Hantavirus as a persistent zoonotic risk: epidemiology and current pharmacological management

Abstract

Hantaviruses are emerging rodent-borne zoonotic viruses that continue to pose a public health concern despite their relatively low incidence in humans. The 2026 Andes virus outbreak linked to the MV Hondius cruise ship renewed international attention on these pathogens, highlighting unresolved questions regarding transmission dynamics, vulnerable populations, and global preparedness. This review provides an updated critical appraisal of recent advances in hantavirus epidemiology, emerging therapeutic strategies, and public health challenges, with particular emphasis on the 2026 Andes virus outbreak, companion animals, and solid organ transplant recipients. A review of the recent literature was performed, focusing on zoonotic transmission, the role of companion animals, current and emerging therapeutic strategies, infections in immunocompromised and solid-organ transplant recipients, and the implications of the 2026 international outbreak. Although the sentinel hypothesis remains plausible, companion animals are not natural reservoirs, and preliminary evidence suggests that their exposure may reflect local hantavirus circulation, while pet rats have emerged as an important source of Seoul orthohantavirus infection. Therapeutic options remain limited: supportive care is the standard of treatment, and ribavirin shows benefit only in early hemorrhagic fever with renal syndrome. Emerging immunotherapeutic approaches, including neutralizing monoclonal antibodies and host-directed therapies, show promising preclinical results but still lack robust clinical validation. In immunocompromised patients, particularly solid-organ transplant recipients, hantavirus infection may mimic graft rejection or present with atypical, potentially fatal manifestations, posing diagnostic challenges. The 2026 MV Hondius outbreak reinforced the need for heightened surveillance, rapid diagnosis, and coordinated international response, while confirming that sustained human-to-human transmission remains exceptional. Recent evidence broadens the clinical and public health relevance of hantaviruses beyond their traditional framing as rodent-borne zoonoses. Advances in targeted therapeutics, integrated surveillance, and One Health preparedness will be pivotal to improving outbreak preparedness and accelerating the development of effective preventive and therapeutic strategies.