{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:39:41Z","timestamp":1791841181054,"version":"4.3.4"},"reference-count":92,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Reviews in Medical Virology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Hantaviruses are emerging zoonotic pathogens of increasing global public health significance. Their epidemiological landscape is rapidly changing due to ecological disruption, climate variability, urbanisation, and evolving human\u2013animal interfaces. This narrative review synthesises current knowledge on hantavirus virology, epidemiology, pathogenesis, clinical management, and emerging countermeasures, with a focus on developments from the past 5\u00a0years. Traditionally classified into Old World viruses causing haemorrhagic fever with renal syndrome (HFRS) and New World viruses causing hantavirus cardiopulmonary syndrome (HCPS), this dichotomy has become increasingly blurred, with overlapping renal and pulmonary manifestations now recognized. Among the most consequential recent advances is the consolidated evidence for person\u2010to\u2010person transmission of Andes virus, documented among household contacts and during the prodromal phase, with viral shedding in respiratory secretions. Endothelial dysfunction remains the pathological hallmark of severe disease, driven by VEGF sensitisation, Src kinase and RhoA pathway activation, pericyte infection, and dysregulated inflammatory responses including IL\u20106\n                    <jats:italic>trans<\/jats:italic>\n                    \u2010signalling. Concurrently, environmental and ecological studies have linked climate change, rodent population dynamics, land\u2010use modification, and urbanisation to increased human disease risk across multiple continents. Diagnostic strategies continue to rely on serology and molecular testing, while management remains predominantly supportive, with extracorporeal membrane oxygenation (ECMO) improving survival in fulminant HCPS. Importantly, recent structural virology advances have enabled the development of broadly neutralising monoclonal antibodies targeting conserved quaternary epitopes, as well as next\u2010generation vaccine platforms including DNA, mRNA, and prefusion\u2010stabilised glycoprotein candidates. Hantaviruses represent a paradigmatic One Health challenge at the intersection of environmental change, viral evolution, and global interconnectedness. Despite major progress in understanding transmission dynamics and endothelial pathogenesis, critical gaps remain regarding determinants of person\u2010to\u2010person spread, long\u2010term post\u2010infection sequelae, and the absence of licenced broadly protective vaccines or specific antiviral therapies. Future preparedness will require integrated surveillance frameworks combining ecological monitoring, genomic epidemiology, and clinical readiness within coordinated international public health strategies.\n                  <\/jats:p>","DOI":"10.1002\/rmv.70191","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:41:51Z","timestamp":1785523311000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Changing Landscape of Hantavirus Infections: A Narrative Review of Epidemiology, Pathogenesis, and Countermeasures"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9687-4841","authenticated-orcid":false,"given":"Francesco","family":"De Maria","sequence":"first","affiliation":[{"name":"Infectious and Tropical Diseases Unit Department of Medical and Surgical Sciences \u2018Magna Graecia\u2019 University of Catanzaro  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9485-3877","authenticated-orcid":false,"given":"Francesco","family":"Branda","sequence":"additional","affiliation":[{"name":"Unit of Medical Statistics and Molecular Epidemiology Universita\u0300 Campus Bio\u2010Medico di Roma  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5921-3180","authenticated-orcid":false,"given":"Giancarlo","family":"Ceccarelli","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases University Hospital Policlinico Umberto I Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3501-714X","authenticated-orcid":false,"given":"Fabio","family":"Scarpa","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences University of Sassari  Sassari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Ciccozzi","sequence":"additional","affiliation":[{"name":"Unit of Medical Statistics and Molecular Epidemiology Universita\u0300 Campus Bio\u2010Medico di Roma  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3846-4620","authenticated-orcid":false,"given":"Alessandro","family":"Russo","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit Department of Medical and Surgical Sciences \u2018Magna Graecia\u2019 University of Catanzaro  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1473\u20103099(23)00128\u20107"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/20477724.2023.2272097"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/21505594.2025.2553784"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/v17050622"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2014.08.033"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfac008"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/v15020561"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1469\u20100691.12291"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/v15030805"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2021.07.026"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiab461"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2010.140353"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1473\u20103099(24)00142\u20107"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2910.230544"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.02992"},{"key":"e_1_2_15_17_1","volume-title":"Hantavirus Cluster Linked to Cruise Ship Travel, multi\u2010country","author":"World Health Organization","year":"2026"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/v13081561"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coviro.2021.07.009"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/imm.13322"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.759198"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/v15051130"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmb.2021.167230"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.virusres.2021.198584"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1012728"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines13020198"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines9050518"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467\u2010024\u201050774\u20103"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41564\u2010023\u201001413\u2010y"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2710.210735"},{"key":"e_1_2_15_31_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.adg1855"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.abl5399"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1013401"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41541\u2010024\u201000991\u20100"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-026-70285-7"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens11010015"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/ece3.71597"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2026.124282"},{"key":"e_1_2_15_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens13090753"},{"key":"e_1_2_15_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13280\u2010021\u201001594\u2010y"},{"key":"e_1_2_15_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201095000\u2010y"},{"key":"e_1_2_15_42_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp15457"},{"key":"e_1_2_15_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/1749\u20104877.12782"},{"key":"e_1_2_15_44_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2901.221092"},{"key":"e_1_2_15_45_1","doi-asserted-by":"publisher","DOI":"10.3390\/v15020467"},{"key":"e_1_2_15_46_1","doi-asserted-by":"publisher","DOI":"10.3390\/v14071516"},{"key":"e_1_2_15_47_1","doi-asserted-by":"publisher","DOI":"10.3390\/v18030366"},{"key":"e_1_2_15_48_1","doi-asserted-by":"publisher","DOI":"10.23750\/abm.v92i4.10661"},{"key":"e_1_2_15_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tim.2023.05.004"},{"key":"e_1_2_15_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coviro.2017.09.003"},{"key":"e_1_2_15_51_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102024\u2010096313"},{"key":"e_1_2_15_52_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12985\u2010021\u201001636\u20107"},{"key":"e_1_2_15_53_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0010844"},{"key":"e_1_2_15_54_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0012074"},{"key":"e_1_2_15_55_1","doi-asserted-by":"publisher","DOI":"10.7554\/elife.69708"},{"key":"e_1_2_15_56_1","doi-asserted-by":"publisher","DOI":"10.1128\/jvi.01534\u201021"},{"key":"e_1_2_15_57_1","doi-asserted-by":"publisher","DOI":"10.1128\/jvi.00396\u201021"},{"key":"e_1_2_15_58_1","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.001989"},{"key":"e_1_2_15_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2021.103765"},{"key":"e_1_2_15_60_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0014132"},{"key":"e_1_2_15_61_1","doi-asserted-by":"publisher","DOI":"10.1128\/jvi.02397\u201007"},{"key":"e_1_2_15_62_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1013042"},{"key":"e_1_2_15_63_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42522\u2010025\u201000136\u2010w"},{"key":"e_1_2_15_64_1","doi-asserted-by":"publisher","DOI":"10.3390\/v15061395"},{"key":"e_1_2_15_65_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2612.202808"},{"key":"e_1_2_15_66_1","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2009.0138"},{"key":"e_1_2_15_67_1","doi-asserted-by":"publisher","DOI":"10.1155\/tbed\/7126411"},{"key":"e_1_2_15_68_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.557273"},{"key":"e_1_2_15_69_1","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01306\u201022"},{"key":"e_1_2_15_70_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usad261"},{"key":"e_1_2_15_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2022.102504"},{"key":"e_1_2_15_72_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2004.70.302"},{"key":"e_1_2_15_73_1","volume-title":"Hantavirus Case Definition and Reporting","author":"Centers for Disease Control and Prevention","year":"2025"},{"key":"e_1_2_15_74_1","volume-title":"Standard Precautions for the Prevention and Control of Infections: Aide\u2010Memoire","author":"World Health Organization","year":"2022"},{"key":"e_1_2_15_75_1","doi-asserted-by":"publisher","DOI":"10.3390\/v13081553"},{"key":"e_1_2_15_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2025.108280"},{"key":"e_1_2_15_77_1","doi-asserted-by":"publisher","DOI":"10.3390\/v14010045"},{"key":"e_1_2_15_78_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0013489"},{"key":"e_1_2_15_79_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfaf212"},{"key":"e_1_2_15_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2024.154867"},{"key":"e_1_2_15_81_1","doi-asserted-by":"publisher","DOI":"10.3390\/v17091241"},{"key":"e_1_2_15_82_1","doi-asserted-by":"publisher","DOI":"10.3390\/v13081597"},{"key":"e_1_2_15_83_1","doi-asserted-by":"publisher","DOI":"10.1038\/s42003\u2010021\u201002182\u20102"},{"key":"e_1_2_15_84_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.1084841"},{"key":"e_1_2_15_85_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1012390"},{"key":"e_1_2_15_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2015.07.019"},{"key":"e_1_2_15_87_1","doi-asserted-by":"publisher","DOI":"10.1086\/653482"},{"key":"e_1_2_15_88_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfab053"},{"key":"e_1_2_15_89_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amj.2023.07.011"},{"key":"e_1_2_15_90_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.26930"},{"key":"e_1_2_15_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2025.106091"},{"key":"e_1_2_15_92_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2013.10.001"},{"key":"e_1_2_15_93_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2023.03.026"}],"container-title":["Reviews in Medical Virology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/rmv.70191","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/rmv.70191","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/rmv.70191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:17:01Z","timestamp":1790605021000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/rmv.70191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":92,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/rmv.70191"],"URL":"https:\/\/doi.org\/10.1002\/rmv.70191","archive":["Portico"],"relation":{},"ISSN":["1052-9276","1099-1654"],"issn-type":[{"value":"1052-9276","type":"print"},{"value":"1099-1654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"assertion":[{"value":"2026-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70191"}}