At least three people have died and three others are seriously ill due to an outbreak of a hantavirus recorded on a cruise ship in the Atlantic, the World Health Organization (WHO) has reported. The infection has been confirmed in one of the deceased and is suspected in the others who have fallen ill. It is exceptional for hantaviruses to be transmitted between people, and there is no precedent for hantavirus outbreaks with multiple cases on cruises.
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1. What is known so far?
The cruise ship MV Hondius set sail from Argentina with about 150 passengers on board. Its route was planned to visit Antarctica and several Atlantic islands. A 70-year-old man died when the ship arrived at Saint Helena Island after developing fever and gastrointestinal symptoms. His 69-year-old wife was evacuated to a hospital in South Africa, where she died. A third person has died and their body was still on board on May 3, Bloomberg reports. Another person is in critical condition in an ICU in South Africa, the South African government reported today. Two crew members require urgent medical attention, Oceanwide Expeditions, the company managing the ship, has reported.
2. What virus caused the infection?
The WHO reported on Sunday night that hantavirus infection has been confirmed in one case and is suspected in five others. It is not yet known which specific species of hantavirus is involved. This is relevant because there are multiple species of hantaviruses that can infect people, but only one is known to be effectively transmitted between people. This is the Andes virus (or ANDV), which naturally lives in rodents in Argentina and Chile. The WHO has reported that genetic sequencing of the virus is underway, which will soon clarify its identity.
3. How was the first case of the outbreak infected?
Human hantavirus infections usually occur through respiratory transmission when viruses from dry rodent feces, urine, or saliva are inhaled as aerosols traveling through the air. The time between infection and the appearance of the first symptoms can be from one to eight weeks, according to the U.S. Centers for Disease Control and Prevention (CDC) website. It is unknown when and where the first affected person on the cruise was infected.
4. How were the other people infected?
If it is confirmed that several of the people who have fallen ill on the cruise contracted a hantavirus infection, the epidemiological investigation will need to clarify how they were infected. One possibility is that passengers were in a place frequented by rodents, where they became infected and then began to show symptoms one after another. It could have even happened “in some area of the ship contaminated by mouse droppings,” epidemiologist Salvador Peiró suggests in statements to SMC Spain.
An alternative possibility is that there was person-to-person transmission. In this case, the investigation will have to clarify how the transmission occurred. Was it through direct contact between the people who fell ill? Or could it have been in some cases through the ship’s ducts?
5. Are we facing a new hantavirus that is transmitted between people?
Although the available data so far do not rule it out, nothing suggests it at this time. The known data are compatible with an outbreak caused by an Andes virus, which is the hypothesis considered most plausible by Charlotte Hammer (epidemiologist at the University of Cambridge) and Michael Head (global health specialist at the University of Southampton) in statements to the Science Media Center. The analysis of the virus genome should clarify this soon.
6. How many people have fallen ill on the ship?
The WHO has reported six cases of people who have fallen ill. Bloomberg has reported that there are “additional suspected cases under investigation” but has not specified how many.
7. Where is the ship now?
The MV Hondius was this morning off the coast of Cape Verde. Local authorities have decided not to authorize its entry into the port of Praia. The cruise plan included disembarking in Cape Verde and then heading towards the Canary Islands, where it could arrive in two or three days. It has not yet been reported whether the cruise will continue the planned route.
8. What risk does this hantavirus pose to the general population?
The outbreak is limited to the passengers and crew of the ship. It is known that the ability of hantaviruses to be transmitted between people is very low. The WHO director for Europe, Hans Kluge, stated today in a communiqué that “the risk to the general population remains low. There is no need to panic or impose travel restrictions.”
This information will be updated throughout the day as more data about what happened on the ship become available
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