Fact-checked by Grok 2 weeks ago

Bunyaviricetes

Bunyaviricetes is a class of enveloped viruses possessing linear, negative-sense, single-stranded RNA genomes that are segmented, ranging from tripartite to polysegmented configurations, and classified within the phylum Negarnaviricota of the kingdom Orthornavirae. Established by the International Committee on Taxonomy of Viruses (ICTV) in April 2024 through the elevation of the former order Bunyavirales to class rank, this taxonomic group accommodates the rapidly expanding diversity of related viruses discovered primarily through metagenomics. Virions are generally spherical or pleomorphic, measuring 80–120 nm in diameter, and feature a lipid envelope studded with glycoprotein projections approximately 5–10 nm long. The class Bunyaviricetes currently includes two orders: Elliovirales, comprising seven families such as Peribunyaviridae, Phasmaviridae, and Tospoviridae; and Hareavirales, which encompasses eight families including Arenaviridae, Nairoviridae, and Phenuiviridae. These viruses exhibit broad host tropism, infecting vertebrates (including humans and livestock), invertebrates (such as arthropods), plants, fungi, and protists, with transmission often occurring via vectors like mosquitoes, ticks, sandflies, or rodents. Genome segments typically encode essential proteins including the RNA-dependent RNA polymerase on the large (L) segment, glycoproteins on the medium (M) segment, and the nucleocapsid protein on the small (S) segment, though some families display ambisense coding strategies or additional non-structural proteins that modulate host immune responses and replication. Members of Bunyaviricetes are of significant medical, veterinary, and agricultural importance, with many acting as emerging pathogens responsible for severe diseases. Notable human pathogens include Crimean-Congo hemorrhagic fever virus (Nairoviridae), Rift Valley fever virus (Phenuiviridae), and hantaviruses (Hantaviridae), which cause viral hemorrhagic fevers characterized by fever, bleeding, and multi-organ failure, often with high case-fatality rates and spread via arthropod bites or rodent exposure. In agriculture, tospoviruses (Tospoviridae) and other plant-infecting members lead to substantial crop losses in tomatoes, peppers, and peanuts, transmitted by thrips. The ecological complexity of these viruses, including their segmented genomes that facilitate reassortment and evolution, underscores their potential for zoonotic spillover and pandemic threats.

General Characteristics

Virion Structure

Bunyaviricetes virions are typically enveloped particles that exhibit spherical or pleomorphic , with diameters ranging from 80 to 120 nm. The consists of a acquired from host membranes during , which surrounds the internal components. This structure is conserved across most families within the , though some members, such as those in Phasmaviridae, may form tubular virions measuring up to 600 nm in length. Embedded within the are surface glycoproteins, primarily and , which form heterodimers or spikes protruding 5-18 nm from the . These glycoproteins play essential roles in host cell receptor binding and low-pH-induced membrane fusion during entry, with often mediating attachment to receptors like DC-SIGN or , while facilitates the fusion process in endosomes. In certain families like Phenuiviridae, additionally contributes to immune evasion by interacting with host factors such as to inhibit signaling and suppress type I responses. Internally, the virions contain helical nucleocapsids composed of the (N) that encapsidates the segmented genome, forming ribonucleoprotein complexes. These nucleocapsids display a characteristic helical , with the N protein adopting a two-lobed structure that clamps the RNA, promoting ordered ; dimensions and exact vary by , such as more elongated, rod-like forms in Hareavirales, where ribonucleoproteins can extend as parallel filaments up to 10 nm thick. Unlike many other negative-sense viruses, most Bunyaviricetes lack a dedicated matrix protein to bridge the envelope and nucleocapsids, relying instead on interactions between glycoprotein cytoplasmic tails and the ribonucleoproteins for virion stability and assembly; exceptions occur in Arenaviridae, where the Z protein serves a matrix-like function.

Genome Organization

The genomes of viruses classified within the Bunyaviricetes consist of a tripartite, single-stranded structure comprising three segments—large (L), medium (M), and small (S)—with a total length of 11–19 . These segments are primarily of negative-sense , though ambisense coding strategies occur in the M and/or S segments of certain genera, such as Phlebovirus (in the family Phenuiviridae). The L segment encodes the (RdRp), the core enzyme for viral genome replication and transcription. The M segment encodes glycoproteins ( and ) derived from precursor polyproteins, along with non-structural proteins like NSm. The S segment encodes the (N), which associates with the genomic to form the ribonucleoprotein complex, and in some cases, a non-structural protein (NSs). Segment lengths vary across families but follow characteristic ranges: the L segment is typically 6.5–8.5 kb, the M segment 3.5–6.5 kb, and the S segment 1–3.5 kb. In ambisense configurations, prevalent in families like Phenuiviridae, the M and S segments utilize internal transcription initiation sites to produce two non-overlapping open reading frames in opposite polarities, enabling the synthesis of both genomic-sense and antigenomic-sense proteins from a single template without requiring splicing. This strategy contrasts with the strictly negative-sense coding in the L segment and in non-ambisense S segments of other families, such as Orthobunyavirus. For instance, in (Phlebovirus genus, Phenuiviridae ), the S segment's ambisense arrangement allows simultaneous expression of N from the negative-sense strand and NSs from the positive-sense strand. Each possesses conserved, complementary sequences at the 5' and 3' termini, which base-pair to form panhandle structures that serve as promoters for replication initiation by the RdRp. These terminal motifs are genus-specific but often share partial conservation; for example, many orthobunyaviruses feature a 5'-AGCAGUU-3' sequence at the 5' end, complementary to the 3' end (3'-UCGUCA A-5'), enabling circularization and efficient synthesis. Similar panhandle formations occur across the class, with variations like 5'-ACAGAUU-3' in phleboviruses, underscoring their role in stabilizing the and directing binding. Bunyaviricetes exhibit substantial , particularly among arthropod-borne members, driven by high rates of $10^{-4} to $10^{-3} substitutions per per year. These elevated rates, observed in viruses like severe fever with thrombocytopenia syndrome virus, reflect adaptations to alternating transmission between invertebrate vectors and vertebrate hosts, contrasting with lower rates in non-arthropod-borne lineages such as hantaviruses.

Replication Cycle

Viral Entry and Replication

Bunyaviricetes viruses initiate infection through receptor-mediated attachment to host cells, primarily via surface glycoproteins such as and . For instance, some orthobunyaviruses and nairoviruses utilize DC-SIGN or L-SIGN as entry receptors, while hantaviruses bind β3 integrins or (DAF/CD55). Following attachment, the virions enter host cells via clathrin-dependent or clathrin-independent , leading to trafficking within endosomes where low pH (approximately 4.9–6.3) triggers conformational changes in the glycoproteins, resulting in fusion of the with the endosomal membrane and release of the ribonucleoprotein complex into the . Upon entry, replication occurs entirely in the , often within Golgi-derived vesicles that provide a protected environment for viral synthesis. The virion-associated (RdRp), along with (N) and other cofactors, initiates primary transcription using the negative-sense genomic segments as templates to produce viral mRNAs. These mRNAs acquire a 5' through a cap-snatching mechanism, where the viral endonuclease domain of the L protein cleaves 10–20 leader sequences from host mRNAs, enabling efficient translation by host ribosomes. After primary transcription, the replication cycle switches to full-length antigenome synthesis, where positive-sense complementary RNAs (cRNAs) are produced from the genomic RNAs and serve as templates for new negative-sense genomic RNA synthesis. In families with ambisense genome segments, such as Phenuiviridae, viral mRNAs are produced by transcription from both the genomic and antigenomic RNA templates, allowing expression of two non-overlapping open reading frames separated by an intergenic region. Many Bunyaviricetes employ a non-structural protein NSs to counteract host antiviral defenses by inducing shutoff of host gene expression, particularly inhibiting the response. NSs achieves this through degradation or sequestration of host transcription factors, such as components of TFIIH or , thereby suppressing interferon-β production and promoting . For example, in Rift Valley fever virus (Phenuiviridae), NSs promotes the degradation of TFIIH subunit p62 to disrupt general host transcription and suppress production.

Assembly and Exit

In bunyaviricetes, nucleocapsid assembly occurs in the , where the (N) encapsidates each genomic segment independently to form ribonucleoprotein complexes (RNPs) within specialized factories often located near the Golgi apparatus. These RNPs associate with the viral (RdRp) for initial packaging signals, facilitating their subsequent incorporation into nascent virions. The process involves interactions between the RNPs and the cytoplasmic tails of glycoproteins, with evidence from (RVFV) indicating non-segment-specific packaging where the M segment may play a central role. Viral glycoproteins Gn and Gc, synthesized as precursors in the (), undergo processing and heterodimerization before trafficking to the Golgi apparatus via the secretory pathway. In the Golgi, these glycoproteins form spikes on the and drive the of RNPs into Golgi-derived vesicles, allowing the virions to acquire a host-derived embedded with Gn-Gc heterodimers. This envelopment process, observed in viruses like severe fever with thrombocytopenia syndrome virus (SFTSV), may also involve the ER-Golgi intermediate compartment (ERGIC) or autophagosome-like structures in some cases, with endosomal sorting complexes required for transport () contributing to membrane scission. Mature virions are released from infected cells through of the Golgi-derived vesicles, completing the egress phase of the replication cycle. Post-budding maturation includes processing, such as by furin-like or /kexin isozyme-1/site-1 (SKI-1/SPase) in families like Nairoviridae (e.g., Crimean-Congo hemorrhagic fever ), which is essential for infectivity. In orthobunyaviruses like Bunyamwera (BUNV), maturation involves trimming in the Golgi trans-compartments. During co-infection with related strains, bunyaviricetes exhibit segment reassortment, where RNPs from different parental viruses are packaged into progeny virions, promoting . Experimental models of orthobunyavirus co-infections, such as Batai and Bunyamwera viruses in mammalian cells, demonstrate reassortment frequencies up to approximately 7-10%, with diploid (mixed-segment) viruses also detected at rates around 25%. This mechanism contributes to rapid evolution and emergence of novel variants in natural settings.

Taxonomy and Evolution

Classification Hierarchy

Bunyaviricetes is a of viruses within the phylum Negarnaviricota and the realm Riboviria, encompassing negative-sense single-stranded RNA viruses characterized primarily by segmented genomes, typically tripartite. In 2024, the Committee on Taxonomy of Viruses (ICTV) promoted the former order Bunyavirales to the rank of Bunyaviricetes to better accommodate the rapid expansion of related polyploviricotine viruses, reflecting their phylogenetic diversity and increasing discoveries across diverse hosts. The class currently comprises two orders: Elliovirales and Hareavirales. As of 2025, Bunyaviricetes includes 15 families distributed across these orders, with ongoing additions driven by metagenomic surveys. For instance, the order Elliovirales features prominent families such as and , while Hareavirales encompasses and .
OrderExample FamiliesKey Characteristics and Examples
EllioviralesPeribunyaviridae, Hantaviridae, Tospoviridae, Fimoviridae, Cruliviridae, PhasmaviridaeArthropod- and rodent-borne viruses with tri-segmented genomes; plant-infecting viruses transmitted by insects; e.g., genus Orthobunyavirus (La Crosse virus), genus Hantavirus (Sin Nombre virus), genera in Tospoviridae affecting crops.
HareaviralesPhenuiviridae, Nairoviridae, MypoviridaeDiverse hosts including vertebrates and invertebrates; e.g., genus Phlebovirus (Rift Valley fever virus), recent additions like Mypoviridae with three-segment genomes.
ICTV classification criteria for Bunyaviricetes emphasize (RdRp) phylogeny, genome segmentation patterns (often large, medium, and small segments), and host range specificity, enabling delineation of genera and families. Recent expansions, such as the inclusion of mypovirids, highlight viruses with conserved three-segment architectures infecting protozoans and arthropods, underscoring the class's broadening scope beyond traditional animal pathogens.

Phylogenetic Insights

Phylogenetic analyses based on the RNA-directed (RdRp) consistently demonstrate the of the Bunyaviricetes within the phylum Negarnaviricota, with member viruses forming a distinct supported by high bootstrap values across multiple sequence alignments. This monophyletic grouping is evident in trees constructed from conserved RdRp domains, separating Bunyaviricetes from other classes like Monjiviricetes and Yunchangviricetes. Arthropod-hosted clades, such as those in Phasmaviridae and insect-specific lineages, occupy basal positions in these phylogenies, supporting an ancestral origin for the class and subsequent diversification into and hosts. The divergence of Bunyaviricetes from other negarnaviruses aligns with the deep evolutionary history of segmented negative-sense viruses and co-divergence patterns observed in arthropod and early vertebrate hosts, estimated in the millions of years. Reassortment of genomic segments has been a key driver of evolutionary diversification within Bunyaviricetes, facilitating adaptations to new hosts and ecological niches. For instance, in the family Phenuiviridae, the emergence of ambisense coding strategies on the small (S) and medium (M) segments is linked to reassortment events during host jumps from arthropods to vertebrates or plants, enhancing viral fitness by optimizing gene expression in diverse cellular environments. Similarly, the evolution of nonstructural (NS) proteins, particularly NSs encoded on the S segment, has been shaped by selective pressures for immune modulation; these proteins antagonize host interferon responses and innate immunity pathways, with sequence variations reflecting adaptations to specific host immune systems across families like Peribunyaviridae and Phenuiviridae. Recent metagenomic discoveries have expanded the known diversity of Bunyaviricetes, incorporating novel tick-borne viruses that reveal previously unrecognized genomic features. The 2024 characterization of Volzhskoe tick virus, an unclassified member detected in Hyalomma marginatum ticks in , highlights phylogenetic placement within the class and demonstrates segment-specific innovations, including potential gene duplications that may contribute to expanded coding capacity in vectors. Such inclusions underscore ongoing taxonomic revisions and the role of environmental sampling in uncovering basal lineages. Genetic distance metrics further delineate evolutionary relationships, with interspecies demarcation typically based on less than 70% identity across conserved regions like the L segment RdRp , allowing differentiation of distinct viral while accommodating intraspecies variability. Codon usage biases also provide insights into , with A/U-rich preferences predominant in arthropod-transmitted clades—such as those in Tospoviridae and Phenuiviridae—reflecting mutational pressures and translational optimization in vectors during host shifts.

Hosts and Transmission

Natural Reservoirs

Bunyaviricetes viruses maintain persistent infections in a diverse array of natural reservoirs, primarily , mammals, , fungi, and protists, depending on the viral order and family. In the order Elliovirales, many viruses are arthropod-borne, with mosquitoes, ticks, sandflies, and culicoid midges serving as key vectors and reservoirs where infections are lifelong and often . For instance, in the order Hareavirales, phleboviruses like virus are maintained in wild ungulates and livestock in , while nairoviruses such as Crimean-Congo hemorrhagic fever virus persist in ticks across temperate and tropical regions. These arthropod reservoirs facilitate , passing the virus transovarially to offspring, which ensures long-term maintenance without requiring frequent vertebrate amplification. In contrast, the order Hareavirales primarily relies on and reservoirs, where cause chronic, non-pathogenic infections without involvement. Over 40 species of (e.g., deer mice for Sin Nombre virus, striped field mice for Hantaan virus), along with , moles, and occasionally bats, act as maintenance hosts, excreting in , , and . These infections are persistent and lifelong, with no overt in the hosts, allowing hantaviruses to circulate endemically in populations. Geographic distribution aligns with reservoir ecology: hantaviruses predominate in temperate zones of , , and , where abundance fluctuates with environmental factors like post-flooding population booms triggered by heavy rainfall and vegetation growth. Plant hosts serve as reservoirs for tospoviruses within Elliovirales, particularly in agricultural ecosystems where weeds and crop volunteers harbor viruses like Tomato spotted wilt virus. These plants act as persistent sources of inoculum, infected via vectors, with over 1,000 species susceptible, including ornamentals and broadleaf weeds that bridge seasons in fields. Fungi and protists serve as reservoirs for certain families in Elliovirales, such as Goukoviridae and Jonviridae, often discovered through , with transmission likely direct or via environmental routes. Non-human mammals, such as bats, have been identified as potential reservoirs for emerging bunyaviruses like Malsoor virus, expanding the zoonotic risk in tropical and subtropical regions. influences reservoir dynamics broadly; for example, flooding events boost densities for hantaviruses, while warmer, wetter conditions enhance populations for vector-borne bunyaviruses in tropical areas.

Transmission Mechanisms

Bunyaviricetes viruses employ diverse transmission mechanisms, predominantly involving vectors for biological transmission, where the virus replicates within the vector before being passed to vertebrate or plant hosts. In families such as Peribunyaviridae (Elliovirales) and Phenuiviridae (Hareavirales) (including phleboviruses like Rift Valley fever virus), mosquitoes serve as primary s, with the virus undergoing replication in the mosquito and salivary glands to facilitate efficient transmission during blood-feeding. For instance, Rift Valley fever phlebovirus replicates in species like and mosquitoes, enabling to progeny and horizontal spread to mammals. Similarly, nairoviruses in the family Nairoviridae (Hareavirales) are transmitted biologically by hard ticks (), which support transstadial and transovarial passage of the virus, as seen with Crimean-Congo hemorrhagic fever virus in ticks. Tospoviruses (Elliovirales), affecting plants, rely on for transmission, where the virus replicates in the insect's body after acquisition by larvae. Non-arthropod-borne members, notably hantaviruses in the family Hantaviridae (Hareavirales), spread through aerosolized particles from excreta, , or , allowing by humans in contaminated environments without requiring direct contact or vectors. Direct contact with infected animal tissues or fluids also facilitates zoonotic spillover for some viruses, such as virus during slaughtering or birthing assistance, and Crimean-Congo hemorrhagic fever virus through skin exposure to tick-infested animals or viremic blood. Foodborne transmission occurs rarely, exemplified by Crimean-Congo hemorrhagic fever virus cases linked to consumption of unpasteurized from infected livestock. Human-to-human transmission can occur for some Bunyaviricetes viruses, such as Crimean-Congo hemorrhagic fever virus via direct contact with infected blood or fluids, including nosocomial settings, but is not documented via respiratory routes or for viruses like virus or hantaviruses. Environmental factors significantly influence transmission dynamics, particularly vector competence and activity. Temperature modulates arthropod vector efficiency; for Culicoides midges, which transmit certain orthobunyaviruses, competence peaks at 25–30°C, enhancing viral dissemination rates. Seasonal epidemics often align with peak vector activity, such as increased mosquito populations during warm, wet periods that amplify outbreaks of mosquito-borne bunyaviruses in endemic regions. These cycles are initiated from natural reservoirs like rodents, underscoring the interplay between host maintenance and vector-mediated spread.

Pathogenicity

Diseases in Humans

Bunyaviricetes viruses cause a range of severe diseases in humans, primarily through zoonotic from reservoirs via vectors such as ticks, mosquitoes, or direct contact with infected . These pathogens lead to syndromes including hemorrhagic fevers, , and hantavirus-specific renal and pulmonary complications, with clinical manifestations varying by virus family and geographic region. Hemorrhagic fevers represent a major human associated with certain Bunyaviricetes, notably Crimean-Congo hemorrhagic fever (CCHFV) from the Nairoviridae. CCHFV typically begins with fever, , and , progressing in severe cases to vascular leakage, multi-organ failure, and hemorrhagic manifestations such as petechiae and ecchymoses due to endothelial damage and increased . The case-fatality rate for CCHFV ranges from 10% to 40%, influenced by viral , patient age, and healthcare access, with higher mortality in regions like and where outbreaks are endemic. Rift Valley fever virus (RVFV), from the family Phenuiviridae, also induces hemorrhagic fever but with a broader spectrum of ocular complications in survivors. Human RVFV disease often presents as an acute febrile illness, but up to 10% of cases develop , characterized by macular and paramacular retinal lesions leading to vision impairment or permanent blindness in approximately 50% of affected individuals. While overall mortality is lower at 1-2%, severe forms include and hemorrhagic , particularly during epizootics in livestock-amplifying regions. Encephalitis is a prominent neuroinvasive outcome of Peribunyaviridae infections, exemplified by La Crosse virus (LACV), which predominantly affects children under 16 years through bites in . Initial symptoms include high fever, severe , , and , often escalating to neuroinvasion with seizures, , and in up to 10% of cases, resulting in long-term neurological sequelae like cognitive deficits in survivors. LACV has a low mortality rate of less than 1%, but pediatric cases require intensive monitoring for complications such as elevated . Hantaviruses within Bunyaviricetes cause distinct syndromes differentiated by geography: hemorrhagic fever with renal syndrome (HFRS) in the and (HPS) in the . viruses like Hantaan virus induce HFRS, featuring fever, , and with and due to renal vascular leakage, with mortality up to 15% in severe cases primarily in . In contrast, viruses such as Sin Nombre virus trigger HPS, progressing rapidly from prodromal fever to (ARDS) with non-cardiogenic and myocardial dysfunction, carrying a fatality rate of 30-40%. The global burden of Bunyaviricetes-associated diseases imposes a significant challenge, with an estimated 100,000 to 200,000 annual human cases worldwide, predominantly in and where socioeconomic factors exacerbate vulnerability. Outbreaks are increasingly linked to variability, such as heavy rainfall promoting proliferation; for instance, a 2023 RVFV epizootic in highlighted how anomalous weather patterns can amplify transmission and human incidence. A outbreak in , starting in late September 2025, further illustrates these risks in .

Diseases in Animals and Plants

Bunyaviricetes viruses cause significant diseases in various animal species, particularly ruminants and . Rift Valley fever virus (RVFV), a member of the genus Phlebovirus in the Phenuiviridae, induces severe epizootics in such as sheep, , and , characterized by high neonatal mortality rates—often exceeding 90% in and kids—and widespread abortions in pregnant females, leading to "abortion storms" during outbreaks. In affected herds, adult animals may experience fever, , and hemorrhagic manifestations, though mortality is lower than in newborns. Hantaviruses, within the family Hantaviridae, primarily infect as hosts, where infections are typically mild or subclinical, with persistent but minimal clinical signs. For instance, Sin Nombre virus in deer mice (Peromyscus maniculatus) results in chronic carriage without apparent disease, allowing the to serve as efficient transmitters. Other bunyaviricete members, such as those in the Nairoviridae family, can cause febrile illnesses or vascular damage in wild and domestic animals, though less frequently documented than RVFV. In plants, viruses from the family Tospoviridae, such as (TSWV), inflict substantial damage on crops including tomatoes, peppers, , and , manifesting as , , , and ring spots on leaves and fruits. Transmission occurs persistently by vectors like Frankliniella occidentalis, enabling efficient spread within fields and greenhouses, often resulting in yield reductions of 50-100% in heavily infected stands. These symptoms disrupt and fruit development, severely compromising vigor. Epizootics caused by Bunyaviricetes viruses impose major economic burdens on and veterinary sectors, with global annual losses from TSWV alone estimated at over $1 billion due to crop failures and control measures. The 2018 Rift Valley fever outbreak in , including areas near , led to losses exceeding $1.9 million in affected pastoralist communities, compounded by restrictions on products and increased surveillance costs. Such events highlight the viruses' role in disrupting and rural economies in endemic regions.

Prevention and Control

Therapeutic Approaches

Supportive care remains the cornerstone of managing infections caused by Bunyaviricetes viruses, particularly for severe cases involving hemorrhagic manifestations or respiratory distress. For hemorrhagic fevers such as Crimean-Congo hemorrhagic fever (CCHF) and (RVF), intravenous fluids administered at maintenance rates help maintain hemodynamic stability and prevent . In (HPS), early , along with inotropic and pressor support, is essential to address acute and . These interventions, often requiring admission, have improved survival rates by mitigating organ failure, though they do not target directly. Among antiviral agents, is the most established option for treating certain Bunyaviricetes infections, particularly those causing hemorrhagic fevers. The recommends its use for CCHF, where observational studies indicate it reduces mortality by approximately 44% when administered early in the course of illness. For RVF, ribavirin has demonstrated efficacy in animal models by suppressing and lowering mortality rates, with similar benefits observed in preclinical rhesus monkey studies. However, its effectiveness is time-sensitive, with optimal outcomes when initiated within the first few days of symptoms, and clinical data remain limited by the lack of large randomized trials. In 2024, the BUNYANTIVIR project was funded to develop novel antivirals against bunyaviruses. Additionally, as of 2025, research into broad-spectrum antivirals targeting viral glycans shows potential for Bunyaviricetes infections. Emerging antiviral candidates include , a carboxamide derivative that inhibits the viral (RdRp). Preclinical studies in mouse models of CCHF have shown to be more potent than in reducing and preventing lethal outcomes. For other bunyaviruses like virus (SFTSV), has exhibited therapeutic promise in human case series from , outperforming in viral clearance. A phase IIb (NCT06860334) is planned to evaluate its efficacy in CCHF, often in combination with standard care, highlighting its potential as an RdRp-targeted broad inhibitor for bunyaviral infections. Monoclonal antibodies targeting viral glycoproteins represent another investigational approach, with several candidates showing neutralizing activity against hantaviruses. For instance, antibodies directed at the Gc glycoprotein of Hantaan virus have demonstrated protective effects in Syrian hamster models of HPS by blocking viral entry and reducing disease severity. Human-derived monoclonal antibodies, such as those isolated from Andes virus survivors, have provided broad neutralization across Old and New World hantaviruses in preclinical settings, offering post-exposure therapeutic potential. Nonetheless, their clinical efficacy is constrained by the high reassortment potential of bunyaviruses, which can generate antigenic variants that evade binding. Key challenges in developing therapeutics for Bunyaviricetes include the absence of broad-spectrum drugs effective against the diverse family, necessitating virus-specific strategies. Additionally, drug resistance has emerged in laboratory models, such as RdRp mutations in RVF virus that confer resistance to favipiravir while imposing a fitness cost on viral replication. These factors underscore the need for combination therapies and accelerated clinical evaluation to address the family's genetic variability and rapid evolution.

Preventive Measures

Preventive measures against Bunyaviricetes infections primarily target , where available, systems, and protocols to mitigate transmission risks from arthropods, , or direct contact in endemic regions. represents a key strategy for livestock in endemic areas, particularly for virus (RVFV), a phlebovirus in the family Phenuiviridae, order Hareavirales. The live-attenuated Smithburn strain , developed in the 1940s, is widely used in to immunize non-pregnant ruminants such as sheep, , and , providing robust protection against clinical disease and reducing outbreak severity when administered during inter-epidemic periods. As of 2025, a Phase II trial of the RVF is underway in , marking progress toward a for RVFV. For hantaviruses (family Hantaviridae), inactivated like Hantavax, targeting Hantaan and viruses, are licensed in and for high-risk populations, involving a two-dose regimen that induces rates exceeding 90% and offers partial protection against hemorrhagic fever with renal syndrome, with reported efficacy up to 86% in reducing severe disease. In 2024, a Phase I trial of DNA targeting Hantaan and Puumala viruses demonstrated safety and immunogenicity. Vector control measures are essential for arthropod-borne bunyaviricetes, including mosquito- and sandfly-transmitted viruses like RVFV and Toscana virus. spraying of breeding sites, use of bed nets, and personal repellents effectively reduce populations and human-vector contact in outbreak-prone areas such as rural . For rodent-borne hantaviruses, preventive actions focus on habitat modification, including sealing entry points in homes and buildings (-proofing), , and proper to minimize infestations and aerosolized excreta exposure. Surveillance plays a critical role in early detection and response, employing serological monitoring of natural reservoirs like and to track seroprevalence and predict outbreaks. approaches integrate data from human, animal, and environmental sectors, facilitating coordinated interventions such as enhanced testing during heavy rainfall events that boost activity. Biosafety protocols are vital for laboratory and occupational handling of Bunyaviricetes, with most agents requiring Biosafety Level 3 (BSL-3) containment due to risks, while high-pathogenicity members like Crimean-Congo hemorrhagic fever necessitate BSL-4 facilities. International travel advisories from organizations like the WHO recommend avoiding contact with sick animals and using protective equipment in endemic African regions during outbreaks, alongside monitoring for symptoms post-travel.

References

  1. [1]
    Promotion of order Bunyavirales to class Bunyaviricetes to ...
    Sep 20, 2024 · In 2017, the International Committee on Taxonomy of Viruses (ICTV) promoted the family to order Bunyavirales and subsequently greatly expanded its composition.
  2. [2]
    Bunyaviridae | ICTV
    Virions generally are spherical or pleomorphic, 80–120 nm in diameter, and display surface glycoprotein projections of 5–10 nm which are embedded in a lipid ...Genus Orthobunyavirus · Genus Phlebovirus · Genus Tospovirus
  3. [3]
    A Look into Bunyavirales Genomes: Functions of Non-Structural (NS ...
    Taxonomical classification of the 13 Bunyavirales families according to the most recent International Committee on Taxonomy of Viruses (ICTV) taxonomy update.
  4. [4]
    About Viral Hemorrhagic Fevers - CDC
    Apr 15, 2024 · Viruses in the Bunyavirales order are spread by rodents or insects, such as mosquitos, ticks, or sand flies. They can produce mild to severe ...
  5. [5]
    ICTV Virus Taxonomy Profile: Peribunyaviridae 2024 - PMC - NIH
    Peribunyavirids produce virions that are spherical or pleomorphic, 80–120 nm in diameter [1], with glycoprotein surface projections (5–18 nm) embedded in a ...
  6. [6]
    ICTV Virus Taxonomy Profile: Phasmaviridae 2024 - PMC - NIH
    Phasmavirids produce virions that are spherical or pleomorphic (60–120 nm in diameter) or tubular (60×600 nm), with lipid envelopes (Table 1 and Fig. 1).
  7. [7]
    Bunyamwera orthobunyavirus glycoprotein precursor is processed ...
    Jul 20, 2016 · Gn and Gc form viral spikes that play a crucial role in virus entry (1, 2). Both Gn and Gc are type I integral transmembrane proteins and form a ...Missing: Bunyaviricetes | Show results with:Bunyaviricetes
  8. [8]
    Current insights into human pathogenic phenuiviruses and the host ...
    Jul 29, 2024 · This review aims to provide a comprehensive overview of the current understanding of the mechanisms of host recognition, viral immune evasion, and potential ...
  9. [9]
    Nucleocapsid protein structures from orthobunyaviruses reveal ...
    All orthobunyaviruses possess three genome segments of single-stranded negative sense RNA that are encapsidated with the virus-encoded nucleocapsid (N) protein ...Missing: Bunyaviricetes | Show results with:Bunyaviricetes
  10. [10]
    High resolution cryo-EM structure of the helical RNA-bound Hantaan ...
    Jan 14, 2019 · Hantaan virus nucleocapsid cryo-EM structure determined at 3.3 Å resolution reveals how nucleoproteins assemble into a metastable helix ...
  11. [11]
    Diverse Morphology and Structural Features of Old and New World ...
    Sep 16, 2019 · Herein our goal was to examine virion structure of New World hantaviruses as compared to HTNV. To enable this comparison and to explore the ...2.1. Cells, Virus... · 2.2. Cryo-Electron... · 3. Results
  12. [12]
  13. [13]
    Cytoplasmic tails of bunyavirus Gn glycoproteins—Could they act as ...
    Mar 15, 2013 · This review brings together what is known on the role of various bunyavirus Gn-CTs in budding and assembly, and hypothesizes on their yet unrevealed functions ...Minireview · Budding Of Nrvs · Bunyavirus Gn-Ct As A...Missing: Bunyaviricetes | Show results with:Bunyaviricetes
  14. [14]
    Segment-specific terminal sequences of Bunyamwera bunyavirus ...
    Both 3′ and 5′ terminal regions of all three segments are identical for the first 11 nt. However after these 11 nt, the nontranslated sequences of each BUNV ...
  15. [15]
    Molecular evolution of fever, thrombocytopenia and leukocytopenia ...
    The evolutionary rates of FTLSV were estimated to be 2.28 × 10− 4, 2.42 × 10− 4 and 1.19 × 10− 4 nucleotide substitutions/site/year for the S, M and L segments, ...
  16. [16]
    Evolutionary and molecular analysis of the emergent severe fever ...
    The estimated rates were 2.57 (1.46–3.74) × 10−4 substitutions/site/year for RdRp, 2.99 (1.87–4.07) for GP, 3.67 (1.83–5.73) for N and 3.09 (1.52–4.87) for NS.Missing: per
  17. [17]
  18. [18]
  19. [19]
  20. [20]
  21. [21]
  22. [22]
  23. [23]
    Annual (2024) taxonomic update of RNA-directed RNA polymerase ...
    Jun 13, 2025 · This is the 2024 annual taxonomic update for RNA-directed RNA polymerase-encoding negative-sense RNA viruses, belonging to realm Riboviria, ...Missing: hierarchy | Show results with:hierarchy
  24. [24]
    Family: Peribunyaviridae - ICTV
    Peribunyaviruses are enveloped viruses with three negative-sense RNA segments, often transmitted by arthropods, and include eight genera.
  25. [25]
    Family: Phenuiviridae | ICTV
    Realm Riboviria, kingdom Orthornavirae, phylum Negarnaviricota, class Bunyaviricetes, order Hareavirales: 23 genera and 159 species. Genus Bandavirus ...<|control11|><|separator|>
  26. [26]
    Promotion of order Bunyavirales to class Bunyaviricetes to ... - NIH
    In 2017, the International Committee on Taxonomy of Viruses (ICTV) promoted the family to order Bunyavirales and subsequently greatly expanded its composition ...
  27. [27]
    Evolutionary and phenotypic analysis of live virus isolates suggests ...
    Jun 2, 2015 · In this study, we provide a comprehensive characterization of two novel lineages of insect-specific bunyaviruses that are in basal phylogenetic ...
  28. [28]
    The diversity, evolution and origins of vertebrate RNA viruses - PMC
    Aug 13, 2018 · Overall, the evolutionary history of vertebrate RNA viruses seems to reflect a complex interplay between long-term virus–host co-divergence and ...Missing: Negarnaviricetes Bunyaviricetes
  29. [29]
  30. [30]
    NSs: the multifaceted bunyavirus virulence factor - PMC
    Sep 3, 2025 · As of 2025, Bunyaviricetes includes two orders, more than a dozen viral families, and more than 600 species. Most available information on ...
  31. [31]
    Genomic characterization of Volzhskoe tick virus (Bunyaviricetes ...
    Aug 15, 2024 · Co- and post-translational processes transform this polyprotein into functional glycoproteins, Gn and Gc, which play a crucial role in ...
  32. [32]
    Bunyavirus Taxonomy: Limitations and Misconceptions Associated ...
    Bunyavirus taxonomy: limitations and misconceptions associated with the current ICTV criteria used for species demarcation.Table 1 · Table 3 · Table 5Missing: Bunyaviricetes | Show results with:Bunyaviricetes
  33. [33]
    Selective Factors Associated with the Evolution of Codon Usage in ...
    Jul 25, 2016 · Our results suggest that codon usage patterns among different arbovirus are consistent with the codon usage of their respective natural hosts, ...Viral Dataset · Results · Codon Usage Could Reflect...
  34. [34]
    Bunyaviridae - ScienceDirect.com
    Bunyaviruses cause transient infection in their vertebrate hosts, whether mammal or bird, and life-long persistent infection in their arthropod vectors, ...Chapter 22 - Bunyaviridae · Properties Of Bunyaviruses · Rift Valley Fever VirusMissing: Bunyavirales | Show results with:Bunyavirales
  35. [35]
    The Ecological Significance and Implications of Transovarial ...
    Nov 27, 2018 · Transovarial transmission (TOT) is a widespread and efficient process through which pathogens can be passed between generations of arthropod vectors.
  36. [36]
    Hantavirus Reservoirs: Current Status with an Emphasis on Data ...
    The known reservoirs are more than 80, belonging to 51 species of rodents, 7 bats (order Chiroptera) and 20 shrews and moles (order Soricomorpha).
  37. [37]
    Long-Term Studies of Hantavirus Reservoir Populations in ... - CDC
    A series of intensive, longitudinal, mark-recapture studies of hantavirus infection dynamics in reservoir populations in the southwestern United States ...
  38. [38]
    Rodent-borne infectious disease outbreaks after flooding disasters
    Results: Heavy rainfall encourages excessive wild grass seed production that supports increased outdoor rodent population densities; and flooding forces ...
  39. [39]
    The Genus Tospovirus: Emerging Bunyaviruses that Threaten Food ...
    The genus Tospovirus is unique within the family Bunyaviridae in that it is made up of viruses that infect plants. Initially documented over 100 years ago, ...Missing: Tospoviridae | Show results with:Tospoviridae
  40. [40]
    Tomato spotted wilt orthotospovirus (tomato spotted wilt)
    TSWV has an extremely wide host range with more than 1300 plants including agricultural crops, wild and weed species ( Parrella et al., 2003 ). This include ...
  41. [41]
    [PDF] A century-old museum sample reveals a bandavirus with modern ...
    Feb 28, 2025 · However, two additional viruses within the SFTSV-like clade have been identified exclusively in bats: Malsoor virus, isolated from two fruit ...
  42. [42]
    Bunyaviruses - Medical Microbiology - NCBI Bookshelf - NIH
    The nucleocapsid is surrounded by a lipid-containing envelope. Surface spikes are composed of two glycoproteins that confer properties of neutralization of ...Missing: morphology | Show results with:morphology
  43. [43]
    Crimean Congo Hemorrhagic Fever Virus for Clinicians—Virology ...
    Apr 15, 2024 · Human CCHFV infection mainly occurs through the bite of an infected tick or exposure to blood or tissue from infected animals; human-to-human ...
  44. [44]
    [PDF] July 2024 - CDC
    Jun 20, 2024 · throughout Africa and a case fatality rate of 10%–40%. CCHF ... epidemiology of Crimean-Congo hemorrhagic fever in humans in Uganda ...Missing: leakage | Show results with:leakage
  45. [45]
    Rift Valley Fever Virus Infects the Posterior Segment of the Eye and ...
    Oct 4, 2022 · Rift Valley fever virus (RVFV) infection leads to eye damage in humans in up to 10% of reported cases. Permanent blindness occurs in 50% of ...
  46. [46]
    Ophthalmological features of Rift Valley Fever Virus - EyeWiki
    Jun 14, 2025 · The prognosis of RVF is variable. Severe ocular morbidity may occur. Spontaneous resolution of active ocular lesions (retinitis, retinal ...Disease Entity · Diagnosis · Differential Diagnoses · Management
  47. [47]
    [PDF] WHO consultation on RVF therapeutics and vaccine evaluation
    Spectrum of Rift Valley fever disease in humans. Fever. Headache. Myalgia ... up to a 3% mortality rate (estimated from Egyptian outbreak). 3-6 day ...
  48. [48]
    Clinical Signs and Symptoms of La Crosse Virus Disease - CDC
    May 14, 2024 · Initial symptoms include fever, headache, nausea, vomiting, fatigue, and lethargy. The disease can progress to encephalitis, meningoencephalitis, or aseptic ...
  49. [49]
    Treatment and Prevention of La Crosse Virus Disease - CDC
    May 14, 2024 · Patients with encephalitis require close monitoring for the development of elevated intracranial pressure, seizures, and inability to protect ...Missing: pediatric | Show results with:pediatric
  50. [50]
    La Crosse Encephalitis Statistics - MN Dept. of Health
    Sep 2, 2025 · Similar to other arboviruses, most La Crosse encephalitis cases occur later in the summer (July through September) when infected mosquito ...
  51. [51]
    Hemorrhagic Fever with Renal Syndrome: Pathogenesis and ...
    Hantaan virus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS), which is a zoonosis endemic in eastern Asia, especially in China.
  52. [52]
    Clinician Brief: Hemorrhagic Fever with Renal Syndrome | Hantavirus
    May 20, 2024 · HFRS is a severe and sometimes deadly disease that affects the kidneys. Symptoms of HFRS usually develop within 1 to 2 weeks after someone is exposed to ...Missing: Sin ARDS 30-40%
  53. [53]
    Hantavirus Cardiopulmonary Syndrome in Canada - CDC
    Nov 12, 2020 · In North America, the case-fatality rate (CFR) of HCPS is 30%–35% (3). Transmission of SNV to humans occurs predominantly through direct contact ...
  54. [54]
    Mapping the viruses belonging to the order Bunyavirales in China
    Jul 7, 2022 · A total of 52 vector species were reported to carry Bunyavirales viruses, with ticks (16 species), mosquitoes (11) and mites (10) acting as the ...
  55. [55]
    Rift Valley Fever Outbreak Investigation Associated with a Dairy ...
    In 2023, an outbreak of RVFV was observed in humans in Mbarara District, Uganda. Epidemiological investigations identified 61 laboratory-confirmed human cases, ...
  56. [56]
    Rift Valley Fever in Animals - Generalized Conditions
    Rift Valley fever is a peracute or acute mosquito-borne zoonotic disease of domestic and wild ruminants, largely confined to sub-Saharan Africa.
  57. [57]
    Rift Valley fever: biology and epidemiology - PMC - PubMed Central
    RVF virus primarily infects domestic livestock (sheep, goats, cattle) causing high rates of neonatal mortality and abortion, with human infection resulting in ...
  58. [58]
    [PDF] Rift Valley Fever - The Center for Food Security and Public Health
    Apr 2, 2025 · Rift Valley fever (RVF) is a zoonotic, mosquito-borne viral disease that can affect ruminants, camelids and some other domestic or wild ...
  59. [59]
    About Hantavirus - CDC
    May 13, 2024 · Hantaviruses can infect and cause serious disease in people worldwide. People get hantavirus from contact with rodents like rats and mice.
  60. [60]
    Hantavirus Risk Maps | NASA Earthdata
    Jul 22, 2020 · On June 14, 1993, the CDC identified the deer mouse, found throughout North America, as the primary carrier. Other rodents have also been found ...
  61. [61]
    Rift Valley fever - WOAH - World Organisation for Animal Health
    The virus can be transmitted to humans through the handling of animal tissue during slaughtering or butchering, assisting with animal births, conducting ...Vector Transmission And... · Public Health Risk (see Who... · Prevention And Control
  62. [62]
    History and Economic Impact - USDA RAMP Project
    An estimated annual average losses of $12.3 million in peanut, $11.3 million in tobacco and $9 million in tomato and pepper for a total of $326 million ...
  63. [63]
    Viral diseases causing the greatest economic losses to the tomato ...
    Tomato spotted wilt virus (TSWV) is one of the most important diseases affecting tomatoes, occasionally leading to losses of up to 100%.
  64. [64]
    Thrips-Transmitted Tomato Spotted Wilt Virus - Amarillo
    Sep 14, 2023 · Tomato spotted wilt virus (TSWV) has become a pandemic virus with an estimated economic impact over $1 billion annually.
  65. [65]
    Socio-economic burden of Rift Valley fever outbreak in a pastoralist ...
    Jul 31, 2025 · Total direct and indirect economic burden/losses were 1,970,000 USD, cattle recorded the highest financial loss at 42.3% (832,850 USD) through ...Missing: Bunyavirales | Show results with:Bunyavirales
  66. [66]
    Rift Valley fever in West Africa: A zoonotic disease with multiple ...
    Jun 16, 2023 · The economic loss from RVF in Kenya alone is estimated at USD 32 million, showing the substantial impact of zoonotic diseases on rural ...
  67. [67]
    Hantavirus: an overview and advancements in therapeutic ...
    Oct 12, 2023 · Hantavirus infections are managed mostly by managing the symptoms, providing supporting care and admitting patients to the Intensive Care Unit ( ...
  68. [68]
    Crimean Congo Hemorrhagic Fever, Lassa Fever, and Hantaviruses
    Aug 7, 2025 · Currently, the usual bundle of treatment includes intravenous fluids at maintenance rate, intravenous ribavirin given as a single dose daily (28 ...
  69. [69]
    Hantavirus Pulmonary Syndrome | Red Book - AAP Publications
    In severe forms, early mechanical ventilation and inotropic and pressor support are necessary. Extracorporeal membrane oxygenation (ECMO) should be ...
  70. [70]
    Treatment of hantavirus pulmonary syndrome - PMC - PubMed Central
    The diagnosis, clinical course and supportive care for patients with New-World hantaviral infections have recently been reviewed (Mertz et al., 2006). The ...
  71. [71]
    Therapeutic management of Crimean-Congo haemorrhagic fever
    The WHO recommends the use of ribavirin for CCHF, although the recommendation with the most support is for Lassa fever. Ultimately, the evidence on the efficacy ...
  72. [72]
    Ribavirin for Crimean-Congo hemorrhagic fever: systematic review ...
    Ribavirin was associated with reduced mortality by 44% when compared to no ribavirin treatment in the pooled observational studies.
  73. [73]
    Recent advances in the development of antiviral therapeutics for Rift ...
    The best approach to control RVF is effective vaccination of both humans and ruminants. Since the 1960s, major vaccine development strategies have been explored ...
  74. [74]
    Prophylaxis of Rift Valley fever with antiviral drugs, immune serum ...
    Ribavirin (loading dose of 50 mg/kg followed by 10 mg/kg at 8-h intervals for 9 days) suppressed viremia in RVF-infected rhesus monkeys. Ribavirin also reduced ...
  75. [75]
    The challenging management of Rift Valley Fever in humans
    Jan 22, 2020 · Evidence suggests ribavirin efficacy in animal models [102, 103], but it failed to prevent from neuropathology in mice infected by RVFV by ...
  76. [76]
    Crimean-Congo Hemorrhagic Fever Virus: Current Advances ... - MDPI
    Work by Oestereich et al. has shown that favipiravir treatment is efficacious in inhibiting viral replication and preventing a lethal outcome following CCHFV ...
  77. [77]
    A Systematic Review of Treatment Strategies Including Future Novel ...
    The study showed that favipiravir was more effective than ribavirin in the treatment of SFTS patients in Japan. Sanijo described that favipiravir is a promising ...
  78. [78]
    Study Details | NCT06860334 | UMIT-2 - Adaptive Phase IIb Platform ...
    This will be a 1:1:1 randomised open-label phase 2b trial of Favipiravir (IV & PO) and Ribavirin (IV & PO) vs optimised standard of care in CCHF aimed at ...
  79. [79]
    Neutralizing Monoclonal Antibodies against the Gn and the Gc of the ...
    Here, we describe an effort to identify, characterize, and develop neutralizing and protective antibodies against the glycoprotein complex (Gn and Gc) of Andes ...
  80. [80]
    Broad and potently neutralizing monoclonal antibodies isolated from ...
    May 4, 2021 · These studies reveal a convergent and potently neutralizing human antibody response to NWHs and suggest therapeutic potential for human mAbs against HCPS.
  81. [81]
    Recent Advances in Bunyavirus Reverse Genetics Research
    This review aimed to summarize current knowledge on reverse genetic studies of representative bunyaviruses causing severe diseases in humans and animals.
  82. [82]
    Preparing for the next viral threat with broad-spectrum antivirals - JCI
    Jun 1, 2023 · We summarize progress and challenges in the development of broad-spectrum antivirals that target either viral elements (proteins, genome structures, and lipid ...Missing: bunyavirus | Show results with:bunyavirus
  83. [83]
    Identification of Single Amino Acid Changes in the Rift Valley Fever ...
    Our results suggest that both changes induce resistance to favipiravir likely associated to some fitness cost that could be the basis for the observed ...<|separator|>
  84. [84]
    Structural insights into RNA polymerases of negative-sense ... - Nature
    Jan 25, 2021 · Resistance to favipiravir can emerge through mutations in thumb and fingers subdomains of RdRP. The nucleoside analogue N4-hydroxycytidine (NHC) ...
  85. [85]
    Rift Valley fever - World Health Organization (WHO)
    Dec 20, 2024 · The virus can be transmitted to humans through the handling of animal tissue during slaughtering or butchering, assisting with animal births, ...
  86. [86]
    Hantavirus Prevention - CDC
    May 13, 2024 · Avoiding exposure to rodents and their urine and feces is the best way to prevent infection. When cleaning up after rodents, special steps ...Reported Cases of Hantavirus... · How to Clean Up After Rodents · Small Mammals
  87. [87]
    Rift Valley Fever vaccines: An overview of the safety and efficacy of ...
    Moreover, vaccination of non-indigenous cattle of European breed with the Smithburn vaccine resulted in abortion of 28% of pregnant cows, with at least three ...
  88. [88]
    Effectiveness of inactivated hantavirus vaccine on the disease ... - NIH
    Dec 31, 2018 · The iHV efficacy against disease progression (VEp) was 58.1% (95% confidence interval, 31.3% to 88.0%). Conclusion. The iHV efficacy against the ...
  89. [89]
    Hemorrhagic Fever with Renal Syndrome in Asia - PubMed Central
    In 1990, this vaccine, under the commercial name Hantavax, was tested in a clinical trial where safety and seroconversion of over 90% was demonstrated [179,180] ...<|control11|><|separator|>
  90. [90]
    Controlling Wild Rodent Infestations - CDC
    Apr 8, 2024 · Look for and seal up holes around the home to prevent rodent infestations. Safe cleanup of rodents and their nesting material and waste is ...How to Trap Up to Remove... · How to Seal Up to Prevent... · About Leptospirosis
  91. [91]
    One Health Surveillance Highlights Circulation of Viruses with ...
    Mar 20, 2023 · In this study, we implemented a One Health surveillance approach to screen biological samples from bats, pigs and humans for five viral families ...
  92. [92]
    A comprehensive list of the Bunyavirales replication promoters ...
    Aug 9, 2022 · Bunyavirales is a new order proposed by the International Committee on Taxonomy of Viruses (ICTV) in 2016. It consists of 12 families of ...
  93. [93]
  94. [94]
    Rift Valley Fever in Mauritania and Senegal - Travel Health Notices
    Seek medical care if you develop fever, weakness, back pain, dizziness, blurred and decreased vision, or sores on the eyes during or after travel.