The rodent-borne hantavirus is suspected in an outbreak aboard a cruise ship in the Atlantic Ocean in which three passengers have died within three weeks.
The World Health Organization said one case of hantavirus has been confirmed and that there are five suspected cases, two of them fatal. Oceanwide Expeditions, the operator of the Hondius expedition ship, said one passenger is in intensive care in Johannesburg and two crew members aboard the vessel have respiratory symptoms.
There are 87 surviving passengers and 61 crew members aboard the vessel, representing almost two dozen countries.
Although hantavirus is normally linked to exposure to infected rodents’ urine or feces — a particular risk while cleaning — in rare cases it can spread between people. Here’s what to know about the disease.
What happened aboard the ship?
Oceanwide Expeditions relayed an alarming timeline in a news release Monday about what it described as a “serious medical situation” aboard the Hondius, a polar-rated expedition ship off the coast of Cape Verde, along Africa’s western coast.
On April 11, a Dutch passenger died on board, but the cause of death could not be determined. His wife accompanied his body as it was brought off the ship on St. Helena, a remote island territory in the South Atlantic Ocean. After she left the ship, she became unwell and died, the company said.
About two weeks after the first death, a British passenger became seriously ill and was medically evacuated to South Africa, where hantavirus was identified. That passenger is in the intensive-care unit in critical but stable condition, the Monday release said.
On Saturday, a third passenger died, a German national.
It has not been confirmed that all three of the deaths were caused by hantavirus, the company said.
Of the passengers, 19 are British, 17 are American, 13 are Spanish and eight are Dutch. More than half of the crew members are Filipino nationals.
What is hantavirus?
Hantaviruses are a family of viruses that can cause serious illness and death. They are spread mainly by rodents and can cause hantavirus pulmonary syndrome (HPS), which is more common in the United States, and hemorrhagic fever with renal syndrome (HFRS), which is found mostly in Europe and Asia, according to the Centers for Disease Control and Prevention. Both are severe and potentially deadly.
It can be contracted by contact with droppings from infected rodents, commonly through inhalation when entering or cleaning unventilated areas. Person-to-person transmission is also possible, but more rare.
What are the symptoms?
Symptoms typically start to show between one and eight weeks after first contact with the virus.
HPS affects the lungs and can cause fatigue, fever and muscle aches initially, followed by coughing and shortness of breath. Once inhaled, the virus can reach the lungs and infect cells that line tiny blood vessels in the lungs, allowing fluid to enter and making it difficult to breathe, accordingto the American Lung Association.
Thirty-eight percent of people who develop respiratory symptoms die of the disease, according to the CDC.
HFRS is less deadly but still serious. It affects the kidneys and causes headaches, back and abdominal pain, fever, nausea and blurred vision. Later symptoms include low blood pleasure, internal bleeding and kidney failure. Fatality rates vary between less than 1 percent and up to 15 percent.
How common is it?
Hantaviruses are found all around the world, but outbreaks are rare. In 1993, a mysterious outbreak of severe respiratory illness originating in the Southwest killed about 30 people. The deaths were the first documented cases in the Americas of hantavirus disease in humans and triggered a public health response that has helped prevent other similarly sized outbreaks to date, The Washington Post reported.
Hantavirus was named as the cause of death for Betsy Arakawa, pianist and wife of actor Gene Hackman, last year.
There were 890laboratory-confirmed hantavirus cases in the United States between 1993, when the CDC began tracking the illness, and the end of 2023. More than 90 percent of those occurred west of the Mississippi River. It is commonly linked to people with occupational exposure, such as those working in construction, pest control, janitorial and agricultural work, the American Lung Association said.
Globally, there may be as many as 150,000 cases of HFRS each year, according to a review by the American Society for Microbiology.
Treatment options are limited, so the best protection against the illness is to avoid contact with rodents and to take care when cleaning their droppings, wearing a well-fitted N95 mask. Health officials also warnagainst vacuuming or sweeping contaminated areas to avoid releasing particles into the air.
What happens now?
The company said the WHO is coordinating the medical evacuation of two symptomatic people — a British national and a Dutch national — as well as a full public health risk-assessment and support to the remaining passengers. On board, passengers are isolating, and hygiene protocols are in place.
The ship operator said it had not received authorization from Cape Verdean authorities to bring ill guests on land for treatment, adding that local health authorities had visited the ship to assess their condition. In a news release Monday, the company said it is considering sailing to Las Palmas or Tenerife in Spain’s Canary Islands to disembark.
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