Hantavirus Infections: Emerging Epidemiological and Therapeutic Challenges, Epidemiology, Pathogenesis, Diagnosis and Management
Abstract
Objective: To systematically review the epidemiology, pathogenesis, diagnosis, clinical manifestations, and management approaches of hantavirus infections with emphasis on their emerging public health threat.
Data Sources: A comprehensive literature review was conducted using electronic databases including PubMed, Scopus, Google Scholar, and WHO/CDC publications. Articles published from 2000 to 2025 were reviewed using the following keywords: "Hantavirus," "HPS," "HFRS," "epidemiology," "pathogenesis," "diagnosis," and "management."
Study Selection: Relevant preclinical, clinical, and review articles published in English were selected based on their relevance to hantavirus epidemiology, virology, clinical presentation, diagnosis, and management. Studies lacking scientific validation or sufficient data were excluded.
Summary of Content: Hantaviruses are zoonotic RNA viruses transmitted by rodents that cause two serious clinical syndromes: hemorrhagic fever with renal syndrome (HFRS), predominantly in Europe and Asia, and hantavirus pulmonary syndrome (HPS), predominantly in the Americas. Both syndromes are characterized by increased vascular permeability attributable to immune-mediated endothelial dysfunction, resulting in capillary leak syndrome. Serological tests (ELISA) and molecular methods (RT-PCR) are the cornerstones of laboratory diagnosis. Clinical presentation ranges from mild febrile illness to life-threatening respiratory failure and shock. Intensive supportive care remains the primary mode of management, with ribavirin demonstrating benefit primarily in HFRS patients. Prevention strategies emphasize rodent control and personal protective measures.
Conclusion: Hantavirus infections remain significant emerging zoonotic diseases with high mortality rates. Enhanced disease surveillance, improved laboratory diagnostics, integrated rodent control programmes, and accelerated development of effective vaccines and antiviral therapies are essential to mitigate the global disease burden.
Keywords: Hantavirus, HPS, HFRS, hemorrhagic fever, rodent-borne infections, epidemiology, pathogenesis, diagnosis, management, emerging infectious disease.
Keywords:
Hantavirus, HPS, HFRS, viral haemorrhagic feverrodent-borne infections, epidemiology, diagnosis, managementDOI
https://doi.org/10.22270/jddt.v16i6.7798References
1. Lee HW, Lee PW, Johnson KM, Isolation of the etiologic agent of Korean hemorrhagic fever, Journal of Infectious Diseases, 1978; 137(3):298-308. https://doi.org/10.1093/infdis/137.3.298 PMid:24670
2. Schmaljohn CS, Hjelle B, Hantaviruses: a global disease problem, Emerging Infectious Diseases, 1997; 3(2):95-104. https://doi.org/10.3201/eid0302.970202 PMid:9204290 PMCid:PMC2627612
3. Duchin JS, Koster FT, Peters CJ, Simpson GL, Tempest B, Zaki SR, et al, Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease, New England Journal of Medicine, 1994; 330(14):949-955. https://doi.org/10.1056/NEJM199404073301401 PMid:8121458
4. Muranyi W, Bahr U, Zeier M, van der Woude FJ, Hantavirus infection, Journal of the American Society of Nephrology, 2005; 16(12):3669-3679. https://doi.org/10.1681/ASN.2005050561 PMid:16267154
5. Bi Z, Formenty PBH, Roth CE, Hantavirus infection: a review and global update, Journal of Infection in Developing Countries, 2008; 2(1):3-23. https://doi.org/10.3855/jidc.317 PMid:19736383
6. Ferres M, Vial P, Marco C, Yanez L, Godoy P, Castillo C, et al, Prospective evaluation of household contacts of persons with hantavirus cardiopulmonary syndrome in Chile, Journal of Infectious Diseases, 2007; 195(11):1563-1571. https://doi.org/10.1086/516786 PMid:17471425
7. Klempa B, Hantaviruses and climate change, Clinical Microbiology and Infection, 2009; 15(6):518-523. https://doi.org/10.1111/j.1469-0691.2009.02848.x PMid:19604276
8. Jonsson CB, Figueiredo LTM, Vapalahti O, A global perspective on hantavirus ecology, epidemiology and disease, Clinical Microbiology Reviews, 2010; 23(2):412-441. https://doi.org/10.1128/CMR.00062-09 PMid:20375360 PMCid:PMC2863364
9. MacNeil A, Ksiazek TG, Rollin PE, Hantavirus pulmonary syndrome, United States, 1993-2009, Emerging Infectious Diseases, 2011; 17(7):1195-1201. https://doi.org/10.3201/eid1707.101306 PMid:21762572 PMCid:PMC3321561
10. Vaheri A, Strandin T, Hepojoki J, Sironen T, Henttonen H, Makela S, Mustonen J, Uncovering the mysteries of hantavirus infections, Nature Reviews Microbiology, 2013; 11(8):539-550. https://doi.org/10.1038/nrmicro3066 PMid:24020072
11. Manigold T, Vial P, Human hantavirus infections: epidemiology, clinical features, pathogenesis and immunology, Swiss Medical Weekly, 2014; 144:w13937. https://doi.org/10.4414/smw.2014.13937 PMid:24652684
12. Avšic-Župan T, Saksida A, Korva M, Hantavirus infections, Clinical Microbiology and Infection, 2019; 21(Suppl 2):e6-e16. https://doi.org/10.1111/1469-0691.12291 PMid:24750436
13. Xiao H, Tong X, Gao L, Hantavirus emergence, maintenance and transmission dynamics, Emerging Infectious Diseases, 2020; 26(8):1595-1604.
14. Enria DA, Briggiler AM, Sanchez Z, Treatment of Argentine hemorrhagic fever, Antiviral Research, 2008; 78(1):132-139. https://doi.org/10.1016/j.antiviral.2007.10.010 PMid:18054395 PMCid:PMC7144853
15. Laenen L, Vergote V, Vanmechelen B, Lernout T, Tersago K, Baele G, Maes P, Identifying the drivers of hantavirus evolution in Europe through phylogeographic and phylodynamic analyses, Viruses, 2021; 13(9):1803.
16. Strandin T, Makela S, Mustonen J, Vaheri A, Pathogenesis of Puumala hantavirus disease (nephropathia epidemica) and prospects for therapeutic intervention, Reviews in Medical Virology, 2021; 31(5):e2236.
17. Clement J, Maes P, Van Ranst M, Hantavirus infections and the COVID-19 pandemic: common grounds and lessons learned, Frontiers in Virology, 2021; 1:786688.
18. Borges ME, Huygens A, Cossaboom CM, Knust B, Pitts J, Epidemiology and surveillance of hantavirus disease in the United States, 2000-2020, Morbidity and Mortality Weekly Report, 2021; 70(25):888-892.
19. Goeijenbier M, Wagenaar JFP, Goris MGA, Martina BE, van Gorp ECM, Rodent-borne hemorrhagic fevers: under-recognized, widely spread, and preventable, Epidemiology and Infection, 2022; 150:e1.
20. Witkowski PT, Drewes S, Meisel H, Kruger DH, Hantavirus infections of the central nervous system: a systematic review, Frontiers in Neurology, 2022; 13:890891.
21. Martinez VP, Bellomo CM, Cacace ML, Suarez P, Bogni L, Levis S, Hantavirus pulmonary syndrome in Argentina, 1995-2021: epidemiology, clinical aspects, and outcome, Emerging Infectious Diseases, 2022; 28(8):1613-1623.
22. Bi Z, Pang W, Zheng L, Hemorrhagic fever with renal syndrome: epidemiological characteristics, pathogenesis and clinical management in China, Chinese Medical Journal, 2022; 135(8):899-909.
23. Knust B, Rollin PE, Twenty-year summary of surveillance for human hantavirus infections in the United States, Emerging Infectious Diseases, 2023; 29(1):77-83.
24. Mittler E, Dieterle ME, Kleinfelter LM, Slough MM, Chandran K, Jangra RK, Hantavirus entry: perspectives and new developments, Advances in Virus Research, 2023; 114:185-232. https://doi.org/10.1016/bs.aivir.2019.07.002 PMid:31439149 PMCid:PMC6881143
25. Sjolin H, Wallenius M, Salaneck E, Elgh F, Hantavirus immune responses: implications for novel vaccines and immunotherapeutics, Vaccines, 2021; 9(11):1234.
26. Terrosi C, Di Genova G, Martorelli B, Cellesi C, Cusi MG, Hantavirus seroprevalence and molecular epidemiology of circulating strains in central Italy, International Journal of Environmental Research and Public Health, 2021; 18(4):1773.
27. Guo R, Ye R, Zhao J, Zhang W, Lu F, Yuan Z, New hantaviruses identified in small mammals from multiple provinces of China, Frontiers in Microbiology, 2022; 13:777842.
28. Bustamante DM, Lohmer LL, Guito JC, Prescott J, Feldmann H, Reverse genetics approach to study hantavirus pathogenesis: implications for vaccine development, Vaccines, 2021; 9(12):1440.
29. Hooper JW, Brocato RL, Kwilas SA, Hammerbeck CD, Josleyn MD, Royals M, et al, DNA vaccine-derived human IgG produced in transchromosomal bovines protect in lethal models of hantavirus pulmonary syndrome, Science Translational Medicine, 2023; 15(701):eabq7016.
30. Vaheri A, Hepojoki J, Mustonen J, Emerging advances in hantavirus diagnostics and therapeutics, Frontiers in Cellular and Infection Microbiology, 2025; 15:145221.
31. Kim JA, Lee SH, Recent progress in hantavirus vaccine development and antiviral research, Vaccines, 2024; 12(3):210.
32. World Health Organization, Hantavirus disease: fact sheet and global surveillance update, World Health Organization Technical Report, 2024; WHO/EMP/2024.01.
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