The World Health Organization said it suspects rare human-to-human transmission of hantavirus among close contacts on a cruise ship off Cape Verde, where an outbreak has left three people dead.
Medics are working to evacuate two people showing symptoms from the vessel, officials said, as efforts continue to manage the situation on board.
Around 150 people remain on the Dutch-flagged MV Hondius following the deaths of a Dutch couple and a German national. A British passenger who was evacuated earlier is in intensive care in South Africa. Most passengers are British, American and Spanish.
The WHO said limited human-to-human spread may have occurred between people in very close contact, such as couples sharing cabins.
“Some people on the ship were couples, they were sharing rooms so that's quite intimate contact,” said Maria Van Kerkhove, the WHO’s director of epidemic and pandemic preparedness.
Human transmission of hantavirus is rare. The disease is usually spread through contact with infected rodents or their urine, droppings or saliva.
The WHO said it had been told there were no rats on board, raising the possibility that initial infections occurred before the voyage or during excursions.
The WHO has identified seven cases linked to the ship, including two confirmed and five suspected.
The Netherlands’ National Institute for Public Health and the Environment (RIVM) has confirmed hantavirus in one symptomatic patient. A source said the Dutch woman who died had also tested positive.
It remains unclear whether all symptomatic cases are linked to hantavirus or whether all deaths were caused by the virus.
Health authorities are focusing on evacuating two sick passengers still on board. Cape Verde officials said plans were under way to transfer them, and possibly others, for treatment.
The ship remains off Cape Verde after authorities refused permission for passengers to disembark as a precaution.
The vessel’s operator, Oceanwide Expeditions, said passengers have been confined to their cabins to limit potential spread.
Passengers have described growing anxiety on board. In a video posted on social media, a U.S. travel blogger said uncertainty was taking a heavy toll, with families waiting anxiously at home.
The WHO said it was working with the ship’s operator and national authorities to ensure passengers are safely repatriated.
The Hondius departed Ushuaia in southern Argentina in March on an Antarctic expedition.
The WHO said its working assumption is that the initial Dutch cases may have been infected before boarding, after travelling in Argentina. Other infections may have occurred during excursions to remote islands where rodents are present.
Experts say some strains of hantavirus found in South America, including the Andes strain, have previously shown limited human-to-human transmission.
The WHO reiterated that the risk to the wider public remains low and that no travel restrictions are recommended.
Hantavirus can cause severe and sometimes fatal respiratory illness, though such outbreaks are typically contained.
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