Andes Hantavirus: What New Research Means for Clinical Preparedness

Healthcare workers in PPE checking a patient's vital signs.

What does the latest research tell us about recognizing and treating Andes virus—and where do important gaps in the evidence remain?

In a recent review published in The New England Journal of Medicine, researchers from the NETEC Special Pathogens Research Network (SPRN) and international partners examined the available evidence on Andes virus (ANDV), an emerging pathogen capable of causing hantavirus pulmonary syndrome (HPS) and the only orthohantavirus known to spread from person to person.

The review brought together investigators from three Regional Emerging Special Pathogen Treatment Centers (RESPTCs)—Emory University, Johns Hopkins University, and the University of Nebraska Medical Center—along with colleagues from the Instituto Nacional de Enfermedades Virales Humanas (INEVH-ANLIS) in Argentina.

In a new episode of Transmission Interrupted, host Jill Morgan, RN, talks with two of the review’s authors: Gavin Harris, MD, associate medical director of Emory University’s Serious Communicable Diseases Unit, and Gaby Frank, MD, professor of medicine and director of the Johns Hopkins Special Pathogens Center.

Harris and Frank discuss the research behind the review, including what the evidence reveals about Andes virus transmission, diagnosis, clinical management, and potential treatments. They also share what they have learned from international colleagues with firsthand experience caring for patients with Andes virus—and why those relationships are important to preparedness in the United States.

Their conversation highlights an important lesson from the research: while significant questions remain about Andes virus treatment, healthcare facilities already have tools that can make a difference—early recognition, coordination with public health authorities, effective infection prevention, appropriate personal protective equipment (PPE), and high-quality supportive care.

What Makes Andes Virus Different?

Hantaviruses are primarily transmitted to humans through exposure to infected rodents, including contact with their urine, feces, or saliva. Andes virus, found primarily in Argentina and Chile, is different because human-to-human transmission has also been documented.

That distinction is important—but the researchers emphasize putting the risk in context. Most Andes virus infections are still associated with environmental exposure rather than transmission between people.

Another challenge is the virus’s potentially long incubation period. Andes virus can have an incubation period of up to eight weeks, although symptoms most commonly develop within the first two weeks following exposure.

When symptoms develop, the illness may begin with fever, severe muscle aches, headache, chills, and gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal pain.

In patients who develop hantavirus pulmonary syndrome (HPS), the illness can then progress quickly to serious breathing and circulatory problems. Patients may develop cough, shortness of breath, low oxygen levels and, in severe cases, respiratory failure and shock.

For healthcare professionals, that combination of a potentially long incubation period, initially nonspecific symptoms, and the possibility of rapid deterioration makes a thorough travel and exposure history especially important.

Recognition Starts With the Right Questions

Because early symptoms can resemble many common illnesses, recognizing Andes virus starts with understanding a patient’s potential exposures.

Clinicians may need to look beyond a patient’s most recent activities. Travel, environmental, occupational, recreational, and rodent exposures from several weeks earlier could provide an important clue. Exposure to someone with suspected or confirmed Andes virus infection should also be considered.

In the podcast, Frank emphasizes returning to a familiar special pathogen preparedness framework: Identify, Isolate, Inform.

Early laboratory findings that can support clinical suspicion include thrombocytopenia, leukocytosis, circulating immunoblasts, and, later in the course of disease, hemoconcentration.

Confirming the diagnosis relies on molecular and serologic testing. Because this testing may need to be performed at specialized laboratories, healthcare teams should contact public health authorities early when Andes virus is suspected to coordinate testing and response.

While testing is underway, suspected cases should be appropriately isolated, and healthcare workers should use recommended PPE and infection prevention precautions.

Supportive Care Remains the Foundation of Treatment

There are currently no licensed vaccines or targeted treatments for Andes virus-associated HPS. That makes early recognition and high-quality supportive care especially important.

Patients who develop HPS can become critically ill over a short period of time. Care may include oxygen and breathing support, careful management of IV fluids, close monitoring of heart and circulation, and medications to support blood pressure when needed. In the most severe cases, advanced life support such as extracorporeal membrane oxygenation (ECMO) may be considered.

These details reinforce one of the central messages Frank and Harris emphasize in the podcast: clinicians may not have a pathogen-specific treatment for Andes virus, but recognizing the disease early and providing the right supportive care can make a difference.

What Does the Research Tell Us About Potential Treatments?

One of the major questions Frank, Harris, and their colleagues examined was what evidence exists for treatments beyond supportive care.

Researchers continue to investigate approaches including antiviral medications, convalescent plasma, and monoclonal antibodies. But the evidence remains limited, and there is currently no targeted treatment proven to be effective for Andes virus-associated HPS.

In the podcast, Harris discusses several existing antiviral drugs that researchers have explored for possible use against Andes virus. The research illustrates the potential value of studying whether medications developed for one disease could eventually be repurposed to help treat another.

At the same time, Harris emphasizes an important distinction: promising laboratory findings or early studies are not the same as demonstrating that a treatment works in patients.

Andes virus also illustrates one of the inherent challenges of studying rare infectious diseases. With relatively few cases, conducting the large clinical trials needed to establish whether a treatment is safe and effective can be difficult.

Continued research—and sharing clinical experience across countries and institutions—will be essential to strengthening the evidence base.

A Research Finding That Reinforces the Value of PPE

One finding particularly stood out to Harris as the team reviewed the available research: very few healthcare-associated transmissions had been reported when appropriate infection prevention and PPE practices were followed.

Human-to-human transmission of Andes virus is possible, including in healthcare settings. But the research reinforces the importance of established infection prevention practices in reducing risk.

For healthcare facilities, that means preparedness cannot begin when a suspected patient arrives. Healthcare workers need opportunities to train with PPE and infection prevention procedures ahead of time so they can safely provide high-quality clinical care when it matters.

As Frank notes in the episode, healthcare workers need to feel comfortable in their PPE so that protecting themselves does not come at the expense of caring for the patient.

Learning From Clinicians With Firsthand Experience

The research behind the NEJM review also demonstrates the importance of international collaboration.

The publication brought together U.S. special pathogen experts with colleagues in Argentina, where Andes virus is endemic. Frank explains in the podcast that their research has also benefited from conversations with international colleagues who have actually cared for patients with Andes virus.

Those clinicians have learned from treating patients in real-world settings and are continuing to investigate and share their experiences with potential treatment approaches.

For rare pathogens, that exchange of knowledge can be particularly valuable.

“We have a lot of international colleagues that did [treat patients], and they learned a lot from it,” Frank says in the episode. “I think we learn from them.”

Morgan connects that experience to a larger lesson for special pathogen preparedness: maintaining relationships with clinicians around the world gives healthcare professionals access to expertise they may not have within their own institutions.

“The knowledge base being shared worldwide is so important because we never know where things are going to pop up,” Morgan says.

For a healthcare team encountering an unfamiliar pathogen, the experience gained elsewhere can help inform recognition, infection prevention, and patient care.

Research That Strengthens Preparedness

The NEJM review is more than an examination of one rare pathogen. It demonstrates how research, clinical experience, and collaboration can translate what is known about an emerging infectious disease into practical preparedness.

It also highlights the role of NETEC’s Special Pathogens Research Network in connecting investigators across the National Special Pathogen System and with international partners to advance the science of special pathogen preparedness.

For healthcare professionals, several practical lessons emerge:

Ask about travel and potential exposures, including relevant activities or exposures that may have occurred weeks earlier.
Recognize that early symptoms may be nonspecific and maintain clinical suspicion when a patient with relevant risk factors develops rapidly worsening respiratory illness.
Identify and isolate suspected cases promptly and use appropriate PPE and infection prevention measures.
Contact public health authorities early to coordinate specialized testing and response.
Prioritize supportive care for patients who become severely ill, including breathing support, careful management of fluids, and support for blood pressure and circulation when needed.
Recognize the limits of the current treatment evidence. There is no licensed vaccine or targeted treatment for Andes virus, and potential therapies require further study.

Meanwhile, continued research—including lessons shared by clinicians who have cared for Andes virus patients—can help answer the questions that remain.

Listen to the full episode of Transmission Interrupted to hear Frank, Harris, and Morgan discuss the research behind the recent NEJM review, the evolving evidence around Andes virus treatment, and what the findings mean for special pathogen preparedness.

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