Evacuation push follows deadly cruise outbreak

Medical teams moved to evacuate two sick people from the MV Hondius on Tuesday after a hantavirus cluster aboard the Dutch-flagged expedition cruise ship left three people dead and forced the vessel to remain off Cabo Verde while international health authorities assessed the risk to passengers, crew and ports along its planned route.

The vessel, carrying 147 people, including 88 passengers and 59 crew members from 23 nationalities, has been held off Praia after authorities were alerted to a cluster of severe respiratory illness. Seven confirmed or suspected cases have been identified, comprising two laboratory-confirmed hantavirus infections and five suspected cases. One patient is critically ill in intensive care in South Africa, while three people aboard have reported milder symptoms, including fever and gastrointestinal problems.

The ship left Ushuaia, Argentina, on 1 April for a South Atlantic expedition that included stops around Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena and Ascension Island. Investigators are examining whether exposure occurred before embarkation in Argentina, during landings in remote wildlife areas, or through close contact between passengers sharing cabins. Health officials have also been told there were no rats aboard the vessel, leaving the precise source of infection unresolved.

Illness among those affected began between 6 April and 28 April. The first fatality was an adult male who developed fever, headache and mild diarrhoea on 6 April, deteriorated into respiratory distress and died on board on 11 April. His body was removed at Saint Helena on 24 April. A close female contact left the ship at Saint Helena with gastrointestinal symptoms, deteriorated during travel to Johannesburg and died after arriving at hospital on 26 April. Her infection was later confirmed by PCR testing.

A third patient, an adult male, developed fever, shortness of breath and signs of pneumonia on 24 April. He worsened two days later and was evacuated from Ascension Island to South Africa on 27 April, where he remains in isolation in an intensive care unit. Another adult female developed fever and pneumonia symptoms on 28 April and died on board on 2 May. Three more suspected cases remain under evaluation, with specimens being collected for laboratory testing.

Hantavirus infection is usually acquired through contact with the urine, faeces or saliva of infected rodents, often when contaminated material becomes aerosolised and is inhaled. The illness can begin with fever, headache, dizziness, abdominal pain, vomiting or diarrhoea, then progress rapidly to coughing, breathlessness, pneumonia, shock and acute respiratory distress. Severe pulmonary disease can be fatal, particularly where diagnosis and intensive care are delayed.

The possibility of limited person-to-person spread is now part of the investigation because the suspected strain may be Andes virus, a hantavirus associated with South America. Human transmission is uncommon, but documented clusters involving very close contact have occurred in parts of Argentina and Chile. That risk profile has shaped onboard precautions, with passengers advised to remain in cabins where possible, reduce contact, wear masks when needed and follow medical instructions while further testing continues.

Cabo Verde, the Netherlands, Spain, South Africa and the United Kingdom are coordinating with the ship’s operator and global health authorities. The immediate operational priority is the evacuation of two symptomatic people still aboard, followed by a plan for the ship to continue towards the Canary Islands if Spain authorises its arrival after inspection and risk assessment. Spanish authorities have indicated that any decision would depend on health data gathered from the vessel and the condition of those on board.