The World Health Organization (WHO) said today that it suspects there has been a rare human-to-human transmission of hantavirus on a luxury cruise ship with seven confirmed or suspected cases, Reuters reported.
Human-to-human transmission is not common, and the WHO, the United Nations (UN) health agency, has reiterated that the risk to the wider population is low, as the disease is usually transmitted from contact with infected rodents.
Reuters reports that officials said a Dutch couple and a German national had died, and that a British national had been evacuated from the ship and was in intensive care in South Africa.
Two crew members require urgent medical attention, the operator of the Dutch-flagged MV Hondius said. The second person on board, who is a suspected case, reported only a mild fever.
The Institute of Public Health (IJZ) announced earlier today that there is also a Montenegrin citizen on the cruise ship, and that he is not ill and is in good health.
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The Dutch are preparing medical evacuations
The Dutch Foreign Ministry said it was preparing a medical evacuation of three people from the ship, which is currently docked off Cape Verde. The island nation in the Atlantic Ocean off West Africa was supposed to be the ship's final destination, but has not allowed the ship to disembark passengers due to an outbreak.
The operator of the MV Hondius, Oceanwide Expeditions, announced today that two specialized medical evacuation planes are en route to Cape Verde, adding that they do not have an exact timeframe.
It was still unclear when and where the nearly 150 other people still on board would disembark, although the company said it was in talks with authorities in Gran Canaria and Tenerife to have the ship dock there. The two Canary Islands are a three-day sailing distance from Cape Verde, it said.
Spain's health ministry had previously said it saw no need to stop the ship in the Canary Islands if everyone who was sick had been evacuated to Cape Verde, unless new cases emerged. A ministry spokesman declined to comment, and the head of the Canary Islands' regional government said the most sensible course of action was to return the ship to the Netherlands.
WHO: We know you're scared.
People usually become infected with hantavirus through contact with infected rodents or their urine, feces, or saliva.
However, limited spread among close contacts has been observed in some previous outbreaks with the Andean strain, which is spreading in South America, including Argentina, and which the WHO believes may be involved in this case. Testing is ongoing. The Hondius left Ushuaia, a city in southern Argentina, in March.
The WHO said it was informed that there were no rats on the ship.
"We believe that there can be human-to-human transmission among really close contacts, between a husband and wife, people who shared cabins," Maria Van Kerkhove, director of epidemic and pandemic preparedness and prevention at the WHO, told reporters in Geneva.
Van Kerkove said the focus is now on evacuating the two sick passengers still on board and then continuing the ship towards the Canary Islands.
"We've heard from quite a few people from the ship. We just want you to know that we're working with the ship operators. We're working with the countries that you're coming from. We hear you, we know you're scared," she said, adding that they're working hard to get people home safely.
The UN health organization said the working assumption was that the Dutch couple were infected before boarding the cruise ship in Argentina.
Other people could also have been infected while on bird-watching trips to islands where the birds and rodents live, they added.
The journey began in southern Argentina
Hondius is carrying mostly British, American and Spanish passengers on the luxury cruise ship that set off from the southern tip of Argentina in late March. The cruise ship visited the Antarctic Peninsula, South Georgia and Tristan da Cunha – some of the most remote islands on the planet.
The trip was marketed as an expedition into the Antarctic wilderness, and cabin prices ranged from 14.000 to 22.000 euros.
The first passenger to fall ill, a Dutchman, died on April 11. His body remained on the ship until April 24, when it was "disembarked on St. Helena, accompanied by his wife who was with him during the repatriation," Oceanwide Expeditions said.
His wife, who had gastrointestinal symptoms when she disembarked, later deteriorated on the flight to Johannesburg. She died upon arrival at the emergency room on April 26, the WHO said, adding that contact tracing was ongoing for passengers on that flight.
South African authorities have confirmed that a British patient being treated at a Johannesburg hospital has tested positive for hantavirus. The Netherlands has confirmed that the virus was found in a Dutch woman who died.
South Africa's National Institute for Communicable Diseases is working to sequence the virus, with results expected by Wednesday, Van Kerk said.
Argentina still has the most cases in the Americas region, the WHO said in December, with a fatality rate of about 32%, higher than the average and other strains of the virus.
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