Hantavirus disease presents with two distinct clinical syndromes depending on which serotype caused the infection. Both share an early flu-like prodrome lasting 3 to 7 days, then diverge sharply: HPS progresses to cardiopulmonary failure; HFRS progresses to renal failure with bleeding. Incubation is 1 to 8 weeks.
Both syndromes begin similarly and are easily mistaken for influenza, COVID-19, viral gastroenteritis, dengue, leptospirosis, scrub typhus, or early sepsis. Typical features per CDC and WHO:
4 to 10 days after symptom onset, HPS rapidly transitions to the cardiopulmonary phase. The defining feature is non-cardiogenic pulmonary oedema with shock. CDC reports overall HPS case-fatality at 38 percent for Sin Nombre virus and 30 to 50 percent for Andes virus. Hallmarks:
HFRS classically progresses through five stages, each lasting hours to days. CFR depends on serotype: Hantaan and Dobrava-Belgrade 5 to 15 percent; Puumala under 1 percent.
| Stage | Features |
|---|---|
| Febrile (days 3–7) | Fever, flushing, conjunctival injection, petechial rash, retro-orbital pain |
| Hypotensive (hours to 2 days) | Vascular leak, shock, tachycardia, oliguria onset |
| Oliguric (days 2–10) | Acute kidney injury, fluid overload, haemorrhagic complications (epistaxis, haematemesis, intracranial bleed in severe cases) |
| Diuretic (days 4 onwards) | Polyuria as renal function recovers; fluid/electrolyte management critical |
| Convalescent (weeks) | Gradual return to baseline; some patients have persistent renal impairment |
Anyone with the prodromal symptoms above plus a credible exposure history — rural rodent contact, recent travel to an endemic area (see country pages), occupational exposure (camping, hunting, conservation, agricultural work, cleaning rodent-infested structures) — should seek urgent medical assessment. Early intensive supportive care, particularly for HPS, is the single strongest predictor of survival. There is no specific antiviral, but ribavirin has shown benefit in early HFRS (less in HPS).
Clinicians evaluating a suspected hantavirus case in 2026 should consider: influenza A and B, COVID-19, viral pneumonia, atypical bacterial pneumonia (Legionella, Mycoplasma), leptospirosis, dengue haemorrhagic fever, scrub typhus, severe sepsis, Plasmodium falciparum malaria, pulmonary embolism, and early HELLP syndrome in pregnancy. The hantavirus blood smear triad (thrombocytopenia, left shift, immunoblasts) plus haemoconcentration is highly suggestive.
Hantavirus Pulmonary Syndrome (HPS) · CFR 30 to 50 percent
Andes virus is the most lethal hantavirus serotype recognised in the Americas. It is endemic to the southern cone of South America and is the primary serotype implicated in the 202…
Read more on ANDV →Hantavirus Pulmonary Syndrome (HPS) · CFR approximately 38 percent
Sin Nombre virus is the principal cause of Hantavirus Pulmonary Syndrome in North America. First identified in 1993 during the Four Corners outbreak, it is carried by the deer mous…
Read more on SNV →Nephropathia Epidemica (mild HFRS) · CFR less than 1 percent
Puumala virus is the most common cause of hantavirus disease in Europe. It produces a milder renal-syndrome variant called nephropathia epidemica and is associated with cyclical ba…
Read more on PUUV →Haemorrhagic Fever with Renal Syndrome (HFRS) · CFR 5 to 15 percent
Hantaan virus is the prototype hantavirus and the most severe cause of HFRS in east Asia. South Korea licences a vaccine (Hantavax) targeting this serotype; no antiviral or vaccine…
Read more on HTNV →Haemorrhagic Fever with Renal Syndrome (HFRS, mild) · CFR 1 to 2 percent
Seoul virus circulates wherever its rat reservoirs do — effectively global. Outbreaks have been reported in pet-rat fanciers in the US and UK and in urban populations near port inf…
Read more on SEOV →Haemorrhagic Fever with Renal Syndrome (HFRS, severe) · CFR 10 to 12 percent
Dobrava-Belgrade virus causes the most severe form of HFRS in Europe, with case fatality rates approaching Hantaan virus levels. It is endemic across the Balkans, Slovenia, and par…
Read more on DOBV →