Hantaviruses as priority zoonotic diseases: A comprehensive review

Abstract

Hantaviruses are zoonotic agents that play a significant role in global public health, primarily due to their ability to cause two highly severe clinical syndromes: Hemorrhagic Fever with Renal Syndrome (HFRS), which is predominant in Eurasia, and Hantavirus Cardiopulmonary Syndrome (HCPS/HPS), which is primarily found in the Americas. Although long recognized, the complex interactions between the virus, its rodent reservoir, and environmental factors make hantaviruses still a relevant epidemiological threat today. This review aims to provide a comprehensive overview of their virological characteristics, epidemiological patterns, pathogenesis mechanisms, risk factors, diagnostic methods, therapeutic options, prevention strategies, and the latest developments in hantavirus vaccines. Several studies have shown that the diversity of hantavirus species is strongly influenced by the ecology of their natural reservoirs, resulting in geographically specific virus distribution patterns. Pathogenesis mechanisms are primarily related to impaired immune response regulation and increased vascular permeability, which underlie the emergence of severe clinical manifestations in the kidneys and respiratory system. Key risk factors include exposure to environments contaminated with rodent excretions, agricultural activities, housing conditions with rodent infestations, and environmental changes that influence reservoir population dynamics. Diagnosis requires a combination of serological testing and molecular detection methods, while clinical management remains supportive due to the lack of specific and effective antiviral therapy. Although vaccine development has shown progress, its implementation remains limited to specific regions. These findings emphasize the importance of implementing a One Health approach that integrates ecological surveillance, clinical preparedness, and rodent control-based prevention strategies to sustainably reduce the risk of hantavirus zoonosis.