Progress in antiviral and vaccine strategies against hantavirus: Current advances and future perspectives

Abstract

Hantaviruses are rodent-associated zoonotic RNA viruses responsible for hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), two clinically distinct diseases characterized by vascular dysfunction and potentially severe organ failure. Their geographic distribution, antigenic diversity, and variable clinical outcomes complicate the development of broadly applicable medical countermeasures. The aim of this narrative review is to critically examine the molecular rationale, current evidence, and translational readiness of antiviral and vaccine strategies against hantavirus infections. Antiviral approaches include ribavirin, favipiravir, RNA interference, neutralizing monoclonal antibodies, and investigational host-directed therapies, with particular attention to differences between human clinical evidence and findings from cell culture or animal models. Vaccine strategies are evaluated across regionally implemented inactivated vaccines, DNA candidates assessed in early-phase human trials, and recombinant protein, viral vector, and messenger RNA platforms that remain predominantly preclinical. The review also distinguishes vaccine immunogenicity, experimental protection, durability of immune responses, and clinical effectiveness. Major barriers to translation include virus-specific therapeutic responses, narrow treatment windows, targeted delivery, antigenic diversity, and the absence of validated correlates of protective immunity. This review highlights the experimental and clinical evidence needed to advance promising antiviral and vaccine candidates toward effective strategies for prevention and treatment of hantavirus infections.