Human infection with Andes hantavirus: an update for the general physician

Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique capacity for sustained human-to-human transmission, occurring via respiratory droplets and prolonged close contact with symptomatic individuals, with a median reproductive number exceeding 2 and an incubation period ranging from 9 to 40 days. ANDV infection can present with a wide range of clinical manifestations. Of them, the most feared is Hantavirus cardiopulmonary syndrome (HCPS), a severe condition characterised by acute respiratory failure, haemodynamic instability, acute kidney injury, hepatic involvement, and dysregulated cytokine release, with high lethality. Disease severity correlates with the degree of neutrophilia, leukocytosis, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase. No approved antiviral therapy or vaccine currently exists; management remains entirely supportive, centred on oxygen supplementation, haemodynamic stabilisation, and renal replacement therapy when indicated. Case fatality rates reached 32% in a 2018-2019 outbreak, with death occurring a mean of 6.7 days from symptom onset. The April 2026 outbreak aboard the MV Hondius cruise ship - involving passengers of 23 nationalities, with 8 cases (6 confirmed, 2 suspected), and 3 deaths reported as of 11 May 2026 (CFR 38%) - exemplifies how a zoonotic pathogen with limited human-to-human transmissibility can rapidly achieve global reach in the era of mass international travel, underscoring the urgent need for clinician awareness, prompt contact tracing, and internationally coordinated outbreak preparedness.