Health authorities raced Tuesday to find a port for a cruise ship battling a hantavirus outbreak, as it remained off the West African coast with passengers isolating after three people died. The World Health Organization said the MV Hondius could head from Cape Verde to Spain's Canary Islands, though Spanish authorities said they wanted health data from the expedition vessel before opening up a port.
The ship had been on an adventure cruise from Ushuaia in Argentina to Cape Verde off west Africa. It has been at the centre of an international alert since Saturday after it was revealed that the rare disease, was suspected in three deaths.
The priority now is to evacuate two sick crew members who require urgent care, potentially to the Netherlands, and "then the ship can move", WHO epidemic and pandemic preparedness and prevention director Maria Van Kerkhove said in Geneva. So far, two hantavirus cases have been confirmed, including in one of the fatalities, with five further suspected cases among the 147 passengers and crew, the WHO said.
Three of those seven have died, one was critically ill and three had reported milder symptoms, including one who is now asymptomatic, it said. One of the dead, a Dutch woman, had left the ship at the Atlantic island of Saint Helena and had flown to Johannesburg where she died on April 26. The WHO said it was trying to contact people who were on the same flight.
Passengers and crew have meanwhile been in isolation on the MV Hondius, operated by Dutch company Oceanwide Expeditions, after Cape Verde authorities barred it from docking.
According to the US Centers for Disease Control and Prevention (CDC), hantaviruses are primarily transmitted through contact with the urine, feces, or saliva of infected rodents and can cause severe illness. Human-to-human transmission is extremely rare.
According to Van Kerkhove, Spanish authorities had "said that they will welcome the ship to do... a full epidemiologic investigation". They would also conduct a "full disinfection of the ship and... assess the risk of the passengers." Spain's health ministry said that a decision on where to send the vessel would be based "on the epidemiological data collected from the ship during its stopover in Cape Verde".
The Canary Islands government said it wanted the ship sent to mainland Spain. Passengers from Britain, Spain and the United States, as well as crew largely from the Philippines, were among 23 nationalities on the MV Hondius. The WHO was scrambling for answers about how hantavirus had appeared on the ship, which set off from from Ushuaia on April 1.
The first person who died developed symptoms on April 6, according to the UN health agency which said it was alerted on Saturday. Human-to-human transmission has only been reported in previous outbreaks of one specific hantavirus called Andes virus, which circulates in South America. Van Kerkhove said the virus species had yet to be confirmed, but highlighted that WHO had been told "there are no rats on board" the ship.
South African researchers were working sequencing the data, said Van Kerkhove, who added that "our working assumption is that it is the Andes virus". "We do believe that there may be some human-to-human transmission that is happening among the really close contacts".
The first two people to die were a Dutch couple, a man who died on April 11 and his wife who died after she disembarked in Saint Helena to accompany his body. The wife was suffering from "gastrointestinal symptoms" and "deteriorated" during a flight to Johannesburg on April 25, the WHO said. She died the following day.
Van Kerkhove said contact tracing had been initiated for people on the flight. She stressed that human-to-human transmission typically only happened "among very close contacts". The ship's operator said a British passenger was in intensive care in Johannesburg. The two crew still on board, one British and one Dutch, needed urgent care, WHO said.
Van Kerkhove said the typical incubation period for the hantavirus was between one and six weeks, leading the WHO to believe that the Dutch couple, who had been travelling in South America, "were infected off the ship". The Hondius, she highlighted, was an expedition vessel, with passengers going ashore on Atlantic islands to do birdwatching and other activities, meaning there could be "some source of infection on the islands".
The WHO has said the risk to the global population from the outbreak is "low".
Among the three victims of a suspected hantavirus outbreak aboard a cruise ship is a German passenger, according to the cruise company Oceanwide Expeditions. A list published by the company on Monday indicated that a total of seven Germans were among the passengers, and one crew member also holds German citizenship. The German passenger died on Saturday, according to Oceanwide Expeditions; the cause of death is still unclear.
The Dutch-flagged MV (motor vessel) Hondius was built in 2019 for polar expedition cruising. Its schedule shows it switches between southern and northern hemisphere summers. The ship is operated by Dutch cruise company Oceanwide Expeditions.
It was built for 170 passengers in 80 cabins, and can take 57 crew, 13 guides and one doctor. The ship is 107.6 metres (353 feet) long and 17.6 metres wide, with a top speed of 15 knots.
Including a deceased German passenger, there are 149 people on board, among them 23 different nationalities. There are 88 passengers, from 15 countries, including 19 from Britain, 17 from the United States 13 from Spain and eight from the Netherlands. There are 61 crew members, from 12 countries, including 38 from the Philippines, five from Ukraine, five from the Netherlands and four from Britain.
The cruise north through the Atlantic Ocean from Argentina to Cape Verde followed an initial March 10-31 return trip from Ushuaia in Argentina to the Antarctic Peninsula. The ship left Ushuaia on April 1, according to tracking site MarineTraffic. After visiting islands including South Georgia and Tristan da Cunha, the vessel called at Saint Helena, where the first fatality was taken off the ship on April 24. It left Britain's Ascension Island on April 27.
These viruses are found all over the world, with infections occurring year-round. For example, China, Russia and South Korea report several thousand cases a year. In the Americas, Finland and France, there are several hundred cases annually. Only certain strains of hantaviruses found exclusively in rodents - rats, mice, and voles, are transmitted to humans.
Hantaviruses are split into two groups: viruses from the old world (Europe, Asia, Africa) and those from the new world (North, Central and South America). For old world viruses, the mortality rate can be as high as 14 percent. However, in developed nations such as France, fatal cases are extremely rare and mainly affect people with pre-existing health conditions.
Some cases are asymptomatic or limited to body aches, an upset stomach and a mild cough. But rare cases can include kidney problems that can develop into acute but reversible renal failure. In contrast, the lethality of new world viruses can exceed 40 percent. These cases can rapidly spread to lungs, leading to breathing issues or sometimes heart problems.
The faster people receive treatment, the better their prognosis. Because there is no specific treatment for hantavirus, instead doctors aim to manage the symptoms. If the virus severely affects the lungs, oxygen therapy in an intensive care unit may be necessary. People who work in particular industries, such as forestry or farming, are particularly at risk.
Like any infection, the most at risk are the elderly, those with weaker immune systems, and people with pre-existing health problems.
It is still unknown whether this was an outbreak of the Andes virus. This is the only strain for which there are confirmed cases of human-to-human transmission, but this required close and prolonged contact, for example, within a family.
Humans are mainly infected by inhaling aerosols contaminated by the saliva, droppings or urine of animals or through direct contact with faeces, or via bites or scratches. For the cruise ship, there are two possible scenarios: human-to-human transmission or isolated infections before people boarded, for example if they took a trip together.
Sequencing the virus from an infected passenger on the ship will identify what strain of hantavirus is involved. Because the ship left from Ushuaia in southern Argentina, the Andes virus is suspected because it circulates there.
However, if it is a different new world strain, for example one called Sin Nombre, which only circulates in North America, contamination in South America can be ruled out. If a new world hantavirus is being transmitted between humans on this ship, that would be unprecedented, to my knowledge.
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