Hemorrhagic fever with renal syndrome (HFRS) is a rare, life-threatening syndrome caused by an Orthohantavirus (family Hantaviridae, order Bunyavirales). Specific hantaviruses that have been identified as causes of HFRS are the Hantaan virus, Seoul virus, Puumala virus, and Dobrava / Belgrade virus. Hantaviruses reside in rodent reservoirs and are excreted in rodent urine and saliva.

HFRS is a febrile illness in humans occurring most commonly in Asia with the highest prevalence in Korea, China, and eastern Russia. In Korea, most infections occur during the rodent breeding season in late autumn and early winter.

Patients present with a febrile illness. Anorexia, emesis, diarrhea, headache, abdominal pain, and conjunctival injection are all common concurrent symptoms. HFRS can progress to septic shock and renal failure, and overall mortality is estimated at approximately 1%-4%.

Laboratory findings are relatively nonspecific, characterized by a leukocytosis, thrombocytopenia, acute kidney injury (elevated blood urea nitrogen and creatinine), and transaminase (aspartate aminotransferase and alanine aminotransferase) elevation. Diagnosis can be confirmed by immunologic or molecular testing specific for the presence of hantavirus in the serum or biopsied tissue.

Ribavirin has potential for improved outcomes in the management of HFRS. A vaccine for the Hantaan virus is available in South Korea, and a bivalent vaccine for Hantaan virus and Seoul virus is available in China.