Hantavirus infection: global overview and current situation in Spain

Hantaviruses are rodent-borne zoonotic RNA viruses with a worldwide distribution and the capacity to cause severe human disease. More than 40 hantavirus species have been identified, of which over 20 are known to be pathogenic to humans. Old World hantaviruses are classically associated with Hemorrhagic Fever with Renal Syndrome (HFRS), whereas New World hantaviruses predominantly cause Hantavirus Cardiopulmonary Syndrome (HCPS), a condition characterized by rapid progression to respiratory failure, shock, and substantial mortality. Human infection is usually acquired through the inhalation of aerosols contaminated with excreta from infected reservoir animals, primarily rodents, although person-to-person transmission has been demonstrated for the Andes virus. This review summarizes current knowledge on hantavirus biology, reservoirs, transmission, epidemiology, clinical manifestations, laboratory diagnosis, treatment, prognosis, and prevention, with particular emphasis on the situation in Spain. Worldwide, hantavirus infections remain underdiagnosed because many cases are asymptomatic or present with nonspecific clinical manifestations. Diagnosis relies mainly on serological and molecular methods. No universally effective antiviral therapy is currently available for hantavirus disease, and management remains largely supportive, with intensive care and extracorporeal membrane oxygenation playing a crucial role in severe cases. Evidence accumulated over the last three decades confirms the circulation of hantaviruses in Spain, both in animal reservoirs and in humans. Although clinically recognized disease remains uncommon, serological and ecological studies demonstrate that these infections are present in the country. Continued surveillance, improved diagnostic awareness, and the development of effective preventive and therapeutic strategies remain important public health priorities.