
      Mucous Membrane Exposure Splash to Eye(s), Nose or Mouth:Direct or indirect contact with mucous membranes
      Inhalation:Unlikely unless aerosolized
      Ingestion:Unlikely in laboratory setting
  4. Host Range/Reservoir
    Ticks and vertebrates. Seroprevalence studies have shown high seroprevalence rates for HRTV in northern raccoons (Procyon lotor), white-tailed deer (Odocoileus virginianus), horses, coyotes, and moose
  5. Symptoms
    Fever, lethargy, anorexia, headache, muscle aches, joint pain, low WBC and low platelet count.
  6. Incubation Period
    Unknown
  7. Viability
    Susceptible to 70% alcohol, 1% sodium hypochlorite, and 2% glutaraldehyde
  8. Survival Outside Host
    Unlikely replicative infection in animals

Information for Lab Workers

  1. Laboratory PPE
    BSL-2 precautions – lab coat, gown, N95 or PAPR, and gloves. Wear eye protection if splash risk.
  2. Containment
    BSL-2 and ABSL-2 practices
  3. In Case of Exposure/Disease
    1. For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
      1. Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
      2. Charles River Campus: call or have a coworker call campus security at 617-353-2121. You will be referred to or transported to the appropriate health care location by the emergency response team.
    2. For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
    3. Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
    4. Provide the wallet-size agent ID card to the physician.
  4. Vaccination
    None available.

Information for First Responders/Medical Personnel

  1. Public Health Issues
    No risk as not transmitted human to human
  2. Diagnosis/Surveillance
    Diagnosed by PCR on blood or tissue. Also can diagnose with 4 x rise in virus specific plaque reduction neutralizing antibodies titers between acute and convalescent specimens.
  3. First Aid/Post Exposure Prophylaxis
    Perform one of the following actions:

    Skin Exposure (Needlestick or scratch):Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution.
    Mucous Membrane Splash to Eye(s), Nose or Mouth:Exposure should be irrigated vigorously.
    Splash Affecting Garments:Remove garments that may have become soiled or contaminated and place them in a double red plastic bag.
  4. Treatment
    There is no treatment other than supportive care.
  5. References
    Bosco-Lauth AM, Calvert AE, Root J, et al. Vertebrate Host Susceptibility to Heartland Virus. Emerging Infectious Diseases. 2016;22(12):2070-2077. doi:10.3201/eid2212.160472.McMullan LK, et al. A new phlebovirus associated with severe febrile illness in Missouri. New Eng Jrl Med 2012;367:834-41.Riemersma KK, Komar N. Heartland Virus Neutralizing Antibodies in Vertebrate Wildlife, United States, 2009–2014. Emerging Infectious Diseases. 2015;21(10):1830-1833. doi:10.3201/eid2110.150380.Wormser G, et al. Update and Commentary on Four Emerging Tick-Borne Infections: Ehrlichia muris-like Agent, Borrelia miyamotoi, Deer Tick Virus, Heartland Virus, and Whether Ticks Play a Role in Transmission of Bartonella henselae. Infectious Disease Clinics of North America, volume 29, Issue 2, June 2015, Pages 371-381

Updated 7/17/19

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