Orthohantaviruses in Wastewater: Transmission Risks and Opportunities for Early Warning

Abstract

The recent outbreak of Andes virus, a rodentborne orthohantavirus, on the cruise ship MV Hondius has received significant media attention, with suggested gaps in response giving rise to concerns about preparedness for the spread of rare zoonotic disease. Early warning of infection spread, such as that obtained through wastewater surveillance (WS), could greatly benefit public health management and interventions for orthohantavirus infections, particularly in regions with limited clinical surveillance. Given the similarities between orthohantaviruses and other enveloped RNA viruses successfully monitored through WS, many of the principles developed by the global WS community over the past several years may be transferable and rapidly implementable for orthohantavirus surveillance. With a specific focus on Andes virus, Sin Nombre virus, Hantaan virus, and Puumala virus, we present key features of orthohantaviruses relevant to advancing quantification efforts and interpreting wastewater data. We summarize the current state of knowledge related to orthohantavirus shedding in excretions relevant to wastewater, highlight case studies documenting orthohantaviruses in wastewater, and discuss promising approaches for implementing WS. Because orthohantaviruses are shed in rodent excretions and the habitats of these rodents are often associated with sanitation systems, the interpretation of orthohantavirus genetic markers in wastewater samples requires careful consideration. Furthermore, based on findings from previous WS studies and current knowledge regarding the environmental persistence of enveloped viruses similar to ANDV, the risk of transmission through wastewater is likely low but not negligible. Key gaps in our understanding include orthohantavirus survival in environmental matrices (particularly wastewater and aerosols) as well as the development and validation of quantitative assays in environmental contexts, which are required for robust WS programs. Further, deployment of assays targeting orthohantaviruses in WS at sentinel sites, such as airports, hospitals, or cruise ships, would be helpful to understand outbreak boundaries. Thoughtful application of orthohantavirus WS, in coordination with public health agencies and existing surveillance and containment efforts, could not only help prevent disease spread but also serve as an important case study for the rapid translation of WS in response to an emerging disease outbreak.