0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Huggins (DB RCT) 74% 0.26 [0.07-0.93] death 3/122 10/107 HFRS, Hantaan Improvement, RR [CI] Treatment Control Malinin (RCT) 67% 0.33 [0.01-7.85] progression 0/37 1/36 HFRS, Puumala Tau​2​ = 0.00, I​2​ = 0.0%, p = 0.029 Early treatment 73% 0.27 [0.08-0.88] 3/159 11/143 73% lower risk Mertz (DB RCT) -30% 1.30 [0.22-7.69] death 2/10 2/13 HCPS, Sin Nombre Improvement, RR [CI] Treatment Control Tau​2​ = 0.00, I​2​ = 0.0%, p = 0.78 Late treatment -30% 1.30 [0.22-7.69] 2/10 2/13 30% higher risk All studies 56% 0.44 [0.16-1.22] 5/169 13/156 56% lower risk 3 ribavirin hantavirus studies c19early.org May 2026 Tau​2​ = 0.04, I​2​ = 4.4%, p = 0.12 Effect extraction pre-specified(most serious outcome, see appendix) Favors ribavirin Favors control
Ribavirin is a broad-spectrum, small-molecule nucleoside analogue antiviral that inhibits hantavirus replication by depleting intracellular GTP pools via the inhibition of host inosine monophosphate dehydrogenase and by interfering directly with the viral RNA-dependent RNA polymerase.
Mar 3
2017
 Malinin et al., Infectious Diseases, doi:10.1080/23744235.2017.1293841 Insufficient efficacy and safety of intravenous ribavirin in treatment of haemorrhagic fever with renal syndrome caused by Puumala virus
15% slower viral clearance (p=0.11). RCT 73 hospitalized patients showing no significant differences with intravenous ribavirin for treatment of haemorrhagic fever with renal syndrome (HFRS) caused by Puumala virus (PUUV). Puumala virus is relatively mild compared to other h..
Jun 4
2014
 Moreli et al., VirusDisease, doi:10.1007/s13337-014-0219-7 Effectiveness of the ribavirin in treatment of hantavirus infections in the Americas and Eurasia: a meta-analysis
Meta-analysis of 7 ribavirin studies (506 patients/animals) showing lower mortality for hemorrhagic fever with renal syndrome (HFRS), but no significant mortality benefit for hantavirus pulmonary syndrome (HPS) in humans. Benefit was seen..
Jan 31
2009
 Rusnak et al., Antiviral Research, doi:10.1016/j.antiviral.2008.09.007 Experience with intravenous ribavirin in the treatment of hemorrhagic fever with renal syndrome in Korea
Retrospective 34 hospitalized patients with hemorrhagic fever with renal syndrome (HFRS) acquired in Korea, showing potential benefit with intravenous ribavirin treatment, with only 3% oliguria and 0% dialysis requirement compared to 39-6..
Nov 1
2004
 Mertz et al., Clinical Infectious Diseases, doi:10.1086/425007 Placebo-Controlled, Double-Blind Trial of Intravenous Ribavirin for the Treatment of Hantavirus Cardiopulmonary Syndrome in North America
30% higher mortality (p=1) and 22% lower progression (p=1). RCT 36 patients (23 with confirmed hantavirus cardiopulmonary syndrome, HCPS) showing no significant differences with intravenous ribavirin treatment. Mortality and the proportion of patients surviving without extracorporeal membrane oxyg..
May 1
1999
 Chapman et al., Antiviral Therapy, doi:10.1177/135965359900400404 Intravenous Ribavirin for Hantavirus Pulmonary Syndrome: Safety and Tolerance during 1 Year of Open-Label Experience
7% lower mortality (p=0.81). Observational study of 140 patients (30 with confirmed HPS) showing no apparent benefit with intravenous ribavirin for hantavirus pulmonary syndrome (HPS). All of the confirmed HCPS patients were enrolled late during the cardiopulmonary p..
Dec 1
1991
 Huggins et al., Journal of Infectious Diseases, doi:10.1093/infdis/164.6.1119 Prospective, Double-Blind, Concurrent, Placebo-Controlled Clinical Trial of Intravenous Ribavirin Therapy of Hemorrhagic Fever with Renal Syndrome
74% lower mortality (p=0.04) and 73% lower progression (p=0.01). RCT 242 hospitalized patients with hemorrhagic fever with renal syndrome (HFRS) from Hantaan virus (the first hantavirus isolated) showing significantly lower mortality with intravenous ribavirin treatment. Ribavirin-treated patients had ..