Hantavirus outbreak linked to cruise ship journey, Multi-locations

On 2 May 2026, in accordance with the International Health Regulations (2005) (IHR), WHO acquired a notification from the National IHR Focal Point (NFP) of the United Kingdom of a cluster of extreme acute respiratory sickness aboard the Netherlands-flagged cruise ship M/V Hondius, with additional particulars quickly notified authorities within the Netherlands and South Africa.

As of two July, a complete of 13 instances (12 confirmed and one possible case), together with three deaths (two confirmed and one possible), have been reported globally linked to the cruise ship. The case fatality ratio for this outbreak thus far is 23%. Since the final Disease Outbreak News was revealed on 28 May 2026, ANDV an infection was laboratory confirmed in a possible case in Tristan da Cunha who developed indicators and signs after disembarkation from the cruise ship. The early detection and isolation of the case prevented additional transmission of the virus, however the restricted diagnostic capacities on the island delayed the affirmation of the case till a pattern was shipped and examined within the United Kingdom. The affected person has recovered and has been discharged.

Among the confirmed instances admitted to hospital, eight have recovered and been discharged, whereas two, one in South Africa and one in France, proceed to be hospitalized. All 13 instances are amongst individuals who travelled on board the M/V Hondius.

Figure 1. Epidemiological curve of Andes hantavirus instances (n = 13) reported to WHO as of two July 2026. 

Nine of the reported instances have been males, and 4 have been females. The median age was 65-years-old (IQR 56-70), just like the median age of the passengers onboard the ship (Figure 2). The ages of the three deceased instances have been 69, 70 and 79-years-old.

Figure 2. Age and intercourse distribution of Andes hantavirus instances (n = 13) reported to WHO as of two July 2026.

Currently obtainable info means that an infection of preliminary instances was seemingly acquired on land previous to embarkation, though the precise supply and route of publicity stay undetermined, with subsequent human-to-human transmission occurring aboard the vessel. Investigations stay underway to ascertain the circumstances and supply of the outbreak, together with genomic sequencing of ANDV samples from surveillance instances in Chile and Argentina, and might be revealed as quickly as these can be found.

This outbreak was managed via a coordinated worldwide response, which included complete epidemiological investigations, case isolation and scientific administration, medical evacuations, laboratory testing, repatriation of passengers and crew from the ship and worldwide contact tracing, in addition to quarantine and monitoring measures.

Contact identification and follow-up of contacts of hantavirus instances linked to the cruise ship has been performed in 33 nations and abroad territories. This included passengers and crew onboard the ship, contacts of the case on Tristan da Cunha, contacts from two totally different worldwide flights, healthcare employees and airport crew who assisted instances earlier than the detection of the outbreak. As of two July 2026, 317 high-risk contacts have accomplished quarantine and monitoring by native well being authorities within the nations and territories the place they have been repatriated, evacuated or recognized. Some 336 low-risk contacts accomplished self-monitoring in keeping with the up to date steerage on administration of contacts of Andes virus (ANDV) instances from the MV Hondius cruise ship revealed on 17 May 2026. 

Hantavirus illness is a zoonotic viral illness attributable to hantaviruses of the genus Orthohantavirus, household Hantaviridae, order Elliovirales, class Bunyaviricetes. More than 20 viral species have been recognized inside this genus. 

Human hantavirus an infection is primarily acquired via contact with the urine, faeces, or saliva of sure species of (particular) contaminated rodents, or by touching contaminated surfaces. Exposure sometimes happens throughout actions resembling cleansing buildings with rodent infestations, although it might additionally happen throughout routine actions in closely infested areas. Human instances are mostly reported in rural settings, resembling forests, fields, and farms, the place rodents are current and alternatives for publicity are larger.

Limited human-to-human transmission has at the moment solely been reported for hantavirus pulmonary syndrome (HPS) related to ANDV virus an infection. ANDV is endemic in South America, with confirmed circulation and human infections reported primarily in Argentina and Chile, and extra instances and associated strains recognized in Uruguay, southern Brazil, and Paraguay.

Andes virus transmission between people

Based on the obtainable info and the present observations of the present outbreak, restricted human-to-human transmission of ANDV is understood to happen. However, no large-scale human-to-human outbreaks have been noticed traditionally.^[1] ANDV circulates in particular species of rodents within the Americas, and there have been many sporadic instances reported in Argentina and Chile that haven’t led to onward transmission.^[2]  Clusters of human instances have been reported in a number of previous outbreaks and have been sometimes related to shut and extended interactions, usually in shared indoor environments resembling households.  The largest reported outbreak of ANDV was reported in Argentina in 2018-2019,² the place excessive viral titres together with attendance at giant social gatherings or intensive contacts amongst individuals have been related to increased transmission.  While the obtainable proof means that there are a number of modes of transmission that happen with ANDV, the likelihood of onward transmission between people stays low.

Initial epidemiological investigation and the genomics evaluation^[3] of the recognized instances present that on this outbreak of ANDV an infection, human-to-human transmission has occurred on the ship. While detailed info on the interplay between instances or with a contaminated atmosphere aboard the ship is at the moment not obtainable, these actual modes of transmission may be elucidated by upcoming outcomes from an in-depth epidemiological investigation, in addition to publication of the environmental sampling carried out after the disembarkation.  

Response actions operated beneath the idea that ANDV transmission:

• might have included contact with an contaminated particular person or contaminated surfaces;
• and/or through-the-air transmission (through direct deposition of infectious respiratory particles onto uncovered facial mucosal surfaces—mouth, nostril, or eyes);
• and/or airborne transmission (through inhalation of infectious respiratory particles).

Given the assault fee among the many ship passengers, in addition to the absence of secondary instances amongst contacts off the ship, the virus didn’t exhibit transmission dynamics in keeping with extremely transmissible airborne pathogens (resembling measles).

Authorities from States Parties managing instances and/or contacts, WHO, and companions such because the European Centre for Disease Prevention and Control have coordinated response measures, together with:

• Ongoing engagement between WHO and the NFPs of nations managing instances and/or contacts ensured well timed info sharing and coordination of response actions.
• International contact tracing and follow-up of contacts was performed by native well being authorities in keeping with nationwide preparations.
• WHO requested common info sharing and periodic updates from States Parties via IHR channels relating to the follow-up of contacts and their well being standing.
• Ongoing epidemiological investigations to outline epidemiological hyperlinks between instances and publicity components on the ship, as effectively as to attempt to perceive the potential supply of publicity.
• A potential pure historical past examine designed to enhance understanding of Andes virus (ANDV) transmission dynamics, incubation durations, immune responses, viral kinetics, and the determinants of extreme illness via harmonised longitudinal follow-up of uncovered people. The examine makes use of a standardised potential protocol applied throughout 21 taking part nations.^[4]
• WHO developed and revealed particular technical steerage paperwork to help response to the occasion, together with:

• The NFPs of nations managing instances and/or contacts have been exchanging passenger- and crew-related info.

• WHO supplied threat communication coordination and help, ensured well timed evidence-based info sharing, activated the coordination mechanisms throughout the three organizational ranges, and supported nationwide authorities in implementing public well being measures, together with in accordance with IHR provisions.
• WHO convened common Member State briefings, skilled discussions overlaying key technical, laboratory, scientific care and an infection prevention and management (IPC) matters, and world webinars through the EPI-WIN information platform to facilitate expertise sharing and coordinate help.
• WHO supported the event of analysis protocols with nationwide and worldwide companions and deliberate a hantavirus session on medical countermeasures.
• WHO coordinated the distribution of the laboratory testing and reference supplies made obtainable by Chile and Argentina, in addition to diagnostic protocols and data on obtainable take a look at kits and their efficiency.

The ANDV outbreak related to the MV Hondius cruise ship not poses a public well being threat and no additional associated transmission is predicted.  ANDV stays endemic in South America, and it’s related to hantavirus pulmonary syndrome with substantial case fatality, its transmissibility stays restricted, sometimes requiring shut and extended publicity, and tends to end in temporally and spatially restricted clusters.

While the confined maritime atmosphere of this occasion seemingly facilitated transmission throughout the voyage, epidemiological and genomic proof helps some extent supply outbreak, originating both from contact with an contaminated animal or contaminated particular person, adopted by restricted chains of human-to-human secondary transmission, with out proof of sustained transmission.

The completion of the 42-day follow-up interval for all recognized contacts with out additional detection of further secondary instances demonstrates efficient interruption of transmission and confirms outbreak containment. Additionally, IPC measures proceed to be utilized for the administration of the 2 instances nonetheless hospitalized.

WHO advises all nations to maintain robust engagement and collaboration to doc and be taught from this outbreak response, together with each successes and operational challenges, and to use the teachings recognized to strengthen preparedness, surveillance together with worldwide tracing and observe up of contacts, scientific care, IPC, threat communication, and response capacities for future public well being emergencies.

WHO additional encourages the continuation of epidemiological, scientific, laboratory, and ecological research to raised perceive the outbreak, its transmission dynamics, threat components, and determinants of illness severity.

In areas the place hantavirus is endemic, WHO recommends strengthening measures to stop and management transmission via enhanced surveillance, public consciousness, environmental administration, discount of publicity to rodent reservoirs and contaminated environments, and early detection, implementation of IPC measures and administration of instances.

WHO additionally encourages continued funding in analysis and growth to advance the provision of efficient diagnostics, therapeutics, and vaccines, and to enhance preparedness and response capabilities for future hantavirus outbreaks.

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