Countries around the world, including the U.S., are preparing to deal with the more than 140 passengers and crew members on board a hantavirus-stricken cruise ship where at least three people have died and several others fallen ill. But exactly how contagious is the virus and how does it spread?
Typically, hantavirus doesn’t spread from human-to-human but in the case of this outbreak, health officials suspect it may be caused by the one strain that can.
Hantavirus is usually spread by the inhalation of contaminated rodent droppings and isn’t easily transmitted between people. Some scientists believe the Andes virus implicated in the cruise ship outbreak may be able to spread between people in rare cases.
The Andes virus is a concerning member of the hantavirus family. The only hantavirus thought to spread human-to-human, it can cause a severe and often fatal lung disease called hantavirus pulmonary syndrome.
Still, transmission between people does not happen easily, and would require “close and prolonged” contact, according to the WHO.
“We haven’t had huge person-to-person spreads of hantavirus infection ever before, and there’s no reason to suspect a huge outbreak from this case at this point,” said Steven Bradfute, an associate professor and associate director of the Center for Global Health at the University of New Mexico Health Sciences Center, which specializes in hantavirus research.
Symptoms usually show between one and eight weeks after exposure.
Still, as American passengers onboard the cruise ship prepare to return to the U.S., plenty of questions remain.
Where the outbreak originated
Argentine investigators suspect a Dutch couple may have first contracted the virus while on a bird-watching trip before they boarded the cruise ship in Argentina on April 1. But no organization has confirmed where or how they acquired the disease.
Argentina’s Health Ministry has zeroed in on the nation’s southernmost town, Ushuaia. Officials plan to travel there in the coming days, according to a written statement to The Associated Press.
What happens next to the remaining passengers
Spanish authorities are preparing to receive the remaining passengers and crew members on Tenerife. Officials said Friday that passengers will be evacuated in small boats to buses only once their repatriation flights are ready to take them.
The United States has agreed to send a plane to the Canary Islands to pick up its citizens, as will the British government.
“CDC is sending a team to the Canary Islands to meet the Americans on board the Dutch cruise ship,” a U.S. Centers for Disease Control and Prevention official said. “They will be quarantined in Nebraska upon arrival in the U.S.”
A State Department spokesperson on Friday told NBC News that the agency expects to bring back 17 Americans aboard the ship in coordination with the CDC.
Other countries have not yet made their plans public, and it is not clear how long boat passengers will have to wait for their flights.
Spain has requested medically equipped planes for passengers experiencing symptoms, Virginia Barcones, the country’s head of emergency services, said Friday.
How many people may have been exposed?
Cruise operator Oceanwide Expeditions and Dutch officials said Thursday that more than two dozen people from at least 12 different countries left the ship at the remote island of St. Helena in the South Atlantic on April 24.
They included a Dutch woman who disembarked with her husband’s body. He was the first passenger to die, but it wasn’t until May 2 that health authorities first confirmed hantavirus in a ship passenger.
At least seven Americans who were on the vessel are isolating at home across five states, and none show any symptoms of the virus, according to local health officials.
The delay left countries scrambling to track the passengers who got off the ship some two weeks earlier.
The passengers included a resident of the remote island of Tristan da Cunha who has been hospitalized with symptoms of hantavirus, according to the British Foreign Office.
Stephen Doughty, the U.K. minister of overseas territories, said in a message to the British overseas territory that his thoughts were with “the islander currently in hospital and their spouse who is isolating.”
Many of the passengers who disembarked at St. Helena traveled on to other countries, including the Dutch woman whose husband died on board. She flew to Johannesburg then briefly boarded a plane preparing to fly to Amsterdam. She was removed because she was too ill to travel, and later died.
South African and Dutch authorities are trying to trace the whereabouts of anyone who had contact with the woman during her travels. A flight attendant who had contact with her has tested negative for hantavirus after reporting symptoms.
Some governments, like the United Kingdom, have confirmed the whereabouts of their citizens who left the boat. However, U.K. officials do not know or have not made public how many others they have come into contact with since.
How does the virus spread?
The virus usually spreads when people inhale contaminated residue of rodent droppings.
Hantavirus is mainly spread by contact with rodents or their urine, saliva or droppings, particularly when the material is disturbed and becomes airborne, posing a risk of inhalation.
People are typically exposed to hantavirus around their homes, cabins or sheds, especially when cleaning enclosed spaces with little ventilation or exploring areas with mouse droppings.
What are the symptoms?
An infection can rapidly progress and become life-threatening. Experts say it can start with symptoms including fever, chills, muscle aches and maybe a headache — much like the flu.
Symptoms of hantavirus pulmonary syndrome usually show between one and eight weeks after contact with an infected rodent. As the infection progresses, patients might experience tightness in the chest, as the lungs fill with fluid.
The other syndrome caused by hantavirus — known as hemorrhagic fever with renal syndrome, which can cause bleeding, high fever, and kidney failure — usually develops within a week or two after exposure.
Death rates vary by which hantavirus causes the illness. Hantavirus pulmonary syndrome is fatal in about 35% of people infected, while the death rate for hemorrhagic fever with renal syndrome varies from 1% to 15% of patients, according to the CDC.
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