Officials said Americans who traveled on the MV Hondius are in quarantine facilities in Nebraska and Georgia as the hantavirus outbreak tied to the cruise ship reached 11 total reported cases, including three deaths. The machinery of public health is now managing the fallout from a cruise ship outbreak that has already killed three people, while passengers are held in facilities in the United States and the risk is described as low for everyone else.
Who Gets Held, Who Gets Managed
Eighteen American citizens, including one British dual national, disembarked the ship off Tenerife, Spain, on May 10 before returning to the United States. Most went to the University of Nebraska Medical Center, including 15 people staying in standard quarantine units and one in the center's biocontainment unit. Two passengers, a couple, were taken to a biocontainment unit at Emory University in Atlanta. Officials from the Centers for Disease Control and Prevention said at a May 11 news conference that the two were moved to preserve space at the Nebraska biocontainment unit. The CDC confirmed two passengers are still at Emory in Atlanta.
All Americans in quarantine at the University of Nebraska were asymptomatic as of May 12, according to the Department of Health and Human Services. One of the two passengers sent to Atlanta was initially symptomatic but tested negative for the Andes variant as of May 12, HHS said. HHS also said one American passenger initially tested "mildly" positive for hantavirus after evacuating the ship, and officials said the person would undergo further testing. The individual had initially given two specimens for testing, which led to one negative result and one positive result, Capt. Brendan Jackson, physician and acting director of the CDC’s Division of High-Consequence Pathogens and Pathology, said during a news conference at the University of Nebraska on May 11. Spain's Ministry of Health said on May 13 that the American with an "inconclusive" test had now tested negative. Dr. Stephen Kornfeld, an American passenger on the MV Hondius, told CNN he was the individual with the "mildly" positive test result. Kornfeld said he stepped in as the ship's doctor in April before eventually starting to experience symptoms himself. He recovered, but was tested alongside other ship staff in early May. When two passengers were evacuated to the Netherlands, one of Kornfeld's test samples was also sent to two labs, which turned up different results. "One lab was negative and one lab was faintly positive, so I was told the test was intermediate, but I think since it wasn't a negative, it's sort of being looked at as a potential positive," he said. Kornfeld said he is currently quarantining in the Nebraska biocontainment unit.
The Human Cost at the Bottom
A French woman who was in intensive care on Tuesday is now on lung support, according to multiple reports. French Health Minister Stéphanie Rist said Tuesday that the woman, infected with Andes virus, was one of five French nationals repatriated from the ship. The woman is being treated with an artificial lung, a doctor at the Paris hospital caring for the sickened passenger said Tuesday. Dr. Xavier Lescure, an infectious disease specialist at Bichat Hospital, said the passenger has a severe form of the disease that has caused life-threatening lung and heart problems. The life-support device pumps blood through an artificial lung, providing it with oxygen and returning it to the body, and is hoped to relieve enough pressure on the lungs and heart to give them time to recover. Lescure called it "the final stage of supportive care." NPR reported that the outbreak had reached 11 total reported cases, 9 of which were confirmed, and said the French woman was critically ill and being treated with an artificial lung. NPR also reported that three people on the cruise died, including a Dutch couple that health officials believe were the first exposed to the virus while visiting South America.
The World Health Organization said confirmed and suspected cases have only been reported among the cruise ship's passengers or crew. WHO Director-General Tedros Adhanom Ghebreyesus said, "At the moment, there is no sign that we are seeing the start of a larger outbreak. But of course the situation could change, and given the long incubation period of the virus, it's possible we might see more cases in the coming weeks." He also said the latest person confirmed to be infected is a Spanish passenger who tested positive after being evacuated from the ship and was in quarantine at a military hospital in Madrid.
What the Authorities Are Doing
Officials said this was the first hantavirus outbreak on a cruise ship. The MV Hondius is sailing back to the Netherlands, where it will be cleaned and disinfected. A total of 87 passengers and 35 crew were escorted from the ship to shore in Tenerife by personnel in full-body protective gear and breathing masks in an effort that ended Monday night. Two aircraft arrived in Eindhoven overnight carrying Dutch nationals as well as passengers from Australia and New Zealand and crew members from the Philippines, and all were placed into quarantine, according to the Dutch government. Some crew stayed aboard the ship and set course for the Dutch port city of Rotterdam, said ship operator Oceanwide Expeditions.
Hantavirus usually spreads from rodent droppings and is not easily transmitted between people, but the Andes virus detected in the cruise ship outbreak may be able to spread between people in rare cases. Symptoms can include fever, chills and muscle aches and usually show between one and eight weeks after exposure. WHO chief Tedros advised that returning passengers should stay in quarantine, either in their homes or in other facilities, for 42 days, and said WHO cannot enforce its guidance and that different countries may handle the monitoring of passengers without symptoms in different ways.
Argentina's health ministry said Tuesday a team of scientific experts will be dispatched in the coming days to investigate the origin of the outbreak. Argentine officials said the Dutch couple identified by the WHO as the first cruise passengers infected with hantavirus spent several months in Argentina and neighboring South American countries before boarding the cruise ship. The husband and wife later died. Argentine officials said the couple took a bird-watching tour that included a stop at a garbage dump where they may have been exposed to rodents carrying the infection. The health ministry said its team will investigate the landfill and other locations the couple visited where rats known to carry the virus are found, although local officials in the province where the cruise departed have challenged the theory it began there.
The Illinois Department of Public Health said it is investigating a potential case of hantavirus in an Illinois resident not linked to the cruise ship outbreak. The CDC is conducting additional testing to confirm the resident is positive for hantavirus, and the health department said it is believed the individual acquired the virus while cleaning a home where rodent droppings were present. CDC staff told IDPH that a confirmatory test result could take up to 10 days.