Notice: Interim recommendations for infection prevention and control of Andes hantavirus in healthcare settings (June 2026)

On this page

• Preamble
• Background
• Interim recommendations for infection prevention and control of Andes hantavirus in healthcare settings
• Acknowledgements
• References

Preamble

An outbreak of Andes hantavirus (ANDV) has been identified on the MV Hondius cruise ship. Canadian travellers have been identified as passengers on the cruise ship and on flights carrying a passenger infected with ANDV. ANDV is not endemic to Canada and is epidemiologically distinct from the hantavirus strain endemic in Canada (the Sin Nombre virus).^{Footnote 1} PHAC's current infection prevention and control (IPC) guidance for healthcare settings does not address ANDV. Given the evolving epidemiological landscape, recommendations for ANDV in the Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (RPAP) guideline have been updated.

Background

At this time, ANDV is not considered to be a pathogen with pandemic potential.^{Footnote 2} While person-to-person transmission of ANDV has been reported in the past and during the current outbreak, to date it appears to be mainly associated with close and prolonged contact and has not demonstrated the capacity for widespread transmission.^{Footnote 3} Given limited evidence on ANDV globally, there is some uncertainty regarding its transmission dynamics. Additionally, there is evidence from in vivo passage studies that ANDV has high genomic stability and does not mutate easily.^{Footnote 4} The incubation period of ANDV is between 1 and 8 weeks, with most individuals becoming symptomatic between 2-4 weeks after exposure.^{Footnote 3} It is possible that currently asymptomatic individuals who were exposed may become infectious and develop symptoms during the observation period.

The purpose of this document is to provide updated guidance on IPC measures in healthcare settings in the event that a person with suspected, probable, or confirmed ANDV is identified within a Canadian healthcare facility. This guidance also addresses IPC measures in healthcare settings in the event that a high risk contact of a person with probable or confirmed ANDV requires care within a Canadian healthcare facility.

The target audiences for this document are IPC professionals, Occupational Health and Safety professionals, and healthcare organizations.

These recommendations were developed with technical expertise from the National Advisory Committee on Infection Prevention and Control (NAC-IPC) and by adopting a precautionary approach.^{Footnote 5Footnote 6} This guidance was also informed by an environmental scan of international and provincial guidance on ANDV and will be updated as new information becomes available.

In this guidance, the term "patient" will be used to include those receiving healthcare who are traditionally and routinely referred to as patients, clients, or residents.

Recommendations for non-healthcare settings are beyond the scope of this document. For other species of hantavirus, application of routine practices is sufficient for IPC management of the patient, including the use of personal protective equipment (PPE) based on a point-of-care risk assessment. Please refer to PHAC's Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings for more information.

Interim recommendations for infection prevention and control of Andes hantavirus in healthcare settings

Additional precautions

Taking a precautionary approach, in addition to routine practices, patients with suspected, probable, or confirmed ANDV should be placed on airborne, droplet, and contact precautions. High risk contacts, even if asymptomatic, require airborne, droplet, and contact precautions. For case and contact definitions, refer to Interim guidance: Public health management of contacts of Andes virus cases from MV Hondius cruise ship.

Only workers essential to the direct care of the patient and their environment, with appropriate PPE, may enter the patient's room to limit potential exposure. Healthcare facilities must be prepared to care for patients with suspected, probable, or confirmed ANDV, with appropriate IPC measures in place.

If a case of ANDV is suspected, immediately notify local public health authorities.

Personal protective equipment

Recommended PPE when caring for suspected, probable, or confirmed cases of ANDV, includes, at minimum:

• gloves
• fluid-resistant or impermeable gown
• eye protection (goggles or face shield)
• a fit-tested N95 respirator (or equivalent or higher protection).

This PPE should also be worn when caring for high risk contacts of probable or confirmed cases of ANDV.

This PPE should be worn by all other individuals in contact with suspected, probable, or confirmed cases of ANDV, and high risk contacts (of probable and confirmed cases). This may include transport workers, environmental services workers, emergency responders, etc.

Patient placement

Patients with suspected, probable, or confirmed ANDV and high risk contacts (of probable and confirmed cases) should be placed in an airborne infection isolation room (AIIR) with the door closed and a dedicated toilet and hand hygiene facilities designated for their use.

If an AIIR is not available:

• the patient should be placed in a single, enclosed room with a dedicated toilet and hand hygiene facilities designated for their use
• the door should be kept closed
• portable HEPA filters may be considered by IPC and facilities personnel to supplement existing ventilation strategies, especially in areas where ventilation does not meet Canadian Standards Association (CSA) standards

Cohorting of patients with known exposures to ANDV is not recommended. If required, it should only be considered in consultation with the local IPC and public health authorities. Only confirmed cases of ANDV with the same strain should be considered for cohorting, if required.

Patient transport

A medical mask, if tolerated, should be worn by the patient when outside their room or care area and the patient should perform hand hygiene prior to masking and after touching or removing a mask.

Dedicated equipment

Non-critical patient care equipment, such as bedpans and blood pressure cuffs, should be disposable when possible and discarded in a designated no-touch biohazardous waste receptacle after use.

Non-critical reusable patient-care equipment (e.g., commode) should be dedicated to the use of one patient and cleaned and disinfected according to manufacturer/organizational policy before reuse with another patient.

Waste, linen, and nutritional services

Waste and linen

Waste from suspected, probable, or confirmed cases of ANDV and high risk contacts (of probable or confirmed cases) is considered Category A waste.^{Footnote 7} Waste, including medical waste, and soiled linen should be managed according to regional and local regulations, policies, and procedures. This guidance does not cover the management of waste in laboratory settings.

Handling dishes and cutlery

Use disposable dishes/cutlery and dispose of in a designated biohazardous waste receptacle at the point-of-use.

Environmental cleaning and disinfection

The care environment should be cleaned and disinfected using Health Canada approved hospital or healthcare disinfectants.^{Footnote 8} Surfaces that are likely to be touched and/or used frequently should be cleaned and disinfected on a more frequent schedule. This includes surfaces that are in close proximity to the patient (e.g., bedrails, bedside/over-bed tables, call bells) and frequently touched surfaces in the patient care environment, such as doorknobs and surfaces in the patient's bathroom. Environmental services staff should use strategies to limit aerosolization as much as possible.

When precautions are discontinued or the patient is moved or discharged, everything in the room that cannot be cleaned and disinfected should be discarded into a designated no-touch biohazardous waste receptacle.

Duration of precautions

Considering that the incubation period of ANDV is between 1 and 8 weeks, duration and discontinuation of additional precautions should be determined in consultation with the IPC program and in accordance with local, provincial or territorial public health guidance and organizational policies.

Handling bodies of deceased patients

Post-mortem examinations (if necessary) and human remains handling should be done in accordance with respective federal and provincial or territorial regulations. Care of deceased bodies should be managed following airborne, droplet, and contact precautions. This includes the use of PPE consistent with ANDV, including a fit-tested N95 (or equivalent, or higher protection), a fluid-resistant gown, gloves, and eye protection. The morgue should be advised of the required precautions prior to transport.

Visitors

Avoid entry of visitors into the patient room. Exceptions may be considered on a case-by-case basis for those who are essential for the patient's wellbeing (e.g., caregiver of children) or in end-of-life or compassionate circumstances. Virtual visits should be considered. If visits are required, they should be scheduled and monitored to allow for:

• Screening of the visitor for ANDV (e.g., symptoms and risk factors) before entering or upon arrival to the hospital. Visitors who have been exposed to ANDV should not be permitted to visit.
• Evaluating visitors for their ability to comply with precautions.
• Providing instruction before entry into the patient care area on hand hygiene, limiting surfaces touched, and use of PPE according to the current facility policy while in the patient's room.

Caregivers and visitors should also wear a fluid-resistant or impermeable gown, gloves, eye protection, and a respirator (or an equivalent or higher protection). Visitors should be made aware of the risk of self-contamination when using their PPE, and movement within the facility should be restricted to the patient's room only.

Considerations for specimen collection and handling

Requests for ANDV testing require advanced planning, notification, and coordination among all relevant stakeholders to ensure the safety of patients, laboratory personnel, and other parties involved.^{Footnote 9} As per routine practice, all staff involved in collection and handling of specimens must be trained and competent in biosafety and incident/exposure response. Specimens should be transported to prevent accidental breakage or spillage of specimens. Avoid the use of pneumatic tube laboratory delivery systems or similar systems. For laboratory-specific considerations, follow facility and provincial/territorial policies and procedures.

Acknowledgements

National Advisory Committee on Infection Prevention and Control (NAC-IPC)

This guideline was developed in collaboration with the National Advisory Committee on Infection Prevention and Control (NAC-IPC). The NAC-IPC is an external advisory body that provides subject matter expertise and advice to the Public Health Agency of Canada (PHAC) on the prevention and control of infectious diseases in Canadian health care settings.

The following individuals formed the NAC-IPC at the time this document was developed. Please note that participation in the NAC-IPC does not constitute endorsement by a member's affiliated organization.

• Dr. Jennie Johnstone (Chair)
• Dr. Titus Wong (Vice-Chair)
• Dr. Marina Afanasyeva
• Dr. Irene Armstrong
• Dr. Zain Chagla
• Dr. Mark Downing
• Dr. Issa Epthimios
• Dr. Jeffrey Eruvwetaghware
• Jennifer Happe, MSc
• Dr. Issa Ephtimios
• Dr. Allen Kraut
• Marianita Lampitoc, MHA
• Donna Moore, RPN, MSc
• Dr. Matthew Muller
• Dr. Leighanne Parkes
• Dr. Brian Sagar
• Dr. Stephanie Smith
• Dr. Nisha Thampi
• Julie Weir, MN

PHAC, Infectious Diseases and Vaccination Programs Branch

Infection Prevention and Surveillance Division (IPSD): Dr. Maureen Carew (Director), Natalie Bruce (Associate Director)

Healthcare Associated Infection Prevention and Control Section (HAIPC, IPSD): Nisrine Haddad (Manager), Co-leads: Maureen McGrath, Amanda Graham