Glossary · Diagnostic
PCR
Polymerase chain reaction. Molecular method for detecting viral DNA or RNA. For hantaviruses: sensitivity ~92%, specificity 100%, result in a few hours.
PCR (polymerase chain reaction) is a molecular biology technique that amplifies a target DNA or RNA fragment millions of times. For RNA viruses like hantavirus, RT-PCR (reverse-transcription PCR) is used, which first transcribes viral RNA into DNA. PCR is the tool of choice for early diagnosis of hantavirus diseases: it was by PCR that Andes virus was identified in MV Hondius patients on 3 May 2026.
Technical principle #
Exponential amplification #
PCR relies on thermal cycles that denature DNA, attach oligonucleotide primers specific to the target sequence, then polymerise a new strand. With each cycle the number of copies doubles. In 30 to 40 cycles, a single original copy can produce up to a billion copies, making the target detectable.
RT-PCR for RNA viruses #
Hantaviruses have an RNA genome. RT-PCR adds a preliminary step of reverse transcription: viral RNA is transcribed into complementary DNA (cDNA) by a reverse transcriptase enzyme, then amplified like a standard PCR. RT-qPCR ("quantitative") measures in real time the amount of amplified DNA at each cycle, allowing both detection and viral load estimation in the sample.
Performance for hantavirus diagnosis #
Sensitivity and specificity #
A reference study published in PLOS Neglected Tropical Diseases evaluated the performance of an RT-qPCR developed for the diagnosis of hantavirus pulmonary syndrome in South America:
- Clinical sensitivity: 92.5%
- Clinical specificity: 100%
- Overall accuracy: 97.6%
- Analytical detection limit: 0.9 viral RNA copy per microlitre
These performances make RT-qPCR the reference test for early diagnostic confirmation, especially in outbreak settings.
Detection window #
Viral load in blood peaks within the first 5 days of symptoms, with detection possible up to about day 11. Beyond that, PCR sensitivity declines rapidly and serology (searching for IgM then IgG) takes over for diagnosis and epidemiological follow-up.
Application to MV Hondius #
Identification of the pathogen #
For the MV Hondius event, it was PCR that on 3 May 2026 enabled the identification of Andes virus in patients on board. Samples collected during medical evacuations (Saint Helena, South Africa) were sent to European reference virology laboratories for confirmation. Rapid identification triggered international surveillance measures and WHO outbreak notification.
Contact surveillance #
Identified passengers and contacts can benefit from RT-PCR upon onset of any suggestive symptom during the 42-day surveillance period. An early negative test does not exempt from surveillance until the end of the period, since incubation can extend up to 6 weeks.
Limits and precautions #
False positives and false negatives #
No test is perfect. An RT-qPCR may be negative very early (before the viraemic phase), during the recovery phase, or in case of a poor-quality sample. Conversely, laboratory contamination can generate rare false positives. Medical decisions always rely on combining the PCR result with the clinical and epidemiological context.
Transport logistics #
Potentially infectious samples are transported in triple packaging UN3373 ("biological substance, category B") to reference laboratories. This logistics introduces delays that must be anticipated in clinical management — the result is typically available in 24 to 48 hours rather than a few hours.
Key figures
-
92.5%
Clinical sensitivity of RT-qPCR for the diagnosis of hantavirus pulmonary syndrome.
PLOS Neglected Tropical Diseases — Development of RT-qPCR for hantavirus pulmonary syndrome
-
100%
Clinical specificity of RT-qPCR for the diagnosis of hantavirus pulmonary syndrome.
PLOS Neglected Tropical Diseases — Development of RT-qPCR for hantavirus pulmonary syndrome
-
0.9 copy/µL
Analytical detection limit of RT-qPCR for Andes virus RNA.
PLOS Neglected Tropical Diseases — Development of RT-qPCR for hantavirus pulmonary syndrome
-
5 days
Peak viral load in blood within the first 5 days of symptoms; detection still possible up to day 11.
PMC — Molecular method for detection of Andes hantavirus infection
Standards & references
- ISO 15189 — Medical laboratories — International accreditation standard for medical biology laboratories that perform PCR tests.
Frequently asked questions
How does PCR work?
PCR (polymerase chain reaction) exponentially amplifies a target fragment of viral DNA or RNA present in a sample (blood, respiratory specimen, biopsy). For an RNA virus like hantavirus, RT-PCR (reverse-transcription PCR) is used, which first transcribes RNA into DNA before amplification. RT-qPCR ("quantitative") measures the amount of target RNA in real time, allowing both detection and viral load estimation.
When should PCR be used for hantavirus?
PCR is the tool of choice for early diagnosis, that is from the first symptoms. Viral load in blood peaks within the first 5 days of symptoms, with detection still possible up to day 11. Beyond that, serology (search for IgM then IgG antibodies) takes over. For MV Hondius, Andes virus was identified by PCR on 3 May 2026.
How long does it take to get a result?
An RT-qPCR in an equipped laboratory can produce a result in 4 to 6 hours from the time the sample is received. With routing delays (collection, transport in triple packaging UN3373 class to a reference laboratory), the result is typically available in 24 to 48 hours for hantaviruses, which are not routinely tested and require shipment to a specialised laboratory.
What is the difference with serology?
PCR directly detects viral RNA, evidence of an ongoing infection. Serology searches for antibodies produced by the immune system in response to infection: IgM appear around day 5-7 and indicate recent infection, IgG appear later and persist for years. For early diagnosis, PCR is more efficient. For retrospective epidemiological investigations, serology is more useful.
Further reading
- Development of RT-qPCR for hantavirus pulmonary syndrome — PLOS Neglected Tropical Diseases (scientific publication)
- Molecular method for detection of Andes hantavirus — PMC / NIH (scientific publication)
- Detection and typing of human pathogenic hantaviruses by RT-PCR — PubMed (scientific publication)