Hantavirus in children: rare but distinct

Children represent a minority of reported hantavirus cases — roughly 5-15% of HPS series and slightly higher in HFRS endemic areas. The disease can look milder at onset but progress just as severely as in adults. Typical pediatric presentation: - Initial flu-like symptoms: high fever, headache, severe muscle aches, fatigue, gastrointestinal complaints (nausea, vomiting, diarrhea, abdominal pain). - Children may complain less of muscle pain and more of abdominal pain than adults — this can lead to misdiagnosis as gastroenteritis or appendicitis. - The pulmonary or renal phase typically begins 4-7 days after symptom onset. Risk factors: - Living or visiting rural areas where rodents are present. - Helping with farm chores, especially cleaning sheds, barns, or grain storage. - Pet rodents or rodent infestations at home. Red flags requiring urgent ER evaluation: - Difficulty breathing, rapid breathing, chest tightness. - Decreased urine output, dark urine, edema. - Cold extremities, weak pulse, or altered mental status. - Bleeding from gums, nose, or in stool (more common in HFRS). Diagnosis follows the same logic as adults: serology and RT-PCR. Treatment is supportive with early ICU transfer for severe cases. Mortality in pediatric HPS is high (similar to adults) but slightly lower in pediatric HFRS, particularly with Puumala virus. Parents in endemic regions should keep children away from cleaning rodent-infested spaces and ensure homes are rodent-proofed (sealed cracks, food in tight containers, regular trash disposal).