Hantavirus and Middle East Public Health Challenges: A Subject Review

Hantaviruses are emerging zoonotic viruses belonging to the family Hantaviridae, which are typically found in rodent reservoirs and transmitted to humans through contact with contaminated saliva, aerosolized particles or excreta. There are two major clinical syndromes associated with human infections: hemorrhagic fever with renal syndrome (HFRS) — mostly reported from Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS) — mostly reported from the Americas. The Middle East has a relatively low incidence of hantavirus disease, but recent epidemiological studies have shown that the virus is circulating in several countries, including Türkiye and Iran. The emergence of hantavirus infections in this area has become a growing concern as the population increases, climate variations occur, the rodents' ecology is changing, the agriculture spreads and the surveillance of this situation is improving. There is limited surveillance, underdiagnosis, and a large clinical overlap with other febrile illnesses all of which are important challenges in quantifying the regional burden of disease. This review aims at summarizing the state of knowledge about the epidemiology of the hantavirus in the Middle East, focusing on geographical distribution, environmental factors, rodent hosts, epidemiology, clinical features, diagnostic methods and public health preparedness. Current data suggest that while human infections are rare, ecological conditions which could sustain hantavirus are present in several Middle Eastern countries, and therefore increased surveillance and research into interdisciplinary and One Health initiatives are needed. Creating closer ties between the medical, veterinary and environmental communities is crucial for early outbreak detection and prevention in the future.