Hantavirus: How Scary Is It??

A weird virus has popped up on a cruise ship, and it’s making a bunch of us nervous. It’s a type of hantavirus called Andes virus, and scientists think that it’s infected almost a dozen people so far — three of them have died. And now people are getting off the boat, some of them going into government quarantine, but some of them traveling home. And people are like, wait … this all sounds VERY familiar … from the early days of Covid. So — how scary is this? Could this hantavirus be the next pandemic?? We talk to Prof. Michelle Harkins, Prof. Ann Sheehy and Dr. Neil Vora to find out. Find our transcript here: https://tinyurl.com/ScienceVsHantavirus In this episode, we cover: (00:00) Hantavirus shows up on a cruise ship (03:11) What happens if you get sick with hantavirus? (09:32) How does hantavirus spread? (14:05) How good is this hantavirus at spreading? (26:08) Is this hantavirus going to cause the next pandemic? This episode was produced by Michelle Dang, with help from Blythe Terrell, Meryl Horn, Rose Rimler, Ekedi Fausther-Keeys and Wendy Zukerman. We’re edited by Blythe Terrell. Wendy Zukerman is the executive producer. Fact checking by Diane Kelly. Mix and sound design by Bobby Lord. Music written by Bobby Lord, Bumi Hidaka, So Wylie, Emma Munger and Peter Leonard. Special thanks to the other researchers we spoke to about this, including Prof. Glenn Marsh. Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Wendy Zukerman?

  Hi, I'm Wendy Zukerman and this is Science Versus.

• 0:05Wendy Zukerman?

  The show that pits facts against another friggin' pandemic?

• 0:16Wendy Zukerman?

  Today on the show, Hantavirus. There's been a lot of reports of an outbreak of a weird virus on the MV Hondius cruise ship.

• 0:27Speaker 01

  What began as a cruise of a lifetime has instead turned into a major medical mystery and an international crisis.

• 0:33Speaker 02

  Three people have died amid outbreak of Hantavirus on a cruise ship sailing the Atlantic.

• 0:39Wendy Zukerman?

  The first cases seem to have started with a husband and wife that boarded after a birdwatching expedition. The couple ended up dying along with one other passenger. And over the next few weeks, more cases have started rolling out.

• 0:54Speaker 03

  A French national has tested positive for Hantavirus following her evacuation from the cruise liner MV Hondius. Now, her condition is said to be deteriorating.

• 1:05Speaker 04

  Eighteen American passengers from the Hantavirus-affected cruise ship are now being monitored at two facilities in the United States.

• 1:12Speaker 05

  One patient has tested positive and is now in a biocontainment unit in Omaha, Nebraska.

• 1:17Speaker 06

  Global health officials warning there are now 11 total cases of the deadly Hantavirus, adding that number could go up as the virus can incubate for 42 days.

• 1:28Wendy Zukerman?

  And one thing that's really worrying here is just how deadly this virus is. Something like 40% of people who get diagnosed with it will die. And scarier still, according to news reports, it feels like this Hantavirus outbreak is weird because it's spreading from person to person.

• 1:48Speaker 07

  Experts are confirming there have been cases of a rare strain on the ship that can be transmitted between humans.

• 1:56Wendy Zukerman?

  Meanwhile, officials have been scrambling to track down some people who left the cruise ship before they knew Hantavirus was on board. No surprises, the internet is freaking out. Hantavirus will spread. It absolutely will get worse. Why did they let the people off the boat? Why'd you let them off the boat? Why did you let them off the boat? Everybody better wake the f*** up with this Hantavirus bullshit. We're not doing it again. The Hantavirus, Antimontana virus. This is crazy. History is about to repeat itself. I have seen this film before, COVID-19. I want to watch a new film, The Titanic. And I'm getting very, very anxious, very nervous, and they should have sank that motherfucking shit where they had the chest.

• 2:37Wendy Zukerman?

  So today on the show, what is going on with Hunter virus? What happens if you get infected? How is it spreading? And how worried do we need to be here? Could this be the next pandemic? When it comes to Hunter virus, there's a lot of people saying,

• 2:53Speaker 05

  We're not doing it again.

• 2:54Wendy Zukerman?

  And then there's science.

• 2:59Wendy Zukerman?

  Science versus Hunter virus is coming up just after the break.

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• 4:43Wendy Zukerman?

  Welcome back. Today, we're talking all about Hunter virus. And this is the first time a lot of us have even heard of this virus. So we're going to break down exactly what it is, starting with what happens if you get infected. Because on the cruise ship, the three passengers died within just a few days of their symptoms starting, which is very scary. So we wanted to know how things can escalate so quickly. And for this, we called out Professor Michelle Harkins.

• 5:13Speaker 06

  I am a pulmonary and critical care physician at the University of New Mexico.

• 5:18Wendy Zukerman?

  And she's treated dozens of Hunter virus patients in the ICU. And she told us that there are a couple of dozen different types of Hunter viruses that can infect humans. The one that Michelle generally sees in New Mexico is called the Sinombre virus. And it is a lot like the version that popped up on the cruise ship.

• 5:40Speaker 06

  Yeah, they're in the same family. We can call them relatives.

• 5:43Wendy Zukerman?

  So if you get infected with Hunter virus and you have all these viral particles in your body, they tend to attack and go after this specific type of cell.

• 5:54Speaker 06

  So this virus likes a particular cell, the endothelial cell, and it lines all the blood vessels. It lines a lot of the cells in the lung.

• 6:03Wendy Zukerman?

  What happens from here is that your body starts to mount an immune response to get rid of this invader. And that's often when you can start to get sick in a way that Michelle says might feel pretty familiar at first.

• 6:17Speaker 06

  It's where you feel like you have the flu. You're sick, you have fever, chills, body aches, headache.

• 6:24Wendy Zukerman?

  And it's possible that more of us have been infected with Hunter virus than we think. Studies have measured the blood of thousands of people for Hunter virus antibodies, evidence that Hunter virus had weaseled its way into their body and then their immune system responded. And they found that in the Americas, just over 2% of people that they looked at had Hunter virus antibodies. A lot of those folks were probably never diagnosed with Hunter virus and might have had pretty mild symptoms. But for others who get infected, like some of the passengers on the cruise ship, it can get very nasty. In the first week of symptoms, you can start getting GI problems.

• 7:09Wendy Zukerman?

  So think stomach pain, nausea, vomiting, diarrhea. And in fact, more than half of the people who actually get diagnosed with Hunter virus end up with severe symptoms. And that can happen because your immune system kind of gets completely carried away. It creates this massive inflammatory response.

• 7:31Speaker 06

  It caused like a war, if you will. It's a whole dysregulation of our immune system that is caused by this virus.

• 7:38Wendy Zukerman?

  This is called a cytokine storm. Cytokines are these small proteins that get secreted by your immune system. And they can go completely haywire during a Hunter virus infection, where they can even start to attack your organs. The same thing can happen with a particularly nasty COVID infection, too. But the thing that sets Hunter virus apart is what happens next. So as the Hunter virus keeps attacking those cells that it loves, the endothelial cells, and particularly the cells that line our blood vessels, that lining can start to break down.

• 8:14Speaker 06

  The blood vessels become very leaky.

• 8:17Wendy Zukerman?

  This means the fluid in your blood vessels, the plasma, can now leach into places it's not meant to go, like your lungs. And fluid can start to build up there. If this happens, your lungs can't bring in enough oxygen and patients will tell Michelle, hmm, I'm coughing, or I am, I'm

• 8:37Speaker 06

  Short of breath, I can't catch my breath.

• 8:39Wendy Zukerman?

  And at this point, things can start to go downhill really fast as your lungs just keep flooding with fluid.

• 8:47Speaker 06

  That can all progress over a matter of, you know, three, four, six hours and get worse. If you enter this phase and you really don't seek medical attention, you have over 50% chance of mortality, and you can die within 24 hours.

• 9:03Wendy Zukerman?

  Another thing that can happen here is called cardiogenic shock, and it's where your heart stops pumping enough blood to get oxygen to your organs. And even if you seek medical attention, your chance of surviving isn't great. We don't have medicine specifically for Hunter virus. Michelle told us that the only thing she can do is really, if you catch it early enough, you can put people on oxygen or even something called an ECMO machine. This is like an artificial lung, where doctors take your blood out, put oxygen in it, and then pump it all back into your body. Michelle told us that she'll hook people up to the ECMO, basically to buy them some time

• 9:47Wendy Zukerman?

  while the virus runs its course. Michelle told us what it was like for some of her patients. She talked to producer Michelle Dang about it.

• 9:56Speaker 06

  Some of the first patients that I saw came in talking. They were on just a little oxygen and then rapidly deteriorated and were put on ECMO within four hours. And it was striking that it can progress that fast.

• 10:11Speaker 02

  Can you see that, like, when you look at a patient who's already come in or expect what, how they might handle the disease?

• 10:19Speaker 06

  No, it is really difficult. Some people come in and you're like, oh, my gosh, they're going to get worse. And they get better and they're off of oxygen in a day or two. And then someone comes in that is, you know, you think a young, healthy-ish person that comes in and they're on two liters of oxygen and then they're on the bypass machine the next day. So it's, you can't just tell by looking.

• 10:43Wendy Zukerman?

  So that's part of what makes Hunter virus so scary. It can sneak up on you, and you can get sick really fast and even die. And there's no vaccine to prevent it. So you, me, we don't want to get a nasty case of Hunter virus. How do people get infected in the first place? Now, Hunter virus is actually found all over the world. We've seen it on every continent except Antarctica. It's often carried by rodents, but it's also found in animals like bats, moles and shrews. And usually, just zooming out from the cruise ship outbreak here, people get infected because they come into contact with poo or wee from an infected rodent.

• 11:28Wendy Zukerman?

  We talked about how this can happen with Neil Vora. He's a doctor who studies spillover diseases from animals to people.

• 11:35Speaker 06

  So, you know, in other scenarios in which we've seen people get infected with Hunter viruses is that they're living in areas where rodents are also living, right? Now, maybe someone is then grooming in their house and they're sweeping all these rodent feces.

• 11:50Wendy Zukerman?

  And as you are sweeping and cleaning the house, any dried up rat crap can kind of turn to dust, go up into the air, and then you breathe that in.

• 12:00Speaker 06

  And you're aerosolizing dust and viral particles at the same time from that feces, and then the person can get infected, right? So that's one possible route of exposure.

• 12:11Wendy Zukerman?

  This virus can also survive stomach acid and potentially infect you if you eat food that's contaminated with, say, little bits of rat poo. The World Health Organization estimates that worldwide, thousands of people get Hunter virus every year. But they're usually infected with a version that's less deadly than the one on the cruise ship. And we think that the vast majority of these infections worldwide come from direct contact with, say, rodent feces. But with the outbreak on the cruise ship, something different seems to be unfolding. So we think that maybe the first infection, patient zero,

• 12:53Wendy Zukerman?

  got exposed this way that we've just described, through aerosolized rat crap dust. Here's Neil again.

• 13:02Speaker 06

  So we don't know for sure how the first person got.

• 13:05Speaker 05

  Infection. Right now, the leading theory is that this person got infection while in Argentina bird watching. And bird watching is a very safe activity. But somehow, they might have interacted with the feces, for example, of a rodent or rodent urine. Maybe got a bite from a rodent, but that's less likely. And then they got infected. But this is, right now, working theory. But it's highly plausible.

• 13:30Wendy Zukerman?

  Now, one or two people getting Hunter virus directly from breathing in rodent poo or pee, this is not surprising. Because, like we said, Hunter virus is around rodents in a lot of places, including Argentina. What's weird is that most of the time, when someone gets Hunter virus from a rodent, it stops with them. Most types of Hunter virus cannot spread from person to person. Except the version of Hunter virus that showed up on the cruise ship. It's called the Andy's virus, and it can.

• 14:07Speaker 05

  Andy's virus is the only Hunter virus that we know of that spreads from one person to the next.

• 14:13Wendy Zukerman?

  And that is probably exactly what happened on the cruise ship. And something that's worrying a lot of people right now is that we might not know everyone who's been infected. Because this virus, it can hang around your body for a while before you start showing any symptoms. Producer Michelle Dang asked Professor Michelle Harkins about this.

• 14:36Speaker 06

  Right after someone breathes in that dust with the Hunter virus from mouse poo, what happens next? They may just go on their merry way, and then there's an incubation period. And unfortunately, it can be from one to eight weeks. Typically, we see people within about two weeks afterwards, but there are studies showing that it can last up to eight weeks.

• 15:00Wendy Zukerman?

  Eight weeks? That means theoretically, some of the people who were on the boat and then left without being quarantined could be infected right now. Wandering around, breathing, coughing, listening to podcasts. So after the break, could this lead to the next pandemic? Coming up.

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• 17:03Wendy Zukerman?

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• 18:45Wendy Zukerman?

  Welcome back. Today on the show, Hunter virus. How freaked out do we need to be? So here's where we're at right now. We know that this virus has the potential to spread from person to person. And now the question is, how quickly can it spread? Could this lead to the next pandemic? And to find out more, we called up Professor Anne Sheehy, a virologist and immunologist at the College of the Holy Cross in Massachusetts. She's a friend of the show. We've had her on before. And Anne told us that when she heard about this Hunter virus outbreak.

• 19:19Speaker 03

  Um, I wasn't happy. So as virologists, you never like hearing about a virus that is doing something unusual.

• 19:26Wendy Zukerman?

  On top of that, she was like, and it's happening on a cruise ship?

• 19:31Speaker 03

  That's traveling all around the world with, with passengers from all around the global community who. We're then gonna disperse. That's not a good setup. You're like, oh, no.

• 19:43Wendy Zukerman?

  Oh, no, I don't want my virologist saying, oh, no. But don't worry, because by the end of this episode, you'll be thinking, oh, yes, because you'll know more science. And that's always great.

• 19:58Wendy Zukerman?

  OK, so as we mentioned, this version of Hunter virus that's roaming around the cruise ship is the only one we know that can transmit from person to person, which makes it different to the one that we heard about from the doctor, Michelle, which was called Sin nombre. So Anne told us that to understand what makes the Andes version capable of spreading, we can compare the two.

• 20:23Speaker 03

  So let's take Andes versus Sin nombre. So if you were to look at those two hantaviruses, they're pretty highly related. But there's regions that are a little bit different between Sin nombre, which doesn't spread human to human, and Andes, that does.

• 20:38Wendy Zukerman?

  One difference is in a protein that sits on the outside of the virus and helps it to break into cells in our body.

• 20:46Speaker 03

  So for coronavirus, for analogy, we think about spike, right? The spike protein. So on Andes virus, instead of, they don't have spike. We call it glycoprotein, so GP.

• 20:58Wendy Zukerman?

  If you think about the cells in your body, like a house with a tiny little door, GP is the key that allows Hunter virus to open that door, break into our cells and infect us.

• 21:10Speaker 03

  So these GP proteins are a little bit different on Andes virus. And the consequence is, at least on the sort of infection level, is the Andes virus can infect a wider range of cells.

• 21:26Wendy Zukerman?

  One study found that the Andes virus also seems to replicate faster in, say, heart tissue compared to other versions of Hunter virus. So potentially, when you get infected with this Andes version, there's just more viral bits in your body and you have a higher viral load, which could then increase the chance that you go To infect someone else. And we have examples from other outbreaks that illustrate how this can all play out. So in Argentina, back in 2018 to 2019, we saw one of the biggest Andy's virus outbreaks ever recorded. Scientists think that it started when one person got exposed to the virus the usual way, from a rodent, and then.

• 22:10Wendy Zukerman?

  So went to a birthday party, was feeling symptomatic, but, you know, birthday party, went, and looks like at that birthday party, probably exposed some other people, but at least two other people that went on to then be involved in social events and spread. One of them was the wake of the second person that had died.

• 22:33Wendy Zukerman?

  Yeah, so it spread at the birthday party. Someone died from that infection and then at their wake, other people got infected. Ultimately, researchers tracked 34 cases and 11 people died. Scientists were able to trace this all pretty well and even test people's blood. And they found that those who had more virus inside their body were more likely to spread the Andy's virus to other people. But what's interesting is that we don't actually know exactly how the virus is spreading from person to person. Is it through coughing, through breathing, through touching?

• 23:16Wendy Zukerman?

  Scientists think that generally speaking, you see really close contacts having a higher chance of spreading it to each other. So not just someone you're passing at the supermarket, say. And we know this, for example, from a study on a cluster of people who got infected in Chile. And they found that sexual contact was a big risk factor for spreading it. And in particular, the paper references deep kissing. That was one of the biggest risk factors they found. And they mentioned deep kissing a lot. They defined it only as exposure to saliva. I guess that is, that is what deep kissing is at the heart of it. Other risk factors in that study were sleeping in the same bed,

• 24:00Wendy Zukerman?

  having sex and being exposed to semen. And on this point, we found another study from 2023 that tracked a 55-year-old man who got infected with the Andy's virus and later recovered. But get this, almost six years later, traces of the virus could still be found in his semen.

• 24:23Wendy Zukerman?

  Now, I think this is probably going to make this type of Hunter virus sound really scary, right? It can spread from person to person. It could stay in semen for all these years. But it's really important to compare how contagious this virus is to other viruses out there that you know and love, like COVID and measles. So remember the R naught from the height of the COVID pandemic. This is basically the number that scientists calculate to say if you get disease X, how many susceptible people will you pass it on to on average? And for some diseases, this is super high, like measles,

• 25:06Wendy Zukerman?

  famous for being incredibly contagious if you're not vaccinated. It's estimated that if you get it, you could give it to 12 to 18 other people. But for this Hunter virus.

• 25:17Speaker 03

  So I think even in the most, with sort of the most dramatic outbreaks we have, the R naught is something like two for Hunter virus. And if you do any quarantining at all, it drops below one. And once one sun R naught drops below one, you're not gonna, it's not gonna be an outbreak. You're not gonna get sustained spread. So I think we're very fortunate that this virus does not spread easily from person to person.

• 25:44Wendy Zukerman?

  This might be partly because Hunter virus doesn't seem to hang around in your nose, throat and lungs in the same way that COVID and influenza does, you know, where a big breath could push out a bunch of viral particles into the air and, you know, maybe infect the person you're talking to. Instead, Hunter virus likes to stick around deeper in the cells of our lungs because it really likes those endothelial cells inside our blood vessels. And the fact that this type of Hunter virus doesn't spread that easily from person to person is probably why the largest outbreaks that we've had of it have gotten just a few dozen people sick.

• 26:27Wendy Zukerman?

  Even with this cruise ship outbreak, so far at least, it's hardly gone bananas. In over a month, so far, we've had about a dozen people infected. Now, in this outbreak, it's worth pointing out that while there were early reports that a woman got infected after just sitting on a plane near someone who was on the cruise ship and later died of Hunter virus, it now looks like that's not true. The woman on the flight later tested negative. So here's where we are at. Hunter virus, when you compare it to other scary and contagious viruses, it does not spread easily from person to person.

• 27:09Wendy Zukerman?

  But also, your chance of getting a nasty case of Hunter virus from a rodent is also pretty low. Michelle, who's our doctor from New Mexico, who's seen how devastating Hunter viruses can be, and she lives in a place where the rodents can be infected with Hunter virus, and people every now and then get infected. So Michelle Dang, our producer, asked her.

• 27:36Speaker 02

  Do you freak out every time that you see a mouse?

• 27:39Speaker 06

  No, I don't. You know, we actually have done trapping campaigns, and about 25% of the mice in New Mexico carry Hunter virus.

• 27:51Speaker 02

  It sounds pretty high, though. Does that scare you?

• 27:53Speaker 06

  Sounds high, but our case rates are really low. So it's not a very easy virus to transmit, and that's like a key thing. It's not easy to get Hunter virus. I actually was bitten by a mouse in my house because my cat chased it in.

• 28:12Speaker 02

  Oh, no.

• 28:13Speaker 06

  And I tried to catch it and release it, and I was bit by the mouse, and I was like, great, I'm gonna get Hunter. But I did not get Hunter.

• 28:24Speaker 06

  I got rat bite fever instead, so.

• 28:27Wendy Zukerman?

  She took antibiotics for the rat bite fever. She's totally fine. But the broader point is that even though there's a lot of mice scurrying around New Mexico, carrying this virus, pooing and wheeing all over the place, and around 2 million people live there, doctors diagnose fewer than 10 cases a year. Anne, our virologist, told us that there might be something else working in our favor here, too. Although we mentioned before the break that Hunter virus can have this long incubation period, where you can have two months between getting infected and showing symptoms, which, yes, is a long time. Even Anne said.

• 29:12Speaker 03

  This is crazy to me.

• 29:14Wendy Zukerman?

  But she also said that unlike COVID, it's not clear that you can actually spread the disease during that time. So here's Anne.

• 29:24Speaker 03

  It appears, at least from the scant evidence that we do have from well-analyzed outbreaks, it appears that most of the time, transmission, when it's been documented well, it happens and that person is sick. Like, they are visibly sick. They have a fever. They are not well.

• 29:43Wendy Zukerman?

  And with all of the bonkers stuff on social media that makes this sound so scary, I'm gonna give you one more comforting thing. This version of Hunter virus that led to the relatively small outbreak on the cruise ship, it's been known to science since 1996, 30 years ago, when Macarena was number one on the charts. And in that time, three decades, it really hasn't mutated, particularly when you compare it to viruses that have caused pandemics.

• 30:19Speaker 03

  COVID is a master mutator, much like influenza. That's their bread and butter. That's how they survive. But that's not the case with Hunter virus. They looked at the Andy's virus.

• 30:32Speaker 06

  That circulated in 2018 in this outbreak. And they compared it to another outbreak that had been documented in 1996. So 22 years previously. And the sequences are virtually the same.

• 30:46Wendy Zukerman?

  So, put it all together. This virus does not spread easily between people, which is why when an odd outbreak has happened before, it doesn't tend to blow up. And so far, this virus hasn't been mutating to become better at transmitting between people. So when we asked Anne, the big question of this episode, the question that so many of you guys had, is this gonna be the next pandemic? Here's what she said.

• 31:14Speaker 06

  No, no, rest easy. This is not it. Get ready, because there will be, there will be something that's more serious. But no, this is not, this is, you can be okay. But I think we're not going to see too many more cases.

• 31:27Wendy Zukerman?

  And other researchers that we spoke to said the same thing.

• 31:31Speaker 06

  I want to be very clear. This current outbreak of Andy's virus, this Hunter virus, is not the next pandemic. No, this is not the next pandemic.

• 31:40Speaker 05

  So yeah, it's not the next pandemic.

• 31:44Wendy Zukerman?

  And I know you might be feeling, hey, some of you scientists said COVID would be fine too. And look what happened. I hear you. But it's easy to forget that COVID was a completely new virus when it just landed on our doorstep in 2019. And at the beginning of the pandemic, scientists were making educated guesses about what was going on and how the virus was going to behave. And they got stuff wrong. With this Hunter virus that's causing the outbreak, the Andy's version, scientists have been studying it for 30 years. And we know that scary outbreaks tend to be pretty small. But still, if you want to be careful,

• 32:29Wendy Zukerman?

  if you're cleaning up a space that might have rodent poo, wear a mask. And if you have a friend that just got off a cruise ship, avoid deep kisses. That's science versus.

• 32:45Wendy Zukerman?

  This episode has more than 80 citations in it. If you want to read more about Hunter virus, understand where we get all of our information from. There's a link to our transcript in the show notes. Go check it out.

• 33:04Wendy Zukerman?

  This episode was produced by Michelle Dang with help from Blythe Terrell, Merrill Horn, Rose Rimla, Akedi Foster Keys and me, Wendy Zukerman. We're edited by Blythe Terrell, I'm the executive producer. Fact checking by Diane Kelly, mix and sound design by Bobby Lord, music written by Bobby Lord, Bumi Hidaka, So Wiley, Emma Munga and Peter Leonard. Special thanks to the researchers we spoke to for this episode, including Professor Glenn Marsh. Science Versus is a Spotify Studios original. You can listen to us for free on Spotify or wherever you get your podcasts. If you are listening on Spotify, you can write a comment. We read them all and nice ones are very, very nice. It also helps the show to grow, keeps our bosses happy. So write us a nice comment.

• 33:46Wendy Zukerman?

  Also, you can follow us and tap the bell icon so you get notifications when new episodes come out. I'm Wendy Zukerman, back to you next time.

• 34:05Speaker 03

  Are you looking for support in your weight management journey? Zepbound terzepatide may be able to help. Zepbound is a prescription medicine used with a reduced calorie diet and increased physical activity to help adults with obesity or some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off. Zepbound is approved as a 2.5, 5, 7.5, 10, 12.5 or 15mg injection. Zepbound contains terzepatide and should not be used with other terzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective for use in children. Don't share needles or pens or reuse needles.

• 34:47Speaker 03

  Don't take if allergic to it or if you or someone in your family had medullary thyroid cancer or if you've had multiple endocrine neoplasia syndrome type 2. Tell your doctor if you get a lump or swelling in your neck. Stop Zepbound and call your doctor if you have severe stomach pain or a serious allergic reaction. Severe side effects may include inflamed pancreas or gallbladder problems. Tell your doctor if you experience vision changes. Before scheduled procedures with anesthesia, if you're nursing, pregnant, plan to be, or taking birth control pills. Taking Zepbound with a sulfonilurea or insulin may cause low blood sugar. Side effects include nausea, diarrhea, and vomiting, which can cause dehydration and worsen kidney problems. Talk to your doctor. Call 1-800-545-5979,

• 35:31Speaker 03

  or visit zepboundslily.com.

• 35:36Speaker 03

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