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Foreign. I kind of went back and forth whether we're going to cover this or not. But it's such a global news magnet right now that, you know, as a medical podcast, we got to say something about this. So this is going to be very brief because it's. It's a. It's a story that is in progress. It is still evolving, and things are happening on our day of recording. We're recording this late on May 10, 2026, where the cruise ship and the remaining passengers are now being triaged to their home countries so that people are going back to where they were based on disease severity. And some are doing a type of quarantine, including 17Americans that are going to be quarantined in a very, very selected special pathogens unit in Nebraska. Okay. So if you can't figure it out, we're talking about the Andes virus, the specific strain of the hantavirus that's been in the news. Okay. And now I'm gonna do this from an OBGYN standpoint. So we're gonna focus just a little bit on hantavirus infection in pregnancy, although we don't know a lot. Okay. Because it's very limited information. There is some published case reports that I found. We're gonna summarize very quickly. I'm gonna give you just synopsis. So if a patient asks you about this thing, first of all, everybody, calm down. Calm down. Even the World Health Organization and members of the CDC are saying everybody can relax. This is not looking like a Covid issue. I mean, that's exactly. Actually, I'm reading it directly from the quote from the cdc, chief. This is not a Covid issue, and it does not look like a global pandemic. Having said that. Yeah. I'm not trying to minimize the issues. Three people have died here. This is a bad virus. But. But it's evolving. The story is evolving as we go. So I'm gonna tell you very quickly where we're at as of May 10, 2026, knowing that things are going to change very quickly. But this all started, of course, with this whole cruise ship issue. This cruise ship was scheduled to last 34 days. It is the MV. It is the MV Hondius. It was supposed to be an Atlantic odyssey going from April 1st until the early part of May. And it was going to go over some very cool sites. Of course, people started getting sick in the middle of April with severe respiratory issues with the infection then being diagnosed as hantavirus. So that's where we're at. Okay. So as of May 2026. It's now been isolated the specific strain of the hantavirus, which is the Andes virus, and that's the issue here, is that of all of the types of hantavirus that are mainly spread by rat feces. By rats. Okay. By direct contamination with rat poop, the Andes virus, the andv Andes virus strain antivirus is a little unique because it can potentially. Now want to listen to this word very carefully. Potentially because it's not an easy mode of transmission this way, but it can potentially be spread person to person through aerosol droplets. But to be very clear, that is a very, very unlikely mode of transmission because it mainly is done rodent to human. But can it be spread person to person? Yes, but it is rare. Just to be clear, it is rare and everybody needs to relax because this is not the first time that we've seen hantavirus. It's actually been in the US before. We've been through this, believe it or not. This was in the late 90s. I'm sor. The early 90s. Like 1993, it was called the Four Corners outbreak. Okay, so 1993, the Four Corners outbreak. Actually, I remember this. This was a severe respiratory illness outbreak in the southwestern part of the US this mainly affected Arizona, New Mexico, Colorado and Utah. And it was then called hps, which is still going on, that is Hantavirus Pulmonary Syndrome, hps. Now it's interesting because that specific strain of hantavirus at that time, remember we're talking about 1993, was called the no name virus. Literally it was called the no name virus. In Spanish. It is sin nombre. The sin nombre virus. I'm not making that up, guys, seriously. It's actually carried by the deer mouse. And that's what people started to freak out because like, oh, this is actually a new world issue now. It's not just something in the third world where originally it was thought to be. Okay, so we're going to talk about very quickly, we're going to set this up. I just wanted to give you a quick overview of what's going on. Hantavirus, a little bit of background where this thing actually was found. We're going to talk about it because it was first identified in the Korean War where some soldiers got really sick. We're going to talk about it. We're going to talk about its effect potentially on pregnancy and what is going to happen to these 17Americans that are, as we speak, as we're recording this being taken and transported to Nebraska to a specialized center in Nebraska, which is called the Special Pathogens Unit. Okay. So actually called the RESPTC unit. It's a very specialized area of epidemiologists and microbiologists, pathologists. It is the regional Emerging Special Pathogens Treatment center. Resptc. Resptc. Okay. Out of the University of Nebraska, we're just going to touch on all this so you can have a working comprehension of hantavirus. Now that I've said all that, I think I've set it up enough. We will be right back. We're just trying to fulfill our life calling and our mission. This is Dr. Chapa's OBGYN no Spin podcast. Okay. I don't want to get too into the weeds here because again, it's an evolving story. But just to say hantavirus, as of right now, every major medical organization says everybody can relax, this is bad, we're not minimizing it. But it doesn't seem that's going to be a worldwide global pandemic because it seems to be under wraps here. Seems to be under control here. There is one little catch here that we have to say. Before this infection was diagnosed as hantavirus, there were a small amount of us passengers that got off the ship and then returned home before, you know, they knew what was going on. Now they've been tracked and some of those came here to my home state in Texas. So they're like, oh man, I'm glad I got off that ship. No, no, no, wait a minute. If you were still potentially exposed, you're kind of being watched. So there was a group that left the boat before all this was going on. So while it's good that they left, they're in the U.S. okay, but, but everybody, but they know where they are and they are being tracked. All right, so to be specific, seven American passengers had already left this CR before the first hantavirus related death was found. And then they traveled to some states including Texas, California, Georgia. And because symptoms can take up to six weeks to appear, that's one of the clinical pearls here. It can take up to six weeks to appear. Don't worry. Everyone is watching these people very closely. And the CDC is on top of them. They're being contact traced. They're looking at how they traveled. So again, they are getting a grip on it. But that's the little concern there. The 17Americans that are otherwise going to Nebraska for quarantine for a total of about 45 days of their quarantine interval, those are under control. They're being flown in a very specific controlled Environment. But there's seven who left the cruise ship before this thing had a name on it. And so they're being tracked again, Texas, California and Georgia. But the CDC is on top of it. So very quickly, just a quick overview on this thing. Huntavirus was first actually found when about 3,000 UN troops got very sick out in the Korean War. They had hemorrhagic fever. It was bad. Okay, so the virus, that's where they get the name because it was found near the Hanchen river in South Korea. Okay. This was isolated in 1978, y'. All. 1978 seems like a long time ago, but it really wasn't because this thing was bad. It was called hfrs. Hfrs, that's hemorrhagic fever with renal syndrome. Okay, so it, it, it's bad, but for like, ah, since it's in remote parts of the world, you know, it's not really going to get anywhere else. But no, since that time there's been other little pockets of it. And then in 1993 it did come here to the US with the Four Corners outbreak. So this is not the first time that we, we, we've had this scare. We've been here before. That's the good news. Okay, now the 17Americans that, as of today, May 10, 2026, those 17Americans that were on the MV Hondias are on the way home. But, but they are going to go through this RESPTC center at University of Nebraska for evaluation. Now what this thing does is it kind of presents with very nonspecific early symptoms. You get this kind of fevery, this Malaysia, this malaise, and then things start to go south. Right? Very quickly you can go into this thrombocytopenia, go into this renal failure and basically shock and go through severe respiratory distress. Now, I want to focus on this from an OB standpoint, but we don't have a whole lot of information on this. It's been based on small case reports. The first question is, can this thing affect the kid vertically? Can this thing pass in utero and infected child? It does not seem to do that. So to be very clear, vertical transmission does not seem to be an issue. It's possible, but as the CDC says, I'm looking at the website right here. It is, quote, exceedingly rare. Okay, Exceedingly rare. So possible, but just very not likely. Most of the adverse fetal outcomes here, including preterm labor and miscarriage in the first trimester, are linked to severe cardiovascular issues, mainly hypoxemia from the respiratory Distress, it causes bad respiratory issues and also hematological collapse causes hypertension. Okay, we do not have again a lot of data on this. There was a Caribbean series of six hantavirus infected pregnant women that was published and it caused acute liver failure. Of course it went into preterm labor. But it really does have some variable outcomes here because not everybody who gets this gets severe respiratory issues. Some can be relatively mild. Right. So it's this weird spectrum of infection. However, I'd want to minimize this thing. It can cause, especially in the third trimester, a severe respiratory issues, including maternal death. So this again, not a lot of data. But what we do have on HPs in pregnancy, especially with the seen normative virus strain, is that the disease seems to parallel illness in non pregnant women. So it's not any worse just because they're pregnant. Because if you get it and you become very symptomatic, then you get this kind of picture of thrombocytopenia acidemia with lactic acid increase. That's from the hypoxia. You get leukocytosis. And all of those things make the perfect storm. Even to lead to hemorrhagic shock in some cases because of the hypoxemia and the vascular disarray. There was a small report published back in AJOG in the 90s where it said, yep, this is pretty bad. But it all stems from the core illness of ards. ARDS is the first thing that takes these patients down. Treatment is kind of supportive. There's no specific one medication to do this. And that's the issue is that you've got to be very aggressive. You got to recognize it early, have to do fluid resuscitation. You can use vasopressors and you have to correct electrolyte imbalances. But there's not one specific treatment for this. Some patients may need ecmo, very similar to Covid, but again, very, very sparse data here. Most of these have been very small case reports. Overall public literature on hantavirus and pregnancy is very limited. There's no randomized trials, we don't have large cohort studies. But if you do get a patient, should you have one that was somehow connected to this boat and they present with weird kind of viral syndrome. You gotta contact your ID person and or the cdc, although remember that those are all being contact traced already. Here's the big take home because again, I don't want to scare anybody into this. I just want to give a quick here's what's going on. As of 5-10-20, 26. They are being triaged to each one of their specific places and countries. Okay, so they're now getting off the boat. They're all being transported into the appropriate triage areas, but those 17 are being treated and are evaluated in a very controlled center. So can this thing be bad? It doesn't seem to be, you know, a global issue right now, according to the cdc, but if you're asked about it, here's a big take home. It's called the Andes strain of the hantavirus. Hantavirus is typically passed by rodent to human with very limited person to person, although this one potentially does have the ability to spread through respiratory droplets, although that's not its main mode of transmission. There is no specific antiviral for it. There's no vaccine right now, although, lo and behold, of course, Moderna is working on one that's also an mRNA, but that is. I'm not gonna get into that, but they are doing some development right now, and they have been for a while. On hantavirus vaccination, placental transmission is exceedingly rare. So we're not talking about congenital malformations. And most of the bad outcomes here, which is either miscarriage early on or preterm labor at the end, have to do with ards, hypoxemia, thrombocytopenia, and lactic acidosis, which all of those things throw off clotting ability and so that bleeding and or hemorrhagic shock can be a part of this infection, although it's mainly a respiratory issue. So hantavirus in pregnancy, yes, it's bad. It can lead to severe maternal hemodynamic compromise. However. However, everybody relax. I'm just doing this as point of, again, education and awareness. It does not seem to be a big global issue now as of May 10, 2026, if something changes, we're going to give an update on that. Anyway, just a quick word about hantavirus. Just let you know what's going on. Let's wrap this up. This wasn't planned. I was supposed to talk about something else, but that was interesting enough to put the word out there. Limited data in pregnancy doesn't seem to be harmful to the child, but harmful to the mom, especially in the third trimester. And it's an evolving story. Podcast family, as always, we're thankful for you. We're glad you're part of our podcast family now that we've done all that. Stay safe, be careful, and we'll see you in the next episode of the no Spin podcast. This is Dr. Chapma's obgyn no spin podcast.