A Public Health Alerts report today provides detailed information on 10 of the 11 cases of Andes hantavirus infection on passengers of the MV Hondius cruise ship, including the first passenger who contracted the disease after the index patient.
Three of the 10 patients died, and two of the other seven remain hospitalized after infection with the Andes strain of the virus (ANDV), which is the only hantavirus strain known to transmit among people. The report was also published on both the New England Journal of Medicine and NEJM Evidence sites. (The report’s appendix is here.)
Public Health Alerts, a collaboration between NEJM Evidence and CIDRAP, fills a gap in reliable data, offering expert-reviewed reports that translate frontline observations into actionable public health evidence. An NEJM Evidence editorial explains the initiative further.
The case not detailed in the report involves a Canadian passenger who tested “presumed positive” late last week.
3 deaths, 2 still hospitalized
The index patient, a Dutch ornithologist, first had symptoms April 6 and died on board the ship on April 11. His wife, described in today’s report as patient 2, first became ill April 24 and died two days later.
The Public Health Alerts report notes that patient 3 first experienced pneumonia symptoms, including shortness of breath and fever, on April 21. He was medically evacuated to Ascension Island on April 27, where chest x-rays showed no concerning signs. His condition while on the island, however, worsened, and he was transferred to aa hospital in Johannesburg, South Africa for ventilator support and intensive care.
A virtual consultation was held on May 2 with medical specialists from South Africa, the United Kingdom, and Holland to discuss the potential link to the two recent deaths tied to the MV Hondius excursion. On May 2, UK officials reported a cluster severe acute respiratory illnesses of unknown cause, resulting in two deaths and one critical illness in a passenger aboard the cruise ship.
Given this information, samples from patient 3 were sent to a South African lab, where hantavirus was confirmed. Sequencing of a before-death sample from patient 2 tested positive for ANDV.
The other seven patients first became ill from April 27 to May 12. One of them (patient 4), who first had symptoms on April 28, died on May 2. Both patient 3 and patient 7 remain hospitalized, with the former in the intensive care unit in Johannesburg and the latter in a hospital in Switzerland.
The primary source of the outbreak is under active investigation.
The authors of the report write, “Because not everyone on board was tested, 3 deaths among 10 cases may represent an overestimation of the case fatality ratio. All cases to date have been among passengers or crew on board the ship.”
They add, “The situation is evolving, and the World Health Organization and European Center for Disease Prevention and Control assess the global risk as low. The primary source of the outbreak is under active investigation, and experts who have experience with ANDV are collaborating to focus on exposures to South American rodents that occurred before the departure of the ship.”
