Health officials around the world are monitoring a deadly hantavirus outbreak linked to a Dutch-flagged cruise ship. So far, there are at least 11 confirmed or suspected cases connected to the ship, including three deaths.
Hantaviruses are a family of rare viruses usually passed to humans through contact with contaminated rodent waste or saliva. They often present with symptoms of pulmonary and respiratory distress that can be severe, according to the U.S. Centers for Disease Control and Prevention. The strain identified in the outbreak on the M/V Hondius cruise ship is called the Andes virus, which is the only known hantavirus strain to spread person to person. Transmission occurs through prolonged close contact, health officials say.
Investigations, contact tracing efforts and isolation protocols were underway in a number of countries to which citizens returned after leaving the cruise on a stop at the end of April, as well as for people who were on a flight with a confirmed case, the World Health Organization said.
The other cruise ship passengers disembarked from the ship after it docked in Spain’s Canary Islands. They were carefully evacuated by nationality and placed on repatriation flights.
As of Tuesday, May 12, new cases were still emerging.
Here’s what to know about the ones confirmed or suspected so far.
Dutch couple believed to be first cases
Oceanwide Expeditions said a 70-year-old Dutch man died aboard the ship on April 11. He developed symptoms less than a week earlier, on April 6, WHO Director-General Tedros Adhanom Ghebreyesus said May 7.
Because his symptoms were similar to those of other respiratory diseases, hantavirus was not suspected at the time of his death, and no samples were taken, Tedros said. However, he is now believed to be the first hantavirus case on the ship.
The man’s 69-year-old wife left the cruise ship on April 24 when it docked in Saint Helena, a remote British island territory in the Atlantic Ocean where a number of other passengers also disembarked. She died two days later in South Africa, after her condition “deteriorated during a flight to Johannesburg,” the WHO said. Her blood later tested positive for the Andes strain of hantavirus.
Before boarding the cruise ship on April 1, the Dutch couple had taken a bird-watching trip through Argentina, Chile and Uruguay, visiting sites where the species of rat known to carry the Andes virus was present, according to the WHO.
Contact tracing procedures were in place for others who were on the wife’s flight from Saint Helena to Johannesburg, Tedros said. He also told reporters that the WHO was working with countries of which the others who disembarked in Saint Helena are citizens.
American “tested mildly PCR positive”
Seventeen Americans and one British dual citizen who lives in the U.S. arrived on a repatriation flight early Monday, May 11.
One American “tested mildly PCR positive for the Andes virus,” and another began showing symptoms, the Department of Health and Human Services said on May 10. Both of those passengers traveled back to the U.S. “in the plane’s biocontainment units out of an abundance of caution,” HHS said.
The CDC’s Brendan Jackson, acting director of the Division of High Consequence Pathogens and Pathology, said on May 11 that the passenger who tested positive was tested on the ship before returning to the U.S., and health officials said the person was not experiencing symptoms. Jackson said the passenger with symptoms tested negative.
“With these PCR tests … there’s sort of a range in where they can fall. And so for that reason, we want to just want to make sure there’s further testing to evaluate that,” he said.
Fifteen of the passengers were taken to the University of Nebraska Medical Center’s National Quarantine Unit for continued monitoring, while one — the person with the positive test — was taken to the center’s biocontainment unit.
The individual who had symptoms, along with the person they were traveling with, were flown to Atlanta for further care and assessment, according to Jackson.
The person in the Nebraska Biocontainment Unit was “doing well” and did not have any symptoms, Angela Hewlett, an infectious disease physician and the medical director of the biocontainment unit, said on May 11. Those who went to the quarantine unit “were in good shape” and “in good spirits,” said Mike Wadman, the medical director of the quarantine unit. They were all asymptomatic as of May 12, according to HHS.
Spanish passenger tests positive
A Spanish passenger who was on the ship has tested positive for the virus, Spain’s health ministry announced on May 12. The person was in quarantine in a military hospital in Madrid — the same hospital where 13 other Spanish nationals who were on the ship were quarantined, The Associated Press reported. Those 13 have all tested negative for the hantavirus.
French woman tests positive
A 65-year-old French woman who traveled on the cruise ship has tested positive for hantavirus and remained hospitalized in intensive care on May 12, infectious disease specialist Xavier Lescure said during a French Health Ministry briefing. She had developed “the most severe form” of the cardiopulmonary illness that can be associated with the virus and was receiving oxygen through an artificial lung, according to Lescure.
France’s prime minister previously said that one citizen began showing symptoms of hantavirus during a repatriation flight. All five passengers on the flight “were immediately placed in strict isolation until further notice,” and will undergo testing, he said on social media.
British passenger hospitalized in South Africa
On April 24, an adult man from the United Kingdom presented to the cruise ship’s doctor with respiratory symptoms and other signs of pneumonia, according to the WHO.
His symptoms had worsened by April 26, so the passenger was medically evacuated a day later from the island of Ascension to South Africa, where he remained hospitalized in an intensive care unit. Tests confirmed that the man had contracted the Andes virus, South African health officials and the WHO said.
Maria Van Kerkhove, the WHO’s director of epidemic and pandemic preparedness and prevention, said May 7 that the man’s health was improving after officials previously described him as being critically ill.
German woman died aboard the ship
Another passenger, from Germany, died aboard the Hondius on May 2, officials said. According to the WHO, the woman initially developed a fever on April 28 and eventually presented with symptoms of pneumonia. Her body was still on the ship, the cruise operator said.
2 crew members treated in the Netherlands
Officials said three people were medically evacuated from the ship on May 6 and May 7, and flown to the Netherlands to receive care.
Testing confirmed two of them — the ship’s doctor and a ship guide — had contracted hantavirus. The Dutch national and British national had shown symptoms of the virus prior to their evacuation, and both later tested positive. Oceanwide Expeditions initially described their conditions as serious, but Van Kerkhove said the WHO had learned both were in stable condition as of May 7. They were each placed in isolation.
The third person, a German passenger closely associated with the German woman who died on May 2, was evacuated as a suspected case, but later tested negative for Andes virus, according to the cruise operator and the WHO.
Swiss man tested positive
A Swiss man who disembarked the cruise ship in Saint Helena tested positive for the Andes strain of hantavirus, according to Swiss health officials and the WHO. The man developed symptoms and underwent testing in Zurich, where he is receiving care, officials said May 6.
The man’s wife, who was with him on the cruise, had not shown any symptoms, but was self-isolating as a precaution, the Swiss public health agency said.
Suspected case on Tristan da Cunha
A British national on Tristan da Cunha, a remote group of islands part of the British Overseas Territory that includes Saint Helena, is another suspected case, U.K. officials said May 8. The person had disembarked from the ship, the U.K. Health Security Agency said.
The ship stopped at Tristan da Cunha between April 13 and 16, Oceanwide Expeditions said. During this time, one crew member disembarked and six passengers joined the cruise, the company said.
International monitoring efforts
The WHO is in touch with officials in at least 12 countries who are monitoring citizens that returned home after disembarking the ship in Saint Helena, Tedros said. Those countries include Canada, Denmark, Germany, the Netherlands, New Zealand, Saint Kitts and Nevis, Singapore, Sweden Switzerland, Turkey, the United Kingdom and the United States.
In the U.S., the health agencies of five states have said they are monitoring people who returned earlier from the ship: two each in Georgia and Texas, one each in Arizona and Virginia, and three in California. A fourth California resident was being monitored after taking an international flight with a cruise passenger later confirmed to have hantavirus. None of the individuals were showing symptoms, the health departments said. Additionally, the New Jersey Department of Health is monitoring two residents who were not on the ship but may have been exposed to a confirmed case during a flight.
A WHO official confirmed to CBS News on May 8 that a KLM airline flight attendant, who had come into contact with cruise passengers and was hospitalized in the Netherlands for monitoring, had tested negative for hantavirus.
The French Ministry of Health said it has identified 22 people who potentially came in contact with the Dutch woman who died in South Africa. That group includes eight French nationals who took the same flight she did from Saint Helena to Johannesburg, and 14 others who took a different flight that the Dutch woman briefly boarded before she was removed from the plane because of her symptoms.
All eight people who flew with the Dutch woman to Johannesburg have been tested and hospitalized in Paris, France’s health minister said on May 12.
