Hantavirus at the Human–rodent Interface: A Global Review and Meta-analysis of Occupational Exposure

Abstract

Hantaviruses are zoonotic negative-sense RNA viruses transmitted to humans principally through inhalation of aerosolised excreta from persistently infected rodent reservoir hosts. They cause two major clinical syndromes: haemorrhagic fever with renal syndrome (HFRS), predominant across Eurasia, and hantavirus pulmonary syndrome (HPS) or hantavirus cardiopulmonary syndrome (HCPS), occurring predominantly in the Americas. Together, these syndromes account for an estimated 150,000–200,000 clinical cases annually, with case fatality rates ranging from less than 0.1% in mild Puumala virus nephropathia epidemica to greater than 50% in Araraquara virus-associated HCPS. Occupational cohorts—including agricultural and forestry workers, military personnel, and laboratory researchers—face disproportionately elevated exposure risks at the human–rodent interface, yet this occupational burden remains inadequately characterised in the global health literature. This critical narrative review, augmented by meta-analytic synthesis of published seroprevalence data, assembles and evaluates the global evidence for hantavirus epidemiology, ecology, transmission, clinical disease, diagnostics, and prevention, with particular focus on occupational risk. Structured searches of multiple biomedical and specialised databases identified peer-reviewed studies published between 2000 and 2024. Pooled seroprevalence estimates across occupational cohorts consistently exceed background population rates by 2- to 10-fold, with the highest estimates observed in Chinese and Korean farmers (8–26%) and European forestry workers (5–15%). Occupational risk is modulated by rodent population dynamics, climate variability, land-use change, and individual behavioural factors. The review critically appraises current diagnostic tools, surveillance frameworks, therapeutic options, and vaccine development, identifies key gaps in occupational health policy, and argues for a strengthened One Health approach to hantavirus surveillance and prevention, particularly in low- and middle-income countries where the burden is least well characterised.