(CNN) — Some human-to-human transmission may have occurred on board the cruise ship hit by a hantavirus outbreak that has left three people dead and several others ill, the World Health Organization (WHO) said Tuesday.
“We do know that some of the cases had very close contact with each other and certainly human-to-human transmission can’t be ruled out so as a precaution this is what we are assuming,” Dr. Maria Van Kerkhove, WHO’s director for epidemic and pandemic preparedness and prevention, told reporters.
However, health authorities have emphasized that the outbreak does not pose a wider public health risk.
“The risk to the general public is low,” Van Kerkhove said, outlining that any suspected human-to-human transmission would have occurred between very close contacts like married couples. “This is not a virus that spreads like flu or like COVID. It’s quite different.”
Almost 150 people, including 17 Americans, remain stranded on the MV Hondius which is currently anchored off the coast of Praia, the capital of Cape Verde, an archipelago nation off Africa’s west coast.
The ship, operated by tour company Oceanwide Expeditions, left Ushuaia, Argentina last month on a voyage across the Atlantic Ocean, stopping off at some of the world’s most remote islands. But along the way, several passengers fell sick with a rapidly progressing respiratory illness, the company said.
Seven cases of hantavirus, a rare disease typically caused by contact with infected rodents’ urine, faeces or saliva, have been identified so far. Two of those are confirmed and five suspected, WHO said Monday.
Three people – a Dutch couple and German national – have died while one British national remains in intensive care in South Africa, though Van Kerkhove said his condition is improving.
Two other people suffering from hantavirus symptoms remain on board the ship, though their medical evacuation is currently underway, Van Kerkhove said.
What happens next?
The top priority for health authorities is to evacuate the two symptomatic crew members so they can receive the medical care they require, Van Kerkhove said, adding that was underway Tuesday morning.
Two specialized aircraft are en route to Cape Verde to evacuate the two symptomatic people and a person “associated with” the German national who died, according to the tour operator. The patients will be taken to the Netherlands though an exact timeline remains unclear, Oceanwide Expeditions said.
Once they have been evacuated and are in transit to the Netherlands, the plan is for the ship to sail to the Canary Islands – either Gran Canaria or Tenerife – which will take three days of sailing, according to the tour operator. Spanish authorities will then conduct a full epidemiological investigation and full disinfectation, Van Kerkhove said. She later said the hope is for the ship to start moving to the next port by Tuesday night.
The Spanish health ministry has not decided the most appropriate port for the ship, it said in a statement to CNN which did not confirm if the ship is bound for the Canary Islands.
Strict health and safety procedures are currently in place on the ship, including isolation measures, hygiene protocols and medical monitoring. The company said the atmosphere “remains calm” and that passengers were “generally composed.”
One passenger, travel vlogger Jake Rosmarin, spoke of the fear and uncertainty percolating through the ship on Monday.
“What’s happening right now is very real for all of us here. We’re not just a story. We’re not just headlines,” he said in a video posted on Instagram, his voice cracking with emotion.
Social distancing is being followed and passengers have the option for meals to be delivered directly to their cabin, Rosmarin said in a statement to CNN Tuesday. Access to the outer decks is permitted for fresh air, though gathering in indoor areas such as the lounge is not allowed, he added.
“Oceanwide Expeditions and the crew have been doing everything within their ability to keep passengers safe, informed, and as comfortable as possible during this time,” he said.
Beyond the ship itself, authorities have initiated contact tracing for those on the flight to Johannesburg with the Dutchwoman who later died.
What do we know about the victims?
The first suspected case was a 70-year-old Dutchman, who suddenly fell ill on the ship with a fever, headache, abdominal pain and diarrhea, South Africa’s Health Department told CNN. He died on board on April 11.
The man’s wife, who was 69 years old and also Dutch, was taken to South Africa but collapsed at an airport while trying to fly home to the Netherlands and died at a nearby hospital. She tested positive for a variant of hantavirus, Oceanwide Expeditions confirmed Monday.
“The beautiful journey they experienced together was abruptly and permanently cut short,” the couple’s family said in a statement sent to CNN by Dutch charity Namens de Familie, which supports people receiving media attention after personal tragedy.
“We are still unable to comprehend that we have lost them. We wish to bring them home and commemorate them in peace and privacy,” they said.
After the ship left Saint Helena, a British national onboard fell sick on April 27. He is now in intensive care at a private medical facility in Johannesburg, though his condition is improving, WHO said. He is the second confirmed hantavirus case.
On May 2, a German national, who presented with pneumonia, died on board the MV Hondius. While her cause of death has not yet been established, it is being treated as a suspected case.
And two crew members — one British and one Dutch national — are currently experiencing acute respiratory symptoms, requiring urgent care, Oceanwide Expeditions said. Hantavirus has not been confirmed in either case.
A seventh person reported a mild fever but is now feeling well, WHO said. They have provided a sample for hantavirus testing too.
How did the outbreak occur?
It’s not yet clear how the outbreak occurred. But WHO are working on the assumption that the Dutch couple who both died were infected off the ship, perhaps while doing some activities in Argentina before they joined the cruise, Van Kerkhove said.
The MV Hondius first left Ushuaia in Argentina over a month ago. It made stops in Antarctica before returning to Ushuaia for a night and leaving again on April 1, according to vessel tracker Marine Traffic. It then stopped at the British overseas territory of Saint Helena before anchoring Sunday off Praia, MarineTraffic said.
Hantavirus typically incubates for one to six weeks before patients start presenting symptoms so they likely fell ill some time after they were infected, she added.
According to WHO, the passengers who fell ill developed symptoms between April 6 and 28, including “fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome and shock.”
On their voyage, passengers visited some of the world’s most remote islands, where they would have seen a lot of wildlife, including whales, dolphins, penguins and seabirds, according to the trip’s itinerary.
“This was an expedition boat and many people were doing birdwatching, things with wildlife,” Van Kerkhove said.
Rodents live in some of these places, so there “could be some source of infection on the islands as well for some of the other suspected cases,” she added.
Only one type of hantavirus, the Andes virus, is known to have some limited human-to-human transmission. Though it is rare, it is primarily found in Chile and Argentina, where the ship originated, and WHO suspect this strain infected passengers on the cruise. They are waiting for the results from sequencing the virus to confirm this theory.
“We do believe there may be some human-to-human transmission happening among the really close contacts, the husband and wife, people who’ve shared cabins,” Van Kerkhove said.
Meanwhile, Rosmarin, one of the passengers, emphasized that the ship “is not a traditional cruise ship, but an expedition vessel” and had followed strict cleanliness protocols throughout its voyage since it visited “remote and environmentally sensitive regions.”
How deadly is hantavirus?
While hantavirus is rare, it is highly deadly – about 38% of people who develop respiratory symptoms may die, according to the CDC.
Symptoms start similar to the flu, with patients suffering from fatigue, fevers, chills and aches. But over time, the virus can damage the heart, lungs or kidneys, causing patients to suffer severe shortness of breath, organ failure and even death.
There’s no specific treatment for hantavirus, according to the CDC, beyond managing symptoms. Patients with severe breathing difficulties may need to be intubated, the CDC said.
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