WHO says possible human-to-human transmission in cruise ship hantavirus outbreak
The World Health Organization says it is investigating possible human-to-human transmission in a hantavirus outbreak aboard a cruise ship off Cabo Verde, while contact tracing is underway for nearly 90 passengers and crew who were on a flight connected to one of the infected travelers.
On Tuesday, Dr. Maria Van Kerkhove, WHO’s director for epidemic and pandemic preparedness and prevention, said the agency is working under the assumption that the outbreak involves the Andes virus, a type of hantavirus that has been linked to limited person-to-person spread in past outbreaks.
“Human-to-human transmission is uncommon, though limited spread among close contacts has been observed in some previous outbreaks with one of the viruses, the Andes virus,” Van Kerkhove said. “We are working under the assumption that it’s the Andes virus, from a precautionary point of view.”
The outbreak involves the m/v Hondius, an expedition cruise ship operated by Oceanwide Expeditions that left Ushuaia, Argentina, on April 1 with 147 passengers and crew from 23 countries. The ship is currently off the coast of Cabo Verde, an island nation off West Africa.
WHO has reported seven illnesses linked to the outbreak, including three deaths. Two cases have been confirmed and five are suspected, though one suspected patient who had a mild fever is now asymptomatic and doing well.
Van Kerkhove said investigators believe the first patient and his wife were likely infected before boarding the ship, based on the timeline of their symptoms and the incubation period for hantavirus, which can range from one to six weeks. She said passengers had been taking part in wildlife-related activities.
“Our assumption is that they were infected off the boat and then joined the cruise,” Van Kerkhove said. She said investigators are also looking at whether some infections could have occurred during stops at islands where rodents may have been present.
But WHO is also examining whether some infections were passed between people who had close contact on the ship.
“We do believe that there may be some human-to-human transmission happening among really close contacts, the husband and wife, people who have shared cabins, etc.,” Van Kerkhove said. “We haven’t had something like this on a ship before.”
The flight investigation is tied to the wife of the first known fatal case. The man, part of a Dutch couple, died on April 11, and his wife later disembarked in Saint Helena to accompany his body.
WHO said she had gastrointestinal symptoms and deteriorated during a flight to Johannesburg on April 25, before dying the following day.
Authorities have started contact tracing for the flight from Saint Helena to Johannesburg, which South African carrier Airlink said was carrying 82 passengers and six crew.
Van Kerkhove said those on board will be contacted by health authorities, asked to monitor for symptoms and assessed by risk level.
WHO said contact tracing is also underway for people who left the ship at different ports during the cruise.
Van Kerkhove said the ship itself remains under monitoring, with passengers asked to remain in their cabins while disinfection and other public health measures are carried out.
Oceanwide Expeditions said two people on the ship who require urgent medical care, along with another person associated with a guest who died on May 2, will be medically evacuated to the Netherlands using two specialized aircraft traveling to Cape Verde. One other patient is in intensive care in South Africa but is improving, according to WHO.
After the evacuations, the Hondius is expected to sail to the Canary Islands, either Gran Canaria or Tenerife, where Spanish authorities are expected to support a broader investigation, risk assessment and disinfection of the vessel.
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Ella Rae Greene, Editor In Chief
