Expedition #cruises, island hopping, and #zoonotic #risk: #governance and operational lessons from the MV #Hondius #Andes hantavirus outbreak

 

Abstract

The Andes orthohantavirus outbreak linked to the MV Hondius expedition cruise illustrates how a probable land-based zoonotic exposure can become a multinational public health event when it intersects with enclosed shipboard environments, delayed clinical recognition, remote navigation, medical evacuation, and international passenger dispersal. Although hantavirus infection is classically associated with exposure to infected rodents or contaminated environments, Andes virus is exceptional among orthohantaviruses because limited person-to-person transmission has been documented, particularly after close and prolonged contact. This Perspective uses the MV Hondius outbreak as an analytical case study to identify governance and operational gaps in expedition-era travel medicine. Existing International Health Regulations, WHO ship-event guidance, and ECDC recommendations provide essential foundations for coordination, notification, isolation, and contact tracing; however, this outbreak exposed expedition-specific gaps in safe port access, medical evacuation, onboard recognition of nonspecific febrile illness, diagnostic escalation, passenger traceability, and post-disembarkation monitoring. We therefore propose an accountability-oriented One Health preparedness model that operationalizes existing guidance through route-level risk assessment, exposure-history assessment, onboard syndromic surveillance, isolation and telemedicine triggers, reference-laboratory pathways, port-of-call agreements, auditable passenger and excursion records, and cross-border post-travel monitoring. The central lesson is not that expedition cruises, birdwatching, or ecological tourism are inherently unsafe, but that their expanding geographic reach requires binding, auditable, and expedition-specific outbreak protocols before passengers embark.

Source: 

Link: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1892006/full

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#Hantavirus cardiopulmonary syndrome in #children: a systematic scoping #review of presentation, critical care management, and outcomes

 

Abstract

Background

Pediatric hantavirus cardiopulmonary syndrome/hantavirus pulmonary syndrome (HCPS/HPS) is rare but can progress rapidly from a nonspecific febrile prodrome to respiratory failure, shock, and multiorgan dysfunction. Pediatric-specific evidence is limited, and a comprehensive map of the clinical literature is lacking.

Methods

We conducted a systematic scoping review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidance (protocol registered at DOI:10.17605/OSF.IO/MZDN4). PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to May 2026. Eligible reports described children or adolescents (age ≤18 years) with HCPS/HPS and extractable pediatric clinical data. Two reviewers independently screened records, assessed overlap, extracted data, and appraised reporting quality using Joanna Briggs Institute tools.

Results

Of 2208 database records, 20 reports were included in the core pediatric synthesis after removal of 976 duplicates and screening. Reports were concentrated in the Americas. Recurrent features included fever, gastrointestinal symptoms, myalgia, thrombocytopenia, hemoconcentration, pulmonary edema, respiratory failure, and shock. Severe cases required mechanical ventilation, vasoactive support, extracorporeal membrane oxygenation, and in some cases renal replacement therapy. Larger pediatric case series and surveillance-level reports reported mortality of approximately 33% to 37%. Evidence was predominantly case-based with variable reporting completeness.

Conclusions

Pediatric HCPS/HPS is rare but potentially rapidly fatal. Early suspicion in endemic regions or after rodent exposure, with prompt supportive critical care and timely consideration of advanced cardiopulmonary support, is central to management.

Source: 

Link: https://www.tandfonline.com/doi/full/10.1080/08998280.2026.2698359

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#Ribavirin post-exposure #prophylaxis for #Andes virus #exposure: a viewpoint

 

Summary

Andes virus (ANDV) is unique among hantaviruses because person-to-person transmission is possible. This raises questions on the relevance of post-exposure prophylaxis (PEP), particularly following high-risk household, healthcare-associated, or laboratory exposures, considering its high case fatality rate. Ribavirin has demonstrated antiviral activity against hantaviruses in vitro and in animal models, although clinical evidence supporting its use for ANDV remains extremely limited. This viewpoint summarises the currently available evidence regarding ribavirin as PEP after potential ANDV exposure. We discuss the knowledge gaps that may limit the applicability of ribavirin PEP, to make informed decisions on the use of ribavirin in the setting of PEP. Potential dosing strategies are visualised by modelling and simulation, and potential dose and duration are discussed. Although the biological rationale for ribavirin PEP appears compelling, absence of controlled human studies and potential toxicity currently limit its role to highly selected exposure scenarios and use shortly after exposure.

Source: 

Link: https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(26)00270-7/fulltext

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First nationwide full- #genome characterisation of #human-derived #Andes virus in #Chile: a retrospective genomic #epidemiology study

Summary

Background

Andes virus (ANDV) is the only hantavirus known to transmit between humans and causes hantavirus cardiopulmonary syndrome in Chile and Argentina. In Chile, ANDV genomic diversity remains incompletely characterised. This study aimed to characterise the genetic diversity, geographical structure, and molecular signatures of ANDV using human clinical samples collected over a 13-year period (2011–24).

Methods

We conducted a retrospective genomic epidemiology study of ANDV infections in Chile. Clinical samples from patients with confirmed ANDV, collected between March 9, 2011, and June 27, 2024, were analysed and sequenced. Clinical and epidemiological data were obtained from diagnostic laboratories and surveillance programmes. Consensus sequences for the S, M, and L segments were generated, and genetic clustering and divergence were assessed using phylogenetic inference and variant calling.

Findings

We analysed clinical samples from 58 infected individuals and identified two major genomic variants of ANDV with distinct geographical distributions, defined by regionally structured patterns of nucleotide and amino acid substitutions across the S, M, and L segments: ANDV Chi-North (central Chile) and ANDV-South (southern Chile). No consistent clustering by clinical severity was observed, and no recurrent non-synonymous substitutions were uniquely associated with severe disease. Substitutions previously associated with person-to-person transmission in outbreaks in Argentina were not consistently observed in Chilean sequences, including in four person-to-person transmission cases. Although some substitutions described in ANDV-like viruses were present in the Chi-North lineage, this lineage remained phylogenetically distinct and geographically restricted to central Chile.

Interpretation

To our knowledge, this study provides the first nationwide genomic characterisation of human-derived ANDV in Chile. The identification of geographically structured variants indicates that ANDV diversity in Chile is driven by regional diversification rather than clinical outcome. The absence of consistent amino acid signatures associated with disease severity or person-to-person transmission suggests that these phenotypes are unlikely to be explained by viral genetic variation alone. These findings refine current understanding of ANDV evolution and highlight the need for continued integrated genomic surveillance in endemic regions.

Funding

Agencia Nacional de Investigación y Desarrollo de Chile and National Institutes of Health.

Source: 

Link: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(26)00109-6/fulltext

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#Andes Virus — A #Clinical #Review

 

Summary

Andes virus (ANDV) is the sole orthohantavirus with documented human-to-human transmission. We summarize the epidemiology and clinical features of ANDV infection and review best practices in clinical management, as based on published expert consensus guidelines, field experience, and clinical trials. We also evaluate currently available and investigational treatments (including the use of antiviral agents), assess emerging monoclonal antibody therapies, and outline prospects for vaccine development. Finally, we discuss important infection prevention and control measures.

Source: 

Link: https://www.nejm.org/doi/full/10.1056/NEJMra2606651?query=TOC

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#Neurological Manifestations of #Hantavirus Infection - A Review

 

Abstract

Importance  

Hantaviruses have caused several recent human disease outbreaks. They carry a high mortality rate, and some species can spread from person to person although they are typically spread from rodents to humans. Neurological complications have been documented but are poorly understood.

Observations

Broadly, 2 types of syndromes have been associated with hantaviruses. The pulmonary syndrome carries a high mortality rate and can result in pulmonary and cardiac failure. Neurological involvement is typically secondary to hypoxic and ischemic injury or metabolic dysfunction. Another manifestation of the infection that is associated with some species of the virus is termed hemorrhagic fever with renal syndrome. Some patients may develop a meningoencephalitis or pituitary apoplexy resulting in sudden visual loss and pituitary dysfunction. Rarely, seizures, myelitis, and peripheral neuropathy may occur. Although there are no specific antiviral drugs approved for treatment of hantavirus, there are several that showed efficacy in preclinical trials. Management is supportive care and treatment of symptoms.

Conclusions and Relevance  

Neurological manifestations of hantavirus infection are uncommon but can be severe. Prospective studies and experimental models are needed to better characterize these manifestations, understand pathophysiology, identify therapeutic targets, and develop guidelines for management.

Source: 

Link: https://jamanetwork.com/journals/jamaneurology/fullarticle/2851731

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#Hantavirus #outbreak linked to cruise #ship travel, Multi-locations (WHO, July 3 '26): End of the Event

 

Situation at a glance

    This is the fifth Disease Outbreak News posting on the Andes hantavirus (ANDV) outbreak linked to the cruise ship M/V Hondius. 

    The outbreak identification followed the notification to the World Health Organization (WHO) on 2 May 2026 of severe acute respiratory illness cases onboard. 

    Since the previous Disease Outbreak News was published on 28 May 2026, one of the probable cases from Tristan da Cunha, an Overseas Territory of the United Kingdom of Great Britain and Northern Ireland (hereafter referred to as the United Kingdom), was laboratory confirmed. 

    As of 2 July, a total of 13 cases, including three deaths, have been notified (case fatality ratio 23%). 

    Twelve cases have been laboratory-confirmed for ANDV infection, and one is a probable case. 

    All confirmed cases are among individuals who travelled onboard the M/V Hondius. 

    Among the ten cases admitted to hospitals, eight have recovered and have been discharged, while two are still undergoing medical treatment. 

    All identified contacts have completed the 42 day follow-up period by local health authorities in line with WHO guidance. 

    The completion of the contact follow up without detection of additional secondary cases demonstrates effective interruption of transmission and confirms outbreak containment. 

    This outbreak no longer poses a public health risk and no further related transmission is expected.

Description of the situation

    On 2 May 2026, in accordance with the International Health Regulations (2005) (IHR), WHO received a notification from the National IHR Focal Point (NFP) of the United Kingdom of a cluster of severe acute respiratory illness aboard the Netherlands-flagged cruise ship M/V Hondius, with further details rapidly notified authorities in the Netherlands and South Africa.

    As of 2 July, a total of 13 cases (12 confirmed and one probable case), including three deaths (two confirmed and one probable), have been reported globally linked to the cruise ship. 

    The case fatality ratio for this outbreak to date is 23%. 

    Since the last Disease Outbreak News was published on 28 May 2026, ANDV infection was laboratory confirmed in a probable case in Tristan da Cunha who developed signs and symptoms after disembarkation from the cruise ship. 

    The early detection and isolation of the case prevented further transmission of the virus, but the limited diagnostic capacities on the island delayed the confirmation of the case until a sample was shipped and tested in the United Kingdom. 

    The patient has recovered and has been discharged.

    Among the confirmed cases admitted to hospital, eight have recovered and been discharged, while two, one in South Africa and one in France, continue to be hospitalized. 

    All 13 cases are among people who travelled on board the M/V Hondius.

(...)

    Nine of the reported cases were males, and four were females. The median age was 65-years-old (IQR 56-70), similar to the median age of the passengers onboard the ship (...). The ages of the three deceased cases were 69, 70 and 79-years-old.

(...)

    Currently available information suggests that infection of initial cases was likely acquired on land prior to embarkation, although the exact source and route of exposure remain undetermined, with subsequent human-to-human transmission occurring aboard the vessel. 

    Investigations remain underway to establish the circumstances and source of the outbreak, including genomic sequencing of ANDV samples from surveillance cases in Chile and Argentina, and will be published as soon as these are available.

    This outbreak was managed through a coordinated international response, which included comprehensive epidemiological investigations, case isolation and clinical management, medical evacuations, laboratory testing, repatriation of passengers and crew from the ship and international contact tracing, as well as quarantine and monitoring measures.

    Contact identification and follow-up of contacts of hantavirus cases linked to the cruise ship has been conducted in 33 countries and overseas territories. 

    This included passengers and crew onboard the ship, contacts of the case on Tristan da Cunha, contacts from two different international flights, healthcare workers and airport crew who assisted cases before the detection of the outbreak. 

    As of 2 July 2026, 317 high-risk contacts have completed quarantine and monitoring by local health authorities in the countries and territories where they were repatriated, evacuated or identified. 

    Some 336 low-risk contacts completed self-monitoring in line with the updated guidance on management of contacts of Andes virus (ANDV) cases from the MV Hondius cruise ship published on 17 May 2026. 

Epidemiology

    Hantavirus disease is a zoonotic viral disease caused by hantaviruses of the genus Orthohantavirus, family Hantaviridae, order Elliovirales, class Bunyaviricetes. More than 20 viral species have been identified within this genus. 

    Human hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of certain species of (specific) infected rodents, or by touching contaminated surfaces. 

    Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. 

    Human cases are most commonly reported in rural settings, such as forests, fields, and farms, where rodents are present and opportunities for exposure are greater.

    Limited human-to-human transmission has currently only been reported for hantavirus pulmonary syndrome (HPS) associated with ANDV virus infection. 

    ANDV is endemic in South America, with confirmed circulation and human infections reported primarily in Argentina and Chile, and additional cases and related strains identified in Uruguay, southern Brazil, and Paraguay.

Andes virus transmission between humans

    Based on the available information and the existing observations of the current outbreak, limited human-to-human transmission of ANDV is known to occur. 

    However, no large-scale human-to-human outbreaks have been observed historically.[1] 

    ANDV circulates in specific species of rodents in the Americas, and there have been many sporadic cases reported in Argentina and Chile that have not led to onward transmission.[2]  

    Clusters of human cases have been reported in multiple past outbreaks and have been typically associated with close and prolonged interactions, often in shared indoor environments such as households.  

    The largest reported outbreak of ANDV was reported in Argentina in 2018-2019,2 where high viral titres in combination with attendance at large social gatherings or extensive contacts among people were associated with higher transmission.  

    While the available evidence suggests that there are multiple modes of transmission that occur with ANDV, the probability of onward transmission between humans remains low.

    Initial epidemiological investigation and the genomics analysis[3] of the identified cases show that in this outbreak of ANDV infection, human-to-human transmission has occurred on the ship. 

    While detailed information on the interaction between cases or with a contaminated environment aboard the ship is currently not available, these exact modes of transmission might be elucidated by upcoming results from an in-depth epidemiological investigation, as well as publication of the environmental sampling performed after the disembarkation.  

Response activities operated under the assumption that ANDV transmission:

    ° may have included contact with an infected individual or contaminated surfaces;

    ° and/or through-the-air transmission (via direct deposition of infectious respiratory particles onto exposed facial mucosal surfaces—mouth, nose, or eyes);

    ° and/or airborne transmission (via inhalation of infectious respiratory particles).

    Given the attack rate among the ship passengers, as well as the absence of secondary cases among contacts off the ship, the virus did not exhibit transmission dynamics consistent with highly transmissible airborne pathogens (such as measles).

Public health response

    Authorities from States Parties managing cases and/or contacts, WHO, and partners such as the European Centre for Disease Prevention and Control have coordinated response measures, including:

        ° Ongoing engagement between WHO and the NFPs of countries managing cases and/or contacts ensured timely information sharing and coordination of response actions.

        ° International contact tracing and follow-up of contacts was conducted by local health authorities in line with national arrangements.

        ° WHO requested regular information sharing and periodic updates from States Parties through IHR channels regarding the follow-up of contacts and their health status.

        ° Ongoing epidemiological investigations to define epidemiological links between cases and exposure factors on the ship, as well as to try to understand the potential source of exposure.

    A prospective natural history study designed to improve understanding of Andes virus (ANDV) transmission dynamics, incubation periods, immune responses, viral kinetics, and the determinants of severe disease through harmonised longitudinal follow-up of exposed individuals. The study uses a standardised prospective protocol implemented across 21 participating countries.[4]

    WHO developed and published specific technical guidance documents to support response to the event, including:

        ° Technical guidance on the management of hantavirus onboard ships was shared with States Parties through IHR channels

        ° Technical note for the disembarkation and onward management of passengers and crew in the context of an ANDV-associated cluster;

        ° Management of contacts of Andes Virus (ANDV) cases from the MV Hondius cruise ship

        ° Laboratory testing of Andes virus (Orthohantavirus andesense) infection: Interim guidance

    The NFPs of countries managing cases and/or contacts have been exchanging passenger- and crew-related information.

    WHO provided risk communication coordination and support, ensured timely evidence-based information sharing, activated the coordination mechanisms across the three organizational levels, and supported national authorities in implementing public health measures, including in accordance with IHR provisions.

    WHO convened regular Member State briefings, expert discussions covering key technical, laboratory, clinical care and infection prevention and control (IPC) topics, and global webinars via the EPI-WIN knowledge platform to facilitate experience sharing and coordinate support.

    WHO supported the development of research protocols with national and international partners and planned a hantavirus consultation on medical countermeasures.

    WHO coordinated the distribution of the laboratory testing and reference materials made available by Chile and Argentina, as well as diagnostic protocols and information on available test kits and their performance.

WHO risk assessment

    The ANDV outbreak associated with the MV Hondius cruise ship no longer poses a public health risk and no further related transmission is expected.  

    ANDV remains endemic in South America, and it is associated with hantavirus pulmonary syndrome with substantial case fatality, its transmissibility remains limited, typically requiring close and prolonged exposure, and tends to result in temporally and spatially restricted clusters.

    While the confined maritime environment of this event likely facilitated transmission during the voyage, epidemiological and genomic evidence supports a point source outbreak, originating either from contact with an infected animal or infected person, followed by limited chains of human-to-human secondary transmission, without evidence of sustained transmission.

    The completion of the 42-day follow-up period for all identified contacts without further detection of additional secondary cases demonstrates effective interruption of transmission and confirms outbreak containment. 

    Additionally, IPC measures continue to be applied for the management of the two cases still hospitalized.

WHO advice

    WHO advises all countries to sustain strong engagement and collaboration to document and learn from this outbreak response, including both successes and operational challenges, and to apply the lessons identified to strengthen preparedness, surveillance including international tracing and follow up of contacts, clinical care, IPC, risk communication, and response capacities for future public health emergencies.

    WHO further encourages the continuation of epidemiological, clinical, laboratory, and ecological studies to better understand the outbreak, its transmission dynamics, risk factors, and determinants of disease severity.

    In areas where hantavirus is endemic, WHO recommends strengthening measures to prevent and control transmission through enhanced surveillance, public awareness, environmental management, reduction of exposure to rodent reservoirs and contaminated environments, and early detection, implementation of IPC measures and management of cases.

    WHO also encourages continued investment in research and development to advance the availability of effective diagnostics, therapeutics, and vaccines, and to improve preparedness and response capabilities for future hantavirus outbreaks.

Further information

    ° World Health Organization. Management of contacts of Andes virus (ANDV) cases from the MV Hondius cruise ship. https://www.who.int/publications/m/item/management-of-contacts-of-andes-virus-(andv)-cases-fromthe-mv-hondius-cruise-ship

    ° World Health Organization. WHO Technical note for the disembarkation and onward management of passengers and crew in the context of an Andes virus-associated cluster MV Hondius cruise ship. https://www.who.int/publications/m/item/who-technical-note-for-the-disembarkation-and-onward-management-of-passengers-and-crew-in-the-context-of-an-andes-virus-associated-cluster-mv-hondius-cruise-ship

    ° World Health Organization. Hantavirus fact sheet. https://www.who.int/news-room/fact-sheets/detail/hantavirus 

    ° World Health Organization. WHO’s response to hantavirus cases linked to a cruise ship. https://www.who.int/news/item/07-05-2026-who-s-response-to-hantavirus-cases-linked-to-a-cruise-ship

    ° World Health Organization. Handbook for management of public health events on board ships. https://www.who.int/publications/i/item/9789241549462

    ° World Health Organization. Guide to Ship Sanitation, 3rd edition https://www.who.int/publications/i/item/9789241546690

    ° World Health Organization. Handbook for management of public health events in air transport, https://www.who.int/publications/i/item/9789241510165

    ° World Health Organization. Guide to hygiene and sanitation in aviation, 3rd edition, https://www.who.int/publications/i/item/9789241547772

    ° Preliminary analysis of Orthohantavirus andesense virus sequences from a cruise-ship related cluster, May 2026. https://virological.org/t/preliminary-analysis-of-orthohantavirus-andesense-virus-sequences-from-a-cruise-ship-related-cluster-may-2026/1029

    ° World Health Organization. Standard precautions for the prevention and control of infections: aide-memoire. https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1

    ° World Health Organization. Transmission-based precautions for the prevention and control of infections: aide-memoire. https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.2

    ° World Health Organization. Hantavirus outbreak toolbox. https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/hantavirus-outbreak-toolbox

    ° World Health Organization (8 May 2026). Disease Outbreak News. Hantavirus cluster linked to cruise ship travel, Multi-country. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON600

    ° World Health Organization (4 May 2026). Disease Outbreak News. Hantavirus cluster linked to cruise ship travel- Multi-country. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON599

    ° World Health Organization. A decision framework for effective, equitable and context-specific public health and social measures during public health emergencies: decision navigator: https://iris.who.int/server/api/core/bitstreams/ceaf4aa7-00c8-4681-9c35-965e231a3706/content

    ° World Health Organization Health Emergencies EPI-WIN webinar: Hantavirus in Focus I: what we know and what it means. https://www.who.int/news-room/events/detail/2026/05/20/default-calendar/hantavirus-in-focus-i-what-we-know-and-what-it-means

    ° World Health Organization Health Emergencies EPI-WIN webinar: Hantavirus in Focus II: hantavirus natural history, infection control and clinical management of patients in hospital. https://www.who.int/news-room/events/detail/2026/05/22/default-calendar/who-health-emergencies-epi-win-webinar-hantavirus-in-focus-ii-hantavirus-in-an-international-maritime-setting-natural-history-infection-control-and-clinical-management-of-patients-in-hospital

    ° World Health Organization Health Emergencies EPI-WIN webinar: Hantavirus in focus III: reflections from the IHR Border Health and Points of Entry perspective. https://www.who.int/news-room/events/detail/2026/06/04/default-calendar/who-health-emergencies-epi-win-webinar--hantavirus-in-focus-iiireflections-from-a-border-health-and-point-of-entry-perspective

    ° World Health Organization Health Emergencies EPI-WIN webinar: Hantavirus in focus IV: Infection prevention and control: from isolation to safe discharge and quarantine. https://www.who.int/news-room/events/detail/2026/06/16/default-calendar/who-health-emergencies-epi-win-webinar-hantavirus-in-focus-iv-infection-prevention-and-control-from-isolation-to-safe-discharge-and-quarantine

    ° Pan American Health Organization / World Health Organization. Infection prevention and control of hantavirus infection, including Andes virus disease. Interim regional guidance for suspected or confirmed cases. https://iris.paho.org/items/bc5a7b5a-5a0a-4407-829e-663c762ad615

    ° Pan American Health Organization / World Health Organization. Clinical management of hantavirus infection, including Andes virus disease: Interim regional guidance for suspected or confirmed cases. https://iris.paho.org/items/0fa0dcb1-4395-467d-a431-5408b4eff337    

    ° Pan American Health Organization / World Health Organization. PAHO supports the international response to hantavirus pulmonary syndrome cases linked to a cruise ship in the Atlantic. https://www.paho.org/en/news/7-5-2026-paho-supports-international-response-hantavirus-pulmonary-syndrome-cases-linked

    ° Epidemiological Alert Hantavirus Pulmonary Syndrome. https://www.paho.org/en/documents/epidemiological-alert-hantavirus-pulmonary-syndrome-americas-region-19-december-2025  

    ° Hantavirus in the Americas: Guidelines for diagnosis, treatment, prevention and control. Available at: https://iris.paho.org/handle/10665.2/40176

    ° Hantavirus Prevention, CDC: https://www.cdc.gov/hantavirus/prevention/?CDC_AAref_Val=https://www.cdc.gov/hantavirus/hps/prevention.html

    ° Martínez Valeria, Paola N, et al. (2020). “Super-Spreaders” and Person-to-Person Transmission of Andes Virus in Argentina. New England Journal of Medicine. 383. 2230-2241. 10.1056/NEJMoa2009040.

    ° US CDC. How to Clean Up After Rodents: https://www.cdc.gov/healthy-pets/rodent-control/clean-up.html

    ° Hantavirus, Washington State Department of Heath, https://doh.wa.gov/sites/default/files/2025-08/420-056-Guideline-Hantavirus.pdf

    ° Hantavirus Infection, MDS Manual, professional version: https://www.msdmanuals.com/professional/infectious-diseases/arboviruses-arenaviridae-and-filoviridae/hantavirus-infection

    ° Hantavirus pulmonary syndrome, https://www.mayoclinic.org/diseases-conditions/hantavirus-pulmonary-syndrome/symptoms-causes/syc-20351838

___

    [1] “Super-Spreaders” and Person-to-Person Transmission of Andes Virus in Argentina | New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2009040

    [2] Padula PJ, Edelstein A, Miguel SD, López NM, Rossi CM, Rabinovich RD. Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus. Virology. 1998 Feb 15;241(2):323-30. doi: 10.1006/viro.1997.8976. PMID: 9499807.  https://pubmed.ncbi.nlm.nih.gov/9499807/

    [3] Preliminary analysis of Orthohantavirus andesense virus sequences from a cruise-ship related cluster, May 2026. https://virological.org/t/preliminary-analysis-of-orthohantavirus-andesense-virus-sequences-from-a-cruise-ship-related-cluster-may-2026/1029

    [4] Twenty-one countries launch coordinated Andes virus research initiative following hantavirus outbreak. https://www.who.int/news/item/12-06-2026-twenty-one-countries-launch-coordinated-andes-virus-research-initiative-following-hantavirus-outbreak  

__

Citable reference: World Health Organization (2 July 2026). Disease Outbreak News. Hantavirus outbreak linked to cruise ship travel, Multi-locations. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON611

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON611

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The #NK Cell #Landscape in the Natural History of #Hantavirus Cardiopulmonary Syndrome in a Chilean Cohort

 

Abstract

Hantavirus cardiopulmonary syndrome (HCPS) caused by Andes Orthohantavirus (ANDV) carries case-fatality rates up to 40%; however, the innate immune determinants of disease severity remain poorly defined. Natural killer (NK) cells are central mediators of early antiviral immunity, but their landscape during the earliest phase of ANDV infection has not been characterized. Using multiparameter flow cytometry and unsupervised UMAP-based clustering in PBMCs from 13 HCPS patients stratified by severity and nine healthy donors, we show that severe HCPS is characterized by a coordinated disruption of the CD56dim NK cell compartment, encompassing reduced subset frequencies, specific reduction in the terminally differentiated NKG2C+CD57+ adaptive-like pool, and intrinsic impairment of IFN-γ production and degranulation, deficits that were absent in mild patients and persisted in part beyond clinical recovery. Furthermore, CD56dimCD16+ NK cell frequencies correlated negatively with viral load across all acute patients, independent of clinical severity. These findings establish severe HCPS not merely as a state of NK cell depletion, but as one of selective functional impairment of the most cytotoxically competent NK cell population during the critical early acute phase of ANDV infection.

Source: 

Link: https://www.mdpi.com/1999-4915/18/7/712

____

#WHO DG's opening #remarks at the media #briefing – 24 June 2026 {#Ebola in #DRC} (Edited): #France reported a NGO #HCW positive for the virus

 

    Good afternoon to those in the room, and good morning, good afternoon and good evening to those online, wherever you are in the world.

    We begin with the Ebola outbreak in the Democratic Republic of the Congo.

    It’s encouraging to see that since the outbreak was first reported five weeks ago, the response has scaled up significantly, under the leadership of the government.

    In the past five weeks, the number of treatment beds has increased from less than 10 to over 500 in 19 health centres.

    With support from WHO and the Africa CDC, laboratory capacity has increased from 30 tests a day at the central laboratory in Kinshasa to over 2000 tests a day in nine labs across three provinces.

    More communities are becoming aware of the risks of Ebola, and asking for the tools and support to protect themselves.

    And more than 100 people have now recovered. With early detection and supportive care, many can survive this disease.

    But we could save many more lives with therapeutics.

    Preparations are now complete for a trial of two therapeutics that is expected to start in DRC next week.

    The trial will evaluate whether two antivirals, MBP134 and remdesivir, can help to reduce mortality in patients with Bundibugyo virus disease, alone or in combination.

    We thank the United States and Gilead Sciences for donating doses for the trial. Together with our partners we will announce more information next week.

    WHO and our partners are working closely with the communities to inform and involve them in the trial.

    We are also working to ensure the communities have access to the therapeutics should they prove safe and efficacious.

    The trial will be conducted by a consortium of partners including DRC’s National Institute for Biomedical Research, ALIMA, Oxford University and WHO.

    Despite the good progress we have made, we still face major challenges, and the outbreak is continuing to outpace the response.

    There are now 1094 confirmed cases, with 277 deaths.

    The outbreak is continuing to move fast.

    Political advocacy and action are essential to create the conditions for increased humanitarian access and a scaled-up response, because the outbreak is happening in a complex situation.

    In neighbouring Uganda, a new case was reported last Sunday, the first in two weeks.

    This brings the total in Uganda to 20 confirmed cases, with two confirmed deaths.

    All cases in Uganda are linked to the outbreak in DRC.

    Today, France reported that a health worker with the NGO ALIMA, who returned to the country after caring for an Ebola patient in DRC, tested positive for the virus, and is now being monitored and receiving care.

    This case is a reminder of the risks faced by frontline responders.

    Almost 80 health workers have been infected, highlighting the risks they face and the importance of strengthening infection prevention and control.

    WHO advises countries to support the safe deployment of personnel responding to this outbreak.

    This includes ensuring that organizations deploying staff provide clear information on risks, how to reduce and manage the risk of exposure, and that countries are prepared to facilitate evacuation if needed.

    Still, the risk to the rest of the world remains low.

    Under the government’s leadership, the coordinated response to the outbreak is starting to take hold.

    But continued scale up is needed.

    Contact tracing is still not at the level needed;

    Capacity at treatment and isolation centres is insufficient;

    Safe and dignified burials remain a major challenge;

    The health system is under pressure;

    Border closures continue to hinder the response;

    Multiple security incidents have been reported;

    The affected area is in the grip of a decades-long humanitarian crisis;

    And financial support is still insufficient.

    Earlier this month, WHO and the Africa CDC announced a joint Continental Preparedness and Response Plan that reflects the funding needs of partners, with an ask of 518 million U.S. dollars.

    Next week, the first financial reporting on pledges and commitments to the plan are expected to be available, providing a clear understanding of gaps and needs. 

===

    Now to the outbreak of hantavirus.

    The total number of cases from the hantavirus outbreak remains 13, including three deaths.

    In all, more than 650 contacts have been identified and followed up by local health authorities in 33 countries and territories.

    All but 54 contacts have completed their period of quarantine, and the remaining contacts are scheduled to complete their quarantine period by the 2nd of July.

    If no further cases are reported by then, WHO will consider the outbreak to be over.

    However, WHO will continue working to advance our understanding of this outbreak, and hantavirus more generally.

    Working with governments and partners, we are continuing investigations into how the outbreak started and spread among those on board.

    We are also working with partners who have collected environmental samples onboard the ship.

    In addition, we are coordinating a study among people exposed to the virus involving 21 countries, to better understand how the disease develops.

    We are also working on having a sample of the virus shared with the WHO BioHub in Switzerland.

    This will be important for developing diagnostics, therapeutics and vaccines for future outbreaks.

    I thank all countries that have contributed in different ways to the response to this outbreak, with special thanks to the leadership and solidarity shown by Spain, especially to Prime Minister Pedro Sánchez.

    I also thank the Captain of the MV Hondius, Captain Jan Dobrogowski, his crew and all passengers for their cooperation in what has been a very difficult situation.

(..)

Source: 

Link: https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing---24-june-2026

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#UK Health Security Agency# update on the #hantavirus cruise ship #outbreak (June 22 '26): All remaining quarantined passengers released from isolation

 

Latest update

    The UK Health Security Agency (UKHSA) can confirm that all remaining individuals have now left Arrowe Park.

    All passengers from the MV Hondius who subsequently returned to the UK have now completed their self-isolation periods.

    Professor Robin May, Chief Scientific Officer at UKHSA, said: 

    ''We would like to reiterate our thanks and gratitude to passengers, crew and other contacts for their cooperation throughout what has been a very challenging time for everyone affected.

    ''Our teams will continue to work closely with local authorities and the NHS to ensure everyone affected by this outbreak has the necessary support in place.

Source: 

Link: https://www.gov.uk/government/news/ukhsa-update-on-the-hantavirus-cruise-ship-outbreak

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Beyond the cruise #ship: #Andes #hantavirus and the neglected #onehealth dimensions of global #outbreak #preparedness

 

{Summary}

The ongoing multi-country outbreak of Andes hantavirus linked to an expedition cruise travel has drawn global public health attention. The outbreak was reported to the World Health Organization on 02 May 2026 after a cluster of severe respiratory illness occurred among passengers and crew aboard the MV Hondius, which travelled across remote regions of the South Atlantic following departure from Ushuaia, Argentina. As of 18 May 2026, the European Centre for Disease Prevention and Control (ECDC) reported 12 cases, including nine confirmed, two probable, and one inconclusive case, as well as three deaths linked to the outbreak. While response efforts have appropriately focused on case detection, isolation, contact monitoring, and clinical management, the event highlights broader gaps in how emerging zoonotic threats are managed globally. Rather than viewing this solely as a cruise-associated outbreak, it should also be understood as a One Health warning signal emerging at the intersection of rodent ecology, environmental and climatic change, expedition tourism, and global human mobility.

(...)

Source: 

Link: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(26)00160-2/fulltext

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Potent In Vitro #Antiviral Activity of 4'-Fluorouridine Against Diverse #Orthohantaviruses including #Andes Virus

 

Highlights:

    • 4′-fluorouridine exhibits broad-spectrum activity against 16 orthohantaviruses.

    • The compound inhibits hantavirus replication by targeting the viral polymerase.

    • Efficacy is maintained in human endothelial and airway epithelial cells.

Abstract

Hantaviruses are emerging pathogens responsible for severe and often fatal diseases, including hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS), for which no FDA-approved antivirals currently exist. Using a Seoul virus minigenome system, we first confirmed that the ribonucleoside analog 4’-fluorouridine (EIDD-2749) effectively targets the hantavirus polymerase complex, inhibiting viral RNA transcription and replication. We subsequently evaluated its antiviral activity against a comprehensive panel of 16 hantaviruses representing both Old and New World lineages including both the Chilean and Argentinian strains of Andes virus. 4’-fluorouridine demonstrated potent, dose-dependent inhibition across all viruses tested, with EC50 values uniformly in the low- to sub-micromolar range. Collectively, these findings establish 4’-fluorouridine as a highly potent, pan-hantavirus inhibitor and a promising candidate for further preclinical development.

Source: 

Link: https://www.sciencedirect.com/science/article/abs/pii/S0166354226001269?via%3Dihub

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#Andes virus #outbreak linked to expedition cruise #ship travel, multi-country #investigation and response, April to June 2026

Abstract

As at 18 June 2026, 13 cases (12 confirmed and one probable) of Andes orthohantavirus have been reported (case–fatality: 23%), linked to the Dutch-flagged expedition cruise ship MV Hondius. The event involved individuals from 23 nationalities and required medical evacuation, repatriation, coordinated international contact tracing, isolation, quarantine and clinical and laboratory testing follow-up. To date, all cases have been passengers (10/121; 8%) or crew members (3/61; 5%). Ongoing monitoring and investigations aim to clarify the source of the outbreak, identify risk factors and prevent further spread.

Source: 

Link: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2026.31.24.2600477?emailalert=true#abstract_content

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#Andes #hantavirus #outbreak in cruise ship (ECDC, June 17 '26): Some quarantined individuals have left isolation after completing follow-up

 

    On 2 May 2026, ECDC was notified of a cluster of severe respiratory illness on MV Hondius, a Dutch-flagged cruise ship with passengers and crew from 23 countries, including nine EU/EEA countries. 

    The virus has been identified as Andes hantavirus.

    As of 17 June 2026, 13 cases have been reported in total, including 12 confirmed and one probable case.

    As of 17 June 2026, some of the identified contacts associated with the outbreak have completed their quarantine period, while others are expected to do so in the coming days. 

    Public health authorities continue to monitor the identified contacts however, based on the information currently available, the likelihood of additional cases related to this event is considered very low. 

    The risk to the general population in the EU/EEA remains very low.

    ° Confirmed cases: 12

    ° Probable cases: 1

    ° Suspected cases: 0

    ° Number of deaths: 3

(...)

Source: 

Link: https://www.ecdc.europa.eu/en/infectious-disease-topics/hantavirus-infection/surveillance-and-updates/andes-hantavirus-outbreak

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#Incubation and infectious period, asymptomatic or presymptomatic #transmission and transmission route in #human-to-human spread of #hantavirus #infection (UKHSA, summary)

 

{Summary)

Main messages 

    1. This systematic evidence summary (search up 1 May 2026) identified and summarised evidence relating to the incubation and infectious period, asymptomatic or presymptomatic transmission and transmission route in human-to-human transmission of hantavirus infection.  

    2. Human-to-human transmission was only reported for Andes virus.  

    3. Seventeen studies were identified to include (1 to 17). All studies were from South America (Argentina, Chile, Paraguay or Uruguay) from 1995 to 2024. Three sets of studies clearly reported on the same outbreak.  

    4. Seven studies reported the incubation period, or enough information to calculate the incubation period of Andes virus (4, 6, 8, 10, 12, 13, 15, 17). Four of these reported overlapping evidence, (4, 8, 12, 17) leaving 5 independent reports. The reported incubation period ranged from 9 to 40 days, with studies reporting a mean between 21.6 to 27.5 days.   

    5. Three studies reporting incubation period included children (6, 10, 12). When evidence for children was separated, the range was 14 to 26 days. The mean (and standard deviation, SD) from one study with data to calculate it was 19.8 days (3.7) in children and 21.9 days (7.4) in adults (12). The available evidence was insufficient to determine if there was a significant difference between adults and children and not all studies separated the results.   

    6. Twelve studies reported the serial interval or enough information to calculate the serial interval of Andes virus (1, 2, 5, 9 to 14, 16, 17). Four of these reported overlapping evidence,(10, 11, 14, 17) leaving 10 independent reports. The reported serial interval ranged from 4 to 40 days with means across studies from 19.6 to 25.7 days.  

    7. Six studies reporting serial interval included children (2, 5, 9, 10, 12, 16). When evidence for children was separated, the range was 16 to 29 days. The mean (and SD) from one study with data to calculate it was 19.7 (3.5) in children and 19.5 (8.1) in adults. The available evidence was insufficient to determine if there was a significant difference between adults and children and not all studies separated the results.  

    8. None of the studies reported confirmed route of transmission. Some hypothesised routes from exposures including the possibility of respiratory, direct contact via breastfeeding, other direct contact and sexual transmission. None ruled out respiratory or fomite transmission alongside other possible routes.  

    9. No studies reported evidence of asymptomatic or presymptomatic transmission. 

    10. Most studies included groups identified as being at risk of health inequalities, including children, pregnant women, people living in rural settings and people in occupations at higher risk of exposure such as agricultural workers or farmers and people working in healthcare settings. However, none of the studies provided a comparison between groups and it was not possible to determine if outcomes differed in these groups. 

    11. Critical appraisal was not performed, which restricts the interpretation of the findings, but important limitations have been highlighted. There were a limited number of cases with likely human-to-human transmission which limits the generalisability of the evidence. Many studies also highlighted the possibility than some of these cases also had environmental exposure, although human-to-human transmission was most likely. All studies rely on selfreport of exposure and symptom onset dates, which may be subject to recall bias or misreporting. There was also discrepancy between some studies reporting on the same cases, which highlights the likelihood of misreporting of this evidence.  

    12. In summary, there was evidence from a limited number of cases to provide information of the incubation period and serial interval for human-to-human transmission of Andes virus. There was no information available that directly informed the infectious period in humans. Evidence suggested incubation period could range from 9 to 40 days, with studies reporting a mean between 21.6 to 27.5 days. The reported serial interval ranged from 4 to 40 days with means from 19.6 to 25.7 days. Although no studies were able to confirm route of transmission, some proposed routes through exposures, including the possibility of direct contact via breast-feeding, and sexual transmission or contact. No studies reported evidence of asymptomatic or presymptomatic transmission. All of the evidence is at risk of bias from misreport or recall bias, possible environmental exposure and ability to generalise due to small numbers of cases. 

(...)

Source: 

Link: https://www.gov.uk/government/publications/hantavirus-human-to-human-infection-transmission-parameters

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