Hantavirus-hit cruise ship to head to Spain as human-human transmission suspected

Madrid/London/Geneva/Amsterdam: The luxury cruise ship hit by an outbreak of the deadly hantavirus is preparing to travel from Cape Verde towards Europe after the Spanish government gave permission for it to dock in the Canary Islands.

The Spanish Health Ministry said it had been asked by the World Health Organisation and the European Union to take the Dutch-flagged MV Hondius “in accordance with international law and humanitarian principles”.

It said it would also receive a medical flight on Tuesday evening carrying the ship’s doctor, a Dutch national who it said was gravely ill, following a formal request from the Dutch government. A British crew member is also due to be medically evacuated, officials said.

A Dutch couple and a German national have died since the outbreak manifested in early April, while a 69-year old British person with hantavirus symptoms was evacuated from the ship on April 27 and is in intensive care in South Africa, officials said, though their condition is understood to be improving.

Another person on board with a suspected case has only reported a mild fever. Four Australians are also on board, though their identities have not been disclosed.

Cape Verde was meant to be the ship’s final destination, but the nation off West Africa has not allowed the vessel to dock or put passengers ashore.

Once in the Canary Islands, at a port yet to be determined, the Spanish Health Ministry said crew and passengers would be examined, treated and repatriated to their respective countries, in co-ordination with the European Centre for Disease Prevention and Control and the WHO.

All necessary safety measures would be taken, the health ministry said, with medical care and transportation in special facilities and vehicles to avoid contact with the local population and protect health workers.

“The World Health Organisation has explained that Cape Verde is unable to carry out this operation,” the statement added. “The Canary Islands are the closest location with the necessary
capabilities.

The ship would take three or four days to reach Gran Canaria or Tenerife from Cape Verde, cruise operator Oceanwide Expeditions said.

“Spain has a moral and legal obligation to assist these people, among whom are also several Spanish citizens.” The Canary Islands are one of Europe’s main arrival points for migrants from West Africa, with tens of thousands of people arriving in rubber dinghies and rickety fishing boats each year.

The MV Hondius would moor either in Gran Canaria or Tenerife, which were three or four days’ sailing away from Cape Verde, according to Oceanwide and the Spanish health ministry.

Health authorities say about 150 people from 23 countries are on board the ship.

At a press conference that began shortly after 6 pm local time (1900 GMT), Cape Verde’s National Director of Health, Angela Gomes, said evacuations would happen “in the coming hours”.

The Dutch Foreign Ministry said earlier on Tuesday it was preparing the medical evacuation of three people to the Netherlands from the ship.

Human-human transmission suspected

People are usually infected by hantavirus through contact with infected rodents or their urine, their droppings or their saliva.

But the World Health Organisation said on Tuesday that it suspects some rare human-to-human transmission took place between very close contacts on board the Hondius.

“We do believe that there may be some human-to-human transmission that’s happening among the really close contacts, the husband and wife, people who have shared cabins,” Maria Van Kerkhove, the director of epidemic and pandemic preparedness and prevention at the WHO, told reporters in Geneva.

Van Kerkhove also sent a direct message to people on board.

“We just want you to know we are working with the ship’s operators,” she said. “We are working with the countries where you are from. We hear you, we know that you are scared.”

Human-to-human transmission is uncommon, and the UN health agency reiterated that the risk to the wider public from a disease typically spread through contact with infected rodents is low. Human infections are relatively uncommon: Between 1993 and 2023, the US recorded just under 900 cases.

Yet, those infections are deadly. The type of hantavirus prevalent in North and South America damages the lungs and heart, killing nearly 40 per cent of the people it infects. The type found in Europe and Asia goes after the kidneys, with a mortality rate of anywhere from 1 per to 15 per cent.

A major problem is that early symptoms are often mistaken for other, more common viruses – and there are no specific treatments for hantavirus infections.

A limited spread among close contacts has been observed in some previous outbreaks of the Andes strain, which spreads in South America, including Argentina, and which the WHO believes could be involved in this instance. Testing is under way, and the WHO is expected to confirm the strain of virus in days.

The Hondius left Ushuaia in southern Argentina in March and visited the Antarctic peninsula, South Georgia, and Tristan da Cunha – some of the remotest places on the planet. Berth prices for the trip – marketed as an Antarctic nature expedition – ranged from €14,000 to €22,000 euros ($16,000 to $25,000).

The passengers are understood to be mostly British, American and Spanish.

The WHO said it had been told there were no rats on board. The UN health body said its working assumption was that the Dutch couple, who joined the ship in Argentina after travelling in the country, were infected before boarding the cruise.

Other cases may also have been infected while on bird-watching trips to islands where birds and rodents live, it said. Such trips are part of the cruise.

Suspicions mount

Infectious disease experts strongly suspect the outbreak was caused by Andes virus. Not only is that strain of hantavirus endemic to parts of Argentina, where the cruise ship first embarked, but it is also the sole pulmonary-syndrome-causing strain known to spread between humans.

Infectious disease sleuths have two main theories for what happened. One scenario is that mice carrying the virus somehow made it onboard the vessel and exposed passengers, say, through the ship’s ventilation system.

An alternate, much knottier scenario – one that is looking increasingly likely – is that one or more passengers contracted the virus before the ship left Argentina or during one of its many stops. On Tuesday, WHO officials told reporters that the first passengers to get sick – a husband and wife who both tragically died – had boarded the vessel in Argentina, and that passengers had been on excursions to multiple islands with rodents.

“There could be some source of infection on the islands as well for some of the other suspect cases,” Maria Van Kerkhove, WHO’s chief of epidemic and pandemic preparedness and prevention, said. “However, we do believe that there may be some human-to-human transmission that’s happening among the really close contacts”, such as the husband and wife and others who have shared cabins.

The first stricken passenger, the Dutch man, died on April 11. His body remained on board until April 24, when it “was disembarked on St Helena, with his wife accompanying the repatriation”, Oceanwide Expeditions said.

His wife had gastrointestinal symptoms when she left the ship and deteriorated during a flight to Johannesburg. She died upon arrival at the emergency department on April 26, the WHO said, adding that contact tracing was under way for passengers on that flight. The Netherlands has confirmed the presence of the virus in her body.

Reuters, Bloomberg

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