Hantavirus on the rise: clinical, virological, immunological, and public health perspectives.

Hantaviruses are enveloped, negative-sense RNA viruses. Rodents serve as natural reservoirs, and spillover into humans causes hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome. While transmission typically occurs by inhaling aerosolized rodent excreta, the Andes virus variant is capable of human-to-human transmission. A recent outbreak involving a person-to-person transmission cluster aboard the cruise ship MV Hondius has underscored the urgency of hantavirus preparedness. Immediate global pandemic risk remains low because sustained transmission requires prolonged close contact, and hantavirus has low environmental stability compared to other RNA viruses with pandemic potential. However, climate change, deforestation, and urbanization increase human-rodent interactions and spillover risks. Additionally, prolonged incubation in immunocompromised individuals, including people with Human Immunodeficiency Virus (PWH) and other chronic conditions, may facilitate viral adaptation, potentially leading to strains with enhanced transmissibility. We review hantavirus classification, epidemiology, transmission dynamics, immunopathology, treatment strategies, the urgent need for global surveillance, and accelerated vaccines and prophylactic development.