Medics are working to evacuate two people with symptoms of the deadly respiratory illness, hantavirus, from a luxury cruise ship being held off West Africa, after three people died and several others fell ill, officials have said.
Around 150 people are still stuck on the ship, which has been blocked from docking in Cape Verde by the country's government on the grounds of protecting public health.
A couple from the Netherlands and a German national have already died and others have fallen ill on the Dutch-flagged MV Hondius.
A British man who left the vessel earlier and tested positive for the virus in South Africa is currently being treated in intensive care in South Africa.
The World Health Organisation (WHO) has said it is supporting the response to the public health incident.
Laboratory testing has so far confirmed two hantavirus cases, with four additional suspected infections.
Health authorities are carrying out further laboratory analysis, including genetic sequencing of the virus, alongside epidemiological investigations. Medical care and support are being provided to both passengers and crew.
The WHO said it is coordinating with member states and the ship’s operators to arrange the medical evacuation of two symptomatic passengers, while also supporting a full public health risk assessment for those remaining on board
Hantavirus infections are usually linked to environmental exposure, particularly contact with the urine or faeces of infected rodents. While rare, the virus can spread between people and may cause severe respiratory illness, requiring close monitoring and specialist care.
The illness begins with flu-like symptoms and can lead to heart and lung failure, with around 40% of cases resulting in death, according to the U.S. Centers for Disease Control.
There are no specific drugs to treat hantavirus, so treatment focuses on supportive care, including putting patients on ventilators in severe cases.
WHO Regional Director for Europe, Hans Kluge, said risk to the wider public remained low.
"There is no need for panic or travel restrictions. While severe in some cases, it is not easily transmitted between people," he said in a statement.
Netherlands-based Oceanwide Expeditions said in a news release it was "managing a serious medical situation" on the ship.
U.S. travel blogger Jake Rosmarin posted a tearful video from the ship on Instagram on Monday (4 May).
"We're not just headlines: we're people with families, with lives, with people waiting for us at home," he said.
"There is a lot of uncertainty and that is the hardest part," he added.
The cruise departed from Argentina about three weeks ago, on a trip marketed as an Antartic expedition. Ticket prices range from €14,000 to €22,000.
It travelled past mainland Antarctica, the Falklands, South Georgia, Nightingale Island, Tristan, St Helena, and Ascension before reaching Cape Verdean waters on Sunday (3 May).
South Africa's Health Ministry said a 70-year-old Dutch man died on St.Helena and his 69-year-old wife later died in South Africa after collapsing at O.R. Tambo International Airport in Johannesburg.
A spokesperson for the Netherlands' National Institute for Public Health (RIVM), which is assisting the investigation into the suspected outbreak, said the source of the infection isn't yet clear.
"You could imagine, for example, that rats on board the ship transmitted the virus. But another possibility is that during a stop somewhere in South America, people were infected, for instance via mice, and became ill that way," he said.
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The public health challenge linked to the emergence of a rare strain of hantavirus is complex, according to pharmacist and health commentator Thorrun Govind. She told AnewZ's Daybreak the situation was complicated by the number of nationalities involved and the need to safely return the passengers.
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