Quick answer
HFRS hantavirus is a group of infections that primarily affect the kidneys. Main viruses are Hantaan (Asia), Puumala (Europe), Dobrava (Balkans) and Seoul (global). Mortality ranges from under 0.5% (Puumala) to 5–15% (Hantaan). There is no licensed specific antiviral in most countries; early supportive care improves outcomes.
HFRS-causing hantavirus types
There is no single "HFRS virus". Several Old World hantaviruses cause HFRS with similar clinical pictures but different prognosis:
| Virus | Region | Reservoir | Approx. CFR | Source |
|---|---|---|---|---|
| Puumala virus | Northern / Central Europe | Bank vole | <0.5% | ECDC |
| Dobrava-Belgrade virus | Balkans / SE Europe | Yellow-necked mouse | ~5–12% | ECDC |
| Hantaan virus | China / Korea / Russia | Striped field mouse | ~5–15% | WHO |
| Seoul virus | Global (commensal rat) | Rattus norvegicus | <1% | WHO, CDC |
HFRS symptoms
HFRS often evolves through clinical phases. Symptoms vary in intensity by virus type and patient.
Early phase (1–7 days)
- Sudden high fever
- Headache
- Back and abdominal pain
- Nausea and vomiting
- Blurred vision
- Facial flushing
Oliguric / hypotensive phase
- Low blood pressure / shock
- Acute kidney injury
- Petechial rash
- Reduced urine output
- Bleeding signs (severe cases)
Recovery
- Polyuric phase
- Gradual renal recovery
- Most patients recover with supportive care
HFRS mortality by virus
HFRS mortality depends strongly on the virus and on access to care. Puumala virus is rarely fatal (<0.5%). Hantaan virus carries the highest CFR within the HFRS group, roughly 5–15% depending on region and context. Dobrava-Belgrade shows variable CFR by sub-lineage. Seoul virus is generally mild with CFR under 1%.
For a detailed comparison with HPS and a broader analysis of fatality rates, see the dedicated hantavirus mortality rate or the hantavirus CFR page.
Treatment and supportive care
There is no specific antiviral licensed for HFRS in most countries; in some settings ribavirin has been used for severe Hantaan virus infections. Management is supportive: fluid and electrolyte control, blood pressure support, dialysis in severe renal failure, and management of coagulation in haemorrhagic cases. Early hospital admission clearly improves outcomes (WHO, ECDC).
2026 context
In 2026 European Puumala seasons remain within typical ranges (RKI and other European institutes report a mild-to-moderate volume). The MV Hondius outbreak is HPS due to Andes virus, not HFRS. There are no active globally significant HFRS alerts as of this page's update date.
HFRS — Frequently Asked Questions
What is HFRS hantavirus?
HFRS stands for Haemorrhagic Fever with Renal Syndrome. It is a group of hantavirus infections that primarily affect the kidneys and cause systemic illness with fever, low blood pressure and acute kidney injury. The main HFRS-causing hantaviruses are Hantaan, Puumala, Dobrava-Belgrade and Seoul viruses.
What is the HFRS mortality rate?
HFRS mortality varies widely by virus type. Puumala virus has a case fatality rate below 0.5% and is rarely fatal. Hantaan virus carries a CFR of around 5–15% and Dobrava-Belgrade around 5–12%. Seoul virus is generally below 1%. These ranges are based on WHO, ECDC and CDC published estimates and depend on healthcare access.
Where does HFRS occur?
HFRS is found across Asia and Europe. Hantaan virus circulates in China, Korea and parts of Russia; Puumala virus in northern and central Europe; Dobrava-Belgrade in the Balkans and south-eastern Europe; Seoul virus globally because of the worldwide distribution of brown rats.
How does HFRS spread?
HFRS spreads through inhalation of aerosolised excreta (urine, droppings, saliva) of infected rodents, contact with contaminated surfaces, or, very rarely, bites. Person-to-person transmission has not been documented for HFRS-causing hantaviruses, only — rarely — for Andes virus, which causes HPS, not HFRS (CDC, ECDC).
What are the main symptoms of HFRS?
HFRS typically begins suddenly with high fever, severe headache, back pain, abdominal pain, nausea and blurred vision. After several days it can progress to low blood pressure, oliguria and acute kidney injury, followed by a polyuric recovery phase. Severe cases can include shock and bleeding signs.
Is HFRS treatable?
There is no specific licensed antiviral for HFRS in most countries, although ribavirin has been studied for severe Hantaan virus infections. Treatment is supportive: fluid and electrolyte balance, blood pressure support, dialysis in severe renal failure. Early hospital admission improves outcomes (WHO, ECDC).
HFRS vs HPS: what is the difference?
HFRS primarily damages the kidneys and is caused mainly by Old World hantaviruses (Hantaan, Puumala, Dobrava, Seoul) in Asia and Europe. HPS damages the lungs and heart and is caused by New World hantaviruses (Sin Nombre, Andes) in the Americas. HPS has a higher case fatality rate per case (~30–40%) than most HFRS variants.
Medical disclaimer: This page is for informational purposes only and does not replace medical advice. CFR ranges and recommendations reflect public documents from WHO, CDC and ECDC. Anyone with symptoms after rodent exposure should consult a doctor.