Last reviewed 2026-05-14
HPS vs HFRS — The Two Hantavirus Syndromes
Hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS) are the two clinical syndromes caused by hantaviruses. They share an early prodrome but diverge sharply in primary organ involvement, geography, and mortality.
Item A
Hantavirus pulmonary syndrome (HPS)
Primary lung involvement · ICD-10 B33.4
An acute respiratory disease caused by New World hantaviruses. Rapid pulmonary edema, hypoxia, and cardiogenic shock. Case-fatality rate 35–40%.
More on Hantavirus pulmonary syndrome (HPS) →Item B
Hemorrhagic fever with renal syndrome (HFRS)
Primary kidney involvement · ICD-10 A98.5
A multi-phase illness caused by Old World hantaviruses. Acute kidney injury, hemorrhagic manifestations, and characteristic five-phase clinical course. Case-fatality rate 0.1–15% depending on strain.
More on Hemorrhagic fever with renal syndrome (HFRS) →Side-by-side
| Feature | Hantavirus pulmonary syndrome (HPS) | Hemorrhagic fever with renal syndrome (HFRS) |
|---|---|---|
| Primary organ | Lungs | Kidneys |
| Geographic range | North and South America | Europe and Asia |
| Example viruses | Sin Nombre, Andes, Choclo, Juquitiba | Hantaan, Puumala, Seoul, Dobrava-Belgrade |
| Case fatality rate | 35–40% | 0.1–15% |
| Hallmark feature | Pulmonary edema and cardiogenic shock | Acute kidney injury with hemorrhagic signs |
| Treatment | Supportive ICU care; mechanical ventilation; ECMO | Supportive ICU care; IV fluids; dialysis; ribavirin (early) |
| Person-to-person spread | Only Andes virus | Not documented |
| Vaccine | None licensed | Inactivated vaccines licensed in Korea (Hantavax) and China |
What they share
- ●Both start with an indistinguishable flu-like prodrome — fever, myalgia, headache, fatigue — for 3–5 days.
- ●Both have incubation periods of roughly 1 to 8 weeks.
- ●Both are caused by hantaviruses in the family Hantaviridae and acquired primarily through inhaled rodent excreta.
- ●Both require ICU-level supportive care and improve dramatically with early hospitalization.
- ●Neither has FDA-approved antiviral therapy in North America.
What sets them apart
- ●HPS damages the lungs; HFRS damages the kidneys. After the shared prodrome, the clinical course diverges sharply.
- ●HPS occurs in the Americas; HFRS occurs in Europe and Asia.
- ●HFRS is much less lethal on average — especially Puumala virus, which has fatality near 0.1% — but Hantaan virus HFRS can approach HPS mortality.
- ●HFRS has licensed vaccines in some countries; HPS has none.
Bottom line
Geography is the first filter. A returned traveler from Patagonia, Brazil, or the rural Southwest United States with rapidly progressive shortness of breath and pulmonary edema after a flu-like illness has HPS until proven otherwise. A traveler from rural Russia, China, Korea, or northern Europe with fever, headache, back pain, and acute kidney injury has HFRS until proven otherwise.