Research and analysis

Qualitative assessment of the risk to the UK human population of Andes virus infection in a UK rodent

Published 18 May 2026

About the Human Animal Infections and Risk Surveillance group

This document was prepared by the UK Health Security Agency (UKHSA) on behalf of the joint Human Animal Infections and Risk Surveillance (HAIRS) group.

HAIRS is a multi-agency cross-government horizon scanning and risk assessment group, which acts as a forum to identify and discuss infections with potential for interspecies transfer (particularly zoonotic infections). Its work cuts across several organisations, including:

• UKHSA
• Department for Environment, Food and Rural Affairs (Defra)
• Department for Health and Social Care (DHSC)
• Animal and Plant Health Agency (APHA)
• Food Standards Agency (FSA)
• Food Standards Scotland (FSS)
• Public Health Wales (PHW)
• Public Health Scotland (PHS)
• Department of Agriculture, Environment and Rural Affairs for Northern Ireland (DAERA)
• Welsh Government
• Scottish Government
• Public Health Agency of Northern Ireland
• Department of Agriculture, Food and the Marine, Republic of Ireland
• Health Service Executive, Republic of Ireland
• Infrastructure, Housing and Environment, Government of Jersey
• Isle of Man Government
• States Veterinary Officer, Bailiwick of Guernsey

Information on the risk assessment processes used by the HAIRS group: HAIRS risk assessment process.

Version control

Date of this assessment: 13 May 2026

Version: 1.0

Reason for the assessment: This assessment was commissioned to the HAIRS group to address the possibility that an animal could become infected with ANDV through contact in a UK household with an infected human, and that this could then become a vehicle for further human infections.

Completed by: HAIRS members.

Non-HAIRS group experts consulted:

• Dr Lorraine McElhinney, Rabies and Viral Zoonoses, APHA
• Dr Richard Puleston, Acute Respiratory Infections Team, UKHSA
• Dr Charlotte Robin, Emerging Infections and Zoonoses Team, UKHSA
• Dr Clarissa Oeser, Emerging Infections and Zoonoses Team, UKHSA
• Dr Dimple Chudasama, Emerging Infections and Zoonoses Team, UKHSA
• Dr Jessica Banks, Emerging Infections and Zoonoses Team, UKHSA

Information on the risk assessment processes used by the HAIRS group.

Summary

On 2 May 2026, the World Health Organization (WHO) received notification regarding a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard a Dutch-flagged cruise ship. The ship departed Ushuaia, Argentina, on 1 April 2026 and followed an itinerary across the South Atlantic, with multiple stops in remote and ecologically diverse regions. Subsequent laboratory testing confirmed Andes virus (ANDV) infection. As of 12 May 2026, 11 cases (9 confirmed and 2 probable cases) were reported, including 3 deaths.  

ANDV is a type of hantavirus within the order Bunyavirales. ANDV infection in humans was first described in 1995 in Argentina and was identified in Chile later in the same year. ANDV is a cause of hantavirus cardiopulmonary syndrome (HCPS), which is an acute, potentially fatal medical complication of specific hantavirus infections.

Wild rodents of the family Cricetidae are the natural animal reservoir of ANDV, particularly the long-tailed pygmy rice rat. Humans can acquire ANDV infection through contact with infected rodents or their excreta, principally in Argentina and Chile, and rarely through contact with an infected person.

Hantavirus species are generally associated with a single rodent host, and the geographic distribution of each virus is therefore largely determined by the range of its predominant reservoir species. The long-tailed pygmy rice rat – the primary natural animal reservoir for ANDV – is not indigenous in the UK nor is it a suitable candidate as a pet. There is no available data on the susceptibility of native UK wild rodents to ANDV infection. However, the Syrian hamster, a common UK pet, is susceptible to ANDV and has been used as an experimental model for ANDV associated HCPS.

The most plausible route for introduction of ANDV into the UK would be via an infected returning traveller; however, available evidence indicates that reverse zoonotic transmission from humans to rodents is unlikely, supported by experimental studies showing limited replication of human-derived ANDV strains in animal models and findings from related hantaviruses (for example, Sin Nombre virus). Confirmed human cases of ANDV in the UK would be managed in specialist healthcare facilities, where clinical waste is handled in accordance with Category A disposal protocols. Infectious ANDV particles have been detected in the urine of patients with acute HCPS, and whilst it is possible that contaminated faecal material from an asymptomatic or symptomatic individual could enter the sewage system, onward transmission to rodents via this route may be unlikely. This reflects both the absence of the primary natural animal reservoir in the UK and the substantial dilution of any virus shed by an infected individual once it enters the sewage system.

A precautionary risk management process should be considered to mitigate the risk of human-to-rodent or rodent-to-human transmission. Any circumstances that may bring contacts of a confirmed ANDV case into contact with rodents should be risk assessed on an individual basis with appropriate mitigations implemented as necessary.

Assessment of the risk of infection in the UK:

The probability of human infection with ANDV in the UK population is considered very low.

The impact of ANDV on human health in the UK is considered Low to Moderate (the latter because no specific licenced antiviral treatment or vaccines are available against ANDV). However, in the context of the outbreak associated with cruise ship travel, the impact is likely to be lower given the implementation of stringent case and contact public health management.

Level of confidence in assessment of risk

Satisfactory.

Evidence is incomplete for the susceptibility of native UK rodent species to ANDV infection.

Experimental studies assessing the susceptibility to ANDV in rodent species other than the reservoir host are limited. In Syrian hamsters, ANDV causes fatal infections due to HCPS with persistent shedding, but in deer mice (the reservoir rodent host for another hantavirus Sin Nombre virus), ANDV causes a transient subclinical infection.

Paucity of evidence relating to ANDV infection in non-rodent species, such as companion animals.

Actions and recommendations

It is not known whether wild rodent species in the UK are susceptible to ANDV infection. As a precautionary measure, contacts of a confirmed ANDV case who are self‑isolating at home should ensure any rodent pets are housed in secure accommodation for the duration of the isolation period. This should include keeping rodent pets in enclosed cages and minimising contact with a pet rodent as much as possible (wearing a disposable face mask and gloves, if available, and thoroughly washing hands before and after any pet maintenance).

Any circumstances (including occupational) that may bring contacts of a confirmed ANDV case into contact with rodents should be risk assessed on an individual basis with appropriate mitigations implemented as necessary.

Step 1. Assessment of the probability of infection in the UK human population

This section of the assessment examines the likelihood of an infectious threat causing infection in the UK human population. Where a new agent is identified there may be insufficient information to carry out a risk assessment and this should be clearly documented. Read in conjunction with the Probability Algorithm found at Annex A.

Is this a recognised human disease?

Outcome: Yes

Quality of evidence: Good 

Hantaviruses are members of the order Bunyavirales, each typically associated with a specific rodent reservoir, including mice and rats. Human infection occurs primarily through inhalation of aerosolised virus from rodent excreta or contaminated dust, or through contact with mucous membranes with contaminated hands. Rodent bites are a rare but potential route of transmission (1). Hantaviruses have a global distribution, including parts of Europe, Africa, Asia, and the Americas. In areas where hantaviruses are present, they can cause illnesses ranging from mild, flu-like symptoms to serious respiratory disease, shock, kidney failure, or haemorrhage.

Two principal clinical presentations of hantavirus disease in humans are recognised:

• haemorrhagic fever with renal syndrome (HFRS), associated with old world hantaviruses which occur in Europe, Asia and Africa, and
• hantavirus cardiopulmonary syndrome (HCPS), associated with new world hantaviruses which occur in the Americas (1)

The clinical features and severity vary depending on the hantavirus species responsible for infection. More than 40 hantaviruses have been identified, of which at least 21 are known to cause disease in humans (2). Most human infections are likely to be asymptomatic or present with mild, non‑specific symptoms such as fever, headache, blurred vision, gastrointestinal disturbance and back pain, and therefore may go unrecognised.

ANDV, a type of hantavirus, was first identified as a cause of human infection in Argentina in 1995, and subsequently reported in Chile later the same year. ANDV is a cause of HCPS, which is an acute, potentially fatal medical complication of specific hantavirus infections. Whilst transmission primarily occurs from rodents to humans, limited human‑to‑human transmission has also been documented following close contact (3). The incubation period typically ranges from 2 to 4 weeks but can extend up to approximately 8 weeks (4).

In the UK, ANDV is classified as an airborne high consequence infectious disease (HCID) (5).

Is the disease endemic in humans within the UK?

Outcome: No

Quality of evidence: Good

Although rodent-associated hantavirus infections occur in the UK, there is no evidence of locally acquired ANDV infection in the UK. It is possible that rare, travel-associated infections may be observed in the UK in individuals returning from Argentina, Chile and Uruguay, although none have been reported to date (4).

Infection with other hantavirus species in the UK is rare and occurs only sporadically (6). Since 2012, there have been 9 confirmed and 6 probable UK‑acquired symptomatic cases of HFRS, all of which were associated with Seoul virus (SEOV), with transmission associated with rat breeders, pet owners, and wild rat colonies (UKHSA unpublished data).

Is the disease endemic in animals within the UK?

Outcome: No

Quality of evidence: Satisfactory

Wild rodents of the family Cricetidae are the natural animal reservoir of ANDV, particularly the long-tailed pygmy rice rat (Oligoryzomys longicaudatus) (7, 8). This rodent species is not found in the UK or Europe (9). ANDV has not been detected in rodent species native to the UK. The susceptibility of native species to ANDV is unknown.

Biomes in the UK currently support the host rodents for three types of hantavirus (Puumala virus, SEOV and Dobrava virus) which cause mild to severe forms of HFRS. However, evidence of hantavirus infection in UK rodents, collected from surveys and epidemiological investigations after reports of human cases, has only been found conclusively for SEOV.

SEOV is carried by wild and pet rats (brown rats, Rattus norvegicus). A high prevalence of SEOV has been documented in pet rats due to widespread infection in breeding colonies in Europe and the US (10). Whilst SEOV is not known to spread between people, cases of SEOV have been reported in the UK since the 1970s, with risk groups being those with occupational exposure to rats and more recently, people who keep rats as pets. A seroprevalence study conducted by Public Health England in 2011 identified seropositivity to SEOV in pet rat owners was higher (34%), compared with 3.3% in a control group (11).

Serosurveillance studies have identified hantaviruses in some wild native species since the 1990s, mostly in wild brown rats on farms (12, 13). A study in 2018 identified SEOV in brown rats on pig farms in northern England (14). In pet rats, investigations following diagnosis of SEOV in a pet rat owner identified SEOV in a third of their rat colony (10, 15). A novel hantavirus (Tatenale virus) has been identified in field voles (Microtus agrestis) in Northern England, and Wales, although its zoonotic potential is unknown (16).

Are there routes of introduction into animals in the UK?

Outcome: Yes and No

Quality of evidence: Satisfactory

The introduction of ANDV into the UK would most likely occur through a returning infected traveller. Whilst there is no evidence of reverse-zoonotic potential of ANDV in natural systems, recent studies have shown that strains of ANDV from rodent or human hosts can produce widely different outcomes in Syrian hamster laboratory models in experimental settings: CHI-7913, a human ANDV isolate, did not cause lethal disease and replicated poorly in hamster tissues compared to the classical rodent isolate Chile-9717869 (17). Prévost and others demonstrated that productive infection was not observed in Deer mice (Peromyscus maniculatus) inoculated with Sin Nombre virus (SNV) – a new world hantavirus closely related to ANDV – concluding that humans are unlikely to serve as a meaningful source of SNV transmission back into reservoir rodents (18).

Evidence is incomplete for the susceptibility of endemic UK rodent populations to ANDV infection. Furthermore, data is not available relating to ANDV infection in non-rodent species, such as companion animals. The primary natural reservoir, the long‑tailed pygmy rice rat, is not present in the UK, nor is it considered a suitable candidate as a pet.

Confirmed human cases of ANDV in the UK would be managed in specialist healthcare facilities, where clinical waste is handled in accordance with Category A disposal protocols. Infectious ANDV particles have been detected in the urine of patients with acute HCPS (19), and whilst it is possible that contaminated faecal material from an asymptomatic or symptomatic individual could enter the sewage system, onward transmission to rodents via this route may be unlikely. This reflects both the absence of the natural animal reservoir in the UK and the substantial dilution of any virus shed by an infected individual once it enters the sewage system.

Are effective control measures in place to mitigate against routes of introduction?

Outcome: Yes

Quality of evidence: Good

In the context of the ANDV outbreak associated with cruise ship travel, all known human cases and contacts are being followed up using stringent public health measures. In the UK, ANDV is classified as a HCID, for which there are established processes for the isolation of cases, rapid diagnostics and infection prevention control procedures in healthcare settings. Following confirmation of infection, cases would be managed in specialist healthcare settings away from companion animals.

Outcome of probability assessment

The probability of human infection with ANDV in the UK population is considered very low.

Step 2: Assessment of the impact on human health

The scale of harm caused by the infectious threat in terms of morbidity and mortality: this depends on spread, severity, availability of interventions and context. Please read in conjunction with the Impact Algorithm found at Annex C.

Is there human-to-human spread of this pathogen?

Outcome: Yes

Quality of evidence: Good

Human-to-human transmission of ANDV has been documented in South America, particularly in Argentina and Chile. Transmission can occur within household settings but overall remains uncommon. A prospective study that followed 476 household contacts of 76 confirmed cases over 5 weeks in Chile suggests that around 3.4% of close contacts develop HCPS, with the highest risk observed among sexual partners (17.6% versus 1.2%) (20). Transmission in healthcare settings appears to be rare (21).

The Epuyén outbreak in Argentina 2018-2019 remains the clearest confirmed example of sustained human‑to‑human transmission and involved 34 cases, including 11 deaths, and was associated with a small number of symptomatic individuals who attended crowded social gatherings (2).

ANDV may be secreted into human saliva and transmitted through the respiratory tract via airborne droplets released by coughing or sneezing. The presence of ANDV infectious particles in gingival crevicular fluid, saliva, nasopharyngeal secretions, urine and blood has been documented in patients with acute HCPS (19, 22).

Studies have indicated that transmission of ANDV may occur via breast milk (23), and vertical transmission has been suggested in isolated case reports (24). Roland and others reported that ANDV ribonucleic acid can persist in human semen for at least 71 months after acute infection. Viral genome sequencing showed only minimal genetic changes over time and no evidence of integration into the host genome, suggesting low‑level or intermittent viral persistence rather than active replication. The detection of persistent viral RNA alongside a strong, long‑lasting neutralising antibody response supports the possibility of sexual transmission (25).

Overall, available evidence indicates that human‑to‑human transmission of ANDV is possible but limited and primarily associated with close and prolonged contact. Identified risk factors include intimate contact (such as sexual contact or kissing), sharing a room, particularly during the early symptomatic (febrile prodrome) phase, and exposure at social events involving symptomatic individuals (1).

Is the UK human population susceptible?

Outcome: Yes

Quality of evidence: Satisfactory

The UK population is immunologically naïve to ANDV and would therefore be presumed susceptible if exposure were to occur; however, infection typically requires contact with infected rodents or, more rarely, close contact with a symptomatic human case. In a non‑endemic setting such as the UK, the practical likelihood of exposure is very low, as the virus is not present locally and the natural rodent reservoir is absent.

Does it cause severe disease in humans?

Outcome: Yes

Quality of evidence: Good

ANDV infection causes hantavirus cardiopulmonary syndrome (HCPS), a severe condition with high mortality, although milder illness can occur. Symptoms typically appear 2 to 4 weeks after exposure (ranging from 4 days to 8 weeks).

Illness begins with a non‑specific, flu‑like prodrome (fever, chills, myalgia), sometimes accompanied by gastrointestinal symptoms, which may predominate early. Upper respiratory symptoms are usually absent. In severe cases, this progresses rapidly to a cardiopulmonary phase characterised by acute respiratory failure and hypotension, often following onset of a dry cough due to pulmonary capillary leak.

Complications include acute respiratory distress syndrome, pulmonary oedema, shock, coagulopathy, haemorrhage, and cardiac arrhythmias; neurological complications are uncommon. Laboratory findings commonly include thrombocytopaenia and elevated liver enzymes.

There is no specific antiviral treatment; management is supportive, with early intensive care involvement essential. Extracorporeal membrane oxygenation should be considered in severe cases. Case fatality is typically around 30 to 50%, and while deterioration of a cases condition can be rapid, recovery may be prolonged (1, 26, 27).

ANDV is an ACDP Category 3 pathogen (28), meaning it can cause severe human disease and may be a serious hazard to those handling and processing samples (for example, healthcare workers, laboratory staff) if appropriate personal protective equipment is not worn.

Would a significant number of people be affected?

Outcome: No

Quality of evidence: Satisfactory

It is unlikely a significant number of people would be affected due to the extensive public health measures available in the UK for confirmed ANDV cases and contact management. ANDV is classified as a HCID in the UK, for which there are established processes for the isolation of cases, rapid diagnostics and infection prevention control procedures in healthcare settings. Following confirmation of infection, cases would be managed in isolation, mitigating the risk of further transmission. Follow up of identified contacts of a confirmed case would be implemented rapidly by the relevant public health agencies.

Although it is not known whether native UK rodent species are susceptible to ANDV infection, there is currently no evidence to suggest ANDV is present in UK rodent populations, and thus wider transmission is not expected.

Are effective interventions available?

Outcome: Yes and No

Quality of evidence: Good

There are effective interventions available in the form of extensive public health measures in the UK, outlined in the section above. However, there is no specific licenced antiviral treatment or vaccines available against ANDV, with clinical management being mainly supportive.

Outcome of impact assessment

The impact of ANDV on human health in the UK is considered Low to Moderate (the latter because no specific licenced antiviral treatment or vaccines are available against ANDV). However, in the context of the outbreak associated with cruise ship travel, the impact is likely to be lower given the implementation of stringent case and contact public health management, as per the National Infection Prevention and Control Manual.

Annex A. Assessment of the probability of infection in the UK population algorithm

Figure 1. Assessment of the probability of infection in the UK population algorithm

Annex B. Accessible text version of assessment of the probability of infection in the UK population algorithm

Outcomes are specified by a ☑ (tick) beside the appropriate answer. Where the evidence may be insufficient to give a definitive answer to a question, the alternative is also considered with the most likely outcome shown with ☑☑ (2 ticks) and/or the alternative outcome(s) with a ☑ (tick).

Question 1: Is this a recognised human disease?

Yes: go to question 3. ☑

No: go to question 2.

Question 2: Is this a zoonosis or is there a zoonotic potential?

Yes: go to question 4.

No: the probability of infection in the UK population is considered very low.

Question 3: Is this disease endemic in humans within the UK?

Yes: go to question 5 [note 1].

No: go to question 4. ☑

Note 1: this pathway considers reverse-zoonosis of a pathogen already in circulation in the human population.

Question 4: Is this disease endemic in animals in the UK?

Yes: go to question 8.

No: go to question 5. ☑

Question 5: Are there routes of introduction into animals in the UK?

Yes: go to question 6. ☑

No: the probability of infection in the UK population is considered very low. ☑

Question 6: Are effective measures in place to mitigate against these?

Yes: the probability of infection in the UK population is considered very low. ☑

No: go to question 7.

Question 7: Do environmental conditions in the UK support the natural vectors of disease?

Yes: go to question 8.

No: the probability of infection in the UK population is considered very low.

Question 8: Will there be human exposure?

Yes: go to question 9.

No: the probability of infection in the general UK population is considered very low.

Question 9: Are humans highly susceptible? [note 2]

Yes: go to question 10.

No: the probability of infection in the UK population is considered low.  

Note 2: includes susceptibility to animal-derived variants

Question 10: Is the disease highly infectious in humans?

Yes: the probability of infection in the UK population is considered high.

No. the probability of infection in the UK population is considered moderate.

Annex C. Assessment of the impact on human health algorithm

Figure 2. Assessment of the impact on human health algorithm

Annex D. Accessible text version of assessment of the impact on human health algorithm

Outcomes are specified by a ☑ (tick) beside the appropriate answer.

Question 1: Is there human-to-human spread?

Yes: go to question 4. ☑

No. go to question 2.

Question 2: Is there zoonotic or vector-borne spread?

Yes: go to question 3.

No: the impact of infection in the UK population is considered very low.

Question 3: For zoonoses or vector-borne disease, is the animal host or vector present in the UK?

Yes: go to question 4.

No: the impact of infection in the UK population is considered very low.

Question 4: Is the human population susceptible?

Yes: go to question 5. ☑

No: the impact of infection in the UK population is considered very low.

Question 5: Does it cause severe disease in humans?

Yes: go to question 8. ☑

No: go to question 6.

Question 6: Is it highly infectious to humans?

Yes: go to question 9.

No: Go to question 7.

Question 7: Are effective interventions available?

Yes: the impact of infection in the UK population is considered very low.

No: the impact of infection in the UK population is considered low.

Question 8: Would a significant [note 3] number of people be affected?

Yes: go to question 10.

No: go to question 9. ☑

Note 3: this question has been added to differentiate between those infections causing severe disease in a handful of people and those causing severe disease in larger numbers of people. ‘Significant’ is not quantified in the algorithm but has been left open for discussion and definition within the context of the risk being assessed.

Question 9: Are effective interventions available?

Yes: the impact of infection in the UK population is considered low. ☑

No: the impact of infection in the UK population is considered moderate. ☑

Question 10: Is it highly infectious to humans?

Yes: go to question 12.

No: go to question 11.

Question 11: Are effective interventions available?

Yes: the impact of infection in the UK population is considered moderate.

No: the impact of infection in the UK population is considered high.

Question 12: Are effective interventions available?

Yes: the impact of infection in the UK population is considered high.

No: the impact of infection in the UK population is considered very high.

References

1. Vial PA, Ferrés M, Vial C and others. ‘Hantavirus in humans: a review of clinical aspects and management’ The Lancet Infectious Diseases 2023: volume 23, issue 9, pages 371 to 382

2. Jonsson CB, Figueiredo LTM, Vapalahati O. ‘A global perspective on hantavirus ecology epidemiology and disease’ Clinical Microbiology Reviews 2010: volume 23, issue 2, pages 412 to 441

3. Martínez VP, Di Paola N, Alonso DO and others. ‘Super-spreaders and person-to-person transmission of Andes virus in Argentina’ The New England Journal of Medicine 2020: volume 282, issue 23, pages 2,230 to 2,241

4. UK Health Security Agency (UKHSA). ‘Andes hantavirus: epidemiology, outbreaks and guidance’ 2026 (accessed 12 May 2026)

5. UKHSA. ‘High consequence infectious diseases (HCID)’ 2026 (accessed 12 May 2026)

6. Jameson LJ, Logue CH, Atkinson B and others. ‘The continued emergence of hantaviruses: isolation of a Seoul virus implicated in human disease, United Kingdom, October 2012’ Eurosurveillance 2013: volume 18, issue 1, pages 4 to 7

7. Astorga F, Escobar LE, Poo-Muñoz D and others. ‘Distributional ecology of Andes hantavirus: a macroecological approach’ International Journal of Health Geographics 2018: volume 17, issue 22

8. Torres-Pérez F, Palma RE, Boric-Bargetto D and others. A 19 Year Analysis of Small Mammals Associated with Human Hantavirus Cases in Chile. Viruses 2019: volume 11, issue 9, page 848

9. European Centre for Disease Prevention and Control. ‘Hantavirus-associated cluster of illness on a cruise ship: ECDC assessment and recommendations’ 2026 (accessed 12 May 2026)

10. McElhinney LM, Marston DA, Pounder KC and others. ‘High prevalence of Seoul hantavirus in a breeding colony of pet rats’ Epidemiology and Infection 2017: volume 145, issue 15, pages 3,115 to 3,124

11. Duggan JM, Close R, McCann L and others. ‘A seroprevalence study to determine the frequency of hantavirus infection in people exposed to wild and pet fancy rats in England’ Epidemiology and Infection 2017: volume 145, issue 12, pages 2,458 to 2,465

12. Pether JVS, Lloyd G. ‘The clinical spectrum of human hantavirus infection in Somerset, UK’ Epidemiology and Infection 1993: volume 111, issue 1, pages 171 to 175

13. Webster JP, Macdonald DW. ‘Parasites of wild brown rates (Rattus norvegicus) on UK farms’ Parasitology 1995: volume 111, issue 3, pages 247 to 255

14. Murphy EG, Williams NJ, Bennett M and others. ‘Detection of Seoul virus in wild brown rats (Rattus norvegicus) from pig farms in Northern England’ Veterinary Record 2019: volume 184, pages 525 to 525

15. Jameson LJ, Taori SK, Atkinson B, and others. ‘Pet rats as a source of hantavirus in England and Wales, 2013’ Eurosurveillance 2013: volume 18, issue 9, page 20415

16. Pounder KC, Begon M, Sironen T and others. ‘Novel Hantavirus in Wildlife, United Kingdom’ Emerging Infectious Diseases 2013: volume 19, issue 4, pages 673 to 675

17. Warner BM, Prévost J, Tailor N and others. ‘High genomic stability of Andes virus following successive passage in vivo in Syrian hamsters’ Journal of Virology 2025: volume 99, issue 8, e0051225

18. Prévost J, Tailor N, Leung A and others. ‘Sin Nombre Virus as Unlikely Reverse Zoonotic Threat’ Emerging Infectious Diseases 2025: volume 31, issue 2, pages 385 to 388

19. Ferrés M, Martínez-Valdebenito C, Henriquez C and others. ‘Viral shedding and viraemia of Andes virus during acute hantavirus infection: a prospective study’ The Lancet Infectious Diseases 2024: volume 24, issue 7, pages 775 to 782

20. Ferrés M, Vial P, Marco C and others. ‘Prospective evaluation of household contacts of persons with hantavirus cardiopulmonary syndrome in Chile’ The Journal of Infectious Diseases 2007: volume 195, issue 11, pages 1,563 to 1,571

21. Martinez-Valdebenito C, Calvo M, Vial C and others. ‘Person-to-person household and nosocomial transmission of Andes hantavirus, southern Chile, 2011’ Emerging Infectious Diseases 2014: volume 20, issue 10, pages 1,629 to 1,636

22. Godoy P, Marsac D, Stefas E and others. ‘Andes Virus Antigens Are Shed in Urine of Patients with Acute Hantavirus Cardiopulmonary Syndrome’ Journal of Virology 2009: volume 83, issue 10, pages 5,046 to 5,055

23. Fernández J, Sotomayor V, Valdés MF and others. ‘Mother-to-child transmission of Andes virus through breast milk, Chile’ Emerging Infectious Diseases 2020: volume 26, issue 8, pages 1,885 to 1,888

24. Bellomo C, Alonso D, Coelho R. ‘A newborn infected by Andes virus suggests novel routes of hantavirus transmission: a case report’ Clinical Microbiology and Infection 2019: volume 26, issue 1, pages 130 to 131

25. Züst R, Ackermann-Gäumann R, Liechti N and others. ‘Presence and Persistence of Andes Virus RNA in Human Semen’ Viruses 2023: volume 15, issue 11, page 2,266

26. Avsic-Zupanc T, Saksida A, Korva M. ‘Hantavirus infections’ Clinical Microbiology and Infections 2019: volume 21, pages 6 to 16

27. Manigold T, Vial P. ‘Human hantavirus infections: Epidemiology, clinical features, pathogenesis and immunology’ Swiss Medical Weekly 2014: volume 144, w13937

28. Health Service Executive. ‘Advisory Committee on Dangerous Pathogens: The approved list of biological agents’ 2023 (accessed 12 May 2026)