Human infection with Andes hantavirus: an update for the general physician
8 affiliations
- 1Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Internal Medicine and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy. Electronic address: [email protected]
- 2Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Internal Medicine and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
- 3University of Campania ‘L. Vanvitelli’, Naples, Italy
- 4Hôpital Beaujon, Clichy, France
- 5Universitas Miguel Hernández, Alicante, Spain
- 6Hospital Distrital de Santarém, Santarém, Portugal
- 7Laiko General Hospital, National and Kapodistrian University, Athens, Greece
- 8Charité-Universitätsmedizin Berlin, Berlin, Germany
Abstract
Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique capacity for sustained human-to-human transmission, occurring via respiratory droplets and prolonged close contact with symptomatic individuals, with a median reproductive number exceeding 2 and an incubation period ranging from 9 to 40 days. ANDV infection can present with a wide range of clinical manifestations. Of them, the most feared is Hantavirus cardiopulmonary syndrome (HCPS), a severe condition characterised by acute respiratory failure, haemodynamic instability, acute kidney injury, hepatic involvement, and dysregulated cytokine release, with high lethality. Disease severity correlates with the degree of neutrophilia, leukocytosis, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase. No approved antiviral therapy or vaccine currently exists; management remains entirely supportive, centred on oxygen supplementation, haemodynamic stabilisation, and renal replacement therapy when indicated. Case fatality rates reached 32% in a 2018-2019 outbreak, with death occurring a mean of 6.7 days from symptom onset. The April 2026 outbreak aboard the MV Hondius cruise ship - involving passengers of 23 nationalities, with 8 cases (6 confirmed, 2 suspected), and 3 deaths reported as of 11 May 2026 (CFR 38%) - exemplifies how a zoonotic pathogen with limited human-to-human transmissibility can rapidly achieve global reach in the era of mass international travel, underscoring the urgent need for clinician awareness, prompt contact tracing, and internationally coordinated outbreak preparedness.
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BibTeX
@article{durantemangoni2026human,
title = {{Human infection with Andes hantavirus: an update for the general physician}},
author = {Emanuele Durante‐Mangoni and Iolanda Cafarella and Silvia Mercadante and Nathalie Scarpulla and Durante-Mangoni Emanuele and Agnès Lefort and Ramos-Rincon Jose Manuel and Roxo Fausto and Samarkos Michael and Miriam Stegemann},
journal = {European Journal of Internal Medicine},
year = {2026},
month = may,
doi = {10.1016/j.ejim.2026.106946},
url = {https://doi.org/10.1016/j.ejim.2026.106946},
note = {CC BY},
}
RIS
TY - JOUR
TI - Human infection with Andes hantavirus: an update for the general physician
AU - Emanuele Durante‐Mangoni
AU - Iolanda Cafarella
AU - Silvia Mercadante
AU - Nathalie Scarpulla
AU - Durante-Mangoni Emanuele
AU - Agnès Lefort
AU - Ramos-Rincon Jose Manuel
AU - Roxo Fausto
AU - Samarkos Michael
AU - Miriam Stegemann
PY - 2026
DA - 2026/05/26
JO - European Journal of Internal Medicine
DO - 10.1016/j.ejim.2026.106946
UR - https://doi.org/10.1016/j.ejim.2026.106946
AB - Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique capacity for sustained human-to-human transmission, occurring via respiratory droplets and prolonged close contact with symptomatic individuals, with a median reproductive number exceeding 2 and an incubation period ranging from 9 to 40 days. ANDV infection can present with a wide range of clinical manifestations. Of them, the most feared is Hantavirus cardiopulmonary syndrome (HCPS), a severe condition characterised by acute respiratory failure, haemodynamic instability, acute kidney injury, hepatic involvement, and dysregulated cytokine release, with high lethality. Disease severity correlates with the degree of neutrophilia, leukocytosis, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase. No approved antiviral therapy or vaccine currently exists; management remains entirely supportive, centred on oxygen supplementation, haemodynamic stabilisation, and renal replacement therapy when indicated. Case fatality rates reached 32% in a 2018-2019 outbreak, with death occurring a mean of 6.7 days from symptom onset. The April 2026 outbreak aboard the MV Hondius cruise ship - involving passengers of 23 nationalities, with 8 cases (6 confirmed, 2 suspected), and 3 deaths reported as of 11 May 2026 (CFR 38%) - exemplifies how a zoonotic pathogen with limited human-to-human transmissibility can rapidly achieve global reach in the era of mass international travel, underscoring the urgent need for clinician awareness, prompt contact tracing, and internationally coordinated outbreak preparedness.
SN - 0953-6205
SN - 1879-0828
ER -