Table 2.

Research needs in hantavirus diseases

Hantavirus ecology and epidemiology• Extension of host reservoir habitats due to climate change• Impact of human migration on hantaviral spread• Characterization of spillover infections, especially to bats, facilitating hantaviral reassortment and spread• Role of human-to-human transmission of ANDV and SNV in public health

Hantavirus structure and life cycle• Role of integrins for cell entry in pathogenic and apothegenic hantaviruses• Integrin gene polymorphisms in hantaviral attachment and the susceptibility for hantaviral infection

Hantavirus pathogenesis and immunopathology• Hantavirus cell tropism and organ-specific dysfunction in HRFS and HCPS• Generation of HFRS animal models reflecting human hantavirus disease• Local and systemic tissue damage caused by pathogenic mediators in hantavirus disease in in vivo models• Assessing causal attribution of involved pathogenic mediators using targeted approaches, i.e. antibodies• Pathomechanisms of AKI in hantavirus disease

Clinical presentation• Characterization of hantavirus disease beyond the dichotomous denominations of HFRS and HCPS• Revised taxonomy beyond HFRS and HCPS• Long-term kidney sequelae in DOBV and HTNV• Prognostic impact of pre-existing CKD, RRT, kidney transplantation and immune suppression in hantavirus disease• Phenotype, frequency and sequelae of kidney involvement in ANDV- and SNV-caused disease• Systematic analyses of overlapping features in pathogenesis, phenotype and treatment approaches between emerging viruses, i.e. SARS-CoV-2, Ebola virus and hantaviruses

Diagnosis• Definition of clinical and diagnostic criteria for hantavirus diseases• Prognosis-indicating scores facilitating risk stratification for the ER and ICU

Prevention• Development of EMA- and FDA-approved vaccines, i.e. on the basis of recent RNA vaccine technology• Development for preventive/precaution measures for public health (especially in endemic areas)

Therapy• Development of targeted antiviral pharmacological approaches examined in randomized controlled clinical trials

AKI: acute kidney injury; CKD: chronic kidney disease; EMA: European Medicines Agency; ER: emergency room; FDA: US Food and Drug Administration; ICU: intensive care unit; RNA: ribonucleic acid.