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Glossary · Clinical

Hemorrhagic fever with renal syndrome

Clinical form of Eurasian hantavirus diseases, primarily affecting the kidneys. Global incidence is 60,000 to 150,000 cases per year, the vast majority in China.

Also called : HFRS, FHSR, Korean hemorrhagic fever Clinical

Hemorrhagic fever with renal syndrome (HFRS, FHSR for fièvre hémorragique avec syndrome rénal in French) is the main clinical form of Eurasian hantavirus diseases. Unlike hantavirus pulmonary syndrome found in the Americas, HFRS primarily affects the kidneys and may be accompanied by hemorrhagic manifestations. It is a zoonosis endemic in East Asia and present in Northern Europe.

Epidemiology

Global distribution

The estimated worldwide annual incidence is between 60,000 and 150,000 cases. China accounts for 70 to 90% of these cases, with between 12,000 and 20,000 reported cases per year. Russia and South Korea (300 to 600 cases per year) follow. In Europe, cases are mainly linked to Puumala virus and concentrated in Scandinavia, Germany and eastern France, generally in a milder clinical form.

Strains involved

The main hantaviruses responsible for HFRS are Old World hantaviruses: Hantaan (East Asia), Seoul (worldwide via the black rat Rattus norvegicus), Puumala (Europe), Dobrava-Belgrade (Balkans). Severity varies: case fatality below 1% for Puumala, up to 15% for Hantaan.

Clinical presentation

Five successive phases

The classic form evolves through five phases: febrile (3 to 7 days, with fever, headache, myalgia, abdominal pain), hypotensive (2 to 3 days, possible hypovolemic shock), oliguric (3 to 6 days, acute renal failure), polyuric (up to several weeks, recovery polyuria) and convalescence (up to several months). Hemorrhagic complications (purpura, mucosal bleeding, hemorrhagic shock) are more common with Asian strains.

Nephropathia epidemica

The European form caused by Puumala virus is called nephropathia epidemica. Milder, it manifests as fever, thrombocytopenia and transient renal involvement, most often without significant hemorrhage. Case fatality is below 1%.

Management and prevention

Treatment

Care is mainly symptomatic: fluid and electrolyte balance, hemodynamic support, dialysis in cases of severe acute renal failure. Intravenous ribavirin has shown partial benefit for Hantaan and Puumala strains when given early, but it is not used systematically.

Available vaccines

Inactivated vaccines against Hantaan and Seoul strains have been produced and used in China and South Korea since the 1990s. They are not licensed in the European Union or the United States. No vaccine currently exists for the New World hantaviruses (Andes, Sin Nombre).

Key figures

Standards & references

  • WHO — HFRS vaccines — WHO document on the standardisation of inactivated vaccines against HFRS (used in China and South Korea).
  • ICD-10 A98.5 — International Classification of Diseases code for hemorrhagic fever with renal syndrome.

Frequently asked questions

What is hemorrhagic fever with renal syndrome?

HFRS is the main clinical form of Eurasian hantavirus diseases. It evolves through five successive phases: febrile (3-7 days), hypotensive, oliguric with acute renal failure, polyuric recovery, then convalescence. The classic hemorrhagic complications are mostly linked to Hantaan virus; Puumala virus (European outbreaks) causes a milder form known as nephropathia epidemica.

Which hantavirus strains are responsible?

The main Old World hantaviruses causing HFRS are: Hantaan (East Asia, severe form), Seoul (worldwide, transmitted by the black rat), Puumala (Europe, moderate form), Dobrava-Belgrade (Balkans, severe form). The Andes virus responsible for the MV Hondius episode belongs to another group (New World hantaviruses) and causes the pulmonary syndrome, not HFRS.

Is there a vaccine against HFRS?

Yes, inactivated vaccines have been marketed in China and South Korea since the 1990s. They are not licensed in Europe or the United States. No vaccine is available against the New World hantaviruses (Andes, Sin Nombre).

Further reading