Global threats and regional trends: Navigating the complex landscape of human orthohantavirus infections

Orthohantavirus infections constitute a significant global public health challenge, predominantly presenting as two distinct clinical syndromes: hemorrhagic fever with renal syndrome (HFRS) in Europe and Asia and hantavirus pulmonary syndrome (HPS) in the Americas. Epidemiological data indicate considerable geographic variability in disease incidence, influenced by intricate interactions among ecological, socioeconomic, and public health determinants. In Asia, a notable reduction in cases has been achieved through enhanced economic conditions, strategic public health initiatives, and effective management of rodent populations. Conversely, Nordic countries continue to report high HFRS incidence, which is attributed to ecological conditions conducive to sustaining reservoir rodent populations. South America has experienced an upward trend in cases, raising concerns about potential large-scale outbreaks, while emerging reports from Africa suggest a possible expansion of endemic regions. Notably, Australia remains one of the few regions without documented orthohantavirus infections and presents a unique epidemiological profile. This review comprehensively examines the global distribution of orthohantavirus infections, analyzes key epidemiological trends, and discusses the environmental and socioeconomic determinants influencing disease dynamics, providing critical insights for public health preparedness and intervention strategies.