Three-tier surveillance framework addresses resource limitations for Hantavirus and hemorrhagic fever with renal syndromeNew Framework Proposed to Track Hantavirus and Hemorrhagic Fever

Hantaviruses maintained in small mammals cause hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. Exposure usually arises from contact with infected rodent excreta, so prevention depends on understanding reservoir ecology, human activities, and the settings in which they intersect. This structured narrative review synthesizes evidence on host relationships, exposure, clinical and laboratory recognition, genomic investigation, and One Health surveillance across several regions. We propose three risk-proportionate tiers: baseline readiness where evidence is sparse, enhanced investigation after a credible signal, and sustained integrated surveillance where transmission is established. Five shared functions are scaled across tiers: reservoir sampling, clinical recognition and referral testing, molecular characterization, occupational and environmental assessment, and cross-sector data review. Published outbreaks in Croatia and long-running surveillance in Panama illustrate how the decision logic could be applied, while the 2026 Andes virus cruise-ship event highlights the need for diagnostics and contact management. The framework provides a practical way to plan surveillance with limited resources, but its triggers, workload, and impact remain to be evaluated prospectively.