MV Hondius hantavirus outbreak

Hantavirus

Hantaviruses are a group of over fifty types of viruses that infect rodents and sometimes humans.^[13][14] In rodents, Hantavirus infection, while usually persistent, does not result in symptoms. Hantaviruses may transmit through rodent populations via aerosols or droplets from infected rodent feces, urine, saliva, and blood;^{[13][15][unreliable medical source?]} through the consumption of contaminated food; or from virus particles shed from skin or fur.^[16]

Andes virus is a species of the Hantaviridae taxonomic family of viruses and the only known hantavirus to spread via human-to-human transmission. Past human outbreaks have indicated that transmission of the Andes virus is possible under specific close-contact conditions.^[10][11] The routes and mechanisms of transmission have not been definitively characterized, but airborne transmission is considered a possibility.^[10][11] Transmission typically occurs in cases of close sustained contact, such as household exposure, caregiving without personal protective equipment, and prolonged exposure in poorly ventilated or crowded settings.^[10][11] In humans, Andes virus usually causes hantavirus pulmonary syndrome – a severe illness affecting the heart and lungs with an incubation period of one to seven weeks.^[17] Andes virus outbreaks are associated with high case fatality rates of 20 to 40 percent.^[10]

On 6 May, it was confirmed that the Andes virus, which is normally found in the Andes mountains of Argentina and Chile,^[18] was responsible for the outbreak on the MV Hondius .^[15][19] The spread of the virus on board has been at least partially attributed to human-to-human transmission.^[20] Early reports identified Ushuaia, Argentina, as a possible site of infection. However, no cases of the virus have ever been recorded there or in the region of Tierra del Fuego, and the city lies 1,500 km south of the endemic range of the long-tailed mouse subspecies known to carry the virus.^[21]

MV Hondius

The MV Hondius is owned by the Dutch company Oceanwide Expeditions.^[22] The ship has accommodation for 196 passengers across 95 cabins, and a crew of 72.^[23] The ship departed from Ushuaia, Argentina,^[22] on 1 April with 114 passengers and 61 crew.^[24] The first people infected had been travelling farther north in Argentina and into Chile before arrival in Ushuaia.^[25] The ship had plans to visit Antarctica and "several isolated islands in the South Atlantic".^[22]

After disembarkation at St. Helena, 149 people of 23 nationalities remained on board Hondius.^[24][14] Passengers mostly came from Spain, France, the United Kingdom, and the United States, while the bulk of the crew came from the Philippines.^[26] Berth prices on the cruise ranged from €14,000 to €22,000.^[27]

April

The ship departed from Ushuaia on 1 April with 175 passengers and crew.^[24] On 6 April, a 70-year-old Dutch man began showing symptoms,^[28] and he died on board on 11 April,^[22][28] initially attributed to generic natural causes.^[28] The ship stopped at the British Overseas Territory of Tristan da Cunha on 13–15 April.^[29][30] On 24 April, the Dutchman's body was taken off the ship^[15][22] upon the ship's arrival at the British Overseas Territory of Saint Helena. At this time, 29 passengers disembarked the ship, including the deceased body; among them was the man's 69-year-old widow, who later took a plane to South Africa.^[46][47] The disembarked passengers were from 12 countries and returned home before contact tracing began.^[48]

On 25 April, the widow, who had unknowingly contracted the virus, boarded KLM flight KL592 (codeshare AF8282, DL9560, SK6855) from Johannesburg to Amsterdam, but she was removed from the plane before takeoff due to her medical condition,^[49] and she died in a hospital in South Africa on the same day.^[15] The widow was on the plane for 45 minutes.^[50] After stopping in Saint Helena, the ship continued on to the British Overseas Territory of Ascension Island,^[51] where an ill British passenger was removed and flown to South Africa for hospital care. On 27 April, Hondius left Ascension Island.^[52]

1–5 May

On 2 May, a German woman died on board,^[22][33] and, as of 8 May^[update], her body remains on board the ship.^[53] Following the identification of the outbreak on 4 May,^[47] passengers were told to limit close contact and frequently use hand sanitizer.^[54] On 2 May, the World Health Organization (WHO) first received a report of the hantavirus outbreak.^[55]

On 3 May, the ship docked in Praia, the capital of Cape Verde.^[15][22] The authorities said they were sending medical supplies and officials to support the ship, and officials in Praia also expanded safety protocols near the port as a precautionary measure.^[22] The Cape Verdean government announced the creation of an isolation area and the coordination of a multidisciplinary team to assist the ship's passengers and crew.^[56][57] Around the same time, South African officials began precautionary contact tracing.^[22] By 4 May, gene sequencing had identified the Andes virus in at least one infected person.^[58]

6 May

On 6 May, the ship was anchored outside Cape Verde, a country not deemed capable of dealing with the medical emergency on board.^[15] Despite the objections of the Canary Islands' president, Spain approved the plan for the Hondius to dock in Tenerife, citing its moral and legal obligation to the passengers.^[60]

The Swiss government confirmed that a man infected with hantavirus was being treated in Zurich, Switzerland. Swiss authorities confirmed that the patient was a passenger on the cruise ship, bringing the total number of infections to eight.^[39] The man was one of the 30 passengers who disembarked on 24 April.^[27] On the same day, it was announced that three more people experiencing symptoms had been sent to the Netherlands by two air ambulances for treatment; these were a 56-year-old Briton, a 41-year-old Dutch national, and a 65-year-old German, one of which was the ship's doctor.^[15][61][53]

The first plane carrying two patients landed in the Netherlands on 6 May; the German national was later transferred to University Hospital of Düsseldorf and the Briton to Leiden University Medical Center.^[62][63] The second plane carrying the Dutch national diverted to Gran Canaria and awaited a replacement aircraft after experiencing technical issues in its life support systems.^[64][65] On 6 May, the ship left Cape Verde for the Canary Islands.^[66] Four medical experts embarked while the ship was leaving Cape Verde. Two of these were medical specialists from Amsterdam University Medical Center and Central Military Hospital, a military hospital in Utrecht. The two others were epidemiologists from Italy and the Netherlands, meant to investigate the scope of the virus on the ship.^[24] The selection, transport, and coordination of these experts was assisted by the WHO and European Centre for Disease Prevention and Control.^[67]

Two anonymous Argentine investigators claimed that the leading hypothesis was that the index case—the Dutch citizen who showed the first symptoms—had contracted the virus.^[68][69] On 6 May, the Argentine health ministry published a report detailing the movements of the index case, the Dutch citizen who presented the first symptoms, prior to the ship's departure; the report showed he had gone on a four-month road trip between 27 November 2025 and 1 April 2026, spanning Chile, Uruguay, and Argentina. Meanwhile, the National Ministry of Health and the Malbrán Institute are advancing the epidemiological investigation at the local level, capturing and testing rodents along the route the Dutch passenger travelled, as well as conducting contact tracing. The index case had returned to Argentina from Uruguay only four days before departure.^[70]

7 May

On 7 May, one of the flight attendants on the flight from Johannesburg to Amsterdam on 26 April was admitted to Amsterdam University Medical Center on suspicion of infection, having been in contact with the deceased Dutch woman.^[71] On 7 May, the diverted flight carrying the third patient from the ship landed in the Netherlands, and that patient was hospitalized at Radboud University Medical Center.^[71] Later that day, the patient tested positive for the virus.^[72] The same day, the Singapore Communicable Diseases Agency announced that two of its residents who had been on the cruise and on the same flight as the Dutch woman from Saint Helena to Johannesburg—one of them symptomatic—were being tested.^[73] They tested negative on 8 May.^[74]

A comprehensive risk analysis of the individuals on the two flights the deceased woman had taken was completed by GGD Kennemerland, the Dutch municipal health service responsible for Amsterdam Airport Schiphol. Five individuals were categorized as high risk for having assisted the woman in leaving KLM flight KL592; the hospitalized flight attendant is one of them. An additional 50 individuals were deemed lower risk, as they had been seated within two rows of the woman. The GGD is still attempting to contact these individuals.^[50] The remaining individuals have been informed and are considered to be at the lowest risk.^[75] From the first flight from Saint Helena to Johannesburg, three individuals have been tested due to symptoms; two of those tests have since come back negative.^[76]

It was reported that two patients had been identified as having the Andes virus in lab work by the National Institute for Communicable Diseases of South Africa.^[77] The same day, the UK Health Security Agency (UKHSA) told the BBC that all thirty people who left the ship during its stop in Saint Helena had been identified and contact traced.^[20] Two of these were Britons who are currently isolating without symptoms.^[53] The Quebec Health Minister confirmed that three Canadians are isolating in Quebec and Ontario. Two of them disembarked in Saint Helena on 24 April, and the third flew on the same flight as the deceased woman to Johannesburg.^[48] On 7 May, Oceanwide Expeditions said the ship was expected to arrive at the Port of Granadilla, Tenerife, in the early hours of 10 May.^[78][79][80]

8 May

On 8 May, it was confirmed that the second British national in a health facility in South Africa, who had been on the same flight as the deceased Dutch woman, tested positive. Another Briton was suspected by the UKHSA of having contracted the virus on the island of Tristan da Cunha, where the ship was docked between 13 and 15 April.^[40][81] This individual was currently hospitalized on the island, and their spouse was isolating.^[82] The KLM stewardess tested negative for the virus on 8 May.^[83] On this day, GGD Kennemerland announced that everyone on flight KL592 was being monitored and in contact with the GGD, an escalation of the prior risk analysis which only deemed the two rows around the deceased to be at risk.^{[citation needed]} Secretary of State for Health Javier Padilla Bernáldez also confirmed that a Spanish passenger on KL592 was symptomatic and hospitalized in Alicante. The individual sat two rows behind the deceased, and was thus classified as lower risk.^[84] The US Centers for Disease Control and Prevention (CDC) classified the outbreak as 'Level 3' emergency response, the lowest on the CDC classification scale. The US administration announced the publication of a full report on the outbreak later that day.^{[85][better source needed]} In a press conference, the Director of Epidemiology and Environmental Health for Tierra del Fuego's Ministry of Health stated that the patients on the Hondius were unlikely to have been infected in the province.^[86]

Evacuation plans for the arrival of the ship on the Canary Islands were being finalized. Spain was coordinating the arrival of the ship with 22 countries, and the WHO. Almost all countries were sending evacuation aircraft for their citizens, and the EU provided two aircraft for those who did not have an assigned flight.^[87] Countries had differing quarantine plans for their nationals once evacuated.^[88][89]

There had been three deaths, with two confirmed to have been caused by hantavirus.^[9] The other one remained under investigation.^[9] As of 8 May, the WHO reported two probable cases and six confirmed cases, for a total of eight.^[9] The UKHSA reported one additional suspected case, with two Britons being confirmed infected.^[90][91]

The sequences of the virus isolated from a Swiss resident was published on virological.org on 8 May. The isolate was designated "ANDV/Switzerland/Hu-3337/2026". Nextstrain pages were set up for this outbreak using these sequences on the same day.^[92]

9–10 May

On 9 May, the ship was en route to the Canary Islands and expected to arrive early on 10 May.^[93]

On 10 May, British military personnel from the 16 Air Assault Brigade parachuted down to Tristan da Cunha from a RAF A400M Atlas, where one of its 220 residents, an earlier passenger on the ship, was suspected of having contracted the virus. As the island has no airstrip, parachuting was the only option given the time-sensitive nature of the situation – the nearest port (in South Africa) is over a week sailing time away. In total six paratroopers, a Royal Air Force (RAF) consultant and an army nurse arrived to the island while oxygen supplies and medical aid were also dropped.^[94] This comes after the island reported their oxygen reserves being at a critical level, ruling out sending equipment by ship from Ascension Island.^[95]

The ship arrived in the Port of Granadilla, around 05:30 WET on 10 May and began disembarkation.^{[96][unreliable source][97]} Spanish health minister Mónica García described the planning to prevent hantavirus spread as "unprecedented".^[98][55] At Spain's request, an EU air ambulance stationed in Norway and crewed by Norwegian doctors was sent to Tenerife to be on stand-by in case of any serious illness found during disembarkation.^[99] The passengers disembarked in order of their homeward-bound flight departure time, with the Spanish nationals disembarking first. The first evacuation flight took off at 13:31 WET.^[100] When the French evacuees arrived at a French hospital, Prime Minister Sébastien Lecornu announced that one of the five French nationals showed symptoms fitting the virus during the flight.^[101] As of late 10 May WET, seven evacuation flights had taken off, transporting 94 passengers to six European countries and Canada.^[102][103]

Some of the ship's crew stayed on board to take it to Rotterdam in the Netherlands after its planned departure from Tenerife on 11 May for the disinfection of the entire ship.^[104] The body of a passenger that died on board will also remain on the ship until its arrival in Rotterdam.^[105] The rest of the crew were to be evacuated by a Dutch government plane on 11 May.^[106]

A flight transporting evacuated passengers landed in Manchester around 21:00 on 10 May. The passengers—consisting of twenty UK citizens, one German national residing in the UK, and one Japanese man (who was evacuated at Japan's request)—were hospitalized at Arrowe Park Hospital, the location of UK's initial quarantine during the COVID-19 pandemic.^[107]

11–12 May

On the morning of 11 May, it was announced that the symptomatic French national had tested positive, with her health worsening overnight. Additionally, one asymptomatic American tested positive, and another had mild symptoms.^[108] The French government increased its public health alertness level, and had identified 22 French nationals who were high risk contact cases with infected individuals.^[109] Later, the WHO reported that the woman was in "very critical condition", and that she had already shown symptoms while on the ship. In the evening of 11 May local time, one of the Spanish nationals who had arrived in Spain the day before tested positive. The 13 other Spanish nationals tested negative.^[110]

During the evacuation of the final passengers aboard the MV Hondius, a Spanish officer died of a heart attack at the port.^[111] Around 20:00 WET, the ship left Tenerife for Rotterdam with 25 crew members and two medics from the RIVM after all passengers and 35 crew members successfully disembarked and were repatriated.^[112] The body of the deceased German national was still on board.^[113] The journey is expected to take six days, with the ship arriving in the evening of 17 May.^[114] In total, 122 individuals disembarked the ship in Tenerife and were repatriated to their home countries, or the Netherlands for those nationalities that did not provide their own evacuation flights.^[113]

On 12 May, a Spanish passenger was confirmed positive, exhibits symptoms, and was isolated in hospital. Twelve hospital workers in Nijmegen, Netherlands, failed to comply with protocols and were placed in isolation.^[115]

13 May

Since the hospitalization of the French passenger on 10 May, her condition has worsened. On 13 May, French authorities stated that she is on life-support. They also said that this is "the final stage of supportive care".^[43] That same day, the WHO posted its third official update regarding the outbreak, and adjusted one of the previously confirmed cases to inconclusive after a second test came back negative, awaiting a third test from the American national who had shown no symptoms.^[2]

15 May

On 15 May, the CDC announced that an American passenger who had developed flu-like symptoms on board and who had initially been listed as having "inconclusive" test results was retested with negative result and showed no antibodies, meaning he was never infected.^[4]

A Canadian passenger isolating in British Columbia tested "presumptively positive", with the patient hospitalized and three others under medical observation. While awaiting national laboratory confirmation, health officials are treating the case as positive during the 21-day isolation period.^[32]

Passenger monitoring and contact tracing

The WHO has been coordinating monitoring of those who disembarked or were evacuated with health care agencies in twelve countries, including Canada, Denmark, Germany, the Netherlands, New Zealand, Saint Kitts and Nevis, Singapore, Sweden, Switzerland, Turkey, the United Kingdom, and the United States.^[121]

Canary Islands arrival

On 6 May, the ship was anchored near Cape Verde, which was not considered able to handle the scale of operation needed for the ship's safe evacuation.^[15] Instead, it intended to travel to Tenerife and have its passengers disembark there. However president of the Canary Islands Fernando Clavijo said he "cannot allow [Hondius] to enter the Canaries" and refused to receive the ship in Tenerife.^[15][60] Clavijo's refusal stemmed from his concern that the ship's arrival would endanger the people of the Canary Islands, a view shared by many islanders, particularly in light of their experiences during the COVID-19 pandemic.^[60] The cruise company said that "Spain has a moral and legal obligation to assist these people, among whom are several Spanish citizens".^[15]

Despite the objections of the Canary Islands' president, Spain approved the plan for the Hondius to dock in Tenerife, with its health agency stating it was "in accordance with international law and humanitarian principles".^[69] The ship set sail for the islands on 6 May.^[69][149]