Hantaviruses cause two severe human diseases: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). Approximately 200,000 cases are reported annually, and there is to date no specific treatment available. A major obstacle in studying the medical aspects of HFRS and HPS has been the lack of an adequate animal model. Here we show that infection of cynomolgus macaques by wild-type Puumala hantavirus resulted in typical signs of HFRS including lethargy, anorexia, proteinuria, and/or hematuria, in addition to cytokine (interleukin 6 [IL-6], IL-10, and tumor necrosis factor alpha), C-reactive protein, creatinine, and nitric oxide responses. Viral RNA was detected in plasma from days 3 to 7 postinoculation until days 24 to 28 postinoculation, infectious virus was recovered, and the virus-specific immune responses (immunoglobulin M [IgM], IgG, and neutralizing antibodies) mimicked those seen in humans. The results indicated that the monkey model will provide a valuable tool for studies of pathogenesis, candidate vaccines, and antivirals for hantavirus disease.Hantaviruses, members of the family Bunyaviridae, are known to cause two serious and often fatal human diseases: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). The clinical symptoms of HFRS are characterized by fever, thrombocytopenia, renal failure, and, in severe cases, hemorrhage caused by capillary leak syndrome (13, 31). Puumala hantavirus (PUUV) causes a milder form of HFRS named nephropathia epidemica (NE), which occurs in northern and central Europe. The more severe forms of HFRS are caused by Hantaan (Asia) and Dobrava (Europe) viruses, while Seoul virus (worldwide) causes an intermediate form (3,17). Hantaviruses are carried by specific rodent hosts, and virus transmission to humans occurs via inhalation of aerosolized animal excreta (5, 32). The mortality of HFRS varies between Ͻ0.1 and 12%, depending on the causative virus (31, 32). Sin Nombre virus, Andes virus, and related hantaviruses cause HPS in the Americas, mainly characterized by acute respiratory dysfunction and with a mortality rate of approximately 40% (26, 27).In the rodent reservoirs, hantaviruses cause persistent and subclinical infections (31). Although successfully used, e.g., for studies of immune responses and for evaluation of vaccine candidates and/or therapeutic reagents, rodent models are of limited value for studying the pathogenesis of human hantavirus infections. Only two earlier studies of nonhuman primates have been reported, and both described models with certain limitations (9, 40). We have previously shown phenotypic and genetic changes of PUUV when propagated in cell culture, resulting in a decrease of infectivity for its natural host, the bank vole (Clethrionomys glareolus) (22). We therefore speculated that wild-type PUUV (strain Kazan-wt) might infect nonhuman primates in a way different from previously reported studies. Here we report the first successful experimental infection of cynomolgus macaque...