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Hantavirus pulmonary syndrome, a rare zoonosis that becomes an ICU emergency.

Rodent-borne, unpredictable and fast-moving. Early recognition, notification to UKHSA and specialist critical care are what change the outcome.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against UKHSA, WHO and specialist infectious diseases sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK notification pathways, UKHSA surveillance and specialist tropical medicine referral routes.

Key facts

Hantavirus at a glance.

What it is, where it circulates, and what UK clinicians actually do when they suspect it.

  • What it is

    A rare, severe viral zoonosis caused by hantaviruses - Sin Nombre and Andes cause hantavirus pulmonary syndrome, Old World strains cause haemorrhagic fever with renal syndrome.

  • How it spreads

    Inhalation of aerosolised rodent excreta from deer mice, rats and voles - person-to-person spread is unusual apart from Andes virus.

  • UK context

    Seoul virus circulates in UK rats and pet rats. Most severe cases are travellers returning from the Americas or exposure to endemic European rodents.

  • Two syndromes

    HPS is a cardiopulmonary illness with mortality around 35 to 40 per cent. HFRS is dominated by haemorrhage and acute kidney injury.

  • Notifiable

    Suspected cases are notified to UKHSA. Diagnosis is confirmed by PCR and serology through specialist reference microbiology.

  • Treatment

    No licensed antiviral. Care is intensive supportive management in a specialist centre - ventilation, careful fluids and, where needed, ECMO.

Why this guide matters

Rare, severe and time-critical.

Hantavirus is uncommon in the UK, so it is easy to miss - and that is exactly why an accurate, plain-English guide is worth having.

  • Exposure history is everything

    Rodent contact, cleaning outbuildings, pet rats or travel to the Americas or endemic Europe changes the whole differential.

  • Deterioration is fast

    A flu-like prodrome can become severe pulmonary oedema and shock within hours - the window for escalation is narrow.

  • Care is specialist and supportive

    There is no licensed antiviral. Intensive care, careful fluids and, if needed, ECMO in a commissioned centre change the outcome.

How the diagnosis is made

From exposure history to confirmed diagnosis.

The steps a UK team will normally follow - a shared framework between infectious diseases, intensive care and UKHSA.

  1. 01

    Assessing

    Exposure history

    Rodents at home or work, cleaning barns or cabins, travel to the Americas, Chile, Argentina or endemic parts of Europe.

  2. 02

    Assessing

    Prodrome recognition

    Three to five days of fever, myalgia, fatigue, headache and gastrointestinal upset - easy to mistake for flu.

  3. 03

    Assessing

    Vital signs and oxygenation

    Rapid deterioration with tachypnoea, hypoxia and shock signals the cardiopulmonary phase - move to critical care.

  4. 04

    Confirming

    Bloods

    FBC showing haemoconcentration, thrombocytopenia, immunoblasts and leucocytosis. U and Es, LFTs, LDH and creatinine complete the picture.

  5. 05

    Confirming

    Imaging and echo

    CXR shows bilateral interstitial infiltrates and pulmonary oedema. Echocardiography assesses cardiac dysfunction, which is a hallmark of HPS.

  6. 06

    Reference

    Reference microbiology

    PCR and paired serology through UKHSA reference laboratories confirm the strain - Sin Nombre, Andes, Puumala, Hantaan or Seoul.

  7. 07

    Reference

    MDT and notification

    Specialist infectious diseases, intensive care and UKHSA are involved from the point of suspicion - the case is notifiable.

Typical timeline: from prodrome to confirmed diagnosis in days, with critical care running in parallel.

Symptoms

What hantavirus infection looks like.

A short prodrome that pivots quickly into cardiopulmonary or, in Old World strains, renal and haemorrhagic disease.

  • Prodromal fever and myalgia

    Three to five days of high fever, muscle aches, fatigue and headache - often with nausea and abdominal pain.

  • Cough and shortness of breath

    A short dry cough gives way to rapid breathlessness as capillary leak floods the lungs.

  • Hypoxia and non-cardiogenic oedema

    Severe hypoxia despite oxygen, with bilateral pulmonary infiltrates on chest X-ray - the cardiopulmonary phase.

  • Shock and cardiac dysfunction

    Cold peripheries, low blood pressure and poor left-ventricular function - a defining feature of HPS.

  • Haemorrhagic features (HFRS)

    Petechiae, conjunctival haemorrhage and bleeding in Old World hantavirus infection.

  • Acute kidney injury

    Oliguria, rising creatinine and, in HFRS, the classic five-phase renal course from febrile to convalescent.

  • Thrombocytopenia

    Low platelets with haemoconcentration and immunoblasts on the film - a strong early laboratory clue.

  • Red flag - travel or rodent exposure

    Any severe febrile respiratory or renal illness after rodent contact or Americas travel needs urgent specialist review.

Treatment

How hantavirus is treated in the UK.

Care is intensive, supportive and specialist. There is no licensed antiviral - what matters is early recognition and the right ICU pathway.

  • Intensive care admission

    Early transfer to critical care with invasive monitoring - deterioration can be rapid once the cardiopulmonary phase begins.

  • Mechanical ventilation

    Lung-protective ventilation for severe hypoxaemic respiratory failure with pulmonary oedema.

  • Careful fluid management

    Capillary leak means over-resuscitation floods the lungs - fluids are titrated cautiously, guided by cardiac output monitoring.

  • Inotropes and vasopressors

    Noradrenaline and dobutamine support blood pressure and cardiac output during the shock phase.

  • ECMO

    Veno-arterial or veno-venous ECMO in specialist commissioned centres for refractory hypoxia or cardiac collapse.

  • Renal replacement therapy

    Haemofiltration or dialysis for acute kidney injury, particularly in HFRS.

  • Ribavirin (selected cases)

    Historical use in Andes virus and HFRS with limited evidence in HPS - a specialist decision on a case-by-case basis.

  • UKHSA notification and MDT

    Specialist infectious diseases, intensive care and the Hospital for Tropical Diseases coordinate care and public health response.

What this guide is based on

The sources behind every claim on this page.

UK national and international guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Any suspected hantavirus infection is a specialist emergency - go to A and E or call 999 for severe breathlessness, chest pain or collapse.

  • UKHSA. Hantavirus: notifiable disease guidance and reference microbiology.

  • WHO. Hantavirus disease fact sheet and outbreak reports.

  • CDC. Hantavirus pulmonary syndrome clinical guidance.

  • ECDC. Puumala virus and nephropathia epidemica surveillance in Europe.

Red flags

When hantavirus needs urgent attention.

Any of these features means a same-day specialist assessment, UKHSA notification and, in most cases, hospital admission.

  • Rapid respiratory deterioration

    Sudden breathlessness and hypoxia after a flu-like prodrome is the classic HPS presentation - transfer to critical care without delay.

  • Shock with cardiac dysfunction

    Cold, mottled, hypotensive and oliguric - cardiogenic shock in HPS carries very high mortality without ICU support.

  • Haemorrhage in a returning traveller

    Bleeding, petechiae and renal failure after travel to endemic Asia or Europe suggests HFRS - notify UKHSA the same day.

  • Andes virus and close contacts

    Andes virus is the one hantavirus with documented person-to-person spread - contact tracing and isolation are essential.

  • Occupational exposure

    Pest controllers, farmers, forestry workers and laboratory staff need occupational-health review and PPE guidance.

  • Pet rat contact

    Seoul virus in pet or wild rats is a recognised UK risk - a low-threshold serology test is reasonable in unexplained AKI.

  • Pregnancy

    Andes virus in pregnancy carries a high risk of fetal loss - specialist maternal-fetal medicine input is essential.

  • Delayed convalescence

    Fatigue, breathlessness and reduced exercise tolerance can persist for months - structured rehabilitation helps.

  • Missed diagnosis

    Flu-like prodrome is often mistaken for viral illness - a low threshold for testing in exposed patients saves lives.

Living with it

After discharge, a slow and steady recovery.

Survivors need structured follow-up. Lungs, heart and kidneys take time to heal, and prevention matters for anyone who lives or works with rodents.

A quiet reminder

Recovery is a marathon, not a sprint.

Fatigue and breathlessness after critical illness are normal. Pulmonary rehabilitation, sleep and paced return to activity make the biggest difference.

  1. 01 Recovery

    Expect a long tail

    Breathlessness, fatigue and reduced exercise tolerance often persist for months - pulmonary rehabilitation helps most patients.

  2. 02 Follow-up

    Structured review

    Infectious diseases, respiratory and, in HFRS, renal follow-up in the first six months picks up late complications early.

  3. 03 Prevention

    Rodent control and PPE

    Seal food, ventilate before cleaning enclosed spaces, damp-wipe rather than sweep, and wear an FFP3 mask and gloves in high-risk work.

  4. 04 Travel

    Advice before you go

    Travellers to endemic Americas or European countryside benefit from pre-travel specialist tropical medicine advice.

Frequently asked

Everything we get asked about hantavirus.

Quick answers on exposure, UK context, diagnosis, treatment and prevention.

  • What is hantavirus pulmonary syndrome?

    HPS is a rare, severe illness caused by New World hantaviruses such as Sin Nombre and Andes. After a flu-like prodrome of three to five days it moves into a cardiopulmonary phase with severe pulmonary oedema, low blood pressure and cardiac dysfunction. Mortality is around 35 to 40 per cent and care is entirely supportive.

  • How is it caught?

    By breathing in aerosolised rodent urine, droppings or saliva - deer mice in the Americas, bank voles in Europe and rats worldwide. Person-to-person spread is unusual apart from Andes virus in South America. Rodents in barns, cabins and neglected outbuildings are the classic setting.

  • Do we see hantavirus in the UK?

    Yes, but rarely. Seoul virus circulates in UK rats and has caused domestic cases, particularly in pet-rat owners. Puumala virus is present in parts of Europe and occasional imported HPS is seen in travellers returning from the Americas.

  • How is it diagnosed?

    A careful exposure history plus bloods showing haemoconcentration, thrombocytopenia and immunoblasts, a chest X-ray with bilateral infiltrates and echocardiography for cardiac dysfunction. PCR and paired serology at a UKHSA reference laboratory confirm the specific hantavirus.

  • Is there a treatment?

    There is no licensed antiviral. Care is intensive supportive management in a critical care unit - lung-protective ventilation, careful fluid management because of capillary leak, inotropes for shock and, in refractory hypoxia, ECMO in a specialist commissioned centre. Ribavirin has been used historically in Andes virus and HFRS.

  • How can I reduce the risk?

    Keep rodents out of the home, seal food, ventilate barns and cabins before cleaning, damp-wipe surfaces rather than sweeping or vacuuming, and wear an FFP3 mask and gloves in high-risk work. Pre-travel advice from a specialist tropical medicine service helps for endemic regions.

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