WHO investigates suspected hantavirus outbreak aboard MV Hondius; three passengers dead

Three passengers have died and several others have fallen ill aboard a cruise ship in a deadly hantavirus outbreak. AFP via Getty Images A cluster of three deaths among cruise ship passengers has raised concerns about a deadly hantavirus outbreak aboard a cruise ship in the Atlantic Ocean. A suspected 7 cases have been identified as investigators are working to determine whether the deaths are linked to hantavirus. The World Health Organization (WHO) maintains that the risk to the general public is low. Three people have died and several others have fallen ill aboard a Dutch cruise ship in what appears to be a deadly hantavirus outbreak.  The MV Hondius, a cruise liner operated by Oceanwide Expeditions, is currently located in the waters near Praia, Cape Verde, a small archipelago in the Atlantic Ocean off the coast of West Africa. Officials in Cape Verde have refused to allow the ship to dock over fears that the suspected outbreak might spread to shore.  A married Dutch couple and a German national who were passengers on the ship have died. A British national aboard the ship was evacuated and is being treated in South Africa. That passenger was the first to be diagnosed with hantavirus infection.  The World Health Organization (WHO) reports that seven cases of hantavirus have been identified — two confirmed “laboratory cases” and five suspected cases. At this time, two of the three deaths have been linked to hantavirus. The WHO, which is managing the outbreak, maintains that the risk to the general public is low. Hantavirus cases in humans are rare. A recent case that made headlines involved the death of Betsy Arakawa, wife of acclaimed actor Gene Hackman, who was discovered dead in their New Mexico home in April 2024. While Arakawa’s cause of death was attributed to hantavirus, Hackman died of Alzheimer’s. While hantavirus infection is uncommon, it is often fatal. The onset typically begins with nonspecific, flu-like symptoms. Infection is most often transmitted through exposure to rodents’ urine or feces. Although human-to-human transmission is possible with a specific viral strain, such cases are exceptionally rare. Steven Bradfute, PhD, an associate professor at the University of New Mexico Health Sciences Center who specializes in hantavirus research, said the situation aboard the cruise ship was unusual. “Usually you have isolated cases, so to hear about a cruise ship with multiple people being infected was definitely not something on our radar,” he told Healthline. Roughly 150 people, including passengers and crew, from more than 20 nations, still remain aboard. The ship may next be bound for the islands of Las Palmas or Tenerife, farther north on the African coast, in hopes of allowing passengers to disembark and undergo medical screening. “[We are] working closely with local and international authorities,” said Oceanwide Expeditions in a statement on May 4. “Strict precautionary measures are in process on board, including isolation measures, hygiene protocols and medical monitoring. All passengers have been informed and are being supported. Oceanwide Expeditions is in close contact with those directly involved and their families, and is providing support where possible.” Timeline of the hantavirus outbreak at sea The incubation period for hantavirus ranges from 1 to 8 weeks after exposure. This may have complicated investigations aboard the ship and public health risk assessments. The Dutch-flagged MV Hondius, operated by Oceanwide Expeditions, left Ushuaia, southern Argentina, in March, roughly three weeks ago, on a long expedition cruise. Its route included several stops in the Atlantic Ocean, including Antarctica, the Falkland Islands, and Cape Verde. A 70-year-old Dutch man died on April 11 after reportedly developing fever, headache, and abdominal pain. On April 24, his body was removed in Saint Helena, a British territory in the South Atlantic. His wife, a 69-year-old Dutch woman, also disembarked, accompanying his body for repatriation.  After disembarking, the woman began showing signs of illness during her journey home. She later died in South Africa at O. R. Tambo International Airport while attempting to return to the Netherlands.  On April 27, the same day that the Dutch woman died, a British national aboard the MV Hondius became seriously ill after the ship left St. Helena. The passenger was subsequently transferred to South Africa and treated in Johannesburg. The patient is in critical but stable condition. This case was the first laboratory-confirmed hantavirus infection linked to the incident. Onboard the ship, the situation continued to escalate. A German national died on May 2; details are sparse and the cause of death has not yet been established by Oceanwide Expeditions or the World Health Organization (WHO). Two crew members, one British and one Dutch, have also reported symptoms consistent with possible hantavirus illness. One was described as mild, and the other as severe; both reportedly require urgent medical care. No other passengers with symptoms have been identified at this time. “It’s possible someone got the infection in Argentina, got on the boat, and it spread from person to person. It’s also possible that passengers on the boat got it from the rodents that were already present on the ship,” Bradfute said. The specific hantavirus associated with human-to-human transmission, known as Andes Virus, is present in Argentina, where the MV Hondius began its voyage, Bradfute explained. Hantavirus signs and symptoms Hantavirus is part of a group of related viruses that can cause serious illness in humans. It is most commonly transmitted through exposure to the urine, droppings, or saliva of wild rodents, including mice and rats. The virus can also spread through inhalation of contaminated dust or aerosolized particles stirred into the air, particularly in enclosed or poorly ventilated spaces.  Symptoms of hantavirus infection vary by geographic region and virus type.  ‘New World’ hantavirus In North and South America, so-called “New World” hantaviruses are most common. Early symptoms typically resemble the flu — fever, body aches, and vomiting — but can progress to a severe respiratory illness known as  hantavirus pulmonary syndrome (HPS).  In early 2024, a spate of deaths linked to HPS made headlines in the United States. Three individuals died in the rural area of Mammoth Lakes, CA. “In the United States, the principal pathogen is Sin Nombre virus, the most common cause of hantavirus pulmonary syndrome (HPS),” said Robert Glatter, MD, attending physician in the Department of Emergency Medicine at Lenox Hill Hospital in New York City, and assistant professor of Emergency Medicine at Zucker School of Medicine at Hofstra/ Northwell. “Exposure is classically linked to infected deer mice and to aerosolized rodent urine, droppings, saliva, or nesting material. U.S. cases remain concentrated in the western states, especially west of the Mississippi River, although sporadic cases occur elsewhere,” Glatter told Healthline. HPS affects the lungs, causing fluid buildup that makes breathing difficult. As oxygen levels drop, other organ systems can begin to fail.  HPS is often fatal, with about 40% of infected individuals dying. Some estimates place the mortality rate as high as 50-60%. “The clinical presentation of HPS is deceptive at onset,” Glatter said. “Patients usually begin with a short febrile prodrome marked by fever, myalgias, malaise, headache, and often gastrointestinal symptoms. What makes hantavirus dangerous is the potential for abrupt progression over the next several days to cough, shortness of breath, noncardiogenic pulmonary edema, shock, and rapid respiratory failure,” he continued. Early warning signs of hantavirus may include low platelet counts, dehydration, high white blood counts, and mild elevation of liver enzymes, Glatter explained. ‘Old World’ hantavirus “Old World” hantaviruses are found primarily in Europe and Asia. Unlike their New World counterparts, these viruses can cause a different severe disease known as hemorrhagic fever with renal syndrome (HFRS). HFRS can cause internal bleeding, low blood pressure, and acute kidney failure. The mortality rate for HFRS can range from less than 1% to about 15%, depending on the specific virus strain.  “Severe ‘Old World’ viruses such as Hantaan and Dobrava can carry materially higher fatality than milder viruses such as Puumala or often Seoul virus, whereas New World HPS viruses in the Americas can have fatality in the 30–40% range, and sometimes higher in specific South American outbreaks,” Glatter said. How is hantavirus treated? There are no approved vaccines or therapeutics available to treat HPS. Instead, the disease is treated through supportive care, primarily supplying the blood with oxygen. In extreme cases, patients may need to be connected to an extracorporeal membrane oxygenation (ECMO) machine to pump and oxygenate the blood. Despite the alarming reputation of hantavirus, Bradfute emphasizes that infection is both preventable and rare. “Panicking is not a good thing to do. We haven’t had huge hantavirus outbreaks like flu or COVID because these viruses just don’t transmit well,” Bradfute said. “Most hantaviruses are not spread person-to-person,” Glatter said. “CDC cruise guidance and reporting materials support that cruise-related public health reporting focuses mainly on gastrointestinal and respiratory illness and death reporting, not hantavirus as a typical onboard transmissible risk,” he noted.  

An outbreak of the rare hantavirus unfolded over weeks on a cruise ship as it sailed across the Atlantic Ocean. At least three passengers have died and several others are sick and were evacuated from the ship. Health authorities are trying to trace passengers who left the ship previously and people who might have had contact with them. More than 140 passengers and crew members are still aboard the Dutch-flagged MV Hondius as it heads for Spain's Canary Islands. Hantavirus is a rodent-borne infection that in rare cases can be transmitted from person to person, though the World Health Organisation says the risk to the wider public is low because the virus can't easily be passed between people. Here's a timeline of the outbreak: April 1 --------- The ship sets off from Ushuaia in the far south of Argentina. Scheduled stops include Antarctica and several isolated South Atlantic Ocean islands. April 6 --------- A 70-year-old Dutch man becomes sick on board with fever, headache and

GENEVA, Switzerland (AFP) — The World Health Organization (WHO) said Thursday that more hantavirus cases could emerge after the disease killed three passengers from a cruise ship but it expected the outbreak to be limited if precautions were taken. Another sick passenger from the MV Hondius landed in Europe earlier in the day, as the vessel headed to the Spanish Canary Islands and health officials scrambled to map the outbreak of the potentially deadly human-to-human strain. The fate of the Hondius sparked international alarm after three people travelling on it died, though health officials have played down fears of a wider global outbreak from the rat-borne virus, which is less contagious than COVID-19. WHO Chief Tedros Adhanom Ghebreyesus told journalists in Geneva that five confirmed and three suspected cases had been reported overall, including the three deaths. "Given the incubation period of the Andes virus, which can be up to six weeks, it's possible that more cases may be reported," he said, referring to the rare strain detected aboard the Hondius, which can be transmitted between humans. The Leiden University Medical Centre in the Netherlands later announced another patient had tested positive. But the WHO's Emergency Alert and Response Director Abdi Rahman Mahamud insisted: "We believe this will be a limited outbreak if the public health measures are implemented and solidarity shown across all countries." People thought to have contracted the virus are being treated or isolating in Britain, Germany, the Netherlands, Switzerland and South Africa. Hantavirus is a rare respiratory disease that is usually spread from infected rodents and can cause respiratory and cardiac distress as well as haemorrhagic fevers. There are no vaccines and no known cure for it. A passenger is thought to have contracted the virus before boarding the ship in Argentina and eventually infected others on board as it sailed across the Atlantic. Three evacuees were whisked away from the ship on Wednesday when it anchored off Cape Verde and a fourth landed on Thursday in Amsterdam, said the vessel's operator, Netherlands-based Oceanwide Expeditions. "No symptomatic individuals are present on board" the ship at the moment, as it sails toward the Spanish island of Tenerife, it said in a statement. The ship is scheduled to arrive there on Sunday and those on board evacuated. The ship's Dutch operator Oceanwide Expeditions said there were 149 people on the ship, including 88 passengers. Two people who returned to the United Kingdom (UK) from the ship have been advised to self-isolate, the UK Health Security Agency said, adding they were asymptomatic and insisting the risk to the public was "very low". Officials in Argentina said they planned to test rodents in the coastal city of Ushuaia, from where the ship had set sail on April 1. A Dutch man who had boarded in Ushuaia along with his wife died aboard the ship on April 11. The man's body was taken off the ship on April 24 in Saint Helena, an island in the south Atlantic where 29 other passengers disembarked, the ship's operator said. It said it was working to trace all passengers and crew who got on or off the ship since March 20. Ghebreyesus said the WHO had informed 12 countries that its nationals disembarked from the cruise ship on Saint Helena. The deceased man's wife — who left the ship to accompany his body to South Africa — died there 15 days later after also falling ill, with hantavirus confirmed as the cause on May 4. The couple had visited Chile, Uruguay and Argentina before the cruise, Argentine officials said. Chile's health ministry said the two passengers who died were not infected in that country as they travelled there at "a period that does not correspond to the incubation time". The WHO says the incubation period for hantavirus can be up to six weeks. The Dutch woman had flown on a commercial plane from the island of Saint Helena to Johannesburg while she was showing symptoms. Officials were trying to trace people on that flight, which South African-based carrier Airlink said was carrying 82 passengers and six crew. A German passenger died on May 2. Her body remains on the ship.

The World Health Organization said that one case of hantavirus infection had been confirmed. The risk to the wider public is low.

Three people have died after becoming infected with hantavirus while onboard the MV Hondius cruise ship with officials now stating there are eight suspected cases and three confirmed infections

More than a dozen countries have been linked to the hantavirus outbreak, as the WHO confirms five cases of the disease. Alex Croft reports