More hantavirus cases are expected, WHO chief says

Three under watch in Kansas after "high-risk exposure"

Mary Walrath-Holdridge

Health officials in Kansas are monitoring three residentswho had "high-risk exposure" to someone with a confirmed case of Andes virus, the Kansas Department of Health and Environment said on Tuesday, May 12.

Citing the CDC, the department said the three were considered "high risk" because they were in close contact with an infected person showing symptoms while traveling.

"The three individuals in Kansas were not aboard the cruise ship and are not currently experiencing symptoms," the statement said. "Based on our current knowledge of Andes virus, individuals are not considered infectious to others unless they become symptomatic."

There are no suspected cases of the virus in Kansas and the risk to the public remains "extremely low," the department said.

Washington health department monitoring three residents for hantavirus

Mary Walrath-Holdridge

Three people who were possibly exposed to hantavirus are under monitoring in Washington, the state health department said in a notice on Tuesday, May 12.

Two of the King County residents sat next to an ill cruise passenger who later tested positive for the virus on an airplane, according to the health department, while another was a passenger of the MV Hondius itself. The two people who were exposed on the plane have shown no symptoms and are being monitored at home. The third passenger, who was aboard the ship, is also asymptomatic but is currently being housed in the quarantine center at the University of Nebraska Medical Center.

"Even though these individuals do not show signs of illness, we have strong contact tracing and monitoring in place," said Dr. Sandra J. Valenciano, Health Officer and Acting Director for Public Health of Seattle and King County, Washington. "These are measures that have contained the spread in previous outbreaks of hantavirus. The risk of this virus spreading to residents of King County is low at this time."

It's unclear whether hantavirus mutated

Natalie Neysa Alund

France's top health advisor on Tuesday said it was unclear whether the hantavirus that caused an outbreak on board the MV Hondius had mutated, but said there was no evidence of widespread circulation in the European country.

"We do not yet have the complete sequencing of the virus, which allows us to say with certainty today, even if we are rather reassured to date ... that this virus has not yet mutated," French Health Minister Stéphanie Rist told the country's lawmakers in a post shared on X.

So far, the World Health Organization has not reported anything unusual about the virus strain detected on the cruise ship aside from the location.

A woman infected with Andes virus remained hospitalized in France on Tuesday, Rist said during a news conference. The woman was one of five French nationals repatriated from the ship. The woman, who is a French citizen, was in intensive care, Rist said.

Rist told the National Assembly that, as of Tuesday, French officials had identified 22 contact cases connected to the outbreak. Rist said the affected people were being quarantined in hospitals to undergo testing to see whether they are positive for the virus.

Contributing: Reuters.

16 quarantined Americans remain asymptomatic

Natalie Neysa Alund

Sixteen Americans who arrived at the University of Nebraska's National Quarantine Center currently remain asymptomatic, the U.S. Department of Health & Human Services said Tuesday.

Two additional Americans were taken to a quarantine unit at Emory University in Atlanta, including one person who was experiencing symptoms. But that person on Monday "tested negative for the Andes variant of hantavirus," the agency posted on X. Health officials believe the Andes virus can spread from person to person.

Health officials did not immediately confirm the condition of the other individual transported to the Georgia unit.

Americans quarantining at home is part of 'typical' US response, says expert

Mary Walrath-Holdridge

American passengers returning from the MV Honduis have been sent for evaluation at a quarantine center, but will not be required to stay at the facility after being risk-assessed, the National Institutes of Health said. Instead, most will be allowed to go home and continue monitoring there.

Dr. Scott Weaver, director of the Institute for Human Infections & Immunity at the University of Texas Medical Branch and Center Director for the Global Virus Network, said authorities' decision not to mandate people stay in a quarantine center is typical of a U.S. infectious disease response.

"If these patients are well educated to quickly identify any signs or symptoms of infection, and they're taking their temperatures twice a day, and maybe have a public health worker – say a county health department worker checking in on them daily, that can reduce the risk a whole lot," he said.

Sixteen American passengers are staying at the National Quarantine Unit in Omaha, Nebraska, which has 20 beds. Two others are staying in an 11-bed communicable diseases unit at Emory University in Atlanta.

"(Hantavrius has) a very long incubation period and it just makes it quite challenging to put these people in quarantine for a long time," he said.

Passenger gives insight into quarantine

Melina Khan

Jake Rosmarin's room at the National Quarantine Unit in Omaha, Nebraska, could be mistaken for a hotel room or college dorm.

The single-occupancy space comes with an ensuite bathroom, bed, recliner and desk, as Rosmarin showed in a video posted to social media on May 12. It's even equipped with a stationery exercise bike, smart TV and mini fridge.

"The room is very spacious and comfortable," Rosmarin said. "I can have stuff sent here for the duration of my stay, so I'm definitely going to be getting some things for me to feel more at home and more comfortable."

Rosmarin told the "TODAY" show on May 12 that he is feeling good and in good spirits after evacuating the ship.

"I'm happy to be in a place where I know we are well cared for and I know if anything happens, we have the medical attention that we need," he said.

How can we prevent spread if quarantines aren't mandated?

Sara Moniuszko

In a media briefing organized by the College of American Pathologists on Tuesday, experts addressed concerns about the hantavirus spreading if quarantines for the repatriated passengers aren't being mandated.

Currently, all U.S. citizens that were aboard the cruise ship at the center of the deadly hantavirus outbreak are in quarantine or biocontainment units in Nebraska or Georgia. In addition to these 18 passengers, more than a half dozen U.S. states are monitoring individuals who may have been exposed to the virus before the outbreak was recognized.

"For those individuals who are either under monitored quarantine in quarantine facilities, or those who are under monitoring and quarantining at home, there has been an understanding that the most important thing is that people are aware that symptoms can develop within a pretty long incubation period," said Dr. Mara Jana Broadhurst, a member of the College of American Pathologist's Microbiology Committee and associate professor at University of Nebraska Medical Center.

She said it's appropriate to take precautions among those who have had an exposure − and if symptoms develop, which can "escalate quickly" and cause "very serious infection," it's important that "people have access to higher levels of care."

"I want to emphasize that every individual who has had an exposure to this virus is very well aware that symptom monitoring is very important, and that being able to access appropriate care with the appropriate infection prevention and control precautions is very important," she said.

An individuated approach is also being taken with testing procedures, Broadhurst said.

What happens to MV Hondius now?

Nathan Diller

MV Hondius is still working with Dutch health and government officials to finalize plans for when the ship arrives in Rotterdam, according to Oceanwide Expedition's May 11 news release.

The ship is said to be thoroughly sanitized once it reaches port on Sunday or Monday, but the exact cleaning procedures are still being decided in coordination with several organizations, including the Dutch National Institute for Public Health and the Environment (RIVM), the World Health Organization (WHO), the Dutch Ministries of Foreign Affairs and Health and Rotterdam Port Health Authority.

"Using my experience in decontamination after a Norovirus outbreak, (which) is much more contagious than Hanta, a crew will board the ship, usually 20-30 contractors," Walt Nadolny, professor emeritus of marine transportation and global business at the State University of New York Maritime College, and a former environmental officer for Carnival Cruise Line and Norwegian Cruise Line, told USA TODAY. "All hard surfaces will be cleaned with a bleach or similar solution. Everything will be wiped: switches, elevator buttons, door handles, etc. All washable lines will be laundered in hot water. Soft goods, cushions, couches, chairs and the like will be either steam cleaned or wiped with a non-bleach solution. All areas of the ship will be cleaned, not just passenger and crew areas. Galleys, control rooms, and embarkation areas. This will take, on average, 1-2 days."

Cruise ships tend to have about a 30-year lifespan, and given the cost of removing the vessel from service, it is very likely that MV Hondius will resume sailing, Nadolny added. Although a name change might be likely, as was the case with Carnival Triumph, known as the "poop cruise," which became Carnival Sunrise.

Where did hantavirus originate?

Melina Khan

How many confirmed hantavirus cases are tied to cruise outbreak?

Melina Khan

As of Tuesday, May 12, a total of 11 people around the world have had either confirmed or suspected cases of hantavirus tied to the MV Hondius outbreak, according to the World Health Organization.

Nine of the 11 cases have been confirmed as the Andes virus, and the two others are probable, Dr. Tedros Adhanom Ghebreyesus, WHO director-general, said at a news conference. The number includes the three people who have died from their infections.

All of the cases are among passengers or crew members from the ship, Ghebreyesus said.

"At the moment there is no sign that we are seeing the start of a larger outbreak. But of course the situation could change and given the long incubation period of the virus it's possible we might see more cases in the coming weeks," he said.

According to the WHO, here is a breakdown of the 11 cases:

1. An adult male developed symptoms of fever, headache, and mild diarrhea on April 6 while on board the ship. He developed respiratory symptoms and died on board on April 11. His body was removed to St. Helena, a British Overseas Territory in the South Atlantic, on April 24. This is a suspected case but was not confirmed.
2. An adult female, identified as the wife of the male who died on board on April 11, went ashore to Saint Helena on April 24 with gastrointestinal symptoms. Her symptoms worsened during a flight to Johannesburg, South Africa, on April 25. She died on April 26. The case was confirmed as a hantavirus infection on May 4.
   • Officials said the husband and wife were Dutch nationals and had traveled in South America, including Argentina, before they boarded the cruise ship.
   • KLM confirmed on May 6 that the woman traveled on board one of its flights.
3. An adult male reported a fever, shortness of breath and signs of pneumonia to the ship's doctor on April 24. After his condition worsened, he was medically evacuated to South Africa on April 27, where he is currently hospitalized in an intensive care unit. Testing confirmed a hantavirus infection, specifically the Andes strain, on May 2.
4. An adult female whose symptoms began on April 28 and included fever and signs of pneumonia. She died on May 2. Her infection was later confirmed through testing to be the Andes virus.
5. An adult male, identified as the ship doctor, whose symptoms began on April 30 and included fever, fatigue, muscle pain and mild respiratory symptoms. Lab testing confirmed an Andes virus infection. He was medically evacuated to the Netherlands on May 6 and is stable in isolation as of May 8.
6. An adult male, who was a ship guide, reported mild respiratory and gastrointestinal symptoms on April 27. Lab testing confirmed an Andes virus infection, and he was medically evacuated to the Netherlands on May 7. He is stable in isolation as of May 8.
7. A Swiss man who had traveled on the ship before disembarking on April 22 and returning home days later. He started experiencing symptoms on May 1, began self-isolating and has since been admitted to a hospital in Zurich. Lab testing confirmed an Andes virus infection on May 5.
8. A French person who was a passenger on the ship and is currently hospitalized, Stéphanie Rist, the country's minister of health, confirmed on May 11. Rist told France Inter radio that the passenger was among five ⁠French people who were evacuated from the ship on May 11. The four other passengers tested negative ​but were being retested, Reuters reported.
9. An American who was evacuated from the ship on May 10 and tested positive for the virus, per the Department of Health and Human Services. They are currently quarantining at a biocontainment unit at the University of Nebraska and do not have symptoms, Dr. Angela Hewlett, director of the Nebraska Biocontainment Unit, said at a May 11 press conference.
10. An American who was evacuated from the ship on May 10 and transferred to a biocontainment unit at Emory University in Atlanta, Georgia. Although they are symptomatic, the case has not been confirmed yet. Their partner, who is asymptomatic, is also under observation, Dr. Aneesh Mehta, chief of infectious diseases at Emory University Hospital, said at aMay 11 press conference.
11. A Spanish person who was evacuated from the ship and arrived at Gómez Ulla Hospital, a military hospital in Madrid, on May 11, tested "provisionally positive" for the virus, Mónica García, the country’s minister of health, announced on X. On May 12, Spain's Ministry of Health said the individual has been confirmed as a positive case.

We should 'respect this virus,' but not panic, experts say

Sara Moniuszko

Pathology experts are assuring the general public that the hantavirus outbreak is serious but not a reason to panic.

“We should respect this virus and not trivialize it but also not catastrophize it," Dr. Bobbi S. Pritt, professor of Laboratory Medicine and Pathology and the Chair of the Division of Clinical Microbiology at Mayo Clinic, said in a news briefing on Tuesday.

"Those that have had close contact to infected individuals, they have a right to be concerned,” she said, but added, “this is not a pandemic setting where we have a high transmission rate.”

Dr. Mara Jana Broadhurst, a member of the College of American Pathologist's Microbiology Committee and associate professor at University of Nebraska Medical Center, added we have more information on hantavirus than we had on the COVID-19 virus at the start of that pandemic.

“We do have more information that is guiding the risk assessment and how this is being approached," Broadhurst said.

American responses to hantavirus

Sara Moniuszko

President Donald Trump and other officials in his administration are responding to the hantavirus outbreak.

Trump called the U.S. handling of the deadly virus "fine" while speaking to reporters on Monday. Asked by USA TODAY whether he had regrets over leaving the WHO, the president said, "No, I’m glad" to have left. 

"The thing with this one is it’s much harder to catch," said Trump of hantavirus when speaking to reporters in the Oval Office. "It seems like it’s not easy to spread, in fact it’s in certain ways very hard to spread. We’ve lived with it for many years and we think we’re in very great shape.

In response to concerns from infectious disease experts that the country isn't prepared for public health threats amid hantavirus, Health and Human Services Secretary Robert F. Kennedy Jr. said, "We have this under control, and we're not worried about it."

Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services, added the country "is prepared."

"The CDC is focused on it, and the agency is well aware of the opportunities to actually treat this problem, not just try to prevent in the future, but treat if it happens," he said.

France's prime minister calls for closer EU coordination

Natalie Neysa Alund

French Prime Minister Sébastien Lecornu said he's asked neighboring European Union countries for closer cooperation amid the hantavirus outbreak.

The country's leader, in a post on Xon Tuesday, called improved internal coordination "essential" to avoid further spread of the virus.

"I have asked the Ministers to immediately strengthen cooperation with neighboring States and to push for closer coordination of the health protocols in place within the European Union and the Schengen Area," Lecornu wrote. "Breaking any potential chains of transmission requires sharing information, decisions, and lessons learned as quickly as possible."

As of Tuesday, a French citizen was among passengers on board the MV Hondius who had contracted the virus, according to Olivier le Polain, unit head of epidemiology and analytics for response with the World Health Organization (WHO), who confirmed the case during a news update one day earlier.

WHO, which spearheaded outbreak response, and the European Centre for Disease Prevention and Control have been leading public health and logistical efforts to contain the virus and repatriate citizens. The Centers for Disease Control and Prevention, in a May 8 post on its website, said it was working with "international partners."

Why are more cases expected from hantavirus outbreak?

Sara Moniuszko

There may be more cases of hantavirus than the initial count, according to World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus.

In a press briefing on Tuesday, he explained this is because the first case on the ship was on April 6, but it wasn't confirmed as infectious until around April 24 or 25.

"There was a lot of interaction with the passengers. And as you know, the incubation period is also six to eight weeks. So, because of the interaction while they were still in the ship, especially before they started taking some infectious prevention measures... we would expect more cases," he explained.

Dutch hospital staff members quarantining after hantavirus exposure

Eve Chen

A dozen staff members of a Dutch hospital are now preventatively quarantining after handling a hantavirus patient's bodily fluids without following the latest protocols.

Radboudumc hospital in Nijmegen said the risk of infection is very low, but the staff members will quarantine for six weeks. The hospital also noted patient care was not interrupted.

Asked about what other countries can learn from this, World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said, "Of course we should learn from this operation: what has been done well and what were also the weaknesses identified, because there should be a constant learning and change should be a constant. Improvement should be a constant, and I know countries see it that way. And that's why, by the way, based on COVID lessons, we're trying to improve the system."

He made the remarks during a joint press conference with Spain's Prime Minister Pedro Sánchez on Tuesday.

Speaking more broadly about safety protocols, Dr. Tedros Adhanom Ghebreyesus said, "Of course WHO has a clear guidance and countries are expected to follow or to use, but at the same time, countries, based on their own assessment, they can make some adjustments because sometimes the local situation could, may need some adjustments."

He noted countries have sovereignty.

"We can't force them to take our protocols. We can only advise and recommend, but I hope they will follow the advice and recommendations we are making," he said.

Contributing: Reuters

What's the difference between quarantine and biocontainment?

Sara Moniuszko

The 18 U.S. citizens who have returned from the center of the deadly hantavirus outbreak have been placed either in quarantine or biocontainment units - but what's the difference?

"Quarantine is sort of like a very well managed air handled hotel room and the bio containment unit is like a very well managed air handled Intensive Care Unit," an official explained at a news briefing on Monday.

Those in quarantine are not showing symptoms, while those in biocontainment have either tested positive, started showing symptoms or were in close contact with someone who has.

Currently, one passenger is at a biocontainment unit at the University of Nebraska while 15 others are quarantining at the university's National Quarantine Center. Two passengers – including one who is symptomatic – have been sent to a biocontainment unit at Emory University in Atlanta, Georgia, for further assessment.

WHO chief declares 'mission accomplished'

Eve Chen

The director-general of the World Health Organization is declaring the debarkation of the MV Hondius a success.

"Mission accomplished thanks to superb leadership by Spanish government — the MV Honduis is on its way to the Netherlands, and passengers and crew are now in good hands with experts from their respective countries," Dr. Tedros Adhanom Ghebreyesus posted on X on Tuesday, thanking Spanish and European Union leaders, as well as the people of Tenerife, where passengers and most crew were able to get off the ship.

The vessel's operator, Oceanwide Expeditions, said 25 crew members and two medical professionals remain on board as the ship heads to Rotterdam, where it's expected to arrive Sunday, May 17.

In an earlier news conference, Dr. Tedros Adhanom Ghebreyesus said, "And to the people of those countries who (are) receiving their citizens, nothing to fear, the risk is low."

The WHO has repeatedly said the risk of hantavirus spreading to the general public is low.

How many Americans came from the hantavirus-stricken ship?

Sara Moniuszko

Eighteen people who were aboard the cruise ship at the center of the deadly hantavirus outbreak were brought to health facilities in the United States. This includes 17 Americans and one British dual citizen who decided to come back to the U.S., officials confirmed at a news briefing on Monday.

Sixteen passengers are at the University of Nebraska − 15 in quarantine and one in a biocontainment unit. The other two passengers are at a biocontainment unit at Emory University in Atlanta, Georgia, for "further assessment," officials said.

Which US states are monitoring residents for possible hantavirus?

Melina Khan

More than a half dozen U.S. states are monitoring individuals who may have been exposed to hantavirus.

In addition to the 18 passengers who are now quarantining in Nebraska and Georgia, several states are monitoring individuals who may have been exposed to the virus before the outbreak was recognized.

The following states are currently monitoring hantavirus:

• Arizona: One state resident was recently a passenger on the ship but is not symptomatic and is being monitored, Magda Rodriguez, a spokesperson for the Arizona Department of Health Services, said in a May 7 email to The Arizona Republic, part of the USA TODAY Network.
• California: Two residents were recently on the ship but had returned to California before the outbreak was recognized. Separately, two Californians remained on the ship prior to its evacuation and are now quarantining in Nebraska, Erica Pan, director of California's Department of Public Health, said at a May 11 press conference.
• Georgia: Two residents who traveled on the MV Hondius are "currently in good health and show no signs of infection," the Georgia Department of Public Health said in a statement to USA TODAY on May 6. Separately, two passengers on the MV Hondius are currently in a quarantine unit at Emory University in Georgia, health officials said during a May 11 news conference hosted by the University of Nebraska.
• Nebraska: Sixteen passengers from the MV Hondius – including 15 U.S. residents and one British dual national – are currently being monitored at the University of Nebraska Medical Center in Omaha, Nebraska, health officials said at the May 11 press conference.
  • It's unclear which states they all reside in. Here's what we know so far:
    • 3 passengers from New York, the New York Department of Health said in a May 11 press release.
    • 3 passengers from Utah, the state's Department of Health and Human Services said on May 11.
    • 2 passengers from California, Pan said at a May 11 press conference.
• New Jersey: Two people living in the state were potentially exposed to a person infected with hantavirus who departed from the MV Hondius. The residents were not passengers on the cruise ship; the potential exposure occurred during air travel. Neither person has any symptoms, the state's health department announced on May 8.
• Texas: Two residents were passengers on the ship and returned to the U.S. before the outbreak was identified. They have not experienced any symptoms, the state's health department said in a statement on May 7.
• Virginia: One resident who returned home from the ship is in good health and is being monitored, Virginia Department of Health spokesperson Maria Reppas told USA TODAY on May 7.

COVID, the hantavirus outbreak and why many feel panicked

Alyssa Goldberg

Experts say news of the recent hantavirus outbreak can be "especially alarming” following the collective trauma experienced during the COVID-19 pandemic. 

“The evolving, prolonged impact of news surrounding illness, loss, and loneliness, as well as lingering questions of if, when, and how we would survive,” says Dr. Vanessa Kennedy, clinical therapist and director of psychology at Driftwood Recovery, “it took an enormous toll on our lives and psyches… We may be experiencing the resurfacing of familiar anxiety, fear, and confusion as news unfolds.”

People have turned to TikTok to express those fears. 

“Trying to work like normal while also having raging anxiety about hantavirus,” one user expressed in a video with over 500,000 views.

But, health experts say we are not in the same situation we were in six years ago. 

Read more about the current outbreak and coping with health anxiety here.