TY - JOUR
T1 - Ribavirin post-exposure prophylaxis for Andes virus exposure
T2 - a viewpoint
AU - Brüggemann, Roger J.
AU - Vollaard, Albert
AU - de Stoppelaar, Sacha
AU - van Hasselt, Johan G.C.
AU - Burger, David M.
AU - Engel, Job J.
AU - van Kampen, Jeroen J.A.
AU - McCall, Matthew
AU - Smits, Loek
AU - Jolink, Hetty
AU - Visser, Leo G.
AU - van de Veerdonk, Frank
AU - Veldkamp, Karin Ellen
AU - Rovers, Chantal P.
AU - Arts, Rob J.W.
N1 - Publisher Copyright:
© 2026 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
PY - 2026/8
Y1 - 2026/8
N2 - Andes virus (ANDV) is unique among hantaviruses because person-to-person transmission is possible. This raises questions on the relevance of post-exposure prophylaxis (PEP), particularly following high-risk household, healthcare-associated, or laboratory exposures, considering its high case fatality rate. Ribavirin has demonstrated antiviral activity against hantaviruses in vitro and in animal models, although clinical evidence supporting its use for ANDV remains extremely limited. This viewpoint summarises the currently available evidence regarding ribavirin as PEP after potential ANDV exposure. We discuss the knowledge gaps that may limit the applicability of ribavirin PEP, to make informed decisions on the use of ribavirin in the setting of PEP. Potential dosing strategies are visualised by modelling and simulation, and potential dose and duration are discussed. Although the biological rationale for ribavirin PEP appears compelling, absence of controlled human studies and potential toxicity currently limit its role to highly selected exposure scenarios and use shortly after exposure.
AB - Andes virus (ANDV) is unique among hantaviruses because person-to-person transmission is possible. This raises questions on the relevance of post-exposure prophylaxis (PEP), particularly following high-risk household, healthcare-associated, or laboratory exposures, considering its high case fatality rate. Ribavirin has demonstrated antiviral activity against hantaviruses in vitro and in animal models, although clinical evidence supporting its use for ANDV remains extremely limited. This viewpoint summarises the currently available evidence regarding ribavirin as PEP after potential ANDV exposure. We discuss the knowledge gaps that may limit the applicability of ribavirin PEP, to make informed decisions on the use of ribavirin in the setting of PEP. Potential dosing strategies are visualised by modelling and simulation, and potential dose and duration are discussed. Although the biological rationale for ribavirin PEP appears compelling, absence of controlled human studies and potential toxicity currently limit its role to highly selected exposure scenarios and use shortly after exposure.
KW - Hantavirus cardiopulmonary syndrome
UR - https://www.scopus.com/pages/publications/105044691475
U2 - 10.1016/j.ebiom.2026.106386
DO - 10.1016/j.ebiom.2026.106386
M3 - Review article
AN - SCOPUS:105044691475
SN - 2352-3964
VL - 130
JO - EBioMedicine
JF - EBioMedicine
M1 - 106386
ER -