Hantaviruses at an inflection point: scientific evidence, spillover risk, and One Health approach

Hantaviruses are zoonotic RNA viruses that cause hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome and are primarily maintained in rodent reservoirs. Transmission to humans occurs mainly by inhalation of aerosolized excreta from infected rodents, but Andes virus uniquely shows documented limited person-to-person spread with important clinical and public-health implications. Environmental change, urbanization, and global mobility have broadened hantavirus geographic risk and contributed to recent multi-country clusters, including expedition cruise-ship–associated events that highlighted preparedness gaps. This review synthesizes current knowledge on hantavirus taxonomy, molecular biology, transmission pathways, host reservoirs, pathogenesis, clinical features, diagnostics, and management, and it critically assesses advances in molecular surveillance, phylogenetics, antiviral research, and emerging nanobiotechnological approaches. I operationalize a One Health framework into concrete prevention and control actions, integrated human–animal–environment surveillance, targeted rodent reservoir monitoring and control, environmental sampling, and formal intersectoral coordination mechanisms, and I map epidemiologic findings to prioritized, group-specific public-health interventions. Finally, I identify current controversies and knowledge gaps (reservoir competence, surveillance sensitivity, and limits of predictive models), and propose a research and policy agenda to strengthen global preparedness for high-consequence hantavirus events.