The Andes virus is the common name of Orthohantavirus andesense species within the Hantaviridae family, subfamily Mammantavirinae, and genus Orthohantavirus, which contains sixty different viruses.1
Orthohantaviruses occur worldwide, but their specific geographic spread depends on the range of their hosts. Some orthohantaviruses are not limited to a single host but are transmitted by multiple animal species.
Orthohantaviruses are known to cause disease in humans, and all pathogenic strains are rodent-borne. People can become infected by inhaling aerosolized excreta or secretions from infected rodents or through direct contact with them.
The World Health Organization recognizes two diseases caused by orthohantaviruses. Hemorrhagic fever with renal syndrome is linked to Asian and European viruses, especially Hantaan, Dobrava, Puumala, and Seoul, carried by rodents in the Apodemus, Myodes, and Rattus genera. Hantavirus pulmonary syndrome is a severe disease caused by American viruses, such as Sin Nombre and Andes, transmitted by rodents in the Peromyscus and Oligoryzomys genera, respectively.2
For most orthohantaviruses, humans are dead-end hosts and do not have the capacity for human-to-human transmission. Only the Andes virus has a certain capacity for it. However, it has been informed that this transmission is limited and may reach only up to four generations.3 Symptoms may take days to weeks to appear and include headache, fever, abdominal and back pain, vomiting and hemorrhaging. It is important to note that the rodent host of the Andes virus, Oligoryzomys longicaudatus, is not present in Europe; therefore, large outbreaks would not be expected unless the virus acquires mutations that enhance human-to-human transmission.
Hantaviruses are enveloped, tri-segmented negative-sense RNA viruses.1 The nucleocapsid protein (N) and the Gn/Gc envelope glycoproteins are encoded by the S (small) and the M (medium) genome segments, respectively. The L (large) segment encodes the polymerase protein. The Gn/Gc glycoproteins form a heterodimer located at the particle surface.
Currently, there is no specific approved antiviral treatment for Andes virus infection. Management is mainly supportive and based on intensive care, but a few therapies using ribavirin, or particularly convalescent plasma, have been explored. Monoclonal antibodies are being actively researched, but none are yet approved for clinical use.
Despite ongoing research efforts, there is currently no licensed vaccine available for Andes virus. An experimental DNA vaccine based on the M segment encoding the envelope glycoproteins was reported in 20034 and has reached early pre-clinical trials in Syrian hamsters and rhesus macaques.5 A Phase I clinical trial of this vaccine in healthy human adults6 demonstrated that it is safe and able to induce a robust and durable immune response. The Moderna company is presently developing an mRNA vaccine candidate against hantaviruses, including Andes virus; however, this candidate remains in the pre-clinical stage.
The recent outbreak on the cruise ship M/V Hondius7 has drawn global attention to an epidemiological situation in the Southern Cone of South America, where approximately 50–150 confirmed human cases occur each year.8
In this context, assuming a vaccine is available, the target population for vaccination would include people living in endemic areas, travelers visiting these regions, and close contacts of confirmed cases.
In the meantime, in outbreak situations, hygienic measures such as ventilation, hand hygiene and use of FFP2 masks remain the best preventive strategy. Additionally, since the Andes virus is an enveloped virus sensitive to regular disinfectants, including alcohol-based solutions, thorough surface disinfection is also essential.9
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