Hantavirus risk and preparedness in Europe in an era of climate change and global mobility

Hantaviruses are rodent-borne zoonoses causing haemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. In Europe, Puumala virus (PUUV) and Dobrava virus (DOBV) account for most recognized disease; Seoul virus (SEOV) is relevant to ports and urban settings. The 2026 MV Hondius cruise-ship cluster of Andes hantavirus (ANDV) infections, involving passengers from 23 countries, has highlighted urgent gaps in European preparedness for both endemic and imported hantavirus disease.

To review hantavirus epidemiology, ecology, clinical recognition, diagnostics, and preparedness in Europe, with emphasis on endemic PUUV, DOBV, and SEOV, and to clarify the separate relevance of imported ANDV infection for travel medicine and maritime response.

We conducted a structured narrative review of literature published from January 2000 to May 2026, prioritizing surveillance reports, systematic and narrative reviews, rodent ecology studies, diagnostic evaluations, external quality assessment studies, and outbreak investigations. WHO, European Centre for Disease Prevention and Control, and International Health Regulations guidance documents were also reviewed.

European hantavirus epidemiology is heterogeneous and shaped by reservoir ecology, biome-specific rodent dynamics, clinical awareness, diagnostic capacity, and surveillance practice. Climate effects are indirect and regionally variable, mediated by mast years, predator-prey dynamics, winter conditions, land use, reservoir density, and human exposure. Diagnostic preparedness is uneven, particularly for molecular detection. Imported ANDV infection is rare in Europe but relevant to travel medicine and high-consequence preparedness because it can cause severe hantavirus cardiopulmonary syndrome and, unlike endemic European hantaviruses, has documented person-to-person transmission.

European preparedness should prioritize PUUV, DOBV, and SEOV through rodent biomonitoring, harmonized surveillance, improved molecular diagnostics, and locally calibrated early warning.