Cruise ship hantavirus outbreak grows to eight cases, three dead

A rare hantavirus exposure on the Dutch-flagged MV Hondius turned into a multinational containment effort after health authorities said the cluster had grown to eight cases, including three deaths. The ship’s 147 passengers and crew came from 23 countries, and officials have been moving evacuees home for quarantine, isolation and specialized monitoring.

The World Health Organization said illness began between April 6 and April 28, with symptoms ranging from fever and gastrointestinal illness to rapid progression to pneumonia, acute respiratory distress syndrome and shock. As of May 4, the organization had reported seven cases, two laboratory confirmed and five suspected, with three deaths. By May 8, the Centers for Disease Control and Prevention said the total had risen to eight cases, six confirmed and two suspected. The agency said the risk to the U.S. public was extremely low.

The outbreak strain was identified as Andes virus, a hantavirus type spread by rodents and the only variant known to have shown limited person-to-person transmission in previous outbreaks. That detail has sharpened concern around the shipboard setting, where close contact among passengers and crew can complicate any response. WHO’s Maria Van Kerkhove described it as the first known cruise-ship outbreak of hantavirus.

The American response has centered on Nebraska, where the CDC said it was working with federal, state and international partners to monitor evacuees. One U.S. passenger flown there tested positive but had no symptoms, while another had mild symptoms. A French woman repatriated to Paris also tested positive, and France’s health minister, Stephanie Rist, said her condition worsened overnight.

The ship’s itinerary helped make the operation unusually complex. The Hondius departed Ushuaia, Argentina, on April 1 and sailed a route that included Antarctica, South Georgia, Tristan da Cunha, Saint Helena and Ascension Island. It was later moored off Cabo Verde before passengers were flown out from Tenerife, Spain, where they were escorted off under protective gear. Health officials said evacuations have been coordinated across more than 20 countries, a scale that shows how quickly a shipboard outbreak can become an international public-health exercise.