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