Risk statement
-- This risk assessment provides an updated analysis of the current situation related to the hantavirus outbreak associated with the cruise ship MV Hondius.
-- The initial rapid risk assessment was issued on 5 May 2026 to the National International Health Regulations (IHR) Focal Points via the secure Event Information Site.
-- The public health risk has been reassessed with the most current information available, and the global risk remains low.
-- The risk for passengers and crew who were onboard the cruise ship remains moderate, as individuals exposed prior to the implementation of control measures may still develop illness during the incubation period and should therefore be closely monitored.
-- This assessment takes into account that all the passengers have now disembarked and are under monitoring, although the ship continues with a reduced crew and a medical team to its home port.
-- It should also be noted that some passengers had disembarked in a limited number of other locations before the outbreak was identified and have likewise been placed under monitoring.
-- Additionally, identified passengers and crew members who travelled on associated flights are also under monitoring.
-- The assessment further considers identified risks, operational limitations, and the potential implications for ongoing public health response activities.
-- Globally, hantavirus infections are considered a serious but generally low-incidence public health threat, primarily associated with environmental exposure to rodents and their excreta, with limited but important outbreak potential in specific geographic regions.
-- There are several variants of hantavirus, but Andes virus is the only hantavirus to have documented human-to-human transmission, which has been observed mainly in outbreaks in southern Argentina and Chile.
-- Hantavirus infection caused by Andes virus may cause hantavirus pulmonary syndrome (HPS; also called hantavirus cardiopulmonary syndrome, HCPS) and may lead to rapidly progressive severe respiratory distress and cardiogenic shock.
-- The case fatality rate (CFR) can reach up to 50%.
-- There is currently no approved antiviral treatment, and early clinical management remains primarily supportive.
-- The current event is related to the notification on 2 May 2026, by the United Kingdom IHR National Focal Point to WHO of a cluster of severe acute respiratory illness cases aboard the Dutch-flagged cruise vessel MV Hondius.
-- The cluster initially included two deaths and one critically ill passenger, with the cause unknown at the time of notification.
-- On the same day, laboratory testing confirmed hantavirus infection in the critically ill passenger hospitalised in Johannesburg, South Africa.
-- Confirmation that the outbreak was caused by Andes virus was subsequently obtained on 5 May 2026 at the Geneva University Hospitals (HUG) laboratory in Geneva from a passenger that had disembarked earlier from the ship and returned to his home country with presentation of symptoms.
-- The vessel departed from Ushuaia, Argentina on 1 April 2026, with 114 passengers and 61 crew, and followed an itinerary across the South Atlantic, including multiple stops in remote and ecologically diverse regions such as mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena, and Ascension Island.
-- During this period several passengers disembarked and embarked the ship at different stops, resulting in a total of 187 persons who were on the ship at some point during the journey.
-- From 11 April to 2 May, three passengers died.
-- On 3 May, MV Hondius moored off the coast of Cabo Verde where local health authorities visited the vessel to assess the condition of two remaining symptomatic individuals. These individuals and a high-risk contact were evacuated from the ship on 6 May, and the ship continued to the Canary Islands, Spain.
-- The vessel arrived at the port of Granadilla, in Tenerife, Canary Islands, on 10 May, carrying 150 individuals, including 86 passengers, 60 crew members, and 4 health professionals from WHO, ECDC and the Netherlands. Passengers and crew represented 25 nationalities: Argentina, Australia, Belgium, Canada, the Democratic Republic of the Congo, France, Germany, Greece, Guatemala, India, Italy, Ireland, Japan, Montenegro, the Netherlands, New Zealand, Philippines, Poland, Portugal, the Russian Federation, Spain, Türkiye, Ukraine, the United Kingdom, and the United States.
-- Passengers and most of the crew disembarked on 10 and 11 May and were repatriated to their respective countries of residence or transit points via specially arranged non-commercial flights, with WHO and partners supporting the disembarkation process. The ship left the Canary Islands on 11 May and is sailing to the Netherlands, with 25 crew members remaining on board, along with two Dutch health care workers to conduct their health monitoring and provide any healthcare that may be necessary.
-- As of 15 May 2026, 10 cases (eight confirmed, and two probable cases), including three deaths (two confirmed and one probable), have been reported (CFR 30%). The contact from the United States of America that was previously reported as inconclusive has now been determined to be negative by serology.
-- Of the eight laboratory-confirmed cases, three were genetically sequenced and identified as Andes virus.
-- Since the last RRA published on 5 May 2026, two additional confirmed cases (France=1, Spain=1) have been reported among the passengers. No secondary cases have been reported outside of the ship.
• Epidemiological investigations traced the travel history of the first two cases, a couple who had spent approximately five months birdwatching across South America. This included visits to several areas where Oligoryzomys are known to occur and includes areas where Andes cases have been recorded in the past. Evidence suggests subsequent human-human transmission onboard the ship. This is also supported by a preliminary analysis of the sequences, which show a near-identical sequence from different cases.
• Andes virus outbreaks that human-to-human transmission is limited, tends to remain clustered, and generally requires prolonged exposure. It can also be rapidly contained with control measures in place. However, infectious diseases pose an increased risk on cruise ships due to close living quarters, shared enclosed spaces, prolonged exposure, and frequent interpersonal contact, all of which can facilitate transmission. As a result, additional sporadic cases may still occur among previously exposed passengers and crew members.
• While additional cases may still occur among passengers and crew members exposed before containment measures were implemented, the risk of onward transmission is expected to be reduced following disembarkation and the implementation of control measures, including rapid identification and isolation of suspected cases. There is no approved antiviral treatment for HPS; suspected cases require prompt medical evaluation, close monitoring, and supportive management, including intensive care where necessary.
-- Consequently, the overall risk at the global level remains assessed as Low.
-- The epidemiological situation will continue to be monitored, and the risk assessment will be updated as needed.
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