安第斯汉坦病毒心肺综合征及其人际传播研究进展——基于MV Hondius邮轮疫情的思考

doi:10.19871/j.cnki.xfcrbzz.2026.04.012

摘要/Abstract

摘要： 汉坦病毒是一类重要的人兽共患病原体,可引起肾综合征出血热和汉坦病毒心肺综合征（hantavirus cardiopulmonary syndrome,HCPS）。其中,安第斯汉坦病毒（andes virus,ANDV）是目前唯一具有明确人际传播证据的汉坦病毒。2026年4—5月,MV Hondius邮轮发生ANDV相关聚集性疫情,WHO于2026年7月2日确认此次疫情得到控制,最终报告13例病例,其中12例实验室确诊病例、1例疑似病例,3例死亡。ANDV感染潜伏期为4~42d,临床分为前驱期和快速进展的心肺期。重症病例可出现毛细血管渗漏、非心源性肺水肿、心肌抑制和休克。多数急性HCPS患者在症状出现时或发病后短期内可检出特异性IgM,但症状前病毒血症可先于抗体出现。既往家庭聚集性疫情、2018—2019年阿根廷Epuyén暴发以及本次邮轮聚集性疫情共同表明,人际传播多发生于近距离、持续接触情境,具体传播途径及症状前传播风险仍需进一步明确。本文结合2026年邮轮疫情资料,讨论ANDV的病原学、流行病学、临床表现与诊治、人际传播证据、重症预警及隔离监测要点,为旅行相关输入性病例的识别和防控提供参考。

关键词: 安第斯汉坦病毒, 汉坦病毒心肺综合征, 邮轮疫情, 人际传播, 接触者管理

Abstract: Hantaviruses are important zoonotic pathogens that can cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). Andes virus (ANDV) is the only hantavirus with clear evidence of human-to-human transmission. In April-May 2026, an ANDV-related outbreak occurred on the MV Hondius cruise ship. The World Health Organization (WHO) confirmed on July 2nd that the outbreak was under control, ultimately reporting 13 cases: 12 laboratory-confirmed cases, 1 probable case, and 3 deaths. The incubation period for ANDV infection ranges from 4 to 42 days. The clinical course usually includes a prodromal phase followed by a rapidly progressive cardiopulmonary phase, and severe cases may develop capillary leak, non-cardiogenic pulmonary edema, myocardial depression, and shock. Specific IgM can be detected in the majority of patients with acute HCPS at the onset of symptoms or shortly thereafter, but presymptomatic viremia may precede antibody presentation. Previous household outbreaks, the 2018-2019 Epuyén outbreak in Argentina, and the current cruise ship incident all indicate that human-to-human transmission primarily occurs in close, continuous contact situations. The specific transmission routes and the risk of pre-symptomatic transmission require further clarification. This review, based on the 2026 cruise ship outbreak, summarizes the virology, epidemiology, clinical manifestations and management, evidence of human-to-human transmission, predictors of severe disease, and isolation and surveillance strategies for ANDV, with the aim of providing a reference for the identification and prevention of travel-related imported cases.

Key words: Andes virus, Hantavirus cardiopulmonary syndrome, Cruise ship outbreak, Human-to-human transmission, Contact management

中图分类号:

R512.99

周念奇, 王福祥, 傅蕾, 彭仕芳. 安第斯汉坦病毒心肺综合征及其人际传播研究进展——基于MV Hondius邮轮疫情的思考[J]. 新发传染病电子杂志, 2026, 11(4): 75-80.

Zhou Nianqi, Wang Fuxiang, Fu Lei, Peng Shifang. Andes virus-associated hantavirus cardiopulmonary syndrome and human-to-human transmission: insights from the MV Hondius cruise ship outbreak[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(4): 75-80.

参考文献

[1] Vial P A, Ferrés M, Vial C, et al.Hantavirus in humans: a review of clinical aspects and management[J]. Lancet Infect Dis, 2023, 23(9):e371-e382.
[2] Harris G H, Sinchi A, Lawler J, et al.Andes Virus - A Clinical Review[J]. N Engl J Med. 2026.
[3] Hertelendy A J, Gostin L O, Ciottone G R.The MV Hondius Hantavirus Outbreak-Lessons for Pandemic Preparedness[J]. JAMA, 2026, 336(3):193-195.
[4] Kupferschmidt K.Cruise ship outbreak spotlights a little-studied hantavirus[J]. Science. 2026, 392(6799):672-673.
[5] Toledo J, Haby M M, Reveiz L, et al.Evidence for Human-to-Human Transmission of Hantavirus: A Systematic Review[J]. J Infect Dis, 2022,226(8):1362-1371.
[6] Islam M S, Chughtai A A, Wood J G, et al.Hantavirus outbreak on a cruise ship in the South Atlantic[J]. Lancet, 2026,407(10545):2286-2287.
[7] World Health Organization. Hantavirus outbreak linked to cruise ship travel,Multi-locations[EB/OL]. (2026-07-02)[2026-08-09]. https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON611.
[8] Centers for Disease Control and Prevention. About Hantavirus[EB/OL]. (2026-05-09)[2026-08-09]. https://www.cdc.gov/hantavirus/about/index.html.
[9] Andes Virus Outbreak Working Group. Andes Hantavirus Outbreak on a Cruise Ship, 2026[J]. N Engl J Med, 2026, 394(24):2477-2479.
[10] World Health Organization. Management of contacts of Andes virus (ANDV) cases from the MV Hondius cruise ship[EB/OL]. (2026-05-17)[2026-08-09]. https://www.who.int/publications/m/item/management-of-contacts-of-andes-virus-%28andv%29-cases-fromthe-mv-hondius-cruise-ship.
[11] Taylor S L, Schmaljohn C S, Williams E P, et al.Pathogenicity and virulence of Rodent-Borne Orthohantaviruses[J]. Virulence. 2025, 16(1):2553784.
[12] Parvate A, Williams E P, Taylor M K, et al.Diverse Morphology and Structural Features of Old and New World Hantaviruses[J]. Viruses, 2019, 11(9):862.
[13] Jangra R K, Herbert A S, Li R, et al.Protocadherin-1 is essential for cell entry by New World hantaviruses[J]. Nature, 2018,563(7732):559-563.
[14] Vaheri A, Strandin T, Hepojoki J, et al.Uncovering the mysteries of hantavirus infections[J]. Nat Rev Microbiol, 2013,11(8):539-550.
[15] Paludan S R, Cherry S.Hantavirus disease and the need for pathogenesis-guided therapy[J]. J Exp Med, 2026, 223(7):e20260871.
[16] Gavrilovskaya I N, Gorbunova E E, Mackow N A, et al.Hantaviruses direct endothelial cell permeability by sensitizing cells to the vascular permeability factor VEGF, while angiopoietin 1 and sphingosine 1-phosphate inhibit hantavirus-directed permeability[J]. J Virol, 2008, 82(12):5797-5806.
[17] Sane J, Laine O, Mäkelä S, et al.Complement activation in Puumala hantavirus infection correlates with disease severity[J]. Ann Med, 2012,44(5):468-475.
[18] Sironen T, Sane J, Lokki M L, et al. Fatal Puumala Hantavirus Disease: Involvement of Complement Activation and Vascular Leakage in the Pathobiology[J]. Open Forum Infect Dis, 2017,4(4):ofx229.
[19] Centers for Disease Control and Prevention. Interim Guidance for Public Health Assessment and Management of People with Potential Exposure to Andes Virus[EB/OL]. (2026-07-07)[2026-08-09]. https://archive.cdc.gov/www_cdc_gov/hantavirus/php/emergency-guidance/index.html.
[20] Mitjà O.Andes virus on a cruise ship: person-to-person transmission and an empty pipeline[J]. Lancet Infect Dis. 2026,26(7):e271-e272.
[21] Dryden M, Blumberg L, Weyer J, et al.Cruise ship hantavirus outbreak in remote island communities[J]. Lancet, 2026,407(10545):2285-2286.
[22] Sehgal A, Mehta S, Sahay K, et al.Hemorrhagic Fever with Renal Syndrome in Asia: History, Pathogenesis, Diagnosis, Treatment, and Prevention[J]. Viruses, 2023,15(2):561.
[23] Ferrés M, Martínez-Valdebenito C, Henriquez C, et al.Viral shedding and viraemia of Andes virus during acute hantavirus infection: a prospective study[J]. Lancet Infect Dis, 2024,24(7):775-782.
[24] Ferrés M, Vial P, Marco C, et al.Prospective evaluation of household contacts of persons with hantavirus cardiopulmonary syndrome in chile[J]. J Infect Dis, 2007, 195(11):1563-1571.
[25] World Health Organization.Laboratory testing of Andes virus (Orthohantavirus andesense) infection: Interim guidance. Geneva: World Health Organization; 2026.
(WHO Guidelines Approved by the Guidelines Review Committee).
[26] Galeno H, Mora J, Villagra E, et al.First human isolate of Hantavirus (Andes virus) in the Americas[J]. Emerg Infect Dis, 2002, 8(7):657-661.
[27] Chediack V, Calvo M, Cunto E, et al.Hantavirus infection: A narrative review focusing on epidemiology, diagnosis, infection control and treatment in the era of globalisation[J]. Med Intensiva (Engl Ed), 2026:502523
[28] Fama F, Molà F, Rizzo A, et al.Andes virus-associated cardiopulmonary syndrome: diagnostic approaches, clinical management, and evidence gaps-a scoping review[J]. Clin Microbiol Infect, 2026.
[29] Dietl C A, Wernly J A, Pett S B, et al.Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome[J]. J Thorac Cardiovasc Surg, 2008, 135(3):579-584.
[30] Safronetz D, Haddock E, Feldmann F, et al.In vitro and in vivo activity of ribavirin against Andes virus infection[J]. PLoS One. 2011,6(8):e23560.
[31] Vial P A, Valdivieso F, Ferres M, et al.High-dose intravenous methylprednisolone for hantavirus cardiopulmonary syndrome in Chile: a double-blind, randomized controlled clinical trial[J]. Clin Infect Dis, 2013, 57(7):943-951.
[32] Miriam E, Sacristán S, Tatiana M F, et al.First reported case of Andes hantavirus cardiopulmonary syndrome treated with a combination of favipiravir, ribavirin, icatibant and baricitinib[J]. Clin Microbiol Infect, 2026, 32(8):1360-1366.
[33] Vial P A, Valdivieso F, Calvo M, et al.A non-randomized multicentre trial of human immune plasma for treatment of hantavirus cardiopulmonary syndrome caused by Andes virus[J]. Antivir Ther, 2015,20(4):377-386.
[34] Torres-Pérez F, Palma R E, Hjelle B, et al.Andes virus infections in the rodent reservoir and in humans vary across contrasting landscapes in Chile[J]. Infect Genet Evol, 2010, 10(6):820-825.
[35] Khalil H, Hörnfeldt B, Evander M, et al.Dynamics and drivers of hantavirus prevalence in rodent populations[J]. Vector Borne Zoonotic Dis, 2014, 14(8):537-551.
[36] Jonsson C B, Figueiredo L T, Vapalahti O.A global perspective on hantavirus ecology, epidemiology, and disease[J]. Clin Microbiol Rev, 2010, 23(2):412-441.
[37] Wells R M, Sosa Estani S, Yadon Z E, et al.An unusual hantavirus outbreak in southern Argentina: person-to-person transmission? Hantavirus Pulmonary Syndrome Study Group for Patagonia[J]. Emerg Infect Dis, 1997, 3(2):171-174.
[38] Martínez V P, Di Paola N, Alonso D O, et al."Super-Spreaders" and Person-to-Person Transmission of Andes Virus in Argentina[J]. N Engl J Med, 2020, 383(23):2230-2241.
[39] Bogacka A, Pupaibool J, Genderen P J J, et al. An Unexpected Outbreak at Sea: Revisiting Hantavirus Transmission Dynamics[J]. J Travel Med, 2026.
[40] World Health Organization. WHO Technical note for the disembarkation and onward management of passengers and crew in the context of an Andes virus-associated cluster MV Hondius cruise ship[EB/OL]. (2026-05-10)[2026-08-09]. https://www.who.int/publications/m/item/who-technical-note-for-the-disembarkation-and-onward-management-of-passengers-and-crew-in-the-context-of-an-andes-virus-associated-cluster-mv-hondius-cruise-ship.
[41] World Health Organization. International Health Regulations (2005). 3rd ed. Geneva: World Health Organization; 2016.