You may have been hearing about cases of Puumala virus (a member of the European Hantavirus family) in the states of Baden-Wuerttemberg and Bavaria through the local media. Although a common annual problem in this region of Germany, this season has seen a significant increase in reported cases around Stuttgart. That being said, there have been no reported cases in U.S. military personnel or family members living in Germany. I still think it important that all are aware and have seen the attached article from the European Regional Medical Command (ERMC) - from "The Citizen" on 15 July.

BOTTOM LINE: As this virus which causes flu-like symptoms is spread from dust contaminated with rodent urine and feces, be cautious when entering dusty buildings or after handling dead rodents. Practice good hand washing and seek medical attention from your primary care manager if you develop flu-like symptoms following an exposure history that fits the above criteria. More about the virus in the below article by Lieutenant Colonel Kenneth R. McPherson, U.S. Army Public Health Command Region - Europe: German public health officials have recently publicized an increase in Puumala virus infections among its citizens in the states of Baden-Wuerttemberg and Bavaria. Though there have been no reported cases of Puumala virus infection in U.S. military personnel or family members living in Germany, awareness of the situation may keep potential cases from occurring. Puumala virus is a member of the European Hantaviruses that can potentially cause hemorrhagic fever with renal syndrome. Between January and April 2010 there were a total of 369 confirmed cases of Puumala virus in German citizens, with most cases occurring in the counties surrounding Stuttgart. Reported cases of Puumala virus in Germany are normally around 200 cases per year. Most cases occurred in exposed persons living and working in rural areas. People are typically exposed when they work with contaminated products or when they disturb dusty sheds and buildings that are contaminated with rodent urine and excrement. The Stuttgart area is seeing more cases due to urban sprawl from the city into the country. This mild form of Hantavirus results from inhaling dusts contaminated with rodent urine and feces. Between 80-95 percent of people exposed do not get sick or develop symptoms. Those who become sick typically have a sudden onset of fever and flu-like symptoms to include muscle aches, gastrointestinal pain and vomiting. Rarely does renal failure, which is the shut-down of the kidneys, occur. Prevention There are no Hantavirus vaccines available, so the best protection is to avoid exposure to rodents and their excrement. The best prevention method is to limit rodent populations in and around buildings by reducing clutter and debris that attracts rodents. This also includes cutting back hedges and bushes away from buildings and keeping grass cut to a manageable height. Fire wood should be stacked away from the home and in a manner that limits rodent attraction and nesting. Avoid disturbing dusty sheds, barns, attics, and rooms that may have rodent nests. Do not use brooms or vacuum cleaners to clean these areas, since these methods promote breathing contaminated dusts. To limit dust in the air, moisten dusty surfaces and floors with water containing a mild detergent and household sanitizers. An inexpensive sanitizer can be made by mixing 1-½ cups of household bleach per gallon of water (use care not to splash in eyes or on skin). Wearing rubber gloves, wipe, mop, or wet sweep treated surfaces. To remove dead rodents, spray them with disinfectant solution, wearing rubber gloves place the rodent in a double bag. Wipe surrounding area with paper towels and place them in the double bag with the dead rodent, seal, and discard in the garbage. After any cleaning operation, wash hands thoroughly with soap and water. Alcohol-based hand sanitizer may be used when soap is not available or when hands are not visibly soiled. Anyone who develops flu-like symptoms after entering dusty buildings or after handling dead rodents should immediately seek medical attention. To find out more about Puumala and other Hantaviruses, visit the U.S. Centers for Disease Control and Prevention Website: www.cdc.gov, the European Centre for Disease Prevention and Control Website: http://ecdc.europa.eu, and the U.S. Army Public Health Command (Provisional) Website: http://phc.amedd.army.mil. (Editor's Note: Col. Eric Shuping, Lt. Col. Ken McPherson, Ms. Michele Balihe and Ms. Melissa Wong contributed to this article.)