WHO monitors deadly outbreak on cruise ship that has claimed three lives; entry points on alert but no transmission detected within country
KATHMANDU, MAY 13
Health authorities have assessed the risk of hantavirus infection in the country as very low, even as a cluster of Andes virus cases linked to a cruise ship has claimed three lives and infected at least 11 people globally, prompting the Epidemiology and Disease Control Division (EDCD) to place international entry points on alert.
The EDCD on Tuesday said no Nepali citizens are known to have been aboard the affected vessel, and no hantavirus infections have been detected in Nepal. Infected passengers on the ship have been isolated and other travellers kept separately, with no transmission reported outside the ship. Hospitals have nonetheless been placed on standby to manage any cases that may emerge, and surveillance has been heightened at international airports and land border crossings.
The hantavirus outbreak linked to the Dutch-flagged cruise ship MV Hondius, first reported to the World Health Organization on May 2, has resulted in 11 confirmed cases and three deaths as of May 12. Spain's health ministry announced on Tuesday that a Spanish passenger evacuated from the ship has also tested positive for the virus.
All passengers aboard the MV Hondius, a Dutch-flagged cruise ship at the centre of the outbreak, have since disembarked in the Canary Islands, Spain, boarding flights to more than 20 countries to enter quarantine. The vessel is now sailing back to the Netherlands, where it will be cleaned and disinfected.
The Hondius had departed the southern Argentine port of Ushuaia on April 1. A Dutch passenger died on board on April 11, but it was not until early May, by which time the ship was off the West African island nation of Cabo Verde, that WHO began responding to a suspected hantavirus outbreak.
With the evacuation of all passengers and many crew members completed, the MV Hondius is now sailing back to the the Netherlands, where it will be cleaned and disinfected.
"MV Hondius has now left the shores of Tenerife. All passengers have safely disembarked and are either on their way or have arrived home... But the work is not over. WHO continues to work closely with experts from all the countries involved. We have requested that they report to WHO on the health and well-being of passengers and crew through the IHR platform weekly," Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization said on Tuesday.
The working hypothesis, according to the WHO, is that the index case, an adult male who had spent more than three months travelling in Argentina, Chile, and Uruguay before boarding the ship on April 1, most likely acquired the infection through environmental exposure, possibly during birdwatching activities in the Southern Cone region of South America, where Andes virus is endemic in local rodent populations. Subsequent cases aboard the ship are believed to have resulted from limited human-to-human transmission, given documented contact with the index case during his illness and the clustering of symptom onsets within known incubation periods.
Epidemiological and genomic sequencing investigations are ongoing, WHO said.
Hantaviruses are a group of rodent-borne viruses that occasionally infect humans through contact with infected rodent urine, droppings, or saliva. Andes virus, found in South America, is the only hantavirus for which limited human-to-human transmission has been documented, typically requiring close and prolonged contact.
In the Americas, hantavirus infection can cause hantavirus cardiopulmonary syndrome (HCPS), a severe and rapidly progressing respiratory illness with a case fatality rate of up to 50 percent. There is no licensed antiviral treatment or vaccine; care is supportive, with early admission to intensive care critical for survival.
WHO has assessed the global public health risk from the event as low but the risk for passengers and crew on the ship as moderate, citing the close living quarters, shared indoor spaces, and the average age of passengers at 65 years.
International contact tracing is ongoing across Argentina, Cabo Verde, Chile, Germany, the Netherlands, South Africa, Spain, Switzerland, and the United Kingdom. WHO has advised against any travel or trade restrictions based on current information.
"Continued international coordination is essential to protect everyone's health," WHO DG Tedros Adhanom Ghebreyesus wrote in his social media post.