With at least one U.S. hantavirus case confirmed in a passenger who came from the cruise ship at the center of the outbreak, how easily is the virus spread, how does it compare to COVID-19 and where have cases been reported so far?
The last remaining passengers disembarked Monday and boarded flights to more than 20 countries to enter quarantine. Passengers began flying home aboard military and government planes Sunday after the MV Hondius anchored in the Canary Islands.
“If they stayed longer on the ship, the situation could have been difficult,” said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization.
Three cruise ship passengers have died, and six people with confirmed or suspected cases of hantavirus are being quarantined, according to the WHO.
Health authorities say it’s the first-ever hantavirus outbreak on a cruise ship. While there is no cure or vaccine for hantavirus, the WHO says early detection and treatment improves survival rates.
The ship’s captain, Jan Dobrogowski, issued a video message Monday praising passengers and crew for their courage and perseverance, and he called for respect for their privacy.
“I could not imagine sailing through these circumstances with a better group of people, guests and crew alike,” he said.
Here’s what to know:
How does hantavirus spread?
Hantavirus usually spreads from rodent droppings and is not easily transmitted between people. But the Andes virus detected in the cruise ship outbreak may be able to spread between people in rare cases.
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.
Scientists are still trying to learn exactly how the Andes virus may be able to spread between people, said Dr. Jeanne Marrazzo, chief executive officer of the Infectious Diseases Society of America. They suspect people could be infectious when they have symptoms, and, if the virus spreads, it may be transmitted through small liquid particles that blow out of an infected person when they talk, cough or sneeze.
Still, transmission between people does not happen easily, and would require “close and prolonged” contact, according to the WHO.
Symptoms usually show between one and eight weeks after exposure.
How does it compare to COVID-19?
Officials said citizens of the countries that passengers are returning to should know “there is nothing to fear, the risk is low, this is not another COVID.”
Hantaviruses have been around for centuries and are thought to exist around the world. The disease gained renewed attention last year after the late actor Gene Hackman‘s wife, Betsy Arakawa, died from a hantavirus infection in New Mexico.
In the U.S., federal health officials began tracking the virus after a 1993 outbreak in the Four Corners region — the area where Arizona, Colorado, New Mexico and Utah meet. It was an astute physician with the Indian Health Service who first noticed a pattern of deaths among young patients.
Most U.S. cases are in Western states. New Mexico and Arizona are hot spots, likely because the odds are greater for mouse-human encounters in rural areas.
COVID-19 spreads much more easily than hantavirus, sometimes even from people who are symptom-free — which made the virus extremely difficult to contain when the pandemic broke out in 2020. Hantavirus is harder to get, though potentially more dangerous once someone is sick.
“There are a lot of unknowns here. But as was mentioned earlier, it seems that with hantavirus, this specific Andes, that this can be transmitted person to person, but it typically does require very close contact and typically when those individuals are symptomatic,” Dr. Angela Hewlett, medical director of the Nebraska Bio Containment Unit, said Monday. “Now again, recognizing that like I said, although this is you know, there are some unknowns. And this is not a not a new virus. This is not the scenario that we encountered with COVID where we had a brand new brand new virus. So there is some information, known about Andes virus. And we’re still fortunate to at least have that. But again, these this will be an ongoing assessment.”
Where have cases been confirmed?
The Hondius left the southern Argentine port of Ushuaia on April 1 and a Dutch passenger died on board April 11. It wasn’t until early May that the WHO said it was reacting to a suspected hantavirus outbreak on the ship, which by that time was off the West African island nation of Cape Verde.
A Dutch woman, the wife of the man who died, showed symptoms of illness and took a commercial flight from St. Helena to South Africa. She died in South Africa after collapsing at an airport while trying to board another plane home.
A British man admitted to a hospital in Johannesburg was also being treated for hantavirus and was gradually improving. He was evacuated from the ship on April 27 after becoming ill.
Another passenger, a German woman, fell sick as the ship sailed for Cape Verde off Africa’s west coast. She died onboard nearly a month after the first passenger fell ill.
Two crew members onboard also became seriously ill, including the ship’s doctor, and another person. Those three people, two of whom tested positive for hantavirus, were evacuated from the ship and flown to specialized hospitals in Europe.
Authorities in Switzerland announced another positive hantavirus test on a man who left the cruise earlier in St. Helena, bringing confirmed cases to five.
Most recently, a French woman tested positive for the hantavirus and was placed in intensive care in stable condition at a Paris hospital, French Prime Minister Sebastien Lecornu said Monday. He said four French passengers who returned Sunday have tested negative but remain in isolation at the same hospital.
One of 18 evacuated passengers flown to the U.S. also tested positive for the hantavirus but is not showing symptoms, while another had mild symptoms, U.S. health officials said.
Meanwhile, health officials in the U.S. said they are now monitoring at least eight passengers who disembarked on April 24 and returned home.
Georgia and Texas each said they are monitoring two residents who were on the cruise ship. Arizona and Virginia are monitoring one each. California’s health department said Friday in a statement that at least one California resident returned to the state after disembarking.
New Jersey’s health department also said that two New Jersey residents who were not passengers on the ship were potentially exposed to an infected person “during air travel abroad.”
Health authorities in Switzerland, Britain, Netherlands, France, Singapore, South Africa and elsewhere are also isolating people who previously left the cruise ship and tracing people who might have come into contact with cruise ship passengers.
What are the symptoms?
The particular strain of hantavirus believed to be behind the current outbreak, known as the Andes virus, can mirror flu-like symptoms to start. Symptoms usually show between one and eight weeks after exposure.
According to the CDC, early symptoms of the virus can look similar to many other illnesses, with symptoms like fatigue, fever and muscle aches, particularly in large muscle groups like the thighs, hips, back, and sometimes shoulders.
In addition to those, however, about half of patients also experience:
Headaches Dizziness Chills Abdominal problems, like nausea, vomiting, diarrhea, and abdominal painAfter these early symptoms, later stages of the virus can bring more serious concerns, the CDC noted.
Four to 10 days in, patients might experience things like coughing, shortness of breath, tightness in their chest and fluid in their lungs.
An infection can rapidly progress and become life-threatening.
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.
“HPS can be deadly. Thirty-eight percent of people who develop respiratory symptoms may die from the disease,” the CDC reported.
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.
The CDC notes that “typically, people are only infectious while they have symptoms.”
What’s happening in the U.S. right now?
The passengers landed in Omaha about 1:30 a.m. CT via a State Department plane after the ship anchored in the Canary Islands Sunday. Personnel in full-body protective gear and breathing masks had escorted the travelers from ship to shore in Tenerife in an effort that was continuing Monday.
After landing early Monday, 16 American passengers — one of them a British-U.S. dual citizen — were taken to the University of Nebraska Medical Center, which has a federally funded quarantine facility and a biocontainment unit for treating people with highly infectious diseases. They were being assessed to determine if they had close contact with any symptomatic people and their risk levels for spreading the virus.
The American who tested positive for hantavirus on the cruise ship was taken to the Omaha campus’ biocontainment unit and will be tested again. The passenger “is doing well and not having symptoms at this time,” said Dr. Angela Hewlett, the unit’s medical director.
The others taken to Nebraska will be monitored in quarantine for several days. They arrived “in good shape, good spirits,” said Dr. Michael Wadman, the quarantine unit’s medical director.
Two additional American passengers, a couple, arrived Monday at Emory University Hospital in Atlanta. One of them has mild symptoms and will be tested for hantavirus.
“We’re going to expect to see people have symptoms. That’s just, you know, if you think in any given week or month, how many times do you experience some level of nasal congestion or upset stomach or something? We’re being very, very liberal in how we’re framing symptoms and monitoring for symptoms here,” Dr. Brendan Jackson, acting director of the Division of High Consequence Pathogens and Pathology with the U.S. Centers for Disease Control and Prevention, said. “And so that’s how the system is working. It doesn’t necessarily mean just because someone has symptoms that they’re going to end up having this illness.”
Health experts said there’s a possibility any asymptomatic passengers in Nebraska could move home to finish their quarantine.
“The passengers that are all in the sort of assessment phase, they’re going to be here for at least a few days while we do assessments and then coordination from what happens next,” Jackson said. “They certainly have the option to stay here for the entire 42-day period, if that’s just the safest and most effective option for them. There’s going to be an individualized decision plan for them to determine if it makes more sense for them to complete their 42-day monitoring at home. And there’s going to be a couple of things that go into to to that decision. First and foremost, do they remain symptom free? But then also, do they have all the structures and support to be able to be continue that period at home, making sure that that they can, be able to isolate in a separate part of structure from anybody else, make sure that they can contact their health department, get tested if necessary, if they develop symptoms or if they need a higher level of medical care that that’s available to them. So there’s a range of structures that need to be in place before anyone would be transferred to their their home. And that would be done in close coordination with the health departments in the states that would be receiving them.”
Tedros of the WHO advised that returning passengers should stay in quarantine, either in their homes or in other facilities, for 42 days. He added that WHO cannot enforce its guidance, and that different countries may handle monitoring of passengers without symptoms in different ways.
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