Andes hantavirus ties 11 cases MV Hondius

CIDRAP reported on May 21 that 11 Andes hantavirus cases were linked to passengers on the expedition cruise ship MV Hondius, adding detailed information on 10 of those infections. The outbreak has been tracked by public health agencies in Europe, the United States and through the World Health Organization after passengers dispersed across multiple countries. (cidrap.umn.edu) ECDC said on May 20 that the Dutch-flagged ship had passengers and crew from 23 countries and that 11 cases had been reported in total. (ecdc.europa.eu) The agency said nine were confirmed and two were probable, with three deaths. (cdc.gov) WHO said on May 13 that all 11 cases were among passengers. ### How did this become an international public health investigation? WHO said it was notified on May 2 by the United Kingdom’s International Health Regulations focal point about a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard MV Hondius. (cidrap.umn.edu) On May 6, WHO confirmed the virus involved was Andes virus, the hantavirus strain tied to this outbreak. CDC said the ship had departed Ushuaia, Argentina, on April 1 and carried 147 people — 86 passengers and 61 crew — on a route that included Antarctica, South Georgia Island, Tristan da Cunha, Saint Helena and Ascension Island. The agency said investigations were under way to assess exposure risk for Americans who had been on the ship or later exposed during travel. (ecdc.europa.eu) ### What do officials say about where the outbreak started? WHO said the working hypothesis is that the first case acquired the infection before boarding the cruise through exposure on land. The agency said investigations with authorities in Argentina and Chile were continuing to clarify the source and circumstances of exposure. (cdc.gov) ECDC said on May 20 that additional cases were still expected to be identified after former passengers and crew returned home because Andes hantavirus has a long incubation period and some infections may have occurred on board. The agency said the ship had been docked in Rotterdam since May 18 and was undergoing ship sanitation. (cdc.gov) ### Why did this outbreak draw extra attention from health agencies? CDC said Andes virus can lead to hantavirus pulmonary syndrome, a severe and potentially deadly disease that affects the lungs. The agency issued a Health Alert Network advisory on May 8 to clinicians and health departments, saying imported cases were possible even though the risk of broad spread in the United States was considered extremely unlikely. (who.int) WHO said the global risk from the event was low. ECDC said the risk to the EU/EEA general population remained very low, while CDC said on May 19 that no cases had been confirmed in the United States as a result of the outbreak. (ecdc.europa.eu) ### What happened to passengers after the ship reached port? CDC said it repatriated 18 passengers who remained on the cruise ship on May 10 and transferred them to the Nebraska Quarantine Unit at the University of Nebraska Medical Center. The agency said those passengers were being assessed and monitored for 42 days. (cdc.gov) Seven other passengers who returned to the United States earlier were being monitored at home by state and local health authorities, CDC said. WHO said one U.S. passenger had inconclusive laboratory results as of May 13 and was being retested after a high-risk exposure on board. (who.int) ### What comes next for the outbreak response? ECDC said its outbreak page is updated once daily, including weekends. CDC said it would continue updating its public situation summary as the outbreak evolves, while WHO said international contact tracing was continuing through International Health Regulations channels. (ecdc.europa.eu) (cdc.gov)