Global threats and regional trends: New insights into navigating the complex landscape of human orthohantavirus infections

This review analyses the distribution and epidemiological trends of orthohantavirus in Asia, Europe, North America, South America, Africa and Oceania respectively. Epidemiological data indicate considerable geographic variability in disease incidence, influenced by intricate interactions among ecological, socioeconomic, and public health determinants. Meanwhile, this review puts forward the challenges in reducing orthohantavirus infections and proposes potential strategies. China's success demonstrates the efficacy of targeted public health interventions; however, the global landscape reveals significant regional disparities. These include Russia's stable infection rates, the high incidence in Nordic countires (further exacerbated by climate change), the rising case numbers in South America, and the emerging concern in Africa. Effective government interventions, such as rodent control and vaccination, are vital to reducing orthohantavirus risks, though human behaviors like more outdoor recreation and rodent pet-keeping may increase transmission risk. However, the prevention and control of orthohantavirus face multi-dimensional challenges, including:

• The strong adaptability of rodent reservoirs and high rates of asymptomatic infection.
• Weak primary healthcare and disease surveillance systems.
• Diverse and evolving viral genotypes.
• Poor "host-environment-human" linkage
• Low vaccine coverage and limited cross-protection.
• Difficulties in early clinical diagnosis.
• A lack of specific antiviral drugs.
• Low public awareness.
• Ecological changes that may exacerbate transmission.
• Barriers to interdisciplinary and international collaboration.

Future research should proceed in the following directions: First, surveillance must be strengthened in data-sparse regions, and cross-border cooperation enhanced to address epidemiological gaps. Second, interdisciplinary collaboration is required to develop integrated "ecology-climate-society" models and to quantify key variables driving virus transmission. Third, successful practical cases should be systematically evaluated to provide more specific guidance for the formulation of regionalized control strategies.