Open Veterinary Journal, (2026), Vol. 16(8): 5009–5013

Review Article

10.5455/OVJ.2026.v16.i8.1

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Hantaviruses: An emerging global challenge in modern public health: A mini review

Betina Boneva-Marutsova^* and Plamen Marutsov

Department of Veterinary Microbiology, Infectious and Parasitic Diseases; Faculty of Veterinary Medicine, Trakia University, Stara Zagora, Bulgaria

*Corresponding Author: Betina Boneva-Marutsova. Department of Veterinary Microbiology, Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, Trakia University, Stara Zagora, Bulgaria. Email: betina.boneva [at] trakia-uni.bg

Submitted: 15/05/2026 Revised: 05/07/2026 Accepted: 14/07/2026 Published: 08/08/2026

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Abstract

Hantaviruses are emerging zoonotic pathogens that represent a significant global threat due to their expanding geographic distribution, broad host range, and potential to cause severe disease in humans, with a case fatality rate of <1%–15% in Asia and Europe and up to 50% in the Americas. These viruses are primarily transmitted via aerosolised excreta from infected rodents, although insectivores and bats have also been identified as potential reservoirs. Human infections can lead to two main clinical syndromes: hemorrhagic fever with renal syndrome, which is predominantly reported in Europe and Asia, and hantavirus cardiopulmonary syndrome, primarily occurring in the Americas. Several factors contribute to the rising incidence and spread of hantavirus infections worldwide, including climate change, environmental disturbances, urbanization, habitat alteration, and increased human–animal interactions. This mini-review synthesises current understanding of hantavirus epidemiology, pathogenesis, diagnosis, treatment, and prevention, highlighting their growing importance within the One Health framework.

Keywords: Emerging infectious diseases, Hantavirus, One health, Rodents, Zoonosis.

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Introduction

Hantavirus infections are an important group of zoonotic diseases caused by viruses belonging to the genus Orthohantavirus, family Hantaviridae (Zerbini et al., 2023). Hantaviruses are enveloped, single-stranded, negative-sense RNA viruses that are maintained in rodent reservoirs through persistent infection (Jonsson et al., 2010; Samples and Arowolo, 2025).

The first recognized outbreaks occurred during the Korean War in the early 1950s, when thousands of soldiers developed Korean hemorrhagic fever (Lee et al., 1978; Lee et al., 2004). Since then, numerous hantavirus species have been identified worldwide. The emergence of hantavirus cardiopulmonary syndrome in the United States in 1993 further underscored the severe zoonotic potential of these pathogens (Nichol et al., 1993; Lee et al., 2004).

Today, hantaviruses are increasingly recognized as a major public health challenge because of climate change, ecological disturbances, expanding rodent populations, urbanization, increased human–wildlife interaction, and lack of specific antiviral therapies (Schmaljohn et al., 1997; Klempa, 2009; Kruger et al., 2015; Samples and Arowolo, 2025). Hantavirus infections are a serious health concern, with case fatality rates ranging from less than 1% to 15% in Asia and Europe and up to 50% in the Americas. An estimated 10,000 to over 100,000 cases occur globally each year, primarily in Asia and Europe (Tortosa et al., 2024).

Taxonomy and virology

Orthohantaviruses belong to the order Bunyavirales and possess three genomic RNA segments designated as small (S), medium (M), and large (L) (Pljusnin and Elliott, 2011; Bradfute et al., 2024).

The S segment encodes the nucleocapsid protein, the M segment encodes viral glycoproteins Gn and Gc, and the L segment encodes RNA-dependent RNA polymerase (Jonsson et al., 2010; Bradfute et al., 2024).

Different hantavirus species are associated with specific rodent reservoirs (Klempa et al., 2013; Vaheri et al., 2013):

➢ Hantaan virus–striped field mouse (Apodemus agrarius)

➢ Puumala virus–bank vole (Myodes glareolus)

➢ Dobrava Belgrade virus – yellow-necked mouse (Apodemus flavicollis)

➢ Sin nombre virus–deer mouse (Peromyscus maniculatus)

➢ Andes virus – long-tailed pygmy rice rat (Oligoryzomys longicaudatus).

Among these, the Andes virus is unique because limited human-to-human transmission has been documented (Martinez-Valdebenito et al., 2014; Bradfute et al., 2024).

Transmission and zoonotic potential

Human infection with hantaviruses primarily occurs through the inhalation of aerosolized particles that are contaminated with the excreta of infected rodents, including urine, saliva, or feces (Jonsson et al., 2010). This mode of transmission highlights the respiratory route as a significant pathway for virus entry into the human host, particularly in rodent populations. Less commonly, transmission can occur via direct rodent bites, mucous membrane contact, or open wounds contaminated with infected rodent secretions (Guo et al., 2013; Vaheri et al., 2013; Kruger et al., 2015; Samples and Arowolo, 2025).

Occupational exposure poses a considerable risk of certain individuals. Activities that disturb rodent-infested environments, such as sweeping, cleaning, or renovating poorly ventilated structures – such as barns, basements, and storage facilities – can aerosolize virus-laden particles, significantly increasing the likelihood of human infection (Vapalahti et al., 2003). Farmers, veterinarians, forestry workers, military personnel, emergency responders, and laboratory staff who may work with rodent populations or their biological materials are at heightened risk (Clement et al., 2014). The prevalence of hantavirus infections in specific occupational settings underscores the need for heightened awareness and preventive measures among these vulnerable groups (Tian and Stenseth, 2019; Samples and Arowolo, 2025).

The zoonotic potential of hantaviruses warrants considerable attention due to the fact that infected rodent species can act as asymptomatic carriers, perpetually contaminating their environment with the virus (Jonsson et al., 2010). Continuous environmental contamination increases the likelihood of human exposure over time. Notably, while most hantaviruses are not transmitted between humans, notable exceptions exist; for instance, the Andes virus has exhibited limited human-to-human transmission, particularly in certain regions of South America, as documented by Martinez-Valdebenito et al. (2014). This potential for limited person-to-person transmission further complicates the epidemiology of hantavirus infections and underscores the importance of ongoing surveillance and research to understand and mitigate the risks posed by these pathogens (Watson et al., 2014; Samples and Arowolo, 2025).

Pathogenesis of Hantavirus infections and clinical manifestations in humans

Hantaviruses, a genus within the Hantaviridae family, predominantly target endothelial cells lining blood vessels. This cellular tropism leads to a marked increase in vascular permeability and capillary leakage, contributing to the hallmark symptoms observed in hantavirus-related diseases (Schonrich et al., 2015). The pathophysiological basis of these symptoms is significantly influenced by the host immune response, which, while necessary for combating the viral infection, can also result in severe clinical outcomes. Excessive cytokine release and subsequent inflammatory dysregulation are pivotal in determining disease severity, often resulting in a cytokine storm that exacerbates tissue injury (Krautkramer and Zeier, 2008).

Two major clinical syndromes arising from hantavirus infections have been recognized: hemorrhagic fever with renal syndrome (HFRS) and Hantavirus cardiopulmonary syndrome (HCPS), each with distinct epidemiological and clinical characteristics (Vaheri et al., 2013).

Importantly, the clinical manifestations of hantavirus infections vary depending on the specific hantavirus species involved. In HFRS, renal dysfunction emerges as a predominant feature, whereas HCPS is characterized by respiratory distress, often culminating in cardiopulmonary collapse (Vial et al., 2023).

HFRS is predominantly observed in Europe and Asia and is associated with a constellation of symptoms that may include high fever, severe headaches, abdominal pain, thrombocytopenia (reduced platelet count), hemorrhagic manifestations, and acute kidney injury (Huggins et al., 1991). The severity of HFRS can vary notably based on the specific viral strain involved in the infection. For instance, infection with the Puumala virus typically triggers a milder clinical picture known as nephropathia epidemica, which is characterized by less severe symptoms. In contrast, Hantaan and Dobrava-Belgrade viruses are associated with more severe clinical presentations and an increased risk of morbidity and mortality (Vapalahti et al., 2003; Klempa et al., 2013; Kruger et al., 2015).

Conversely, HCPS is primarily observed in the Americas and is characterized by an initial onset of nonspecific influenza-like symptoms, such as fever, myalgia, and fatigue. However, this initial phase can rapidly progress to pulmonary oedema, respiratory failure, hypotension, and ultimately cardiogenic shock in severe cases. The mortality rate for HCPS can be alarmingly high, exceeding 30% in patients with severe disease manifestations (Jonsson et al., 2010; Vial et al., 2023).

These clinical profiles highlight the significant heterogeneity in disease presentation and severity, underscoring the importance of understanding the specific hantavirus species involved in infection for effective diagnosis and management (Samples and Arowolo, 2025).

Diagnosis

Diagnostic procedures for viral infections rely heavily on a combination of epidemiological hisory, clinical findings, and laboratory tests to ensure accurate identification of the pathogen involved. According to Kruger et al. (2015), this multifaceted approach enhances the reliability of the diagnosis by integrating different types of evidence.

One of the primary diagnostic tools is serological assays, which are designed to detect specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against the virus in question. The presence of IgM typically indicates a recent infection, while IgG suggests past exposure, making these assays invaluable for establishing the timing and severity of the infection (Vapalahti et al., 2003). Serological testing is widely used due to its relatively straightforward execution and ability to provide results that can guide clinical management and public health responses.

In addition to serological methods, molecular diagnostics, particularly reverse transcription polymerase chain reaction (RT-PCR), play a crucial role during the acute phase of infection. RT-PCR detects viral RNA, which can be present in high quantities soon after infection. As highlighted by Jonsson et al. (2010), this method is particularly advantageous for early diagnosis and can facilitate rapid epidemiological investigations. The ability to detect viral genetic material promptly can significantly influence treatment decisions and outbreak control measures.

Patients with certain viral infections may exhibit laboratory abnormalities that provide further insight into the disease process. Common findings include thrombocytopaenia (low platelet count), leukocytosis (increased white blood cell count), elevated liver enzymes indicative of liver inflammation or damage, proteinuria (presence of protein in urine), and impaired renal function (Vaheri et al., 2013). These laboratory abnormalities not only support the diagnosis but also help assess the infection severity and monitor the patient’s response to treatment.

In summary, a comprehensive approach to diagnosis – integrating epidemiological context with serological and molecular testing, alongside careful evaluation of clinical and laboratory findings – is essential for effective management of viral infections (Vial et al., 2023).

Treatment

Currently, there is no universally recognized and specific antiviral treatment for hantavirus infections, as highlighted by Kruger et al. (2015). The management of these infections primarily revolves around supportive care, which may necessitate interventions such as intensive care monitoring, oxygen therapy, mechanical ventilation, hemodynamic stabilization, and even dialysis in cases of severe renal impairment (Vial et al., 2023).

Preventive strategies are critically focused on minimizing exposure to rodent populations and environments that may be contaminated with their excreta. According to Jonsson et al. (2010), effective rodent control measures, the secure storage of food items and animal feed, proper management of waste products, and thorough disinfection of surfaces exposed to potential contamination are essential components of an integrated prevention plan (Clement et al., 2014).

Moreover, when undertaking cleaning activities in areas known to harbor rodent infestations, it is imperative to utilize appropriate wet disinfection methods combined with personal protective equipment (PPE). These practices are crucial for reducing the risk of aerosolization of pathogens, as pointed out by Kruger et al. (2015). By implementing these comprehensive measures, the risk of hantavirus transmission can be significantly mitigated.

One health importance

The concept of One Health is critical for understanding and addressing complex health issues arising from the interconnectedness of humans, animal, and environmental health. A compelling illustration of this principle can be found in the epidemiology of hantavirus infections. These infections illustrate the intricate relationships among wildlife reservoirs, environmental factors, and human activities. Destoumieux-Garzón et al. (2018) found that the emergence of hantavirus infections is often linked to several ecological and anthropogenic influences.

Factors such as climate change, urbanization, and habitat modification significantly alter the dynamics of ecosystems, which can facilitate the transmission of these viruses from wildlife to humans. For example, as human encroachment into natural habitats increases, so does the likelihood of contact with wildlife that may harbor zoonotic pathogens, including hantaviruses (Clement et al., 2014). This relationship underscores the need to examine health issues through a multidisciplinary lens, recognizing that human health is inextricably linked to the health of animals and the environment.

To effectively combat the threat posed by hantavirus infections and similar zoonotic diseases, an integrated surveillance system is imperative. This system should encompass various stakeholders, including health care providers, veterinarians, ecologists, microbiologists, and public health authorities. Collaborative efforts among these groups are crucial for the early detection, prevention, and control of outbreaks. By sharing data and expertise, these diverse professionals can contribute to a more comprehensive understanding of the factors that drive disease emergence, ultimately leading to more effective public health interventions (Destoumieux-Garzón et al., 2018). In conclusion, recognizing and implementing the One Health approach is essential for mitigating the risks posed by zoonotic diseases such as hantavirus, thereby safeguarding both human health and the integrity of the ecosystems we depend on.

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Conclusion

Hantaviruses are critical zoonotic pathogens that pose substantial public health risks worldwide. The transmission dynamics of these viruses are closely related to their persistence in rodent reservoirs, the contamination of environments where humans may come into contact with infected rodents, and direct human exposure to rodent habitats. While hantavirus infections are uncommon, they can cause severe and even fatal disease in affected individuals. Effective prevention strategies, including rodent population management, environmental cleanliness maintenance, public education initiatives, and comprehensive One Health surveillance, are essential for minimizing the risk of hantavirus infections in human populations.

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Acknowledgments

The authors express their most sincere gratitude to the Faculty of Veterinary Medicine, Stara Zagora, for the APC support.

Conflicts of interest

The authors declare no conflicts of interest.

Funding

This study received no external funding.

Authors' contributions

Conceptualization: B. B-M., P.M.; resources: B.B-M. P.M.; writing – original draft preparation: B.B-M. P.M.; writing – review and editing: B.B-M., P.M. All authors have read and agreed to the published version of the manuscript.

Data availability

Data supporting the findings are available from the corresponding author on reasonable request.

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References

Bradfute, S.B., Calisher, C.H., Klempa, B., Klingström, J., Kuhn, J.H., Laenen, L. and Maes, P. 2024. ICTV virus taxonomy profile: hantaviridae 2024. J. Gen. Virol. 105(4), 001975.

Clement, J., Maes, P. and Van Ranst, M. 2014. Hemorrhagic fever with renal syndrome in the new, and hantavirus pulmonary syndrome in the old world: paradigm lost or regained? Virus Res. 187, 55–58.

Destoumieux-Garzón, D., Mavingui, P., Boetsch, G., Boissier, J., Darriet, F., Duboz, P. and Voituron, Y. 2018. The one health concept: 10 years old and a long road ahead. Front. Vet. Sci. 5, 14.

Guo, W.P., Lin, X.D., Wang, W., Tian, J.H., Cong, M.L., Zhang, H.L. and Zhang, Y.Z. 2013. Phylogeny and origins of hantaviruses harbored by bats, insectivores, and rodents. PLoS Pathog. 9(2), e1003159.

Huggins, J.W., Hsiang, C.M., Cosgriff, T.M., Guang, M.Y., Smith, J.I., Wu, Z.O. and Zhang, T.M. 1991. Prospective, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J. Infect. Dis. 164(6), 1119–1127.

Jonsson, C.B., Figueiredo, L.T.M. and Vapalahti, O. 2010. A global perspective on hantavirus ecology, epidemiology, and disease. Clin. Microbiol. Rev. 23(2), 412–441.

Klempa, B. 2009. Hantaviruses and climate change. Clin. Microbiol. Infect. 15(6), 518–523.

Klempa, B., Avsic-Zupanc, T., Clement, J., Dzagurova, T.K., Henttonen, H., Heyman, P. and Vaheri, A. 2013. Complex evolution and epidemiology of Dobrava-Belgrade hantavirus: definition of genotypes and their characteristics. Arch. Virol. 158(3), 521–529.

Krautkrämer, E. and Zeier, M. 2008. Hantavirus, causing hemorrhagic fever with renal syndrome, enters from the apical surface and requires decay-accelerating factor (DAF/CD55). J. Virol. 82(9), 4257–4264.

Kruger, D.H., Figueiredo, L.T.M., Song, J.W. and Klempa, B. 2015. Hantaviruses—globally emerging pathogens. J. Clin. Virol. 64, 128–136.

Lee, H.W., Lee, P.W. and Johnson, K.M. 2004. Isolation of the etiologic agent of Korean hemorrhagic fever. J. Infect. Dis. 190(9), 1711–1721.

Martínez-Valdebenito, C., Calvo, M., Vial, C., Mansilla, R., Marco, C., Palma, R.E. and Ferrés, M. 2014. Person-to-person household and nosocomial transmission of Andes hantavirus, Southern Chile, 2011. Emerg. Infect. Dis. 20(10), 1629.

Nichol, S.T., Spiropoulou, C.F., Morzunov, S., Rollin, P.E., Ksiazek, T.G., Feldmann, H. and Peters, C.J. 1993. Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science 262(5135), 914–917.

Pljusnin, A. and Elliott, R.M. 2011. Bunyaviridae: molecular and cellular biology., Finland: University of Helsinki.

Samples, O.M. and Arowolo, J. 2025. Hantavirus (Hantavirus spp.). The One Health Model as Applied to Zoonotic Diseases. 253–256.

Schmaljohn, C. and Hjelle, B. 1997. Hantaviruses: a global disease problem. Emerg. Infect. Dis. 3(2), 95.

Schönrich, G., Krüger, D.H. and Raftery, M.J. 2015. Hantavirus-induced disruption of the endothelial barrier: neutrophils are on the payroll. Front. Microbiol. 6, 222.

Tian, H. and Stenseth, N.C. 2019. The ecological dynamics of hantavirus diseases: from environmental variability to disease prevention, largely based on data from China. PLoS Negl. Trop. Dis. 13(2), e0006901.

Tortosa, F., Perre, F., Tognetti, C., Lossetti, L., Carrasco, G., Guaresti, G. and Izcovich, A. 2024. Seroprevalence of hantavirus infection in non-epidemic settings over four decades: a systematic review and meta-analysis. BMC Public Health 24(1), 2553.

Vaheri, A., Henttonen, H., Voutilainen, L., Mustonen, J., Sironen, T. and Vapalahti, O. 2013. Hantavirus infections in Europe and their impact on public health. Rev. Med. Virol. 23(1), 35–49.

Vaheri, A., Strandin, T., Hepojoki, J., Sironen, T., Henttonen, H., Mäkelä, S. and Mustonen, J. 2013. Uncovering the mysteries of hantavirus infections. Nat. Rev. Microbiol. 11(8), 539–550.

Vapalahti, O., Mustonen, J., Lundkvist, Å., Henttonen, H., Plyusnin, A. and Vaheri, A. 2003. Hantavirus infections in Europe. Lancet Infect. Dis. 3(10), 653–661.

Vial, P.A., Ferrés, M., Vial, C., Klingström, J., Ahlm, C., López, R. and Mertz, G.J. 2023. Hantavirus in humans: a review of clinical aspects and management. Lancet Infect. Dis. 23(9), e371–e382.

Watson, D.C., Sargianou, M., Papa, A., Chra, P., Starakis, I. and Panos, G. 2014. Epidemiology of Hantavirus infections in humans: a comprehensive, global overview. Crit. Rev. Microbiol. 40(3), 261–272.

Zerbini, F.M., Siddell, S.G., Lefkowitz, E.J., Mushegian, A.R., Adriaenssens, E.M., Alfenas-Zerbini, P. and Varsani, A. 2023. Changes to virus taxonomy and the ICTV Statutes ratified by the International Committee on Taxonomy of Viruses (2023). Arch. Virol. 168(7), 175.