Dobrava-Belgrade virus: Phylogeny, epidemiology, disease

Dobrava-Belgrade virus (DOBV) is an Old World hantavirus that causes hemorrhagic fever with renal syndrome in humans. With a case fatality rate up to 12%, DOBV infection is the most life-threatening hantavirus disease in Europe. The virus was initially identified in the Balkans, but the discovery of new endemic foci have expanded its recognized geographic range. The recent description of novel genetic variants with different degrees of pathogenicity have complicated its taxonomic analysis. The original rodent host of DOBV is Apodemus flavicollis, however additional Apodemus species, such Apodemus agrarius and Apodemus ponticus, have been found to serve as hosts of the various DOBV genotypes. The complex evolution and genetic diversity of the virus are still under investigation. The present review aims to provide an update on the phylogeny of DOBV and the epidemiology of infection in rodents and humans; to describe the clinical characteristics of the disease; to present current knowledge about laboratory diagnosis, treatment and prevention; discuss the current state of the art in antiviral drug and vaccine development.

► Dobrava-Belgrade virus (DOBV) is the principal cause of hemorrhagic fever with renal syndrome in southeastern Europe. ► The epidemiology of DOBV and phylogenetic relationships among DOBV strains are described. ► Different DOBV genotypes present different levels of pathogenicity for humans. ► Approaches used for drug development and vaccine design are summarized.