Hantavirus cluster linked to cruise ship journey, Multi-country

On 2 May 2026, WHO acquired notification from the National International Health Regulations (2005) (IHR) Focal Point of the United Kingdom of Great Britain and Northern Ireland (hereafter known as the United Kingdom) concerning a cluster of extreme acute respiratory sickness, together with two deaths and one critically sick passenger, aboard a Dutch-flagged cruise ship. On 2 May 2026, laboratory testing performed in South Africa confirmed hantavirus an infection in a single affected person who’s critically sick and in intensive care. On 3 May, one further loss of life was reported. An additional three suspected circumstances stay on board. As of 4 May, a complete of seven (two confirmed and 5 suspected) circumstances, together with three deaths, have been reported.

The vessel departed Ushuaia, Argentina, on 1 April 2026 and adopted an itinerary throughout the South Atlantic, with a number of stops in distant and ecologically numerous areas, together with mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena, and Ascension Island. The extent of passenger contact with native wildlife through the voyage, or previous to boarding in Ushuaia stays undetermined. The vessel carries a complete of 147 people, together with 88 passengers and 59 crew members. Onboard passengers and crew characterize 23 nationalities.  As of 4 May 2026, the vessel is moored off the coast of Cabo Verde.

Summary of circumstances:

Case 1: An grownup male developed signs of fever, headache, and gentle diarrhoea on 6 April 2026 whereas on board the ship. By 11 April, the case developed respiratory misery and died on board on the identical day. No microbiological exams had been carried out. The physique of the passenger was faraway from the vessel to Saint Helena (a British Overseas Territory) on 24 April.

Case 2: An grownup feminine, who was a detailed contact of case 1, went ashore at Saint Helena on 24 April 2026 with gastrointestinal signs. She subsequently deteriorated throughout a flight to Johannesburg, South Africa, on 25 April. She later died upon arrival on the emergency division on 26 April. On 4 May, the case was subsequently confirmed by PCR with hantavirus an infection. Contact tracing for passengers on the flight has been initiated.

Cases 1 and a pair of, had travelled in South America, together with Argentina, earlier than they boarded the cruise ship on 1 April 2026.

Case 3: An grownup male introduced to the ship’s physician on 24 April 2026 with febrile sickness, shortness of breath and indicators of pneumonia. On 26 April, his situation worsened. He was medically evacuated from Ascension to South Africa on 27 April, the place he’s at present hospitalised in an Intensive Care Unit (ICU). Laboratory testing on an in depth respiratory pathogen panel was unfavourable; nonetheless, polymerase chain response (PCR) testing confirmed hantavirus an infection on 2 May 2026. Serology, sequencing and metagenomics are ongoing.

Case 4: An grownup feminine, with presentation of pneumonia, died on 2 May 2026. The onset of signs was on 28 April, with fever and a basic feeling of being unwell.

Three suspected circumstances have reported excessive fever and/or gastrointestinal signs and stay on board. Medical groups in Cabo Verde are evaluating the sufferers and accumulating further specimens for testing.

Authorities from States Parties concerned within the administration of the occasion so far – Cabo Verde, the Netherlands, Spain, South Africa and the United Kingdom – have initiated coordinated response measures together with:

• Ongoing engagement between WHO and the National IHR Focal Points of Cabo Verde, the Netherlands, South Africa, Spain and the United Kingdom, to make sure well timed data sharing and coordination of response actions.
• WHO shared details about the occasions with National IHR Focal Points globally.
• Passengers onboard have been suggested to observe maximal bodily distancing and stay of their cabins the place attainable.
• Epidemiological investigations are underway to find out the supply of publicity.
• The National IHR Focal Point of Argentina shared the passenger and crew lists with the National IHR Focal Points of the respective international locations, in response to every individual’s nationality.
•  In line with the Working Arrangement between the WHO Emergency Medical Team (EMT) Secretariat and the EU Emergency Response Coordination Centre (ERCC), the EMT Secretariat has launched formal discussions to help the scientific administration and medical evacuation of symptomatic passengers.
• Logistic help has been offered, together with pattern assortment gadgets.
• Laboratory testing and affirmation of hantavirus an infection have been performed on the National Institute for Communicable Diseases (NICD) of South Africa. Serology, sequencing and metagenomics are ongoing.
• Additional laboratory samples from symptomatic passengers are being despatched, with WHO help, to the Institut Pasteur de Dakar, Senegal, for testing.
• WHO has activated three-level coordination and is supporting nationwide authorities in implementing risk-based, evidence-informed public well being measures in accordance with the provisions of the IHR and associated WHO technical steering paperwork.

Hantavirus cardiopulmonary syndrome (HCPS), also referred to as hantavirus pulmonary syndrome (HPS), is a zoonotic, viral respiratory illness brought on by hantaviruses of the genus Orthohantavirus, household Hantaviridae, order Bunyavirales. More than 20 viral species have been recognized inside this genus. In the Americas, Sin Nombre virus is the predominant reason for HPS in North America, whereas Orthohantavirus andesense is answerable for most circumstances in South America.

Human Hantavirus an infection is primarily acquired by contact with the urine, faeces, or saliva of contaminated rodents or by touching contaminated surfaces. Exposure usually happens throughout actions comparable to cleansing buildings with rodent infestations, although it could additionally happen throughout routine actions in closely infested areas. Human circumstances are mostly reported in rural settings, comparable to forests, fields, and farms, the place rodents are current, and alternatives for publicity are better. HPS is characterised by headache, dizziness, chills, fever, myalgia, and gastrointestinal issues, comparable to nausea, vomiting, diarrhoea, and stomach ache, adopted by sudden onset of respiratory misery and hypotension. Symptoms of HPS usually happen from 2-4 weeks after preliminary publicity to the virus. However, signs could seem as early as one week and as late as eight weeks following publicity.

Hantavirus infections are comparatively unusual globally.  In 2025 (as of epidemiological week 47), within the Region of the Americas, eight international locations reported 229 circumstances and 59 deaths with a CFR of 25.7%. ^[1] In the European Region, 1885 hantavirus an infection reported in 2023 (0.4 per 100,000), marking the bottom price noticed between 2019 and 2023.^[2] In East Asia, notably China and the Republic of Korea, Hantavirus haemorrhagic fever with renal syndrome (HFRS) continues to account for a lot of hundreds of circumstances yearly, though incidence has declined in current many years.

Hantavirus infections are related to a case fatality price of <1–15% in Asia and Europe and as much as 50% within the Americas. While there are not any particular remedy nor vaccines for hantavirus infections, early supportive care and fast referral to a facility with a whole ICU can enhance survival.

Environmental and ecological components affecting rodent populations can affect illness developments seasonally. Since hantavirus reservoirs are sylvatic rodents, transmission can happen when folks come into contact with rodent habitats.

Although unusual, restricted human‑to‑human transmission of HPS because of Andes virus has been reported in group settings involving shut and extended contact. Secondary infections amongst healthcare staff have been beforehand documented in healthcare amenities, although stay uncommon.

WHO at present assesses the danger to the worldwide inhabitants from this occasion as low and can proceed to observe the epidemiological state of affairs and replace the danger evaluation as extra data turns into out there.

WHO advises that States Parties concerned on this occasion proceed efforts in detection, investigation, reporting, case administration, an infection management, and public well being administration on board, together with ship sanitation measures, in shut coordination with the conveyance operator, to forestall and management infections brought on by hantaviruses.

In the context of the present outbreak, passengers and crew members ought to observe frequent hand hygiene, stay vigilant of Hantavirus signs and undertake lively symptom monitoring for 45 days.  Crew should guarantee satisfactory environmental cleansing (avoiding dry sweeping) and air flow within the ship. Passengers and crew members experiencing signs ought to inform medical professionals on board and self-isolate. If respiratory signs are current to observe respiratory etiquette and put on a medical masks.

Vigilance amongst travellers, crew, together with these concerned in implementing ship sanitation measures, or different personnel coming back from areas the place hantavirus is understood to be current, in addition to on conveyances engaged in eco-tourism on a journey from and thru these areas, is important.

Early recognition of suspected circumstances, immediate isolation, and constant adherence to really helpful an infection prevention and management measures stay important to guard healthcare personnel.

Diagnosis of HPS is with serologic testing for IgM or rising titres of IgG antibodies utilizing enzyme-linked immunoassay (ELISA) or with reverse transcriptase polymerase chain response (RT–PCR) to detect viral RNA.

In healthcare environments, commonplace precautions* must be utilized for all sufferers, together with hand hygiene and secure dealing with of blood and physique fluids. In addition to plain precautions, transmission-based precautions must be carried out for administration of suspect or confirmed circumstances. Standard precautions mixed with droplet precautions throughout shut contact are thought of adequate. Routine airborne precautions are usually not usually required, besides throughout aerosol‑producing procedures. ^[3]

When HPS is suspected, sufferers must be promptly transferred to an emergency division or intensive care unit for shut monitoring and supportive administration.

Initial administration ought to embody supportive care with antipyretics and analgesics as wanted. For confirmed hantavirus, antibiotics are usually not routinely indicated. However, earlier than a definitive analysis is established (and bacterial an infection is a diagnostic chance), or if superadded bacterial an infection is suspected, empiric broad-spectrum antibiotics could also be acceptable. Clinical administration depends totally on cautious fluid administration, hemodynamic monitoring, and respiratory help. Given the fast development of HCPS, shut monitoring and early switch to ICU are important for extra extreme circumstances. Mechanical air flow, meticulous quantity management, and vasopressors could also be required. For extreme cardiopulmonary insufficiency, extracorporeal mechanical oxygenation could also be lifesaving. In extreme circumstances of renal dysfunction, dialysis could also be required.

Although ribavirin has proven efficacy in opposition to hantavirus haemorrhagic fever with renal syndrome, it has not demonstrated effectiveness for HCPS and isn’t licensed for both remedy or prophylaxis of hantavirus pulmonary syndrome. At current, there isn’t a particular antiviral remedy accepted for HCPS.

Public well being consciousness efforts ought to deal with enhancing early detection, making certain well timed remedy, and decreasing publicity dangers. Preventive measures ought to handle occupational and ecotourism-related exposures, emphasize commonplace and transmission-based an infection prevention and management practices, and embody rodent management methods. Most routine tourism actions carry little or no threat of publicity to rodents or their excreta.

The potential for human-to-human transmission must be thought of in areas the place Andes and probably different South American hantaviruses are endemic.

Individuals participating in out of doors actions the place endemic transmission is understood, comparable to visiting rural areas, tenting or mountain climbing, ought to take precautions to minimise potential publicity to infectious supplies.

Risk communication and group engagement interventions ought to prioritize clear, well timed, and culturally acceptable communication to lift consciousness of hantavirus transmission dangers—notably publicity to rodent excreta in endemic areas—and promote sensible preventive behaviours comparable to secure meals storage, avoiding contact with rodents, wet-cleaning strategies (no dry sweeping), and correct air flow. Community engagement methods ought to contain native leaders and staff in high-risk occupations to co-develop and disseminate tailor-made messages, handle misinformation, and reinforce early care looking for.

Surveillance for HPS must be built-in right into a complete nationwide surveillance system and embody scientific, laboratory, and environmental elements. The implementation of built-in environmental administration methods geared toward decreasing rodent populations can also be really helpful.

*Standard precautions check with a set of practices which might be utilized to the care of sufferers, whatever the state of an infection (suspicion or affirmation), in anywhere the place well being providers are offered. These practices intention to guard each healthcare professionals and sufferers and embody hand hygiene, use of private protecting gear, respiratory hygiene and cough etiquette, secure dealing with of sharps supplies, secure injection practices, use of sterile devices and gear and cleansing of hospital environments and the surroundings. Adapted from “Standard precautions for the prevention and control of infections: aide-memoire”- WHO, 2022.  Available at

WHO advises in opposition to the applying of any journey or commerce restrictions based mostly on the present data out there on this occasion.