Americans from hantavirus-hit ship arrive in U.S., including 1 who tested positive

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Seventeen Americans and a dual British-U.S. citizen evacuated from the cruise ship hit with a deadly outbreak of hantavirus arrived in the U.S. early Monday.

One American on the repatriation flight “tested mildly PCR positive for the Andes virus,” the strain involved in this outbreak, and another began showing symptoms, the Department of Health and Human Services said Sunday night.

Both passengers were “travelling in the plane’s biocontainment units out of an abundance of caution,” HHS said. The passenger who tested positive was not experiencing symptoms, according to a statement from the University of Nebraska Medical Center. The passenger who did have mild symptoms later tested negative for the virus, HHS said.

Most taken to Nebraska quarantine and biocontainment units

The flight to the U.S. landed in Omaha early Monday and a convoy, ambulance and multiple buses took passengers to the University of Nebraska Medical Center, where 16 will stay for monitoring.

Two other passengers were flown to Atlanta, where the U.S. Centers for Disease Control and Prevention is based, for further assessment and care, said the CDC’s Brendan Jackson, acting director of the Division of High Consequence Pathogens and Pathology. 

Of the Nebraska group, 15 people were taken to the National Quarantine Unit at the medical center, while another person was taken to a biocontainment unit there, health officials said at a briefing Monday. 

The person in the biocontainment unit, which provides hospital-based care, was “doing well” as of Monday morning and did not have any symptoms, according to Angela Hewlett, an infectious disease physician and the medical director of the Nebraska Biocontainment Unit.

The 15 people who went to the quarantine unit “were in good shape” and “in good spirits,” said Michael Wadman, an emergency physician and the medical director of the quarantine unit. They were all asymptomatic as of Monday morning, Wadman said, and were being monitored in the unit, which is more like a hotel rather than a care space, he said.

Wadman described the transfer of the 15 people to the unit as smooth, safe and successful. 

There have been at least 10 confirmed or suspected cases of hantavirus linked to the outbreak on the ship, the MV Hondius, including three fatalities: A Dutch couple and a German woman. Patients involved in the hantavirus outbreak have tested positive for the Andes strain, which can be transmitted from person to person. Hantavirus is typically transmitted by rodents.

The details surrounding the arrivals came after France’s prime minister said Sunday afternoon that a citizen of that country also began showing symptoms during a repatriation flight. All five passengers on that flight “were immediately placed in strict isolation until further notice,” and will undergo testing, French Prime Minister Sébastien Lecornu said on social media.  

The country’s health minister later told France Inter radio the woman tested positive for hantavirus and her condition has deteriorated.

A complex and careful disembarkation 

The MV Hondius was carrying nearly 150 people from more than 15 countries, including 17 Americans, when it set sail earlier this week from Cape Verde to Granadilla, after Spain agreed to take the ship.  

Passengers began disembarking Sunday morning from the ship after it docked in Spain’s Canary Islands. They were carefully evacuated by nationality and placed on repatriation flights. Spanish nationals disembarked first, then boarded a plane for Madrid, where they were taken to a military hospital. French and British passengers also evacuated.

Oceanwide Expeditions, the ship’s operator, said all passengers and a portion of the approximately 60 crew members evacuated the ship using launch boats that carry a maximum of five to 10 people each. 

People were then checked for symptoms. Passengers and crew members had no contact with the local population on Tenerife before they were taken to their evacuation flights, authorities said. A video shared by Spain’s defense ministry shows the inside of one repatriation flight, revealing surfaces wrapped in plastic and crew members wearing protective gear. 

The operation in Tenerife was supervised by Spain’s health and interior ministers as well as the World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus.

Although health officials have said risks from the cruise outbreak remain low for the general public, those disembarking and port workers wore face masks, hazmat suits, respirators and other protective gear during the evacuation process.

After disembarkation, a skeleton crew was to take on supplies and then begin the journey to Rotterdam, Netherlands, which is expected to take about five days, Oceanwide Expeditions said. The body of a passenger who died on board will also remain on the ship, which will be disinfected once it arrives in Rotterdam, according to Spanish authorities.

Quarantine protocols

U.S. nationals were Sunday’s last evacuation group. The CDC said it was sending a team of epidemiologists and medical professionals to the Canary Islands to “conduct an exposure risk assessment for each American passenger and provide recommendations for the level of monitoring required.”

After disembarking from the Hondius, 18 people were flown back to the U.S. in a plane that was sent by the U.S. Centers for Disease Control and Prevention and HHS. 

The medical center said the passenger who tested positive was “managed separately from other passengers during transport using appropriate biocontainment measures.” 

The university’s statement did not mention the passenger HHS said was experiencing symptoms.

Dr. Wadman, of the National Quarantine Unit, previously said that each of them will have their own room while they quarantine for an unspecified amount of time. 

Centers for Disease Control and Prevention acting Director Dr. Jay Bhattacharya told CNN’s “State of the Union” that seven Americans who left the cruise earlier have been in the U.S. for roughly two weeks and returned to several different states. Health officials say they are being monitored and none have shown symptoms. 

Each country has come up with its own quarantine plan. British authorities said U.K. passengers and crew will be hospitalized for observation once they are flown home, while the 14 Spaniards will be under quarantine at a military hospital in Madrid. 

In France, Lecornu said that in addition to isolating the passengers on the repatriation flight, he will issue a decree “to implement appropriate isolation measures for close contacts and to protect the general population.” 

Officials insist the public is at low risk 

Hantaviruses are a family of diseases that are spread to people from rodents through urine, droppings or saliva, according to the CDC. It can take up to eight weeks after contact for symptoms to develop.

WHO says that the Andes strain of the virus, which is found in Latin America, is the only one that is known to be able to transmit the virus through human-to-human contact, with Tedros assessing the public risk as “low.”

He told CBS News at a briefing Sunday morning that Americans “shouldn’t worry” about the impending return of cruise passengers and encouraged people to put their trust in health officials.

“This is not another COVID, and the risk to the public is low. So, they shouldn’t be scared and they shouldn’t panic,” said Tedros. He also said years of scientific evaluations of the virus and its behavior, in addition to how the virus has behaved so far in this particular outbreak, have informed that judgement.

Tedros’ assessment was echoed by the acting CDC director. Former FDA Commissioner Scott Gottlieb said Sunday on “Face the Nation with Margaret Brennan” that U.S. passengers being brought home are likely reaching the peak of the virus’ incubation cycle this week and “nearing the end of the transmission window.”

Outbreak timeline

The source of the outbreak remains under investigation. Prior to boarding the ship, the Dutch couple who died, a 70-year-old man and his 69-year-old wife, are believed to have spent weeks traveling through Argentina, Chile and Uruguay on a bird-watching trip in areas where the species of rodent known to carry the Andes virus is present, Tedros said.

The man developed symptoms on April 6 and died on the ship on April 11, WHO said, but no samples were taken because his symptoms were similar to those of other respiratory viruses, and hantavirus was not suspected at the time.

His wife then went ashore when the ship docked on the British territorial island of St. Helena. She showed serious symptoms on a flight to Johannesburg, South Africa, on April 25, and died in South Africa the following day, WHO said. Testing confirmed she had contracted hantavirus.

The German woman showed symptoms on April 28 and died aboard the ship on May 2, according to WHO.

Three other patients were flown off the ship to the Netherlands for emergency medical care this week, and a Swiss man who began showing symptoms after disembarking the ship was receiving care in Zurich. A British man was medically evacuated to South Africa, while another British national who had disembarked the ship is hospitalized on the island of Tristan da Cunha, a British territory.

Oceanwide Expeditions said 32 passengers from about a dozen countries had disembarked the Hondius in St. Helena, including the Dutch woman who died days later. Those American passengers who returned to the U.S. prior to the discovery of the outbreak were being monitored by state health agencies in California, Georgia, Texas, Virginia and Arizona.

The Hondius set sail for its cruise April 1 from Ushuaia, Argentina, which took it to several islands in the south Atlantic, including the South Georgia and South Sandwich Islands, Tristan da Cunha, Gough Island and then St. Helena from April 21 to April 24.

The vessel then anchored off the coast of Cape Verde, an archipelago located off West Africa, for several days before heading to the Canary Islands.