What are hantaviruses?

Hantaviruses are a family of RNA viruses (family Hantaviridae) carried by specific rodent reservoir hosts without causing disease in the rodents. Humans are infected through inhalation of aerosols from infected rodent urine, faeces or saliva — or through direct contact with rodent nesting materials. They cause two main clinical syndromes: HFRS (Old World — prominent kidney failure) and HPS (New World — prominent pulmonary failure). Unlike most other viral haemorrhagic fever viruses, hantaviruses (except Andes) do not spread person-to-person.

How is hantavirus transmitted?

Primary route: inhalation of aerosolised rodent excreta — created when sweeping, vacuuming, disturbing rodent nests or handling infected materials. Higher-risk activities: cleaning enclosed spaces (barns, cabins, outbuildings) with rodent infestation; agricultural work; military field exercises; camping. Less commonly: rodent bite; contact with rodent-contaminated food. Prevention: avoid disturbing rodent habitats; use respirators when cleaning infested spaces; rodent-proof homes and food storage.

Haemorrhagic fever with renal syndrome (HFRS) is the Old World hantavirus disease — caused by multiple species including Hantaan (China, Korea — most severe, CFR 1-15%), Dobrava (Balkans), Seoul (global, from rats — mild), and Puumala (Europe — mildest, CFR <0.5%). After a febrile prodrome, patients develop acute kidney injury (oliguria → anuria → polyuria), thrombocytopenia, haemorrhagic manifestations and — in severe Hantaan infection — shock. Most patients recover after weeks; dialysis may be needed.

Hantavirus pulmonary syndrome (HPS) — the New World hantavirus disease — begins with a 3-5 day prodrome of fever, myalgia, headache and GI symptoms, then rapidly progresses to pulmonary oedema (fluid in the lungs from capillary leak) and cardiogenic shock. Death occurs from cardiac failure (not ARDS) — typically within 24-48 hours of respiratory symptoms. Survival requires immediate ICU support, often with extracorporeal membrane oxygenation (ECMO). Case fatality approximately 38% in the US (Sin Nombre).

Is there a vaccine or treatment?

No WHO-approved vaccine exists for any hantavirus in humans. A killed bivalent HFRS vaccine is used in China and Korea — with variable efficacy estimates. No specific antiviral is approved for HPS. IV ribavirin reduces mortality in HFRS (especially Hantaan) if given early; it showed no benefit in HPS in a clinical trial. Treatment is entirely supportive: IV fluid management (avoiding over-hydration); dialysis for HFRS; mechanical ventilation/ECMO for HPS; vasopressors for shock.

Where is hantavirus found geographically?

HFRS: primarily China (approximately 90,000 cases/year — Hantaan and Seoul); Korea (approximately 300-400 cases/year); Russia (approximately 7,000 cases/year); Scandinavia/Northern Europe — Finland, Sweden, Belgium, Germany (approximately 3,000 cases/year — Puumala virus); Balkans (Dobrava). HPS: primarily USA (approximately 50-100 cases/year — Sin Nombre); Argentina, Chile, Brazil (Andes virus — most cases in the Americas after USA); Bolivia, Paraguay, Uruguay.

Why are hantavirus outbreaks linked to the weather?

Hantavirus transmission to humans depends on the density of rodent reservoir populations — which fluctuate dramatically with environmental conditions. Years of high precipitation → abundant vegetation → rodent population explosions → increased human-rodent contact → more hantavirus spillover. El Niño events (warm Pacific Ocean — affecting rainfall patterns globally) are associated with increased HPS outbreaks in the Americas. The 1993 US Four Corners HPS outbreak followed an exceptionally wet winter (El Niño) that caused a 10-fold increase in deer mouse populations.

How does GMJ News cover hantavirus?

GMJ News covers WHO hantavirus burden data, HFRS in Asia and Europe, Puumala nephropathia epidemica, HPS in the Americas, climate-rodent-outbreak links, and prevention. Hantavirus (Puumala) has been detected in Georgia/South Caucasus rodent populations — relevant to PHIG's zoonotic disease surveillance.

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Hantavirus

Q: What is HPS?

Hantavirus pulmonary syndrome (HPS) — the New World hantavirus disease — begins with a 3-5 day prodrome of fever, myalgia, headache and GI symptoms, then rapidly progresses to pulmonary oedema (fluid in the lungs from capillary leak) and cardiogenic shock. Death occurs from cardiac failure (not ARDS) — typically within 24-48 hours of respiratory symptoms. Survival requires immediate ICU support, often with extracorporeal membrane oxygenation (ECMO). Case fatality approximately 38% in the US (Sin Nombre).

Q: Is there a vaccine or treatment?

No WHO-approved vaccine exists for any hantavirus in humans. A killed bivalent HFRS vaccine is used in China and Korea — with variable efficacy estimates. No specific antiviral is approved for HPS. IV ribavirin reduces mortality in HFRS (especially Hantaan) if given early; it showed no benefit in HPS in a clinical trial. Treatment is entirely supportive: IV fluid management (avoiding over-hydration); dialysis for HFRS; mechanical ventilation/ECMO for HPS; vasopressors for shock.

Q: Where is hantavirus found geographically?

HFRS: primarily China (approximately 90,000 cases/year — Hantaan and Seoul); Korea (approximately 300-400 cases/year); Russia (approximately 7,000 cases/year); Scandinavia/Northern Europe — Finland, Sweden, Belgium, Germany (approximately 3,000 cases/year — Puumala virus); Balkans (Dobrava). HPS: primarily USA (approximately 50-100 cases/year — Sin Nombre); Argentina, Chile, Brazil (Andes virus — most cases in the Americas after USA); Bolivia, Paraguay, Uruguay.

Q: Why are hantavirus outbreaks linked to the weather?

Hantavirus transmission to humans depends on the density of rodent reservoir populations — which fluctuate dramatically with environmental conditions. Years of high precipitation → abundant vegetation → rodent population explosions → increased human-rodent contact → more hantavirus spillover. El Niño events (warm Pacific Ocean — affecting rainfall patterns globally) are associated with increased HPS outbreaks in the Americas. The 1993 US Four Corners HPS outbreak followed an exceptionally wet winter (El Niño) that caused a 10-fold increase in deer mouse populations.

Q: How does GMJ News cover hantavirus?

GMJ News covers WHO hantavirus burden data, HFRS in Asia and Europe, Puumala nephropathia epidemica, HPS in the Americas, climate-rodent-outbreak links, and prevention. Hantavirus (Puumala) has been detected in Georgia/South Caucasus rodent populations — relevant to PHIG's zoonotic disease surveillance.

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Hantaviruses — a family of rodent-borne RNA viruses transmitted through inhalation of contaminated rodent excreta — cause two distinct life-threatening syndromes: haemorrhagic fever with renal syndrome (HFRS) in the Old World (approximately 150,000 cases per year, predominantly in Asia and Europe, with case fatality 1-15%) and hantavirus pulmonary syndrome (HPS) in the Americas (approximately 300-400 cases per year in the US but with case fatality up to 40%) (WHO). No approved vaccine or specific antiviral treatment exists for any hantavirus disease in humans. Rodent control is the primary prevention strategy.

Key messages

Two distinct syndromes — HFRS and HPS

Hantaviruses cause two distinct life-threatening syndromes: haemorrhagic fever with renal syndrome (HFRS) in the Old World — approximately 150,000 cases/year, 1-15% CFR; and hantavirus pulmonary syndrome (HPS) in the Americas — approximately 200-400 cases/year in the US with up to 40% CFR (WHO).

Rodent-borne — no human-to-human transmission

Hantaviruses are maintained in specific rodent reservoir species — transmitted to humans through inhalation of aerosolised rodent excreta (urine, faeces, saliva). Unlike Nipah and CCHF, hantaviruses (except Andes virus) do NOT spread person-to-person.

No approved vaccine or antiviral

No WHO-approved vaccine or specific antiviral treatment exists for hantavirus disease in humans. Management is entirely supportive — ICU care, fluid management, oxygen support, and dialysis for HFRS.

HFRS — most cases in Asia and Europe

Hantaan virus (from the striped field mouse — Apodemus agrarius) causes severe HFRS in China and Korea (approximately 100,000 cases/year). Puumala virus (from bank voles) causes milder nephropathia epidemica across Europe. Seoul virus (from rats) occurs globally.

HPS — Americas — high mortality

Sin Nombre virus (from the deer mouse — Peromyscus maniculatus) causes HPS in the US Southwest — with dramatic cardiovascular collapse and approximately 38% mortality. Andes virus (South America) is the only hantavirus with documented person-to-person transmission.

Climate variability drives outbreaks

Hantavirus outbreaks often follow years of high precipitation → increased vegetation → population explosion in rodent reservoir species → increased human-rodent contact. El Niño years are associated with increased HPS in the Americas.

Key statistics

150K

HFRS cases/year (primarily Asia/Europe)

WHO

200-400

HPS cases/year in the Americas

CDC/PAHO

38%

HPS case fatality rate (Sin Nombre virus)

CDC

1-15%

HFRS case fatality (varies by virus — Hantaan highest)

WHO

approved vaccines or antivirals globally

WHO 2024

Andes only

hantavirus with human-to-human transmission

WHO

Hantavirus HFRS cases by country (approximate annual average) — WHO/national data

Source: WHO. China and Korea account for the majority of HFRS. European cases mainly from Puumala (nephropathia epidemica).

Glossary of key terms

HFRS (Haemorrhagic fever with renal syndrome)
WHOOld World hantavirus disease — caused by Hantaan, Seoul, Puumala, Dobrava and other viruses. Five phases: febrile, hypotensive (shock), oliguric (renal failure), polyuric, and convalescent. Thrombocytopenia, haemorrhagic manifestations (petechiae, haematuria) and acute kidney injury are hallmarks.

HPS (Hantavirus pulmonary syndrome)
WHO/CDCNew World hantavirus disease — caused primarily by Sin Nombre virus (USA) and Andes virus (South America). Characterised by prodromal fever/myalgia → rapid cardiopulmonary deterioration → pulmonary oedema, cardiogenic shock, death from cardiac failure (not ARDS). Case fatality approximately 38% in US.

Sin Nombre virus
CDCThe primary HPS agent in North America — carried by the deer mouse (Peromyscus maniculatus). First identified during a 1993 outbreak in the US Four Corners region (New Mexico, Arizona, Colorado, Utah). Transmitted by inhalation of deer mouse excreta during sweeping, cleaning or disturbing rodent-infested spaces.

Andes virus
PAHO/WHOThe primary HPS agent in South America (Argentina, Chile) — unique in that it is the only hantavirus with documented person-to-person transmission (through close contact with infected patients' saliva, blood or urine). Cases in close contacts of HPS patients have been documented in Argentina.

Puumala virus (PUUV)
WHO/ECDCThe causative agent of nephropathia epidemica — a milder HFRS form endemic across Northern and Central Europe (Scandinavia, Germany, Belgium, France, Balkans), transmitted by bank voles (Myodes glareolus). CFR <0.1-0.5%; renal failure requiring dialysis in approximately 5-10%.

Ribavirin for hantavirus
WHOIV ribavirin reduces mortality in HFRS (especially Hantaan virus) when given early. Little evidence for HPS — a randomised trial showed no benefit. The only antiviral with any evidence in hantavirus disease.