A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Fri 22 Jun 2018
Source: New York Times [edited]
https://www.nytimes.com/2018/ 06/22/nyregion/hantavirus- belmont-death.html

A worker at Belmont Park racetrack has died in what health officials believe may be a rare case of [a] hantavirus [infection] in New York State.

The worker, whose name has not been released, was found earlier this month [June 2018] collapsed outside the ramshackle employee barracks, tucked between the horse barns and exercise pens where he and scores of other grooms, hot walkers and riders live, state health officials said. He was hospitalized and died on [6 Jun 2018] of what appears to have been hantavirus pulmonary syndrome [HPS], an advanced stage of the virus [infection], according to the New York State Department of Health's preliminary findings.

The illness, the pulmonary form of which has a nearly 40 percent fatality rate, according to the Centers for Disease Control and Prevention, cannot be communicated between humans. It is typically contracted by inhaling air contaminated with rodent droppings [urine and saliva] in confined spaces, or, in rare cases, via a bite.

In New York State, there have been 5 cases of hantavirus since the state began tracking it in 1993: 3 were in Long Island and 2 upstate, according to the Health Department. Nationwide, there have been 728 reports of hantavirus pulmonary syndrome HPS between 1993 and 2017, according to the C.D.C. (The center is reviewing the case at Belmont, which will officially determine if [a] hantavirus caused the death.)

At Belmont, which is in Elmont, N.Y., near the Queens border, far from the sun-hatted hordes in the stands on big race days like the Belmont Stakes, dilapidated bungalows house the mostly immigrant work force responsible for cosseting and caring for the thoroughbreds that race there. According to interviews with residents, a jockey and a former trainer, the barns and living spaces are plagued with rats.

"When you get down on your knees to do a horse up? They run up your legs," said Peter Daly, a former trainer who now owns Tack Room Products, a supply shop across the street from the park.

Inspectors on [Thu 21 Jun 2018] ordered the removal of 32 workers from rooms they found had dangerous conditions. They have been relocated to other housing on-site, according to the New York Racing Association, a nonprofit corporation. Between 900 and 1000 people live on the premises. The racing association, which is responsible for the housing, has begun patching holes; securing overflowing feed bins and containing waste to remediate the problem.

"We are redoubling our prior efforts to address appropriate rodent control measures throughout all backstretch facilities," Patrick McKenna, a spokesman for the racing association, said in an email.

Drawn by the feasts of horse oats and refuse, rats often pass unimpeded from the barns through holes visible in the sides of the cinder-block dorms and small clapboard shacks where the workers live, according to workers who reside there. Rooms are often shared, and many are squalid, with mattresses or pallets on the floor, some with punched-out windows covered by cardboard. The workers asked not to be named because they feared reprisal for criticizing the facility, which is state-owned and operated by the racing association.

"It's a challenging setting because of the nature of the industry; rodents like the environment," said Brad Hutton, the New York State Department of Health's deputy commissioner for public health. Mr. Hutton and a team of epidemiologists and inspectors have spent the past several days at the track, assessing conditions and teaching workers how to identify early symptoms of hantavirus. The illness can start with flulike symptoms and can progress over weeks to the point where "it feels like someone is sitting on your chest," Mr. Hutton said.

As inspectors have visited the facility this week to root out the conditions that may have caused the possible case of hantavirus, they have also found other types of infestation, Mr. Hutton said. One worker, who said he has lived in the barracks on the racetrack grounds for 20 years, showed a reporter the roughly 10-by-12-foot room he shares with another man: blotches of blood from crushed bedbugs stained the walls. Next to a pillow was a can of repellent with which his roommate sleeps.

NYRA, as the New York Racing Association is known, was returned from state to private control last year. It has made some improvements to the facility, which was first constructed at the turn of the 20th century, as part of a 30 million USD multiyear campaign that includes renovations to more than 50 residential cottages and nearly 30 barns. In 2016, the association completed the construction of a new residential dormitory, and is in the midst of building a 2nd. This week, lawmakers voted to make it eligible to receive state funding for the redevelopment project.

"While the improvements have been substantial and meaningful, there is more work to be done," said Mr. McKenna.

[Byline: Sarah Maslin Nir]

--
Communicated by:
ProMED-mail from HealthMap Alerts
< promed@promedmail.org >

The rats mentioned in the above report are doubtless brown rats (_Rattus norvegicus_). The deplorable living conditions of the workers and abundant nearby food sources for the rats provide an ideal environment that can sustain abundant rat populations and probably maintenance of Seoul hantavirus (SEOV) in them. This virus has been found in brown rats in a number of port cities in the USA, including New York (see ProMED-mail archives for 2014 below). Only 5 cases of SEOV infection have been documented in the USA, most in the city of Baltimore. SEOV infections can result in hemorrhagic fever with renal syndrome (HFRS). Hantavirus expert Dr. Jan Clements commented that, "Old World hantaviruses like SEOV can also cause a fatal "HPS" (Roig IL, Musher DM, Tweardy DJ: Severe Pulmonary Involvement in a Case Attributed to Domestically Acquired Seoul Hantavirus in the United States. Clin Infect Dis, 2012; 54(1): 91-4. doi: 10.1093/cid/cir748; http://cid.oxfordjournals.org/ content/54/1/91.long ). The finding that 4 out of 5 cases of domestic SEOV-nephropathy in the USA were registered in the Baltimore region so far, where the bulk of epidemiological SEOV research had been done, suggests that low medical awareness is probably the most important explanation of the paucity of American HFRS cases to date" (see ProMEd-mail archive Hantavirus update - Americas (42): USA (NY) Seoul virus, rat reservoir, comment 20141028.2907225 ). Although other hantaviruses such as New York and Monongahela viruses occur in white-footed mice (_Peromyscus leucopus_) in New York state, the situation described in the above report points to SEOV in brown rats. ProMED-mail awaits confirmation from the CDC with interest. - Mod.TY

HealthMap/ProMED-mail map
New York State, United States: http://healthmap.org/promed/p/ 234 ]

See Also