Hantaviruses are carried by rodents and cause two serious illnesses in people: hemorrhagic fever with renal syndrome (HFRS), with an estimated 150,000 to 200,000 cases each year, mostly in Asia and Europe, and hantavirus cardiopulmonary syndrome (HCPS) in the Americas, which kills up to 40% of those affected. The infections returned to the headlines in May 2026, when the World Health Organization reported a cluster of Andes virus infections linked to the expedition cruise ship MV Hondius: 13 cases and 3 deaths, with more than 600 contacts traced across 32 countries, territories, and areas.
Although the effects of hantaviruses on the kidneys, lungs, and blood are well described, the oral and salivary side of infection has received little attention. In an invited review published in Infectious Diseases & Immunity , Prof. Sukumaran Anil of Chulalongkorn University, Thailand, and Manipal Academy of Higher Education, India, with Dr. Vishnupriya K. Sweety and Dr. Aman Pratap Singh, brings together the virology, epidemiology, clinical features, diagnosis, and treatment of human hantavirus infection and examines what each means for the mouth and for dental care.
Saliva and the one hantavirus that spreads between people
Andes virus (ANDV), found in Argentina and Chile, is the only hantavirus for which person-to-person spread has been repeatedly documented, with deep kissing and sexual contact identified as risk factors. The review highlights laboratory evidence that ANDV antigen is present in the secretory cells of human salivary glands and that ANDV, unlike other hantaviruses, resists the natural antiviral activity of human saliva. In a Chilean study of 131 confirmed cases, viral RNA was detected in 30% of acute-phase gingival crevicular fluid (the fluid around the gums) sample and in 12% of acute-phase saliva samples, and replication-competent virus was recovered from 18 of 43 positive samples tested (42%). The authors stress that this makes an oral route biologically plausible but does not prove that saliva carries the infection from one person to another.
Warning signs in the mouth
A severe sore throat lasting 2 to 3 weeks, together with swelling of the face, neck, and throat, has been described early in hantavirus infection and is easily mistaken for ordinary pharyngitis or tonsillitis. Small hemorrhages on the soft palate may appear during the febrile phase of HFRS. In the later oliguric phase, platelet counts can fall below 20,000-30,000 per microliter, bringing a real risk of spontaneous gum bleeding and of bleeding after even minor oral procedures.
Saliva as a diagnostic sample
An oral fluid IgM test for Hantaan virus agreed closely with serum testing, with 96.7% sensitivity and 94.9% specificity. Because dental clinics handle saliva routinely, the authors propose that dental clinics be evaluated as sites for non-invasive surveillance in endemic communities, while cautioning that the test has not yet been validated in dental patients, in ANDV-endemic populations, or as a point-of-care device.
What dental teams can do
The review sets out a four-step approach: recognize, time the care, protect the team, and support the patient. Elective dental treatment should be deferred during active illness and resumed only after platelet and kidney function have recovered, in consultation with the treating physician. Unavoidable emergency procedures belong in a hospital setting with support to control bleeding. For suspected HCPS, FFP2 or N95 respirators and hand instruments are preferred over aerosol-generating equipment; for suspected ANDV infection, enhanced protective equipment and a pre-procedural mouthrinse are reasonable precautions. Patients treated with ribavirin may need help with mouth ulcers, taste changes, and dry mouth.
The authors are explicit about the limits of the evidence. There are no clinical studies of dental care in hantavirus infection and no reported transmission to a dental worker, so the dental recommendations are precautionary and extrapolated from medical, virological, and general infection control evidence. Dentists are not expected to diagnose the disease; their role is to avoid dismissing these signs as routine and to refer promptly.
“The dentist is unlikely to be the clinician who diagnoses hantavirus infection, but may be the first to notice that a sore throat has lasted far too long or that the gums are bleeding without explanation,” said Prof. Anil. “The cruise ship cluster showed that travel can carry this risk well beyond endemic regions, so every dental team should know these signs and when to refer.”
The authors call for prospective studies that document oral findings systematically, longitudinal studies of salivary mucins and immunity, and validation of saliva-based tests in real-world and dental settings.
Infectious Diseases & Immunity
Literature review
People
Human Orthohantavirus infections: From virology and clinical epidemiology to oral biological features and dental practice
14-Oct-2026