The Ministry of Health has established that patients in Spain with a positive hantavirus diagnosis may leave the hospital once their clinical recovery has been confirmed. To do so, they must accumulate at least three days without signs compatible with the infection and have two negative results, or cycle thresholds (practically undetectable viral load) greater than 38, in PCR tests performed on urine and oropharyngeal swab, separated by a minimum of 48 hours.
These conditions are included in the "Protocol for the management of people under surveillance in Spain in relation to the ship affected by an Andes hantavirus outbreak," which the Public Health Commission has reviewed to specify the clinical and microbiological requirements necessary to authorize the discharge of confirmed cases, as well as the guidelines for concluding the surveillance of their close contacts.
Health details that the most recent scientific studies on the Andes virus show that the presence of viral RNA in blood can be maintained for a prolonged period after clinical improvement. For this reason, discharge criteria are not solely based on a negative blood PCR, but on the disappearance of symptoms and the negativization of biological samples most linked to the possible elimination of the virus, such as urine and oropharyngeal swab.
The document makes it clear that some patients may continue to show a positive blood PCR after discharge. "The available scientific evidence indicates that this persistence of viral genetic material can be prolonged after clinical recovery, without it having been demonstrated that this poses a risk of disease transmission," Health stated.
Once discharged from the hospital, these individuals will undergo periodic monitoring at the hospital service designated by the autonomous community where they reside for the following six months, with a monthly clinical review to rule out the appearance of sequelae. If at any time symptoms compatible with the disease arise, an urgent evaluation by the reference team will be carried out.
Monitoring of cases with positive blood PCR
The protocol also specifies the control of those who maintain a positive PCR in blood at the time of discharge. In these cases, monthly blood draws will be scheduled until a negative result is achieved. Given that the persistence of the virus in semen for prolonged periods has been described, it is advisable to avoid unprotected sexual relations for at least four months after the onset of the clinical picture.
The affected person must refrain from any activity that may involve a risk of exposure to blood, such as blood draws or tasks in healthcare settings with possible blood contact. Likewise, it is recommended to restrict contact sports and other practices that may lead to trauma and bleeding. These precautions will be maintained until a negative result or CT values above 38 in the blood PCR are obtained.
If the person with a positive blood PCR requires healthcare for any reason, they must inform in advance of their diagnosis of Andes hantavirus infection to the professional attending them and, as soon as possible, communicate with the Public Health official responsible for their follow-up.
Control of contacts in quarantine
Regarding contacts under surveillance, they must complete the maximum quarantine period of 42 days, which will end on June 21.
If they remain asymptomatic throughout the home isolation, a sample will be collected at the end of that period, which will be sent to the National Center for Microbiology for analysis. Only with a negative result can the follow-up measures be concluded and their usual routine be fully resumed.
The Ministry of Health has specified that the first Spaniard diagnosed with hantavirus "remains asymptomatic," while the second "has presented a slight fever in the last few hours." Regarding the 12 contacts who remain in quarantine at the Central Defense Hospital Gómez Ulla in Madrid, it has been indicated that "they are well."