What we know about the hantavirus cases tied to the deadly cruise ship outbreak

Health officials around the world are monitoring the deadly situation hantavirus outbreak linked to the Dutch-flagged cruise ship. So far, there are 10 confirmed or suspected cases linked to the ship, including three deaths.

Hantaviruses are a family of rare viruses that are often transmitted to humans through contact with contaminated rodent droppings or saliva. They often present with symptoms of pulmonary and respiratory distress that can be severe, according to the US Centers for Disease Control and Prevention. The strain identified in the M/V Hondius outbreak is called Andes virus, the only known human-to-human hantavirus. Infection occurs through prolonged contact, health officials said.

Investigations, contact tracing efforts and isolation procedures were ongoing in many countries where citizens were returning after sailing at the stop at the end of April, as well as the people on the flight with a confirmed case, said the World Health Organization.

The other passengers of the cruise ship disembarked after you boarded Canary Islands in Spain. They were carefully de-nationalized and placed return flights home.

New cases have emerged in the days since the passengers returned to their countries, although health officials around the world continue to reassure the public that the risk to them remains low.

Here’s what you need to know about the confirmed or suspected cases so far.

A Dutch couple are believed to be the first cases

Oceanwide Expeditions said a 70-year-old Dutch man died on the ship on April 11. He had symptoms less than a week ago, on April 6, WHO Director-General Tedros Adhanom Ghebreyesus said on May 7.

Because his symptoms were similar to other respiratory infections, hantavirus was not suspected at the time of his death, and no samples were taken, Tedros said. However, it is now believed to be the first case of hantavirus on a ship.

The man’s wife, 69, left the ship on April 24 when it docked in Saint Helena, a remote British Island in the Atlantic Ocean where a number of other passengers also disembarked. He died two days later in South Africa, after his condition “became worse during the flight to Johannesburg,” the WHO said. His blood later tested positive for the Andes strain of hantavirus.

Before boarding the ship on April 1, the Dutch couple had gone on a bird-watching trip through Argentina, Chile and Uruguay, visiting areas where there was a species of rat known to carry the Andes virus, according to the WHO.

Tracing procedures were in place for others on the wife’s flight from Saint Helena to Johannesburg, Tedros said. He also told reporters that the WHO was cooperating with the countries of some of the citizens of Saint Helena.

The British passenger has been hospitalized in South Africa

On April 24, an elderly man from the United Kingdom presented to a cruise ship doctor with respiratory symptoms and other symptoms of pneumonia, according to the WHO.

His symptoms worsened on April 26, so the passenger was evacuated by doctors the next day from Ascension Island to South Africa, where he remained in the hospital’s intensive care unit. Tests confirmed that the man had Andes virus, South African health officials and the WHO said.

Maria Van Kerkhove, WHO’s director of epidemiology and pandemic preparedness and prevention, said on May 7 that the man’s health was improving after officials described him as critically ill.

A German woman died on board

Another passenger, a German, died on the Hondius on May 2, officials said. According to the WHO, the woman first had a fever on April 28 and ended up with pneumonia symptoms.

Samples collected from him before his death tested positive for hantavirus, the WHO said on May 15.

2 workers are being treated in the Netherlands

Officials say three people were medically evacuated from the ship on May 6 and May 7, and headed to the Netherlands for help.

Tests confirmed that two of them – the ship’s doctor and the ship’s director – contracted the hantavirus. The Dutch and British nationals had shown symptoms of the virus before they left, and both tested positive. Oceanwide Expeditions initially described their conditions as critical, but Van Kerkhove said the WHO had learned that both were in stable condition as of May 7. They were all placed in isolation.

A third person, a German passenger who was close to a German woman who died on May 2, was released as a suspected case, but later tested negative for the Andes virus, according to the ferry operator and the WHO.

A Swiss man has been tested positive for HIV

A Swiss man who disembarked in Saint Helena tested positive for the Andes strain of hantavirus, according to Swiss and WHO health officials. The man developed symptoms and was evaluated in Zurich, where he is receiving care, officials said on May 6.

The man’s wife, who was traveling with him, was not showing symptoms, but was self-isolating as a precaution, Swiss health officials said.

Alleged case against Tristan da Cunha

The British nation of Tristan da Cunha, a remote group of islands that are part of the British Overseas Territory that includes Saint Helena, is another suspected case, UK officials said on May 8. The person got off the ship, the UK Health Security Agency said.

The ship stopped at Tristan da Cunha between April 13 and 16, Oceanwide Expeditions said. At this time, one crew member disembarked and six passengers joined the ship, the company said.

The Spanish passengers were diagnosed with HIV

A Spanish passenger on board has tested positive for the virus, the Spanish Ministry of Health announced on May 12. The person was placed in isolation at a military hospital in Madrid – the same hospital where 13 other Spaniards on board were kept, the Associated Press reported. Those 13 all tested negative for hantavirus.

A French woman has been tested positive for HIV

A 65-year-old French woman who was on a cruise ship tested positive for hantavirus and was hospitalized in intensive care on May 12, infectious disease expert Xavier Lescure said at a French Health Ministry briefing. He had developed a “severe form” of heart disease linked to the virus and was receiving oxygen through artificial lungs, according to Lescure.

France’s prime minister earlier said one citizen began showing symptoms of hantavirus during a flight home. All five passengers on the flight were “immediately isolated until further notice,” and will be tested, he said on social media.

The American test is negative

An American who “had a partial PCR test positive for Andes virus” on the ship later tested positive in the US and was no longer included in the WHO’s case count, officials said.

Person – one of 17 Americans and one British citizen who arrived in flight home early Monday, May 11 – was taken to the Nebraska Biocontainment Unit University of Nebraska Medical Center for further testing.

On May 13, that person was medically cleared to move to the National Quarantine Unit, where 15 other passengers were taken for symptomatic treatment, Nebraska Medicine said.

Officials did not identify the person, but Dr. Stephen Kornfeld confirmed to CBS News on May 13 that he tested positive and was moved from the biocontainment unit to the isolation unit at the University of Nebraska Medical Center. An oncologist from Bend, Oregon, was aboard the MV Hondius and helped care for other sick passengers, the Associated Press reported.

Those in the isolation unit were asymptomatic, said Michael Wadman, medical director of the isolation unit, on May 13.

Two other American passengers, one of whom had some symptoms, were I flew to Emory University Hospital in Atlanta care and testing, Brendan Jackson, acting director of the CDC’s Division of High Consequence Pathogens and Pathology, said on May 11. The symptomatic person later tested negative for hantavirus, he said.

International monitoring efforts

The WHO is in contact with officials in at least 12 countries that are monitoring citizens who have returned home after the ship disembarked in Saint Helena, before the outbreak became known, Tedros said. Those countries include Canada, Denmark, Germany, the Netherlands, New Zealand, Saint Kitts and Nevis, Singapore, Sweden, Switzerland, Turkey, the United Kingdom and the United States.

In the US, the CDC said on May 14 it is monitoring 41 people for exposure to hantavirus. That includes 16 from the University of Nebraska Medical Center, two from Emory University Hospital, seven who left the ship early and others who may have been exposed during the flights.

Health departments in several states, including Arizona, California, Georgia, New Jersey, Texas, and Virginia, had previously said they were monitoring people who may have been exposed. None of them showed symptoms, said health departments.

A WHO official confirmed to CBS News on May 8 that a KLM flight attendant, who met the boaters and was hospitalized in the Netherlands for observation, has tested negative for hantavirus.

French Health Minister Stephanie Rist said 26 people in France may have tested positive for the virus on May 14 but will continue to be isolated in hospital and tested three times a week. Rist said early referrals “may be ruled out for now,” and health officials will no longer share public updates on an isolated group unless someone tests positive for HIV.

Earlier, the Ministry of Health in France said it had identified 22 people who may have met the Dutch woman who died in South Africa. That included eight French people who took the same flight as the one she took from Saint Helena to Johannesburg, and 14 others who took a different flight that the Dutch woman boarded briefly before being removed from the flight because of her symptoms.