MV Hondius linked to hantavirus cluster

The World Health Organization said on May 13 that MV Hondius, a Dutch-flagged cruise ship, was the center of a multi-country hantavirus cluster first reported to WHO on May 2. The agency said passengers and crew developed severe respiratory illness during a voyage in the Atlantic Ocean and that testing identified Andes virus, a hantavirus associated with hantavirus cardiopulmonary syndrome. WHO said 11 cases, including three deaths, had been reported by May 13. Earlier notices described two deaths and one critically ill passenger at the time the cluster was first escalated to international health authorities. ### How was the ship linked to the cluster? WHO identified MV Hondius by name in its Disease Outbreak News updates, saying the severe respiratory illness cases were among people aboard the ship. The agency said the outbreak was linked to cruise ship travel and traced the initial alert to passengers and crew on the vessel. The European Centre for Disease Prevention and Control also said on May 21 that it had been notified on May 2 of a cluster on MV Hondius involving travelers from 23 countries. (who.int) The CDC said on May 8 that the U.S. government was monitoring a hantavirus outbreak linked to the M/V Hondius cruise ship and had issued guidance for affected American passengers through the State Department. CDC said the risk to the broader American public remained “extremely low.” ### What exactly did officials know on May 2? (who.int) WHO said the May 2 notification concerned a cluster of severe acute respiratory illness among passengers and crew in the Atlantic Ocean. In its initial outbreak notice, WHO said that as of May 4 there were seven identified cases: two laboratory-confirmed hantavirus infections and five suspected cases. That first notice said the cluster included three deaths, one critically ill patient and three people with mild symptoms, with illness onset between April 6 and April 28. (cdc.gov) CDC’s Health Alert Network notice described the same early stage slightly differently, saying the May 2 cluster included two deaths and one critically ill passenger whose laboratory tests confirmed hantavirus. WHO later said the virus type was confirmed as Andes virus on May 6. ### Why is Andes virus drawing unusual attention? WHO said Andes virus is the hantavirus identified in the outbreak. (who.int) Andes virus is unusual among hantaviruses because health authorities have documented person-to-person transmission in some circumstances, which is why agencies in multiple countries have been tracing passengers, crew and close contacts. A New England Journal of Medicine correspondence published this week said a virtual consultation was held on May 2 with specialists from South Africa, the United Kingdom and Holland to discuss a possible link between two recent fatalities associated with the same ship. (cdc.gov) CIDRAP, citing a Public Health Alerts report, said detailed case descriptions pointed to transmission among passengers after the index patient. (who.int) ### How large is the outbreak now? WHO said on May 13 that the total had reached 11 cases, including eight laboratory-confirmed Andes virus infections, two probable cases and one inconclusive case under further testing in the United States. The agency said those 11 cases included three deaths. ECDC said on May 21 that no new cases or deaths had been reported since its previous update and kept the total at 11, including nine confirmed and two probable cases as of May 22. (nejm.org) An MSN report summarizing a later WHO update said a 12th case was confirmed after a crew member tested positive when the ship arrived in the Netherlands for disinfection. Because that report was not an original WHO posting in the search results, the latest official count visible here remains the 11 cases and three deaths reported by WHO on May 13 and ECDC on May 21. (who.int) ### What happens next for passengers and health agencies? Oceanwide Expeditions’ ship has already been the subject of disembarkation, contact tracing and follow-up testing across several countries, according to WHO, CDC and ECDC updates. Those agencies said monitoring is focused on passengers and crew because the exposure risk is tied to people who were aboard the vessel or had close contact with confirmed cases. (msn.com) WHO’s Disease Outbreak News page, CDC’s Health Alert Network notice and ECDC’s outbreak update are the main official sources for the next case counts and country-by-country follow-up. Any further revisions are likely to come through those agencies as laboratory testing and contact monitoring continue. (who.int)