A hantavirus outbreak linked to the cruise ship MV Hondius is reported to have grown to 11 total cases, including nine confirmed, with authorities in France stepping up monitoring and contact controls. The main reported patient is a French woman who is repatriated and critically ill in intensive care in Paris. Doctors say she has a severe form of the disease affecting her lungs and heart and is being treated with life support involving an artificial lung and blood-oxygenation support. Authorities are also monitoring other people who may have been exposed. France’s prime minister says five passengers are quarantined in Paris “until further notice.” Additional reports cite 22 contact cases in France overall.

Health officials report three deaths connected to the outbreak, including a Dutch couple believed to be among the first exposed during a trip to South America. Meanwhile, the ship is returning to the Netherlands for cleaning after evacuation of passengers and many crew members. France’s health ministry and related agencies say there is no evidence of widespread circulation of the virus in the country, and investigations continue to identify the source and contain transmission.