Hantavirus cardiopulmonary syndrome

Overview 
Theory 
Diagnosis 
Management 
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Evidence last reviewed: 4 May 2026

Topic last updated: 29 May 2026

29 May 2026

Hantavirus outbreak linked to cruise ship

A cluster of hantavirus cases have been reported on a Dutch-flagged cruise ship, the MV Hondius, which departed Argentina on April 1, 2026. The ship traveled across the South Atlantic, with various stops in remote regions, and carried 147 passengers and crew.

The outbreak was first reported to the World Health Organization (WHO) on May 2, 2026. As of May 27, 2026, 13 cases have been reported (11 confirmed and 2 probable cases), including 3 deaths (case fatality rate 23%). Cases have been reported from France, Canada, the Netherlands, and Spain. All cases to date have been passengers or crew members on the ship.

Illness has been characterized by fever, gastrointestinal symptoms, and rapid progression to pneumonia, acute respiratory distress syndrome, and shock. Symptoms typically appear within 4 to 42 days after exposure.[6]

Hantaviruses are primarily transmitted to humans from contact with infected rodents or their urine, saliva, or feces (or with contaminated surfaces). Infection can cause a range of illnesses including severe disease, and even death. Clinical manifestations are divided into two clinical syndromes:

Hantavirus cardiopulmonary syndrome (HCPS) - seen in the Americas
Hemorrhagic fever with renal syndrome (HFRS) - seen in Asia and Europe

This outbreak is due to the Andes virus (ANDV), which is typically found in South America and causes HCPS. It is the only species of hantavirus that has been associated with limited human-to-human transmission, particularly in community settings involving close and prolonged contact, and among healthcare professionals looking after infected patients. The case fatality rate is reported to be 30% to 50%.

The situation is developing, and you should consult your local public health authority for updates. Information is available from the WHO, the Centers for Disease Control and Prevention (CDC), and the UK Health Security Agency (UKHSA).

The WHO has currently assessed the risk to the global population as low.

See Epidemiology

Original source of update

Hantavirus cardiopulmonary syndrome (HCPS) is a notifiable condition.

Epidemiologic history of rodent infestation in or around the dwelling and/or cleaning out of rodent-contaminated enclosed areas are risk factors for hantavirus infection.

Human-to-human transmission has been rarely described with the Andes virus (ANDV), which is found in South America.

Presents as a nonspecific viral illness with fever, headache, myalgias, and often prominent gastrointestinal symptoms. During the pulmonary phase there is increasing dyspnea and hypoxemia, which can progress rapidly to cardiogenic shock and death.

Testing is recommended if a patient has compatible symptoms and recent rodent exposure in an endemic region or contact with a known case of ANDV infection during an outbreak.

Although there is no specific treatment or cure, early intensive medical care is critical to improve the chances of recovery. Supportive care includes careful fluid management, oxygen, vasoactive agents, platelet transfusion, and possibly mechanical ventilation.

In the cardiopulmonary phase of the disease, a falling cardiac index with evidence of cardiovascular collapse is an indication for extracorporeal membrane oxygenation (ECMO).

Mortality rate is 30% to 50%, due to pulmonary edema and cardiogenic shock.

Definition

Hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS), is a severe, life-threatening complication of hantavirus infection. It is an acute febrile illness marked by a nonspecific viral prodrome followed by rapidly progressive pulmonary insufficiency and shock occurring in an otherwise healthy person. Infection is typically acquired through aerosol contact with rodent excreta.[1]

Hantavirus infection is associated with two types of severe acute febrile illness: HCPS, which occurs in the western hemisphere, and hemorrhagic fever with renal syndrome (HFRS), which occurs in Asia and Europe and is an Old World disease.[1]

New World hantaviruses (e.g., Sin Nombre, Bayou, New York, Black Creek Canal, Monongahela, and Andes viruses) are associated with HCPS, while Old World hantaviruses (e.g., Hantaan, Dobrava, Seoul, and Puumala viruses) cause HFRS.[2]

This topic focuses on the diagnosis and management of hantavirus infection resulting in HCPS. HFRS is beyond the scope of this topic. While HCPS with renal involvement has been reported, it is not considered to be HFRS.

History and exam

Key diagnostic factors

exposure to rodent excreta/bite
dyspnea
hypotension

Full details

Other diagnostic factors

fever
myalgia
gastrointestinal symptoms
headache
normal or low oxygen saturation
lung rales
cough, chest tightness

Full details

Risk factors

exposure to rodent excreta/bite
close contact with hantavirus-infected humans

Full details

Diagnostic tests

1st tests to order

CBC
chest x-ray
serology
reverse transcriptase polymerase chain reaction (RT-PCR)

Full details

Tests to consider

ABG
serum lactate
ECG
echocardiogram
flow-directed pulmonary artery catheter (Swan-Ganz catheter)
lung biopsy

Full details

Emerging tests

virus isolation

Full details

Treatment algorithm

INITIAL

sepsis of unknown cause

ACUTE

confirmed hantavirus infection

Contributors

Authors

Michael Sands, MD, MPH &TM, FIDSA

Professor of Medicine

College of Medicine

University of Florida

Jacksonville, FL

Disclosures

MS declares that he has no competing interests.

Carmen Isache, MD

Professor of Medicine

College of Medicine

University of Florida

Jacksonville, FL

Disclosures

CI declares that she has no competing interests.

Peer reviewers

Tze Wai Wong, FFPH, FRCP (Glasg)

Professor

School of Public Health and Primary Care

The Chinese University of Hong Kong

Prince of Wales Hospital

Shatin

Hong Kong

Disclosures

TWW declares that he has no competing interests.

Mary Joung Won Choi, MD, MPH

Medical Officer

Viral Special Pathogens Branch

US Centers for Disease Control and Prevention

Atlanta, GA

Disclosures

MC declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centres for Disease Control and Prevention. Clinician brief: hantavirus pulmonary syndrome (HPS). May 2026 [internet publication].Full text

Ulloa-Morrison R, Pavez N, Parra E, et al. Critical care management of hantavirus cardiopulmonary syndrome. A narrative review. J Crit Care. 2024 Dec;84:154867.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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Hantavirus cardiopulmonary syndrome