Clinical management of hantavirus infection, including Andes virus disease: Interim regional guidance for suspected or confirmed cases

Hantaviruses are enveloped viruses belonging to the family Hantaviridae, genus Orthohantavirus, which currently comprises approximately 60 species. They are broadly classified into Old World hantaviruses, distributed in Europe, Asia, and Africa, and New World hantaviruses in the Americas, which are associated with distinct clinical syndromes: hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. These viruses are maintained in nature through chronic, asymptomatic infection of specific mammalian reservoirs, primarily rodents of the families Muridae and Cricetidae, with each hantavirus species linked to a single reservoir host that sheds virus in urine, feces, and saliva. Human infection occurs predominantly through inhalation of aerosolized particles contaminated with infected rodent excreta, particularly in enclosed or poorly ventilated environments. In the Americas, person-to-person transmission has been described for Andes virus (ANDV), particularly in settings of close and prolonged exposure. Hantavirus infection may progress rapidly from a nonspecific febrile illness to severe cardiopulmonary compromise, with high case-fatality rates, underscoring the need for early recognition and prompt clinical management.

This interim guidance provides practical recommendations for early recognition, clinical management, referral, and integration of infection prevention and control measures for suspected or confirmed cases. Suspected hantavirus infection should be managed as a clinical emergency. These measures should be implemented immediately and should not be delayed while awaiting laboratory confirmation. The objective is to reduce morbidity, mortality, and secondary transmission through early clinical suspicion, timely diagnostic confirmation, immediate public health notification, appropriate infection prevention and control, early referral to critical care, and coordinated clinical management.