Last reviewed 2026-05-14
Hantaan Virus vs Puumala Virus
Both Hantaan virus and Puumala virus cause hemorrhagic fever with renal syndrome (HFRS), but the two strains produce very different illness severity, geographic distribution, and reservoir ecology.
Item A
Hantaan virus (HTNV)
Hantaviridae · Old World hantavirus
The prototype hantavirus, first isolated in 1976 from the Hantan River area in South Korea. Causes the most severe form of HFRS, with mortality up to 15%.
More on Hantaan virus (HTNV) →Item B
Puumala virus (PUUV)
Hantaviridae · Old World hantavirus
The dominant hantavirus across northern Europe, causing the locally-named milder syndrome 'nephropathia epidemica.' Carried by the bank vole.
More on Puumala virus (PUUV) →Side-by-side
| Feature | Hantaan virus (HTNV) | Puumala virus (PUUV) |
|---|---|---|
| Clinical syndrome | HFRS (severe) | HFRS (mild — nephropathia epidemica) |
| Geographic range | East Asia (Korea, China, Russian Far East) | Northern Europe (Finland, Sweden, Germany, Russia) |
| Primary reservoir | Striped field mouse (Apodemus agrarius) | Bank vole (Myodes glareolus) |
| Case fatality rate | 5–15% | ~0.1% |
| Hemorrhagic features | Prominent (petechiae, mucosal bleeding, DIC in severe cases) | Usually mild or absent |
| Renal involvement | Severe; dialysis often required | Moderate; dialysis occasionally required |
| Vaccine | Hantavax (Korea) and bivalent inactivated vaccine (China) | None licensed |
What they share
- ●Both cause HFRS with the characteristic five clinical phases: febrile, hypotensive, oliguric, diuretic, and convalescent.
- ●Both are spread by inhalation of aerosolized rodent excreta.
- ●Both show seasonal incidence linked to rodent population dynamics.
- ●Neither has documented human-to-human transmission.
What sets them apart
- ●Hantaan virus is 50–150× more lethal on average than Puumala virus.
- ●Puumala virus rarely causes overt hemorrhagic signs, whereas Hantaan virus can produce DIC and severe bleeding.
- ●Hantaan virus has effective licensed vaccines in Korea and China; Puumala has none.
- ●Reservoir species differ (mouse vs vole), and they occupy distinct ecological niches.
Bottom line
If a patient is from rural Korea, China, or the Russian Far East with severe AKI, hemorrhagic signs, and shock, consider Hantaan-virus HFRS — and start supportive ICU care plus early ribavirin. If the patient is from northern Europe — particularly Finland, Sweden, or Germany — with fever, back pain, and mild-to-moderate kidney injury, consider Puumala (nephropathia epidemica) and expect a milder course.