PUBLIC HEALTH SIGNIFICANCE OF HANTAVIRUS RE-EMERGENCE: A NARRATIVE REVIEW

Abstract

Hantaviruses are rodent-borne orthohantaviruses that continue to re-emerge through a convergence of ecological disruption, changing land use, climate variability, occupational exposure, expanding eco-tourism, and uneven surveillance. Human disease is classically grouped into haemorrhagic fever with renal syndrome (HFRS), seen mainly in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS), also called hantavirus pulmonary syndrome, seen mainly in the Americas. Although global incidence is low compared with many respiratory or arboviral infections, public health significance is disproportionate because HCPS can progress within hours to shock and respiratory failure, case fatality in the Americas is high, early symptoms are non-specific, and no approved curative antiviral treatment exists. The 2026 multi-country cluster linked to cruise-ship travel illustrates a modern re-emergence pattern: rare zoonotic infections can be exported rapidly through travel networks, creating diagnostic, infection-prevention, risk-communication, and International Health Regulations coordination challenges. Re-emergence should therefore be framed not as a constant pandemic threat but as a sentinel of human-rodent-environment interface failure. Priorities include integrated human-animal-environment surveillance, locally adapted rodent control, safer housing and occupational practices, rapid diagnostics, clinician awareness, culturally respectful community engagement, and research on vaccines, therapeutics, and correlates of protection.

Search strategy and selection criteria

This narrative review used English-language sources identified from PubMed, WHO, CDC, ECDC, PAHO-linked materials, and reference chaining from major reviews. Search terms included “hantavirus”, “orthohantavirus”, “hantavirus pulmonary syndrome”, “hantavirus cardiopulmonary syndrome”, “haemorrhagic fever with renal syndrome”, “Andes virus”, “Sin Nombre virus”, “re-emergence”, “climate”, “land use”, “rodent reservoir”, “surveillance”, “diagnosis”, “vaccine”, and “public health”. Priority was given to Lancet or major infectious-disease reviews, systematic reviews, public health agency reports, and peer-reviewed studies from 2020–2026, with older landmark papers used where they remain foundational. The review is narrative rather than systematic; no formal meta-analysis or risk-of-bias scoring was performed.