Abstract / Summary
Andes orthohantavirus (ANDV) is a rodent-borne, tri-segmented, negative-sense RNA virus that causes hantavirus cardiopulmonary syndrome in southern South America. Most infections follow exposure to dust, surfaces, or particles contaminated with urine, faeces, or saliva from infected reservoir rodents. ANDV is unusual among hantaviruses because limited person-to-person transmission has been reported in Argentina and Chile. This critical narrative review evaluates ANDV taxonomy, genetic diversity, reservoir ecology, patient shedding, outbreak epidemiology, transmission mechanisms, and countermeasures from a One Health perspective. The evidence supports a narrow conclusion: ANDV can spread between people, especially after close, prolonged, household, caregiving, nosocomial, or intimate exposure. Recent studies showing viral RNA, and sometimes infectious virus, in blood, oral, nasopharyngeal, urine, and other compartments strengthen the biological plausibility of close-contact transmission. However, RNA detection, body-fluid infectivity, similar viral genomes, and co-housing animal transmission do not by themselves show routine casual airborne spread. Most disease still follows rodent-associated environmental exposure, and shared environmental exposure remains a major confounder in endemic areas. ANDV should not be described as non-transmissible between humans, but it should also not be framed as an efficient airborne respiratory virus. Preparedness should combine rodent-exposure reduction, early clinical recognition, isolation and body-fluid precautions for suspected cases, contact monitoring, paired human-rodent sequencing, updated serosurveys, and continued development of vaccines, antibody-based therapies, and early antivirals.