The cruise ship Hondius, at the centre of a hantavirus outbreak, is likely to dock in the Canary Islands where Spanish authorities will assess passengers, disinfect the ship and conduct a full epidemiological investigation.

This is according to Maria van Kerkhove, director of the World Health Organization’s (WHO) Department of Epidemic and Pandemic Preparedness and Prevention, at a media briefing in Geneva on Tuesday.

Meanwhile, arrangements are being made for two crew members with symptoms of the potentially fatal virus to be medically evacuated to the Netherlands, along with a third person travelling with the passenger who died onboard on 2 May.

The crew members have “acute respiratory symptoms, one mild and one severe”, according to cruise operator Oceanwide Expeditions. All 149 people on board have been asked to remain in the cabins as a precaution.

The WHO has deemed the global threat posed by the outbreak to be “low”, based on how the virus spreads.

Seven passengers are suspected of having contracted the virus although laboratory tests have only confirmed it in two of the cases. Three passengers have died. A passenger was medically evacuated to South Africa where he is in intensive care. and two others are ill on board. The seventh originally had a fever but now appears asymptomatic, said Van Kerkhove.

“Illness onset occurred between 6 and 28 April 2026 and was characterised by fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome and shock.,” according to the WHO.

There is no specific treatment, and a high case fatality rate of up to 50% for the hantavirus found in the Americas, but “early supportive medical care is key to improving survival”, according to the WHO.

Human-to-human transmission is ‘uncommon’

People usually contract hantaviruses from exposure to the urine, droppings or saliva of infected rats. Human-to-human transmission is “uncommon”, but it has been documented in Argentina involving the Andes virus, a species of the hantavirus, according to Van Kerkhove.

The virus spreads between humans in “very close physical contact”, said Van Kerkhove.

“When you have an enclosed settings, you have people that are spending a lot of time together. These types of things can happen,” she added.

The Andes virus is found in Argentina, where the cruise ship began its voyage. It is thus possible that the index passenger was infected before he embarked, rather than on the ship.

The first passenger to die was a  70-year-old male passenger “who suddenly became ill in the ship en route from Ushuaia to St Helena Island, and presented with fever, headache, abdominal pain, and diarrhoea”, according to the South African Department of Health.

He died on arrival at St Helena. His 69-year-old wife flew to South Africa from St Helena, but collapsed at Johannesburg airport and later died at a nearby health facility.

“The initial case and his wife joined the boat in Argentina, and with the timing of the incubation period of hantavirus, which can be anywhere from one to six weeks, our assumption is that they were infected off the ship,” said Van Kerkhove.

The third patient, a British national, became ill while the ship was travelling from St Helena to Ascension, and was flown to a private health facility in South Africa. He has been confirmed with hantavirus and is in a “critical condition in isolation”.

Hantavirus infection was confirmed in two of the patients by South Africa’s National Institute for Communicable Diseases (NiCD). Further tests, including sequencing of the virus, is being conducted by NiCD, as well as well as testing the two symptomatic patients on board with the support from Institut Pasteur of Dakar in Senegal. 

Van Kerkhove described the collaboration with member states as “excellent”.

The WHO was informed of “a cluster of severe acute respiratory illness” aboard the ship by the UK on 2 May, in terms of the International Health Regulations.

The timeline issued by Oceanwide Expeditions is as follows:

• On 11 April, a passenger died on board. The cause of death could not be determined.
• On 24 April, his body was disembarked on St Helena, with his wife accompanying the repatriation.
• On 27 April, Oceanwide Expeditions was informed that the wife had become unwell during the return journey and had later died. Both passengers were Dutch nationals. On 4 May,  a variant of hantavirus was confirmed in the woman.
• On 27 April, another passenger became seriously ill and was medically evacuated to South Africa. This person is currently being treated in the intensive care unit in Johannesburg and is in a critical but stable condition. This passenger is of British nationality. A variant of hantavirus has been identified in this patient.
• On 2 May, another passenger on board died. The cause has not yet been established. This passenger was of German nationality.

Image Credits: Oceanwide Expeditions.