No specific antiviral, but timing matters enormously
The single most important predictor of survival from severe hantavirus disease is how quickly the patient reaches an intensive-care unit. Patients who arrive after pulmonary edema is established or shock has set in have markedly worse outcomes than those admitted during the early cardiopulmonary phase. Clinicians who suspect hantavirus should escalate to ICU monitoring even before frank respiratory failure.
Supportive care for HPS
Hantavirus pulmonary syndrome care is built around three pillars:
- Careful fluid management — over-resuscitation worsens pulmonary edema; under-resuscitation worsens shock. Target central venous pressure with vasopressors rather than crystalloid boluses.
- Mechanical ventilation with low tidal volumes and PEEP, as for ARDS.
- ECMO (extracorporeal membrane oxygenation) for refractory hypoxemia. Centres with ECMO programs report substantial mortality reductions for patients who reach the cannulation stage.
Supportive care for HFRS
Hemorrhagic fever with renal syndrome care focuses on managing the kidney injury and bleeding diathesis. Hemodialysis is required in roughly 40% of severe Hantaan-virus cases. Platelet transfusion may be required for severe thrombocytopenia. Careful fluid balance through the oliguric and diuretic phases is essential to prevent volume overload or dehydration as the kidneys recover.
Ribavirin — works for HFRS, not HPS
Intravenous ribavirin reduces mortality in hemorrhagic fever with renal syndrome when started within four days of symptom onset. The effect is best documented for Hantaan-virus disease in China and Korea, where ribavirin is routinely used. For hantavirus pulmonary syndrome in the Americas, controlled trials have not shown a survival benefit, and ribavirin is no longer recommended for HPS.
Investigational therapies
Several monoclonal-antibody products targeting Andes and Sin Nombre viruses are in clinical evaluation. Convalescent plasma from recovered Andes-virus patients was used during the 2026 cruise-ship cluster on a compassionate basis. Favipiravir and remdesivir have shown in vitro activity but no convincing clinical benefit. None of these is licensed as of May 2026.